6/18/2018 Welcome Externalizing Behavior Problems: Introduction Screening, Prevention and Schedule for the Day Intervention in Schools Questions Andy V. Pham, Ph.D. July 2012 1 2 Introductions Schedule for Today 8:00-10:00 Workshop Andy V. Pham, Ph.D. 10:00-10:15 Break ◦ Assistant Professor in School Psychology 10:15-12:00 Workshop ◦ Florida International University ◦ Research and Clinical Interests: 12:00-13:30 Lunch Neuropsychological assessment of developmental disorders, 13: 30-16:00 Workshop Reading development in children Parent and teacher perceptions of ADHD and treatment School-based treatment for ADHD 3 4 Goals Problems Defined Participants will learn: Problem behavior is a discrepancy ◦ The various symptoms of common externalizing behavioral between current behavior (B) and the disorders in childhood and adolescents. standard (S) ◦ Individualized and systematic screening and prevention methods used to address externalizing behavior disorders. ◦ Basic principles and skills in conducting functional behavioral B S assessment (FBA) and implementing behavioral intervention plans (BIP). ◦ Basic principles and skills in conducting behavioral consultation Discrepancy with teachers and parents. ◦ Effective classroom management techniques and school-based interventions for common behavior problems. 5 1
6/18/2018 Disruptive Behavior How severe are we talking about? Oppositional Defiant Disorder (ODD) ◦ “A pattern of negativistic, hostile, and defiant behavior 90 th percentile lasting at least 6 months” ◦ T emper outbursts, irritability, spitefulness ◦ Arguing with adults, defiance Attention Deficit Hyperactivity Disorder (ADHD) ◦ Hyperactivity, Impulsivity and/or inattention = frequent disruptive and noncompliant behavior Conduct Disorder ◦ Proactive aggression, stealing, fire setting, truancy, etc. ◦ Poor prognosis ◦ More common in teens 7 8 Young Children Why Target Disruptive Behaviors Signs and Symptoms in School School ◦ Interfere with child’s learning Runs into people ◦ Interfere with learning of others Knocks things down during play ◦ Disrupt social development ◦ Reduce instructional time Gets injured frequently ◦ Add to stress for all involved ◦ Drain resources Does not want to sit for stories or games ◦ Bad modeling for other students Fidgets or squirms in seat ◦ Not having an effective strategy can worsen behaviors Does not adhere to classroom rules and Home/Family expectations ◦ Harmful to parent-child relationship ◦ Negative modeling for siblings ◦ Creates and maintains a coercive cycle 9 10 Middle Childhood Adolescence Signs and Symptoms in School Signs and Symptoms in School Ignores social rules of games Symptoms of inattention persists, symptoms of motor hyperactivity tend to diminish Interrupts teacher or classmates frequently Inattentive symptoms in adolescence may reflect Fidgets or engages in off-task behavior during interest, skill or motivation rather than ADHD class (tapping pencil, bouncing in chair) Restless and fidgety during quiet or independent Struggles to complete multi-step assignments activities Makes noises that are disruptive Interrupts others Gets into trouble frequently Grabs objects and possessions from others Motor over-activity is often replaced by a pervasive Lack of organization, work incomplete sense of restlessness Lack of organization, work incomplete 11 12 2
6/18/2018 The Coercive Cycle Implications for Practice Parent Variations in temperament are normal Child refuses makes Parent gives in demand or ignores High levels of activity do not indicate a problem or (maybe just a little) disorder if it does not impair functioning at home, school, or in the community Parent feels guilty Parent repeats Activity and impulsivity should be judged in the or exhausted demand firmly context of caregiver’s or educators’ expectations and level of stress Parent punishes Child refuses, Some parents and teachers may have a low tolerance and/or criticizes this time with for developmentally appropriate inattention – Parent threatens, yells. feeling “Goodness of fit” Child sees the yell and raises a scream 13 14 A public health approach Screening and Prevention Formal diagnosis Intensive Interventions Targeted Interventions 80% Universal Interventions Intensity of Problem 15 16 Models of Intervention Why a public health model? Encourages collaboration across systems and Serious shortages of mental health personnel relative to needs creation of systems of care Provides appropriate intensity and duration Many children are not progressing developmentally, and of services are at significant risk of being left behind A focus on issues rather than procedures or processes Untreated, child mental health problems persist into adulthood, and often fail to improve or get worse Family, cultural and community readiness factors Public Health Model Pyramid: Tiered Model 17 18 3
6/18/2018 Intervention Service Delivery Continuum of services Three-Tiered Model Tier 3 Intensity of needs Tier 3 - Comprehensive Assessment Intensive Intensity of intervention Individualized Intensive & Problem Analysis ~5% of students Increase in data collection Interventions Increase in assessment Tier 2 -Progress Monitoring & Intensive Interventions Tier 1 Risk Reduction - Screening & Tier 2 ~15% of Students Early Intervention 80% Targeted Interventions Prevention - Universal Positive Behavior Support ~80% of Tier 1 Intensity of Problem students Universal Prevention 19 20 Essential Components of a Successful Building a Pyramid of Support Tiered Model of Service Delivery Tier 1: Core instructional or behavior interventions Multiple tiers of intervention service Preventative and Proactive delivery Universal supports available to all students Continuous Improvement Cycle Tier 1 Integrated data collection/assessment system to inform decisions at each tier Comprehensive/School Wide Interventions 21 22 Building a Pyramid of Support Building a Pyramid of Support Tier 2: Tier 3: Targeted group interventions, supplemental Individual, Intensive interventions instruction Intensive supports for students with At-risk students significant chronic deficits that require the most intensive service available in the school Individualized supports for students with and/or district more significant academic or behavioral needs Tier 2 Tier 3 Targeted Interventions Intensive Interventions 23 24 4
6/18/2018 Continuous Improvement Cycle Four ways to use data Data Based Decision Making Screening Evaluate Implement Problem solving and intervention planning Intervention monitoring Adjust Analyze Diagnosis 25 26 Screener for Behavior Problems Functional Behavior Assessment (FBA) and Behavior Intervention Plan (BIP) ◦ Example: SNAP-IV 27 28 What is a Functional Behavior FBA Assessment (FBA)? FBAS are appropriate when: An FBA: ◦ The student is not responding to school-wide ◦ Is a systematic method for obtaining strategies or classroom strategies information about the purpose of behavior (function)? ◦ There is a pattern of behaviors that is either already at a high level or is increasing in ◦ Provides results that are used to guide the frequency/intensity design of an intervention for decreasing problematic behaviors and increasing ◦ Can be done on almost every student. appropriate behaviors 30 5
6/18/2018 FBA Process Handouts Step 1: Referral meeting to discuss problem Step 2: Data Collection Step 3: Analyze the Data Step 4: Develop the Behavior Intervention Plan (BIP) 31 32 FUNCTIONAL BEHAVIOR FBA (A-B-C) ASSESSMENT (FBA) Fast triggers/Antecedents Parts of the FBA ◦ What happens before the behavior occurs ◦ Student strengths/interests Good place to get ideas for rewards! Targeted behaviors of concerns Focus on positives ◦ When developing FBA, choose 1-3 behaviors for the Behavior Intervention Plan ◦ Slow triggers/Setting events ◦ Observable and measurable Sometimes the school can do little in the way of Instead of Define as intervention but important for the teacher to know Student is aggressive Any diagnoses, family situation, learning difficulties, multiple moves, etc. Poor reading skills Off-task FBA (A-B-C) Why do children misbehave? Perceived function of the behavior T o get something ◦ Grabbing toys or crayons from other children ◦ What is the student trying to avoid or escape? ◦ Seeking control ◦ What is the student trying to obtain? To get attention ◦ Yelling teacher’s name repeatedly Skill Deficit ( Can’t do it ) ◦ Acting silly during class time ◦ Has not learned the skill T o avoid something ◦ Refusing to open math book; refusing to write Performance Deficit ( Won’t do it ) ◦ Doesn’t understand the task ◦ Has learned the skill/behavior but chooses not to do it or does not know when to do it. To express, self-stimulate or self-regulate ◦ Running around the room; humming to self, crying or yelling. 36 6
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