Understanding and Treating Problem Behavior: From Functional Assessment to Intervention

1. Understanding and Treating Problem Behavior:From Functional Assessment to Intervention Frank R. Cicero PhD, BCBA Seton Hall University Presented for SPLASH April 17, 2018

2. Have you ever heard….? • “His behavior has no purpose, he just does it.” • “His tantrum behavior is totally maladaptive.” • “Well of course he’s going to be aggressive, he has autism.” • “She just screams all the time.” • “She just gets so angry that she lashes out.” • “Its like he becomes a different person.”

3. Misconceptions • Challenging behavior is not functional • If the behavior is undesirable for us it must be maladaptive for the student • Challenging behavior happens out of the blue

4. Challenging behavior occurs because the child “has __________.” • Challenging behavior occurs because the child is bored, angry, sad etc. • Challenging behavior comes from the home

5. Behavioral Framework • According to the principles of ABA, challenging behaviors are: • Learned from past and present experiences with the environment. • Controlled by the situation. • Learned and maintained in the same way as appropriate behavior. • Voluntary and adaptive • Treated through the systematic manipulation of the environment.

6. How are behaviors learned? • Challenging behavior, as well as appropriate behavior, is learned over time as an individual gains experience with environmental contingencies. • The basic learning principle: SD -------------------- R ------------------- SR (trigger) (response) (reinforcer)

7. Examples of the learning principle

8. Understanding Behavior • Before you can treat a behavior, you have to understand it. • Randomly chosen treatments will lead to a “revolving door” effect. • Why the child engages in the behavior is more important to designing a treatment than what the behavior is that you are treating. • Remember that according to the principles of ABA, all behavior serves a purpose. • Behaviors occur because they are reinforced by others and by the environment

9. Functions of Behavior • Escape/Avoidance • Attention • Access to Tangibles • Sensory/Internal

10. Topography v. Function

11. Importance of Function • If you DO NOT look at the function of the challenging behavior before designing a treatment three things could happen: • You might get lucky and reduce the behavior • You might develop a plan that has no effect • You might make the behavior worse through your “treatment”

12. How do you find out the function of a behavior? • Figuring out the function of a behavior is a carefully done process. • It is usually the most time consuming part of behavior plan development • Guessing or assuming are not acceptable methods. • You need to be objective about what is happening in the environment.

13. Indirect Functional Assessment • Indirect methods involve gathering information from people who have direct contact with the child and the situations in which challenging behavior is observed. • Usually involve parent or teacher interviews. • Advantage is that you can gather information quickly and easily. • Disadvantage is that you might be obtaining subjective and incorrect information.

14. Interviews • “Why did you just do that?” • “Why do you usually scream when you see John in the hallway?” • “When does Alyssa usually tantrum?” • “When does Alyssa never tantrum?” • “How do you usually respond to Alyssa’s tantrums?”

15. Motivation Assessment Scale (MAS) • Paper and pencil assessment tool (Durand & Crimmins, 1992). • Similar to a standardized interview. • Divides into four functions of behavior. • Likert scale rating system. • Administer to several raters independently. • Although subjective, the MAS can provide you with some preliminary information in order to make a preliminary hypothesis about function.

16. Direct Functional Assessment • ABC Assessment Antecedent = What happened before the behavior? Behavior = What behavior was displayed? Consequence = What happened after the behavior?

17. ABC and the Learning Principle SD -----------------R-------------------SR Antecedent -----------Behavior -------Consequence Trigger --------------Behavior------------Reinforcer

19. ABC Assessment • Collected for several days to several weeks depending on the baseline rates of the behavior. • ABC recordings must be objective. Only observable behavior and situations are recorded. • Patterns in the ABC records will tell you the function of the behavior. • The antecedents tell you the common triggers to the behavior. • The consequences tell you why the behavior is being maintained. • Treatment will involve the manipulation of both the antecedents and the consequences.

20. Four Component Treatment Noncontigent Reinforcement Functional Communication Training Extinction Differential Reinforcement

21. Treatment Considerations • Treatments must be practical and feasible in natural settings. • Treatment strategies should not be too numerous or confusing. • Plan must be customized to the individual child, behavior and function. • Consider the ability of the caregivers to implement the plan consistently in non-school settings. • Program for generalization and maintenance. • Program for success, not failure.

22. Reduce Motivation • Challenging behavior will not decrease if motivation to get a need met stays high • Function is never wrong….the topography of the behavior is inappropriate • Punishment might suppress a particular behavior but, in isolation, will lead to symptom substitution • You have to satisfy the need in order to reduce the motivation

23. The Four Term Contingency EO --------- SD --------- R --------- SR • Establishing operations act upon all three elements of the three term contingency. • Deprivation first makes specific stimuli more reinforcing to the organism • The organism is then “driven” to display responses that will result in those stimuli • Finally, discriminative stimuli in the environment that are associated with the reinforcing stimuli will become more evocative

24. The Establishing Operation • An establishing operation is something that makes a particular stimulus more reinforcing to an individual at a given moment in time. • For example, liquids are most reinforcing when you are thirsty. Money is most reinforcing when you need to pay bills. • The establishing operation can be found through your functional assessment data or another system. • Treating the establishing operation will reduce a child’s motivation to engage in the target behavior.

25. Noncontingent Reinforcement Schedules • Offering the functional reinforcer on a fixed time schedule regardless of behavior • Noncontingent breaks from work • Noncontingent attention from others • Noncontingent access to a desired item or activity • Noncontingent specific sensory input

26. Communication Training • Teach the child some communicative response that serves the same function for them as the challenging behavior • Must conduct a functional assessment first • The new response should be reinforced, while the challenging behavior is not • Understand the environment (ex. Teaching going to the bathroom as an escape from work instead of asking for a break)

27. Fading • Begin by reinforcing each occurrence of the communicative response • Gradually and systematically build in tolerance • Do not fade to zero…remember the function isn’t wrong • Think of alternate strategies in situations where communication cannot be honored (ex. Escape from airplane, asking for a hug)

28. Learning to Explain and Bargain • Three exchange strategy • Provide an directive and rationale • Listen to their perspective and either give in or repeat directive and rationale • Listen again to their perspective and either give in (with explanation) or give direction last time (without rationale) • Ensure follow through

30. Extinction • Definition: A procedure in which the reinforcer that is maintaining a behavior is systematically and consistently withheld • A functional assessment must be conducted. The type of extinction plan that is used is based on the function of the challenging behavior • Without extinction of challenging behavior, almost no treatment plan will be successful • Extinction is not “ignoring the student”

31. Extinction Challenging Behavior Antecedent -------Behavior-------Consequence Extinction Antecedent -------Behavior-------Consequence

32. Types of Extinction(based on function of challenging behavior) Escape Extinction“You have to finish your work” Attention Extinction“I will speak with you when you stop” Access Extinction“Sorry, no more chips today” Sensory Extinction(having a child where earphones so they can’t hear their own screaming)

33. Issues with Extinction • Consistency is needed • Extinction bursts • Spontaneous recovery • Practical/safety issues may be involved

34. Differential Reinforcement • Systematic reinforcement of one behavior, but not another • Include: • DRA (reinforce ALTERNATE behavior) • DRO (reinforce OMISSION of behavior)

35. Compliance Training • 3 steps • Give a directive (wait) • Give a directive with a contingency (wait) • Prompt compliance or not allow compliance if you cannot prompt

36. Data Collection • In order to make objective decisions about the effectiveness of a behavioral intervention, data must be collected.

37. Why Collect Data? If you do not collect data, the following errors in treatment are likely: 1. Ineffective programs may be wrongly continued 2. Effective programs may be wrongly discontinued

38. Data Should be... • Objective • Accurate • Based on observable events • Able to be replicated • Recorded or graphed • Saved for a period of time • Analyzed

39. Thank You… Questions? Comments?