Addressing the Problematic Behaviors of Individuals on the Autism Spectrum Dr. Cathy Pratt, BCBA-D Director, Indiana Resource Center for Autism Indiana Institute on Disability and Community Indiana University Phone: (812) 855-6508 Fax: (812) 855-9630 firstname.lastname@example.org www.iidc.indiana.edu/irca Individuals with problem behaviors are often excluded due to the presence of challenging behaviors. Behavioral Characteristics • • • • • • • • Anxiety Rituals/Compulsive Mannerisms Self-Stimulatory Behavior Refusal Withdrawal Self-Injury/Abuse Aggression Property Destruction “What do we do when…?” • 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 individual and context. Safety should be the first concern. 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 What it looks like 5 4 3 2 1 Hurting self Hurting others What student can do IT’S TOO LATE! YOU WILL RECEIVE A CONSEQUENCE Level 4 Bail Out Plan Throwing Running Hitting/Kicking Objects Screaming- volume too loud Yelling Wandering Going under a table/desk Not working Use a coping strategy Staff Response Difficulty working, but completes task Staring or grumpy Still at desk Ask for a fidget Ask for a friend Earn a reward Great mood Working Following directions Earn a reward Fill out Aggressive Student Report Report to administrator Give space Direct to yellow Bail-out Zone NO INTERACTION WITH STUDENT Observe to ensure safety Redirect with dry-erase board or reinforce Mind the Gap- choice making Observe to redirect Remind of expectations Provide visuals Give rewards When we get calls about behavior, part of the process is figuring out what the true issues are. Is this an issue about lack of resources, limited training/knowledge, classroom management, school culture, home conditions, or what is really happening. Functional Behavioral Assessment: • A process for determining the relationship between a person’s internal/external environment and the occurrence of problematic behavior. A Functional Behavior Assessment Is/Is Not: • A Form/A Single Instrument…Should Include Multiple Strategies, Forms • A One-Time Event…Should be Ongoing • A Record of Consequences • Documentation for Suspension/Expulsion • Simply to define behaviors and identify techniques for elimination • Not a Three Year Evaluation… process for gathering input from relevant parties. Who is Qualified to Guide a Functional Assessment Process? • Though IDEA regulations do not directly address this issue, Dunlap suggests the following general standards: Who is Qualified to Guide a Functional Assessment Process? (Dunlap) Ability to work within a collaborative, problem-solving context. Knowledge of principles and methods of behavior analysis. Familiarity with school environments and their many influences on the behavior of students and teachers. Experience in using a variety of social, curricular and instructional strategies to support change in students’ behavior. Step One: Identify Behavior Support Team Multidisciplinary Team • • • • • Learner’s teacher Related Service Personnel Paraprofessionals Learner’s Parents Learner with ASD • Should identify a FBA Coordinator Step Two: Identify Interfering Behaviors Operationally define and identify behaviors of concern. Remove all judgment. Child hits with open hand causing red mark. Child bites self on the arm breaking skin. Students says “no” Defining Target Behaviors: Poor Examples • • • • Tantrum Hyperactive Angry Poor Impulse Control • Being Aggressive • Frustrated • Distractible • Non-compliant How Do You Define the Target Behavior? • When Describing Behavior: – Be concrete: “What does it look like?” – Describe sequence of events – Describe actual movements If behavior occurs as part of a behavior chain, identify all behaviors. Why do we do this? Decide if behavior is truly a problem. Choose which behavior are truly problematic: Is the behavior dangerous to the learner or to others? Does the behavior interfere with learning? Does the behavior interfere with socialization or acceptance from peers? Is the behavior disruptive or intense on a frequent basis? Determine significance of behavior by looking at: • Frequency • Duration • Intensity • Overall Impact Step Three: Gather Information • Once behavior is determined, need to begin process of identifying antecedents and consequences. Antecedents • Antecedents are events that happen before the behavior. • There are two types of antecedents: – Slow Triggers (Setting Events) – Fast Triggers (Immediate Antecedents) Slow Triggers/Setting Events • May happen in or out of school/classroom context. • Conditions that increase the likelihood that behavior will occur. • • • • • • • • • • • • Anxiety/Biological Issues Schedule changes Staff changes Medications changed/missed Irregular sleep patterns Illness/Impending Illness Missed meals Excessive hot/cold temperatures Argument/fight with classmates/parents/teachers Difficulties on the Bus Skills Deficits Home Conditions Antecedents: “Fast Triggers” • Events that are directly related to the challenging behavior. • Events that immediately precede the behavior. • Circumstances or conditions that might trigger the behavior. • • • • • • • • • Antecedents/Fast Triggers Teasing/Bullied Assignment 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 Consequence • • • • • Follows a Behavior or Response Reinforcement Punishment What is the payoff? What maintains behavior? Various tools are available to assist in the functional behavior assessment process and in obtaining this information. The number and type of instruments used may differ according to the severity of the behavioral challenge. Professional or experiential judgment is often not enough. Hard to truly see what is happening when in the midst of a behavioral challenge. Indirect Assessment Methods Informal or structured interviews with multiple informants, including the individual. Rating Scales/Behavior Checklists Record Reviews Team Meetings Information Obtained from a Functional Assessment • 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 Functional Assessment • 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 Functional Assessment • In what settings does the behavior happen? • What aspects of the environment may be contributing to the behavior? Information Obtained from a Functional Assessment • 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? Information Obtained from a Functional Assessment • 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 Functional Assessment • 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 Functional Assessment • 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? At times, behaviors may reflect conditions at home. If this is the case, outside help from various agencies may be needed. Must Also Look At: • Classroom Structure – 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 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? Motivation Assessment Scale (MAS) • How will an individual respond to: – – – – Sensory Issues? Attention? Difficult tasks/activities? Being denied something? Motivation Assessment Scale Name: Rater: Mark SB Date: 9/10 Behavior Description: Leaves his seat, runs to peer and slaps him/her on the head. Setting Description: Small group language arts instruction. Motivation Assessment Scale Sensory Escape Attention Tangible 1. 5. 9. 13. 0 2. 6. 10. 14. 3. 7. 11. 15. 4. 8. 12. 16. Total Score = Mean Score = 0 15 0 3.75 0 0 0 4 3 5 3 2 4 3 2 0 0 0 0 11 0 2.75 0 Record Review • Medical Records • Individualized Education Program (IEP) • Previous Behavior Support Plans • Psychological Assessment • Previous Interventions • Anecdotal Records • Others Direct Methods for Gathering Information • • • • Frequency Recording Duration Scatterplot Setting Events Direct Observation • Conduct for multiple days and across time periods. • Conduct during a variety of activities and circumstances. • Conduct across multiple settings and support providers. • Use multiple trained observers. • Conduct until a consistent trend and patterns begin to emerge and until and an obvious plan begins to materialize. ABC Recording Form A B C What happened just prior to Behavior? Describe the situation. What did the person do? What did it look like? What was the reaction of staff or others? What happened to the activity or task? ABC Antecedent Teacher asks Matthew to stop pushing classmates. Teacher asks Matthew to stop pushing on the classmates. Behavior Matthew continues. Teacher asks Matthew to stop pushing classmates…but this time louder. Teacher threatens Matthew with losing recess in the future. Matthew ignores and continues. Teacher screams louder and tells Matthew to stop immediately, Matthew ignores. The bell rings signaling it is time to go in. The teacher directs all to go into the building. Matthew goes into the building. Matthew ignores teacher requests. Matthew ignores. Consequence Teacher again asks Matthew to stop pushing classmates. Teacher asks Matthew to stop pushing classmates…but this time louder. Teacher threatens Matthew with losing recess in the future. Teacher screams louder and tells Matthew to stop immediately. The bell rings signaling it is time to go in. The teacher directs all to go into the building. The teacher does not mention the behavior to Matthew. Scatter Plot Student: Date: Mike 1/10-14, 1/17-21 Cursing, staring at peers and making loud noises Respondent: 7th Grade Teachers Behavior: Key: = 1X = 2-5 X = >5X Scatter Plot Activity Day 1 Day 2 Day 3 Day 4 Day 5 P.E. Lunch Math English Industrial Arts Science Study Computer Use simple, clearly defined setting events information and correlate with behavior data. Setting Event Checklist 9/16 9/17 9/18 9/19 Slept less than 6 hours No breakfast Physical fight with siblings Use simple, clearly defined setting events data and correlate with behavior data. Corresponding Behavior Data Physical Aggression 4.5 4 3.5 3 2.5 2 1.5 1 0.5 0 9/16 9/17 9/18 9/19 Recommendations for Improving Practice • FBA should be conducted whenever an individual has a reputation of difficult behavior. • Start early in the school year if a student has a previous history of challenging behaviors - avoid at all costs having to start the process under time constraints or in the midst of crisis. Recommendations for Improving Practice • Develop procedures and formats which are understandable and usable by people. Focus on outcomes of process, rather than type of form. • Understand that initial efforts at FBA may yield modest and/or confusing results. • Focus initial efforts on obtaining clarity in defining the problem across all settings, people and activities. • Again, recognize the idiosyncratic nature of autism! “…functional assessment has been accomplished when: • You can operationally describe the problem behavior. • You can identify the setting events and more immediate antecedents that predict when the behaviors will occur and not occur. • You have developed reasonable hypotheses about the contingencies maintaining the behaviors. • Your predictions and hypotheses are based, in part, on systematic direct observation. (Horner, O’Neil, & Flannery, 1993) Step 4: Develop Hypothesis Statement • An informed guess about the relationship between events or conditions and the individual’s problematic behavior(s). Informed means that objective information has been gathered. Hypothesis Statement (Problem Behavior Pathway) Setting Events Triggering Antecedents Problem Behavior Lack of opportunities to interact with peers Sees peers playing with toys Grabs toy, hits peers with toy if they resist Maintaining Consequence Gets to play with toy. Brief interaction with peers. Teacher attention. Hypothesis Statement (Problem Behavior Pathway) Setting Events Triggering Antecedents Anxiety Lack of Social Skills Pragmatic Communication Difficulties Sees classmate violating “rules” Problem Behavior Has a meltdown in hallway by screaming at classmate and pushing other students Maintaining Consequence Release of frustration. Gets staff attention. Gets student to stop for the moment. Hypothesis Statement (Problem Behavior Pathway) Setting Events Communication: No System in Place Lack of Choices or Ability to Recognize Choices Medication Constipation Extreme Sensory Challenges Changes in Life: Sister Left Limited Social Skills and Interactions Lacks Self-Regulation Autism ANXIETY Lack of Structure: Structure on Own Terms Potential Allergies Lack of Sleep Picky Eater Triggering Antecedents Transitions Sitting Too Long Waiting Problem Behavior Hits Kicks Head Butts Drops to Floor Continual Movement Tears Items Maintaining Consequence Sensory Access to something he wants. Left alone to do what he wants. Hypothesis Statement (Problem Behavior Pathway) Setting Events Autism/Anxiety Seizures Medications Allergies Communication Limitations Sensory Challenges Lack Self-Regulation and Self-Management Poor Social Skills Triggering Antecedents 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. Problem Behavior Pinching Yelling Screaming Elopement Refusal Kicking Hitting Maintaining Consequence Ends an Activity Gains Access to Desired Event/Activity Attention Sensory Hypothesis Statement (Problem Behavior Pathway) Setting Events Triggering Antecedents Strengths/Skills: Problem Behavior Maintaining Consequence • 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. This should be the focus of the behavior support plan. Teaching Alternative Behaviors • Specific alternative or replacement behaviors that must be made as efficient and effective as the problem behavior(s). Alternative Skills • • • • • • • Problem-Solving Skills Choice-Making Ability Anger Control Relaxation Training Self-Management/Control Communication Social Skills Create Support Plan Behavior support plans should logically evolve from hypotheses you develop through the functional behavioral assessment process. Comprehensive Plan • ALL behaviors are addressed • Implemented across all relevant settings and times of day…as much as possible. • Blends multiple procedures • Driven by a functional assessment • Must fit context (values, skills, resources, embedded within typical routines). Behavioral Support Plans • Defined: A clearly written document that defines how an environment will be altered in an effort to change a specific pattern of behavior for an individual and alternative behavior(s) the individual will be taught. • Behavior support plans should be developed in the context of the overall educational program. • Should address long term change and supports. Long Term Prevention • Permanent supports to maintain desired behaviors and reduce recurrence of problem behaviors • Lifestyle improvements to improve quality of life, including: – Health and well-being; – Increased participation in school and community; – Access to more choice and more control; and – Increased and strengthened friendships and connections. • Increase opportunities to acquire sense of belonging within school and community. Examples of Long Term Strategies • Establish Acceptable Mode of Communication • Teach Self-Monitoring/SelfManagement • Expand and Build Upon Natural Supports/Circles of Friends • Conduct Person Centered Planning Process/Future’s Planning Long Term Prevention • May need to identify family supports in your community, and the type of services and supports specific families need. Implement Intervention Considerations for Evaluating a Behavior Support Plan (Horner) • Are the strategies in the plan: – – – – Socially acceptable; Likely to be effective; and Doable within the local context? Does the plan include procedures for monitoring and improving the program? Monitor Implementation and Outcomes Behavior Support Plans • General evaluation strategies to measure: – Reductions in problem behaviors; – Increases in alternative/prosocial behaviors; – Meaningfulness of outcomes; and – Teacher, parent and even student satisfaction. Guidelines for Adopting Positive Behavior Support Approach • Do not wait until things get out of control; be proactive. • Make sure that the team has reached consensus concerning the course of action and that there is a mechanism for ongoing communication and monitoring of progress. • Involve multiple components when designing your behavior support plan. Recommendations for Improving Practice • Need to implement a process for ensuring the transition of information across environments and grades. • Need to determine mechanism for conducting functional behavior assessment, for designing positive behavior support plan, and for maintaining ongoing monitoring of plan. • Need to address staff/family support. Behavior Support Plans • Person is not only focus of change. How will others change their behavior? • Has to evolve from information gathered. – Goal is to make problem behaviors irrelevant, inefficient and ineffective. • Has to be a good contextual fix. • Has to be implemented systematically. Changing behavior requires honesty, a willingness to change, relationship building, and calm perseverance.