THE ABC’S OF ADDRESSING

CHALLENGING BEHAVIOR:

WHY CHALLENGING BEHAVIORS OCCUR AND STRATEGIES SUPPORT

STAFF CAN IMPLEMENT TO PREVENT THEM

Sally Michelle Radford, MA, BCBA

An interactive, hands-on workshop designed to teach participants how to address common functions of problem behavior in children with Down syndrome. Particular emphasis will be placed on strategies to prevent and treat problem behavior maintained by attention and escape. Learn how to use your child's unique motivation to maximize learning and social opportunities.  

CHALLENGING BEHAVIOR

“…behavior by a learner that results 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 & Reichle, 1991, p. 215)

BEHAVIORAL PHENOTYPE OF INDIVIDUALS WITH DOWN

SYNDROME Dykens (1995) defined

behavioral phenotype as “…the heightened probability or likelihood that people with a given syndrome will exhibit certain behavioral and developmental sequela relative to those without the syndrome” (p. 523).

BEHAVIORAL CHARACTERISTICS THAT ARE

MORE LIKELY Attention problems Social withdrawal Noncompliance Compulsions High rates of repetitive behavior Behaviors associated with anxiety,

depression, and withdrawal increase with age

Avoidance behaviors Misuse of social behaviors

BEHAVIORAL CHARACTERISTICS THAT ARE

MORE LIKELY Avoidance behaviors seem to start in infancy

(Wishart, 1993a, 1993b) Children with Down syndrome tend to avoid

task demands that are slightly above their current skill level beginning in infancy.

In combination with this, they tend to misuse social behaviors.

Enhanced social motivation Poor communication skills Poor ability to read emotions Sleep disorders and frequent illness may also

contribute to higher rates of challenging behavior.

BEHAVIORAL PHENOTYPE

Not all individuals with Down syndrome with develop this unique pattern of strengths and weaknesses.

Given the increased likelihood, intervention must start early to make sure that the foundational skills necessary for life long learning are not compromised.

OTHER IMPACTS OF CHALLENGING BEHAVIOR Limited access to typical community

and educational settings Kids who have access to general

education settings tend to have better outcomes.

Challenging behavior is usually the reason for removal from these settings.

HOW WE RESPOND TO CHALLENGING BEHAVIOR WILL DETERMINE

WHETHER OR NOT IT PERSISTS

Intervention must begin early Behavioral interventions used for

individuals with developmental disabilities found to be effective with children with Down syndrome.

Based on functional assessment Addresses characteristics of behavioral

phenotype Uses careful manipulation of the

environment and strategic reinforcement to shape the behaviors we want more of and to reduce or eliminate challenging behavior.

WHAT ARE THE FOUR MAIN FUNCTIONS OF PROBLEM

BEHAVIOR

Socially mediated positive reinforcement

Socially mediated negative reinforcement

Automatic positive reinforcement

Automatic negative reinforcement

SOCIALLY MEDIATED POSITIVE REINFORCEMENT

AttentionTangible itemsAccess to preferred activities

SOCIALLY MEDIATED NEGATIVE REINFORCEMENT

Escape from non-preferred activities, environments, and people

Avoidance of non-preferred activities, environments, and people

AUTOMATIC POSITIVE REINFORCEMENT

To get access to something (Out of seat to get a pencil)

Doing it feels good (talking, tapping, fidgeting, stims, etc…)

AUTOMATIC NEGATIVE REINFORCEMENT

Relieves some discomfort (scratch an itch, rub temples)

Turns off an aversive stimulus (putting seatbelt on)

TWO MOST LIKELY FUNCTIONS OF PROBLEM BEHAVIOR FOR INDIVIDUALS

WITH DOWN SYNDROME

Socially mediated positive reinforcement

Socially mediated negative reinforcement

Otherwise known as Attention Avoidance

SOME COMMON FORMS OF CHALLENGING BEHAVIOR

Escape/AvoidanceSitting downSwiping materials off the tableOther property destructionHead downAggression and self-injurySelf-stimulatory behaviorsTeeth grindingThrowing itemsTurning awayOthers?

SOME COMMON FORMS OF CHALLENGING BEHAVIOR Misuse of social behaviors: Children

may also use social behaviors to distract the instructor in an effort to avoid the task or gain attention.Prolonged eye contact with instructorSmilingBlowing raspberriesClappingHuggingStarting conversationComplimentingOthers?

SOME COMMON FORMS OF CHALLENGING BEHAVIOR Attention Seeking Behaviors:

Approaching a forbidden or dangerous areaHittingBitingTouching forbidden itemsThrowing itemsCrying Others?

HOW ARE THESE BEHAVIORS LEARNED?

REINFORCEMENT A functional relationship between two

environmental events: a behavior and a consequence

This relationship is termed reinforcement only if the response/behavior increases or maintains its rate of occurrence as a result of the consequence

POSITIVE REINFORCEMENT

The contingent presentation of a stimulus immediately following a response that increases the future rate and/or probability of the response

PRIMARY REINFORCERS Stimuli that have biological importance

to an individual Described as natural, unlearned, or

conditioned reinforcers. Given their biosocial importance, we assume that they will be highly motivating

Examples: foods, liquid, sleep, shelter, sex

SECONDARY REINFORCERS Include social stimuli such as words,

phrases, the opportunity to engage in preferred activities

Also, a symbolic representation, such as a token, exchangeable for another reinforcer.

Do not have biological importance to individuals; their value has been learned or conditioned

Examples: music, computer time, stars, tokens, money

NEGATIVE REINFORCEMENT The contingent removal of an

aversive stimulus immediately following a behavior

Such that the behavior increases in the future

Whereas in positive reinforcement, a stimulus is added (i.e., positive), in negative reinforcement, an aversive stimulus is removed or taken away (i.e., negative)

CONTINGENT REINFORCEMENT PROCEDURES Important for interventionists to be

prepared to respond when the child engages in appropriate behaviors.

Important for interventionists to know how to respond if the challenging behavior does occur.

GIVEN WHAT WE KNOW ABOUT THE BEHAVIORAL PHENOTYPE, HOW CAN WE

PREVENT OR MINIMIZE CHALLENGING BEHAVIOR

Attention: behaviors maintained by access to attention, especially that of caregivers.

What typically happens? The child engages in challenging behavior and the caregiver inadvertently reinforces the behavior. For example:

When parent is busy with household chores, the child climbs onto a chair to reach the kitchen counter. The parent notices and immediately goes to the child and says, “No, no. That’s dangerous! We don’t climb on chairs,” while moving the child to a safer place.

What just happened? What’s wrong with this?

GIVEN WHAT WE KNOW ABOUT THE BEHAVIORAL PHENOTYPE, HOW CAN

WE PREVENT OR MINIMIZE CHALLENGING BEHAVIOR

Attention: Caregivers frequently respond to

challenging behavior with proximity, and both verbal and physical attention. This makes it more likely that the child will repeat the behavior in the near future.

What could be done differently?Remove the child from the dangerous

location silently and without making eye contact.

Give lots of attention every time the child is playing in a safe location.

GIVEN WHAT WE KNOW ABOUT THE BEHAVIORAL PHENOTYPE, HOW CAN WE PREVENT OR MINIMIZE CHALLENGING

BEHAVIOR

Escape/Avoidance: Behaviors maintained by the removal of or avoidance of non-preferred or slightly difficult tasks.

What typically happens? When given a task to do, children engage in challenging or “charming” behavior to get the adult to terminate the lesson or to make it easier. For example:

A parent is trying to teach the child to walk nicely to the car from the house. Every time they leave the house, the child drops to the floor just outside the front door. The parent, in a rush, picks the child up and carries her to the car.

What just happened? What’s wrong with this?

GIVEN WHAT WE KNOW ABOUT THE BEHAVIORAL PHENOTYPE, HOW CAN

WE PREVENT OR MINIMIZE CHALLENGING BEHAVIOR

Escape/Avoidance: Caregivers/teachers frequently respond to challenging behavior by giving up on the lesson or by making it easier. This makes it more likely that the child will do it in the future.

What could be done differently? Make the task easier from the beginning by

teaching one part at a time. Carry the child close to the car, and then have her walk the last part of the way to the car. Praise her abundantly when she does.

Follow through. If she drops to the floor, gently prompt her to stand up (silently and without eye contact). Never carry her at this point.

ATTENTION Since we know that many children with

Down syndrome are highly motivated by attention, it should be delivered following appropriate behavior and especially used to reinforce new or more challenging skills.

By dosing kids with attention when they are doing the right things, they will do more of those things AND they will be less likely to seek attention using challenging behavior.

We must identify the challenging behaviors that are used to gain attention and be sure to not systematically reinforce them.

ATTENTION Deliver following appropriate behaviors Give healthy doses at the right time

decreased motivation. Don’t follow challenging behavior with

attentionEye contactProximityPhysical contactVocalizationEmotional intensity

ESCAPE/AVOIDANCE From a very early age, demands should be

broken down into small parts that are easy. When a demand is placed, the adult should

follow through always. If necessary, prompt the response and provide reinforcement when the child does what you asked.

Slowly increase difficulty over time and shape approximations to the skill you are trying to teach.

Be vigilant about not giving in to “charming” behaviors designed to distract from the demand.

ESCAPE/AVOIDANCE Address task difficulty Increase difficulty slowly over time Use prompts to ensure correct

responding Follow through Use reinforcement to increase

behaviors you are trying to teach. Don’t give in to “charming” behaviors

designed to distract you.

TEACH REQUESTING From infancy, babies learn to communicate

using eye gaze, gesture (pointing), and vocalization to request items, activities, and attention. Teach this systematically in infants with Down syndrome.

Vocal imitation may be a pivotal skill-it leads to the acquisition of other good skills.

Will lead to less challenging behavior if kids have a vocal repertoire with which to learn other skills.

Motor imitation skills are usually strong. Teach first, then vocal imitation to make it easier.

DECREASE SELF-STIMULATION

Children with Down syndrome may engage in a variety of different self-stimulatory behaviors such as rocking, talking to self, teeth grinding, tongue clicking, hands in mouth, etc…

What works? Interrupt gently (without attention)Prompt a more appropriate behavior Reinforce

WHAT CAN WE DO TO TREAT NEW BEHAVIORS THAT ARISE?

Define the behavior operationally Assess the behavior functionally Address antecedents and setting events Decide on skills to be taught

(replacement behaviors) Decide on consequences

For replacement behaviors (reinforcement!)

For challenging behaviors (no reinforcement)

FUNCTIONAL BEHAVIOR ASSESSMENT

Process of determining the relationship between events in a person’s environment and the occurrence of challenging behaviors

Behavior is affected by what happens before it (antecedent variables) and what happens after it (consequent variables)

What is regularly associated with the occurrence and nonoccurrence of problem behavior?

THE FUNCTION INFORMS THE TREATMENT: HOW DO WE DETERMINE WHAT THE

FUNCTION OF THE BEHAVIOR IS?

Functional Assessment and Analysis Interviews

Consider variables of setting, time, people, tasks, and transitions

Consider setting events Consider motivating operations

ABC observations Antecedent, behavior, consequence

Functional Analysis Test each of several conditions to see in which

one behavior is highest.

SETTING EVENTS Remove the setting event (e.g., ensure

good night sleep, medication is taken) Neutralize the effect of the setting event

(e.g., relaxation routine, provide food or medication, allow for a nap)

Remove stimuli that occasion problem behavior when setting event present (e.g., change in schedule, reduce demands)

Increased the rewards available for appropriate behavior when setting event present

ANTECEDENT STRATEGIES What can you do to set up the situation

so problem behavior is less likely to occur?

What can you do to set up the situation so appropriate behavior is more likely to occur?

OFFERING CHOICES

Choices may be the most effective strategy to reduce noncompliant/oppositional responding

Choices can be offered on where to do a task, when, with which materials, how, and with whom

Generally, forced choices (e.g., “You can have the red or blue pencil”) produce more compliant behavior than “yes/no” choices (e.g., “Do you want to get your pencil?”)

PREFERRED ITEM AS DISTRACTOR In situations in which student

engages in challenging behavior, identify point at which behavior is likely to occur

Identify set of preferred items that do not interfere with target activity

Engage student with preferred item prior to point where he/she is likely to engage in challenging behavior

E.g., cassette player while riding bus, play game on computer while put on his/her orthotics

HIGH PROBABILITY REQUEST SEQUENCE

Identify set of high probability requests Identify set of low probability requests Ensure validity of those request Implement high probability requests

(followed by praise) followed by low probability request

Teacher Student Teacher

“Show me thumbs up”

Puts thumb up “Great job!”

“Give me five” Gives teacher five “Perfect!”

Touch your nose” Touches nose “Wonderful!”

“Put your books away”

Puts books away “Hurrah!”

COLLABORATIVE ACTIVITY Identify an activity that the student

does not like to perform or complete Split the responsibility of the task Gradually require the student to take

on more and more of the task independently

E.g., teacher puts blocks away while student puts animals away, teacher writes first sentence student writes second sentence

FUNCTIONAL COMMUNICATION TRAINING

Teaching communicative equivalents

to make the display of problem

behavior inefficient. Reinforcement is given (i.e., function

is met) quickly for communication Communication can be verbal,

gestural, sign, token, etc. Reinforcement is withheld for

problem behavior

CHOOSING AN APPROPRIATE RESPONSE

Functional equivalence = both problem behavior and replacement behavior serve the same purpose and both are successful in getting the need met for the student

Both problem behavior and replacement must occur in the same context and result in the same consequences

CHOOSING AN APPROPRIATE RESPONSE

The alternative behavior must be efficient, from the child’s perspective, in meeting the child’s need

VARIABLES INFLUENCING THE EFFICIENCY OF A COMMUNICATIVE REPLACEMENT: Response Effort

Immediacy of Reinforcement

Rate of Reinforcement

Quality of Reinforcement

SKILL BUILDING STRATEGIES Replace challenging behavior with

appropriate skillsCommunicationSocialPlay skillsAcademic

INTERVENTIONS FOR ESCAPE BEHAVIOR

Skill Building Teach communication skills to:

Temporarily delay the task (“break”) Gain assistance (“help”) Provide visual cues to prompt

communication (e.g., break cards) Teach task organization skills Teach coping skills for when task is

unavoidable Teach tolerance for the activity

(gradual)

Food Toys Activity

  

   

  

   

  

   

  

   

  

   

Drink Physical Social

  

   

  

   

  

   

  

   

  

   

Other items Self-Stimulation  

  

   

  

   

  

   

  

   

  

   

Reinforcer List and Pairing Data SheetStudent name: ________________________________________Consider what the student also enjoys at home and indicate it. (H: Home, S: School)

1.  2.  3.  4.  5.  6.  7.  8.  9.  10.  

Social Games and Charming BehaviorsList out the social games and behaviors that your child/student enjoys. These can be used as powerful reinforcers to teach new skills. Also, a great way to remember not to reinforce when child is avoiding a task.

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Tasks and activities that my child/student avoidsList out the activities and tasks that your child avoids, does not respond to, or engages in challenging behavior during.

Behavior Support Plan

Behavior Function Setting Events

Antecedents Skills Reinforcers Consequences

Sits down during afternoon PT and won’t get up   

Escape from difficult PT activities.

Very tired by 4pm. Give a nap from 1-3. Go to bed 15 minutes earlier at night.

Play favorite music when PT starts.

Teach her to ask for a break using 2 break cards. Break task into shorter parts

Dancing in between activities “tea party” juice break. Smiles, hats, clink glasses.

If she sits down, shut music off, prompt to stand back up and finish. No attention.

        

         

        

         

        

         

        

         

Scenario #1 Your toddler is beginning to drop food off of the high chair tray onto the floor when he is finished eating.  

Scenario #2 You want to teach your child how to put her shoes on independently.

Scenario #3 Your 10 month old loves to read books with you. You want to use this as an opportunity to teach communication. What can you teach at this age? How would you do it?

Scenario #4 During your daily playtime with your 18 month old, you notice that rather than engaging with you and with the toys, she is playing mostly with her own hands. You want to do something to stop this and get her to play with toys.