Behavioral Intervention Strategies by Benjamin Todd Eller

Why we use Applied Behavior Analysis

Applied Behavior Analysis employs methods based on scientific principles of human behavior. The behavioral approach includes that autism and other learning disabilities involve behavioral deficits and excesses that can be treated with specific treatments. These treatments focus on teaching small, measurable units of behavior systematically. Every skill a child does not demonstrate, from simple to complex acts, is broken into specific steps (American Psychological Association, 1994 and Lovaas, 1993, 1996 & 1997).

Over the past three decades, consistent and systematic research projects have demonstrated the utility of the behavioral approach, and many recent studies have consistently demonstrated that behaviorism yields significant benefits for children with autism as well as other learning deficits (Harris & Handleman, 1994). One of the largest studies was conducted by Ivar Lovaas of UCLA (1987). His long term research demonstrated the benefits of behavioral techniques for learning disabled children and adults. Since then, numerous studies have duplicated Lovaas’ research validating that behaviorism is often superior to medicine and other psychological treatments (American Psychological Association, 1994 and Lovaas, 1993, 1996 & 1997).

Behavioral Intervention

Behavioral Intervention employs a variety of strategies. Best Practices will utilize proven techniques to reach defined goals with parents, guardians and their children. Supervisory staff members will oversee each program provided to the consumers. The supervisors of Best Practices have over 40 years of combined experience working with autistic and learning disabled children including regional center services. The resumes and experience of the supervisory staff have been provided in this packet. Behavioral Intervention typically takes anywhere from 36 to 41 hours from 3 to 6 months. The service can be longer or shorter according to the needs of the consumer. This service involves training to parents, guardians and their children using a variety of behavioral strategies. These strategies include:

Reinforcement-based methods

Positive Reinforcement

Positive Reinforcement is any event or consequence which increases the probability of a response. For instance, to increase sitting behavior, a therapist could reward a child with verbal praise, snacks, toys and other tangible items. It is important to discover what the child likes so that s/he will be motivated to engage in the appropriate behavior. According to the National Autism Association (2004), this is one of the most effective methods to assist children in shaping their behavior.

Differential Reinforcement

There are three types of differential reinforcement.

A. Differential Reinforcement of Alternate Behavior (DRA)

The child receives attention to an appropriate behavior that is an alternative to an undesirable one. For example, if the child starts to tantrum, and the behaviorist asks and reinforces the child to use “quiet voice” instead.

B. Differential Reinforcement of Other Behavior (DRO)

Attention is provided to the child for any appropriate behavior. For example, if the child acts, in general, appropriately during a certain period of time and does not engage in the behavior problem, then s/he is given positive attention.

C. Differential Reinforcement of Incompatible Behavior (DRI)

Attention is given to behaviors that are incompatible with the behavior problem. For example, if the child, who is known to tantrum, sits quietly for a certain amount of time, then s/he is given positive attention. This is similar to DRA, however, with DRI the behaviorist tries to catch the child behaving appropriately and then reinforces him/her.

Differential reinforcement is highly employed by Best Practices. Empirical evidence suggests that these methods work far better than punishment strategies and behavior is more likely to have more permanent changes (American Psychological Association, 2004 and Lovaas, 1993, 1996 & 1997).

Token Economies

Token economy is a form of positive reinforcement. However, not all children will respond to this system. A child must understand the value of the token, or as Skinner would say, “a token must be reinforcing to the child.” The first step in implementing a token economy system is to decide on the target behavior to increase. This could be self-help, appropriate communication, finishing chores and other desirable behaviors. Tokens can also be used to decrease behaviors such as screaming, biting, kicking or self-stimulatory problems. It is important to define the target behavior in specific, observable, and measurable terms so there is consistency in the treatment program. For example, decide how many minutes the child needs to be engaging in the target behavior, or how many times they display the behavior before they earn the token (Skinner, 1989).

Self-Monitoring

The aim of self-monitoring is teach the child to become more aware of his/her own behavior. A target behavior(s) is selected, such as aggression, making nonsense noises, and staying on task; and the child is taught to monitor when this behavior(s) occurs. One strategy is to teach the child to monitor his/her own behavior at short time intervals. At first, a therapist may remind the child every 10 or 15 minutes to observe his/her behavior. Later, a kitchen timer can be used to present an auditory signal every 10 or 15 minutes to cue the child to observe whether the target behavior occurred. An eventual goal may be to teach the child to monitor his/her behavior without a prompt. For example, after performing an undesirable behavior, s/he may become immediately aware of what s/he is doing. Such awareness may then prompt the child to stop the behavior before it escalates. Sometimes there is a reactivity effect in which the undesirable behavior decreases merely because of the process of observation (Center for the Study of Autism, 2000). It is important to note that some children will not have the capability of self-monitoring their own behavior. This strategy should be used only with children who possess the skill of self-evaluation. This can be determined by the assessment process which is discussed later. A sample assessment has been provided in this packet.

Social Skills Training

One method used to enhance social skills training is Social Stories. Social Stories provide individuals with accurate information in regard to situations they encounter. These stories describe social situations in terms of relevant social cues and often define appropriate responses. They are written in response to individual student needs and target situations. Social stories should aim to describe one situation, be written well within a child’s comprehension, and be written in the first person. For children who are unable to read, pictures or audio may be used in place of words. It is also considered best practice to state sentences positively, describing desired responses instead of describing problem behaviors (Carol Gray, 2006).

Systematic Desensitization

Systematic desensitization is a technique used to treat phobias and other extreme or erroneous fears based on principles of behavior modification. To employ this method involves non-contingent reinforcement. This is used only at certain times such as when a child is suffering from a phobia. The behaviorist must be careful not to reinforce inappropriate behaviors. For instance, if a child has an intense fear of strangers and screams and runs away from the therapist, it may be necessary to use “systematic desensitization” which involves giving a child a highly desirable item such as food or toys when the therapist is around. This behavioral approach is quite effective in aiding the child to reduce the fear of the therapist and associate the behaviorist with something positive (R. Koegel, Openden, & L. Koegel, 2005).

Instruction Statements

Best Practices believes that empirical research has demonstrated that how we state the instruction influences how the instruction is followed. If the child is paying attention, hears the instruction and has the ability to perform the task, s/he is more likely to follow it. Before giving the instruction, it is imperative to get the child’s attention through eye contact and prompting. The instruction must be clear, short and phrased as a statement. If an instruction has too many words, this can be confusing to the child. For instance, Sara, “can you please stop yelling and shouting and sit down so we can start work and later we can have a snack.” This phrase is inappropriate. A better phrase would be “sit quietly please.” It is also important to keep the wording the same for each instruction so the child is clear on what is expected. One of the rules we teach parents in our workshops is to remove the word “no” from their vocabulary as much as possible. For example, instead of saying “stop hitting”, one can say “quiet hands.” Of course, “quiet hands” needs to be demonstrated and understood, but positive clear statements work better than negative commands (American Psychiatric Association, 2004).

Child’s Response

In response to the therapist’s instruction, the child may respond in one of three ways: 1) correctly, 2) incorrectly or 3) ignore the instruction. Generally, waiting three to five seconds for the child to respond is adequate. If the child is not responding, then the therapist can repeat the instruction a few times. However, other consequences may be needed (National Autism Association, 2004).

Consequences

The consequence is the therapist’s or adult’s response. Consequences vary according to the child’s response. If the child responds correctly, then immediate reinforcement is warranted. It is important to identify want is reinforcing or rewarding to the child such as food, hugs, verbal praise, a toy or attention from a parent. When a child begins to respond incorrectly or engages in inappropriate behaviors, Best Practices believes that providing an effective prompt should first be attempted. This can be a verbal prompt by making statements like ‘try again”, “do better”, and repeating the instruction. However, we do not repeat the instruction more than four times as this can cause a child to learn that s/he does not need to respond to verbal commands. Instead, physical prompts can also be used such as touching the arm, hand over hand assistance and lightly touching the chin to prompt the child to look in the right direction. Physical prompting helps the child learn what the instruction means. If s/he understands, but chooses not to respond, the physical guidance can teach the child that s/he is expected to comply. If inappropriate behaviors such as tantrumming or other forms of resistance continue, then the therapist can employ one or several of the non-reinforcing methods mentioned earlier (Skinner, 1989).

Short Pause Between The Consequence

The period between the consequence and the next instruction is called “between-trials interval.” It involves a discrete pause of three to five seconds between the consequence and the next trial. This helps define for the child that the trial has ended and a new one is beginning. Best Practices believes that each new request needs to be made clear and consistent. During the between trial interval, it is important to praise the child for appropriate behaviors such as sitting, listening, using quiet voice and reinforcing the child (Lovaas, 1997).

Non-Reinforcing Methods

These are methods used to decrease undesirable behaviors.

Redirection

Redirection involves quickly diverting children's attention to an appropriate activity when they misbehave. For instance, if a child is screaming in the grocery store, an adult can hold the child’s hands and have him/her count to ten to help the child get control of his/her behavior and distract the child from the negative action. Other redirection strategies include: drawing, singing a favorite song for a few seconds, clapping hands and looking or holding a favorite object (Center for the Study of Autism, 1999).

Extinction

Extinction is the discouragement of a behavior that used to be reinforced by no longer reinforcing it. Extinction is often successful at decreasing or even eliminating behaviors but can be difficult. Typically, when a behaviorist or parent sets out on an extinction path for a particular behavior, the occurrence of that behavior actually increases for some period of time. Consequently, if one is to maintain an extinction path for a behavior, it must be approached with a certain degree of vigilance, for reinforcement of the behavior along that initial path of escalation can cause the child increase his attempts to gain additional reinforcement for the behavior (Lovaas, 1993, 1996 & 1997).

Self-Injurious Behavior

Self-injurious behavior (SIB) can be defined as any behavior that causes physical damage to the person exhibiting this behavior. SIB can be a learned behavior or self-stimulatory in nature. The child with autism or other disability may continue this destructive behavior because it produces some kind of change in the environment which s/he feels is desirable. Flavell and Greene (1980) state that there are three consequences of SIB that may strengthen or maintain the abusive behavior. The autistic person with SIB may receive positive rewards when engaged in self-abuse. For example, it may be a good way to get either positive or negative attention. The SIB may be an avoidance behavior. The person may engage in SIB when s/he does not want to do a certain task; "self-injury is rewarded and strengthened by allowing the individuals to escape or avoid what are to them unpleasant situations" (Flavell & Greene, 1980, p. 3). And finally, SIB may produce sensory stimulation that the autistic person may find enjoyable. The following behavior modifications are utilized by Best Practices for children with SIB (Flavell and Greene, 1980):

A. Altering the situations in which SIB occurs and extending the periods when SIB does not happen. The behaviorist must observe when the SIB most frequently occurs and when the child does not engage in SIB.

B. Providing stimulation in other ways by enriching the environment. Providing constant access to toys and activities that the individual prefers, changing activities as the child's preference and attention changes, and eliminating excessive waiting. It is also important to remember to provide lots of positive interactions between the behaviorist, child, parent etc. Using a powerful reward to strengthen appropriate behaviors and trying to withhold the same rewards following a SIB incident.

C. Removing rewards for SIB. Reducing the attention paid to the child following a SIB incident. If the rewarding and non-rewarding of the SIB is inconsistent, the child may continue to engage in the self-abuse, looking for the opportunities to be rewarded. Also, the issue of safety must be considered when this method is utilized. Practitioners cannot ignore severe self-injury. However, practitioners can try to protect the individual as much as possible while giving as little attention to the behavior as possible.

Time-Out

Best Practices has a philosophy that time-outs should only be used after the above methods have been attempted. It is simply a last resort. This is not a punishment, but a method that helps a child to relax and be in a place free of a great deal of stimulation. Following an inappropriate behavior, the child is removed from the setting and not allowed any positive reinforcements for a specified time period. The child is never left alone and always in the physical presence of the therapist. This specified time period varies from child to child, but it is common practice to send a child to a time-out setting for an average of five minutes. This time can be longer or shorter according to how quickly a child can self-correct their behavior. It is important to make the setting from which the child has been removed more attractive than the time-out setting. This is especially important for children with autism. Frequently they want to be left alone and enjoy the time-out area. Thus, the time out setting becomes a reward for the child with autism. In this case, a therapist could have what we call “a working time-out.” The child is required to go to the time-out area and continue work with activities like flash cards and writing letters (National Autism Association, 2004).