Positive Behavior Support and Autism Spectrum Disorders

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Positive Behavior Support and Autism Spectrum
Disorders

• Rose Iovannone, Ph.D.
• University of South Florida
• iovannone_at_fmhi.usf.edu
• 813-974-1696

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Agenda

• Autism
• Description and Relevant Characteristics
• Behavioral Intervention and Support
• General Strategies
• Individualized Assessment and Intervention
• Example(s)

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Objectives

• Participants will
• Identify characteristics of autism spectrum
  disorder
• Describe the steps of the PBS process
• Identify examples of activities related to steps
  of PBS

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Projects and Web Sites

• Autism
• Center for Autism and Related Disabilities
• http//card-usf.fmhi.usf.edu/
• Autism Society of America
• www.autism-society.org
• Positive Behavior Support
• FL - PBS Project
• http//flpbs.fmhi.usf.edu
• RRTC-PBS
• www.rrtcpbs.org
• OSEP Center on PBIS
• www.pbis.org

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Autism

• A Developmental Disability characterized by
  disorders in social relatedness and language and
  a tendency to engage in perseverative,
  repetitious behaviors.
• A diverse (heterogeneous) disability, with
  individuals displaying a great range of abilities
  and disabilities.

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Autism Spectrum Disorder

• Autism (Autistic Disorder)
• Pervasive Developmental Disorder NOS
• Aspergers Disorder
• Retts Disorder
• Childhood Disintegrative Disorder

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Characteristics of Autism

• Delays/disorders in communication
• Delays/disorders in social relatedness
• Repetitive, perseverative, stereotypic patterns
  of behavior
• Uneven patterns of development
• Occurrences of problem behavior
• (though this is not a diagnostic characteristic)

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Autism

• Cause(s)
• Unknown, but strong indications of genetic
  neuro-physiological factors
• Prevalence
• Increasing -----
• Current estimates of about 1/500
• Recent (1996) CDC prevalence study estimates
  overall rate of 3.4 per 1000 (34 per 10,000)
  reported in American Medical Association (2003,
  V. 289)

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Autism - Intervention

• History of Fads
• Consensus that Educational/Behavioral Strategies
  are the Most Effective

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Some Sensible Standards for Intervention

• Based on Empirical Research
• Conceptually Coherent
• Low Risk
• Low Inference
• Functional Outcomes

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Positive Behavior Support for Students with Autism

• General Strategies
• Individualized Approaches

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Problem Behaviors Autism

• Destructive Behaviors
• Aggression SIB Property Destruction
• Disruptive Behaviors
• Long tantrums Loud, Repetitive Noises Running,
  etc.
• Irritating Interfering Behaviors
• self-stim repetitive and perseverative speech
  or actions, etc.

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General Strategies

• System-wide Support Strategies
• Group Contingencies Positive Culture
• Enriched Environment
• Interesting, Constructive Curriculum
• Comprehensive Attention to Physical Health and
  Social/Emotional Well-being

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What is Positive Behavior Support?
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Positive Behavior Support

• Values-based, empirically valid approach
• Purpose resolves problem behaviors and helps
  people lead enhanced lifestyles
• Teaches new skills and changes persons
  environment
• New applied science of behavior change
• Validated processes
• Systems change
• Behavioral and biomedical science

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Characteristics of Positive Behavior Support
Plans

• Assessment-based
• Prevention
• Comprehensive
• Normalization and inclusion
• Team-based
• Person-centered values
• Long-term planning
• Broad view of intervention success
• Contextual fit

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Individualized Process of PBS

• Goal Setting and Team Building
• Functional Behavioral Assessment
• Hypothesis Development
• Behavior Support Plan-Development and
  Implementation
• Support Plan Evaluation and Monitoring

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Step 1 Goal Setting Team Building

• Goals
• Reduce challenging Behaviors
• Build new competencies and opportunities
• Teams
• Teachers, family, others
• Act as partners
• Activities
• Person-Centered Planning

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Making Person-Centered Plans
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What is Person-Centered Planning?

• Person-Centered Planning is a way for diverse
  people, who share a common need to align.
• Their vision, purposes, and goals
• Their understanding of the focus persons past,
  present and future life
• Their actions for change, mutual support,
  personal and team development, and learning

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Why is Person-Centered Planning so important to
PBS?

• Retains focus on the person
• Supports a team approach
• Broadens the level of analysis
• Changes participants
• Makes the functional assessment better
• Broadens the number of effective interventions
• Creates the best contextual fit

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Five Essential Goals ofPerson-Centered Planning

• Being present and participating in community life
• Gaining and maintaining satisfying relationships
• Expressing preferences and making choices in
  everyday life
• Having opportunities to fulfill respected roles
  and live in dignity
• Continuing to develop personal competencies

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Person-Centered Plan Sample Template
Dream 1
Hopes Fears 2
Places 4
History 6
Respect 8
Barriers and Supports 10
First Steps 13
Goals 12
People 3
Health 5
Choices 7
Strategies 9
Themes 11
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Brandons Person Centered Plan
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Brandons Team

• Mom (Debbie)
• School
• Ann (Behavior Analyst-CABA)
• Brenda (Paraprofessional)
• Setta (OT)
• Joanne (Teacher)
• Home
• Wendy- Behavior Analyst (CBA)
• Abram Residential Rehabilitation
• CARD

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D R E A M
THE

• With this frame we want to help the person
  identify his/her dream for the future, including
  all the ideas, values, people and things that are
  important to the person.
• List anything that is important for the person to
  have the kind of life desired.

Potty trained
Independence Self help care
DANCE
Circle of Friends
Communication
Shop
Increase interests!!!
JOB-willing worker
Active in community independent
Generalize skillsall
Work with animals
SWIM
Pre-vocational skills
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Hopes

• Identify the hopes and fears you have for this
  individual.
• Under Hopes list what is possible if we do the
  best we can.
• Under Fears list what is possible if things do
  not improve or get worse.

Remain healthy and happy Care
for self
Social skills to develop friendships Spend more
time with animals Independence in community
Communicate outside circle of friends/family
Continued learningfunctional
Success in all environments/transitions
Fears
Remain incontinent Brandon would be
misunderstood Hygiene neglected
Not reach full potential No
improved communication Limited social
relationships Remain prompt dependent
Safety concerns
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PEOPLE
Family
Agency

• List the people who are present in the persons
  life.
• Place their name in the appropriate section of
  the circle.
• Place the name of individuals who are closest to
  the person in or near the inner circle.

Ms. Dawson Ms. Lundy Ms.
Bonafe Seeta Ann Sharon Kristen Crystal
Ms. Yurillo Wendy Abram Brenda
Evan Nicole Chris Jessica
Memaw/Ppaw Nanny Aunt Denise Aunt Day Aunt
Esta Mom Dad Pat Boy Barkley Boris Uncle
Mike/Bill Mike Aunt Ardie
Linda Michelle Paula Ms. Judy Gail
Kelly
Beth Jordon Jeffrey Elisa Joan Kevin Amelia
Michele Tasha Jessy Alex Lee Ashley
Lyman Nike
Friends
Community
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P L A C E S

• Indicate activities in which the individual
  participates in the school.
• Indicate activities in which the individual
  participates in the home.
• Indicate places in the community in which the
  individual participates on a consistent basis.
• List only 4-5 primary activities in each setting.

School
Home
Speech (group) PT (safety) 1-on-1 OT 1-on-1
group Lunch Adaptive PE Assemblies
Art (group) Cooking Team sports
Cleaning
Sets table Waters plants
Feeds dog Brings dirty clothes
to laundry
Picks up toys
Plays basketball Goes for
walks
Community
Horseback Track team
Bowling team Swim team Shopping
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HEALTH

• Describe the individuals health by listing any
  positive or negative conditions.
• Indicate any medications the individual is
  currently taking.

Good eater Good teeth Happy
Healthy Special diet
(Casen/gluten free)
Motor planning problems Constipation Sleep
Allergies (food, bugs)

Medicines
IBIG
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9-23-89
Born
6 mos.knew something was wrong. Reflex disorder.
Not walking until 2
.
Horseback riding at 3 yr. At 5 yrs. Auditoy
Aerobics

• Indicate some of the critical events that
  occurred in the persons life from birth until
  today.
• Put a next to any positive events.
• Put a - next to any negative events.

6 yrs. Sleep through the night
7 yrs. got a dog 9 yrs. started diet
sleep normal
10 yrs. started IBIG Started Special Olympics
12 yrs - NOW
11-4-01
Today
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Personal
Academic
Choices
Drink Snack Bathroom
Activity Reinforcers Clothing
Compliant or noncompliant
Reinforcers When finished-Lunch
Where to sit -boundaries Art
choice of colors
Toys/activities Compliant or noncompliant
Bathroom

• What choices can the individual make within
  his/her personal and academic life?
• Identify what choices are presented to the
  individual within both areas.

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Gains
Respect!
Smiles a lot Good eye
contact Seeks out social interaction
Good sense of humor Friendly
Acknowledges social
greetings Redirects nicely Very
forgiving

• List any behaviors or characteristics of the
  person that cause him/her to gain or lose respect
  or his/her peers or adults.
• Under Gains list those things you really like
  about the person.
• Under Loses list those behaviors that you do
  not like to see.

Loses
Loud noises Flops
Zones out
Unaware of personal space Grinds teeth
Inappropriate touching
Inappropriate laughing/giggling
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• What strategies work well for the individual?
• What strategies have not been as successful or
  cause the challenging behavior to increase?

What Works!!!
Reinforcers (bubbles, food, music, tape, social,
tickle, physical)
Routine flexibility
Least to most prompting
Familiar items
Meaningful work
Exercise

Food
Mat
Break
Activities with no function for Brandon or above
level Non-instructional
environment Most-to-least
prompting Teach w/o reinforcers Unmeaningful
tasks
What Doesnt Work!!!
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Opportunities

• What are some barriers and opportunities for this
  individual and his/her team?

Team meetings/PBS Opportunities in the
community Support of Beh. Tech.
Barriers
Class size-too much of a mix of disabilities
Lack of communication between providers
Functional plan in all environments
Distractions - interruptions
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• Identify any patterns or themes you found
  throughout this process.
• List at least one main point from each of the
  other frames that you want to share with the
  team.

Themes
SOCIAL SKILLS
COMMUNICATION
INDEPENDENCE
CONSISTENCY
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• List the goals that you would like to see
  achieved one year from today.
• Think about what might be possible if everyone
  tries their hardest.
• Consider any outcome as long as it is POSSIBLE
  and POSITIVE.

Goals
Communicate with more words/signs Potty
trained Friends/social/relationship in various
settings Generalize skills Learning more
functional increase compliance
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• What
• actions can
• be taken
• immediately?
• These
• steps
• can be
• small

• Conduct Functional Behavior Assessment
• 7th period make symbols for cleaning to help
  Brandon be more involved use choice boards
• Set up peer buddy for Brandon Mrs. Y/OT Seeta
• Increase communication between all providersMrs.
  Y. will use current notebook for all providers to
  sign OT/Speech/CBA/Home/Teacher/ TECH

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Step 2Functional Behavioral Assessment

• A process of information gathering that leads to
  an understanding of the relation between problem
  behavior and events in the environment
• Purpose is to develop effective behavior support
  plans

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Primary Methods of FBA

• Record reviews
• Interviews reports
• Direct observations

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Outcomes of FBA

• Good, specific description of target behaviors
• Identification of times, places, situations where
  behaviors occur
• Identification of times, places, situations where
  behaviors do not occur
• Identification of behaviors consequences, and
  presumed function (purpose) of behavior

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What are the ABCs of behavior?

• A Antecedent
• B Behavior
• C Consequence

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Antecedents

• Events happen prior to challenging behavior
• Fast triggers
• Examples
• Demands
• Nonpreferred activity
• Working with peers
• Working alone
• Teacher attending to another student
• ..

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Setting Events

• Removed in time from the occurrence of behavior
• In or out of the classroom
• Conditions that increase the likelihood behavior
  will occur
• oversleeping
• no breakfast
• forgotten medication
• conflict with . . .

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Consequences

• What happens AFTER the behavior occurs? What do
  others do as a result of the behavior?
• What is the pay-off?
• What does the student get?
• What does the student avoid?

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ABC CardsFront
Setting Time/Date Observer
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ABC CardsBack
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FBA Data Collected for Brandon

• Interviews
• Anne-school team
• CARD-home team
• Scatterplot for grinding behavior
• Brenda (behavior tech.)-school
• Mom-home
• A-B-C cards4 weeks (12/12-1/10)
• Brenda-school
• Abram-home

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Brandons FBA results

• Main triggers
• Demands (particularly academic 11 goals)
• Transitions
• Setting events
• Sleep deprivation
• Functions
• Multipleescape and attention

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Step 3 Hypothesis Development

• Analysis of Patterns in FBA Information
• Contexts
• Functions
• Development of Statements (Hypotheses) that
  Represent Understanding of How Behavior Relates
  to Environment

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Hypothesis Development

• Formula
• When (trigger/antecedent/setting event) occurs.
• the student does (describe behavior)
• to (obtain or escape or avoid)..(functions)

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Brandons Hypotheses

• When presented with a demand (particularly 11
  goals), Brandon will scream, yell out, and laugh
  to obtain attention and to avoid doing tasks.
• When making a transition to another environment,
  Brandon screams to get adult and peer attention.

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Step 4 Behavior Support Plan-Development and
Implementation

• Based on FBA and Hypotheses
• Based on Team Input and Goals
• Includes Teaching Objectives and Strategies
• Includes Manipulations of Context (Antecedents)
• Includes Consequences
• May Include Management of Crises

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Methods of Interventions

• Preventing behavior from occurring
• Fast trigger or slow trigger alteration
• Teaching other behaviors
• Replacement skills
• General skills
• Coping and tolerance skills
• Responding to behaviors
• Changing consequences for challenging behavior
• Lifestyle enhancements

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Some Possible Prevention Interventions
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Some Possible Replacement Behaviors
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Responding Strategies

• Requires adults in students life to change ways
  they react to both positive and negative
  behaviors
• Supports students use of alternative behaviors
• Focus remains on teaching student new ways to
  meet needs rather than reacting to challenging
  behaviors

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Lifestyle Interventions
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Brandons Support Plan

• Preventive interventions-Hypothesis 1
• Choices-activities and reinforcers
• Demands become less aversive

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Step 5 Support Plan Evaluation and Monitoring

• Action Planning and role specification
• Training and resources
• Monitoring important outcomes

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Amys Difficulties Week of _____________
Rate the problem behavior 0no problems, 1
whining, resisting , 2 screaming, falling on
floor, 3screaming, hitting, other aggression
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Bens Playtime
3Cooperated, stayed briefly
2Fussed, took several turns
1 Cried, refused to play
4Laughing, stayed


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Data Monitoring Example
Screaming 1 0 2 1-3 3 4-6 4 7-9 5
10 or more Hitting 1 0 2 1-2 3 3-4 4
5-6 5 7 or more
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Example John

• Goal 1 John will follow verbal directions to
  complete a task 3 out of 4 times with 75
  accuracy over a nine week period.

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Students Name John Week of
John will follow verbal directions to complete a
task 3 out of 4 times with 75 accuracy over a
nine week period.
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Brandons Monitoring/Data Collection Plan

• Daily data sheets for choice making and
  requesting break
• Anecdotal notes for appropriate greetings

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Outcomes for Brandon

• Significant decrease in problem behaviors
• Increase in use of replacement behaviors (asking
  for a break and high five)
• Other outcomes
• Choice-making increase in task engagement
• Complies with initiating tasks

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Generalization/Lifestyle Changes for Brandon

• Used new behaviors in multiple settings
• School (Cafeteria, PE, OT, Speech)
• Community (Restaurants, Special Olympics, Church
  Activities)
• Invited by peers to join in activities

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Nearing the End

• Questions
• Comments
• Summary