Addressing the Social and Behavioral Needs of Students with Autism and Other Developmental Disabilities

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Addressing the Social and Behavioral Needs of
Students with Autism and Other Developmental
Disabilities

• Friday, March 12, 2010
• Carol Ann Davis, EdD
• University of Washington
• cadavis1_at_uw.edu

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Characteristics of Positive Behavior Support

• Assessment-based Interventions directly linked
  to environmental influences and a hypothesis
  concerning the function of the problem behavior.
• Comprehensive plans, usually involving multiple
  interventions
• Proactive, involving teaching alternative skills
  and adapting the environment.
• Emphasizes lifestyle enhancement and inclusive
  settings as both the context for and long-range
  goals of intervention.

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Characteristics of Positive Behavior Support
(cont.)

• Reflects person-centered values that honor the
  dignity and preferences of the individual.
• Designed for use in everyday settings using
  typically available resources.
• Broad view of intervention success that includes
• (a) increases in the use of alternative skills,
• (b) decreases in the incidence of challenging
  behavior, and
• (c) improvements in quality of life.

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Conduct Assessments
Assessment of the Environment
Assessment of Instruction and Adult - Child
Interactions

• Explicit Implicit

Increase in Teacher Time and Level of
Intrusiveness
Assessment of Antecedents and Consequences
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Evaluate the Environment (Environmental Checklist)
Environmental Can all of the children be seen?
Can all of the children see you or other instructional materials?
Is the noise distracting to children?
Is there enough light in the work areas?
Do the children seem to be affected by the number of children in the area?
Do the children seem to be affected by the number of adults in the area?
Is the temperature in the room comfortable?
Are there areas which may be visually distracting to the children?
Programmatic Is there a schedule for the classroom?
Does the schedule reflect varied activities (i.e., quiet/loud, active/passive, etc.)?
Are transitions planned and time allotted?
Are the materials appropriate for the age group?
Have material been rotated within the last two weeks?
Are there enough materials for all children to be actively involved?
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Changes in the Environment (Interventions)

• Visual supports
• Arranging the room (defining specific areas in
  the room)
• Limiting the number of children in an area
• Zone staffing
• Post and teach rules and procedures
• Use novel materials or rotate materials

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Instructional Checklist
Is the ratio of praise statements to negative statements at least 5 to 1?
Does the instruction occur immediately prior to requesting the child to perform a new or not yet mastered task?
Is the difficulty of the task set slightly above the childs assessment skill level?
Does the instruction provide adequate rate of success?
Are directions for the activity clear?
Are the tasks age-appropriate and functional?
Have preferences been incorporated into the instruction?
Is feedback occurring for incorrect responses?
Is feedback occurring for correct responses?
Are you withholding reinforcement for inappropriate behavior?
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Strategies to Influence Behavior by Changing the
Instruction

• Content
• Include individual child preferences
• Break the tasks into simple steps
• Make the task meaningful and functional
• Presentation
• Shorten the length of the task
• Provide choices
• Insure child success (errorless learning)
• Vary the difficulty of the tasks (intersperse
  mastered with new)
• Provide unsolicited attention

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Obtain Desirable Events
Avoid/Escape Undesirable Events
Internal
External
Internal
External
Attention
Objects/ Activities
Objects/ Activities
Attention

• Difficult
• tasks
• Change in
• routine
• Interruption
• of desired
• activity

• Rhythmic
• rocking
• Endorphin
• release
• Visual
• stimulation

• Smiles,
• hugs
• Frown,
• scolding
• Surprise

• Smiles,
• hugs
• Frown,
• scolding
• Surprise

• Food
• Preferrred
• activity
• Money

• Sinus
• pain
• Skin
• irritation
• Hunger

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What is a FBA?

• A process that
• Defines the target behaviors
• Determines the environmental events and factors
  that contribute to challenging behaviors
• Identifies the antecedents and consequences that
  occur before and after the challenging behaviors
• Hypothesizes the function or purpose of the
  challenging behaviors
• Provides direction for developing appropriate and
  effective positive interventions

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FBA is a process in which many instruments may be
used to gather information

• Reviewing existing documents
• Interview
• Scale or Screening Instruments
• Scatterplot
• Direct Observation Tools
• Environmental Manipulation

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Introduction of Case Study

• Nick is a 8 year old boy who attends a local
  school. He is in a self-contained classroom with
  students with a variety of severe disabilities.
  Nick was diagnosed with autism at 2.5 years old.
  He has limited verbal skills but will use I want
  frequently to request items or people. Nick
  loves to fidget with action figures and likes to
  listen to music. Nick likes to verbally label
  pictures and look at books during academic times.
  Nick has demonstrated significant challenging
  behaviors including head-banging (fist to temple,
  fingers to bridge of nose), other bodily injury
  (knocking knees together, banging wrists
  together, banging wrists on table, biting
  wrists), object banging (using multiple objects
  to bang against head), and aggression towards
  others (biting, kicking). Nick lives at home
  with three sisters, mother, and father. His
  mother drives him to and from school as Nick has
  been demonstrating self-injurious behaviors while
  on the bus. His mother reports that she is
  seeing similar behaviors at home but not with the
  same intensity.

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Existing Written Documents

• Medical records
• Previous IEP/IFSP
• Social Work/Counseling Reports
• Reports from previous service providers

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What events do I need to consider when I begin an
intensive FBA?

• Setting Events
• Conditions that increase the likelihood that
  problem behavior will occur. They can be
• Removed in time from the behavior (e.g., the
  child wakes up late, is rushed through breakfast,
  and hurried out the door to daycare two hours
  before she refuses to clean up her toys)
• In close proximity to the behavior (e.g., the
  child has a block taken from him immediately
  prior to hitting another child in that center
  student has a bad interaction in the hallway
  prior to screaming at the teacher) Example
• An ongoing situation or state (e.g., the student
  is extremely fatigued due to a cold and not
  sleeping well the night before).

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Setting Event Checklist Case Study
9/12 9/13 9/14 9/15 9/16 9/19 9/20 9/21 9/22
Did not sleep at least 6 hours X X X X
Does not watch TV in the morning X X X X
Did not access lunchbox at lunch X X X
Late to school X X X X
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9/12 9/13 9/14 9/15 9/16 9/19 9/20 9/21 9/22
Did not sleep at least 6 hours X X X X
Does not watch TV in the morning X X X X
Did not access lunchbox at lunch X X X
Late to school X X X X
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Another Example
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Setting Events

• Bad interaction with family previous to school
• Sick, Hungry, Tired
• Was reprimanded in class and privilege taken away

Advantages Disadvantages
Identifies events that may influence whether or not a behavior will occur No information regarding function, or frequency of behavior
Helps identify sources of variability in the childs performance No information on history or prior intervention outcomes
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Motivation Assessment Scale

• A 16-item survey that assists in developing a
  hypothesis about the function of the problem
  behavior
• http//www.monacoassociates.com/mas/index.html

Advantages Disadvantages
Easy and quick to use Information may or may not be reliable
Easy to understand
Provides information regarding developing a hypothesis for the function of the behavior
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Motivation Assessment Scale
Questions Never 0 Almost Never 1 Seldom 2 Half Time 3 Usually 4 Almost Always 5
1. Would the behavior occur continuously if this child was left alone for long periods of time? Never 0 Almost Never 1 Seldom 2 Half Time 3 Usually 4 Almost Always 5
2. Does the behavior occur following a command to perform a difficult task? Never 0 Almost Never 1 Seldom 2 Half Time 3 Usually 4 Almost Always 5
3. Does the behavior occur when you are talking to other persons in the room? Never 0 Almost Never 1 Seldom 2 Half Time 3 Usually 4 Almost Always 5
4. Does the behavior ever occur to get a toy, food, or game that he or she has been told that he she cant have? Never 0 Almost Never 1 Seldom 2 Half Time 3 Usually 4 Almost Always 5
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Interviews

• An interview that describes the problem behavior
  and identifies physical and environmental factors
  that reliably result in the problem behavior.

Advantages Disadvantages
Provides information of potential function Assessment is time consuming
Provides information of possible setting events Information may or may not be reliable
Provides information regarding resources for developing a positive behavior support plan
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Interview Information

• What exactly does the behavior look like?
• What do you think is the function of the
  behavior?
• What events/situations predict the behavior?
• What are the learning characteristics?
• What does the child like or not like?
• How does the child communicate needs, wants,
  etc.?
• What are some of the other factors (e.g.,
  medical, schedule) that may influence behavior?

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Scatterplot

• An interval recording system that assists in
  determining if patterns of problem behavior exist
  during specific time periods

Advantages Disadvantages
Pinpoints the time periods in which the behavior is likely and unlikely to occur. Little information on setting events, environmental influences, or antecedents and consequences
Quick to complete and interpret No information on prior interventions
Assist in identifying functions
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Scatterplot Form
1
2 - 3
gt 3
0
Time/Activity
9/12
9/13
9/14
800 - 820
820 - 835
835 - 915
920 - 935
935 - 955
955 - 1030
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Scatterplot Form Case Study
6-10
11-15
gt 15
lt5
Time/Activity
9/12
9/13
9/14
800 - 815
815 - 830
830 845
845-900
900 - 915
915 - 930
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Scatterplot Form Activity
Time/Activity
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Scatterplot Form
1
2 - 3
gt 3
0
Time/Activity
7/28
7/29
800 830
830 900
900 - 930
930 1000
1000-1030
1030 - 1100
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ABC Analysis

• Event recording system that determines patterns
  of antecedents and consequences associated with a
  particular behavior.

Advantages Disadvantages
Describes antecedents and consequences to the behavior. Does not provide information on the times antecedents and consequences were prevalent and no behavior occurred.
Provides confirmation of the hypothesized function of the indirect assessment. Can be time consuming.
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Antecedent-Behavior-Consequence Analysis
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What do I do with all of this? (i.e., How do I
summarize the data?)

• Evaluate the antecedent that are predicting the
  behavior

Antecedent Behavior Consequence A T E ?
Task demand (put away) Verbal outburst, throws object Removed to principals office x
Task demand (make correction) Verbal outburst No redirection x
Task demand (put a way) Verbal outburst, Attempts to leave Removed to principals office x
Task demand (give a turn) Verbal outburst No redirection x
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What do I do with all of this? (i.e., How do I
summarize the data?)

• Evaluate the consequences that are maintaining
  the behavior

Antecedent Behavior Consequence A T E ?
Task demand (put away) Verbal outburst, throws object Removed to principals office x
Task demand (make correction) Verbal outburst No redirection x
Task demand (put a way) Verbal outburst, Attempts to leave Removed to principals office x
Task demand (give a turn) Verbal outburst No redirection x
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What do I do with all of this? (i.e., How do I
summarize the data?)

• Evaluate the whole sequence

Antecedent Behavior Consequence A T E ?
Task demand (put away) Verbal outburst, throws object Removed to principals office x
Task demand (make correction) Verbal outburst No redirection x
Task demand (put a way) Verbal outburst, Attempts to leave Removed to principals office x x
Task demand (give a turn) Verbal outburst No redirection x
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What do I do with all of this? (i.e., How do I
summarize the data?)
2

• Evaluate the antecedent that are predicting the
  behavior

Antecedent Behavior Consequence A T E ?
Task demand (put away) Verbal outburst, throws object Removed to principals office x
Playing alone Throws objects T. asked why and removed to TO x
Asked to leave computer and move to table Argues Given 3more minutes x
Task demand Hits Redirected to the task x
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What do I do with all of this? (i.e., How do I
summarize the data?)
2

• Evaluate the consequences that are maintaining
  the behavior

Antecedent Behavior Consequence A T E ?
Task demand (put away) Verbal outburst, throws object Removed to principals office x
Playing alone Throws objects T. asked why and removed to TO x
Asked to leave computer and move to table Argues Given 3more minutes x
Task demand Hits Redirected to the task x
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What do I do with all of this? (i.e., How do I
summarize the data?)
2

• Evaluate the whole sequence

Antecedent Behavior Consequence A T E ?
Task demand (put away) Verbal outburst, throws object Removed to principals office x
Playing alone Throws objects T. asked why and removed to TO x
Asked to leave computer and move to table Argues Given 3more minutes x
Task demand Hits Redirected to the task x
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ABC Analysis Case Study
Antecedent Behavior Consequence A T E ?
Task demand (write name) Bangs head with hands Attention Dont hurt yourself X X
Alone in play area Bangs head on bookshelf Ignore X
Toy out of reach Bites wrist Is given toy X
Transition from free time to academic time Bangs head with hands and toys, screams Guided to academic area X X
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Environmental Manipulation

• Systematic manipulation of environmental
  variables that you believe will and will not
  result in the demonstration of the problem
  behavior.
• Can only be used when it is possible for the
  interventions to manipulate the relevant factors
  (hot vs. cold, tired vs. awake)
• Potential benefits of the procedures should be
  weighed against the potential risks to the
  student
• Required consent
• Strategies should be developed to ensure safety
  of the student, the interventionist, and others
  in the environment
• This is just an overview.

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Environmental Manipulations
Advantages Disadvantages
Validates hypotheses regarding the functions of the behavior. Implementation of environmental manipulations may provoke problem behavior. (Ethical considerations)
Assists in identifying the multiple functions of a behavior. Time Consuming
Initial manipulations may fail to verify the hypothesized function of behavior.
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Environmental Manipulations

• Antecedent variables are set up in advance and
  are not contingent on problem behavior (e.g.,
  student is given hard task versus an easy task
  low attention versus high attention)
• Based on the ABC, identify the variables that are
  likely to influence problem behavior.
• Identify a time period and situation that can be
  set up to test your hypothesis (e.g., high rates
  of attention and low rates of attention).
• Collect data on the problem behavior that occurs
  in each condition
• Conduct the conditions across several days,
  testing each condition at least two times.

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Antecedent Manipulation Case Study

• Hypothesis Given an academic demand, Nick will
  bang his head to avoid doing the work.
• FA could help determine if the subject of the
  task influenced the rate of head banging.

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Case Study

1. Develop a hypothesis about two variables that you
   believe to influence challenging behavior
2. In the same setting, test out those two variables
   related to their effects on the students behavior

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Environmental Manipulations

• Consequence variables to be tested are
  presented contingent on problem behavior
  exhibited by the student.
• Based on the ABC, identify the variables likely
  to influence problem behavior.
• Identify a time period and conditions that can be
  set up to test your hypothesis.
• Based on problem behavior, variables are
  implemented. For example
• During an escape condition, when the problem
  behavior occurs, the task is removed
• During an attention condition, when the problem
  behavior occurs, attention is provided
• During a tangible condition, when the problem
  behavior occurs, a tangible item is provided

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Developing a Hypothesis Statement

• Hypothesis statements are developed for each
  behavior.
• Review the data to identify patterns
• Under what condition does the behavior occur?
• What happens when the behavior occurs?
• Summarize when X happens, S engages in problem
  behavior to get Y

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Hypothesis Development
when this happens (setting event /context/antecedent) the student does (describe the target behavior) for what purpose (obtain/escape/ avoid)
When William has to wait for the bus and he is presented with a difficult task screams, swings his arms to escape having to do the work
 When Annie has been working independently on a math assignment Wanders the classroom shoving the materials of her classmates on the floor to obtain attention
After a weekend with his grandparents and when transitioning from recess to reading groups Quintalis puts his head down and begins to doodle on the paper to escape having to read
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Questions?