A BEHAVIOR ANALYTIC PERSPECTIVE ON

TRAUMA

Brett DiNovi & Associates

December 7, 2016

Brett DiNovi, BCBA & Matt Linder, BCBA

Matt@brettdassociates.com

Brett@brettdassociates.com

www.brettdassociates.com

WHAT PERCENTAGE OF CHILDREN WITH

DISABILITIES HAVE BEEN ABUSED?

• About 70%

• Twice as likely to be

physically or sexually

abused by someone

without a disability

???

AGENDA

• Identify functions of behavior

• Strengthening behavior

• Trauma

• LRE

• How to decrease problem behavior (extinction burst)

• Common challenges with behavior interventions

• Sample interventions

• Applied Behavior Analysis is the

science of behavior change.

ABA

“A SCIENTIFIC APPROACH IS A

WILLINGNESS TO CHANGE THE WAY WE DO

THINGS, TO TRY OUT NEW IDEAS AND TO

JUDGE THEIR WORTH BY EVIDENCE RATHER

THAN BY OPINION.”

- JULIE S. VARGAS

WHY BEHAVIOR HAPPENS…

MISCONSEPTIONS

• Why should I reward her for something she should do anyway?

• Reinforcement does not produce“intrinsic motivation”

• Reinforcement is“bribery”

• Many think ABA is only effective w/ autistic population or individuals or severely

disabled students.

https://www.youtube.com/watch?v=JA96Fba-WHk

• Goal is for behavior itself to contact the day to day natural rewards (recognition, making friends, earning $).

• Contrived reinforcers are eventually “thinned out” (i.e. reading for leisure).

LONG TERM GOAL OF REINFORCEMENT

PURPOSE TODAY

• Identify functions of behavior

• Strengthening behavior

• How to decrease problem behavior (extinction burst)

• Common challenges with behavior interventions

• Sample interventions

Identifying the function of any behavior is the most critical step to intervening.

FUNCTIONS

Tangible Stimuli- food, money, videos games,

activities like sports, cell phones, bracelets, cars,

going to movies, etc.

SOCIAL ATTENTION

FUNCTIONS

https://www.youtube.com/watch?v=avUsS9EKyq0

Escape or avoidance of something undesirable: out of class work Removal from

program/school Delaying a task by

arguing w/ staff Putting head down on

desk rather than working

FUNCTIONS

https://www.youtube.com/watch?v=1ycoXiEDBZk

SENSORY

Automatic Reinforcement or “sensory” behavior produces “internal

stimulation” such as visual, auditory, vestibular, gustatory, olfactory, or tactual.

SHELLY ASKED TO WRITE HER NAME

SHELLY ATTACKS TEACHER

BITING & SCRATCHING

3 BIG GUYS ESCORT HER TO TIME OUT AREA

SHELLY HAPPILY GOES TO TIME OUT ROOM

SHELLY “DIFFUSES” ON COMPUTER

SHELLY CALMED BY “TACTILE” STIMULATION

SHELLY GOES BACK TO CLASS

AFTER PICKING FROM PRIZE BOX

START ALL OVER AGAIN TO WRITE HER NAME

WHAT HAPPENED WITH SHELLY?

What Controls Behavior -How to Determine Function

Three-Term Contingency

Antecedent

What

happens

before the

behavior?

Behavior

What is the

behavior?

Consequence

What happens

after the

behavior?

WHAT’S THE FUNCTION?

Mark calls out in class and the teacher reprimands him. Each time-it gets worse:

a) escape

b) automatic

c) tangible

d) attention

WHAT’S THE FUNCTION?

Brandi screams when asked to do work, and she is placed in time-out. It gets worse:

a) escape

b) automatic

c) tangible

d) attention

WHAT’S THE FUNCTION?

Tiffany rocks back & forth for hours when she is alone

a) escape

b) automatic

c) tangible

d) attention

WHAT’S THE FUNCTION?

Lance steals food from his classmates at lunch and it gets worse:

a) escape

b) automatic

c) tangible

d) attention

WHAT’S THE FUNCTION?

Carlos lies to his mother and says he did his chores and she never checks so he get away with it.

a) escape

b) automatic

c) tangible

d) attention

WHAT’S THE FUNCTION?

Brian bullies a classmate to take his lunch money:

a) escape

b) automatic

c) tangible

d) attention

WHAT’S THE FUNCTION?

Jose flings spitballs at his teacher and his friends laugh. It gets worse.

a) escape

b) automatic

c) tangible

d) attention

WHAT’S THE FUNCTION?

Michelle forces herself to vomit and the teacher lets her go to the nurses office. It gets worse.

a) escape

b) automatic

c) tangible

d) attention

STRENGTHENING FUNCTIONALLY EQUIVALENT

ALTERNATIVE BEHAVIORS

STRENGTHENING FUNCTIONALLY EQUIVALENT

ALTERNATIVE BEHAVIORS

Attention Function:

Escape:

Tangible:

Automatic:

THE EXTINCTION BURST

41

Livy

PB

spit

The worst time to reinforce problem

behavior

The burst can be

attenuated by

strengthening functional

equivalents

Minutes

Fre

quency o

f Pro

ble

m

Beha

vio

r

THE BURST

• Extinction Bursts Are Natural & Innate

• Phylogenetic Behavior

• Extinction Induced Variation of Behavior

• Response Class Hierarchy

TRANSLATION: WE DO IT TO SURVIVE

BUT WHAT ABOUT TRAUMA?

WHAT IS TRAUMA?

• The behavior

• The 3 term contingency

• The history (sometimes)

WHAT CAN WE SEE?

WHERE DOES TRAUMA COME FROM?

A BAD EXPERIENCE

A STIMULUS IN THE ENVIRONMENT

A DESIRE TO ESCAPE THE ENVIRONMENT

• Difficult to deescalate

• Dangerous behavior

• Additional associations

A VISCERAL REACTION

• Slowly

• Gradually

HOW TO TREAT?

GRADUATED EXPOSURE

• Similar to systematic desensitization

• Use a powerful reinforcer

• Allow success to drive your timeline

THE GIRL IN RESIDENTIAL

0-400 BITES PER DAY

8 MONTHS OF TRYING TO FIGURE IT OUT

FACIAL HAIR

THE REINFORCER?

THE RE-PAIRING PROCESS

THE RE-PAIRING PROCESS

THE RE-PAIRING PROCESS

THE RE-PAIRING PROCESS

THE RE-PAIRING PROCESS

THE RE-PAIRING PROCESS

THE RE-PAIRING PROCESS

HOW WOULD YOU CREATE A GRADUATED

EXPOSURE PROGRAM

• Choose a behavior

• Develop the gradual process

• Systematic steps

THE BOY WHO GRADUATED

GRADUAL PROCESS

• Very little resistance

• Progress as you hit 3-5 presentations without problem behavior

• Move onto the next step

COMMON MISTAKES

• Extinction procedure used, however no alternative communicative response strengthened

- Ex. Student behavior is ignored but alternative response to get attention is not reinforced, consequently a more severe “burst” occurs

• Student is sent to time-out during demand situation but she prefers to be in timeout to escape work

COMMON MISTAKES

• Student is sent to principal’s office, but this functions as a reinforcer b/c he gets attention & escapes work

• Student is prevented from engaging in a ritualistic behavior, problem behaviors increase, and she is not permitted to have an alternative for these rituals

• Student suspended from school & plays video games at home w/ all friends that are also suspended RA

COMMON MISTAKES

• Student suspended from school & plays video games at home w/

all friends that are also suspended RA

• Teachers stop an intervention intended to decrease behaviors

because the student has problem behaviors during & after the

unpleasant procedure & it appears as though its ineffective

• Teachers ask students what their reinforcers are, however this is

often inaccurate

COMMON MISTAKES

• Speaking loudly to student with a disability that does

not have hearing impairment

• Student has problems right after “getting what they

want” or does not perform also known as a

“postreinforcement pause”

COMMON MISTAKES

• Staff have an inconsistent method of giving the student directions/demands

• Staff use a protective hold to maintain student’s safety but this tactile stimulation functions as a reinforcer

• Behavioral Strategies only used “when the student needs it”

• Student is sent to a more restrictive placement without a FBA and function-based intervention

COMMON MISTAKES

• The value of a reinforcer we choose does not compete with the value of the reinforcer for problem behavior

• Descriptive or interview methods of the FBA do not accurately identify the function of problem behavior; & the FBA process stops there

• Staff ignores student’s behavior & says, “I’m ignoring you!”

COMMON MISTAKES

• If descriptive assessment methods or A-B-C methods do not elucidate the function, analogue methods (manipulation of conditions) should be attempted (Iwata et al., 1982)

COMMON MISTAKES

• Procedural integrity is not assessed or monitored to determine if intervention is correctly implemented before changing it

• When attempting to reinforce appropriate communication, the student first engages in a problem behavior to get the teacher’s attention and then makes an appropriate communicative response

• Ex. Student has verbal outburst, teachers comes over & prompts him to “use your words”, then gets what he wanted

FUNCTION-BASED INTERVENTIONS

INTERVENTIONS FOR ATTENTION

• Attention Extinction:

Withholding reinforcement (R+) for a previously reinforced behavior; side effects: extinction burst

SIDE EFFECTS OF EXTINCTION • Extinction Burst

• When the computer freezes, think of how much you click (and usually

harder clicking too)

• Extinction-Induced Variation in Responding / Response Induction

• Trying something new to get what you want when the target behavior

fails: Pressing escape key, Ctrl+Alt+Del, Hard Restart, Unplugging

the computer

• Spontaneous Recovery

• Trying the response to determine if reinforcement will follow after

rates decrease (like trying a broken key on the keyboard when you

know it will not work)

OTHER IMPORTANT PIECES FOR CHANGE

FUNCTIONAL COMMUNICATION TRAINING

• Strengthening alternative attention seeking response; raising hand, tapping teacher’s arm, leading the class, “excuse me” picture card, etc.

• If training is constructed so that the appropriate response is more efficient at obtaining the reinforcer, the student should quickly choose to obtain the goal with the new response (Durand & Carr, 1991)

Be sure that attention given during

functional communication training

exceeds attention given for problem

behavior.

NON-CONTINGENT REINFORCEMENT OR FIXED

TIME SCHEDULE

Response independent or time-

based based reinforcement with

stimuli with known reinforcement

properties (Vollmer et al.,1993)

• Ex. Provide student w/ attention every 5 minutes when timer sounds whether there are problem behaviors or not

• The interval of reinforcement should be determined based on the inter-response time: Calculate the average number of minutes between problem behaviors & set the timer for slightly less

• NCR schedules work b/c the student receives a dense schedule of reinforcement prior to engaging in problem behaviors

• Like having snacks throughout the day before you get hungry

• NCR schedules break the history of receiving reinforcement contingent on problem behaviors & make behavior independent of consequences

ATTENTION FUNCTION TX’S (CONT)

89

• Common Problem: the value/quality of the social attention for problem behaviors is more reinforcing than the type of attention given for appropriate behavior

• Different types of attention have different value, just like different currencies of money have different value

• Ex. Student flops to the ground, screams & laughs as teacher tries to physically prompt student off the floor. The type of attention the student receives for appropriate behavior (intervention) needs to involve tactile reinforcement (i.e. high fives, tickles, etc.) to compete with the type of attention received for problem behavior

ATTENTION FUNCTION TX’S (CONT)

90

• Student permitted to a leader in the class & teacher “helper” & get

appropriate peer attention as a result

• Earning access to 5 min of individual teacher attention in lieu of behavior

problem demanding individual teacher attention for 20 min

• 1:1 walk in the hallway

• Meeting

ATTENTION TX’S (CONT)

• Differential Reinforcement of Alternative Behavior:

• Identify an appropriate behavior to reinforce with attention

• Compliance

• Task Completion

• Hand Raising

• Appropriate behavior directed towards peers

CREATE YOUR OWN INTERVENTION FOR A

BEHAVIOR MAINTAINED BY ATTENTION

• Work with friends

• Remember Antecedent and consequence based interventions

• 5 minutes

INTERVENTIONS FOR ESCAPE

• Escape extinction: Student not permitted to get out of the demand or should be expected to complete the demand after problem behavior

• Hand-over-hand physical prompting often effective with younger students, however ineffective with older or bigger/older students

• Differential Reinforcement of Alternative Behavior (DRA):

• Token systems or conditioned reinforcers delivered for each compliant behavior

Level Systems For Compliance:

• Green level: Student chooses seat, access to electronic devices/games, homework pass, school store, hall pass, extra recess, sports, lottery entries, & music

• Yellow level: Access to only typical school privileges but no highly preferred reinforcers

• Red level: Assigned seat, supervision in hallway, lunch detention, loss of recess, etc

ESCAPE TX’S (CONT)

98

• Functional Communication Training: Teaching the student to request breaks from demands or undesirable stimuli

• Are the students going to abuse the break privilege

• Not if being on break is less reinforcing b/c preferred activities are not available as opposed to earning preferred reinforcers for working and completing tasks

• The student is getting out of work

• Response Chaining: As student’s mands (requests) for breaks increase and problem behaviors decrease, the teacher should begin adding demands before the student gets a break

• Delay to Reinforcement: Can also teach student to wait for break after asking

• Waiting is best accomplished by engaging student

ESCAPE TX’S (CONT)

99

• Fixed-Time Schedule: A timer is set for pre-determined intervals and the student receives breaks when timer sounds

• Breaks are independent of behavior problems

• Behavioral Momentum: (Mace, 1988)

• Prompt student to engage in a series of 3 or 4 high probability (easy & likely) behaviors & then prompt the behavior associated with non-compliance

• Ex. “Give me a high five”, “Touch your nose”, “draw a picture”, “now put on your shoes”

http://www.youtube.com/watch?feature=player_detailpage&v=D5vyx6u7xn0

ESCAPE TX’S (CONT)

• Alter Response Effort

• Break the task up into smaller pieces, decreasing the

required effort to complete 1 demand

• Choice

• Provide Restricted choice in a dimension of the task

(materials, task order, task setting)

ESCAPE TX’S (CONT)

101

• 3-Step Prompting: (Tarbox et al. 2007), AKA Least to Most Prompting Ex:

1. Verbal Prompt: “Write name”

2. Verbal & Gesture/model: Point to pencil & paper & “Write name” or demonstrate name writing

3. Light Physical: Hand-over-hand prompts to physically assist student to write name

• Escape Extinction: Student not permitted to get out of the task

- Ex. Take work assignment to floor if flopping to ground

CREATE YOUR OWN INTERVENTION FOR A

BEHAVIOR MAINTAINED BY ESCAPE

• Work with friends

• Remember Antecedent and consequence based interventions

• 5 minutes

AN ANALYSIS OF INTERVENTIONS

103

• Differential reinforcement of alternative behavior (DRA) vs. (DRO) of other behavior?

• DRO’s are often difficult for students b/c an absence of behavior problems is required over time

• Ex. Student earns a token for every 5 min that he does not engage in a problem behavior

• DRA’s may be more effective b/c student gets immediate reinforcement for some appropriate behavior.

• Ex. Receiving a token & praise for each demand completed, or receiving attention each time student raises hand

• DRA allows more mistakes to be made (failures in treatment integrity) while therapeutic results maintain (Vollmer et al., 1999 …)

TOKEN SYSTEMS

104

• A common mistake is requiring the student to earn multiple tokens in the early stages of learning the system

• A common mistake is when a student may return from holiday break and teacher requires student to pick up where he/she left off at 10 tokens

• Should start by requiring student to make one simple, high probability response in exchange for one token & immediately provide the reinforcer

Ex: High five in exchange for token

• Begin adding a 2nd token for two simple and probable behaviors, a 3 rd token, and so on

• Begin increasing the complexity, duration, & number of demands http://www.youtube.com/watch?feature=player_detailpage&v=ybIr6NCfA2U

TOKEN SYSTEM

105

TOKEN SYSTEM IN ACTION

106

TANGIBLE FUNCTION TX’S

107

• Activity Reinforcers also fall in this category

• The Premack principle: Engaging in a high-probability behavior can reinforce the occurrence of a low-frequency behavior

- Ex. Complete the class assignment prior to talking to friends http://www.youtube.com/watch?feature=player_detailpage&v=a5odC5acaBQ

• Various assessments can empirically derive what tangible stimuli may function as a reinforcer:

- Stimulus preference assessments

- Free operant assessments

- Reinforcer assessments

TANGIBLE FUNCTION TX’S

• Using Choice with time periods of reinforcement

• “Do you want to play on the computer for 3 minutes or 5 minutes”

• If the student chooses one of the options, provide them the reinforcer for that amount of time

• If they chose another option, or neither, choose the shorter time period

TANGIBLE FUNCTION TX’S

109

• Reinforcer Menu: prompt student to choose from an array of tangible reinforcers for compliance & other appropriate behaviors (ex. toys, activities, etc.)

- A picture reinforcer menu is effective to facilitate choice by the student

• Picture Schedule: intersperse preferred activities/tangibles after completing demands on the schedule. Activity schedules with pictures can facilitate transitions & promote independence (MacDuff et al., 1993)

• Response Cost: removal of tangible stimuli or tokens contingent on problem behaviors (McGoey & DuPaul, 2000)

• Satiation: Provide prolonged access to certain activities or items in order to decrease engagement with item (Hanley et al., 2009)

http://www.youtube.com/watch?feature=player_detailpage&v=8Fe1K3XAZY

SAMPLE PICTURE SCHEDULE

110

WHY DO STUDENTS HAVE PROBLEMS AFTER

THEY EARNED A REINFORCER?

111

• This is called a post-reinforcement pause

• Ex. Student earned to use the computer & engages in a tantrum after he finishes using it

• This can be avoided by using a reinforcer to transition back to the less preferred activity

• Ex. Get a token for returning to work station

• A surprise reinforcer can be delivered intermittently for finishing the desirable activity and returning to work without a problem

ENDING A DESIRABLE ACTIVITY

112

• Timers are very effective to signal the end of a preferred activity to transition to a less preferred activity

• Timers remove the teacher’s vocal prompt therefore not pairing the adult with an unpleasant event

• Sand timers, visual timers, or digital timers make time more salient & predictable

• Watches with alarms can also be useful dad

CREATE YOUR OWN INTERVENTION FOR A

BEHAVIOR MAINTAINED BY ACCESS TO

TANGIBLE • Work with friends

• Remember Antecedent and consequence based interventions

• 5 minutes

SAMPLE TIMERS

114

Automatically

resets to

interval with

one push of

button

Can purchase

at Wallmart

Visual Timer

AUTOMATIC FUNCTION TX’S

115

• Need to identify what type of sensory reinforcement the student is gaining from the problem behavior:

- auditory, tactile, vestibular, gustatory, olfactory, etc

• Punishing this behavior without a replacement

that serves the same sensory needs will NOT work in the long-term

• Competing Activities (Lane et al., 2006); Ex. Skin picking (neurotic excoriation) can be decreased by occupying student’s hands with competing items

• TX: Habit Reversal: Effective for a variety of habits such as tics and stuttering (Miltenberger et al., 1998)

• Tics may include rapid eye blinking, facial grimacing, neck or arm jerking

• Habit reversal consists of awareness training and competing response training

AUTOMATIC FUNCTION TX’S (CONT)

116

• Ex. Student that was previously restrained (for aggression) decreases aggression by requesting weighted vest & requesting “pressure” from staff

• Ex. Student scratching face (SIB) decreases by replacing with access to vibrating toy applied to face

• Ex. Student with rocking behavior (stereotypy) decreases rocking by earning access to a rocking chair

AUTOMATIC FUNCTION TX’S (CONT)

117

• Ex. Student engages in hand-flapping & this is eliminated by replacing it with a paddle and ball on elastic string

• Ex. Student is aggressive toward teachers because of increase in sexual urges, however it decreases when his mother encourages “private time” before going to school

• Sensory Extinction: Student picks off his eyebrows and this decreases by placing Vaseline on the eyebrows making it difficult to pick at them

• Ex. Student with head banging self-injury wears protective equipment therefore extinguishing the automatic reinforcement

• Ex. Student has vocal stim in class (auditory) but this decreases when he listens to headphones of himself vocally stimming

AUTOMATIC FUNCTION TX’S (CONT)

118

• Ex. Student bites his hand and shirt, but this decreases when he is given alternative rubber item to bite

• Ex. Student rips apart papers, and this decreases when he earns to shred used papers and cut them after working appropriately

• Ex. Student screams when dogs bark or certain pitch noises are heard, and this decreases when he self-monitors & puts on noise blocking headphones as needed

• Ex. Student is compelled to engage in a ritualistic behavior, so this ritualistic activity is used as a reinforcer for compliance to tasks. I.e. Student earns to open & close cabinet doors for completing academic work

Functional Communication Training

• Teaching the student to request breaks from demands or undesirable stimuli

- Are the students going to abuse the break privilege?

- Not if being on break is less reinforcing b/c preferred activities are not available as opposed to earning preferred reinforcers for working and completing tasks

• Response Chaining • As student’s mands (requests) for breaks

increase and problem behaviors decrease, the teacher should begin adding demands before the student gets a break

- Delay to Reinforcement: Can also teach student to wait for break after asking

- Waiting is best accomplished by engaging student

ACTIVITY

RECAP

• Functions

• Reinforcement

• Extinction

• Trauma

• Function-Based Interventions

• Curriculum Modification

• Antecedent Strategies