Developing Proactive Strategies for Managing Problem Behaviors
[vc_row][vc_column][vc_column_text]By Lori Ernsperger, Ph.D.
Individuals with autism often exhibit a wide variety of challenging behaviors: physical aggression, self-injury, tantrums, and noncompliance. These behaviors can be stressful to parents, disconcerting to school personnel, and often interfere with an individual’s ability to benefit from other learning situations. Highly effective behavioral programs for individuals with autism emphasize proactive strategies for reducing these problem behaviors and are generally based on the following principles:
The problem behavior serves a purpose
The need to teach an alternative or replacement skill that serves the same function
Examination and modification of antecedents and environmental controls as needed.
A comprehensive behavior intervention plan will include a careful balance between proactive strategies and antecedent controls such as changing schedules, modifying the curriculum, and rearranging the physical environment.
Before proactive strategies can be developed at school or at home, it is important to understand why the problem behavior is occurring and what purpose it serves for the individual with autism. A functional assessment can provide these answers.
An effective functional assessment is based on several assumptions. First, the problem behavior serves a function for the individual; it aids him/her in achieving a specific outcome. Second, if an individual is repeating a problem behavior, the consequence of the behavior has been reinforced for that individual in the past. Most of us tend to repeat behaviors that are reinforced. Third, individuals exhibiting problem behaviors often do not know the correct adaptive skills, or they have not been effectively reinforced for displaying appropriate adaptive behaviors.
Whether mandated on a child’s IEP or completed as an informal assessment by the family, a functional assessment can be conducted efficiently and easily by following these steps.
Step 1. Define the Target Behavior(s)
First, define an observable and measurable problem behavior. This problem behavior will vary greatly from individual to individual. Be sure to clearly define the target behavior. “Hitting” or “biting” is too general. A better-defined behavior might be “Hitting Sally during the lunch period.”
Step 2. Gather Information
This step focuses on the antecedents (what comes immediately before) and consequences (what comes immediately after) the target behavior. You will want to collect information from a variety of sources, especially from adults who have a significant relationship with the individual. The family or school team may interview teachers, family members, or related service personnel who work with the individual.
Data can be gathered through informal conversations, written questionnaires, or direct observation, and should note the frequency (how often it occurs), duration (how long it occurs), and intensity (strength) of the target behavior, and the physical/social environment (does it always occur at the same time of day? With only certain people? In particular rooms? etc). Ideally, observations should occur in the natural settings where the target behavior is exhibited.
It is also important to carefully take note of certain physiological factors that may influence problem behaviors. If the individual is hungry, thirsty, or sick and has no functional communication system with which to convey this, the outcome may very well be irritability or an escalation of the problem behavior. The family or school team should immediately address these issues in order to reduce further problem behaviors.
Step 3. Develop a Hypothesis Statement
Once data has been gathered and reviewed, the function of the behavior should be apparent and a hypothesis statement can be written. While this can vary among individuals with autism, listed below are a few common functions of behavior and applicable questions to be addressed by the family or school team:
Escape/Avoidance of Tasks or Requests
Does the behavior start when a request or demand is made?
Does the behavior stop when the individual is removed from the activity?
Is the individual alone or unattended for long periods?
Does the individual exhibit the behavior when s/he is alone?
Does the behavior occur to get a reaction?
Â· Is the individual given choices in the home or classroom?
Â· Does the behavior stop after the individual receives a desired object?
Does the individual have a functional and reliable communication system?
Is the individual provided with the necessary equipment/skills to communicate wants and needs?
Does the individual have adequate skills to release stress in an appropriate manner?
Does the individual seem calm or relaxed after the problem behavior has stopped?
Self-Stimulation or Sensory Stimulation
Is the behavior part of the stereotypical pattern of behaviors exhibited by individuals with autism?
Does the individual repeat the behavior when alone?
Does the individual appear unaware of his surroundings?
Does the individual’s behavior suggest a sensory component, ie shielding eyes from bright lights, covering ears, removing clothing, holding nose closed or holding breath, etc.
Each hypothesis statement identifies the target behavior and provides an “informed guess” as to the function of the behavior for the individual. A clear hypothesis statement is written in a positive manner, based on the gathered facts. The following are examples of hypothesis statements:
When mom is making dinner, Samantha attempts to run out of the house to get immediate attention from mom.
When Stephen goes to the cafeteria with the fifth grade class, he pushes other kids out of the way and runs down the hallway in order be first in line and avoid waiting with the other students.
Step 4: Develop a Behavior Intervention Plan
The behavioral intervention plan is a written document that includes:
Definition of the target behavior
Written hypothesis statement stating the function of the behavior
List of modifications to the environment and/or schedule
List of replacement or alternative behaviors that meet the same needs
Criteria or outcome evaluation
Due to the severe deficits in expressive and receptive language skills for individuals with autism, it is important that the family or school team first provide an effective communication system if one does not presently exist. Problem behaviors will only persist or increase if the individual is unable to communicate his basic wants and needs.
Environmental modifications should also be addressed in the behavior intervention plan. The goal of environmental controls is to provide a stable and predictable environment in order to prevent problem behaviors. Families and school teams should review the following environmental considerations:
Written and visual schedules are posted
Comprehensible and concise rules are established
Clearly defined use of space with limited distractions
Visual supports are implemented
Many problem behaviors can be minimized with effective environmental modifications.
Teaching Replacement Skills
Effective behavior intervention plans include a list of replacement behaviors that will be systematically taught to the individual. The replacement behavior must be as effective and powerful as the maladaptive behavior, meet the same need, be implemented across settings and result in an efficient and meaningful alternative for the individual.
Families or school teams can use a variety of instructional methods for teaching replacement behaviors to individuals with autism. They may select a direct instruction approach such as discrete trial instruction, which includes a set of adult-directed instructions and consequences. Or, they may utilize other strategies, including shaping and token economies.
Shaping is a proactive strategy that builds on current individual skills and reinforces successive approximations to the desired alternative or replacement behavior. Shaping reinforces behaviors that come progressively closer to the adaptive skill.
Guidelines for Implementing Shaping Procedures
List all necessary steps to take the individual from his/her present level of functioning to the desired alternative behavior.
High quality reinforcement must be provided each time the individual exhibits an approximation of the alternative behavior.
Reinforcement may occur at different rates based upon the individual’s ability and learning speed.
At first it may be necessary to heavily reinforce all approximations to the alternative behavior.
Shaping procedures provide built-in opportunities for immediate reinforcement as the individual is learning the new skill. Although shaping can be a time-consuming method, it provides a practical approach to teaching replacement behaviors.
A token economy system can be an effective procedure for managing problem behavior and is a useful and practical strategy for reinforcing and teaching alternative behaviors. Token economies are flexible and easy to use in home and school settings.
Guidelines for Implementing a Token Economy System
Select a tangible token that is durable and easy to manipulate. Stickers, coins, points, and buttons are appropriate tokens. Create a sturdy, appropriate token board. Velcro is useful in adhering tokens to the board.
Determine the criteria and rules for successful task completion and make sure that the individual understands what is required of him/her. Model appropriate behaviors if needed for comprehension.
Select high quality reinforcements that will be exchanged for the token.
Establish the ratio of exchange for the tokens and the reinforcement. Initially, reinforcement should be provided immediately after the first token. Gradually increase the ratio of tokens to reinforcement as the individual is more successful in exhibiting the alternative or replacement behavior.
Token economies provide an easy to use system for reinforcing alternative behaviors. The token serves as visual evidence to the individual that s/he has achieved the desired behavior.
Step 5. Choosing Reinforcement Strategies
Regardless of which instructional technique is used to teach replacement behaviors, the family and school team must carefully select high-quality reinforcers that are meaningful to the individual. This is a key element in managing problem behaviors. Most typically developing individuals are reinforced internally, through task completion and verbal praise, but this is generally not the case with individuals with autism. They require external motivation to maximize their learning and increase appropriate behaviors. Families and school personnel must identify appropriate reinforcers and use them consistently and effectively throughout the school day.
Guidelines for Selecting Reinforcers
Selecting reinforcers for individuals with autism is a continuous process, which changes throughout the school year. Not all individuals are motivated by the same items and over time, even favorite reinforcers can lose their appeal. Selecting appropriate high-quality reinforcement involves observing the individual in the home or classroom, completing a reinforcement survey, and/or interviewing the individual or other family members. The reinforcement interests of some individuals may be readily apparent while other individuals require serious investigation. Think creatively and don’t be afraid to experiment.
According to Leaf and McEachin (1999), there are a few basic tenets for using reinforcement:
Reinforcers are contingent upon the individual’s behavior. The individual is only reinforced after meeting the criteria for the task or exhibiting a replacement behavior.
Use a variety of reinforcers, rotated frequently, to avoid satiation. If the same reinforcement is used every day, it will lose its potential to change behaviors.
Â· Use age-appropriate reinforcers based on the chronological age of the individual, NOT on the developmental age.
Remember that the goal is to assist the individual to be more functional and independent. Choose reinforcers accordingly.
Don’t allow free access to strong reinforcers; they should only be available within the context of the particular behavior management program.
Pair high-quality reinforcers with praise to further develop more natural reinforcement. The ultimate goal is to naturally reinforce through social interaction with the adult.
(For a further discussion of reinforcement selection and implementation, refer to A Work in Progress (Leaf & McEachin, 1999)).
When first teaching a new skill or desired behavior, reinforcement will be immediate and continuous, to insure repetition of the desired behavior. As the individual progresses with a newly acquired skill or behavior, the reinforcement schedule will be thinned and become more intermittent and varied. Finally, delayed reinforcement is used in a token economy system whereby the tokens are earned and exchanged for a desired reinforcement at a later time. To continually increase the desired behavior, delayed reinforcement should be systematically scheduled. Inconsistencies with delayed reinforcement may result in individual frustration and can trigger problem behaviors. The goal of reinforcement is to help the individual become naturally self-motivating. Ultimately, the individual will be reinforced through the completion of the task and naturally occurring consequences.
Step 6. Evaluate the Intervention Plan
The final step in a proactive behavior management program is to collect data to determine if the target behavior has actually decreased and the alternative behavior increased. Both families and school personnel can easily evaluate the outcomes of a particular plan by collecting frequency, duration and/or intensity data. If the target behavior has decreased, the team can assume the plan has been successfully implemented. However, if the target behavior has increased, the family or school team must re-evaluate the plan. Keep in mind that problem behaviors will often get worse before significant changes are observed.
Developing proactive strategies for managing problem behaviors is a long-term process and requires patience and commitment. Families and school teams must remember to take it one step at a time and celebrate the small successes along the way.
Helpful Hint: Token Economy System Puzzles
Reinforcement puzzles are a creative way to work with a token economy system. You start by taking a photograph of the high-quality reinforcer that motivates the individual. For example, if an individual enjoys working on the computer, take a picture of the computer. Make several copies and laminate each. Cut each picture into several pieces, based on how long the individual is able to maintain the desired behavior. Add small pieces of Velcro on the back of each piece. Initially, the picture is divided into only two pieces, and the individual is taught that he must earn each piece of the puzzle in order to receive the favored reinforcement, in this example, time on the computer. The completed picture of the computer is a visual cue to the individual of his success.
Lori Ernsperger, a recognized expert in the field of autism and behavioral disorders, is from Henderson, Nevada. She received her doctorate in Special Education from Indiana University, and has over 17 years experience in the public schools as a classroom teacher, administrator, and behavioral consultant. Dr. Ernsperger is the owner of Autism and Behavioral Consulting, and works with school district personnel and parents to provide effective educational programs and best practice strategies for students with autism and behavioral disorders. Her just-released book, Keys to Success for Teaching Students with Autism (Future Horizons) is a practical, step-by-step resource that unlocks the secrets of six critical elements in teaching students with autism. Contact her at 702.616.8717 or email@example.com.
Reprinted with permission from the July 2003 issue of the Autism Asperger’s Digest, a 52 page bimonthly magazine devoted to autism. www.autismdigest.com[/vc_column_text][/vc_column][/vc_row]