173: Autism: Overview

and Treatment Debbie Laffranchini, Professor

Chapter 7: Comprehensive Behavior Interventions for Individuals with ASD

From “Autism Spectrum Disorders: Foundations, Characteristics, and Effective Strategies”

Boutot and Myles

Functional Behavior Assessment

• What happens before a challenging behavior is important

• What happens after a challenging behavior is important

• Before behavior: antecedent

• After behavior: consequence

• Consequence doesn’t mean what a person does to punish a behavior

Functional Behavior Assessment

• Assess behavior, where did it come from?

• If all behavior communicates, what is the child communicating?

• What purpose (function) is the behavior accomplishing?

• How can you support a positive outcome?

Behavioral Triggers

• Time of day

• Presence of specific people

• Specific classroom subject

• Transition

• Change in routine

• Settings with too much/too little structure

• Request or demand to stop a behavior

• Why would you do that?

• Punishment

• Medication changes

• Family circumstances

Intervention Based on Functional Behavior

Assessment

• If you understand the “pattern” (ABC) of behavior, your intervention is strengthened

• Antecedent intervention:

• Anticipate and prevent!

• Behavior intervention:

• Replace the behavior

• Consequence intervention:

• Reinforce what you want to encourage

• Allow for recovery

Beyond Functional Assessment: Address the

Underlying Need

• If you interpret a child’s misbehavior

as being “willful” when they are not, it

can have great risks

• Low self-esteem

• Hopelessness

• Depression

• Lack of opportunity to learn alternative

behaviors

Beyond Functional Assessment: Addressing

Underlying Needs

• Address the underlying needs of autism, not just what you see (behaviors)

• Target underlying needs

• Be proactive

• Don’t just address the consequence

• If you only address “what you see”, it will not be effective and won’t have a sustainable change

Beyond Function Assessment: Addressing

Underlying Needs

• Intervention plans must be comprehensive

• Thorough analysis of biological events

• Antecedent events

• Consequence events

• Intervention plans must involve multiple strategies

• Strategies are informed by functional assessment

Positive Behavioral Support (PBS)

• Research-based strategies used to increase quality of life

• Decreases problem behavior by teaching new skills

• Decreases problem behavior by changing the environment

“If it’s not working, change the environment”

Critical Features of

Positive Behavioral Supports (PBS)

• Comprehensive lifestyle change and quality of life

• Life span perspective

• Ecological validity (real life applicability)

• Stakeholder participation (parents as experts, professionals)

• Social validity (are interventions practical, effective?)

• Systems change

• Multi-component intervention

• Emphasis on prevention

• Flexibility with respect to scientific practices (appreciate and use other practices)

• Multiple theoretical perspectives

Characteristics of Autism that May Be Related

to Off-task Behavior

• Individual has difficulty imitating actions or words of others

• Chooses or prefers solitary activities

• Appears to be in their “own world”

• Seems to be unmotivated by customary rewards

• Has little or no speech

• Has problems handling transition and change

• Has difficulty following instructions

• Seeks activities that provide touch, pressure, or movement

• Swinging, hugging, pacing)

• Appears to be unresponsive to others (their own name)

• Displays atypical activity level

Comprehensive Planning: Moving Beyond

Functional Behavior Assessment

• Must understand:

• Characteristics of ASD

• What causes and maintains behavior

• Plan must be

• Multi faceted

• Implemented across all of child’s day

• Responsive to unique needs and strengths

• Ziggurat Model is framework for designing comprehensive interventions, consistent with principles above

In-Class Activity

• What are antecedent interventions? (1 - 2 sentences)

• What three levels of the Intervention Ziggurat consist primarily of antecedent strategies?

• Looking at the first level of the Intervention Ziggurat, sensory and biological interventions, summarize in one paragraph the antecedent interventions.

• What are the three levels of task demands? For each level, identify what makes the task a particular level?

• Looking at task demands, the fourth level of the Intervention Ziggurat, summarize in one paragraph.

• Looking at structure and visual/tactile supports, the third level of the Intervention Ziggurat, summarize in one paragraph.

• What is the goal of antecedent interventions?

• Summarize “skills to teach” in 2 – 3 sentences.

• What do “reinforcers” do according to your book, page 174?

• Summarize “reinforcement” in 1 – 2 sentences.

Antecedent Interventions (Prevent Behaviors)

• Prevent behaviors by changing the environmental factors

• Be proactive, not reactive

• Interventions that are responsive to individual needs:

• Sensory differences and biological needs

• Task demands

• Structure, visual supports and tactile supports

Antecedent Interventions

I don’t manipulate

others; just their environment!

• Prevent triggers

• Teach replacement behavior

• Improve environment

• Change difficulty of task

• Give REAL choices

Sensory and Biological Interventions

• Unmet sensory and biological needs will result in changes in behavior

• Crying

• Running away

• Withdrawing/failing to participate

• Becoming easily distracted

• Noise making

• Tantruming

• Hypersensitivity

Task Demands

• Conversation and play:

• Social skills

• Communications skills

• Levels of demand

• Easy

• Challenging/emerging

• (zone of proximal development

• Too demanding

Task Demands (cont)

• Zone of proximal development

• Not yet mastered but can do with

support

Structure and Visual/Tactile Supports

• Spoken instructions and information are often lost for child with ASD

• Visual supports

• Pictures

• Written schedules

• Task strips

• Social stories

• Video modeling

Video Modeling

• https://www.youtube.com/results?

search_query=video+modeling

Behavior

• Prevent many problem behaviors using antecedent interventions

• Antecedent interventions based on three levels of Intervention Ziggurat (sensory/biological, task demand, structure and visual/tactile supports)

• Visual supports

• Shorten length of circle time

• Something to hold

• Build activities that provide movement

• Use a first-then visual chart

• Provide optimal location on floor

Skills to Teach

• Behavior is communicative

• Non-compliance and aggression is communication

• Behavior problems may communicate hidden skill deficits

• The child with autism is not the problem

• Ask, “What skill is missing?”

Hidden Curriculum

• Standards and rules that are

assumed to be known by everyone

and must be learned through

observation

Consequence

• Reinforcer increases the likelihood that

a behavior will recur

• Be creative when arriving at an

appropriate reinforcer

• Create social reinforcers when possible

• Objects or activities related to

obsessions are often more effective

than food