ADHD AND BEHAVIOR CHANGE STRATAGIES

1. ADHD AND BEHAVIOR CHANGE STRATAGIES Thomas J. Power The Children’s Hospital of Philadelphia and University of Pennsylvania John C. Lestino District School Psychologist Edgewater Park School District

2. Psychoeducational Interventions By Change Agent Strategy Intervention teacher-mediated instructional match . contingency management daily reports/home-school notes contingency contracting computer assisted instruction parent-mediated goal setting contracting peer-mediated peer tutoring cooperative learning self-directed self-monitoring

3. Functional Behavior Assessment(Nelson, Roberts, & Smith, 1998) • Why conduct an FBA? • All behaviors occur for a reason because they serve a purpose for an individual. • An understanding of why and how a behavior serves a particular purpose for a student is critical in developing an intervention plan that is more likely to be effective for a student • Systematic way to select intervention procedures that will be maximally effective • What is an FBA? • Series of assessment procedures that identify environmental factors that serve to maintain a problem behavior(s) for an individual. • Collaborative process

4. Steps to conducting an FBA and developing an intervention(Nelson, Roberts, & Smith, 1998) • Problem identification and definition • prioritize problem behavior • objectively define target behavior in measurable, observable terms • Problem analysis • what is the function of the problem behaviors and what events are related to them? • validate and clarify information from problem identification • Development of intervention • Progress Monitoring

5. Common Functions of Behavior • Escape/Avoidance • school work and task demands • social situations • Attention • adult • peers • Access to an object or activity • Autonomic Reinforcement (self-stimulation) • Multiple Functions

6. Functions of BehaviorEscape/Avoidance • Activity (e.g., academic demands) • student wants to escape performance situation • guiding principles for intervention: • do not reinforce the student’s avoidant behavior • reinforce student’s attempts to engage in academic demands (giving breaks contingent upon work completion) • support student’s efforts to meet the academic demands (breaking up work into smaller quantities; reducing numbers of problems on the page; providing choices on a menu)

7. Functions of BehaviorEscape/Avoidance • Social (e.g., school avoidance) • student wants to avoid social situation (may be related to anxiety) • Guiding principles for intervention: • do not reinforce the student’s attempts to avoid the social situation • reinforce student’s attempts to stay in social situation • teach student skills to help promote tolerance to social situation (e.g., progressive muscle relaxation, guided imagery, role playing, social skills training).

8. Functions of BehaviorAttention-Peer & Adult • Student is more likely to engage in the behavior when peer and/or adult attention is provided • Guiding principles for intervention: • Increase opportunities for non-contingent attention (show and tell, peer tutoring) • Provide attention contingent on responsible and adaptive behavior

9. Functions of BehaviorAccess to an Object or Activity • Target behavior occurs most often when a desired object or activity is unavailable • Target behavior occurs least often when a desired object or activity is available • Guiding principles for intervention: • do not provide access to the object or activity contingent upon the target behavior • teach an alternative behavior to request access to the object or activity • provide access to the object or activity contingent upon appropriate behavior

10. Functions of BehaviorAutonomic Reinforcement • Target behaviors occur for an intrinsic reason (e.g., daydreaming stemming from boredom) • Guiding principles for intervention: • prevent the behavior from occurring with antecedent interventions--enrich the environment (e.g., CAI; hands on activities) • interrupt the behavior (verbal redirection; telling the child what to do not what not to do) • reinforce the student when he or she exhibits appropriate behavior

11. Advantages to FBA • A good start to help address many school-based problems • Empirically supported decision-making process to select among a multitude of interventions • Helps to select efficient and effective interventions • Beats a “fishing trip expedition”; “trial and error”; “plan and hope”.

12. Limitations to FBA • Time comsuming process • Requires a certain amount of training • Requires teacher participation • Typically, a child’s cognitive processes are not assessed or considered when conducting an FBA • Generalizability across time and settings cannot be assumed

13. Behavioral Interventions Teacher-Mediated • Proactive strategies to classroom management • Instructional Match • Giving Instructions • Choice Making • Computer Assisted Instruction • Consequence oriented strategies to classroom management • Token Economies/Response Cost • Contingency Contracting • Daily Reports/Home-School Notes

14. Instructional Match • Correspondence between child’s instructional level and the difficulty level of curriculum materials • Curriculum-student mismatch can result in task avoidance, inattention, misbehavior • Strategy to prevent attention and behavior problems is to present material at a level that matches the child’s ability to learn

15. Guidelines for Determining Instructional Match • Instruction of children • known material - 80% • unknown material - 20% • Independent activities • known material - 95% • unknown material - 5%

16. Presenting Instructional Material • Keep instruction brief • Organize material - talk in outlines • Differentiate key points from exemplars • Use novel methods, humorous examples • Use multisensory methods • Frequently check for understanding • Rapid-fire questioning • Brief written tasks • Vary instructional pace in response to student need • Provide frequent opportunities for feedback; praise understanding and effort

17. Choice Making as an Academic Intervention • Antecedent intervention strategy • Helps children exert control over their environment in a positive manner • Received a lot of attention in literature for students with severe disabilities • Research with higher functioning students with emotional and behavioral difficulties has demonstrated that this is a promising strategy