v Intervention for Young Children’s Challenging Behaviors
Jan 03, 2016
vIntervention for Young Children’s
Challenging Behaviors
Intervention for Young Children’s
Challenging Behaviors
Challenging BehaviorsChallenging Behaviors
Destructive BehaviorsAggression; SIB; Property Destruction
Disruptive BehaviorsLong tantrums; Loud, Repetitive Noises; Running, etc.
Irritating & Interfering Behaviors“self-stim;” repetitive and perseverative speech or actions, etc.
Social WithdrawalLack of responsivity and initiations
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Importance of Challenging Behaviors
Importance of Challenging Behaviors
Barrier to Inclusion, Community Participation, and Social Opportunities
Most Significant Impediment to Social-emotional Development and Education
Present Physical & Emotional Risk (and reduction of quality of life!) for Child and for Families, Teachers, Other Professionals, Peers and Friends---------------
Need to Prevent/Resolve Challenging Behaviors as Early and as Thoroughly as Possible
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Some Changing Perspectives on
Autism and Challenging Behaviors
Some Changing Perspectives on
Autism and Challenging Behaviors
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Early Perspectives (1960s ---)
Early Perspectives (1960s ---)
• Challenging Behaviors are “part of autism”• Not “diagnostic”, but “characteristic”
• Intervention = contingency management• Largely reactive
• Reinforcement (DRO) for desired behavior (or absence of problem behavior)
• Time out, extinction, or punishment for problem behavior
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1st Generation Effects1st Generation Effects
Often, short-term beneficial effects
But usually without maintenance or generalization
Occasionally ineffective, leading to escalating intensity of rewards and negative consequences
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Changing Perspectives (mid 1980s ---)
Changing Perspectives (mid 1980s ---)
I. Challenging behaviors are not “part of autism”
II. Challenging behaviors: (1) are maladaptive ways of responding to inadequacies in the environment, (2) occur due to lack of socially-adaptive skills for controlling environment
III. Children with autism are at high risk for developing challenging behaviors due to difficulties with learning, communication, and perception
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Changing Perspectives (continued)
Changing Perspectives (continued)
Intervention involves PREVENTING problem behaviors from developing or occurring by:I. Arranging the environment so that
challenging behaviors are unnecessary (and desired behaviors are encouraged), and
II. Teaching skills needed to navigate and control the social environment
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Positive Behavior Support
Positive Behavior Support
Level 3 procedures for children with serious challenging behavior
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Positive Behavior SupportPositive Behavior Support
An approach for resolving challenging behaviors that is based on person-centered values, empirical data and a multi-disciplinary scientific orientation
A pragmatic, data-based problem-solving approach for enhancing development and improving quality of life in natural, everyday contexts
A preventative approach emphasizing teaching and environmental redesign 10
PBS – ComponentsPBS – Components
1. Team-building, Goal SettingPerson-Centered Planning
2. Functional Assessment of Challenging Behavior
3. Individualized Behavior Support Plan
4. Implementation
5. Evaluation11
Core Elements of a Behavior Support Plan
Core Elements of a Behavior Support Plan
(Linked to Assessment Information)Prevention Strategies – Arrangements of
antecedent environmentTeaching Strategies – Building skills to teach
throughout the day to replace the challenging behavior
Reinforcers – Providing effective reinforcement schedules (note --- this is the contingency management component)
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+ Evaluation strategies 12
EvaluationEvaluation
All support plans should have some form of evaluation, so team knows if plan (or parts of a plan) is working as intended
Evaluation can focus on desired outcomes AND on extent to which elements of plan are being implemented
Evaluation should NOT be complicated or effortful, but it should be valid…and valued
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vPrevent-Teach-
ReinforcePrevent-Teach-
Reinforce
A Standardized and Individualized Model
For Challenging Behaviors
Purpose of P-T-RPurpose of P-T-R
To provide a standardized, easy-to-use model with which to apply research-based, behavioral strategies for addressing serious problem behaviors.
For all students with serious problem behaviors --- special education, general education.
Intended for pre-K through high school, however the bulk of research has been conducted in grades K-8
PTR ModelPTR Model
Research-based PracticesAssessment and Intervention
Team-driven decision-makingSteps are scripted as much as possibleEach step ends with self-evaluation
(checklist)Selection of interventions is menu-drivenEntire process is manualized
The PTR ModelThe PTR Model
5-Step ProcessDeveloping a Team
Establishing clear goals (short and long term)
Functional Assessment
Designing and Implementing a Behavior Intervention Plan
Evaluation (ongoing) and Revision (as necessary)
Step 1: TeamingStep 1: Teaming
Purpose: Establish group involved with developing and implementing intervention
Members: Teacher(s), Para-educator(s), School professionals, Family members, etc.
3-8 individualsAt least one person (e.g., administrator) who can
deliver resources and develop/interpret policiesAt least one person knowledgeable in behavioral
theory and principles and experienced in FA and BIP
Step 2: Goal Setting and Data Collection
Step 2: Goal Setting and Data Collection
Purpose: (1) to establish clear long and short-term objectives; (2) to establish a unified vision for desired outcomes; (3) establish feasible strategies for valid data collection
Kinds of goals: (1) Reducing specified problem behaviors; (2) Develop academic competencies; (3) Improve social competencies, problem solving, and interpersonal relations/interactions
Data CollectionData Collection
Data instrument(s) decided by team
Recommendations are often for Behavior Rating Scales –
Usually 5-point scales with specific anchors indicating frequencies, durations, and/or intensities of problem behavior
Step 3: Functional Assessment
Step 3: Functional Assessment
Purpose: Identify function(s) and antecedent variables influencing target behavior(s)
Strategy: (1) Detailed, structured questionnaires for each team member focused on antecedent variables, functions, and maintaining consequences. (2) Team meeting to produce consensus.
Outcomes: Hypothesis statement(s) with each component specified.
Step 4: Intervention Design and Implementation
Step 4: Intervention Design and Implementation
Purpose: To build a Behavior Intervention Plan (BIP) based on FA information
Features:(1) BIP must include at least one strategy from each
of the 3 components: Prevent, Teach, Reinforce
(2) Menus of research-based strategies for each component; forms and templates to build plan
(3) Selection of strategies is made by team, based on FA and on team’s ability/resources to implement
Examples of “Prevent” Strategies
Examples of “Prevent” Strategies
Increase “comprehensibility” of environment --- picture schedules, transition objects, lists
Choice making Add stimuli associated with desirable
(prosocial) behavior Remove stimuli associated with
challenging behaviors
“Teach” - Replacement Skills
“Teach” - Replacement Skills
Can be in any form (e.g., words, gestures, pictures) that is effective
Should be appropriate to developmental level (but more efficient than the challenging behavior!), and consistent with overall plan for language development
Use natural teaching opportunities throughout day
Functional Communication Training
Functional Communication Training
Determine function of the behavior within a routine
Select a functionally equivalent communicative behavior to replace
Prompt the child to use the replacement behavior
Reinforce the use of the replacement behavior
“Reinforce”“Reinforce”
Be sure reinforcers are strong (and as natural as possible) for desired behavior
Be sure reinforcers do not follow challenging behavior
May need reinforcer assessment to determine what is really effective
EvaluationEvaluation
Purpose: (1) Measure effects of intervention on problem behaviors and academic/social behaviors; (2) Measure fidelity of implementation
Features: Simple (easy-to-use) instruments --- behavior rating scales; checklists; etc.
Research on PTRResearch on PTR
Randomized Control Group EvaluationIncluding students with ASDIovannone et al. 2009, Journal of Emotional and Behavioral
Disorders
Case Study (A-B) AnalysesBehavior rating scale (BRS) dataDirect observation dataDunlap et al., 2010, Journal of Positive Behavior Interventions
Multiple Baseline Across Participants (with ASD) Design
Strain et al., in preparation
Teacher’s Ratings of Mike’s Behavior
Teacher’s Ratings of Mike’s Behavior
Disruptive Behavior
Engagement
Task Completion
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2
3
4
5
Disruptive Behavior
1
2
3
4
5
Engagement
5 10 15 20 25 34 39 44 491
2
3
4
5
Independent Task Completion
Baseline PTR intervention
Sessions
Teacher’s ratings of Jose’s Behavior
Teacher’s ratings of Jose’s Behavior
Following Directions
Appropriate Interactions
Off Task Behavior
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2
3
4
5
Following Directions
1
2
3
4
5
Times to Interact
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 231
2
3
4
5
Off Task
Baseline PTR Intervention
Sessions
Ali (Iovannone et al., unpublished)
Ali (Iovannone et al., unpublished)
6 years oldAutism; nonverbal; significant intellectual
disabilitySelf-contained Spec Ed classroomBIP..
P: curricular modifications; small task steps; choice making; etc.
T: Request attention; Request break; Delay of SR+
R: Music as reinforcer; 30s intervals
Ali’s Disruptive Behavior - Frequency
Ali’s Disruptive Behavior - Frequency
Sessions
0
5
10
15
20Frequency Disruption
Ali Disruptive behavior
Baseline Intervention
Ali’s Engagement - Duration
Ali’s Engagement - Duration
Baseline
0
10
20
30
40
50
60
70
80
90
100
Sessions
Duration Engagement
Multiple Baseline Analysis - Participants
Multiple Baseline Analysis - Participants
3 students with ASD; Josh, Alex, JasmineKindergarten; Grade 2; Grade 4Cognitive functioning = Typical to mild delayAll had verbal language, but often not used
effectivelyMajority of time in general education classesAll had frequent problem behaviors, and were
identified as students with most serious problems in their classes
property destruction; disruptive behavior, outbursts, crying, some aggression
ProceduresProcedures
Baseline (services as usual)PTR = Independent Variable
Teaming, goal setting, data collection (BRS)PTR (Functional) AssessmentIndividualized Behavior Intervention Plans
Data for study obtained from video recordings15 minute sessions in regular classroom context10-second time samples% of samples with occurrence of behavior
Dependent VariablesProblem BehaviorEngagement
Behavior Intervention PlansBehavior Intervention Plans
JOSHP = explicit expectations on cardT = instruction on expectations; self-managementR = self-recruited SR+; praise for following expectations;
“tokens” with stickers/treasures as back ups
ALEXP = written schedulesT = self-management (using lists for independent
responding)R = sea shells + time to examine his sea shells
BIPs (continued)BIPs (continued)
JASMINEexplicit expectations/instructions for social
interaction
instruction on social interactions; problem solving; and self-monitoring (journal)
“CIA (caught in the act)” credits
Problem Behavior (% Intervals)
Problem Behavior (% Intervals)
Josh
Alex
Jasmine
Engagement (% Intervals)Engagement (% Intervals)
Josh
Alex
Jasmine
Working with FamiliesWorking with Families
Issues and ConsiderationsRelated to Families and
Young Children with Serious Challenging Behaviors
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Family-Professional Relationships
Family-Professional Relationships
Considerations Related to Functional Assessment and Function-based Interventions
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Family Involvement and Outcomes
Family Involvement and Outcomes
Strong, functional families are children’s greatest resourceGoal is to help families develop knowledge (= power),
competence, confidence, and comfort in areas related to their child’s development, education, and supportFamily support comes in many different forms and flavors
---Information, friendship, referrals, respite, training, counseling, helping, understanding, etc., etc.
But a vital support for all families is providing knowledge and practical tools needed to help their child
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FamiliesFamilies
Owners of unique body of information (data) that can be vital to comprehensive FA
Child historyChild’s ecologyChild’s preferencesFamily systems --- goals, preferences, routines, values
As intervention agents, it is essential to incorporate inputContextual fit; commitment
Families as unique and individualized systems
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MAIN MESSAGESMAIN MESSAGES
When working with families (and children in family contexts), it is crucial to:
Establish rapport and trustInclude key family members in all processes of assessment and intervention
Behavior analysts are the experts in behavioral theory and practices; Family members are experts in most everything else
Family choice is the main determinant of what goes into a behavior intervention plan
Respect it!
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ISP(Fox & Dunlap)
ISP(Fox & Dunlap)
Individualized Support Program (Early Intervention – Positive Behavior Support)
A family-centered model designed to:
Help families build skills in PBS, and confidence in problem solving
Help children gain competencies (e.g., communication) to promote optimal development
Help children reduce problem behaviors
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Brendan’s Support PlanBrendan’s Support Plan
Assistance with comprehending the environment
Picture schedules
Social Stories
Clear instructions and expectations
Careful teaching of skills in routines
Assistance with communication and self-control
Etc..
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