5490 Lecture Week 4

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Antecedent Package   Behavioral Package   Comprehensive Behavioral Treatments for Young Children   :

Antecedent Package   Behavioral Package   Comprehensive Behavioral Treatments for Young Children   Heather Enos Ed.S ., BCBA University of Colorado Denver

Agenda:

Agenda Review EBP What does the treatment package look like? What skills does each target? For whom does it work? Can it be implemented in early childhood settings?

Evidence based interventions for children with autism :

Evidence based interventions for children with autism What is an intervention? Intensity / who / when / why Outcomes How do we pick? Assessment Evaluation piece

What are the components of an intervention? :

What are the components of an intervention? Intensity? Match the child’s developmental age Learning style Needs

Consider the delivery:

Consider the delivery Computer assisted instruction Children with autism made more gains with computer assisted instruction than traditional and vice versa for children with typical development (Chen & Bernard- Optiz , 1993; Sweden, Heiman , 1995).

What are the components of an intervention? :

What are the components of an intervention? To increase and decrease behaviors

What are the components of an intervention? :

What are the components of an intervention? Observable Measurable Functional Generative

What are the components of an intervention? :

What are the components of an intervention? For children with autism this often means those “core skills”: Communication Play Social Adaptive skills

What are appropriate goals?:

What are appropriate goals? Curriculum should be linked to assessment Beginning skills through advanced….

Several curricula include: :

Several curricula include: Nonverbal imitation Block imitation Verbal imitation Matching Receptive instructions Expressive labels Emotions Dressing Writing letters and numbers Choice making Motor skills Drawing / cutting Colors and shapes Prepositions Wh questions Conversation I want / I see /I have Toileting Brushing teeth Toy play

What are the components of an intervention? :

What are the components of an intervention? Across settings, people, time

Evidence based practices:

Evidence based practices There exists a set of practices that have been effective for young children with autism Which simply gives us a place to start

Components of Evidence Based Strategies:

Components of Evidence Based Strategies Get family input Communicative partner must be skilled Frequent opportunities Use motivation Acknowledge attempts Embed into ongoing routines Incorporate affect and enjoyment Elaborate communication duration and complexity (following the child’s lead)

CO Guidelines Nine Recommended Strategies:

CO Guidelines Nine Recommended Strategies Antecedent Package Prompting Behavioral Intervention Package Positive Behavior Interventions and Supports (PBIS) Discrete Trial Training (DTT) Joint Attention Modeling Naturalistic Teaching Strategies Peer Training Package Pivotal Response Treatments Schedules (Use of Pictures) Augmentative and Alternative Communication (AAC)

Antecedent Package (NSP Behavioral Package):

Antecedent Package (NSP Behavioral Package) What is an antecedent? What happened BEFORE Designed to modify the environment BEFORE a target behavior occurs These interventions involve the modification of environmental or situational events that precede the occurrence of a target behavior.

Antecedent Package (NSP Behavioral Package):

Antecedent Package (NSP Behavioral Package) Examples; Prompting – Clues, support, hints ( physical or verbal) Most-to-Least Prompting Least-to-Most prompting Time - Delay Neitzel , J., & Wolery , M. (2009). Steps for implementation: Time delay. Chapel Hill, NC: The National Professional Development Center on Autism Spectrum Disorders, Frank Porter Graham Child Development Institute, The University of North Carolina

Antecedent Package (NSP Behavioral Package):

Antecedent Package (NSP Behavioral Package) What are the target skills? Reduce problem behaviors Improve a range of skills Toilet training Play and make choices Decrease stereotypies Identify objects

Antecedent Package (NSP Behavioral Package):

Antecedent Package (NSP Behavioral Package) How to implement? Across routines In play In a home environment Classroom

Antecedent Package (NSP Behavioral Package):

Antecedent Package (NSP Behavioral Package) These interventions involve the modification of environmental or situational events that precede the occurrence of a target behavior. Reflected in treatments representing applied behavior analysis, positive behavior supports, and behavioral psychology

Antecedent Package (NSP Behavioral Package):

Antecedent Package (NSP Behavioral Package) What does the research say? Evidence? With what ages is ABI effective? What skills or intervention goals can be addressed by ABI? In what settings can ABI be effectively used?

Antecedent Package (NSP Behavioral Package):

Antecedent Package (NSP Behavioral Package) Common antecedent-based intervention strategies include: Arranging the environment; Changing the schedule/routine; Structuring time; Using highly preferred activities/items to increase interest level;

Antecedent Package (NSP Behavioral Package):

Antecedent Package (NSP Behavioral Package) Offering choices; Altering the manner in which instruction is provided; Enriching the environment so that learners with ASD have access to sensory stimuli that serve the same function as the interfering behavior (e.g., clay to play with during class, toys/objects that require motor manipulation); and

Antecedent Package (NSP Behavioral Package):

Antecedent Package (NSP Behavioral Package) Implementing pre-activity interventions (e.g., issuing a warning about the next activity, providing information about schedule changes).

Step-by-Step Instructions :

Step-by-Step Instructions Four essential steps for antecedent based interventions. These include: 1. Identifying the interfering behavior 2. Collecting baseline data 3. Implementing the appropriate antecedent based intervention, and 4. Monitoring progress.

Summary:

Summary Antecedent-based intervention strategies can be used to address both on-task and inappropriate behaviors. This evidence-based practice involves using environmental modifications to change the conditions in the setting that prompt a learner with ASD to engage in an interfering behavior.

Summary:

Summary The goal of ABI is to identify factors that are motivating the interfering behavior and then modify the environment or activity so that the factor no longer causes the interfering behavior. Antecedent-based intervention strategies are often used in conjunction with other evidence-based practices such as functional communication training (FCT), extinction, and reinforcement.

Behavioral Package :

Behavioral Package Based on behavior principles Four fundamental consequences that explain most behavior When a desirable consequence happens after a behavior occur-s the behavior is likely to happen again. ( sr +) Example? When an undesirable consequence happens after a behaviors occurs- the behavior is likely to decrease. (p+) Example? When a desirable consequence is removed after a behaviors occurs that behavior is less likely to occur again. (p-) Example? When a undesirable consequence is removed after a behavior occurs the behavior is likely to occur again. ( sr - ) Example?

Behavioral Package :

Behavioral Package Often requires… Determine the function of the problem behavior How? Functional assessment Functional analysis Descriptive assessment

Behavioral Package :

Behavioral Package What are the functions? Obtain?? Escape?? Not specified/Automatic?

Behavioral Package :

Behavioral Package Target Behaviors Academic skills Communication Social skills Play skills Problem behaviors Your articles????

Behavioral Package:

Behavioral Package Reduce problem behaviors and increase functional skills Contingency contracting Toilet training Shaping Token economy Functional Communication Training

Behavior Intervention Package:

Behavior Intervention Package Positive Behavior Interventions and Supports (PBIS) An approach for changing a child’s behavior Is based on humanistic values and research. An approach for developing an understanding of why the child has challenging behavior and teaching the child new skills to replace challenging behavior. A holistic approach that considers all of the factors that impact on a child, and the child’s behavior

Research on PBS:

Research on PBS Effective for all ages of individuals with disabilities 2-50 years. Effective for diverse groups of individuals with challenges: mental retardation, oppositional defiant disorder, autism, emotional behavioral disorders, children at risk, etc. PBS is the only comprehensive and evidence- based approach to address challenging behavior within a variety of natural settings.

Old Way New Way:

Old Way New Way General intervention for all behavior problems Intervention is reactive Focus on behavior reduction Quick Fix Intervention matched to purpose of the behavior Intervention is proactive Focus on teaching new skills Long term interventions

Behavior Intervention Package: PBIS:

Behavior Intervention Package: PBIS 5 components of PBIS: Establishing a Team Conducting Functional Assessment Developing the Intervention Plan Reducing targeted behaviors Teaching new (replacement) behaviors Implementation Evaluations

1. Potential Team Members:

1. Potential Team Members Parents/Family Teacher Assisting Teacher/Paraprofessional Therapists Administrative Staff Other(s)

Functional Assessment:

Functional Assessment A process for developing an understanding of a person’s challenging behavior and, in particular, how the behavior is governed by environmental events. Results in the identification of the “purpose” or “function” of the challenging behavior.

Functional Assessment:

Functional Assessment Observe the child in target routines and settings Collect data on child behavior, looking for situations that predict challenging behavior and that are linked with appropriate behavior . Interview persons most familiar with the child Review records.

3. Behavior Support Plan:

3. Behavior 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 predict challenging behavior easier for the child to manage Replacement Skills - Skills to teach throughout the day to replace the challenging behavior Responses - What adults will do when the challenging behavior occurs

4. Implementation:

4. Implementation Identify outcomes valued by the team “KIS it” (Keep It Simple) Create simple, user-friendly forms to monitor outcomes (e.g., rating scales, check sheets) Schedule dates for check-ins

Monitoring Progress:

Monitoring Progress Behavior Date Frequently Screams Minimal screaming 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 Screaming to protest (loud, inappropriate voice) : 1 = 0-2 times 2 = 2-4 times 3 = 5-8 times 4 = 9-15 times 5 = 16 or more times Screams

Slide42:

Support providers enter into play activities and teach Tim new play routines. Adults provide support by scaffolding Tim’s interactions in play routines outside and during centers. Yes No Sometimes Adults assist Tim with turn-taking interactions by moving into play activities and mediating his social exchanges; and then scaffold the interaction. Yes No Sometimes Adults facilitate the use of communication repair strategies by Tim. Tim may use unintelligible mumbling or aggression if adults fail to quickly interpret his message. Yes No Sometimes Pre-teach Tim through the use of a scripted story the following skills: asking to play, everyone can play (turn taking), being flexible and accepting other’s ideas and space, and asking the teacher for help. Yes No Sometimes Tim is cued with visual cue cards. The cue card is presented to Tim after gaining his attention (i.e., directly given to him by showing him the picture cue along with simple verbal cue). Yes No Sometimes 5. Evaluation Support Plan Implementation

Comprehensive Behavioral Treatment (CBTYC) :

Comprehensive Behavioral Treatment (CBTYC) Discrete Trial Training (DTT) Discrete Trial Training (DTT): distinct, repetitive responses following a specific stimulus that result in reinforcement. A discrete trial is a single cycle of instruction that may be repeated several times until a skill is mastered.

Discrete Trial Training (DTT) :

Discrete Trial Training (DTT) Discrete trial training (DTT) facilitates the acquisition of skills by breaking the skill down into small, teachable steps that can be repeated. DTT facilitates learning new skills by isolating the important components of the skill and rewarding successful completion of small steps.

Discrete Trial Training (DTT):

Discrete Trial Training (DTT) Each teaching trial has a beginning or prompt (antecedent), a response (the target skill) and an end (the consequence or reinforcer ). SD  Response ( Bx )  consequence (SR+/SR-/EC) The use of antecedents and consequences is carefully planned and implemented. Positive praise and/or tangible rewards are used to reinforce desired skills or behaviors. SD ------------------ > R < -------------------- SR (prompt)   (feedback)

Step by Step Instructions :

Step by Step Instructions Nine steps to implementing DTT . 1. Deciding what to teach: assessment and summarizing results 2. Breaking the skill down to teachable steps 3. Setting up the data collection system 4. Designating location(s) 5. Gathering materials 6. Massed trial teaching 7. Delivering the trials 8. Conducting discrimination training 9. Review and modify

Massed Trial Teaching:

Massed Trial Teaching A discrete trial consists of 5 main parts : An initial instruction – ex. “ Touch your nose. ” A prompt or cue given by the provider to help the child respond correctly – ex. Provider points to child ’ s nose. A response given by the child – ex. Child touches their nose. An appropriate consequence, such as correct responses receiving a reward designed to motivate the child to respond correctly again in the future – ex. “ Nice job touching your nose, ” teacher gives child a sticker. A pause between consecutive trials – waiting 1 – 5 seconds before beginning the next trial.

Expanded Trials & Random Rotation:

Expanded Trials & Random Rotation Expanded Trials : Adding distractors Increase systematically Builds memory retention Random Rotation : Original MT item is now randomly rotated with other mastered items

Incidental Teaching:

Incidental Teaching Environmental arrangement Child initiation Ask for elaboration Provide the object

Comprehensive Behavioral for Young Children :

Comprehensive Behavioral for Young Children Treating the defining symptoms of ASD Having treatment manuals High degree of intensity Measuring effectiveness

Thoughts/ Questions:

Thoughts/ Questions Assignment See assignment page in module 4 Discussion See discussion page in module 4 Readings See content page in module 4 You only have to read 3 articles (one from each intervention)

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