v preventing and addressing challenging behavior in children with autism glen dunlap and phil strain...
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vPreventing and Addressing Challenging Behavior in
Children with Autism
Preventing and Addressing Challenging Behavior in
Children with Autism
Glen Dunlap and Phil StrainPresented at the 2009 OSEP Early
Childhood Conference
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v
www.challengingbehavior.org
Purpose of PresentationPurpose of Presentation
Describe issues related to problem behaviors and ASD
Present a multi-tiered model of prevention
Discuss implications for practice
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AgendaAgenda
Introduction
Autism and Challenging BehaviorChanging Perspectives
A Model of Prevention
Implications, Directions and Conclusions
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4 Main Messages4 Main Messages
The best way to address challenging behaviors of children with autism is with a multi-tiered (hierarchical) framework of prevention and intervention
A sensible and effective (evidence-based) approach to intervention is positive behavior support
Families are essential elements of children’s lives, and are deeply affected by challenging behaviors and by interventions*
A vital challenge is to help systems (e.g., schools) establish responses to ASD, and challenging behavior, that are: (a) fully incorporated into the system, (b) effective, and (c) sustainable 5
Autism Spectrum Disorder(s)
Autism Spectrum Disorder(s)
A diverse syndrome involving problems with the development of communication and social relatedness… as well as restricted interests and perseverative and stereotypical patterns of behavior
ASD encompasses a great range of abilities and disabilities
For instance, some children with ASD have very serious risks for challenging behavior; others have relatively mild risks
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Challenging BehaviorsChallenging Behaviors
Destructive BehaviorsAggression; SIB; Property Destruction
Disruptive BehaviorsLong tantrums; Loud, Repetitive Noises; Running, etc.
Irritating & Interfering Behaviors“self-stim;” repetitive and perseverative speech or actions, etc.
Social WithdrawalLack of responsivity and initiations
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Importance of Challenging Behaviors
Importance of Challenging Behaviors
Barrier to Inclusion, Community Participation, and Social Opportunities
Most Significant Impediment to Education Present Physical & Emotional Risk for Individual
and for Families, Teachers, Other Professionals, Peers and Friends---------------
Need to Prevent/Resolve Challenging Behaviors as Early and as Thoroughly as Possible
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It is important to appreciate that challenging behaviors seriously detract from:
• all aspects of social/emotional/intellectual development
• opportunities and quality of life of children• quality of life of the children’s family
members….
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vSome Changing Perspectives on
Autism and Challenging Behaviors
Some Changing Perspectives on
Autism and Challenging Behaviors
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Early (1st Generation) Perspectives
Early (1st Generation) Perspectives
• Challenging Behaviors are “part of autism”• Not “diagnostic”, but “characteristic”
• Intervention = contingency management• Largely reactive
• Reinforcement (DRO) for desired behavior (or absence of problem behavior)
• Time out, extinction, or punishment for problem behavior
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1st Generation Effects1st Generation Effects
Often, short-term beneficial effects
But usually without maintenance or generalization
Occasionally ineffective, leading to escalating intensity of rewards and negative consequences
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Changing (2nd Generation) Perspectives
Changing (2nd Generation) Perspectives
I. Challenging behaviors are not “part of autism”
II. Challenging behaviors: (1) are maladaptive ways of responding to inadequacies in the environment, (2) occur due to lack of socially-adaptive skills for controlling environment
III. Children with autism are at high risk for developing challenging behaviors due to difficulties with learning, communication, and perception
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Changing Perspectives (continued)
Changing Perspectives (continued)
Intervention involves PREVENTING problem behaviors from developing or occurring by:I. Arranging the environment so that
challenging behaviors are unnecessary (and desired behaviors are encouraged), and
II. Teaching skills needed to navigate and control the social environment
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3rd Generation Challenges3rd Generation Challenges
Developing Strategies for Incorporating Effective Prevention Practices into the Systems that Affect our Service Delivery
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Multi-tiered Prevention Frameworks
Multi-tiered Prevention Frameworks
Increasingly common (e.g., community health; school-wide PBS)
Basic framework has 3 levels:1) Universal strategies (primary prevention)--- for
everybody; low intensity prevention practices
2) Targeted strategies (secondary prevention) --- for particularly high risk groups; higher intensity
3) Indicated strategies (tertiary prevention/ intervention)--- for individuals already affected by problem; usually intensive and individualized strategies
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Preventing Challenging Behavior for Children with
ASD
Preventing Challenging Behavior for Children with
ASD
LEVEL 3:Individualized
Intensive Interventions
LEVEL 2:Building social and communicative
competencies inconsistent with challenging behavior
LEVEL 1:Building positive relationships, supportive
environments, and healthy physiologies
Prevention – Universal (Level 1)
Prevention – Universal (Level 1)
Positive RelationshipsNurturing, caring, secure
Enhances influence of adult caregiver
Physical and Emotional HealthPhysical health and nutrition
Social-emotional well beingSafe, responsive, “friendly” and stimulating environment
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Prevention – Level 1 Practices
Prevention – Level 1 Practices
Adult-child interactionsPositive attention
Organized environmentStructure, routine, schedule
A comprehensible environment
InstructionUseful communicationSocial skillsClear, consistent behavioral expectations
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Preventing Challenging Behavior for Children with
ASD
Preventing Challenging Behavior for Children with
ASD
LEVEL 3:Individualized
Intensive Interventions
LEVEL 2:Building social and communicative
competencies inconsistent with challenging behavior
LEVEL 1:Building positive relationships, supportive
environments, and healthy physiologies
Level 2 Prevention Practices
Level 2 Prevention Practices
Differences from Level 1 PracticesIntensity of Intervention
Planfulness of Intervention
Intensity of Data Collection
Intensity of Family Involvement
For children at risk for challenging behavior:
Parent training classes
Social-emotional teaching curricula21
Building Functional Competencies
Building Functional Competencies
Interventions focused on teaching and building appropriate engagementIntervention supports for enhancing motivation
e.g., Pivotal Response Training
Group strategies (classroom models) with direct focus on teaching and motivating social interaction
e.g., LEAP; Project DATA; Walden22
“Active” Engagement Is Key“Active” Engagement Is Key
Rethinking Story Time and the “Dead Person”
“Active” Engagement Is Key“Active” Engagement Is Key
Rethinking Circle and the “Dead Person”
“Active” Engagement Is Key“Active” Engagement Is Key
Rotations and Novelty• Centers• Toys• Materials
“Active” Engagement Is Key
“Active” Engagement Is Key
Books as the GlueThe Three Little Pigs go to:
Art Activity
Circle
Free Play
Transitions
Reinforcer Assessment Is The Pivotal Assessment
Reinforcer Assessment Is The Pivotal Assessment
Developmental assessment and wasted time and money
Conducting Reinforcement AssessmentsCaregiver interview
Observation as a check
Paired comparisons
Choosing from the hierarchy
Repeated assessments
Keeping To A Routine Is Insufficient Routine For
Many
Keeping To A Routine Is Insufficient Routine For
Many
Routine = Redundancy Routine = Restricted Stimuli Routines within Routines (Circle Example)
Circle Time RoutineCircle Time Routine
Opening Song1. Child passes out
prop
2. Sing song
3. Child collects prop
Circle Time RoutineCircle Time Routine
Calendar1. Clap out month
2. Sing Days of the Week song
3. Count to today with motor movement
4. Review the pattern
Circle Time RoutineCircle Time Routine
Child Choice Song1. Child chooses song
from 3-4 options
2. Props, Materials and/or Motor Movement are utilized with every song.
Circle Time RoutineCircle Time Routine
Center Choices1. Adult holds up
name cards
2. Children come up and choose a Center
3. Children go off to play
Keeping To A Routine Is Insufficient Routine For
Many
Keeping To A Routine Is Insufficient Routine For
Many
Routines should help provide answers to these key questions.
1. What am I doing now?
2. Where am I in the Routine?
3. How do I know when I’m finished?
4. What comes next?
Preventing Challenging Behavior for Children with
ASD
Preventing Challenging Behavior for Children with
ASD
LEVEL 3:Individualized
Intensive Interventions
LEVEL 2:Building social and communicative
competencies inconsistent with challenging behavior
LEVEL 1:Building positive relationships, supportive
environments, and healthy physiologies
Level 3 Practices - Intensive Individualized InterventionsLevel 3 Practices - Intensive Individualized Interventions
Are used for children with persistent and severe challenging behavior
Are used when children do not respond to preventive practices, child guidance procedures (e.g., redirection), or social-emotional teaching strategies
Children with multiple, severe risk factorsIntellectual-Communicative Disability (e.g., autism)
Exposure to substances, violence, depression, poverty, etc., etc. 35
vPositive Behavior Support
Positive Behavior Support
Level 3 procedures for children with serious challenging behavior
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Level 3 - Positive Behavior Support
Level 3 - Positive Behavior Support
An approach for resolving challenging behaviors that is based on person-centered values, empirical data and a multi-disciplinary scientific orientation
A pragmatic, data-based problem-solving approach for enhancing development and improving quality of life in natural, everyday contexts
A preventative approach emphasizing teaching and environmental redesign 37
PBS – ComponentsPBS – Components
1. Team-building, Goal SettingPerson-Centered Planning
2. Functional Assessment of Challenging Behavior
3. Individualized Behavior Support Plan
4. Implementation
5. Evaluation38
Core Elements of a Behavior Support Plan Level 3 - PBS
Core Elements of a Behavior Support Plan Level 3 - PBS
(Linked to Assessment Information)Prevention Strategies – Arrangements of
antecedent environmentTeaching Strategies – Building skills to teach
throughout the day to replace the challenging behavior
Reinforcers – Providing effective reinforcement schedules (note --- this is the contingency management component)
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+ Evaluation strategies 39
EvaluationEvaluation
All support plans should have some form of evaluation, so team knows if plan (or parts of a plan) is working as intended
Evaluation can focus on desired outcomes AND on extent to which elements of plan are being implemented
Evaluation should NOT be complicated or effortful, but it should be valid…and valued
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Summary and
Conclusions
Summary and
Conclusions
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Closing MessagesClosing Messages
Preventing and resolving challenging behaviors is extremely important….
Because of the implications for the quality of life of individual and all those who are close to the individual
Because of opportunities that can be compromised if challenging behaviors persist
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Implications of the Prevention Model
Implications of the Prevention Model
Some children with ASD will respond well to high quality implementation of Level 1 (universal) procedures
Some additional children with ASD will respond well to high quality implementation of Level 2 procedures
The remaining children with ASD will require implementation of Level 3 procedures
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The proportion of children with ASD who require some Level 3 procedures may be high, but we can presume that the implementation of high quality Level 1 and 2 procedures will mitigate the intensity with which the Level 3 procedures need to be implemented.
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What We Need to DOWhat We Need to DO
Early Identification --- because autism presents so many risk factors
Provide ALL identified children/families with supports for Level 1 prevention strategies
Provide ALL child care and pre-K classrooms with supports for implementing Level 1 prevention strategies
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Need to Do (continued)Need to Do (continued)
Disseminate the rationale and logic of the multi-tiered prevention framework as well as specific procedures associated with all levels.
Conduct research to validate and refine prevention model
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What We Need To DoWhat We Need To Do
Provide for training and direct technical assistance so that all children/families have access to effective supports in designing and implementing PBS plans
In early intervention programsIn schoolsIn community agenciesFor initial implementation and for ongoing support and evaluation
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Develop, evaluate and disseminate standardized models of PBS to enable large numbers of school practitioners to implement strategies with sufficient fidelity to be effective
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