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Intervention for Young Children Challenging Behaviors UCONN UCEDD

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Intervention for Young Children Challenging Behaviors UCONN UCEDD Powered By Docstoc
					          v
Intervention for Young
Children’s Challenging
      Behaviors
   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
     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
   Some Changing
   Perspectives on
     Autism and
Challenging Behaviors


                        4
 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
  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
Changing Perspectives (mid 1980s ---)


 I. Challenging behaviors are not “part of autism”
 II. 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
 III. Children with autism are at high risk for
      developing challenging behaviors due to
      difficulties with learning, communication, and
      perception
                                                       7
           Changing Perspectives
                    (continued)


   Intervention involves PREVENTING
    problem behaviors from developing or
    occurring by:
    I.    Arranging the environment so that
          challenging behaviors are unnecessary (and
          desired behaviors are encouraged), and
    II.   Teaching skills needed to navigate and
          control the social environment
                                                       8
Positive Behavior
    Support
Level 3 procedures for children
with serious challenging behavior



                                    9
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
       PBS – Components


1. Team-building, Goal Setting
       Person-Centered Planning
2. Functional Assessment of Challenging
   Behavior
3. Individualized Behavior Support Plan
4. Implementation
5. Evaluation
                                          11
         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
          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
  Prevent-Teach-
    Reinforce
        v



  A Standardized and
  Individualized Model
For Challenging Behaviors
          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
            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
        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)
          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
 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
          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
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.
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
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
“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
  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
           “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
            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.
        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
     Teacher’s Ratings of Mike’s
             Behavior
                              Baseline                          PTR intervention

                      5



Disruptive Behavior   4


                      3


                      2
                                                                   Disruptive Behavior
                      1

                      5



Engagement            4


                      3


                      2
                                                                      Engagement

                      1

                      5



Task Completion       4


                      3


                      2
                                                              Independent Task Completion

                      1
                          5     10       15   20   25         34     39     44     49
                                                   Sessions
      Teacher’s ratings of Jose’s
              Behavior
                                   Baseline                                    PTR Intervention

                       5




Following Directions   4

                                                                                          Following Directions
                       3


                       2


                       1

                       5



Appropriate            4



 Interactions          3

                                                                                        Times to Interact
                       2


                       1

                       5
                                                                                        Off Task

                       4



Off Task Behavior      3


                       2


                       1
                           1   2   3   4   5   6   7   8   9 10     11 12 13 14 15 16 17 18 19 20 21 22 23

                                                                  Sessions
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
        Ali’s Disruptive Behavior -
                 Frequency
 Ali Disruptive behavior

       Baseline            Intervention
20
                                          Frequency Disruption


15



10



 5



 0
 Ali’s Engagement - Duration
      Baseline
100
                           Duration E
 90
 80
 70
 60
 50
 40
 30
 20
 10
  0
  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
             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
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
       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
Problem Behavior (% Intervals)
     Josh




      Alex




     Jasmine
Engagement (% Intervals)
  Josh




  Alex




 Jasmine
Working with Families

       Issues and Considerations
        Related to Families and
 Young Children with Serious Challenging
               Behaviors
  Family-Professional
    Relationships

Considerations Related to Functional Assessment
       and Function-based Interventions



                                                  42
   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
                  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
         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
                      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
  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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