Behavior From the Inside Out

Marcia L Braden, PhD PC Licensed Clinical Psychologist www.marciabraden.com Karen Riley, PhD Associate Professor Domain Chair Educational Research Policy and Practice Morgridge College of Education

Goals of the Presentation

Participants will understand the behavioral and

cognitive characteristics associated with FXS. Participants will understand how to develop a behavior plan. Participants will understand how to address antecedents to decrease the occurrence of behaviors. Participants will understand what to do when behaviors occur.

Understanding Problem Behavior

Disruptive to home or school environment Interferes with the childs ability to learn Interferes with others ability to learn Presents danger to self or to others Interferes with social acceptance

In the Beginning
We thought behavior occurred in isolation We thought that one size of intervention would fit

all types of children Some believed that the behavioral problems in special populations was just part of the condition and should be accepted without attempting to change it

And Then We Saw the Light

Etiology Left Medicine and Entered Education

Generalists were no longer able to meet the

unique needs of all special populations With the revision of IDEA and the accompanying mandates, the one size fits all philosophy was abandoned RtI grew out of the revisions in IDEA with emphasis on research based methodology The push from parents of children with autism dovetailed with the revisions of the new mandate

The Balance
Behavior intervention is often unnecessary when

etiology is considered Understanding hard wiring of students makes disciplining archaic Supporting students individual differences enables them to thrive, save face and take risks. Acting out, struggling for power and non compliance then become extinct

What Ive learned about FXS and Behavior

They show or tell us what they need

It is our job to give them a more appropriate way

to communicate their need We have to observe the behavior looking for function in order to help modify the behavior

The behavioral cycle

Response from Parent, teacher Therapist Gross and fine motor delays Anxiety Language delays

Neurobiological underpinnings Sensory dysfunction Running away Throwing shoes Hitting head Pulling hair

Cognitive delays

Characteristics that Impact Behavior

Karen Riley, Ph.D.

Cognitive deficits Sensory integration dysfunction Speech and language delays Gross and fine motor delays Physical ailments Social/Psychological Characteristics

How could cognitive deficits affect behavior?

Boys
Expectations too high = frustration Expectations too low = boredom Both = behavior issues

Girls
Learning disabilities and attention deficits
Awareness of being different and not being able to

do what others are able to do. Performance anxiety; social anxiety

How could cognitive deficits affect behavior?

video

How could sensory integration dysfunction affect behavior?

There are a number of ways that sensory

dysfunction contributes to behavioral issues Sensory diets, accommodations in the classroom and regulation protocols should be considered when developing behavior intervention plans

Characteristics that Impact Behavior

Speech and language delays video

Marcia L Braden, PhD PC

How could speech/language delays affect behavior?

Difficulty communicating needs which likely

results in showing an unmet need through a behavioral sequence such as this:

The child says I want a drink

Mom misunderstands and gives him a biscuit

He gets angry and hits his mom

Marcia L Braden, PhD PC

Characteristics That Affect Behavior Gross and Fine Motor Delays video

Marcia L Braden, PhD PC

How could gross and fine motor delays affect behavior?

If you can not kick the ball, you do not play If you cannot ride a bike, you are left out If you cannot write your name, you look different If you cannot tie your shoe you look different

Frustration and anger and behavioral outbursts

Marcia L Braden, PhD PC

Characteristics That Affect Behavior Physical Ailments

Prone to ear infections Cant always tell us they are sick, but rather show

us their discomfort through their behavior Anxiety can contribute to GI problems and/or headaches

Characteristics That Affect Behavior Social/Psychological Deficits

video

How could social/psychological deficits affect behavior?

If you are anxious in social settings, you cant

make friends It is easier to be with adults than age similar peers because adults repair social interaction and help support successful social collaboration If you have social deficits you dislike talking on the phone, attending social events, being with people you dont know, and taking social risks

Most Common Behavior Problems in the Classroom

Distractibility/ Lack of Interest Skill Level Incompatible with Classroom

Expectations Causing Behavioral Excesses Anxiety that manifests in withdrawal, self abuse, hand flapping or other motor excesses Hyperactivity caused by over stimulation

Marcia L. Braden, Ph.D., P.C.

Most Common Behavior Problems in the Classroom

Poor impulse control
Lack of visual supports cause confusion and

frustration Lack of support for transitions Anticipation of schedule changes, novel tasks and environmental chaos

Marcia L. Braden, Ph.D., P.C.

How could poor impulse control and hyperactivity affect behavior?

Difficult to stay focused on the lesson The need to move from the desk, stand up, walk

around could interrupt the learning of others Touching things that are interesting- taking others things without permission could cause others distress

Marcia L Braden, PhD PC

Neurobiological Factors
CHANGE IN ROUTINE AND

TRANSITIONS
Easily upset by changes in schedule, routine and people or perceived expectations. Transitions create anxiety School has many transitions inherent in the setting. As children get older there are more and more transitions in their day. Transitions require students to trust the environment and what is coming next sometimes without warning
Marcia L Braden, PhD PC

Transitions
Video of Preston in TX before and after a BIP was

written and instituted

Marcia L Braden, PhD PC

How could difficulty with transitions affect behavior?

Going to recess (outside to play) Leaving the classroom to eat lunch Coming to school and leaving school Many other times during the day

Marcia L Braden, PhD PC

Behavior Plan for Transitions

videos of Cade pre post BIP

Desensitizing him to the group

Marcia L Braden, PhD PC

Gradually building trust and Making it fun with music

Anxiety and Negative Emotions

Anxiety plays an important role in negative

emotions such as anger, rage and irritability These feelings can result in behavioral episodes such as aggression and explosive outbursts Inconsistent regulation of the arousal functions (attention, motor control, and impulses) contribute to a fear of being out of control Belser and Sudhalter, 2001)
Marcia L Braden, PhD PC

How to Create A Behavior Intervention Plan

Define observable behavior (What). 2. Identify events that predict When & Where the specific behavior occurs. 3. Identify Why a student engages in the specific behavior. 4. Construct hypothesis statements that summarize the What, When, Where, & Why of a students behavior
1.

sloman@uoregon.edu

Practical FBA process D.A.S.H.

Define behavior in observable and measurable terms Ask about behavior by interviewing staff & student
-specify routines where & when behaviors occur -summarize where, when, & why behaviors occur

sloman@uoregon.edu

Practical FBA process D.A.S.H.

See the behavior
-observe the behavior during routines specified -observe to verify summary from interviews

Hypothesize: a final summary of where, when &

why behaviors occur

sloman@uoregon.edu

ABCs of Understanding Why students engage in problem behavior: Finding out the Pay-off or Function of Behavior
A= Antecedent(s). Find out the events that occur right before the behavior.
Allows you to predict: Where (During routine)? &

When (Trigger event)?

sloman@uoregon.edu

ABCs of Understanding Why students engage in problem behavior: Finding out the Pay-off or Function of Behavior
B=Behavior. Find out what is the observable problem behavior? C=Outcome/ Consequence. Find out what happens after the behavior occurs? WHY?

ABC
sloman@uoregon.edu

How do we address the antecedents?

What is RTI?
Response to Intervention Part of the Reauthorization of IDEA in 2004
Move away from the test-deficit-place

Two different approaches

Problem solving

Standard protocol

Hallmarks of RTI
Tiered approach Increase of intensity of intervention as one moves

up the tiers Problem solving Progress monitoring Collaborative approach

What are the potential pitfalls?

Immediate assignment to the top tier

Intensive
Intensive, individualized interventions for students who have an insufficient response to evidence-based interventions in the first two tiers.

Targeted
Targeted, specific prevention or remediation interventions for students whose academic performance or behavior lag behind the norm for their grade and educational setting

Universal
High quality instructional and behavioral supports for all students in general education

Cherry Creek Schools Achievement Services

Behavior Intervention Plan

Individual Child Specific modified curriculum, classroom accommodations such as sensory tools, preferential seating Interventions for Children with Behavior Challenges Support and supervision for social interaction, clear behavioral expectations, specific & consequences behavioral follow through Universal Strategies and Interventions Strategies that are good for all students, , Structure, predictability, basic accommodations, integrated curriculum, research based strategies, common behavioral programs such as Love and Logic

RtI as a means for advancing research for FXS

Case study design in educational research

Universal Level
Best practice at all levels Includes all domains Empirically substantiated methodology The type of intervention is determined by the overall

focus of the pyramid along with the function of the application Pyramids have been used for educational strategies along with health and behavioral intervention programs What we know is good for all children Do not assume that these are all in place

Tier 2 could change education for our boys.

Infusing etiology into intervention a model for

translational research in education, (Riley, 2011) Match etiology to intervention Research N of 1 studies

Dialogic Reading (Hear and Say)

Video Dialogic Reading

S:\My Videos\dialogic reading (2).mpg

Additional Reading Approaches

Edmark
http://www.proedinc.com/customer/ProductV

iew.aspx?ID=1068
Reading Recovery
http://www.readingrecovery.org/reading_rec

overy/facts/index.asp
See and Learn
http://www.seeandlearn.org/en/gb/

Logo Reading or Word Builder

http://marciabraden.com

Consistent approach

Math games

http://mindresearch.net/media/ edu/demoFolder/demo/games/ JiJiCycle/html/Unicycle6LI.html

Inclusion is not geography

What to do when addressing the antecedent is not enough?

Why do most behavior plans fail?

They assume behavior occurs in isolation. They are not holistic in their approach. They are too complicated. Do not address the foundations of the behavior.

The answers to these questions guide the intervention:

Which one of these antecedents is primary? What is your goal?
This can differ over time, but defining is paramount. Needs to be pragmatic. Needs to be realistic and attainable.

Assumes that appropriate supports are in place.

If the antecedent is not addressed you will be able

to change a behavior however another behavior will surface.

Consequences
Must be based on the

goals for the child and the situation. Must address the function of the behavior. Behavior does not continue unless somehow reinforcing. If truly consistent in the behavior plan reexamine the function of the behavior not all reinforcements are external. Can be positive and negative.

What about when the behavior occurs?

Total Melt Down

Keep the child and others safe, including

yourself Calming techniques and sensory integration activities will not work at this time Remove them from the cause or remove the cause from them if possible unless this is a controlled burn View it as a learning experience
What did you learn from this ?
What did the child learn from this ?

Make a plan for the next time

What is the most important thing to teach at this age?

I mean what I say
Limit the rules Limit the threats

Follow through
Follow through even if

you think you might be wrong. Consistency

What about adolescents and adults?

Teens and Young Adults

Video interview

Assessing and Treating Aggression in Children and Adolescents with Developmental Disabilities: A 20-Year Overview (2005) Matson, J.L., Dixon, D.R., Matson, M L.
54 studies on assessment and 62 on treatment were

found. All of the assessment studies and 34 of the treatment studies met methodological criteria for this review. 22 assessment studies using checklists and 32 using behavioral observations. Of the In treatment studies 32 used behavioral interventions and two used pharmacological interventions. The most commonly used treatments were functional communication training and differential reinforcement of other behavior. While there are still relatively few methodologically sound assessment and treatment studies, the number of viable publications is increasing.

The Rs
Realize and Recognize Realizing and recognizing ones emotions is critical to effective emotional

regulation. Labeling Remove He should remove himself from the situation. This is not punishmentit is a way to deal with negative emotions. You may need to tell him to do it initially, but hopefully, he will come do it himself over time. Relax Figure out activities that he finds relaxing. He could listen to music, read a magazine, or draw. Or he might just want to lie on his bed. He should have several options available in his room. Refocus Your adolescent should have a physical activity that allows him to refocus before rejoining the group. He may want to swing, go for a bike ride, or go for a walk. Make sure he has more than one choice. Rejoin

Dixon-Webber

Questions.

Recommended Websites
http://www.nectac.org/contact/contact.asp#groups http://www.directionservice.org/cadre/

Bibliography
Walker, H.M., Ramsay, E. & Gresham, F.M.

(2004). Antisocial behavior in school: Evidencebased practices (2nd ed.). Belmont, CA: Wadsworth/Thomson Learning. Gresham, F. M.(2004). Current status and future directions of school-based behavioral interventions. School Psychology Review 3, 326343.