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Lina Patel, Psy.D.

Senior Instructor at the University of Colorado Health Science Center Director of Psychology at the Sie Center for Down Syndrome Children's Hospital Colorado

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List 3 areas of difficulty typically experienced by children with Down Syndrome } Identify 2 strategies used to manage problematic behaviors of children with Down Syndrome } Understand the difference between antecedent, behavior, and consequence
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Behaviors that result in } Self-injury or injury of others } Causes damage to the physical environment } Interferes with the acquisition of new skills } And/or socially isolates the learner
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Doss and Reichle, 1991

Running Away/Wandering from Caregivers } Struggles with Following Directions or Stubbornness } Attention Issues } Social Withdrawal } Noncompliance with use of Adaptive Tools } Compulsive Behaviors or Hyperfocus } Hitting, Kicking, Physical Aggression } Yelling, Cursing, Inappropriate Language
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Antecedent

Response

Consequence

Avoidance/Escape
Pain/Discomfort Interaction Environmental Factors (i.e. boredom, overstimulation, difficult work)

Acquisition
Attention/Interaction Desired Item Sensory Input Relief

Events that occur at one point in time that may change the likelihood of a targeted behavior at a later point in time by momentarily altering the value of the consequence. Feeley and Jones, 2008

Medical Issues

Vision and Hearing Deficits Thyroid Function Celiac Disease Sleep Apnea Reflux Constipation Depression Anxiety

Skill Deficits

Communication Social Motor Academic/Cognitive

Sensory

Medical Issues } Skill Deficit


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Sensory

Communication Social Motor Academic/Cognitive

Strategies for Setting Events:


Checklist of setting events Decrease presence of antecedents Increase available reinforcers Provide visual cues/structure Provide predictable routines Modify environment to decrease sensory distractions or increase alertness

Antecedent Strategies

Prespecified reinforcer Preferred item as a distractor Offer a choice High probability request sequence

Use strengths and interests to engage

Offer of collaboration Learn by doing Use first do this, then get that directions and schedules Highlighting (giving social praise) appropriate behaviors Tell them what to do instead of what not to do Cause-and-effect planned ignoring: First get calm, then I will talk with you

Skill Building Strategy


Teaching appropriate social skills Social stories (Gray, 2000) Teach awareness and expression of feeling states Role play-notice what was right/wrong

Consequence Strategies

Differential reinfiorcement of the ommision of behaviors Token System Error correction- Try again with demonstration Visual road map

Observed Behavior

Time/ Date/ Activity Initials of person documenting

Antecedent/ Trigger/ What happened right before?

Behavior/ Details Consequence/ of behavior What happened after?

Function of the behavior?

The important point is that difficult behaviors do not occur by accident, or because someone has a disability. Difficult behaviors are expressions of real and legitimate needs. All behavior, even if it is self-destructive, is meaning-full. David Pitonyak, PhD Blacksburg, VA Down Syndrome News

Questions? Thank you for your time!