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Evidence-Based Practices to Reduce Challenging
Behavior
Lise Fox, Ph.D.University of South Florida
Evidence-Based Practices to Reduce Challenging
Behavior
Lise Fox, Ph.D.University of South Florida
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Session DiscussionSession Discussion
Critical importance for developing systems to support teacher implementation of evidence-based practices
Adoption of a promotion, prevention, intervention model
Identifying evidence-based practices for early educators
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National Centers - ResourcesNational Centers - Resources
Center on the Social and Emotional Foundations for Early LearningCenter on the Social and Emotional Foundations for Early Learning(CSEFEL) (CSEFEL)
www.vanderbilt.edu/csefel
Technical Assistance Center on Social Emotional Intervention (TACSEI)Technical Assistance Center on Social Emotional Intervention (TACSEI)
www.challengingbehavior.org
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Key MessagesKey Messages
High quality caregiving + high quality environments ≠ No challenging behavior
Addressing challenging behavior = Promoting the development of social competence
We have evidence-based practices; but we need practitioners and systems to implement those practices with fidelity
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An estimated 9 to 13% of American children An estimated 9 to 13% of American children and adolescents between ages nine to 17 and adolescents between ages nine to 17 have serious diagnosable emotional or have serious diagnosable emotional or behavioral health disorders resulting in behavioral health disorders resulting in substantial to extreme impairment.substantial to extreme impairment.(Friedman, 2002) (Friedman, 2002)
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o More than half of students with More than half of students with SED drop out of grades 9-12, the SED drop out of grades 9-12, the highest rate for all disability highest rate for all disability categories. categories. (U.S. Department of Education, (U.S. Department of Education, 2002; 2006)2002; 2006)
o At 2 years post high school, At 2 years post high school, 58% of youth have been arrested 58% of youth have been arrested at least once and 42% are on at least once and 42% are on probation or parole. (NLTS2, probation or parole. (NLTS2, 2005).2005).
o Students with ED reported use Students with ED reported use of alcohol (54%), illegal drug use of alcohol (54%), illegal drug use (36%), marijuana use (33%), and (36%), marijuana use (33%), and smoking (53%) at rates higher smoking (53%) at rates higher than all other disability categories than all other disability categories (NLTS2, 2008)(NLTS2, 2008)
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Over 15% of all students with disabilities (6-21) are taking psychotropic medications (USDOE, 2005)
About 1/3 of all adolescent students with disabilities have been suspended or expelled (USDOE, 2005)
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Campbell (1995) estimated that approximately 10-15% Campbell (1995) estimated that approximately 10-15% of all typically developing preschool children have of all typically developing preschool children have chronic mild to moderate levels of chronic mild to moderate levels of behavior problems.behavior problems.
Children who are poor are much more likely to develop Children who are poor are much more likely to develop behavior problems with prevalence rates that approach behavior problems with prevalence rates that approach 30% (Qi & Kaiser, 2003).30% (Qi & Kaiser, 2003).
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Children who are identified as hard to Children who are identified as hard to manage at ages 3 and 4 have a high manage at ages 3 and 4 have a high probability (50:50) of continuing to have probability (50:50) of continuing to have difficulties into adolescence (Campbell & difficulties into adolescence (Campbell & Ewing, 1990; Campbell, 1997; Egeland et al., Ewing, 1990; Campbell, 1997; Egeland et al., 1990).1990).
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Early Predictors
•Temperamental Difficulties
•Early Aggression
•Language Difficulties
•Noncompliance
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Family Factors
•Maternal Depression
•Harsh Parenting
•Stressful Family Life Events
•Low Social Support
•Family Instability
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Depression Hurts
• D• Children of mothers who were depressed in their infancy are more likely to be delayed
• Children of depressed mothers are at increased risk for behavior problems, depression, and mood disorders in adolescence
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The correlation between The correlation between preschool-age aggression preschool-age aggression and aggression at age 10 and aggression at age 10 is higher than that for IQ.is higher than that for IQ. (Kazdin, 1995)(Kazdin, 1995)
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Early appearing Early appearing aggressive behaviors are aggressive behaviors are
the best predictor of the best predictor of juvenile gang juvenile gang membership membership and violence.and violence.
(Reid, 1993)(Reid, 1993)
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When aggressive and When aggressive and antisocial behavior has antisocial behavior has
persisted to age 9, further persisted to age 9, further intervention has a poor intervention has a poor
chance of success.chance of success. (Dodge, 1993)(Dodge, 1993)
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Young Children with Young Children with Challenging Behavior:Challenging Behavior:
•Are rejected by peersAre rejected by peers•Receive less positive Receive less positive
feedbackfeedback•Do worse in schoolDo worse in school•Are less likely to be Are less likely to be
successful in successful in kindergartenkindergarten
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Preschool children are three times more likely to be “expelled” than
children in grades K-12
(Gilliam, 2005)
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Faculty in higher education early childhood programs report that their graduates are least likely to be
prepared to work with children with persistently challenging behavior
(Hemmeter, Santos, & Ostrosky, 2004)
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Of the young children who need mental Of the young children who need mental health services, it has been estimated health services, it has been estimated that fewer than 10% receive services that fewer than 10% receive services for these difficulties. for these difficulties.
(Kataoka, Zhang, & Wells, 2002) (Kataoka, Zhang, & Wells, 2002)
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There are evidence-based practices that are effective in changing this developmental trajectory…the problem is not what to do, but rests in ensuring access to intervention and support (Kazdin & Whitley, 2006)
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The Pyramid ModelThe Pyramid Model
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Pyramid ModelPyramid Model
UniversalPromotion
SecondaryPrevention
TertiaryIntervention
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Nurturing and Responsive Relationships
Nurturing and Responsive Relationships
Foundation of the pyramidEssential to healthy social developmentIncludes relationships with children, families
and team members
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RelationshipsRelationships
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High Quality EnvironmentsHigh Quality Environments
Inclusive early care and education environments
Comprehensive system of curriculum, assessment, and program evaluation
Environmental design, instructional materials, scheduling, child guidance, and teacher interactions that meet high quality practices as described by NAEYC and DEC
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Reviewing Rules
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Transitions
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Circle Time – Universal DesignCircle Time – Universal Design
Adult Support
From: www.headstartinclusion.org
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Circle Time – Universal DesignCircle Time – Universal DesignPeer Support
From: www.headstartinclusion.org
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Circle Time – Universal DesignCircle Time – Universal Design
Child Preference
Special Equipment
From: www.headstartinclusion.org
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Circle Time – Universal DesignCircle Time – Universal Design
Environmental Support
From: www.headstartinclusion.org
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Circle Time Circle Time Special Equipment
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Circle Time Circle TimeChild Preference
From: www.headstartinclusion.org
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Circle TimeCircle Time
Invisible Support
From: www.headstartinclusion.org
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Circle TimeCircle Time
Simplify the Activity
From: www.headstartinclusion.org
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Targeted Social Emotional Supports
Targeted Social Emotional Supports
Self-regulation, expressing and understanding emotions, problem solving, developing social relationships
Explicit instructionIncreased opportunities
for instruction, practice, feedback
Family partnershipsProgress monitoring and
data-based decision-making
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Friendship Skills
• Gives suggestions (play organizers)
• Shares toys and other materials
• Takes turns (reciprocity) • Is helpful• Gives compliments• Understands how and
when to give an apology• Begins to empathize
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On Monday When
it Rained
Glad MonsterSad Monster
Hands Are Not for Hitting
Book Nookswww.vanderbilt.edu/csefel
Book Nookswww.vanderbilt.edu/csefel
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Feeling Wheel & Feeling Dice
Feeling Wheel & Feeling Dice
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Turtle Technique
Recognize Recognize
that you that you
feel angry.feel angry.
““Think” Think”
Stop.Stop.
Go into shell. Go into shell. Take 3 Take 3 deep deep breaths breaths and think and think calm, calm, coping coping thoughts.thoughts.
Come out of Come out of shell shell when when
calm and calm and think of a think of a solution.solution.
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Would it be safe?Would it be fair?How would everyone feel?
Problem Solving Steps
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Step 2
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The Solution KitThe Solution Kit
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Secondary – Skill Instruction
Secondary – Skill Instruction
Identify target skill
Identify learning opportunities and seek to maximize the number of learning trials
Select procedure for teaching
e.g., least to most, most to least, incidental teaching procedure, peer support, modeling, visual prompts
Track child progress
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Individualized Intensive Interventions
Individualized Intensive Interventions
Comprehensive interventions
Assessment-based
Skill-building
Partnerships with families
Progress monitoring and data-based decision-making
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Positive Behavior SupportPositive Behavior Support
Convene a team
Conduct functional assessment
Identify hypotheses
Develop behavior support plan for all relevant environments
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4 years oldOnly childFirst preschool experience Strengths – very smart, loves books, engages well
with adultsChallenging Behaviors - Aggression, Verbal
threats, Destroys other children’s products, Damages toys intentionallySignificant risk of Preschool Expulsion
About TimAbout Tim
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Before PBS
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Team of individuals who know him best – teacher, parents, paraprofessional, assistant directorBehavior consultant guided the processFocused on understanding the purpose of Tim’s challenging behavior - importance of gathering informationDeveloped a comprehensive plan that includes:
Strategies for preventing his challenging behaviorNew skillsAdult responses
Classroom team and family implement and monitor plan outcomes
Develop PlanDevelop Plan
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HypothesesHypotheses
Tim engaged in challenging behavior to:
initiate social interactions
enter into play
get access to particular toys
get teacher or peer attention
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Behavior Support PlanBehavior Support Plan
Prevention StrategiesSocial story to describe behaviors that were expected during center play and outdoor activitiesReview of social story prior to center timePriming to remember skills to useVisual prompt to remember skills to use
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I Can Be a SUPER FRIEND!I Can Be a SUPER FRIEND!
Created for Tim by Lisa Grant & Rochelle Lentini2002
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I like talking and playing with my friends
at school.
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My Friends get sad or mad when I hit, kick, use mean words, or take toys.
Sometimes, I want to play with what my friends are playing with.
When I play, I sometimes feel like taking toys, using mean words, or hitting and kicking.
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If I want to join in play, I need to join nicely or ask to play with my friends’ toys.
I can say, “Can I play with that toy?” or “Can I play with you?”.
Can I play with you?
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I can join my friends and play nicely. I can take turns.
I can go with the flow. I can stop, think, and do.
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I CAN BE A SUPER FRIENDI CAN BE A SUPER FRIEND
I can join my friends and play nicely. ________
I can take turns nicely. ________
I can go with the flow. ________
I can stop, think, and do. ________
DATE: ___________
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Tim’s Plan (cont.)Tim’s Plan (cont.)
Instructional StrategiesSocial skills instruction of each new skill (role play
and story review)Self-management system for new skills
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Tim’s Plan (cont.)Tim’s Plan (cont.)
New ResponsesAttention to child who was assaultedPrevent access to toy or activityReview with Tim after incident has been
resolved
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Tim – with PBSTim – with PBS
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“If a child doesn’t know how to read, we teach.”
“If a child doesn’t know how to swim, we teach.”
“If a child doesn’t know how to multiply, we teach.”
“If a child doesn’t know how to drive, we teach.”
“If a child doesn’t know how to behave, we…… teach?… punish?”
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Pyramid ModelPyramid Model
UniversalPromotion
SecondaryPrevention
TertiaryIntervention
Evidence-Based Practices that
Promote the Social Emotional
Development of All Children
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Assess your teachingAssess your teaching
How skilled are you at….Developing strong teaming relationships?Developing parent partnerships?Creating classroom environments that support the
active engagement of all children?Teaching social emotional skills intentionally to all
children?Teaching social emotional skills with sufficient
intensity to individual children who are at-risk of challenging behavior?
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Assess your ProgramAssess your Program
Does your program…
Have a system for screening children for social emotional delays?
Ensure that children at-risk of challenging behavior receive intentional instruction and support that leads to outcomes?
Use data to make decisions about how to support children effectively?
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Assess your programAssess your program
Does your program…Have a system for ensuring that children
with persistent challenging behaviors receive intensive, individualized support?
Offer teachers individualized professional development (training and coaching) to provide evidence-based approaches?
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National Centers - ResourcesNational Centers - Resources
Center on the Social and Emotional Foundations for Early LearningCenter on the Social and Emotional Foundations for Early Learning(CSEFEL) (CSEFEL)
www.vanderbilt.edu/csefel
Technical Assistance Center on Social Emotional Intervention (TACSEI)Technical Assistance Center on Social Emotional Intervention (TACSEI)
www.challengingbehavior.org