11/6 Behavioral Supports Flashcards
Behavioral challenges in 50%+ of those with ID. As many as 64% have multiple challenges.
Why?
Stressful. Difficulty communicating needs.
Do people engage in problem behavior BECAUSE they have ID?
NO!
Problem behavior serves function and purpose.
Form of behavior
What it looks like
ex: words, sentences, eye gaze, pulling adult, crying, biting, tantrums
Function of behavior
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.
Why do we need a systematic way to provide intervention?
Behaviors have multiple functions and may serve different functions across individuals and settings. (Tasse, 2006)
Applied Behavior Analysis (ABA)
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
Positive Behavioral Supports (PBS)
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)
How is PBS similar to ABA?
Empirical approach to interventions (data!!!)
Conceptual Foundation (operant learning)
Assessment and intervention Procedures
How is PBS different from ABA?
PBS implemented in complex systems
Outcome variables more broad
Focused on systems change
What do the ABCs of behavior stand for?
Antecedents that might be triggering/causing
Behavioral presentation
Consequences that might be maintaining/reinforcing the behavior
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.
A: worksheet, B: tantrum, C: hallway
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.
A: phone call, B: throw ball, C: dad resumes playing
How do you identify the function of problem behavior? SOME (really MOSE but ok)!
What is motivation operation?
What are setting events?
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)
What are motivating operations basically?
What else plays a role?
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
Four term contingency:
- motivating operation,
- antecedent,
- behavior,
- consequence.
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?
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. (?)
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?
More attractive.
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.
A: classmates don’t follow rules B: Juan flips tables/shouts C: peers make remarks, teacher join in to help.
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?
What was the MO? Did it increase or decrease the potency of the reinforcement? MO: friend who was nice. …decrease reinforcement? (Check this)
The function of behavior is what the person ___ for engaging in behavior.
We engage in behavior for what reasons?
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”)
Positive reinforcement
You do something
You get what you like
You are more likely to do the thing in the future
Negative Reinforcement
You do something
You escape or avoid what you hate
You are more likely to do the thing in the future
Positive and Negative Reinforcement have in common?
More likely to do behavior
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?
addition
Bit and hug
Access to hug
Function is to get hug and attention.
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?
B: tantrum C: lecture
Got attention. Got access, positive reinforcement
Behavior to get attention.
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?
Removal
B: tantrum C: food away
Get out of eating. Negative reinforcement
Get out of eating unpleasant foods.
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?
Out of meal time. Negative reinforcement
Function to get out of meal time.
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.
negative
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
positive
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.
positive
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.
negative
A process for developing an understanding of a person’s behavior and how behavior is governed by their environment is ___________.
Functional Behavior Assessment (FBA)
Functional Behavior Assessment (FBA) results in identification of the ___ and ___ of behavior.
Purpose and function
Indirect FBAs include _____
Direct FBAs include ____
Indirect FBAs include parent/teacher/client report
Direct FBAs include direct observations
The four steps of the functional behavior assessment process
Interview, Observation, Data Collection, Behavioral Hypotheses
Things done during interview stage
- 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
Importance of addressing medical etiology and role of possible mental health conditions:
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
Importance of addressing trauma/Trauma-informed care:
Avoid re-traumatization
Emphasis on safety
Person-Environment Mismatch is about the contribution of…
underdeveloped skills
important to know language (expressive/receptive), cognitive, and adaptive skills
Data Collection and Operational definition.
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).
What is the goal of operation definition?
a stranger could walk in, look at the definition, and be able to identify the behavior when they see it.
Why do we want operational definition?
we want an ACCURATE reading of how often the behavior is occurring.
Is it operational?
Andrew gets really mad when he has to do homework
No
Is it operational?
Tiffany engages in off-task behavior during English, defined as talking with peers and orienting her head away from the instructor.
Yes
Is it operational?
Robert engages in aggression when presented with non-preferred food.
No
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!”)
Yes
Descriptive analyses often involve what?
How might this look?
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.
What is systematic experimental manipulation of environmental characteristics?
functional analysis
Why do you want to evoke problem behavior during functional analysis?
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)
What do you do to look at attention and escape reinforcements?
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
Variations of FAs and trauma informed treatment 1:
Interview-informed, synthesized contingency analysis or IISCA.
Practical Functional Assessment (Hanley et al, 2014)
From interview develops specific conditions to client. Individualized
Variations of FAs and trauma informed treatment 2:
Standard Protocol
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.
Variations of FAs and trauma informed treatment 3:
Behavioral skills training
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.
FA example will show you a graph of what.
Behaviors during attention alone demand and control conditions
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.
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.
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.
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.
What do you do if you have trouble making hypothesis?
What would make the behavior stop?
Collect more data.
Same form but multiple functions?
Does it continue to serve another function?
What are the interventions for problem behavior?
1.Antecedent/preventative strategies
- Replacement behaviors
- Consequence strategies
Preventative strategies: Consistent Language
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.”
Preventative strategies: Giving directions
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?”
Preventative strategies: recognize EARLY signs of escalation-clear and observable
at peak escalation they don’t listen to you, so intervene early.
Redirect to another activity
Reduce demands
Prompt to take a break
Preventative strategies: Assume Trauma/Recognize signs of trauma and recognize metnal health changes
Trauma-Informed Care
Timely communication with counselors (if involved)
Adjusting supports as needed
Preventative strategies: structured schedule and adjustments to schedule
Increased predictability and aids transition
Categorize as preferred, non-preferred
Non-preferred –> Preferred
Preferred –> Neutral
Adjust: length, difficulty, too crowded, loud, overstimulating.
Preventative strategies: Behavioral Momentum
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
Preventative strategies: Demand Fading
Remove instruction and gradually reintroduce demands
Preventative strategies: Choice-making
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.
Preventative strategies: Non-contingent attention and praise
Non-contingent attention - remember to give them attention, have it be there.
Scheduled or Random
Praise good behavior
Preventative strategies: Visual Schedules / task breakdown
Allow individual to view upcoming activity
Increase understanding of sequence
Increases predictability
BREAKDOWN TASK TO MANAGEABLE CHUNKS
Preventative strategies: Warning of transitions
Verbal: 19 mins, 5 mins, 1 min, count down
Visual Timers
First then visual strip (visualize: first we do this, then this)
Replacement Skills involves finding a ___ for behavior using ______
substitute
Functional Communication Training (words, vocalization, signs, gestures, pictures)
Asking for break
Asking for attention
Asking for toy/food item/activity
How do you teach replacement behavior?
Examples of teaching
Defining the behavior
Modeling the behavior
Role-playing the behavior
Giving feedback
Ex: asking to take a break. Inviting someone to play
Escape Maintained Intervention: Differential Reinforcement
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
Escape Maintained Intervention: Extinction
Follow through on demands if client presents with problem behavior
Know when extinction is not appropriate! –> easier with smaller child
Attention-Maintained Intervention: Extinction
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!
Attention-Maintained Intervention: Differential Reinforcement
Reward appropriate attempts to get attention and do not reward target behavior
Attention-Maintained Intervention: Time out
Why only good for attention and not escape behavior?
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.
What are concerns about ignore strategy in research and practice?
Ignore is imprecise
May be functionally irrelevant
Can be dangerous
May not be feasible
May not be socially valid
Overused in caregiver training
What should we do if ignoring is imprecise?
Provide specific safety instruction
Devise interventions without extinction
Identify root cause
Account for consumer preference
Be technological in writing
Use precision to teach caregivers
Token Economies
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)
Restrictive Strategies used in behavioral support
- Restrictive/preventative
- Restrictive
- Crisis management
- Restrictive/Preventative (Lock on refrigerator; GPS tracking devices)
- Restrictive Strategies (Time out; Response cost)
- Crisis Management (Restraint)
Training, on-going monitoring, and revisions
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
