Support Strategies for Challenging Behaviors Benjamin R. Thomas, M.A., BCBA

Behavior Behavior is anything people: Behavior is anything people:DoorSay

Behavior Behavior is: Behavior is: –Verbal: communicates with another person –Nonverbal: interacts with environment only

Appropriate Behaviors Communication (asking for wants/needs) Communication (asking for wants/needs) Play and leisure skills Play and leisure skills Social behaviors with family and friends Social behaviors with family and friends Following directions/listening Following directions/listening Etc. Etc.

Challenging Behaviors Looking away, non-responding, non- compliance Looking away, non-responding, non- compliance Self-stimulatory (rocking, mouthing objects, etc.) Self-stimulatory (rocking, mouthing objects, etc.) Falling to the floor, running from adults Falling to the floor, running from adults Climbing on tables, counters, bookcases, etc. Climbing on tables, counters, bookcases, etc. Screaming, yelling, crying, loud noises, etc. Screaming, yelling, crying, loud noises, etc. Hitting, biting, kicking others Hitting, biting, kicking others Self-injurious behaviors Self-injurious behaviors Refusal to eat Refusal to eat

Applied Behavior Analysis (ABA) The three-term contingency (ABC analysis) The three-term contingency (ABC analysis) Antecedent Behavior Consequence Child wants juice Says “Juice” Parent gives child juice Child wants juice Says “Juice” Parent gives child juice Antecedent Behavior Consequence Child doesn’t want Runs from adults Delays taking a bath Child doesn’t want Runs from adults Delays taking a bath to take a bath and gets chased to take a bath and gets chased

What Causes Behavior? 1.Recognize the cues for the behavior (antecedent) – Where and when a behavior is likely to occur 2.Recognize the events that follow a behavior (consequence) –What happens immediately after a behavior occurs? If the behavior persists, the consequence is REINFORCING the behavior.

Escape Behaviors Why won’t your child do it? Why won’t your child do it? Too hard Too hard Uncomfortable sensory input Uncomfortable sensory input No reason to do it (nothing in it for him/her) No reason to do it (nothing in it for him/her) Prevention Prevention –Start small- introduce a little bit at a time –Change the task- reduce uncomfortable input (ex. Gloves for water, headphones) Appropriate behavior Appropriate behavior –Teach to say “No,” ask for a “Break,” or a way to make it go away Strengthen Strengthen –Offer incentive for compliance- access to preferred item/activity –Honor appropriate requests to terminate situation

Behaviors that Get Things What does your child want? What does your child want? Prevention Prevention –Have items/activities available at all times or regularly at scheduled times –Arrange home so child does not pass by preferred things as s/he is transitioning out the door –Timed access/sharing/scheduled access Appropriate behavior Appropriate behavior –Teach to ask nicely for what s/he wants (i.e., “juice” to get juice when thirsty) –Teach waiting, accepting “no”/ “not right now” Strengthen Strengthen –Honor all appropriate requests for things –Ignore challenging behaviors (inappropriate requests) that get things

Behaviors that Get Attention How does s/he want you to pay attention? How does s/he want you to pay attention? Prevention Prevention –Pay attention regularly/on a schedule- use a timer to remember –Enrich environment with other fun things to do so you are not the only source of fun during specific times Appropriate behavior Appropriate behavior –Teach to ask nicely (i.e., “Hug, “Pick up,” “play with me”) –Social/play skills- receive attention from others Strengthen Strengthen –Honor all appropriate requests for attention –Ignore challenging behaviors that get attention

Self-stimulatory Behaviors What kind of feedback/input does your child get from the behavior? What kind of feedback/input does your child get from the behavior? Prevention Prevention –Enrich environment with other fun things s/he enjoys –Structure daily routine to minimize periods without appropriate activities –Provide an acceptable place where the behavior may occur Appropriate behavior Appropriate behavior –Teach play skills, leisure skills- how to do appropriate things that give similar feedback (*that may also help make friends) Strengthen Strengthen –Reinforce periods with absence of behaviors –Provide incentive to play appropriately -(why should they do something new when they already know an easy way to entertain themselves?) –Block inappropriate behaviors to the extent possible- the only way to get the sensory input will be the appropriate way

Ignoring Challenging Behavior: Extinction Be prepared for an extinction burst Be prepared for an extinction burst Eye contact is often attention (reinforcement) Eye contact is often attention (reinforcement) Don’t show facial reactions Don’t show facial reactions Don’t argue, scold or talk (attention) Don’t argue, scold or talk (attention) Don’t show anger (attention) Don’t show anger (attention) Act absorbed in some other activity, walk away Act absorbed in some other activity, walk away Give your child attention shortly after the bad behavior stops Give your child attention shortly after the bad behavior stops (Mark Sundberg, Ph.D., BCBA)

Identifying Precursors What responses precede problem behavior What responses precede problem behavior What conditions What conditionsEx: 0) None; 1) Glazed/vacant look (not working); 2) Scripting about behavior incidents from earlier; 3) Tensing of the arms and hands; 4) Disruptive behavior 5) Aggression 0) None; 1) Glazed/vacant look (not working); 2) Scripting about behavior incidents from earlier; 3) Tensing of the arms and hands; 4) Disruptive behavior 5) Aggression 0)None; 1)Tensing, shaking, facial grimace; 2)Inappropriate vocalizations; 3) Disruption; 4) SIB; 0)None; 1)Tensing, shaking, facial grimace; 2)Inappropriate vocalizations; 3) Disruption; 4) SIB; 5) Aggression to Others

During a meltdown Your behavior: Your behavior: –Avoid eye contact (often a reinforcer) –Avoid facial reactions –Avoid reprimands, arguing, talking –Safe position = 45° behind child at arms length

Getting your child back on track Allow child to calm down before instructions Allow child to calm down before instructions Reinforce calming down Reinforce calming down Counting, Breathing Counting, Breathing High-probability response sequence High-probability response sequence –Present a series of easy to follow requests for which your child has a history of compliance, followed by the target request.

Token Economy A motivation system in which tokens are delivered for desirable behaviors. The tokens are accumulated and exchanged for preferred items/activities/privileges (reinforcers). A motivation system in which tokens are delivered for desirable behaviors. The tokens are accumulated and exchanged for preferred items/activities/privileges (reinforcers). –Sticker charts –Points system –Penny board/token board –Allowance –Paycheck

Token economy components Appropriate behaviors to strengthen Appropriate behaviors to strengthen What to use for tokens What to use for tokens What the tokens will be exchanged for (reinforcers) What the tokens will be exchanged for (reinforcers) Schedule for token delivery Schedule for token delivery Rate/time/place to exchange tokens Rate/time/place to exchange tokens Response cost/fine for inappropriate Response cost/fine for inappropriate

Token Economy (cont) Selecting Reinforcers (consequences that increase appropriate behaviors) Selecting Reinforcers (consequences that increase appropriate behaviors) Preference assessments Preference assessments –Observation –Interview –Assessment –Asking? Low correspondence  Activity RAISD

Token economy (cont) Make bed: 1pt Make bed: 1pt Brush teeth: 1pt Brush teeth: 1pt Homework: 3pts Homework: 3pts Eat dinner at the table: 1pt Eat dinner at the table: 1pt Play with brother nicely: 4pts Play with brother nicely: 4ptsStore: Go to Baskin Robbins: 15pts Xbox: 10pts, Bike ride w/dad: 8 pts, TV: 8pts,

Schedules Clear expectations of events Clear expectations of events Tie into token economy Tie into token economy Scheduled access to preferred items/activities Scheduled access to preferred items/activities

After School Routine Hang up jacket Hang up jacket Unpack/hang up bag Unpack/hang up bag Bathroom Bathroom Snack Snack Choose something to do (choice board) Choose something to do (choice board) *(activity schedule book) *(activity schedule book) Outside play Outside play Set table Set table Dinner Dinner

Self-monitoring: promoting independence

Self-monitoring (cont) Hang up jacket □ Hang up jacket □ Unpack/hang up bag □ Unpack/hang up bag □ Choose something to do □ Choose something to do □ activity schedule book □ activity schedule book □ Set table □ Set table □ Dinner at table □ Dinner at table □ Total ___/6__

Difficulty with Transitions Transitions Transitions –Allow child to transition with a preferred item- fade to after transition –Incorporate reinforcement/tokens for successful transitions –Warnings prior to transitions –Visual timers for activities –Daily schedule

Change in routine/schedule Anticipate and prepare your child Anticipate and prepare your child Social stories (Carol Gray) Social stories (Carol Gray) Change in routine card Change in routine card w/social story w/social story Add to daily schedule (see it many times) Add to daily schedule (see it many times) Reinforce tolerance of change/new activity Reinforce tolerance of change/new activity Change in Routine Card Notice: ____ will be changed on _____ Because_________________________ The new activity is _________________

Trip to the Doctor’s Office Sit in the waiting room. Go into the exam room. Sit on the table. Dr. Jay will look in my ear. Dr. Jay will look in my mouth. Say “AHH.” Go to Baskin-Robbins for ice cream!

Patrick’s Fire Drill Story written just for Patrick Fire Drills tell people when to go outside in case there is a fire. We have fire drills two times a month in school. Most of the time these are just for practice. There isn’t a fire. The alarm goes off and everyone lines up. We walk outside together and wait until it is time to go in.

Sometimes the fire alarm scares me. It’s very loud. There are some things I can do when the alarm goes off to make it less scary. When the fire alarm goes off, I can do these things: 1. Put my headphones on. They will make the alarm quieter. 2. Ask to hold someone’s hand. 3. Tell myself, “It will be over soon.”

I will still line-up with my class and walk out of the building I will wait outside until the alarm sops and we can go inside. Once the alarm ends it’s over! I can go back inside and go back to my school work. Fire drills are loud, but when I use my headphones and ask someone to hold my hand, it will be okay.

Waiting and Accepting “NO” Activities to keep occupied, activity schedules Activities to keep occupied, activity schedules Teach counting to wait/delay (for interruptions) Teach counting to wait/delay (for interruptions) Visual timers Visual timers Scheduled access (build into daily schedule) Scheduled access (build into daily schedule) Reinforce accepting “No” with access to something else preferred. ***Have these items with you at all times when traveling Reinforce accepting “No” with access to something else preferred. ***Have these items with you at all times when traveling

2 nd Place aka “LOSING” Losing Losing –Reinforce “sportsmanship” –Points for playing games (gym class) 1 pt for winning 1 pt for winning 2 pts for losing and not getting mad (meltdown) 2 pts for losing and not getting mad (meltdown) 0 pts for getting upset 0 pts for getting upset Points exchanged for preferred items, privileges, etc Points exchanged for preferred items, privileges, etc –2 games: making friends and actual game (Jed Baker, 2008)