Behavioral Treatment Strategies. Yiliana Puerto, M.S., BCBA BCBA Program Manager PsychSolutions, Inc.

Transcription

1 Behavioral Treatment Strategies Yiliana Puerto, M.S., BCBA BCBA Program Manager PsychSolutions, Inc.

2 Professional Background BCBA Program Manager at PsychSolutions, Inc. Worked in Applied Behavior Analysis (ABA) field since 2008 and Board Certified Behavior Analyst (BCBA) since 2012 Master s degree in Counseling with concentration in Advanced Behavior Analysis Experience working in outpatient hospital, homes, schools and summer camps Working towards completion of doctoral degree in Marriage and Family Therapy Attended a variety of workshops/trainings related to crisis intervention, parent training and pediatric feeding disorders Mother to a 7 month old baby girl, Jubilee Grace

3 Learning Objectives Understand basic principles of Applied Behavior Analysis (ABA) and the use of descriptive assessment in ABA (i.e., antecedents, behavior, consequences) and how these variables influence behavior. Learn how to identify clients in your sessions who may benefit from the use of behavioral strategies. Learn how to identify antecedent interventions to prevent problem behaviors. Learn how to identify the function(s) of behavior and develop replacement or alternative behaviors that are more effective and appropriate. Participants will be able to discuss the benefits of utilizing a multidisciplinary systemic approach to benefit the client.

4 The WH s of Applied Behavior Analysis (ABA)

5 What is Applied Behavior Analysis (ABA)? ABA is the science of human behavior It is data driven! Focuses on decreasing inappropriate behaviors, increasing adaptive behaviors and teaching of new skills Attends to the relationship occurring between antecedents, behaviors, and consequences and how to utilize these to determine function and treatment Consistent, ongoing, objective assessment and data analysis to inform clinical decision-making

6 Who can benefit from ABA? Children with Autism Spectrum Disorders (ASD), Down Syndrome, pediatric feeding disorders or other diagnoses Individuals who present with mental health challenges or challenging behaviors Individuals who meet medical necessity criteria Medicaid Insurance carrier

7 When can ABA be beneficial? Staggering or sudden increase in maladaptive behaviors More time is spent redirecting problem behaviors than on goal progression in your session (e.g., Johnny requires 20 minutes of behavioral intervention in each of his 30-minute Occupational Therapy sessions) Plateau or regression with current therapeutic intervention

8 Where can ABA take place? Natural Environment Training (NET) Home School Community Discrete Trial Training (DTT) In sessions Classrooms Combination of NET and DTT To promote generalization

9 Benefits of ABA in Autism Treatment Repetitive and consistent Focused Increase social skills Comprehensive Threats to health or safety Skill Acquisition: Verbal behavior, communication, listener receptive behavior, motor skills, social skills, academic skills, self-care skills, vocational skills, etc. Reduction: Aggression towards others, selfinjurious behaviors, task refusal, tantrums, stereotypic behaviors, property destruction, etc.

10 Why do behaviors occur? Learned as a result of their consequences and through repeated exposure to the environment Escape/delay Attention Tangibles/activities Sensory/automatic reinforcement Everybody E.A.T.S.!

11 How can we define behaviors? By defining what we are directly observing or how they specifically look (i.e., overt vs. covert behavior) Definition must be operationally defined Using objective terms Using clear and concise language Must be measurable Importance for consistency and accuracy Subjective terms are likely interpreted differently by different people

12 ASR: Let s Practice! Johnny s anxiety is defined as one or more instance of high-pitched screaming, repetitive motor movements (i.e., pacing back and forth), nail biting, intermittent crying bouts of 20 seconds, and stomping of feet on floor, which typically occurs in duration between 2 to 30 minutes per episode. Is this an objectively defined definition? TRUE or FALSE?

13 ASR: Let s Practice! The answer is: TRUE!

14 ABC s of Behavior

15 ABC s of Behavior Antecedent: What is happening before the behavior takes place? (i.e., setting, time, activities, people) Behavior: What is the behavior that s taking place? (i.e., action, what does it look like) Consequence: What happens after the behavior? (i.e., natural vs. delivered) What effects influence the likelihood of this behavior in the future?

16 Think about your clients Antecedent: What happens before the problem behavior takes place? Behavior: What behavior is disrupting progression of treatment? Consequence: What happens after the behavior? What effects influence the likelihood of this behavior in the future?

17 Antecedent Interventions

18 Do your homework! Medical rule out! Ask caregivers about their day! (e.g., school, drop-off, pick-up, changes to routine, family staying over, etc.) Learn about potential reinforcers they are willing to work for! Assess reinforcers frequently Pair yourself with reinforcers! Interests versus willing to work for!

19 Antecedent Manipulations Set up the physical environment to promote success Use visual supports/visual schedule/checklists when appropriate Pictures Writing State specific instructions (tell them what to do!) First/Then schedule Reward chart Increase choice making Proximity control (e.g., redirection, physical assistance, 3-step prompting) Provide non-contingent attention Shorten activities or provide periodic breaks

20 Little Albert Think about your clients Social interactions Physical effort Feeding Repairing of conditioned stimuli Stimulus-stimulus pairing to increase language

21 Behavioral Momentum Dissertation (100+ pages) Turn on laptop Log in course Research an article Write 5 pages Speech Therapy Greet the client/transition Receptive task Expressive task Always pairing yourself with reinforcers!

22 ASR: Let s Practice! Upon greeting Susie and her mother in the lobby who were running late for session, you briefly learn that Susie did not have a good night s rest and is reported to have a so-so day at school. She was up most of the night coughing. Her speech therapist is also running a few minutes behind from the previous session and decides to hit the ground running and focus solely on expressive tasks for the entire session. Susie has a diagnosis of selective mutism following a traumatic event. This will likely result in a normal productive session. TRUE or FALSE?

23 ASR: Let s Practice! The answer is: FALSE! Susie appears to be coming down with a cold and is on little rest. It is likely that her parents did not receive accurate information from her teachers about her school day. The therapist is also running behind, has not paired herself, or utilized behavioral momentum to get the session off to a good start. This session is likely to result in little to no progress and may potentially provoke problem behaviors in Susie.

24 Consequent Interventions

25 Function-Based Treatment Think back to 4 possible functions of behavior (E.A.T.S.) Behavior serves a function to get the child what they need or want! Successful function-based treatment: Blocks access to reinforcement for problem behavior Teaches access to reinforcement for appropriate replacement skills Example: Johnny does not get access to preferred snack when he launches a chair across his classroom (blocks access), but is taught to use I want snack mand (teaches access)

26 Preventing Pay-Off Escape- Prevent escape/delay for escape/avoidant problem behaviors Attention- Withhold attention for inappropriate attention seeking behaviors Tangibles- Withhold tangible items for problem behaviors that are seeking to obtain access to items/activities Sensory- Block access or remove inappropriate object used for automatic stimulation

27 Reinforcement Reinforcement must occur contingent on appropriate behaviors DRA- differential reinforcement of alternative behaviors DRI- differential reinforcement of incompatible behaviors DRO- differential reinforcement of other behaviors A reinforcer follows behavior (i.e., consequence) and increases/maintains the future likelihood of a given behavior Remember, inappropriate behaviors can be reinforced even if on an intermittent basis!

28 In Closing Systemic approach and collaboration is key! The entire family system is our client (e.g., client, caregivers, therapy team, educators, etc.) Attend to contingencies/variables playing a role for caregivers also! Grief Trauma Accessibility to resources Histories of reinforcement/punishment

29 References Ayvazoglu, N. R., Kozub, F. M., Butera, G., & Murray, M. J.. (2015). Determinants and challenges in physical activity participation in families with children with high functioning Autism Spectrum Disorders from a family systems perspective. Research in Developmental Disabilities, 47, Behavior Analyst Certification Board. (2014). Applied Behavior Analysis Treatment of Autism Spectrum Disorder: Practice guidelines for healthcare funders and managers (2 nd edition). Littleton, CO. Blanche, E. I., Diaz, J., Barretto, T., & Cermak, S. A.. (2015). Caregiving experiences of Latino families with children with Autism Spectrum Disorder. The American Journal of Occupational Therapy, 69 (25), Carroll, R. A., & Klatt, K. P.. (2008). Using stimulus-stimulus pairing and direct reinforcement to teach vocal verbal behavior to young children with Autism. The Analysis of Verbal Behavior, 24, Cooper, J. O., Heron, T. E., & Heward, W. L.. (2007). Applied behavior analysis (2 nd edition). Upper Saddle River, N.J.: Pearson/Merrill- Prentice Hall. Everybody E.A.T.S. (2018). Retrieved from: Little Albert. (2018). Retrieved from: Miliotis, A., Sidener, T. M., Reeve, K. F., Carbone, V., Sidener, D. W., Rader, L., & Delmolino, L.. (2012). An evaluation of the number of presentations of target sounds during stimulus-stimulus paring trials. Journal of Applied Behavior Analysis, 45,

30 Questions? Yiliana Puerto, M.S., BCBA BCBA Program Manager PsychSolutions, Inc. (305) x