Positive Beginnings Supporting young children with challenging behavior

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graphic Positive Behavior Interventions and Support
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Learner Objectives

  • This workshop will teach you to:
    Identify the steps of the process of PBS
  • Describe and select strategies that may be used to prevent challenging behavior
  • Identify replacement skills that may be taught to replace challenging behavior
  • Identify how to respond in a way that does not maintain or reinforce challenging behavior
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“If a child doesn’t know how to read, we teach.”

“If a child doesn’t know how to swim, we teach.”

“If a child doesn’t know how to multiply, we teach.”

“If a child doesn’t know how to drive, we teach.”

“If a child doesn’t know how to behave, we… … teach?… punish?”

“Why can’t we finish the last sentence as automatically as we do the others?”

–Tom Herner (NASDE President ) Counterpoint 1998, p.2

graphic Brendan – Before PBS
graphic Brendan – With PBS
Tim – Before PBS
Tim – With PBS
Importance of PBS

Process of Positive Behavior Support

Step 1: Establishing a collaborative team and identifying goals

Step 2: Gathering information (functional assessment)

Step 3: Developing hypotheses (best guess)

Step 4: Designing behavior support plans

Step 5: Implementing, monitoring, evaluating outcomes and refining plan in natural environments

Hypotheses Statements

  • Triggers of the challenging behavior
  • Description of the challenging behavior
  • Responses that maintain the challenging behavior
  • Purpose of the behavior

Hypotheses Statements

  • Brendan is likely to tantrum (prolonged whining, crying, screaming, and dropping to the ground) and then sometimes will throw an object when someone places a demand to go somewhere. When he tantrums and/or throws objects, he is sometimes allowed to continue playing or the transition of going somewhere is prolonged. This results in temporarily escaping the transition or delaying “going somewhere.”

Brendan’s Behavior Equation

Triggers:

  • Walking to car from house
  • Walking from car to public place
  • Demand is placed to go to next “activity”
  • Change in routine

Setting Event:

  • Tired/late afternoon

Behaviors:

  • TANTRUMS: cries then yells and screams, throws self onto ground, sometimes throws objects

Function:

  • Avoid/prolong transition

Responses:

  • Sometimes allowed to continue what he was doing a bit longer
  • Verbal coaxing
  • Physically helped after a bit of his tantrum

Not Sure About the Hypothesis?

  • What would make the challenging behavior stop? Is it something you would provide or allow the child to access? Or is there something to remove? Or can you allow the child to leave?
  • If still unsure, collect more data in the same context
  • Some challenging behavior may have the same form, but serve multiple functions.
  • Some challenging behaviors may begin around one function (e.g., escape) and continue to serve another function (e.g., gain attention)
Activity
Think Outside the Box:

There are Many Variables to Explore

Health:
Trauma, Illness, Stamina, Medication...

Play:
Toys, Level of play, Opportunities, Choice, Expectations...

Learning Environment:
Schedules, Room arrangement, Materials, Adaptations, Resources, Predictability...

Instruction:
Transitions, Cues, Prompts, Supports, Accommodations...

Home & Family:
Routines, Resources, Siblings, Environment, Respite, Predictability, Extended family...

Outings/Events:
Places family goes, Activities...

Friends:
Shared interests & experiences, Relationships...

Interactions:
Communication to the child, Emotional support, Attachment...

Process of Positive Behavior Support

Step 1: Establishing a collaborative team and identifying goals

Step 2: Gathering information (functional assessment)

Step 3: Developing hypotheses (best guess)

Step 4: Designing behavior support plans

Step 5: Implementing, monitoring, evaluating outcomes and refining plan in natural environments

Support Plan

  • Behavior Hypotheses - Purpose of the behavior, your best guess about why the behavior occurs
  • Prevention Strategies - Ways to make events and interactions that trigger challenging behavior easier for the child to manage
  • Replacement Skills – New skills to teach throughout the day to replace the challenging behavior
  • Responses - What adults will do when the challenging behavior occurs to ensure that the challenging behavior is not maintained and the new skill is learned

Prevention Strategies

  • How can the environment be changed to reduce the likelihood that challenging behavior will occur?
  • What can be done to make challenging behavior irrelevant?
  • What procedures can I select that fit in the natural routines and structure of the classroom or family?

Prevention Strategies (Cont.)

  • How can I build on what works?
  • What can be done to help the child not respond to the trigger or changes the trigger so it does not cause challenging behavior?
Observation Vignette #1
Observation Vignette #2

Escape (e.g., activity, demands, social interaction)

Sample Prevention Strategies

  • Modify expectations, materials, instructions, seating arrangements, ways child is expected to respond, and etc. to reduce the need for escape
  • Use choice, manipulatives, peer support, child interests, etc. to reduce child desire to escape
  • Reduce distractions or competing events, materials, etc. that may contribute to desire to escape

Escape (e.g., activity, demands, social interaction)

Sample Prevention Strategies (continued)

  • Use visual supports, activity schedules, social stories, timers, first/then boards, selecting the reinforcer prior to activity, etc. to support child to engage in undesired activity, interaction, or demands
  • Use self-management to assist child in completing difficult activities or approaching avoided social interactions

Obtain (e.g. attention, object, activity)

Sample Prevention Strategies

  • Modify activities, materials, instructions, response mode, task length or other modifications that will reduce need to request help
  • Provide peer support, scheduled interaction with adult, more frequent attention or other strategy to reduce need to request attention
  • Use activity schedule, social stories, visual schedules, or scripts to provide child with information on when access to desired object, event, interaction, or activity will occur

Obtain (e.g. attention, object, activity)

Sample Prevention Strategies continued

  • Use completion contingency, first/then schedules, etc. to support child in understanding when access will occur
  • Use choices, manipulatives, child interest, etc. to distract or support child during times when access can not be provided
  • Use timers or reinforcement delay signal to let child know when access to activity, object, attention, etc. will occur

Preventions to Minimize the Affect of the Setting Event

  • Provide the child with a calming or desirable activity
  • Decrease demands on the child
  • Increase attention or comfort
  • Offer a chance to rest or cuddle
  • Provide additional supports for routines and activities (e.g., transition warnings, visuals, adult assistance)

Prevention: Choice

  • Choice can be offered using photographs, visuals, or actual objects
  • When used as a prevention strategy, choices must be offered explicitly and personally to the child
  • Choices should represent options of desirable activities or materials
Show real items or photograph of items to child to allow to make a toy choice.
Circle Choices
Song Choices
Center Choices

Prevention: Safety Signal

  • Make eye contact and gain the child’s attention
  • Provide a warning to the child (e.g., 5 more minutes or 3 more times)
  • Give the child several countdowns (e.g., 2 more times, 1 more time, all done)
  • State the ending activity and activity to follow (“5 more minutes, then clean-up”)
  • Use visuals, photographs, or object to represent next activity
  • May use timer for countdown
Safety Signal

Prevention: Visual Schedule

  • Use photographs or line drawings
  • Depict the major activities or steps of an activity
  • Assist the child in removing the visual once the activity is complete
 Visual Object Schedule
 Visual Photo Schedule
 Mini Schedule with Line Drawings
 First/Then Photo Schedule
 First/Then Visual Schedule
 First/Then Mini Schedule

Prevention: Visual Activity Analysis

  • Provide visuals of the steps used within an activity (e.g., art project)
  • Child can use the visuals to complete activity independently
  • Some children may need to remove each visual when steps are completed
 
 

Prevention: Visual Guidance

  • Provide visuals for children that highlights boundaries
  • Use feet for line-up (each child stands on a set of foot prints), carpet squares for circle time, mats for block structures
 Visual Guidance
 Activity Turn-Taking Cue

Prevention: Social Stories

  • Social stories provide a script for the child about social situations and expectations
  • The story is written from the child’s perspective
  • The story includes descriptive, perspective, and directive sentences
  • The story must match the child’s symbolic and receptive communication level

Prevention: Self-Management

  • Identify an observable behavior that the child will self-manage
  • Visually display behaviors for the child
  • Provide instruction to the child on the targeted skill
  • Give child a mechanism to monitor engagement in the behavior through a checklist or chart
  • Provide positive attention to the child for engaging in the behavior and using the self-monitoring system

 I can be a Super Friend

I can join my friends and play nicely. ________

I can take turns nicely. ________

I can go with the flow. ________

I can stop, think, and do. ________

 

Date: ________

Support Plan

  • Behavior Hypotheses - Purpose of the behavior, your best guess about why the behavior occurs
  • Prevention Strategies - Ways to make events and interactions that trigger challenging behavior easier for the child to manage
  • Replacement Skills – New skills to teach throughout the day to replace the challenging behavior
  • Responses - What adults will do when the challenging behavior occurs to ensure that the challenging behavior is not maintained and the new skill is learned

Teaching Replacement Skills

  • Teach alternative behavior to challenging behavior
  • Replacement skills must be efficient and effective (i.e., work quickly for the child)
  • Consider skills that child already has
  • Make sure the reward for appropriate behavior is consistent

Functional Equivalence

  • Identify an acceptable way that the child can deliver the same message
  • Make sure that the new response is socially appropriate and will access the child’s desired outcome
  • Teach the child a skill that honors that function of the behavior (e.g., if child wants out of activity, teach child to gesture “finished”)
  1. Child told sibling gets a turn
  2. Child yells, kicks, throws
  3. Parent gives child another turn

 

  1. Child told sibling gets a turn
  2. Child asks for one more turn
  3. Parent says "one more turn, then your brother's turn" and gives turn

 

  1. Child can't make toy work
  2. Child cries and bangs head
  3. Adult comes running and hugs child

 

  1. Child can't make toy work
  2. Child gestures or asks for hug/help
  3. Adult hugs and helps

Discussion Activity

  1. Child asked to join the circle
  2. Child screams and resisits
  3. Teacher lets child out of activity

 

  1. Child asked to join the circle
  2. Child gestures "all done"
  3. Teacher lets child out of activity

 

When You Can’t Honor the Function of the Challenging Behavior…

  • Teach tolerance for delay in achieving the reinforcer (e.g., help the child stay engaged by giving a signal about how long to hang in “two more songs, then all done”)
  • Provide choices (“You can wear goggles or the visor hat, but we need to wash your hair.”)
  • First, then contingency (“First, ride in car. Then, playground.”)

When You Can’t Honor the Function of the Challenging Behavior…(Continued)

  • Provide preferred items as distraction (“Sit in car seat; you can have teddy bear or you can have blanket.”)
  • Teach child to anticipate and participate (e.g., provide a transition warning and a visual schedule so the child can anticipate the transition and actively participate)

Escape (e.g., activity, demands, social interaction)

Possible Replacement Skills

  • Request break
  • Set work goals
  • Request help
  • Follow schedule
  • Participate in routine
  • Choice
  • Self-management
  • Say “No”
  • Say “All done”
  • Identify and express feelings
  • Use supports to follow rules
  • Anticipate transitions

Obtain (e.g. attention, object, activity)

Possible Replacement Skills

  • Follow schedule
  • Participate in routine
  • Self-management
  • Request help
  • Teach delay of reinforcement
  • Request attention
  • Choice
  • Ask for a hug
  • Ask for a turn
  • Ask for item

Teaching Replacement Skills: How to Teach

  • Teach skills intentionally using planned procedures
  • Teach replacement skills during time the child is not having challenging behavior
  • Teach throughout the day

Designing Replacement Skill Instruction Procedures

  • Select a skill to teach
  • Select a method of instruction
  • Follow steps of instructional procedure systematically
  • Teach throughout the day

Most-to-Least Prompting

  1. Full physical assistance
  2. Partial physical assistance
  3. Verbal direction
  4. Natural trigger for the skill

Most-to-Least Example: Say “All Done” with Gesture

  1. Physically assist child using hand-over-hand to gesture “all done”: Do this for 8 days in a row.
  2. Partially assist child by placing hands on elbow to prompt to gesture “all done.” Do this for 8 days. If child does not respond, provide full physical assist as correction.
  3. Model gesture and verbally direct child by stating “say all done”; do this for 8 days in a row. If child does not respond, provide partial assistance. If child does not respond to partial assistance, provide full physical assistance.
  4. Ask child “What do you want?” If child does not respond, provide verbal direction with gesture for “all done.” If child does not respond to verbal with gesture, provide partial physical. If child still does not respond, provide full assistance.

Least-to-Most Prompting

  1. Natural trigger for the skill
  2. Verbal or visual prompt
  3. Gestural or model prompt
  4. Physical guidance

Least-to-Most Example: Teaching to Sit in Car Seat

  1. Look at child with expectation to sit
  2. If child doesn’t sit, state “sit please”
  3. If child doesn’t sit with verbal direction, gesture to sit by patting car seat while stating “sit please”
  4. If child still doesn’t sit, physically guide child to car seat and praise for sitting (e.g., “thank you for sitting”)

Modeling/Request Imitation

  1. Arrange the environment to capture the child’s attention or interest
  2. Provide a command (e.g., “Tell me what you want”) and wait 4-6 seconds
  3. If the child does not respond correctly, provide a model “say _______” and wait 4-6 seconds
  4. If the child responds correctly, provide item/request with a verbal expansion. If the child does not respond, provide item/request with a model.

Modeling/Request Example: Teaching to Say “Help Me Please”

  1. Have art materials available as a choice for child (one being a closed bottle of glue). After child goes to the area and gets frustrated with opening the glue bottle, look expectantly and say “what?”, then wait 4-6 seconds
  2. If child is still frustrated, say, “Tell me what you want” and wait 4-6 seconds
  3. If child says “help me please”, provide help with opening the glue and verbally expand on what was said, “You want help opening the glue. I’ll help you.”
  4. If the child doesn’t respond, provide model. “Say, help me please” and then look expectantly at her. Delay for 2-4 seconds. If child says “help me please”, provide help and say “o.k., I’ll help you open the glue.”
  5. If child still doesn’t say “help me please” repeat model & then help child.

Teaching Replacement Skills: When to Teach

  • Teach skills intentionally using planned procedures
  • Teach replacement skills during time the child is not having challenging behavior
  • Teach throughout the day
Teaching Request Help
New Skill: Transition to Breakfast
Replacement Skills Cue Cards

Social Skills Instruction

  • Determine the skill to be taught, be specific (what does the behavior look like?)
  • Ensure that opportunities to teach and practice skill are available
  • Decide on the method of instruction (e.g., role play, prompt and praise, etc.)
  • Teach skill
  • Provide opportunities to practice skill
  • Reinforce skill use in natural contexts

Support Plan

  • Behavior Hypotheses - Purpose of the behavior, your best guess about why the behavior occurs
  • Prevention Strategies - Ways to make events and interactions that trigger challenging behavior easier for the child to manage
  • Replacement Skills – New skills to teach throughout the day to replace the challenging behavior
  • Responses - What adults will do when the challenging behavior occurs to ensure that the challenging behavior is not maintained and the new skill is learned

Response to Challenging Behavior

  • Responding in a way that will make challenging behavior ineffective
  • Make sure rewards for appropriate behavior are equal to or exceed rewards for challenging behavior

Escape (e.g., activity, demands, social interaction)

Possible Replacement Skills

  • Redirect/cue to use appropriate “new replacement skill” and then allow escape
  • Cue with appropriate prevention strategy
  • State “exactly” what is expected
  • Offer alternatives
  • Use “wait-time”
  • Praise/reinforce when replacement skill is performed
  • Respond in a way that does NOT maintain challenging behavior

Obtain (e.g. attention, object, activity)

Possible Replacement Skills

  • Redirect/cue to use appropriate “new replacement skill”
  • Cue with appropriate prevention strategy
  • State “exactly” what is expected
  • Offer choices
  • Use “wait-time”
  • Praise/reinforce when replacement skill is performed
  • Respond in a way that does NOT maintain challenging behavior
Group Activity: Discuss Strategies Used to Support Gabby

Safety-net Procedures

  • If a child is in danger of harming himself or others, you must first be concerned about safety
  • You may hold a child or remove a child from the situation to keep children safe
  • Safety-net procedures may be planned for children who have a history of dangerous outbursts
  • Safety-net procedures only keep children safe, they do not change behavior.
  • Safety-net procedures are only appropriate when there is also a full behavior support plan or intention to develop a plan

Major Messages

  • The behavior support plan includes four parts: behavior hypotheses, prevention strategies, replacement skills, and new responses
  • Hypotheses statements describe the triggers, challenging behavior, maintaining consequences, and function
  • Prevention strategies are used to soften the triggers of challenging behavior
  • Replacement skills (to replace challenging behavior) are taught systematically and throughout the day