BEHAVIOR REDUCTION PLAN

Transcription

1 Dr. Vincent J. Carbone, Director 614 Corporate Way, Board Certified Behavior Analyst-Doctoral Valley Cottage, NY Certificate # Vincent J. Carbone, Ed.D., BCBA, LLC Phone: Fax: Kristin Albert, M. Ed., Assistant Director Board Certified Behavior Analyst Certificate # Jaimie Weinlein, MAT, Supervisor of Education Therapy BEHAVIOR REDUCTION PLAN Sabrina: Sabrina Date of Birth: Age: 9 years, 3 months Disability: Autism Parents/Guardian: Clinic Start Date: 07/16/2013 Reported By: Lisa Reynolds, M.Ed., BCBA; Kristin Zulkeski, B.S., BCaBA; Julien Mollereau Approved by: Jaimie Weinlein, MAT; Kristin Albert, M.Ed., BCBA Date of Report: 07/26/2013 Brief Description of Assessment Methods During a 4-session assessment period from July 16, 2013 to July 19, 2013, sequence analysis (antecedent-behavior-consequence; ABC) data were recorded on the frequency and cumulative duration of problematic behaviors emitted by Sabrina that interfered with instruction. The following clinic-wide definitions of episode and cumulative duration were used when recording data on problem behaviors: An episode of problem behavior begins with the emission of a response that is a member of any of the topographical response classes defined below and ends when there is a break of at least 3 seconds during which no additional responses that are members of any of the topographical response classes defined below are emitted. Any response, which is a member of any of the topographical response classes defined below, emitted following an inter-response time greater than 3 seconds shall constitute the beginning of a new episode of problem behavior. The cumulative duration is the amount of time (i.e., seconds and/or minutes) during which episodes of problem behavior are emitted within a session. The duration of each episode of problem behavior is measured from the beginning to the end of that episode in accordance with the above definition. Therefore, the shortest duration for any episode of problem behavior will be 3 seconds. The durations of individual episodes are added together to calculate the cumulative duration for a session. Across the 4-session assessment period, Sabrina emitted a cumulative total of 72 episodes of problem behavior, lasting for a cumulative duration of 43 minutes and 0 seconds. This averaged out to 18 episodes per session, lasting for an average cumulative duration of 10 minutes and 45

2 seconds per session. Episodes of problem behavior included the topographies listed below. Of the 72 total episodes of problem behavior, 10 occurred when Sabrina was interrupted or transitioned from a reinforcing activity, 7 occurred when Sabrina was denied access to a reinforcer (told no ), 16 occurred when there was a motivating operation (MO) that was strong but Sabrina manded inappropriately, 10 occurred when Sabrina was presented with demands during discrete trial instruction (DTI), 11 occurred when Sabrina was presented with demands during activities, 5 occurred when automatic reinforcement was high in value, 13 occurred when the MO was unclear (i.e., Out of the Blue ), and 0 occurred when another MO was in effect. Based on these data, the following behaviors have been topographically defined and targeted for reduction: Biting (B): Opening the mouth and placing an item or any body part (often the part of her palm between her thumb and wrist) between her teeth and closing her jaw so that teeth close around body part or item. Bolting (BT): Leaving or attempting to leave (walking or running) an activity or setting in which she is engaged or has been instructed to stay. Crying (C): The production of tears. Often accompanied by whining (emitting vocal wailing sounds or high pitched, non-functional noises consisting of intelligible or unintelligible speech sounds/words) and/or the emission of vocalizations at an excessively loud and socially unacceptable volume. Flopping (F): When not instructed to do so, any sudden drop to the ground, or attempt to do so, that occurs while sitting or standing. Grabbing (G): Any extension of the hand or arm in the direction of an object or person accompanied by wrapping or attempting to wrap her fingers around that object or person. May, but does not have to, be accompanied by squeezing of the object or person. Physical Resistance (P): When physically prompted, using or attempting to use any part of her body to push against the instructor in the opposite direction of the prompt that lasts more than 3 seconds. Shoes Off (SO): Any instance in which shoes are removed from feet, when not instructed to do so, either by using her hands or using the other foot to push the shoe off of the opposite foot. This is only considered a problem behavior if Sabrina does not comply with keep your shoes on or put your shoes back on within 3 seconds of instruction to do so. Whining (W): Any time Sabrina emits vocal wailing sounds or high pitched, non-functional noises consisting of intelligible or unintelligible speech sounds/words that are not accompanied by tears. 2

3 Problem Behavior Summary Data Sheet Across Antecedents Date 07/16 07/17 07/18 07/19 Cumulative Total Interruption/ Transition Told No / Denied Access MO Strong but Mands Inappropriately Demand during DTI Demand during Activities Automatic Reinforcement is High in Value MO Unclear/Out of the Blue Other Total frequency Total duration 6:05 19:15 3:57 13:43 43:00 3

4 Tentative Functional Analysis and Possible Treatments Antecedent / Frequency Behaviors Tentative Analysis of Function Possible Treatment Data Collection Interruption/ Transition 10 Told No/ Denied Access (7) MO Strong but Mands Inappropriately (16) Demand during DTI (10) Demand during Activities (11) Automatic reinforcement is high in value (5) MO Unclear/Out of the Blue (13) BT, C, F, G, P, W BT, C, F, W, SO, G BT, G, P, W, C Socially-mediated positive and negative reinforcement Socially-mediated positive reinforcement Socially-mediated positive reinforcement B, C, W, P Socially-mediated negative reinforcement C, W, F, SO, B, BT, P Socially-mediated negative reinforcement B, P Automatic positive reinforcement B, BT, C, F, G, P, SO, W Socially-mediated positive and negative reinforcement Interruption/ Transition Protocol Told No Protocol Count and Mand Protocol Demand During Discrete Trial Instruction Protocol Demand During Activities Protocol Response Blocking Out of the Blue Protocol Total frequency and cumulative duration of episodes of problem behavior per session by antecedent Total frequency and cumulative duration of episodes of problem behavior per session by antecedent Total frequency and cumulative duration of episodes of problem behavior per session by antecedent Total frequency and cumulative duration of episodes of problem behavior per session by antecedent Total frequency and cumulative duration of episodes of problem behavior per session by antecedent Total frequency and cumulative duration of episodes of problem behavior per session by antecedent Total frequency and cumulative duration of episodes of problem behavior per session by antecedent 4

5 Functional Definitions of Problem Behavior Sequence analysis data recorded on Sabrina s problem behavior suggest that the problem behaviors listed above are multiply-controlled. The antecedent conditions that evoked problem behavior included: when interrupted from a preferred item or activity and/or transitioned to another item or activity, when Sabrina was told no or denied access to a reinforcing item or activity, when an MO was strong by Sabrina manded inappropriately, when demands were presented during DTI, when demands were presented during activities, when automatic reinforcement was high in value, and when the specific MO was unclear (i.e., out of the blue). These data suggest that there may be a functional relationship between the responses and a history of access to socially-mediated positive reinforcement (SMPR), socially mediated negative reinforcement (SMNR), and automatic positive reinforcement (APR). Interruption/Transition Antecedent: When Sabrina is interrupted from a preferred activity and transitioned to a less preferred item or activity, she will engage in any of the problem behaviors listed above because in the past these behaviors have been reinforced by the removal of the demand to transition (SMNR) and the maintenance of access to the preferred item or activity (SMPR). Told No /Denied Access Antecedent: When Sabrina is told no or denied access to a preferred item or activity, she will engage in any of the problem behaviors listed above because in the past these behaviors have been reinforced by the presentation of reinforcing stimuli (SMPR) in an effort by others to stop the problem behavior. MO Strong but Mands Inappropriately Antecedent: When there is a strong MO for a specific reinforcer, Sabrina will mand inappropriately by engaging in any of the problem behaviors listed above to gain access to that item instead of appropriately manding for the item because in the past these problem behaviors may have been reinforced by receiving access to the desired item (SMPR). Demand during DTI or Demand during Activities Antecedents: When Sabrina is presented with demands during ITT or during activities, she will engage in any of the problem behaviors listed above because in the past these behaviors may have been reinforced by removal or delay of the demand (SMNR). Automatic Reinforcement is High in Value Antecedent: When Sabrina is in a reinforcer-deprived environment, she may engage in stereotypic/self-stimulatory behavior because in the past this behavior has been reinforced by the feeling/sensation produced simply by engaging in the behavior (APR). MO Unclear/Out of the Blue Antecedent: When Sabrina is motivated for some type of a change to be made within the current environment (e.g., attention, a generally enriched environment) but the specific MO is unclear, she will engage in any of the problem behaviors listed above because in the past these behaviors may have been reinforced by the presentation of reinforcing stimuli (SMPR) in an effort by others to stop this seemingly out of the blue problem behavior. 5

6 Behavior Reduction Plan Sabrina s Behavior Reduction Plan will include using MO manipulations to decrease the value of the reinforcers associated with each antecedent that evokes problem behavior (thereby decreasing the likelihood that problem behavior will be emitted), differential reinforcement to increase alternative/appropriate replacement behaviors (DRA), and extinction (EXT) to reduce the frequency of problem behavior. The following treatment protocols, specific to each antecedent that evoked problem behavior during the assessment period, will be implemented: 1. Interruption/Transition Protocol: Treatment for Interruption/Transition Antecedent (Page 7) 2. Told no /Denied Access Protocol: Treatment for Told no /denied access antecedent (Page 9) 3. Count and Mand Protocol: Treatment for MO Strong but Mands Inappropriately Antecedent (Page 11) 4. Demand during DTI Protocol: Treatment for Demand during DTI Antecedent (Page 14) 5. Demand during Activities Protocol: Treatment for Demand during Activities Antecedent (Page 17) 6. Out of the Blue Protocol: Treatment for MO Unclear/Out of the Blue Antecedent (Page 19) 7. Topography-specific Treatments (Page 21) a. Response Blocking for Biting b. Walk With Me Protocol 6

7 1. Interruption/Transition Protocol: Treatment for Interruption/Transition Antecedent The purpose of this protocol is to teach Sabrina to transition from a reinforcing activity to another activity without engaging in problem behavior as a replacement for problem behavior that is maintained by a history of SMNR (having the demand to transition removed) and SMPR (maintaining access to the reinforcing activity). Set up many transition opportunities per day for Sabrina to learn this skill. SABRINA S ACTIVITY INTERRUPTED Consequence: EXT + DRA (Asked to Leave One Activity and Directed to Another Activity) Prevention: MO manipulation HOWEVER, IF SABRINA EMITS PROBLEM BEHAVIOR (Bolting, crying, whining, physical resistance, grabbing, flopping) Offer a Promise NO YES REMOVES DEMAND SABRINA MAINTAINS ACTIVITY Problem Behavior KEEPS REMOVES PROMISE REMOVES ACTIVITY MAINTAINS DEMAND After Transition and Several Responses without Problem Behavior----Reinforces Problem Behavior STOPS Sabrina Transitions Easily 7

8 MO Manipulations o Approach Sabrina while holding out a promise (i.e., a highly preferred item) so it is clearly visible to Sabrina. o Present a demand to transition away from the current activity or reinforcer by asking Sabrina to physically leave the area in which the activity was taking place or by asking her to give you the reinforcer she currently has access to. o Initially offer the promise during every transition. But, over time, thin the schedule of reinforcement by offering a promise only intermittently, and eventually not at all. DRA o If Sabrina complies (with prompting if necessary) and does not engage in any problem behavior, deliver the promise as a reinforcer immediately and continue with the transition. o It may be necessary to provide additional reinforcers throughout the transition depending on the effort and number of demands required to complete the transition (see Walk with Me Protocol on p. 21 of this document). o Once you have successfully transitioned to the next activity, deliver reinforcers as appropriate to maintain Sabrina s responding. o Over time, fade prompts to increase independence during transitions and thin the schedule of reinforcement so as to intermittently reinforce appropriate transition behaviors. Extinction o If Sabrina engages in problem behavior when you present the demand to transition, DO NOT ALLOW HER TO MAINTAIN ACCESS TO THE PREFERRED ITEM OR ACTIVITY SHE WAS BEING ASKED TO GIVE UP. Physically remove or block access to this preferred item or activity. o ALSO, REMOVE THE PROMISE THAT WAS OFFERED. o DO NOT REMOVE THE DEMAND TO TRANSITION. Maintain the demand to transition by vocally representing the demand about every 2 3 seconds and using physical guidance (i.e., prompts) to obtain compliance. o If Sabrina attempts to engage in any aggressive or self-injurious behaviors, the instructor will use physical prompting to protect her while providing the minimal amount of attention possible. o Block access to all reinforcers as long as problem behavior continues. o ONCE PROBLEM BEHAVIOR STOPS OCCURRING FOR ABOUT 3 5 SECONDS (i.e., 3 5 responses), begin delivering reinforcers so as to reinforce appropriate transition behavior. o If problem behavior is still occurring after completing the transition, begin requiring responses related to the activity to which you have just transitioned (see the Demand during DTI or Demand during Activities protocols on p. 15 or p. 17 of this document). 8

9 2. Told no /Denied Access Protocol : Treatment for Told no /denied access antecedent The purpose of this protocol is to reduce problem behavior that is maintained by a history of SMPR (i.e., gaining access to denied activity or item) by offering an alternative and reinforcing accepting no behavior. Set up many opportunities per day for Sabrina to learn this skill. SABRINA ASKS FOR SOMETHING Consequence: EXT + DRA TOLD NO (or access to reinforcer is denied in some way) HOWEVER, IF SABRINA EMITS PROBLEM BEHAVIOR (Bolting, crying, flopping, whining, shoes off, grabbing) Prevention: MO manipulation Offer an Alternative NO YES Gives Sabrina what she wants; Negotiates; Offers other items; Attends to behavior Does not give Sabrina what she wants; Does not offer an alternative Problem Behavior KEEPS Removes all attention for problem behavior (except to protect) Problem Behavior STOPS Sabrina Accepts No in Future 9

10 MO Manipulations o When Sabrina mands for something that you are not willing to give her, approach her while holding out an alternative (i.e., a highly preferred item) so it is clearly visible to Sabrina. o Deny access or say no to Sabrina s mand for a desired activity or item. o As you deny access or say no, offer an alternative activity or item saying, But you can have this, or, But you can do this. o Initially offer the alternative for each instance of denying access. But, over time, thin the schedule of reinforcement by offering an alternative only intermittently, and eventually not at all. DRA Differential reinforcement of alternative behaviors o If Sabrina complies (with prompting if necessary) and does not engage in any problem behavior, deliver the alternative as a reinforcer immediately and continue to deny access, then continue on to the next activity. o Once Sabrina successfully accepts no, deliver reinforcers as appropriate to maintain Sabrina s responding. o Over time, fade prompts to increase accepting no and thin the schedule of reinforcement so as to intermittently reinforce appropriate accepting no behaviors. Extinction o When Sabrina emits problem behavior following being told no or denied access, do not change environment or provide any attention, items, actions, activities, or other potential reinforcers contingent upon the problem behavior. o If Sabrina engages in problem behavior when you say no or deny access to an activity or item, DO NOT ALLOW HER TO ACCESS THE DESIRED ITEM OR ACTIVITY FOR WHICH SHE WAS TOLD NO. Physically block access to the desired item or activity. ALSO, REMOVE THE ALTERNATIVE THAT WAS OFFERED. o DO NOT GIVE ACCESS TO THE DENIED ACTIVITY OR ITEM. Maintain no or continue denying access by blocking access to the activity or item. o If Sabrina attempts to engage in any aggressive or self-injurious behaviors, the instructor will use physical prompting to protect her while providing the minimal amount of attention possible. o Block access to all reinforcers as long as problem behavior continues. o ONCE PROBLEM BEHAVIOR STOPS OCCURRING FOR ABOUT 3 SECONDS, reengage with Sabrina and reinforce appropriate behaviors. o If problem behavior continues for an extended duration and time/schedule dictates a transition, present subsequent demands and treat accordingly using Interruption/Transition (p. 7), Demand during DTI (p. 14), or Demand during Activities (p. 17) protocols. 10

11 3. Count and Mand Protocol: Treatment for MO Strong but Mands Inappropriately Antecedent The purpose of this protocol is to reduce problem behavior that is maintained by a history of SMPR (i.e., gaining access to desired items and activities) by teaching appropriate mand topographies as replacements for the problem behavior. Conduct mand training across many different MOs many times per day to teach these skills. Consequence: EXT + DRA SABRINA WANTS SOMETHING (MO) Prevention: MO manipulation HOWEVER, IF SABRINA ASKS WITH PROBLEM BEHAVIOR (Bolting, grabbing, whining, crying, physical resistance) Teach Mands Frequently NO YES Gives Sabrina What she wants; Asks what she wants; Searches for what Sabrina wants Problem Behavior KEEPS Immediately withdraws attention (except to protect) Uses count procedure Until 5-10 Seconds of No Problem Behavior + Prompts and Reinforces Appropriate Mand Problem Behavior STOPS Sabrina Mands Appropriately 11

12 MO Manipulations o Have a wide variety of reinforcers readily available. o Begin by delivering reinforcers for free (i.e., without placing any demands) to build motivation. o Frequently contrive opportunities to conduct mand training so as to teach Sabrina to appropriately vocally mand across a variety of motivational categories, settings, stimuli, and instructors. DRA o Use prompting and prompt fading as appropriate to teach Sabrina new vocal mand topographies. If the mand topography matches the MO, regardless of the quality of her articulation provide MO specific reinforcement for Sabrina s initial vocal mand. Contrive another trial and vocally prompt Sabrina immediately after delivering the reinforcer in order to shape the quality/articulation of Sabrina s vocal mand. Provide reinforcement for each vocal approximation. Differentially reinforce and provide larger amounts of the specific reinforcer as vocal mand topography improves. Once Sabrina has improved her vocal mand with instructor-provided echoic prompts, run an item only trial. In other words, if Sabrina s vocal mand improvement is maintained with the item only, differentially reinforcer with a larger amount of the reinforcer. o Differentially reinforce appropriate mand responses. In other words, deliver larger amounts of the reinforcer when Sabrina independently emits vocal mands and deliver smaller amounts of the reinforcer when Sabrina emits vocal mands following echoic prompts. Extinction o When Sabrina declares motivation for a reinforcer that you are willing to deliver but she mands using problem behavior, run the COUNT AND MAND PROCEDURE as described below. o Tell Sabrina, No (problem behavior), and begin counting aloud and showing the passage of time by using your fingers. You will say, No (problem behavior), one, two, three as you hold up your fingers. Use a slow count to 10 initially. If Sabrina counts, ignore her counting and maintain your pace of counting. o If you complete the count and Sabrina has not engaged in another form of problem behavior, vocally prompt the appropriate vocal mand topography. As soon as Sabrina imitates the vocal mand, deliver a small amount of the reinforcer. o HOWEVER, if at all during the count interval, Sabrina engages in any form of problem behavior (see topographies above) restart your count. For example, No (problem behavior), one, two, no (problem behavior), one, two, three, no (problem behavior), one, two, etc.). Continue this process until Sabrina has stopped engaging in all forms of problem behavior for the entire interval (i.e., to the count of 10) and you can therefore prompt the appropriate vocal mand and deliver the reinforcer. o If you repeat the count for many trials without reaching 10, then discontinue by merely withdrawing the reinforcer without comment AND THE OPPORTUNITY TO COUNT AND MAND IS NO LONGER AVAILBLE TO SABRINA. If she moves away from you, ensure her safety, but do not follow her. If and when she returns to you with continued problem behavior 12

13 and a clear motivation for a particular reinforcer, restart the count and mand procedure. If he/she does not return to you and time dictates that it is necessary to move on to a new activity, then merely carry on and the opportunity to count and mand is no longer available. o If Sabrina attempts to engage in any aggressive or self-injurious behaviors, the instructor will use physical prompting to protect her while providing the minimal amount of attention possible. 13

14 4. Demand during DTI Protocol: Treatment for Demand during DTI Antecedent The purpose of this protocol is to abolish the reflexive conditioned motivating operation (CMO-R), thereby abolishing (decreasing) the value of escape as a reinforcer and abating (decreasing) problem behavior during DTI, which was maintained by a history of SMNR (i.e., escape). DTI will comprise 30% of the time during Sabrina s sessions. Consequence: EXT + DRA INSTRUCTIONAL DEMAND IS PRESENTED Prevention: MO manipulation Abolish CMO-R HOWEVER, IF SABRINA EMITS PROBLEM BEHAVIOR (Biting, crying, whining, physical resistance) NO YES REMOVES OR DELAYS DEMAND OR REMINDS SABRINA OF REINFORCERS Problem Behavior KEEPS MAINTAINS DEMAND (EXT) REQUIRES SEVERAL APPROPRIATE RESPONSES THEN REINFORCES Problem Behavior STOPS Sabrina Complies with Instructional Demands 14

15 MO Manipulations (Antecedent Curricular Revisions) 1. Use competing positive reinforcers (pairing): Pair the instructional environment with the delivery of highly valued, positive reinforcers. 2. Mix and vary tasks: Present instructional demands in which the stimuli and response requirements vary from trial to trial. The use of mixed verbal behavior (MVB) cards (index and picture cards) will assist the teacher in ensuring there is a mix of skills being presented. 3. Use errorless teaching: Ensure high levels of correct responding through the use of errorless teaching (0-second prompt delay) and error correction procedures. During the errorless teaching procedure, the instructor will prompt, transfer, present distracters, and probe. - Prompt: present the discriminative stimulus (S D ; i.e., instruction) and, using a zero second time delay, prompt the correct response by using the least intrusive/most effective prompt necessary. - Transfer: present the S D and prompt the correct response using a faded prompt and/or a 2-second constant time delay. - Distracters: present one to four known MVB skills. - Probe: present the S D and further fade prompts or allow for an independent response. 4. Intersperse easy and difficult demands: Present easy tasks which result in correct responding and are correlated with a higher density of reinforcement along with relatively more difficult tasks. About 80% of tasks presented should be easy (previously mastered skills) versus 20% of tasks presented being relatively more difficult (current acquisition skills). 5. Fade in the number of demands: At every intensive teaching session begin by presenting a low frequency of demands before delivering reinforcers and fade in greater and greater response ratio requirements. 6. Fade in the effort and difficulty of tasks: Begin by presenting easy tasks that are of a relatively low response effort and fade into more difficult tasks. This should also be done at each intensive teaching session. 7. Pace instruction properly: The pace of instruction should be relatively fast, using an inter-trial interval of about 1 2 seconds. Once you have removed reinforcement, begin presenting tasks immediately. Once Sabrina has responded, only 1 2 seconds should pass before the next demand is placed or reinforcement is delivered. (See an article regarding this topic that was recently published by Dr. Carbone and colleagues: Carbone, V. J., Morgenstern, B., Zecchin-Tirri, G., Kolberg, L. (2010). The role of the reflexive-conditioned motivating operation (CMO-R) during discrete trial instruction of children with autism. Focus on Autism and Other Developmental Disabilities, 25, DRA o Delays in the receipt of reinforcers have been demonstrated to be related to higher levels of problem behavior. Therefore, reinforcers will be immediately delivered for all desirable or on-task behaviors, such as complying with demands, following directions, keeping hands folded, appropriate manding, and correct responding. o Specific items, activities, and actions that have functioned as reinforcers (e.g., edibles, Elmo videos, tickles) during the assessment period will be used to 15

16 differentially reinforce appropriate behaviors (e.g., sitting with hands folded, correctly responding to instructional demands). o Based on the assessment period, it was determined that during DTI reinforcement will be delivered according to a variable ratio schedule of 10 (VR 10), which means that the reinforcer is delivered after approximately 10 responses. Extinction o When Sabrina engages in any of the problem behaviors defined above, the instructor will withhold reinforcement by implementing escape extinction, thereby not allowing her to escape the instructional demand. o In other words, the instructor will maintain the instructional demand by representing the demand in a neutral voice about every 2 3 seconds and using prompts (e.g., vocal, physical) if necessary, to obtain compliance. o The instructor will not deliver verbal praise or any other reinforcers while implementing escape extinction. o ONCE PROBLEM BEHAVIOR STOPS OCCURRING FOR ABOUT 3 RESPONSES, the instructor will return to using a natural tone of voice, frequently delivering verbal praise, and delivering other reinforcers according to Sabrina s previously established schedule of reinforcement (i.e., VR 10) so as to reinforce compliance during DTI. o If Sabrina attempts to engage in any aggressive or self-injurious behaviors, the instructor will use physical prompting to protect her while providing the minimal amount of attention possible. 16

17 5. Demand during Activities Protocol: Treatment for Demand during Activities Antecedent The purpose of this protocol is to decrease problem behavior that occurs during the completion of daily activities (e.g., those that are a part of natural environment teaching (NET)) due to a history of SMNR (i.e., escape). NET will comprise 70% of the time during Sabrina s session. Consequence: EXT + DRA DEMAND PRESENTED DURING ACTIVITY (e.g., Stay with Me, Play with These Toys ) Prevention: MO manipulation HOWEVER, IF SABRINA EMITS PROBLEM BEHAVIOR (Crying, whining, flopping, physical resistance, shoes off, biting, bolting) Abolish CMO-R NO YES REMOVES OR DELAYS DEMAND OR REMINDS SABRINA OF REINFORCERS MAINTAINS DEMAND (EXT) THEN REINFORCE AFTER SEVERAL APPROPRIATE RESPONSES Problem Behavior KEEPS Problem Behavior STOPS Sabrina Complies with Demands during Activities 17

18 MO Manipulations o During NET, pair non-preferred items/activities with previously established reinforcers so as to build the motivation for these items/activities. Deliver preferred items for free (i.e., without placing any demands) at high rates (i.e., several times per minute). o Initially stay with activities, especially non-preferred activities, for short periods of time. As these non-preferred activities become conditioned reinforcers, gradually increase the amount of time Sabrina is required to stay with them. DRA o After a period of pairing, fade in the number and difficulty of demands. Mands should be the first responses required prior to mixing and varying across the other verbal operants. o Use prompt and prompt fading procedures so as to errorlessly teach skills, thereby decreasing the response effort ensuring frequent opportunities to reinforce appropriate responses. o Specific responses to be reinforced include mands, playing with toys according to their function, social interactions with adults or other students, using language (e.g., tacts, intraverbals) during NET activities, and completing personal care/self-help routines. o Begin with a dense schedule of reinforcement during NET and thin this schedule as appropriate based upon Sabrina s motivation and the response effort required. Extinction o When Sabrina engages in any of the problem behaviors defined above, the instructor will withhold reinforcement by implementing escape extinction, thereby not allowing her to escape the activity-based demand. o In other words, the instructor will maintain the activity-based demand by representing the demand in a neutral voice about every 2 3 seconds and using prompts (e.g., vocal, physical), if necessary, to obtain compliance. o The instructor will not deliver verbal praise or any other reinforcers while implementing escape extinction. o ONCE PROBLEM BEHAVIOR STOPS OCCURRING FOR ABOUT 3 RESPONSES, the instructor will return to using a natural tone of voice, frequently delivering verbal praise, and delivering other reinforcers as appropriate given Sabrina s motivation and the response effort required within that activity. o Subsequently, the instructor will require a period of compliant responding without additional problem behavior prior to transitioning to another activity. During this time the instructor will make adjustments to his/her behavior (e.g., quicker pace of instruction, denser schedule of reinforcement, using a wider variety of and/or more valuable reinforcers) so as to increase Sabrina s motivation to participate in the activity and decrease the likelihood of additional escape-maintained problem behavior. o If Sabrina attempts to engage in any aggressive or self-injurious behaviors, the instructor will use physical prompting to protect her while providing the minimal amount of attention possible. 18

19 6. Out of the Blue Protocol: Treatment for MO Unclear/Out of the Blue Antecedent The purpose of this protocol is to teach Sabrina to appropriately mand for a generalized rich environment as a replacement for problem behavior that has previously been maintained by obtaining access to a variety of reinforcing stimuli (i.e., SMPR). This type of problem behavior may occur seemingly without reason, and may therefore be mistakenly thought to be a sensory or medical issue. Consequence: EXT + DRA OUT OF THE BLUE (No obvious environmental stimulus (no demand, not told no, etc.) and it is not medical problem) Prevention: MO manipulation HOWEVER IF SABRINA EMITS PROBLEM BEHAVIOR (Biting, bolting, crying, flopping, grabbing, physical resistance, shoes off, whining) Teach Manding Frequently NO YES Asks what she wants; Searches for what Sabrina may want; Talks to Sabrina to discover reason for behavior Problem Behavior KEEPS Immediately withdraws attention (except to protect) Blocks access to reinforcers Waits for 3-5 seconds of NO problem behavior BEFORE attending to Sabrina and reinforcing appropriate change in behavior Problem Behavior STOPS Sabrina Complies with Demands during Activities 19

20 MO Manipulations o Have a wide variety of reinforcers readily available. o Begin by delivering reinforcers for free (i.e., without placing any demands) to build motivation. o Frequently contrive opportunities to conduct mand training so as to teach Sabrina to appropriately vocally mand across a variety of motivational categories and settings. DRA o Use prompting and prompt fading as appropriate to teach Sabrina new vocal mand topographies. (See the Count and Mand Protocol on p. 11 of this document for detailed teaching procedures.) o Differentially reinforce appropriate mand responses. In other words, deliver larger amounts of the reinforcer when Sabrina independently emits vocal mands and deliver smaller amounts of the reinforcer when Sabrina emits vocal mands following echoic prompts. EXT o When problem behavior occurs, the instructor will immediately block access to all suspected reinforcers, including attention by not looking at or talking to Sabrina. o Otherwise, the instructor will not change anything about the environment. In other words, the instructor will not remove potentially aversive stimuli from the environment. o If Sabrina attempts to engage in any aggressive or self-injurious behaviors, the instructor will use physical prompting to protect her while providing the minimal amount of attention possible. o The instructor will continue to block access to all suspected reinforcers until Sabrina ceases engaging in problem behavior for a period of 3-5 seconds. o After this period of time passes without Sabrina engaging in problem behavior, the instructor will reengage with Sabrina and return to reinforcing appropriate responding according to previously described schedules of reinforcement. 20

21 7. Topography-specific Treatments a) Response Blocking for Biting o When Sabrina engages in biting (self), the instructor will physically block the behavior from occurring and will simultaneously redirect Sabrina to engage in whatever appropriate behavior should be occurring at that time. o If this behavior is evoked by one of the antecedents listed above, the instructor will also implement the antecedent-specific protocol. b) Walk with Me Protocol The purpose of this protocol is to teach Sabrina to walk in close proximity to the instructor when transitioning from one activity to another activity without bolting, walking ahead, holding onto the instructor, or touching the walls or other objects. Set up many contrived opportunities to practice each day. Start by completing transitions with short distances, provide many prompts, and reinforce. Increase distance for transitions and decrease prompts/reinforcers as appropriate. MO Manipulations o Before transitioning/walking, offer Sabrina a promise (i.e., a highly preferred edible) and ensure that it is clearly visible to Sabrina. o Present a vocal SD similar to, Walk with me. DRA o If Sabrina complies by walking in close proximity to the instructor (with prompts if necessary) during the transition, deliver the promise as reinforcement every 3-5 seconds. o Once you have successfully transitioned to the next activity, deliver reinforcers as appropriate to maintain Sabrina s responding. o Over time, fade prompts to increase independence during transitions and thin the schedule of reinforcement so as to intermittently reinforce appropriate walking and transitioning behaviors. Extinction o If Sabrina engages in problem behavior or walking ahead, during the transition, DO NOT ALLOW HER TO GAIN ACCESS TO THE PROMISE. If needed, physically remove or block access to this preferred item. o ALSO, INDICATE REINFORCEMENT IS NO LONGER AVAILABLE, BY REMOVING THE PROMISE. o DO NOT REMOVE THE DEMAND TO WALK WITH ME. Maintain the demand by representing the demand about every 2 3 seconds and using physical guidance (i.e., prompts) to obtain compliance. o Block access to all reinforcers as long as problem behavior continues. o Once you have completed the transition, if problem behavior is still occurring begin requiring responses related to the activity to which you have just transitioned. o ONCE PROBLEM BEHAVIOR STOPS OCCURRING FOR ABOUT 3 5 SECONDS (i.e., 3 5 responses), begin delivering reinforcers so as to reinforce appropriate behavior (e.g., walking next to the instructor in the absence of problem behavior, completing the activity in the absence of problem behavior). o If Sabrina bolts (i.e., leaves or attempts to leave) during the transition, return to the location where the bolt began, then continue the transition from there. 21

22 Data Sequence analysis (ABC data) per episode of problem behavior Duration data per episode of problem behavior, cumulative duration per session Summary data by antecedent, total frequency, and cumulative duration. Graphing Total Frequency and Cumulative Duration of Episodes of Problem Behavior per 2.5-hour Session Total Frequency of Problem Behavior by Antecedent per 2.5-hour Session for: o Interruption/Transition o Told No /Denied Access o MO Strong but Mands Inappropriately o Demand during ITT o Demand during Activities o Automatic Reinforcement is High in Value o MO Unclear/Out of the Blue. Criteria for Success 10 consecutive sessions without problem behavior 22