Assessment and Treatment of Operantly Controlled Severe Problem Behavior Diana Davis-Wilson, M.Ed, BCBA 1 Goal of FBA is to. Produce statement that Describes problem behavior and context in which it occurs, and Leads to development of effective and efficient interventions. 2 FBA Process is Process for problem solving Conducted by a team Requires behavioral expertise Requires on-going monitoring 3 1
Guiding Behavioral Principles Human behavior is important, understandable, and predictable. Human behavior is learned. Human behavior is malleable and teachable. Human behavior does not occur in a vacuum it is affected directly by environmental events. 4 Understanding and Assessing Behavior 5 The 4-Term Contingency Motivating operation (MO) Antecedent (A) Behavior (B) Consequence (C) Basic unit of analysis in the analysis of operant behavior All ABA procedures involve the manipulation of one or more components of the 4-term contingency 6 2
Model of Behavior Context of Genetic Endowment Context of Individual s History of Learning Antecedents: (a) Motivating Operation (b) Discriminative Stimulus Behavior Consequence 7 Function vs. Topography Topography = form of the behavior Function = purpose of the behavior Different topographies of problem behavior Can serve the same function Can serve different functions Similar topographies of problem behavior Can serve the same function Can serve different functions Function is more important for intervention than form 8 Why do we behave? (Function) Escape/avoid (negative reinforcement) - Non-preferred people, places, activities, pain Access to preferred things: (positive reinforcement) Edibles (food) Tangibles (stickers, pencils, toys) Activities (recess, games) Sensory stimulation (positive reinforcement) Deep pressure, lotion on arms, back rubs, head rubs Social reinforcers, attention (positive reinforcement) Physical contact, proximity, attention, praise, reprimand It is important to note that reinforcement is relative across people 3
Responses 11/17/2015 Extinction Withholding of a reinforcement of a previously reinforced behavior Primary effect is a decrease in the frequency of the behavior Predictable responding under extinction conditions: Extinction burst Gradual reductions Spontaneous recovery Novel behaviors (e.g., aggression, property destruction, SIB) Behavioral & Academic Interventions, LLC all rights reserved, 2008 10 Extinction Burst Baseline Extinction Extinction Burst Spontaneous Recovery 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Sessions Behavioral & Academic Interventions, LLC, all rights reserved, 2008 11 What affects the effectiveness of extinction? Continuous reinforcement schedules (CRF) May produce behavior less resistant to extinction Intermittent Reinforcement May produce behavior that is more resistant to extinction The thinner the schedule, the more resistant to extinction the behavior will be Behavioral & Academic Interventions, LLC, all rights reserved, 2008 12 4
What affects the effectiveness of extinction? History of reinforcement Behavior with a longer history of reinforcement may be more resistant than behavior with a shorter history of reinforcement Response effort Behavioral & Academic Interventions, LLC, all rights reserved, 2008 13 Logic of function-based approach Behaviors are maintained by consequence events (function). Behaviors are occasioned by antecedent events. Changing behaviors requires consideration of maintaining consequences. Behavioral & Academic Interventions, LLC, all rights reserved, 2008 14 General FBA Process 15 5
Level of Precision Level of Difficulty 11/17/2015 Conducting an FBA Gather information via indirect and descriptive assessments Interpret information and formulate hypotheses Test hypotheses using functional analysis (ideal) or through some manipulation in the classroom measured by direct assessment Develop intervention options based on the function of problem behavior 16 1. Gathering Information Conduct functional assessment interview with individual s care providers Use this information to define target problem behaviors, identify and define potential antecedents and consequences, and to determine what other assessments.are warranted Conduct direct observations of the problem behavior within the natural routine Use this information to confirm/disconfirm information obtained in interviews 17 Continuum of FBA Methods Functional analysis Direct observation in natural routine Indirect Assessments 18 6
Conducting a Functional Behavioral Assessment Record Review Interview (FAIR-T, FAIR-P, RAIS-D) Rating scales (QABF/MAS/FAST) Interpret interviews and rating scales Observe ABC/Narrative Developing Hypothesis Activities or Events Associated with Problem Behaviors (MO) Lack of sleep Illness Hunger Trouble at home Fight/conflict with peers Noises or distractions Seating arrangement Negative events at home or elsewhere 20 Predictors (what sets the behavior off) Demands that are: Too hard Irrelevant Unclear Too long Reprimands Peer Taunting Low attention Transitions Interruptions 21 7
What does the person gain or avoid? What events consistently follow the occurrence of the behavior(s)? What does this person get or avoid by performing this behavior? 22 Functions of Problem Behavior Positive Reinforcement Getting something Negative Reinforcement Getting out of something These functions can be Socially mediated Non-socially mediated (automatic) 23 Activity Write down activities or situations that students gain for problem behavior. Write down activities or situations that students get out of for problem behavior. 24 8
Indirect FBA Methods Record review Structured interviews Checklists Rating scales Questionnaires These are all considered indirect because they do not involve observing the behavior; rather they involve soliciting another s recollection of the behavior 25 Record Review Medical history Identifies conditions that exacerbate problem behavior Provides data regarding previous and current medications prescribed to the client Social history Provides data concerning setting events or establishing operations that may be influencing the client s problem behavior 26 Record Review Disciplinary history Identification of patterns of behavior Identification of effective and ineffective strategies Knowledge of possible maintaining consequences Provides data concerning the progression of the client s problem behavior over time 27 9
Record Review Results of previous FBA or related assessments Monitor potential changes in function of problem behavior Provides history of behavioral intervention Previous interventions Which interventions have been effective or ineffective? Who was responsible for implementing the interventions? Where were the interventions implemented 28 Record Review Recent IEP Are the problem behaviors currently being addressed? Are data being collected on the student s target behavior? 29 Indirect Assessments: Interview Three key topics in the interview: A description of the problem behavior The triggers for the problem behavior The reaction the problem behavior evokes from others 30 10
Interviewing Tools Functional Assessment Interview Record for Parents / Staff (Edwards et. al., 1990) Combination of parents, staff, care givers completed rating scale and interview FAIR-T or FAIR-P (see packet) Covers topics including academic ability, medical information, behavior consequence history, reinforcers, daily routines, identification of target behaviors, and the antecedents and consequences contingent with target behaviors. 31 Questionnaires/Rating Scales Motivation Assessment Scale (Durand & Crimmins, 1988) See packet Functional Analysis Screening Tool (The Florida Center on Self- Injury; 5th edition, 2002) See packet Questions About Behavioral Function (QABF) (Volmer & Maison) 32 Questionnaires/Rating Scales Limitations of Questionnaires/Rating Scales Unreliable Results often do not match function of problem behavior obtained from functional analysis 33 11
Advantages of Indirect FBA Useful source of information for guiding subsequent, more objective assessments Contribute to hypothesis development regarding the variables that may occasion or maintain problem behavior Very convenient because they do not require direct observation of behavior 34 Limitations of Indirect FBA Informants may not be accurate Informants may be biased Little research exists to support the reliability of information obtained from indirect assessments Not recommended as principal means of identifying functions of behaviors. Best used for hypothesis development. 35 Descriptive FBA Direct observation of problem behavior under naturally occurring conditions Events are NOT arranged in a systematic manner Different Forms ABC Continuous Recording ABC Narrative Recording Scatterplot 36 12
Structured ABC (Antecedent-Behavior-Consequence) Analysis Form Date Individual: Continuous Time Staff Behavior (list specific problem): 1: 2: 3: Location where behavior occurred: Residence Worksite School Outside Community outing Other: General activity in progress: Leisure/solitary (TV, music, etc.) Leisure/social (with Meal (preparation, eating, cleanup) Self-care or household chore Academic, work, or training activity Residence: Use this form to identify situational factors related to the occurrence of a behavior problem. Each time a target behavior occurs, record the date, time, and your initials. Use check marks to identify the target behavior, location, activity, and what happened immediately before and after the behavior. Data on antecedents (As) and consequences (Cs) can be summarized in the boxes below. As and Cs are organized under likely behavioral functions (Note: some As or Cs may reflect more than one function). In each box, enter the number of times an A or C was checked (use the arrows as guides). Enter the overall totals at the bottom of each column. Pos. Reinf. Pos. Reinf. Neg. Reinf. Auto Reinf. Alone (sitting, in bed, etc.) Other: (attention) (materials) (escape) (sensory) Immediate antecedent: Ignored by staff or staff walked away --> Leisure material or ofod removed/denied --------------> Other request denied --------------> Given instruction/prompt to work --------------------------- Provoked by peer --------------------------- None (individual alone/doing nothing) --> ---------------------------- Immediate consequence: Attention, response block, told to "stop" --> Redirected to another area/activity --> --> Leisure material/food given --------------> Work requirement terminated --------------------------- Staff walked away --------------------------- --> Staff did nothing ----------------------------------------- Adapted from The Florida Center on Self-Injury (1995) TOTAL 37 Advantages of ABC Continuous Recording Uses precise measures Provides useful contextual information and correlations regarding environmental events and the problem behavior, which can provide useful information for later functional analyses Does not require disruption of the individual s routine 38 Limitations of ABC Continuous Recording Often, antecedents and consequences do not reliably precede and follow problem behavior, making correlations difficult to detect May use conditional probabilities Proportion of occurrences of problem behavior preceded by a specific antecedent Proportion of the occurrence of problem behavior followed by a specific consequence These may be misleading, however 39 13
ABC Narrative Recording Form Individual observed: Date: / / Narrative Observer: Time Begin: am/pm Time End: am/pm A-Antecedent B-Behavior C-Consequence (explain the events that come (explain exactly what the person (explain the events that follow the before the behavior) did or said the actual behavior) behavior or occurred as a result of the behavior) 40 Limitations of ABC Narrative Recording Utility in identifying behavioral function not established May yield false positives because data are collected only when problem behavior occurs The same antecedent and consequent events may be present when problem behavior is absent 41 Limitations of ABC Narrative Recording Reliability may be low Unless trained, observers may report inferred states rather than events It is often difficult to discriminate which environmental events actually occasion the problem behavior 42 14
Scatterplot Observer records the extent to which problem behavior occurred at the end of predetermined intervals of time Reveals temporal patterns of behavior associated with specific environmental events Provides information regarding optimal times to directly observe problem behavior Limitations: Does not identify specific behavioral antecedents or consequences associated with problem behavior 43 Scatterplot Data Sheet SCATTERPLOT Individual: Behavior: SCORING: Zero in box 0 = No occurrences Slash in box / = < 5 occurrences Filled in box = > 5 occurrences ----------------------------------------------------------------------------------------------------------------------------------------------------------------- -DAY/DATE TIME Activity/Location Comments 8:00-8:30 8:30-9:00 9:00-9:30 9:30-10:00 10:00-10:30 10:30-11:00 11:00-11:30 11:30-12:00 SCATTERPLOT Individual: Behavior: SCORING: Zero in box 0 = No occurrences Slash in box / = < 5 occurrences Filled in box = > 5 occurrences Format/Content Area Large group Instruction Small group instruction 1:1 instruction Independent activity Activity transition Setting transition Comments 44 2. Interpreting Information and Formulating Hypotheses Write hypothesis statements in ABC format Antecedent Behavior Consequence When Tonisha is prompted to wash her hands in preparation for lunch, she screams and tantrums, which is followed by termination of hand washing and lunch by being sent to time-out. Hypothesized function = escape from hand washing or lunch 45 15
Are these testable hypotheses? Carl talks to himself because he is socially maladjusted. Carol cries and hits her peers because she is immature. Hector is out of his seat and off-task all day because he has ADHD. 46 Testable Hypothesis Observable/measurable Able to be manipulated Environment/context focused Objective descriptions Lead to behavioral interventions 47 Are these testable hypotheses? Carl talks to himself when his teacher does not speak to him for more than 4 minutes. Carol cries and hits her peers when they call her a crybaby and stick their tongues out at her. During independent seat work, Hector leaves his seat when he s given more than 20 math problems to complete. 48 16
Activity Using the data from each ABC recording we did, develop a testable hypothesis for each student s behavior. What are the limitations of these hypotheses? 49 3. Testing Hypotheses Ideally, the most accurate method to test hypotheses is to conduct a functional analysis. While it was thought that it was difficult to perform in school settings, the practice is increasing. Often altering environmental conditions will indicate whether a hypothesis is correct. 50 4. Developing an Intervention FBA does NOT identify the interventions that will be effective DOES identify powerful reinforcers that can be used in intervention (i.e., it identifies the function of a behavior) 51 17
Functional Equivalence Intervention must match the function of the problem behavior If problem behavior = escape function Intervention should provide escape for alternative behavior OR alter task demands to make escape less reinforcing 52 Functional Equivalence Intervention must match the function of the problem behavior If problem behavior = gain function Intervention should provide desired outcome (access to attention or tangibles) for alternative behavior OR alter antecedent conditions to make attention and/or tangibles less reinforcing 53 ESCAPE/AVOIDANCE For Task Avoidance: Reinforce for Compliance Teach How to Seek Help Teach Acceptable Alternatives to Escape Reinforce for Absence of Problem Initially Remove/Reduce Task Demands and Then Gradually Introduce/Increase Demands For Social Avoidance: Pair Social Attention with Strong Reinforcers Reinforce for Compliance Reinforce for Absence of Problem Avoid Extinction (Ignoring) Timeout 18
ATTENTION SEEKING Increase Attention for Appropriate Behaviors Use Extinction on Problem Behavior Teach Acceptable Alternatives for Attention (Functional Communication Training) Use Timeout as Last Resort Avoid Verbal Reprimands Response Interruption/Redirection ACCESS (To Material, Activity, or Food) Deny Access (Extinction) Teach Acceptable Alternatives to Obtain Access Provide Frequent Non-Contingent Access Use Response Cost or Timeout as Last Resort Avoid Access to Material, Activity, or Food Following Problem Behavior SENSORY STIMULATION AND PAIN RELIEF Increase Access to Alternative Sources of Stimulation Interrupt/Redirect Behavior Use Differential Reinforcement Strategies Avoid Withholding Attention Timeout 19
Alter the ABC Contingency Antecedent Behavior Consequence When Deshawn is left alone with toys or work He hits others, which is followed by Attention in the form of a reprimand and discussion. 58 Alter the Antecedent Antecedent Behavior Consequence When Deshawn is left alone with toys or work He hits others, which is followed by Attention in the form of a reprimand and discussion. Deshawn is provided with a peer buddy during work/play periods These are irrelevant because problem behavior is avoided. 59 Alter the Behavior Antecedent Behavior Consequence When Deshawn is left alone with toys or work He hits others, which is followed by Attention in the form of a reprimand and discussion. Deshawn is prompted to ask a peer or adult to play/help, which is followed by Attention in the form of socialization and help. 60 20
Alter the Consequence Antecedent Behavior Consequence When Deshawn is left alone with toys or work He hits others, which is followed by Attention in the form of a reprimand and discussion. Neutrally blocking the hitting and ignoring Deshawn. 61 Develop Competing Pathways Summary Statement Components: Confirmed testable hypothesis Desired replacement behavior to be displayed in problem situation (behavioral objective) Alternative behavior that could achieve same outcome as problem behavior How IEP team meeting 62 MO Triggering Antecedents Behaviors Desired Replacement Consequences Typical Behavior Consequences Problem Behavior Acceptable Replacement Behavior 63 21
Summary Statement Desired Alternative Do work w/o complaints. Typical Consequence Points, grades, questions, more work. MO Triggering Problem Maintaining Antecedents Behavior Consequences Lack of peer contact for 30 min. Do difficult math assignment. Noncompliance, profanity, physical aggression, Avoid task, remove from class. Acceptable Alternative Ask for break, ask for help. 64 Activity Using the information for each student, develop a competing pathway summary for each student s behavior. Use the competing pathway summary sheets provided Provide function-based recommendations for each student. 65 Outcomes of a Functional Behavioral Assessment Operational definitions of problem behaviors Identification of events that reliably predict occurrence and non-occurrence of problem behaviors Identification of maintaining functions Hypothesis statement (summary of FBA information) Direct observation data confirming hypotheses Recommendations for behavior intervention plan 66 22
Putting it all together Summarize background information Identify and operationalize the target behaviors ABC data hypothesis statements Identify an intervention that aligns with the hypothesized function statement Behavior Intervention Plans 68 Purposes of Behavior Intervention Plan Define critical features of environments where the focus person will be successful. behavior intervention plans describe what we will do differently to establish these critical features Facilitate consistency across multiple implementers Provide professional accountability 69 23
Behavior Intervention Plan Related directly to FBA information Operationally defines problem behavior Defines hypotheses that guide development of all features of BIP Strategies for addressing Motivating operations Triggering antecedents All behaviors Maintaining consequences 70 Behavior Intervention Plan Focuses on identifying & teaching replacement behaviors Employs strategies that are least intrusive procedures likely to produce functional effect Describes specific behaviors expected of staff and context in which those behaviors should occur Is focused on overall improvement of client lifestyle in addition to reduction of problem behavior 71 Features of BIP Design Intervention procedures (that make the problem behavior irrelevant, inefficient, and ineffective). Client Factors (quality of life variables) Health and Physiology Communication Mobility Predictability Control/Choice Social Relationships Rich Activity Patterns (NCR) 72 24
BIP Design Intervention Procedures Design motivating operation strategies to eliminate or neutralize effects of motivating operations Less impact on routines and reinforcers Prevention (Make problem behavior irrelevant) Schedule Curriculum (content, sequence) Instruction Design antecedent strategies to make triggering antecedents irrelevant No longer serve as triggers 73 BIP Design Teaching New Skills (Make problem behavior inefficient) Replacement skills Maintained by same function as problem behavior More efficient than problem behavior Adaptive skills Design consequence strategies to make maintaining consequences ineffective Prevent reinforcement of problem behavior (make problem behavior ineffective) Less reinforcing Increase reinforcement of desired and replacement behaviors (make problem behavior inefficient) 74 BIP Design Negative consequences The use of socially acceptable punishers may be needed to prevent reward of problem behaviors Do not add negative consequences to the plan until the other parts of the behavior intervention plan are defined. Do not use negative consequences that result in pain, humiliation or tissue damage 75 25
BIP Design Safety Plan/Crisis Plan (if needed) Prevent damage to people, property Prevent reward of problem behavior Prevent defining events Evaluation and Assessment Define what information will be collected Identify who will collect the information Define when and how the information will be used for decision-making 76 BIP Design Is contextually appropriate Consistent with local values Efficient Minimally intrusive for client/staff/family Includes procedures for Accurate implementation Monitoring progress Adjustment of plan as needed 77 BIP Design Buy In Implementers involved in design of plan Plan consistent with values of implementers Plan consistent with skills of implementers Plan consistent with resources of implementers Plan consistent with administrative structure Plan perceived as: (a) likely to be effective and (b) in the best interest of the focus individual 78 26
Develop Details and Routines for Full Implementation of BIP Implementation Plan (Who will do what, when?) Schedule prep activities (e.g., communication system development) Schedule staff Schedule teaching times/curriculum Schedule monitoring Schedule data system design/use Schedule on-going times for assessment 79 Monitoring Issues Treatment analysis Is the intervention working do the data support continued use? Treatment Integrity Is the intervention being implemented? Correctly Consistently Procedural Drift 80 Book References Books Carr, J. E., & Wilder, D. A. (2003). Functional assessment and intervention (2 nd ed.). Homewood, IL: High Tide. Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied Behavior Analysis (2 nd ed.). Upper Saddle River, NJ: Prentice Hall. O Neill, R. E., Horner, R. H., Albin, R. W., Sprague, J. R., Sotrey, K., & Newton, J. S. (1997). Functional assessment and program development for problem behavior: A practical handbook (2 nd ed.). Pacific Grove, CA: Brooks/Cole. Pryor, K. (1999). Don t shoot the dog: The new art of teaching and training (rev. ed.). New York: Bantam. 81 27
Articles Iwata, B. A., Dorsey, M. F., Slifer, K. J., Bauman, K. E., & Richman, G. S. (1982/1994). Toward a functional analysis of self-injury. Journal of Applied Behavior Analysis, 27(2), 197-209. 82 28