Challenging Behavior in Natural Settings: PBS: What the Research Says

Kathryn Hoover, Ph.D.

Radford University, Radford, VA

April 30, 2008

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Introductions and Overview First, who I am Next, who are you? Overview

Rationale for addressing challenging behavior Discussion/Definition of terms found in the research Research based steps to Positive Behavior Support

with group work to practice each step in the process

I hope one of you will provide us with a case study so we can apply these strategies to real life situations. Please remember to respect the confidentiality of the child and family (no identifying information), and to describe objectively what the behavior looks like—just what can be seen, try not to interpret yet.

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What Children Need (and Seek) Children need to be able to predict and control

as much as they can in their world How do infants control parent behavior (when hungry,

tired, dirty diaper, frightened, etc.—what do they do? And what do parents do?). Children become adults.

Did you make your own decision to come to this workshop? How important is the control of your life to you? It is important to children, too!

To be predictable, the environment needs to be consistent, and provide structure and choices within limits Research shows that teachers respond more

predictably to challenging behavior than appropriate (Jolivette, Stichter & McCormick, 2002; Nielsen & McEvoy, 2004)—given that, how do you think a child who needs predictability is more likely to act if they need predictability: appropriately or ?

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Why is it important to address challenging behavior?

What children risk if they take challenging behaviors to day care, preschool, school: Rejection by peers (and by programs!) Negative interactions (relationships) with teachers: sets

children up for negative relationships in future Probable negative impact on family and family

relationships (for all members) Risk of later substance abuse, delinquency,

unemployment, etc. (Powell, Fixsen, Dunlap, Smith & Fox, 2007)

What can we do? Positive Behavior Supports in all environments (focus

time and attention on prevention of challenging behavior: how to do it) (Boulware, Schwartz & McBride, 1999).

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First, Some Definitions PBS Terminology Handout Terms you will hear as we discuss PBS and FBA:

PBS: Positive Behavior Support/s FBA (Functional Behavior Assessment) Challenging Behavior: (why not ‘misbehavior’?) Environment (includes surroundings, people, things) Antecedent events or triggers Consequences Positive Reinforcement (reinforcers) Punishment Function of a Behavior

Attention, escape, tangible, sensory

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Just a few more Definitions Replacement Behavior (communication

included) Altering antecedents (environment) Family-Centered Intervention: COLLABORATION

Contextual fit: any plan to address challenging behavior must fit into the needs of the child AND the family, and the abilities and comfort in implementing the plan of family members; and fit into the routines and daily work of the family

Shared decision-making and responsibility Why is this crucial? Research shows that families can learn to conduct

FBA’s and implement Behavior Intervention Plans (Tyrell, Horn & Freeman, 2006)

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OK, now let’s get to it! Prevention of Challenging Behavior at Home or

in a Program (child care, classroom): Focus on Teaching Social Skills to Prevent

Problem Behavior First, identify the social behaviors that you want the

child to learn (communication is a social behavior) Then, Teach those behaviors: all adults use the same

language: “’We say please when we want’ (a toy)” Respond consistently to appropriate prosocial

behavior –give the child feedback so she knows how she is doing (remember, if we are only consistent when we ‘punish’ they will seek punishment when they need predictability)

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Instruction in Discipline First, set up a few simple rules (pick your battles): state

what the child is to do (not what she is to not do) Example: “Toys are for playing” “Hands stay on your own body”

“Feet stay on the floor” “Walking feet in the hall”

Next, decide how you will respond to the child when a rule is ‘broken’ (natural fit, not punishment for children under 18 months-2 years, do-able, and all commit to do it)

TEACH the desired behavior, don’t just expect the child to learn it without instruction

Then ALWAYS respond as planned when a child breaks a rule (act, do not react: not in anger); explain why the consequence is being delivered, and how to avoid in future: “If you throw a toy, the toy is gone for now. Are you all done? Then show (or tell) me ‘all done.’”

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What if it doesn’t work? FBA Basic Steps of FBA (based on Boulware, et al., 1999)

Identify the problem (define the behavior) Gather information: observations, checklists, interviews Brainstorm possible functions and possible solutions Make a plan Implement the plan Evaluate the results

Steps of FBA Handout 1 Does anyone have a situation you would like to

share with the group? Then you will do this as small groups for another child: real life or case study

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Steps of FBA: Identify the Problem Identify the Problem

With family, decide what the problem is: sometimes clear (aggression) sometimes not clear (tantrums at ‘unpredictable’ times: transitions/change or “No” etc.)

Helps to identify when it occurs, with whom, and what it looks like (tantrum: what does it mean?)

Very important also to know when the behavior DOES NOT occur!

So with our case study: What is the problem? What does it look like? When does it occur? With whom? (with what?) When does it NOT occur? Now, with your handout 1, get in groups and do as small

group (10 minutes)

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Next Step: Gather Information & Hypothesis Gather Information

Interviews (formal or informal) with family, other care givers, (bus driver, etc. for school setting)

Motivational Assessment Scale: MAS (handout is old version): several who interact with child complete

Observation: ABC chart (handout) Antecedent—what happened before behavior Behavior (describe what you see) Consequence—what happened after, which is

probably reinforcing the behavior, to keep it effective The Consequence often then becomes the

Antecedent for the next cycle of ABC

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Gathering Information and Hypothesis Also need to ask:

How does the child communicate? All behavior communicates—is lack of appropriate communication a major factor in the behavior?

What predicts the behavior?

Hypothesis: When _________ happens (antecedent), the

child ________________ (behavior) in order to

get ________________(consequence); therefore the

function of the behavior is _________________.

For our case study child, can we hypothesize?

So now, with FBA Handout 2: complete—10 min.

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Step 3: Make a Plan

The Purposes of the Plan are: A. Prevent the challenging behavior; B. Help the child be successful in the situation; C. TEACH a REPLACEMENT (appropriate)

behavior which will serve the same function (achieve same goal); and

D. what will you do if the behavior still occurs (sometimes called ‘crisis intervention plan’)

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A) Prevent the Behavior (most important!)

First, Look at the environment: what are the antecedents (triggers) and can any of them be changed so the behavior is reduced? Can you: Change the room arrangement; amount of materials, location Adapt the schedule (are you rushing the child when he needs

more time for an activity? Do you plan nap time after outside?) Modify activities or tasks: is it too hard? Too easy? Boring? Provide cues for the child: transition cues: verbal, visual, model Ignore inappropriate behavior if not harmful or destructive Redirect or distract the child Remind child/ren of the rules, teach/review the rules before

situation; point out appropriate behavior (target behavior) Give choices: a very effective preventative strategy (McCormick,

Jolivette & Ridgeley, 2003)

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Prevent: Offering Choices Helps promote self-determination, gives ‘control’—

prevents or resolves a lot of power struggles! Opportunities can you give a child to make a choice?

1) Order of tasks, materials (which color?)2) Where to do it (living or kitchen?)3) Person to go/do with

4) Partner (peer)5) Which activity afterwards6) When to take a break7) When to end and do something else

“Do this or go to time out” is NOT giving choices! Choices must be honored –don’t offer if not available Who should ultimately control the child’s activities,

career, life when she is an adult? So teach now.

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Skills children need to be able to make choices

Be aware of the options (understand) Show them object, activity, or picture if they

understand pictures

They need to have favorites (preferences) Activities, events, people, objects

Be able to show you their choice Reach for it, point to it, gesture, name it

Be able to make a choice when offered options Be able to engage in the choice (play with it) You can teach any of the above

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Choices Young children need choices within the activity

or right before the next activity For example: the child does not like his bath:

“Joey, do you want Daddy or Mommy to give you a bath today?” (only if both are available)

Or: a child does not like to come in from outside, so a few minutes before it is time to go inside, ask “Carrie, do you want to watch your movie or help me with dinner when we go inside?”

The adult controls the choices, but give the child control over which to choose, and honors the choice.

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B & C: Help the Child be Successful: Teach

Prevention is a major part of success for the childTeach a Replacement Behavior is the next most

important part of the PlanFirst identify what behavior will achieve the same goal

(perform the same FUNCTION)Then decide how best to TEACH the child that behaviorIs it a need to ask for a break? Understand the schedule

or order of the day? Have control over some part of the task? (choices) Need more sensory input?

Tell the child what she can do, show her what to do, and practice (role play) what she can do (when she is calm, and teachable)

Include exactly what to say to the child in the plan

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D. Crisis Management Plan What will you do if you try all of these things (or until the plan

has been developed and is in place) when the behavior occurs?

Needs to be respectful of the child: feelings, needs, age appropriate, not punishment but consequences to protect the child and others—this is a temporary stopgap Example: interrupt the behavior: “You may not ________ because

_________” and physically walk the child to the quiet area “You are _________ (label the emotion), let’s go to the quiet area until you are calm (define: “your voice is quiet” or “your feet are quiet”) then we will talk”. If child can be left, leave, if not stay and provide gentle physical support, not punishment, just help to be calm, while protecting yourself) then come back (or when calm) praise for regaining calm, and redirect or calmly review rules, encourage to try again, etc.

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Prevent, Teach, Crisis Management

So with our case study child, what might we do to prevent the behavior?

What behavior might we teach him or her? How? What can we do if it occurs before learning takes

place? (Crisis Management Plan) With Handout 3, answer these questions in your

group—NOTE that at every step you will ask the family if it will work for them—they will implement

AND Complete the Support Planning Chart 15 minutes

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Implementation and Program Evaluation

Now, with the plan developed, it is time to prepare to implement the plan

First, all those who will implement (family, child caregivers, teachers, therapists, etc.) need to be comfortable, and feel they can do it!

May need support to change the environment, change the way they talk to the child, etc.

Decide how it will fit into the routines of life May want to practice: role play child, parent or

teacher, and let them practice the plan Role play crisis intervention implementation

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Evaluating the Plan After implementation begins, evaluate the plan Handout 4: Evaluation: You want to know: 1—How effective is the plan

Is the behavior happening less frequently? Is the child learning and using the replacement

behavior? Is the child more successful?

2—Is the problem solved to the satisfaction of the family (and teacher if appropriate) Is the behavior decreased enough? Does the

intervention fit with daily life activities in the family (classroom), etc.

If not, go back to brainstorming; create another plan

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Positive Behavior Support Works!

Remember, challenging behaviors have been developed over time, and it will take time and work to re-teach the child appropriate behavior

The adults must change their behavior first (ignore, redirect, change antecedents, teach, etc.) before the child’s behavior will change

Putting the effort into changing antecedents is worth the effort—it may be all that is needed!

Remember, it is for the child’s future! Please complete my evaluation before you

leave, thank you.