Managing the Behavior of Managing the Behavior of Children with DD or Autism and Children with DD or Autism and Severe Behavior: What the ____ Severe Behavior: What the ____

Are We Supposed to Do??Are We Supposed to Do??

Russell J. Kormann, Ph.D.Russell J. Kormann, Ph.D.Director - Project NSTMDirector - Project NSTM

Rutgers, The State University of New JerseyRutgers, The State University of New Jersey

Westwood Regional School DistrictWestwood Regional School District

Who is Kormann??

• Licensed Clinical Psychologist• State Certified School Psychologist• Served Autism/DD Community since 1986 • Director of Project: Natural Setting Therapeutic Management • Director of Rutgers School Consultation Program-Serving 20 School Districts• Regular Presenter and Consultant to Autism New Jersey (COSAC)• Fellow: American Association For Intellectual Disabilities• All Around Good Guy (Good Looking Too!)

Project: NSTMProject: NSTM

• A DDD funded, community-based A DDD funded, community-based intervention program serving individuals intervention program serving individuals with developmental disabilities/Autism and with developmental disabilities/Autism and behavioral challenges and their families.behavioral challenges and their families.

• NSTM seeks to transform the environment NSTM seeks to transform the environment in which the “problems” are identified (i.e. in which the “problems” are identified (i.e. the home) into a therapeutic one.the home) into a therapeutic one.

Meet Phillip

PARENTS PERSON WITH DD

Can wekeep him

home?

Who do welisten to?

(Consult with?)I want to be

like everybodyelse

PEERSPEERS

OCCUPATIONALOCCUPATIONAL

THERAPISTTHERAPIST

VOCATIONALVOCATIONAL

COUNSELORCOUNSELOR

NEUROLOGISTNEUROLOGIST

PHYSICIANPHYSICIAN

RELATIVESRELATIVESPSYCHOLOGISTPSYCHOLOGIST

TEACHERTEACHERNEIGHBORHOODNEIGHBORHOOD

SPEECHSPEECH

THERAPISTTHERAPIST

LAWYERLAWYER

SOCIALSOCIAL

WORKERWORKER

PSYCHIATRISTPSYCHIATRIST

PHYSICALPHYSICAL

THERAPISTTHERAPIST

THE MESS THAT IS THE MESS THAT IS ‘PROFESSIONAL INPUT’ ‘PROFESSIONAL INPUT’

BEHAVIORBEHAVIOR

CONSULTANTCONSULTANT

WHO IS THE EXPERT?WHO IS THE EXPERT?

• Physician

• Behavioral Consultant

• Teacher

• Parent

THE BEHAVIORAL CONSULTANT

• An individual with training in Applied Behavior Analysis (ABA)

• An individual with experience utilizing ABA skills in natural settings

• BUT… Can the expert REALLY know your home situation???

• So…Can he/she really be the expert?

So then…Who is the Expert??

YOU ARE!!

GUESS WHO GUESS WHO MUSTMUST DO DO THE WORK??THE WORK??

THE EXPERTTHE EXPERT

Critical Issues

Issue #1

Behavioral “Tips” Never Work

Responding to a behavioral event which is occurring RIGHT NOW!

ReactiveReactive -- --

• Act as firefightersAct as firefighters

• Always running to put out the next Always running to put out the next firefire

BURNOUTBURNOUT

Expectations

Stress

SupportCommunicationProblem Solving

Intervening before a

behavioral event takes place.

• Forces us to think of ways to prevent fires

ProactiveProactive----

Student with DD or Autism

REFERRAL BIASREFERRAL BIAS

FOUR FACTOR ASSESSMENTFOUR FACTOR ASSESSMENT

Target Problem

SYSTEM

BEHAVIOR MANAGER

If other than, or in addition to “Person”1.Parent2. Direct Care Staff3. Parent Surrogate

ENVIRONMENT1. People (ex. Parents, Neighbors)2. Places (Ex. Home, Neighborhood)3. Routine/Schedule

SYSTEM = THE GLOBAL CLIMATE IN WHICH THE OTHER THREE FACTORS EXISTSYSTEM = THE GLOBAL CLIMATE IN WHICH THE OTHER THREE FACTORS EXIST

i.e. Federal (IDEA, HCFA regs), State (Licensing Regulations & Budgets), i.e. Federal (IDEA, HCFA regs), State (Licensing Regulations & Budgets),

County (Zoning Laws), Treatment Philosophies .County (Zoning Laws), Treatment Philosophies .

SYSTEM

PERSON

Individual with a Developmental Disability

APPLIED APPLIED BEHAVIOR BEHAVIOR ANALYSISANALYSIS

A TREATMENT APPROACH THAT ATTEMPTS TO OBSERVE, IDENTIFY, AND UNDERSTAND BEHAVIOR IN A WAY WHICH

ALLOWS US TO CHANGE IT FOR THE INDIVIDUAL’S BENEFIT

Assumptions of ABAAssumptions of ABA

1. Concentrates on observable behavior only.

2. Behavior, adaptive and maladaptive, is learned.

3. People behave to satisfy needs/wants.

Issue #2

Behavior Must Be Understood Before We

Can Do Anything!

Issue #3

A Big “Chunk” of Behavior is Learned and

Functional

Issue #4

Therefore..it is Understandable and

Logical

FUNCTIONAL FUNCTIONAL ASSESSMENTASSESSMENT

A series of reports describing behavioral incidents as they occurred. These reports include a description of the variables that were in place before the incident began as well as those that followed the incident. A functional assessment, therefore allows one to understand the "function" which that behavior may have served for the individual.

ANTECEDENT (SETTING EVENT) -ANTECEDENT (SETTING EVENT) - The stimulus situation(s) which are associated with a behavior's presentation.

BEHAVIOR -BEHAVIOR - Choosing and operationally defining the behavior.

CONSEQUENCE -CONSEQUENCE - The stimulus situation(s) which followed the behavior.

Issue #5

Your Child Has Reinforcers..The

Negative Behavior Hasn’t Stopped

ANTECEDENT CHANGES

Individual Factors

• Psychiatric/Neurological Conditions• Medications (side effects &

changes)• Syndromes (Asperger’s)• Abilities/Disabilities• Schedules & Preferences

What “Sets Up” a Behavior?What “Sets Up” a Behavior?

1. An individual’s routine or schedule: What’s in it, in what order does each activity occur & does the person like his/her routine?

2. A person’s abilities: what is he/she good at?

3. A person’s disabilities: what’s hard for him/her?

4. What is the physical configuration of the person’s home environment?

5. Parent preparation

6. General response style of parents.

CONTINGENCY

MANAGEMENT

Contingency Management Options

There is a Requirement of Making Positive Behavior “Worthwhile”

Reinforcement Based Behavior Plans

Effective Use of Naturally Occurring Reinforcers

- We MUST be Creative

- Use people, activities and locations that are special

Importance of Differentially Based Outcomes

Have to Make the Negative Behavior Less “Valuable” than the Positive

Issue #6

Consequating (Punishing) Negative

Behavior Doesn’t Work!

PROBLEMS WITH PROBLEMS WITH PUNISHMENTPUNISHMENT

1. Slows Behavior--Does not necessarily eliminate it.

*How long does effect last?*

*Have you ever had to repeat the punishment?*

2. Individuals Tend to Habituate to Punishment.

*May require one to continually increase severity of punisher.*

3. Generates Escape Behavior

*Child may start to avoid you.*

4. Punishment Does Not Teach New Behavior

*Does not promote the acquisition of adaptive behavior.*

5. Provides a Model for Inappropriate Behavior

*Ever had a second child begin to act like the problem kid?*

Issue #7

Reinforcement is Good! The Goal is to Reverse the Value of Neg. & Pos.

Behavior

An increase in the occurrence of a behavior when it is immediately followed by some event

A REINFORCERREINFORCER – Anything that increases or maintains a behavior

KEY CONCEPTS TO REMEMBER:KEY CONCEPTS TO REMEMBER:FOLLOWS

INCREASESIF/THEN SITUATION

THE PRINCIPLE OF THE PRINCIPLE OF REINFORCEMENTREINFORCEMENT

THINGS YOU CAN DO AT HOME

Catch ‘em Being Good Always connect outcome to behaviorThink about behavior “functionally”Set up the environment to be successfulPrepare, Prepare, Prepare Have a crisis plan

REMEMBER……

The Goal is to Make Positive Behavior Valuable And to Make Negative Behavior “Worthless”Is Changing Behavior Worth Paying For??It Better Be….Or They Won’t Change!!Always Be on the “Lookout” for the Good Stuff…it’s There…if you Look Hard !

All Right We Get it BUT……We’re exhausted We don’t have the energy or the help to do this ALL the timeThe behavioral approach doesn’t always work…..sometimes he/she just doesn’t care!His/her behavior PISSESS ME OFFIt is causing other problems in my house (other kids modeling, marital problems, etc)

All Right We Get it BUT……

• Did I mention that I am PISSED OFF??• Oh, yeah, and BURNED OUT???

And Stay Tuned Because Summer is Coming………………

Yeah, But School is Ending and Yeah, But School is Ending and Summer is ComingSummer is Coming……

Summer represents a HUGE change in daily routine What plans have you made to replace your child’s daily activities Your child might not know or care about the calendar….Monday June 29 is just Monday for him/her and that means getting on a bus and going somewhereIf there is no camp/summer program, it is important to develop a “schedule” for your child at home

What the Heck Am I Gonna Do What the Heck Am I Gonna Do All Day???……All Day???……

Try and develop a few scheduled activities in the morning and several in the afternoon (it doesn’t have to a million things and they don’t have to be complicated) What you are trying to accomplish is a summer routine during which both you and your child has an idea about what is going to happen during the day (or evening) It gives you some comfort in knowing that there is a plan for the day and its not just 100 hours of Sponge Bob!

What the Heck Am I Gonna Do What the Heck Am I Gonna Do All Day???……All Day???……

This then gives you the opportunity to reinforce your child for positive behavior centered on these activitiesSet up mini-contracts based on these activities: “Remember, Bobby, as soon as we finish coloring these three pages, we’ll take a walk to the 7-Eleven for a piece of gum.”Use as many people and places outside of the home as you can to make the summer schedule attractive to both your child and YOU….it shouldn’t be just locking you up in the house waiting for bed time (starting at 9AM)

• Individual Behavioral Support ServicesIndividual Behavioral Support Services

• Group Training in Behavior Management, Group Training in Behavior Management, Staff Communication & BurnoutStaff Communication & Burnout

• On-Site Behavioral Consultation ContractsOn-Site Behavioral Consultation Contracts

Project NSTM ServicesProject NSTM Services

Contact:Russell J. Kormann, Ph.D.Director - Project NSTM

Rutgers, The State University797 Hoes Lane West

Piscataway, NJ 08854-8022732-445-2704

kormann@rci.rutgers.edu