Addressing the Problematic Behaviors of Individuals on the Autism Spectrum

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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 [phone]
• Fax [phone]
• prattc_at_indiana.edu
• www.iidc.indiana.edu/irca

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Individuals with problem behaviors are often
excluded due to the presence of challenging
behaviors.
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Behavioral Characteristics

• Anxiety
• Rituals/Compulsive Mannerisms
• Self-Stimulatory Behavior
• Refusal
• Withdrawal
• Self-Injury/Abuse
• Aggression
• Property Destruction

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What do we do when?
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• 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.

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Safety should be the first concern.
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De-Escalation Plan

• All must be safe
• Must have a written plan
• Short-term solution
• Minimize your verbal comments

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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 behaviorbeware
• Avoid power struggles

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Individual 5 point scales
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What it looks like What student can do Staff Response
5 Hurting self Hurting others ITS TOO LATE! YOU WILL RECEIVE A CONSEQUENCE Fill out Aggressive Student Report Report to administrator
4 Throwing Running Hitting/Kicking Objects Screaming- volume too loud Level 4 Bail Out Plan Give space Direct to yellow Bail-out Zone NO INTERACTION WITH STUDENT Observe to ensure safety
3 Yelling Wandering Going under a table/desk Not working Use a coping strategy Redirect with dry-erase board or reinforce Mind the Gap- choice making
2 Difficulty working, but completes task Staring or grumpy Still at desk Ask for a fidget Ask for a friend Earn a reward Observe to redirect Remind of expectations Provide visuals
1 Great mood Working Following directions Earn a reward Give rewards
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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.
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Functional Behavioral Assessment

• A process for determining the relationship
  between a persons internal/external environment
  and the occurrence of problematic behavior.

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A Functional Behavior Assessment Is/Is Not

• A Form/A Single InstrumentShould Include
  Multiple Strategies, Forms
• A One-Time EventShould 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.

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Who is Qualified to Guide a Functional
Assessment Process?

• Though IDEA regulations do not directly address
  this issue, Dunlap suggests the following general
  standards

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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.

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Step One Identify Behavior Support Team
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Multidisciplinary Team

• Learners teacher
• Related Service Personnel
• Paraprofessionals
• Learners Parents
• Learner with ASD
• Should identify a FBA Coordinator

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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

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Defining Target Behaviors Poor Examples

• Tantrum
• Hyperactive
• Angry
• Poor Impulse Control

• Being Aggressive
• Frustrated
• Distractible
• Non-compliant

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How Do You Define the Target Behavior?

• When Describing Behavior
• Be concrete What does it look like?
• Describe sequence of events
• Describe actual movements

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If behavior occurs as part of a behavior chain,
identify all behaviors. Why do we do this?
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Decide if behavior is truly a problem.
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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?

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Determine significance of behavior by looking at

• Frequency
• Duration
• Intensity
• Overall Impact

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Step Three Gather Information

• Once behavior is determined, need to begin
  process of identifying antecedents and
  consequences.

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Antecedents

• Antecedents are events that happen before the
  behavior.
• There are two types of antecedents
• Slow Triggers (Setting Events)
• Fast Triggers (Immediate Antecedents)

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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

Examples
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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.

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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

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Consequence

• Follows a Behavior or Response
• Reinforcement
• Punishment
• What is the payoff?
• What maintains behavior?

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Various tools are available to assist in the
functional behavior assessment process and in
obtaining this information.
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The number and type of instruments used may
differ according to the severity of the
behavioral challenge.
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Professional or experiential judgment is often
not enough. Hard to truly see what is happening
when in the midst of a behavioral challenge.
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Indirect Assessment Methods

• Informal or structured interviews with multiple
  informants, including the individual.
• Rating Scales/Behavior Checklists
• Record Reviews
• Team Meetings

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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?

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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?

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Information Obtained from a Functional Assessment

• In what settings does the behavior happen?
• What aspects of the environment may be
  contributing to the behavior?

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Information Obtained from a Functional Assessment

• According to the individuals 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?

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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?

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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 individuals primary means of
  communication?

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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 persons nutritional
  needs being met?

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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 persons
  life like outside of school/work?
• Are there conditions inside the home which may be
  troubling the individual?

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At times, behaviors may reflect conditions at
home. If this is the case, outside help from
various agencies may be needed.
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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?

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Must Look At

• Behaviors of Others in the Classroom
• Are there other students who are also engaging in
  problematic behaviors?

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Must Look At

• Staff Behavior/Instructional Approaches Used,
  Including
• Instructional/Proximity Control
• Rapport Building
• Positives Outweigh Negatives
• Direct Instruction
• Reinforcement

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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?

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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?

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Motivation Assessment Scale (MAS)

• How will an individual respond to
• Sensory Issues?
• Attention?
• Difficult tasks/activities?
• Being denied something?

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Motivation Assessment Scale
Mark
SB
9/10
Leaves his seat, runs to peer and slaps him/her
on the head.
Small group language arts instruction.
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Motivation Assessment Scale
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Record Review

• Medical Records
• Individualized Education Program (IEP)
• Previous Behavior Support Plans
• Psychological Assessment
• Previous Interventions
• Anecdotal Records
• Others

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Direct Methods for Gathering Information

• Frequency Recording
• Duration
• Scatterplot
• Setting Events

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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.

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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?



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ABC
Antecedent Behavior Consequence
Teacher asks Matthew to stop pushing classmates. Matthew continues. Teacher again asks Matthew to stop pushing classmates.
Teacher asks Matthew to stop pushing on the classmates. Matthew ignores teacher requests. Teacher asks Matthew to stop pushing classmatesbut this time louder.
Teacher asks Matthew to stop pushing classmatesbut this time louder. Matthew ignores and continues. Teacher threatens Matthew with losing recess in the future.
Teacher threatens Matthew with losing recess in the future. Matthew ignores. Teacher screams louder and tells Matthew to stop immediately.
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.
The bell rings signaling it is time to go in. The teacher directs all to go into the building. Matthew goes into the building. The teacher does not mention the behavior to Matthew.
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Scatter Plot
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Scatter Plot
? ? ? ? ? ? ? ? ? ? ? ?
?
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Use simple, clearly defined setting events
information and correlate with behavior data.
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Use simple, clearly defined setting events data
and correlate with behavior data.
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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.

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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!

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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, ONeil, Flannery, 1993)
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Step 4 Develop Hypothesis Statement

• An informed guess about the relationship between
  events or conditions and the individuals
  problematic behavior(s). Informed means that
  objective information has been gathered.

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Hypothesis Statement(Problem Behavior Pathway)
Lack of opportunities to interact with peers
Sees peers playing with toys
Grabs toy, hits peers with toy if they resist
Gets to play with toy. Brief interaction with
peers. Teacher attention.
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Hypothesis Statement(Problem Behavior Pathway)
Release of frustration. Gets staff
attention. Gets student to stop for the moment.
Anxiety Lack of Social Skills Pragmatic
Communi-cation Difficulties
Has a meltdown in hallway by screaming at
classmate and pushing other students
Sees classmate violating rules
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Hypothesis Statement(Problem Behavior Pathway)
Sensory Access to something he wants. Left alone
to do what he wants.
Communication No System in Place Lack of Choices
or Ability to Recognize Choices Medication Constip
ation 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
Transitions Sitting Too Long Waiting
Hits Kicks Head Butts Drops to Floor Continual
Movement Tears Items
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Hypothesis Statement(Problem Behavior Pathway)
Ends an Activity Gains Access to Desired
Event/Activity Attention Sensory
Autism/Anxiety Seizures Medications Allergies Comm
unication Limitations Sensory Challenges Lack
Self-Regulation and Self-Management Poor Social
Skills
Certain Demands Too Much Talking Transitions
Leaving School Bus Changes in Routines Certain
academic worktoo much paperwork and being read
to or lectured to.
Pinching Yelling Screaming Elopement Refusal Kic
king Hitting
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Hypothesis Statement (Problem Behavior Pathway)
Setting Triggering
Problem Maintaining Events
Antecedents Behavior
Consequence

Strengths/Skills
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• 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.

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Teaching Alternative Behaviors

• Specific alternative or replacement behaviors
  that must be made as efficient and effective as
  the problem behavior(s).

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Alternative Skills

• Problem-Solving Skills
• Choice-Making Ability
• Anger Control
• Relaxation Training
• Self-Management/Control
• Communication
• Social Skills

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Create Support Plan Behavior support plans
should logically evolve from hypotheses you
develop through the functional behavioral
assessment process.
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Comprehensive Plan

• ALL behaviors are addressed
• Implemented across all relevant settings and
  times of dayas much as possible.
• Blends multiple procedures
• Driven by a functional assessment
• Must fit context (values, skills, resources,
  embedded within typical routines).

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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.

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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.

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Examples of Long Term Strategies

• Establish Acceptable Mode of Communication
• Teach Self-Monitoring/Self-Management
• Expand and Build Upon Natural Supports/Circles of
  Friends
• Conduct Person Centered Planning Process/Futures
  Planning

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Long Term Prevention

• May need to identify family supports in your
  community, and the type of services and supports
  specific families need.

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Implement Intervention
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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?

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Monitor Implementation and Outcomes
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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.

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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.

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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.

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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.

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Changing behavior requires honesty, a willingness
to change, relationship building, and calm
perseverance.