“ Why Does My Child Do That? Understanding Challenging Behavior ” Presented by

1. “Why Does My Child Do That? Understanding Challenging Behavior” Presented by Lupe Castañeda, MS, BCBA Pediatric Rehabilitation and Behavioral Services Board Certified Behavior Analyst January 24, 2013

2. What is problem behavior? • In the educational environment, behaviors are considered problematic if they • consistently interfere with the child’s or other children’s education • restrict the child from participating in general education activities, and • endanger the child, other students or adults • Home and community, behaviors might be considered problematic if they • (a) interfere with the family’s desire to participate in community or extended family activities, • (b) endanger the child, siblings or other family members, • Most problem behavior is believed to be learned (operant) Problem behavior often serves a purpose/function or a combination of functions for the individual engaging in the behavior

3. Problem Behaviors Reported in Individuals with Autism/Asperger’s • Meltdowns for no “apparent reason” • Non-compliance • Lack of production (e.g. incomplete assignments) • Lack of motivation • Slow pace • Inattentiveness • Inapropriate comments to peers/adults • Aggression towards others • Property destruction • Difficulty with transitions • Talking out in class • Dominating conversations • Difficulty with changes in routines/schedules • Self-injury • Talk about hurting self or others • Excessive self-stimulation

4. Why is Problem Behavior so Prevalent in Autism? • Not a byproduct of autism, but rather many are learned due to ineffective means to get needs met • Difficulty with communication • Some language, but not as efficient as problem behavior • Social deficits • Difficulty interacting w/peers seeking attention • Difficulty knowing how to initiate, maintain, end or avoid social interactions • Restricted interests • Insistence on sameness • Viewing the world through laser beam rather than flashlight

5. Functional Assessment

7. Functional Behavior Assessment • Assists in identifying variables influencing behaviors • Function can be determined by • direct observation, • interviews with the child or those who know him/her well • functional analysis

8. Possible Functions • Obtain Desired Events • Obtain Internal Stimulation (Automatic Positive) • Visual stimulation • Endorphin release • Obtain Attention (Social Positive) • Smiles, Hugs, Frowns • Obtain Activities or Objects (Access to Tangibles/activities) • Escape/Avoid Undesirable Events • Escape/Avoid Internal Stimulation (Automatic Negative) • Sinus pain, itching, hunger • Escape/Avoid Attention (Social negative) • Smiles, hugs, frowns, correction • Escape/Avoid Tasks and Activities • Hard tasks, change in routine, unpredictability

9. Determining the Function of Problem Behavior • Setting • Does the behavior occur in specific settings? • Does the behavior occur in all settings? • Setting Event • Was the child sick? • Was the child hungry? • Did the child have an argument with someone earlier in the day? • Antecedent • Was the child given an instruction to do something? • Was the child alone or being ignored at the time of the behavior(s)? • Did the child want something that was not available at the time?

10. Determining the Function of Problem Behavior • Behavior • What did the behavior look like? Be specific. Use words like hit, screamed, kicked rather than aggressive, angry, upset or frustrated. • Was it one or more behaviors? • Consequences • Was the child reprimanded?

11. Attention as a Function of Problem Behavior • Quality of attention? • Any attention? • Peer attention? • Adult attention? • Undivided attention • High intensity attention? • Physical attention? • Certain person’s attention? • Duration of attention and between instances of attention

12. Escape or Avoidance as a Function of Problem Behavior • What is individual escaping? • Demand too challenging? • Task too boring? • Demand centered around non-preferred activities? • Demand associated with certain type of stimulation? • Social demand? • Specific to certain person? • Demand too long?

13. Access to Desirable Object, Activity, Food • What activities or items does the individual get? • Does behavior occur when time to give up item? • Does behavior occur when he/she needs to wait for item? • Does behavior occurs when it’s time to share? • Does behavior occurs when he/she needs to take turns

14. Automatic Reinforcement as Function • What is sensation individual is seeking? • Is behavior related to medical condition?

15. Assessment Tools • Functional Assessment Screening Tool (FAST) • Motivation Assessment Tool (MAS) • Direct Observation (A-B-C Analysis, Structured A-B-C Checklist) • Functional Analysis (experimental manipulation of consequences)

16. ABC (Antecedent-Behavior-Consequence) Analysis Form

18. Function-Based Intervention • Linked to the function of problem behavior as identified by the functional behavior assessment • Based on the basic principles of behavioral science • Plan make behavior problems “irrelevant, ineffective and inefficient.” • General Rule: Must teach a replacement behavior for every behavior to decrease

19. Make Behaviors “Irrelevant” • The child no longer needs to engage in problem behavior to meet his wants or needs • Example: A child engages in attention-getting behavior while his mother prepares dinner. The intervention may include asking the child to help set the table while his mother cooks. The attention-getting behavior may decrease because his mother is providing attention while he helps her. This makes the problem behavior “irrelevant.”

20. Make Behaviors “Ineffective” • Problem behaviors no longer enable the child to achieve the function of the behavior. • Example: A child who tantrums when he wants a snack before dinner is told by his parents that he has lost snack for the remainder of the day and he will have the opportunity for snack the following day. The problem behavior becomes “ineffective” at getting snack before dinner.

21. Make Behaviors “Inefficient” • Appropriate/desired behaviors should be made more efficient than problem behaviors. • Example: A child tantrums to avoid doing chores, which results in a delay or avoiding the chores about 50% of the time. His tantrums are effective, but require much physical effort. When he is taught to say “break” or “I’m finished now,” his problem behaviors diminish to near zero levels because the “appropriate” behaviors result in immediate termination of the undesired activity.

22. Prevention Strategies • Alterations to the environment that make challenging behavior irrelevant • Why try to prevent or avoid situations that may trigger problem behavior? • Reduces child’s or family’s stress • Allows time to teach appropriate replacement behaviors • Replacement behaviors should be taught at other times • Social Stories (see example) • Short story written from individual’s perspective • Describes situation appropriate responses to difficult/new situations • Provides rationale for why the individual should do or say in a social situation

23. Prevention Strategies (Making Behaviors Irrelevant) • Usually involves making changing physical setting of environment • Enriching environment • Providing individual with more information or adaptive strategies • Increasing predictability • Providing choices • Won’t resolve challenging behaviors, but may reduce individuals need to use challenging behavior while learning appropriate skills

24. Prevention Strategies • Priming (video modeling, roleplay, or social scripts) • Often used to teach appropriate social/play skills • Can be used with Social Stories to prepare for difficult/new situation • Visual schedules/task lists (written, photographic, symbols, combination) • Increases predictability (see example) • Clarifies expectations for common routines, activities, or skills within the home and community (see example) • Rule Cards (see example) • Power Cards • Rule cards using favorite cartoon characters, sports idols, etc. to communicate rules

25. Prevention Strategies • Transitions • Visual schedules • Warn (e.g. verbally, timer, etc.) • Allow closure (e.g. complete computer game or finish watching television show) • Morning routine • Prepare as much as possible night before • Lay out clothes • Organize school supplies, etc. near door • Provide incremental alarms for awakening (e.g. 10-minute alarm, 5 min, 1 min, etc.)

26. Prevention Strategies • Mealtimes • For picky eaters, introduce 1 food at a time and 1 bite at a time • May need slower pace for some individuals • Tolerating new foods on table, plate, smelling food, touching food with fingers, touching food to lips, placing food in mouth, and then swallowing. • Research indicates may take at least 2 weeks to consistently accept new food • Keep mealtime consistent • May need weekly menu or meal schedule • Serve individual’s food with the rest of family • Make clear expectations to eat with family at table • Some may need frequent breaks away from table

27. Prevention Strategies • After school routine • May need down time to “decompress” • Others may need time to “burn” excess energy (e.g. physical activity) • Bedtime • Provide advance warning of upcoming bedtime • Establish consistent routines • Allow to engage in quiet activities prior to bedtime (e.g. reading, etc.) • Family outings • Social Stories • Gradually acclimate to new activities

28. Prevention Strategies • Change situation to reduce need for individual to engage in behavior • Remedy physiological ailments • If overstimulated, overwhelmed in a situation • Allow individual to take/request frequent breaks from the situation • Gradually introduce exposure to similar situations over time • Warn of upcoming event • Inform individual that preferred/positive activity will follow

32. Prevention Strategies • Motivate compliance and cooperation by • (a) allowing the child to make choices, • (b) give positive praise for compliance, • (c) use high-probability requests • Pre-correct behaviors (before the problem behavior occurs) by reminding the child • (a) how to ask for attention, • (b) what behaviors are expected at a relative’s home, • (c) how to share a favorite toy with a sibling. • Use safety signals to inform the child that an activity is near completion

33. Replacement Behaviors • Require less effort • Easily understood by others • Results in the same “rewards” as the problem behaviors • Ex. Attention is provided immediately when the child says, “Mom” rather than hitting the mother or throwing an object

34. Factors Affecting Replacement Behaviors • How frequently behavior is reinforced • How quickly behavior is reinforced • How much effort is required

35. Teaching Replacement Skills • Select skills to teach • Consistency and repetition • Skills taught throughout day when not engaging in challenging behavior • Identify opportunities in daily routines

36. Prevention Strategies: Obtain (e.g., attention, object, activity) • Provide more frequent attention/reinforcement • Activity schedule • Contingency for activity completion • Schedule time with adult or peer • Scheduled access to desired object/event • Choice of activity, material, and/or partner • Use timer, alarm to delay reinforcement

37. REPLACEMENT SKILLS: Obtain (e.g., attention, object, activity) • Follow schedule • Participate in routine • Self-management • Request help • Teach delay of reinforcement • Request attention • Choice • Ask for a hug • Ask for a turn • Ask for item

38. RESPONSES TO PROBLEM BEHAVIOR: Obtain (e.g., attention, object, activity) • Redirect/cue to use appropriate “new replacement skill” • Cue with appropriate prevention strategy • State “exactly” what is expected • Offer choices • Use “wait-time” • Praise/reinforce when replacement skill is performed • Respond in a way that does NOT maintain problem behavior • Minimize attention while responding to severe behavior • Ignore minor behavior (“Planned ignoring”)

39. Prevention Strategies: Escape (e.g., activity, demands, social interaction) • Modify task length, • Modify expectations • Modify materials • Modify instructions, • Modify response mode • Break task down • Provide choice • Modify seating arrangements • Reduce distractions • Provide activity schedule • Select reinforcer prior to activity • Incorporate child’s interest • Use timer • Self-management system • Provide peer supports • Add manipulatives • Provide visual supports • Follow least preferred with most preferred

40. Add Predictability to the Demand • Prepare for upcoming demand • Verbal warning of upcoming demand • Visual schedule • Increase clarity of task • Review expectations/requirements of demand

41. Eliminate Signal for Escape or Avoidance • Complete task in new setting • Change task materials • Change wording of task • Change people involved with task

42. Increasing Compliance • High probability instruction sequence • Behavioral momentum • Begin with several instructions that are consistently followed • Issue instruction(s) • Reinforce (praise, thanks) • Issue difficult instruction • Reinforce if child complied • Interspersing simple and complex tasks • May begin with easy task (behavioral momentum) • Follow with more complex task • Reinforcement procedures (token system)

43. REPLACEMENT SKILLS: Escape (e.g., activity, demands, social interaction) • Request break • Set work goals • Request help • Follow schedule • Participate in routine • Choice • Self-management • Say “No” • Say “All done” • Identify and express feelings • Use supports to follow rules • Anticipate transitions

44. Consequence Based Strategies for Escape/Avoidance • Differential Reinforcement • DRA (alternative) • DRO (omission/other) • DRI (incompatible) • Extinction • Punishment

45. RESPONSES TO PROBLEM BEHAVIOR: Escape (e.g. demands, activity, social interactions • Redirect/cue to use appropriate “new replacement skill” and then allow escape • Cue with appropriate prevention strategy • State “exactly” what is expected • Offer alternatives • Use “wait-time” • Praise/reinforce when replacement skill is performed • Respond in a way that does NOT maintain problem behavior

46. Stereotypy • Noninjurious behavior that involves repetitious and invariant movement of one or more body parts that serves no apparent social function and a high time allocation (Lewis & Baumeister, 1982). • Literature review (Rapp & Vollmer, 2005) concluded that stereotypy often maintained by automatic positive reinforcement • Stereotypy persisted in absence of social consequences • Noncontingent access to preferred objects was correlated with reductions in stereotypy • Sensory extinction produced temporary reductions in stereotypy • Contingent access to stereotypy functioned as reinforcer for other behavior • Restricted access (deprivation) produced increases in time allocation to stereotypy

47. Noncontingent access to matched stimulation • Continuous access to preferred, matched stimulation decreased stereotypy and other automatically reinforced behaviors • Matched stimuli selected by examining behavior and hypothesizing about possible sensory consequences • Systematic stimulus preference assessments using leisure materials with similar stimulation were conducted • Leisure materials • Immediately reinforcing • Requires little effort to produce reinforcement • May require prompts to engage in leisure item

48. Contingent Access to Matched Stimulation • Stereotypy decreased when matched stimuli provide for alternative behavior (e.g. task completion) • Need additional treatment components to be more effective than NCR • Blocking or interrupting stereotypy may increase effectiveness of DRA by shifting response allocation to matched stimulation

49. Removing Antecedents for Stereotypic Behavior • Presences of specific items may set occasion for stereotypy or other automatically reinforced behaviors • Identification and removal of antecedent influences can be effective intervention • Some studies indicate that reducing or restricting access to one form of stereotypy may reduce other forms of stereotypy • However, blocking or reducing access to certain responses may increase stereotypy

50. Differential Reinforcement of Omission/Other Behavior (DRO) • Reinforcing any other response other than a target behavior for a specified interval of time • Provide reinforcement at the end of interval if target response does not occur • No reinforcement provided at end of interval in which problem behavior occurs • Minimal side effects as seen with punishment and extinction (e.g. agitation, aggression, escape avoidance)