Handouts for Overcoming Behavioral Roadblocks in
3/18/15 Disclosure Statement Overcoming Behavioral Roadblocks in Speech-‐Language IntervenAon Patricia Villarreal, M.S., CCC-‐SLP Ellen Kester, Ph.D., CCC-‐SLP Texas Speech-‐Language Hearing AssociaAon ConvenAon March 21, 2015 San Antonio, TX Nonfinancial — None Financial — Ellen Kester is the founder and owner of Bilinguistics. Ellen Kester and Patricia Villarreal receive salaries from Bilinguistics. Bilinguistics receives royalties from product sales. BilinguisAcs 2015 2 Co-‐occurrence of communicaAon disorders and behavior Studies indicate that between 1.5% and 11% of children with communication disorder also have significant behavior issues! Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. Poor Behavior – No Therapy? Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. 1 3/18/15 Speech Therapist OccupaAonal Therapist Behavior Specialist Teacher You are NOT following my agenda! You are NOT following my agenda! Principal School Psychologist Parent Resource Copyright © 2014 BilinguisAcs, Inc. All Teacher Rights Reserved. Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. Behavior problems are common in children with communicaAon disorders. Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. 2 3/18/15 “The best way to understand behavior is to observe the causes of a behavior and the consequences of that behavior.” Operant CondiAoning Changing behavior through the use of reinforcement given a_er a desired response. Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. FuncAon of the Behavior Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. What is the funcAon of the behavior? Behavior MoAvaAon Obtain AbenAon Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. Avoid Sensory Input Objects AcAviAes © 2013 Emergent Tree EducaAon Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. 3 3/18/15 Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. Punishments and Reinforcers Reinforcement Decreases Behavior Punishment Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. q Change connected to the “punisher” and does not generalize to other seengs q EffecAveness decreases over Ame (escalates to maintain) q Immediate but not sustained change in behavior q Generalizes to other seengs q May be faded and sAll maintain effecAveness q Slow but sustained change in behavior Increases Behavior ABCs Copyright © 2014 BilinguisAcs, Inc. All © 2013 Emergent Tree EducaAon Rights Reserved. 4 3/18/15 Examples of behavior supports AccommodaAon Difficult Behaviors Replacement Behavior Desired Behavior ModificaAon Copyright © 2014 BilinguisAcs, Inc. All © 2013 Emergent Tree EducaAon Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. Rights Reserved. Establish rapport Establish Rapport Direct ObservaAon Assessment Parent Interview The first few sessions should look like… Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. 5 3/18/15 Consistency of Behavior How o_en do the behaviors occur? Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. ABC log Student: Date: Time: Target Behavior: Ac,vity Antecedent Exact Behavior Consequence Student Reac,on Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. Parent/teacher interviews Determine: 1.) behaviors that interfere with daily acAviAes 2.) aetudes about the behaviors 3.) methods tried to manage behavior 4.) effecAveness of the methods tried Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. 6 3/18/15 Preference assessments • IdenAfy the most powerful reinforcers • Provide a systemaAc way to present reinforcement for desirable behaviors Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. Single Item Preference Assessment 1. Present objects or acAviAes one by one 2. Present each item several Ames in random order 3. Record how long the person engages with each object or acAvity Item Time Rocking horse 3 s Princess book 15 s Rocking horse 0 s Barbie 10 s Princess book 15 s Barbie Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. Pairwise Preference Assessment Procedure: 1. 2. 3. 4. Present two items Child selects item Remove other item Present next two items unAl every item is paired 5. Count and rank order Example: Pairing Selected chip and cheese cheese cracker and chip cracker cheese and cracker cheese Order of Preference: 1. cheese 2. cracker 3. chip 5 s Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. 7 3/18/15 Helpful Hints for preference assessment IntervenAon • Food assessments separate from toys/acAviAes • Limit access to preferred objects/acAviAes • Rotate and vary reinforcers • Pair reinforcers with praise and social interacAon (pat on the back, Ackle, high five, “great!”) Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. Approach to IntervenAon Reinforcement-‐Based Plan *Recommend conducAng SAmulus-‐Based Plan Changes to the environment preference assessments before beginning RBP Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. Reinforcement-‐Based Plans 1. DifferenAal Reinforcement of Other Behavior (DRO) 2. DifferenAal Reinforcement of IncompaAble Behavior (DRI) 3. Reinforcement of Skills AcquisiAon (PRT) Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. 8 3/18/15 Skills AcquisiAon • Compliance Training (Discrete Trial Training) • Self-‐management • Differen,al reinforcement of communica,ve behavior (DRC) • Func,onal independence training Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. SAmulus-‐Based Plans 1. Introduce factors that control low rates of behavior problems. 2. Modify factors that control high rates of behavior problems. 3. Embed S,muli that control high rates of behavior problems among those that control low rates of behavior problems 4. Modify curriculum associated with behavior problems 5. Improve upon context-‐dependent behaviors Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. Evaluate the effect of changes Begin a Behavior IntervenAon Plan (BIP) • One variable at a Ame • ConAnuously review effecAveness of BIP • Adjust as necessary Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. 9 3/18/15 Data CollecAon Examples Func,on Undesired Behavior Reinforced by: Replaced with: Gain abenAon Hits Being told “no” “Play with me” Access a toy Screams and cries Being given the toy “I want X” Sensory sAmulaAon Pokes his eye Effect on vision Kaleidoscope Escape instrucAon Time out “I need help” Relief of ear pain Pharmacological IntervenAon DistracAng classmates Avoid pain from ear Head banging infecAon Case Study • 14 year old boy diagnosed with Intellectual disability • High levels of aggression towards others (scratching, hieng, kicking, biAng) • Aggressive when demands are made *Examples cited from: Carr, E., et al. (1990) • What is the funcAon of his behavior? Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. IntervenAon without funcAonal analysis… Results • Eight one hour sessions • ConAnuing demands in spite of aggressive acts à 1-‐2 acts per session • Allowed to escape instrucAon conAngent on aggression à 1625 aggressive acts per session Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. 1st case: Boy with auAsm who bites himself DRO implemented: Glass of juice Result: Problem is exacerbated Why?: Bites when he has to urinate 2nd case: Girl with ID who screams. DRI implemented: Sing Result: No change in behavior Why?: Screams when frustrated during work Ame Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. 10 3/18/15 GeneralizaAon Fade tangible with naturalisAc reinforcers Gradually increase intervals Use intermibent intervals when transiAoning Wait to fade or transiAon unAl child is at least 80% successful • Teach the approach in all seengs • • • • References • • • • • • • • • • • • Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. Bopp, K., Brown, K., Mirenda, P. (2004). Speech-‐language pathologists’ roles in the delivery of posiAve behavior support for individuals with developmental disabiliAes. American Journal of Speech-‐Language Pathology Vol. 13 p. 5-‐19 Carter, D. R., & Horner, R. H. (2007). Adding func.on-‐based behavioral support to First Step to Success: Combining manualized and func.on-‐based interven.ons. Journal of Posi.ve Behavior Interven.ons, 9, 4, 229-‐38. Durand, V. M., & Merges, E. (2001). FuncAonal communicaAon training: A contemporary behavior analyAc technique for problem behavior. Focus on AuAsm and Other Developmental DisabiliAes, 16, 110–119. Filter, K. J., and R. H. Horner. "FuncAonally-‐indicated academic intervenAons for problem behavior." Journal of Posi.ve Behavior Interven.ons (2006). Ingram, K., Lewis-‐Palmer, T., & Sugai, G. (2005). FuncAon-‐based intervenAon planning: Comparing the effecAveness of FBA funcAon-‐based and non-‐funcAon-‐based intervenAon plans. Journal of Posi.ve Behavior Interven.ons, 7, 224-‐236. Jensen, Eric. (2000). Brain-‐Based Learning. Alexandra, Virginia. Thousand Oaks, California: Corwin Press. March, R. E., & Horner, R. H. (2002). Feasibility and contribuAons of funcAonal behavioral assessment in schools. Journal of Emo.onal and Behavioral Disorders, 10, 158-‐170. McIntosh, K., Campbell, A. L., Carter, D. R. and Dickey, C. R. (2009). DifferenAal Effects of a Tier Two Behavior IntervenAon Based on FuncAon of Problem Behavior. Journal of Posi.ve Behavior Interven.ons, 11, 2, 82-‐97. Morgan, S. B., & Coffman, M. (2013). Developing quality FBAs that lead to effecAve BIPs. PresentaAon at the Texas Council of Administrators in Special EducaAon Annual MeeAng. AusAn, TX., Newcomer, L. L., & Lewis, T. J. (2004). FuncAonal behavioral assessment: An invesAgaAon of assessment reliability and effecAveness of funcAon-‐based intervenAons. Journal of Emo.onal and Behavioral Disorders, 12, 168-‐181. Skinner, B.F. (1938). The behavior of organisms: An experimental analysis. Carr, E., Robinson, S., Taylor, J., Carlson, J. (1990). PosiAve Approaches to the Treatment of Severe Behavior Problems in Persons with Developmental DisabiliAes: A Review and Analysis of Reinforcement and SAmulus-‐Based Procedures. Copyright © 2014 BilinguisAcs, Inc. All Rights Reserved. 11
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