Behavioral Interventions for Severe Aggression and Self Injurious Behavior

Transcription

1 Behavioral Interventions for and Self Injurious Behavior Embassy Suites Norman Friday November 14, :00 2:30 General Background Me, me, me. Behavioral approach to treatment Behavior is communication Triggers and consequences Determine function Interventions match function But, it isn t their fault They have autism. Vollmer, Borrero, Lalli, & Daniel (1999): Evaluating self control and impulsivity in children with severe behavior disorders. What does severe mean? Examples from audience Personal examples Aggression Self injury Destruction Not just those with developmental disabilities Start early! (Kurtz et al., 2003) 1

2 Functions: Why?! Attention from someone To get something tangible Sensory stimulation / automatic reinforcement Escape / avoid something Functional analysis it isn t always easy to catch the behavior. Vollmer, Borrero, Wright, Camp & Lalli (2001) Intervention Options. BIG QUESTION: Why is punishment first choice? Extinction Bursts. Lalli, Casey, & Kates, K. (1997) - extinction is not required Vollmer et al. (1998) Fixed time SoR as effective Lerman, Iwata, & Wallace (1999) - less than half of cases Preliminary investigation is lacking Pelios, Morren, Tesch, & Axelrod (1999): use of Functional Analysis increases reinforcement based interventions. Intervention Options. Figure out the antecedent Fritz, Iwata, Hammond & Bloom (2013) antecedents are more mild Antecedent has same reinforcement as target So.. Treat the precursor. Fahmie & Iwata (2011) 17 articles / 34 subjects Unintelligable vocalizations 27% (AGG) Non-directed movements 32% (SIB) Cracobly & Smith (2012) Confirmed treatment of antecedents can decrease SIB 2

3 Intervention Options. Matching Law Borrero & Vollmer (2002) organize our behavior based on where reinforcement is coming from Immediate and small vs. large and delayed. Consider history of therapist, teacher, aids, etc working with the client / student. Progar et al. (2001) worked with student at prior placement *Attention Thompson, Fisher, Piazza & Kuhn (1998): functional communication training with extinction Type of attention matters Positive Preferred staff, Topics (Roscoe, Kindle, & Pence, 2010) Too much? (Taylor, Ekdahl, Romancyck, and Miller, 1994) Proximity (Oliver, Oxener, Hearn, & Hal, 2001) Negative Reprimands, laughed at, etc. Tangibles Non-contingent access to items Avoid using Highest preferred item for Reinforcement 3

4 Escape / avoidance Baker, Hanley & Mathews (2006): non-contingent escape Progar et al. (2001): Edible reinforcement for compliance Automatic Reinforcement Thompson, Fisher, Piazza & Kuhn (1998): Response blocking Severe SIB Attention Lerman, Iwata & Wallace: Extinction as part of a package Non-contingent attention Severe SIB Escape / Avoidance McCord, Thompson & Iwata (2001) - DRA was combined with extinction and response blocking. Non-contingent breaks Tangibles 4

5 Severe SIB *Automatic reinforcement Rooker & Roscoe (2005) Relationship to self restraint Tiger, Fisher, & Bouxsein, 2009 DRO Self Management Toussaint & Tiger, 2012 Covert SI behaviors After the fact. Not near as effective Variable momentary DRO (also with attention) Wrap up. Start early! Define function Treat antecedents when possible Take data! Use treatment package, if possible References Baker, J.C., Hanley, G.P., & Mathews, R.M. (2006). Staff administered functional analysis and treatment of aggression by an elder with dementia. JABA, 39, Borrero, J.C. & Vollmer, T.R. (2002). An application of the matching law to severe problem behavior. JABA, 35, Dracobly, J. D. & Smith, R.G. (2012). Progressing from identification and functional analysis of precursor behavior to treatment of self injurious behavior. JABA, 45, Fahmie, T.A., & Iwata, B.A. (2011). Topographical and functional properties of precursors to severe problem behavior. JABA, 44, Fritz, J.N., Iwata, B.A., Hammond, J.L., & Bloom, S. E. (2013). Experimental analysis of precursors to severe problem behavior. JABA, 46, Kurtz, P.F., Chin, M.D., Huete, J.M., Tarbox, R.S.F., O Conner, J.T., Paclawskyz, T.R., & Rush, K.S. (2003). Functional analysis and treatment of self injurious behavior in young children: A summary of 30 cases. JABA, 36, Lalli, J.S., Casey, S.D., & Kates, K. *1997). Non-contingent reinforcement as a treatment for severe problem behavior: Some procedural variations. JABA, 30, Lerman, D.C., Iwata, B.A. & Wallace, M.D. (1999). Side effects of extinction: Prevalence of bursting and aggression during the Treatment of self Injurious behavior. JABA, 32,

6 References McCord, B.E., Thomson, R.J., & Iwata, B.A. (2001). Functional analysis and treatment of self injury associated with transitions. JABA, 34, Ollver, C., Oxener, G., Hearn, M. & Hall, S. (2001). Effects of social proximity on multiple aggressive behaviors. JABA, 34, Pelios, L., Morren, J., Tesch, D., Axelrod, S., (1999). The impact of functional analysis methodologies in treatment choice for self injurious and aggressive behavior. JABA, 32, Progar, P.R., North, S.T., Bruce, S.S., DiNovi, B.J., Nau, P.A., Eberman, E.M., Bailey, Jr., J.R.,& Nussbaum, C.N. (2001). Putative behavioral history effects and aggression maintained by escape from therapists. JABA, 34, Roscoe, E.M., Kindle, A.E., & Pence, S.T. (2010). Functional analysis and treatment of aggression maintained by preferred conversational topics. JABA, 43, Rooker, G.W. & Roscoe, E.M. (2005). Functional analysis of self injurious behavior and its relation to self restraint. JABA, 38, References Taylor, J. C., Ekdahl, M. M., Romancyck, R. G., & Miller, M. L. (1994). Escape behavior in task situations: Task versus social antecedents. Journal of Autism and Developmental Disorders, 24, Thompson, R.H., Fisher, W.W., Piazza, C.C. & Kuhc, D.E. (1998). The evaluation and treatment of aggression maintained by attention and automatic reinforcement. JABA, 31, Tiger, J.H., Fisher, W.W. & Kelly, J. (2009). Therapist- and self monitored DRO contingencies as a treatment for the self injurious skin picking of a young man with Asperger Syndrome. JABA, 42, Toussaint, K.A., & Tiger, J.H. (2012). Reducing covert self injurious behavior maintained by automatic reinforcement through a variable momentary DRO procedure. JABA, 45, Vollmer, T.R., Borrero, J.C., Lalli, J.S., & Daniel, D. (1999). Evaluating self control and impulsivity in children with severe behavior disorders. JABA, 32, Vollmer, T.R., Borrero, J.C., Wright, C.S., Van Camp, C., & Lalli, J.S. (2001). Identifying possible contingencies during descriptive analysis of severe behavior disorders. JABA, 34, Vollmer, T.R., Progar, P.R., Lalli, J.S., Van Camp, C.M., Sierp, B.J., Wright, C.S., Nastasi, J., & Eisenchink, K.J. (1998). Fixed-time schedules attenuate extinction-induced phenomena in the treatment of severe aberrant behavior. JABA, 31, Thanks for coming! Identify at least two things you learned during this presentation that you will apply in your personal or professional life. Identify three steps you will take in the next month to implement what you learned in your personal or professional life. R. Nicolle Carr, Ph.D., BCBA-D nicollematthews@hotmail.com Skype: nicolle.matthews (405)