Behavior Management of Behavior Management of Children with Severe Children with Severe

DisabilitiesDisabilities

Martin E. Block, Ph.D.Martin E. Block, Ph.D.

Curry School of EducationCurry School of Education

University of VirginiaUniversity of Virginia

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OutlineOutline

Review Types of Behavior ProblemsReview Types of Behavior Problems

Review Two Major Approaches to Review Two Major Approaches to TreatmentTreatment

Review Terminology Review Terminology

Outline Format to Develop Behavior PlanOutline Format to Develop Behavior Plan

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Types of Behavior Types of Behavior ProblemsProblems

Stereotypic BehaviorStereotypic Behavior

Self-Injurious BehaviorSelf-Injurious Behavior

AggressionAggression

Non-compliant/Disruptive BehaviorNon-compliant/Disruptive Behavior

Inappropriate Social BehaviorInappropriate Social Behavior

Disorders of Physical RegulationDisorders of Physical Regulation

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Stereotypic/Self-Stereotypic/Self-Stimulatory BehaviorsStimulatory Behaviors

Repetitive cycles of behavior that Repetitive cycles of behavior that persist for long periods of time.persist for long periods of time.• Body rockingBody rocking• finger flickingfinger flicking• hand flappinghand flapping• tapping objectstapping objects

Cause - may stimulate/entertain childCause - may stimulate/entertain child Problem - interferes with learning; Problem - interferes with learning;

prevents community placementprevents community placement

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Self-Injurious BehaviorSelf-Injurious Behavior

Response that inflicts direct harm on the Response that inflicts direct harm on the individual.individual.

Cause - unknown. May have higher Cause - unknown. May have higher levels of pain tolerance, gets attention, levels of pain tolerance, gets attention, organic (e.g., Lesch-Nyhan), may organic (e.g., Lesch-Nyhan), may somehow act as a natural opiate through somehow act as a natural opiate through production of endorphins in the CNS.production of endorphins in the CNS.

Problem - physical harm, inappropriate Problem - physical harm, inappropriate behaviors prevent community living.behaviors prevent community living.

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AggressionAggression

A behavior that represents a danger to the A behavior that represents a danger to the client or others. Generally means act of client or others. Generally means act of physical violence against others.physical violence against others.

Cause - Cause - fearfear (escape fearful situation), (escape fearful situation), angeranger (frustration or anger), (frustration or anger), manipulation of othersmanipulation of others (get them to do what you want or escape (get them to do what you want or escape demands of situation)demands of situation)

Angry aggression often occurs as part of Angry aggression often occurs as part of tantrum - crying screaming, thrashing out, tantrum - crying screaming, thrashing out, attacking others, damaging propertyattacking others, damaging property

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Non-compliant/Disruptive Non-compliant/Disruptive BehaviorBehavior

Refusing reasonable requests, running off Refusing reasonable requests, running off instead of coming when called, becoming instead of coming when called, becoming limp and dropping to the floor, resisting limp and dropping to the floor, resisting transitions, not performing chores or transitions, not performing chores or duties.duties.

Cause - attempt to control others/situation, Cause - attempt to control others/situation, attempt to exert independence and some attempt to exert independence and some control over one’s activitiescontrol over one’s activities

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Inappropriate Social Inappropriate Social BehaviorBehavior

Failure to have learned more Failure to have learned more appropriate social skills and rules - appropriate social skills and rules - stripping, showing affection to strangers, stripping, showing affection to strangers, stealing or hoarding, lying, masturbating stealing or hoarding, lying, masturbating in public, swearing/shouting.in public, swearing/shouting.

Cause - no inhibition, not aware of how Cause - no inhibition, not aware of how others view them, not knowing social others view them, not knowing social rulesrules

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Disorders of Physical Disorders of Physical RegulationRegulation

Limited physical control due to failure to Limited physical control due to failure to acquire (or loss of) self-regulation over acquire (or loss of) self-regulation over bodily functions - copresis, enuresis, bodily functions - copresis, enuresis, drooling, and tongue thrustdrooling, and tongue thrust

cause - physical problems coupled with cause - physical problems coupled with failure to try and teach self-regulationfailure to try and teach self-regulation

treatment might include adaptations treatment might include adaptations (e.g., diaper, bib) and teaching tolerance(e.g., diaper, bib) and teaching tolerance

Types of InterventionTypes of Intervention

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Elimination ApproachElimination Approach

Views behavior problems as Views behavior problems as maladaptive or interfering actions that maladaptive or interfering actions that make it impossible or difficult for make it impossible or difficult for children to learnchildren to learn

Goal is to eliminate these behaviors - Goal is to eliminate these behaviors - undesirable behaviors must be undesirable behaviors must be eliminated before new, adaptive eliminated before new, adaptive behaviors can be taughtbehaviors can be taught

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Elimination Approach Elimination Approach (Cont.)(Cont.)

Negative behaviors are regarded Negative behaviors are regarded as high priority intervention goals as high priority intervention goals because they are viewed as because they are viewed as interfering with learning.interfering with learning.

Entire IEP’s are often devoted to Entire IEP’s are often devoted to decelerating or stopping behaviors decelerating or stopping behaviors rather than teaching new skillsrather than teaching new skills

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Elimination Approach Elimination Approach (Cont.)(Cont.)

Some behaviors are perceived as Some behaviors are perceived as being so disruptive that special staff is being so disruptive that special staff is called into to deal with the child.called into to deal with the child.

Some children are viewed as needing Some children are viewed as needing to be put into a special class or school to be put into a special class or school for children with similar behaviors in for children with similar behaviors in order to carry out an elimination order to carry out an elimination program.program.

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Problems with Elimination Problems with Elimination ModelModel

Does it really work?Does it really work? Might something else have worked Might something else have worked

better?better? Is it wise to postpone teaching other Is it wise to postpone teaching other

skills?skills? These programs often involve aversivesThese programs often involve aversives Programs often involve homogeneous Programs often involve homogeneous

groupingsgroupings

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Educative ApproachEducative Approach

Major purpose is to encourage adaptive Major purpose is to encourage adaptive behavior and promote maximum behavior and promote maximum participation of individual in participation of individual in meaningful, daily activities.meaningful, daily activities.

Instruction is not delayed until Instruction is not delayed until behaviors are under control. At best behaviors are under control. At best deceleration programs are deceleration programs are supplemental to active treatementsupplemental to active treatement

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Educative Approach Educative Approach (cont.)(cont.)

Not all behavior problems are equal Not all behavior problems are equal priority targets for behavior change.priority targets for behavior change.

Most effective strategy to reduce Most effective strategy to reduce behaviors might be to replace it with a behaviors might be to replace it with a skill that accomplishes the same function.skill that accomplishes the same function.

Deceleration programs do not use Deceleration programs do not use aversivesaversives

Lifestyle PerspectiveLifestyle Perspective

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Compare Our Lifestyle Compare Our Lifestyle with a Person with a with a Person with a DisabilityDisability

Choices/ControlChoices/Control PeoplePeople ThingsThings ActivitiesActivities Community ExperiencesCommunity Experiences

Prioritizing Targeted Prioritizing Targeted BehaviorsBehaviors

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Prioritizing BehaviorsPrioritizing Behaviors

Level I:Level I: Urgent behaviors requiring Urgent behaviors requiring immediate attentionimmediate attention

Level II:Level II: Serious behaviors requiring Serious behaviors requiring formal considerationformal consideration

Level III:Level III: Excess behaviors reflecting Excess behaviors reflecting normal deviancenormal deviance

Review of TerminologyReview of Terminology

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A - B - C AnalysisA - B - C Analysis

AntecedentAntecedent (stimulus) - an event (stimulus) - an event occurring prior to a behavior which in occurring prior to a behavior which in some way influences that behaviorsome way influences that behavior

BehaviorBehavior (response)- any observable (response)- any observable or measurable act by an individualor measurable act by an individual

ConsequenceConsequence - an event that occurs - an event that occurs after a behavior has been exhibited after a behavior has been exhibited and in some ways is influenced by or and in some ways is influenced by or related to the behavior.related to the behavior.

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ReinforcementReinforcement

Applying a technique that results in an Applying a technique that results in an increase in a targeted behavior.increase in a targeted behavior.

• Positive reinforcementPositive reinforcement - present something - present something positive that increases targeted behavior.positive that increases targeted behavior.

• Negative reinforcementNegative reinforcement - take away - take away something aversive that increases something aversive that increases targeted behaviortargeted behavior

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Types of ReinforcersTypes of Reinforcers

PrimaryPrimary - unconditioned reinforcer, one that - unconditioned reinforcer, one that does not have to be learned to be effective does not have to be learned to be effective (food, water, and other necessities of life)(food, water, and other necessities of life)

SecondarySecondary - a conditioned reinforcer, one - a conditioned reinforcer, one that is learnedthat is learned • activity/sensoryactivity/sensory - a reinforcer that involves - a reinforcer that involves

participation in an event or sensationparticipation in an event or sensation• TokenToken - receiving an item that can be exchanged - receiving an item that can be exchanged• SocialSocial - a reinforcer that involves interaction - a reinforcer that involves interaction

between two or more persons.between two or more persons.

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Other Types of ReinforcersOther Types of Reinforcers

ALT-RALT-R (strengthen incompatible behaviors) (strengthen incompatible behaviors)

DRLDRL (reinforce lower amounts of behaviors) (reinforce lower amounts of behaviors)

DRODRO (reinforce other behaviors) (reinforce other behaviors)

DRTDRT-O (reinforce others in general area)-O (reinforce others in general area)

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Reinforcement SchedulesReinforcement Schedules

ContinuousContinuous - everytime child exhibits - everytime child exhibits targeted behavior (best initially for targeted behavior (best initially for establishing a behavior)establishing a behavior)

IntermittentIntermittent - reinforce sometimes - reinforce sometimes• fixed - same number every time (every fixed - same number every time (every

3rd try)3rd try)• variable - average number (between 3rd variable - average number (between 3rd

and 5th try)and 5th try)

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PunishmentPunishment

Presentation of an aversive event Presentation of an aversive event or consequence that leads to a or consequence that leads to a decrease in targeted behavior.decrease in targeted behavior.

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Other Key termsOther Key terms

CueCue - a signal, sign, request, or information - a signal, sign, request, or information that calls for the occurence of a behavior.that calls for the occurence of a behavior.

Response costResponse cost - removal of a specific - removal of a specific quantity of reinforcement.quantity of reinforcement.

Time-outTime-out - removal from a reinforcing - removal from a reinforcing situationsituation

ExtinctionExtinction - a reinforcer that previously - a reinforcer that previously sustained a behavior is withheld for the sustained a behavior is withheld for the purpose of eliminating that behaviorpurpose of eliminating that behavior

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Other key terms Other key terms (continued)(continued)

Over-correctionOver-correction - making individual do - making individual do restitution for what he/she has done restitution for what he/she has done plus extra workplus extra work

DesistsDesists - verbal reprimands - verbal reprimands

SatiationSatiation - providing a reinforcer for so - providing a reinforcer for so long or so often thatlong or so often that it has lost its it has lost its effectivenesseffectiveness

Creating the Behavior PlanCreating the Behavior Plan

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Creating the Behavior PlanCreating the Behavior Plan

Define Behavior in Observable, Define Behavior in Observable, measurable terms.measurable terms.

Observe the BehaviorObserve the Behaviorwhen does it occurwhen does it occurwhere does it occurwhere does it occurwhy do you think it occuredwhy do you think it occured

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Creating the Plan Creating the Plan (Continued)(Continued)

Explore the ConsequencesExplore the Consequenceswhat happened when the behavior what happened when the behavior

occurredoccurredwhen did these consequences take when did these consequences take

placeplacehow did the student respond to these how did the student respond to these

consequencesconsequences

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Creating the Plan Creating the Plan (Continued)(Continued)

Consider AlternativesConsider Alternativesmoving studentmoving studentregrouping classregrouping classrearranging environmentrearranging environmentchanging time of activitychanging time of activitychanging class formatchanging class formatother possible ideasother possible ideas

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Creating the Plan Creating the Plan (Continued)(Continued)

Clearly State the Desired GoalClearly State the Desired Goal Outline Procedure for Outline Procedure for

Preventing/Reducing BehaviorPreventing/Reducing BehaviorDescribes cues you will useDescribes cues you will usedescribe reinforcers you will usedescribe reinforcers you will usedescribe how you will present reinforcersdescribe how you will present reinforcersdescribe what you will do if behavior describe what you will do if behavior

occursoccurs