Assessment and Treatment of Severe Problem Behaviors

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Assessment and Treatment of Severe Problem
Behaviors

• Joel E. Ringdahl, Ph.D.
• The University of Iowa

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Objectives

• Learn the differences between various behavior
  assessment
• Learn the reinforcers instrumental in maintaining
  problem behavior
• Learn typically implemented behavior change
  techniques
• Learn the link between assessment and treatment

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Behavioral Terms

• Positive reinforcement presentation of a
  stimulus results in an increased probability of
  the behavior
• Negative reinforcement removal of a stimulus
  results in an increased probability of the
  behavior
• Note both positive and negative reinforcement
  indicate an increased likelihood of behavior, the
  difference is in the presentation or removal of a
  stimulus
• Punishment presentation or removal of a
  stimulus results in a decreased probability of
  the behavior
• When addressing behavior problems,
  reinforcement-based approaches allow for most
  consistent results

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Goals of Behavioral Assessment

• First Provide prescriptive information
  regarding treatment
• Second Identify under what conditions the
  behavior is most likely to occur
• Third Identify the specific reinforcers
  maintaining problem behavior
• Identification of the relevant reinforcers can be
  achieved through a variety of methods
  (descriptive or experimental)

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Types of Assessment

• Descriptive Assessment
• Informal observation
• No direct manipulation of the environment
• Experimental Assessment
• Formal observation
• Direct, systematic manipulation of variables in
  the environment

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Behavioral Assessment Experimental Method
(Functional Assessment/Functional Analysis)

• A process for gathering information that can be
  used to maximize the effectiveness and efficiency
  of behavior support (Five steps)
• A clear description of the problem behavior
• Identification of antecedents (events, times,
  situations)
• Identification of consequences that occur after
  problem behavior
• Hypothesis development
• Hypothesis verification (functional analysis)

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Why do a Functional Assessment?

• Increase the probability that the developed
  intervention will work.
• Help identify the appropriate intervention.

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When Should it Be Conducted?

• By law, a functional behavioral assessment must
  be conducted and behavioral intervention plan
  implemented prior to removal of a student from a
  particular placement (IDEA, 1997).
• In practice, a functional assessment should be
  conducted before the implementation of any
  behavior change program.

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What Behaviors Are Appropriate for Assessment

• ADHD behaviors
• Severe problem behaviors
• aggression
• self-injurious behavior
• pica
• Tantrum behavior
• Among others

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Possible Functions

• Positive Reinforcement (Gain)
• Attention (either from adults or peers)
• Preferred activities or items

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Case Example 1 Jack

• 4 years old
• Autism severe mental retardation
• Referred for assessment and treatment of
  aggressive behavior (pulling mothers hair)
• No appropriate communicative strategies

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Possible Functions Continued

• Negative Reinforcement
• Escape or avoidance of nonpreferred activities
  (e.g., chores, homework)
• Escape or avoidance of aversive situations (e.g.,
  social contact, appointments)

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Case Example 2 Calvin

• 10 years old
• Pervasive developmental disorder mild/moderate
  mental retardation
• Referred for assessment and treatment of
  aggression and noncompliance
• Communicated through speech

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Behavior maintained by negative reinforcement
(escape)
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Possible Functions Continued

• Automatic reinforcement Behavior occurs
  independent of the social environment
• Automatic positive reinforcement produces some
  sort of pleasurable sensory outcome
• Automatic negative reinforcement alleviates some
  aversive physiologic condition

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Case Example 3 Mark

• 15 year old young man
• Autism severe/profound mental retardation
  visual impairment
• Referred for assessment and treatment of
  self-injurious behavior (head and body hitting)
• No communicative behavior

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Behavior maintained by automatic reinforcement (A)
11.5
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Free play
10.5
Attention
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Tangible
9.5
Escape
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Alone
8.5
Free play
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Alone
7.5
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6.5
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Behavior/Min
5.5
5
4.5
4
3.5
3
2.5
2
Mark
1.5
1
0.5
0
-0.5
1
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Sessions
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Case Example 4 Bill

• 16 year old young man
• Mild/moderate mental retardation
• Referred for assessment and treatment of
  stereotypic (i.e., repetitive) hand flapping
• Communicated through speech

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Behavior maintained by automatic reinforcement (B)
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Treatment Options

• Withhold the functional reinforcer (extinction)
• Provide free access to the reinforcer
  (noncontingent reinforcement)
• Provided response-dependent access to the
  reinforcer (differential reinforcement)

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Treatment Options Extinction

• Extinction Behavior no longer results in
  identified reinforcer.
• Drawbacks include potential increase in intensity
  of problem behavior and variation in topography
  access to the reinforcer is limited does not
  teach a new behavior.
• Extinction is seldom used as a sole component of
  treatment.

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Treatment Options NCR

• Noncontingent reinforcement Functional
  reinforcer is provided independent of behavior.
• () Reduces motivation for problem behavior
  eliminates side effects associated with
  extinction simple to implement.
• (-) Does not teach a new behavior might
  accidentally reinforce problem behavior.

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Treatment Options Differential Reinforcement

• Differential reinforcement Reinforcer available
  contingent on communication (i.e., functional
  communication training).
• () Reduces side effects associated with
  extinction provides access to the reinforcer
  teaches a new behavior.
• (-) Can be difficult to implement individual
  might spend a lot of time with the reinforcer.

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Positive reinforcement treatment example