Individuals with problem behaviors place a tremendous stress on families and professionals. Tip One. What do we do when?

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1 Understanding Challenging Behavior and Linking Treatment to the Behavior Support Plan Dr. Cathy Pratt, BCBA-D Director, Indiana Resource Center for Autism Indiana Institute on Disability and Community Individuals with problem behaviors place a tremendous stress on families and professionals. Tip One Know that there is no categorical approach to behavior supports. Accept the fact that there is no single recipe for handling problem behavior, because each individual and situation is different. Must understand/know the individual and the role the context is playing. What do we do when?

2 De-Escalation Plan All must be safe Must have a written plan Short-term solution Minimize your verbal comments De-Escalation Plan Do not approach quickly Goal is to de-escalate Catch a behavior before it escalates out of control Our reaction may strengthen behavior beware Avoid power struggles Individual 5 point scales! 5! 4! 3! 2! 1 Feeling like I m going to explode- I need help to calm down Feeling really worried- I need to calm down Feeling worriedsomething is bothering me Feeling fineeverything is OK Feeling happy-things are going well

3 Tip Two Recognize that crisis management is only a shortterm solution to problem behavior. It does not necessarily equate long term behavior change. Tip Three Realize that a crisis management approach may actually strengthen/reinforce negative behavior. Tip Four Always choose your battles. Certain behaviors may be better to ignore. At the very least always respond with a neutral affect and keep words to an absolute minimum. Do not approach quickly and excuse yourself if your behavior escalates.

4 Tip Five The only definition of consequence is that it comes after a behavior. The only definition of reinforcement is that it increases a behavior. Punishment decreases a behavior. A punitive approach does not necessarily address the function of the behavior and the effects will likely not generalize. Most important, focus on self-control rather than adult-controlled behavioral supports. If you use threats or warnings, do once and follow through. Tip Six Think prevention, rather than reaction when it comes to dealing with problem behavior. The best time to address behavior is when behavior is not happening. Tip Seven Know that in order to be maximally effective, a behavior support plan should evolve from a thorough assessment of both the problem behavior and the context in which it occurred. This requires a team approach. Work with your school or other support teams on this. Tip Eight Remember that behavior serves a purpose for the individual, and that our job is to figure out that purpose.

5 Tip Nine Functional Behavioral Assessment: A process for determining the relationship between a person s internal/external environment and the occurrence of problematic behavior. There are two types of antecedents. For students on the autism spectrum, slow triggers or settings events are often the antecedents that are most important to consider. Slow Triggers/Setting Events Conditions that increase the likelihood that behavior will occur. Anxiety/Biological Issues Schedule/Staff changes Medications changed/missed Irregular sleep patterns Illness/Impending Illness Missed meals Excessive hot/cold temperatures Argument/fight with classmates/parents/teachers Examples Difficulties on the Bus Skills Deficits Lack of Communication System Sensory Issues Inconsistencies at Home Antecedents/Fast Triggers Teasing/Bullied Too Difficult/Boring/Easy Task Specific Type of Task/Activity Specific Request or Wording of A Request Certain Noise/People Unstructured Time Behavior of Others Interrupted During Preferred Activity Transitions

6 Information Obtained from a What is the history of the undesirable behavior? When did the behaviors first happen? Have the behaviors persisted across grade levels/settings? Has the behavior improved or deteriorated? What strategies have been effective in addressing the behavior? What strategies have been ineffective? Information Obtained from a Under what conditions does the individual do well? During what times or activities is the individual most successful? What are areas of strength and interest for the individual? Are identified strengths and interests utilized for programming purposes and are they reinforced? Information Obtained from a In what settings does the behavior happen? What aspects of the environment may be contributing to the behavior? Information Obtained from a According to the individual s schedule, is the majority of his/her day spent engaged in instruction/productive activity? Are there extensive periods of unstructured or down time? Does the individual have a tendency to engage in problem behaviors during certain times of the day?

7 Information Obtained from a Are there specific activities or courses during which the student is more likely to engage in problem behavior? Are there specific instructors/ staff/adults who are more or less successful with the individual? Information Obtained from a Does the individual have the skills or ability to respond in an appropriate fashion? Does the behavior serve a purpose for the individual? What is the individual s primary means of communication? Information Obtained from a Does the individual have any medical problems or take any medications? Could this be affecting behavior? Or is there a possibility of substance abuse? Does the individual have difficulty with sleeping and/or with eating? Are the person s nutritional needs being met? Information Obtained from a Functional Assessment Does the individual have the opportunity to engage in a range of activities outside of school/work? In other words, what is the person s life like outside of school/work? Are there conditions inside the home which may be troubling the individual?

8 At times, behaviors may reflect conditions at home. If this is the case, outside help from various agencies may be needed. Classroom Structure Must Also Look At: What message do students get when entering the classroom? Does the structure provide an opportunity for all students to be supervised and to be engaged? Is the setting chaotic or is it organized to facilitate smooth transitions? Are routines clearly articulated? Are expectations reflected somewhere in the room? Must Look At: Behaviors of Others in the Classroom Are there other students who are also engaging in problematic behaviors? Must Look At: Staff Behavior/Instructional Approaches Used, Including: Instructional/Proximity Control Rapport Building Positives Outweigh Negatives Direct Instruction Reinforcement

9 Must Look At: Engagement/Schedule Has a schedule been designed for staff and students? Are transitions minimized? Are students engaged for a majority of the time or are their major downtimes? Is there a visual schedule? Must Look At: Even Look Beyond at School Culture and Discipline/PBIS Has the school a plan for overall school behavior issues? Are rules articulated clearly? Are they consistent followed? Are student with disabilities included in that school wide plan? Are strategies being practiced by all? Student: Date: Behavior: Mike Respondent: 1/10-14, 1/17-21 Scatter Plot Cursing, staring at peers and making loud noises 7th Grade Teachers 1 X 2-5 X > 5 X Key: / = Χ =! = Scatter Plot Activity Day 1 Day 2 Day 3 Day 4 Day 5 Math Χ Χ Χ English Industrial Arts P.E. / Χ / Lunch Science Study Computer Χ Χ Χ / /

10 Tip Ten When looking at consequences, it is important to understand the consequence from the perspective of the individual and with this in mind, realize that we may intentionally or unintentionally reinforce problematic behaviors. Focus on reinforcers in terms of those things that maintain or strengthen behavior. Tip Eleven Realize that not everything impacting an individual s behavior is related to their autism. Sometimes it is not about autism, but rather resources, quality of life issues or other events in an individual s life. Tip Twelve Hypothesis Statement (Problem Behavior Pathway) Behavior support plans should logically evolve from hypotheses you develop through the functional behavioral assessment process. Setting Events Biological Problem Anxiety Social Skill Deficit Triggering Antecedents Sees Sibling Violating Rule Problem Behavior Yells, Kick and Pushes Sibling Maintaining Consequence Small Release of Anxiety. Parent Attention. Gets Sibling Away.

11 Hypothesis Statement (Problem Behavior Pathway) Hypothesis Statement (Problem Behavior Pathway) Setting Events Triggering Antecedents Problem Behavior Maintaining Consequence Setting Triggering Problem Maintaining Events Antecedents Behavior Consequence Autism/Anxiety Seizures Medications Allergies Communication Limitations Sensory Challenges Lack Self-Regulation and Self-Management Poor Social Skills Certain Demands Too Much Talking Transitions: Leaving School Bus Changes in Routines Certain academic work too much paperwork and being read to or lectured to. Pinching Yelling Screaming Elopement Refusal Kicking Hitting Aggression Ends an Activity Gains Access to Desired Event/Activity Attention Sensory Strengths/Skills: Tip Thirteen Make the teaching of alternative responses an integral part of your behavior response/plan. In truth, IEP goals should be stated in the positive and not the negative. Teaching Alternative Behaviors Specific alternative or replacement behaviors that must be made as efficient and effective as the problem behavior(s).

12 Alternative Skills Problem-Solving Skills Choice-Making Ability Anger Control Relaxation Training Self-Management/Control Communication Social Skills Tip Fourteen Utilize effective instructional approaches when teaching alternative skills. Some of these include the following: Provide Choice Incidental Teaching/Coaching Increase Praise/Rapport Minimize Unstructured Time Provide Clear Expectations Increase Predictability-Visual Supports Build Routines Direct Teaching Reinforcement Tip Fifteen The ultimate focus should be on long term strategies that support families and individuals, and that maintain behavioral change. Tip Sixteen Behavior support plans must be doable within the contexts in which an individual lives, works and attends schools.

13 Tip Seventeen The outcome of a good behavior support plan is not so much that there is a reduction in problem behavior, but rather that there is an increase in alternative behavior. Tip Eighteen Bear in mind that in order for behavior support plans to work they must be followed. Make sure that all have reached consensus concerning the course of action and that there is a mechanism for ongoing communication and monitoring of progress. Tip Nineteen Realize that effective behavioral change may require that all involved in the individual s life change their behavior, as well. Tip Twenty Changing behavior requires honesty, a willingness to change, relationship building, and a calm perseverance.