Evidence-Based Practices to v Reduce Challenging Behavior Lise Fox, Ph.D.

University of South Florida

Session Discussion
Critical importance for developing systems to support teacher implementation of evidence-based practices Adoption of a promotion, prevention, intervention model Identifying evidence-based practices for early educators

National Centers - Resources
Center on the Social and Emotional Foundations for Early Learning (CSEFEL) www.vanderbilt.edu/csefel

Technical Assistance Center on Social Emotional Intervention (TACSEI)


Key Messages
High quality caregiving + high quality environments  No challenging behavior Addressing challenging behavior = Promoting the development of social competence We have evidence-based practices; but we need practitioners and systems to implement those practices with fidelity


An estimated 9 to 13% of American children and adolescents between ages nine to 17 have serious diagnosable emotional or behavioral health disorders resulting in substantial to extreme impairment.
(Friedman, 2002)

o More than half of students with SED drop out of grades 9-12, the 9highest rate for all disability categories. (U.S. Department of Education, 2002; 2006) o At 2 years post high school, 58% of youth have been arrested at least once and 42% are on probation or parole. (NLTS2, 2005).

o Students with ED reported use
of alcohol (54%), illegal drug use (36%), marijuana use (33%), and smoking (53%) at rates higher than all other disability categories (NLTS2, 2008)

Over 15% of all students with disabilities (6-21) are taking psychotropic medications (USDOE, 2005) About 1/3 of all adolescent students with disabilities have been suspended or expelled (USDOE, 2005)


Campbell (1995) estimated that approximately 10-15% 10of all typically developing preschool children have chronic mild to moderate levels of behavior problems. Children who are poor are much more likely to develop behavior problems with prevalence rates that approach 30% (Qi & Kaiser, 2003). (Qi 10

Children who are identified as hard to manage at ages 3 and 4 have a high probability (50:50) of continuing to have difficulties into adolescence (Campbell & Ewing, 1990; Campbell, 1997; Egeland et al., 1990). 11

Early Predictors ‡Temperamental Difficulties ‡Early Aggression ‡Language Difficulties ‡Noncompliance

Family Factors
‡Maternal Depression ‡Harsh Parenting ‡Stressful Family Life Events ‡Low Social Support ‡Family Instability

Depression Hurts
Children of mothers who ‡‡ D were depressed in their infancy are more likely to be delayed ‡ Children of depressed mothers are at increased risk for behavior problems, depression, and mood disorders in adolescence


The correlation between preschoolpreschool-age aggression and aggression at age 10 is higher than that for IQ.
(Kazdin, 1995)

Early appearing aggressive behaviors are the best predictor of juvenile gang membership and violence.
(Reid, 1993)

When aggressive and antisocial behavior has persisted to age 9, further intervention has a poor chance of success. (Dodge, 1993)


Young Children with Challenging Behavior:
‡Are rejected by peers ‡Receive less positive feedback ‡Do worse in school ‡Are less likely to be successful in kindergarten


Preschool children are three times more likely to be ³expelled´ than children in grades K-12
(Gilliam, 2005)

Faculty in higher education early childhood programs report that their graduates are least likely to be prepared to work with children with persistently challenging behavior
(Hemmeter, Santos, & Ostrosky, 2004)

Of the young children who need mental health services, it has been estimated that fewer than 10% receive services for these difficulties.
(Kataoka, Zhang, & Wells, 2002)

There are evidence-based practices that are effective in changing this developmental trajectory«the problem is not what to do, but rests in ensuring access to intervention and support (Kazdin & Whitley, 2006)



The Pyramid Model

Pyramid Model

Tertiary Intervention Secondary Prevention Universal Promotion

Nurturing and Responsive Relationships
Foundation of the pyramid Essential to healthy social development Includes relationships with children, families and team members


High Quality Environments
Inclusive early care and education environments Comprehensive system of curriculum, assessment, and program evaluation Environmental design, instructional materials, scheduling, child guidance, and teacher interactions that meet high quality practices as described by NAEYC and DEC

Reviewing Rules


Circle Time ± Universal Design
Adult Support

From: www.headstartinclusion.org

Circle Time ± Universal Design
Peer Support

From: www.headstartinclusion.org

Circle Time ± Universal Design

Child Preference

Special Equipment

From: www.headstartinclusion.org

Circle Time ± Universal Design

Environmental Support

From: www.headstartinclusion.org

Circle Time
Special Equipment

Circle Time
Child Preference

From: www.headstartinclusion.org

Circle Time
Invisible Support

From: www.headstartinclusion.org

Circle Time

Simplify the Activity
From: www.headstartinclusion.org

Targeted Social Emotional Supports
Self-regulation, expressing and understanding emotions, problem solving, developing social relationships Explicit instruction Increased opportunities for instruction, practice, feedback Family partnerships Progress monitoring and data-based decision-making

Friendship Skills
‡ Gives suggestions (play organizers) ‡ Shares toys and other materials ‡ Takes turns (reciprocity) ‡ Is helpful ‡ Gives compliments ‡ Understands how and when to give an apology ‡ Begins to empathize

Book Nooks www.vanderbilt.edu/csefel

On Monday When it Rained

Glad Monster Sad Monster

Hands Are Not for Hitting

Feeling Wheel & Feeling Dice

Turtle Technique
Recognize that you feel angry. ³Think´ Stop.

Go into shell. Take 3 deep breaths and think calm, coping thoughts.

Come out of shell when calm and think of a solution.

Problem Solving Steps

Step 2

Would it be safe? Would it be fair? How would everyone feel?


The Solution Kit


Secondary ± Skill Instruction
Identify target skill Identify learning opportunities and seek to maximize the number of learning trials Select procedure for teaching e.g., least to most, most to least, incidental teaching procedure, peer support, modeling, visual prompts Track child progress

Individualized Intensive Interventions
Comprehensive interventions Assessment-based Skill-building Partnerships with families Progress monitoring and data-based decisionmaking

Positive Behavior Support
Convene a team Conduct functional assessment Identify hypotheses Develop behavior support plan for all relevant environments

About Tim
4 years old Only child First preschool experience Strengths ± very smart, loves books, engages well with adults Challenging Behaviors - Aggression, Verbal threats, Destroys other children¶s products, Damages toys intentionally Significant risk of Preschool Expulsion

Before PBS

Develop Plan
Team of individuals who know him best ± teacher, parents, paraprofessional, assistant director Behavior consultant guided the process Focused on understanding the purpose of Tim¶s challenging behavior - importance of gathering information Developed a comprehensive plan that includes: Strategies for preventing his challenging behavior New skills Adult responses Classroom team and family implement and monitor plan outcomes


Tim engaged in challenging behavior to: initiate social interactions enter into play get access to particular toys get teacher or peer attention

Behavior Support Plan
Prevention Strategies
Social story to describe behaviors that were expected during center play and outdoor activities Review of social story prior to center time Priming to remember skills to use Visual prompt to remember skills to use


Created for Tim by Lisa Grant & Rochelle Lentini 2002

I like talking and playing with my friends at school.

Sometimes, I want to play with what my friends are playing with. When I play, I sometimes feel like taking toys, using mean words, or hitting and kicking. My Friends get sad or mad when I hit, kick, use mean words, or take toys.

If I want to join in play, I need to join nicely or ask to play with my friends· toys.

Can I play with you?

I can say, ´Can I play with that toy?µ or ´Can I play with you?µ.

I can join my friends and play nicely.

I can take turns.

I can go with the flow.

I can stop, think, and do.

I can join my friends and play nicely. ________

I can take turns nicely.


I can go with the flow.


I can stop, think, and do.

DATE: ___________

Tim¶s Plan (cont.)
Instructional Strategies
Social skills instruction of each new skill (role play and story review) Self-management system for new skills

Tim¶s Plan (cont.)
New Responses
Attention to child who was assaulted Prevent access to toy or activity Review with Tim after incident has been resolved

Tim ± with PBS

³If a child doesn¶t know how to read, we teach.´ ³If a child doesn¶t know how to swim, we teach.´ ³If a child doesn¶t know how to multiply, we teach.´ ³If a child doesn¶t know how to drive, we teach.´ ³If a child doesn¶t know how to behave, we« « teach?« punish?´


Pyramid Model
Evidence-Based Practices that Promote the Social Emotional Development of All Children

Tertiary Intervention Secondary Prevention Universal Promotion

Assess your teaching
How skilled are you at«.
Developing strong teaming relationships? Developing parent partnerships? Creating classroom environments that support the active engagement of all children? Teaching social emotional skills intentionally to all children? Teaching social emotional skills with sufficient intensity to individual children who are at-risk of challenging behavior?

Assess your Program
Does your program« Have a system for screening children for social emotional delays? Ensure that children at-risk of challenging behavior receive intentional instruction and support that leads to outcomes? Use data to make decisions about how to support children effectively?

Assess your program
Does your program« Have a system for ensuring that children with persistent challenging behaviors receive intensive, individualized support? Offer teachers individualized professional development (training and coaching) to provide evidence-based approaches?

National Centers - Resources
Center on the Social and Emotional Foundations for Early Learning (CSEFEL) www.vanderbilt.edu/csefel

Technical Assistance Center on Social Emotional Intervention (TACSEI)