Challenging Challenging Behavior: What to Behavior: What to

do?do?

Carrie Cadwell PsyD HSPPCarrie Cadwell PsyD HSPP©©Cadwell Psychological Services, LLCCadwell Psychological Services, LLC

www.cpsllc.infowww.cpsllc.info

IDEA 2004IDEA 2004

• New regulations went into effect in New regulations went into effect in October 2006October 2006– Functional Behavior Assessment and Functional Behavior Assessment and

Behavior Plan regulationsBehavior Plan regulations– Response to InterventionResponse to Intervention

• Students of concern—implement a series of Students of concern—implement a series of increasingly intensive individualized increasingly intensive individualized instruction or behavioral intervention----instruction or behavioral intervention----monitor responsiveness to assist in monitor responsiveness to assist in identifying learning disabilitiesidentifying learning disabilities

• Implemented in general education with Implemented in general education with support from specialistssupport from specialists

Why Problem Behavior?Why Problem Behavior?

• Challenging behaviors impede Challenging behaviors impede quality of life (Lucyshyn et al, 2002):quality of life (Lucyshyn et al, 2002):– Isolation from peers, family, communityIsolation from peers, family, community– Decrease number of learning Decrease number of learning

opportunitiesopportunities– Impede family quality of lifeImpede family quality of life

– Increase anxiety and depression riskIncrease anxiety and depression risk

Positive Behavior Positive Behavior SupportSupport

• ““application of behavior analysis to the social application of behavior analysis to the social problems created by such behavior as self-problems created by such behavior as self-injury, aggression, property destruction, pica, injury, aggression, property destruction, pica, defiance, and disruption” (Horner, 2000)defiance, and disruption” (Horner, 2000)

• features (Horner, 2000): features (Horner, 2000): – Commitment to environmental change not just Commitment to environmental change not just

individual change/skill acquisitionindividual change/skill acquisition– Change environments to PREVENT problem Change environments to PREVENT problem

behaviorbehavior– ““effective environments make problem behavior effective environments make problem behavior

IRRELEVANT, INEFFICIENT, AND INEFFECTIVE”IRRELEVANT, INEFFICIENT, AND INEFFECTIVE”

Positive Behavior Positive Behavior SupportSupport

• Comes out of several traditions (Carr Comes out of several traditions (Carr et al)et al)– Applied Behavior AnalysisApplied Behavior Analysis

• Conceptual framework for behavior changeConceptual framework for behavior change• Functional assessment and interventionFunctional assessment and intervention

– Normalization/Inclusion MovementNormalization/Inclusion Movement• A life in the community for everyoneA life in the community for everyone

– Person-centered ValuesPerson-centered Values• Person-centered planning not program-Person-centered planning not program-

centered planningcentered planning• Value on self-determinationValue on self-determination

School SettingsSchool Settings

• From 2002 to 2006 Illinois and Hawaii From 2002 to 2006 Illinois and Hawaii schools participated in a study of PBIS schools participated in a study of PBIS training and implementationtraining and implementation– Found significant difference between 3Found significant difference between 3rdrd grade grade

reading ISAT scores for school implementing reading ISAT scores for school implementing PBS or notPBS or not

– Improved measures/scores on school safetyImproved measures/scores on school safety– Less office discipline referrals…which Less office discipline referrals…which

indicates more time in the classroomindicates more time in the classroom– Illinois has found that school wide PBS has led Illinois has found that school wide PBS has led

to greater time and ability to provide more to greater time and ability to provide more intensive “wraparound” services to youth who intensive “wraparound” services to youth who need more intense supportsneed more intense supports

Challenging Behavior Challenging Behavior ChecklistChecklist

• Ask yourself/team:Ask yourself/team:– Is it problem?Is it problem?– Whose problem is it?Whose problem is it?– Does the problem belong in basket A,B, or Does the problem belong in basket A,B, or

C (Ross Greene)C (Ross Greene)– Is there a skill deficit or skill performance Is there a skill deficit or skill performance

issueissue– Have there been times when the behavior Have there been times when the behavior

was not present? What was happening? was not present? What was happening? What were we doing different?What were we doing different?

Challenging Behavior Challenging Behavior ChecklistChecklist

• What factors may be making the What factors may be making the child more vulnerable to the child more vulnerable to the problem behavior***problem behavior***

• What are the immediate triggers?What are the immediate triggers?• What happens after the behavior? What happens after the behavior? • What does the client get from the What does the client get from the

behavior? What does the behavior behavior? What does the behavior communicate?communicate?

Assessment of Behavior (Fl Assessment of Behavior (Fl Ed, 1999)Ed, 1999)

• 5 outcomes of Behavior Assessment?5 outcomes of Behavior Assessment?– Description of problem behaviors Description of problem behaviors

(including sequences)(including sequences)– Identifying events, times, situations that Identifying events, times, situations that

predict problem behaviorpredict problem behavior– Identification of consequences that Identification of consequences that

maintain problem behaviormaintain problem behavior– Development of hypotheses/summary Development of hypotheses/summary

statementsstatements– Collection of data via observationCollection of data via observation

Target Behavior Target Behavior

• What you see and what you hearWhat you see and what you hear• How often? (frequency)How often? (frequency)• Intensity/severityIntensity/severity• Where? With whom?Where? With whom?• what skills appear to be lacking?what skills appear to be lacking?• When is the behavior not occurring—is When is the behavior not occurring—is

this skill generalization issue, is this a this skill generalization issue, is this a environmental issue, what can we learn environmental issue, what can we learn from thisfrom this

FAI cont.FAI cont.

• Consequences:Consequences:– What does person get or avoidWhat does person get or avoid– What are the individuals likes/dislikesWhat are the individuals likes/dislikes

From all information develop From all information develop hypotheses/summary statementshypotheses/summary statements

For each PB what are the possible setting For each PB what are the possible setting events, immediate antecedents, events, immediate antecedents, consequences-consequences-

Challenging Behavior Challenging Behavior ChecklistChecklist

• **Setting factors:**Setting factors:– Changes/transitionsChanges/transitions– FamilyFamily– Medical/physicalMedical/physical– PainPain– Sleep/EatingSleep/Eating– Vision/hearingVision/hearing– DevelopmentalDevelopmental– CognitiveCognitive– Mental HealthMental Health– Goals—are we all working on the same thingGoals—are we all working on the same thing

—educators/parents—educators/parents

HypothesesHypotheses

• Lucyshyn 2005:Lucyshyn 2005:– ““When When (triggers)(triggers) occur, student engages in occur, student engages in

(problem behavior),(problem behavior), to get to get (function)(function). . Problem behaviors are more likely when Problem behaviors are more likely when (setting events)(setting events) occur or because of occur or because of (setting (setting events).”events).”

– Can be multiple triggers, multiple setting Can be multiple triggers, multiple setting events but limit to one problem behavior and events but limit to one problem behavior and one functionone function

– Can write several summary statementsCan write several summary statements

ExampleExample

• When repeated requests are made of When repeated requests are made of Tommy to complete fine motor exercises, Tommy to complete fine motor exercises, he engages in moaning, followed by he engages in moaning, followed by dropping to the floor, followed by physical dropping to the floor, followed by physical aggression to escape (the task or escalating aggression to escape (the task or escalating verbal demands). This behavior is more verbal demands). This behavior is more likely to occur when Tommy does not get likely to occur when Tommy does not get enough sleep, has not taken his medication, enough sleep, has not taken his medication, and when teacher 1 makes these requests and when teacher 1 makes these requests and because he has motor skill deficits.and because he has motor skill deficits.

Ex: O’Neil et al 1997Ex: O’Neil et al 1997

• ““When Jacqueline is prompted to stop When Jacqueline is prompted to stop playing with the computer or record playing with the computer or record player in the play area, she is likely to fall player in the play area, she is likely to fall on the floor and scream to try to continue on the floor and scream to try to continue to be allowed to play with the play items”to be allowed to play with the play items”

• ““When Andrea begins to have difficulty When Andrea begins to have difficulty with a reading or math assignment, she with a reading or math assignment, she will put her head down, refuse to respond, will put her head down, refuse to respond, and close her books to try to avoid having and close her books to try to avoid having to complete the assignment. The to complete the assignment. The likelihood of this pattern increases if likelihood of this pattern increases if Andrea has received teacher reprimands Andrea has received teacher reprimands earlier in the day”earlier in the day”

Lets meet “Hannah”Lets meet “Hannah”adapted from Anne Todd, University of Oregon, 2001adapted from Anne Todd, University of Oregon, 2001

Hannah is fourth grader at a local elementary school. She Hannah is fourth grader at a local elementary school. She receives special education services. She receives most of her receives special education services. She receives most of her academic instruction in the special education classroom academic instruction in the special education classroom located across from the fourth grade classroom. Teachers located across from the fourth grade classroom. Teachers describe Hannah’s problem behaviors as off task and describe Hannah’s problem behaviors as off task and disruptive to instruction/activities. The behaviors include disruptive to instruction/activities. The behaviors include excessive giggling, sticking out her tongue, doodling, excessive giggling, sticking out her tongue, doodling, prolonged waving and pointing at peers across the hall, and prolonged waving and pointing at peers across the hall, and excessively long transitions from one school area to the next. excessively long transitions from one school area to the next. Hannah does no complete assigned work, she spends her work Hannah does no complete assigned work, she spends her work time engaged in the above behaviors. Further, when there are time engaged in the above behaviors. Further, when there are groups of kids (5 or more per 1 teacher), Hannah is more groups of kids (5 or more per 1 teacher), Hannah is more likely to engage in problem behavior than when in a smaller likely to engage in problem behavior than when in a smaller group or one-on one. Her parents report that Hannah’s group or one-on one. Her parents report that Hannah’s allergies have been worse this year and she has had several allergies have been worse this year and she has had several bouts with the flu. Recently her parents sought help for sleep bouts with the flu. Recently her parents sought help for sleep problems for Hannah from her pediatrician.problems for Hannah from her pediatrician.

HannahHannah

• Given independent seatwork and Given independent seatwork and group instruction with more than 5 group instruction with more than 5 students, Hannah engages in high students, Hannah engages in high rates of off task behavior including rates of off task behavior including ignoring directions, doodling, talking ignoring directions, doodling, talking to peers, making silly faces to get to peers, making silly faces to get peer attention. This occurs more peer attention. This occurs more frequently when Hannah is not feeling frequently when Hannah is not feeling well or has not gotten enough sleep.well or has not gotten enough sleep.

Functional Assessment Functional Assessment ObservationObservation

• Once hypotheses are established its Once hypotheses are established its time to do some observation time to do some observation

• If problem behavior occurring in If problem behavior occurring in multiple contexts= multiple context multiple contexts= multiple context observationobservation

• One time observation is not sufficientOne time observation is not sufficient• Purpose: to determine the accuracy of Purpose: to determine the accuracy of

hypotheseshypotheses

FAO cont.FAO cont.

• Various forms exist to conduct Various forms exist to conduct observationobservation

• Several attributes in common:Several attributes in common:– Ex: place—home, school, daycare, etcEx: place—home, school, daycare, etc

• Daily routine---- school=class periods; home= Daily routine---- school=class periods; home= morning routine or nighttime routinemorning routine or nighttime routine

• Frequency counts for each problem behaviorFrequency counts for each problem behavior• Marking antecedents/triggers and Marking antecedents/triggers and

consequencesconsequences• After ask: does my FAO data support or refute After ask: does my FAO data support or refute

my hypotheses?my hypotheses?– PBS is a process!!PBS is a process!!

FAO: scatterplotFAO: scatterplot

TimeTime ActivitActivityy

8/148/14 8/158/15 8/188/18 8/198/19

8:008:00 Circle Circle time/ftime/free ree playplay

XX XX XX

8:308:30

9:009:00 Fine Fine motormotor

XX XX

FAO: ABCs FAO: ABCs (Fl Dept of Ed, 1999)(Fl Dept of Ed, 1999)

A: A: antecedentsantecedentsDescribe specifically Describe specifically what was happening what was happening immediately immediately precedingpreceding

B: behaviorB: behaviorWhat did the What did the individual say/doindividual say/do

C: C: consequenceconsequenceDescribe events Describe events immediately immediately following following behavior/results of behavior/results of behaviorbehavior

FAOFAO

• Collect data until clear patterns Collect data until clear patterns emergeemerge– Remember interim/crisis planningRemember interim/crisis planning

• Minimum time: (O’Neil et al 1997)Minimum time: (O’Neil et al 1997)– Over 2-5 daysOver 2-5 days– Over 15-20 occurrences of the behaviorOver 15-20 occurrences of the behavior

PBS is a commitment to a process (ie PBS is a commitment to a process (ie time needed can vary)time needed can vary)

What now?What now?

• Start to develop your plan (Lucyshyn 2005)Start to develop your plan (Lucyshyn 2005)– What is goal/target behaviorWhat is goal/target behavior– Think intermediate and long-term solutionsThink intermediate and long-term solutions– Think about changing setting eventsThink about changing setting events– Changing antecedents/preventativeChanging antecedents/preventative– What doe we need to teach individual/familiesWhat doe we need to teach individual/families– Shifting consequences/adding reinforcement for Shifting consequences/adding reinforcement for

exhibition of target behaviorexhibition of target behavior– Use as many supports as needed to get behavior Use as many supports as needed to get behavior

right first time around and fade supports over right first time around and fade supports over timetime

– Evaluate and modify as neededEvaluate and modify as needed

Developing Intervention Developing Intervention PlanPlan

• Lucyshyn (2005)Lucyshyn (2005)– ““promote change in one setting at a promote change in one setting at a

time” (ie setting and/or routine)time” (ie setting and/or routine)– Get it right the 1Get it right the 1stst time time

• What supports are needed for the What supports are needed for the replacement behavior or desired behavior replacement behavior or desired behavior to be demonstrated succesfullyto be demonstrated succesfully

InterventionIntervention

• Lucyshyn 2005 cont.Lucyshyn 2005 cont.– Setting events: remove,minimize, Setting events: remove,minimize,

neutralizeneutralize– Antecedents: replace triggersAntecedents: replace triggers– Desired/Replacement Behaviors: TEACHDesired/Replacement Behaviors: TEACH

• What skills need to be taught? What skills need to be taught? • Skill deficit vs performance deficitSkill deficit vs performance deficit

– Consequence: reinforce Consequence: reinforce desired/replacement and end/minimize desired/replacement and end/minimize problem behavior reinforcementproblem behavior reinforcement

InterventionIntervention

Setting Setting Event Event strategiesstrategies

PreventivPreventive or e or AntecedeAntecedent nt StrategiesStrategies

Teaching Teaching StrategiesStrategies

Conseq. Conseq. StrategiesStrategies

Lucyshyn, 2005Lucyshyn, 2005

HannahHannah

Setting Setting Event Event strategiesstrategies

AntecedeAntecedent nt StrategiesStrategies

InstructioInstruction n StrategiesStrategies

Conseq. Conseq. StrategiesStrategies

Morning check-in Morning check-in @sleep/illness@sleep/illness

Stabilize nightime Stabilize nightime routine at home routine at home for sleepfor sleep

Offer frequent Offer frequent breaks during daybreaks during day

Precorrect Precorrect expected expected behaviorsbehaviors

Precorrect peers Precorrect peers to ignore silly to ignore silly behaviors and behaviors and reinforce reinforce appropriate appropriate behaviorsbehaviors

When tired/ill, When tired/ill, offer choice of offer choice of small group/one-small group/one-on oneon one

Teach on-Teach on-behavior for behavior for group group instruction/seat instruction/seat workwork

Teach use of self-Teach use of self-monitoring monitoring systemsystem

Pluses on self-Pluses on self-management cardmanagement card

Trade pluses for Trade pluses for class pointsclass points

Invite friend for Invite friend for free timefree time

Positive attn from Positive attn from teacher for teacher for desired behaviordesired behavior

Planning for ChangePlanning for Change

• REMEMBER:REMEMBER:– Including youth in planning for change Including youth in planning for change

in age-appropriate ways increases in age-appropriate ways increases likelihood of successlikelihood of success

– Collaborative Problem-Solving Collaborative Problem-Solving Approach (Greene & Ablon)Approach (Greene & Ablon)

Last ThoughtsLast Thoughts

• ““Effective behavior support should not Effective behavior support should not only help to reduce problem behavior but only help to reduce problem behavior but should also change the opportunities a should also change the opportunities a person has for learning new skills, for person has for learning new skills, for social inclusion, for access to meaningful social inclusion, for access to meaningful activities, and for basic participation in activities, and for basic participation in the local community”the local community”

• PBS… “is a process for redesigning PBS… “is a process for redesigning environments so they “work” for environments so they “work” for people…”people…”

Both quotes O’Neill 1997, p 1, p 2Both quotes O’Neill 1997, p 1, p 2