Behavioral Treatments, Dr. Michael Powers

Where are your placements?
All Benhaven?
And Chapel Haven. Ok, good. So.
You're going to see some kids and adults today on some of our video clips
that I will probably remind you of some people you've seen, not because they are the people you've seen,
but because the types of issues and behaviors demonstrating are
relatively consistent.
And,
I'll give you a little caveat about
what we're going to do for the next hour and a half or so.
How do you guys handle questions? Whenever they want, good?É Ok.
I have two ground rules, if you don't mind. The first one is if you have a question, don't
wait,
ok? Just ask it.
Because ten other people in this room have the same question and they're shy.
The second thing is,
I know you're doing some practicums, so you've got some other clients you're working with.
If you want to ask a question about one of the people you're working with,
I don't mind that, but let's save it till the whole thing is over and I'll stick around for a little
bit, ok?
I imagine you've got supervisors on the sites where you are, so you wouldn't
necessarily want to come to me with that 'cause I don't know your clients,
but if you had something like that. If you wanna ask a question about
somebody on the videotapes,
I can certainly respond to those.
If it looks like we're running a little bit later on some of the discussions and everything
like that, then what I'm going to do is probably hold a couple of videotapes, but I'll show 'em to you as soon as we finish.
Ok? 'Cause they're kind of fun.
And what I want to do is use the videotapes as a way of giving you an example of what
we're talking about.
We're going to spend pretty much all of this time talking about
what happens when you've got behavioral issues with people with autism, and
you may have heard this from some of the other presenters, but
the most important thing I can tell you today, and it's really the take-home message, is: behavior is communication,
and you're going to spend 85% of your time on the assessment side,
ok? Because with a good assessment,
you will very clearly inform your intervention practice, and with a poor assessment,
you may get lucky,
or you may be completely off base and you may end up
either encouraging or reinforcing a behavior you really don't want to see. Or
you might end up doing some harm.
And when I say harm, we're talking about
problems in learning, problems in behavior, and everything that goes beyond that.
And...
We're gonna start with a little story, and
this is
about a kid that I worked with a number of years ago.
I was called into a school system-- not up here in Connecticut, it's when I worked down in DC-- and I was
asked to do some consulting around this kid.
The kid had a pretty important and problematic behavior, and
it kind of went like this. He'd be--
it was in a regular classroom, it was in a public school--
it's a guy with autism, he was about nine years old-- got language, he reads, does some academics.
In a learning center, which is more or less a special education environment with
some integration into the mainstream at various points during the day. Now, this
request for consultation is around significant challenging behavior, and it goes like this:
the guy is
sitting at a table--
maybe like one of these, about half that size--
four students sitting around the table,
they're all doing their seat work.
Well, in the middle
of something,
our fellow here stands up,
grabs a-hold of the table,
screams "The Rosenberg findout!" and flips the table.
Everything scatters. Tips the table on top of the other kids.
So the
person who seems-- who
I'm working with, we're looking at this and we're thinking, "Alright, well,
what's the best way to think about this problem?"
The guy's name isn't Rosenberg, it has nothing to do with Rosenbergs.
It has to do with something else, and we
have the opportunity to try to sort that out.
We go through a process, and the process is really one that I'm going to outline for you this
afternoon, including the treatment side of it.
But the process is one of investigation. It's one of asking "why" questions. Why would he do this?
Under what circumstance?
What precipitated it?
What was the--
what we would call the setting events and the antecedent conditions?
And when we think about it this way, it allows us to ask questions,
pose responses
based on observable facts or data.
Those are the things that we as behavioral analysts and psychologists who are working in
this field
sort of live and die by, this-- when you work with significant challenging behavior,
with people
with developmental disabilities.
I'm going to use autism today as an example, but you could have an individual who's got
cri du chat syndrom or somebody who's got an intellectual disability by virtue
of Down syndrome--
any number of other situations.
You're going to see some videos of kids who are severely, profoundly typical.
Who are just
typically developing toddlers-- to
to give you an illustration of some important points.
The good part of this is that behavior
has
relatively--
in many cases, relatively clear-cut
contingencies.
What starts it,
what keeps it going.
And our job as folks trying to solve these issues is really to wrap them up and understand
what's going on so we can help the kids or adults learn to respond or behave in a somewhat
different way that's going to be a little more socially appropriate than
flipping tables, screaming "The Rosenberg Findout."
"So as we're doing our investigation with this guy,
we ask a bunch of questions and we talk to different people, and we watch, and we observe over several
days and see several examples of flipping the tables. It's not like a one-time deal.
Pretty much the same response every time.
Now, because I'm anchored to this, I can't run around the room, but
what would happen typically:
scream-- stand up, scream "The Rosenberg findout,"
flip the table,
run to the door,
but not go through.
Stand at the threshold of an open door
and watch
the chaos going on around him. So you can imagine, you got kids jumping around, you got teachers
and teacher aides that are getting crazy.
He's kind of sitting there taking it all in.
In a couple seconds, one of the adults in the room comes over him and says, "Alright, Joey--
go sit down over there by the books and the bean bag chair and just, like, calm down."
That's the scenario. So we see this
very consistent pattern of,
he's at the table, jumps up, screams, flips, runs, stops-- somebody sends him to the
book area to sit in the bean bag chair. It happens six or eight times.
So we're looking at this and saying,
"Wonder what that's all about."
What are you thinking so far?
What do you thinks far?
What's going on here?É
He wants some kind of a reaction. Good, terrific. Now,
we talk about reaction--
from whom?
Anybody in particular that
comes into mind for you?
Maybe the teachers? Sure, it could be the kids.
Could just be
a reaction, right?
We don't know yet, but you're on the right track, because there was a behavior and then there
is an effect.
We have something that's started and some
way of having an effect.
We look a little further and we start asking ourselves questions.
"What's he doing at the table?"
This is not happening all day long.
He's not flipping the table every time he sits
down at the table to do work.
So we watch him.
He reads.
He answers questions. He does math worksheets.
And we start to watch the work at the table and we notice there's one particular time that this is
more likely to occur. We're going to call that a high probability sequence, ok?
The time when it's most likely to occur is when he has a worksheet in front of him
that has an open-ended question, ok? Now, we have
an example. Closed-based and open-ended questions. A closed-based question might be like a multiple-choice
question, alright?
Where the universe of possible responses-- you know, A, B, C, and D--
they're defined for you, you don't have to say, "Well,
I'm not sure where to go with this," because the four choices are right in front of you.
We call those closed-based questions. Open-ended questions would be like,
"So, what are you going to do today after you've finished with this class?"
Dot dot dot.
Fill in the blank. Write me seven sentences about that, alright?
It's up to you to decide.
But it's also incumbent on you to organize.
Ok? So you have to
come up with a gestalt, and then you have to say, "Ah, well.
Probably gonna go have supper--
with who, where.
Immediately or later.
I can stop and do some work first."
You have to put that all together.
This guy
had pretty reliable antecedent
events that included open-ended
response situations that
had a written component.
So if he had a teacher sitting next to him saying,
"So what just happened in this story? Was it this, this, this, or this?"--
no problema.
If he had
open-ended--
"What would you think would happen to the child
if the event didn't occur?
Write it down"--
flip the table, Rosenberg findout, to the door, to the beanbag chair, look at the books. Ok?
What do you think's going on now?
It may well be to escape from the work, exactly. It--
good hypothesis, and it's actually the one we're working with to start.
He may be saying,
"I'm looking at this work,
not going to do it,"
one way to get out of doing the work is to flip
the table and--?
Run to the door, very good...
I'm a behavioral analyst. At the end of this class, I'm going to show you a graph of response latencies. Yours.
How long it takes you to answer the question when I first ask it. No, I'm just teasing. Ok.
He's getting away from this, and he's zipping to the door, ok? Now,
there's something else going on here, and it's subtle.
But escape
from demand
is certainly a hypothesis that we want to test out here.
But there's something else that's going on, because what else is he doing?
He's hitting the door and then what is an adult saying to him?
"Go to the beanbag chair and--"?
It could be a reinforcer. Let's make a distinction between rewards and reinforcers, ok?
This may be a minor one but in my book it's going to be a fairly major one.
"It could be a reinforcer." Have you guys had any background on the difference between rewards
and reinforcers?
So you know that reinforcers do what?
Increase the...?
Probability of...?
The behavior occurring in the...?
Future. Ok, that was an intraverbal--that's very close to a closed-based question, ok?
And you got it. Very good.
So what we have with this is somebody
who says, "Hey, wow. I get out of this--
'cause I don't wanna do it anyway--
and I get to go sit in a beanbag chair,
and look at a book."
Now I want to make a distinction for me.
If both of them are possibly reinforcers,
what type of reinforcers would books and beanbag chairs be?...
Positive. Good.
I want to dig a little deeper than that.
You get the same
feedback.
You get the same neurological feedback from reading a book
as sitting in the beanbag chair.
Has anybody here not sat in a bean bag chair in their life? Ok, good.
What's it like? What's it feel like to sit in a beanbag chair? Say?...
It's relaxing.
What's it feel like, not what's it think like. What does it feel like?
Comfortable, ok.
Does it kind of mold to your body?
Ok? It kind of smooches in?
Can you think of a difference between sitting in a beanbag chair and being smooched into that
and having somebody
give a really tight squeeze and a hug?
You know what kind of sensory information you're getting from that?
It's called proprioception.
Ok? Basically joint compression or deep pressure.
The information that goes into your joints goes into your brain and says, I know where I am physically
in this environment. I'm sort of wrapped, okay?
It's like when we have little tiny babies who are very disregulated after they're
born?
And even when they're not disregulated? What do we do with those blankets?
We swaddle them! Exactly. We wrap them up tight. Do you know why we do that?
'Cause babies have a startle reflex and when they go like this it scares the daylights out of 'em.
So you swaddle them, they don't get scared-- they're much calmer, ok?
All these people walking around with babies in papooses and kangaroo babies and everything else like
this,
there's meaning to that. Alright.
So what we've got is a guy who's getting a reinforcer,
at two levels: read the book,
sit in this really cool chair. Pretty big payoff.
But for what?
Good behavior, bad behavior?
Problem behavior, you betcha.
Now, you're the kid.
You're seeing the teacher walk over with the handouts. She's gonna put them on the table. You take a quick look; you
see it's open-ended. What are you thinking?
You're thinking, I know how to get out of here.
And I know how to get what I want,
'cause they consistently give me the bean bag chair and the books.
I like the bean bag chair and the books. There's one very clear way to say that to my teachers. It is:
Rosenberg findout, flip the table, and they'll give me my books.
So if I'm a person with autism and I'm saying, "I'd like to look at the books now,"
one way
that I can communicate that
clearly-- perhaps not
adaptively, but clearly-- is do the behavior that's problematic.
Everybody understands it.
Therein lies the problem. Ok?
That's the problem we confront. So when we start talking about what people with autism might do,
what people with developmental disabilities might do,
what we're really looking at
is the purpose behind their behavior. We call that purpose function. Ok?
And you're going to hear me talk about function,
functional analysis, functional assessment pretty much all afternoon.
When we talk about folks
with autism spectrum disorders
and behavioral issues,
we have to remember first and foremost: if you have an autism spectrum disorder, it is
a social learning disability. Yes, ma'am?
Punishing him would not take away the thing that was troubling him initially, that's right.
How many of you guys are psychology majors?
Who's not? What are you guys in? Spanish? Ok.
Biology, ok.
Gotcha, ok.
Biochem, ok.
Everybody in here wants to help somebody, right?
You wanna help them talk--
speak better Spanish, you wanna
make them better biochemists, or whatever you guys do with your lives.
You make all of us healthy, which is a good thing-- in my case, it's a very good idea.
Here's the thing:
you all want to help people, so you have a natural tendency to jump to an intervention
before you-- before it's time.
Which is exactly what you did.
And I'm not faulting you for it,
because all of us are going to do that-- we're gonna say, ok, what do we do?
You know what the answer is at this point?
You don't.
You understand it better so you don't make mistakes.
Now, you asked a really good question when you said,
"Giving this guy some sort of punishment procedure is not likely to address
the trigger, the antecedent, right?
Of the behavior itself.
So we could punish him until the cows come home, but every time he sees that paper,
he's going to have to think,
"Maybe I'll take the punishment.
'Cause I've really had it with this paper stuff."
What if I told you that there are two other important things we have to do: change the
antecedent,
and change the adult behavior.
And teach him a new behavior.
Now what is flipping the table, screaming "the Rosenberg findout"
saying?
What's the communicative intent?É Louder?
Before that. Before--
who?
"I don't want to do this work." You said it before. "I don't want to do this paper."
Maybe it's also saying,
"I wanna go sit in the beanbag chair and read the book."
Let's just say for argument's sake,
initially,
it's saying
"I don't want to do this work" or "I don't know how to do this work."
Fair enough? Are we good?
Tell me an alternative
response
that you, as that student,
could emit, could do,
to say,
"I don't want to do it" or "I need help."
What could you do that would be socially acceptable?
That's exactly right.
Ok. Did you
have some kind of a class when were a little kid to teach you hand-raising?É Did you really?
É Where'd you learn it?
Did you pick it up in kindergarten?
You probably did, ok?
And why are you using it now?
Most of you, when you had a question, raised your hand. Why?
Yeah, you're not that nice. Why do you use it?
Because it works.
It's functional.
It's what we call a pivotal response.
I know what hand-raising means. You raise your hand, I'm gonna say,
"You have something you wanna ask, 'cause you need help,
or you don't understand,
or you gotta use the restroom. Something.
But it's an attention cue, it's an attention signal, and
I know what it means.
I didn't take a class in hand-raising any more than you did.
But I did learn it by observation,
modeling,
and reinforcement, ok?
I didn't learn it by punishment.
I learned it because when I raised my hand, I got somebody's attention
faster than when I flipped a table, screamed "the Rosenberg findout,"
When we start talking communicative intent, we have to go-- to get to your question-- we have
to go back to, what is he trying to say to us? That's why I said to you, behavior is communication.
He is saying,
"Out of here, need help,
can't do it."
If he raised his hand without flipping the table,
what would be the most likely thing that you as a teacher would do?
Would you ignore him?
You're not sure.
Don't teach Spanish if you would ignore him. Not good. What's that?...
É You would walk over. You'd go,
allow him to solicit your attention, your assistance, and you would do something about it.
Now if you did something,
and it made work easier for him,
what's his payoff?
i.e. what's his reinforcer?
If you help them with the work, is it easier or harder than if he does it himself?
It's easier, ok. If it's easier, that means there's less effort on his part,
with greater success.
You will do the things
that are easier for you to do
and also have them maintain high correct response rates of success, ok?
You'll do that, alright?
Organisms do that. They go for what's easy and what works best.
That's all we have to work with. If you take that example, pretty much everything we talk
about the rest of the afternoon is going to start to hang together.
We good with your question? Ok?
This is a social learning disability.
A lot of behavior in autism--
and because I know you heard a few lectures before I got here, you know that the range of capacity
in autism
is tremendous.
Some of you are working at Chapel Haven and so you've got
some individuals who are-- to say that they're high-functioning is an understatement. Some of these
folks, you know, wrote the book on IQ. And they can do things in their heads that we can't
conceive of. On the other hand,
they may do that with absolutely no understanding that there's a social engagement that goes
on with this, that you have to
participate in some meaningful way to share
what you know and are doing with someone so they
wanna do it back with you.
The social learning disability and the misunderstanding of social context is one of the biggest problems
that we deal with in autism that affects the behavioral issues.
The second thing is-- 0:20:19.330,0:20:21.200-- and another thing I'm sure you've heard is
that folks with autism don't necessarily
know that you're thinking
the way you are;
they may be thinking you think like they think.
Now I know that was a rather convoluted thing, but I want you to think of
having to take someone's perspective and what that requires you to do, ok?
It requires you to think about how someone else is experiencing something
as opposed to your
immediate experience.
And the importance of that
as a core issue in the social disability of the autism spectrum really can't
be understated.
So if we have someone who
says, "Well, what's wrong with flipping the table and screaming 'the Rosenberg findout'?"
Well, it's not exactly what you see in school.
And then if I said to you, "What's wrong with 'the Rosenberg findout' as a phrase?"
What would you say?
Why is that a bad communicative strategy?
Doesn't communicate anything about what you want or need, true enough. It doesn't--
well, if I had autism,
and that's my phrase.
Works for me, right?
My blindness is--
the person with autism saying, "It works for me, it must work for you.
You read my mind.
You know my mind. My blindness is:
I don't know that you don't, ok?
The phrase "the Rosenberg findout"
is very specific type
of social communication problem; it's called a neologism.
It's a word made up
by someone to mean something.
So we have lots of neologisms in autism; they go all over the place, all over the map,
but the bottom line is the person with autism is the thinking, "You know what I'm trying to
say here"
and you as the teacher-- you as the student sitting next to him are saying,
"I don't know what's going on.
This guy's wild."
Ok? "This is dangerous, to be around here."
The third thing is that executive functions are generally
compromised
in the world of autism.
So if you have somebody who has difficulty
looking at a situation and deciding what's the most relevant piece of information here.
You have somebody who
doesn't necessarily take
experiences from the past that they've had
and apply them to the situation in a somewhat flexible or modified. way.
If somebody who doesn't
scan the environment for somebody who's being successful and say, "I would just hang around
that successful person
and I'll do ok."
That's the problem of executive functions, and they're rampant
in autism.
The fourth thing is that
we have this tendency towards rigidity, and if you've done anything with Benhaven-- are
some of you guys going to Benhaven in Wallingford, to the school?
With Karen Lee? Ok.
And some of your-- some of you going over to
the residence?
You've seen some
folks with autism who are a little rigid?
You know what behavioral rigidity-- certainly you've seen that with some of the individuals at
Chapel Haven who are very capable,
you know? Things have to be a certain way?
That rigidity--
that's not peskiness.
That's like air. That's a necessity to organize oneself
to respond, ok?
That's something that's very important to the person. Now
that might lead you to think, well, fine if that's what they need, let's give it to them.
But rigidity isn't very adaptive in the environment because if you're rigid
in your
access to the environment, you can only access
highly predictable environments,
which means you can only go to the places that you really know and understand.
You don't get out of your orbit, your environment,
and if you think about what a lot of people with autism do, is they fail in novel environments.
They could look really good in familiar environments, but they fail in novel environments, and that
particular problem is called a lack of fluency.
You can't use your skill in a variety of novel settings,
and it doesn't serve folks with autism very well.
When we think about behavioral interventions, we absolutely
positively
wrap it around learning and social environments
for assessment and for intervention--
treatment, planning, and development.
The behavior has lots of purposes. The stuff on the left,
from aggression all the way down to motor tasks--
that's what you're going to call us about.
You're going to say, "I've got a kid and he bites."
Or "I've got a kid and he flaps his fingers and he does this," or
"He kind of"-- this is a great room for this, if you autism, you'd have a field day
in here, perhaps, because
we've got verticals, we've got fluorescent lights,
I can do all kinds of things and make patterns with my hands,
I can make this room very visually stimulating
without even talking to you guys.
And I could sit here and do this
and really get off on it and enjoy it,
and not be thinking,
does this group of students think I'm nuts?
Do they think that this is just not what the professor does?
And not only not think it,
not care to know.
'Cause I'm more involved
in getting this type of visual
sensory feedback that I'm looking for, ok?
That's part of the problem we see, but
we often get these requests, or these calls to consult or solve
the problem, when people identify the behavior in question. So they say, we've got aggression, or we
have pica. You know what pica is?
Ingesting inedibles?
So people who eat cigarette butts?
Not chew on; swallow.
Ok? Or coins.
Rocks, stones?
You know, it's fairly dangerous behavior.
We're not talking about people who chew their shirt.
We're talking about ingestion.
Self-injury, noncompliance, you know you name it.
Those behaviors are problematic, they get in the way, they're stigmatizing, they're dangerous, they're--
minimally, they're annoying.
And what we've done some research on looking at--
so, when we have behaviors, where do they go? We find that
for the majority of individuals with autism spectrum disorders, escape from demands
is the most likely function,
purpose behind, reason for the behavior.
So we find that people will do
behaviors to get out of other things that you want them to do.
Fair enough
We also find that
when we look across a whole-- and this is about--
we're talking about a couple hundred individuals in this particular sample
of a study done a number of years ago--
if you just take
access to tangibles,
ok, which is:
I want a certain thing and if you don't give it to me, I'm going to have a fit.
You've got almost fifty percent--forty four and a half percent of the individuals
in this particular surveying--
their behavior was maintained by, triggered by,
wanting access or wanting escape.
"I want what I want, and I don't want to do what you're asking me to do."
That is a very common finding in the world of autism.
We do have
people, however, who
engage in behavior problems to access social attention.
They do it for purposes of
obtaining
sensory feedback, or what we call stereotypies.
And then there's a lot of behavior that's multiply functioned. We think about the
Rosenberg findout--
that behavior was actually multiply functioned, ok?
You said it's escape from the task,
and young lady in the back said maybe he wanted the access
to the attention or the reading of the book or sitting in the beanbag chair.
Perfectly reasonable.
This is negative reinforcement.
You're talking about positive reinforcement.
And by the way, why is
getting out of doing the dirty work
with the open-ended question negative reinforcement?
And not punishment?
Have you guys
tackled that yet?
Who drives a car?
Whether here
at university or somewhere else?
All of you have seatbelts?
What happens if you don't put the seatbelt on?
What happens if you turn the ignition on, you don't put the seatbelt on?
The car dings at you. You have some sort of an audible signal?
Most of you.
Ok, that's good, you're driving cars that are
post-1970, that's a good thing.
So you have a noise that happens. You like the noise?
Do any of you like the noise?
What do you need to do to make the noise go away? Sorry?É You've gotta
put on your seatbelt and click it, right?
What is the aversive stimulus? The noise.
What do you do to terminate the aversive stimulus?
You put the seatbelt on.
Is wearing your seat belt considered a positive or a
negative behavior? Is it appropriate or not appropriate?
Ok, so, negative reinforcement
is terminating an aversive stimulus, alright?
In order to
get reinforcement. What's your reinforcement when you put the
seat belt on?
It stops, exactly. The noise goes away. So you're saying, "Thank god, all I have to do is click my seatbelt
to make this aversive contingency go away."
So what we've got is the
removal of an aversive contingency
that you have control over, and you do something good to do that, and that's a good
pro-social behavior, but it operates in the context of negative reinforcement, which is exactly what's
going on here.
Now the tricky little thing is, as soon as you do that, this kid
flips the table
and he runs over there and they tell him to sit down in the chair--
we have two things going on. He's reinforced because he doesn't have to do the work,
you tell him to go sit down in the chair, now he's quiet,
everything's calm...
You, the adult, are reinforced.
We have a very dangerous trap going on here
that people fall into all the time. And it even has a term: it's called a negative reinforcement trap.
More on that a little bit later.
But at the end of the day, if we don't analyze these individual
what we call contingencies,
you might say,
"Don't flip the table, I'm going to put you in time-out,"
which will not change this behavior over the long term. It will lead to symptom substitution.
All kinds of problems, all kinds of consequences. You can have educational access that you lose,
you can have social access that you lose. You can get into trouble with the law. You
can
break things and have people make you pay for them. Please?...
When you say the word "they," you mean folks with autism here?É Got it.
It makes perfect sense. Is that the intent-- is that what you took from what I said?
Ok. You got it, ok?
everybody in this room response a negative reinforcement
Everybody in this room responds to negative reinforcement contingencies, ok? And everyone in this room seeks positive reinforcement contingencies.
And some of you don't manage them well, and sometimes you're more negative and people
leave you alone, and if you like being left alone that's a really good strategy, except that you won't have
many friends after a while.
On the other hand,
if you really want to be around people, and you're crabby all the time,
you don't get what you want.
The key difference in here-- the one distinction that I want to make is-- you had something in
which you may or may not have intended to say in the same way, which, is of lower intelligence.
Don't make an assumption about intelligence
when you talk about autism.
Because-- there's a term that I'm going to use with you, and you may have heard this before too:
multiple intelligences.
I want you to think of people with autism
from the context of multiple intelligences rather than a global intelligence
factor or something like gene,
okay-- that we would say, "Well, there is an IQ."
The world of autism is far too variable for that.
It's much more common to have somebody who's got
absolutely breathtaking visual perceptual skills and can see something,
close their eyes,
and reproduce the schematic of that
like this.
But have horrifically bad verbal skills and can't have a conversation.
The literature is full of individuals like this,
so what I want us to be thinking about is people with
intelligences or domains of intelligence and domains of deficit, ok?
Rather than a global.
And don't know
if you're at Chapel Haven or Benhaven,
but if you're at Chapel Haven you're running across some folks
who are, you know, working on six cylinders
in some areas.
And even if you're at Benhaven with some individuals who are very significantly compromised,
you also know that there are
some fellows there, and women there,
that can do things you say,
"How can that be?"
The person
can't handle any situation that demands flexibility; they have no language.
A lot of behavioral problems.
Yet they can still--
whatever they can do that's exceptionally good.
Really that's the paradox of autism.
It's what makes it so uniquely different than intellectual disability in its most
straightforward form,
is the variability. And
if you're somebody like me-- and you know,
this is thirty six years that I've been working with kids in the autism spectrum,
adults in the autism spectrum,
that's the thing that makes me get up everyday. That's the wow factor. And it's like,
"How'd you do that?
That's really cool.
Well, to this we move to
some basic assumptions
that build upon something that you were saying, which is, if behavior is communication,
then we also recognize that behavior is a relationship between the person and the environment.
Behavior doesn't occur in a vacuum.
And when I talk about environment, I'm not just talking about physical environment, I could be talking
about internal environment.
Anybody here had the flu yet-- hope not?
Did ya? Ouch. Ok.
In the early part of your flu--
you guys who have had the flu--
did you go to class
some days when you started to get sick?
Were you at the top of your game?
Probably not, right?
'Cause you're probably feeling kind of funky
but you're not even sure why you're not feeling good, and then all of a sudden you're real sick?
Ok. Then you finally, hopefully, stop going to class and got a little better? Maybe not?
You could have an internal environment.
Illness is
an environmental setting-- we call them a setting event--
can affect your performance.
So if you had been really doing well in a class and studying
and getting great grades on tests and quizzes and you go sick and take a test and bomb--
have you become dumb?
Or
is it your illness that's interfering with your attention, focus, and the short term working
memory?
Probably the latter.
We call the illness a setting event,
or an establishing operation.
More on that later.
But it is an important variable, and if you don't think of those variables,
you'll be saying,
"Everything is outside,
it's peripheral to the person with autism," when we have some internal issues.
We have people with
neurocognitive deficits-- they have right brain/left brain
discrepancies. We have people with
poor right hemisphere
abilities and great left hemisphere abilities
and vice versa.
If you know that,
you have a way of thinking about how this person with autism thinks.
If you don't know that,
you're throwing mud at the wall and seeing what sticks.
You're hoping you can figure it out.
So as we gather this kind of information, the more we get the better we are.
If you're going to intervene,
you address the variables that are functional to the situation,
which is why--
in the situation you describe, we got a guy who's trying to escape from a demand, and
we say, "Fine, you wanna escape, I'm giving you a time-out."
Now, I want to put yourself in
the place of the person with autism in that situation. Right?
You don't wanna do this.
You get upset, you say, "I don't wanna do this." You misbehave.
I say, "Fine, time-out for you." What have I just done? Really. Come on.
Were you happy to get the time-out?
Or were you not so happy?
Yeah-- why?
You're happy; why?
'Cause you don't wanna do it anyway! So what did i do functionally for you
by giving you time-out?
I gave you an escape.
I run the risk that I just gave you a functional reinforcer, don't I?
Ok? Because it
increases the likelihood that you're going to
try to get out of doing the work in the same way, 'cause you're going to get the time-out.
So we have someone who
does a misbehavior, we say, "Fine, time-out for you," and the person's going, "Yes!"
Or they understand me.
Communication works for this.
Those are the pitfalls that we're
we're really trying to stay on top of, because
it happens regularly.
Ok, let's hope for the best.
Émake this work.
Now this is really the basics of what we're talking about and I want you to watch.
What's going on? Hm?...
What's the problem-- what's the target behavior?
What's the problem behavior here?
The child is doing the problem behavior-- what is it?...
Yeah, it's having a tantrum.
Nobody's ever seen this before, right? You've never seen a tantrum. Ok.
Come to my house.
Ok, we have tantrum behavior.
What is the learning contingency
that is maintaining that tantrum?É Sorry?É
He gets to stay on the camera. You think it's being on camera. Who else?
He's getting adult attention,
in the form of..? For him?
He perceivesÉ?
Positive attention or negative attention?
Probably positive attention. It's positive reinforcement.
Alright, so, positive reinforcement
through social attention here. Right.
And what this little guy is thinking is, "Hey, whenever I see these people, when I fall on the floor, this is
going to work."
Fair enough?
You watched about seven sequences; I can show you twelve more if you want to see them, because it goes on for
a little while.
Now at the end of the class there's going to be a little jar over here; I want to
put spare change in it, because it's going to be his therapy fund.
'Cause this kid's gonna need it when he's older; he's basically--
for infinity he's on--
on YouTube here.
This is a very straightforward example of problem behavior maintained by social attention.
When we
as clinicians are looking to understand problem behavior, we say
"What happens after the problem behavior
to increase the likelihood of its future occurrence?
And what is setting the stage for it?"
Now what if I said this kid is
super tired,
versus
just got up from his nap and he's
really well rested and well-fed and he's pretty robust?
What if I told you that in this situation, the kid is super, super tired?
What would part of your intervention include?
Letting the poor little guy have a nap, right?
All right. But what if I said to you,
not tired, he's not hungry,
he has access to all kinds of good stuff.
Then what would part of
your intervention include, or not include? The naps, right?
If we want to change its behavior, what is one of the things we have to do?
Change the relationship
between when he has tantrums
and when he does or doesn't get attention.
That is a basic--
that's a basic intervention strategy here.
So that's one of the things we're going to be thinking about.
When we look at behavioral assessment and treatment, it's
not a linear process. It's really a circular process that never ends until you decide
that you have a replacement behavior
that's accessible to the child
or the adult with autism, and it's fluent, meaning it can be used in a variety of novel
situations.
When you assess, you get information, you develop a treatment plan, you go ahead and do the intervention,
plant a new tree, and then finally you move to an evaluation phase. And the evaluation gives you
information that reinforms your assessment.
When you're reinforcing assessment,
you're continuously changing what's going on.
Now you can imagine, in the case of that little guy,
we change one thing.
What if I said to the parents, "Alright, I want you to put this behavior on extinction.
No attention whatsoever."
From what you know about basic principles of extinction,
what is that behavior likely to do in the beginning?
Exactly. Why is it gonna get worse, and what do we call it?
We call it an extinction burst.
Why is it going to get worse?
Think like the kid.
Don't think like an adult.
Think like an eighteen month old kid.
"Hey. They didn't hear my scream.
These poor people, they must be doing something else.
I'm going to ramp it up six or seven notches,
then they'll really pay attention to me."
That's kid-think.
That's the way these things work.
That's why extinction bursts work, alright?
What's the worst thing you can do with an extinction burst?
Behavior's climbing; what's the worst thing you do?
Give attention as it's climbing.
You know why?
You just reinforced persistence.
You know why? 'Cause the kid's saying, "Alright, the little stuff, it doesn't get what I want; the big
stuff works. The next time, I'm going right to the top."
Kids are smart.
Way smarter than we are.
So that's what's going to happen with it. If you think about this as you're going through
this rubric for,
figure it out, develop a treatment,
evaluate the treatment,
reinform your assessment and treatment plan as you go,
you'll be getting the right idea.
When we do behavioral assessment, we do behavioral assessment for three reasons: we wanna predict
what's going on
as we intervene--
we want to be able to say, "Alright, I know what's going on, I have a pretty good plan
but I wanna inform
my ongoing intervention. That's that
circular loop of,
new information adds to my thinking about my treatment plan and its effect.
And we wanna provide this information so we can make readjustments.
We them want to be able to do a summative evaluation
in our behavioral assessment
formula which says,
I understand what happened.
Now there's good reasons
for having a summative assessment, even when the problem is now gone.
Particularly in autism.
Because we can have behaviors
that change
form
but retain function.
Now let me explain what that means.
Let's say instead of flipping the tables, I engage in self-injury.
Ok? And I slap myself in the face.
Ok? And I slap myself in the face, and I slap myself in the face.
You get rid of face-slapping.
But now what I'm doing is, I'm biting my wrist.
And I'm biting my wrist. And then you get rid of that one, and then I'm getting into property
destruction.
That kind of a sequence of substituting an alternative form
happens when we don't address the function.
So if I don't get at the very basic fact that this guy
in the Rosenberg findout
cannot do open-ended
grapho-motor tasks,
if I don't get at that problem,
I will likely have new behaviors
that substitute for flipping the table and screaming "the Rosenberg findout."
I'll something else. However,
if I intervene at the level
of the complexity or the processing demand of the problem itself,
I will
remove the reason for those behaviors.
Does that make sense?
That's behavioral assessment and treatment.
Thinking about what causes it,
altering the contingencies
so the behavior is no longer functional-- there's no reason to scream "the Rosenberg findout";
work's not hard--
or if work's hard,
I raise my hand,
you help me,
and I say, "Whoa,
that worked."
I'm going to raise my hand when I need help; the guy comes over. Ok."
That's a lot easier
than running around the room and having people upset with you.
When we do behavioral assessment and treatment,
we're going to first think of changing the environment.
We look at the target behavior. We say,
"Hm, got this guy sitting at the table with four other kids, four other students.
What's one environmental modification I can make
just to the physical environment?
What comes to mind quickly?
Four kids at the table.
Let him work at his own desk. I could reduce
the crowding.
For anybody who's done any basic
animal research:
what happens with crowding?
What does it generally do to arousal rates?
What does it generally do to stereotypic responses?
It ramps them up, right?
I mean, for that matter it also increases cortisone levels. So
you've got poor response sets, you've got poor adaptive responses in
highly crowded situations. Well, most of us would say, well, four kids at a big table,
not so crowded. But
what if you are overstimulated by physical movement and you see people moving and you
watch people move, and it distracts you
from your task and you can't get back onto your task because
people are moving around
and it's an unpredictable visual field for you.
There is a problem that can be an aversive event
in autism--
might not be for you or me,
but it could be for someone in autism.
The second thing that you do
is you manipulate contingencies. Now the contingencies we talk about in this particular case are
escape from demand
and positive reinforcement.
So we want to do something to tinker with those. We want to
change the escape
consequence.
And we want to turn the escape consequence into a positive behavior
that gets what he needs, which
might be
assistance when he raises his hand
as opposed to
no assistance, return to work when he flips the table.
Because right now, flip the table means work is gone, right?
That's what you said the reinforcing contingency was before, and you were absolutely right.
So now we want to say, you flip the table,
you do the work again.
Instead of, flip the table and the work goes away. That's reversing a contingency.
We also want to say, "Raise your hand,
I help you with the work, make it easier."
That's adding a positive contingency for a more adaptive,
and I would say adaptive and functional behavior.
We teach a functionally equivalent alternative response.
You identified what it was. You said, "Raise his hand." That's a very common one to use.
And then finally we want to teach a behavior that will address long-term needs, and the reason
I use the Rosenberg findout is it basically helps us wrap all this up.
Because here you guys are, right, in your
thirteenth, fourteenth, fifteenth year of schooling
and you still remember how to raise your hands.
Ok, and sometime you're going to be working someplace in a large meeting,
as a professional,
and you're going to raise your hand.
Hand-raising
to solicit attention or assistance
has longitudinal value,
and in this culture--
most cultures, many cultures--
it's a socially acceptable way of doing it.
People are going to pay attention.
They give you attention,
they reinforce your hand-raising.
The natural consequences are fairly evident. Now,
skip what's written, 'cause
there's a lot of fifty-cent words in here.
Here's the basic concept.
You guys had the flu.
You didn't feel so good,
alright? Maybe some of you are sitting here saying,
"I didn't have lunch today.
I'm really having a hard time paying attention." Or
"I not only had lunch,
I had four desserts,
and I'm about to hit a hypoglycemic low, and it's gonna get ugly."
That is a setting event,
alright? It is not an immediate trigger stimulus, it's not the immediate antecedent.
It is what occurs before that that sets the stage
for the likelihood that reinforcement will occur or the likelihood that punishment will
occur.
And that's why we call it a motivating operation, because it
establishes or it sets the stage for the next operation-- it could be a reinforcing or
punishing operation. When we say operation we're basically using the same word as contingency.
The easy ones we think about are, "So how are you feeling? Are you hungry, are you tired, have you had
the wrong foods to eat?" Some of you guys had eight cups of coffee today, some of you had
maybe none,
alright, and your caffeine levels are a little better.
Jamie and I were talking before. I just came back from working in Italy
where we have three projects going on, and one of things that I get to do in Italy is I get to drink
espresso the way you're supposed to drink espresso,
but I don't drink
caff americano, I don't drink a
big cup of coffee.
Basically I'm doing shots.
But I'm somebody who really likes coffee a lot--
not a little; a lot-- and
I drink a lot of espresso and it doesn't affect me to have
twelve, fifteen
espressos a day.
It's kind of an interesting thing. But if I were to have the equivalent amount of caffeine
in coffee here, I'd be non-functional.
I think it's-- I think it's a volume-- and the short burst that goes through. I just sort
of keep on a constant fuel cycle with it.
Hey, for better or for worse. It--
I could show you this exact same lecture done on fifteen espressos in front of,
you know, an audience of three hundred people Italy with
simultaneous translation and I probably wouldn't be talking any differently.
It's just one of those things. But the reality is that
some of these things set the stage for better or poor performance, and they are
internal events, ok?
Some of them are external events.
Some of you guys working at Benhaven
have clients
that you work with
who have schedules of their activities, right? Picture schedules? No? Ok.
Let's say that
you're working--
are you in the classroom?
You're in the residence?
But there's a schedule in residence for activities, right?
Let's just say you go in there and say, "Hey, you know what?
I'm smart.
I'm in molecular biology"--
What are you in? What's your field?
Biochem. Alright. "I'm in biochem.
I know more than these psychology geeks who are doing this autism stuff.
We're doing away with the schedules."
And behaviors go off the wall.
Now, what's the relationship between schedules and behaviors going off the wall,
for a bunch of people with autism?
Why would they have anxiety?
What does the schedule give them?
You're right on the mark here. What does the schedule give 'em? Hm?
A sense of control, and I don't mean coercive control or manipulative control, but sort of
knowing what's next.
Let's say structure, routine, predictability.
Schedules give you that.
Some of the people have
PDAs, you've got
other kinds of things.
I'm more basic,
I have this.
And I make lists.
Any of you make lists, nobody here? Do you?
It's not a twelve-step program, it's just-- any of you make lists?
What do you do with your lists when you finish stuff?
Why do you cross 'em off?
Because it feels good?
Ok, good. Well, at least there's honesty here.
And now-- you cross them off because it feels good. Do you cross it off because you finished it?
Ok, it's not about the work, it's how I feel, ok.
So you cross it off because you finished it, and
as your list gets crossed off, what are you doing?
You're completing your tasks.
As the
number of cross-offs increases,
and the uncrossed off items decreases,
what do we call that?
Progress, right? We call it-- it's a progression of time and task.
If you have a schedule for a person with autism,
and they're starting here on the schedule and they're working their way down, and as they
complete the activity they take the picture way or the words away that
identified that particular task,
they're doing exactly the same thing.
Now, I don't want any hands for this, but some of you guys, when you make these lists,
because you're gonna across things off so you can feel good about it--
you put things on the list you've already done.
So you cross them off right away.
There's about
a quarter of you in here that do that. It's not because you're bad people.
You just need a lot more reinforcement to motivate yourself. And it's really ok to
do that.
You have my permission to do that.
When you have a behavior issue,
a lot of times people say, "Well, what was the immediate trigger?"
You'll only get so far if you think of those immediate triggers. You have to move up a level
to ask what's the physical context (think crowding);
what's the social context
(think sarcasm--
tell you about that in just a second);
what's the biological context (think illness). Ok? So. Let's see.
We'll pick somebody here that I haven't picked on yet.
Lady in the back who's really typing madly on there. I could say, 'cause you have a pendant on
that's shaped like a heart--
I could say,
"Wow, beautiful pendant!" Right?
Or I could go,
"Beautiful pendant."
Same words.
What differs?
Tone, good. What else?
Affect, good. What else?
Don't think words,
think face. Yeah. Well, facial
expression, sure.
One was a little friendlier, one was a little
not-so-friendlier.
What's the most important piece of information? The words?
No. Not the words.
Because the words are the same.
Tone, facial expression,
affect,
volume, voice
all of that comes together
as social context
to say, "In one, he was giving a compliment, but the other, maybe he was being sarcastic.
Wouldn't that be rude, for some guy you've never seen before to walk into your class and be sarcastic
about your pendant?"
You might go on to think all kinds of things about what a not nice or
nice person I might be in other situations,
depending on
how I give you
either one of those two responses.
That's context.
Now, that informs
any of these, and you need to know what these are
or you're going to short yourself on understanding this. You need the background.
So if you think about
what's going on in the macro, and we think about this as more macro, and now what's going on
in the micro,
the immediate trigger that sets it off--
you have a better understanding
of the experience of the person with an autism spectrum disorder
in that behavioral moment.
Now in behavioral assessment we do four things, and I'm going to tell you about them and then we'll go through them.
I have some videos as we go through these too.
An ecological assessment, a motivational assessment, reinforcer, and then a functional assessment or
functional analysis.
Is anybody in here--
has anybody in here been involved in doing functional analysis before?
As in a contingency reversal,
or came from behavioral
background anywhere else or
is moving towards that? Ok.
Or work with little autistic kids where you did ABA or anything along those lines? No? You did? Ok.
As a home tutor?
It's a summer camp. Ok.
Functional assessment and functional analysis are some of the things we get really involved with
to understand learning as well as behavioral issues.
We talk about ecological assessment--
I want you to think macro,
what's the big picture telling us? We do several things.
We look at the physical environment. We say, "What in this physical environment might set
the stage?"
With the Rosenberg findout, we said, "Where is the kid sitting?
Is it crowded?
Is it noisy?"
What if I told you that instead of
the paper that I brought
to the kid that was open-ended
triggering him,
it was his classmate
who hums
coming into the room, sitting next to him,
and he's constantly humming.
And that's the trigger.
Whenever he hears the hum, he flips the table.
There'd be a different intervention.
One of the interventions that you might suggest would be,
"How about we move the humming guy away from the guy who's flipping the tables?"
Or
what else could you do to the guy who has to listen to the hum?
To soften the impact of the hum.
Huh? Yeah, ear buds. Or headphones, for something that
kind of puts white noise behind it, drowns it down. Ok.
The next thing we look at are antecedent-behavior-consequent conditions
Just call them ABC's of behavior, ok? And we're looking to see,
does the behavior
have a reliable or predictable set of things that almost always trigger it?
Does the behavior itself look fairly consistent in its presentation? And what are the typical consequences
that occur?
When we do an ecological assessment,
we often find that there are very reliable antecedents
and very reliable consequences.
'Cause behavior, believe it or not, is fairly predictable.
Most people do things the same way over and over again. They just don't think about that.
The next thing we do is look at the learning environment. In the case of the Rosenberg
findout kid,
that learning environment involved
a cognitive task, being able to process open-ended information,
construct a rubric
for producing
a graphomotor response.
Fairly complex if you think about it in those terms.
For this guy, he may have been able to read it
and talk it,
but not write it.
You work with somebody with Asperger's syndrome, the problem of
being able to
speak
an amazingly coherent paragraph,
but not write more than three sentences,
would not surprise a lot of us.
Ok? 'Cause in Asperger's syndrome, a graphomotor deficit thatcould be part of a right hemisphere
deficiency
is a very common thing to have happen.
And then finally a temporal analysis has to do with,
"When does this occur? Early in the day,
after lunch, right before lunch?
Only on Mondays?
Only on Wednesday mornings but never any other day of the week?"
And then you go back and do a little looking,
and you find out, Wow,
mom and dad don't live together--
no, mom and dad do live together, he's got an intact family, but every Tuesday night he goes and stays
with Nanny and Grampy.
And Nanny and Grampy are
nannies and grampies.
They do whatever he wants,
no contingencies.
It's a free-for-all.
The kid comes in the next morning thinking,
"I can get whatever I want.
I just did."
So what we have now
is the infamous nanny and grumpy interventions,
which have
probably more to do with fixing this behavior
than working on the kid.
When we have a motivational assessment, we're asking questions about what makes this behavior go, what makes
it happen.
We have several things that we can think about. The first
that we described is positive reinforcement.
It can be social attention
or stuff.
You are reinforced by what I give you.
You really like these little kind of neat pointers, and then I give it to you.
And then you play with it.
You shine it at people, do things like that.
That's a positive reinforcer or a material reinforcer.
Social attention, however, is all about us.
You do things and I
respond to you and you do more of that and I respond more to you.
Escape/avoidance
of demands is exactly what he did.
Reinforcer loss is really a subset of this one. I have it separated for a very important reason,
because
behavior is maintained
by losing access, is what we're talking about.
So you're
playing your Nintendo DS,
and you haven't hit the level yet
and if you turn it off or close it up,
you're gonna lose all your points thus far, right?
That's what my seven-year-old tells me. He says, "I can't turn it off and go start my homework
because I'm between levels.
And since I can't do the DS,
I know I'm getting scammed, but I don't know how to beat this problem.
'Cause I know he really can
to stop this and save it, butÉ
It's a trick you play on your parents, I think.
They lose all the time.
The loss of access
to something that you like,
a material thing that you like.
Or you say, "I want it," and I say, "Not now."
You have to wait; you can't have it now." That's
a problem that is about reinforcer loss.
The next one has to do with sensory consequences, reinforcement or negative reinforcement.
Sensory reinforcement is...
I am much more interested
in the way this looks
than in talking to you.
And I will do this for a really long time.
It doesn't make any difference to me what you think or what I think,
I like this; it's giving me what kind of feedback?
Let me just tell you what I'm doing; I'm looking through my fingers and
I'm looking at that light.
and I'm going like this.
What kind of feedback am I getting?
Visual, good. What type of visual feedback?
Remember: fingers, the light.
I'm going to give you a clue:
if I look at my fingers, if I focus on my fingers,
something different happens to the background with the light. If I focus on the light, I have
eight fingers.
I'm getting a-- what?
A little figure/ground distortion?
You with me? Try it. I'm the guy on YouTube, you're not.
Alright. It's my life. You can do this in the privacy of your own home.
I lied, you're all on YouTube, it's going to go up in about a month.
So you do this,
and I'm getting a figure/ground distortion.
That's kind of close to 3-D, isn't it?
Alright? See things in different dimensions, stereoscoped?
If you're a five year old and you're on the playground and you're doing this
against the trees or against the leaves that are blowing
on the trees,
what do you think other five year olds are gonna do with me?
Typical five year olds.
Are they going to run up to you and say, "Wow,
can I do that too?" You don't think?
Everybody makes fun of you. They might avoid you.
If they're five and they're nice, maybe they just won't even play with you.
They'll just say, "Hm," you know? By the time they get to seventh grade,
that's when they make fun of you.
Now what can I go buy at a store right now. Toys R Us.
KB Toys.
What can I buy at a store
that has been around for
thirty years
that provides really good
figure/ground feedback
that has
context
that other children would want to play with?
A kaleidoscope, perfect. What else?
The viewfinder thing. That's exactly right, and it's-- yes, and it's a--
you know what I'm talking about, right? A
viewmaster, thank you. I lost it for a second there. A viemaster is what you're thinking about. And I go and
buy a, you know,
Disney princess disc, put it in there,
and all the other little kids who like Disney Princesses come over and they want to look
at it.
I do this, I generate avoidance behaviors.
I do a viewmaster
with an interesting disc in it, and I generate
approach behaviors.
For the kid in the spectrum,
both stimuli
are providing
similar
visual perceptual feedback.
Part of the intervention is often to understand
what's maintaining the behavior at that level,
at the sensory level, and saying, "Can I come up with a better
alternative that will access
approach behaviors?"
Part of your intervention is to
bring them to the child, and still give the child things that they're looking for.
Classical conditioning certainly happens. Think fears and phobias. And
organic factors certainly occur.
We have a little guy right now-- we just finished a sleep study down here,
and he has obstructive sleep apnea.
But nobody was thinking about that; they were just thinking about this little kid who was tantruming wildly.
Problem was,
he was having so many episodes of obstructive sleep apnea
that he was having no REM sleep.
He would drop into REM, he would [snort].
He would awake,
he would snort and awake, and he'd pop right back up again, and
he basically couldn't recharge his batteries, and this was going on for years.
And he was a
very unhappy little boy.
And you know what the intervention was?
Tonsils and adenoids.
The doc said,
"We've got to cure him of obstructive sleep apnea, he's got tonsils the size of oranges, and let's make those
go away."
And
lo and behold, you have a physical intervention for a physical problem that affects behavioral output.
You don't want to forget the fact that
human beings sometimes have these
events, physical events, that get in the way.
We look at assessing stimulus preferences as reinforcer assessment-- that's something
we were doing when I was showing you the
the hand flapping episode and you came up with an alternative, which was, get him a viewmaster,
get him a kaleidoscope.
When you think about stimulus preferences, you say, "What is the information the person is getting?"
to guide what they're getting afterwards.
Reinforcers that you pick have to be common and be available, right,
'cause if they're not--
if they're exotic,
they're not going to be in the natural environment.
So I may be able to teach you guys in this class
how to do something, because I have something that you can't get anywhere else,
so by virtue of novelty,
I shape your behavior. But if it doesn't work anywhere else, it's not
going to generalize the behavior,
there'll be no fluency.
Reinforcers have to be functional, meaning they work, they increase behavior.
And they really need to be age-appropriate. Now,
functional analysis
is the process
of answering the question in an empirical way,
"Why does this behavior happen?"
Ok? That's what this is all about.
What I'm going to do is show you the four FAA
vignettes
at the end,
ok? If you want to stay for 'em, that's okay; if you don't
I understand that.
They're useful
to the extent that they give you
a real-life in-clinic
observation of how we do it and what the child's response is to that.
But what do we get when we do a functional analysis? What we find out
with empirical validation-- this is
essentially
having controlled conditions--
it's a little experimentÉ Actually it's
four little experiments.
You have a controlled condition where you do something and get the response from the child.
Or you don't do something and you see what the response from the child is.
I look at this child with the Rosenberg findout's behavior, and I say,
I don't allow him to escape--what happens to the
problem behavior?
Up through the ceiling. In other words I say, "No, just keep working on this worksheet."
Or, as soon as he
starts to get fidgety, I say, "Hey, don't
worry about the worksheet. Go take a break."
The behavior ramps right back down again.
On, off,
on, off. I want to watch the behavior rise and fall, rise and fall.
What I'm doing is experimentally validating the hypothesis.
The second thing we do is we find out what consequences we're maintaining.
We're able to look at what we call chains of behavior.
Ok? Now, I'll tell you what the chain was for this guy--
because, he'd be sitting in his chair, he'd be working kind of nicely,
I'd bring his worksheet over,
put it down in front of him.
I'd start to see him fidget,
a little agitation,
kind of like this, push the paper away...
pop! Ok? Scream, jump, run.
If I wanna intervene at an early point
in the behavioral chain, where do I go?
At what point do I intervene?
Do I wait for him to scream, jump?
Maybe when I saw him
start to agitate, ok?
And once the paper was down,
on a good day, he might do just fine.
But if I start to see the agitation and I'm saying to myself,
"Predictably, reliably, that agitation is a precursor
to the behavior of blowing up," and I
documented that--
and how do I do that? I'll document that with an ABC analysis. Then I'll say, "OK,
now I know where I'm going with this.
If I intervene here with assistance,
before he blows up,
I'm able to capture the behavior,
respond to his need,
before he has
exhibited a problem behavior that I didn't have to respond to for safety reasons, ok?
We have high and low probability situations that we find out when we do a functional assessment.
We say, when is a behavior most likely to occur, when is it least likely to occur?
We look for functionally equivalent behavior--
what's a thing we can teach them to do that has the same communicative payoff,
but is more adaptive and successful?
Raise your hand
is more adaptive than flipping tables.
These are the conditions in a functional analysis.
And you'll see four of these conditions when--
when I show you the tapes a little bit later.
We've got
a time when there's nothing going on, we don't do anything to you. There's no consequence
for your behavior.
We have a situation when the kid's playing by themselves, the kid engages in a problem behavior, alright?
And the adult responds to it.
"Oh, don't worry; it's okay.
Don't be concerned."
But for appropriate behavior we don't do anything. We only respond with social attention to
the problem behavior.
Inn this situation, we get the problem behavior, we give him something.
So the kid's
trying to get something; we put all the fun stuff out of reach.
The kid says, "I want it."
The kid starts having a tantrum. We say, "Oh, here you go." And you give it to 'em.
Let him play with it for thirty seconds, then you put it away, put it back up. The behavior ramps up again.
"Ok, here you go." You give it back.
You manipulate his
behavior with access to materials,
and then later we're able to compare,
does it get higher or lower when it's social attention versus materials?
See where this is going?
We're able to experimentally validate
in about
two minutes
for each of these,
times two or three--
so we're talking about, what, five times two,
two, three, four, five times two is ten, times-- thirty minutes, we can have
an experimental validation
of the effect
of our attention,
escape on demand,
materials-- or
nothing at all. The last couple conditions have to do with, does behavior occur
when there are no consequences going on. So this one down here is
designed to elicit stereotopy
if it's going to occur-- in other words, he doesn't care about the material or you.
This one up here is essentially a baseline condition, where it says "Free Play."
Ok, we're going to move past that for a second.
You could do several things to get this information.
You can look at
comments people make.
You can review records.
You can have interviews.
You can do some fairly formal structured things. There are several we use,
they're available commercially.
They're short and sweet. They're all based on Likert scales--
never happens, always happens, five points.
With some degree of-- actually, a very good degree of reliability and validity for each of these.
The Motivation Assessment Scale and the Functional Analysis Screening Tool-- the MAS and the FAST--
are the two most common ones used.
They have each twenty questions, you circle
the items,
the items are loaded
for behavior
that occurs
because of attention
versus escape from demand.
So for example, on both of them there's a very similar question:
does this behavior occur
in order to get your attention?
Or does this behavior occur
when you're in the room with other people and you're talking to the other people, not the
target child?
And if you circle always,
you're beginning to load towards social attention.
Alternatively, there might be questions that say,
does this behavior when the child's
doing some-- when you give the child something difficult to do,
and won't take it away?
That's escape from demand.
You have a number of questions for each of these and they're loaded up into a little
scoring algorithm,
and they give you
a hypothesis.
They don't tell you the answer.
Now why don't they tell you the answer?
How are you gathering this information?
Direct observation or
talking to people?
Talking to people. There's no direct observation here.
One of the things that we don't want to do is limit our assessment to
talking to people. We want to watch, see, and observe.
When we get to a descriptive analysis, we're getting to the watch, see, and observe.
An ABC analysis that I mentioned to you a little earlier, something called a scatter plot--I'll show you both in a second.
And then we can do direct observation.
So if I was
doing direct observation in this room of people
who are
looking at the screen,
I could be watching the clock in the back
and then I could say whenever the clock,
hits one of the
numbers, in other words, if you have a 5 second interval,
I'm talking to you guys, I'm looking at the clock and as soon as it hits,
I look around and I see, "Are you writing or not?"
Sorry, "Are you looking at the board or not?"
And I just put a little plus or minus. And then it hits the next number, and I take a look at you.
For the intervening five seconds, I don't care what you do.
But on that 5 second mark,
I will watch to see for the occurrence or the non-occurrence of your behavior.
That's what we call
a time sample,
and it's
one of several different ways of gathering
objective information
that we then aggregate form some sort of a behavioral profile.
We won't spend a lot of time on this or the next one because I think they're fairly
self-evident.
when you have what's called an ABC analysis, you see the A, what happened before, you see the B,
the behavior itself, and C for the consequence.
And a little description down at the bottom.
When you have an ABC analysis, you are taking one real-time event,
and writing it down.
So one flip of the table with the Rosenberg findout. Here we say,
"The kid was sitting at the table
doing his thing, he screamed 'The Rosenberg find out,' flipped the table and ran to the door."
What were the antecedents? Well, time of day,
who he was with, what the date was.
He's sitting at the table, it's after lunch,
I bring over
the Halloween worksheet, and I say, "What are you going to be for Halloween?" He's got to fill it out and write me five
sentences about that.
He flips the table. Then what do we do? What do we do?
We tell him to go sit down in the beanbag chair. What does he do? He gets quiet.
We do 10 of these.
Then we look for patterns.
If we do 10 of these and we look for patterns, we are going to find patterns most likely in the antecedents.
Antecedents and consequences are going to give us patterns.
If you had to choose,
should you intervene at the antecedent level or at the consequence level?
Which one would you choose first?
What do you think? Yeah?
Why? At the antecedent level. Why?
You'll get it before it happens, right?
Sure. It's a good idea, when you can, to intervene at the antecedent level so you don't
have to deal with consequent responses.
Recognize, of course, that this is
human nature and there's fallibility involved all over the place.
But you do want to be able to get to the behavior before it happens, and maybe get to the early
part of that chain, like the fidgeting we were talking about.
A scatter plot is nothing more than
putting information on a time series.
So when this behavior occurs, by day,
by hours here. Instead of hours on this side, I could have activities,
but all we're doing is putting tick marks on here.
Nothing more than a check.
Were looking for aggregated volumes of
behavioral events.
When we do an FBA,
we gather all this information,
we pull it together in a way that has some coherence,
and we do that
so that we can say
what's making sense peer to Now there's a downside to this too, because it's fairly time-consuming.
You may accidentally
or intentionally reinforce problem behaviors because,
remember, if the behavior is to --
in the functional analysis, if the behavior is to gain escape,
and you don't allow escape, you will increase behavior.
All right?
You make a judgment as to whether it's a safe thing to do or not.
There's training demands because you have to be very valid, very reliable with this, but
you will experimentally confirm or disconfirm a hypothesis. That is the power of doing
a functional analysis.
I'll tell you at our clinic,
at our cent,r we have a specific clinic for the assessment and treatment of severe challenging
behavior.
We don't do functional analyses on a regular basis.
We do them, as it were, for
the worst of the worst behaviors.
We'll do a functional assessment, which is basically to say,
let's get the hypothesis and test it in situ, in real life.
It's a lot easier in the school, it's a lot easier to convince people that's a reasonable place to
go.
But what you'll be able to do with a functional analysis is to demonstrate with a fair degree of reliability
and validity what's going on.
Now, you get all this information, 85% of your work, and now you've got to do something with it.
So you have to link
your intervention with a treatment plan.
And the reason I show you this --
this particular slide is is just to emphasize that
for the particular function, you have a particular treatment plan.
And you may have two or three of these. You may have the behavior that's--
as in the case I gave you,
there's both escape and access to positive reinforcement
operating,
and you've got to have two
integrated components of the treatment plan.
So you have to be thinking ahead to know
how do they work together.
And when you do this,
I guess there's really three take-home messages.
First one is that behavior is functional. Second is communication. The third one is --
LAN you're doing
behavior management, you're really doing teaching.
You have to teach an alternative.
If you don't teach an alternative,
you're leaving the client with nothing.
If you make behavior go away,
in a practical sense, you're saying to the person with autism, "Figure it out on your own.
Figure out what to do next." Now, it's a social learning disability, they're not likely to pick the right
social behavior to demonstrate for you.
If it's based on function, not form,
what it allows us to do is to say we have particular skill sets
that may be linked together. Different behaviors may be linked together by function.
We have general rules for intervention that we consider. The first is, function is preeminent
To the second is,
it's called the Fair Pair rule, which means
if you take one away, you put one back.
You always replace.
If I teach you
not to flip tables, I must teach you what to do instead.
And the third thing is --
any of you who work with kids or have worked with kids in the past,
if you keep people busy and happily engaged, you'll have fewer behavior problems.
So as long as we
think ahead to
functional engagement,
replacement skills that we teach,
and looking at the functional application of those skills so we can evaluate them effectively,
we're in good shape.
If you have communication skill teaching strategies, social teaching programs,
a behavior support plan is integrated with that.
As you were suggesting in the back when I talked to you about the schedules,
routine,
structure, predictability, order,
control --
those are elements of stability for a person with autism.
The more we provide each of those in the person's experience,
the more --
the more appropriate behavior we're going to see,
but we're also going to see more likely demonstration of the behaviors that have been taught.
So if we teach someone,
"Schedules guide your day,
transitions can happen but
we can describe them visually on a schedule.
When you've got a schedule,
you can handle the transition."
That's one of the things we can do for a person with autism
that makes for lower arousal rates -- you'll call it anxiety, I'll call it lower arousal, the same
concept
is going on here. Conversely, when we have breakdown
in structure, predictability, order
or control,
we're likely to see a behavior problem.
So if I said to you,
we've just had a breakdown in all those things, and now we've got this behavior going on--
what's one of your first thoughts on intervention?
What can you do
to try to bring behavior
back to a better form?
You could increase the --? Structure?
Predictability?
Routine? Control? Order
of the client's experience.
Two simply bring them back to what they expect, bring them back to what's predictable.
If we look at adult behavior,
in the example I gave you a little earlier with sarcasm,
if we look at the adult behavior and say, "Is it consistent or not?"
we often see the chinks in the armor of
problem behavior
that we create -- not the client creates -- that we create.
We've got a guy who we are working with right now who has very serious
aggressions and property destruction -- he's little, he's years old,
but one of the reasons he does is he works in a room --
if you guys can see the room, the little space in the back? --
it's smaller than that.
And it has
shelves and cabinets in it.
And it's a little nine-year-old kid with two adults in a room that's that size.
Talk about crowding.
Has no natural light, has only fluorescent light,
and he can't get out the door.
So we've got big behavior problems going on this kids' life right there, and
one of the things we have to recognize is
some of the circumstances that the
program he's in
may have created for him,
ramp up the likelihood of that behavior.
He simply can't move.
He has no way out of that.
We sometimes teach people various kinds of strategies to compensate or to move beyond
the behavior,
which involves self-management.
Sometimes relaxation strategies,
sometimes what we're going to call a personal time out.
Now, as we think about our intervention plans, we are necessarily going to think about four
things. We have to change
communication.
We have to change what the client says and does,
and, how they do it
so it works better.
That's called functional communication training,
and we're going to teach a better
response. Now, the better response, as you suggested, was hand-raising
instead of flipping the table.
The second thing we're going to do
is we're going to teach
the replacement skill. Remember the Fair Pair rule?
You have a new skill you want to teach,
you have to use reinforcement strategies
to build that skill -- so you're going to teach the child
or the adult
to do something different
that more likely elicits the response that they want.
You're going to modify the conditions around the behavior,
if they're tired you give them sleep, if they are hungry
they get two have something to eat, or
perhaps it's crowded,
perhaps there is no schedule to follow, perhaps there is
no other way of them knowing what's coming next and you address that
as an antecedent condition.
And finally we recognize that there are going to be consequences,
because not all behavior can be highly predictable in anyone's life,
and we recognize that our consequence strategies have to be
highly,
highly socially valid, meaning
that they must be
accepted by the consumers
in the environment.
By the consumers, we don't just talk about teachers or parents,
we talk about
other people in the environment -- the social environment of the school, a community,
a neighborhood, whether this particular
behavior itself is considered aberrant.
Whether the intervention strategy's considered acceptable, and and whether the outcomes we seek to
achieve are considered socially acceptable, socially valid.
We have to use the least restrictive interventions that
can be used, because to
euphemistically
kill a fly with a cannon is pointless.
But you can have very heavy-handed approaches
misused in dealing with problem behaviors.
and what you end up with is reinforcing escape.
Now if you come all the way back to what
the autism spectrum is all about,
we have a group of people
with a social learning disability
who have problems with social interpretation
who are more likely to be confused by the social environment
So now in addition to their confusion we give them punishment contingencies
so they want to escape more.
Makes no sense.
So the use of punishment procedures
is really something that we approach
in a minimalist way,
and as you suggested a little bit earlier, we go after the antecedents.
On the equation,
the left-hand side of the equal sign is where we're headed;
we recognize that we have to deal with the right hand side,
but we recognize more that the left-hand side of that equation-- the antecedent
or the environmental conditions are gonna give us more information and more strategies to
move forward.
When we talk about treatment planning
and some of the things we're going to do with treatment planning,
we recognize that we have functional communication training,
where we teach someone an alternative.
So in teaching this young man to raise his hand instead of
slipping tables,
I come all the way back to the idea that I have to give him a way
of getting
my attention
when he needs it, before he flips the table. And I'm gonna give him a hard task or
something that requires him to write a written response, and I am going to be there to coach him
to raise his hand, and then I give him the attention and reduce his demand.
We conduct that particular intervention much in the same way as we would conduct a functional
assessment
for a behavioral problem,
but it's simply a functional assessment of communication.
When behavior is maintained by reinforcement, whether it's positive reinforcement for social
attention, or whether it's materials themselves,
we give someone
escape from
that reinforcing stimulus. So if you're going to misbehave
to get my attention
like that little kid on the video,
I'm not going to give you attention when you are misbehaving.
But when am I going to give you the attention?
When you are --?
When you are not misbehaving, when you're not tantruming,
that's when I'm going to give you plenty of attention. So I want you to learn this contrast
called behavioral contrast, where we say,
from the child's perspective,
"I behave this way, it's sweetness and light. I behave this way, there's no attention.
This way, no attention.
Yes, no. I want the attention I will behave this way."
We get to apply reinforcement, in this case a differential reinforcement procedure,
to teach an alternative behavior which might be getting attention in a more socially acceptable way.
If the behavior's maintained by escape,
we absolutely identify that we have to not allow escape to be successful.
Because it will strengthen the behavior.
So what we're going to do alternatively
is we're going to try to
make the environment rich
with information, so
the child says, "There's no need to escape.
I don't want to escape from this task,
because I like being in the task too much.
I get help,
the task is fun,
the materials are preferable to me."
And something that provides a significant reinforcement for staying in the game
versus leaving the game.
In the case of behavior that is maintained by loss of access to reinforcers,
we have -- access to reinforcement is available predictably throughout the day
and can be earned
but is not freely accessible.
We put it on what's called a contingency for time.
And while we do that,
we also recognize that we're going to teach
children and adults
to wait to get what they want.
Just like we all have to wait for things that we want --
we can't have immediately in most situations --
we're going to say that we are going to teach someone that waiting is a skill to be acquired.
When behavior is maintained by sensory consequences
that are escape from a sensory event that is subversive,
you have to attenuate it, ramp it down,
those are the headphones or the earbuds that we talked about before --
or you teach people to
mitigate the over-arousal effect of that
through exercise, systematic desensitization, relaxation training.
The last point here -- paired stimulating -- is pairing
that aversive event with a highly reinforcing stimulus.
So you'll say, "I'll put up with the aversive to be in this."
One of my older children says, "That's what happens to guys when they go to chick
flicks."
They really don't want to be there at the movie, but they're gonna eat a lot of candy and popcorn to put up with, so
they're like, "Ok. If that's what you have to do to put up with it,
it's okay by me." He is
managing pretty well with in that system, I don't know how long it's going to last him, though.
But it's working for him at the moment.
When you have automatic positive reinforcement, though, which is
"This is under my control." This is stereotypy. This is the hardest nut to crack.
But you have to substitute something for it. This is the Viewmaster example.
If you substitute something that is
socially appropriate and more accessible,
then you have the opportunity to teach the child,
"Get this -- get your information this way, your sensory information one way,
it's more acceptable,
then this other way
which will cause
people to run away from you or to not want to engage with you."
We allow them to earn sensory reinforcement if necessary,
and we make sure that we enrich the environment.
Enriching the environment is a very important thing to do.
But in autism, sometimes environmental enrichment means we have to think like the person
with autism.
What do they like, what are they looking for?
If we give them that information and make it accessible, 1:29:45.070,1:29:46.559 we have a much better chance of
bring together
what they're looking for.
Now I recognize that we're also, I think running short on time, or running out of time,
so I am going to leave you with
a little bit of a wrap up, and then if you want to stick around we'll either talk or I'll show you a couple
of videos.
The most important things I want you to take home from this are that
you can understand why behavior occurs
by looking at the immediate trigger
and the setting events, the contingencies in the environment that operate beyond that, above
that at the macro level.
Those could be
reflective of the client's ability to predict what's about to happen,
their physical state, like hunger or illness,
their ability
to experience and respond flexibly to novelty versus things that are more highly predictable.
But at the end of the day
you could begin to investigate that in some very systematic ways.
One of the systematic ways is called functional behavioral assessment
and in its more
advanced form,
functional analysis.
These allow you to know.
They allow you to generate hypotheses
would you then test.
As you think about behavior, think about communication.
Behavior speaks.
Behavior tells you
what's going on.
You then become the student,
and your client because the teacher.
Because your job is to listen
and interpret.
What does that behavior mean?
In all likelihood,
for a person with autism,
there's a high probability
that the behavior will be consistent
in its meaning.
So It generally means something that the client understands and knows,
and you can come to them.
The last point about this is:
interventions
come and go, and if you've been in the field, like
a lot of people at the Child Study Center, for a very long time,
working in autism,
all kinds of interventions are proposed, whether that's
certain kinds of diets,
or certain kinds of activities or hyperbaric chambers or,
you know, drinking cod liver oil is going to relieve symptoms of autism --
at the end of the day,
you live and you die on the science.
If there is good science, good evidence,
that's well constructed
to support certain intervention practices -- use it.
If there's not,
you may choose to use it cautiously,
but you'll apply
an empirical rubric to that, you will engage in hypothesis testing
and analysis in order to determine
whether what you're doing led to what you wanted
to see happen,
the outcome that you achieved.
The final point in this is:
it's not a good intervention if it didn't work.
You can always analyze why something doesn't work,
but if it's not effective
in bringing about the outcome that you seek,
it was not an effective intervention. It means modification.
You've been very patient; sorry to keep you and run over.
Any of you that want to stay, I'll show you a couple of videos and I'm happy to have you, but have a
great rest of the day and thanks for being attentive.