Shaping Communication to Decrease Challenging Behavior

Transcription

1 Shaping Communication to Decrease Challenging Behavior Carol Koch, M.A., CCC-SLP, Clinical Coordinator/Instructor Jennifer Woods, B.S., Graduate Student ASHA Annual Convention ~ November 17, 2006 ~ Miami Beach

2 Autism Statistics What is your best guess about prevalence?

3 Intervention Menu Dietary Behavioral Medication Developmental

4 Historical Perspective of ABA and SLP : 1975: application of behavioral techniques to clinical practice was frequently reported in the SLP literature Stimulus presentation and reinforcement Response shaping and modeling Behavioral techniques used to treat articulation, voice, fluency and language (Ogletree & Oren, 2001; Koenig & Gerenser,, 2006)

5 Historical Perspective of ABA and SLP Late 1970s and 1980s: the field of SLP became increasingly influence by models of social learning theory, generative grammar and generative semantics (Chomsky, 1957; Bloom, 1970; Brown, 1973; Bandura,, 1977) Language behaviors were a manifestation of a more basic, underlying, abstract, rule system SLPs became facilitators of the language learning process without controlling stimuli and responses, but rather worked in a natural, non-intrusive way (Ogletree( Ogletree,, 2001) Chomsky s s (1959) review of Skinner s s (1957) Verbal Behavior further created a divide among members of the two professions (Ogletree & Oren, 2001; Koenig & Gerenser,, 2006)

6 Historical Perspective of ABA and SLP Late 1980s: noted limitations in generative language models combined with pragmatics frameworks (Halliday( Halliday,, 1975) Importance of communicative functions and other aspects of social interaction to natural and assisted language learning Each profession operated in parallel course despite common interests (Koenig & Gerenser, 2000) Very little information exchange (Ogletree & Oren, 2001; Koenig & Gerenser,, 2006)

7 Historical Perspective of ABA and SLP 1990s significant increase in information exchange Dramatic increase in incidence of autism P.L Publication of Catherine Maurice s s book Let Me Hear Your Voice (1993) Personal story of parent with 2 children diagnosed with Autism Spectrum Disorder, including ABA intervention and SLP Highlighted Lovaas 1987 research which highlighted the efficacy of early intensive behavioral treatment (Ogletree & Oren, 2001;Koenig & Gerenser,, 2006)

8 Historical Perspective of ABA and SLP 1990s continued: Programs offering early intensive behavioral intervention increased dramatically ABA and SLP began working together on teams Workshops offered on the use of behavioral interventions for children with autism Internet networking Benefits observed in home-based early intervention (Ogletree & Oren, 2001;Koenig & Gerenser,, 2006)

9 Historical Perspective of ABA and SLP (Ogletree & Oren, 2001; Koenig & Gerenser,, 2006) 1990s and beyond: Conferences focused on autism with emphasis on behavioral approaches to communication enhancement SLPs pursuing post graduate education and certification in ABA (see Listserv for professionals in SLP and ABA (see ABA/) Association for Behavior Analysis created a Special Interest Group for SLPs who attend the ABA convention (see Increase of representation of SLP papers at ABA convention and increase in behavioral presentations at ASHA

10 Building Bridges

11 Benefits of Collaboration Creation of evidence-based therapeutic approaches Improve the integration of support provided by SLPs and ABA professionals on intervention teams Reduction in the number of reinvented wheels Higher quality of service delivery (Koenig & Gerenser,, 2006)

12 What is ABA? The science of studying patterns of behavior in relationship with environmental interactions. Applied behavior analytic approaches allow an observer to understand how specific interventions or techniques affect behavior.

13 ABA Mythbusters Results in robot-like behavior Experimental Uses negative reinforcement/punishment Doesn t t generalize

14 Positive Reinforcement A type of reinforcement in which the occurrence of the behavior is followed by the presentation of a stimulus that increases the future probability of that behavior. Describes a functional relationship between two environmental events: a behavior (observable action) and a consequence (Ogletree & Oren, 2001)

15 Negative Reinforcement A type of reinforcement in which the occurrence of the behavior is followed by the contingent removal or avoidance of an aversive stimulus and increases the future probability of that behavior. (Ogletree & Oren, 2001)

16 What type of reinforcement? You leave home earlier than usual one morning, and don't run into heavy traffic. You leave home earlier again the next morning and again you avoid heavy traffic.

17 What type of reinforcement? Students in Professor Ohno's class were given a weekly quiz. The students' percent correct quiz responding on the first quiz was low, so Professor Ohno began praising the performance of those students who answered the quiz questions correctly. As a result of this procedure, the students' quiz performance improved on the rest of the quizzes.

18 What type of reinforcement? When a child says "please" and "thank you" to his/her mother, the child may not have to engage in his/her dreaded chore of setting the table.

19 What type of reinforcement? In an elementary school classroom research was conducted to study the effects of teacher behavior on student behavior. During one phase of the study, the teacher began disapproving of the students' disruptive behaviors when they occurred. This resulted in an increase in the level of disruptive behaviors.

20 Punishment The process in which a consequence immediately following a behavior decreases the future probability of that behavior.

21 SLP Role Screening and Diagnosis Assessment and Intervention Working with Families Collaboration Professional Development Research Advocacy

22 Recognizing Challenging Behaviors Is You ll know it when you see it enough? Challenging Behaviors

23 Challenging Behaviors? Screaming Aggression Tantrums Self-injurious

24 Various Tools and Checklists ABC INCH CHAT M-CHAT Checklists Interviews Observations ADOS CARS ADI-R PIA GARS

25 Functional Behavior Assessment A tool that is used to gather information to create an environment that makes problem behavior unnecessary and to develop interventions so that new skills can be taught to replace problem behavior with socially appropriate ones. Functional behavioral assessment is a critical part of positive behavior support. Gather information about why a behavior is occurring Most problem behaviors have a purpose or function Purpose of FBA is to clearly define the problem behavior and to identify setting events, antecedents, and consequences maintaining problem behavior.

26 How to Determine the Function of the Behavior Setting Events Immediate Antecedent (Trigger) Problem Behavior Consequence Maintaining Behavior Function

27 Why children with ASD demonstrate challenging behaviors? Behaviors can be viewed as a form of communication Behaviors are the individuals best attempt to convey a message or communicate a need Behaviors are not responses to be reduced or eliminated

28 What are possible functions of challenging behavior? To gain access to desired items Food, drink, preferred activities tangible-motivated behaviors To gain attention To escape a situation Sensory?

29 Why Determine the Function of the Behavior? Recognizing the significance of the communication underlying the behavior Therapeutic significance

30 What can we do with challenging behaviors? positive, nonaversive approaches to address challenging behaviors are the most effective, evidence-based practice for individuals with disabilities (cited in ASHA, 2006b); source: Horner, et al., 2000) Positive Behavior Supports Functional Communication Training Visual schedules

31 Components of PBS Develop Team Complete Functional Behavior Assessment Formulate Behavior Hypothesis Use Prevention Strategies Foster Replacement Skills Respond in a Positive Manner (Buschbacher & Fox, 2003)

32 ASHA Knowledge and Skills Statements Regarding FBA, FCT and PBS: SLPs should have knowledge about and skill using systematic observation, rating scales, checklists, and questionnaires to assess relationships between behavior (including problem behavior) and communication (ASHA, 2002)

33 We Know the Function of the Behavior Now What?

34 Replacement Behavior Functional communication as the new behavior is the goal (Durand, Berotti, & Weiner, 1993) For communication training to be successful, the response taught must be Equal to the challenging behavior (Durand, et al, 1993; Carr, 1988)

35 What is the child saying? After examining the function of the behavior, develop a hypotheses on what the learner is trying to say. Observe the learner in different settings. Observe the learner with different people. Determine the amount of time between an antecedent event and the behavior.

36 3 Steps for choosing a response 1. Make a list of the functions 2. Make a list of response equivalent messages 3. Evaluate the messages

37 Escape Functions 1.Rejection 2.Request a break No! I don t want to. I need a break! Can I do something else? 3.Request an alternative

38 Escape Functions Rejecting Avoidance of undesired: people, place, objects, and environmental conditions. Importance of a socially acceptable response. The teacher decides to give out skittles to all of her students. Johnny does not like skittles. When she gets to Johnny, he..

39 Escape Function: Request a break The need to remove oneself from a task. Expectation of returning During music, Johnny covers his ears and closes his eyes. He needs a a

40 Request an Alternative Activity Desire to change activity Need to control their own environment Johnny s s teacher wants everyone to complete a puzzle as a quiet activity during a transition period. Johnny does not like puzzles, he like to read books. Johnny needs.

41 Access to Tangibles Function Or How do I get the good stuff? Teach an acceptable message of request. Teach in the absence of the verbal prompt What do you want? Preference assessment Place items just out of reach Prompt response immediately after the learner shows interest (eye gaze, reach..) Prompt before challenging behavior!

42 Attention Function Teach requesting want/needs: Can I have a high-five? five? I I want to talk I I want to play I I need help Teach seeking attention when they are finished with a task: Look, I am all done Any socially appropriate response: Hi! Hi! Look at me!

43 Teaching Strategies Utilize observation information about time between antecedent and challenging behavior. Prompt response before challenging behavior occurs. Systematically fade prompts within teaching sessions. Use your data to determine prompt level.

44 Important! Never prompt communication during or immediately after a challenging behavior. Remember rules of reinforcement. FCT is just one piece of the puzzle. What if it doesn t t work?: Evaluate!

45 Evaluating the Message Will this message be successful in all environments? Response success is an important component in FCT (Bopp, et al., 2004) Is it acceptable? Response acceptability would follow the social rules in all environments (Durand, et al, 1993)) Is the message recognizable? Response recognizability means that anyone can interpret the message (Durand, et al, 1993) interpret the message (Durand, et al, 1993)

46 We know what they will say, but how are they going to say it? There are many ways to communicate: Verbal Gestures Manual Signs VOCA Pictures Try to choose a communicative behavior that is already within the individuals repertoire. An SLP s knowledge base in speech, language and communication can help in the decision making progress.

47 Choosing Mode of Communication The most important factor is response efficiency (Bopp, et al, 2004;Mirenda, 2003; Durand, et al, 1993; Horner & Day, 1991). Is saying it just as easy as( )?

48 Reinforcement If the new behavior does not result in the same amount or more reinforcement than the challenging behavior, the intervention will fail (Durand & Carr, 1991; Cooper, et al, ; Horner & Day, 1991).

49 Reinforcement Johnny has to hit the Break button on his VOCA five times before someone acknowledges him. Or Johnny kicks the student next to him and throws his book across the room. Kyle asks the teacher for attention. She engages with him briefly before moving on. Or Kyle runs around the room pulling all the girls hair.

50 Teaching the Message Teach it in all environments Systematically fade prompts Take data! Use the data to make decisions.every day! Communicate the how with all members of the team Everyone should be doing the same thing Every where & Every time

51 Case Study: Michael 20-years years-old Diagnosis of autism No expressive language Uses vocalizations to communicate Challenging Behaviors: Hitting, Hair Pulling, Kicking, Throwing objects, Screaming, Falling to the ground

52 Comments about Michael: We think he is significantly cognitively impaired We tried PECS,, and he just could not understand it

53 Baseline Data Mike Average Weekly Frequency BASELINE Aggressions Disruptions Weeks

54 Functions Functional assessment checklist was utilized It was filled out by the teacher, assistant teacher, student teacher, SLP, parent, respite worker, & sibling A-B-C C charts were also used

55 Functions Behaviors were grouped for data purposes Aggressions were defined as any instance of hitting, kicking, and hair pulling. Disruptions were defined as any instance of screaming, throwing objects, or falling to the floor.

56 Results of Functional Assessment Access to tangibles Attention Escape

57 FCT Picture communication system: too much effort Chose a voice output device with overlay

58 Replacement Behavior Requests for preferred tangibles Request for attention : Look at me! Request for break: I need a break!

59 He asks for it. He gets it! Everyone Michael encounters was taught to respond to any requests immediately Taught to use device by physically prompting him from behind and fading prompts systematically, before a challenging behavior occurs Data was evaluated morning and afternoon to make prompt decisions.

60 Progress Mike Average Weekly Frequency BASELINE FCT Weeks

61 Behavior spike Aggressions began to reappear although they were milder (grabbing, hitting lightly) What was happening? Michael was now engaging in more activities. Some of these tasks were difficult for him. Now we needed to teach him to request help.

62 Comments about Michael: I can t t believe I ever thought he was low-functioning functioning He is a pleasure to be around He looks really happy He has outgrown his device so we ordered him a new one with unlimited capacity. He learned how to switch between screens very quickly. We constantly have to program it with new things to say.

63 Is it really my job as an SLP to solve behavior problems? NO! It is a team problem and it will take a team effort to solve it! The SLP s role is critical as a team member in supporting the individual, the environment, and the communication partner to maximize opportunities for interaction. (ASHA, 2006, p.34)

64 Working Together Collaborate with behavior analysts, special education teachers, para-professional, professional, allied health professionals, administrators, and family members. Increase your awareness of other fields Increase your awareness of research Make others aware of contributions you can make

65 Survey CSD Capstone Project: Rockhurst University, Kansas City, MO SLP s role within behavior interventions For everyone who took the time to fill out this survey, I thank you.

66 QUESTIONS?

67 References American Speech-Language-Hearing Association, (2002). Augmentative and alternative communication: Knowledge and skills for service delivery. ASHA Supplement, 22, American Speech-Language-Hearing Association. (2005). Roles and responsibilities of speech-language pathologists with respect to augmentative and alternative communication: Position statement. Available from American Speech-Language Hearing Association. (2006a). Knowledge and skills needed by speech-language pathologists serving individuals with autism spectrum disorders. Available from American Speech-Language Hearing Association. (2006b). Guidelines for speech-language pathologists in diagnosis, assessment, and treatment of autism spectrum disorders across the life span. Available from American Speech-Language-Hearing Association. (2006c). Roles and responsibilities of speech-language pathologists in diagnosis, assessment, and treatment of autism spectrum disorders across the life span: Position statement. Available from Baer, D.M., Wolf, M.M., & Risley, T. (1968). Current dimensions of applied behavioral analysis. Journal of Applied Behavioral Analysis,1, Bandura, L. (1977). Social learning theory. Englewood Cliffs, NJ: Prentice-Hall. Buschbacher, P. W., & Fox, L. (2003). Understanding and intervening with the challenging behavior of young children with autism spectrum disorder. Language, Speech and Hearing Services in Schools, 34, Bopp, K.D., Brown, K.E., & Mirenda, P. (2004). Speech-language pathologists roles in the delivery of positive behavior support for individuals with developmental disabilities. American Journal of Speech-Language Pathology, 13, 5-19.

68 References Brown, K.A., Wacker, D.P., Derby, K.M., Peck, S.M., Richman, D.M., Sasso, G.M., et al. (2000). Evaluating the effects of functional communication training in the presence and absence of establishing operations. Journal of Applied Behavior Analysis, 33, Carr, E.G., Dunlap, G., Horner, R.H., Koegel, R.L., Turnbull, A.P., Sailor, W., et al. (2002). Positive behavior support: Evolution of an applied science. Journal of Positive Behavior Interventions, 4, Carr, E.G., & Durand, V.M. (1985). Reducing behavior problems through functional communication training. Journal of Applied Behavior Analysis. 18, Chomsky, N. (1959). Review of Verbal Behavior by B.F. Skinner. Language, 35, Cooper, J.O., Heron, T.E., & Heward, W.L. (1987) Applied Behavior Analysis. New Jersey: Merrill Durand, V.M. (1990). Severe behavior problems: A functional communication training approach. New York: Guilford Press. Durand, V.M. (1999). Functional communication training using assistive devices: Recruiting natural communities of reinforcement. Journal of Applied Behavior Analysis, 32, Durand, V.M., Berotti, D., & Weiner, J. (1993). Functional communication training: Factors affecting the effectiveness, generalization, and maintenance. Durand, V.M., & Carr, E. (1991). Functional communication training to reduce challenging behavior: Maintenance and application in new settings. Journal of Applied Behavior Analysis, 25, Durand, V.M., & Carr, E. (1992). An analysis of maintenance following functional communication training. Journal of Applied Behavior Analysis, 25,

69 References Durand, V.M., & Merges, E. (2001). Functional communication training: A contemporary behavior analytic technique for problem behavior. Focus on Autism and Other Developmental Disabilities, 16, Fombonne,, E. (2003). The prevalence of autism. Journal of the American Medical Association, 289, Fox, L., Dunlap, G., & Buschbacher,, P. (2000). Understanding and intervening with children s s challenging behavior: A comprehensive approach. Hagopian,, L.P., Fisher, W.W.., Sullivan, M.T., Acquisto,, J. & LeBlanc, L. (1998). Effectiveness of functional communication training with and without extinction of punishment. Journal of Applied Behavior Analysis, 31, Halliday,, M. (1975). Learning to mean: Explorations in the development of language. New York: Arnold. Horner, R.H., & Day, H.M. (1991). The effects on response efficiency ency on functionally equivalent competing behaviors. Journal of Applied Behavior Analysis, 24, Horner, R.H., & Albin,, R., Sprague, J., & Todd, A. (2000). Positive behavior support for students with severe disabilities.. NJ: Prentice Hall Kennedy, C.H., Meyer, K.A., Knowles, T., & Shulka,, S. (2000). Analyzing the multiple functions of stereotypical behavior for students with autism: Implication for assessment and d treatment. Journal of Applied Behavior Analysis, 33, Koenig, M., & Gerenser,, J. (2006) SLP-ABA: Collaborating to Support Individuals with Communication Impairments. Journal of Speech and Language Pathology-Applied Behavior Analysis, 1, 2-11 Michael, J. (1982). Distinguishing between discriminative and motivational functions of stimuli. Journal of Experimental Analysis of Behavior, 37, Ogletree,, B.T. & Oren, T. (2001). Application of ABA principles to general eral communication instruction. Focus on Autism and Other Developmental Disabilities, 16, 2, Retrieved September 15, 2006 from ProQuest Psychology Journals. Skinner, B.F. (1957). Verbal Behavior. New York: Macmillan.

70 More about ABA & SLP: References