Practical Strategies for Addressing Problem Behaviors for Students with Autism Spectrum Disorders LORI ERNSPERGER, Ph.D. Autism and Behavioral Consulting.

Practical Strategies for Addressing Practical Strategies for Addressing Problem Behaviors for Students withProblem Behaviors for Students with

Autism Spectrum DisordersAutism Spectrum Disorders

Practical Strategies for Addressing Practical Strategies for Addressing Problem Behaviors for Students withProblem Behaviors for Students with

Autism Spectrum DisordersAutism Spectrum Disorders

LORI ERNSPERGER, Ph.D.LORI ERNSPERGER, Ph.D.Autism and Behavioral ConsultingAutism and Behavioral Consulting

702-616-8717702-616-8717

[email protected]@cox.net

Managing Problem Behaviors:Overview

• Overview of ASD• Review elements of a functional

assessment• Develop a behavior intervention plan• Examine environmental controls• Identify the principles of proactive

programming• Review instructional methods for

teaching replacement skills• Develop a reactive program and crisis

management plan

Jeopardy“Autism 101”

• Review each of the following autism/AS facts

• Be sure to write your answers in the form of a question

• Each question is worth 100 pts.• Good Luck!

HISTORICAL NATURE OF AUTISM

• First identified by Leo Kanner in 1943

• Recognized by the medical field in 1980 DSM-III

• Disability category under IDEA beginning in 1990

• Asperger’s Syndrome 1994

PERVASIVE DEVELOPMENTAL DISORDERS DSM-IV (U.S.)

• Autistic Disorder• Asperger’s Syndrome• Pervasive Developmental

Disorder-Not Otherwise Specified• Rett’s Disorder• Childhood Disintegrative Disorder

DEFINITION OF AUTISM• Autism is a complex developmental

disability that typically appears during the first three years of life. The result of a neurological disorder that affects the functioning of the brain. It is four times more prevalent in boys than girls and knows no racial, ethnic, or social boundaries. (ASA, 2000)

AUTISM SPECTRUM DISORDERS

• Impairment in• Impairment of • Restricted repetitive and stereotypical

patterns of behavior and activities• Onset prior to age

•“The Triad of Characteristics”

Other Characteristics• Sensory Dysfunction

– sensitivities to touch, taste, sounds, light, and smells

• Motor Difficulties– coordination, balance, dexterity

• Executive Functioning– organization– planning and self-monitoring– starting and stopping– Time management

Prevalence Rates (U.S.- Advocate)

• 1 in 250 births• 1 to 1.5 million Americans• Fastest growing DD• 10-17% annual growth• Growth Comparison in the 1990’s

– US population 13%– Disabilities 16%– Autism Increase 172%

Spectrum of Impairment

• Communication• Social Skills• Sensory• Behavior• Gross and Fine Motor• Cognitive/Academic

Reasons for Problem Behaviors

• Changes in routine• Unfamiliar events or situations• Inability to understand instructions• Lack of social skills• Inability to communicate• Sensory dysfunction: hypo and

hyper-sensitivity• Limited ability to understand the

thoughts and feelings of others (TOM)

Managing Problem Behaviors

• Proactive Programming

• Reinforcement Surveys

• Environmental Changes

• Skill acquisition

• Reactive Programming

• Consequence based

• Loss of reinforcement

• Waiting for problem behavior

BEHAVIORAL LEARNING THEORY

A B C

Mother Smile Attention

See toy Walking Freedom

Dirty Diaper Cry ChangeDiaper

Stove Touch Burner Get Burned

Go to Beach Forget Lotion Get SunBurned

COMMON BEHAVIORS

A B CPayoffs/Costs

Circle Time Non-compliance

Change inRoutine

Crying

Freeplay Self-injury

Recess Perimeterwalking

Proactive Programs• Modify the antecedents and teach

replacement skills• Determine the function of the behavior

for the student• Assumes the behavior serves a purpose• Views the behavior as a way for the

student to communicate

Functional Assessment• FA focuses on

investigating the nature of the target behavior.

• FA is part of the proactive program

Functional Assessment• Sate and federal regulations stipulates

the need for a functional assessment when student’s behavior impedes his or her learning

• All students with autism should have a Behavior Intervention Plan written as part of their IEP, particularly with impaired social skills

Functional Assessment• FA is a process for gathering

information that can be used to maximize the effectiveness and efficiency of behavioral supports.

• A process of identifying functional relationships between the environmental events and occurrence of a target behavior.

Step 1. Define Target Behavior

• Observable and measurable• Objective and unambiguous• Selection of problem behaviors may

depend on the the ability of the team to teach replacement behaviors

• Severe behaviors vs. less interfering behaviors

Prioritization of Target Behavior

• Danger to student or others?• Frequency of behavior?• Is it chronic?• Is there a replacement behavior?• Will the new behavior provide

powerful reinforcement?• Can the environment be effectively

controlled?

Words of Wisdom• “I would not talk about my child’s

behavior to others in front of him. What I say will impact others’ perceptions of him and more importantly it impacts his perception of himself. He is an individual first and foremost with dreams, personality, feelings, and dignity.”

Melanie, TX

Step 2. Information Gathering

• Direct Observations

• Interviews

• Rating Scales• Record Review• Baseline data

Ecological Factors• Extraneous environmental stimuli• Teacher proximity• Classroom layout or décor• Schedules• Adult assistance• Interactions with classmates• Adequate feedback and reinforcement

Physiological Factors• Diet and nutrition• Sleep patterns and fatigue• Medication side effects• Sickness• Stress outside the classroom

Data Collection• Event recording/Frequency

– tally count of behavior

• Duration Recording– how long the behavior continues

• Time Sampling– Noting the presence of behaviors

within a specific time interval

Event/Frequency Recording

• Tally or count a target behavior• Indicates the number of times a behavior

occurs in a specific environment• It does not interfere with other events in

the classroom• Easy• Always produces a numerical product

Frequency Recording• To count the number of times a

target behavior occurs• Useful when recording a behavior

that has a clear beginning and end• Recommended for high rate of

occurrence

Event/Frequency Recording

• KISS– Golf counter– Hand-counter– Masking tape– Pennies or paper clips from one

pocket to another

Event/FrequencyStudent Name:Target Behavior:Comments:

Date Time Setting Frequency

Duration Recording• Establishes how long a behavior

persisted• It establishes how long a student

engages in a particular behavior• Targets behaviors that occur

infrequently but for lengthy periods.

Duration Recording• KISS

– Stopwatch– Wall clock– Kitchen timer– Portability– Timetimers

(AAPC)

DurationStudent Name:Target Behavior:Comments:

Date Setting Duration Comments

Time Sampling/Interval Recording

• Indicates whether or not a behavior occurs in a specific time period

• Records the presence or absence of a behavior during a specific timed interval

• Provides an estimate of the actual number of times

• Easy to use for high rates of behaviors• Requires observers undivided attention

Time Sampling• KISS

– Select amount of time: 10-15 minutes– Select interval period: 30 seconds– Mark for the behavior as it occurs– Determine chart and coding: + or –– Requires direct observation and

consistency

Time SamplingStudent Name: Bill Interval: 15 secDate: 2/14Target Behavior: On-Task; Working on Math

+ + + - -

- + + + +

Step 3. Develop a Hypothesis

• The team examines the information and develops a written statement regarding the function of the behavior

• For example– When this occurs (the context)– The student does (target behavior)– in order to (describe the function)

Hypothesis statements• When Stephen goes to the

cafeteria, he pushes the other students to be first in line, in order to avoid waiting his turn

• When Carlos is presented with his morning work, he screams and hits his head, in order to escape the teacher’s demands

Functions of Behavior?• Escape/Avoidance• Attention• Power/Control• Communication• Stress/Frustration• Self-stimulation or Sensory

Stimulation

Theory of Mind• Intent must be considered when

determining the function of behavior• Theory of Mind is the ability to read the

beliefs, desires, perception, and intentions of others in order to understand and predict behavior.

• People with autism have a limited ability to “Mind Read”

Theory of Mind • Individuals with autism have difficulty

with emotional understanding, sarcasm, irony, “white lies” and non-literal speech.

• Students with ASD generally do not have a behavioral intent to disrupt the classroom or anger the teacher

• Mindblindness; (Baron-Cohen)

Escape/Avoid• Does the B start when the student is

asked to do something? Demand?• Does the B when the task takes a

long period of time?• Is it the Students way of protesting?• Does the B stop when the student

escapes from activity/demand?

Attention• Does the behavior start to draw

attention?• Does the B start when the student is

alone?• Does the B start when someone leaves

the room?• Does the B get a strong reaction from

others?

Power/Control• Does the B start when the

students demands are not complied?

• Does the B start when the student has to wait?

• Does the B stop when the student receives the requested item?

Key Concept Functional Communication• Students with autism often

have language and communication deficits. A lack of adequate functional communication will greatly increase problem behaviors.Therefore, an alternative communication device must be available and implemented consistently.

Functional Communication Assessment

• As part of the student profile, the team should ask the following:

• Can the student adequately:– Express their wants and needs– Request help– Protest or refuse– Initiate a social interaction– Ask for affections or comfort

Communication Form• Review form for each

student• Determine the level of

communication for each function

• Select communication system

Words of Wisdom• “Your child is not bad. Imagine

how frustrated you would feel if you couldn’t communicate your wants and needs.”

Carol, TX

Communication Systems

• Reliability across settings• Universal for all people to

understand• Portability• Student’s acceptance of system

Communication Systems

There is not One specific system which is effective and appropriate for all students.

Communication• Students with ASD may be able to use

language quite effectively to discuss topics of interest, but they have tremendous difficulty expressing anger, sadness, frustrations, and other emotive messages.

• Problem Behaviors are therefore selected to communicate emotions

Stress/Frustration• Does the B have strong emotion or

anger?• Does the student seem agitated or

nervous?• Once the B has ceased, does the

student appear relaxed or calm?

Self-Stimulatory• Does the B occur when the student

is alone? Repeatedly?• Does the student appear to enjoy

the B?• Does the student appear calm

while engaging in the B?• Self-Stim and physiological

reinforcement

Step 4. Behavior Intervention Plans

• A written plan developed by a school team• The plan includes:

– a summary of relevant data from the FA– operational description of the target

behavior– **Goals and objectives that include

replacement behaviors (Social skills and stress management)

Step 4. Continue– **List of modifications to the

environment and creating a positive learning environment

– Criteria for outcome evaluation– Reactive programming to

include crisis plan

Create a Positive Learning Environment

• The physical set up and layout of a classroom sets the tone for learning.

• The classroom should support a students behavioral needs and facilitate independence and smooth transitions.

• A cheerful and organized environment increases motivation and the acquisition of new skills.

Goals for the Environment

• “An ounce of prevention is worth a pound of Cure”

• Proactive measures and organization• Reduces stress and problem

behaviors• Organization and structure

maximizes opportunities for skill development

Back to School Idea:Environmental

Checklist• Conduct an environmental

inventory• Review the importance of each

component as it relates to the student’s needs

• Develop a plan of action to address deficit areas

Environment and Sensory Integration

• Carefully review the environment for sensory factors– noise level– Visual stimuli– Seating (large ball)– lighting– gross and fine motor requirements– smells

Executive Functioning:Schedules

• Provide consistency and predictability

• Prevents behavioral challenges• One of the characteristics is to

preserve sameness• Do not cater to rigidity- teach

structured flexibility

Weekly/Daily Schedule• Reflect changing needs of the students• Varied activities• Post for easy reference• Minimize “Free Time”• Teach the concepts “before and after”• Teach the concepts “First-Then”

Weekly/Daily Schedule• Review schedule on a daily basis

with all students• Highlight any changes to the

routine• Laminate and place velcro on each

scheduled activity• Keep paper or 3x5 cards readily

available

Back To School Idea: Individualized Schedules

• Some students may require an individualized schedule

• Create a portable version of the daily schedule

• Allow students to remove each activity when completed or create a checklist

• Include both the written word with a visual cue

Considerations for Less Structured Times of the Day

• Transportation/Bus– Seating/Rules/Assistance

• Physical Education– Coordination/Dressing

• Lunch– Seating/Noise level

• Passing Periods– Visual Supports/Checklists

• Before and After School– Designated area

Executive Functioning Supports

• Color code school subjects• Buddy System• Checklist for each class or desk:

– Review each paper– Place in correct color coded folder– Place all unwanted papers in the black

folder– Homework folder

Back to School Ideas: Visual Supports

• Map of the School• Schedule of classes with supply list• List of teacher expectations and routines• Schedule of activities with each class• List of Homework modifications• Visual cue to return to homebase or comfort

zone

BIP:Teaching Replacement

Behaviors• Change is a complex process• “Gate of Change” – Stephen Covey• Developing a plan must be child-centered

and strength based• Include the student as much as possible• A BIP is not done to the child• Reinforcers must be developed and

readily available

Reinforcement Strategies

• High quality reinforcement is provided to the student for the absence of the targeted behaviors

• Reinforcement is provided when the students exhibits an alternative behavior or replacement behavior

“Catch’em Being Good”• According to Teaching Exceptional

Children:

–“94-96% of appropriately displayed behaviors by students goes unnoticed and unrecognized by teachers”

Key Concept:Reinforcement

• Reinforcement is a key element to an effective proactive behavior program

• School personnel must continuously observe the classroom and ask themselves: “What behaviors can I immediately reinforce for this student?”

REINFORCEMENTREINFORCEMENTREINFORCEMENTREINFORCEMENT

•Increases Or Decreases the Increases Or Decreases the Frequency of the Target BehaviorFrequency of the Target Behavior•The Presentation Or Removal Of A The Presentation Or Removal Of A Reinforcer Contingent Upon A Reinforcer Contingent Upon A BehaviorBehavior

TWO TYPE OF REINFORCERS

• POSITIVE- presented to an individual when a desired behavior has occurred.

• NEGATIVE- removal of a non-preferred stimulus when a desired behavior has occurred.

• In Both Cases Appropriate Behavior Has Been Reinforced and Will Be More Likely to Occur in the Future.

Words of Wisdom• “Students respond to me because

I show them unconditional love and reinforce their positive behaviors constantly”

Sandra, TX

Types of Reinforcers• Edibles• Tangibles• Social Praise• Activities

BIP: Goals and Objectives

• Teaching replacement skills should result in:– Meeting the same function or purpose

for the student– Teaching a skill which can be

implemented across settings– Efficient and effective alternative for

the student

Replacement BehaviorsFUNCTION Replacement Skill

Attention Initiation techniques Social skills

Avoidance Requesting Skills Compliance Training

Power Increase Choice making Flexibility Training

Communication Verbalization skills PECS

Stress Stress Reduction Frustration Tolerance

Stress Reduction Techniques

• Data Collection• Stress Hierarchy

– Identify a list from least to most stressful– Include parents and student– Identify trigger– List physical symptoms– Implement Stress Thermometer

Stress Reduction Skills• Skill must be able to be

implemented across settings• Should not appear odd or more

disruptive• Build on a current adaptive skills• Teach in a structured setting• Provide a non-verbal cue

List of Potential Skills• Deep breathing• visualization• Counting• Squeeze ball• Break time• Listen to music• Walk/Pace

• Read• Talk to a trusted

person• Massage or vest• Jumping• Swing• Head down

Back to School Idea:Comfort Bags

• Familiar items reduce stress• Collect a few canvas bags• Create a list of comfort items for the

student• Teach the student how to use the

comfort items• Carry the bag during difficult transitions

and changes in the schedule

Words of Wisdom• “Children with autism are not

broke-you can’t fix them.• Children with autism are not sick-

you can’t cure them.• Children with autism are children-

you CAN teach them.”Brian, TX

Social Skills Training• Appropriate and effective social

skills are the best predictor of positive, long term outcomes for people with special needs

• Foundation upon which many other crucial skills are built

• Often the first priority for families

List of Potential Social Skills

• Emotions• Reading verbal

and non-verbal cues

• Conversation starters/greetings

• Making a friend• Abstract thinking

• Giving and Receiving Compliments

• Tone of voice• Eye Contact• Emotions

Social Skills Training• Pictures• Video self-modeling• Role-play• Direct Instruction• Scrapbook of Emotions

– Happy or Sad Book• Incidental teaching• “Cool and Uncool” game• Social Stories

Circle of Friends• Establish a network of friends who

will support the student outside of the classroom.

• Identify two or three students• Provide specific Friendship Tips to

the students• Assess for success

8 Steps for Teaching Social Skills

• Step 1: Identify the necessary social skill

• Step 2: Identify skills that are valued by the student

• Step 3: Teach in the natural setting• Step 4: Include as part of the

everyday curriculum

Steps (cont.)• Step 5: Identify on-going

opportunities to practice new skill• Step 6: Provide feedback • Step 7: Teach students to self-

monitor• Step 8: Use a variety of

instructional techniques

Social Stories (Gray, 1996)

Select a clear goal or desired outcomeWrite in the first personUse Wh questions as an outlineWrite with literal accuracyWrite positive behaviors and outcomesVisual and concrete informationConsider a student’s cognitive level

Back to School Idea:Emotion Books and

Bulletin Boards

• Recognition of facial expressions

• “Happy” or “Sad” books• Create a scrapbook of

emotions and label• Designate a bulletin

board with a new skill

BIP and Replacement Skills Overview

• Identify function of behavior• Select one replacement skill• Write the goal and objectives• Determine the reinforcement• Develop curriculum• Select data collection methods• Evaluate and Celebrate!

Reactive Programming:Cautions

• A reactive system has little incentive to be proactive because positive outcomes do not create noise.

• Reactive programs are most concerned about their problematic students.

• Reactive programs wait for the behavior to occur and our usually in a crisis mode

Words of WisdomYou can’t discipline out a disability,

but….You can teach a new ability!

Brenda, OH

Reactive Programs • Extinction• Response-Cost• Selectively reinforce alternative

behavior• Aversives and Punishment• Crisis management plan

Reactive Programs• Keep in the present• Progress will be negligible if you are not

working within the child’s best interest• Ask yourself- “What are my intentions”• A reactive plan must be consistently

implemented

Extinction• “Ignore it and it will go away”• Extinction is the elimination of

reinforcement for the target behavior in order to extinguish the problem behavior

• Effective if the function is Attention• TB becomes worse before it gets

better

Extinction

• Extinction must be planned, may produce aggression

• In some cases minimal attention must be given:– Calm and neutral voice– Little or no eye contact– Minimal physical restraint– Reduce but not eliminate demands

Extinction• Not all behaviors will respond to

Extinction• Combine with other procedures,

skill replacement training• Withhold consistently, include all

staff and parents

Response-Cost• The removal of reinforcement contingent

upon the problem behavior• Loss of a preferred activity or

reinforcement• Effect will show quickly (3-5 days)• Combine with a token economy• Increased aggression or stress• COMPUTER

Selective Reinforcement

• Identify the alternative behavior• Reinforce other students who are

displaying the alternative behavior• Only effective if the student is an

observational learner

Punishment: Time-Out• Time Out from Positive Reinforcement• Withdrawal of the opportunity to earn

reinforcement• Determine the function• If the function is escape, then time-out is

reinforcement• Is rarely an effective strategy for long

term change

Time-Out• Consider other options• Determine placement of TO• Define B leading to TO• Explain the TO rules• Apply consistently• Create reinforcing environment• Evaluate effectiveness

Crisis Management Plan

• Cycle of Crisis– Calm– Trigger– Irritable, frustrated, anxious– Peak, tantrum, SIB– De-escalation– Recovery

Back to School Idea: Triggers• Identify a list of triggers for

each student and include in the student profile. Write a “worst case scenario” for each student.

• List all environmental and physiological triggers that would initiate a problem behaviors.

Back to School Idea:Crisis Plan

• Remain calm• Decrease verbal language and increase

visual supports• Encourage stress reduction techniques• Minimize demands without allowing

complete escape• Identify Home Base• Practice, Practice

Academic Success• Achievement and academic success is

often an antidote for stress and anxiety• Be sure to create a schedule that offers

opportunities for student success• They are rewarded by task completion

and intelligence

Reactive Programs

• Reactive techniques and punishment should not be used in isolation but combined with other behavioral change procedures

• FAIR-PAIR Rule: choose one or more alternative proactive programs for every reactive technique

Where do you go From Here?

• Take a minute and review the Environmental Checklist and Behavior Intervention Plan

• Analyze your current program.

• Select one goal for next week. • Involve the entire staff.• Collect data.• Celebrate Success!!

Multidisciplinary Approach

• Paraprofessionals• Related Service Personnel• Parental Involvement• School Administration

Teacher Support• Networking

– exchange phone numbers and e-mails with other participants

• Mentors• Conference and workshop

attendance• Autism Support Organizations• Resources

– Books– Websites

Back to School Message

• Proactive programming will provide long term behavioral change and improve the quality of life for students with autism spectrum disorders

• Effective behavioral programming establishes a positive and respectful relationship with the student and staff

Words of Wisdom

“Treat people as if they werewhat they ought to be and

You help them become what they are capable of being”