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13 Elements That Influence Behavior (and what should be in a good IEP) Michael J. Weiss, Ph.D. Applied Developmental Analysis (ADA) Therapy, LLC Fairfield.

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Presentation on theme: "13 Elements That Influence Behavior (and what should be in a good IEP) Michael J. Weiss, Ph.D. Applied Developmental Analysis (ADA) Therapy, LLC Fairfield."— Presentation transcript:

1 13 Elements That Influence Behavior (and what should be in a good IEP) Michael J. Weiss, Ph.D. Applied Developmental Analysis (ADA) Therapy, LLC Fairfield University (realfamilies@aol.com) Level 4: Inconsolable and/or in danger Level 3: Upset & Refusing Participation Level 2: Distressed, in Disagreement, but communicative & Compromising Level 1: Calm & Collaborative Level 4: Reactive Safety Level 3: Requiring Participation Level 2: Read Emotions & Acknowledge Distress (READ) Level 1: Proactive Growth Factors

2 Levels of Emotional Regulation Level 4: Inconsolable and/or in danger Level 3: Upset & Refusing Participation Level 2: Distressed, in Disagreement, but Communicative & Compromising Level 1: Calm & Collaborative

3 Level 4: danger to self or others Level 3: Upset & Refusing Participation Level 2: Distressed, in Disagreement, but communicative & Compromising Level 1: Calm & Collaborative Level 4: Reactive Safety Level 3: Requiring Participation Level 2: Read Emotions & Acknowledge Distress (READ) Level 1: Proactive Growth Factors A Developmental system for thinking about self-regulation and adult supports

4 Four levels of adult responsiveness to childs levels of emotional regulation Level 1: Proactive growth factors –Need for meaningful education, therapy & relationships –Need to "push the envelop of growth" in emotional regulation Level 2: Read Emotions & Acknowledge Distress (READ ) –Need for recognition, acknowledgement and communication related to a person's distress, disagreement or other forms of refusal –Need to return to proactive growth factors through communication, collaboration & compromise Level 3: Adult insistence on participation –Interaction partners need to both recognize the difference between a request/choice and a "requirement –If the activity is a "requirement – adult must compel participation –Need to move past point of conflict and through the activity Level 4: Reactive strategies to extreme distress & actions –Need to keep everyone safe –Need to create calm & return to proactive growth factors

5 Level 1: proactive factors & strategies that influence childrens growth & behavior 1.Definitions & Data 2.Medical team evaluation 3.Relationships and finding my childs (and my) voice 4.Communication 5.Sensory & movement issues 6.Multimodal channels of information 7.Intensity, diversity, generalization 8.Assume competence: offering a wide academic window 9.Inclusion in the world 10.Make plans do-able 11.Understand your belief-systems 12.Dynamic behavior (parenting) plan 13.Medical management

6 Level 1.1: Definitions & data: be evidence based Have you defined the behaviors, educational and therapeutic targets of concern? Factually note: what, where, when, who What happened before and after events –Indicate antecedents and consequences or environmental factors Record frequency and duration of events?

7 But, beware of data-ists You know… racist, sexist, dataist…. The big data lie – there is no data… –Beware of statements like, the literature indicates… –no data is interpreted to mean no truth –Concerning most therapies, what should be said is that it hasnt been appropriately studied yet Assessing issues in clinical settings is time consuming, costly, hard-to-control & contrary to providing services right now –That doesnt mean intuition should be ignored –Nor, does it mean that we should NOT collect information An absence of evidence is not evidence of absence (Dr. Carl Sagan)

8 Level 1.2: Medical team evaluations Pervasiveness of medical issues that follow our kids, i.e., Neurological, Gastrointestinal anomalies –See Tim Buie in Bauman & Kemper (2004) Neurobiology of Autism Who is the total team that is sharing information –Neurologist, Geneticist, Endocrinologist, ENT, Urologist, Immunologist, Orthopedist, GI, Dentist, & more…. Psychopharmocology generally, put in place non- medical interventions of behavioral development first – use of medications should routinely go last

9 Level 1.3: Recognizing the PERSON: Finding your childs voice What does your child like to do? What do they gravitate toward? Consider the who, what, where, when of actions in terms of why –go beyond the facts and make guesses about motives and desires about what is motivating a childs behavior –Yet, recognize the fallibility of guessing! Enlist your child on his/her terms –Join in (Floor time/Relationship Development Intervention) Offer age-appropriate options, choices & autonomy Create therapeutic opportunities for self-expression –Have you asked the child/student/patient why they do what they do or how they feel about what is going on?

10 Level 1.4: Communication Communication occurs ALL DAY Not two times 30-minutes Should NOT require a Speech & Language Pathologist Training staff & family is the life blood of all-day communication Total Communication systems Verbal behavior programs Gestures & Sign Picture-symbol-systems Augmentative and Alternative Communication (AAC) Schedules, aided Language boards & use of visuals MUSIC Teaching THE ALPHABET!! Have you given the child a means of saying what they might like to say? None of the above More string to stim with please Drop dead you jack-ass

11 Level 1.4: Communication Using music & reading to access speech & language

12 Level 1.4: Communication Discussions of feelings, thoughts, desires –Social-affective-emotional vocabulary Social curricula with instruction in pragmatics –Social grammar: turn-taking, reading cues, etc. –Learn how to anticipate what others are saying –Learn how to interpret others feelings about what they are saying –Use commercially available curricula as instructional/therapeutic guide Age-typical partners: dont let your childs only communication partners be adults and other children with developmental concerns Rehearsal of social communication –Social stories –Social scripts –Video models and video self-monitoring

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15 Social script rehearsal for Maine conversations Pam:Do you ever go skiing in the mountains? Megan:Yes, I go skiing in the mountains. Pam:What else can you do in the mountains? Megan:I can go sledding. I can go hiking up a mountain path. Pam:What else? Megan:I can climb rocks. Pam:What do mountains look like? Megan:Mountains are tall. Mountain peaks are pointed. Sometimes snow is on the mountain peak, even in the summer. Pam:When there is a lot of snow in the driveway what do you need to do? Megan:I need to shovel the snow to clear the way.

16 Level 1.5: Sensory & Movement realities Recognizing autism (and a wide host of other developmental disorders) as a sensory- movement disorder Consider what types of therapies influence movement regulation in others that share the diagnosis of ASD Consider other forms of movement disorders (i.e., issues related to cerebellum or basal ganglia; Parkinsons; stroke patients, etc.) and what therapies help these individuals

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20 The Neurobiology of Movement Disorders & Autism (Bauman, 2008; Bauman & Kemper, 2005; Courchesne & Allen, 1997; Hollander, et al., 2005) The embryological early anomalies to effect development: –Brainstem/Inferior Olive Cranial nerve development Somatosensory information –Cerebellum Regulates all movement Regulates sensory processes Motor, language & cognitive planning, sequencing, timing & organization –Basal Ganglia Enlarged aspects (right caudate/total putamen volume) correlates with uncontrolled or perseverative movement

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22 Correlations among aberrant movement patterns in: Speech Ballistic/Aberrant & repetitive movements Throwing Grasp/hand use Lip Closure Gait Hopping & jumping Reaching/Crossing midline Kneeling & standing Disassociation of movement of different body parts Difficulties in core strength, idiosyncratic weakness and/or hypotonia Balance and coordination dysregulation Cerebellum and Basal Ganglia regulation? What might they have in common? Autism is a movement disorder!

23 Level 1.5: Sensory & Movement realities Recognizing environmental contributions (noise in any sensory modality) Again, therapies are ALL DAY Sensory Diets: managing arousal cycles Oral-motor programming and daily carry-over Real movement opportunities –Movement/expressive therapies (music/dance/art) –Break-a-sweat exercise –Use incidental exercise: sitting on a stool –Organize when movement is and is not encouraged

24 Level 1.6 Considering multimodal channels of information Which modalities of taking in information goes with the least distress (seeing, hearing, touching??) How to systematically combine modalities: – Play with modalities one at a time – Systematically add, subtract, mix modalities – Use behavior as an index of too many or too few? Most common good combination? – Use visual information more – Talk at children less – Incorporation of touch that suits the child

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26 Level 1.7: Understanding Intensity, diversity & generalization strategies Intensity means: –hundreds of repetitions daily to further responsiveness –long periods of time dedicated –early intervention for 3-hours/week exemplifies non-intensity Diversity of experiences effects attention –Moderate novelty in activities associated with alerting –Redundancy is associated with inattention (i.e., habituation) Teach with intensity and diversity promotes generalization – systematically put in long hours with several differing: –Ways of presenting materials –People –Locations –Orders of activities –Repetition of activities through the day (rather than all at once)

27 Intensity-diversity-generalization of exposure to curricula (1)Communication systems are an all day requirement (2)Assistive technologies are omnipresent (verbal behavior; aided language boards; software; communication devices; picture-symbol systems) (3)Expansion into the personal world of interest-reality themes (4)Expansion into the social world (social scripts; social stories; functionality in the real world) (5)Table-top activities in support of real-world activities (how instruction traverses different methodologies) (6)Taught through diverse medium/methods (i.e., learning to read music) (7)Taught in a generalized manner; learned for generalize application

28 Level 1.8: Assuming competence: offering the dignity of age-appropriate curricula The retardation or the not ready yet assumptions –Performance is a measure of competence? Ask a person diagnosed with Cerebral Palsy if they agree –Work at the childs developmental level? Which is….? Fallacy of IQ or Developmental Quotients as global indicators –Discussions that the child can hear (but, shouldnt) stick of furniture phenomenon –Assuming high level of performance is a splinter skill or an odd behavior is the death of developing person- specific abilities/skills

29 Level 1.8: Assuming competence: offering the dignity of age-appropriate interactions and curricula So…what should be our guide? Have a great teacher as one of our guides! Do use a tracking device (i.e., Activities of Basic Learning & Language Scales (ABLLS)) or other measurable data systems Avoid linear programming and mastery criteria as only mechanism of change Select a developmentally wide window of activities concurrently Vary extent of supports v. level of independence as a function of task complexity, i.e., high-level activity with errorless supports Select activities that lend themselves to age appropriate modifications –What is an age-appropriate version of the childs obsessions or preoccupations?

30 Level 1.8: Assuming competence: offering the dignity of age-appropriate curricula Academic computer software offering a wide window of intellectual opportunity (without the social distractions) Simple Sentence Structure EER: Plurals EER: Prepositions First Categories Adjectives & Opposites Words & Concepts I, II & III Concentrate! I Follow Directions: 1 & 2 Level Commands Micro-LADS programs (i.e., Prepositions & Pronouns) Sentence Master 1, 2, & 3 Number Maze Dollars and Cents Picture Sentence Key 1 Picture Sentence Key 2 Pix Writer Clicker 5 First Keys to Literacy All My Words Write: Out Loud Simon Sounds It Out 2 Visual Voice Typing Quick and Easy Black Beauty

31 Software companies that you should know about Don Johnston Laureate Learning Systems Crick Software

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33 Level 1.9: Inclusion in the world Real relationships: friends, loved ones and being a legitimate member of our community –Modeling and regression toward the mean Organizing and generalizing our day-to-day conduct – dont avoid going out Catch-22 irony: why arent our kids included? Usually related to complicated behavior. Why is behavior complicated? Partly because we arent included in the world. –Going out IS HARD TO DO! –Promoting behavior in the world? Dont want to make a scene

34 Level 1.10: Make plans Do-able Figuring out how much you can realistically do Prep time for all involved REAL training and consultation of teaching staff and family (not 15-minutes per week consult) Team meeting opportunities Formalizing fun time together Formalizing fun time apart Getting a babysitter In-home services Insistence on sufficient staffing

35 Connecticut Bill 301 – Family Insurance coverage for ASDs Coverage for behavior services, OT, PT, Speech/Language (home programs) Must be a diagnosis of ASDs Age and amount ($) of coverage –2 to 9: $50,000/year –9 to 13: $35,000/year –13 to 15: $25,000/year

36 Level 1.11: Beliefs about childrearing and my child Wanting change is not mutually exclusive with accepting people for who they are People diagnosed with a developmental difference are still children, adolescents, adults –Interact with each individual according to both developmental status and chronological age –Yet, at no point across development is harming yourself or others acceptable behavior Beliefs about competence translates into levels of expectations –Expectations establish comfort zone for what we will insist of our children –Young man in Westport, CT diagnosed with Aspergers who drives himself to University I (teacher/parent/therapist) am entitled to respect and deference from my child/student/client, just as I owe them respect and deference

37 Level 1.12: A flexible & dynamic behavior (parenting) plan Predicated on concepts from the study of social development (i.e., children benefit from authoritative parenting), not from animal models of learning –Children do well in a climate combining unconditional love & support, with high standards & expectations Understanding basic principals of Operant Theory is extremely useful in understanding how you are parenting/teaching a child –Know the definition of (i) positive reinforcement; (ii) negative reinforcement; (iii) punishment; & (iv) extinction Principal focus of contingencies should revolve around self-determination (or the restrictions there of) –Naturally occurring consequences of doing what you want if you are comporting yourself appropriately… or not.

38 Level 1.13: Data-driven medical management Going in the right order: points 1 through 12 above go first whenever possible –Obvious medical exceptions i.e., seizure activity, medical illness, disease, conditions, etc. (see point #2)) Find a physician who: (i) you like!; (ii) returns your phone calls; (iii) is data driven; (iv) who asks about the educational/therapeutic programs; (v) is willing to try a diverse set of approaches Back to point #1: define what you are doing and collect data –Be able to define what you are treating –If medical treatment isnt working… CHANGE OR STOP!! Identify blind evaluators in the data collection process

39 Level 1: proactive factors & strategies that influence PEACE 1.Definitions & Data 2.Medical team evaluation 3.Relationships and finding my childs (and my) voice 4.Communication 5.Sensory & movement issues 6.Multimodal channels of information 7.Intensity, diversity, generalization 8.Assume competence: offering a wide academic window 9.Inclusion in the world 10.Make plans do-able 11.Understand your belief-systems 12.Dynamic behavior (parenting) plan 13.Medical management

40 Video: Tate in the Grocery Store

41 Use of positive consequences to insist the childs participation 1.Autonomy (doing as they please) 2.Attention (eye contact, body posture, proximity, being silly, etc.) –Verbalizing toward child (i.e., yelling at them, praise, singing a song to them, etc.) is highly reinforcing! 3.Any desired objects (i.e., favorite toys) 4.Any desired activity (trips, games, places, etc.) 5.Token systems and markers of impending rewards

42 Use of negative consequences (penalties) to insist on the childs participation 1.Ignoring minor or low priority actions 2.Verbal redirection 3.Physical redirection (blocking & proximity management) 4.Removal of rewards/autonomy (all forms of time- out or response cost) 5.Physical escorts, hand-over-hand requirement (over-correction) 6.Restitution (righting the environment) 7.Restrictive-location time-out (bedroom/high chair) 8.Physical restraint (using appropriate training protocols such as Prevention & Management of Aggressive Behavior (PMAB))

43 The positive behavioral supports are those… … done proactively (and sometimes reactively); … non-contingently; … regulated with the willingness or choosing of the child.

44 Positive behavioral supports are not… … anything that involves a contingency! Cardinal rule of Operant Condition: create a state of want or desire by depriving the person of the putative reinforcer. Only give access to reinforcer when it has been earned. This type of contingent relationship (between child and gate keeper of the rules) is – by definition – a form of power assertion (and not very fun if you are on the low end of the relationship).

45 TIMING!!!!!!!!!!!!!!!! Timing of response to appropriate behavior Frequency and predictability in giving rewards Only ask the child to give you a behavior that is in their repertoire "Fading" and "thinning" of rewards

46 TIMING!!!!!!!!!!!!!!!! Timing of response to inappropriate behavior Immediacy and certainty: be startling –Startle is very compelling –Use this to convey important messages –Use this to insist that you be attended to The importance of brevity and frequency –Adult responses are moments in duration (duration of a startle) –Adult responds as often as possible to behavior

47 TALKING!!!!!!!!!!!!!!!! Verbal exchange around inappropriate behavior? Say Nothing!!! Act first, then talk! Talk AFTER the fact of a penalty, or during calm periods. Vocal tones and facial expressions carry "the message": actively modulate your affect

48 Level 1.4: Communication Discussions of feelings, thoughts, desires –Social-affective-emotional vocabulary Social curricula with instruction in pragmatics –Social grammar: turn-taking, reading cues, etc. –Learn how to anticipate what others are saying –Learn how to interpret others feelings about what they are saying –Use commercially available curricula as instructional/therapeutic guide Age-typical partners: dont let your childs only communication partners be adults and other children with developmental concerns Rehearsal of social communication –Social stories –Social scripts –Video models and video self-monitoring

49 PROXIMITY!!!!!!!!!!!!!!!! Where are you standing in relation to behavior? Be close enough to physically intervene if it is needed –talking (complaining, directing, repeating) from a distance is often reinforcing inappropriate behavior –paying attention to the child, yet too far away to physically intervene The "riskier" the situation, the closer you should be standing Practice giving your child some space –Set up routines in which you can come and go

50 Insisting of our children? INTERNAL CONSISTENCY Are you "credible"? Are you following your sense of right? Say what you mean, mean what you say, do what you say you are going to do!

51 Insisting of our children? Decisive Parenting/Teaching Do you have a plan that allows you the luxury of being confident in what you are expecting? Once you have developed the plan, let it play out even if what you are finding is that the plan is wrong Defining words: conclusive, definitive, determined, final, definite, positive, resolute. Antonyms: inconclusive, hesitant Being decisive is NOT INCONSISTENT with warmth and sensitivity

52 Insisting of our children? Decisive Parenting/Teaching Easier to read from the childs point of view –offers more clear-cut cues compared to subtle variations in response More consistent and predictable –allows the child to anticipate what is going to happen and accommodate change in actions before the fact of a behavior Decisive people who are warm and caring are more: –desirable to the children –Are attended to –relied upon as a source of information

53 The results of challenging our childrens challenging behavior? Their options of being out in the world grow exponentially Your childs intellect will be challenged & promoted Your childs autonomy and voice will be preserved and promoted We convey a sensitivity to lifes difficulties, yet convey a message of mutual fun, love, respect & participation


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