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HEALTH AND SAFETY PROGRAMS: ABA PROCEDURES AND OUTCOMES
Drugs: (e.g., anti-anxiety)• Efficacy?• Side effects
General anesthesia:• Effective• Risk events (death is rare, but
1:100,000)• Expensive
TX OPTIONS
Power through these activities Emotional behavior Risk events Often involves restraints
TX OPTIONS
Contracting• Can be effective• Long sequences?
GRADUAL INTRODUCTION OF STIMULI
People With Phobias Use hierarchies of feared stimuli Least frightening Most frightening
Learn relaxation skills Apply to hierarchy of feared stimuli
TX OPTIONS
Hierarchy Example Sight of picture of a snake Sight of snake at 20 ft distance Sight of snake at 10 ft distance Sight of snake at 5 ft distance Sight of snake at 1 ft distance Touch snake for 1 sec Touch snake for 5 sec Touch snake for 10 sec and so on until…
TX PROCEDURES
Teach Participant to Relax then… Sight of picture of a snake + relaxation Sight of snake at 20 ft distance + relaxation Sight of snake at 10 ft distance + relaxation Sight of snake at 5 ft distance + relaxation Sight of snake at 1 ft distance + relaxation Touch snake for 1 sec + relaxation Touch snake for 5 sec + relaxation Touch snake for 10 sec + relaxation etc
APPLICATIONS TO HEALTH & SAFETY
Social Validity of the Hierarchy: What are the essential steps?
Interview provider of services Interview others who have successful
experience Go through the experience Such as…Taking a pill…
Then develop steps and sub-steps
PROCEDURE HIGHLIGHTS
Break down task into small steps
1.Tolerate empty capsule within 1 ft
2.Tolerate empty capsule within 6”
3.Tolerate empty capsule touching lip
4.Accept ½ empty capsule into mouth for 2”
5.Accept ½ empty capsule into mouth for 5”
6.Swallow ½ empty capsule into mouth with chaser
7.Swallow whole empty capsule into mouth with chaser
DATA DISPLAY
DATA DISPLAY
Baseline
Step #
Yelling
0
2
4
6
8
10
12
14
16
18
20
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Step
# a
t E
nd
of
Sess
ion
Session
PROCEDURES
• Potential Reinforcers:• Escape from hierarchy• Transition to previous step• Contingent breaks with preferred items
• Prompts as needed• High probability request sequence prior to
introducing step• Modeling steps
PROCEDURES
• Teach request escape• Perhaps use differential reinforcement
• More reinforcers for completing hierarchy vs reinforcer for mand
• Extinction? • Escape extinction – prevent termination of the
procedure contingent on problem behavior• Non-contingent escape• If escape for problem behavior is inevitable…
PROCEDURES
Low intensity High Intensity Escape
Low intensity Escape
VS
FOOD ACCEPTANCE
Case: Food refusal that may result in hospitalization
Facts: 1. 3 year old female with history of food
refusal2. Some mands3. Consumed food: cookies, M&Ms,
Pediasure
FOOD ACCEPTANCE
1. Tx elementsA. FR 1 for taking biteB. Escape extinction – keep food in proximity
until criterion metC. Simultaneous presentation of preferred
and non-preferred foodD. Sequential presentation of…
non-preferred preferred food
FOOD ACCEPTANCE
1. Tx elements (contd)C. Hierarchy of food acceptance
I. Show foodII. Food on spoonIII. Food w/in 6”IV. Spoon touches mouthV. Food in mouthVI. Swallow
D. FR 1 escape for refusals: “All done” + push food away Extinction
SCHEDULE EFFECTS AND EXTINCTION
• Preparing for Extinction• History of FR 1• Then…Extinction
Case: 1. 12 year old male who would participate in some medical procedures2. Major procedures (e.g., blood work) done under anesthesia3. Because of new meds, weekly blood draws scheduled, which required 5 person restraint
PROCEDURES
1. Contracting2. Checklist of tasks each day3. Weekly blood draws with restraints as needed4. Blood draw training with hierarchy
• IOA WAS COLLECTED ACROSS PARTICIPANTS FOR A MINIMUM OF 30% OF
SESSIONS.
• IOA WAS COMPUTED BY NUMBER OF AGREEMENTS/ TOTAL NUMBER OF
TRAILS PER SESSION ACROSS SKILLS X 100
• IOA RANGED FROM 96.67%-100%
ULTIMATE TEST: CLOTHES ON TEST
• DRESS CHILD IN STREET CLOTHES
• PUT HIM/HER INTO WATER
• STAY CLOSE BUT OUTSIDE POOL
• OBSERVE IF CHILD MAKES IT TO SAFETY
HOW DOES THIS EXTEND CURRENT LITERATURE?
• ALL SKILLS WERE TAUGHT IN 10 DAYS OR UNDER WITHOUT
PREREQUISITE TRAINING.
• THIS STUDY DISPLAYED EVIDENCE THAT A BEHAVIOR SKILLS PACKAGE IS
EFFECTIVE IN TEACHING CHILDREN WITH AUTISM SWIMMING SKILLS AT
DIFFERENT FUNCTIONING LEVELS.
• THE BEHAVIORAL SKILLS PACKAGE IS EFFECTIVE IN TEACHING A
SWIMMING CURRICULUM (AMERICAN RED CROSS LEARN-TO-SWIM).
• IN TOTAL WE TAUGHT 10 DIFFERENT SKILLS ACROSS PARTICIPANTS
FUTURE DIRECTIONS
• COMPONENT ANALYSIS
• COMPARISON BETWEEN RED CROSS SWIM LESSONS AND ABA SWIM
LESSONS
• SWIMMING FOR EXERCISE
• BEHAVIORAL SKILLS TRAINING FOR WATER SAFETY INSTRUCTORS
CURRENT RESEARCH: WHAT ARE THE EFFECTS OF BEHAVIORAL SKILLS TRAINING ON A WATER SAFETY
INSTRUCTOR’S BEHAVIOR?
• METHOD:
• PARTICIPANT
• KATIE, FEMALE, 22 YEARS OLD, 4 YEARS AS A WATER SAFETY
INSTRUCTOR (WSI)
• SETTING:
• ALL SESSIONS CONDUCTED IN AN INDOOR POOL.
EFFECTS OF BEHAVIORAL SKILLS TRAINING ON A WATER SAFETY INSTRUCTOR’S BEHAVIOR?
• MATERIALS:
• DATA SHEET
• POOL NOODLE
• POSSIBLE REINFORCERS
• CAMERA
• LAMINATED GRAPHS
• INSTRUCTIONS FOR TARGET BEHAVIORS
• HOW TO CONDUCT DISCRETE TRIAL TRAINING
• HOW TO ANALYZE GRAPHS
DEPENDENT VARIABLES:
• RESPOND TO VARIOUS INSTRUCTIONS GIVEN BY
EXPERIMENTER
• I.E. “PERFORM DISCRETE TRIAL TRAINING TO THE BEST OF YOUR
ABILITY” & “ANALYZE THE GRAPH TO THE BEST OF YOUR ABILITY”
• PERCENT CORRECT ACROSS SKILLS
BASELINE
TREATMENT
DATA COLLECTIONSd: Given a graph + "analyze the graph to the best of your ability"
Date/Initials:
Target
1. check at 3 ascending data points (1 cm below x axis, 1 cm to the right of the session number) Y N NA Y N NA Y N NA
2. phase change after 3 decending data points (vertical dashed line from x-axis to 1 cm above y axis) Y N NA Y N NA Y N NA
3. phase change after 3 flat data points (vertical dashed line from x-axis to 1 cm above y axis) Y N NA Y N NA Y N NA
4. phase change after ascending to 4 flat (vertical dashed line from x-axis to 1 cm above y axis) Y N NA Y N NA Y N NA
5. check if 3/5 data points are ascending (1 cm below x axis, 1 cm to the right of the session number) Y N NA Y N NA Y N NA
6. phase change if 3/5 data points are decending (vertical dashed line from x-axis to 1 cm above y axis) Y N NA Y N NA Y N NA
7. phase change line inserted after last data point where mastery criteria (3 data points at 80% or higher) is met (vertical dashed line from x-axis to 1 cm above y axis) Y N NA Y N NA Y N NA
8. Continue process (steps 1-7) if appropriate Y N NA Y N NA Y N NA
Percent Correct
DATA COLLECTION
Sd: Given a skill + "teach this skill using DTT to the best of your ability"
Date/Initials:
Target
Conducts preference assessment Y N NA Y N NA Y N NA Y N NA
Clears extraneous materials Y N NA Y N NA Y N NA Y N NA
Has reinforcers out of reach Y N NA Y N NA Y N NA Y N NA
Attempts to get attention Y N NA Y N NA Y N NA Y N NA
Gives instruction (with simultaneous prompts if necessary) Y N NA Y N NA Y N NA Y N NA
Verbal prompt (if needed) Y N NA Y N NA Y N NA Y N NA
Model prompt (if needed) Y N NA Y N NA Y N NA Y N NA
Physical prompt (if needed) Y N NA Y N NA Y N NA Y N NA
Provide Consequence Y N NA Y N NA Y N NA Y N NA
Record Data Y N NA Y N NA Y N NA Y N NA
Percent Correct
BASELINE RESULTS
HOW WILL THIS EXTEND CURRENT LITERATURE?
• GIVES A POSSIBLE TRAINING TOOL.
• MAY SHOW THAT BST WORKS TO TRAIN TEACHERS (WSI) TO
USE BEHAVIOR ANALYTIC TECHNIQUES.
EVIDENCE FOR USE: AVOIDANCE OF WATER ACTIVITY: THE EFFECTS OF GRADUAL EXPOSURE ON AQUATIC
SKILLS (LAMPERT, 2018)
• WHAT ARE THE EFFECTS OF GRADUAL EXPOSURE ON AQUATIC
SKILLS?
MATERIALS
• RULER
• DATA SHEET
• CAMERA
PARTICIPANTS
• PATRICIA
• 6 YEARS OLD
• DIAGNOSED WITH ASD
• EXHIBITED PROTESTS, SCREAMS FOR HELP, FLAILING, AND FORCING
HERSELF UNDER THE WATER BECAUSE OF NEAR DROWNING
EXPERIENCE
• EZRA
• 8 YEARS OLD
• DIAGNOSED WITH ASD
• RESISTANT TO ALL WATER ACTIVITIES, UNLESS HOLDING ON TO AN
ADULT
SETTING
OUTDOOR POOL SUPERVISED BY A LIFEGUARD.
DEPENDENT VARIABLE
• PERCENT OF STEPS COMPLETED IN THE HIERARCHY CALMLY
AND WITHOUT ADDITIONAL ASSISTANCE FOR EACH AQUATIC
SKILL
EXAMPLE HIERARCHY
Sample from Ezra’s Hierarchy -“Grab the wall”
1. In 1.85 meters ,.61 meters away from the wall + "Grab the wall
2. In 1.85 meters, 1.22 meters away from the wall + "Grab the wall"
3. In 1.85 meters, 1.83 meters away from the wall + "Breathe at least 1 time and grab the wall"
4. In 1.85 meter, 2.44 meters away from the wall + "Grab the wall" (Will breathe at least 1x independently)
5. In 1.85 meters, 3.05 meters away from the wall + "Grab the wall" (Will breathe at least 1x independently)
6. In 1.85 meters, 4.57 meters away from the wall + "Grab the wall" (Will breathe at least 2x independently)
7. In 1.85 meters, 6.09 meters away from the wall + "Grab the wall" (Will breathe at least 2x independently)
8. In 1.85 meters, 6.86 meters away from the wall + "Grab the wall" (Will breathe at least 2x independently)
9. On wall with therapist 3.35 meters out in 1.83 meters of water + "Swim to me" (Will breathe at least 1x
independently)
10. On wall with therapist 6.86 meters out in 1.83 meters of water + "Swim to me" (Will breathe at least 2x
independently)
EXAMPLE 2
Sample from Ezra’s Hierarchy -“Float on your back”
1. In 1.85 meters, laying back with full physical prompts + backwards count of 5 seconds
2. In 1.85 meters, laying back with full physical prompts + backwards count of 10 seconds
3. In 1.85 meters, laying back with partial physical prompts + backwards count of 5 seconds
4. In 1.85 meters, laying back with partial physical prompts + backwards count of 10 seconds
5. In 1.85 meters, laying back with partial physical prompts + backwards count of 15 seconds
6. In 1.85 meters, laying back, hands are removed + backwards count 5 seconds
7. In 1.85 meters, laying back, hands are removed + backwards count 10 seconds
8. In 1.85 meters, laying back, hands are removed + backwards count 15 seconds
9. In 1.85 meters, laying back + turn over + partial physical