Best Practices Dealing With Problem Behaviour of Children and Adolescents with ASD’s

1. Best Practices Dealing With Problem Behaviour of Children and Adolescents with ASD’s Sponsored by: Children’s Mental Health Ontario Dr. Joel Hundert & Dr. Nicole Walton-Allen Behaviour Institute

2. Welcome Sites

3. Schedule For the Workshop • 1:30 - 2:30 Joel Hundert: Understanding and assessing problem behaviours • 2:30 - 2:45 Questions • 2:45 - 3:55 Break • 2:55 - 3:55 Nicole Walton-Allen: Interventions • 3:55 - 4:10 Questions • 4:10 - 4:30 Application to school & families

4. What is the Behaviour Institute? • The Behaviour Institute is a private agency providing intensive behavioural intervention for young children with autism. Home-based services are provided out of Hamilton and Toronto offices; centre-based IBI services out of Toronto office • Training organization for the Ontario Autism Initiative

5. Sponsor of part-time Master’s degree program in Behaviour Analysis offered in Toronto by the University of Nevada, Reno (42 students) • Directors are Dr. Joel Hundert & Dr. Nicole Walton-Allen, psychologists and Board Certified Behaviour Analysts

6. Goals of the Workshop • Understanding of the unique behaviour / emotional needs of children with ASDs • Knowledge of the conceptual and research foundations of PBS • Knowledge and skills in conducting a functional behavioural assessment • Knowledge and skills of PBS strategies to anticipate and prevent problem behaviours

7. Goalscont’d • Knowledge and skills of PBS strategies to teach functional skill alternatives • Knowledge and skills of how to use PBS with families • Knowledge and skills of how to use PBS with schools

8. How to Get Materials http://www.behaviourinstitute.com

9. AGENDA • Autism • Positive Behaviour Support • How to Implement PBS • Forming a team • Functional assessment • Develop a hypothesis

10. AgendaCont’d • Behaviour support plan • Anticipate and prevent • Teach positive alternatives • No longer let the problem behaviour be effective • Implement & evaluate • Promote generalization of positive behaviours • Application to schools • Application to families

11. Assumptions • You are experienced children’s mental health clinicians • Less experienced in working with children and youth with ASD’s and their families • Have read Best Practices document • Have attended or have knowledge of introductory and advanced training provided by Geneva Centre

12. CMHO Training Plan • Introductory training (1-day) • Advanced training (2-days) • Specialized training • Best Practices for Dealing with Problem Behaviours of Children and Youth with Autism Spectrum Disorders • Best Practices for Children and Youth with Asperger’s Disorder

13. AUTISM SPECTRUM DISORDERS

14. What We Know About Autism Spectrum Disorders • Is a neurodevelopmental disorder with no clearly understood cause, although there evidence that it runs in families and has a genetic component • Is not caused by poor parenting • Prevalence is about 1/300 (Yeargin-Allsopp et al., 2003) and increasing

15. What We Knowcont’d • Can identify by 24 months (Stone et al., 1999) • More common in boys (4:1) • No prevention or cure • There is a treatment that works (Early Intensive Behavioural Intervention)

16. Growth Trajectory Typically-developing children Developmental Age Chronological Age

17. Growth Trajectory Typically-developing children Children with autism Developmental Age Chronological Age

18. Growth Trajectory Typically-developing children Goal of IBI Children with autism Developmental Age Chronological Age

19. Summary of Research on IBI • 20 - 40 hours/week of IBI can produce significant and long-lasting gains in young children with autism to a point where about half achieve average IQ and do not need special help in school • The success of IBI depends on staff being trained and supervised by competent behavioural consultants

20. Critical Componentscont’d • A large proportion of the child’s waking hours should involve active engagement in learning 20 hours 100 waking hours

21. Challenges Of CMH Agencies Serving This Population • Problems are chronic and episodic • Motivational and skill deficits

22. Challengescont’d • Compared to families of typically-developing children and children with other forms of developmental disabilities, levels of stress and depression is the highest in families of children with ASD’s • Lack of cross-sectorial service coordination (e.g., medical, educational, developmental services, etc.) is common

23. Problem Behaviours and Children / Adolescents with ASD’s • About 50% have significant problem behaviours including aggression, tantrums, stereotypic behaviours, and self-injurious behaviours • No evidence of spontaneous improvement • More frequent and severe problem behaviours are associated with children / adolescents who have more severe symptoms of autism • Problem-behaviours crytallize and become more entrenched as children get older

24. POSITIVE BEHAVIOUR SUPPORT • Origins were to provide an alternative to the use of aversives • Early researchers: Glen Dunlap, Ted Carr, Mark Durand, Rob Horner, Robert Koegel • Journal of Positive Behavior Interventions • Association and annual meeting

25. POSITIVE BEHAVIOUR SUPPORT • Origins were to provide an alternative to the use of aversives • Early researchers: Glen Dunlap, Ted Carr, Mark Durand, Rob Horner, Robert Koegel • Journal of Positive Behavior Support Interventions • Association and annual meeting

26. PBScont’d • Since 1997, amendment to Individuals with Disabilities Act (IDEA) requires: • a) PBS; and, • b) functional behavioural assessment

27. Carr & Durand (1985) Problem behaviours have a function Understanding the function of behaviours lead to more effective treatment

28. ABA, IBI, and Autism Psychology ABA Autism IBI

29. ABA, IBI, PBS and Autism PBS is ABA PBS Psychology ABA Autism IBI

30. Core Features of PBS Interventions • Driven by functional assessment • Result in outcomes that are acceptable to the individual, family and the supportive community • Fit the contexts within which the behaviour occurs

31. Core Features of PBS • Consistent with values of those who will implement the procedures; • Consistent with the skills of the people who will implement the procedures; • Consistent with the resources available to the people who will implement the procedures and matched by administrative support (Horner, 2000)

32. Core Features of PBS InterventionsCont’d • Operate from a person-centred values base (Anderson & Freeman, 2000) • Blend multiple, empirically-based procedures (Horner, 2000), • Focus on large unit of analysis and intervention

33. PBS is ABA Dressed-Up and Ready to Go Out ABA PBS

34. HOW TO DELIVER PBS

35. Case Example • Cameron is a six year old boy who has been receiving IBI for the past 1.5 years. He attends a community school with support from a PDD class in the school. Major areas of need: • Social pragmatics (e.g., conversation) • Peer interaction • Compliance

36. CAMERON IN IBI

37. CAMERON IN PLAY

38. STEPS • Form a team around the child or youth • Complete a functional assessment • Develop a hypothesis of the triggers and maintaining factors • Develop a Behaviour Support Plan • Implement and evaluate • Generalize

39. STEP 1 • Form a team around the child of individuals who can help or hinder the child’s adjustment • Like Wrap-Around, Person-Centred Planning

40. Identify strengths and needs

41. STEP 2 • Complete a functional assessment

42. Problem behaviours do not occur at random. They occur to meet a need of the child

43. Functions of Behaviour Obtain • Objects • Activities • Attention • Sensory Escape If positive If negative

44. Form & Function • Different forms of problem behaviours may serve the same function (e.g., kicking, crying to get a desired object) • Same form problem behaviours may serve different functions (e.g., crying at home to escape, crying at school for attention)

45. Identify the Problem Behaviour, Its Form and Possible Functions David is a 14 year old boy with autism who is fascinated by brightly coloured string, shoe laces, and other long fabric. He takes the string between two cupped hands, rocks while making humming noises.

46. Identify the Problem Behaviour, Its Form and Possible Function(s) Jane is late from work and rushing at the grocery store with her son, Andy. At the check out, Andy spots the chocolate bars. Andy asked for a candy bar. His mother, Jane, said, “You can’t have candy now, it’s almost dinner time.” Andy asked for it again and again, began to whine and cry. Jane was embarrassed and said, “OK, but you better eat your dinner tonight.”

47. Identify the Problem Behaviour, Its Form and Possible Function(s) Emily is a four-year with autism and hates to have her hair washed. Sometimes when her dad, Ron, bathes her, she kicks and screams. When this happens, Ron decides to wait for his wife to come home to wash Emily’s hair that day.

48. Identify The Possible Functions 1. David, a 13-year old is given seat work to do at the back of the room which he does not like. Periodically, David will run out of the room. a] escape situation; b] obtain attention; c] escape attention; d] obtain internal stimulation e] obtain object or activity

49. Identify The Possible Functions 2. Tommy is a 5 year old who hovers nears other children at outdoor play but does not play with them. Periodically, he will run by and hit a child who is playing in a group. a] escape situation; b] obtain attention; c] escape attention; d] obtain internal stimulation e] obtain object or activity

50. The Importance of Functions Before you develop an intervention for behaviour problems, you must understand the function(s) of the behaviour and develop an intervention based on that understanding. Interventions built on an understanding of functions are more effective (Carr et al., 1999)