Your Behavior Plan Made Everything Worse!

“We have been working with a behavior analyst and it seems like every time they give us a new behavior intervention things just get worse, not better. What gives?”

Well, if you are working with a Board Certified Behavior Analyst, I’d like to believe that the interventions they are recommending for you are good ones. (i.e. research-based, effective, only have behavior analytic principles). So it’s likely that you are just experiencing an extinction burst.

Got it? Okay, now go do the steps your behavior analyst gave you.

Wait, what? You don’t know what an extinction burst is? Let me try to clear things up for you a bit.

Here is the definition of an extinction burst (Cooper, Heron, & Heward, 2007): an increase in the rate of responding when reinforcing consequences are withheld after the occurrence of the target behavior.

Basically, things usually get worse before they get better.  Great news, I know.  You’re welcome.

Why is this? Let’s try an example to make sense out of this technical stuff.

What if my daughter screeched and yelled every time she saw something on the kitchen counter? I could give her the item each time she screamed. She would then be quiet.  But who wants to live with a toddler who screams and yells constantly for things that are out of reach?

So one day I realize this isn’t a great plan and decide to teach her a replacement behavior- to ask nicely for things. I stop giving her the item every time she yells and instead wait for her to ask nicely for it.

What do you think will happen first? She’ll scream louder and longer. This has worked for her for so long that she just increases the intensity of the problem behavior to try to get access to the items out of reach (aka the reinforcers for the problem behavior). This is the extinction burst.

My daughter is probably thinking, “This screaming thing has worked forever. I just need to do it louder and more often to make sure she hears me and gives me what I want!” My girl gets louder and louder and eventually stops, realizing that the stuff just isn’t coming.

The behavior got worse before she recognized that screaming was not going to get her access to the desired item.

In behavior analytic terms:

Child screaming = problem behavior

Me giving her whatever she wanted= reinforcer

I stop providing the reinforcer to try to extinguish the behavior = intervention

Child screams louder and longer= extinction burst

Child stops screaming altogether= success

Now what would have happened had I given in to the louder screaming? Next time my daughter saw something she wanted, she would probably start screaming at the louder volume immediately to get access to the reinforcer, the preferred item.

I would have to stay strong and make it through the loud screaming without giving in so that the problem behavior would stop.

If I want this plan to be successful – if I want her to ask nicely for things – I need to stay strong through the increased screaming. Eventually she will realize that the screaming just isn’t working and that all she has to do is ask nicely for items. We can move on with our lives and be ready to teach more appropriate behaviors with less screaming and yelling involved.

The exact same thing applies to the interventions your behavior analyst is recommending. If the problem behavior gets stronger, more frequent, more intense, more anything as soon as you stop reinforcing it – you’re doing the right thing!

Stick to your guns, even though it can be really hard. Follow the steps your behavior analyst laid out and ride the wave of the extinction burst. To decrease that problem behavior and replace it with something appropriate will be so very worth it.

If an extinction burst leads to an increase in aggression, unsafe behaviors toward self or others, or a level of problem behavior you cannot reasonably live with – talk to your behavior analyst. Let them know what will or will not work for your child or your family and work together to create a plan that will work.

Extinction bursts aren’t fun for anyone. But replacing a problem behavior with something functional for your child is worth it. You can do it!

Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied behavior analysis.

Lerman, D.C., & Iwata, B.A. (1995). Prevalence of the extinction burst and its attenuation during treatment. Journal of Applied Behavior Analysis, 28, 93-94.

Lerman, D.C., Iwata, B.A., & Wallace, M.D. (1999). Side effects of extinction: Prevalence of bursting and aggression during the treatment of self-injurious behavior. Journal of Applied Behavior Analysis, 32, 1-8.

This piece originally appeared at www.bsci21.org. 


About The Author 

Leanne Page, MEd, BCBA, is the author of Parenting with Science: Behavior Analysis Saves Mom’s Sanity. As a Behavior Analyst and a mom of two little girls, she wanted to share behavior analysis with a population who could really use it- parents!

Leanne’s writing can be found in Parenting with Science and Parenting with ABA as well as a few other sites. She is a monthly contributor to bSci21.com , guest host for the Dr. Kim Live show, and has contributed to other websites as well.

Leanne has worked with children with disabilities for over 10 years. She earned both her Bachelor’s and Master’s degrees from Texas A&M University.  She also completed ABA coursework through the University of North Texas before earning her BCBA certification in 2011. Leanne has worked as a special educator of both elementary and high school self-contained, inclusion, general education, and resource settings.

Leanne also has managed a center providing ABA services to children in 1:1 and small group settings. She has  extensive experience in school and teacher training, therapist training, parent training, and providing direct services to children and families in a center-based or in-home therapy setting.

Leanne is now located in Dallas, Texas and is available for: distance BCBA and BCaBA supervision, parent training, speaking opportunities, and consultation. She can be reached via Facebook or at Lpagebcba@gmail.com.

Being Realistic about Changing the Environment

Recently I visited the home of one of my clients. I asked the RBT working there if our client was still throwing materials. She said he hadn’t thrown anything all week. I was excited to hear this news, until I heard her next sentence. “I realized he always throws the materials when he asks to be all done and I say ‘not yet.’ So now, whenever he says he’s all done, we just clean it up.”

While it is true that behavior analysts make changes to the environment to improve behaviors, that doesn’t mean we change the environment at the expense of teaching new skills. Our ultimate goal for any client is that they lead as independent a life as possible. For this particular client, I hope that one day he will be employed. This means that we need to start teaching him now that sometimes he will have to complete a task, even when he doesn’t feel like it.

So how do you know when you’re being realistic about changing the environment?  Here are a few questions you should ask yourself:

Is the environmental change I’m suggesting something that will be implemented in the natural environment? If no, then you should think about how to shape appropriate behaviors rather than simply avoid the problematic behavior. For this client, refusing to work further would not be acceptable in a school or in future work environments. It could also potentially result in more restrictive learning environments for the client.

In what future circumstances might this behavior cause problems for my client? If you can envision scenarios in employment, social situations, or in public, then you need to focus on teaching an appropriate behavior rather than simply avoiding the problematic behavior. Furthermore, thinking about these circumstances may help you identify potential replacement behaviors that you can teach.

How can I shape an appropriate behavior? Think about the steps you can plan for shaping a replacement behavior. For instance, with the example of my client, we could start by requiring him to complete one more simple instruction before putting the activity away (such as placing one more puzzle piece, responding to one more question, or imitating one more action.) After he’s mastered that step, we could increase the requirement to completing two more simple instructions, then to working for one more minute, then two more minutes, etc. We can implement a systematic plan for teaching an appropriate response and completing the work even if he doesn’t want to anymore.

Is what I’m asking reasonable? In another case, one of my clients’ goals was to pull her hair back into a ponytail independently. The intention behind this goal was to do it in situ, when she would naturally be pulling her hair back. However, the implementation of the goal resulted in her practicing pulling her hair back and taking it down multiple times. Her hair would often tangle and she would feel pain while taking her hair out of the ponytail. It’s fair to say that asking a client to put up and take down her hair several times is an unreasonable request. If your request isn’t reasonable, think about how to change it so the client still learns the skill without it becoming aversive.

Ultimately, we should not change the environment in order to avoid behaviors, unless there is something unreasonable or unnecessary about what we are requesting the client to do. It is our job to teach the client how to communicate effectively, as well as to teach and reinforce appropriate behaviors to promote independence.


WRITTEN BY SAM BLANCO, PhD, LBA, BCBA

Sam is an ABA provider for students ages 3-15 in NYC. Working in education for twelve years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges.

Back to School!  Using Behavioral Strategies to Support Academic Success

 

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Back to school is an exciting time for students and teachers, but those with learning differences might find it stressful to start a new school year with new faces, rules, and expectations.  Fortunately, there are behavioral support strategies that can help to smooth the way for a fun, productive year of learning.  Following are some research-based methods to consider.

  • Choice

One of the easiest ways to help students to succeed in school is to offer choices!  Dunlap at el. (1994) found that students were more engaged in tasks and less disruptive when offered choices of activities.  Giving students choices of activities that all achieve the same learning objective is a great way to facilitate engagement and ownership of task outcomes.  Students who can pick how they learn something may be more enthusiastic about learning overall.

  • Momentum

Another great way to get compliance with task demands is to use the strategy of momentum.  This involves asking the student to do tasks that he is likely to comply with, before asking him to do things that are harder.  For example, a teacher might present a coloring activity to a student who likes to color, and then praise him for completing that activity.  The next activity could then be something a little harder and less preferred, like spelling, but now the student has a history of reinforcement for compliance and so is more likely to continue to comply.  Lipshultz and Wilder (2017) offer a review of the recent research in this area.

  • Task Distribution

Sometimes stretching learning out over multiple sessions and across days can be helpful.  Some research shows that distributed learning, where students are given instruction on the same skill for several days, is more efficient and effective than massed learning, where students are given lengthy instruction on the same skill all at once (e.g., Haq et al., 2015).  For students who struggle in a particular area, consider shorter, more frequent opportunities to practice and learn. 

Given thoughtful supports and reasonable, meaningful accommodations, students with learning challenges can be successful and happy in school.  Adding some strategies like the ones described here can make for a fun and productive year!

 

References

Dunlap, G., DePerczel, M., Clarke, S., Wilson, D., Wright,S., White, R., & Gomez, A. (1994). Choice making to promote adaptive behavior for students with emotional and behavioral challenges.  Journal of Applied Behavior Analysis, 27, 505–518.

Haq, S. S., Kodak, T., Kurtz-Nelson, E., Porritt, M., Rush, K., & Cariveau, T. (2015).  Comparing the effects of massed and distributed practice on skill acquisition for children with autism.  Journal of Applied Behavior Analysis, 48, 454–459.

Lipschultz, J. & Wilder, D. A. (2017).  Recent research on the high-probability instructional sequence:  A brief review.  Journal of Applied Behavior Analysis, 50, 424–428.


About The Author 

Dana Reinecke is a doctoral level Board-Certified Behavior Analyst (BCBA-D) and a New York State Licensed Behavior Analyst (LBA).   Dana is an Assistant Professor and Department Chair of the Department of Special Education and Literacy at Long Island University Post.  Dana provides training and consultation to school districts, private schools, agencies, and families for individuals with disabilities.  She has presented original research and workshops on the treatment of autism and applications of ABA at regional, national, and international conferences.  She has published her research in peer-reviewed journals, written chapters in published books, and co-edited books on ABA and autism.  Current areas of research include use of technology to support students with and without disabilities, self-management training of college students with disabilities, and online teaching strategies for effective college and graduate education.  Dana is actively involved in the New York State Association for Behavior Analysis (NYSABA), and is currently serving as President (2017-2018).

Medication Considerations

What do you do when your doctor recommends medication? In this month’s ASAT feature, Megan Atthowe, RN, MSN, BCBA, offers insight on a variety of approaches parents can take when medication is recommended for children exhibiting aggressive behaviors. To learn more about ASAT, please visit their website at www.asatonline.org. You can also sign up for ASAT’s free newsletter, Science in Autism Treatment, and like them on Facebook!


My son with autism has developed aggressive behavior, and his doctor is considering whether medication could help. What can I do to prepare for this conversation?
Answered by Megan Atthowe, RN, MSN, BCBA

doctor-563428_960_720First, you should know that there is no medication that specifically treats autism. Medications approved by the United States Food and Drug Administration (FDA) for other conditions can be useful only to lessen symptoms. That said, off-label use of pharmaceuticals is by no means unique to autism and is common practice for many health conditions. So while research on the use of particular psychotropic medications in the autistic population is growing, our body of knowledge is still limited. In addition, medications can and do affect every individual differently, and children can respond differently as they develop, so it is likely to take time to find the best medication at the appropriate dose. Medication management, in other words, is a complex and an ongoing process and one that is highly individualized. It is a good idea, then, to be prepared with the right information before every visit to your health care provider.

Do you know how often the aggression actually occurs? Bringing data like this to the visit can be very helpful. You may want to ask your son’s teachers to share any information they have about the aggression with your health care provider, too. (They would need your consent to talk with him/her or to share any confidential information such as behavior data.) If you have not been keeping track of the aggression, now is a good time to start, even if there are only a few days until your visit. An easy way to do this is to use a calendar. Record specifics about when the aggression happens, what the behavior is like, how long it lasts, and whether you have noticed any recent changes. It is difficult for anyone to recall these details accurately, especially if the behaviors happen frequently, so writing them down will help you to share the most meaningful information you can with your health care provider. If your son’s school team is not already collecting data, perhaps they should start as well.

In addition to information about the current levels of the behavior, be prepared to describe how the school and your family are addressing the behavior and how long that plan has been in place. Has your son’s team considered or tried Applied Behavior Analysis (ABA) to treat the behavior? Research supports ABA as an effective intervention for decreasing problem behaviors such as aggression as well as for teaching children with autism new skills. It is important to be sure that a qualified behavior analyst is supervising any ABA interventions, as they must be implemented correctly to be effective. Your health care provider may be able to refer you to a local ABA provider, or you can find a list of board certified behavior analysts at the Behavior Analysis Certification Board’s website.

Before your visit, prepare a list of the names and doses of any medications your son takes, as well as any over-the-counter medications, vitamins, or other supplements. If your son receives other therapies, share what they are with your health care provider. He or she will want to ensure that any new medication is safe to take and will not interact with other medications.

If you and your health care provider decide to start your son on a medication, decide what the goal is. How will you know when the medication has been effective? How will you know if it is ineffective? Be specific and write the goal down. Schedule a date when you will check in with your health care provider on your son’s progress. He or she may have specific suggestions about what type of data to keep.
Finally, there are some important questions that you should have the answers to before you leave. Make sure that you ask any questions you have—a responsible health care provider will want to know that you understand how to use the new medication correctly. If you think of questions later, do not hesitate to call and ask your physician, nurse, or pharmacist.

Key Questions:

  • What is the name of the medication?
  • What is the medication used for?
  • When and how should I give it to my son, and how much do I give?
  • Should I give this medication with food?
  • What effects should I expect to see?
  • What are common side effects?
  • How long will it be until I notice the desired effects and side effects
  • What side effects are serious, and what should I do if I notice them?
  • Will side effects lessen over time?
  • Is there anything I should avoid giving my son while he is on this medication?
  • If I decide that I would like to stop giving him the medication, what should I do?
  • What should I do if I miss a dose?

Please note that there is information about research related to medications elsewhere on the ASAT website.

ABOUT THE AUTHOR

Megan Atthowe, MSN, RN, BCBA, LBA, is a registered nurse and behavior analyst who has worked with people with autism and other special needs in educational, home, and healthcare settings for over 15 years. Currently she consults to educational teams who serve students with autism in public schools.

How To Prepare To Reinforce Appropriate Behavior

Often when we’re working with children with autism there are two areas we focus on: communication and play. However, due to the nature of your day or a specific activity, you may unintentionally punish spontaneous communication or play. So before we learn how to prepare to reinforce appropriate behavior, let’s consider a couple of examples:

How To Prepare To Reinforce Appropriate Behavior

Julie is a teacher in a first grade classroom with six children with autism. One of her students is Marcos, who rarely uses spontaneous language. While Julie is running the morning meeting, Marcos suddenly interrupts and says “I like elephants.” Julie says, “It’s quiet time, right now, Marcos.”

David is a teacher in a fourth grade inclusion classroom. Jaylene is a student with autism who rarely initiates interactions. He is speaking with another teacher when Jaylene approaches with a puppet, hands it to David, and says “puppet.” David tells her, “In just a minute, Jaylene.”

 In both of these instances, the teacher has not done anything wrong. In fact, we have all done this from time to time in the midst of busy days in which we’re managing multiple tasks. But there’s an argument to be made here that both Marcos and Jaylene missed opportunities for reinforcement of the behaviors we most want them to exhibit.

One thing that can help is to prioritize your goals. If the primary goal for Marcos is to use spontaneous language, then when we start out we want to provide a continuous rate of reinforcement. This means that it will sometimes interrupt other tasks, but if it is the biggest priority, that’s okay! The long term gains of reinforcing Marcos’s spontaneous language likely outweigh the frustration of an interrupted lesson.

The second thing that can help is communicating the priorities to other adults and staff. If David lets other teachers and administrators know that Jaylene’s foremost goal is to initiate interactions related to play, then a brief interruption in a conversation should not be an issue. Again, the long term gains of reinforcing Jaylene’s initiation of play likely outweigh any issues around an interrupted conversation.

Finally, try to plan ahead. Think about instances in which the child is most likely to engage in the targeted behaviors and talk with staff about how to ensure reinforcement takes place. The last thing we want to do is to unintentionally punish the desired behaviors.

WRITTEN BY SAM BLANCO, MSED, BCBA

Sam is an ABA provider for students ages 3-15 in NYC. Working in education for twelve years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. Sam is currently a PhD candidate in Applied Behavior Analysis at Endicott College. She is also a lecturer in the ABA program at The Sage Colleges.