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Transcript of Brittany R. Rothe, B.S., BCaBA University of Houston-Clear Lake Keys to Compliance: Strategies for...
Brittany R. Rothe, B.S., BCaBAUniversity of Houston-Clear Lake
Keys to Compliance: Strategies for Increasing Compliance in Learners
with and Without an ASD
Overview Define complianceDetermine who is concerned with complianceProblems with noncomplianceReasons for noncomplianceWays to encourage complianceBreakConsequences for compliance/noncomplianceDifficult casesGeneralizationFinal considerations
What is compliance? Following instructions/directionsIndependently initiating/completing a request Within a time frame (6 s)
Noncompliance: opposite of or lack of complianceSometimes accompanied by problem
behaviorNoncompliance—most common childhood
problemNoncompliance vs. Lack of ability
Compliance
Who can be noncompliant? Typically developing learners Learners with an Autism Spectrum Disorder
(ASD)You and me! Noncompliance is not limited to young
children
Compliance
Common situations/instructions for noncomplianceSchoolworkTransitionsActivities of daily living/choresDoctor visits
Who is concerned with compliance?Parents/CaregiversTeachersDoctors/NursesTherapists
Compliance
Creates deficits in skill developmentAcademic skillsSelf-help skillsSocial skills
Affects family life/stressParentsSiblings
Leads to other behavior problems
Problems with Noncompliance
Why does noncompliance occur? Escape from or delay an unpreferred activity
SchoolworkAccess or maintain access to preferred
items/activitiesToys, games, food
Gain attention (verbal, physical, both) Teacher, parents, peers
Noncompliance is tricky because the reason is not always obvious
Common reactions to compliance and noncompliance
Why Noncompliance?
Prevention StrategiesGoals: Prevent noncompliance & encourage
compliance
Consequence StrategiesGoals: Provide rewards for compliance &
encourage future compliance
Treatments/Interventions
Used alone or in combinationWhat works?
Simple Instruction Tips (Package)High-Probability (High-p) Request ProcedureTime-based RewardsLearner Choice
What doesn’t work?Warning or advance notice (transitions or
termination) Rationales
Prevention Strategies
Deliver instruction a short distance from the learner1 ft.
Crouch to small learner’s level Gently touch learner’s shoulderAttempt to make eye contact
Avoidance in ASDInterrupt current play/activity
Gently block hands
Simple Instruction Tips
Should be in statement formCorrect: Pick up the toys. OR Please, pick up
the toys. Incorrect: Will you/can you pick up the toys?
“Do” requestsCorrect: Sit down in the chair.Incorrect: Don’t lay on the floor.
Specific
Keep a neutral tone
Instructions/Demands
High-probability request procedure High-probability request
Compliance likely“Touch your nose” “Clap your hands” Imitation: “Do this”
Low-probability requestCompliance unlikely
“Give me the toy” “Say Mom” “Put on your shoes”
High-p/Low-p
How to use the high-p, low-p instructional sequenceDeliver ~3 high-p instructionsSnacks/toy rewards + praise for compliance~ 10 s between high-p instructions
Speed of demandsBenefits
Widely studiedAppropriate for wide variety of situations
Examples: Medical exams, educational settings, homeWeaknesses
Difficult if very few high-p
High-p/Low-p
Know your learnerOne-step vs. multiple-step instructions
Modify aspects of task that is aversive Make task more manageable/ enjoyable
Break task into stepsReward each step
Don’t modify instruction after giving itIndividuals will learn demands will get easier
if they are noncompliant
Modified Instructions
Who would benefit from breaks?Learners who are noncompliant to escapeWill comply for some period of time
Short breaks interspersed throughout taskExample: Work for 2 min. 30 s break repeat
Length of “work” time between breaksBased on current behaviorDetermine average time before noncompliance
ConsiderationsFeasibility (Tracking time)MotivAiders, timer, watchDifficulty w/ transitions—break in work area
Time-based Breaks
Who would benefit?Learners who are noncompliant to gain attention or
itemsWill comply for some period of time
Looks procedurally similar to time-based breaks
Learner receives attention or toys instead of breakAttention: High-fives, praise, tickles, pat on the backSmall pieces of snacksEasily removable toys
Time-based Attention/Toys
What happens if the individual is noncompliant? Time-based not “behavior-based” Learner receives scheduled break/attention/toy
Why do time-based rewards work? Decreases motivation for noncomplianceLearner already getting what they want
Do I have to do this all day/every day? Tasks when noncompliance likely
Will I have to do this forever? Increase work timeBased on success of learner
Common Questions: Time-based Rewards
Learner can control some aspect of instruction Teacher/Caregiver decision
Allow learner to choose taskOrder of tasks: Math or Science firstType of tasks: Different worksheets
Allow learner to choose location Work at the table or at the desk
Writing workUse a colored pencil or a regular pencil
DressingOrder of dressing, color of
shirt/shorts/underwear
Learner’s Choice
Substantially more effective than antecedent interventions Commonly used in combination
What works?Extinction of noncompliance Guided Compliance (3-step prompting)Rewards (toys, foods, etc.) for complianceCombining breaks with toys/activities as a
rewardNot recommended
Time-out for noncompliance
Consequence Interventions
Behavioral terminologyLearner doesn’t get what he/she wants
BreakAttentionToys, Snacks, Activities
Consider reason for noncomplianceNot always feasible Most effective when combined with
reinforcement for compliance!
Extinction of Noncompliance
Also known as: “Three-step prompting”Caregiver/Teacher guides learner through taskStep 1: Delivery of instructionStep 2: Instruction + Model desired
behaviorStep 3: Instruction + Physical guidance Benefits
Teach learner compliance is mandatoryGives opportunity for independence
FeasibilityLarger learnersOther challenging behaviors
Guided Compliance
“Functional” reinforcersReason for noncompliance
Escape (Break) Tangible (Toys, edibles, etc.)Attention (Praise, reprimands, physical
prompts)Use functional reinforcers for compliance
Noncompliance No break (Extinction) ComplianceBreak (Reinforcement)
Prompted vs. Unprompted ComplianceDifferent rewards
Rewards for Compliance
Rewards should be individualizedAllow learner to choose reward
Verbal learnerNonverbal learner
Preferences for rewards change Frequently reevaluate rewards
Alternate highly-preferred rewardsPrevent satiation
If compliance is not increasing evaluate if reward is really a reward
Rewards for Compliance
PraiseEnthusiasticSpecificPhysical
All Rewards Immediate (within 5 s) Frequent (in the beginning)
Pair praise with other rewardsPreferences for rewards may change
Tips for Delivering Rewards
Allows more time between large rewards
Tokens exchangeable for different rewardsPrevents satiation on one reward
Used across settings
Classroom settingEasy to use with multiple students
Benefits of Token Economies
Large end goalCorrectly complete a math worksheet
independently Break into smaller steps
Sit at deskTake out pencilComplete 1 math problem with assistanceIndependently complete 1 math problemComplete multiple problems
Smaller steps receive rewardsGradually increase requirement to receive
reward
Shaping Compliance
When physical guidance is not feasible:Do not allow access to preferred itemsDo not acknowledge noncompliance (reprimands)Continue verbal/gestural prompts every 30 sMake noncompliance “uncomfortable” Do not “bribe” or “threaten”
Interference of other problem behaviors Aggression, property destruction, screaming, self-
injuryTreatment for other behaviors
Consider changing the reinforcement for complianceMagnitude, Quantity, Quality….
Difficult Cases
Compliance is a learned skillLearners with ASD may have trouble
generalizing skillsNo experience or “history” of rewards
Compliance needs to be practiced In different settingsWith different people
Understand when compliance does not generalize
Know when follow-through is not likely Grandma’s houseBabysitter
Generalization
ALWAYS FOLLOW THROUGH!Don’t give a demand if you can’t follow
through immediatelyMay want to postpone demand
Compliance will not happen overnightMay be regression before progress in the
beginningDon’t use the child’s name exclusively before
demandsLabor intensive in the beginning
You will get out what you put in
Final Considerations
Carlos A. Zuluaga & Matthew P. Normand. (2008) An evaluation of the high-probability instruction sequence with and without programmed reinforcement for compliance with high-probability instructions. Journal of Applied Behavior Analysis, 41, 453-457.
Coleman, C. L., & Holmes, P. A. (1998). The use of noncontingent escape to reduce disruptive behaviors in children with speech delays. Journal of Applied Behavior Analysis, 31, 687-690.
David A. Wilder, Janelle Allison, Katie Nicholson, O. Elizabeth Abellon, & Renee Saulnier (2010). Further evaluation of antecedent interventions on compliance: The effects of rationales to increase compliance among preschoolers. Journal of Applied Behavior Analysis, 43, 601-613.
Einar T. Ingvarsson, SungWoo Kahng, & Nicole L. Hausman. (2008) Some effects of noncontingent positive reinforcement on multiply controlled problem behavior and compliance in a demand context. Journal of Applied Behavior Analysis, 41, 435-440.
Kasey M. Stephenson & Gregory P. Hanley (2010). Preschoolers’ compliance with simple instructions: A descriptive and experimental evaluation. Journal of Applied Behavior Analysis, 43, 229-247.
*Kazdin, A.E. (2009). The KAZDIN METHOD for Parenting the Defiant Child: With no pills, no therapy, no contest of wills. New York, NY: Houghton Mifflin Harcourt
References
Kelly J. Bouxsein, Henry S. Roane, & Tara Harper (2011). Evaluating the separate and combined effects of positive and negative reinforcement on task compliance. Journal of Applied Behavior Analysis, 44, 175-179.
Kodak, T., Miltenberger, R. G., & Romaniuk, C. (2003). The effects of differential negative reinforcement of other behavior and noncontingent escape on compliance. Journal of Applied Behavior Analysis, 36, 379-382.
Marcus, B. A., & Vollmer, T. R. (1995). Effects of differential negative reinforcement on disruption and compliance. Journal of Applied Behavior Analysis, 28, 229-230.
Matthew P. Normand & Lauren Beaulieu (2011). Further evaluation of response-independent delivery of preferred stimuli and child compliance. Journal of Applied Behavior Analysis, 44, 665-669.
Piazza, C. C., Moes, D. R., & Fisher, W. W. (1996). Differential reinforcement of alternative behavior and demand fading in the treatment of escape-maintained destructive behavior. Journal of Applied Behavior Analysis, 29, 569-572.
Rortvedt, A. K., & Miltenberger, R. G. (1994). Analysis of a high-probability instructional sequence and time-out in the treatment of child noncompliance. Journal of Applied Behavior Analysis, 27, 327-330.
References