Introduction to ABA and Targeting Challenging Behaviors. By: Kirsten Powers Trumpet Behavioral Health

Introduction to ABA and Targeting Challenging Behaviors By: Kirsten Powers Trumpet Behavioral Health

Topics Introduction to ABA What, why, who Common Myths Principles and targeting challenging behavior Taking a functional approach Basic strategies for challenging behavior Identifying high quality ABA Barriers to Accessing Services

Behavior Analysis The scientific study of behavior and the environmental events that affect it. Experimental Analysis of Behavior (EAB) -Examines and identifies basic principles of behavior -Both animals and humans participate in experiments Applied Behavior Analysis (ABA) -Approaches/techniques are developed and evaluated from results of EAB studies -Focuses on improving socially significant behavior and quality of life

Applied Behavior Analysis (ABA) Approach to understanding and changing human behavior Looking at environmental variables that can influence behavior through observation and measurement We can systematically change behavior to improve lives Reduce/change unwanted behavior Increase appropriate behavior Teach new behavior Evidence based: Means that the strategies and techniques we use have been verified by others (researchers) and have shown promising effects.

Why ABA? ABA is the only treatment for ASD that is endorsed by American Academy of Pediatrics the US Surgeon General the American Medical Association. ABA is the most clinically-supported therapy for ASD, and no other intervention has been shown to have the magnitude of success as intensive ABA services. Howard (2005)

Why is ABA an effective tx for autism? Use reinforcement across structured and natural environments to establish and maintain new skills. Breaking complex skills down into simpler tasks Emphasis on making learning fun for the learner. Withholding reinforcement for inappropriate behavior, but teach replacement skills. Rely on data collection and analysis to guide and determine effectiveness of treatments and interventions and make timely appropriate modifications. Individualized

What the research has shown.. ABA is effective for learners with autism Children with autism who participate in early, intensive ABAbased programming learn many new skills and reduce their challenging behaviors substantially Children with autism who have not learned from typical educational environments, may learn a great deal when the environment is appropriately constructed Behavioral interventions are most effective when they are intense and start at a young age Strategies have been used successfully with older students and adults across a wide range of behaviors and skill levels

Who is involved? Registered Behavior Technician (RBT) 40+ hours training Competency assessment and exam Board Certified Behavior Analyst (BCBA) Masters degree or higher Supervised fieldwork hours Assesses, development treatment plan, monitors progress, supervising Behavior Analysis Certification Board (BACB) Family, client, other providers

Misconceptions of ABA ABA = Discrete Trial Teaching There are many teaching procedures for children with autism that are based on the principles of ABA Relies on punishment Uses bribes Ignores the real causes of behavior, just treats the symptoms Behavior modification only works with kids and people with intellectual disabilities ABA creates rote, robotic skills

Variety of Applications Early Intervention??? Matching Making sounds Functional communication Receptive/expressiv e language Imitation Play Group skills Food expansion Toilet training Self help skills

Variety of Applications Early Intervention Social Skills?? Initiating conversation Responding to others Group interactions Appropriate greetings Perspective taking Identifying social cues Safe vs. unsafe

Variety of Applications Early Intervention Social Skills Money Skills Community skills Laundry Cooking Grocery shopping Dressing Independent Living Skills?

Variety of Applications Early Intervention Independent Living Skills Social Skills Behavior Reduction Self injurious behavior Aggression Non-compliance Pica Property destruction Elopement

Examples of interventions Discrete trial teaching Structured Many learning opportunities Naturalistic Teaching Contrived or spontaneous Motivated setting for child Child initiated Verbal Behavior Applies principles of behavior to language Separates language into categories of function

Core Philosophy of ABA All behavior happens for a reason Behavior is a function of it s consequences. Learning occurs as a result of an individual s experiences within the environment and it is the experiences that shape future behavior All behavior is changeable By understanding the impact that the environment has on an individual s behavior, we can learn how to change the environment to change behavior and enhance learning

Terminology

What are Reinforcers? Reinforcers are not simply things Reinforcers are stimuli that, when used as consequences for a behaviors, increase future occurrences of the behavior Can change over time Different for everyone!

How do I Identify Potential Reinforcers? Interview: parents, other service provides, the individual if appropriate Observe: what does the individual seem interested in Informal Preference Assessment: present two items and let the individual pick present several choices, allow time to choose and interact with one, the sequentially represent the rest of the items until you have gone through all of them. Keep track of the rankings.

When Do I Reinforce Behaviors? Generally: Immediately following the response Schedules of reinforcement: Usually based on how difficult the responses are and how difficult it is to keep an individual s attention Fixed (set schedule at -time intervals or number of responses) Intermittent (most powerful -slot machine example)

When Do I Reinforce Behaviors? Differential Reinforcement: Give smaller/lower quality reinforcers for easy responses (e.g., mastered items, highly preferred tasks/activities, prompted responses) Give reinforcers less frequently for easy responses Give bigger/higher quality reinforcers for difficult responses (e.g., new targets, unknown targets, independent responses) Give reinforcers more frequently for difficult responses (e.g., new targets)

How do I Deliver Reinforcers? Immediately Vary them, switch them up Pair tangibles edible items, toys, activities with praise Be creative Try out social games, songs, silly handshakes, winks Be smart. Do not give reinforcers that will make subsequent responding difficult Don t give a whole gummy bear in the middle of a verbal imitation program

Reinforcement Reinforcement occurs when something following a behavior makes the behavior more likely to occur in the future This is the most important principle used in behavior change programs. All behaviors that we exhibit and that others exhibit are contacting reinforcement. Unwanted behaviors may be being reinforced too! Even if we don t see it or want to admit it. If the behaviors were not contacting reinforcement they would not be occurring.

Examples Positive Reinforcement a correct response is followed by praise, treat, or access to a toy and the behavior is more likely to occur in the future a screaming child is given the thing s/he wants and the behavior is more likely to occur in the future Negative Reinforcement appropriately asking someone to move away from you is followed by the person moving away and the behavior is more likely to occur in the future a tired parent gives their screaming child candy, the screaming stops and the giving behavior is more likely to occur in the future

Addressing Challenging Behavior

WHY IS HE/SHE DOING THIS???

Behavior is a function of it s environment.

Challenging Behavior AKA: problem behavior, negative behavior, inappropriate or aberrant behavior Generally, any behavioral excess or deficit that falls outside the typical range for a given behavior Challenging behaviors are those that present a safety concern, prohibit learning, or reduce social opportunities or independence

Cookie Cutter Interventions Not specific to each case, applied across the board Does not look at the specific antecedents and consequence of the behavior Examples of cookie cutter interventions Ignore students who scream Physically guide students who trash their environment to clean up their mess Hug a student who cries Vocally reprimand a student who is aggressive towards you Place a student in time out if they are aggressive to another student

ABC s of Behavior A An Antecedent B Behavior C Consequence Antecedent Event that evokes ( triggers ) the behavior Behavior The behavior itself Consequence An event that follows the behavior and determines how often the behavior will occur in the future

Antecedents Triggers Occur before the behavior Two effects: Makes the behavior more likely to occur Makes the behavior less likely to occur Can be: Events People Sensations, etc.

Antecedent Strategies: Increase the value of a reinforcer for requesting, difficult responses or non-preferred tasks Withhold or severely limit access to the items (be sure to have family and other settings withhold too) Rotate toys or other reinforcing items/materials to retain or enhance their reinforcing effects Decrease the value of a challenging behavior Increase access to the consequence in high levels to produce satiation (e.g., frequent breaks make outbursts to escape less frequent)

Example Consequence: Pizza More valuable if. Not having pizza for 6 months Finishing a 2 hour work out Not eating anything all day Less valuable if Working in a pizza place Just eat pizza the day before Just ate a double-double with cheese

Antecedent Examples Behavior More Likely Less Likely Stomp feet Task given Fun activity or no task given Screaming Neighbor present Family present Tantrum Denied activity Given activity Hit sibling Mom on the phone Mom playing child Run away Asked to work Asked to play video game

Examples of Behavior: Hitting Kicking Biting Yelling Crying Punching Whining Scratching Smiling Walking Tying shoes Doing homework Asking permission Sharing Driving

Consequences Change in the environment Immediately follows target behavior Makes target behavior more or less likely to occur in future Two possible effects of consequences Target behavior is increased in future Target behavior is decreased in future

Relationship of ABC s Antecedents determine the conditions under which the behavior will or will not occur Determine where, and when behavior will occur or will not occur Consequences determine whether or not behavior is likely to occur again in the future Determine if behavior will occur again

ABC s of Behavior: Example A Antecedent B Behavior C Consequence Do your homework Child hits you Child is put in timeout (does not have to do HW)

Participation What happens next time you ask the child to do his homework?

ABC s of Behavior: Example A Antecedent B Behavior C Consequence Do your homework Child hits you Child is put in timeout (does not have to do HW)

Functions of Behavior Access to Attention Access to a preferred toy or activity Something about the behavior results in a preferred sensation Escape from Aversive Event

Importance of Functions Tell us about the environmental conditions under which the challenging behavior reliably occurs Allows for: Predicting and Antecedent Management Teaching Replacement Behavior Purposeful Reactions/Consequences

Social Positive To Gain Access To Something Access to Attention: adult, peers, very specific person, particular reaction Obvious (calming, reassurance, help, reprimands, laughing, restraint, increased engagement, etc.) Subtle (eye contact, facial expression, increased proximity, sighing, etc.) Access to Items: toys, edibles Access to Activities/Locations: including ability to complete rituals/routines

Social Negative To Escape/Avoid/Delay Escape, avoid, or delay aversive/non-preferred stimulus Work/Demands/Specific Activities Social Interaction Environmental Stimuli: noise, crowds, heat, etc. Anything the individual finds aversive The escape or delay can be VERY brief

Automatic/Sensory Something about the sensation produced is reinforcing in and of itself Adding sensory stimulation (positive) Alleviating sensation/pain (negative) Cannot be determined by what the behavior looks like Need to focus on function, not topography

Functional Approach What does it mean to take a functional approach to managing problem behavior? Identifying the target behavior Identifying why the behavior occurs Behavior Analyst School/Teacher/Social Worker Introduce a strategy that compliments the behavior Teaching an alternative behavior in order to replace the negative behavior Matching the behaviors

4 Steps to Decreasing Challenging Behavior 1. Identify and operationally define the challenging behavior 2. Determine the function of challenging behavior 3. Place the challenging behavior on extinction 4. Teach a replacement behavior

Step 1: Operationally Define the Challenging Behavior Objective no need to interpret Observable exactly what you see/hear Measurable can you count/measure it A definition is NOT a label: Aggression vs. single hit with one or both open hands, any attempt to actual biting any part of another s body, one or more of the following: kicking, head butting, pulling hair, pinching, scratching may occur singly or in combination

Step 2: Identify Function Why not just guess? Need information about the conditions under which the challenging behavior reliably occurs Antecedents Consequences What consequences are reinforcing (social positive, social negative, automatic)?

Step 2 Contd. Functional Assessment: interviews, direct observation of the student, and experimental manipulation of antecedents and consequences to evaluate their effects on behavior ABC Data Descriptive Analysis Data Functional Analysis (FA)

Descriptive Analysis (DA) Card Student: Date: Time: Staff Member: Antecedents Check all that apply student is asked to do something student is asked not to do something preferred activity ends non-preferred activity begins group instruction one-on-one instruction student is alone preferred object is taken away other: Behavior Check all that apply hits other student hits staff hits self throws objects at someone at something spitting kicking screams or makes other sound property destruction what: runs away from staff other: Consequences Check all that apply verbal reprimand (e.g., told no or stop that ) activity ends/demand is removed request is repeated until student complies behavior is ignored preferred object is removed preferred object is given student is escorted outside to cool-off length of time until student is calm: other:

Step 3: Place the Challenging Behavior on Extinction Withholding the reinforcer that has previously maintained a response In order to implement an extinction procedure, we must know the function of the challenging behavior Extinction is a critical component of most interventions designed to decrease problem behavior

Extinction Knowing the function of behavior before implementing an extinction procedure is critical If the function of behavior is not known beforehand, a well-intentioned extinction procedure might end up increasing the challenging behavior Planned ignoring is only extinction if the behavior is maintained by social attention! Typically used in combination with another procedure

Extinction Withholding the typical reinforcement may produce initial increases in the challenging behavior (extinction burst) Data can help determine how long we need to stick with it

Maintaining Function Gain access to attention (social positive) Gain access to tangible (social positive) Escape/avoid/delay work (social negative) Automatic Extinction Procedure Do not give attention following occurrence of challenging behavior Do not give access to tangible following occurrence of challenging behavior Do not remove work demand Prevent/block access to sensory stimulation

Importance of Consistency If a behavior is reinforced only now and then, it is more likely to persist (intermittent reinforcement) The client will keep engaging in the challenging behavior because it periodically pays off sometimes Not only will the challenging behavior persist, it may increase in intensity

Step 4: Replacement Behavior Functionally Equivalent Produces SAME consequence As fast, or faster More often Same or better quality/magnitude/intensity Already in repertoire Needs to be strengthened New Skill Needs to be taught

Examples Client slaps instructor to escape work tasks. Client hugs and grabs people to get attention. Client chews and occasionally swallows inedible items.

Teaching Replacement Behavior Teach the new skill: teach how and when (think antecedents) to use Set up many opportunities to practice, practice, practice With support/prompting During times student is likely to be successful In successively more natural/difficult situations Reinforce, Reinforce, Reinforce (start rich and lean out) The more you reinforce it, the more likely it is to occur!

Some Points to Consider Be aware of their own behavior at all times and how it may be affecting the client s behavior eye contact sighing or annoyance laughing Repeated verbal instructions waiting pausing the activity changing activities Presenting options or alternatives, esp if preferred

Novel Behaviors Without knowing the function, generally speaking you should: Remain neutral minimize comments to student or other staff Stay on task do not change or delay the activity for extended periods of time Deliver brief praise for appropriate behaviors hold off on trade-ins or edible items until appropriate Maintain a safe environment Provide the client with the opportunity to appropriately communicate and reinforce any appropriate communication, even if it is at a lower level then the student is capable of

Target Behavior: Hitting Definition: Making contact with other individual s body with an open or closed fist Antecedent event (triggers) Behavior is most likely to occur when tasks are issued Consequent events Child gets to leave work table and have a break Function (what does the child want?): Avoiding tasks

Target Behavior: Hitting Strategy: Use a Behavioral Contract If then statement Continue to place tasks until the child completes Use positive reinforcement when the client completes the task Avoid timeout (do not use) Alternative behavior: Teach the child to appropriately requests a break

Target Behavior: Hitting Alternative Behavior Cont d Children who are verbal Teach them an appropriate word to say: Break Play Toys Consider starting with a visual prompt Children who are non-verbal Use a visual prompt

REMEMBER! Avoiding Task: Closer Look If you use timeout in this situation then chances are the next time you do homework the same thing will happen again!

REMEMBER! Avoiding Task: Closer Look Continue to do the homework Give break when replacement behavior is used Use positive reinforcement Stay calm! Break

Target Behavior: Hitting Demand Fading Start with easy tasks, then gradually fade in harder tasks Example: Eat your food, throw your napkin away, clean your dish Make it fun! Use positive reinforcement Visual supports Schedule (either picture or written) To do list Include fun things on the list as well as harder tasks The last item on the list should be the highest reinforcer Token System Behavioral Contract

Example: Getting Something Target Behavior: Yelling/Crying Antecedent event (triggers) Behavior is most likely to occur when a parent is on the phone talking with someone else Function (what does the child want?): Attention from parent Strategy: Withhold your attention Refrain from verbal reprimands Block and move away Keep others safe Once your child is calm, provide attention Alternative behavior: Teach the child how to ask for your attention

Attention: Closer Look Provide free attention! Non contingent attention Enrich the environment Prepare for success! Example: You have a very important call at 4:00pm, at 3:30 provide lots of 1:1 attention, closer to 4:00 provide your child his favorite toy. Every so often if your child is being quiet while you are on the phone provide him with small amounts of attention ( good job, a pat on the back, a hug). Planned Ignoring Eliminate your verbal reprimands (this is a form of attention) Reduce your frustrated body language in front of the child

Attention: Closer Look REMEMBER! By delivering verbal reprimands you are providing 1:1 attention to the child chances are that could reinforce the behavior!

Attention: Closer Look REMEMBER!

Attention: Closer Look REMEMBER! Continue to talk on the phone Stay calm Avoid verbal reprimands When the child is quiet, provide attention Provide free attention through-out

Behavior (Extinction) Burst Things might get worse before they improve! It is a signal you are on the right track! Don t give up now or it could be harder to change behavior in the future!!!!!

General Tips for Success Model correct behavior Say calm Consider your language Consider your behavior Use visual supports Schedules Use reinforcement Praise Token Be consistent Have follow through! If you say it then stick to it! Use motivation/antecedents to your advantage!

High Quality ABA Supervision and staffing Appropriate credentials Adherence to BACB guidelines Clinical quality systems Easy to work with Scheduling, insurance services Case Coordination Treatment plan Parent training Evidence based Peer Review Ethics Hotline Quality Assurance Research Base

Maximizing Access to Services Many children don t receive the help they need Knowledge Acceptance Choices of therapy Schedules/availability Insurance

Questions?

Thanks! Kirsten Powers kpowers@tbh.com 872-242-5014