Helping Children with Autism and Their Families Live Free of Problem Behavior

Transcription

1 Helping Children with Autism and Their Families Live Free of Problem Behavior Gregory P. Hanley. Ph.D., BCBA-D Groden Center April, 5

2 Fact: Autism is characterized by Impairments in language development social interaction and Excessive repetitive behavior

3 Fact: With Autism, there is a higher likelihood of problem behavior Meltdowns Self-injury Aggression References: Baghdadli, Pascal, Grisi, & Aussilloux, 3; Horner et al., ; Kim et al., ; Murphy, Healy, & Leader, 9; Thompson, 9

4 Fact: Problem behavior has led to a highly restrictive life style for many persons with autism and their families

5 Working assumption: Problem behavior is learned But why is it not readily eliminated? From what does the lifestyle dictated by problem behavior emanate?

6 Opinion: This lifestyle persists partly because problem behavior of children with autism is merely modified, medicated, or mollified

7 To understand = to determine the personally relevant outcomes and context that influence problem behavior behavior analysts conduct functional assessments

8 Functional Assessment Process Indirect Assessment interviews Descriptive Assessment observations Functional Analysis observations with manipulation

9 Fact: Functional analysis of problem behavior is well researched 435 studies with functional analyses and 98 distinct functional analyses have been published Beavers, Iwata, & Lerman, 3; Hanley, Iwata, & McCord, and integral to the power of behavioral intervention Larger reductions in problem behavior were evident when a functional analysis was part of the functional assessment process Campbell, ; Kahng, Iwata, and Lewin, 3, Hayvaert et al.,

10 Many (most?) Behavior Analytic Practitioners who work with children with autism and/or intellectual disabilities have shied away from conducting functional analyses (Desrochers, Hile, & Williams-Mosely, 997; Ellingson, Miltenberger, & Long, 999; O Neill & Johnson, ; Weber, Killu, Derby, & Barretto, 5) Why?

11 Why? Took too much time and resources, Never did one before (i.e., training issue), Seemed unsafe, Were unsafe, Often inconclusive Still ended up using behavior modification-based treatment i.e., arbitrary rewards in DROs & punishment

12 Summary of procedures for overcoming obstacles to being analytic published in : For a copy, just Google: functional assessment myths (article also contains our open-ended interview)

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14 Similar results were obtained with all three children Similar results were replicated in home and schools settings (Santiago, Hanley, Moore, & Jin, under review) Aggregated Results Problem Behaviors Social Skills Compliance (per min means) (per min means) (%) Pseudonym: Age: Diagnosis: Problem Behaviors: 6 Baseline Treatment 4 5 Gail Dale Bob yo Autism meltdowns, aggression, screaming 3 yo PDD-NOS meltdowns, aggression, screaming from Hanley et al., JABA, 4 Participants 8 yo Autism meltdowns, aggression, screaming

15 Case Example (Bob, 8 yo, dx: Autism) Therapist: Sandy Jin Setting: Clinic 6 5 Hypothesis: Bob engages in meltdowns and aggression in order to obtain: His way in the form of escape from adult instructions and access to preferred ways of interacting with electronics or academic materials Problem Behavior per Min Escape / Tangible Escape / Tangible Bob (Ipad context) Bob (Math context) Sessions

16 Case Example (Dale, yo, dx: Autism) Therapist: Sandy Jin Setting: Clinic Hypothesis: Dale engages in meltdowns and aggression in order to obtain: His way in the form of escape from adult instructions and access to preferred (tangible) items, and adult attention. Problem Behavior per Min Analyst Test Escape Escape / Control Tangible / Tangible Attention / Attention / Mand compliance Dale Dale Sessions

17 Case Example (Gail, 3 yo, dx: PDD-NOS) Therapist: Nicholas Vanselow Setting: Clinic Interview suggested that Gail engaged in meltdowns and aggression. when Mom was attending to other tasks or siblings. in order to gain Mom s undivided attention and to have Mom play with her and her most preferred toys. Problem Behavior Context (suspected establishing operations) Outcome (suspected reinforcers) Suspected reinforcing contingency

18 Case Example (Gail, 3 yo, dx: PDD-NOS) Therapist: Nicholas Vanselow Setting: Clinic Hypotheses: 4 3 Analyst Tangible / Attention Mother Analyst Mother Analyst Gail engages in meltdowns and aggression in order to obtain: preferred (tangible) items, And maternal attention, Problem Behavior per Min 4 3 Tangible Test Control Gail 4 3 Attention Meltdowns Col Sessions

19 Case Example (Bob, 8 yo, dx: Autism) Therapist: Sandy Jin Setting: Clinic 6 5 Hypothesis: Bob engages in meltdowns and aggression in order to obtain: His way in the form of escape from adult instructions and access to preferred ways of interacting with electronics or academic materials Problem Behavior per Min Escape / Tangible Escape / Tangible Bob (Ipad context) Bob (Math context) Sessions

20 Case Example (Dale, yo, dx: Autism) Therapist: Sandy Jin Setting: Clinic Hypothesis: Dale engages in meltdowns and aggression in order to obtain: His way in the form of escape from adult instructions and access to preferred (tangible) items, and adult attention. Problem Behavior per Min Analyst Test Escape Escape / Control Tangible / Tangible Attention / Attention / Mand compliance Dale Dale Sessions

21 Case Example (Zeke, 4 yo, dx: Autism; non-verbal) Analyst: Joana Santiago Setting: Classroom 4 Hypothesis: Zeke engages in SIB and aggression in order to obtain: escape adult instructions and access to preferred (tangible) items and high quality attention. Problem Behavior per min 3 Escape/ Tangible/ Attention Sessions Zeke

22 Case Example (Karen, yo, dx: Autism) Analyst: Kiera Moore Setting: Home Hypotheses: Karen engages in tantrums and aggression in order to obtain: attention, her ipad, preferred conversations, but these appeared to be provided in different contexts 6 Problem Behavior per min Control Test Attention & Attention Tangible Preferred Conversation Sessions Karen

23 Take a moment to reflect on this particular functional assessment process. How is it similar to and different than the process you implement? Discuss with your neighbor.

24 Some Important Aspects of our Approach. Extensive descriptive assessments are never part of the process because they are: time-consuming and usually suggest invalid relations St. Peter et al., 5; Thompson & Iwata, 7

25 Some Important Aspects of our Approach. Closed-ended indirect assessments (MAS, QABF, FAST) are never used in the process because they do not provide any information about personally unique or qualitative features of potentially influential variables

26 Some Important Aspects of our Approach 3. An open-ended interview is always part of the process (as is one brief and informal observation) Goals of interview are to: a) Develop rapport with parents or teachers b) Identify unique contingencies c) Develop function hunches d) Set up a safe and quick analysis Interviews allow for discoveries which can then be verified (or not) in a functional analysis

27 Some Important Aspects of our Approach 4. A standard 4 or 5 condition analysis (with the play condition as the control, e.g., Iwata et al., 98) is never part of the process Probably a mistake to standardize a powerful and flexible tool like a functional analysis

28 Some Important Aspects of our Approach 5. A two-condition analysis designed from the open-ended interview is always part of the process (i.e., an interview-informed analysis) Functional analysis: Direct observation of behavior under at least two conditions in which some event is manipulated Two Conditions: Test: Contains the reinforcing contingency thought to maintain severe problem behavior Control: Does not contain the reinforcing contingency thought to maintain severe problem behavior

29 Some Important Aspects of our Approach 6. We synthesize multiple contingencies into one test condition, if the interview suggests the contingencies are operating simultaneously

30 Why might problem behavior occur? Single contingencies:. Attention or toys (social-positive reinforcement). Escape/avoidance (social-negative reinforcement) 3. Sensory/non-social (automatic reinforcement) Combinatorial contingencies:. Attention and Toys. Escape to toys 3. Escape to toys and attention 4. Escape to automatic reinforcement 5. Compliance with mands 6. Escape to access to rituals, preferred conversations 7. Escape to controlling people or objects 8. Etc..

31 Some standard analyses published a while ago

32 Some standard analyses published a while ago

33 Some standard analyses published a while ago

34 Problem behavior per min Bob (Context ) Will Sam Dale Bob (Context ) Kat (Context ) Gail Zeke Kat (Context ) Alex (Context ) 4 Jack (Context ) Jeff Interview informed, synthesized contingency analyses (IISCAs) conducted within a 6- month time span (-3) 4 Sid Dan Alex (Context ) Jack (Context ) 3 Test Control Sessions From Jessel, Hanley, and Ghaemmaghami (under review)

35 Consider an Interview Informed Synthesized Contingency Analysis IISCA Standard Functional Analysis Multiple test conditions Uniform test conditions Isolated test contingencies Toy-play control conditions Reinforce dangerous behavior Interview-informed Synthesized Contingency Analysis Single-test condition Individualized test conditions Synthesized contingencies Test-matched control Reinforce precursors to and dangerous behavior

36 Functional analysis format Towards a more efficient analysis Standardized Other N = 456 N = 5 Trial-based Min Max N = Brief N = 64 Latency-based N = 6 IISC Within-session IISC 4 6 Analysis duration (min) N = 6 N = From Jessel, Hanley, and Ghaemmaghami (under review)

37 Functional analysis format Towards a more efficient analysis Standardized Other N = 456 N = 5 Trial-based Min Max N = Brief N = 64 Latency-based N = 6 IISC Within-session IISC 4 6 Analysis duration (min) N = 6 N = From Jessel, Hanley, and Ghaemmaghami (under review)

38 Levels of Analytic Control Strong Test condition: Control condition: Consistently elevated rates Zero or near-zero rates Problem Behavior per Min 4 3 Test Control Sessions Moderate Test condition: Control condition: Some zeros or near-zero rates Zero or near-zero rates Problem Behavior per Min 4 3 Test Control Weak Test Condition: Control condition: Variable but higher rates Lower but non-zero rates Problem Behavior per Min 4 3 Sessions Test Control Sessions

39 Functional analysis format Towards a more controlled analysis Control No Weak Moderate Strong Standardized Other Trial-based Brief Latency-based IISC Within-Session IISC N = 456 N = 5 N = N = 64 N = 6 N = 6 N = Percentage of applications

40 Interpretation and Implications of Varying Levels of Analytic Control Strong experimental control Interpretation: Have access to all reinforcers and EOs Implication: Can turn off problem behavior with reinforcement; should achieve meaningful outcome with only function-based treatment Problem Behavior per Min Sessions Test Control

41 Interpretation and Implications of Varying Levels of Analytic Control Moderate experimental control Interpretation: Some other EO is probably uncontrolled and interacting Implication: Skill development may be slower as motivation may vary across sessions, but should achieve meaningful outcome with only function-based treatment Problem Behavior per Min Sessions Test Control

42 Interpretation and Implications of Varying Levels of Analytic Control Weak experimental control Interpretation: All reinforcers for problem behavior are not identified Implication: Variable responding will persist throughout skill development, probably necessitating punishment or arbitrary reward system Problem Behavior per Min 4 3 Test Control The necessity of punishment when function-based treatments are made more practical is commonly reported: Fisher et al., 3, Hagopian et al.,998, Hanley et al., 5, Wacker et al., Sessions

43 To achieve the humane outcomes that are possible with exclusive reliance on functionbased treatments, it is important that we do everything we can to exert strong experimental control in our analyses.

44 Foundation of IISCAs set by CLINICAL INTERVIEWING Iwata, Wong, Riordan, Dorsey, & Lau (98). Assessment and training of clinical interviewing skills: Analogue analysis and field replication. JABA. FUNCTIONAL ANALYSIS Iwata, Dorsey, Slifer, Bauman, & Richman (994). Toward a functional analysis of self-injury. JABA. (Reprinted from AIDD, 98) EMPHASIS ON THE WHOLE CONTINGENCY Worsdell, Iwata, Conners, Kahng, & Thompson (). Relative influences of establishing operations and reinforcement contingencies on self-injurious behavior during functional analyses. JABA. SIMPLIFYING EXPERIMENTAL DESIGNS Vollmer, Marcus, Ringdahl, & Roane, (995). Progressing from brief assessments to extended experimental analyses in the evaluation of aberrant behavior. JABA. Iwata, Duncan, Zarcone, Lerman, & Shore (994). A sequential, test-control methodology for conducting functional analyses of self-injurious behavior. Behavior Modification. CONSIDERATION OF PRECURSORS TO PROBLEM BEHAVIOR Smith & Churchill (). Identification of environmental determinants of behavior disorders through functional analysis of precursor behaviors. JABA. Herscovitch, Roscoe, Libby, Bourret, & Ahearn (9). A procedure for identifying precursors to problem behavior. JABA. ANALYSES OF ECOLOGICALLY RELEVANT AND SYNTHESIZED CONTINGENCIES Bowman, Fisher, Thompson, & Piazza (997). On the relation of mands and the function of destructive behavior. JABA. Fisher, Adelinis, Thompson, Worsdell, & Zarcone (998). Functional analysis & treatment of destructive behavior maintained by termination of don t (& symmetrical do ) requests. JABA. Hagopian, Bruzek, Bowman, & Jennett (7). Assessment and treatment of problem behavior occasioned by interruption of free-operant behavior. JABA.

45 Take Home Point Prior to treating problem behavior of children with autism, take an hour to:. Conduct an open ended interview to discover the context and outcomes that seem relevant to problem behavior. Conduct an IISCA to demonstrate the validity of the suspected contingency and to set up the motivating conditions to teach skills

46 Get together with team members and design an analysis based on contingency provided. Let s role play.

47 Treatment Treatment relies on strengthening: functional communication delay/denial toleration compliance An aside:

48 Treatment Analysis Dale -year old boy Problem Behavior per min BL Simple FCR FCT + EXT Complex FCR Denial BL Denial and Delay Tolerance Training Treatment Extension diagnosed with Autism Simple FCR per min 3. Complex FCR per min Tolerance Response per min Sessions forcement (%) /4 /5 / /3 / /5 /6 / /5 / / Visits Dale /8 3/ 3/5 3/6 3/8 3/3 3/ 3/4 3/7 3/9 4/ 4/3 4/5 4/ 4/ 4/ 4/9 4/4 4/6 5/

49 Treatment Analysis Dale -year old boy diagnosed with Autism Problem Behavior per min Simple FCR per min BL Simple FCR FCT + EXT Complex FCR Denial BL Denial and Delay Tolerance Training Treatment Extension Complex FCR per min Tolerance Response per min Sessions Reinforcement (%) /4 3 /5 / Visits Dale /3 / /5 /6 / /5 / /6 /8 3/ 3/5 3/6 3/8 3/3 3/ 3/4 3/7 3/9 4/ 4/3 Calendar Days (3) 4/5 4/ 4/ 4/ 4/9 4/4 4/6 5/

50 Treatment Analysis Dale -year old boy diagnosed with Autism Problem Behavior per min Simple FCR per min BL Simple FCR FCT + EXT Complex FCR Denial BL Denial and Delay Tolerance Training Treatment Extension Complex FCR per min Tolerance Response per min Sessions Reinforcement (%) /4 3 /5 / Visits Dale /3 / /5 /6 / /5 / /6 /8 3/ 3/5 3/6 3/8 3/3 3/ 3/4 3/7 3/9 4/ 4/3 Calendar Days (3) 4/5 4/ 4/ 4/ 4/9 4/4 4/6 5/

51 Treatment Analysis Dale -year old boy diagnosed with Autism Problem Behavior per min Simple FCR per min BL Simple FCR FCT + EXT Complex FCR Denial BL Denial and Delay Tolerance Training Treatment Extension Complex FCR per min Tolerance Response per min Sessions Reinforcement (%) /4 3 /5 / Visits Dale /3 / /5 /6 / /5 / /6 /8 3/ 3/5 3/6 3/8 3/3 3/ 3/4 3/7 3/9 4/ 4/3 Calendar Days (3) 4/5 4/ 4/ 4/ 4/9 4/4 4/6 5/

52 Treatment Analysis Dale -year old boy diagnosed with Autism Toleran pe Reinforcement (%) Response to Instructions (%) BL Noncomp. Compliance FCT + EXT Denial BL 3 Levels Denial and Delay Tolerance Training Sessions Dale /4 3 /5 / Visits /3 / /5 /6 / /5 / /6 /8 3/ 3/5 3/6 3/8 3/3 Calendar Days (3) 3/ 3/4 3/7 3/9 4/ 4/3 4/5 4/ 4/ 4/ 4/9 4/4 4/6 5/ PROGRESSIVE INCREASE IN COMPLEXITY OF INSTRUCTIONS Simple motor movements Walk over here, stand up, sit down, clap your hands, touch your (shoulder, head, toes) Simple academics Draw a circle, write your name, copy what I write Homework/Task preparation Unzip your backpack, take out the book, erase the board come to the board, put these books on the book shelf 3 Complex academic: Reading skills Read this paragraph, Answer this question., Sound out the words Complex academic: Math skills Solve this (addition, subtraction etc ) Self-help skills Wash your hands, do this chore (e.g., organizing chairs) Play skills Throw or kick the ball

53 Treatment Analysis Dale -year old boy diagnosed with Autism Toleran pe Reinforcement (%) Response to Instructions (%) BL Noncomp. Compliance FCT + EXT Denial BL 3 Levels Denial and Delay Tolerance Training Sessions Dale /4 3 /5 / Visits /3 / /5 /6 / /5 / /6 /8 3/ 3/5 3/6 3/8 3/3 3/ 3/4 3/7 3/9 4/ 4/3 4/5 4/ 4/ 4/ 4/9 4/4 4/6 5/ Calendar Days (3)

54 Treatment Analysis Dale -year old boy diagnosed with Autism Problem Behavior per min Simple FCR per min BL Simple FCR FCT + EXT Complex FCR Denial BL Denial and Delay Tolerance Training Response Chaining Treatment Extension * Complex FCR per min Tolerance Response per min Sessions Reinforcement (%) /4 3 /5 / Visits Dale /3 / /5 /6 / /5 / /6 /8 3/ 3/5 3/6 3/8 3/3 3/ 3/4 3/7 3/9 4/ 4/3 Calendar Days (3) 4/5 4/ 4/ 4/ 4/9 4/4 4/6 5/

55 Treatment Analysis Dale -year old boy diagnosed with Autism Problem Behavior per min Simple FCR per min BL Simple FCR FCT + EXT Complex FCR Denial BL Denial and Delay Tolerance Training Response Chaining Treatment Extension * Complex FCR per min Tolerance Response per min Sessions Reinforcement (%) /4 3 /5 / Visits Dale /3 / /5 /6 / /5 / /6 /8 3/ 3/5 3/6 3/8 3/3 3/ 3/4 3/7 3/9 4/ 4/3 Calendar Days (3) 4/5 4/ 4/ 4/ 4/9 4/4 4/6 5/

56 Treatment Analysis Dale -year old boy diagnosed with Autism Toleran pe Reinforcement (%) Response to Instructions (%) BL Noncomp. Compliance FCT + EXT Denial BL 3 Levels Denial and Delay Tolerance Training Treatment Extension Sessions Dale /4 3 /5 / Visits /3 / /5 /6 / /5 / /6 /8 3/ 3/5 3/6 3/8 3/3 3/ 3/4 3/7 3/9 4/ 4/3 4/5 4/ 4/ 4/ 4/9 4/4 4/6 5/ Calendar Days (3)

57 Similar results were obtained with all three children Treatment Results Problem Behaviors Social Skills (per min means) (per min means) 6 Baseline Treatment 4 from Hanley et al., JABA, 4 Compliance (%) 5 Pseudonym: Age: Diagnosis: Problem Behaviors: Gail Dale Bob yo Autism meltdowns, aggression, screaming 3 yo PDD-NOS meltdowns, aggression, screaming 8 yo Autism meltdowns, aggression, screaming Participants

58 Take a moment to reflect on this particular treatment process. How is it similar to and different than the treatment you implement? Discuss with your neighbor.

59 IISCAs have led sociallyvalidated outcomes Social Acceptability Questionnaire Results Ratings Questions Gail Dale Bob Mean. Acceptability of assessment procedures Acceptability of treatment packages Satisfaction with improvement in problem behavior Helpfulness of consultation Note. 7=highly acceptable, highly satisfied, or very helpful =not acceptable, not satisfied, or not helpful from Hanley et al., 4

60 Personalized Social validity Data Parents' Comfort Level of Presenting the Evocative Situation Comfort Levels Questions Pre-treatment Post-treatment Gail. Taking away toys 7. Telling child "no" when they ask for something Giving instructions 5 7 Dale. Interrupting child's preferred activity and telling them to do homework or other non-preferred activities 4 6 Bob. Taking away DS or ipad at meal times 3 7. Taking away DS or ipad on a transition Interrupting or correcting math work 3 7 Note. 7=very comfortable =not comfortable.

61 Some open-ended responses from the Social Acceptability Questionnaire

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63 Time Assessment Steps # of Visits ( hr each) Range Mean Cost (in US dollars) Range Mean * Interview * Functional Analysis Functional Communication Training Complex FCT Tolerance Response Training Easy Response Chaining * Difficult Response Chaining ,3 8* Treatment Extension ,467 Totals: ,467 Supervision meetings: Report writing / planning: Grand Totals: ,7

64 Cost Assessment Steps # of Visits ( hr each) Range Mean Cost (in US dollars) Range Mean * Interview * Functional Analysis Functional Communication Training Complex FCT Tolerance Response Training Easy Response Chaining * Difficult Response Chaining ,3 8* Treatment Extension ,467 Totals: ,467 Supervision meetings: Report writing / planning: Grand Totals: ,7

65 Main Commitment in Treatment Our function-based treatments are always skill-based Published in 8 (available for free at PubMed Central)

66 And, we always increase the complexity, flexibility, and/or interactional nature of the FCR before teaching delay/denial tolerance Simple FCR: ( My way or My way, please ) Complex FCR: Excuse me After a second or two, Yes, Billy May I have my way, please? Will you play my way, please? After a second or two, Sure, Billy

67 Case Example (Jeff, 6 yo, dx: ASD, ADHD) Analyst: Mahshid Ghaemmaghami Setting: Clinic Tolerance Response ("Okay") (rpm) "Excuse me... May I have my way pls?" (rpm) "Excuse me may I have my way pls?" (rpm) "May I have my way pls?" (rpm) "My way pls" (rpm) Aggression & Disruptions (rpm) BL FCT + EXT Delay (s) Jeff 6 yrs old ASD/ADHD Fluent speech Sessions % of Session Engaged in Emotional Responding

68 5 Critical Aspects of Delay/Denial Tolerance Training. Always provide immediate sr for some FCRs. Teach an appropriate response to multiple cues of delay, denial, or disappointment 3. Progressively increase the average amount of behavior required to terminate the delay (See Hanley, Jin, Vanselow, & Hanratty, JABA, 4, and studies from Mahshid Ghaemmaghami in upcoming year)

69 With only Progressive Reinforcement Delay: As delay increases, FCR weakens & probability of PB increases

70 Time-based vs. Contingency-based Progressive Delay (Lead Author: Mahshid Ghaemmaghami) Problem Behavior per min No Delay Terminal Delay (no EXT) No Delay TBPD (with EXT) No Delay CBPD (with EXT) Alex Responses per min Ind TR Ind FCR Sessions Scheduled Delay 3 4 Mean Experienced Delay Sessions

71 Time-based vs. Contingency-based Progressive Delay (Lead Author: Mahshid Ghaemmaghami) Problem Behavior per min No Delay Context No Delay Context Time-Based Progressive Delay Terminal Delay Without Extinction No Delay No Delay Contingency-Based Progressive Delay (CBPD) Terminal Delay Without Extinction CBPD % of Session Engaged in Emotional Responding Appropriate Responses per min Context Context FCR Tolerance Response % of Delay Interval Engaged in Alternative Activity 4 Duration of Delay (s) Context Context Scheduled Experienced Jack Sessions

72 Time-based vs. Contingency-based Progressive Delay (Lead Author: Mahshid Ghaemmaghami) Problem Behavior per min No Delay Context No Delay Context Time-Based Progressive Delay Terminal Delay Without Extinction No Delay No Delay Contingency-Based Progressive Delay (CBPD) Terminal Delay Without Extinction CBPD % of Session Engaged in Emotional Responding Appropriate Responses per min Context Context FCR Tolerance Response % of Delay Interval Engaged in Alternative Activity 4 Duration of Delay (s) Context Context Scheduled Experienced Jack Sessions

73 5 Critical Aspects of Delay/Denial Tolerance Training. Always provide immediate sr for some FCRs. Teach an appropriate response to multiple cues of delay, denial, or disappointment 3. Progressively increase the average amount of behavior required to terminate the delay 4. Terminate the delay for various amounts of behavior 5. Probably best to not signal how much behavior is required to terminate the delays (See Hanley, Jin, Vanselow, & Hanratty, JABA, 4, and studies from Mahshid Ghaemmaghami in upcoming year)

74 Treatment relies on set of reinforcers identified via the IISCA Reinforcement is: Function-based Sr Examples: Access to attention and toys Escape from instructions to access preferred activities Escape from parent instructions to access preferred activities and to have people comply with his requests Termination of non-preferred conversations and access to preferred conversations Access to ritualistic behaviors Escape from discrete-trial work to child-led play with the teacher

75 Reinforcement is: Function-based Differential Problem Behavior Simple FCR Sr Sr Complex FCR Sr Complex FCR No Tolerance response Sr Complex FCR No Tolerance response Instruction Compliance Sr

76 Reinforcement is: Function-based Differential Intermittent 5% Compliance Complex Functional Communications Tolerance responses 3% %

77 % Reinforcement is: Function-based Differential Intermittent % Compliance % % Complex Functional Communications Tolerance responses % 3%

78 Reinforcement is: Function-based Differential Intermittent Complex FCR Complex FCR Complex FCR Sr Sr Sr Complex FCR No Tolerance response Complex FCR No Tolerance response Sr Sr Complex FCR No Tolerance response Instruction C Sr Complex FCR No Tolerance response Instruction Compliance Sr Complex FCR No Tolerance response Instruction Compliance Sr Complex FCR No Tolerance response Instruction Compliance Complex FCR No Tolerance response Instruction Compliance Sr Sr

79 Reinforcement is: Function-based Differential Intermittent Response requirement is: Variable Unpredictable Complex FCR No Tolerance response Sr Complex FCR Sr Complex FCR No Tolerance response Instruction Compliance Sr Complex FCR No Tolerance response Sr Complex FCR No Tolerance response Instruction Compliance Sr Complex FCR No Tolerance response Instruction C Sr Complex FCR Sr Complex FCR No Tolerance response Instruction Compliance Sr Complex FCR No Tolerance response Instruction Compliance Sr Complex FCR Sr

80 Reinforcement is: Response requirement is: Function-based Variable Differential Unpredictable Intermittent Variable in duration Complex FCR No Tolerance response Sr Complex FCR Sr Complex FCR No Tolerance response Instruction Compliance Sr Complex FCR No Tolerance response Sr Complex FCR No Tolerance response Instruction Compliance Sr Complex FCR No Tolerance response Instruction C Sr Complex FCR Sr Complex FCR No Tolerance response Instruction Compliance Sr Complex FCR No Tolerance response Instruction Compliance Sr Complex FCR Sr

81 Reinforcement is: Response requirement is: Function-based Variable Differential Unpredictable Intermittent Variable in duration Complex FCR No Tolerance response Sr Complex FCR Sr Complex FCR No Tolerance response Instruction Compliance Sr Complex FCR No Tolerance response Sr Complex FCR No Tolerance response Instruction Compliance Sr Complex FCR No Tolerance response Instruction C Sr Complex FCR Sr Complex FCR No Tolerance response Instruction Compliance Sr Complex FCR No Tolerance response Instruction Compliance Sr Complex FCR Sr

82 Treatment Implementation. Put these in your pocket. Pull one out while child is experiencing their reinforcers 3. Keep it to yourself 4. Require that behavior next time *Materials not needed: Laminate Laminating machine Glue guns Vis a vis markers Velcro Tokens Token boards Timers Stickers Candies Anything that was not already in the child s environment!

83 Additional Considerations The speed with which this model will bring about meaningful improvements in problem behavior is probably moderated by: children s ability to learn via instructions and/or modeling The overall success of this model is probably moderated by: the complexity of the contingencies influencing problem behavior people s willingness and ability to manage those contingencies

84 Come up with at least one question relevant to implementing the function-based treatment as described.

85 A final message With Autism, there is a higher likelihood of problem behavior Meltdowns Aggression Self-injury References: Baghdadli, Pascal, Grisi, & Aussilloux, 3; Horner et al., ; Kim et al., ; Murphy, Healy, & Leader, 9; Thompson, 9

86 freedom from these behaviors for persons with Autism and their familie is attainable

87 It is attainable without drugs without hospitalization without harsh punishment without candies, stickers, and token boards

88 It is attainable by first understanding* why the child is engaging in the problem behavior understanding can be realized quickly, safely, and analytically

89 It is attainable when children are taught skills* to help them navigate our complex social world *Communication and toleration

90 The Treatment Buffet

91 The Balanced Meal Compliance Functional communication Tolerance responses Compliance Compliance Teaching of academic, hygiene, play, & social skills Independent play/work Access to toys, foods electronics, activities, attention, breaks

92 Good luck with all that you do for all who you teach and provide care Contact info.: Gregory P. Hanley, Ph.D., BCBA-D Psychology Department Western New England University 5 Wilbraham Road Springfield, Massachusetts 9 ghanley@wne.edu