11/6 Behavioral Supports

Question 1

Behavioral challenges in 50%+ of those with ID. As many as 64% have multiple challenges.

Why?

Answer 1

Stressful. Difficulty communicating needs.

Question 2

Do people engage in problem behavior BECAUSE they have ID?

Answer 2

NO!

Problem behavior serves function and purpose.

Question 3

Form of behavior

Answer 3

What it looks like

ex: words, sentences, eye gaze, pulling adult, crying, biting, tantrums

Question 4

Function of behavior

Answer 4

Reason or purpose of behavior

ex: access object, activity, person, escape/avoid demands, escape/avoid activity, escape/avoid person, request social interaction, gain attention, request/access sensory stimulation, escape/avoid sensory stimulation.

Question 5

Why do we need a systematic way to provide intervention?

Answer 5

Behaviors have multiple functions and may serve different functions across individuals and settings. (Tasse, 2006)

Question 6

Applied Behavior Analysis (ABA)

Answer 6

focuses “on the environmental contingencies that are affecting behavior”

involves identifying the variables maintaining behavior, changing those variables when needed, and teaching new, appropriate behaviors

Question 7

Positive Behavioral Supports (PBS)

Answer 7

Emphasizes redesigning the environment to address the environment-behavior mismatch and using antecedent interventions to teach skills and create systems of support

Strategies you can implement widely. Develop annectant interventions on wide scale, provide systems of support. Try to find environment-behavior mismatches, but more wide than just individual client basis. As you move up continuum, find ABA at top of pyramid (individualized)

Question 8

How is PBS similar to ABA?

Answer 8

Empirical approach to interventions (data!!!)

Conceptual Foundation (operant learning)

Assessment and intervention Procedures

Question 9

How is PBS different from ABA?

Answer 9

PBS implemented in complex systems

Outcome variables more broad

Focused on systems change

Question 10

What do the ABCs of behavior stand for?

Answer 10

Antecedents that might be triggering/causing

Behavioral presentation

Consequences that might be maintaining/reinforcing the behavior

Question 11

Find the ABCS!

teacher presents difficult math worksheet, which leads to kid’s work refusal/tantrums, which leads to teacher sending kid out of the classroom for the rest of math class.

Answer 11

A: worksheet, B: tantrum, C: hallway

Question 12

Find the ABCS!

dad is playing with catch with his kid. Dad gets phone call and stops playing to answer it. Kid starts calling for dad to continue playing and throws ball at dad. Dad ends phone call and resumes playing with kid.

Answer 12

A: phone call, B: throw ball, C: dad resumes playing

Question 13

How do you identify the function of problem behavior? SOME (really MOSE but ok)!

What is motivation operation?

What are setting events?

Answer 13

MOTIVATION OPERATIONS: variables in the environment that alter the potency/attractiveness of the consequence AND alter the frequency of behavior that previously resulted in access to that consequence.

Setting Events are stimuli that impact subsequent stimulus-response relationships more broadly (e.g., quality of rapport between caregivers and client)

Question 14

What are motivating operations basically?
What else plays a role?

Answer 14

something in environment makes something more or less rewarding (or more or less unpleasant and changes in behavior) Examples: hunger (time haven’t eaten), tired, cold, illness.

Mental health and trauma play roles

Question 15

Four term contingency:

Answer 15

1. motivating operation,
2. antecedent,
3. behavior,
4. consequence.

Question 16

Find the MO!

Revisit Example 1:Teacher tells the class to work on one problem at a time on their own then they’ll come together as a class to walk through each problem. Student grumbles while working on each problem and heaves several big sighs, but gets support after each problem.

What was the MO?
Did it increase or decrease the potency of being sent out of class?

Answer 16

What was the MO? The way they are going through the worksheet.

Did it increase or decrease the potency of being sent out of class? Decrease. (?)

Question 17

Find this MO!

Teacher has been lecturing for an hour on a difficult subject in math. Teacher presents difficult math worksheet, to be worked on independently and quietly for the next half hour.

…How attractive is the option of being sent out of class in this scenario?

Answer 17

More attractive.

Question 18

ABC example:

Juan is considered a loner and doesn’t have friends at school. Sometimes Juan plays a board game or does some kind of activity with his classmates. If his classmates do or say something that is not consistent with the rules of the game/activity, Juan shouts at them and can sometimes get to the point of flipping over materials. In response, his peers might scoff at him or make remarks about how uptight he can get. His teacher usually joins in at some point and talks with Juan trying to calm things.

Answer 18

A: classmates don’t follow rules B: Juan flips tables/shouts C: peers make remarks, teacher join in to help.

Question 19

ABC Example:

Juan has just spent a whole morning on a field trip with his classroom. He was paired with a buddy who was really nice to him. When they get back, he played Candyland with a group of classmates. His peers messed around and skipped some steps. He noticed this and said something about it, but didn’t say or do anything else (e.g., no flipping board game over).

What was the MO? Did it increase or decrease the potency of the reinforcement?

Answer 19

What was the MO? Did it increase or decrease the potency of the reinforcement? MO: friend who was nice. …decrease reinforcement? (Check this)

Question 20

The function of behavior is what the person ___ for engaging in behavior.

We engage in behavior for what reasons?

Answer 20

When we engage in a behavior…

we get access to something (like attention, or a cool toy) OR we get out of something (like avoiding food we don’t like)
The function of the behavior = what the person gets for engaging in the behavior.

Getting access to attention –> function is attention (“attention-maintained”)

Getting out of something –> function is escape (“escape-maintained”)

Question 21

Positive reinforcement

Answer 21

You do something
You get what you like
You are more likely to do the thing in the future

Question 22

Negative Reinforcement

Answer 22

You do something
You escape or avoid what you hate
You are more likely to do the thing in the future

Question 23

Positive and Negative Reinforcement have in common?

Answer 23

More likely to do behavior

Question 24

Positive reinforcement is the ____ of stimulus that increases likelihood behavior will happen again.

Example: A: parent presents bite. B: Child takes a bite. C: parents hugs him and says good job. Kid takes more bites.

What is the behavior and what is the response or consequence?

Did Robert get access to something or out of something?

What is the function of his behavior?

Answer 24

addition

Bit and hug
Access to hug
Function is to get hug and attention.

Question 25

Example: parent presents bite. Child takes a bite. But throws tantrum Parent lectures on why he needs to be calm. Kid has more tantrums.

What is the behavior and what is the response or consequence?

Did Timmy get access to something or out of something?

What is the function of his behavior?

Answer 25

B: tantrum C: lecture

Got attention. Got access, positive reinforcement

Behavior to get attention.

Question 26

Negative reinforcement: The ____ of a stimulus that increases the likelihood that the behavior will occur again.

Example: parent presents bite. tantrum. take food away. Kid has more tantrums.

What is the behavior and what is the response or consequence?

Did Willy get access to something or get out of something? Get out of eating.

What is the function of his behavior?

Answer 26

Removal

B: tantrum C: food away

Get out of eating. Negative reinforcement

Get out of eating unpleasant foods.

Question 27

Example: A: parent presents bite. B: “accidently” knocks over bowl, C: parent ends meal. Kid has more clumsy behaviors again.

Did Louie get access to something or out of something?

What is the function of his behavior?

Answer 27

Out of meal time. Negative reinforcement

Function to get out of meal time.

Question 28

Positive or Negative Reinforcement?

Mahmoud is working on a history test. 10 minutes in, he starts crying and says he has a stomach ache. The teacher sends him to the nurse. Mahmoud often visits the nurse on test days.

Answer 28

negative

Question 29

Positive or Negative Reinforcement?

Ari is chatting with his friends in the back of the classroom during a presentation. His teacher reprimands him loudly in front of the class. He quiets down for a minute but then resumes talking with his friends

Answer 29

positive

Question 30

Positive or Negative Reinforcement?

As soon as her music teacher begins playing music, Latisha runs out of the room. Her teacher always runs after her and asks what is wrong. She is often able to get Latisha back in her classroom and lets her act as her “assistant” and pass out materials.

Answer 30

positive

Question 31

Positive or Negative Reinforcement?

Harriet’s brother keeps singing and won’t stop. She keeps asking him to stop but he doesn’t listen. She finally hits him on the head with her backpack. He cries and runs to his room.

Answer 31

negative

Question 32

A process for developing an understanding of a person’s behavior and how behavior is governed by their environment is ___________.

Answer 32

Functional Behavior Assessment (FBA)

Question 33

Functional Behavior Assessment (FBA) results in identification of the ___ and ___ of behavior.

Answer 33

Purpose and function

Question 34

Indirect FBAs include _____

Direct FBAs include ____

Answer 34

Indirect FBAs include parent/teacher/client report

Direct FBAs include direct observations

Question 34

The four steps of the functional behavior assessment process

Answer 34

Interview, Observation, Data Collection, Behavioral Hypotheses

Question 35

Things done during interview stage

Answer 35

• Medical/Mental Health
  
  • Define behavior (describe what you see)
  • Describe frequency and intensity
  • Explore possible motivation operations
  • Identify predictors
  • Identify maintaining consequences
  • Identify current communicative functions
  • Describe efficiency of the behavior
  • Describe previous efforts
    Identify possible reinforcers

Question 36

Importance of addressing medical etiology and role of possible mental health conditions:

Answer 36

Once medical, dental, or pharmacological factors ruled out or are treated-can proceed with assessment.

Mental Health Conditions do not negate the importance of FBA but may act as a setting event or MO

Question 37

Importance of addressing trauma/Trauma-informed care:

Answer 37

Avoid re-traumatization
Emphasis on safety

Question 38

Person-Environment Mismatch is about the contribution of…

Answer 38

underdeveloped skills

important to know language (expressive/receptive), cognitive, and adaptive skills

Question 39

Data Collection and Operational definition.

Answer 39

Physical aggression” is vague. Be specific for your client/patient and what it looks like. Might have similar behavior that doesn’t fit definition of behavior.

Observable, Measurable, (Frequency, Duration, Rate), measurement good for behavior.

times, places and circumstances in which the problem behavior(s) occurs and does not occur

Identification of the factors that precede the occurrence of the problem behavior (i.e. antecedents).

Identification of the factors that follow the occurrence of the problem behavior (i.e. consequences).

Question 40

What is the goal of operation definition?

Answer 40

a stranger could walk in, look at the definition, and be able to identify the behavior when they see it.

Question 41

Why do we want operational definition?

Answer 41

we want an ACCURATE reading of how often the behavior is occurring.

Question 42

Is it operational?

Andrew gets really mad when he has to do homework

Answer 42

No

Question 43

Is it operational?

Tiffany engages in off-task behavior during English, defined as talking with peers and orienting her head away from the instructor.

Answer 43

Yes

Question 44

Is it operational?

Robert engages in aggression when presented with non-preferred food.

Answer 44

No

Question 45

Is it operational?

Robert engages in aggression, defined as hitting others with an open palm or closed fist, and sometimes accompanied by a negative vocalization (e.g., “no!”)

Answer 45

Yes

Question 46

Descriptive analyses often involve what?

How might this look?

Answer 46

direct observation of behavior under naturally occurring (uncontrolled)conditions in an attempt to identify environmental correlates of problem behavior.

Record in real time

Scatter plot of when behavior occurs throughout the day. Not as often with adults.

Question 47

What is systematic experimental manipulation of environmental characteristics?

Answer 47

functional analysis

Question 48

Why do you want to evoke problem behavior during functional analysis?

Answer 48

to determine under what conditions it occurs (like allergy test).

Social-positive reinforcement
(Attention/Access to tangible)

Social-negative reinforcement (Escape/Avoidance)

Automatic reinforcement (Alone condition)

Question 49

What do you do to look at attention and escape reinforcements?

Answer 49

Attention: After identifying the specific challenging behavior of concern, during this component of an FA, the therapist will only give attention following that challenging behavior.

Escape: After identifying the specific challenging behavior of concern, during this component of an FA, the therapist will only remove demands following that challenging behavior

Question 50

Variations of FAs and trauma informed treatment 1:

Interview-informed, synthesized contingency analysis or IISCA.

Answer 50

Practical Functional Assessment (Hanley et al, 2014)

From interview develops specific conditions to client. Individualized

Question 51

Variations of FAs and trauma informed treatment 2:

Standard Protocol

Answer 51

HRE (Happy Relaxed Engaged)- focus is on rapport building and trust

Focused on not starting with placing demands on individuals. Building trust first. Patient doesn’t have to if they don’t want to. Want to choose to participate.

Question 52

Variations of FAs and trauma informed treatment 3:

Behavioral skills training

Answer 52

Functional Communication Training with Delay Training – start easy and let person get their way each and every time before slowly and intermittently introducing delays

Teaching don’t always get what you want when you ask for it.

Question 53

FA example will show you a graph of what.

Answer 53

Behaviors during attention alone demand and control conditions

Question 54

Hypothesis statement practice:

Billy will initiate a chase game by pulling the adult’s hand or positioning the adult. If the adult does not comply, Billy will cry loudly, scream, and bring his hands to his face or ears. Often the adult will comply with his request.

Answer 54

Statement: When adult does not play Billy’s game, he cries, screams, and brings his hands up. This behavior is typically followed by adults complying. The function on the tantrum is to get the adult to play the game.

Question 55

Hypothesis statement example:

When Marcia is asked to transition from an activity (e.g., watching television) to another activity, she will whine, cry, pretend to vomit, slap at the adult, and scream. When she does this, the adult lets her stay a little longer with the original activity.

Answer 55

When asked to transition, Marcia whines, cries, etc. This behavior is followed by adults letting her stay long. The function of the tantrum is to delay the transition.

Question 56

What do you do if you have trouble making hypothesis?

Answer 56

What would make the behavior stop?

Collect more data.

Same form but multiple functions?

Does it continue to serve another function?

Question 57

What are the interventions for problem behavior?

Answer 57

1.Antecedent/preventative strategies

2. Replacement behaviors
3. Consequence strategies

Question 58

Preventative strategies: Consistent Language

Answer 58

First______, Then_______

Give brief, clear, and concise directions. Use only the words needed to complete the task.

“Sean, sit down,” not “Come over here and sit in this chair.”

Question 59

Preventative strategies: Giving directions

Answer 59

Brief, Firm tone (not authoritarian, more direct and clear.

More appropriate for parents to give children firmer directions than it is for adults speaking to other adults).

State, do not ask a question

Word positively

Be specific

YES: “Please come to the dinner table.”
NO: “Tommy, do you want to come to dinner now?”

Question 60

Preventative strategies: recognize EARLY signs of escalation-clear and observable

Answer 60

at peak escalation they don’t listen to you, so intervene early.

Redirect to another activity

Reduce demands

Prompt to take a break

Question 61

Preventative strategies: Assume Trauma/Recognize signs of trauma and recognize metnal health changes

Answer 61

Trauma-Informed Care

Timely communication with counselors (if involved)

Adjusting supports as needed

Question 62

Preventative strategies: structured schedule and adjustments to schedule

Answer 62

Increased predictability and aids transition

Categorize as preferred, non-preferred
Non-preferred –> Preferred
Preferred –> Neutral

Adjust: length, difficulty, too crowded, loud, overstimulating.

Question 63

Preventative strategies: Behavioral Momentum

Answer 63

Start VERY basic

Do this (then tap your leg)

Light physical prompt to have them do it

Cheer like they did it perfectly on their own, can even reinforce with desired items

Do with another easy task-e.g., tapping table

Question 64

Preventative strategies: Demand Fading

Answer 64

Remove instruction and gradually reintroduce demands

Question 65

Preventative strategies: Choice-making

Answer 65

Give choices around the order of tasks; the type of tasks; the type of materials; length of time

Basically, the idea is that the client will complete the task, but they have some input on how to do it.

Question 66

Preventative strategies: Non-contingent attention and praise

Answer 66

Non-contingent attention - remember to give them attention, have it be there.
Scheduled or Random

Praise good behavior

Question 67

Preventative strategies: Visual Schedules / task breakdown

Answer 67

Allow individual to view upcoming activity

Increase understanding of sequence

Increases predictability

BREAKDOWN TASK TO MANAGEABLE CHUNKS

Question 68

Preventative strategies: Warning of transitions

Answer 68

Verbal: 19 mins, 5 mins, 1 min, count down

Visual Timers

First then visual strip (visualize: first we do this, then this)

Question 69

Replacement Skills involves finding a ___ for behavior using ______

Answer 69

substitute

Functional Communication Training (words, vocalization, signs, gestures, pictures)

Asking for break
Asking for attention
Asking for toy/food item/activity

Question 70

How do you teach replacement behavior?

Examples of teaching

Answer 70

Defining the behavior
Modeling the behavior
Role-playing the behavior
Giving feedback

Ex: asking to take a break. Inviting someone to play

Question 71

Escape Maintained Intervention: Differential Reinforcement

Answer 71

Give reinforcement when a kid appropriately tries to get out of an activity (like saying they want a 5-min break).

Give reinforcement when a kid is engaged in an activity they normally try to escape

Question 72

Escape Maintained Intervention: Extinction

Answer 72

Follow through on demands if client presents with problem behavior

Know when extinction is not appropriate! –> easier with smaller child

Question 73

Attention-Maintained Intervention: Extinction

Answer 73

Planned Ignoring for attention-getting behavior. Don’t reinforce problem behavior.

Minimal eye contact and talking

Neutral facial expression

Know when extinction is not appropriate!

Question 74

Attention-Maintained Intervention: Differential Reinforcement

Answer 74

Reward appropriate attempts to get attention and do not reward target behavior

Question 75

Attention-Maintained Intervention: Time out

Why only good for attention and not escape behavior?

Answer 75

This is a punishment. Developmental appropriate for young children, not older children or adults.

Why is time-out good for attention-maintained behavior, but not escape-maintained behavior? Time-out can function as an escape.

Question 76

What are concerns about ignore strategy in research and practice?

Answer 76

Ignore is imprecise
May be functionally irrelevant
Can be dangerous
May not be feasible
May not be socially valid
Overused in caregiver training

Question 77

What should we do if ignoring is imprecise?

Answer 77

Provide specific safety instruction

Devise interventions without extinction

Identify root cause

Account for consumer preference

Be technological in writing

Use precision to teach caregivers

Question 78

Token Economies

Answer 78

Earning tokens for behaviors we want to increase or for the absence of behaviors we want to decrease

Exchanging tokens for preferred items/activities (Menu of rewards from which to choose)

Response Cost (Loss of earned rewards or tokens for engaging in behavior we want to decrease)

Question 79

Restrictive Strategies used in behavioral support

1. Restrictive/preventative
2. Restrictive
3. Crisis management

Answer 79

1. Restrictive/Preventative (Lock on refrigerator; GPS tracking devices)
2. Restrictive Strategies (Time out; Response cost)
3. Crisis Management (Restraint)

Question 80

Training, on-going monitoring, and revisions

Answer 80

Important that all those working with an individual are trained on the plan

Data should be collected

Should be on-going meetings to review data

Plan is not a static document