PSY 3410

AUTISM SPECTRUM DISORDERS &

INTELLECTUAL DISABILITY
Unit 8: Problem Behavior
Instructor: Dr. Lauren Moskowitz

Class #17 & 18 October 22, 25, & 29, 2018

 Why children fail---
Initial reasons for referral

1. Problem behavior issues (50% of cases)

2. Social development issues (30% of cases)

3. Academic issues (20% of cases)

What Is “Problem Behavior”?

¨ Aggression
¨ Self-injury
¨ Property destruction
¨ Tantrum behavior
¨ Disruptive Behavior
¨ Noncompliance
¨ Repetitive behavior/stereotypy
 Prevalence of Problem Behavior
¨ In ASD:
¤ As many as 94% of children with ASD exhibit some form of challenging behavior (e.g.,
Matson, Wilkins, & Macken, 2009)

¨ In ID:
¤ Challenging behaviors shown by 10-15% of people with ID (Emerson et al., 2001)
¤ Most common forms of challenging behaviors reported were ‘other’ behavior
(9%–12%), aggression (7%), destructive behavior (4%–5%) and self-injury (4%)
¤ Majority of people identified showed 2 or more of these four general forms of
challenging behavior
¤ Approximately 50% of the people identified as showing more demanding
challenging behavior were living with their families
¤ People who showed more demanding challenging behavior were more likely to
need greater levels of assistance in eating, dressing and washing, be incontinent
and have more restricted expressive and receptive communication
Why Is Problem Behavior Important?
¨ Prevents full community integration
(home/school/employment)
¨ Demoralizes family members (parents/siblings) and
teachers
¨ Increases likelihood of institutionalization (loss of
choice/dignity)
¨ Rejection by others (social isolation/no friends)
¨ Damages self-esteem (shame/regret)

Summary: Destroys quality of life

What Is Our Understanding of
Problem Behavior (Assessment)?
¨ Through functional assessment, we determine what
the triggers (discriminative stimuli) and
consequences (payoffs/reinforcers) are for
problem behavior
¨ Common triggers include academic demands,
home chores, and work tasks
¨ Common reinforcers (consequences) include
attention, escape (from task demands), escape
(from people), tangibles (edibles, toys, activities),
sensory reinforcement
 Assumptions of Behavior Theory
1) Behavior is learned
¤ So if you learn an inappropriate behavior, you can
learn a replacement or new behavior

2) Behavior is functional
¤ Behavior serves a purpose

3) Behavior depends on context… it doesn’t

occur in a vacuum!
How do we learn behavior?
• Operant conditioning
¤ Future probability of a behavior is
determined by its past consequences
Reinforcement
Punishment

• Classical conditioning
¤ Association learning:
stimulus-response relationships

• Social learning - modeling

¤ Learn new behaviors through
observing others model the behavior
Reinforcement

¨ When a behavior is strengthened by its

immediate consequence
¨ reinforcer versus reward

¨ How do you use reinforcement?

Reinforcement
¨ Positive reinforcement - the addition of
a stimulus (positive reinforcer)
strengthens behavior

¨ Negative reinforcement - the removal

of a stimulus (aversive stimulus)
strengthens a behavior
 Examples of
Positive & Negative Reinforcement

Mother nags daughter to clean room until she

does
¨ Behavior (Room Cleaning) à SR- (nagging removed)

Father plays game with son after he finishes

his homework
¨ Behavior (doing homework) à SR+ (play game)
Positive versus Negative Reinforcement
 Question for Class
¨ A child completes an academic task
independently and his teacher walks up to his
desk and says “Good job.” Is this an example of
positive reinforcement?

§ We can’t tell because not enough

information is presented. It would only be an
example of positive reinforcement if, as a
result of the praise, the child was more likely
to complete academic tasks independently
in the future.
 Discriminative Stimulus (SD)

¨ SD is an antecedent stimulus that predicts

that a specific response will be followed by a
reinforcer
¨ The presence of an SD alerts the subject that
a certain behavior will be reinforced
¤ e.g., Buzzer is the SD that lets the rat know he will get food
Stimulus Control
¨ When a behavior is emitted more
often in the presence of a stimulus
(SD) than in its absence
¤ Antecedent/Stimulus (S) à Behavior/Response (R)

Red light: SD for STOP

Green light: SD for GO

Shaping

¨ Reinforcing successive approximations

¨ teaching error - shaping idiosyncratic
communication
Shaping
Prompting

¨ A stimulus or event used to evoke a

behavior
¤verbal
¤gestural
¤modeling
¤physical
¨ Prompting too much
 Assumptions of Behavior Theory
1) Behavior is learned

2) Behavior is functional
¤ Behavior serves a purpose

3) Behavior depends on context… it doesn’t

occur in a vacuum!
 Problem Behavior is Functional
q Children engage in challenging behavior because it
pays off – it serves a FUNCTION or PURPOSE
q Problem behavior persists because it meets an
immediate need
e.g., waiting quietly in line can be boring or overwhelming; “acting
up” can provide attention and/or escape from the boredom or
escape from the overstimulation of waiting in line

q Behaviors persist because children want/need to…

Get something Escape something
•Gain parent/peer/staff attention •Escape or avoid task demands
•Obtain preferred items or activities •Escape or avoid social interaction
•Obtain sensory stimulation •Escape or avoid anxiety
•Escape or avoid sensory stimulation
(Positive Reinforcement) (Negative Reinforcement)
Problem Behavior = Communication
I hate
this!

¨ Functions of Communication
¤ Request object, activity, person (e.g., “I want the book”)
¤ Request help or assistance (e.g., “I need help”)
¤ Obtain attention (e.g., “Look at this!” or “Talk to me!”)
¤ Request social interaction (e.g., “Can I play with you?”)
¤ Request information (e.g., “How much longer do we have?”)
¤ Request sensory stimulation (e.g., “This motion makes me feel calm”)
¤ Escape demands (e.g., “I don’t want to do this work”)
¤ Escape activity (e.g., “I don’t like this; I need a break”)
¤ Escape a person (e.g., “I don’t want you to talk to me”)
¤ Escape anxiety (e.g., “This makes me anxious; I need to get out of here!”)
¤ Escape sensory stimulation (e.g., “This noise is too loud”)
¤ Comment (e.g., “I like you” or “Look at that airplane”)
¤ Protest (e.g., “No, I don’t want to do that”)
¤ Reassurance/predictability (e.g., “I am afraid, I need consistency”)
The Problem with
Nonfunctional Interventions

“If we select an intervention based on the child’s

behavior only, and ignore the environmental
reasons, we can - at best - stop the behavior
temporarily
We cannot stop it for good because the reasons for
it continue to exist”

- Ted Carr
 Assumptions of Behavior Theory
1) Behavior is learned

2) Behavior is functional
¤ Behavior serves a purpose

3) Behavior depends on context… it doesn’t

occur in a vacuum!
 Problem Behaviors Depend on
Context

Context

Setting Trigger
Response Consequences
events stimuli
“Time to go to school” Aggression Gets out of getting
on bus
Sometimes gets on bus Parent praise

Fatigue “Time to go to school” Aggression Gets out of taking bus

No Fatigue “Time to go to school” Gets on bus Parent praise

Functional Behavior Assessment Includes:
¨ Identifying & measuring the problem behavior(s)
¨ Collecting data on antecedents, consequences, and
setting events
¨ Developing hypotheses about the antecedents &
consequences likely to trigger or maintain the problem
behavior
¨ Testing the hypotheses
¨ Designing an intervention, based on the hypotheses, in
which antecedents and/or consequences are altered
and replacement behaviors are taught & the child’s
behavior is monitored
 How do we conduct an FBA?

¨ Interviews
¤ Multiple informants; e.g., Functional Assessment Interview (FAI)
¨ Direct observation
¤ Conduct across multiple settings, multiple observers
¤ e.g., scatterplot, ABC chart
¨ Checklists and Questionnaires
¤ Motivation Assessment Scale (MAS) (Durand & Crimmins, 1988)
¤ Functional Assessment Checklist (FACTS) (March et al., 2000)
¤ Setting Events Checklist (Gardner et al., 1986)
¤ Contextual Assessment Inventory (CAI) (Carr et al., 2008)
¨ Functional analysis
¤ Experiment to verify function of behavior (Iwata etFor
al., 1994)
more tools, see
http://www.kipbs.org/kmhpbs/resources/functional-assessment.html
 FBA Tools:
Example of Questionnaire (Nathan’s MAS)
2. Does the behavior occur following a request to perform a difficult
task? 6-Always
3. Does the behavior seem to occur in response to your talking to other
persons in the room? 2-Seldom
4. Would the behavior ever occur to get a toy, food or activity that this
person has been told he/she can’t have? 2-Seldom

Motivation Assessment Scale (MAS), by Durand & Crimmins (1998)

Functional Assessment: Interview

ü In clear, concrete, observable terms, what is the behavior?

ü Where, when, & with whom does it occur most often?
ü Is the behavior triggered by specific events or conditions?
ü What happens right after the behavior occurs?
ü Are expectations for this student realistic?
ü Does the environment provide opportunities for achievement,
control, & mastery?
ü Does the environment support self-efficacy & self-esteem?
ü Does the student know a better way (sometimes behave &
cope well)? Under what circumstances?
ü Does the student need to develop new skills (a better way)?
What skills are needed?
ü How can we motivate this student? Can we adapt a successful
class or schoolwide incentive program?
Functional Assessment Interview (O’Neill et al., 1997)
 Follow-up Interview
After identifying the problematic context, identify the specific situations that set
off problem behavior.

Example Problematic Context from CAI: Having to wait

¨ What specific activity is most/least likely to cause PB?
n Example: Having to wait in line at the grocery store.
¨ With whom is the PB most/least likely to occur?
n Example: Having to wait in line at the grocery store with father.
¨ In what setting is the PB most/least likely to occur?
n Example: Having to wait in line at Trader Joes.
¨ During what time of day is the PB most/least likely to occur?
n Example: Having to wait in line at the grocery store after school.
¨ How do you respond to the PB?
n Example: Leave the grocery store.
¨ What is your child’s reaction to your response?
n Example: He calms down after leaving the store.
Hypothesis?
PB is likely escape-motivated. Child more likely to escape when w/ dad,
in TJ’s, & after school. Consider setting events that make more likely to escape
Functional Assessment:
Examples of Direct Observation
v ABC Chart*: logging all incidents of behavior, along
with antecedents & consequences in real-time
v Scatter Plot: checking off or tallying each time period
during which the behavior does occur; determine days or
times when problem behavior occurs
v Functional Assessment Observation Form:
checklist, record up to 25 incidents of several different
behaviors; check typical antecedents, perceived functions,
& consequences
v Observation Cards
Example of Scatter Plot
Example of Filled-In ABC Chart
 FBA: Example of ABC Chart
Antecedent Behavior Consequence Most likely
function?
Mother is on the Eddie yells Mother says, “Eddie, I’m on
phone (not talking the phone.”
to Eddie)

Mother asks Eddie Eddie yells Mother stops interacting

to do math with Eddie and leaves him
homework. alone.
As dinner time Ben walks into the Ben’s mother quickly gives
nears, Ben’s mother kitchen and begins him one of favorite foods
goes into kitchen to cry and then
scream

Going to library. Jen screams, kicks, Mother picks her up to

Mother says, “Let’s drops to floor, carry her into library
go inside.” becomes wet
noodle
Lauren Moskowitz
 Functional Assessment: Functional Analysis

ü Experimental conditions designed to identify motivational variables

a) Condition in which demands are withdrawn contingent upon
problem behavior
Ø Increase in problem behavior suggests escape motivation
b) Condition in which attention is made contingent upon problem
behavior
Ø Increase in problem behavior suggests attention-seeking motivation
c) “Alone” condition (in which toys & people are absent)
Ø Increase in problem behavior suggests non-socially motivated
(sensory-seeking or biologically driven)
d) Play condition involving access to toys, frequent attention for non-
problem behavior, & no demands
Ø Control condition (expected to produce minimal problem behavior)
Iwata et al. (1982)
 Low Attention
Difficult Tasks
Reduced Tangibles
Control
100 100
75 Matt 75
50 50
Ron
25 25
0 0
1 3 5 7 9 11 1 3 5 7 9 11
Percentage of Intervals

100 100
75 Allison 75
David
50 50
25 25
0 0
1 3 5 7 9 11 1 3 5 7 9 11

100
75
50
Mike
25
0
1 3 5 7 9 11
Durand (1999)
Sessions
Example Hypothesis: Sam
Sam engages in disruptive behavior when asked to
complete independent seatwork because, when
he does, he avoids (escapes) having to complete
the work. This is more likely to happen during
afternoon classes, particularly when he hasn’t
slept well the previous night.
 How Do We Treat Problem Behavior?
Positive Behavior Support (PBS)
¨ Key idea: assessment is linked to treatment. Functional
Assessment information is used to design treatments
¨ Major categories of treatment include:
¤ Environmental redesign (e.g., choice)
¤ Skills training (e.g., functional communication training)
¤ Extinction
¤ Punishment (e.g., timeout)

¨ Typically, these are combined to increase effectiveness

¨ Always use positive strategies first before resorting to
punishment (in PBS, we don’t use punishment)
PBS intervention based on functional
assessment (example)
Setting Event Antecedent (SD) Behavior Consequence
Amount of time Toys are Self-injury Mother gives
since toy was last currently out of (bangs her head) child her toys
played with (i.e., reach
child has not had
access to her toys
for a while)

Alter setting Remove Teach Alter consequences:

event: antecedent: replacement for If child appropriately
requests toys, give
Immediately Place toys within behavior: her toys.
schedule play child’s reach can teach child to
time with request her toys If she head-bangs, do
preferred toys NOT give toys
Horner & Carr (1997)
PBS Intervention to Reduce Problem
Behavior & Improve QOL
¨ Prevention Strategies
¤ Antecedent Strategies (e.g., cues & prompts)
¤ Setting Event Strategies (e.g., environment redesign,
curricular modification, ↑ predictability)
¨ Replacement Strategies
¤ Communication Skills; i.e., Functional Communication
Training (e.g., teaching kids to say or sign “please,”
“break,” or “help” to get what they wanted)
¤ Coping Skills, Relaxation Skills, Life Skills, Problem
Solving Skills, Academic Skills, Daily Living skills, etc.
¨ Response or Consequence Strategies
¤ Positive Reinforcement
¤ Extinction
¤ Differential Reinforcement (DRA, DRI, DRO)
Prevention Strategies
Prevention Strategies:
Using Visual Supports for Transitions

¨ Increases predictability
¤ Helps make the environment, activities & tasks more
predictable, less overwhelming
¨ Enhances sense of control over environment;
promotes independence
¨ Reduces stress, uncertainty, anxiety
¨ Helps child prepare for transitions, preview what is
coming next
¨ Builds on child’s strengths
First Then

Potty
Lentini, R., Vaughn, B. J., & Fox, L. (2005). Teaching Tools for Young Children
Play
with Challenging Behavior. Tampa, Florida: University of South Florida,
Early Intervention Positive Behavior Support.
Prevention Strategies:
Using Timers/Countdowns

¨ Advanced warnings: Used to alert child of

end of activity
¤ Provides child with time to prepare
¤ Prevents/reduces anxiety, frustration associated
with transitions
¤ Makes the transition a gradual process, instead of
abrupt ending
¤ Increases predictability, provides greater sense of
control
Prevention Strategies:
Provide Choices
¨ Provide frequent opportunities to make choices
¤ Enhances sense of control
¤ Child learns to become an active participant, rather
than a passive, helpless bystander
¤ Increases motivation to participate & behave well
 Prevention Strategies:
High-Probability Requests

ž Behavioral Momentum: Prior to difficult or disliked

activities/tasks, ask child to do 3 quick, easy, & preferred
activities/tasks to increase the likelihood that he will
experience success & be motivated to complete the less
preferred activity
› Examples:
– Sing a song, give a high five, and give a hug before putting on coat
– “Everybody stand up tall” “give 1 friend a high-5” “everyone clap
your hands” “Everyone walk to your desk & sit down for readers’
workshop”
ž Embedding: Intersperse highly preferred, easy tasks
among more difficult & disliked ones
› Increases opportunities to experience success
› Enhances motivation
 Prevention Strategies:
Priming

| Priming:
| Previewing materials & learning activities in 1:1
basis, under relaxed conditions
| Effective for children for whom group instruction
may be overwhelming
Replacement Strategies
 Reducing Problem Behaviors Requires
Increasing Alternatives
(Building replacement skills)
q If problem behavior is functional, it meets some need
for the child
q We can’t simply remove something that is serving a purpose
without replacing it with a more appropriate alternative

q First step is understanding the function it serves (what

need it meets)

q Next step is to offer the child a better way to meet that

need
q Types of skills that serve as Alternative Behavior:
Ø Self-regulation (e.g., relaxation skills)
Ø Communication skills (e.g., request for help)
Ø Social skills (e.g., conversational skills)
Ø Academic skills (e.g., analytic ability)
Functional Communication Training
¨ One of the most frequently used approaches to
reducing these challenging behaviors in people with
ASD involves replacing the problem behavior with
an alternative behavior—a technique known as
functional communication training (FCT) (Durand,
1990; Durand & Merges, 2008; Durand & Merges,
2009).
Steps to FCT
STEPS DESCRIPTION

Use two or more functional assessment techniques to

1. Assess the function of behavior determine what variables are maintaining the problem
behavior.

Identify how you want the individual to communicate with

2. Select the communication modality others (e.g., verbally, through alternative communication
strategies).

Identify situations in the environment that are triggers for

3. Create teaching situations problem behavior (e.g., difficult tasks) and use these as the
settings for teaching the alternative responses.

Prompt the alternative communication in the setting where you

4. Prompt communication
want it to occur. Use the least intrusive prompt necessary.

Quickly fade the prompts, insuring that no problem behaviors

5. Fade prompts
occur during training.

When possible, teach a variety of alternative communicative

6. Teach new communicative responses responses that can serve the same function (e.g., saying “Help
me” or “I don’t understand”)

When appropriate, changes in the environment – such as

7. Environmental modification improving student-task match in school – should be
implemented.
 Functional Equivalence

The Principle of Functional Equivalence

Behavior Problems
(e.g., Aggression)
ATTENTION

Communication
(e.g., “Hello”)

If both hitting and saying “Hello” lead to attention,

they are equivalent responses for the purpose
(function) of gaining attention.
Carr & Durand (1985); Durand & Carr (1991)
Replacement Strategies:
Teaching to Request a Break
¨ Designate a quiet, neutral area where child
can go to “chill out” & use coping skills
¤ Set up area to be calming: bean bag chair, soft
music with headphones, stress-squeeze balls
¤ Post a list of coping strategies on wall in “Break
Area” as visual reminders of ways to calm down
¤ Set timer (5 minutes), alert them that when it
beeps, they will return & continue task
¤ Prompt child to ask for break BEFORE
problem behavior (not AFTER)
How Do We Teach New Behaviors?

1) Shaping
• Reinforcing successive approximations to a final desired
behavior (i.e., skill)
Ø E.g., at first “Mm” accepted, then “Ma,” then “Mam,” then “Mama”
2) Chaining
• Reinforcing successive elements of a behavior chain (a
sequence of related behaviors that make up a skill)
• In a chain, each behavior provides the cue for the next, and
the last behavior is reinforced
Ø E.g., pick up coat, put hand in left sleeve, put hand in right sleeve, zip
3) Prompting
• The presentation of any physical, verbal, gestural, or sensory
stimulus or cue to initiate a response
Ø Verbal directions
Ø Physical guidance
Ø Imitation
Ø Modeling
Response Strategies
Consequence Strategies:
Linking Reinforcers to FUNCTION of Behavior
Function:
Attention
Examples •Sit in teacher’s chair
of Daily •Line leader
Rewards: •First in lunch line
•Play freeze tag with class
for 5 minutes
•Get to tell 1 joke to class
at end of the day (or end
of each period)
Examples •Invite 1 or 2 friends to
of Weekly eat lunch in classroom
Rewards •Read morning
announcements over
loudspeaker
•Choose book for teacher
to read aloud to class
•Breakfast with favorite
person (e.g., custodian)
See http://www.behaviordoctor.org/rewards.html for more ideas for rewards
Function: Function:
Escape Tangible
•Choosing which •10 min of Computer
homework or time
classwork problem •Get to play Angry Birds
the teacher will give on class Ipad for 5 min
the answer to for a •10 min of reading
“freebie” preferred book
•Get to go to Lunch •Pick a book from school
or Recess 5 min early library at end of day
•Get out of •Trip to vending machine
homework pass at school
•Get out of classwork •Get to buy lunch instead
pass of bring lunch for a day
•“Buy back” a bad •Get to pick a prize (toy
grade or treat) from a prize box
•Get to leave school a •Get to print out 10
half-hour early on pictures from computer
Friday
Response (Consequence)
Strategies: Extinction
¨ Withdrawing reinforcement from a previously
reinforced behavior; its rate of occurrence
decreases
¤ Example 1 – Function: To Gain Desired Object
Previously: Child whines (R) à child gets toy at store
Extinction: Child whines à child does NOT get toy

¤ Example 2 – Function: To Gain Attention

Previously: Child screams (R) à gets mom’s attention
Extinction: Child screams à mom WITHDRAWS attention

¤ Example 3 – Function: To Escape Situation

Previously: Child tantrums (R) à gets out of running errands
Extinction: Child tantrums à mom does NOT return home
Effects of Extinction
¨ Initial effects of extinction are different from long-
term effects!
¤ Initially, the behavior actually gets WORSE –
n This is why people often give up
¨ Long-term effect of extinction is that problem
behavior gradually decreases
n Child learns problem behavior is no longer effective!

¨ Avoid intermittent reinforcement of behavior

¨ Extinction (NO reinforcement for inappropriate
behavior) is most effective when combined with
positive reinforcement for adaptive/appropriate
behavior
Example Interventions if Function is to
Gain Attention
¨ Prevention Strategies
¤ Scheduled attention: give undivided attention for periods of time
¤ When adult is occupied, assign highly preferred or easier work
(e.g., computer games or work that is mastered) or a preferred
solitary activity (e.g., listening to music or arts & crafts).
¨ Teach Replacement/Coping Skills
¤ Teach child communication skills to ask for your attention.
n e.g., “Watch what I’m doing!” “Look at that!” “Look what I did!” Look at
n e.g., “Can I play with you?”, “Do you want to play Uno?” me!
n e.g., “Hi, what’s up?”
n e.g., “Can you read to me?”
n e.g., tap on arm
¨ Response (Consequence) Strategies
¤ When child engages in inappropriate attention-getting behaviors,
ignore these completely!
¤ When child engages in appropriate attention-getting behaviors,
respond immediately with praise or attention!
Example Interventions if Function is to
Gain a Preferred Item/Activity
¨ Prevention Strategies
¤ Provide advanced warning (indicate that activity will end soon)
n Use Timer
n Use Countdown
¤ Provide access to preferred item/activity on a schedule
¤ Use Transition activity (e.g., transition song, like clean-up song)
¨ Teach Replacement/Coping Skills
¤ Teach child communication skills to ask for item/object/activity.
Ø e.g., I want book please.” (“want book.”)
Ø e.g., “Can I play with that?”
My turn
Ø e.g., “Can I take a turn with that?”
Ø e.g., “My turn please.”
¨ Response (Consequence) Strategies
¤ When child requests the object/activity appropriately, give it to him
¤ Over time, have the child wait for longer periods of time to obtain
the item/activity
 Example Interventions if Function is to
Escape Demand or Situation
¨ Prevention Strategies
¤ Adjust demand difficulty (e.g., curricular revision, slow pace)
¤ Modify mode of task completion
¤ Use embedding or behavioral momentum
¤ Include child’s preferences & interests in the activity
¤ Offer choices between tasks or how to complete tasks
¨ Teach Replacement/Coping Skills
¤ Teach child communication skills to….
How much longer?
n Escape by requesting assistance (e.g., “I need help.”)
n Escape by requesting a break (e.g., “I need a break”)
n Escape by terminating an activity (e.g., “I’m finished” or “I’ve had enough”)
n Escape by rejecting (e.g., “No, thank you”)

¨ Response Strategies
¤ As soon as child asks appropriately, provide assistance or give short break
¤ Provide child with praise, reward, or stickers/tickets/tokens
to count towards reward for doing the task/activity
Example Intervention if the Function is to obtain
Sensory Reinforcement
¨ Prevention Strategies
¤ Provide alternative sensory reinforcement
n e.g., offer radio to a child seeking auditory reinforcement, or visual stimuli to a child seeking
visual reinforcement, or tactile stimuli to a child seeking tactile reinforcement
¤ Enrich environment
n Fill environment with interesting and stimulating activities
¨ Replacement Strategies
¤ Teach replacement behavior that is incompatible with the self-stimulatory behavior
n e.g., if child pinches himself, teach to squeeze a ball or play with play-doh
n e.g., if child engages in finger-flicking, teach to fiddle with jewelry or draw pictures
¤ Automated delivery of vibro-tactile sensation can potentially serve as a sensory
replacement for self-stimulatory behavior
¨ Response Strategies
¤ Provide non-problem-behavior alternatives for accessing preferred sensory stimuli
¤ Differential reinforcement of other behavior (DRO)
n Provide reinforcement following a period of time in which no problem behavior occurs
n Gradually increase length of DRO interval
¤ Differential reinforcement of incompatible behavior (DRI)
n Provide reinforcement for an alternative behavior that is physically incompatible with the
problem behavior
n Gradually increase length of DRI interval
Example Intervention if the Function is to obtain
Sensory Reinforcement
¨ Prevention Strategies
¤ Provide alternative sensory reinforcement
n e.g., offer radio to a child seeking auditory reinforcement, or visual stimuli to a child seeking
visual reinforcement, or tactile stimuli to a child seeking tactile reinforcement
¤ Enrich environment
n Fill environment with interesting and stimulating activities
¨ Replacement Strategies
¤ Teach replacement behavior that is incompatible with self-stimulatory behavior
n e.g., if child bites his finger, teach to chew gum or licorice
n e.g., if child pinches himself, teach to squeeze a ball or play with play-doh
n e.g., if child engages in finger-flicking, teach to fiddle with jewelry or draw pictures
¤ Automated delivery of vibro-tactile sensation can serve as sensory replacement
¨ Response Strategies
¤ Provide non-problem-behavior alternatives for accessing preferred sensory stimuli
¤ Differential reinforcement of other behavior (DRO)
n Provide reinforcement following a period of time in which no problem behavior occurs
n Gradually increase length of DRO interval
¤ Differential reinforcement of incompatible behavior (DRI)
n Provide reinforcement for an alternative behavior that is physically incompatible with the PB
n Gradually increase length of DRI interval
 Real-Life Case Study:
Running Errands
• Problem: John Doe (age 7) engages in problem
behavior (e.g., yelling, tantrums, self-injury,
aggression) when running multiple errands
• Function(s):
¤ Escape situation that causes anxiety & frustration
¤ Gain preferred activity (e.g., going home)
• Detriment to Quality of Life:
¤ Mom feels trapped by her child; he dictates where
she can go and what she can do
 Running Errands:
Sample Baseline Session
¨ 4:46:53 – J yells, “I wanna go home!”
¨ 4:47:21 – J yells, “Turn around!”
¨ 4:47:50 – J yells, “Turn around!”
¨ 4:48:27 – J yells “Home!” J slaps his leg. Mom yells, “That’s unacceptable! You can
tell me that you’re frustrated, but you cannot hit yourself.”
¨ 4:48:54 – J yells “I wanna go home!” 5 times.
¨ 4:49:06 – J hits his head 3 times. Mom says, “Please do not hit your head!”
¨ 4:49:15 – J screams, “Turn around!” Mom says, “When the clock says 5:00, we will
be going home.”
¨ 4:49:21 – J screams, “Turn around!” Mom does not respond.
¨ 4:49:32 – J screams, “Turn around!” Mom does not respond.
¨ 4:49:42 – J screams, “Turn around!” Mom does not respond.
¨ 4:49:49 – J screams, “Turn around!” Mom says, “When you speak to me properly
and stop hitting yourself, that’s when I will start talking to you.”
¨ 4:50:03 – J screams, “Home! Home! I wanna turn around!”
¨ 4:50:14 – J screams, “I wanna go home!”
¨ 4:50:23 – J screams, “Home!”
¨ 4:50:34 – J screams, “Home!”
¨ 4:50:55 – J slaps his leg.
¨ 4:51:24 – We pull into a parking spot at the butcher’s.
 Running Errands: Intervention
ü Alter Setting Events
v Visual Schedule & Social Story – provide info proactively to
increase predictability, thereby reducing anxiety re: transitions
v Providing Choice – provide inc control over environment
ü Address Antecedent
v Presenting SD for appropriate behavior – introduce SDs
associated w/appropriate behavior or redirect attention to SDs
ü Address consequence
v Positive reinforcement – inc motivation to complete errands
v Extinction – reduce escape motivation by elim reinforcement
v Exposure – expose to the feared situation so that he
habituates
v Counterconditioning
ü Skills training/teach alternative to problem behavior
v Social Story – teach replacement behavior of helping Mom
Running Errands
Visual Schedule
 Running Errands:
Results
Multiple Baseline: JS' Running Errands
Total Problem Behavior
110
Baseline Intervention
100
90
80
Total Problem Behavior

70
60
50
40
30
20
10
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29

Sessions

5/29/08 to 2/27/09
 Running Errands:
Excerpt from Sample Intervention Session
4:37 – We are driving to the post office (2nd errand). RE says, “I want to go home.” Mom
says, “First we’re going to the post office, then home.”
4:37 – RE stomps his feet and yells, “Home!” Mom repeats, “First we are going to the
post office, and then we will go home.” RE is quiet for almost a minute.
4:38 – RE asks quietly, “Can we go home?” Mom says, “I’m going to the close post
office, and then we’re going home. I have a job for you to do at the post office. Will
you swipe my credit card for me at the post office?” RE smiles.
4:39 – RE resumes looking through his Cars sticker book and talking about the Cars
with Mom and Lauren.
4:43 – We arrive at the post office and go inside. (RE gets out of car and walks in
without a problem, carrying his Cars sticker book.)
4:44 – Mom waits in line at the post office and RE sits on the floor playing with his Cars
sticker book. He is ripping the stickers off and sticking them on pages. This continues
the entire time Mom is in the post office.
4:51 – RE swipes credit card when it is time to leave.
4:53 – We get back in the car. RE says, “And now home?” Mom says, “Yes RE, now we
get to go home!” Mom prompts RE to remove the post office picture from his visual
schedule as she says, “We are finished with the dry cleaner, finished with the post
office, and now we get to go home!” Mom and Lauren praise RE for what a great job
he did at the post office.
4:58 – We get home.
 How Well Has PBS Succeeded
(Outcome)?
¨ A wide variety of problem behaviors have been
treated successfully using PBS interventions
¨ Depending on the studies reviewed, between one-
half to two-thirds of the individuals treated show
at least 80-90% reduction in problem behavior from
baseline
¨ Treatments based on functional assessment
information are about twice as likely to succeed as
those that are not

See meta-analyses by Carr et al. (1999) & Horner et al. (2000)