Intervention for Young Children’s Challenging Behaviors

1. Intervention for Young Children’s Challenging Behaviors

2. Challenging Behaviors • Destructive Behaviors • Aggression; SIB; Property Destruction • Disruptive Behaviors • Long tantrums; Loud, Repetitive Noises; Running, etc. • Irritating & Interfering Behaviors • “self-stim;” repetitive and perseverative speech or actions, etc. • Social Withdrawal • Lack of responsivity and initiations 2

3. Importance of Challenging Behaviors • Barrier to Inclusion, Community Participation, and Social Opportunities • Most Significant Impediment to Social-emotional Development and Education • Present Physical & Emotional Risk (and reduction of quality of life!) for Child and for Families, Teachers, Other Professionals, Peers and Friends --------------- • Need to Prevent/Resolve Challenging Behaviors as Early and as Thoroughly as Possible 3

4. Some Changing Perspectives on Autism and Challenging Behaviors 4

5. Early Perspectives (1960s ---) • Challenging Behaviors are “part of autism” • Not “diagnostic”, but “characteristic” • Intervention = contingency management • Largely reactive • Reinforcement (DRO) for desired behavior (or absence of problem behavior) • Time out, extinction, or punishment for problem behavior 5

6. 1st Generation Effects Often, short-term beneficial effects But usually without maintenance or generalization Occasionally ineffective, leading to escalating intensity of rewards and negative consequences 6

7. Changing Perspectives (mid 1980s ---) Challenging behaviors are not “part of autism” Challenging behaviors: (1) are maladaptive ways of responding to inadequacies in the environment, (2) occur due to lack of socially-adaptive skills for controlling environment Children with autism are at high risk for developing challenging behaviors due to difficulties with learning, communication, and perception 7

8. Changing Perspectives (continued) • Intervention involves PREVENTING problem behaviors from developing or occurring by: • Arranging the environment so that challenging behaviors are unnecessary (and desired behaviors are encouraged), and • Teaching skills needed to navigate and control the social environment 8

9. Positive Behavior Support Level 3 procedures for children with serious challenging behavior 9

10. Positive Behavior Support An approach for resolving challenging behaviors that is based on person-centered values, empirical data and a multi-disciplinary scientific orientation A pragmatic, data-based problem-solving approach for enhancing development and improving quality of life in natural, everyday contexts A preventative approach emphasizing teaching and environmental redesign 10

11. PBS – Components • Team-building, Goal Setting • Person-Centered Planning • Functional Assessment of Challenging Behavior • Individualized Behavior Support Plan • Implementation • Evaluation 11

12. Core Elements of a Behavior Support Plan (Linked to Assessment Information) Prevention Strategies – Arrangements of antecedent environment Teaching Strategies – Building skills to teach throughout the day to replace the challenging behavior Reinforcers – Providing effective reinforcement schedules (note --- this is the contingency management component) ----------------- + Evaluation strategies 12

13. Evaluation All support plans should have some form of evaluation, so team knows if plan (or parts of a plan) is working as intended Evaluation can focus on desired outcomes AND on extent to which elements of plan are being implemented Evaluation should NOT be complicated or effortful, but it should be valid…and valued 13

14. Prevent-Teach-Reinforce A Standardized and Individualized Model For Challenging Behaviors

15. Purpose of P-T-R • To provide a standardized, easy-to-use model with which to apply research-based, behavioral strategies for addressing serious problem behaviors. • For all students with serious problem behaviors --- special education, general education. • Intended for pre-K through high school, however the bulk of research has been conducted in grades K-8

16. PTR Model • Research-based Practices • Assessment and Intervention • Team-driven decision-making • Steps are scripted as much as possible • Each step ends with self-evaluation (checklist) • Selection of interventions is menu-driven • Entire process is manualized

18. The PTR Model • 5-Step Process • Developing a Team • Establishing clear goals (short and long term) • Functional Assessment • Designing and Implementing a Behavior Intervention Plan • Evaluation (ongoing) and Revision (as necessary)

19. Step 1: Teaming • Purpose: Establish group involved with developing and implementing intervention • Members: Teacher(s), Para-educator(s), School professionals, Family members, etc. • 3-8 individuals • At least one person (e.g., administrator) who can deliver resources and develop/interpret policies • At least one person knowledgeable in behavioral theory and principles and experienced in FA and BIP

20. Step 2: Goal Setting and Data Collection • Purpose: (1) to establish clear long and short-term objectives; (2) to establish a unified vision for desired outcomes; (3) establish feasible strategies for valid data collection • Kinds of goals: (1) Reducing specified problem behaviors; (2) Develop academic competencies; (3) Improve social competencies, problem solving, and interpersonal relations/interactions

21. Data Collection • Data instrument(s) decided by team • Recommendations are often for Behavior Rating Scales – • Usually 5-point scales with specific anchors indicating frequencies, durations, and/or intensities of problem behavior

22. Step 3: Functional Assessment • Purpose: Identify function(s) and antecedent variables influencing target behavior(s) • Strategy: (1) Detailed, structured questionnaires for each team member focused on antecedent variables, functions, and maintaining consequences. (2) Team meeting to produce consensus. • Outcomes: Hypothesis statement(s) with each component specified.

23. Step 4: Intervention Design and Implementation • Purpose: To build a Behavior Intervention Plan (BIP) based on FA information • Features: • (1) BIP must include at least one strategy from each of the 3 components: Prevent, Teach, Reinforce • (2) Menus of research-based strategies for each component; forms and templates to build plan • (3) Selection of strategies is made by team, based on FA and on team’s ability/resources to implement

24. Examples of “Prevent” Strategies • Increase “comprehensibility” of environment --- picture schedules, transition objects, lists • Choice making • Add stimuli associated with desirable (prosocial) behavior • Remove stimuli associated with challenging behaviors

25. “Teach” - Replacement Skills Can be in any form (e.g., words, gestures, pictures) that is effective Should be appropriate to developmental level (but more efficient than the challenging behavior!), and consistent with overall plan for language development Use natural teaching opportunities throughout day

26. Functional Communication Training Determine function of the behavior within a routine Select a functionally equivalent communicative behavior to replace Prompt the child to use the replacement behavior Reinforce the use of the replacement behavior

27. “Reinforce” • Be sure reinforcers are strong (and as natural as possible) for desired behavior • Be sure reinforcers do not follow challenging behavior • May need reinforcer assessment to determine what is really effective

28. Evaluation • Purpose: (1) Measure effects of intervention on problem behaviors and academic/social behaviors; (2) Measure fidelity of implementation • Features: Simple (easy-to-use) instruments --- behavior rating scales; checklists; etc.

29. Research on PTR • Randomized Control Group Evaluation • Including students with ASD • Iovannone et al. 2009, Journal of Emotional and Behavioral Disorders • Case Study (A-B) Analyses • Behavior rating scale (BRS) data • Direct observation data • Dunlap et al., 2010, Journal of Positive Behavior Interventions • Multiple Baseline Across Participants (with ASD) Design • Strain et al., in preparation

30. Teacher’s Ratings of Mike’s Behavior Disruptive Behavior Engagement Task Completion

31. Following Directions Appropriate Interactions Off Task Behavior Teacher’s ratings of Jose’s Behavior

32. Ali (Iovannone et al., unpublished) • 6 years old • Autism; nonverbal; significant intellectual disability • Self-contained Spec Ed classroom • BIP.. • P: curricular modifications; small task steps; choice making; etc. • T: Request attention; Request break; Delay of SR+ • R: Music as reinforcer; 30s intervals

33. Ali’s Disruptive Behavior - Frequency

34. Ali’s Engagement - Duration

35. Multiple Baseline Analysis - Participants • 3 students with ASD; Josh, Alex, Jasmine • Kindergarten; Grade 2; Grade 4 • Cognitive functioning = Typical to mild delay • All had verbal language, but often not used effectively • Majority of time in general education classes • All had frequent problem behaviors, and were identified as students with most serious problems in their classes • property destruction; disruptive behavior, outbursts, crying, some aggression

36. Procedures • Baseline (services as usual) • PTR = Independent Variable • Teaming, goal setting, data collection (BRS) • PTR (Functional) Assessment • Individualized Behavior Intervention Plans • Data for study obtained from video recordings • 15 minute sessions in regular classroom context • 10-second time samples • % of samples with occurrence of behavior • Dependent Variables • Problem Behavior • Engagement

37. Behavior Intervention Plans • JOSH • P = explicit expectations on card • T = instruction on expectations; self-management • R = self-recruited SR+; praise for following expectations; “tokens” with stickers/treasures as back ups • ALEX • P = written schedules • T = self-management (using lists for independent responding) • R = sea shells + time to examine his sea shells

38. BIPs (continued) • JASMINE • explicit expectations/instructions for social interaction • instruction on social interactions; problem solving; and self-monitoring (journal) • “CIA (caught in the act)” credits

39. Problem Behavior (% Intervals) Josh Alex Jasmine

40. Engagement (% Intervals) Josh Alex Jasmine

41. Working with Families Issues and Considerations Related to Families and Young Children with Serious Challenging Behaviors

42. Family-Professional Relationships Considerations Related to Functional Assessment and Function-based Interventions 42

43. Family Involvement and Outcomes Strong, functional families are children’s greatest resource Goal is to help families develop knowledge (= power), competence, confidence, and comfort in areas related to their child’s development, education, and support Family support comes in many different forms and flavors --- Information, friendship, referrals, respite, training, counseling, helping, understanding, etc., etc. But a vital support for all families is providing knowledge and practical tools needed to help their child 43

44. Families Owners of unique body of information (data) that can be vital to comprehensive FA Child history Child’s ecology Child’s preferences Family systems --- goals, preferences, routines, values As intervention agents, it is essential to incorporate input Contextual fit; commitment Families as unique and individualized systems 44

45. MAIN MESSAGES When working with families (and children in family contexts), it is crucial to: Establish rapport and trust Include key family members in all processes of assessment and intervention Behavior analysts are the experts in behavioral theory and practices; Family members are experts in most everything else Family choice is the main determinant of what goes into a behavior intervention plan Respect it! 45

46. ISP(Fox & Dunlap) Individualized Support Program (Early Intervention – Positive Behavior Support) A family-centered model designed to: Help families build skills in PBS, and confidence in problem solving Help children gain competencies (e.g., communication) to promote optimal development Help children reduce problem behaviors 46

47. Brendan’s Support Plan Assistance with comprehending the environment Picture schedules Social Stories Clear instructions and expectations Careful teaching of skills in routines Assistance with communication and self-control Etc.. 47

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