overcoming behavioral roadblocks in speech-language intervention

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Overcoming Behavioral Roadblocks in Speech-Language Intervention

Patricia Villarreal, M.S., CCC-SLPEllen Kester, Ph.D., CCC-SLP

Texas Speech‐Language Hearing Association ConventionMarch 21, 2015 San Antonio, TX

Co‐occurrence of communication disorders and behavior

Studies indicate that between 1.5% and 11% of children with communication disorder also have significant behavior issues


Poor Behavior –No Therapy?


Speech Therapist

Occupational Therapist

Behavior Specialist

Teacher

Principal

School Psychologist

Parent

Resource TeacherCopyright © 2014 Bilinguistics, Inc. All

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You are NOT following my agenda!


You are NOT following my agenda!

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Behavior problems are common in children with communication

disorders.


“The best way to understand behavior is to observe the causes

of a behavior and the consequences of that behavior.”

Operant ConditioningChanging behavior through the use of reinforcement given after a desired

response.


Function of the Behavior


What is the function of the behavior?

Behavior Motivation

Obtain

Attention Sensory Input

Avoid

Objects Activities

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ABCs


Punishments and Reinforcers

PunishmentChange connected to

the “punisher” and does not generalize to other settings

Effectiveness decreases over time (escalates to maintain)

Immediate but not sustained change in behavior

ReinforcementGeneralizes to other

settingsMay be faded and

still maintain effectiveness

Slow but sustained change in behavior

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Decreases Be

havior

Increases B

ehavior


Difficult Behaviors Replacement Behavior Desired Behavior

Accommodation

Modification

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Examples of behavior supports


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Parent Interview

Direct ObservationEstablish

Rapport

Assessment


Establish rapport

The first few sessions should look like…


Consistency of Behavior

How often do the behaviors occur?


ABC log

Date: Time: Activity Antecedent Exact Behavior

Consequence Student Reaction

Student: Target Behavior:


Parent/teacher interviews

Determine:1.) behaviors that interfere with daily activities2.) attitudes about the behaviors3.) methods tried to manage behavior4.) effectiveness of the methods tried


Preference assessments

• Identify the most powerful reinforcers• Provide a systematic way to present reinforcement for desirable behaviors


Single Item Preference Assessment

1. Present objects or activities one by one2. Present each item several times in random order3. Record how long the person engages with each

object or activityItem Time

Rocking horse 3 s

Princess book 15 s

Rocking horse 0 s

Barbie 10 s

Princess book 15 s

Barbie 5 s


Pairwise Preference Assessment

Procedure:1. Present two items2. Child selects item3. Remove other item4. Present next two

items until every item is paired

5. Count and rank order

Pairing Selected

chip and cheese cheese

cracker and chip cracker

cheese and cracker cheese

Example:

Order of Preference:1. cheese2. cracker3. chip


Helpful Hints for preference assessment

• Food assessments separate from toys/activities

• Limit access to preferred objects/activities

• Rotate and vary reinforcers

• Pair reinforcers with praise and social interaction (pat on the back, tickle, high five, “great!”)


Intervention


Approach to Intervention

Reinforcement‐Based Plan*Recommend conducting preference assessments before beginning RBP

Stimulus‐Based PlanChanges to the environment


Reinforcement‐Based Plans

1. Differential Reinforcement of Other Behavior (DRO)

2. Differential Reinforcement of Incompatible Behavior (DRI)

3. Reinforcement of Skills Acquisition (PRT)


Skills Acquisition

• Compliance Training (Discrete Trial Training)

• Self‐management

• Differential reinforcement of communicative behavior (DRC)

• Functional independence trainingCopyright © 2014 Bilinguistics, Inc. All

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Stimulus‐Based Plans

1. Introduce factors that control low rates of behavior problems.

2. Modify factors that control high rates of behavior problems.

3. Embed Stimuli that control high rates of behavior problems among those that control low rates of behavior problems

4. Modify curriculum associated with behavior problems

5. Improve upon context‐dependent behaviors


Evaluate the effect of changes

Begin a Behavior Intervention Plan (BIP)

• One variable at a time • Continuously review effectiveness of BIP• Adjust as necessary


Data Collection ExamplesFunction Undesired Behavior Reinforced by: Replaced with:

Gain attention Hits Being told “no” “Play with me”

Access a toy Screams and cries Being given the toy “I want X”

Sensory stimulation Pokes his eye Effect on vision Kaleidoscope

Escape instruction Distractingclassmates

Time out “I need help”

Avoid pain from ear infection

Head banging Relief of ear pain PharmacologicalIntervention

*Examples cited from: Carr, E., et al. (1990)


Case Study

• What is the function of his behavior?

• 14 year old boy diagnosed with Intellectual disability

• High levels of aggression towards others (scratching, hitting, kicking, biting)

• Aggressive when demands are made


Results

• Eight one hour sessions

• Continuing demands in spite of aggressive acts 1‐2 acts per session

• Allowed to escape instruction contingent on aggression 1625 aggressive acts per session


Intervention without functional analysis…

1st case: Boy with autism who bites himselfDRO implemented: Glass of juice Result: Problem is exacerbatedWhy?: Bites when he has to urinate

2nd case: Girl with ID who screams.DRI implemented: SingResult: No change in behaviorWhy?: Screams when frustrated during work time


Generalization

• Fade tangible with naturalistic reinforcers• Gradually increase intervals• Use intermittent intervals when transitioning• Wait to fade or transition until child is at least 80% successful

• Teach the approach in all settings


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References• Bopp, K., Brown, K., Mirenda, P. (2004). Speech‐language pathologists’ roles in the delivery of positive behavior

support for individuals with developmental disabilities. American Journal of Speech‐Language Pathology Vol. 13 p. 5‐19

• Carter, D. R., & Horner, R. H. (2007). Adding function‐based behavioral support to First Step to Success: Combining manualized and function‐based interventions. Journal of Positive Behavior Interventions, 9, 4, 229‐38.

• Durand, V. M., & Merges, E. (2001). Functional communication training: A contemporary behavior analytic technique for problem behavior. Focus on Autism and Other Developmental Disabilities, 16, 110–119.

• Filter, K. J., and R. H. Horner. "Functionally‐indicated academic interventions for problem behavior." Journal of Positive Behavior Interventions (2006).

• Ingram, K., Lewis‐Palmer, T., & Sugai, G. (2005). Function‐based intervention planning: Comparing the effectiveness of FBA function‐based and non‐function‐based intervention plans. Journal of Positive Behavior Interventions, 7, 224‐236.

• Jensen, Eric. (2000). Brain‐Based Learning. Alexandra, Virginia. Thousand Oaks, California: Corwin Press.• March, R. E., & Horner, R. H. (2002). Feasibility and contributions of functional behavioral assessment in schools.

Journal of Emotional and Behavioral Disorders, 10, 158‐170. • McIntosh, K., Campbell, A. L., Carter, D. R. and Dickey, C. R. (2009). Differential Effects of a Tier Two Behavior

Intervention Based on Function of Problem Behavior. Journal of Positive Behavior Interventions, 11, 2, 82‐97.• Morgan, S. B., & Coffman, M. (2013). Developing quality FBAs that lead to effective BIPs. Presentation at the

Texas Council of Administrators in Special Education Annual Meeting. Austin, TX., • Newcomer, L. L., & Lewis, T. J. (2004). Functional behavioral assessment: An investigation of assessment reliability

and effectiveness of function‐based interventions. Journal of Emotional and Behavioral Disorders, 12, 168‐181. • Skinner, B.F. (1938). The behavior of organisms: An experimental analysis.• Carr, E., Robinson, S., Taylor, J., Carlson, J. (1990). Positive Approaches to the Treatment of Severe Behavior

Problems in Persons with Developmental Disabilities: A Review and Analysis of Reinforcement and Stimulus‐Based Procedures.
