Lina Patel, Psy.D. Senior Instructor at the University of Colorado Health Science Center

Director of Psychology at the Sie Center for Down Syndrome Children's Hospital Colorado

}  None

}  List 3 areas of difficulty typically experienced by children with Down Syndrome

}  Identify 2 strategies used to manage problematic behaviors of children with Down Syndrome

}  Understand the difference between antecedent, behavior, and consequence

}  Behaviors that result in… }  Self-injury or injury of others }  Causes damage to the physical environment }  Interferes with the acquisition of new skills }  And/or socially isolates the learner

Doss and Reichle, 1991

}  Running Away/Wandering from Caregivers }  Struggles with Following Directions or

“Stubbornness” }  Attention Issues }  Social Withdrawal }  Noncompliance with use of Adaptive Tools }  Compulsive Behaviors or Hyperfocus }  Hitting, Kicking, Physical Aggression }  Yelling, Cursing, Inappropriate Language

Antecedent Response Consequence

Avoidance/Escape

•  Pain/Discomfort •  Interaction •  Environmental Factors

(i.e. boredom, overstimulation, difficult work)

Acquisition

•  Attention/Interaction •  Desired Item •  Sensory Input •  Relief

}  Events that occur at one point in time that may change the likelihood of a targeted behavior at a later point in time by momentarily altering the value of the consequence. Feeley and Jones, 2008

}  Medical Issues ◦  Vision and Hearing Deficits ◦  Thyroid Function ◦  Celiac Disease ◦  Sleep Apnea ◦  Reflux ◦  Constipation ◦  Depression ◦  Anxiety

}  Skill Deficits ◦  Communication ◦  Social ◦  Motor ◦  Academic/Cognitive

}  Sensory

}  Medical Issues }  Skill Deficit ◦  Communication ◦  Social ◦  Motor ◦  Academic/Cognitive

}  Sensory

�  Strategies for Setting Events: �  Checklist of setting events �  Decrease presence of antecedents �  Increase available reinforcers �  Provide visual cues/structure �  Provide predictable routines �  Modify environment to decrease sensory distractions or

increase alertness

�  Antecedent Strategies �  Prespecified reinforcer �  Preferred item as a distractor �  Offer a choice �  High probability request sequence �  Offer of collaboration �  Learn by “doing” �  Use “first do this, then get that” directions and schedules �  Highlighting (giving social praise) appropriate behaviors �  Tell them what to do instead of what “not” to do �  Cause-and-effect planned ignoring: “First get calm, then I

will talk with you” �  Use strengths and interests to engage

�  Skill Building Strategy �  Teaching appropriate social skills �  Social stories ™ (Gray, 2000) �  Teach awareness and expression of feeling states �  Role play-notice what was right/wrong

�  Consequence Strategies �  Differential reinfiorcement of the ommision of behaviors �  Token System �  Error correction- “Try again” with demonstration �  Visual road map

Observed Behavior

Time/ Date/ Activity Initials of person documenting

Antecedent/ Trigger/ What happened right before?

Behavior/ Details of behavior

Consequence/ What happened after?

Function of the behavior?

}  “The important point is that difficult behaviors do not occur by accident, or because someone has a disability. Difficult behaviors are expressions of real and legitimate needs. All behavior, even if it is self-destructive, is “meaning-full.””

David Pitonyak, PhD Blacksburg, VA Down Syndrome News

Questions?

Thank you for your time!