Behavior Management of Children with Severe Disabilities

1. Behavior Management of Children with Severe Disabilities Martin E. Block, Ph.D. Curry School of Education University of Virginia

2. Outline • Review Types of Behavior Problems • Review Two Major Approaches to Treatment • Review Terminology • Outline Format to Develop Behavior Plan

3. Types of Behavior Problems • Stereotypic Behavior • Self-Injurious Behavior • Aggression • Non-compliant/Disruptive Behavior • Inappropriate Social Behavior • Disorders of Physical Regulation

4. Stereotypic/Self-Stimulatory Behaviors • Repetitive cycles of behavior that persist for long periods of time. • Body rocking • finger flicking • hand flapping • tapping objects • Cause - may stimulate/entertain child • Problem - interferes with learning; prevents community placement

5. Self-Injurious Behavior • Response that inflicts direct harm on the individual. • Cause - unknown. May have higher levels of pain tolerance, gets attention, organic (e.g., Lesch-Nyhan), may somehow act as a natural opiate through production of endorphins in the CNS. • Problem - physical harm, inappropriate behaviors prevent community living.

6. Aggression • A behavior that represents a danger to the client or others. Generally means act of physical violence against others. • Cause - fear (escape fearful situation), anger (frustration or anger), manipulation of others (get them to do what you want or escape demands of situation) • Angry aggression often occurs as part of tantrum - crying screaming, thrashing out, attacking others, damaging property

7. Non-compliant/Disruptive Behavior • Refusing reasonable requests, running off instead of coming when called, becoming limp and dropping to the floor, resisting transitions, not performing chores or duties. • Cause - attempt to control others/situation, attempt to exert independence and some control over one’s activities

8. Inappropriate Social Behavior • Failure to have learned more appropriate social skills and rules - stripping, showing affection to strangers, stealing or hoarding, lying, masturbating in public, swearing/shouting. • Cause - no inhibition, not aware of how others view them, not knowing social rules

9. Disorders of Physical Regulation • Limited physical control due to failure to acquire (or loss of) self-regulation over bodily functions - copresis, enuresis, drooling, and tongue thrust • cause - physical problems coupled with failure to try and teach self-regulation • treatment might include adaptations (e.g., diaper, bib) and teaching tolerance

10. Types of Intervention

11. Elimination Approach • Views behavior problems as maladaptive or interfering actions that make it impossible or difficult for children to learn • Goal is to eliminate these behaviors - undesirable behaviors must be eliminated before new, adaptive behaviors can be taught

12. Elimination Approach (Cont.) • Negative behaviors are regarded as high priority intervention goals because they are viewed as interfering with learning. • Entire IEP’s are often devoted to decelerating or stopping behaviors rather than teaching new skills

13. Elimination Approach (Cont.) • Some behaviors are perceived as being so disruptive that special staff is called into to deal with the child. • Some children are viewed as needing to be put into a special class or school for children with similar behaviors in order to carry out an elimination program.

14. Problems with Elimination Model • Does it really work? • Might something else have worked better? • Is it wise to postpone teaching other skills? • These programs often involve aversives • Programs often involve homogeneous groupings

15. Educative Approach • Major purpose is to encourage adaptive behavior and promote maximum participation of individual in meaningful, daily activities. • Instruction is not delayed until behaviors are under control. At best deceleration programs are supplemental to active treatement

16. Educative Approach (cont.) • Not all behavior problems are equal priority targets for behavior change. • Most effective strategy to reduce behaviors might be to replace it with a skill that accomplishes the same function. • Deceleration programs do not use aversives

17. Lifestyle Perspective

18. Compare Our Lifestyle with a Person with a Disability • Choices/Control • People • Things • Activities • Community Experiences

19. Prioritizing Targeted Behaviors

20. Prioritizing Behaviors • Level I: Urgent behaviors requiring immediate attention • Level II: Serious behaviors requiring formal consideration • Level III: Excess behaviors reflecting normal deviance

21. Review of Terminology

22. A - B - C Analysis • Antecedent (stimulus) - an event occurring prior to a behavior which in some way influences that behavior • Behavior (response)- any observable or measurable act by an individual • Consequence - an event that occurs after a behavior has been exhibited and in some ways is influenced by or related to the behavior.

23. Reinforcement • Applying a technique that results in an increase in a targeted behavior. • Positive reinforcement - present something positive that increases targeted behavior. • Negative reinforcement - take away something aversive that increases targeted behavior

24. Types of Reinforcers • Primary - unconditioned reinforcer, one that does not have to be learned to be effective (food, water, and other necessities of life) • Secondary - a conditioned reinforcer, one that is learned • activity/sensory - a reinforcer that involves participation in an event or sensation • Token - receiving an item that can be exchanged • Social - a reinforcer that involves interaction between two or more persons.

25. Other Types of Reinforcers • ALT-R (strengthen incompatible behaviors) • DRL (reinforce lower amounts of behaviors) • DRO (reinforce other behaviors) • DRT-O (reinforce others in general area)

26. Reinforcement Schedules • Continuous - everytime child exhibits targeted behavior (best initially for establishing a behavior) • Intermittent - reinforce sometimes • fixed - same number every time (every 3rd try) • variable - average number (between 3rd and 5th try)

27. Punishment • Presentation of an aversive event or consequence that leads to a decrease in targeted behavior.

28. Other Key terms • Cue - a signal, sign, request, or information that calls for the occurence of a behavior. • Response cost - removal of a specific quantity of reinforcement. • Time-out - removal from a reinforcing situation • Extinction - a reinforcer that previously sustained a behavior is withheld for the purpose of eliminating that behavior

29. Other key terms (continued) • Over-correction - making individual do restitution for what he/she has done plus extra work • Desists - verbal reprimands • Satiation - providing a reinforcer for so long or so often thatit has lost its effectiveness

30. Creating the Behavior Plan

31. Creating the Behavior Plan • Define Behavior in Observable, measurable terms. • Observe the Behavior • when does it occur • where does it occur • why do you think it occured

32. Creating the Plan (Continued) • Explore the Consequences • what happened when the behavior occurred • when did these consequences take place • how did the student respond to these consequences

33. Creating the Plan (Continued) • Consider Alternatives • moving student • regrouping class • rearranging environment • changing time of activity • changing class format • other possible ideas

34. Creating the Plan (Continued) • Clearly State the Desired Goal • Outline Procedure for Preventing/Reducing Behavior • Describes cues you will use • describe reinforcers you will use • describe how you will present reinforcers • describe what you will do if behavior occurs