Positive Behavioral Change Practical Strategies for Changing Behavior Across the Lifespan Presented by Barbara T. Doyle, MS Clinical Consultant www.barbaradoyle.com 2013 The ARC of Illinois Living with Autism Conference Let’s focus on:  Quickly targeting essential skills and issues  More efficient teaming  Recognizing and celebrating what is working  Teaching appropriate and efficient replacement behavior  Providing peers with information and support  Keeping track of what teams are doing 2 If you learn only one word of Japanese: KAIZEN Kaizen means continuous improvement involving everyone. Kaizen means preserve what is working well while focusing on what needs to be done next. Adapted from Kaizen: The Key to Japan’s Competitive Success, by Masaaki Imai 3 Step One: Kaizen       Kaizen: celebrates and preserves what is working well. Helps us recognize where to put more focused attention and effort. Provides an informal record of discussion and progress Quickly do a Kaizen at the beginning of each team meeting. Be sure it is signed and dated as everything written about anyone must be Take a look at a sample Kaizen 4 “We must BE the change we wish to see in the world.” Mahatma Gandhi 5 Five Unifying Assumptions:  We are all fully human  We all have thoughts and feelings beyond what we can express  Without communication we cannot be safe or successful  Everyone has a right to strive for a high quality of life  We should use only socially valid interventions 6 The Assumption of Competence Assume that there is always more “internal life” in a human being than what they are able to show us, even when they are babies and little children, even when they have lots of “Ds,” even when they cannot speak or perform according to an age expectation. “I’ve always been in here.” 7 The difference between the right word and the almost right word is the difference between lightning and the lightning bug. Mark Twain If thought corrupts language, language can also corrupt thought. George Orwell 8 Step Two: Teaming Skills  Let’s review the handout: Objective vs. Subjective  Let’s look at the handout Avoid Psychiatric Terms”  Rate yourself on your own objectivity and your use of terms. How well do you separate facts from opinions? Is there anything that you want to change? 9 The Two-Minute Teaming Rule  The person who disagrees has two minutes to say everything they want to about why they disagree. NO ONE INTERRUPTS  Everyone else takes notes about every point being made  After the two minutes, someone reads the notes back to be sure the person was understood  Then, the meeting proceeds 10 Teaming Skills: Assume CAN’T instead of WON’T Assumption of Won’t leads to punishment, power struggles, rejection, and embarrassment (YIKES!) 11 of Can’t leads to creative problem solving, and creative interventions  Assumption of Can’t keeps everyone in a more calm emotional state  Assumption of Can’t models interpersonal support, belonging, and acceptance  Assumption 12 Discuss and take notes with a partner  What are some positive, non-clinical words to use to describe people and what they do?  What are three ways that descriptions can affect our interactions, service, and outcomes?  How can we better describe children and adults focusing on their unique qualities as individuals? 13 Step Three: Make a List  List current problems and issues the person is experiencing  Describe each objectively  Retain subjective opinions as to cause: this will be addressed in Step 6 14 Step 4: Prioritize the most serious behaviors to address Use these test questions to determine priorities:  “If I allow this person to do this behavior, will the police come? Will an ambulance come? Will I lose my job? Will anyone be in danger? Will the person be at risk?”  If the answers are all no, it might not be a priority behavior at this time. Stay calm, reduce input (like stop talking and touching) and keep everyone safe.  Make a note and ask for help BEFORE this happens again. 15 Categorize and Prioritize Sort” behavior into four categories:  Dangerous or potentially dangerous  Stigmatizing  Unconventional  Conventional Take a look at the Behavioral Prioritization Grid 16 Step Five: Choose Target Behavior and Take Data  Select one or two high priority behaviors to address now  Collect simple data: slash and tally, paperclips in cups, hourly or activity-based sampling.  Use the Data collection sheet for low incidence behavior or to sample more frequent behavior  Someone needs to collect and analyze data with charts and graphs: saves time, reveals hidden causes. Assign this responsibility. 17 ISBN# 0-8077-2911-6 18 Step Six: Develop Hypotheses  “Best guesses” as to underlying causes for each behavior  Be sure to note them as subjective.  For each hypothesis, brainstorm a way to test it. Some things cannot be tested.  Make the plan to test. Assign responsibilities and timelines.  Take a look at the Sample Hypotheses and Testing Plans handout 19 Remember  Everyone is always making sense.  No one does anything “out of the blue.”  No one does anything “for no reason.”  Everyone does things responding to internal stimulus or external stimulus  Put yourself in the person’s shoes: What if they did not have a disability label? 20 Step Six: Develop Hypotheses  Think about the “Why” behind the behavior.  Don’t get “stuck” on “avoiding task,” or “wanting attention.” People with ASD are complex, just like everyone else.  Look at sensory issues as causes.  Don’t blame the person, the parents, or yourself.  Consider “fear” and “confusion” 21 Step Six: Develop Hypotheses Some VERY common underlying causes are:  Medication and medication side effects  Being sick or in pain  Having an undiagnosed condition  Having an untreated condition  Take people with disabilities to the doctor if their behavior changes quickly or becomes severe. 22 A word about medications  There are no medications designed to be used to change the behavior of children and adults with ASD  All medications have side effects, some are uncomfortable, some are fatal  People with ASD are less able to tell us if they are experiencing side effects  Take a look at your handout about the use of medications 23 Step Seven: Select Replacement Behavior Select one or more replacement behaviors that:  Have HIGH impact on people and events  Send the same message without danger or destruction  Are easier (may not be the best, but better than current behavior)  Can be seen and reinforced  Can have data collected about them 24 What are some important lifetime behavioral goals?  Being a safe person (not hurting self or others, not destroying property)  Having safe ways to express all emotions (there are no wrong or bad emotions)  Using privacy (caring completely for own body, respecting others’ privacy) 25 ISBN # 1-885477-94-5 26 What are some important lifetime behavioral goals? But what about compliance???  Compliance as a goal might be over-rated! What if the people with disabilities did what everyone told them to?  Systematically teach compliance to safety and most important instructions  Teach exceptions to compliance 27 Step Seven: Select Replacement Behavior  If you can, begin to teach replacement behavior, in private sessions/therapies  Think about teaching, not just talking.  Take a look at your handout: Using Visual Strategies to Support and Teach Successfully  Take a look at the sample “Replacement Behavior” chart 28 Step Eight: Design Motivation Systems:  Why should people be “rewarded?”  Neurological effects of working for rewards include organization, focus, endurance, tolerance, motivation, persistence…  Why might verbal praise not be enough?  Always add verbal praise but recognize it may not MOTIVATE people with social communication issues 29 Step Eight: Design Motivation Systems:  What about “bribes?”  Use only for objectively-defined, target behaviors  Keep it simple, Sweetheart  Be sure people earn rewards quickly in the beginning  Later, teach self-monitoring 30 Step Eight: Design Motivation Systems:  Can use different systems in different places  Allow the person to choose and work for a specific liked object, activity, person or environment that you can easily provide.  Consider reduction in the amount of “less preferred” work as a reward  Look at the Reinforcement Inventory 31 Step Nine: Real Inclusion “Clue In”  Can have general discussions that are not person-specific at any time  Provide reasonable explanations for what others observe  Get appropriate permissions before talking about a person specifically 32 We are changing our world! Each time a (person) stands up for an ideal, or acts to improve the lot of others, or strikes out against injustice, s/he sends forth a tiny ripple of hope, and crossing each other from a million centers of energy and daring, those ripples build a current that can sweep down the mightiest walls of oppression and resistance. Robert F. Kennedy P.S. This would be us! 33 Step Ten: What Will You Do Now? It is only in the doing, the applying, that knowledge and understanding are internalized. Stephen R. Covey, “The Eighth Habit: From Effectiveness to Greatness” 34 Thank you for all you do! To contact me: Barbara T. Doyle, M.S. 708-966-4683 [email protected] www.barbaradoyle.com www.asdatoz.com 35 Two award-winning books by Barbara T. Doyle MS and Emily Doyle Iland MA ISBN# 0-9768222-0-2 ISBN# 1-932565-07-8 36 Two New Products from Barbara T. Doyle, MS Three Hour CD Set for Staff, Teachers, Therapists and Families DVD Teach Sign Language to People with Communication Needs 37