1. Behavior Management of Children with Severe Disabilities Martin E. Block, Ph.D. Curry School of Education University of Virginia

2. 2 Outline b Review Types of Behavior Problems b Review Two Major Approaches to Treatment b Review Terminology b Outline Format to Develop Behavior Plan

3. 3 Types of Behavior Problems b Stereotypic Behavior b Self-Injurious Behavior b Aggression b Non-compliant/Disruptive Behavior b Inappropriate Social Behavior b Disorders of Physical Regulation

4. 4 Stereotypic/Self-Stimulatory Behaviors b Repetitive cycles of behavior that persist for long periods of time. Body rockingBody rocking finger flickingfinger flicking hand flappinghand flapping tapping objectstapping objects b Cause - may stimulate/entertain child b Problem - interferes with learning; prevents community placement

5. 5 Self-Injurious Behavior b Response that inflicts direct harm on the individual. b Cause - unknown. May have higher levels of pain tolerance, gets attention, organic (e.g., Lesch-Nyhan), may somehow act as a natural opiate through production of endorphins in the CNS. b Problem - physical harm, inappropriate behaviors prevent community living.

6. 6 Aggression b A behavior that represents a danger to the client or others. Generally means act of physical violence against others. b Cause - fear (escape fearful situation), anger (frustration or anger), manipulation of others (get them to do what you want or escape demands of situation) b Angry aggression often occurs as part of tantrum - crying screaming, thrashing out, attacking others, damaging property

7. 7 Non-compliant/Disruptive Behavior b Refusing reasonable requests, running off instead of coming when called, becoming limp and dropping to the floor, resisting transitions, not performing chores or duties. b Cause - attempt to control others/situation, attempt to exert independence and some control over ones activities

8. 8 Inappropriate Social Behavior b Failure to have learned more appropriate social skills and rules - stripping, showing affection to strangers, stealing or hoarding, lying, masturbating in public, swearing/shouting. b Cause - no inhibition, not aware of how others view them, not knowing social rules

9. 9 Disorders of Physical Regulation b Limited physical control due to failure to acquire (or loss of) self-regulation over bodily functions - copresis, enuresis, drooling, and tongue thrust b cause - physical problems coupled with failure to try and teach self-regulation b treatment might include adaptations (e.g., diaper, bib) and teaching tolerance

10. Types of Intervention

11. 11 Elimination Approach b Views behavior problems as maladaptive or interfering actions that make it impossible or difficult for children to learn b Goal is to eliminate these behaviors - undesirable behaviors must be eliminated before new, adaptive behaviors can be taught

12. 12 Elimination Approach (Cont.) b Negative behaviors are regarded as high priority intervention goals because they are viewed as interfering with learning. b Entire IEPs are often devoted to decelerating or stopping behaviors rather than teaching new skills

13. 13 Elimination Approach (Cont.) b Some behaviors are perceived as being so disruptive that special staff is called into to deal with the child. b Some children are viewed as needing to be put into a special class or school for children with similar behaviors in order to carry out an elimination program.

14. 14 Problems with Elimination Model b Does it really work? b Might something else have worked better? b Is it wise to postpone teaching other skills? b These programs often involve aversives b Programs often involve homogeneous groupings

15. 15 Educative Approach b Major purpose is to encourage adaptive behavior and promote maximum participation of individual in meaningful, daily activities. b Instruction is not delayed until behaviors are under control. At best deceleration programs are supplemental to active treatement

16. 16 Educative Approach (cont.) b Not all behavior problems are equal priority targets for behavior change. b Most effective strategy to reduce behaviors might be to replace it with a skill that accomplishes the same function. b Deceleration programs do not use aversives

17. Lifestyle Perspective

18. 18 Compare Our Lifestyle with a Person with a Disability b Choices/Control b People b Things b Activities b Community Experiences

19. Prioritizing Targeted Behaviors

20. 20 Prioritizing Behaviors b Level I:Urgent behaviors requiring immediate attention b Level II:Serious behaviors requiring formal consideration b Level III:Excess behaviors reflecting normal deviance

21. Review of Terminology

22. 22 A - B - C Analysis b Antecedent (stimulus) - an event occurring prior to a behavior which in some way influences that behavior b Behavior (response)- any observable or measurable act by an individual b Consequence - an event that occurs after a behavior has been exhibited and in some ways is influenced by or related to the behavior.

23. 23 Reinforcement b Applying a technique that results in an increase in a targeted behavior. Positive reinforcement - present something positive that increases targeted behavior.Positive reinforcement - present something positive that increases targeted behavior. Negative reinforcement - take away something aversive that increases targeted behaviorNegative reinforcement - take away something aversive that increases targeted behavior

24. 24 Types of Reinforcers b Primary - unconditioned reinforcer, one that does not have to be learned to be effective (food, water, and other necessities of life) b Secondary - a conditioned reinforcer, one that is learned activity/sensory - a reinforcer that involves participation in an event or sensationactivity/sensory - a reinforcer that involves participation in an event or sensation Token - receiving an item that can be exchangedToken - receiving an item that can be exchanged Social - a reinforcer that involves interaction between two or more persons.Social - a reinforcer that involves interaction between two or more persons.

25. 25 Other Types of Reinforcers b ALT-R (strengthen incompatible behaviors) b DRL (reinforce lower amounts of behaviors) b DRO (reinforce other behaviors) b DRT-O (reinforce others in general area)

26. 26 Reinforcement Schedules b Continuous - everytime child exhibits targeted behavior (best initially for establishing a behavior) b Intermittent - reinforce sometimes fixed - same number every time (every 3rd try)fixed - same number every time (every 3rd try) variable - average number (between 3rd and 5th try)variable - average number (between 3rd and 5th try)

27. 27 Punishment b Presentation of an aversive event or consequence that leads to a decrease in targeted behavior.

28. 28 Other Key terms b Cue - a signal, sign, request, or information that calls for the occurence of a behavior. b Response cost - removal of a specific quantity of reinforcement. b Time-out - removal from a reinforcing situation b Extinction - a reinforcer that previously sustained a behavior is withheld for the purpose of eliminating that behavior

29. 29 Other key terms (continued) b Over-correction - making individual do restitution for what he/she has done plus extra work b Desists - verbal reprimands b Satiation - providing a reinforcer for so long or so often that it has lost its effectiveness

30. Creating the Behavior Plan

31. 31 Creating the Behavior Plan ¬ Define Behavior in Observable, measurable terms. ­ Observe the Behavior 3when does it occur 3where does it occur 3why do you think it occured

32. 32 Creating the Plan (Continued) ® Explore the Consequences 3what happened when the behavior occurred 3when did these consequences take place 3how did the student respond to these consequences

33. 33 Creating the Plan (Continued) ¯ Consider Alternatives 3moving student 3regrouping class 3rearranging environment 3changing time of activity 3changing class format 3other possible ideas

34. 34 Creating the Plan (Continued) ° Clearly State the Desired Goal ± Outline Procedure for Preventing/Reducing Behavior 3Describes cues you will use 3describe reinforcers you will use 3describe how you will present reinforcers 3describe what you will do if behavior occurs