“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

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

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

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

Functional Assessment

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

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

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?

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?

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

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?

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

Automatic Reinforcement as Function

What is sensation individual is seeking?

Is behavior related to medical condition?

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)

ABC (Antecedent-Behavior-Consequence) Analysis Form

Setting/ Activity/

Setting Events

Grocery store

Event Prior to Behavior

Parent told child to put

candy back on shelf

Behavior

Child screams, cries that he wants

the candy

Consequence

Parent lets the child have the candy to stop

him from crying

Home Sibling playing video

game

Hits, kicks, and bites sibling

Sibling gives the video

game to child

STUDENT:TARGET BEHAVIOR:Date/Time 30 1:00 1:30 2:00 2:30 3:00 3:30 4:00 4:30 5:00 5:30 6:00 6:30 7:00 7:30 8:00 8:30 9:00 9:30 10 Frequency Data

Tar Behv:

Behavior Date Tar Behv:123Location Tar Behv:

Notes:

Activity

Pos. Reinf. Pos. Reinf. Neg. Reinf. Auto. Reinf.

Antecedent (attention) (materials) (escape) (sensory) Ignored by staff Leisure materia deniedother request deniedgiven inst. Prompt to w orkprovoked by peerNone (doing nothing)

ConsequenceAttention, response blockredirected to another arealeisure material givenw ork requirement terminstaff w alked aw aystaff did nothing

TOTAL

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

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.”

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.

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.

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

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

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

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.)

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

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

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

Keep My Cool!

I’m a teenager who will be looking for job this summer. I’ve worked as a carry-out/sacker at a grocery store before. That’s one of my favorite jobs. When I’m working, I sometimes get asked to do a lot of things as part of my job. Sometimes I like what I’m asked to do and sometimes I don’t really want to do what I’ve been asked. Sometimes I may have to talk to customers when I don’t feel like talking to them. These things are all part of keeping a job. These things may make me angry. It’s okay to get angry, but I have to try to Keep My Cool. When I’m angry, I can make some choices to help Keep My Cool. Some good choices I can make are:

1. Take a deep breath and let it out without saying anything

2. Walk to a quiet spot for a few minutes when given my trigger word.

When I’m mad, it is not okay to hurt another person. When I’m mad, it is not okay to cuss at them. When I’m mad, I will try to make some good choices to help me stay calm and Keep My Cool. Keeping My Cool can help me Keep my Job!

Hurt

Bus Rules

When you’re on the bus Buckle Up!

Bus Rules

When you’re on the bus Buckle Up!

Grant’s School Schedule

1.

8.

2.

9.

3.

10.

4.

11. or or

5.

12.

6.

13.

7.

My Rewards

Follow the rules and get 10 minutes of my choice:

Rules

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

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, “Mo

m” rather than hitting the mother or throwing an object

Factors Affecting Replacement Behaviors

How frequently behavior is reinforced

How quickly behavior is reinforced

How much effort is required

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

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

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

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”)

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

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

Eliminate Signal for Escape or Avoidance

Complete task in new setting

Change task materials

Change wording of task

Change people involved with task

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)

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

Consequence Based Strategies for Escape/Avoidance

Differential Reinforcement DRA (alternative) DRO (omission/other) DRI (incompatible)

Extinction

Punishment

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

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

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

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

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

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)

DRO (example)

Target behavior: Profanity

Interval: 1 hour

If no instance of target behavior during hour, reinforce with star and descriptive praise

If target behavior is exhibited, no reinforcement provided

Differential Reinforcement of Alternative Behavior (DRA)

Reinforce desirable alternative (not necessarily incompatible – DRI)

Alternative behavior occupies time that problem behavior normally use Ex. Reinforcing cooperative activities instead of

arguing with peer Ex. Plastic block in bucket instead of loud vocalizations Ex. Giving “Break” card or saying “No” instead of

disruptive behavior during task

Differential Reinforcement of Incompatible Behaviors (DRI)

Not possible to perform problem behavior and incompatible behavior simultaneously e.g. reinforce child with deep pressure massage on back while he

is completing his assignments rather than while flapping his hands e.g. provide reinforcement for staying at circle time and not for

roaming classroom

DRA

Purpose is to increase behavior that will compete with stereotypic behavior

Access to preferred objects and activities provided contingent on specific forms of adaptive behavior

May need prompts and instructions to engage in alternative response

Important Points!

Behavior can serve multiple functions

Behaviors that look different can serve the same function

Some events that occur earlier in the day or that are ongoing (e.g. illness, hunger, stress) can effect behavior

Important Points!

Make problem behaviors irrelevant, ineffective and inefficient

Teach alternative behaviors to replace problem behaviors

Praise and reinforce appropriate behaviors as often as possible

Plan and implement emergency procedures for severe behavior

Contact Information

Lupe Castañeda, MS, BCBA

Board Certified Behavior Analyst

Executive Director

Behavior Analytic Solutions, LLC DBA

Pediatric Rehabilitation and Behavioral Services

Office: 210-858-9062

Fax: 210-566-3433

Email 1: lupe@rehababa.com

Website: www.rehababa.com

References

Cooper, J.O., Heron, T.E., & Heward, W.L. (2007). Applied Behavior Analysis (2nd ed.). Pearson: New Jersey.

Crone, D.A. & Horner, R.H. (2003). Building Positive Behavior Support Systems in Schools: Functional Behavior Assessment. Guilford Press: New York

Glasberg, B.A. (2006). Functional Behavior Assessment for People with Autism. Woodbine House: Bethesda, MD.

Glasberg, B.A. (2008). STOP That Seemingly Senseless Behavior! FBA-Based Interventions for People with Autism.

Koegel L.K., Koegel, R.L. & Dunlap, G. (1996). Positive Behavioral Support: Including People with Difficult Behavior in the Community. Brookes Publishing: Baltimore, MD.

Latham, G. I. (1994) The Power of Positive Parenting. P&T Ink: North Logan, UT.

References

LaVigna, G.W. & Donnellan, A.M. (1986). Alternatives to Punishment: Solving Behavior Problems with Non-aversive Strategies. Irvington Publishers: New York.

Lucyshyn, J.M., Dunlap, G. & Albin, R.W. (2002). Families and Positive Behavior Support: Addressing Problem Behavior in Family Contexts. Brookes Publishing: Baltimore, MD.

Luiselli, J.K. & Cameron, M.J. (1998). Antecedent Control. Brookes Publishing: Baltimore, MD.

References

O’Neill, R.E., Horner, R.H., Albin, R.W., Sprague, J.H., Storey, K., & Newton, J.S. (1997). Functional Assessment and Program Development for Problem Behavior: A Practical Handbook. Brookes/Cole: New York

Texas Behavior Support Initiative

Web Sites

Cambridge Center for Behavioral Studies http://www.behavior.org/

Center for Evidence Based Practice: Young Children with Challenging Behavior http://challengingbehavior.fmhi.usf.edu/pbs.html

OSEP Technical Assistance Center on Positive Behavior Interventions and Supports http://pbis.org/

Rehabilitation Research and Training Center on Positive Behavior Support http://rrtcpbs.fmhi.usf.edu/