3/3/2017 Overview • Anxiety, Stress, and Challenging Behavior 1 Anxiety De-escalation & • Positive Behavior Intervention and Supports • Function-based, multi-component planning 2 Stress Reduction Techniques • Cognitive Behavioral Therapy for Vanessa Hus Bal, Ph.D. Anxiety Gregory Lyons, Ph.D., BCBA 3 3/3/2017 STAR (Service, Treatment, Advocacy & Research) Center for ASD and NDDs (Lyons & Bal, 2017) 3/3/2017 Case Example: Functional Behavior Assessment Anxiety, Stress, and Challenging Behavior Saul is 12 years old and uses phrased speech. Saul’s parents note that he gets stressed easily when he is in new/less familiar places. He also expresses his need for sameness by becoming upset and/or avoidant (he will either meltdown or shutdown)—he gets very anxious when something is different or does not go as expected. Often times this results in him Challenging running off (eloping). His mother also explained that he becomes anxious Behavior when his dad wears button down T-shirts, and will scream until dad removes the shirt. These types of challenges are more likely to happen if he misses a meal, does not sleep through the night, or had to deal with a stressful situation earlier in the day. These setting events make him less tolerant. Stress Anxiety The behavior analyst collaborated with Saul’s parents clarify the topography of the behaviors, the associated environmental variables , and finally the behavior functions . STAR (Service, Treatment, Advocacy & Research) Center for ASD and NDDs (Lyons & Bal, 2017) 3/3/2017 3/3/2017 1
3/3/2017 Contextualizing Anxiety & Stress Responses Features of Positive Behavior Support � 4 primary behavior functions � Uses principles of Applied Behavior Analysis (ABA) � Positive, prevention focus � Reinforcement rich Multi-component behavior support plans: � Reduced role of punishment; no aversive stimuli � Prevention strategies � Function-based � Teaching communicative replacements and skills � Multi-component � Consequence management � Ecologically valid and generalizable � Acceptable and feasible by stakeholders � Collaborative involvement � Person-centered � Evidence-based, data-driven STAR (Service, Treatment, Advocacy & Research) Center for ASD and NDDs (Lyons & Bal, 2017) 3/3/2017 STAR (Service, Treatment, Advocacy & Research) Center for ASD and NDDs (Lyons & Bal, 2017) 3/3/2017 Why does challenging behavior happen? Why does challenging behavior happen? � To obtain (Positive reinforcement) Behavior is (often) communication! Functions • Attention of � Limited communication/social repertoires can contribute to development Challenging • Tangible and maintenance of problem behavior Behavior • Sensory stimulations � The function of behavior refers to the message that is ultimately conveyed through the behavior � To escape (Negative reinforcement) • Obtain • Demanding tasks • Escape/Avoid • Social interactions • Attention • Activity, event, or place STAR (Service, Treatment, Advocacy & Research) Center for ASD and NDDs (Lyons & Bal, 2017) 3/3/2017 STAR (Service, Treatment, Advocacy & Research) Center for ASD and NDDs (Lyons & Bal, 2017) 3/3/2017 2
3/3/2017 Why does challenging behavior happen? EATS � Escape from demands E scape Common E • Tantrums when asked to do get dressed Functions A ttention of Behavior A for Children T angible � Obtain attention from an adult or peer T • Throwing toys to get someone to play with them S ensory (automatic) S � Obtain access to a preferred item or activity • Throwing cup on floor to get more milk STAR (Service, Treatment, Advocacy & Research) Center for ASD and NDDs (Lyons & Bal, 2017) 3/3/2017 STAR (Service, Treatment, Advocacy & Research) Center for ASD and NDDs (Lyons & Bal, 2017) 3/3/2017 Why does challenging behavior happen? Data Examples Direct Data Indirect-Informant Data Functional Behavioral Assessment (FBA) � Observation of contexts, � Functional Assessment antecedents, behaviors, Interview � Behavioral assessments aim to determine what environmental variables consequences influence behavior, including the functions � FBA scales and screeners • ABC Chart • Data! • FAST (Iawata & DeLeon, 1996) • BCBA and expertise in FBA needed to assess, design, and implement � Scatter plot ‒ 67% reliability � Used to develop a behavior support plan (BSP) � Frequency, duration data • Without understanding why the behavior is happening, it is difficult to � Functional analysis create an effective intervention plan � Consistently noted as an evidence-based practice STAR (Service, Treatment, Advocacy & Research) Center for ASD and NDDs (Lyons & Bal, 2017) 3/3/2017 STAR (Service, Treatment, Advocacy & Research) Center for ASD and NDDs (Lyons & Bal, 2017) 3/3/2017 3
3/3/2017 Scatterplot George’s Scatter Plot 9:00 Time 9:15 9:30 9:45 1 2 3 4 5 Successive Days 3 or more books thrown 1-2 books thrown No books thrown 13 The A-B-Cs of PBS ABC Analysis Date ____/____/____ Name of Person Observed: ________________________________ Observer: _________________________________ Behavior(s): __________________________________________________________________________________________________________ Date Time Antecedent Behavior Consequence Possible Function Antecedent: Before the behavior Functions Behavior: What the behavior looks like of Consequence: After the behavior Behavior Setting Events Behavior Support Plan! STAR (Service, Treatment, Advocacy & Research) Center for ASD and NDDs (Lyons & Bal, 2017) 3/3/2017 4
3/3/2017 Anatomy of a Behavior Support Plan Based on FBA, we: Prevent – Teach – Reinforce. Prevention Strategies Behavior Teaching & Reinforcement Replacement Skill Strategies Antecedent changes Strategies Consequence management STAR (Service, Treatment, Advocacy & Research) Center for ASD and NDDs (Lyons & Bal, 2017) 3/3/2017 18 A. Prevention B. Skill Teaching Avoiding and altering setting events and triggers � Teach functionally-equivalent communicative replacement behaviors Clarifying expectation and predictability � Priming/pre-exposure and preparing � Teach coping and calming down strategies � Warnings, foreshadowing, timers, activity schedules, checklists � First, then • Key chains or Toolboxes Increasing understanding � Increase related-skill competencies � Social narratives, role playing/modeling Gradual approaches � Practice and reinforce behavioral flexibility � Systematic fading � Gradual demand exposure Altering control and motivation: Choices & Preferences; Leisure STAR (Service, Treatment, Advocacy & Research) Center for ASD and NDDs (Lyons & Bal, 2017) 3/3/2017 STAR (Service, Treatment, Advocacy & Research) Center for ASD and NDDs (Lyons & Bal, 2017) 3/3/2017 5
3/3/2017 C. Consequence Management C. Consequence Management Gradual exposure and systematic desensitization Gradual exposure and systematic desensitization • Response hierarchy and competing reinforcement • Response hierarchy and competing reinforcement Motivational systems Motivational systems • Differential reinforcement • Differential reinforcement • Token economies • Token economies • Self-monitoring and self-management • Self-monitoring and self-management ‒ Self-evaluation and self- awareness ‒ Self-evaluation and self- awareness ? Self-regulation ‒ Self-reinforcement ‒ Self-reinforcement STAR (Service, Treatment, Advocacy & Research) Center for ASD and NDDs (Lyons & Bal, 2017) 3/3/2017 STAR (Service, Treatment, Advocacy & Research) Center for ASD and NDDs (Lyons & Bal, 2017) 3/3/2017 Newer Research Avenues in PBS CBT for Anxiety � Rigorous, large-scale RCT data elaborated on • Present-focused decades of research showing that parents can • Time-limited learn and implement these programs (Bearss et al., Thoughts Thoughts • Problem-solving oriented 2015) � Useful to use CBT techniques to increase 1.Identify distorted thinking optimism in parents and teachers learning PBS 2.Modify beliefs strategies (Durand & Moskowitz, 2015; Durand et al., 2013) Behaviors Behaviors Feelings Feelings 3.Change behaviors • High degrees of pessimism interferes STAR (Service, Treatment, Advocacy & Research) Center for ASD and NDDs (Lyons & Bal, 2017) 3/3/2017 STAR (Service, Treatment, Advocacy & Research) Center for ASD and NDDs (Lyons & Bal, 2017) 3/3/2017 6
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