Patching Problem Behavior Perplexity: Stitching Together Skill Deficits from a Multitude of Variables
Part 2
Last week I introduced the idea of non-linear contingency analysis! Read that article here and read about how some of our more traditional training might be falling short when analyzing problem behavior.
I promised several examples of how this approach might work. Let’s dive in!
Leo, a 6-year-old child with autism, frequently exhibits tantrums and non-compliance during school activities. His problem behaviors include crying, yelling, and refusal to participate in tasks. You conduct a non-linear contingency analysis, which reveals that Leo's tantrums engage in problem behavior when more difficult aquisition tasks are introduced, there’s a lack of predictability during the day, and he has negative peer interactions. The consequences maintaining his behaviors are escape from specific difficult tasks, escape from peers, and attention from adults.
To address Leo’s issues with predictability in schedule, you create the following interventions:
Introduce and train Leo on a visual schedule to provide a little structure and predictability.
Teach Leo a mand to access/look at the daily schedule.
Teach Leo a mand to ask about information that happens next, this afternoon, and/or tomorrow.
Teach and use visual timers (and eventually clocks) so Leo gains an understanding for the passage of time.
To address Leo’s issues with aversive aquisition tasks, you create the following interventions:
Offer high value reinforcement exclusively in exchange for any interaction with aquisition tasks.
Teach mands for breaks from non-preferred tasks.
Teach mands for other aquisition tasks.
When presenting the task, offer other aquisition tasks to choose from.
Introduce aquisition tasks at times of the day Leo is most willing to give them a try.
To address neagtive interactions with peers, you create the following interventions:
Teach Leo how to mand for adult and peer attention.
Teach mands to escape from peers that are unfriendly.
Have all peers randomly offer tangible and social reinforcement to Leo throughout his day.
Have Leo label peers that are his friends.
Samantha, an 8-year-old child with autism, often displays aggressive behavior towards her peers, including hitting, kicking, and pushing. In conducting a non-linear contingency analysis, you realize that she engages in these behaviors when there are more than three peers in a room and when a peer is being attended to by a preferred adult. You also discover that she is not played with at home and often times left alone completely to play by herself. Finally, these problem behaviors seem to increase toward the end of the day.
To address Samantha's problem behaviors, you might implement the following interventions:
To combat divided attention by adults, you create the following interventions:
Teach a mand for attention.
Teach a mand for a specific kind of preferred interaction (teach a mand for high fives, fist bumps, tickles, wrestling, etc.)
Teach her to mand with an adult’s name.
Teach her how to raise her hand in the presence of peers.
Offer her high value tangible reinforcement when peers enter a room or in any instance where her preferred adult gives attention to another peer.
Remain in physical contact with her when speaking to other peers (hand on back, head etc.). Offer preferred social praise immediately if she allows it without engaging in problem behavior.
To combat lack of attention at home, you create the following interventions.
Coach caregivers on give exclusive 1:1 positive attention each evening for an extended period of time.
Challenge caregivers to keep data on and increase the number of positive interactions they have with Tiara (Ex: 10 hugs every night!)
To combat the late day problem behavior.
Thicken her reinforcement schedule towards the end of the day.
Offer highest value reinforcers exclusively at the end of the day.
Refrain from introducing low probability, non-preferred tasks at the end of the day and—instead—introduce them during parts of the day that she is most receptive to them.
Michael, a 10-year-old child with autism, frequently attempts to leave his classroom or designated area, putting himself at risk for injury. His problem behaviors include running out of the room, climbing over barriers, and bolting during transitions. Non-linear contingency analysis reveals that Michael's elopement is triggered by loud environments, unstructured classroom time, and he seems to really like being “chased”.
To address Michael’s issues with loud environments, you create the following interventions:
Teach Michael to label loud and quiet.
Teach Michael to mand for escape in loud environments.
Teach Michael to wear headphones (or similar) for increasing amounts of time during selected preferred activities and low probability tasks.
Teach Michael to mand for headphones in loud situations.
To address Michael’s issues with unstructured environments, you create the following interventions:
Introduce Michael and teach Michael to engage with a variety of preferred items and activities.
Teach Michael to look for and identify preferred items and activities in a variety of environments (playgrounds, playrooms, classrooms, etc.)
Offer highest value reinforcement for instances where Michael engages with any items, activities, or people in unstructured environments (instead of engaging in elopement).
Rehearse with Michael and have him label the areas that are safe to play in/allowed.
To address Michael’s extreme preferences for being chased, you create the following interventions:
Teach Michael to label “chase” or “run” or “tag”.
Teach a mand for being chased.
Introduce and teach a “chase” as game in controlled and appropriate environments (on playgrounds, gross motor areas, gyms, etc.).
Eventually, offer “chase” as a high value reinforcer for low probability tasks.
Engage in the “chase” game at the beginning of each session for extended periods of time so Michael satiates.
Encourage therapist to make the game more fun and exciting than elopement by itself.
Emily frequently engages in disruptive vocalizations, such as screaming and shouting. Non-linear contingency analysis shows that Emily's vocalizations increase on days she wakes up incredibly early or goes to bed late and in instances where she’s been denied adult or peer attention.
To address Emily's issues regarding sleep, you create the following interventions:
If there isn’t a structured bedtime routine in place, you work with caregivers to create one.
To address Emily’s issues regarding denied adult and peer attention, you create the following interventions.
Teach Emily how to mand to peers and adults for attention.
Teach Emily to mand with names of peers and adults.
Teach Emily to raise her hand when she needs attention.
When preferred attention is denied, offer alternative, high value reinforcement. Return preferred attention if Emily engages in the alternative reinforcer.
Teach Emily to label scenarios where we wait for attention and need to find something to do (Ex: This person is busy, so we need to find something to do while we wait.)
Teach Emily to label things to do when it is time to wait across a variety of scenarios.
Certainly these examples don’t encompass everything, but they serve as food for thought. A few very important things to note:
First, you see that in all of these scenarios, there are multiple variables likely impacting just one (or a few) problem behaviors. Not one variable or one function like we might be used to seeing. This approach acknowledges that all of the variables interact with each other, bringing about certain behaviors. One problem behavior likely indicates that there are multiple variables impacting it.
Second, if we adopt the constructionist approach, we realize that the multiple variables impacting the problem behavior mean that there are multiple skill deficits. It’s actually multiple skill deficits in multiple skill areas (like bedtime, clasroom time, scanning, etc.) that play off each other and make meltdowns happen. Whoa! Read that again.
It’s actually multiple skill deficits in multiple skill areas (like bedtime, classroom time, scanning, etc.) that play off each other and make meltdowns happen.
In the days of yore, I remember being taught to target only one skill per function. For example, if the function of the behavior was deemed to be attention, we taught one skill: a mand for attention. One program. That’s it. With a multivariate approach, you see that there are numerous skills that you might need to teach.
Third, since one problem behavior can indicate multiple skill deficits in multiple areas, that means a significant portion of your treatment plan goals (for learner and caregiver) will be driven by the problem behavior your learner is engaging in. We tend to think of the behavior plan separately when coming up with authorization goals. Yet, an FBA (whether you are conducting a traditional or non-linear analysis), is an assessment that discloses skills we should be teaching in the same way a VB-MAPP or AFLS does. An FBA is still a skills assessment and a reinforcer assessment rolled into one process. Keep that in mind!
As always, hit me back with commentary and emails. I love hearing from you!
A few other notes:
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Read more about non-linear contingency analysis here!
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