Understanding and Managing Problem Behavior

1. Understanding and Managing Problem Behavior Presented by: Lynsey Jackson, BCABA Melissa Liotti, BCaBA University of Houston Clearlake Applied Behavior Analysis Program

2. Presentation Overview Common problem behaviors and their effects The role of the environment Common “functions” of problem behavior Methods for determining which function the child’s problem behavior is serving Strategies based on the results of your assessment Recognizing some common maladaptive strategies that MAY be maintaining the problem behavior Some adaptive strategies that can help reduce problem behavior

3. Problem Behavior • Some common types: • Aggression, self-injury, property destruction, disruption, elopement, stereotypy, etc… • Some effects: • Risk of physical harm, lack of social development leads to isolation, skill acquisition deficits, independent skill deficits (long term care), family stress • So why does problem behavior occur? Why do they do it?

4. Why Do They Do It? • Problem behavior is probably the easiest way for children who lack speech to communicate • Problem behavior is usually a learned behavior that serves a purpose for the child (it gets them what they want) • Behavior is related to specific antecedents (what happens before the behavior) and consequences (what happens after the behavior) in the environment. • Understanding a child’s behavior = determining what the "function” or “reinforcer” for the behavior is

5. Why Do They Do It? • The relevant antecedents or consequences often involve the behavior of others (e.g., reactions to the problem behavior).

7. Understanding Behavior Antecedent BehaviorConsequence • Antecedents: • Occur immediately before a behavior • Potential “triggers” for problem behavior • Can affect the frequency and intensity of behavior • Examples: • Difficult or ‘excessive’ tasks • Denial of desired items or activities

8. Understanding Behavior Antecedent BehaviorConsequence • Consequences: • Occur immediately after a behavior • What the behavior “gets them”- reaction, items, etc. • Affect the likelihood of the behavior occurring again in the future • Examples: • Attention in the form of stern looks or reprimands • Removal of difficult tasks

9. Main Functions of Problem Behavior • Attention! • Children are quick to learn that engaging in problem behavior can get them lots of attention! • Remember- any form of attention can be desirable to the child- even stern looks, reprimands, and restraint! • “There’s no such thing as bad press.”

12. Main Functions of Problem Behavior • Access things they like! • Problem behavior can get them things they want • Problem behavior can get them things that have been restricted or denied (“5 more minutes!”)

15. Main Functions of Problem Behavior • Escape or avoid things they don’t like • Children are quick to realize that misbehavior will result in getting them out of things they don’t like • This may happen when a child is placed at a desk with work, asked to help with chores, is told it’s time for a bath or bed, or is in the presence of aversive events (loud environments, close proximity to others, etc.)

18. Main Functions of Problem Behavior • Sensory stimulation • Most difficult behavior to treat • The consequences are not provided by anyoneelse (child engages in the behavior when alone) • Access to pleasurable stimulation (e.g. rocking)

20. So How Do I Determine the Function? • Indirect Assessments • No direct observation • Ask people about the behavior • Easy and fast but potentially inaccurate/biased • Descriptive Assessments • Direct observation over several sessions/days • Tracks behavior as it naturally occurs • Tracks the relevant antecedents and consequences for each instance of problem behavior

21. Descriptive Assessments • Help us.. • gather information/data through direct observation • evaluate and interpret the data, look for patterns/commonalities • develop a behavior intervention plan (BIP) • Some common descriptive assessments: • Narrative ABC Recording • Structured ABC Recording

22. Narrative ABC Recording

23. Structured ABC Recording Hit others    Throwing     2   2    1            3        2          1            

24. Look for a pattern Common antecedents? Common consequences? Determine the possible function May not always be the same across behaviors and situations Now What? Interpreting the Results

25. Mom gets off phone - scolds Dan Mom on phone (low attn) Access attention Dan hits sister Teacher tells Nicole to put her dish in the sink (demand) Nicole yells and throws herself on the floor Teacher takes the plates to the sink instead Escape Teacher says computer time is all done Dan bites himself on the hand Teacher says “Ok! 2 more minutes!” Access items

26. Tom Beth 03/03/10 Hit others   Throwing         

27. SO ONCE YOU SUSPECT A FUNCTION, HOW DO YOU TREAT IT?

28. Managing Problem Behavior Decrease Attention Tangible Escape Problem Behavior Increase Attention Tangible Escape Appropriate Behavior

29. Strategies for Attention-Maintained Problem Behavior • Behavior occurs to get attention • Catch your child being good • Use Planned Ignoring • Teach Your Child A Better Behavior 29

30. Strategies for Attention-Maintained Behavior Catch Your Child or Student Being Good Give attention often (for example, every 5 minutes). Give attention as soon as you see any good behavior. Give enthusiastic attention. Don’t give attention if problem behavior just occurred.

31. Strategies for Attention-Maintained Behavior Planned Ignoring Ignore only behaviors that are not harmful. Ignore behavior immediately. Make ignoring obvious. If giving attention, immediately remove it. Still catch your child being good!

32. Strategies for Attention-Maintained Behavior Teach Better Behavior Identify the specific behavior you want to teach Practice with your child or student

33. Teaching the Better Behavior - Attention Set up for Practice Wait 5 Seconds yes No Provide Attention Model or Physically Guide to do Response Child does behavior with assistance Provide Attention

34. Teaching the Better Behavior - Attention Get on the phone Wait 5 Seconds Did not tap you on the shoulder Tapped you on The shoulder Take child’s hand and show him or her how to tap your shoulder Provide Attention Provide Attention

35. Strategies for Tangible-Maintained Problem Behavior • Behavior occurs to access preferred items/activities • Do not give preferred items when problem behavior occurs • Teach your child a better behavior 35

36. Strategies for Tangible-Maintained Problem Behavior Teach a Better Behavior Place car for your child to see Wait 5 Seconds Does not say anything Says approximation to car Direct your child to “Say Car” Give car and praise Child says “car” Give car and praise

37. Strategies for Escape/Avoidance-Maintained Problem Behavior • Behavior occurs to avoid or get out of disliked activities or instructions • Use Effective Instructions • Use Three-step Prompting • Reinforce Instruction-Following • Teach a Better Behavior • Additional Strategies to Prevent Problem Behavior 37

38. Strategies for Escape/Avoidance-Maintained Problem Behavior Use Effective Instructions Instructions should be: Simple Clear and Specific Short Presented when your child is paying attention

39. Strategies for Escape/Avoidance-Maintained Problem Behavior 3-Step Prompt Sequence (To be used when your child is not following a direction) TELL your child what to do: Give clear instruction Wait 5 seconds SHOW your child what to do: Model the exact response OR provide gestures that indicate what you want (e.g. point to object) Restore environment Tell your child, “now you do it.” HELP your child do it: Take your child hand-over-hand through entire response and say, “you need to _______.”

40. Strategies for Escape/Avoidance-Maintained Problem Behavior Reinforce Instruction-Following Follows instructions = lots of reinforcement! Reinforcers could be one or more of the following: Break from task Social: praise, hugs, tickles, high-5 Material: toy, edible, favorite activity

41. Strategies for Escape/Avoidance-Maintained Problem Behavior Teach a Better Behavior Say, “Clean up the blocks”” After 5 seconds of following instruction Did not give you “break” card Child gives you “break” card Take child’s hand and physically guide them to hand you card Provide a break Provide break

42. Strategies for Escape/Avoidance Maintained Problem Behavior (cont’d) Additional Strategies to Prevent Problem Behavior • Provide choices or more preferred activities when possible • Make the situation/event less aversive by manipulating • Task length/difficulty • Novelty of tasks • Noise • Crowding • Schedule 42

43. Strategies for Problem Behavior Maintained by Sensory Stimulation Arrange an “Enriched Environment” Identify highly preferred activities and objects Rotate/activities often and encourage engagement

44. Managing Behaviors is the Hard Part, Right? • Sorry! • The really tough part: • Doing the procedures correctly • Follow your plan exactly • Doing the procedures consistently • Don’t make exceptions, use the plan every time 44

45. Barriers to Implementing Procedures Sometimes behavior will get worse before it gets better! Some settings not conducive for running the program Plan ahead to prevent problems More effortful to do procedure than to give in Adult behavior is just as sensitive to reinforcement as child behavior…the vicious cycle!

46. Break the Cycle! Determine why Antecedents - Behavior - Consequence Decrease Attention Tangible Escape Problem Behavior Increase Attention Tangible Escape Appropriate Behavior