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Autism Spectrum Disorders

IntégréTéléchargement
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
prattc@indiana.edu
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.
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