ADHD AND BEHAVIOR CHANGE STRATAGIES

Thomas J. Power

The Children’s Hospital of Philadelphia and University of Pennsylvania

John C. Lestino

District School Psychologist

Edgewater Park School District

Psychoeducational Interventions By Change Agent

Strategy Interventionteacher-mediated instructional match .

contingency management daily reports/home-school

notes

contingency contracting

computer assisted instruction

parent-mediated goal setting

contracting

peer-mediated peer tutoring

cooperative learning

self-directed self-monitoring

Functional Behavior Assessment(Nelson, Roberts, & Smith, 1998)

• Why conduct an FBA?– All behaviors occur for a reason because they serve a purpose for

an individual.– An understanding of why and how a behavior serves a particular

purpose for a student is critical in developing an intervention plan that is more likely to be effective for a student

– Systematic way to select intervention procedures that will be maximally effective

• What is an FBA?– Series of assessment procedures that identify environmental

factors that serve to maintain a problem behavior(s) for an individual.

– Collaborative process

Steps to conducting an FBA and developing an intervention

(Nelson, Roberts, & Smith, 1998)

• Problem identification and definition– prioritize problem behavior

– objectively define target behavior in measurable, observable terms

• Problem analysis – what is the function of the problem behaviors and what events are

related to them?

– validate and clarify information from problem identification

• Development of intervention

• Progress Monitoring

Common Functions of Behavior

• Escape/Avoidance– school work and task demands

– social situations

• Attention– adult

– peers

• Access to an object or activity

• Autonomic Reinforcement (self-stimulation)

• Multiple Functions

Functions of BehaviorEscape/Avoidance

• Activity (e.g., academic demands)– student wants to escape performance situation

– guiding principles for intervention:• do not reinforce the student’s avoidant behavior

• reinforce student’s attempts to engage in academic demands (giving breaks contingent upon work completion)

• support student’s efforts to meet the academic demands (breaking up work into smaller quantities; reducing numbers of problems on the page; providing choices on a menu)

Functions of BehaviorEscape/Avoidance

• Social (e.g., school avoidance)– student wants to avoid social situation (may be

related to anxiety)

– Guiding principles for intervention:• do not reinforce the student’s attempts to avoid the

social situation

• reinforce student’s attempts to stay in social situation

• teach student skills to help promote tolerance to social situation (e.g., progressive muscle relaxation, guided imagery, role playing, social skills training).

Functions of BehaviorAttention-Peer & Adult

• Student is more likely to engage in the behavior when peer and/or adult attention is provided

• Guiding principles for intervention: – Increase opportunities for non-contingent

attention (show and tell, peer tutoring)– Provide attention contingent on responsible

and adaptive behavior

Functions of BehaviorAccess to an Object or Activity

• Target behavior occurs most often when a desired object or activity is unavailable

• Target behavior occurs least often when a desired object or activity is available

• Guiding principles for intervention:– do not provide access to the object or activity

contingent upon the target behavior– teach an alternative behavior to request access to the

object or activity– provide access to the object or activity contingent

upon appropriate behavior

Functions of BehaviorAutonomic Reinforcement

• Target behaviors occur for an intrinsic reason (e.g., daydreaming stemming from boredom)

• Guiding principles for intervention:

– prevent the behavior from occurring with antecedent interventions--enrich the environment (e.g., CAI; hands on activities)

– interrupt the behavior (verbal redirection; telling the child what to do not what not to do)

– reinforce the student when he or she exhibits appropriate behavior

Advantages to FBA

• A good start to help address many school-based problems

• Empirically supported decision-making process to select among a multitude of interventions– Helps to select efficient and effective

interventions– Beats a “fishing trip expedition”; “trial and

error”; “plan and hope”.

Limitations to FBA

• Time comsuming process• Requires a certain amount of training • Requires teacher participation• Typically, a child’s cognitive processes are

not assessed or considered when conducting an FBA

• Generalizability across time and settings cannot be assumed

Behavioral Interventions

Teacher-Mediated• Proactive strategies to classroom management

– Instructional Match– Giving Instructions– Choice Making– Computer Assisted Instruction

• Consequence oriented strategies to classroom management– Token Economies/Response Cost– Contingency Contracting– Daily Reports/Home-School Notes

Instructional Match

• Correspondence between child’s instructional level and the difficulty level of curriculum materials

• Curriculum-student mismatch can result in task avoidance, inattention, misbehavior

• Strategy to prevent attention and behavior problems is to present material at a level that matches the child’s ability to learn

Guidelines for Determining Instructional Match

• Instruction of children– known material - 80%– unknown material - 20%

• Independent activities– known material - 95%– unknown material - 5%

Presenting Instructional Material

• Keep instruction brief• Organize material - talk in outlines• Differentiate key points from exemplars• Use novel methods, humorous examples• Use multisensory methods• Frequently check for understanding

– Rapid-fire questioning– Brief written tasks

• Vary instructional pace in response to student need• Provide frequent opportunities for feedback; praise

understanding and effort

Choice Making as an Academic Intervention

• Antecedent intervention strategy• Helps children exert control over their

environment in a positive manner• Received a lot of attention in literature for

students with severe disabilities• Research with higher functioning students with

emotional and behavioral difficulties has demonstrated that this is a promising strategy