engaging the child with challenging behaviorspediatrics.med.miami.edu/documents/challenging... · i...

Monica Dowling, PhDDouglene Jackson, PhD, OTR/L, LMT

October 26, 2016

Engaging the Child withChallenging Behaviors

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My name is Monica Dowling. I will be speaking about managing challenging behaviors in children with neurodevelopmental disorders. I have no relevant financial interests or conflicts of interest. I am employed by the University of Miami. I have no financial interests to disclose.

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My name is Douglene Jackson. I will be speaking about managing challenging behaviors in children with neurodevelopmental disorders. I have no relevant financial interests or conflicts of interest. I am employed by the University of Miami. I have no financial interests to disclose. I am the Commission on Education Clinical Fieldwork Educator for the American Occupational Therapy Association and sit on both the Transition and Autism workgroups. I do not receive any compensation for my roles.

It’s ALL about U!

Your knowledge!Your skills!Your behavior!

Function of challenging behavior

Behavior predicts outcomes

Neurodevelopmental disorders do not walk alone (APA Spotlight on Disability, Sept 2016)Behavior problems 4x more common than in peers (Emerson, 2013)Impact access to care due to lack of trained professionals (Thompson, 2009)

Interventionists’ AimsYour GOAL is to:

Minimize the impact of challenging behavior onChild’s performance and participationYour ability to do your job

Understand the childModel skills for the parentUse evidence-based practice

Pyramid ModelThe pyramid model for supporting social emotional competence in infants and young children fact sheet

Public health model for promotion, prevention, and intervention Universal, secondary, tertiary approaches http://challengingbehavior.fmhi.usf.edu/do/py

ramid_model.htm

Reinforcement*Prompting*Time delay*ModelingTask analysis

Functional behavior assessment*Antecedent based intervention*Extinction*Response interruption/Redirection*Differential reinforcement of alternative, incompatible or other behavior (DRO)*Functional communication training*

Social skills training*Peer mediated instruction Social narratives*Structured play groupPECS

Visual supports*Discrete trial Naturalistic interventionParent implemented interventionPivotal response trainingScriptingExercise*

Computer assisted, SGDs, smartphones, tablets*Video modeling*

Overview

Goldilocks RuleChoices, choices, choicesSooner than laterCatch them being goodAnytime, AnyplaceLess is more

Not too big, not too small,not too loud, not too bright;not too fast, not too slow,not too hard, but just right!

Set the stageJust right fitPlan aheadMovement!

Visual SupportsVisual schedulesFirst/then boardsChoice boardsToken boardsTimers

ModelingPersonal Narratives

Choiceworks

iRewardFirst/Then

Visual supports: High Tech

Visual supports: Low Tech

Visual supports: Self-regulation

Visual supports: Self-regulation

A way to communicate without acting outAAC toolsAAC strategies

Positive reinforcementDifferential reinforcementRedirectionPromptingPlanned ignoringExtinction

Follow child’s leadEvery moment counts

From start to finishTeachable moments within visitsModel for families

Preparation and recoveryAnticipationCalm before the stormCalm after the storm

ABCs of behaviorAntecedents, Behavior, & Consequences

Your behavior matters!Time DelayChange your expectationsConsider the client

Self-regulation, Self-managementphysiological

Model for the parent

Take one minute to identify one strategy/intervention you would use with this child

Goldilocks RuleChoices, choices, choicesSooner than laterCatch them being goodAnytime, AnyplaceLess is moreIt’s ALL about U!

Monica Dowling, PhDmdowling@med.miami.edu

Douglene Jackson, PhD, OTR/L, LMTdouglene@med.miami.edu

AFIRM Team. (2015/2016). FPG Child Development Center, University of North Carolina:

http://afirm.fpg.unc.edu/antecedent-based-interventionhttp://afirm.fpg.unc.edu/promptinghttp://afirm.fpg.unc.edu/reinforcementhttp://afirm.fpg.unc.edu/time-delayhttp://afirm.fpg.unc.edu/visual-supports

www.ccids.umaine.edu/resources/ec/visual-supports

http://zorten.com/token-board

http://learningworksforkids.com/apps/choiceworks/Stopbreathethink.orgBreatheThinkDo with Sesame Street KidConnect app (14+)Smiling Mind apphttp://learningworksforkids.com/apps/ireward-

chart/http://www.zonesofregulation.com/the-zones-of-

regulation-apps.html

E-book: A Beginning Step to Using Functional Behavior Assessment and Behavior Intervention Plans (2008) www.AutismClassroom.com

Calm Down Book-drjepstein@southshorepsych.comPositive solutions for families: eight practical tipsfor parents of young children with challengingbehaviorwww.dds.ca.gov/HealthDevelopment/SARC/PositiveSolutionsforFamilies.pdfwww.tpt.comwww.gonoodle.comwww.do2learn.com

Bayat, Mojdeh. (2015). Addressing Challenging Behaviors and Mental Health Issues in Early Childhood. Council for Exceptional Children - RoutledgeBurge, P., Ouellette-Kuntz, H., Isaacs, B., & Lunsky, Y. (2008). Medical students views on training in intellectual disabilities. Canadian Family Physician, 54, 568-569)Dababnah S. & Parish S.L. (2016). Incredible Years program tailored to parents of preschoolers with autism: pilot results. Research in Social Work Practice, 26, 372-385Emerson, E. (2013) Prevalence of psychiatric disorders in children and adolescents with and without intellectual disability. Journal of Intellectual Disability Research, 47, 51-58)Masse, J., McNeil, C., Wagner, S., and Quetsch, L. (2016). Examining the efficacy of parent-child interaction therapy with children on the autism spectrum. Journal of Child and Family Studies, 25, 2508-2525Odom, S.L. & Wong, C.I. (2015). Connecting the dots: supporting students with ASD. American Educator

Thompson, J.R., Bradley, V., Buntinx, W.H.E., Schalock, R.L., Shogran, K.A., Snell, M.E., Wehmeyer, M.L. et al. (2009). Conceptualizing supports and the support needs of people with intellectual disability. Intellectual and Developmental Disabilities, 47, 135-146Totsika, V.I., Hastings, R.P., Emerson, E., Lancaster, G.A., and Berridge, D.M. (2011). A population-based investigation of behavioural and emotional problems and maternal mental health: associations with autism spectrum disorder and intellectual disability. Journal of Child Psychology and Psychiatry, 52, 91-9. doi: 10.1111/j.1469-7610.2010.02295.x. Weiss, J.A., Baker, J.K., & Butter, E.M. (2016). Mental health treatment for people with autism spectrum disorder (ASD): Fostering the mental health needs of people with ASD. Spotlight on Disability Newsletter, 8. Retrieved from http://www.apa.org/pi/disability/resources/publications/newsletter/. Wong, C.I., Odom, S.L., Hume, K.A., Cox, A.W., Fettig, A., Kucharczyk, S., Brock, M.E., Plavnick, J.B., Fleury, V.P., and Schultz, T.R. (2015). Evidence-Based Practices for Children, Youth, and Young Adults with Autism Spectrum Disorder: A Comprehensive Review. Journal of Autism and Developmental Disorders, 45, 1951-1966. doi:10.1007/s10803-014-2351-z