Jason Garner, M.A. ABA Clinical Director

Jason Garner, M.A. ABA Clinical Director

Discuss Autism Definition Prevalence rates Discuss Applied Behavior Analysis (ABA) Discuss challenging behavior Functions of Behavior Discuss behavior management strategies Antecedent Modifications vs. Consequence Manipulations

What is Autism?

Before defining Autism, we must realize that Autism is a spectrum disorder. This means that although these individuals are grouped/categorized by the diagnosis (label), they are people so they are all different from one another 10 Things every child w/ Autism wishes you knew #1: I am an individual with Autism, not primarily Autistic It is 1 characteristic of their character It does not define them as people

Definition Autism is a disorder of neural impairment characterized by impaired social interaction and communication, and by restricted and repetitive behavior. In order for child to receive diagnosis of Autistic Disorder, he/she must meet a total of 6-criteria from 3 different domains listed in the DSM-IV. These signs all begin before a child is three years old It is one of three recognized disorders in the autism spectrum (ASDs), the other two being Asperger Syndrome which lacks delays in cognitive development and language, and Pervasive Developmental Disorder-Not Otherwise Specified (commonly abbreviated as PDD-NOS), which is diagnosed when the full set of criteria for autism or Asperger syndrome are not met.

From a behavioral perspective, the diagnosis is irrelevant because we focus on the treatment of behavioral deficits and excesses. Behavior Excesses Stereotypy Non-compliance Tantrums Aggression Self-injury Behavior Deficits Language Receptive Expressive Play Social Skills Perspective Taking Executive Functions Motor Skills Adaptive Skills School Skills

Pervasive Developmental Disorders Generally characterized in 2 or more areas of development 3 Types PDD-NOS Delays in all 3 areas: Communication Social Stereotypic Behaviors Asperger s Disorder No cognitive or language delay Impaired social interaction with high rates of stereotypic behaviors Autism Impaired communication Impaired social interaction Restricted, Repetitive, Stereotypic Behaviors Includes 6 or more symptoms

Autism currently affects 1 in 110 individuals (as reported by the Center for Disease Control & Prevention (CDC))

Applied Behavior Analysis (ABA)

Definition of Behavior Analysis Science of behavior based upon the principles of learning and motivation studied extensively by psychologist B.F. Skinner Definition of Applied Behavior Analysis Application of the principles of behavior to issues that are socially important in an effort to produce practical change Applications Special education Intervention for individuals with Autism Regular education Treatment of troubled teens Anyone needing &/or wanting to change behavior

Desirable consequences increase behavior whereas undesirable consequences decrease behavior

In ABA, we manipulate reinforcers in order to increase functional and adaptive behaviors, and decrease challenging behaviors We give reinforcers when a good (adaptive) behavior occurs We remove reinforcers when a bad (challenging) behavior occurs The key is to realize that we cannot simply extinguish challenging behaviors without replacing them with appropriate skills!

Challenging Behavior

He hits people Throws himself on the floor Runs away Throws things at people Screams Bangs his head Spits at people Refuses to do things Runs into windows Jumps in front of cars

What is Behavior All behavior serves a purpose Behavior is anything we do that is: Good Bad Neutral Challenging behaviors make life less fulfilling and more difficult for the child and his family Challenging behavior is anything that could hurt someone, or be maladaptive in any way

Challenging Behavior is your child s way of telling you what he/she wants He/She may not care that his/her way of telling you is not the appropriate way He/She may not have the skills to tell you the appropriate way!

ABA studies behavior by analyzing: The behavior What happened right before it (Antecedents) What happened right after it (Consequences) This is called a behavioral contingency If we can change the behavioral contingency, we can change behavior!

It is imperative we teach appropriate communication skills, so we can replace challenging behaviors in our kids General Comment: Challenging behaviors are NOT part of the Autism diagnosis! They are simply the child s way of communicating!

If we ignore problem behavior AND reward good behavior, then you will shape more appropriate/desired behavior In order to know how to best manage problem behavior, we must 1 st look at the reason why the behavior is occurring

Functions of Behavior

When we say functions of behavior, we are referring to the reason (WHY) the behavior is occurring 4 main functions: 1. Attention 2. Access to Tangibles 3. Escape/Avoidance 4. Automatic Reinforcement

A problem behavior occurs and someone responds by giving attention to the individual. Attention: 1. Vocal Attention Consoling, reprimands, lecture/discussion, etc. 2. Physical Attention Hugging, patting, spanking, etc. 3. Facial Expressions / Body Language Shaking head, hands on hips, eye-contact, etc. A B C Khalid has no attn Khalid screams Khalid gets scolded

A problem behavior occurs and someone responds by giving access to the item/activity. Tangible: 1. Tangibles Food, toys, I-Pad, etc. 2. Activities Going outside, watching TV, playing computer, etc. A B C Daniel wants to play I-Pad Daniel bites Daniel gets I-Pad

A problem behavior occurs and someone responds by allowing escape from undesired task/event. Escape: 1. Discontinue Task No follow through, allow break, etc. 2. Leave Structured Setting Getting out of circle time, not having to take exam, etc. A B C Adam does not want to shower Adam pees his pants Adam is taken to change his clothes

An intrinsically (internally) rewarding behavior occurs and individual receives automatic sensory stimulation. Automatic: 1. Physical - Visual - Vocal - Tactile Hand flapping, watching/spinning wheels, repeating sounds/phrases, rubbing textures, etc. A B C Sultan has no visual stimulation Sultan puts his head on the table & watches wheels of train Sultan gets visual stimulation

Behavior Management Interventions

Noncontingent Reinforcement Extinction Differential Reinforcement of Other Behavior (DRO) of Alternative Behavior (DRA) of Incompatible Behavior (DRI) Non-Exclusionary Time-Out Response-Cost

NCR is also known as Enriched Environment NCR is an antecedent intervention that may be used to reduce problem behavior Access to reinforcers are delivered on a time-based schedule, independent of the problem behavior Basically, we are giving the child what they want for free If we are providing the reinforcer for free, it should not be necessary for the child to engage in problem behavior to gain access to your attention or a toy that they want If we are providing stimulating items to engage with for free, NCR may also make it less likely for some children to engage in behaviors maintained by automatic reinforcement

Definition No longer give the reinforcer for a previously reinforced behavior The result is a decreased future frequency of behavior Extinction is also referred to as planned ignoring

When beginning to implement extinction, we may see an Extinction Burst Definition: Initial increase in the frequency or intensity of the behavior Example: In the past, people gave Jacob tangible reinforcers such as candy when he cried When therapists & parents begin to implement extinction, initially, Jacob cries louder as well as begins to throw tantrums, falling on the floor & kicking If we continue to consistently use extinction, Jacob will stop crying in these kinds of situations

Reinforce desired behavior (A) AND Don t reinforce (extinguish) undesired behavior (B) Types of Differential Reinforcement DRO: Differential Reinforcement of Other Behavior DRA: Differential Reinforcement of Alternative Behavior DRI: Differential Reinforcement of Incompatible Behavior

Definition Presenting a reinforcer contingent on the absence of a problem behavior for a specified period of time. The BIP will specify the time interval that the child has to go without engaging in problem behavior to receive a reinforcer At the end of the time interval, the reinforcer is delivered for any other behavior occurring besides problem behavior Example A child is crying in class and the teacher/lsa verbally praises him for cleaning up his desk

Definition A differential reinforcement procedure where a specific appropriate response is taught to replace an inappropriate response It is best when the new appropriate response produces the same reinforcing outcome that the old inappropriate response produced Sometimes the replacement behavior is a form of communication (this is called Functional Communication Training) that involves essentially asking for the reinforcer (attention, a toy, a break, etc.) Example A child bangs his head when his I-pad is taken away. He gets it back when he says I want I-Pad please

What do you do when a child engages in the alternative response while also engaging in problem behavior at the same time? Ignore the alternative or communicative response at this time, and wait until the child engages in the desired response without engaging in problem behavior If this is happening often, your supervisor may choose to use the last differential reinforcement procedure that will be discussed (DRI)

Procedurally, this type of differential reinforcement is the same as DRA The difference is that it is impossible for the alternative behavior to occur simultaneously with the problem behavior Thus, the alternative behavior is incompatible with the problem behavior Example A child tries to place his hands in his mouth, so the LSA asks him to fold his hands

Definition Immediate removal of access to a reinforcer contingent on challenging behavior, resulting in a decreased frequency of that response In this procedure, the child is removed from an area/activity Example A child is placed in a chair in the back of the room for hitting his classmate

A reinforcing activity must be in effect prior to time out, otherwise time out will be an opportunity for escape or avoidance Time-out should never involve closing a child into a room as this would be considered exclusionary and an aversive Time out should be immediate No attention should be given during time out Duration of time out depends on the age of your child (1 min per 1 year of age) When time is up, if your child is engaging in any inappropriate behavior, wait for him or her to behave appropriately for at least 15 s before removing from time out

Definition Immediate, response contingent, removal of a portion of a tangible reinforcer, resulting in a decreased frequency of that response In this procedure, the item (or portion of) is removed Example A child does not clean his room when his mother asks, so he loses access to his X-Box

Antecedent Modifications vs. Consequence Manipulations

An antecedent modification involves changing something about the child s environment before the behavior occurs Antecedent modifications are a good place to start because they make the target behavior less likely to occur in the first place Antecedent modifications often involve simple changes in the child s environment Let s go through some examples of antecedent modifications that could be implemented for each function of behavior

Behavior maintained by attention NCR: Provide lots of attention to the child so that the child does not need to engage in problem behavior to get attention Catch the child being good and provide reinforcement Behavior maintained by access to tangible Use tangible reinforcers that are easy to give and remove during your session

Behavior maintained by escape Fade in demands, starting with one demand and a break followed by two demands and a break, etc. Use a higher ratio of preferred tasks to nonpreferred tasks during your session Behavior maintained by automatic reinforcement Noncontingent delivery of a reinforcer (NCR) that will compete with the problem behavior (e.g., toys)

A replacement behavior is a behavior you are trying to teach the child to engage in instead of the problem behavior Replacement behaviors will be acquired faster if they are easy to engage in Replacement behaviors will be maintained longer if they result in the reinforcer maintaining the problem behavior Let s go through some examples of replacement behaviors your supervisor might have you implement for each function of behavior

Behavior maintained by attention The child will engage in any other behavior than the target problem behavior (DRO) The child will tap the therapist s shoulder (FCT) The child will hold up an attention card (FCT) Behavior maintained by access to tangible The child will say, May I have a sucker, please? (FCT) The child will sign for an item or activity (FCT) The child will hand over a PEC for an item or activity (FCT)

Behavior maintained by escape The child will ask for a break using a break card (FCT) The child will comply with 1 demand, then 2 demands, then 3 demands (DRA + Demand Fading) Behavior maintained by automatic reinforcement The child will play with a toy (DRA)

Consequence manipulations may involve one or more of the following Extinguishing a problem behavior (Extinction) Reinforcing other (DRO), alternative (DRA), communicative (FCT), or incompatible (DRI) replacement behaviors Response Reduction Procedures (nonexclusionary time-out or response cost) Let s go through some examples of consequence manipulations that might be implemented for each function of behavior

Behavior maintained by attention Do not provide attention contingent upon problem behavior (extinction for target behavior) Provide attention contingent upon the absence of problem behavior on a time schedule (extinction for target behavior & reinforcement of other behavior) Provide attention when the child raises his/her hand (extinction for target behavior & reinforcement of other behavior) Remove a token contingent upon problem behavior (response cost procedure)

Behavior maintained by access to tangible Do not give the child access to tangibles contingent upon problem behavior (extinction) Provide a tangible reinforcer contingent upon saying, May I have the toy, please (extinction for target behavior and reinforcement for replacement behavior) Provide a tangible reinforcer contingent upon exchanging a PEC (extinction for target behavior and reinforcement for replacement behavior) Remove tangible or activity contingent upon problem behavior (response cost procedure)

Behavior maintained by escape Do not allow the child to escape from demands contingent upon problem behavior (escape extinction) Provide a break contingent upon the absence of problem behavior for a specified period of time (extinction for target behavior and reinforcement of other behavior) Provide a break contingent upon the complying with demands (extinction for target behavior and reinforcement of replacement behavior) Provide a break contingent upon handing over a break card (extinction for target behavior and reinforcement for replacement behavior)

Behavior maintained by automatic reinforcement Block the behavior from occurring (sensory extinction) Reinforce toy manipulation (reinforcement of replacement behavior) Remove a token each time the problem behavior occurs (response cost procedure)

Questions