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ABA: EVALUATION &TREATMENT OF CHALLENGING BEHAVIORS

ABA: EVALUATION &TREATMENT OF CHALLENGING BEHAVIORS. October 11, 2013 Todd Kopelman , PhD, BCBA. What are “Challenging Behaviors?”. Interfere with:  Parent-child, sibling interactions  Student’s ability to learn, socialize & participate in classroom routines.

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ABA: EVALUATION &TREATMENT OF CHALLENGING BEHAVIORS

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  1. ABA: EVALUATION &TREATMENT OF CHALLENGING BEHAVIORS October 11, 2013 Todd Kopelman, PhD, BCBA

  2. What are “Challenging Behaviors?” Interfere with: Parent-child, sibling interactions  Student’s ability to learn, socialize & participate in classroom routines.  Teacher’s ability to instruct.  Adult’s ability to obtain/maintain employment, stable housing, social relationships

  3. Challenging Behaviors Noncompliance – active (refusal), passive (off-task), or combination Aggression Tantrums Destruction Self-injurious behavior www.statesman.com

  4. Path to Negative Outcomes • Reduced learning opportunities • Academic difficulties, retention, suspension, drop-out, unemployment, substance abuse (Carr et al., 1991; Wehby et al., 1993 Lipsey & Derzon, 1998, CBHC.org) • Teacher and parent burnout (Hastings & Bham, 2003) http://world.edu/unhappy-teacher-bad-apple-tree/

  5. ABA: What is it? Not ABBA!

  6. What is ABA? John Watson (“Little Albert”) www.glogster.com

  7. Burrhus Frederick Skinner (1904-1990) Interested in understanding behavior as a function of environmental histories of reinforcing consequences.

  8. Applied Behavior Analysis A systematic and experimental approach for evaluating the effects of changes in the environment on a person’s behavior

  9. ABA Behavioral principles often incorporated into other therapeutic approaches (CBT, ACT, VB, PCIT, etc) 1000’s peer-reviewed studies using ABA procedures published across different ages, settings, diagnoses, behaviors

  10. ABA: An Evidence-Based Treatment • Surgeon General Report • American Academy of Neurology • American Academy of Family Pediatrics • American Academy of Occupational Therapy Association • American Psychological Association • American Speech-Language Hearing Association • Society for Developmental and Behavioral Pediatrics • Autism Society of America • National Institute of Child Health & Human Development • National Institute of Mental Health

  11. Core Components of ABA • Applied (Socially significant) • Environment-behavior relationships • Technological (detailed & clear procedures) • Single subject design (Small N’s) • Observable behaviors

  12. Do We Intervene? www.simpsonscrazy.com

  13. Do We Intervene? www.ocregister.com

  14. Do We Intervene? Autisminnb.blogspot.com

  15. Core Components of ABA • Applied (Socially significant) • Environment-behavior relationships • Technological (detailed & clear procedures) • Single subject design • Observable behaviors

  16. Function • Function: the reason why problematic behavior continues to occur. • Social function: environmental events that maintain problematic behavior. • Automatic function: internal events maintain problematic behavior • Treatment is based on identified function, not on topography.

  17. Rationale for Function-Based Treatment Once the function of the problem behavior is known, treatment involves: • Disrupting the response-reinforcer relation (e.g., extinction) • Providing a known reinforcer contingent on the desired behavior (e.g., DRA)

  18. Maintaining Events • Positive reinforcement: a “gain” function • Social attention, tangibles, preferred items • Negative reinforcement: an “escape” function • Nonpreferred activities, tasks • Automatic reinforcement: unknown or intrinsic

  19. Functional Approach to Behavior:The Basics http://bookwag.com/2013/03/6-actors-who-have-played-sherlock-holmes/

  20. Determining Function

  21. Determining Function of Behavior Indirect Measures Behavioral Interview or Checklist • Topography of behavior • Times of day • Activities • Settings • People present • Antecedents • Consequences • Biological Variables • Medications

  22. Determining Function of Behavior • Direct Observation: Scatter Plot Analysis

  23. Functional Analysis (“Gold Standard”) • Experimentally tests hypotheses regarding variables that maintain problem behavior • Actively manipulate antecedents and consequences surrounding behavior • Observations are conducted within an experimental design to demonstrate functional control.

  24. Functional Analysis Procedures • Manipulate attention, escape, and access to preferred items or activities. • Contrast with a control condition (free play). • Conduct 5-minute analogue conditions within an experimental design. • Continue until a consistent pattern of behavior is identified.

  25. Functional Analysis Procedures • Condition 1: Free play • Control condition • Access to preferred items and social attention • No demands • Problem behavior ignored • Appropriate behavior reinforced

  26. Functional Analysis Procedures (continued) • Condition 2: Escape • Task demand presented • Brief break for problem behavior • Condition 3: Attention • Client ignored • Social attention provided for problem behavior • Condition 4: Tangible • Removal of tangible • Access to tangible given for problem behavior

  27. Brief Functional Analysis

  28. We Identified the Function…Now What? Common Treatment Components 1. Reinforcement-based procedures Differential Reinforcement DRA/DRC (FCT), DRI, DRL/DRH, DRO Noncontingent Reinforcement (NCR) 2. Extinction-based procedures 3. Punishment-based procedures 4. Antecedent-based procedures

  29. Common Treatment Components Uncommon to use single treatment procedure Individualized packages (e.g., combination of antecedent, reinforcement, extinction procedures) Goals of a treatment plan should be parsimony & internal consistency (treatments matched to function)

  30. Applied Behavior Analysis

  31. ABA in Iowa: From Research to Practice

  32. The Case for Behavioral Telehealth Urgent Need for Behavioral Interventions • Applied behavior analysis (ABA) is an evidence-based treatment for challenging behavior in ASD • Access to ABA is inconsistent Strategies for Intervention • Use functional analysis (FA) and functional communication training (FCT), to replace problem behavior with social communication • Train parents to use FA/FCT with their children under the direction of a behavioral consultant • Use telehealth to reach underserved areas

  33. In-Home ABA

  34. Clinic Telehealth ABA

  35. Home Telehealth ABA Sheldon Armstrong Fertile Oelwein Cedar Rapids Irwin Bettendorf Fairfield Centerville Keokuk Average distance from I.C. = 122 miles

  36. Home Telehealth Eligibility Criteria Children 18 to 83 months of age with: • Autism Spectrum Disorder diagnosis • Significant challenging behaviors (e.g., aggression, destruction, SIB, repetitive behaviors, severe tantrums) • Reside in IA at start of study • Referrals from CHSC or UI clinics

  37. Behavioral Procedures • Weekly 60-min telehealth sessions from UI Children’s Hospital to family home • Parents conduct all sessions with child with telehealth coaching from behavior therapist • All sessions recorded, scored, & graphed • Participation lasts up to 6 months • RCT design in home-based project • Immediate vs wait control assignment

  38. General Procedures (cont.) Clinic & Home-Based ABA Telehealth: Functional Analysis: Iwata et al. (1982/1994) procedures; multielement design • Assessment: Goal is to identify function of child’s target behavior(s) Functional Communication Training: Carr & Durand, 1985. • Treatment: Goal is to replace problem behavior with appropriate communication that serves same function

  39. Behavioral Telehealth Successes • Reduction in problem behavior through telehealth averages over 90%, comparable to ABA provided in vivo when therapists visit the home • High treatment acceptability • Average weekly cost of delivering telehealth was $60 per participant, compared to $291 if consultants traveled to provide coaching on site or in home • Increased accessibility to rural areas of state

  40. Statewide Behavior Resources UIHC (Outpatient & Day Treatment Programs) Adult Psychiatry Clinic (Jodi Tate/Todd Kopelman) ITABS (Susan Smith) Money Follows the Person

  41. Challenging Behavior Teams • Each AEA has a Challenging Behavior Team (CBT) • “Top tier” experts in FBA & BIP • Local school team can request consultation • Parents can ask school if CBT is involved!

  42. Board Certified Behavior Analysts • http://www.bacb.com/ (Can look up IA providers) • Certified to conduct behavior assessments and interventions • BCBA’s work in school, residential, hospital, and private practice • Certification requires Masters in behavior analysis or closely related field & 225 graduate hrs of instruction in behavior analysis + 15oo hrs supervised experience & examination

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