Tag Archives: behavioral interventions

Building Variability Into The Routine

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Several years ago, I was working with a 6-year-old boy we’ll call Terrence. Terrence was diagnosed with autism. He was a very playful child who was generally good-tempered, enjoyed playing with trains and watching TV, and posed few difficult behavior issues for his parents…until the day there was construction on their walk from the grocery store to their apartment and they decided to take a different route home. What happened next is what most people would call a full-blown meltdown: Terrence dropped to the ground, screaming and crying, and refused to move.

 

Many of the parents I work with have a similar story when it comes to their child with autism and an unexpected change in the routine. The change varies: the favorite flavor of fruit snacks is out of stock at the store or the babysitter greeted the child at the bus instead of the parent or they grew out of the coat they wore the past two winters… In fact, it can be difficult to anticipate exactly what specific routine may be a trigger for your learner. This is precisely why building variability into the routine can be helpful.

Here are a few things to consider:

  • First, think about the routines that are the most likely to be interrupted. Make a list of these so you can begin thinking about how to address those issues.
  • Second, work with your team (whether that means family or practitioners that work with your learner) to select 2-3 routines to focus on first.
  • Discuss how those routines would most likely be interrupted. For instance, a favorite TV show may be interrupted during election season or you may have a family function when the TV show is aired. In teaching your learner to be flexible with changes in routine, you will contrive changes that are likely to occur to give your learner quality practice.
  • Plan to vary the routine. Essentially, you are setting up the change in routine, but you will be prepared in advance to help your learner behave appropriately. (You’re much more likely to experience some success in this scenario than you would be if a change in routine occurs unexpectedly and/or last minute.)
  • Give your learner a vocabulary for what is happening. I teach many of my students the term “flexible.” I might say, “I appreciate how you’re being flexible right now” or “Sometimes when plans change we have to be flexible. This means…”
  • Reinforce appropriate behaviors related to flexibility! You want to be clear when they’ve made an appropriate, flexible response. In the planning phase, you can discuss what appropriate reinforcers might be for the routines you are targeting.

If you build in variations in routine and teach your learner some strategies for being flexible, you and your learner are much more likely to be successful in navigating unexpected changes.

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.

Tip of the Week: Common Mistakes in Implementing Reinforcement

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Over the years, I’ve seen several behavior intervention plans written and implemented. Typically, these plans include reinforcement for the desirable behavior, but I see the same mistakes crop up again and again. Here are a few common mistakes in implementing reinforcement to look out for:Common Mistakes in Implementing Reinforcement

Fail to identify individual reinforcers. Hands down, the most common error I see is identifying specific activities or items as reinforcing. For instance, many people love gummy bears, but they make me want to puke. Presenting me with a gummy bear would not increase my future likelihood of engaging in the appropriate behavior! You must account for individual differences and conduct a preference assessment of your learner, then make a plan based on his or her preferences.

Fade reinforcement too quickly. Let’s say you’re working with a child named Harold who draws on the walls with crayon. You implement a reinforcement plan in which he earns praise and attention from his parent each time he draws on paper. The first few days it’s implemented, Harold’s rate of drawing on the wall greatly decreases. Everyone claims that his behavior is “fixed” and suddenly the plan for reinforcement is removed… and Harold begins drawing on the wall once more. I see this sort of pattern frequently (and have even caught myself doing it from time to time). After all, it can be easy to forget to reinforce positive behavior. To address this issue, make a clear plan for fading reinforcement, and use tools such as the MotivAider to help remind you to provide reinforcement for appropriate behavior.

Inconsistent with reinforcement plan. Harriet is writing consistently in a notebook, to the detriment of her interactions with peers. Her teachers implement a DRO, deciding to provide reinforcement for behavior other than the writing. However, the teachers didn’t notify all the adults working with her of the new plan, so Harriet’s behavior persists in certain environments, such as at recess, allowing her to miss multiple opportunities for more appropriate social interaction. To address this issue, make a clear outline of the environments in which the behavior is occurring and what adults are working in those environments. Ensure that all of the adults on that list are fully aware of the plan and kept abreast of any changes.

Don’t reinforce quickly enough. This one can be quite challenging, depending on the behavior and the environment. Let’s saying you’re working with a boy named Huck who curses often. You and your team devise a plan to reinforce appropriate language. You decide to offer him tokens that add up to free time at the end of the school day. However, sometimes as you are handing him a token for appropriate language, he curses again right before the token lands in his hand. Though it was unintentional, the cursing was actually reinforced here. Remember that reinforcement should be delivered as close to the desired behavior as possible. To address this issue, consider your environment and materials and make a plan to increase the speed of delivery.

Fail to make a plan to transfer to natural reinforcers. Ultimately, you don’t want any of these behaviors to change based solely on contrived reinforcement. Making a plan for reinforcement of appropriate behavior is essential, but your ultimate goal is to have the behavior be maintained by naturally occurring reinforcement. To address this issue, the first thing you need to do is identify what that naturally occurring reinforcement might be. For Harold, it might be having his artwork put up in a special place or sharing it with a show and tell. For Harriet it might be the interactions she has with peers on the playground. Once you have identified those reinforcers, you can create a plan for ensuring that the learner contacts those reinforcers over time. This might include pairing the naturally occurring reinforcers with the contrived reinforcers, then fading out the latter.

Ultimately, it’s important to remember that reinforcement is not as simple as it seems. Taking the time to plan on the front end will help with long-term outcomes.

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.

Regulating Sleep in Children with Autism

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With the new school year in session, it’s especially important to regulate sleep in students. In this month’s ASAT feature, Lauren Schnell, MA, BCBA, offers insight on a variety of approaches parents can take to address sleep disturbances in their kids with autism. 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!

I am a home program coordinator who works with a six-year old child diagnosed with autism. The parents are concerned because their child struggles at bedtime and will often wake up in the middle of the night to come into their room. The parents want their child to stay asleep and have tried everything to get him to stay in bed all night. What can I suggest they do to treat their child’s sleep behavior?

Answered by Lauren Schnell, MA, BCBA

Sleep disturbances in children with autism are a common concern for many parents. It has been estimated that approximately 25% of typical children between the ages of one and four struggle with nighttime wakings (Lozoff, Wolf, & Davis, 1985). For children with special needs, the number increases dramatically with upwards of 80% experiencing some type of sleep problems (Lamberg, 1994). Of those who frequently wake at night, the majority end up sleeping in their parent’s bed and the sleep problems often persist over time.

 

The good news is there are a variety of behavior analytic approaches found to be effective in addressing sleep disturbances in children with autism. An underlying premise of these approaches is that poor sleep patterns are learned, and, as such, can be unlearned.

Prior to implementing a behavioral sleep program, it is important to first rule out any medical reasons for the sleep disturbance, such as physical discomfort related to an illness. Discussions with a pediatrician should help to determine if the sleep issues may be associated with an underlying medical issue and if further testing or evaluation is warranted.

If the sleep issues are thought to be behavioral, the first step is to complete a sleep log to determine the extent of the problem and potential environmental factors that may be adversely affecting the child’s sleep. A sleep log outlines the time the individual is put into bed, the actual time he/she falls asleep, frequency of night wakings, and the duration of those awakenings. Additional information may be collected on any other behaviors which are observed during bedtime, such as tantrums during the bedtime routine or disruptive behavior during the night. Baseline data collection should continue until a consistent pattern of sleep (or lack thereof) or challenging behavior is apparent. This information can later be used to assess the effectiveness of the sleep intervention.

Some questions which may be helpful for parents in completing the sleep log are:

  • What time does the child go to bed?
  • What does the child do leading up to bedtime?
  • What else is going on in the home while the child is in bed which could be influencing his/her sleep?
  • What activities does the child engage in prior to falling asleep?
  • What time does the child awaken during the night as well as in the morning?
  • Does the child take naps during the day?

Based upon the results of the baseline data collected in the sleep log, a number of interventions may be considered. Below are several practical strategies which may be helpful to improve the sleep behavior of the child with autism.

Bedtime Routines
A bedtime routine can be helpful for the child, as it creates predictability in the sequence of activities leading up to bedtime. A written or visual schedule may be helpful in ensuring the routine is consistently followed. The schedule should outline activities preceding bedtime; for example, brushing teeth, changing into pajamas, saying goodnight to loved ones, and reading a bedtime story. The routine should begin at least 30-60 minutes prior to bed time. It is also recommended that parents eliminate all foods and drinks containing caffeine at least six hours prior to bed, and avoid rigorous activities during the later evening hours.

Initially, the child may need a high rate of positive reinforcement for following the routine. Eventually, the parent may consider providing the child with positive reinforcement the following morning if he/she successfully follows the nighttime activity schedule and remains in bed throughout the night. Such reinforcement might include earning access to a favorite breakfast cereal, a toy, or getting a sticker to put on a special chart upon waking (Mindell & Durand, 1993). Continue reading →

How To Have A Successful School Experience

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Every parent wants their child to succeed in school. The definition of success may differ from parent to parent, but most would agree that they want their child to get good grades, demonstrate good behavior and make friends. These desires are no different for parents who have children with developmental disabilities. So, how do you know if your child is ready and are there ways to predict how well they will do? Tools like the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP), which is one of the primary assessment tools used at the Behavior Analysis Center for Autism (BACA), can assist parents and professionals alike in assessing their child’s skills and providing them with valuable information as to what areas they can support their child to increase the chances of them doing well in whatever educational setting they may enter.

How To Have A Successful School Experience

General skill deficits will likely determine the educational placement of your child, but may not be the biggest issue at hand.

Behavior problems and problems with instructional control can cause significant barriers to achievement with grades, developing friendships and avoiding expulsion. Learned prompt dependency may make developing independence and responsibility more difficult. Failure to generalize already existing knowledge across multiple examples, people and environments will require more teaching time and may manifest inconsistent performance on tests and classroom work. If your child likes very few things, seemingly peculiar things, or has strong motivation for some things, but is unwilling to work to attain them, it may make it more difficult to motivate them to learn material that is presented. If your child is reliant on getting something for responding every time in order for learning to occur, the teaching process will likely remain a tedious one and decrease the likelihood that they will be able to maintain those responses when those incentives are not provided as frequently. Many children with developmental disabilities will rely on providing themselves with reinforcement in the form of self-stimulation when such dense access to preferred items or activities is not provided.

Overall skill level will undoubtedly increase the odds that your child will be able to manage good grades. However, their ability to acquire new material quickly and then retain that information for later use may play a more critical role in their long term accomplishment. Adapting to change quickly or ‘going with the flow’ will be critical when faced with day to day schedule changes that occur in classrooms or other instructional environments. General independence with functional skills such as toileting, eating and managing their personal items such as backpacks, folders, etc., will decrease the amount of time their teachers may need to focus on teaching these skills and allow more time for teaching other critical skills.

All of these things taken together can seem daunting, even for parents of typically developing children. The good news is that there are things that every parent can do to help. Perfect parenting is unattainable, but valiant and consistent attempts with certain things can go a long way. Allowing your child to experience the consequences of their behavior can be tough, but is central to ensuring that they will behave well when it counts. Having your child try things on their own before helping them and then only helping them as much as needed to get the job done whenever possible will foster independence. Exposing your child to new or different things within fun activities can increase the things they are interested in. Those things can then be used to motivate them to learn. Setting up opportunities for them to experience even small changes, modeling a calm demeanor and praising them for doing the same when unexpected things happen can also help.

Your child’s teacher or other professionals like Board Certified Behavior Analysts can aid you in thinking of other ways to enhance what you are already doing and assist in developing an individualized treatment plan to support you and your child.

WRITTEN BY MELANY SHAMPO, MA, BCBA

Melany Shampo is a clinical director at the Behavior Analysis Center for Autism in Fishers, IN.

This post first appeared on Indy’s Special Child. 

Is Inclusive Education Right for Children with Disabilities?

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This week, we’re honored to feature an article by Edward Fenske, MAT, EdS, the former executive director of the Princeton Child Development Institute, who shares his critique on the U.S. Departments of Health and Human Services and Education’s joint statement on inclusive education for all children with disabilities. Ed’s extensive experience in delivering intervention to children with autism, support services to their families, and training and supervision to professional staff spans 39 years. His published works address home programming, language development, and early intervention.

Is Inclusive Education Right for My Child with Disabilities?
by Edward Fenske, MAT, EdS
Princeton Child Development Institute

On September 14, 2015 the U.S. Department of Health and Human Services and the U.S. Department of Education issued a joint policy statement recommending inclusive education for all children with disabilities begin during early childhood and continue into schools, places of employment, and the broader community. The policy includes numerous assertions about the educational benefits and legal foundation of inclusion and a lengthy list of supporting evidence. This paper examines some of these assertions, the supporting evidence, and comments on the departments’ recommendation.

 

Assertion: Children with disabilities, including those with the most significant disabilities and the highest needs, can make significant developmental and learning progress in inclusive settings.

Supporting Evidence: Green, Terry, & Gallagher (2014). This study compared the acquisition of literacy skills by 77 pre-school students with disabilities in inclusive classrooms with 77 non-disabled classmates. Skill acquisition was assessed using pre/post intervention scores on the Peabody Picture Vocabulary Test, Third Edition (Dunn & Dunn, 1997) and the Phonological Awareness Literacy Screening Prekindergarten (Invernizzi, Sullivan, Meier, & Swank, 2004). The results found that children with disabilities made significant gains that mirrored the progress of their typical classmates, although the achievement gap between the two groups remained. Participants had a variety of diagnoses (e.g., developmental delays, autism, pervasive developmental disorder-not otherwise specified, speech and language impairments, cognitive impairments, and Down syndrome). There were several requirements for participation in this study that would appear to severely limit conclusions. Participants with disabilities were functioning at social, cognitive, behavioral and linguistic levels to the extent that their Individual Education Program (IEP) teams recommended participation in language and literacy instruction in the general education classroom with typical peers-an indication that these skills were considered prerequisite to meaningful inclusion.

A further restriction for participation was that only data from children who were able to complete the tasks according to standardized administrative format were included in the study. It is therefore unclear whether all students with disabilities in these inclusive preschool classes made significant developmental and learning progress. The authors suggest that had the lower achieving students received explicit, small group or individual instruction, the achievement gap between typically developing students and children with disabilities may have been narrowed. We can therefore conclude that regular instruction provided in the inclusive preschool classes in this study was not sufficient for all students with disabilities. Furthermore, because the results were not separated by disability, it is not possible to determine whether there was a significant difference in learning across disabilities.

Assertion: Some studies have shown that children with disabilities who were in inclusive settings experienced greater cognitive and communication development than children with disabilities who were in separate settings, with this being particularly apparent among children with more significant disabilities.

Supporting Evidence: Rafferty, Piscitelli, & Boettcher (2003). This study described the progress in acquiring language skills and social competency of 96 preschoolers with disabilities attending a community-based program. Sixty-eight participants received instruction in inclusive classes and 28 attended segregated special education classes. Progress was assessed using pretest and posttest scores from the Preschool Language Scale-3 (Zimmerman, Steiner, & Pond, 1992) and the Social Skills Rating System (SSRS)–Teacher Version (Gresham & Elliott, 1990). Level of disability (i.e., “severely disabled” or “not severe”) was determined by scores on the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-R), but the authors did not provide any information about the participants’ specific clinical diagnoses. Posttest scores were comparable for “not severe” students in both class types. Children with “severe” disabilities in inclusive classes had higher posttest scores in language development and social skills than their peers in segregated classes, but had higher rates of problem behavior. The extent to which problem behavior interfered with learning for both typical children and those with disabilities was not addressed. Problem behavior, such as tantrums, aggression, stereotypy, self-injury, property destruction and defiance; is displayed by some children with disabilities. These behaviors have very different implications for preschool-aged children than for older children. In this writer’s experience, severe problem behavior is extremely resistant to change when not successfully treated during preschool years and may ultimately result in more restrictive academic, vocational and residential placement during adolescence and adulthood. The significance of any academic gains by children with disabilities in inclusive settings should be carefully weighed against the long-term implications of unchecked maladaptive behavior.

Continue reading →

“From Panic to Progress: Supporting Students with Autism Who Escalate” by Patrick Mulick, BCBA, NBCT

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In this week’s guest article, Patrick Mulick, BCBA, NBCT explains the escalation cycle by which educators and caregivers can evaluate what to expect in their students’ behaviors and how to intervene in the most effective and least intrusive ways. We’ve also included FREE downloadable data sheets so you can try incorporating Patrick’s Escalation Cycle into your program!

From Panic to Progress: Supporting Students with Autism Who Escalate
by Patrick Mulick, BCBA, NBCT

As critical as it is to change the behaviors of those who escalate, it can be particularly hard to do so in those with autism. The antecedent (trigger) can range greatly from observable events, such as a puzzle piece not fitting properly to a private event that is difficult to predict (such as a strong discomfort from flickering lights in a room). The learner often will exhibit behaviors in attempt to escape the overwhelming experience that they have entered, but those behaviors are often uncoordinated, lack reasoning, and are unsafe. It is here that students may break windows, chase after staff, or hit themselves. And it is here where educators need to be at the top of their game to support a safe de-escalation.

This entails knowing the student, knowing their escalation cycle, and having a system by which one can continually evaluate the de-escalation strategies being used. Ten years ago I created the cycle below to help do just that. In many cases, it has been the starting point to great gains for my students who were prone to escalate.

Breaking down the cycle into five levels of observable behaviors allows for a much clearer understanding of what to expect. Identifying the appropriate interventions for each level allows for the actions of staff to be the least intrusive and the most effective. It is easy to be reactive in a moment of crisis, yet the moment calls for everyone involved to act in a prescribed manner. Whether it be dimming the lights, providing a break area, or clearing the room of other students, every intervention is with good purpose and good timing.

Visually representing all of this for an entire school team, from parents to principals, allows for a better common understanding of the plan and greater fidelity in its implementation. Any issues with ineffective supports used at the wrong times can be quickly weeded out, and any staffs’ fears who interact with the learner can be eased. To allow the school team more depth or specifics, this overlay can be used to spell out more details.

Escalation Cycle-2

Knowing that a plan is being implemented with higher fidelity, we can then begin to look at data. A standard A-B-C data sheet for specific incidents should suffice in tracking the plan’s effectiveness.

Where the above tools can help most significantly is in the coding of behavior clusters, which can then be tracked in the student’s day, such as on a chart similar to the below.

Escalation Cycle-3

As the student progresses through their tasks and activities, staff indicate the highest escalation cycle level the student reached, even if only for a moment (think partial interval recording). This tracking done all day, every day, provides teams with data that can inform the effectiveness of the de-escalation techniques being used. For example, learners with a tendency to become aggressive are generally perceived as escalating with high frequency. Utilizing objective data tracking can substantiate such subjective perceptions, more clearly showing the frequency of escalation behaviors and if they are improving week to week. Working from a place that is measurable and observable can help move your team from being reactive to proactive, fearful to confident, and from helpless to equipped.

WRITTEN BY PATRICK MULICK, BCBA, NBCT

Patrick is the Autism Specialist of the Auburn School District in Washington State. Over his twelve years as a teacher and consultant, he has grown to have a particular passion for equipping school teams that support students with autism. Patrick enjoys engaging educators through his hybrid of inspirational and instructional speaking. He is currently working toward becoming a certified member of the John C. Maxwell Leadership program. To learn more, visit his website at www.patrickmulick.com.

Tip of the Week: How to Implement a Successful Behavioral Intervention

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Creating a successful behavior intervention is more challenging than it first appears. Below, I’ve listed four essential parts for changing maladaptive behaviors and increasing desired behaviors. Most of the time, when a behavior intervention is not working, one or more of these steps has been neglected.

1.  Find a BCBA or ABA provider who can guide you through the process. Getting help from someone with experience in addressing challenging behaviors is an essential first step. They should be a wealth of information about each of the following steps, provide check-ins and troubleshooting during the intervention process, and maintain data on the behavior to insure the intervention is working.

2.  Identify the function of the behavior. There are four reasons that any of us behave: attention, escape/avoidance, access to a tangible (such as chips or a toy train), and automatic reinforcement (meaning physical sensations that are not related to social interactions, including sound, taste, touch, or a response to movement). A BCBA can be especially useful in helping to identify the function of the behavior. They may utilize an ABC chart to determine the function, which means they observe the behavior and note it’s antecedent, what the behavior looks like, and the immediate consequence. If the ABC chart is not helpful, they may perform a more formal Functional Analysis. Before any intervention is put in place, all parties interacting with the child should understand the function (or reason) for the problematic behavior.

3.  Provide a replacement behavior. As a part of the intervention, a replacement behavior should be provided. A BCBA or ABA provider should be able to help you find appropriate replacement behaviors for the problematic behavior. For example, with one student who was chewing his shirt, we introduced a replacement behavior of chewing gum. With another student who was throwing his iPad, we used tape to put an “X” on his desk and taught him to place it on the “X.” The idea is to provide an appropriate behavior that is incompatible with the problematic behavior. But that’s not always possible. For example, one of my former students was banging her head on the table during instruction. We taught her to request a break by touching a picture of a stop sign. Realistically, she was able to bang her head while simultaneously touching the stop sign, but once she learned that she got to escape the activity by touching the stop sign, she stopped banging her head in order to escape. It’s important to note that using the stop sign wouldn’t work for all head-banging behavior, but we had identified the function of the behavior and were able to introduce a replacement behavior that served the same function while meeting the skill level and needs of that individual student.

4.  Provide reinforcement for appropriate behavior. A specific plan for providing reinforcement for use of a replacement behavior and any other desired behaviors is essential. The reinforcement for the appropriate replacement behavior should serve the same function as the problematic behavior. This can sometimes be difficult to achieve, but without this aspect of intervention, you may see slow success, or no success at all.

Again, creating a multi-pronged intervention can be a challenge. It’s important to seek out help, and to take a look at research related to the problem behavior you are trying to address. It is possible to create a strong intervention that has a huge impact on your learner, but it must include the aspects listed above to have the highest potential for success.

WRITTEN BY SAM BLANCO, MSED, BCBA

Sam is an ABA provider for students ages 3-12 in NYC. Working in education for ten years with students with Autism Spectrum Disorders and other developmental delays, Sam has developed strategies for achieving a multitude of academic, behavior, and social goals.