1. Tracy Palm, MS, BCBA Executive Director Transformations Autism Treatment Center

2. Why does my child act like this? Assessment is key Treatment strategies Severe Self Injury Physical Aggression

3. The child has been reinforced. Positive Reinforcement in the form of attention I scream you come over and ask what’s wrong. Positive Reinforcement in the form of access I scream you come over and ask if I want to go outside. Negative Reinforcement in the form of escape I scream when you ask me to do something and you say ok fine we’ll do it later. Automatic Reinforcement I scream when get water on my hands even if I’m by myself.

4. Your child is being reinforced differently by different people. The Grandma Effect Your child has a different learning history with different people. I’ve going known your child for 1 month vs you have been with them their whole life. Your child experiences different environmental situations in different locations. At school they use a classroom management system.

5. WATCH your child Write down what happened right before during and after the behavior happened (A-B-C’s) Read over your notes while asking yourself: Is there a certain time that my child does this? Does my child do this behavior when he is asked to do something? Does my child do this behavior when he wants to do something? Does my child do this when he is alone?

6. Physical Aggression caused by Positive Reinforcement from attention 1)Time out 1)Make sure that you are not attending to the person in time out by talking to them or interacting with them in any way 2)Ignore/ Don’t react 3)Teach appropriate attention seeking behaviors 1)Tapping you on the arm 2)Saying your name 3)Asking you to do something with them

7. Physical Aggression Caused by Positive Reinforcement in the form of access to items or activities 1)Do NOT give the person the item/activity! 2)Ignore/ Don’t react 3)Teach the person what they need to do to get the item/activity 1)Handing you a picture 2)Use a choice board 3)Saying the name of what they want 4)Ask for things that they want

8. Physical Aggression Caused by Negative Reinforcement in the form of escape 1)Do NOT let the child escape from the task or activity until he/she has completed the activity. 2)If you can not “make” the child complete the activity due to the aggression then use restraint or time out then bring the child back to the activity immediately following. 3)Use physical prompts to make the child complete the task. 4)If you have to “help” the child do the activity then make the child do it again on their own before moving on to something else.

9. Physical Aggression Caused by automatic reinforcement 1.Immediately stop the behavior then prompt using the teaching methods below. 2.Prompt the person to engage in a behavior that mirrors the problem behavior. 3.Teach the person a way to communicate what he/she is feeling and needing 1.Pictures, sign, vocals 4.Use physical prompts to “help” the person get them to “fix” anything that is brothering them 1.Ex. I scream when I get wet. (use PP to get the child to dry themselves off)

10. Self Injurious Behaviors Caused by Positive Reinforcement in the form of attention 1.Block any severe behavior. Do not make eye-contact or say anything to the person. 2.Teach the person what to do to get your attention and prompt these behaviors when the person does this behavior. 3.Medications (serotonin reuptake inhibitors, opiate blockers, and beta-adrenergic blockers)

11. Self Injurious Behaviors Caused by Positive Reinforcement in the form of access to items/activities 1.Block any severe behavior. Do not make eye- contact or say anything to the person. 2.Do NOT allow the person to access the items/activities at this time. 3.Teach the person how to get the item appropriately. 1.Vocal communication, pictures, sign

12. Self Injurious Behaviors Caused by Negative Reinforcement in the form of escape 1)Block any severe behavior. Do not make eye- contact or say anything to the person. 2)Make sure to continue with the task, while blocking the behavior until the person has completed the activity appropriately 3)Present the task that normally causes the behavior often but in short increments

13. Self Injurious Behaviors Caused by automatic reinforcement 1)Teach the person a more appropriate behavior to do that will “feel” the same but not cause harm. 2)Medications 3)Block the behavior while reinforcing more appropriate behaviors. 4)Set a timer and reinforce the person for doing other behaviors for a period of time.

14. General o Token System o Positive Reinforcement Jar o Behavior Contracts o Positive Practice o Compliance Training o Overcorrection

15. Tracy Palm, MS, BCBA Executive Director Transformations Autism Treatment Center www.transformingautism.com tracypalmaba@aol.com 901-231-1931