Helping Parents With Challenging Children Parents With Challenging...Durand, Vincent Mark. Helping parents with challenging children: positive family intervention: facilitator guide/V.

Helping Parents With Challenging Children

editor-in-chief

David H. Barlow, PhD

scientific

advisory board

Anne Marie Albano, PhD

Gillian Butler, PhD

David M. Clark, PhD

Edna B. Foa, PhD

Paul J. Frick, PhD

Jack M. Gorman, MD

Kirk Heilbrun, PhD

Robert J. McMahon, PhD

Peter E. Nathan, PhD

Christine Maguth Nezu, PhD

Matthew K. Nock, PhD

Paul Salkovskis, PhD

Bonnie Spring, PhD

Programs That Work™

Helping ParentsWith ChallengingChildrenPOSITIVE FAMILY INTERVENTION

F a c i l i t a t o r G u i d e

V. Mark Durand • Meme Hieneman

2008

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Library of Congress Cataloging-in-Publication Data

Durand, Vincent Mark.Helping parents with challenging children: positive family intervention: facilitator guide/V. Mark Durand, Meme Hieneman.

p.; cm. — (ProgramsThatWork)Includes bibliographical references.ISBN 978-0-19-533298-8 (pbk.: alk. paper) 1. Behavior disorders in children—Treatment. 2. Problem children—Behavior

modification. 3. Child psychotherapy—Parent participation. I. Hieneman, Meme. II. Title. III. Series: Programs that work. [DNLM: 1. Child Behavior Disorders—prevention & control. 2. Behavior Therapy—methods. 3. Education—methods.

4. Parents—education. WS 350.6 D949h 2008]RJ506.B44D89 2008

618.92’89142—dc222007048238

ISBN-13 978-0-19-533298-8 Paper

1 3 5 7 9 8 6 4 2

Printed in the United States of America on acid-free paper

iv

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About ProgramsThatWork™

Stunning developments in health care have taken place over the last

several years, but many of our widely accepted interventions and strate-

gies in mental health and behavioral medicine have been brought into

question by research evidence as not only lacking benefit but perhaps

inducing harm. Other strategies have been proven effective using the best

current standards of evidence, resulting in broad-based recommendations

to make these practices more available to the public. Several recent devel-

opments are behind this revolution. First, we have arrived at a much

deeper understanding of pathology, both psychological and physical,

which has led to the development of new, more precisely targeted inter-

ventions. Second, our increased understanding of developmental issues

allows a finer matching of interventions to developmental levels. Third,

our research methodologies have improved substantially, such that we

have reduced threats to internal and external validity, making the out-

comes more directly applicable to clinical situations. Fourth, governments

around the world, health care systems, and policymakers have decided

that the quality of care should improve, that it should be evidence-based,

and that it is in the public’s interest to ensure that this happens (Barlow,

2004; Institute of Medicine, 2001).

Of course, the major stumbling block for clinicians everywhere is the

accessibility of newly developed evidence-based psychological interven-

tions. Workshops and books can go only so far in acquainting respon-

sible and conscientious practitioners with the latest behavioral health

care practices and their applicability to individual patients. This new

series, ProgramsThatWork™, is devoted to communicating these excit-

ing new interventions to clinicians on the frontlines of practice.

The manuals and workbooks in this series contain step-by-step, detailed

procedures for assessing and treating specific problems and diagnoses. But

this series also goes beyond the books and manuals by providing ancillary

materials that will approximate the supervisory process in assisting prac-

titioners in the implementation of these procedures in their practice.

In our emerging health care system, the growing consensus is that

evidence-based practice offers the most responsible course of action for

the mental health professional. All behavioral health care clinicians

deeply desire to provide the best possible care for their patients. In this

series, our aim is to close the dissemination and information gap and

make that possible.

This facilitator guide and the corresponding parent workbook target

parents of children with challenging behavior. Challenging behaviors

are common and disruptive to the lives of children and their families.

They can negatively affect a child’s developmental progress and the

functioning of the entire family. Families struggling with behavior

problems may have difficulty completing parent training and following

through with interventions.

This guide describes an innovative combination of approaches aimed at

assisting parents who have particular difficulty implementing treatments

for their child. It uses the principles of applied behavior analysis and pos-

itive behavior support (PBS) to teach parents how to effectively address

their child’s problem behavior. Cognitive restructuring techniques are

also taught to help parents take a more positive approach to their child’s

behavior and developmental challenges. The guide outlines step-by-step

instructions for guiding parents through the PBS process and encourag-

ing optimistic thinking. The corresponding workbook includes all the

materials parents need to participate in the training and carry out the

intervention strategies.

The Positive Family Intervention program can be used for a range of

behavior problems and in conjunction with treatment for other disor-

ders. This guide will be a welcome addition to the literature for facilita-

tors working with challenging youth and their families.

David H. Barlow, Editor-in-Chief,

ProgramsThatWork™

Boston, Massachusetts

vi

References

Barlow, D. H. (2004). Psychological treatments. American Psychologist, 59,869–878.

Institute of Medicine (2001). Crossing the quality chasm: A new health systemfor the 21st century. Washington, DC: National Academy Press.

vii

viii

Acknowledgments

A number of professionals guided and directed this work over the years

and we are deeply indebted to them. We would especially like to thank

Carolyn Kessler—whose dissertation served as the pilot project for this

approach—and the therapists who field-tested this protocol (Melissa

Zona, Shelley Clark, Laura Casper, and Kristin Knapp-Ines), as well as

Bobbie Vaughn who contributed to the early development of the proto-

col. We would also like to express our gratitude to the many parents who

have taken part in our research and taught us so much. Support and

funding from the University of South Florida St. Petersburg and the

U.S. Department of Education Office of Special Education Programs

assisted greatly with this work. The developmental editor for this book—

Julia TerMaat—helped wrestle and make sense of a tremendous amount

of information that went into these plans and we truly appreciate her

patience and guidance.

ix

Contents

Chapter 1 Introductory Information for Facilitators 1

Chapter 2 Identification and Assessment of Challenging

Behavior 15

Chapter 3 Session 1: Introduction and Goal Setting 21

Chapter 4 Session 2: Gathering Information 39

Chapter 5 Session 3: Analysis and Plan Design 53

Chapter 6 Session 4: Preventing Problems 63

Chapter 7 Session 5: Managing Consequences 75

Chapter 8 Session 6: Replacing Behavior 83

Chapter 9 Session 7: Putting the Behavior Support Plan

in Place 93

Chapter 10 Session 8: Monitoring Results and Wrap-up 107

PBS Resources 115

References 125

About the Authors 133

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1

Chapter 1 Introductory Information for Facilitators

Background Information and Purpose of This Program

This book is designed as a resource for professionals who work with

families that have a child who displays significant challenging behaviors.

The program uses the principles of applied behavior analysis and posi-

tive behavior support (PBS) to address child behavior problems.

Challenging behaviors—including aggressive, disruptive, and socially

inappropriate behaviors—are highly prevalent, especially among chil-

dren with disabilities. These behaviors may disrupt all aspects of the

children’s and family’s lives, including activities at home, in the commu-

nity, and at school. It is generally agreed that meaningful progress on

educational and social goals are in serious jeopardy unless challenging

behaviors can be significantly reduced. In addition to the impact on the

child’s progress, the effects of these behaviors on family life can be over-

whelming. Typically, families completely adjust their schedules and

life patterns to compensate for the disruption that ensues from these

behaviors. All aspects of a family’s life may be negatively affected by a

child’s behavior problems, from day-to-day activities such as shopping

to marital satisfaction (Plant & Sanders, 2007).

Unfortunately, the challenges posed by a child’ significant behavior

problems and their effects on the family can interfere with the success

of behavioral parent training. These families are at increased risk for

dropping out of treatment or otherwise not fully participating in

intervention efforts (Durand, 2007). The program outlined in this

guide is designed to directly address these obstacles and assist families

in their efforts to help their children. We imbed into the treatment an

adaptation of cognitive-behavioral therapy (CBT) designed to train

2

parents how to better approach their child, with the goal of helping

them persist with treatment until they experience success with the

intervention.

This program is designed to be used with family members who have

one or more children displaying severe challenging behavior. It is suit-

able for families with children of different ages, as young as 2 to 3 years

old to adult children living at home. It can also be used in conjunction

with treatment for developmental disabilities and other childhood dis-

orders in which challenging behavior becomes an important target of

treatment (for example, ADHD or oppositional defiant disorder).

Research suggests that the interventions are effective across a range of

developmental disabilities, including autism spectrum disorders

(Durand, 2007). In addition, although participation by two parents is

desired, the intervention can be effective with one parent as well as with

single parents or extended family members (for example, grandparents

when they are the primary caregivers).

Information on Challenging Behavior

Challenging behaviors often represent a major obstacle for children with

disabilities in their efforts to fully participate in meaningful educational

and community activities. There is ample evidence that these behaviors

serve as obstacles when attempting to place children in community set-

tings (Eyman & Call, 1977; Jacobson, 1982), and they increase recidivism

significantly for those individuals referred to crisis intervention programs

from community placements (Shoham-Vardi et al., 1996). Challenging

behavior has a negative impact on such important activities as family life

(Cole & Meyer, 1989), educational activities (Koegel & Covert, 1972),

and employment (Hayes, 1987). In one of the largest studies of its kind,

researchers examining almost 10,000 children found that the single best

predictor of early school failure was the presence of behavior problems

(Byrd & Weitzman, 1994). The presence of behavior problems was a bet-

ter predictor of school difficulties than factors such as poverty, speech

and hearing impairments, and low birth weight. One study found that

almost 40% of preschool teachers reported expelling a child each year

due to behavior problems (Gilliam & Shahar, 2006). Additionally, some

problem behaviors can pose a physical threat to children and those who

work with them.

Assessing the nature and function of these behaviors is essential to suc-

cessful treatment planning; therefore, instruments to identify and assess

challenging behavior are addressed in Chapter 2.

Development of This Treatment Program and Evidence Base

The program outlined in this guide was initially developed at the

University at Albany, State University of New York, in the mid-1990s

and expanded at the University of South Florida, St. Petersburg, in the

mid-2000s. We have used information on behavioral function to teach

alternative behaviors and rearrange environments. This approach has

been enhanced and expanded by a number of researchers; when com-

bined with broader supports, it is collectively labeled positive behavior

support. The goal of our research was to substantially reduce challeng-

ing behavior in children and youth with developmental disabilities

in an effort to produce socially significant improvements in the lives

of these individuals and their families. The background research on

positive approaches to reducing behavior problems revealed that,

despite clinical successes, some families were unable or unwilling to

complete the parent training required to intervene with their children.

Here we briefly review the evidence base for the effectiveness of these

interventions followed by a summary of our work on improving reten-

tion and outcomes for these treatments.

Positive Behavior Support

Positive behavior support (PBS) is an approach based on the principles of

applied behavior analysis (ABA) designed to produce meaningful changes

in behavior within the context of typical environments and routines. The

aim was to couch effective ABA practices within a broader system of sup-

port that values the rights and needs of people with disabilities and par-

ticipation of stakeholders in the process. Instead of single interventions

(e.g., time-out, rewards), PBS involves multi-component treatment

3

packages that combine the most effective strategies (Dunlap et al., 2000;

Horner et al., 1990; Koegel, Koegel, & Dunlap, 1996; Sugai et al., 2000).

PBS has a set of key features that will be introduced in Session 1 and

elaborated throughout this protocol. In this introductory section, we

provide a brief summary of those features with references to relevant lit-

erature to assist facilitators wishing to expand their knowledge. First,

PBS involves the identification of consequences maintaining problem

behavior and other associated environmental factors (Day, Horner, &

O’Neill, 1994; Durand & Crimmins, 1988; Iwata, Dorsey, & Slifer,

1994; O’Neill et al., 1997). Using a process of functional assessment,

the purposes a behavior is serving for the child may be gleaned

(e.g., gaining attention, avoiding difficult tasks). With this information,

more effective strategies can be identified that allow children to adapt

to environments and meet their needs in more productive ways (Carr

et al., 1999). Methods for collecting data and completing functional

assessment are presented in Sessions 1 through 3.

Second, PBS interventions involve a combination of components based

on the functional assessment: prevention, teaching, and management

(Durand, 1990; Hieneman, Childs, & Sergay, 2006). These components

are described in Sessions 4, 5, and 6. Prevention involves modifying cir-

cumstances that provoke problem behavior (i.e., antecedents, setting

events) to reduce temporarily the likelihood of the behavior (Horner,

Vaughn, Day, & Ard, 1996; Luiselli & Cameron, 1998). Demonstrations

of effective antecedent-based interventions have included curricular

modifications (Dunlap, Kern-Dunlap, Clarke, & Robbins, 1991), incor-

poration of choice or preference (Blair, Umbreit, & Bos, 1999; Shogren,

Fagella-Luby, Bae, & Wehmeyer, 2005), and introduction of “neutraliz-

ing” routines to diminish problem behavior (Horner, Day, & Day, 1997).

Increasingly, preventive strategies are being used within the context

of family homes to improve overall structure (Boetcher, Koegel, &

McNerney, 2003; Bushbacher, Fox, & Clarke, 2004).

Teaching involves identifying specific replacement behaviors that serve

the same function as the problem behavior and encouraging a child

to use these behaviors in lieu of maladaptive behavior (Carr et al.,

1994; Durand, 1990; Meyer & Evans, 1990). Specific skills can include

independence in daily living skills, methods for tolerating situations

4

(e.g., waiting), and—possibly most important—communication.

Management involves controlling access to reinforcers (e.g., attention,

escape) so that they are available for only positive (not problem)

behavior. A foundation of PBS that combines its components and is

well documented in the research literature is functional communication

training (FCT). Because of its importance and level of empirical sup-

port, we will describe it in greater detail in the following section.

The final feature of PBS that is consistently described in the literature

is an effort to achieve broader lifestyle changes, rather than just address-

ing discrete behavior (Risley, 1996). Because of this vision, PBS incor-

porates self-determination and person-centered planning (Kincaid,

1996; Wehmeyer, Baker, Blumberg, & Harrison, 2004), as well as an

explicit emphasis on collaboration among the people who will actually

implement the plan. Efforts to design and implement methods for eval-

uating improvements in quality of life (McClean, Grey, & McCracken,

2007; Smith-Bird & Turnbull, 2005) are beginning to emerge in the

literature, but team cooperation and lifestyle change have not been

implemented or investigated to the extent that other features have been

(Carr, 2007; Meyer & Evans, 1993; Snell, Voorhees, & Chen, 2005).

Further research in these areas is therefore warranted. Unlike the other

elements of PBS, these features are not addressed within particular ses-

sions of this guide but are instead interwoven through the materials by

encouraging involvement of other people in the process, calling atten-

tion to broad goals, and continually considering factors that might

make plan implementation more successful.

A great deal of research using single-subject designs supports the

efficacy of a range of positive behavioral parent training approaches to

reduce challenging behavior (e.g., Clarke, Dunlap, & Vaughn, 1999;

Dunlap & Fox, 1999; Koegel, Steibel, & Koegel, 1998; Lucyshyn,

Albin, & Nixon, 1997; Lucyshyn et al., 2007; Moes & Frea, 2000,

2002; Vaughn, Clarke, & Dunlap, 1997; Vaughn, Wilson, & Dunlap,

2002). Lucyshyn and colleagues, for example, reported on a 10-year

follow-up of their work with the family of one girl and found mainte-

nance of treatments gains (Lucyshyn et al., 2007). One comprehensive

analysis of the research on positive behavioral support concludes that

from one-half to two-thirds of the outcomes from single-subject studies

are successful when carried out completely (Carr et al., 1999). As a

5

result, PBS has become the foundation of many intervention and par-

ent support practices (Hieneman, Childs, & Sergay, 2006; Lucyshyn,

Dunlap, & Albin, 2002); however, actual implementation of positive

behavior support with families in integrated, real-life situations is com-

plicated and requires attention to a variety of factors to be successful.

Functional Communication Training

One technique frequently used in positive behavior support plans

involves replacing behavior problems with more acceptable alternatives—

an intervention called functional communication training (FCT).

FCT has received extensive empirical support in reducing the frequency

of challenging behavior. It involves assessing the function of chal-

lenging behaviors and teaching functionally equivalent responses, such as

communication, which serve the same function as the child’s problem

behavior (e.g., Carr & Durand, 1985; Durand, 1990). FCT is now one

of the most commonly used interventions for challenging behavior

(Halle, Ostrosky, & Hemmeter, 2006; Matson, Dixon, & Matson, 2005).

FCT is one of the few skill-focused behavioral interventions cited as hav-

ing extensive support from initial efficacy studies (see Smith et al., 2007).

Durand and Carr (1992) compared the effectiveness of FCT with

time out from positive reinforcement for the attention-maintained

behavior problems in two groups of children. An initial finding was

that both interventions were successful in reducing these problem

behaviors. However, further analysis showed that, when the children

were in the presence of a teacher who was unaware of the different

interventions that had been used, only children who had received

FCT continued to display low levels of problem behavior. These chil-

dren continued to request (and receive) attention, which appeared to

account for the effectiveness of this intervention even with untrained

individuals.

Important comparative treatment research is now evaluating how

FCT compares with other behavioral interventions. Hanley and col-

leagues, for example, compared the effectiveness of FCT with non-

contingent reinforcement (NCR) on the multiple behavior problems

of two children (Hanley, Piazza, Fisher, Contrucci, & Maglieri, 1997).

6

They found that both interventions initially reduced problem

behaviors but that the participants demonstrated a preference for

FCT. This advantage—preference by consumers—is an important

aspect of clinical utility.

One study more directly addressed the ability of FCT to be successful

in typical community settings—a key goal of PBS. Durand (1999) eval-

uated the effectiveness of FCT as an intervention for the problem

behavior exhibited by five children with severe disabilities both in

school and in the community. Following an assessment of the function

of their problem behavior, the children were taught to use assistive com-

munication devices in school to request the objects and activities that

presumably were maintaining their behavior. The results indicated that

not only did the children use their devices successfully, but the interven-

tion also reduced their problem behavior outside of school and with

untrained community members.

Limitations

Although evidence exists that PBS and, more specifically, FCT can be

effective, there may be limits to its impact in community settings. These

limitations may be related to the acceptability of the treatments and/or

the degree to which the interventions are appropriate to the settings and

circumstances (Albin et al., 1996; Kazdin, 1981; Reimers, Wacker, &

Koeppl, 1987). Failure to design plans appropriately or provide sufficient

support and guidance to follow through can impede generalization and

maintenance.

The usefulness of treatments outside of specially designed settings is an

essential component that will need to be more fully addressed in the

coming years. Too often for people with disabilities, interventions are

implemented that cannot be used in regular education classrooms or

in typical community settings. Two recent studies by Hieneman and

Dunlap (2000, 2001) surveyed individuals providing PBS in commu-

nity settings and resulted in the identification of a range of potential

factors contributing to its success and failure. Among those factors, the

“buy-in” and capacity of the individuals using the plans emerged as most

important.

7

The applicability of these interventions to the broader population,

referred to as clinical utility, is of particular concern (Durand & Rost,

2005). Are our treatments effective with all families who have children

with severe behavior problems, or are there subgroups with whom we

are more or less successful? For example, how many families give

up on efforts to assist their children (Munro, 2007)? Our clinical

experience and research from other areas of study outside of the dis-

abilities field suggest that up to 50% of families refuse participation in

parent training for a variety of reasons (e.g., Irvine et al., 1999). For

example, between 40% and 60% of families who begin treatment

related to child mental health issues terminate services prematurely

(Kazdin, 1996). It is unclear, however, how many families of children

with more severe cognitive and developmental disorders who begin

behavioral parent training drop out or otherwise do not complete

intervention.

To begin to answer this question, we conducted a review of the behav-

ioral intervention literature to more accurately gauge these rates

(Durand & Rost, 2005). Unfortunately, less than 3% of these studies

noted if participants dropped out from their research. In other words,

in more than 97% of these studies no mention was made of any partic-

ipants who did not finish treatment. In addition, none of the handful

of studies that did mention drop-out analyzed the characteristics of

those not completing the research, and no studies indicated whether

any participants or their guardians refused to participate. The relative

lack of information on attrition leaves open questions about the gener-

alizability of this research to the population of persons exhibiting chal-

lenging behavior. In other words, are behavioral interventions only

successful with highly motivated families and educators? We, as yet, do

not know the answer to this question.

To gather information on these children and their families, we conducted

a three-year longitudinal prospective study to examine factors that might

contribute to later behavior problems in young children and their impact

on families (Durand, 2001). One hundred forty children who were 3 years

of age and who had a cognitive and/or developmental disability and dis-

played behavior problems were identified and followed for up to three

years. A number of factors were measured to assess their role in predicting

which children would later display more severe behavior problems. These

8

included measures of IQ, DSM-IV diagnosis, child behavior problems,

child adaptive skills (communication and social skills), and a variety of

family indicators (e.g., stress, attitudes, etc.).

The most significant factor in predicting later behavior problems was

not the severity of a child’s problems at age 3, nor was it the extent of

cognitive or adaptive behavior deficits initially displayed by the child.

Rather, the best predictor of which children would have more severe

problems three years later was a measure of parental optimism or pes-

simism. In other words, parents who had limited confidence in their

ability to influence their child’s behaviors by the time the child was

3 years of age were most likely to have children with more difficult

behaviors later in life. For example, if parents resisted placing

demands on their children for fear of escalating behavior problems,

then children were more likely to develop severe behavior problems as

they became older. This finding was true despite the fact that some of

the children with more optimistic parents initially had more severe

deficits and behavior problems. It appeared that parental optimism

may have served as a protective factor for these children, and parental

pessimism may put a child more at risk for developing severe behav-

ior problems.

Our data on parental pessimism suggest that we may be overestimat-

ing our success rates if we report data only on those families who

complete our interventions. A more conservative view of our out-

comes is that behavioral interventions are effective with that portion

of the population who has the ability and/or the motivation to com-

plete all aspects of our intervention. Viewing the behavior of these

families from a functional perspective—asking what it is about our

interventions that increase resistance and drop-out rates among some

families—could result in an important reconceptualization of our

intervention process.

Positive Family Intervention

If an important obstacle to successful behavioral parent training is the

pessimistic attitudes of some family members, the logical next ques-

tion is, “Can we intervene with these families in a way that will help

9

them feel more optimistic about their abilities to work with their chil-

dren?” In turn, if we can successfully intervene with these families to

assist them with this attitudinal barrier, will it help them continue

in and complete behavioral parent training, and will this lead to

improvements in child behavior? The answers to these questions have

been tested in a study of children with behavior problems and their

families.

The Positive Family Intervention Project is a multisite study designed

to develop and assess the effectiveness of a treatment package that

integrates cognitive-behavioral intervention with function-based

behavioral parent training (referred to as Positive Family

Intervention, or PFI). Families from throughout the Tampa Bay area

of Florida (through the University of South Florida, St. Petersburg)

and the Capital region in New York (through the University at

Albany, State University of New York) participated in this project.

At-risk families with high scores on our measure of pessimism were

assigned to one of two groups: 1) family members who received train-

ing in PBS for their child and 2) individuals who received PBS along

with a cognitive-behavioral component (PFI). We evaluated if PFI

would increase family participation in training and if it would suc-

cessfully prevent child behavior problems from escalating into more

severe problems. Follow-up of the children is being conducted up to

two years following initial intervention at home, and initial results

suggest that all families who successfully complete sessions observe

meaningful reductions in their child’s challenging behaviors.

PFI is a clinically based approach to provide family members with the

skills they need to cope with the stressors associated with every day life

along with the added stress of having a child with significant challenges.

More specifically, we adapt cognitive-behavioral intervention techniques

to meet the specific needs of these families and combine this approach

with the components of PBS. Fortunately, there is work under way

addressing pessimism, through “learned optimism,” and the need for

some people to address feelings of being out of control. This research

appears to be an invaluable addition to our traditional approaches for

helping these families. Seligman (1998), for example, outlines a treat-

ment protocol that focuses on the way people view events and attempts

to provide them with more adaptive styles. Research on this cognitive-

10

behavioral therapy approach suggests that significant improvements can

be observed in persons with pessimistic styles, which, in turn, results in

improvements in such areas as depression.

PFI is an adaptation of PBS, integrating Seligman’s work for use with

families of children with disabilities and challenging behavior. For

example, in our preliminary work, we find that parents who score high

on a measure of pessimism might describe a child’s difficult trip to the

supermarket this way: “Shopping with my child is a disaster.” On the

other hand, parents scoring high on optimism might describe it this

way: “My child is not ready yet for long shopping trips.” The former

pessimistic description suggests that the problem is pervasive (all shop-

ping is a problem) and permanent (shopping may never get better),

while the latter optimistic view is local (it is just long shopping trips

that are a problem) and temporary (someday he will be ready).

Presenting families with their styles of describing situations and having

them practice more adaptive optimistic styles—referred to as positive

family intervention—is proving to be successful. More than 70% of

“pessimistic” families who receive the added components in PFI follow

through with parent training.

Background of Facilitators

Facilititators require knowledge of the principles of applied behavior

analysis and positive behavioral support, as well as hands-on experience in

conducting functional behavior analyses and implementing multicom-

ponent interventions. In addition, it is helpful if facilitators have some

training in working with cognitive-behavioral therapy techniques.

Additional clinical skills, such as active listening, often need to be devel-

oped. With proper training, this program can be successfully delivered

by real-world providers, such as social workers, school counselors, and

applied behavior analysts.

In preparing to facilitate this program, facilitators should review the

objectives, content, and materials. If there are areas in which a facilita-

tor has limited experience or training, she should check the reference

list (at the back of this guide) or obtain additional training.

11

Outline of This Treatment Program

This treatment program is typically delivered in eight weekly sessions of

90 minutes each. More or less time can be spent on sessions as needed,

and follow-up sessions may be required. Each session builds on the con-

tent of the last; therefore, it is important to follow the order as outlined

in Table 1.1. Fidelity checklists are included in an appendix to assist with

treatment adherence. Throughout the sessions, this guide provides rec-

ommendations for using assessments with families; however, facilitators

might want to supplement these instruments with others discussed in

Chapter 2.

By the end of the program, parents will have worked through all five

steps of positive behavior support: Step 1) Establish goals, Step 2) Gather

information, Step 3) Analyze patterns, Step 4) Develop a plan, and

Step 5) Monitor results. Throughout the sessions, parents engage in cog-

nitive-behavioral therapy to increase their optimism about their child’s

behavior and their ability to follow through with the intervention.

In each session, the facilitator reviews the previous session and asks par-

ents if they have any questions regarding the content from the previous

12

Table 1.1 Outline of Treatment Protocol

Behavior Support Plan Cognitive-Behavioral Integration

Session #1 Introduction and Goal Setting Identify situations and associated self-talkSession #2 Gathering Information Determine the consequences of beliefs on

behaviorSession #3 Analysis and Plan Design Use a distraction to interrupt negative

thinkingSession #4 Preventing Problems Dispute current thinking (accuracy and

impact)Session #5 Managing Consequences Substitute with more positive, productive

thoughtsSession #6 Replacing Behavior Practice skills developed for recognizing and

modifying pessimistic self-talkSession #7 Putting the Behavior Support Continue practicing skills developed for

Plan in Place recognizing and modifying pessimistic self-talk

Session #8 Monitoring Results and Wrap-Up Help identify strategies to maintain positive changes in self-talk

week. The facilitator then goes over the parents’ Weekly Progress Report

and homework to determine what has been accomplished. If parents

have not completed all of the homework, the facilitator assists them in

doing so. Throughout this review, the facilitator provides feedback and

guides parents to consider other ideas as necessary.

Prior to, following, or during the homework review, the facilitator

leads the parents in a discussion of their self-talk for the previous

week. This is initiated by asking parents to share events they perceived

to be difficult and successful and then to describe what they were

thinking during those events. Each week, the facilitator presents a

new concept and guides the parents to examine their self-talk based

on the concept: consequences of negative thinking, disputation and

distraction methods, and, finally, reattribution. Once all of the ele-

ments have been addressed, the facilitator continues to review these

concepts for the remaining sessions of the training, helping parents to

evaluate and modify their thinking as necessary. These discussions are

also facilitated during the sessions by probing self-talk when it seems

to be relevant.

After outlining the goals of the session and presenting the content,

facilitators provide examples as needed and help parents to apply the

ideas to their own children, families, and circumstances. Facilitators

should encourage parents to write down the ideas they generate on the

homework forms in the workbook. Facilitators should also document

the relevant information shared by the participants in the notes sec-

tion of the fidelity checklists; these notes can then be used to facilitate

the “Application” sections that follow and provide a starting point for

future discussions. At the end of each session, facilitators go over the

homework instructions and forms, making sure parents are prepared

to complete them.

Working with Parents and Families

Sessions can be attended by individual parents or caregivers, or parents

and caregivers together as a team. Carrying out the intervention will

require the parent to involve other family members and people in

the child’s life (e.g., teachers, grandparents, babysitters). Cooperation

13

among those involved in the child’s care is essential to the success of

the behavior plan. Troubleshooting with families and their teams might

be necessary if one or more members have difficulty collaborating

effectively.

Participants will vary in their background and ability to grasp the con-

cepts presented. Therefore, facilitators should pace material and adjust

their language based the needs of the participants. The examples used

should be relevant to the child and the family. It might be necessary for

facilitators periodically to shift between topics based on the participant’s

needs.

Use of the Workbook

The corresponding workbook aids parents in implementing this pro-

gram for their child. Every chapter of the workbook corresponds to a

session of treatment as outlined in the guide. It includes all of the mate-

rials parents will need to participate in the sessions, including goals for

each session, a review of the content to be covered in session, and

instructions and forms for completing the homework assignments.

Worksheets are included for each step of PBS, as well as Self-Talk

Journals for cognitive-behavioral therapy. In addition, Weekly Progress

Reports help track how families are using what they have learned and

any progress that is occurring with their children’s behavior. (Additional

copies of forms can be photocopied from the workbook as needed.)

As parents must act as the “primary therapist” with their child, use of the

workbook helps ensure their active participation. Encourage parents to

attend all the sessions and complete the homework. If parents are having

any trouble understanding, give additional examples or spend more time

as needed. Stress to parents that their persistence is crucial to successful

intervention of their child’s behavior problems. As children with

significant challenging behaviors often continue to need support, the

workbook is a valuable resource for parents to refer to after therapy has

ended.

14

15

Chapter 2 Identification and Assessment of ChallengingBehavior

Assessment is an essential feature of behavioral interventions and, there-

fore, of the Positive Family Intervention program. A number of assess-

ment instruments have been developed to 1) identify the nature and

severity of behavior problems and 2) identify the functions challenging

behaviors serve for these individuals (Durand & Christodulu, 2006).

Using these instruments, it is possible to identify children and families

in need of this type of intervention, select appropriate strategies based

on the purposes of behavior, and evaluate outcomes of intervention.

Assessment procedures for identifying behavioral problems and their

functions are generally placed into the following categories: interviews,

behavior rating scales, self-report measures, and direct observation pro-

cedures (Durand & Christodulu, 2006; Johnson, 1998; Paclawskyj,

Kurtz, & O’Connor, 2004). The purpose of this chapter is to describe

various methods and instruments that may be used to assess behavior

and, therefore, maximize the effectiveness of this intervention.

Interviews

A history of how difficulties develop helps determine the nature of the

presenting problem. To make an accurate assessment, it is essential to

gather information on the course and context of how behavior prob-

lems developed. However, because many individuals with disabilities

have difficulties with language, relevant information is generally gath-

ered from interviews with family members or caregivers. Levitas and

Silka (2001) outline two different, but equally valid, approaches to

gathering information: a more traditional approach that begins with

the presenting problem and proceeds to a developmental history,

16

and an alternative approach that starts with gathering a complete

developmental history and progresses to the current concern. A clear

advantage of conducting interviews is the ability to gather a significant

amount of information in a short period of time (Rush, Bowman,

Eidman, Toole, & Mortenson, 2004).

Behavior Rating Scales

Administering rating scales to caregivers can be a cost-effective method

for obtaining reliable and valid assessment information (Matson et al.,

2003). Although behavior scales created for typically developing

children—such as the Child Behavior Checklist (CBCL) (Achenbach &

Edelbrock, 1991), the Preschool Behavior Questionnaire (Behar &

Stringfield, 1974), and the Conners’ Rating Scales-Revised (CRS-R)

(Conners, 1997)—have been used with children and adolescents with

mild disabilities, the measures may be insensitive and inappropriate for

assessment of children with more severe impairments (Johnson, 1998).

The Developmental Behavior Checklist (DBC) (Einfeld & Tonge, 1989),

an adaptation to the CBCL, includes items more specific to children with

developmental disabilities. Two scales developed specifically for use with

individuals with disabilities are the Behavior Problem Inventory (Rojahn,

1989) and the Aberrant Behavior Checklist (Aman & Singh, 1986). An

additional scale developed for the behavioral assessment of children and

adolescents with developmental disorders is the Nisonger Child Behavior

Rating Form (CBRF) (Aman, Tassé, Rojahn, & Hammer, 1996).

The Scales of Independent Behavior-Revised (SIB-R) (Bruininks,

Woodcock, Weatherman, & Hill, 1996) is an adaptive skills assessment

covering the full range of skills across the lifespan (from infancy to

80 years and older). Several forms of the SIB-R are available for varying

needs: the Full Scale (includes assessment of motor skills, social interac-

tion and communication skills, personal living skills, and community

living skills), the Problem Behavior Scale (internalized maladaptive

behavior, asocial maladaptive behavior, externalized maladaptive

behavior), the Short Form, and the Early Developmental Scale (infancy

through 8 years). A General Maladaptive Behavior Index on the SIB-R

provides for an assessment of the severity of challenging behaviors.

Rating scales typically have better psychometric properties than inter-

views and can recognize low-frequency behaviors. On the other hand,

rating scales rely on recollections, which are subjective in nature and

subject to bias (Rush et al., 2004).

Direct Observation Procedures

Behavioral observation is an instrumental part of assessment. Direct

observation can occur in either naturalistic conditions (e.g., observing

the child in her home) or analogue conditions (e.g., observing the

child in a setting similar to her home) (Bielecki & Swender, 2004).

Assessment in the natural environment is preferable as results of the

observation may generalize better across setting and time (Gettinger &

Kratochwill, 1987). Although structured observations yield more

objective and reliable data than subjective measures (e.g., interviews

and rating scales), conducting observations is generally more costly and

time-consuming. In addition, the presence of an observer can cause

reactivity with the individual being observed.

Important considerations for direct observation procedures are identify-

ing and operationally defining the target behaviors, determining the

duration of the observation session (e.g., frequently occurring behaviors

may be assessed in short observations, while infrequently occurring

behaviors require longer periods of observation), and selecting the

observation schedule (e.g., continuous vs. sampling) (Rush et al., 2004).

If there is uncertainty as to when a behavior occurs or under what con-

ditions, other assessments can be useful. In this protocol, we share a few

simple tools for gathering data on frequency, duration, and severity of

problem behavior, but the applied behavior analytic literature is replete

with other alternatives for direct observation that may be useful.

Functional Assessment

In addition to using assessment to identify the presence and severity of

challenging behavior, progress has been made in developing assessments

to determine the functions of these behaviors. Because many problem

17

behaviors are related to behavioral function (e.g., escape from the

demands of others or seek attention from others), a comprehensive

assessment of maladaptive behavior should include a functional assess-

ment of behavior. A variety of techniques assist clinicians, educators,

and families in determining the role of antecedent and consequent

influences on behavior. This information is essential for proper treat-

ment design.

There are a number of functional assessment strategies that are useful

for determining the function of behavior, including functional

analyses, ABC charts, and a variety of rating scales. A functional

analysis—manipulating aspects of the environment to assess behavior

change—is frequently cited as the best method for determining the

function of a behavior problem (Mace, 1994). However, there are also

a number of issues to consider prior to conducting this type of assess-

ment (Durand, 1999). One issue is the ability to manipulate certain

conditions. There are certain influences that you can’t or wouldn’t

manipulate or change in order to perform a functional analysis.

Factors such as some illnesses and disrupted family life can certainly

affect behavior problems, but they can’t or shouldn’t be turned on and

off to assess their influence.

Another concern involves the ethics of conducting a functional analysis.

There are circumstances you could create that might prompt or increase

problem behavior, but would be distressful or even dangerous. In many

instances, deliberately increasing a severe behavior problem in order

to assess it (e.g., by reinforcing challenging behavior) can be questioned

on ethical grounds. In these cases, assessment that does not involve

manipulation (and subsequent increases in challenging behavior) would

be recommended (for a more detailed discussion of these issues, see

Durand, 1993).

One useful technique is referred to as an ABC assessment. In this assess-

ment, the events that immediately precede a behavior (A), the target

behavior (B), and the events that immediately follow a behavior (C) are

recorded. With this method, you can analyze patterns in the entries to

determine if there are particular circumstances in which the behavior is

more likely to occur. We provide open-ended ABC recording formats in

this protocol; however, there are other ABC formats that allow coding of

18

the circumstances surrounding the behavior (e.g., the Functional Analysis

Observation Form, O’Neill et al., 1990). A scatter plot is a practical

tool for assessing low-frequency behaviors or behaviors that occur in

bursts, and it assists with identifying patterns of responding (Touchette,

MacDonald, & Langer, 1985). Scatter plots allow examination of the fre-

quency of behavioral occurrences across activities or times of day and are

also useful for recognizing changes in behavior patterns.

Interview formats designed specifically for obtaining information on the

perceived functions of problem behavior and other variables (e.g., eco-

logical, curricular) that may be contributing to its occurrence are also

valuable. In our protocol, we simply provide a set of open-ended ques-

tions; however, there are other well-developed tools. Two examples, the

Questions About Behavioral Function (QABF) (Paclawskyj, Matson,

Rush, Smalls, & Vollmer, 2000) and the Functional Analysis Interview

Form (FAIF) (O’Neill, Horner, Albin, Storey, & Sprague, 1990), are use-

ful alternatives to conducting analogue functional analyses.

The one rating scale with the most research support is the Motivation

Assessment Scale (MAS): a questionnaire that is administered to teach-

ers, paraprofessionals, family members, or anyone else who has a great

deal of contact with the child (Durand & Crimmins, 1988, 1992). The

MAS asks questions that determine where, when, and under what con-

ditions problem behaviors occur and determines their motivations. It is

available free online at http://www.monacoassociates.com/mas/

MAS.html. Information from the MAS, along with other forms of

functional behavioral assessments, is used to design plans for reducing

the behavior problems.

More research is needed for the tools described in this section in order

to demonstrate and improve their psychometric properties (e.g., relia-

bility and validity). In the meantime, however, they are the most useful

resources for assessing the nature and severity of problem behavior and

conducting functional assessments.

19

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21

Chapter 3 Session 1: Introduction and Goal Setting

(Corresponds to overview chapter and session 1 of the workbook)

Materials Needed

■ Self-Talk Journal – Session 1 form

■ Establishing Goals form

■ Defining My Child’s Behaviors of Concern form

■ Counting Behaviors form

■ Timing Behaviors form

■ Rating Behaviors form

■ Frequency Graph form

■ Weekly Progress Report form

Outline

■ Introduce the training program

■ Discuss importance of thoughts and feelings

■ Give background and definition of positive behavior support

(PBS) as foundation of the program

■ Present key features of PBS and the program

■ Give overview of PBS process

■ Discuss getting others involved

22

■ Help parent establish goals

■ Define behaviors of concern

■ Present options for keeping track of behavior

■ Discuss crisis planning (optional)

■ Assign homework

Introduction to Training

Explain the purpose of the sessions and what to expect over the course

of the training. Answer any questions as needed. You may want to use

the following dialogue:

The purpose of these sessions is to teach you how to understand and

address your child’s problem behavior using the best available

scientifically tested assessments and interventions. Because you are

such an important part of this process, we will also be getting to

know you and how you think about your child’s behavior. By exam-

ining your self-talk, we hope to be able to help you be more produc-

tive and optimistic when approaching your child’s behavior.

Remind the parent that anything he shares with you will be confidential;

you will not repeat it to other people or use it in any way unless he gives

you permission. Let the parent know that you may take notes during the

session; the notes are simply to help you remember important things the

parent says so that you can discuss them later as needed.

Preview the overall agenda for the training sessions and the topics to be

addressed within this first session. Refer to the parent workbook,

explaining how it will be used for homework and self-study.

Importance of Thoughts and Feelings

Tell the parent that the sessions will include discussions regarding his

thoughts and feelings and explain why this is important. The following

dialogue may be helpful:

In addition to teaching you how to develop a plan for your child, we

will be asking you to share your thoughts and feelings about your

child’s behavior. We do this for a couple of reasons. First, to help you

create a good plan for your child and family, we need to get to know

you and what is important to you. Second, we realize that our

thoughts can affect our feelings and behavior. Exploring your

perceptions as we go through the process may help you to be more

successful and better able to overcome any challenges you face.

Inform the parent that the way in which you will approach this is by

discussing what he thinks and feels during each of the sessions, as well

as having him record his thoughts and feelings between sessions.

Introduce the Self-Talk Journal (refer to the parent workbook). Provide

an opportunity for the parent to ask any questions.

Explain that during this session you will focus on identifying what the

parent thinks and feels when things are going well and when things are

particularly challenging. You will help the parent determine what situ-

ations prompt positive and negative self-talk.

Application

Have the parent list areas of difficulty and success his child has. Give

him a choice of starting with the child’s successes or difficulties, and ask

him to pick a specific situation and to talk about what he thinks or feels

when it occurs. Record or have the parent record responses in the first

two columns of the Self-Talk Journal. Do the same for the other area

(difficulty or success).

Throughout the session, help the parent to recognize his thoughts and feel-

ings as well as the circumstances that precipitate them. This may be done

while he is relating his experiences by asking questions such as: “What

were you thinking when that happened? Exactly what was going on that

made you feel that way?” If the parent provides a vague reply (e.g., “I was

thinking, ‘oh no, here we go again’ ”), ask him to explain what that means

to him. Keep asking questions (e.g., “What do you mean? What do you

think is going to happen?”) until the thoughts are explicit. Pay attention

to the parent’s body language as you discuss different topics. If the parent

23

appears to be uncomfortable or resistant, prompt him to identify his self-

talk by saying something like “You seem uncomfortable. What are you

thinking right now?” These questions should be blended throughout the

session and not unnecessarily interrupt the flow of the training.

Positive Behavior Support

Explain that the approach used in this program is based on the princi-

ples of applied behavior analysis and, in particular, positive behavior

support (PBS). Briefly describe its background. (The following sections

involve a great deal of lecture. It may be beneficial to warn the parent

and explain that this will not be the norm throughout the training.) You

may want to use the following dialogue:

The particular set of approaches we will be using in our sessions is

based on the principles of applied behavior analysis and is commonly

referred to as positive behavior support—or PBS for short. PBS is a

research-based approach to supporting people with behavior problems

in their homes, schools, and communities. PBS was created for use

with children and adults with very serious behavior problems, with

an emphasis on teaching them replacement skills and designing set-

tings at home and at school to help them behave better. PBS has been

shown to be very effective with a range of persons and behavior prob-

lems; it is now widely accepted among educators and researchers.

Explain that, in the past, approaches were often “trial and error” efforts

that were reactive and focused on decreasing behavior. PBS offers a

practical, problem-solving approach that emphasizes important values

such as treating children with disabilities in ways similar to their non-

disabled peers. PBS helps us understand what causes children’s behavior

so we can select the right strategies to improve it.

Key Features of the Program

Next, describe and provide examples of the key features of the program

(i.e., positive behavior support) as outlined here.

24

Assessment

At the heart of PBS is the assumption that we need to know why a child

is misbehaving in order to design a successful plan. We can find out why

children “act out” by looking at the situations that seem to set the stage

or provoke behavior problems and what the child may be gaining or

avoiding by misbehaving. By understanding why problem behaviors

occur (i.e., their purpose) and the situations that seem to set off these

behaviors, we are then able to develop effective solutions.

A great deal of research stands behind the PBS process as a way of gain-

ing an objective understanding of a child’s behavior. There are several

methods we can use to try to find out why a child is misbehaving as part

of a process called functional behavioral assessment (FBA). This can

involve structured observations by educators and other professionals

and the use of questionnaires; however, the process can often be imple-

mented less formally by parents and other care providers to successfully

understand a child’s behavior. Part of the next few sessions will be

devoted to helping the parent understand his child’s behavior using

different forms of FBA. Tell the parent that, just like detectives, we will

look for clues to understand his child’s behavior better. Through this

process we will figure out when, where, with whom, and why the child

behaves in certain ways.

To illustrate, have the parent consider the following scenario:

Jerome, age 4, and his mother are in a convenience store. Jerome

begins taking packages off of the shelves and pouring the contents on

the floor. When his mother tries to intervene, he runs away and

laughs hysterically. Now why is he doing that?

What if we learn that Jerome’s mother typically avoids taking Jerome

out in public and that, at home, the house is well child-proofed and he

does not have access to many interesting items? What if we notice that,

in addition to dumping the items, Jerome is also smelling and feeling

them? Or what if his mother admits that he and his uncle commonly

play a run-and-chase game where they try to keep items away from

each other? Knowing this additional information might help us (and

Jerome’s mother) address Jerome’s behavior more effectively (e.g., teach

him more appropriate ways to entertain himself in public places).

25

(If appropriate, ask the parent if something like this has ever happened

to him and to consider how he would think or feel in this circumstance.)

Explain that our understanding of the possible purposes of behavior or

circumstances affecting behavior provides the basis for how we address

behavior. Knowing the patterns allows us to adjust particular circum-

stances and outcomes surrounding behavior. As we come to better

understand a child and his motivations, we are empowered to deal with

his behavior in a more positive and effective manner.

Prevention

Continue with a description of the role of prevention in PBS.

Understanding the patterns surrounding behavior allows us to adjust

aspects of the environment to create positive changes in behavior.

Sometimes behavior problems require immediate attention, and knowing

the situations that provoke these problems can help us craft short-term pre-

vention strategies. Prevention strategies can include avoiding particularly

difficult circumstances (e.g., seating a child away from a disruptive peer),

changing aspects of activities to make them more pleasurable (e.g., allow-

ing a child to listen to music while waiting), or providing reminders for the

child to use expected behavior (e.g., using visual cues to put toys away).

Temporarily making changes in certain types of circumstances can often

remove the trigger for behavior problems, making them less likely to occur.

Teaching

Explain that, although prevention is often helpful for producing short-

term changes in behavior, it does not empower a child to function more

effectively when faced with difficulties. Long-term change in difficult

behaviors requires teaching children new skills. This program focuses on

helping children learn strategies to deal with challenging situations and

develop better ways to get their needs and wants met. Depending on the

situation, this may involve teaching a child skills for better communicat-

ing his needs, interacting with other people, dealing with stressful or

unpleasant circumstances, or becoming more independent in daily tasks.

26

Management

Describe the role of managing consequences. In addition to preventing

problems and teaching children more appropriate skills to replace prob-

lematic behavior, this program addresses how parents can manage their

reactions to a child’s behavior so that they do not inadvertently encour-

age the problem. The goals are for parents to respond in ways that

strengthen positive behavior (e.g., providing attention only when the

child is actively engaged in a task) and to discourage outcomes of mis-

behavior that may be desirable to the child (e.g. not allowing the child

to leave an unpleasant situation when he acts inappropriately).

Because PBS emphasizes a positive approach, efforts to punish behavior

are discouraged. Research suggests that replacing problem behavior with

more adaptive skills—rather than just trying to stop behavior problems—

is a highly effective strategy. Consequences such as time out, restriction,

or reprimands are therefore used sparingly, if at all.

Changing Lives

Explain that sometimes it is important to consider the “bigger picture”

when looking at making changes that improve behavior. PBS, and there-

fore this program, emphasizes trying to improve a child’s overall well-being

in addition to addressing specific behavioral concerns and the immediate

circumstances surrounding problem behavior. The philosophy is that chil-

dren being happier and appropriately challenged can help improve their

daily behavior. Therefore, the intervention process may include creating

friendships and reassessing educational goals and home expectations—all

with an eye toward improving general life satisfaction. The PBS process

encourages parents to step back from the day-to-day crises to reconsider

how their families lead their lives and what’s truly important.

Collaboration

Discuss the importance of collaboration in PBS. To be successful in

changing significant child behavior problems, input and support from

27

a variety of people who are important in the child’s life are essential.

Cooperation and involvement are encouraged, therefore, not just from

both of the parents but also from other family members, teachers, ther-

apists, friends, and anyone else who could have an impact on what hap-

pens with a child’s behavior. This type of working relationship requires

that everyone communicate openly with one another and develop plans

that make sense everywhere problems occur. Having shared goals and

responsibilities provides “buy-in” by everyone and helps improve the

likelihood of successful outcomes. This collaboration is essential for

understanding a child’s behavior, putting strategies in place, and mak-

ing sure they work.

Overview of the PBS Process

Introduce the case study of Ben, explaining that the case will be used to

illustrate each of the five main steps of the PBS process and be inter-

woven throughout the remainder of the sessions. (If Ben’s case study

would not be relevant to the participating parent, substitute another

example that includes all of the elements described in the case example

sections throughout the book). The initial description should include

the child’s age, sex, strengths, challenges (and the impact of those chal-

lenges on the child and family), and family circumstances.

Case Study: Ben

■ Ben is 3 years old. He is an only child and lives with both of his

parents. His father works as a data programmer, and his mother

stays at home with him. Ben’s grandmother lives nearby and visits the

family almost daily. Ben attends a preschool program for children

with developmental delays and disabilities from 9:00 to 12:00 on

weekdays.

Ben loves to play alone, has a keen interest in animals, and is especially

good at working puzzles. Ben has very limited spoken language, using

only a few words and more often relying on sounds, gestures, and prob-

lem behaviors to get his needs met. Ben has extreme difficulty with

changes in activities, routines, or settings. He often refuses attempts by

his parents or other children to play with him. When others interrupt

28

his play or change his activity or routine, Ben cries, screams, and drops

to the floor. When he is required to go somewhere in the car, he resists

getting his shoes on and being taken to the car, and then he continues to

cry well into the trip. Ben eats very little at breakfast or lunch and is

usually extremely hungry by dinnertime. He then cries and screams

until his mother gives him something he wants to eat. He eats his food

while wandering around the house. Ben resists tooth brushing and is not

potty trained. His parents reluctantly admit that he still sleeps with

them every night.

The challenges posed by Ben’s disability and problem behavior leave his

parents very isolated and discouraged. They feel that they cannot go

places or spend time with family and friends. Other than school, they

try not to take Ben out. In fact, they take turns running errands,

leaving one parent to stay at home with Ben. They cannot leave Ben

with babysitters because they feel that nobody else can handle him. Ben’s

mother believes her husband is denying his disability and is frustrated

with her mother-in-law’s frequent comments that Ben just needs “proper

discipline.” All of these things are creating tremendous stress on the

marriage and family. ■

Five Steps of PBS

Review the five steps of PBS. PBS offers a creative, problem-solving

process for understanding why behavior occurs and dealing with it

effectively. The process involves five general steps or components

focused on improving children’s behavior and families’ lives. The basics

of the five steps are as follows:

■ Step 1) Establishing goals: defining the problem, including the

child’s behaviors of concern and specific changes we want to occur

■ Step 2) Gathering information: watching the child’s behavior and

talking to other people to understand why the child is behaving

in this manner

■ Step 3) Analyzing patterns: determining what circumstances are

affecting the child’s behavior and what the child is getting or

avoiding as a result

29

■ Step 4) Developing a plan: creating strategies to prevent prob-

lems, teaching the child better ways of behaving, and responding

appropriately to behaviors when they occur

■ Step 5) Monitoring results: reviewing progress to ensure that the

strategies are working and making changes as needed

Getting Others Involved

Explain the importance of collaboration in PBS, who should be involved,

and how to work together. The following dialogue may be helpful:

PBS is most effective when everyone who cares for and interacts with

a child is involved. This is because, working together, we can be

confident that everyone in the child’s life agrees on the goals, shares

ideas and information openly, understands the patterns associated

with the child’s behavior, and is committed to following through with

the plan. The PBS process works because everyone is learning together

and supporting one another.

The people who should be involved in the process include parents, fam-

ily members, teachers, friends, and others who interact with the child.

At minimum, this includes those who know the child best, see the

child on a daily basis, and will ultimately be using the plan. To work

together effectively, everyone must agree to participate, communicate

openly and respectfully, and resolve problems together as they arise.

Case Example: Ben’s Team

■ To make the PBS process work, both of Ben’s parents, his grandmother,

and preschool teacher needed to be included. This meant having family meet-

ings and communicating with his teacher through email and conferences. ■

Application

Ask the parent to consider briefly who should be involved in the PBS

process and how to engage them. (If the parent discusses or alludes to

30

any discrepancies in perspectives or practices [e.g., with an estranged

spouse] explore his thoughts or feelings.)

Establishing Goals

Explain the rationale for setting broad goals for children’s behaviors and

lives and provide examples of such goals. The following dialogue may

be used:

The first step in the positive behavior support process is to create a clear,

positive vision for the future. Before trying to understand and address a

child’s problem behavior, it is important to consider what broad goals

we want to achieve through our efforts. We may want to consider why

changing a child’s behavior is so important and what we would ulti-

mately like to see in terms of changes in the child’s life. Through this

process, we want to achieve more than just changing or stopping certain

behaviors; we want your child and your family to have better lives.

Broader life goals might focus on:

■ Improving a child’s health or emotional state

■ Making it possible for a child to go more places or do more things

■ Giving a child more opportunities to make his own choices

■ Enhancing or expanding a child’s friendships and other relationships

■ Improving family life in general

In establishing these goals, it is important to think about the child’s

strengths and interests, as well as difficulties. We can then build on the

child’s strengths, as well as respond to his needs. Identifying goals

should be done with the child, family, and other people who care for

the child and are involved in his daily life.

Having a positive vision for the child’s future gives the parent and other

family members hope and direction. Identifying these goals also builds

unity among those involved in the life of the child. The result is greater

optimism and motivation to make the changes needed, as well as better

outcomes for the future.

31

Case Example: Ben’s Goals

■ Ben’s family developed the following goals: help him play with other

children and adults, better handle transitions and change, and ride in the

car and eat with the family without problem behavior. In addition, his

parents wanted him to develop more interests (beyond animals and

puzzles) and participate in typical childhood experiences, including

spending time with friends. They also wanted him to become more inde-

pendent with his self-care, to sleep alone, and to develop the skills he

needed to keep himself safe (e.g., looking out for traffic). Ben’s parents

wanted to be able to enjoy life as a family without the constant stress pre-

sented by his problem behavior. They hoped to be able to go places and do

more things as a family and to reduce the conflict in their lives. ■

Application

Taking into account the information presented in this section, have the

parent consider his child’s strengths and challenges and identify at least

one goal he has for his child. (If discussion of the future prompts strong

feelings, explore the parent’s self-talk by saying something like, “When

you think about the future, what comes to mind?”) The goals should be

broad but objective, and they should include things such as increased

independence, community participation, and friendships. The goals

should be recorded on the Establishing Goals form in the workbook.

Defining Behaviors of Concern

Explain that an important beginning step in trying to understand the

patterns surrounding a child’s behavior is to define the specific behav-

iors that we are finding to be a problem and that we, therefore, want to

change. By defining behavior in this way, we can:

■ Look at the behavior and the possible influences objectively (and

gather consistent information)

■ Be more consistent when trying to understand and deal with

behavior

32

■ Make sure that everyone interacting with a child is addressing the

same concerns and is “on the same page”

A child’s behavior should be defined in terms of what the child says or

does and in ways that are observable and measurable. The description

should be specific enough that everyone who is involved in the child’s

life will immediately know the behavior when it occurs. The goal is to

describe behavior in enough detail that parents, spouses, mothers-in-

law, and others would all agree when it occurs.

(If appropriate, discuss the parent’s ability to be objective regarding his

child’s behavior. Explore his assumptions or the labels he assigns to the

behavior.)

Criteria and Examples

Describe how to define behavior objectively, providing examples of

clear and unclear definitions. Share the following criteria.

Well-defined behavior (that is free of labels and assumptions):

■ Describes what the behavior looks like

■ Describes what the behavior sounds like

■ May include typical examples of the behavior

■ Does not use words with unclear meaning

Give the following definition examples for tantrum behavior:

Clear definition: screaming accompanied by wildly waving arms, kicking

legs, lasting for at least one minute

Unclear definition: a loud fit that causes everyone to look

Case Example: Ben’s Behaviors of Concern

Illustrate by defining the behaviors of concern for the case example:

■ Screaming, crying, and dropping to the floor (i.e., tantrums). ■

Use other examples as necessary and appropriate. Make sure the behav-

iors are objectively stated (in terms of what the child says or does).

33

Application

Have the parent define one or more of his child’s behaviors of concern

and record his definition(s) on the Defining My Child’s Behaviors of

Concern form. (You may also want to again discuss, if appropriate, the

parent’s ability to be objective regarding his child’s behavior.) If the par-

ent identifies multiple behaviors, help him to prioritize those behaviors

(e.g., the top three).

Keeping Track of Behavior

Explain that it is often helpful to get an estimate of how often or how

long a child’s behaviors of concern are happening right from the start of

the PBS process. Establishing this “baseline” on how the child behaves

before implementing the PBS steps allows us to evaluate changes after

the plan has been put in place. This helps to confirm that what we are

doing is effective. Later on, we should be able to say with some assurance

that the child’s behavior is improving and that the plan is working

(e.g., hitting has decreased from about five times per day to about three).

To gather this information about a child’s behavior before starting PBS,

we want to use the simplest method possible that will tell us how often,

how long, or how difficult a child’s behavior is. Some options for

recording a child’s behavior might include:

1. Counting the behavior (i.e., frequency): making note of every

time a child does the behavior

2. Timing the behavior (i.e., duration): recording how long a

behavior goes on

3. Rating the seriousness of the behavior (i.e., magnitude): using

some kind of scale (e.g., between 1 and 5) to estimate how often

the behavior occurred or how bad it was each day

If these methods seem too difficult or time-consuming, parents simply

can get a sample of behavior. This means limiting their recording to short

periods each day. For example, parents might just observe what happens

prior to the child going to sleep, rating how bedtime went. Go over the

variety of data collection forms found in the workbook: Counting

34

Behaviors, Timing Behaviors, Rating Behaviors, and Frequency Graph.

See Figures 3.1. through 3.4 for example rows from each form (based on

the definition of Ben’s tantrums). Point out the pros and cons of each

instrument so the parent can select one that will work at home.

35

Date Start Time Stop Time Tallies Total

10/13 3:30 4:00 / / / 3

Date Time Behavior Started Time Behavior stopped Total Time

10/13 3:30 4:00 30 min

Date Time/Activity Behavior Rating Comments

10/13 3:30-4:00/snack 3 2 1 0 Was unable to open snack package and had to ask for help

Figure 3.1

Completed Example Row of Counting Behaviors Form

Figure 3.3

Completed Example Row of Rating Behaviors Form

Figure 3.4

Completed Example Rows of Frequency Graph Form

Figure 3.2

Completed Example Row of Timing Behaviors Form

10/13 10/1410 10

9 9

8 8

7 7

6 6

5 54 4

3 3

2 2

1 1

Application

If appropriate, have parent select a simple method for collecting base-

line data on his child’s top-priority behaviors of concern. Review

the corresponding form in the workbook and make sure the parent is

confident in using it. If, for some reason, the parent is unable to collect

data, encourage him to at least do a Weekly Progress Report. Introduce

this form as a method of tracking changes in the child’s behavior each

week. Make sure the parent understands how to complete it.

Crisis Planning (optional)

If the child is engaging in behavior that is placing himself or others at risk

or severely disrupting the environment, discuss with the parent ways to

ensure safety while developing the behavior support plan. Severe behavior

problems require agreed upon crisis management strategies. These may

also be needed at times when the child is not dangerous but is so disrup-

tive as to cause educators or caregivers to abandon behavior support plans.

In these cases, it may be necessary to remove the child from a situation,

block his behavior (e.g., stand between him and another child), hold onto

the child briefly until he calms down, or get some help. This type of “cri-

sis management” is not intended to be a type of punishment, or even a

solution, but a temporary way to ensure the safety of children, families,

and homes until we develop a better plan. If these methods are required to

manage emergencies, they should be used cautiously (i.e., with the least

amount of verbal or physical force to make the child safe) and only long

enough for the child to regain control of his own behavior. Approvals from

all parties—parents, teachers, school administration—must be obtained

prior to using any approach that would be considered restrictive.

Homework

✎ Have parent keep Self-Talk Journal.

✎ Have parent identify the people who will be participating in the PBS

process. Encourage parent to talk with them to help define the child’s

behavior and identify goals.

36

✎ Have parent complete the Defining Behavior form.

✎ Have parent complete the Establishing Goals form.

✎ Have parent complete selected data collection forms (e.g., Counting

Behaviors, Timing Behaviors, Rating Behaviors, Frequency Graph).

✎ Have parent complete the Weekly Progress Report.

✎ If needed, have parent develop a crisis plan.

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39

Chapter 4 Session 2: Gathering Information

(Corresponds to session 2 of the workbook)

Materials Needed

■ Self-Talk Journal – Session 2 form

■ Motivation Assessment Scale

■ Interview Form

■ Scatterplot form

■ Behavior Log

■ Information Gathering Plan

Outline

■ Preview agenda

■ Review homework

■ Explore the relationship between thoughts and behavior

■ Discuss the importance of assessing antecedents and consequences

for understanding behavior

■ Introduce the Motivation Assessment Scale

■ Introduce methods for gathering information

■ Review observing behavior

■ Review interviewing people

40

■ Review recording information

■ Help parent choose an information-gathering strategy

■ Assign homework

Agenda Preview

Preview the agenda for this session as referred to in the outline. Add any

other items relevant to the parent.

Homework Review

Ask the parent if she has any questions about the previous session or the

workbook reading. Review homework forms for definition of behavior,

broad goals, and baseline data. (If the parent did not complete the

homework, help her to identify goals and problem behaviors, suggest-

ing that she review them with the other members of her team between

sessions.)

Ask about communications with family and others. Provide feedback.

Also review Weekly Progress Report.

Self-Talk Journal Review

Review the Self-Talk Journal and ask the parent to choose one success

and one difficulty from the past week and read the entry (including the

situation and self-talk) aloud. If the parent is not comfortable reading

her journal, she may paraphrase it or let you read it. Note any pessimistic

thoughts. Ask the parent what the consequences were for the pessimistic

beliefs (e.g., “So Jimmy was having a tantrum at the library, and you

were thinking, ‘I’m a bad Mom; I can’t take him anywhere.’ What hap-

pened next? How did you respond to the tantrum?”). Also note how the

parent describes her successes: whether she takes credit for good events

or attributes them to something else (e.g., good health, fewer demands).

Relationship Between Thoughts and Behavior

After identifying the consequences of the pessimistic beliefs, explain

the relationship between thoughts and behavior. Use the parent’s expe-

riences to clarify this relationship. The following dialogue might be

helpful:

Sometimes when we are feeling overwhelmed and frustrated and

begin thinking these negative thoughts (“It’s all my fault; things are

never going to get better”), our behavior changes. We might give up

more easily or do things we know we shouldn’t do. What we think

affects what we do.

Application

Have the parent select one of the negative beliefs she shared previ-

ously and identify the consequences of that belief (including how she

reacted to the situation). Have her record it in the Self-Talk Journal

as an example.

Throughout the session, help the parent to recognize her thoughts and

feelings, the circumstances that precipitate them, and the consequences

of those beliefs. This may be done while she is relating her experiences

by asking questions such as:

■ What exactly happened?

■ What were you thinking when that happened?

■ How did you react as a result of your thoughts or feelings?

Pay attention to the parent’s body language as you discuss different

topics. If the parent appears to be uncomfortable or resistant, prompt

her to identify her self-talk by saying something like, “You seem

uncomfortable. What are you thinking right now?” Be sure to probe

until the self-talk is explicit (i.e., statements rather than just labels).

These questions should be blended throughout the session and not

unnecessarily interrupt the flow of the training.

41

Understanding Behavior

Explain why collecting information (i.e., conducting a functional

behavioral assessment) is essential to effective intervention and the role

families should play in this process. Stress that at the heart of all

effective interventions is a clear understanding of the functions of the

behavior problem(s). Once priorities have been identified, the next step

is to conduct an assessment of what is triggering (antecedents) and

maintaining (consequences) these behaviors. Parents’ input is essential

at this stage, and the information they provide and obtain will assist in

designing a plan that fits best with their family’s needs. You may want

to use the following dialogue in your discussion:

You serve as the eyes and ears of this important next step, allowing us

to get an insider’s view of what goes on during a typical day and

night with your child. We need to begin to understand what things

seem to trigger behavior problems and why they might continue to

occur despite your best efforts. We will work together using some

simple tools: focusing on what is going on before your child misbe-

haves and what happens right after these incidents. This important

information will allow us to design ways to interact with your child

and will also help us to identify specific skills to teach your child that

will significantly improve behavior.

Antecedents

When trying to determine what triggers or provokes behavior, we need to

consider the circumstances that exist before the problem behavior occurs.

This involves asking questions related to who, what, where, and when:

■ Who is around? (e.g., sister, friends, father, dog, neighbor)

■ What are the activities, demands, or expectations? (e.g., playing

with toys, cleaning room, getting dressed)

■ Where does it occur? (e.g, at home, in the car, at the store, at

Grandma’s)

■ When does it occur? (e.g, in the morning, at dinner, after play dates)

42

In addition to the immediate influences on behavior problems, other

events or conditions can affect how a child will behave. These conditions

do not by themselves seem to trigger behavior problems, but they will

make these behaviors more likely to occur when the triggers are present.

Examples of more distant events or circumstances (sometimes called set-

ting events or establishing operations) that can influence behavior are:

■ Physical conditions (e.g., pain, hunger, sickness, tiredness)

■ Events (e.g., changes in routines, family conflict)

These types of conditions or events can have an effect on a child’s gen-

eral demeanor and make her react more strongly to typical triggers.

Consequences

Understanding what consequences behaviors produce for a child is as

important to assessment as knowing what triggers behavior problems.

We need to inventory all typical responses and outcomes (conse-

quences), including formal reactions (e.g., using time-out) as well as

informal or unplanned reactions (e.g., saying “stop that,” trying to calm

the child with soothing words, or simply allowing the child to have her

way). The reactions of people who interact with a child on a day-to-day

basis may be reinforcing behavior problems either through 1) what a

child gets (i.e., positive reinforcement such as attention received for

misbehaving) or 2) what a child avoids (i.e., negative reinforcement

such as avoiding unpleasant demands).

(If appropriate, discuss how thoughts and feelings can serve as a mediator

to our reactions; for example, when we interpret a child’s behavior—or

the impact of her behavior—in a particular way, it may affect how

we react.)

Motivation Assessment Scale

Introduce the Motivation Assessment Scale and review its content

and format (see http://www.monacoassociates.com/mas/MAS.html).

Explain that it is a screening tool that helps us to pinpoint the function,

43

or goal, of a child’s problem behavior. By completing it, we can make

an educated guess regarding whether behavior is motivated by atten-

tion, tangibles, sensory outcomes, or escape.

Application

Have the parent complete the Motivation Assessment Scale on a

behavior of significant concern, defining the context in which it

occurs. Explain that the answers reflect hypotheses about what is

affecting the child’s behavior. (Score the MAS for the family either at

this time or between sessions and share the results during the next

session.)

Introduction to Information Gathering

Explain that there are a variety of informal ways to collect information,

but the purpose should be to better understand the behaviors of con-

cern. You may want to use the following dialogue:

There are a number of different ways to find out what is influencing

your child’s behaviors. Some of these techniques require a great deal of

time and need to be supervised closely by behavioral professionals.

Fortunately, we have less formal ways of finding out the same infor-

mation that can be just as effective. They include three general meth-

ods: observing behavior, interviewing people, and recording

information.

Emphasize that the purpose of information gathering is to understand

the causes and purposes of a child’s behavior. Present each of the three

methods for gathering information as follows.

Observing Behavior

Discuss observing (simply paying attention) as a way of learning

more about a child’s behavior. Provide examples of what parents

might notice (e.g., that problem behaviors seem to occur more

44

frequently when the child is approached in a certain way or that

the child is able to avoid completing at least part of an activity she

dislikes through her behavior). Use the following dialogue in your

discussion:

There is nothing more valuable to us than the observations of a well-

informed parent. Once you know what to look for, your view of the

situations that lead up to problems and how things change after the

incident can be invaluable for designing plans. The trick is to watch

the child with “objective” eyes, not “parent who deals with this child

every day” eyes. You need to pay attention and take note of what is

happening around your child’s behavior.

Explain that observing means noticing situations in which a child

behaves well, in addition to those in which she has difficulty. We con-

sider who, what, where, and when (see questions under “Antecedents”)

and what a child gets or avoids as a result of the behavior. (If the parent

mentions ways that her thoughts and feelings cloud her observations,

explore possible self-statements regarding patterns she perceives.)

Use the following case example to illustrate the observation method.

Give other examples as appropriate and needed.

Case Example: Observing Ben’s Behavior

■ Ben’s parents decided to pay attention to times when Ben could change

activities without problems (e.g., when he was going to do something he

really liked) and compare them with times that were difficult. They also

wanted to look at playtime to try to figure out how involved they could get

in Ben’s play and how much they could do with him (e.g., sitting near

him, handing him toys) before he would resist. They thought that by look-

ing closely at those circumstances they could get a better idea of what was

influencing his behavior. ■

Interviewing People

Explain interviewing to gather information. Talk about who should be

interviewed (i.e., those people who know the child well and interact

with her on a daily basis) and the types of questions interviews may

45

include. Provide examples of questions (see Interview Form in the

workbook). Use the following dialogue to begin:

A simple and useful method of gathering information about a child’s

behavior is to talk to other people who know the child well and inter-

act with her in a variety of situations. We should “interview” family

members, friends, and others who see the child frequently and are

familiar with the problem behavior, like teachers and babysitters.

Taking the opportunity to discuss concerns and get input from other

people allows us to better consider everyone’s perceptions and to

generate new ideas.

(If the parent discusses differences in how people perceive her child’s

behavior, prompt her to discuss those perceptions and how they con-

trast with her own.)

Tell the parent that, during the interviewing process, the following

should be explored:

■ Behavior patterns, considering who, what, where, and when

■ “Distant” events or conditions that might be affecting a child’s

behavior

■ What happens after: the reactions to or results of the behavior

Suggest that it may be helpful for the parent to record what she learns

through these discussions, as sometimes it is easier to find a pattern

when the information is down on paper. Explain that there are a vari-

ety of ways that can be used to record the responses (including the

Interview Form in the workbook).

Use the following case example to illustrate the interviewing method.

Share other examples of interviews as needed.

Case Example: Interviews about Ben

■ Ben’s parents decided to make individual lists of the times that things

were easy and hard for each of the parents with Ben. They could then

compare notes and discuss what was happening more objectively, looking

at the when, what, and where of their challenges with Ben. They decided

to ask the same of Ben’s teacher and grandmother. ■

46

Recording Information

Explain that recording what we discover from observing a child is often

an essential part of the intervention design process. It can also allow for

a more objective view of the behavior and circumstances surrounding it,

which will improve the quality of the assessment and, therefore, the

effectiveness of the strategies derived from that assessment. Keeping a

simple daily journal of the events of the day, or using more elaborate

methods to track details about a child’s behavior (e.g., when, how often,

how long), can yield important insights.

Review the various methods that can be used to record information,

including Scatterplot forms and Behavior Logs. Refer the parent to the

data forms and completed examples in the workbook.

Scatterplot

We can record behavior in a way that helps us pinpoint the times

of day a child’s behavior is most and least likely. With this system, we

simply mark whether or not a behavior occurs within a particular peri-

od of time. Using this information, we can narrow down when to look

more closely at the child’s behavior and the circumstances around her

behavior. For example, if we were to look at an example that shows the

times of day Ben whines, we might want to focus our attention on the

early morning, midday, and just prior to dinnertime (see Figure 4.1).

Provide examples, and practice completing the Scatterplot form with

the parent as needed to reinforce this concept.

Behavior Logs

Behavior logs, or ABC charts, have a long history of use as an assess-

ment of a behavior’s function in part because they are relatively easy

to use. When a behavioral problem occurs, we can record what hap-

pened before the incident (the antecedent, or “A”), a description of

the behavior itself (“B”), and what happened afterward (the conse-

quence, or “C”).

47

48

ScatterPlot

Child: ____________Ben_____________ Behavior: ______________________________________Dates: _____5/1___ through ________5/10___Record the times of day (and/or activities) in which the behavior might occur. Write in the dates for therecording period in the first row. When the behavior occurs, shade in the corresponding box.

Dates

Time Activity 5/1 5/2 5/3 5/4 5/5 5/6 5/7 5/8 5/9 5/107–8a.m.

Preparing for school

8–9a.m.

Transition to school

9–10a.m.

Arrival/centers

10–11a.m.

Outside (transition)

11–12p.m.

Swim/change

12–1p.m.

Lunch

1–2p.m.

Transition home

2–3p.m.

Arrival home /change

3–4p.m.

Home/play alone

4–5p.m.

Play outside home

5–6p.m.

Dinner

6–7p.m.

Bath

7–8p.m.

Bedtime

Source: Adapted from Touchette, MacDonald, & Langer, 1985.

Figure 4.1

Example of Completed Scatterplot

Screaming, crying, and dropping to the floor

49

Antecedent (Before Behavior) Behavior

Consequence (After Behavior)

Ben’s mother asks him to put onhis shoes

Ben extends his body,cries, and screams

Ben’s mother takes his shoes tothe car, letting him go in hisbare feet

Ben’s mother guides him fromthe car into school

Ben cries and screams Classroom assistant hands him a toy and brings him into the class

Ben is told it is time to comeinside from the playground

Ben extends his body,cries, screams, and thendrops to the ground

Assistant waits for him to getcalm and then physically guideshim in

Ben’s mother sits down to playwith him

Ben extends his body,cries, and screams

Ben’s mother says “I just wantto play with you” and then movesaway, leaving him alone

As dinner time nears, Ben’smother goes into the kitchen

Ben walks into thekitchen and begins to cryand then scream

Ben’s mother quickly gives himone of his favorite foods

Ben’s father asks him to sit atthe table to eat

Ben sits brieffy and thenpicks up his food and walksaround

Ben’s mother asks him to comeback or says “don’t you want tosit?” and then lets him go

Behavior Log

Record situations in which your child’s behavior is difficult, including specifically what your child saysand does and what occurs before and after the behavior.

Figure 4.2

Example of Completed Behavior Log for Ben

Provide examples of completed ABC recordings, and practice com-

pleting the Behavior Log form with the parent as needed to rein-

force this concept. Refer to the case example of a behavior log in

Figure 4.2.

Choosing a Strategy

Discuss how to select particular information-gathering tools and strate-

gies. Note that the Behavior Log provides a lot of important informa-

tion, but it also takes more time to complete than simple checklists

(e.g., for frequency, duration). Using another format such as the

Scatterplot first might help us pinpoint the times of the day problem

behaviors are most likely and least likely to occur, making it possible to

plan recording for those times of day. Strategies for keeping a record

of the child’s behavior should be selected (or designed) based on the

family’s needs and situations. They should not be ridiculously time-

consuming or difficult, or parents will find it hard to use them consis-

tently. Furthermore, they should capture the things the parent and

family are most concerned about.

Application

Prompt the parent to look over all of the tools for interviewing other

people and recording information presented in this session, discussing

the pros and cons of each. Help her select and plan strategies for gath-

ering information. Have her record ideas on the form provided in the

workbook (see Information Gathering Plan). Guide her to be realistic

about what she can do, even if it simply involves paying attention to a

particular situation and talking to a couple of people.

Homework

✎ Have parent continue to keep Self-Talk Journal.

✎ Have parent continue to complete the Weekly Progress Report.

50

✎ Have parent develop a plan for gathering information about the

child’s behavior (e.g., using the Interview Form, Scatterplot, Behavior

Log, or some other format if appropriate).

✎ Encourage parent to talk with family members and others to get their

input.

✎ Have parent complete the MAS on the child’s behavior(s), if it was

not completed during the session or if you want to complete

additional forms for other behaviors.

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53

Chapter 5 Session 3: Analysis and Plan Design

(Corresponds to session 3 of the workbook)

Materials Needed

■ Self-Talk Journal – Session 3 form

■ Pattern Analysis Worksheet

■ Brainstorming Interventions form

Outline

■ Preview agenda

■ Review homework

■ Discuss the use of distraction for dealing with unproductive

self-talk

■ Teach parent how to use information to analyze patterns

■ Help parent to create hypotheses or summary statements

■ Use patterns to brainstorm intervention ideas

■ Assign homework

Agenda Preview

Preview the agenda for this session as referred to in the outline. Add any

other items relevant to the parent.

54

Homework Review

Ask the parent if he has any questions about the previous session or the

workbook readings.

Review information gathered through observing behavior, interviewing

people, and recording information. (If the parent did not gather much

information, let him know that it might be helpful to continue collect-

ing data to support or challenge the summary statements to be devel-

oped during this session.)

Review the results of the Motivation Assessment Scale and current

hypotheses about the child’s behavior.

Ask about communications with family members and others. Provide

feedback. Review Weekly Progress Report.

Self-Talk Journal Review

Review the Self-Talk Journal and ask the parent to choose one success

and one difficulty from the past week and share the entry (including the

situation, his self-talk, and the consequences of his self-talk). When the

parent has shared his entries, review how his thoughts and feelings

influenced his behavior in each situation. For example, you might say

something like:

It sounds like you believe you are a bad father because you can’t

control Mary during public outings, so you just avoid taking

her out at all. In the example you shared, your belief about

your parenting skills affected your decision to stay home rather

than take an opportunity to teach Mary how to behave in

public.

Point out any positive events the parent fails to take credit for, and

where credit is probably due (e.g., “You had a couple of very success-

ful outings as a family; you must have done a lot to contribute to those

successes”).

Use of Distraction

Explain that when we recognize that we are engaging in unproductive

self-talk, we may have to do something to interrupt that way of thinking

so we can handle situations more effectively. At those times, distraction

is helpful.

Distraction involves shifting our attention away from any pessimistic

thoughts during activities such as a meeting at school, dealing with a

behavior problem, or a stressful workday. This can be done with a vari-

ety of methods, for example:

■ Singing to oneself

■ Choosing a mantra (e.g., “things will soon get better”)

■ Writing down the belief and throwing the piece of paper away

■ Scheduling time to think through the belief (e.g., after work,

when the kids are in bed)

■ Reading a 3 � 5 note card that says “STOP!”

Application

Have the parent decide what distraction strategies he will use and in

what situations they might be helpful. Have him make a note of the

strategies he plans to use under the comments section of his Self-Talk

Journal. Throughout the session, help the parent to recognize his

thoughts and feelings, the circumstances that precipitate them, and the

consequences of his beliefs. Remind him to use distraction (e.g., “You

are stating some negative ideas, how can you stop them?”) when neces-

sary to interrupt unproductive thinking.

Pay attention to the parent’s body language as you discuss different topics.

If the parent appears to be uncomfortable or resistant, prompt him to iden-

tify his self-talk by saying something like, “You seem uncomfortable. What

are you thinking right now?” This discussion should be blended through-

out the session and not unnecessarily interrupt the flow of the training.

55

Analyzing Patterns

Explain that the purpose of analyzing information in this session is to

figure out patterns affecting the child’s behavior. Reiterate what we are

looking for when reviewing the information, namely patterns related to

the circumstances (who, what, where, when) and the consequences of

the behavior. Provide examples of data and patterns as needed. You may

use the following dialogue to begin:

Remember that the information we collect will be used to try to

determine if there are patterns in your child’s behavior problems.

This includes patterns in what happens before and after the behav-

ior. Usually, collecting information for a week or so is enough to

come up with first guesses, although it may take longer to see clear

trends. We will continue to collect information until the patterns

are clear.

Stress that what we are looking for are patterns that repeat themselves—

typical sequences that occur in different situations and on different

days. The goal is to identify situations that occur again and again, allow-

ing us to predict circumstances in which we are likely to see behavior

problems. In other words, we determine what situations are expected to

set the stage for behavior and what consequences, outcomes, or results

reliably follow the behavior. If we already have assumptions about what

is affecting a child’s behavior (which is often the case), the purpose of

this step is to use the information we collect to either support or chal-

lenge those assumptions.

Explain to the parent that we need to review the assessment informa-

tion and respond to the following questions:

■ What are the circumstances (i.e., when, where, with whom, dur-

ing what activities) in which the behavior is most likely and least

likely to happen?

■ What are the typical outcomes and reactions (consequences) of

the behavior? That is, what does the child get or avoid through

his actions?

■ What would cause the child to behave this way, and what would

make the child stop?

56

(If the parent offers an explanation such as “she just can’t help it” for

the child’s behavior, prompt him to consider the impact of that kind

of self-talk on his expectations of his child or on his reactions to the

behavior.)

Explain that behaviors can serve more than one function for a child.

Use the following dialogue:

It is important to remember that some behaviors can have more than

one purpose or function. For example, children might scream in one

situation to get the attention of people around them and scream at

another time to express their discomfort with an activity. Therefore, it

is important to identify not only the goals (i.e., functions) behaviors

achieve but also the circumstances in which those functions are

meaningful.

Provide examples as necessary and appropriate. For those examples and

the case example, list times, places, people, situations, and activities asso-

ciated with problem behavior and those in which problems rarely occur.

List consequences (reactions, results) that tend to follow behavior.

Case Example: Ben’s Patterns

■ Most likely to misbehave: sitting at dinner table; transitions to

the car, when getting ready to leave the house, between activities,

schedule changes within routines, when his mother or others try to play

with him

■ Least likely to misbehave: playing alone, tickle games, eating meals

(while walking around), going swimming (a type of transition), when

holding small toys (e.g., stuffed animals)

■ Results: mother leaves him alone, feeds him quickly, and lets him walk

around with food; limits trips in the car; and generally delays transitions

Broader Issues

Remind the parent to consider broader issues when identifying patterns.

As previously mentioned, in addition to the immediate events preceding

and following a child’s behavior, there might be other conditions or more

57

distant events that are influencing the child’s current behavior. These

might include:

■ Medical conditions (e.g., allergies or dietary problems result in

greater irritability, in general)

■ Activity patterns (e.g., too many activities lead to resistance when

asked to participate in family events)

■ Personal relationships (e.g., presence of a friend makes child more

willing to participate in activities)

Case Example: Ben’s Broader Issues

■ In addition to the immediate issues affecting Ben’s behavior, there were

other concerns. He had a restricted diet and poor sleep patterns, both of

which could have been affecting his behavior. Also, because of his problem

behavior, he did not have the opportunity to participate in the range of

typical activities or have the quality of relationships children his age

usually enjoy. ■

Creating Hypotheses or Summary Statements

Explain why it may be helpful to summarize patterns (i.e., to clarify

how behavior is influenced by environmental conditions, to create a

usable format for intervention planning). Tell the parent that, once we

have identified circumstances that appear to precipitate and follow

behavior, it is often helpful to summarize these patterns in a phrase, sen-

tence, or short paragraph. The summary will then be used to guide our

intervention planning. The summary should include:

■ What sets the stage or triggers the child’s behavior

■ What is the behavior of concern (i.e., what the child says

or does)

■ What occurs afterward (what the child gets or avoids as a result)

Provide an example of a summary statement (see the following case

example). The statement should include the context(s) in which behav-

iors are a problem, specific behaviors of concern, and the function(s)

58

served by the behavior. Setting events might also be identified. The

statement should be specific, concise, and broadly applicable.

Case Example: Summary Statements for Ben

■ When Ben’s parents try to put his shoes on to leave the house, he screams,

cries, and drops to the floor. This delays the transition, forces his mother to

take him out without shoes, or results in her canceling the errand or getting

someone else to do it.

■ When his parents or peers try to play with Ben, he screams and cries; if

they don’t back off, he turns his back on them or pushes them away.

Eventually, the children or family members back off, and Ben is able to

continue playing contentedly by himself.

■ When Ben doesn’t eat well at breakfast and lunch, he screams and cries

as dinnertime approaches. If Mom doesn’t feed him right away, he gets

louder and runs around the kitchen. As a result, she quickly prepares

him something he likes to eat. She often allows Ben to carry his food

around (rather than requiring him to sit with the family during meals).

Testing Hypotheses

Explain that it is sometimes necessary to test out hypotheses to verify their

accuracy. At times the patterns are clear, and it is easy to identify what is

triggering and maintaining a behavior. However, there are other times

when the circumstances surrounding behavior problems are more com-

plex. Tell the parent that, in this case, it might be helpful to test our

hypotheses, or best guesses, about the purposes of the behavior. We do this

by setting up situations we think might affect a child’s behavior and see

what happens. Ultimately, the hypotheses will be confirmed—or not—

when we put the intervention into effect. If our strategies work, we were

right; if they don’t, we need to investigate further to see if there is anything

we missed. See the following example of how to test a hypothesis.

Case Example: Testing Ben’s Hypothesis

■ To confirm one of Ben’s patterns, Ben’s mother could alternate requir-

ing and not requiring Ben to wear his shoes and see whether his tantrums

predictably occur. ■

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Application

Have the parent look at all of the information collected so far and look

for patterns for each behavior category. Using the Pattern Analysis

Worksheet or a flip chart, ask the parent to consider the circumstances

(when, where, with whom, what activities) and consequences (what the

child gets or avoids as a result) of the behavior. If the patterns are not

clear, continue to probe (e.g., “Does that happen every time? If not,

why?”). If there is time, repeat this process for other behavior patterns.

Based on this information, help the parent to generate at least one

hypothesis or summary statement, including both the contexts and

functions of behavior. Have the parent record the hypothesis or sum-

mary statement on the Pattern Analysis Worksheet.

(Acknowledging that problem behavior might be related to parents’ inter-

actions with their child can be difficult for some parents, particularly when

such an acknowledgment would challenge longstanding beliefs. If the par-

ent has difficulty accepting hypotheses that contradict his previous assump-

tions, explore this by questioning his self-talk surrounding that hypothesis.)

Using Patterns to Brainstorm Intervention Ideas

Describe how summary statements (hypotheses) provide the founda-

tion for intervention. Reiterate that we must understand a child’s

behavior before we can begin to address it effectively. Once we have

gathered information and analyzed patterns, we should have a solid

understanding of:

■ The specific behaviors that concerns us

■ The alternative behaviors we would like to teach

■ The triggers for the child’s best and worst behavior

■ The purpose or function of the child’s behavior (what the child

gets or avoids as a result)

With this information in hand, we can design an effective intervention

for the child’s behavior. Hopefully, our plans will also improve family

life in general.

60

Identifying Strategies

Introduce the components of a behavior support plan, and explain how

individualized strategies may be identified based on the hypotheses. Use

the following dialogue:

The behavior support plan is made up of strategies derived from the

hypothesis statements and designed so that a child no longer needs

problem behavior to achieve his wants and needs. We help children

learn and use more appropriate behaviors that work better and result

in positive outcomes for them—and us! This might involve changing

our behavior (including how we react to our children’s behavior). It

might also involve changing things in the environment to “set chil-

dren up” for their best possible behavior.

The three general strategies that make up a behavior support plan are:

■ Prevention: preventing problems by changing circumstances that

trigger or set the stage for problem behavior

■ Management: providing rewarding outcomes for positive behavior

and managing consequences to avoid inadvertently rewarding

problem behavior

■ Replacement: teaching children more effective and appropriate

ways to communicate their needs and cope with difficult situations

Explain how we use the hypotheses to brainstorm strategies associated with

each of these areas. Because we can predict what events (i.e., antecedents

or setting events) precipitate a child’s problem behavior, we are able to

develop effective prevention strategies. Because we have defined our

specific behavioral concerns and the circumstances affecting that behavior,

we can identify appropriate replacement behaviors. And, as we now recog-

nize what functions or purposes a child’s behavior might be serving, we can

choose to respond in ways that encourage the right kinds of behavior.

Once we generate ideas for strategies, we might want to try them out (like

with the hypothesis testing) to make sure they work before integrating

them into our overall plan.

(If appropriate, guide the parent to recognize that changing his own

behavior might also involve changing his self-talk or his beliefs about

his child’s behavior.)

61

Present an example of a hypothesis (see summary statements for Ben in

earlier case example), and ask the parent to identify one or more strate-

gies to prevent problems, manage consequences, or replace behavior.

Share other examples as appropriate and necessary.

Application

Using one of the hypotheses or summary statements the parent devel-

oped, help him to generate ideas for intervention that include prevent-

ing problems, managing consequences, and replacing behaviors or

teaching skills. (If appropriate, discuss any self-talk that might be an

obstacle to generating ideas.) Have the parent jot these down on the

Brainstorming Interventions form or use flip chart paper. The parent

will build on these preliminary ideas in future sessions (4 through 6).

Homework

✎ Have parent continue to keep Self-Talk Journal.

✎ Have parent practice using the distraction strategies and record the

results in the Self-Talk Journal.

✎ Remind parent to complete the Weekly Progress Report.

✎ Have parent continue data collection using the method(s) selected in

Sessions 1 and 2.

✎ Have parent complete the Pattern Analysis Worksheet.

✎ Have parent complete the Brainstorming Interventions form.

✎ Encourage parent to share summary statements and intervention ideas

with family members and others to get their input and agreement.

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63

Chapter 6 Session 4: Preventing Problems

(Corresponds to session 4 of the workbook)

Materials Needed

■ Self-Talk Journal – Session 4 form

■ Completed Brainstorming Interventions form

■ Preventing Problems Worksheet

Outline

■ Preview agenda

■ Review homework

■ Introduce the disputation process

■ Discuss circumstances that precipitate behavior

■ Present strategies for avoiding difficult situations

■ Present strategies for improving difficult situations

■ Present ways to provide a child with choices

■ Present strategies for prompting good behavior

■ Have parent identify prevention strategies

■ Assign homework

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Agenda Preview

Preview agenda for this session. Review the brainstorming interventions

format (introduced in Session 3) pointing out which area will be

addressed during this session (preventing problems).

Homework Review

Ask the parent if she has any questions about the previous session or

workbook readings. Review homework: summary statements, strategies

based on hypotheses, and data collected. (If the parent was unable to

generate usable hypotheses, work with her to create or revise them.)

Ask about communications with family members and others. Provide

feedback. Review Weekly Progress Report.

Review parent’s Self-Talk Journal. Ask the parent to choose one success

and one difficulty from the past week and share the entry (including the

situation, self-talk, and the consequences of the self-talk). Have the par-

ent describe how she used distraction when faced with pessimistic

beliefs and discuss how effective that strategy was in stopping the esca-

lation of those thoughts.

Disputation Process

Explain that there are strategies to help with pessimistic beliefs.

Introduce the process of disputation, a strategy for arguing or challeng-

ing a person’s beliefs. Review the four steps and provide examples:

■ Step 1: Identify the negative belief (i.e., “What exactly do you say

to yourself that is pessimistic?”). For example, a parent might say

something like, “Nothing I do makes a difference with my child’s

behavior.”

■ Step 2: List evidence that supports or refutes the belief

(i.e., “What makes you believe that to be true or false?”). The

parent could acknowledge that her child is still having tantrums

every day; however, those tantrums do not go on as long or

require her to restrain her child anymore. Therefore, her actions

are making a difference. When she ignores her child’s screaming,

it initially gets louder and more dramatic but then it stops.

■ Step 3: Find alternative explanations for the problem (i.e., “Are

there other possible reasons or motives?”). For example, the par-

ent might recognize that the tantrums are leftovers of the time

when she tried to soothe her child rather than withhold attention.

She might admit that she sometimes just soothes her child or

gives him what he wants to make the tantrums cease, particularly

when she is feeling inadequate as a parent. She might see that she

is still trying to teach her child more efficient and effective ways

of getting his needs met and, once these skills are firmly in her

child’s repertoire, tantrums will not be necessary.

■ Step 4: Evaluate the usefulness of maintaining the belief (i.e., “In

what ways does that belief benefit you or others or improve the

situation?”). Continuing with the example, the parent might now

understand that, when she thinks “nothing I do makes a

difference,” she is more likely to give in or respond inconsistently,

which actually prolongs or strengthens her child’s tantrums.

Application

Have the parent consider one of the negative beliefs she just shared

from her Self-Talk Journal. Guide her through the four steps to dispute

that belief. Help her record the information as an example in column 4

of her Self-Talk Journal.

Throughout the session, help the parent to recognize her thoughts and

feelings, the circumstances that precipitate them, and the consequences

of those beliefs. Make sure she is explicit in her descriptions. Guide her

through the disputation process as needed. This might be done while

she is relating her experiences by asking questions such as:

■ What exactly happened?

■ What were you thinking when that happened?

■ How did you react as a result of your thoughts or feelings?

65

■ Do you think the belief is true? If so, why?

■ What are other reasons why that could have happened?

■ So, given all of this, is this belief helpful?

These elements should be blended throughout the session and not

unnecessarily interrupt the flow of the training. Pay attention to the

parent’s body language as you discuss different topics. If the parent

appears to be uncomfortable or resistant, prompt her to identify her

self-talk by saying something like “You seem uncomfortable. What are

you thinking right now?”

Circumstances that Precipitate Behavior

Discuss the role of circumstances that precipitate behavior. Tell the parent

that, as mentioned previously, a range of possible circumstances (referred

to as triggers, antecedents, or setting events) can prompt problem behav-

ior. These things can include physical discomfort, stressful situations,

withdrawal of attention, demands to do something, changes in routine,

and a variety of other issues. It is essential that these circumstances—and

those that prompt good behavior—be identified so that a child’s behavior

can be improved.

(If the parent describes ways in which she prompts problem behavior

through her interactions with the child [e.g., allowing anticipatory

stress to change how she interacts with her child, failing to plan ahead],

explore what she is thinking during those times and what impact those

thoughts might have.)

Explain that information obtained about the situations that seem to trig-

ger problem behavior can be used to rearrange the environment in ways

that can prevent problem behaviors from flaring up. Have the parent ask

herself the following question: “What could I change about this situa-

tion that would increase the chance that my child would behave better?”

Problem behavior may be prevented through a variety of strategies,

including avoiding or improving difficult situations, providing choices,

or using methods to prompt more positive behavior. Review each of

these strategies with the parent.

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Avoiding Difficult Situations

Describe how to avoid problem situations and, therefore, make problem

behavior less likely to occur. Use the following dialogue:

There are a number of ways behavior problems can be prevented, and

families are often well aware of how to do this. You might already

have made changes to how you do things at home to avoid problems;

however, we are going to discuss some strategies you can use as tempo-

rary measures until you can teach your child alternative behaviors.

Review the following types of strategies and examples to illustrate how

to avoid problem circumstances altogether:

1. If a child is disruptive in certain places, during certain activities,

or with particular people—and these situations are unnecessary—

avoid them (e.g., not shopping when stores are particularly busy,

not serving peas).

2. If changing aspects of a child’s environment or interrupting a

child’s routine causes disruption, keep the surroundings or sched-

ule as consistent as possible.

3. If sickness, tiredness, or hunger make a child more likely to

misbehave, address those conditions as best as possible, and avoid

typical triggers during those times (e.g., not asking the child to do

something difficult when she is tired).

4. If a child’s problem behavior is thought to be attention-getting,

provide a great deal of unconditional attention throughout the day.

5. If a child misbehaves when asked to stop a favorite activity,

extend the time available to continue playing or engaging in a

preferred activity.

Sometimes avoiding difficult situations is an appropriate and respectful

way of responding to a child’s needs and interests. However, preventing

problems by completely avoiding situations might not always be possi-

ble, such as when a child becomes upset when going to school or during

necessary personal hygiene tasks. Avoidance could also become a bad

habit, where parents have orchestrated a child’s environment so much

that she never has to deal with any adversity, which is not natural or

67

helpful. (If the parent is finding that she is avoiding going places or

doing things that she would enjoy, explore what she is saying to herself

regarding those situations and whether those thoughts are beneficial.)

Improving Difficult Situations

Describe how to make situations that typically set the stage for problem

behavior better and, thereby, reduce problems. When it is not practical

or possible to avoid a task or situation that causes disruption, inserting

or embedding pleasant activities can make the whole task or situation

more enjoyable. Several examples of successful strategies include:

1. If a child’s problem behavior occurs only during particular activi-

ties, change the most troublesome parts of those activities to create

a more positive experience (e.g., shorten the duration of a task,

make the task easier, add favorite music, or include a friend).

2. If a child misbehaves for attention, give her something fun to do

(e.g., a toy or a book) while waiting for us to interact with her again.

3. If interrupting favorite activities causes behavior problems to

occur, add a transition activity that is fun or involve the child

directly in the steps needed to move to the next activity (e.g.,

have her turn off the computer or put away a game). Or inform

the child of when the next opportunity for the favored activity

will be available.

(If the parent has negative thoughts about the possibility of making

these changes, guide her through the disputation process.)

How Parents Communicate

Emphasize that one important consideration in making difficult situa-

tions better is the way in which parents communicate their expectations

to children and interact with them in general. Not only what the parents

say is important but also the tone, body language, and kind of expressions

that they use. For example, if parents approach a child expecting

resistance, it might show on their faces and through their demeanors.

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Children quickly pick up on tension and respond in kind. Changing one’s

style of communication can trigger cooperation and pleasant interactions

rather than resistance and negative behavior from children.

Providing Choices

Discuss how offering choices and providing a child with more control

over tasks and situations can be an effective way of preventing problem

behavior and encouraging positive behavior. There are a number of areas

where parents often make decisions for children that the children could

be making for themselves. In fact, this could be contributing to their dis-

ruptive behavior. Providing more opportunities to make choices can

build independence skills and foster good decision-making, as well as

reduce problem behavior. Some examples of ways to provide choices to

children are to allow them to decide:

■ Which toys they want to play with

■ Ways to organize their belongings

■ The order of activities for the day

■ Their own clothing (e.g., give choice of two outfits)

■ Between meal or snack options

■ The people with whom they interact

■ To just say “no” once in a while

These choices might be presented verbally (e.g., by asking the child

which item or activity she wants) or through written words or pictures,

often displayed in choice menus.

Prompting Good Behavior

Explain that many children require help to know how to behave in par-

ticular circumstances. At first a child might need an explanation about

what is expected in situations (e.g., “You must use your ‘inside’ voice

when at the store”). Later on the child might still require prompts to

69

remember to use this skill when actually in the situation. Written

reminders or pictures (e.g., pictures on storage boxes to show where toys

should be placed) can be useful reminders for children who do not

require constant verbal prompts. Review how to establish predictability,

use schedules, and give warnings. Provide examples (e.g., schedules, cue

cards) as appropriate for the parent’s child.

(If appropriate, discuss what the parent might need to say to herself to ade-

quately anticipate and prepare for changes—i.e., the preparation for poten-

tially difficult circumstances may need to be mental, not just physical.)

Predictability

When a child faces a new situation, many problems can be prevented

by reviewing expectations for behavior (e.g., “we don’t touch other

children at the mall”) and explaining what is going to happen next

(e.g., “we will go to the drug store and then the toy store”). Instruct par-

ents to clearly tell the child where they are going, who will be there, how

long the child will stay, and exactly how they want the child to behave.

Stress that it is important not to assume that children know how to do

what parents want them to do; they might have to be very clear about

the steps or sequences of skills required. One way this can be achieved

is through social stories. Give an example of how a social story might be

used to clarify expectations for a child:

We are going to the park. When we get there, I need you to hold my

hand while we are in the parking lot. You can climb on the jungle

gym, swing, and run around the playground, but you must stay on

the mulch. When it is time to leave the park, I want you to hold my

hand again while we go to the car. Afterward, if you have followed

these rules, we can stop for ice cream.

Scheduling

Younger children, those who have difficulty with too much verbal

information, or those who tend to get anxious (and display problem

behavior) when routines change might benefit from written or visual

70

schedules to clarify upcoming events and activities. If appropriate, dis-

cuss with the parent whether she might want to provide these kinds of

schedules for her child. Schedules might include pictures that illustrate

the typical daily routines or drawings of special activities on a calendar.

When routines have to change or a child is required to wait, these

things may be indicated visually on the schedule (e.g., by moving the

activity down the schedule).

Warnings

Some children have problems when an activity goes on too long or they

have to wait. In this case, parents might warn the child that the end is

near (e.g., “We’re almost done; I think you can stay in your seat and

play with your toys for five more minutes”). Parents can also use timers

or countdowns (e.g., 3 minutes, 2 minutes, 1 minute) when nearing the

end of an activity.

Emphasize that, in general, the use of cues (subtle prompts to remind

children of expected behavior) can prevent a good deal of problem

behavior.

Identifying Prevention Strategies

Present a sample hypothesis (see the following case example) and ask the

parent to identify the circumstances preceding problem behavior

(antecedents and setting events) and strategies to prevent problems that

include avoiding or improving difficult situations, providing choices,

and prompting good behavior. Discuss how these strategies might be

put in place. Share other examples as necessary and appropriate.

Case Example: Hypothesis about Ben

■ When Ben’s parents try to put his shoes on to leave the house, he

screams, cries, and drops to the floor. It is especially bad when he is tired.

The tantrum delays the transition, forces his mother to take him out

without shoes, or results in her canceling the errand or getting someone

else to do it. ■

71

Based on the summary statements for the case study, describe strategies

for preventing problems. The strategies might include avoiding prob-

lems, making difficult circumstances better, providing choices, or adding

cues to positive behavior. Provide visual examples of the strategies where

possible. Explain how prevention strategies might be faded over time as

the child gains skills necessary to cope with her circumstances.

Case Example: Prevention Strategies for Ben

■ Set up a schedule with pictures of Ben’s typical daily activities.

■ Prior to transitions (starting about 15 minutes prior to leaving),

remind him periodically of where he will be going by pointing to that pic-

ture on his schedule.

■ Explain what he needs to do when transitioning (e.g., “When it is

time to go, I will help you put away your toys, get your shoes on, and take

your toy bag to the car). Remind him of fun things he can do or treats he

will receive where he is going.

■ Create a bag of special toys that Ben may take with him in the car when

he goes somewhere, and place a few of his favorites in the glove compart-

ment. Change out the toys periodically, and keep them only for transitions.

■ Schedule several different play sessions during and after school, and

include those sessions on Ben’s schedule. Alternate playing with mom or

teacher and playing independently (so that Ben can enjoy his time alone

during play also). Make the sessions very short, with only small attempts

to play with him (e.g., handing him a toy or simply playing with the toys

next to him without asking anything of him). Tell him exactly what you

want to do with him before play will be finished (e.g., “after we finish this

puzzle together, I will let you play alone”).

■ Have Ben eat meals and snacks only at the table. Provide Ben with

some of his favorite foods during breakfast and lunch (to encourage him to

eat). Prior to starting to prepare a meal, get Ben involved in an activity

he particularly likes to distract him from dinner preparation. Set the table

ahead of time, and do whatever preparations can be done earlier in the

day (when Ben is not hungry). When it’s time to eat, bring him to the

table explaining that he must sit to eat.

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Application

Using a hypothesis or summary statement the parent developed about

her child, repeat the preceding exercise. Refer back to the initial ideas

for preventing problems recorded in the left column of the completed

Brainstorming Interventions form from Session 3. Continue to develop

ideas for avoiding or improving difficult situations, providing choices,

and prompting good behavior. Have the parent record these ideas on

the Preventing Problems Worksheet.

(Discuss how self-talk might interfere with the parent’s ability to design

and implement strategies to prevent problems.)

Homework

✎ Have parent continue to keep Self-Talk Journal.

✎ Have parent practice using the disputation process to replace

pessimistic beliefs.

✎ Remind parent to complete the Weekly Progress Report.

✎ Have parent complete the Preventing Problems Worksheet. Parent

should try some of these strategies and observe the impact on the

child’s behavior (continue data collection using the methods selected

in Sessions 1 and 2).

✎ Encourage parent to talk with family members and others to get their

input on prevention strategies.

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75

Chapter 7 Session 5: Managing Consequences

(Corresponds to session 5 of the workbook)

Materials Needed

■ Self-Talk Journal – Session 5 form

■ Completed Brainstorming Interventions form

■ Managing Consequences Worksheet

Outline

■ Preview agenda

■ Review homework

■ Teach parent how to use affirmations

■ Discuss how reactions may maintain a child’s behavior

■ Explain how to manage consequences

■ Have parent identify consequence strategies

■ Discuss taking precautions with using punishment (optional)

■ Assign homework

Preview Agenda

Preview the agenda for this session. Review the brainstorming interven-

tions format (introduced in Session 3), pointing out which area will be

addressed during this session (managing consequences).

76

Homework Review

Ask the parent if he has any questions about the previous session or

the workbook readings. Review the homework—identifying precipi-

tating circumstances and choosing strategies to prevent problem

behavior. (If the parent did not generate additional prevention strate-

gies, prompt him to do so using one of his hypothesis statements and

record these on the homework forms.)

Ask the parent about communications with family members and

others. Provide feedback. Review Weekly Progress Report.

Review the parent’s Self-Talk Journal. Ask the parent to choose one

success and one difficulty from the past week and share the entry

(including the situation, self-talk, and consequences of the self-talk).

Have the parent describe how he disputed or distracted himself from

pessimistic beliefs.

Using Affirmations

Explain that, once we identify inaccurate and unproductive thoughts

and are able to stop them in process, it is beneficial to then replace those

beliefs with positive self-talk. This is called substitution or reattribution.

In essence, we replace the pessimistic ideas with affirmations (e.g., “This

is a difficult situation, and I am handling it well. I am a committed, lov-

ing parent.”). These affirmations should be:

■ Stated in present tense (e.g., “I am a gentle, but firm, parent” vs.

“I will be better next time”)

■ Focused on solutions, stating what can be done to resolve a situa-

tion (e.g., “I can explain calmly what I want him to do and guide

him, if necessary”)

■ Both specific and comprehensive (i.e., clear and relate to

various situations in which pessimistic beliefs are likely

to arise)

■ Honest and practical (i.e., not resulting in false impressions or

unreasonable expectations)

Application

Have the parent consider one or more of the entries in his Self-Talk

Journal and identify an affirmation he might use to substitute the

pessimistic thinking. (Ask, “What could you say to yourself in that

situation?”) Have the parent record the affirmation in column 5 of his

Self-Talk Journal as an example.

Throughout the session, help the parent to recognize his thoughts and

feelings, the circumstances that precipitate them, and the conse-

quences of those beliefs. Pay attention to the parent’s body language as

you discuss different topics. If the parent appears to be uncomfortable

or resistant, prompt him to identify his self-talk by saying something

like, “You seem uncomfortable. What are you thinking right now?”

Guide him through the disputation process when appropriate or

prompt him to use distraction (e.g., “You are stating some negative

ideas; how can you stop them?”). Prompt the parent to substitute

pessimistic thoughts with positive affirmations. These elements should

be blended throughout the session and not unnecessarily interrupt the

flow of the training.

Maintaining Problem Behavior

Discuss how consequences (e.g., parental reactions) maintain behavior,

providing examples. What we say or do in response to a behavior – as

well as what naturally occurs as a result of that behavior (e.g., the sound

hitting a window makes which pleases the child) – can increase the like-

lihood that the behavior will continue to occur. For example:

■ Yelling or providing long explanations about why a behavior is a

problem just after the incident can reinforce the behavior with

attention (because any attention is better than none) rather than

being perceived as punitive or simply educational by the child.

■ Backing off from a demand because the child gets upset can also

reinforce the behavior because the child no longer has to com-

plete a seemingly unpleasant activity and, therefore, might cause

the child to act up again to avoid or escape demands.

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■ Giving in to a request for a toy, food, or an activity because the child

becomes increasingly demanding or disruptive will make that behav-

ior worthwhile and, therefore, likely increase the probability that the

behavior will occur in the future.

■ Ignoring certain kinds of behavior to avoid giving attention can

be counterproductive. If the behavior occurs because it feels,

looks, or sounds good to the child (e.g., hand flapping) it might

be more likely to continue if left alone.

(If the parent feels that his reactions to the child [e.g., giving in to placate

the child] might be inadvertently encouraging problem behavior, prompt

him to consider what he is saying to himself at the point when he reacts

that way and what results might be maintaining his own behavior.)

Explain that identifying the specific consequences that appear to be

maintaining a child’s problem behavior can help us to respond more

effectively. Have the parent ask himself the following question: “How

can I respond to my child’s behavior so that he gets the results he desires

more readily for good behavior than problem behavior?”

Managing Consequences

Explain how to change consequences to promote positive behavior and

deter problem behavior. The ultimate goal when managing conse-

quences is to make sure a child’s goals (i.e., the purposes or functions of

his behavior) are achieved through positive behavior rather than prob-

lem behavior (as well as ensuring that our reactions are not actually

feeding into the problem). Provide examples:

■ If a child misbehaves for attention, ask other people to interact

with the child only when he is behaving nicely. As soon as he

begins to act out, they should stop looking at the child or com-

menting on his behavior.

■ If a child acts up when he wants an activity, a toy, or other item,

make sure those things are available for positive, but not problem,

behavior (e.g., requiring the child to say or sign for something

before receiving it or allowing treats only after finishing dinner).

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■ If a child seems to enjoy the behavior itself (i.e., it feels good),

find other ways for the child to get that same kind of stimulation

(e.g., dancing, manipulating toys instead of rocking and flapping

hands).

■ If a child behaves badly to escape something he doesn’t like, give

the child breaks or reduce the demands when he is behaving

appropriately, but try not to allow the child to avoid those situa-

tions otherwise (e.g., allowing the child to leave a restaurant and

go for a walk if he “signs out”).

Emphasize that, obviously, we do not have control of every conse-

quence of a child’s behavior (e.g., attention strangers provide, the

“feel good” factor) in every situation; however, the modifications we

make will still produce positive change. To have the most impact

when using consequences, we must strive to respond immediately

when behaviors occur (e.g., to reward positive behavior) and to be as

consistent as possible.

Identifying Consequence Strategies

Present a sample hypothesis (see the following case example). Ask the

parent to identify the consequences that appear to be maintaining the

problem behavior (what the child gets or avoids) and strategies to

manage consequences that include providing rewards only following pos-

itive behavior and withholding positive consequences in response to

behavior problems. Discuss how these strategies might be put in place.

Share other examples as appropriate and necessary.

Case Example: Hypothesis about Ben

■ When Ben’s parents try to put his shoes on to leave the house, he

screams, cries, and drops to the floor. It is especially bad when he is

tired. The tantrum delays the transition, forces his mother to take

him out without shoes, or results in her canceling the errand or

getting someone else to do it. ■

Based on the summary statement for the case study, describe how to

respond to the child’s behavior—to provide reinforcement when he

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engages in positive or replacement behavior and to withhold reinforce-

ment when he engages in problem behavior. Be specific, and make sure the

example consequence strategies are functional and minimally intrusive.

Case Example: Responding to Ben’s Behavior

■ If Ben asks appropriately for a delay in a transition or a break from

playing with someone (e.g., by putting his hand up, by pointing to a

toy or puzzle piece, or by saying “go”), back off for one minute saying,

“Okay, you need space; one more minute.” (Allow some time in the

schedule for these brief delays.)

■ Praise Ben for transitioning and tolerating others participating in his

play, and acknowledge it is hard for him. Praise every little action he

does appropriately (e.g., standing, walking out the door, sitting in the

car or with a person, taking a puzzle piece). Provide little rewards

for going places and doing things without tantrums (e.g., a special

activity at school, a treat on an errand, time to play by himself ).

■ During a transition, if Ben refuses to leave or drops to the floor, guide

him gently but firmly to leave. Do not allow his behavior to delay the

transition. Ignore crying and screaming, and do not comment on his

behavior (e.g., “You’re just being a baby” or “I’m sitting here whether

you like it or not”).

■ If he begins to cry or scream during play, encourage him to say “go”

(e.g., “do you want me to go?”) or put his hand up, helping him to do

it if necessary, and then back away. After a brief period, re-enter his

play, saying, “I just want to play for a bit” (e.g., just long enough to

hand him a toy). If he handles play without crying and screaming for

a short period (e.g., one minute), ask him if he would like to be

alone, prompt him to say “go,” and leave. Gradually extend the time

he is expected to play before he can ask someone to go.

Application

Using the hypotheses or summary statements the parent developed for his

child, repeat the preceding exercise. Refer back to the initial ideas for

managing consequences recorded in the center column of the completed

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Brainstorming Interventions form from Session 3. Continue to develop

ideas for reinforcing positive behavior and avoiding rewarding problem

behavior. Have the parent record these ideas on the Managing

Consequences Worksheet. Consider how these strategies might be put

in place.

(Guide the parent to consider self-talk that may make it difficult for

him to be consistent in managing the consequences he has identified

and how he might replace that self-talk.)

Use of Punishment

It is very common for parents to react negatively to behavior problems,

especially when they are tired or frustrated. If the parent uses punish-

ment to address behavior, and the use of these methods is interfering

with implementation of positive behavior support, engage in a discus-

sion of the concerns associated with punishment. Stress that, whether

this is simply an unplanned reaction to the behavior (e.g., yelling “stop

that”) or part of an ongoing punishment plan (e.g., using long time-outs,

spanking, or withholding favorite things), it is important to use punish-

ment strategies sparingly and with caution. This is because, among other

concerns, the effects of punishment are often limited and short-lived.

Discuss the following points:

■ Although punishment might interrupt the behavior, and the

child’s initial response might be to stop being disruptive,

usually the behavior problems return again in the same

situation.

■ Children often learn when they will be punished (for example, by

Dad at home) and when they will not be punished (for example,

at a relative’s house); therefore, they misbehave more in some

places.

■ A child may comply or stop a behavior quickly (but temporarily)

through punishment, reinforcing parents to use it again.

■ When punishment becomes less effective, there is a tendency to

use more severe forms (for example, yelling louder, spanking, or

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removing access to more and more favorite things). This escala-

tion of punishment can be difficult to stop.

■ Punishment focuses on what we want a child not to do, rather

than what we want a child to do in these situations.

Homework

✎ Have parent continue to keep Self-Talk Journal.

✎ Have parent continue practicing distraction and/or disputation

strategies.

✎ Have parent develop and practice positive affirmations.

✎ Remind parent to complete the Weekly Progress Report.

✎ Have parent complete the Managing Consequences Worksheet. The

parent should try out these strategies and observe the impact they

have on the child’s behavior (continue data collection using the

methods selected in Sessions 1 and 2).

✎ Encourage parent to talk with family members and others to get their

input on consequence strategies.

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Chapter 8 Session 6: Replacing Behavior

(Corresponds to session 6 of the workbook)

Materials Needed

■ Self-Talk Journal

■ Completed Brainstorming Interventions form from Session 3

■ Replacing Behavior Worksheet

■ Teaching Plan form

Outline

■ Preview agenda

■ Review homework

■ Review and practice cognitive restructuring

■ Discuss replacing behavior

■ Have parent select replacement behaviors

■ Discuss how to teach a child skills

■ Assign homework

Agenda Preview

Preview the agenda for this session. Review the brainstorming interven-

tions format (introduced in Session 3), pointing out which area will be

addressed during this session (replacing behavior and teaching skills).

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Homework Review

Ask the parent if she has any questions about the previous session or the

workbook readings.

Review the homework—identifying strategies to manage consequences

(providing and withholding rewards) and efforts to use these strategies

and outcomes. (If the parent did not generate additional strategies for

responding to her child’s behavior, prompt her to do so using one of her

hypothesis statements and record these on the homework forms.)

Ask about communications with family members and others. Provide

feedback. Review Weekly Progress Report.

Review the parent’s Self-Talk Journal. Ask the parent to choose one suc-

cess and one difficulty from the past week and share the entry (includ-

ing the situation, self-talk, and consequences of the self-talk). Have her

describe how she disputed or distracted herself from pessimistic beliefs

and what positive statements (i.e., affirmations) she used for substitu-

tion. Note: the statements should be honest and practical and be stated

in present tense (e.g., “I am a gentle, but firm, parent”), focused on

solutions (i.e., state what will be done to resolve a situation), and be

both specific and comprehensive (i.e., clear and relate to various situa-

tions in which pessimistic beliefs are likely to arise).

Cognitive Restructuring

Have the parent consider one or more of the entries in her Self-Talk

Journal and work through the entire process. Have her evaluate how she

is doing with the cognitive restructuring strategies (e.g., “What is work-

ing well? What isn’t working? How will you do things differently next

time?”). Then have her record her impressions in the comments section

of the Self-Talk Journal.

Throughout the session, remind the parent to identify any negative

thoughts or feelings, circumstances that precipitate them, and conse-

quences of those beliefs. Pay attention to the parent’s body language as

you discuss different topics. If the parent appears to be uncomfortable

or resistant, prompt her to identify her self-talk by saying something

like, “You seem uncomfortable. What are you thinking right now?”

Encourage her to use disputation and/or distraction and to substitute

pessimistic thoughts with positive affirmations. These elements should

be blended throughout the session and not unnecessarily interrupt the

flow of the training.

Replacing Behavior

Discuss the importance of identifying positive skills to replace prob-

lem behaviors, types of skills we might select, and some considerations

in choosing replacement behaviors. Emphasize that, while problem

behavior is often frustrating and overwhelming to families, it is

important to recognize that the behavior is purposeful. Children mis-

behave because, at the moment, they lack appropriate and effective

skills to deal with unpleasant situations or to get what they want.

Problem behavior is typically communicative—it is a child’s way of

telling other people that she needs something or wants something to

stop. Realizing that problem behavior is simply a means to an end

helps us find other, more appropriate or desirable ways for the child

to behave and, therefore, replace problem behavior. (If the parent’s

beliefs about the child’s capability to learn and use appropriate behav-

ior enters into the discussion, explore her self-talk and guide her to

create positive affirmations.)

A question that helps us identify specific replacement behaviors is:

“What else could the child do to get what she needs, to avoid or delay

a difficult situation, or to deal with particular circumstances more

appropriately and effectively?”

Replacement behaviors can include children requesting specific

items, activities, or types of interactions; completing chores or other

daily living tasks more independently; or simply learning to tolerate

unpleasant circumstances (e.g., having to wait) for periods of time.

For example:

■ If a child misbehaves when uncomfortable or upset, teach the

child how to address her own needs (e.g., breathe deeply when

anxious, get a drink when thirsty).

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■ If a child has difficulty with certain activities, encourage her to ask

for help, switch to another activity, or take periodic breaks.

■ If a child acts out when wanting attention, teach her how to begin

an interaction (e.g., by touching a person’s hand or holding up a

toy) or to get involved in another activity until a person becomes

available.

■ If a child usually responds to having to give up preferred items or

toys with misbehavior (e.g., resisting putting away her favorite

magazine), teach her how to appropriately ask for the things back,

take turns sharing them with others, or put the items away herself.

In addition to these immediate ways of resolving problems and meeting

needs, we might also want to teach the child other life skills such as:

■ Social skills to use when interacting with other children (e.g., how

to join play or take turns in a game)

■ How to use toys or other items appropriately

■ Self care such as grooming

■ Leisure activities (e.g., hobbies) so the child can entertain herself

for periods of time

(If this discussion challenges the parent’s assumptions about skills the

child is capable of developing, explore her self-talk regarding the child’s

capabilities.)

Competing with Problem Behavior

Explain that long-held habits can be difficult to change. Just as our own

patterns of behavior are hard to break, a child who is used to being

disruptive to communicate or to get her needs met might initially resist

efforts to change her behavior and feel frustrated that behaviors that

have worked previously are no longer working. For other, more appro-

priate behavior to replace problem behavior, the new behavior has to be

easy for the child to use and produce the same or similar outcomes. By

competing effectively with the problem behavior, a child learns that it

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might be easier to get what she wants by using the new behavior rather

than the old, inappropriate behavior. The “payoff” is as good or better

for the new behavior and, therefore, outweighs the benefits of using the

problem behavior.

For example, a child’s screaming when she doesn’t get her way with her

parents might be very effective because they “give in” immediately to stop

the screaming. If the parents try to get the child to say in a full sentence

“I want ____ please” and she has difficulty speaking, it will certainly be

easier for her to scream. In this situation, it might be more appropriate to

simplify the expectation and require the child only to point to the item.

The parents could later expect her to say the word and then speak in a full

sentence. This way the child can be immediately successful and will be

more likely to communicate in an appropriate manner.

Selecting Replacement Behaviors

Present a sample hypothesis (see the following case example) and ask the

parent to think about both the function of the problem behavior and the

circumstances precipitating it. Have her identify positive behavior that

would replace the problem behavior. Discuss how these strategies might

be put in place. Share other examples as necessary and appropriate.

Case Example: Hypothesis about Ben

■ When Ben’s parents try to put his shoes on to leave the house, he

screams, cries, and drops to the floor. It is especially bad when he is tired.

The tantrum delays the transition, forces his mother to take him out

without shoes, or results in her canceling the errand or getting someone

else to do it. ■

Based on the summary statements for the case study, describe behav-

iors that could be taught to replace the child’s problem behavior. The

behaviors should achieve the same function as the problem behavior

(and/or allow the child to cope better with the circumstances). The

behaviors should be clearly defined and be efficient and effective. For

example, the following are ways Ben’s parents taught him new behav-

iors to replace his problem behavior.

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Case Example: Replacing Ben’s Problem Behavior

■ Encourage Ben to ask for a brief delay in transitions by putting his

hand up or pointing to a puzzle piece (to indicate he wants to contin-

ue playing). To prompt him, say, “What do you want?” and physically

guide him through the movement.

■ Teach Ben to check his schedule prior to transitions. (The schedule will

be posted near his play area where he has access to it at all times.)

Have him put his puzzles or toys away prior to leaving.

■ Have him practice waiting for food for brief periods of time and

stopping activities to do something else (e.g., to wash his hands or wipe

his mouth). Encourage Ben to ask to continue activities: say, “what do

you want?” Help him point toward the activity and then say, “Oh, you

want to play with the puzzle?”

■ Practice playing with Ben by initially sitting beside him, then touch-

ing his toys, then handing him toys he needs, and eventually taking

turns with toys. Prompt him to say “go” or put his hand up when he

needs a break, and move away.

■ Have Ben practice eating at the table for short periods of time, provid-

ing praise and treats when he remains in his seat.

Application

Using the hypothesis or summary statement the parent developed,

repeat the preceding exercise. Refer back to the initial ideas for replacing

behavior recorded in the right column of the completed Brainstorming

Interventions form from Session 3. Continue to develop ideas for

replacement behaviors that would achieve the same function as the prob-

lem behavior (and/or allow the child to cope better with the circum-

stances). Have the parent record these ideas on the Replacing Behaviors

Worksheet. Consider how these strategies might be put in place.

(If appropriate, discuss any self-talk of the parent that would interfere

with the development of these skills for the child.)

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Teaching Skills

Describe the basic steps for systematically teaching new skills, provid-

ing examples. The most important long-term approach for addressing

children’s behavioral concerns is to give them better ways to meet their

needs and handle difficult situations. In essence, positive behavior sup-

port is really about teaching—guiding children to develop the skills

they need to be successful.

For many children, learning new behaviors takes more than simply

showing them or describing what we want them to do. Often times, new

skills must be presented in a systematic way for them to be effectively

learned. The following are steps for teaching skills (see case study for

examples of each step):

Step 1. Identify what exactly you want to teach (i.e., what you want your

child to say or do). Break it down into teachable units, and define

the steps or components clearly. This is called a task analysis.

Step 2. Decide where, when, and with whom this skill is needed (e.g.,

when shopping in public, at meal times, or with grandparents).

Step 3. Arrange the environment to prompt the use of the skill, and

provide reminders, relying on natural cues whenever possible.

Step 4. Help your child to be successful in performing the skill by using

effective prompting methods such as:

■ Giving the child an example

■ Showing the child how to do it

■ Using gestures (e.g., pointing)

■ Physically guiding the child through the behavior

Step 5. Praise and reward use of the skill or progress in the right direction

(“successive approximations”). Correct errors, and withhold

rewards following mistakes and resistance.

Step 6. Gradually reduce your assistance, your feedback, and the

rewards you provide to lessen dependence and so that use of the

skill and the results it produces become their own reward.

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Consider examples of goals for behavior, and discuss how the parent

would teach the required skills.

Case Study: Teaching Ben Skills

Share an example of how to teach a replacement skill (e.g., transition-

ing), using the six steps described in the previous section.

Step 1: Ben’s parents identified that they wanted to teach Ben to transition

from the house or classroom to the car by having Ben:

1. Put away toys and other materials

2. Walk to his schedule and point to the picture indicating the next

activity

3. Put on his shoes (with assistance from his parent or teacher)

4. Pick up his “car toys” bag and take it with him

5. Walk calmly to the car and get in

Step 2: Ben’s parents decided this transitioning skill was needed any time

Ben must leave one place to go to another (e.g., from home, school,

or the store to the car).

Step 3: To provide cues for the skill, Ben’s parents put a small bag of

special car transition toys near the door but out of Ben’s reach.

They changed these toys periodically and whenever Ben seemed to

lose interest in them. Prior to each transition, they would point to

the bag and show Ben on his schedule where he would be going

(e.g., “In a couple of minutes, we will be going to ____ ”). They

also placed Ben’s shoes near the play area with the Velcro undone.

When it was time to leave, they would say, “Time for ____

(e.g., school, store).”

Step 4: Ben’s parents showed Ben the behavior they wanted from him.

Their plan was as follows:

■ If Ben does not respond to “time for school” by putting away

his toys, his parents model for him by putting one of his toys

away for him and saying, “Your turn, Ben; put away _____

(whatever toy he has).”

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■ They wait for him to respond to the cue or prompt. If he still

continues to play, they gesture and move the toy bin or

container closer, saying “Put away ____” (and pointing in the

container).

■ If there is still no response, then they say, “I will help you

Ben. This is hard. Put away ____,” and guide Ben to drop

the toy in the bin. If he does not drop it, they say “put

away” and then pry the toy away and put it in the bin.

“We can play later (after school).” Then they have Ben

put on his shoes (or put them on for him) and get “car

toys” bag.

Step 5: Ben’s parents praised him frequently for putting his toys away

(even if the toy had to be put in hand-over-hand), getting up

and moving toward the door, picking up his toy bag, and leaving

his shoes on (e.g., “Wow, you did it! You are walking with

mommy”). If Ben made it to the car without a tantrum, they

gave him an extra toy (kept in glove compartment). Once in the

car, they said something every minute or two about sitting nicely

in the car. When he arrived at his destination without a

tantrum, they provided a special treat (e.g., fun activity at

school, treat on the errand). They made a schedule to show him

what he would get upon arrival to school. If Ben threw a

tantrum, they continued the sequence described in Step 4 and

made sure all toys got put away so there was complete closure

to activities. They would say “one more puzzle piece or one

more animal, then we go.” They ignored screaming, crying,

and dropping to the floor. They would say, “It is hard to stop

playing. You can play later.” They moved him through each

step with as little delay as possible, reassuring him along

the way.

Step 6: Ben’s parents waited longer and longer (e.g., adding a few seconds

each time) to praise or help Ben to put away his toys and get his

shoes on. They praised him for spontaneously using his schedule.

In the beginning, they limited transitions only to things Ben has

to do (e.g., school) or really likes to do (e.g., swimming), then

gradually added more activities.

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Application

Refer to the ideas the parent listed on the Replacing Behavior Worksheet.

Consider which replacement behaviors require systematically teaching the

child new skills. Choose one, and work through the preceding steps,

recording the information on the Teaching Plan form. (If appropriate,

discuss any self-talk of the parent that would interfere with the develop-

ment of these skills for the child.)

Homework

✎ Have parent continue to keep Self-Talk Journal.

✎ Have parent continue practicing distraction, disputation, and positive

affirmations.

✎ Remind parent to complete the Weekly Progress Report.

✎ Have parent complete the Replacing Behavior Worksheet. The parent

should try out these strategies and observe the impact they have on

the child’s behavior (continue data collection using the methods

selected in Sessions 1 and 2).

✎ Have parent complete the Teaching Plan form. The parent should try

teaching skills and observe their impact on the child’s behavior.

✎ Encourage parent to talk with family members and others to get their

input on replacing behavior and teaching skills.

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Chapter 9 Session 7: Putting the Behavior Support Planin Place

(Corresponds to session 7 of the workbook)

Materials Needed

■ Self-Talk Journal

■ Behavior Support Plan form

Outline

■ Preview agenda

■ Review homework

■ Review self-talk and apply cognitive strategies

■ Introduce designing a behavior support plan

■ Discuss how to make sure the behavior support plan fits

■ Consider how the behavior support plan promotes lifestyle change

■ Help parent begin creating an action plan

■ Assign homework

Agenda Preview

Preview the agenda for this session. Explain that the focus of the session

will be on how to put the behavior support plan in place. The content

will include putting the plan into a usable format, choosing strategies

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that fit the child and family, considering how the plan creates lifestyle

change, and making sure we have what we need to put our ideas into

action.

Homework Review

Ask parent if he has any questions about the previous session or the

readings. Review the homework—selecting replacement behaviors and

efforts to teach skills. (If the parent did not generate additional strate-

gies for replacing the child’s behavior, prompt him to do so using one

of the hypothesis statements and record these on the homework forms.)

Ask about communications with family members and others. Provide

feedback. Review Weekly Progress Report.

Review Self-Talk Journal, and ask the parent to choose one success and

one difficulty from the past week and share the entry (including the

situation, self-talk, and consequences of the self-talk). Have the parent

describe how he disputed or distracted himself from pessimistic beliefs

and what positive statements (i.e., affirmations) he used for substitution.

Self-Talk Review and Application

Have the parent review his entire Self-Talk Journal (every form) and

look for themes or patterns. Ask him to evaluate how he is doing with

his self-talk (e.g., “What is working well? What isn’t working? How

will you do things differently next time?”). Have him record his

impressions in the comments section of his Self-Talk Journal.

Throughout the session, remind the parent to identify any negative

thoughts or feelings, circumstances that precipitate them, and

consequences of those beliefs. Pay attention to the parent’s body

language as you discuss different topics. If the parent appears to be

uncomfortable or resistant, prompt him to identify his self-talk by

saying something like, “You seem uncomfortable. What are you think-

ing right now?” Encourage him to use disputation and/or distraction

and to substitute pessimistic thoughts with positive affirmations. These

elements should be blended throughout the session and not unnecessar-

ily interrupt the flow of the training.

Designing a Behavior Support Plan

Explain the importance of developing a comprehensive written behavior

support plan to help get it in place and to ensure that it will be used con-

sistently. Emphasize that once we understand the patterns surrounding

a child’s behavior and have developed relevant interventions, identifying

and putting the strategies in place might seem to follow naturally; how-

ever, there are issues that will influence how well the plan will be imple-

mented and, therefore, how effective it will be. These issues include:

■ The clarity of the plan

■ The degree to which the strategies fit the child and family

■ The degree to which the plan produces positive lifestyle changes

■ The specific steps taken to put the plan into action

Integrating Components

Review the components of a comprehensive behavior support plan, and

provide examples. Explain that written behavior support plans are

important because they facilitate communication among the people

implementing them. They can be reviewed frequently to keep interven-

tions on course and revised as changes become necessary. Behavior

support plans should be based on our hypotheses or best guesses

(i.e., patterns identified in information gathering) and include the fol-

lowing components:

1. Strategies to prevent behavior problems (e.g., avoiding difficult

circumstances, making situations better, adding prompts for good

behavior)

2. Strategies for managing consequences (i.e., making sure rewards

are provided for positive behavior and not problem behavior)

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3. Strategies for systematically teaching replacement skills so that the

child’s needs can be met through more appropriate means where

and when they are needed

Case Example: Behavior Support Plan for Ben

Review the behavior support plan for the case study of Ben (see

Figure 9.1.; a copy is provided in the workbook). If using another

example, provide a copy of a sample plan. The plan should include

(at minimum) goals, target behaviors, summary statements, strategies

for preventing problems, strategies for managing consequences, skills

for teaching replacement behavior, and a monitoring plan.

Application

Review the activities the parent completed in Sessions 1 through 6

(establishing team, identifying goals and target behaviors, developing

hypotheses, brainstorming interventions). Look over the Behavior

Support Plan form. Begin inserting appropriate information,

and make sure the parent is comfortable completing the plan as

homework.

Making Sure the Plan Fits

Discuss issues associated with a plan’s contextual fit. When brainstorm-

ing possible strategies for addressing children’s behavior based on the

hypotheses, it may be evident that there are a variety of options from

which to choose. For example, there may be numerous ways to prevent

problems from occurring or several specific behaviors that may be

identified as replacement skills. When selecting among the possible

strategies, the best choices are the ones that are right for the child and

family—those that fit their needs, skills, strengths, challenges, and

goals. For this reason, parents should discuss their concerns and ideas

with the child and other family members to get their input whenever

possible.

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Figure 9.1

Example of Completed Behavior Support Plan

Behavior Support Plan: Part 1

Child’s Name: Ben Date: 10/1/07

Team Members: Who is involved in the process?

Ben’s parents, his grandmother, and his preschool teacher (also include friends at school andin neighborhood and babysitter)

Intervention Settings: Where will the plan be used?

Home, school, community outings

Description of Problem Behavior: Baseline Estimate:What does the child say or do? How often? How long?Tantrums: screaming, crying, 5 times per daydropping to the floor

Broad Goals: How would you like life to improve for your child and family?

Ben will play with other children and adults, handle transitions and change better, and ride in the carand eat with the family without problem behavior.

Ben will develop more interests (beyond animals and puzzles) and participate in typical childhoodexperiences, including spending time with friends.

Ben will become more independent with his self-care, sleep alone, and develop the skills he needsto keep himself safe (e.g., looking out for traffic).

Ben’s parents will be able to enjoy life as a family without the constant stress presented by hisproblem behavior. They hope to be able to go places and do more things as a family and to reducethe conflict in their lives.

Summary Statements: Describe circumstances, behavior, and consequences (get/avoid).

When Ben’s parents try to put his shoes on to leave the house, Ben screams, cries, and drops tothe floor. This delays the transition, forces his mother to take him out without shoes, or results inher canceling the errand or getting someone else to do it.

When his parents or peers try to play with Ben, he screams and cries; if they don’t back off, heturns his back on them or pushes them away. Eventually, the children or family members back off,and Ben is able to continue playing contentedly by himself.

When Ben doesn’t eat well at breakfast and lunch, he screams and cries as dinnertime approaches.If Ben’s mother doesn’t feed him right away, he might bang his head. As a result, she quicklyprepares him something he likes to eat. She often allows Ben to carry his food around (rather thanrequiring him to sit with the family during meals).

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Behavior Support Plan: Part 2

Intervention Components: What strategies will be used (based on the summary statements)?

Prevention: What changeswill be made to avoid prob-lems, make difficult situationsbetter, or prompt goodbehavior?

Set up a schedule with pic-tures of Ben’s typical dailyactivities. Prior to transitions,remind him of where he willbe going by pointing to thatpicture on his schedule. Explain what he needs to doduring the transition, usingconsistent words. Remind himof fun things he can do ortreats he will receive wherehe is going.Create a bag of special toysthat Ben may take with himon outings, and place a few ofhis favorites in the glove com-partment. Change out the toysperiodically, and keep themonly for transitions.Schedule play sessions duringand after school. Alternateplaying with others and play-ing independently. Make thesessions very short, with onlysmall attempts to play withhim or simply playing withthe toys next to him withoutdemands. Tell him exactlywhat you want to do withhim before ending playtime.

Management: How will yourespond to reward positivebehavior and not problembehavior?

If Ben asks for a delay ina transition or a break fromplay appropriately, back offfor one minute, saying,“okay, you need space/oneminute.”Praise Ben for transitioningand tolerating others playingwith him. Praise every actionhe does well. Provide smallrewards for going places anddoing things withouttantrums.During a transition, if Benrefuses to leave or drops tothe floor, guide him gentlybut firmly to leave. Do notdelay the transition. Ignorecrying and screaming.If he plays without cryingand screaming for a shortperiod, ask him if he wouldlike to be alone, prompt himto say “go,” and leave.Gradually extend the timehe is expected to play beforeasking someone to go. If hebegins to cry or screamduring play, remain in thearea until he asks “go.”Allow Ben to leave the

Replacement: What skills willbe taught to replace the prob-lem behavior?

Encourage Ben to ask fora brief delay in transitionsby putting his hand up orpointing to a toy (to indi-cate he wants to continueplay). To prompt him, say,“What do you want?” andguide him through themovement.Teach Ben to checkhis schedule prior to transi-tions. Have him put his toysaway prior to leaving.Have Ben practice waitingfor food for brief periodsof time and stopping activi-ties to do something else.Encourage Ben to ask tocontinue by saying to him,“what do you want?” Helphim point toward the activ-ity and then say, “Oh, youwant to play withpuzzle/animals.”Teach Ben to tolerate playwith other people by sittingbeside him, touching his toys,handing him toys, and even-tually taking turns with thetoys. Prompt him to say “go”or put his hand up when heneeds a break.

Figure 9.1 continued

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Behavior Support Plan: Part 2

Intervention Components: What strategies will be used (based on the summary statements)?

Have Ben eat meals andsnacks only at the table.Provide Ben with some of hisfavorite foods during break-fast and lunch. Before mealpreparation, get Ben involvedin an activity. (Set the tableahead of time, and do what-ever preparations can be doneearlier in the day). When it’stime to eat, bring him to thetable explaining that he mustsit to eat.

table during meals, but askhim to put his food downbefore he goes. If he refus-es, remove the food. Whenhe is seated, return thefood. Reward Ben for eat-ing at the table with hisfavorite foods.

Have Ben practice eating atthe table for short periodsof time.Teach Ben daily living skills,such as tooth brushing andpotty training.

Figure 9.1 continued

Crisis Management:Is a plan needed to ensure the safety of your child, other people, and the surroundings? __X__yes__noIf so, describe strategies:

If necessary, physically guide or carry Ben out of public places or unsafe situations—being careful to begentle but firm.

Other Support: What else can improve life for your child and your family?Take Ben out to new places (e.g., a water park, playground, convenience store) periodically.

Find peers in the neighborhood and at school to play with Ben weekly; teach the children how toenter his play without upsetting him.

Develop a plan for teaching Ben to use the potty (e.g., creating a schedule, using rewards) and self-care skills (e.g., washing hands). Institute a regular bedtime routine.

Locate a babysitter for weekend dates. Become involved in a support group in the community.

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Behavior Support Plan: Part 3

Action Plan Steps

Steps to be taken: Person responsible: Time to be completedby:

Review the plan and get a Mom 10/7commitment from other people who care for Ben (e.g., family members, teachers) to carry out the plan.

Create a picture schedule for Mom and Teacher 10/14home and school (take pictures, purchase supplies, and laminate).

Get oversized bag and new toys for Dad and Grandma 10/14outings.

Monitoring:How often will the plan be monitored? __x__daily __x__weekly __monthly __other

How will implementation and outcomes be evaluated?

Continue using scatterplot and ABC recording forms to evaluate changes in behavior. Keepa daily journal that includes particularly successful and unsuccessful transitions, results ofattempts to play with Ben, and estimated times Ben remains at the dinner table. Meetbriefly with Ben’s teacher at the end of the school day on Fridays to discuss progress anddecide on changes to be made.

Monitoring methods (e.g., forms): Scatterplot, Behavior Log

Figure 9.1 continued

Whether behavior support plans are implemented as designed depends

on the commitment of the people using the plan and the degree to which

strategies are really “doable.” What we do to address a child’s behavior

should be determined based on a consideration of resources and natural

patterns of family life. Things that need to be taken into account include:

■ Amount of time and energy implementing particular strategies

will require

■ Financial and material resources that will be necessary

■ Family values and roles, members’ relationships with one another,

cultural characteristics (i.e., making sure that whatever is designed

“fits” with the style of the whole family)

■ Typical routines, patterns, and traditions (i.e., trying to design the

plan to meld with the patterns that are comfortable for the other

family members)

Assess the degree to which the plan fits the child and family by look-

ing back at the strategies identified and considering the following

questions:

1. Does the team have enough time to put this in place?

2. Does the team have the energy to use it consistently?

3. Does the team have the resources it needs to make the plan

work?

4. Does the plan fit given the family’s values and needs?

5. Does the plan work within typical family routines?

6. Does everyone believe in the plan and agree to use it?

(Consider the parent’s current beliefs that might make implementing

the plan difficult, whether or not those beliefs can be altered and, if not,

how the plan might need to be modified.)

Case Example: Making Ben’s Plan Fit

Describe issues associated with contextual fit for the case study child

and family, pointing these out in the behavior support plan. This

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should include any factors that would affect the design or implemen-

tation of the plan.

■ The primary challenges for Ben’s family were getting everyone on the

same page (including Grandma) and managing all the individual tasks

associated with the plan. It was important to make sure everyone had the

same goals and expectations and was adequately supported. Ben’s team

(parents, grandma, and teacher) agreed to meet and go over the plan

together, discussing any concerns, making sure everyone understood what

he or she was doing and why, and making adjustments to the plan as

needed to ensure buy-in. Then they all promised to follow through and

communicate openly about their concerns as time went by. They also dis-

cussed the fact that it might take time for the plan to work and that they

all needed to be patient. Ben’s mom talked to his teacher about how

overwhelmed she was with trying to create his schedule. His teacher

agreed to help Mom put it together after school while Dad watched Ben.

Ben’s mom found that trying to carry all of the different items to the car

was difficult, so she bought an oversized bag to use during transitions. ■

Promoting Lifestyle Change

Remind the parent that the primarily goal of positive behavior support

is not just to diminish problems but also to promote positive lifestyle

change. Discuss issues that should be considered in making sure that a

plan focuses on these broader goals. As we develop plans to address a

child’s behavior, it may become evident that broader “life issues” are

affecting the child’s behavior and will, therefore, need to be addressed

to produce positive changes. For example, if a child (or adult) is gen-

erally dissatisfied with the types of activities or circle of friends with

whom he interacts, those circumstance produce worse behavior over-

all. Some questions we might want to think about are:

1. Are there physical or medical conditions that need to be

addressed?

2. Is the child allowed to make choices and exert control over

important aspects of his life?

3. Do the child’s current schedule and daily routines match his pre-

ferred style?

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4. Are there aspects of the child’s surroundings that need to be

changed?

5. Does the child have positive, non-instructional interactions (i.e.,

simply playing without placing demands on the child) with other

people?

Considering these questions, we might be able to make some broad

adjustments to a child’s life that will improve his overall behavior—

and even make using the other strategies less necessary. (If appropri-

ate, revisit the discussion regarding goals in the first session,

considering whether and how the parent’s beliefs about his child’s

future may have changed.)

Case Example: Improving Ben’s Life

Describe strategies for the case study directed at improving the broader

quality of life for the child or family (e.g., related to independence,

community participation, relationships), pointing out these things in

the behavior support plan.

■ Ben’s parents decided to start trying to take Ben out to new places (e.g., a

water park, playground, convenience store) once in a while to expose him

to new things. They also found a child from the neighborhood who was

willing to come over once a week to play with or around Ben; Ben’s

mom taught the child how to enter his play without upsetting him. The

same was done at school by his teacher with a child from another class.

■ Ben’s parents and teacher worked together to develop a plan for teach-

ing him to use the potty (e.g., creating a schedule, using rewards), and

they identified self-care skills (e.g., washing hands) they could teach

together using the steps for teaching skills described in Session 4. His

parents also instituted a regular bedtime routine to create a more con-

sistent, positive transition to bed at night.

■ Ben’s parents were able to find an assistant at Ben’s preschool who was

willing to babysit periodically so that they could go out on dates

together. They also became involved in a support group in the commu-

nity so that they could foster relationships with other families and get

support when they needed it.

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Application

Work with the parent to integrate all elements of the behavior sup-

port plan using the Behavior Support Plan form. Discuss issues relat-

ed to contextual fit and identify strategies for lifestyle change while

constructing the plan. (If appropriate, ask the parent what he might

need to say to himself to believe in the plan and, therefore, follow

through.)

Creating an Action Plan

Explain the rationale for creating an action plan for getting the behavior

support strategies into place. Discuss issues that should be considered,

and provide examples. Explain that once we are satisfied with our plan for

dealing with a child’s behavior, certain steps need to be taken to

implement the plan with some degree of consistency. Consistency is

important because “hit and miss” use of behavioral strategies can actually

be detrimental because problem behaviors could sometimes end up being

reinforced. To get the plan in place, it may be necessary to line up sup-

port from extended family, friends, babysitters, or teachers and to consid-

er how to draw in extra assistance for times that are too difficult to handle

alone. Preparations might also include changing schedules, setting up

methods to record changes in behavior over time, rearranging things at

home, or making other modifications that can reduce some of the stress

associated with implementing the plan. By doing this type of preplan-

ning, the behavior support plan will be easier to put in place and adhere

to over time. (If the parent addresses attitudinal barriers that might inter-

fere with the plan’s implementation, ask him what steps need to be taken

to revise those beliefs.)

Case Example: Action Plan Steps for Ben

Describe or provide a written example of an action plan for the case

study (included in the Behavior Support Plan form). The action plan

should include what will be done, by whom, when, and/or how.

1. Review the plan, and get a commitment from other people who care

for Ben (e.g., family members, teachers) to carry out the plan.

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2. Work with Ben’s teacher to create a schedule for home and school that

includes transitions and play times. Decide beforehand who will get

what materials (e.g., Ben’s mother will get poster board, pictures of

settings or things that can represent activities for home, toys for the

bag, and some other reward to leave with the teacher; teacher will

take photographs of activities at school, get pictures of possible

rewards, and laminate the schedule for home and school).

3. Continue using the data collection procedures (scatterplot and ABC

recording) to monitor and evaluate how the plan is working.

4. Meet briefly at the end of the school day on Fridays to discuss progress

and decide on changes to be made.

Application

Guide the parent to identify one or more action steps that need to be

implemented and to record them on his Behavior Support Plan form.

Homework

✎ Have parent continue to keep Self-Talk Journal.

✎ Have parent continue practicing distraction, disputation, and positive

affirmations.

✎ Remind parent to complete the Weekly Progress Report.

✎ Have parent complete the Behavior Support Plan, including developing

action plan steps for implementing the behavior support plan.

✎ Encourage parent to talk with family members and others to get their

input on behavior and action plan steps.

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Chapter 10 Session 8: Monitoring Results and Wrap-up

(Corresponds to session 8 of the workbook)

Materials Needed

■ Self-Talk Journal

■ Monitoring Plan Worksheet

■ Monitoring Form

Outline

■ Preview agenda

■ Review homework

■ Review self-talk and apply cognitive strategies

■ Discuss monitoring the results of the plan

■ Discuss making adjustments over time

■ Wrap up the training

Agenda Preview

Preview the agenda for this session. Explain that the focus will be on

determining how to monitor the implementation and results of the

behavior support plan and making adjustments as needed to sustain the

outcomes over time.

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Homework Review

Ask the parent if she has any questions about the previous session or the

workbook readings. Review the homework—comprehensive behavior

support plan, action plan for putting it in place, status of implement-

ing strategies and outcomes. (If the parent did not complete the behav-

ior support plan and action plan, assist her in recording at least the most

essential information.)

Ask about communications with family members and others. Provide

feedback. Review Weekly Progress Report.

Review the parent’s Self-Talk Journal, identifying the situations in

which she was successful and areas in which she is having difficulty.

Have the parent describe how she disputed or distracted herself from

pessimistic beliefs and what positive statements (i.e., affirmations) she

used for substitution.

Self-Talk Review and Application

Have the parent review all her Self-Talk Journal sheets from the past

seven weeks and look for general themes and patterns. Ask her to

evaluate how she is doing with her self-talk (e.g., “What is working

well? What isn’t working? How will you do things differently next

time?”). Have her then record her impressions in the comments section

of the Self-Talk Journal. Help her to identify strategies to maintain

positive changes in self-talk (e.g., ongoing monitoring and feedback) or

to continue evaluating and addressing self-talk now that the sessions

will be ending.

Throughout the session, focus on areas of difficulty, prompting

effective use of the cognitive restructuring methods. Pay attention to

the parent’s body language as you discuss different topics. If the par-

ent appears to be uncomfortable or resistant, prompt her to identify

her self-talk by saying something like, “You seem uncomfortable.

What are you thinking right now?” These elements should be blend-

ed throughout the session and not unnecessarily interrupt the flow of

the training.

Monitoring Results of the Plan

Discuss the importance of monitoring the results of our plans (e.g., to

make sure the plan is working, to provide those involved with the

positive feedback they need to stay motivated). Review what we

should look for to determine whether a behavior support plan is

working. Explain that it is important to track whether a behavior sup-

port plan is working and that evaluating progress objectively often

requires continuing to collect data. Sometimes changes in behavior

can be subtle or take some time to occur. Perceptions might not nec-

essarily match reality, and it can be very helpful to review the progress

across several weeks or even months and note changes that might not

be obvious on a day-to-day basis. In these cases, a system for record-

ing and reviewing results can provide the positive feedback necessary

to continue with the plan.

The goals of PBS, and therefore the target areas for monitoring, are not

only reductions in problem behaviors but also broader outcomes

related to a child’s and family’s quality of life. Here are some questions

to ask when monitoring results:

■ Are the child’s problem behaviors decreasing in frequency or

intensity?

■ Is the child using replacement behaviors appropriately and more

than before?

■ Are we achieving the lifestyle-change goals we established in these

sessions?

■ Is the behavior support plan still working for the child and family

(i.e., does it fit the circumstances and needs)?

The specific methods used to monitor these results can be quite

simple or more complex, as described in Session 1. For example, we

might use simple frequency counts to evaluate changes in behaviors of

concern, or we might use ratings or estimates of how well or often

replacement skills are used (e.g. 4 out of 5). For behaviors that occur

less often (e.g., once or twice a day), we can simply take note of when

they occur. However, if problems occur more frequently or they seem

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to be very complicated, it may be beneficial to create a more involved

recording system. The people involved in using the plan could meet

periodically and look at the goals and target behaviors together to

evaluate broader outcomes.

Generally, the methods and timeline used should be based on how often

problems occurred before the plan was implemented. With this in

mind, we need to decide how often we will review the plan and out-

comes (e.g., if the child is hitting others on a daily basis, we would want

to review the data more often than for a child who has weekly

tantrums).

(If appropriate, explain to the parent that it is very easy to convince

ourselves that a plan is working or not working based on how we are

thinking or feeling instead of judging the plan on the objective evidence.

Discuss ways of avoiding this pattern.)

Case Example: Monitoring the Behavior Support Plan for Ben

Describe how the plan for the case study child could be monitored to

evaluate its effectiveness over time. Include the specific monitoring

strategies and schedule.

Ben’s parents kept:

■ A daily journal including when, where, and with whom Ben made

transitions and his accompanying problem behaviors

■ A brief log of their attempts to play with Ben (i.e., what they were

able to do with him)

■ An estimate of how long he remained seated with the family for

dinner each night

Application

Have the parent review the data she has collected to this point and

develop a plan for monitoring how the behavior support plan is used

and its outcomes for her child and family. Refer the parent to the

Monitoring Plan Worksheet in the workbook. Also have her consider

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when and how she will communicate with her family members and

others involved in her child’s care to assess progress. Parents might want

to use the Monitoring Form provided in the workbook to track the

results of the behavior support plan.

Making Adjustments over Time

Explain that positive behavior support is an ongoing, problem-solving

approach (rather than a quick fix). Discuss how life transitions and other

changes can prompt the need to review and adjust plans. Stress that PBS

is not something we do once and forget about. To be successful, plans

must be used consistently over time and modified as needs arise. While

initially it is important to be patient and not change the behavior support

plan too quickly, if significant improvements have failed to occur after

several weeks, the plan should be revisited. Even the best plans occasion-

ally need to be revised.

Parents and others caring for the children should be continually asking

themselves what is working and what is not, and adjusting the plan as

needed. As time passes and children continue to develop, their needs and

the situations affecting their behavior change. Families might go through

transitions or life experiences that throw a wrench into the works. It is

important to recognize that changes in routines, circumstances, or lives

in general can prompt changes in children’s behavior. And as children go

through typical developmental changes (e.g., developing friendships,

starting school, learning new skills) or other unanticipated events, their

needs, and therefore our approach to dealing with them, will necessarily

change.

Parents need to take note of such changes and the impact they have on a

child’s behavior, and they must be prepared to deal with them. Better yet,

they should anticipate and prepare for changes (e.g., taking children to

visit their new teachers, building the skills they need to play with friends),

avoiding unnecessary problems when possible. Parents can use the frame-

work of PBS and its tools over and over, repeating the process as needed.

In this way, parents can effectively support their children as they

encounter new situations and phases of their lives.

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Case Example: Outcomes of Ben’s Plan

Describe the outcomes of the case example, highlighting the types of

changes that occurred over time.

■ Within three weeks of putting the plan in place, Ben’s screaming and

crying during most transitions decreased just to whining and occurred

only about three times per week (and no longer than 30 seconds each

time). When Ben started speech therapy, however, transitions again

became a problem. When Ben knew he was headed to speech therapy at

either home or school, his tantrums escalated in severity and were much

longer. His parents, teachers, and therapists met to discuss this concern.

They reviewed the circumstances surrounding his behavior and possible

consequences. They determined that speech was particularly difficult for

Ben and decided to make some changes to reduce the demands. The strate-

gies included starting therapy sessions with activities they knew to be easier

for Ben, giving Ben periodic breaks, and adding special rewards when he

transitioned and participated well. These strategies were quite successful.

During play times, his mother and teacher were now able to sit with

him while he was playing and pick up and hand him toys. He usually

allowed them to remain with him for about two to three minutes

before saying “go.” He still wandered around the dinner table, but he

began putting his food down before leaving without reminders. His

parents were hopeful that he would start sitting with the family before

long. Ben even looked at his schedule and put his toys away sponta-

neously. He seemed to enjoy the predictability of knowing where he was

going and what would happen when he got there. Because of these

improvements, his parents felt confident beginning to expose Ben to

new people and places and tackling new skills such as sleeping alone

and potty training. ■

Application

Have the parent consider new behaviors of concern or upcoming

events, changes, or transitions that might influence her child’s behavior

and/or the appropriateness of the plan. Prompt the parent to describe

how the PBS process could be used to address those issues.

112

Also, identify one or more ways the parent can continually assess the

plan, resolve problems, and make adjustments as needed. Have parents

record this information on the Monitoring Plan Worksheet.

Wrap-up to PBS Sessions

Reiterate the key themes of the training:

■ Self-talk affects the way a person feels and acts.

■ Replacing pessimistic beliefs with positive affirmations allows

parents to follow through with interventions and cope more

effectively with challenges.

■ PBS is collaborative—all those involved in a child’s life should

work together.

■ PBS begins with an understanding of the circumstances that

affect the child’s behavior and the purposes the behavior serves

for the child.

■ Sometimes problem behavior can be prevented by:

■ Anticipating difficult situations.

■ Avoiding or changing aspects of those situations.

■ Prompting the child to behave more appropriately.

■ Parents can manage their reactions so that they provide

their children with rewards for positive, and not problem,

behavior.

■ The most important element of a behavior support plan is to

replace problem behavior by teaching a child appropriate skills to

meet her needs.

■ Behavior support plans should be clear, reasonable, and focused

on important goals.

■ To be effective, behavior support plans must be used consistently

by all those involved.

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■ Behavior support plans must be monitored objectively on an

ongoing basis to determine their effectiveness and recognize when

adjustments are necessary.

Give an opportunity for the parent to ask additional questions or dis-

cuss any issues not adequately covered during the training. Provide

closure to the sessions (e.g., explaining the level and extent of

ongoing support available from your program). Make referrals to

other agencies or support groups as necessary. Thank the parent for

participating, and congratulate her on completing the program.

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115

PBS Resources

Books/Articles

Carr, E. G., Dunlap, G., Horner, R., Koegel, R. L, Turnbull, A. P., Sailor,W., Anderson, J. L., Albin, R. W., Koegel, L. K., & Fox, L. (2002).Positive behavior support: Evolution of an applied science. Journal ofPositive Behavior Interventions, 4(1), 4–16.

Carr, E. G., Levin, L., McConnachie, G., Carlson, J. I., Kemp, D. C., &Smith, C. E. (1994). Communication-based intervention for problembehavior: A user’s guide for producing positive change. Baltimore, MD:Paul H. Brookes Publishing.

Durand, V. M. (1990). Severe behavior problems: A functional communica-tion training approach. New York: Guilford Press.

Durand, V. M. (1998). Sleep better! A guide to improving sleep for childrenwith special needs. Baltimore, MD: Paul H. Brookes Publishing.

Hieneman, M., Childs, K. E., & Sergay, J. (2006). Parenting with positivebehavior support: A practical guide to resolving your child’s difficultbehavior. Baltimore, MD: Paul H. Brookes Publishing.

Hieneman, M., Nolan, M., Presley, J., De Turo, L., Roberson, W., &Dunlap, G. (1999). Facilitator’s guide: Positive behavioral support. PositiveBehavioral Support Project, Florida Department of Education.

Koegel, L. K., Koegel, R. L., & Dunlap, G. (1996). Positive behavior sup-port: Including people with difficult behavior in the community.Baltimore, MD: Paul H. Brookes Publishing.

Lucyshyn, J. M., Dunlap, G., & Albin, R. W. (2002). Families and positivebehavior support: Addressing problem behavior in family contexts.Baltimore, MD: Paul H. Brookes Publishing.

O’Neill, R. E., Horner, R. H., Albin, R. W., Sprague, J. R., Storey, K., &Newton, J. S. (1997). Functional assessment and program developmentfor problem behavior: A practical handbook. Pacific Grove, CA:Brooks/Cole.

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Scotti, J. R., & Meyer, L. H. (1999). Behavioral intervention: Principles,models, and practices. Baltimore, MD: Paul H. Brookes Publishing.

Sugai, G., Horner, R. H., Dunlap, G., Hieneman, M., Lewis, T. J., Nelson,C. M., Scott, T., Liaupsin, C., Sailor, W., Turnbull, A. P., Turnbull,H. R., Wickham, D., Ruef, M., & Wilcox, B. (1999). Applying positivebehavioral support and functional behavioral assessment in schools (TAG 1).OSEP Center on Positive Behavioral Interventions and Supports.

Web Sites

Association for Positive Behavior Support (www.apbs.org)Beach Center on Disability/PBS Program (www.beachcenter.org/pbs/

default.aspx)Center for Evidence-Based Practice: Young Children with Challenging

Behavior (www.challengingbehavior.org)Center on the Social and Emotional Foundations for Early Learning

(www.vanderbilt.edu/csefel)OSEP Center on Positive Behavioral Interventions and Supports (www.

pbis.org)Kansas Institute for Positive Behavior Support (www.kipbs.org)Florida’s Positive Behavior Support Project (http://flpbs.fmhi.usf.edu)Colorado Positive Behavior Support Initiative (www.cde.state.co.us/pbs)Positive Behavior Support—Nevada (www.pbsnv.org)Journal of Positive Behavior Interventions (www.ingentaconnect.com/

content/proedcw/jpbi)Scott, T. M., Liaupsin, C. J., & Nelson, C. M, (1999). Understanding prob-

lem behavior: An interactive tutorial. OSEP Center on Positive BehavioralIntervention and Support & EDSRC, University of Kentucky(http://serc.gws.uky.edu/pbis).

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Session 1: Introduction and Goal Setting

Client Name: _________________________ Date: ______________

Rate your fidelity to each session element on a scale of 1 to 7, with 1 indicating poor fidelityand 7 indicating high fidelity.

___Introduce the training program

___Discuss importance of thoughts and feelings

___Give background and definition of positive behavior support (PBS) as foundation of theprogram

___Present key features of PBS and the program

___Give overview of PBS process

___Discuss getting others involved

___Help parent establish goals

___Define behaviors of concern

___Present options for keeping track of behavior

___Discuss crisis planning (optional)

___Assign homework

Notes:

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Session 2: Gathering Information

Client Name: _________________________ Date: ______________

Rate your fidelity to each session element on a scale of 1 to 7, with 1 indicating poor fidelityand 7 indicating high fidelity.

___Preview agenda

___Review homework

___Explore the relationship between thoughts and behavior

___Discuss the importance of assessing antecedents and consequences for understandingbehavior

___Introduce the Motivation Assessment Scale

___Introduce methods for gathering information

___Review observing behavior

___Review interviewing people

___Review recording information

___Help parent choose an information-gathering strategy

___Assign homework

Notes:

Session 3: Analysis and Plan Design

Client Name: _________________________ Date: ______________

Rate your fidelity to each session element on a scale of 1 to 7, with 1 indicating poor fidelityand 7 indicating high fidelity.

___Preview agenda

___Review homework

___Discuss the use of distraction for dealing with unproductive self-talk

___Teach parent how to use information to analyze patterns

___Help parent to create hypotheses or summary statements

___Use patterns to brainstorm intervention ideas

___Assign homework

Notes:

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Session 4: Preventing Problems

Client Name: _________________________ Date: ______________

Rate your fidelity to each session element on a scale of 1 to 7, with 1 indicating poor fidelityand 7 indicating high fidelity.

___Preview agenda

___Review homework

___Introduce the disputation process

___Discuss circumstances that precipitate behavior

___Present strategies for avoiding difficult situations

___Present strategies for improving difficult situations

___Present ways to provide a child with choices

___Present strategies for prompting good behavior

___Have parent identify prevention strategies

___Assign homework

Notes:

120

Session 5: Managing Consequences

Client Name: _________________________ Date: ______________

Rate your fidelity to each session element on a scale of 1 to 7, with 1 indicating poor fidelityand 7 indicating high fidelity.

___Preview agenda

___Review homework

___Teach parent how to use affirmations

___Discuss how reactions may maintain a child’s behavior

___Explain how to manage consequences

___Have parent identify consequence strategies

___Discuss taking precautions with using punishment (optional)

___Assign homework

Notes:

121

Session 6: Replacing Behavior

Client Name: _________________________ Date: ______________

Rate your fidelity to each session element on a scale of 1 to 7, with 1 indicating poor fidelityand 7 indicating high fidelity.

___Preview agenda

___Review homework

___Review and practice cognitive restructuring

___Discuss replacing behavior

___Have parent select replacement behaviors

___Discuss how to teach a child skills

___Assign homework

Notes:

122

Session 7: Putting the Behavior Support Plan in Place

Client Name: _________________________ Date: ______________

Rate your fidelity to each session element on a scale of 1 to 7, with 1 indicating poor fidelityand 7 indicating high fidelity.

___Preview agenda

___Review homework

___Review self-talk and apply cognitive strategies

___Introduce designing a behavior support plan

___Discuss how to make sure the behavior support plan fits

___Consider how the behavior support plan promotes lifestyle change

___Help parent begin creating an action plan

___Assign homework

Notes:

123

Session 8: Monitoring Results and Wrap-up

Client Name: _________________________ Date: ______________

Rate your fidelity to each session element on a scale of 1 to 7, with 1 indicating poor fidelityand 7 indicating high fidelity.

___Preview agenda

___Review homework

___Review self-talk and apply cognitive strategies

___Discuss monitoring the results of the plan

___Discuss making adjustments over time

___Wrap up the training

Notes:

124

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About the Authors

V. Mark Durand, PhD, is a professor of psychology at the University of

South Florida St. Petersburg. He served in several administrative roles

during the past decade, including as founding Dean of Arts and

Sciences and as the Regional Vice Chancellor for Academic Affairs.

Durand previously was on the faculty at the University at Albany, State

University of New York, where he received the University Award for

Excellence in Teaching and founded the Albany Center for Autism and

Related Disabilities in the mid-1990s. Dr. Durand is a Fellow of the

American Psychological Association and has administered more than $4

million in federal research and training grants.

His published works include numerous books and more than 100 other

research publications. One book, Severe Behavior Problems: A Functional

Communication Training Approach, is the product of 10 years of empirical

research and outlines a novel treatment for problem behavior using com-

munication. Dr. Durand developed the Motivation Assessment Scale, a

functional behavioral assessment instrument that is now translated into 15

languages. He has also authored several bestselling textbooks, including

Abnormal Psychology: An Integrative Approach, and he published the first

book on sleep disorders for children with disabilities—Sleep Better! A

Guide to Improving Sleep for Children with Special Needs. Dr. Durand

serves on the editorial boards of several journals, including Clinical

Psychology Review, Journal of Developmental and Physical Disabilities,

Journal of Positive Behavior Interventions, and Focus on Autism and Other

Developmental Disabilities. He was recently elected to the Panel of

Professional Advisors for the Autism Society of America.

Meme Hieneman, PhD, is the Director of the Positive Family

Intervention Project at the University of South Florida St. Petersburg.

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She has a PhD in Special Education and is nationally certified as a

behavior analyst. She has published a variety of articles and chapters in

the area of positive behavior support (PBS) and is the lead author of a

book titled Parenting with Positive Behavior Support: A Practical Guide

to Resolving Your Child’s Difficult Behavior.

In her professional career, Hieneman has worked with children with

severe behavior problems for more than 20 years. She was a group home

manager, behavior specialist for a school district, staff member for a pro-

gram assisting families and professionals of children with autism, direc-

tor of a statewide project helping schools implement positive behavior

support, and co-training coordinator for the National Research and

Training Center on PBS.