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Many children with autism exhibit disruptive behaviors. Procedures such as teachingfunctionally equivalent replacement behaviors and self-management are frequentlycited in die literature as effecdve in reducing these behaviors. This chapter describeshow these two procedures can be effectively combined into amulticomponent treatment package to produce rapid reduction of problem behaviors and acquisition offluent appropriate replacement behaviors. In addition, the chapter discusses how theuse of these combined procedures can result in long-term maintenance of behavioralchanges. Specifically, disruptive behavior quickly decreases when aself-managementintervention is introduced. Simultaneously, it is critical that appropriate replacementbehaviors be taught to facilitate long-term maintenance of behavioral improvements.Such multicomponent programs are critical for inclusive settings, in which immediate reduction ofproblem behaviors are necessary to maintain aplacement mthe leastrestrictive environment and fluent, sometimes complex, functionally equivalent replacement behaviors are crucial for long-term elimination of behavior problems.

BACKGROUND

Challenging behaviors, such as aggression and self-injury, cause great social concernand generally predict avery poor future. These behaviors rapidly lead to more restrictive school placements and typically limit the amount of time astudent can enjoyinclusive community settings and activities. Anumber of technologies have been researched that beneficially affect the life quality among people with challenging behaviors, and amulticomponent intervention is recommended within apositive behavior supportplan (Reid, 2000).

Functional assessment and self-management are two procedures that have beenshown to be very effective in reducing challenging behaviors and increasing appropriate behaviors. Functional assessment, which is die process of identifying whyproblem behaviors occur and replacing diese behaviors with functionally equivalentalternative replacement procedures (Durand 8c Carr, 1991, 1992; Horner &Oarr,1997; Horner et al., 1990; O'Neill, Horner, Albin, Storey, 8c Sprague, 1990; Sprague8c Horner, 1995; Vaughn, Clarke, 8c Dunlap, 1997), has resulted in effective infffventions that are likely to generalize over time, settings, and people. Epidemiologicstudies suggest that as many as 75%-80% of problem behaviors may have acoimunicative function Perby et al., 1992; Iwata, Dorsey, Slifer, Bauman, 8c ^^J1994); therefore, changes in behavior that occur when antecedent sQmUV* dcdressed and functionally equivalent behaviors are taught can be quite ^(Wacker et al., 1998). However, the acquisition of afunctionally equivalen r p^ment behavior and die decrease of behavior problems is less well under\i°as hoWmay vary across children. This may be due to anumber of variables, su ^well established the problem behavior is, die efficiency of the problem an ^ment behaviors, reinforcement schedules, die child's ability to tolerate a ^other environmental variables (L.K. Koegel, 2000). However, for m0^behaviorthere will be a time period before the functionally equivalent replacemei-

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can be accomplished either by taking videotapes ofachild orcollecting on-line (in vivo)data. Next, based on the preinterventiondata, intervalsare selected that are a shortertime period than the intervals between disruptive behaviors. In other words, for thechild's first intervals to besuccessful, it is necessary to begin with time intervals thatare short enough for the child to experience success. Next, child-selected reinforcersare gathered that are provided as rewards for the child's successful intervals. Following these preparatory steps, the child is taught to self-manage. Initially, the child istaught to discriminate between the desired and undesired behaviors. After the childcan identify appropriate and inappropriate behaviors, he or she is taught to tally intervals with appropriate behavior. Once the child is able to discriminateand monitorhis or her behavior, steps to create independence are instated. Intervals are lengthened and added before areward is provided. For example, achild with more frequentbehavior challenges may begin with intervals ofa few seconds, which are graduallyincreased to 10-15 minutes. Another child may be able to begin with intervals ofseveral minutes, which can be gradually and systematically increased to a whole classperiod or even a whole day. In addition, the interventionist's prompts arc faded sothat the child is monitoring without die adult vigilance. Finally, die self-managementis programmed tooccur in other settings without the presence ofthe interventionist.Specifically, the monitoring devices (e.g., awrist counter, apiece ofpaper with boxesfor tallying, a repeat chronographic alarm watch) are sent with the child into additional settings, and the child is instructed to use the procedures in those settings.Regular validation checks are implemented inthose settings (these do not have to bedone by an interventionist) to ensure diat the child is actually monitoring and exhibiting the target behaviors in those settings.

Phase II: Replacement Behaviors

Phase II consists ofteaching the child to use functionally equivalent replacement behaviors. The first step ofdie functional assessment is to define the disruptive behaviors. Next, abaseline ofthe child's behaviors is established. As can be seen by the chartin Figure 14.1, die disruptive behavior is listed first, as well as the time and place whereit occurred. Next, the chart contains a number of boxes so the clinician can checkwhat happened before and what happened after the disruptive behavior. Finally, theclinician then hypothesizes why the disruptive behavior occurred. This step is criticalto the process, as functionally equivalent replacement behaviors are developed basedon the function ofthe behavior. Appropriate behaviors are specifically chosen to replace the problem behaviors, even though they are reduced using self-managementprocedures in Phase I. Replacement behaviors are important because they addressthe child's need for appropriate ways to communicate and improve the likelihood oflong-term maintenance ofreduced problem behaviors. The functional replacementbehaviors are determined based on the functional assessment performed during baseline data collection. The functionally equivalent replacement behaviors are worphrases designed to serve die same purpose as the disruptive behavior noted durinthe preintervention assessments. The following section presents amore detailed |planation of the measures that can be used.

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Occurrence Of Disruptive Behavior The occurrences of disruptive behaviorscan becounted during specific time periods, or the child can bevideotaped (with theparents' permission) and the tapes can be analyzed later. The data ondisruptive behavior can becollected inseveral ways. Afrequency recording system, wherein eachdisruptive behavior is tallied, can becollected for a specified time period. If the childhas lengthy tantrums, it may be easier to measure the duration of the behavior during designated time periods (e.g., recess, a 15-minute session, a class period).

Functional Assessment Functional assessment ofeach disruptive behavioralincident can be recorded. These data are later used to determine appropriate functionally equivalent behaviors to teach inplace ofthe inappropriate behaviors. As discussed previously, the problem behavior, the time it occurred, and setting where itoccurred are recorded on the top ofa form like the one shown in Figure 14.1. Next,what happened before andafter the behavior and die likely function of thebehaviorare recorded in the box. Based on this data, analternate appropriate behavior, whichhas the same function as the inappropriate behavior, can be taught.

Occurrence ofReplacement Behaviors Throughout the preintervention, intervention, and follow-up stages, it is important to collect data on the child's use ofthe replacement behavior. Long-term maintenance ofproblem-free behavior dependson the child's use offunctionally equivalent behaviors. Each appropriate use ofthereplacement behavior can be recorded either throughout the day or during specifiedtime periods. Data can be collected during baseline and throughout intervention andperiodically after intervention is complete.

Case Examples

This chapter uses extended case examples to present astudy that used the two-phaseintervention program.

History and Data Collection Kurt's and Trevor's families sought interventionfor challenging behaviors. Each boy had received adiagnosis ofautism from alicensedpsychologist at a center for children with developmental disabilities; the diagnosiswas made according to the criteria specified in the Diagnostic and Statistical ManualforMental Disorders (DSM-IV-TR; American Psychiatric Association, 2000). According toparent, teacher, and child care provider report, both children had a documented history of behavior problems for at least 1year across avariety of settings.

Data were collected in the children's regular intervention (special education pull-out programs), play, and educational settings. At baseline, other than verbal reprimands and time-out, no systematic interventions were in place for disruptive behaviors.

Trevor Trevor was 5 years, 6 months when his school district called the clinicto intervene for his aggression. He was diagnosed with autism and demonstrated alanguage delay, although he was capable of combining up to five words to producesyntactically correct phrases. His vocabulary was in the ninth percentile, and his Language and Socialization scores on the Vineland Adaptive Behavior Scales (Sparrow,Balla, &Cicchetti, 1984) were below age level by 1and 3 years, respectively. Trevorparticipated in a full-inclusion kindergarten classroom 5 days per week without an

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and™ toys. Ail subsequent sessions were then conducted at Trevor's school either in his classroom or during recess. Recess was targeted for the implemcntauon ofmrae;zrzTdur'as tofhis severe bcha™r * «^£mg that time. Functionally equivalent replacement behaviors were initially tauehtdniing one-to-one speedvtherapy sessions in the school's small speech-the apv roomrt*Z7£a tab,e and chairs- F°Uo™s inidal a^isi-'> °f *«52behaviors mthe one-to-one setting, Trevor's speech-language specialist conductedseveral sessions in the natural environment (i.e., during riLs).ticiJe"!, in fen W3S 5yCarS' "I™?"15 ?"le Stan °f inK™nt,on. Kurt initially par-c ooMu' ro TInUmty TCh°01 W'thOUt "" ^ but ™S asked to '-ve the pre-school clue to behavior problems. His parents subsequently enrolled him in another

behavior. K, received weekly speech and occupational therapy in the preschool setbng/The pubhc school aide had no experience in developing oYtorJernSa3Wi^ :ZSUPP°rt 'hCre(0rc' deSP'te **•« re"ds and~§u 3' benavior pioblems were not decreasing.

Communicatively, Kurt demonstrated cognitive and language delays although

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mJST P^a9e Ph3Se ': Se,f-Ma"a^n-ent For both children, die self-wernZZluZ°C r WTrdalJy taUgHt ^ a«"*»" ""«"«< dmician andwere ill X'7kmented b? Pare™ °r teachers. Self-management procedures2CC°*S,° *« Procedu^ ^Horn to %a* Self-Ua^ement toPeople rfanSt^!^rra^J*^(L^K°^,Koegd,&Parks) 1992). First, Tre«»rih them ^ S 'u reCOgniZe ^ tarS" disruPdve beha™« and correcdy iden-tuy diem, fhey were then taught to use abehavior recording chart (a small sheet of

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school sessions to30 minutes, based on the same criterion of80% appropriate behavior. Using this same system ofsystematically increasing the length of theintervals,Trevor's intervals were increased until he was only required to record his behavioroccasionally throughout the school day (i.e., a maximum of three times perday). Intervention continued in this manner until session probe number 17, when it becameapparent that Trevor no longer required shorter intervals during the school day tomaintain appropriate behavior. From this point forward, self-management was continued on a once-daily basis only, wherein Trevor was provided with a special treatat the end ofeach day ifhis behavior was appropriate for the entire day (see Figure14.2). From this point forward, Trevor only evaluated his behavior once per dayupon leaving school with his parents.

Treatment Package Phase II: Replacement Behaviors The second part ofthe intervention package involved teaching the child the functionally equivalent replacement behaviors in conjunction with the ongoing self-management. Thebaselinedata suggested that each child's disruptive behaviors primarily served die functionsoftrying to get help with a difficult task (Kurt) or to seek attention (Trevor). Therefore, Kurt was taught to ask for help when frustrated, and Trevor was taught appropriate phrases to initiate social interaction and seek attention. Although diese phraseswere relatively easy for the children tolearn tosay, itwas more difficult to teach themto spontaneously use the behaviors when the need arose. Therefore, this phase of thetreatment package targeted both initial acquisition of the phrases and spontaneoususe of these phrases in natural contexts.

Kurt was taught appropriate phrases to seek help or ask for a break in frustratingsituations, such as, "I need help," "Let's take a break," or "It's too hard." Thesephrases were taught and prompted during sessions until Kurt used them independently across a variety of activities and toys during his interactions with his parents.He continued to use his self-management program, as previously discussed, to maintain the decreases in his disruptive behavior during Phase II ofintervention.

Trevor was prompted to use appropriate replacement phrases to seek attentionfrom his peers, such as, "What are you doing?" and "Let's go play!" He was firsttaught these phrases in a one-to-one setting with his speech-language specialist atschool. After several teaching sessions in her office, she implemented twice-weeklysessions during recess, wherein she prompted Trevor to use the phrases with his peersuntil he was using them spontaneously to seek attention. The total number ofsessions in the natural environment was fewer than five over the course of approximately 2 weeks. Trevor then continued to receive self-management reinforcementfrom his parents at the end of the school day (as previously discussed) for appropriate behavior (i.e., self-management remained faded to the length ofschool day whilehe learned replacement behaviors).

Findings Anonconcurrent multiple baseline design across participants (Barlow 8c Hersen, 1984) was employed with the two children across baseline and the twophases ofintervention. The design gave die ability to control for history and maturation (Barlow &Hersen, 1984). Specifically, because intervention was started at different points in time after stable periods of the disruptive behaviors, the likelihood

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DISCUSSION OF CHAPTER CONCEPTSThe findings discussed in this chapter are consistent widi the «e^uch|gests that multicomponent interventions may be importanto consider to^disruptive behaviors (Carr Sc Carlson, 1993; Kemp 8c Carr1995.To—results presented in this chapter, selfimanagement is an effec r^*£ b,reduce the problem behaviors. Furthermore, teaching im ctonally eq *haviors provides children with an effective replacement lb. then d.srup

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Similarly, delayed reinforcement may also occur for behaviors that are on athin schedule of reinforcement or are relatively inefficient, such as many socially appropriatebehaviors. In these cases, teaching self-management to individuals with disabilitiesmio-ht be analogous to the self-control that most people demonstrate msustainingappropriate responding over long periods of time to secure some types of delayed re-inforcers. This responding typically involves complex behaviors, which may taketime to teach. The results of diis study may have addressed this issue, mthat selt-management may have provided intermediary reinforcement while complex, moreefficient appropriate replacement behaviors were being learned. More research onthe specific mechanisms that made these combined procedures effective is warranted.

In summary, this multicomponent intervention appeared to be an effective wayto quickly reduce problem behaviors while teaching appropriate replacement behaviors to ensure long-term maintenance of the behavioral improvements. Tins multi-component intervention addressed not only amethod for efficiently reducing dieproblem behaviors but also taught the replacement behaviors that could be used toaddress the same behavioral functions and maintain treatment gains over time, leading to the participants' ability to function appropriately in inclusive settings. More research relating to the most effective multicomponent intervention plans may helpchildren with autism and behavior issues make more rapid gains.

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