Treating Severe Problem Behavior A Focus on Strengthening Socially Important Behavior Gregory P. Hanley Ph.D., BCBA-D For more information go to: www.practicalfunctionalassessment.com
Specific Process Commitments and Aims safety understanding trust holistic progressive high expectations skill development contextual fit balanced relationships
First, we learn about the child and contexts in which problem behavior is most and least likely with an open-ended interview Case Example: From Santiago et al. (2016) JADD Zeke, 14 years old, PDD-NOS in order to …. Interview suggested that when …. Zeke engaged in SIB and aggression…. Antecedent Behavior Consequence Possible establishing operations (EOs) Problem Behavior Possible reinforcers
IISCA: Two condition analysis explicitly designed from an Second, we conduct an analysis to open-ended interview directly understand what is 4 influencing problem behavior Problem Behavior per min 3 Interview-Informed Synthesized Contingency Analysis 2 Single-test condition Individualized test conditions Escape/ 1 Tangible/ Synthesized contingencies Attention Reinforce precursors to and Zeke 0 dangerous behavior 1 2 3 4 5 6 Test-matched control Sessions
Functional Analysis Zeke 4 Problem Behavior per min 14-year old boy 3 diagnosed with Autism 2 Engaged in Severe Escape/ SIB and Aggression 1 Tangible/ Attention 1:1 in Specialized Zeke 0 School 1 2 3 4 5 6 Sessions
FCT + EXT BL Denial and Delay Tolerance Training Simple FCR Complex FCR 4 100 Problem Behavior Reinforcement (%) Response Chaining Treatment Extension Treatment Problem behavior no longer yields the 80 3 per min 60 reinforcers (escape to child-directed play Analysis 2 40 and teacher attention) 1 20 Zeke 0 0 A simple response 4 Simple FCR (button press: “ My way please”) 3 per min 14-year is prompted and reinforced with 2 old boy (escape to child-directed play & teacher 1 attention) 0 diagnosed 4 Complex FCR per min with 3 Autism 2 1 0 Engaged in 4 Tolerance Response Severe SIB 3 and per min 2 Zeke Aggression 1 0 Process in 100 Instructions (%) Noncomp. Response to School 80 Compliance 1 2 3 60 Levels 40 20 0 5 10 15 20 25 30 35 40 45 50 55 60 65 Sessions
FCT + EXT BL Denial and Delay Tolerance Training Simple FCR Complex FCR 4 100 Problem Behavior Reinforcement (%) Response Chaining Treatment Extension Treatment 80 3 per min 60 Analysis 2 40 1 20 Zeke 0 0 4 Simple FCR 3 per min 14-year 2 old boy 1 0 A more interactional response diagnosed 4 Complex FCR (shoulder tap, per min with 3 wait for teacher acknowledgement, Autism 2 two-button press: 1 0 May I have / My way please”) Engaged in 4 Tolerance Response is prompted and reinforced Severe SIB 3 and per min 2 Zeke Aggression 1 0 Process in 100 Instructions (%) Noncomp. Response to School 80 Compliance 1 2 3 60 Levels 40 20 0 5 10 15 20 25 30 35 40 45 50 55 60 65 Sessions
FCT + EXT BL Denial and Delay Tolerance Training Simple FCR Complex FCR 4 100 Problem Behavior Reinforcement (%) Response Chaining Treatment Extension Treatment 80 3 per min 60 Analysis 2 40 1 20 Zeke 0 0 4 Simple FCR 3 per min 14-year 2 old boy 1 0 diagnosed 4 Complex FCR Now, FCRs are reinforced half the time. per min with 3 The other half, the teacher denies the bid Autism 2 (e.g., says’s no, do your work without me, 1 please) 0 Engaged in Responses to disappointment 4 Tolerance Response Severe SIB are prompted and reinforced: 3 and per min 2 (Take a breath and nodding yes) Zeke Aggression 1 Cues of disappointment, 0 Process in Delays to reinforcement, and 100 Instructions (%) Noncomp. Response to School 80 unpredictable outcomes Compliance 1 2 3 60 Levels have now been introduced! 40 20 0 5 10 15 20 25 30 35 40 45 50 55 60 65 Sessions
FCT + EXT BL Denial and Delay Tolerance Training Simple FCR Complex FCR 4 100 Problem Behavior Reinforcement (%) Response Chaining Treatment Extension Treatment 80 3 per min 60 Analysis 2 40 1 20 Zeke 0 0 Now, FCRs are reinforced 4 Simple FCR 1/3 of the time. 3 per min 14-year 2 old boy 1 TRs are reinforced 1/3 of 0 the time. diagnosed 4 Complex FCR per min with 3 And compliance with Autism 2 progressively longer and 1 more challenging 0 Engaged in 4 instructions is reinforced Tolerance Response Severe SIB 3 and per min 2 Zeke Aggression 1 0 Process in 100 Instructions (%) Noncomp. Response to School 80 Compliance 1 2 3 60 Levels 40 20 0 5 10 15 20 25 30 35 40 45 50 55 60 65 Sessions
FCT + EXT BL Denial and Delay Tolerance Training Simple FCR Complex FCR 4 100 Problem Behavior Reinforcement (%) Response Chaining Treatment Extension Treatment 80 3 per min 60 Analysis 2 40 1 20 Zeke 0 0 4 Simple FCR 3 per min 14-year 2 old boy 1 0 diagnosed 4 Complex FCR per min with 3 Autism 2 1 0 Engaged in 4 Tolerance Response Severe SIB 3 and per min 2 Zeke Aggression 1 0 Process in 100 Instructions (%) Noncomp. Response to School 80 Compliance 1 2 3 60 Levels 40 20 0 5 10 15 20 25 30 35 40 45 50 55 60 65 Sessions
What is the treatment???? Intermittent and unpredictable reinforcement of life skills: Functional Communication Delay/denial toleration Compliance Granted Reinforcement Functional 20% communication Variable amount request (FCR) 60% Tolerance of work/play Denied Compliance response (TR) expectations
Treatment Implementation 1. Put these in your pocket 2. Pull one out while child is experiencing their reinforcers 3. Keep it to yourself 4. Require that behavior next time * Materials not needed: Laminate Laminating machine Glue guns Vis a vis markers Velcro Tokens Token boards Timers Stickers Candies Anything that was not already in the child’s environment!
App called “Names in a Hat”
App called “Roundom”
SBT - Brandon Problem Behavior Baseline Simple BL Simple Complex Tolerance response Contextually appropriate behavior Transfer 3 FCT FCT FCT training chaining test per min Age: 3 2 1 Diagnosis: None 0 Language Level: Speaks in Short Sentences 3 Simple FCR per min Context A- Analyst 1 Referred for: Aggression, Meltdowns, Noncompliance 2 Context B- Analyst 2 Context A- Analyst 3 1 0 3 Complex FCR per min 2 1 0 Tolerance Response 3 per min 2 1 0 100 Compliance 75 (%) 50 25 Brandon 0 600 500 Duration of session in EO 400 in Reinforcement 300 (s) 200 100 0 CAB 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 LIFE SKILLS CLINIC Chaining Sessions AT WESTERN NEW ENGLAND UNIVERSITY
SBT - Luke Pred. ND 10 Responses per minute Age: 4 • 8 Diagnosis: Autism, Attention Deficit Hyperactivity Disorder • PB 6 Language Level: Fully fluent speech FCR • TR Referred for: Aggression, Property Destruction, Meltdowns 4 • Luke 2 0 100 7 Compliance % Delay Level 6 75 5 4 50 3 25 2 1 0 20 40 60 80 Sessions CAB Chaining LIFE SKILLS CLINIC AT WESTERN NEW ENGLAND UNIVERSITY
SBT - Diego Age: 11 • Diagnosis: Autism • Language Level: Speaks in Short Sentences • Referred for: Self-injurious behavior, • Aggression, Property Destruction CAB Chaining LIFE SKILLS CLINIC AT WESTERN NEW ENGLAND UNIVERSITY
Good alternatives to Full Extinction: 1. Partial Extinction escape always available PB = escape to nothing vs. Skills = escape to everything 2. No extinction with full assent Client can leave practice sessions with all of their stuff at anytime They surprisingly don’t very often probably due to preference for earned sr
Can we do this process without bursts or physical management (i.e., without extinction procedures)? Will children choose to participate in these processes if they can leave with all of the reinforcers at anytime? Can the process be made unassailable to skeptics/critics?
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