Severe Behavior Disorders Behavior Therapy vs.

Traditional Psychotherapy   -traditional therapy doesn’t necessarily offer behavior mod, rather just insight Why we prefer behavior therapy in this class

Problems with quasi-medical model: May divert attention from the real problem May encourage problem Not empirically conceptualized Not empirically validated Often does not suggest a treatment Often does not suggest a prognosis BT assumes… maladaptive bxrs are mostly acquired  -Something becomes maladaptive when it’s not working for you anymore learning principles can be extremely effective specific, clearly defined treatment goals rejection of classical trait theory  Implies something innate to you that creates your behavior o From your inner self so can’t change Behavior Therapy vs. Traditional Psychotherapy BT adapts his/her method of treatment  Remember Harry BT concentrates on the here and now BT places great value on obtaining empirical support  Always have data that supports Autism Spectrum Disorder DSM-IV-TR (SEE DX CRITERIA FILE ON TED)  Diagnostic manual Pervasive Developmental Disorders – traditionally described by these six in early childhood development: Autistic disorder Asperger’s disorder PDD-NOS – persuasive developmental disorder (another type of autism) Fragile X Rett’s Childhood Disintegrative Disorder

Maybe some environmental factors Occurs equally across cultures and SES Practitioners can detect ASD reliably by 12-18 months Typically diagnosed between 1-3 years old  Important to treatment & intervention DSM-IV-TR Diagnostic Criteria –  Must operationalize behaviors using diagnostic criteria Three behavior categories: * Social communication. or achievements with other people Qualitative impairment in communication o Echolalia. mom can’t move the stacked cans or the child will have a fit   Myths about ASD All individuals with ASD have special skills or abilities (“Autistic Savants”)  Only very small portion have savant activity ASD can appear & disappear suddenly All act the same All are extremely smart All dislike physical contact and prefer to be alone Manifestation of Symptoms Speech and Language ~25-50% fail to develop speech Abnormal speech Joint Attention – ability to shift attention (autistic kids can’t do this) Theory of Mind – what’s in your mind is different from mine . interests. etc. etc. PPD-NOS) Biologically-based neurodevelopmental disorder with multiple causes  The reality is.Overview of ASD – (Autistic. we don’t know. extended conversation is difficult o Lack of make-believe play & imagination Restricted repetitive and stereotyped patterns of behavior. I.e. interests. & activities o Vague. o But even if language is appropriate. Engaging in behaviors that are maladaptive. lots of unexplained behavior: stacking cans. Aperger’s. restrictive repetitive behavior or impairment in communication  Qualititative impairment in social interaction o Most important o Failure to do something (difficulty making friends) o Lack of spontaneous seeking to share enjoyment.

but it was acquired through research in behavior mod Most common forms are head-banging. Lack of eye contact Inappropriate affect Little sharing of experience – preference for aloneness Preference for aloneness Lack of awareness of subtle social cues Lack of peer contact and interactive play Failure to attend to others Prevents learning from observation Sensory Abnormalities Desire for Sameness Stereotyped Behavior – “flapping bird” video Associated Characteristics Physical Characteristics Coexisting medical condition (10%) Sleep disturbances and gastrointestinal symptoms .ToM: false-belief task M&M test – video shown where kid opened bag of M&Ms but with pencils inside instead of candy. Gradually decreased when reinforcing consequences (attention) removed Does it respond to punishment? – yes. self-biting. rather than them learning from the environment ToM: false-belief task ToM task – has no joint attention. mood problems Self-injurious behaviors Self-Injurious Behavior (SIB) 50-75% of children with autism engage in SIB – old number. Rapidly decreased when contingent punisher applied . hair pulling. Can range from slight bruising or redness to death <how to address the behaviors with principles> Test of “Operantness” of SIB (Lovaas and Simmons. you must specifically teach to autistic kids. what do you think would be in the bag? Kid w/o theory of mind will say “pencils. 1969) Is it under Sd control? – yes. stimulus situations Does it show extinction? – yes. Rate varied in diff. Then asked if your dad was here.” Therefore. self-hitting/slapping. Autistic child cannot switch to a different task Social Behavior “Good babies” – most autistic children are not needy babies.will target the sleep disturbance first Accompanying disorders and symptoms Mental Retardation Epilepsy ADHD & learning disabilities Anxieties & fears.

Ph. but if echolalia.Does it increase with positive reinforcement? Yes.reinforcement works. Carr) Positive reinforcement Negative reinforcement Self-stimulatory (automatic reinforcement) – Ed Carr also found this functional analysis. no contingencies . gave back toys. and that SIB is internal.D. Functional Analysis Systematically manipulate environmental antecedents and consequences Tells us what is maintaining behavior Can use this information Functional Communication Training Assume SIB and other challenging behaviors serve communication function Teach alternative means of communication Alternative means of communication must serve same function as challenging behavior and be no more difficult to perform Communicative Functions of Echolalia in Children with Autism: Assessment and Treatment (2002) Michelle Thibault Sullivan. Ed Carr first person to show that +/. <addressing echolalia> -She wanted to find out what the communicative function of echolalia served Research Questions Will a functional analysis identify a unique communicative function of echolalia for each child with autism? Will functional communication training replace echolalia? Functional Analysis Conditions Attention – child received 30 sec attention Demand – tasks were removed for 30 sec Tangible – child had free access to toys. Increased when contingent positive reinforcement given --Kind of a functional analysis SIB as an Operant Under Sd control?: Susceptible to extinction?: Susceptible to positive reinforcement? Functions of SIB (Edward G. (Wanted to see if echolalia meant child was upset) Toy Play – no demands.

adult-driven. Did they use the same intervention? Evidence-based practice (EBP) is the integration of the best available research with clinical expertise in the context of patient characteristics. the child subject. he used echolalia to gain attention (maintained by attention). child-driven.-Via graph. show me colors!” . repetition (academic) DISCRETE TRIAL THERAPY (DT or DTT) -first treatment therapy that showed that autistic children can be taught to talk -after that. and preferences. culture. incidental (play) INCIDENTAL TEACHING PIVOTAL RESPONSE TRAINING (PRT) Augmentative communication system PICTURE EXCHANGE COMMUNICATION SYSTEM (PECS) Discrete Trial Training (DTT) A-B-C model – all behavioral therapy talked about today uses ABC model Discrete Trial Features: “Show me blue. “Can I have a turn?” *Was Echolalia maintained by the same thing for all kids? NO. it showed that Alan. What is evidence? Two controlled group design studies OR large series of single-case design studies Two investigators Treatment manual Therapist training and adherence Clinical and functional outcomes Long-term outcomes Current state of evidence-based psychosocial intervention for ASD Early intervention improves outcomes Research supports behavioral treatments and comprehensive models No one specific treatment method as the standard The cost of serving individuals with ASD in the US is over $35 million per year Types of Behavioral Treatment Structured. they gave him a redirection by teaching him to say “Can you play with me?” -Brad: Echolalia by teaching him to say “Can you help me?” -Sarah: maintained by tangible. Therefore. they switched to a more naturalistic model (generalization) Unstructured.

1988 “pivotal behaviors” – critical for wide area of functioning (like response generaln.Adult-directed. to increase generalization Components of Pivotal Response Training Motivation – find out what’s interesting to that child Child Attention Child Choice Reinforce Attempts . Tasks require response to simultaneous multiple cues (conditional discriminations). repetitive Controlled setting. Naturalistic Strategies Occur in naturally-occurring situations and environments Child initiated – incidental teaching. usually at a table Break down tasks to simplest components Repetitive trials DTT Results of Early Behavioral Intervention Initial demonstrations involved highly structured discrete trial format Proved to be very effective in establishing a wide range of behaviors Provided basis for all behavioral treatments to follow Can lead to substantial improvement in many children with autism Limitations of DTT: Difficulties with… generalization maintenance robotic responding lack of spontaneity prompt dependency – waiting for you to ask.shaping Direct Reinforcement – you can only reinforce what the child’s asking for Intersperse Maintenance Tasks Shared Control (Turn Taking) Responsivity “Stimulus overselectivity” or the failure to learn via simultaneous multiple cues. reliant on you acceptability by child/clinician use of aversives Pivotal Response Training (PRT) Koegel and Schreibman. natural setting.) Motivation – find out what’s interesting to that child multiple cues Play-based. pulling it out of what’s already there Play based Involve natural and direct consequences Involve more loosely arranged interactions . structured – over and over.

Legislature is influenced by what is found in research Targeting the defining symptoms of ASD – (especially social) Treatment manuals High degree of intensity – do it a lot in order to create pathways (like titrate meds) Measuring overall effectiveness Picture Exchange Communication System (PECS) –also behavior mod/naturalistic sort of like PRT Naturalistic Use of pictures symbols to communicate – instead of language Bridge to language Reduce prompt dependence Increase independence – pictures are clear Does not require receptive language .DTT vs. seek to answer the “who. PRT DTT is not natural and strictly arranged PRT is more flexible & enjoyable (less staff & parent burnout) Results of Naturalistic Teaching Strategies Greater generalization More positive affect – subjects smile more & seem happier & parents will adopt More positive home interactions .” “what. You’re making an operational behavior chain.” “where. Do things piece by piece. “Walking in Line” social skills lesson (gives child alt.flexible More enjoyable for children and for treatment provider Story-Based Intervention Package (other interventions) Written description of challenging situations Stories may be supplemented with: Prompting Reinforcement Discussion Social Stories™ are the most well-known story-based interventions – behaviors that you want your child to do.” and “why” (5 W’s) i.e. Like a behavioral contract w/ yourself. behavior) Comprehensive Behavioral Treatment for Young Children (CBTYC)* -this is what you see mostly in California Combination of ABA txts delivered to young children in a variety of settings with a low student-to-teacher ratio -you want to be able to think on your feet. Also creates discussion for child who has cognitive ability but has trouble explaining.” “when.

Don’t just pick interventions u are trained in. must have a plan mapped out. The below are affected by laws and principles. Family values are ethical. but very different at post Variable deficits “Clinical judgment” based intervention (wastes precious time and resources) Evidence-based practice Values and Preferences Values of family members – this is a big part.Picture Exchange Communication System (PECS) cont… Does not require imitation Does not require a pointing response Does not require use of abstract symbols Seems to be readily acquired by most students Can be expanded to involve more linguistically complex components Involves social interaction – more than PRT b/c kids approach you Limitations of Behavioral Intervention Differential response to treatment – differential=differently responding (looks the same at pre. Performance data tells us: What should we be teaching? Is our instruction successful? Is the student making progress? . and makes family accept it more Ineffective outcomes or undesirable side-effects Client rights Capacity Implemented in an existing system – must fit into local system “local expert” – nearby person or facility What has to be considered when applying an EBP? Fidelity! -Medical Model: o Condition o Patient o Drug/procedure o Dosage o How administered o Measure of efficacy o When to change -Education/Intervention o Content/behavior o Student o Teaching approach o How much time daily o Specific procedures o Data collection & examination o When to change approaches Why is data critical for EBP use? – like a social story for yourself.

we usually start w/ PRT.Do we need to change the teaching plan? Is it time to introduce a new skill? Next steps in research Determining which intervention to use based on specific child characteristics. (see “less severe bx notes”) .e. Train and hope Sequential modification Introduce to natural maintaining contingencies Train sufficient exemplars Train loosely – tickling video (make up on the spot) Use indiscriminable contingencies Program common stimuli Mediate generalization Train to generalize FUNCTIONAL ASSESSMENT – use when trying to determine what maintains behavior (origins). but if nothing changes in six weeks we change Developing research-based ways to choose specific interventions. – i. Must use experimental approach. Early Start Denver Model – (example only) Alternative Communication Decision Hierarchy Generalization Strategies – there are generalization problems with DTT or PRT?? (Find out)(You want stimulus generalization).

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