Proactive Strategies for Managing Challenging Behaviors of Students with Autism Spectrum Disorders

Presented by Mae Barker, PhD, BCBA-D Florida Autism Consultants & Educational Services mae@facesjax.com
A Regional Workshop hosted by PEPSA & CARD Feb. 9, 2012

What is our goal for any student?

To demonstrate the necessary skills and knowledge in order to be . A contributing member of society Integrated into the social milieu of everyday life As independent or self-sufficient as possible Happy and healthy

What are behavior problems or challenging behaviors?

Behaviors that interfere with the student accomplishing this goal! Behaviors that the student engages in that Disrupt the home or classroom Place the student and/or others at risk of injury Impede his or her learning

Is this a problem behavior that warrants assessment?

Aggression Spitting Toe-Walking Biting finger nails Calling people bad names Not following directions Whining

Thinking about Behavior Some key points to remember

Parents and teachers are responsible for teaching children how to be good learners = PROACTIVE!
Following directions Cooperating with others Participating in instruction Using language skills to communicate effectively

The longer a behavior problem continues, the harder it is to change We should assess the students overall well-being and how it may relate to the students behavior (e.g., medical needs, family situation, problems outside of school that may factor into students behavior)

Effectively Addressing Behavior Problems Involves

Correctly identifying why a behavior is occurring
Functional Behavioral Assessment (FBA)

Systematically applying proactive techniques

To prevent problem behavior from occurring To increasing the likelihood that the student will engage in desired behavior

Systematically applying management strategies when the student engages in problem behavior Collecting data to judge the effectiveness of using the above strategies

Looking at Behavior
Lets look at Sam

Looking at Behavior
What did you see?

Sam was being aggressive.

Sam was spitting at his peers. Sam was being mean to his friends.

Thinking about BEHAVIOR

THE BEHAVIOR TRAP: Behavior involves more than just what the student is doing!

Functional Behavioral Assessment (FBA)

Antecedent Behavior Consequences

Antecedent: What happens before the behavior? Motivation: Events that contribute to the behaviorinfluence students motivation to engage in behavior (deprived of attention, illness, hungry, tired) Behaviors: What is the student doing? Consequences: What happens after the behavior? What are consequence(s) that could be strengthening the behavior?

Looking at Motivation
We dont just respond to things in our environment. We respond when we have a need to do so! When looking at motivation, consider
The students preferences The students current state of need (i.e., deprivation)

Looking at Antecedents
What happened prior to the problem behavior?

Was the student asked to do something?

Was the student alone?

Did someone approach the student?

Did something happen in the students environment (e.g., fire drill, parent leave the classroom, item removed, someone made comment to the student) Was the student doing a preferred activity and then required to stop?

Looking at the Students Behavior/Response

When looking at BEHAVIOR/RESPONSE: 1. Frequency how many times did the behavior occur?

2. Intensity severity of behavior

3. Duration how long did behavior occur?

4. Progression of behavior: Is there a build-up of the behavior? (Ex: whining screaming falling to the ground)

Looking at Consequences
What happened after the problem behavior?
Common Maintaining Consequences: Does the student obtain preferred items or activities by engaging in P.B.? Does the student escape or avoid a task by engaging in P.B.? Does the student obtain attention by engaging in P.B.? Does the student obtain sensory stimulation (automatic reinforcement) by engaging in P.B.?

Did the behavior work for the child?

Could the consequence be a reinforcer? Reinforcers are consequences that strengthen behavior.
Positive and Negative Reinforcers

RethinkAutism Problem Behavior Training Video

Video provided courtesy of RethinkAutism RethinkAutism is a web-based educational program providing assessment, training, curriculum, and data tracking For more information on the programs and services offered through RethinkAutism, go to www.rethinkautism.com

Motivation Antecedent What could What seems to motivate your trigger your child to childs response? engage in this What is happening response? immediately before your childs response?

Response What do you see your child doing?

Consequence Likely function What happens of the after your childs behavior? response? What do you think your child achieves by doing this behavior?

Playing Playing alone, alone, peers playing likes nearby attention from kids

Approaches peers, Makes rasberry sound towards them, then hits Max, and then scratches him

Max turns around and yells at Sam to stop it

Attention
Access to preferred item/activity Removal of task/demand/ work Enjoyment from the act itself (stimulation) Other???

Functional Behavioral Assessment

Descriptive Assessment
Direct observation of behavior under naturally occurring conditions (as in previous example) Hypotheses based on correlation between events/environmental stimuli and target behavior

If we recorded several other similar episodes for Sam, our hypothesis would likely be:
Sam engages in aggressive behavior towards his peers for attention.

Lets Continue to Practice Collecting FBA Data Using Descriptive Assessment

 Brady is a PreK student with Developmental Disabilities. He is learning to independently go potty. Throughout the day, his teacher will tell him to go potty. As soon as he is told this, he starts to scream and protest. Sometimes, he will also run away from the adult. When the teacher or aide escort him to the bathroom, he often continues to protest and refuses to go to the bathroom (although he is capable of doing so). The teacher and aide often respond to his outbursts by continuously telling him to go potty while remaining in the bathroom with him. They do not allow him to leave the bathroom until he eliminates, but this may take up to 20 minutes before he complies.

Motivation Antecedent What could What seems to motivate your trigger your child to childs response? engage in this What is happening response? immediately before your childs response?

Response What do you see your child doing?

Consequence Likely function What happens of the after your childs behavior? response? What do you think your child achieves by doing this behavior?

doesnt Told to go to Screams, like to go the bathroom runs away from teacher, potty by teacher

Teacher directs him to bathroom, repeatedly tells loudly him to go potty, protests in stays in bathroom with bathroom, goofs off in him until he is done

Attention
Access to preferred item/activity Avoids/Escapes task/demand/ work Enjoyment from the act itself (stimulation) Other???

bathroom

So how do we change this behavior?

What do we want Brady to do?
Follow the direction to go to the bathroom calmly on the first time

How do we achieve this goal?

Need to modify one or more of the four boxes!

Modifying Bradys Behavior

Motivation: Increased his motivation with reward system Antecedent: Teacher tells him, Brady, please go to the bathroom and go potty, and then you can earn a behavior buck! Behavior: Brady cooperatively goes to the bathroom Consequence: Behavior-specific praise + Reward (Brady, that was great! You followed my direction and went potty like a big boy! Here is a behavior buck!

Modifying Bradys Behavior

If he doesnt follow the direction, what happens then?
No reward Ignore whining Try again later

FBA Resources
Center for Effective Practice and Collaboration: http://cecp.air.org/fba/ Autism Training Solutions: www.autismtrainingsolutions.com Functional Behavioral Assessment, Diagnosis, and Treatment: A Complete System for Education and Mental Health Settings by Ennio Cipani and Keven Schock

Being Proactive: Can we prevent challenging behavior from occurring in the first place?

Proactive Strategies
Require the educational professional to
1. Know what he/she wants the student to do at all times!
In other words, you must know what behaviors would be most appropriate for the student to perform across places, people, and situations

2. Structure the environment in a way to promote these behaviors 3. Teach appropriate student behavior (as one would think about teaching academic skills)

Proactive Approaches to Modifying Student Behavior

Involve using one or more of these approaches:
Antecedent Interventions
Providing explicit direction and clear expectations Motivating the student to engage in desired behaviors Restructuring the environment Using Visual Supports (e.g., First/then, schedules, token strips) Using the Premack Principle Using Vicarious Reinforcement

Consequence Interventions
Reinforcing the student for engaging in desired behaviors Changing consequences for problem behavior

Eight Skills Every Teacher Should Have (Glenn Latham, 1997)

http://www.behavioralinstitute.org/FreeDown loads/TIPS/8%20skills%20every%20teacher%2 0should%20have.pdf

Eight Skills Every Teacher Should Have (Glenn Latham, 1997)

1. The ability to teach expectations. 2. The ability to get and keep students on task. 3. The ability to maintain a high rate of positive teacher-to-pupil interactions. 4. The ability to respond noncoercively to inappropriate behavior that is inconsequential. 5. The ability to maintain a high rate of risk-free student response opportunities. 6. The ability to serve problem-behavior students in the classroom. 7. The ability to avoid being trapped. 8. The ability to manage behavior scientifically.

The ability to teach expectations (Latham, 1997)

Expectations should be
1. Taught situationally 2. Taught formally using role-play, modeling, and practice 3. Kept to a small number (max of 4 or 5) 4. Stated in an instructive (rather than prohibitive manner)

Teaching Expectations CHAMPS Approach

Great Resource
http://www.browardprevention.org/resources /prevention-curriculum-infusion/champs/
Video examples of using CHAMPS across the grade levels

Teaching Expectations The Skillstreaming Curriculum

Skillstreaming employs a four-part training approachmodeling, role-playing, performance feedback, and generalizationto teach essential prosocial skills to children and adolescents. http://www.skillstreaming.com/

The ability to get and keep students on task.

Have learning materials and reinforcers ready Infuse learning activities with fun-ness and show excitement in the material Quickly engage the students in the learning activity When the student is not involved in teacher-led activity, direct student to perform independent work or leisure activities
Activity schedules are often helpful to promote independent engagement

The ability to get and keep students on task. (continue)

Active supervision (Colvin, 1996) and Proximity Control
Moving around the classroom Frequently interacting with students
Delivering instructional cues Giving feedback Delivering reinforcement

Effectively utilize paraprofessional support

Coaching Zoning plan

Classroom Zoning Plan Erins Classroom Time/ Activity 7:30-8:15 Teacher Arrival 8:15-8:30 Arrival/ Bathrooming Erin Getting materials ready for the days activities Remains in room, getting folders ready, helping students put away lunches, assisting with bathrooming Assisting A with choice time Maria Check on schedules / food Pick up T Pick up A Pam Check on schedules / food Pick up T Assists with bathrooming and putting things away Comments/ Contingency

Picking up A can rotate between Pam and Maria

8:30-8:45 Choice Time

Assisting A with choice time

Accompanies T to kindergarten

B is at Ms. Coverts Maria or Erin may switch w/ A and other person can help prepare activities

8:45-9:00 Inclusion Classes 9:00-9:15 Snack 9:15-9:30 Independent Work / Snack

Remain in class; get materials ready for snackPECS, food, etc. Trainerprovider of foodperson students communicate with Trainer for PECS

Go to inclusion with A ; Structure choice time when return to class after he is finished Facilitate / prompt PECS

Accompany T to inclusion

Facilitate / prompt PECS

Facilitate / prompt PECS

9:30-9:45 Circle (all) 9:45-9:30 Circle (class) Choice Time 2/6/2012 (Andrew)

Running circle; facilitate M and B Running circle; facilitate M and B

Facilitate T Facilitate T

Assist A with bathroom; transition him to Independent Work; assist in independent work Facilitate A Structure As choice time; target play skills in structured play area?

39

The ability to maintain a high rate of positive teacher-to-pupil interactions.

Start the day off by acknowledging a good behavior that your student does Respond to good behavior by frequently delivering positive reinforcers
Praise + Individualized, Established Reinforcers

Avoid the bad habit of I only respond to you when you are misbehaving Avoid coercive means of controlling student behavior (Do this, or else. )

Homework Assignment
1. Videotape yourself during an instructional period 2. Watch the video and count how many times you reinforce student behavior 3. Next, set a goal for yourself to increase this # by at least 3! Repeat steps 1 and 2 and also look at the difference in your students behavior.

The ability to manage behavior scientifically.

Looking at the function of behavior Employing empirically-based strategies One size fits all does not really fit all
Avoid employing a one size fits all approach to behavior

Dont jump off the bridge just because others are doing it
In other words avoid mindlessly copying how others may respond to behavior or set up classwide behavior systems

Parent Management Training

Developed by Dr. Alan Kazdin with the Yale Parent Center and Child Conduct Clinic Based on the field of Applied Behavior Analysis Research-supported approach Website: http://www.yale.edu/yalepar entingcenter/training.html

Identifying the Positive Opposite

Identify the problem behavior what is it that you see or hear your child do that is problematic?
Ex: Yelling No! and refusing to complete homework when directed

Identify the Positive Opposite: What is the positive behavior that youd rather your child do? = EXPECTATION
Ex: Calmly follow the direction to complete homework when asked the first time

Prompting the Positive Opposite

Prompt = your direction to the student to engage in the positive opposite A GOOD PROMPT:
Specific Statement (not a question) Given in close proximity to the child Calmly stated Delivered immediately before you want the behavior to occur

Example Prompts
Put your homework in the red basket please. Chew with your mouth closed please. Wait in line with your hands by your side please. Sit down at the table and complete your writing worksheet please.

Using Visual Supports to Prompt the Student to Engage in Desired Behaviors

Schedules Posting of Expectations Modeling
Live modeling Peer modeling Video modeling
Ipad Applications

Benefits of Schedules
Promotes independence and purposeful selfdirection Can be used to motivate students to perform certain activities
Premack Principle First, Then ordering of pictures

Can be helpful for keeping staff on track too

Schedules
How to Teach a Student to Follow a Schedule
www.rethinkautism.com

Visual Schedules Module:

http://cdd.unm.edu/swan/autism_course/module s/environ/visualschedule/index.htm

Recommended Book:
Activity Schedules for Children With Autism: Teaching Independent Behavior by McClannahan & Krantz (1999)

RethinkAutism Video Teaching a student to follow a visual schedule

Video provided courtesy of RethinkAutism RethinkAutism is a web-based educational program providing assessment, training, curriculum, and data tracking For more information on the programs and services offered through RethinkAutism, go to www.rethinkautism.com

Examples of Video Models

A poor example: http://www.youtube.com/watch?v=Qjg3a3Tq hKg Good examples:
http://www.youtube.com/watch?v=qjlSA-u8KUI

Common Problematic Misapplications of Visual Supports

Inconsistency of use Lack of organization Failure to teach the student how to follow the visual support Teachers/educational professionals fail to follow the visual supports or honor the portrayed arrangement Lack of specificity in visual supports

Using Choice to Motivate Your Students to Perform

Giving the student a choice specific to tasks or work activities
Activities Materials Location Utensil or output device Who the student wants to work with

Giving the student choice of reinforcers

Picture menu

Show me the money!

All behavior is functional! We all need to be motivated to engage in behaviors that are mundane, challenging, or difficult.
Some people need more extrinsic motivation than others Some people are motivated by social consequences while others are not or not so much

Motivating the Student to Engage in Desired Behaviors

State task/direction using First/Then statement Use a Token Economy Make the activity fun Pair yourself with sources of reinforcement = become a conditioned reinforcer Use vicarious reinforcement Establish a history of reinforcement with the student

Positive Reinforcement
Why use positive reinforcement?
Positive reinforcement = the delivery of a consequence following a behavior that increases the likelihood that that behavior will occur again!

Types of Positive Reinforces:

Attention: Behavior-specific praise Tangible: Preferred items, toys, materials Activities: Access to preferred activities Tokens: Tokens can be traded in for established reinforcers (think of your paycheck!)

Identifying Reinforcers
Determine students preferences identify potential reinforcers that could be used to strengthen desired skills Observe student: What does he/she play with? Look at? Grab for? Ask for? Ask the parent or the child
See Reinforcer Survey handout

Structured choice assessment

Audience Exercise
See Reinforcer Survey in your handouts
Reinforcer Assessment for Individuals with Severe Disabilities (RAISD)
Fisher, W. W., Piazza, C. C., Bowman, L. G., & Amari, A. (1996). Integrating caregiver report with a systematic choice assessment to enhance reinforcer identification. American Journal on Mental Retardation, 101, 1525.

How to Use Positive Reinforcement?

Immediately after the desired behavior occurs,
Praise: Enthusiastic and behavior-specific Reward: For teaching new behaviors, it is important to regularly reinforce behaviors with praise and access to a reward.
Access to preferred item/activity Earn Token (Ex: Behavior Buck.)

As the child more readily engages in the desired behavior, you will fade out use of reinforcement.

Token Economy
Reinforcement program for increasing student engagement in desired behaviors (e.g., completing work, following directions, sitting in seat for circle time) We give tokens following students engagement in desired behaviors
Tokens could be stickers, check marks, pennies, etc.

Tokens are like paychecks!

Tokens are reinforcing to earn because you can trade them in for things that you really want such as food, clothes, trip out to the movies, etc.
If your paycheck did not result in access to such reinforcers, then you would not work to earn it! Same concept in place when we use tokens as consequences for student behavior.

Step 1: Pinpoint target behaviors

What are behaviors that you will reinforce with tokens?
Academic? Social? Communication? Good learner behaviors?

Define these in specific, clear, and observable terms.

Ensures that staff will deliver tokens following the right behavior Helps student understand the behavioral expectation

Step 2: Build the Token Economy

Select tokens
Safe to use Easy to dispense Easy to replace Commonly used tokens: pennies, stamps, smily face or other positive visuals (with velcro)

Create the token strip

Use materials that can be reused or easy to reproduce Laminated materials, velcro

Building the Token Economy

Build the REINFORCER bank tokens will be exchanged for these reinforcers in the bank Special privileges: computer time, trip to library, playing games Preferred items: toys, snack items, stickers Free time/Break Bank of reinforcers for which tokens can be exchanged Need to make sure the bank is in a secure spot that students cannot easily access! May need separate accounts (containers) for individual students Reinforcer Menus very helpful Student can select from options presented on reinforcer menu Consists of pictures of items and activities that student can work for

Building the Token Economy

Setting token value: What earns a token???
What does the student have to do in order to earn a token?
Examples: After each problem completed, the student will earn a token. When the student answers 3 questions in circle time, he will receive a token. When the student stands in line for transition from class to lunch without instances of problem behavior, he will earn a token. When the student follows teacher directions, he will earn a token.

Keep in mind
When teaching new skills, tokens should be delivered continuously (1 behavior = 1 token).
As the student becomes proficient, tokens can be delivered less often (example: 4 behaviors = 1 token)

The payoff needs to match the behavioral expectation. Are tokens being delivered often enough? Write on the token strip the rules for earning tokens. This is essential for successful use of the token economy by staff.

Building the Token Economy

When will tokens be exchanged? For younger students and students who are being exposed to token systems for the first time, completed strips should be immediately exchanged for reinforcers. Later on, you can designate times when completed token strips can be exchanged for reinforcers from the bank.

Implementing the Token Economy

1. Explain the program to the student
What does the student have to do to earn a token? Write it down or use a visual to illustrate this expectation? May need to start with 1-5 boxes on strip at first to teach student the concept of earning tokens for back-up reinforcers As students behavior improves and learns program, can increase expectations increase number of boxes on strip = student must earn more tokens prior to cashing in.

2. Deliver tokens with behavior-specific praise

Frequently Asked Questions

I am using a token economy, and it isnt working. What is wrong?
Are you using the token economy consistently? Are you giving the student tokens often enough? Are you allowing the student to cash in token strips for items/activities that are truly reinforcing? Is the student always working for the same thing?

Frequently Asked Questions

When should I use the token economy?
It depends You can use the token economy across the entire day or during specific times of the day when the student needs to increase specific behaviors.

Frequently Asked Questions

Should I tell the childs parent that I am using a token economy at school?
Yes! This may be helpful for the parent to use at home. Make sure you tell the parent how to use the system at home.

Frequently Asked Questions

Can the student give himself the tokens?
Yes, over time, the student will learn when he is engaging in the desired behavior and can be taught to deliver his own tokens. This is referred to self-management. You will still want to check up on the student and make sure that he is doing this correctly.

Token Economy Resources

http://www.usu.edu/teachall/text/behavior/L RBIpdfs/Token.pdf - Great How-To handout http://www.abaresources.com/free2.htm: Free token economy materials http://www.polyxo.com/visualsupport/tokene conomies.html - more info on using token economies for students with ASD

Functional Communication Training: Teaching replacement behaviors

Treatment involves: 1. Identifying the communicative function of a problem behavior
Example: To obtain preferred items, student grabs them from others

2. Select an appropriate communicative response for the student

Example: To obtain preferred items, student will say the name of the item and wait until the item is handed to him.

3. Teach the student by prompting and reinforcing the appropriate communicative response and not reinforcing the problem behavior (Differential Reinforcement).
Example: When students says, Toy, he is handed a toy. When he grabs for toy, his grab is blocked and he doesnt receive the toy.

Selecting Interventions for Behavior Reduction

Cooper, Heron, and Heward (2007). Applied Behavior Analysis, 2nd Edition. Upper Saddle River, NJ: Pearson Education.

Example Intervention Options for Behavior with Escape Function

Intervention
Teach a new behavior

Antecedent
When student is required to perform a undesirable task When student is required to perform a undesirable task

Behavior

Consequence

He will say, May The teacher will allow I take a break student to take a break now?* from task =Negative Reinforcement And he engages in problem behavior He will be required to continue working on the task and the timeout intervention will be discontinued = Differential reinforcement

Change the reinforcement contingency

*Must take into account students communicative ability when specifying replacement communicative response to be taught and reinforced. Cooper, Heron, and Heward (2007). Applied Behavior Analysis, 2nd Edition. Upper Saddle River, NJ: Pearson Education.

Example Intervention Options for Behavior with Tangible Function

Intervention
Teach a new behavior

Antecedent
When students access to preferred materials is restricted
When students access to preferred materials is restricted

Behavior

Consequence

He will say, Can And the teacher will I have that back, provide access to the please?* preferred materials
And he engages in problem behavior He will be redirected to engage in the desired communicative response when the student engages in this response, he will be given the preferred materials (differential reinforcement)

Change the reinforcement contingency

*Must take into account students communicative ability when specifying replacement communicative response to be taught and reinforced. Cooper, Heron, and Heward (2007). Applied Behavior Analysis, 2nd Edition. Upper Saddle River, NJ: Pearson Education.

Example Intervention Options for Behavior with Sensory (Automatically Reinforced) Function
Intervention
Teach a new behavior

Antecedent
When student is motivated to engage in behavior for sensory stimulation

Behavior

Consequence

He will be The student will be directed to allowed to engage in functional this activity activities that provide this form of stimulation

Decrease Student is directed Student Student obtains motivation to on a schedule (based engages in sensory stimulation engage in on FBA data) to sensory (decreasing desire to behavior perform sensory activities for engage in instances of (noncontingent activities specified time future behavior) reinforcement) Note: If the behavior compromises the safety of the individual or others (e.g., eye poking), it may be appropriate to use also use an extinction or punishment procedure to reduce the behavior. However, this should be done under the guidance of a Board Certified Behavior Analyst (BCBA). Cooper, Heron, and Heward (2007). Applied Behavior Analysis, 2nd Edition. Upper Saddle River, NJ: Pearson Education.

Example Intervention Options for Behavior with Attention Function

Intervention
Teach a new behavior Teach a new behavior

Antecedent
When adult or peer attention is diverted from student When adult or peer attention is diverted from student

Behavior
He will say the persons name

Consequence
The adult or peer will provide attention

He will earn tokens And the teachers will during provide him with 1:1 time independent work after his token strip is full. time on a variable schedule (#) reinforcement To increase the probability that Brian will work independently Which will increase adult opportunities to praise and attend to appropriate behavior

Change the antecedent

During indep work times, adults will provide attention to Brian every 5 minutes

Cooper, Heron, and Heward (2007). Applied Behavior Analysis, 2nd Edition. Upper Saddle River, NJ: Pearson Education.

Other Helpful Resources www.autismtrainingsolutions.com excellent training modules www.rethinkautism.com excellent training videos www.autisminternetmodules.org great site for training materials Center for Effective Practice and Collaboration: Great site with information on educational issues and behavior management. Free manuals and data sheets can be downloaded for free. http://cecp.air.org/ Online Manuals on Conducting a Functional Behavioral Assessment These are excellent and also have data sheets