Behavior Management: Assessment & Interventions

The CARD program consists of two components, Skill Repertoire Building and Behavior Management. The previous lessons, Skill Repertoire Building focused on increasing appropriate behavior whereas the following lessons focus on Behavior Management the second and equally important part of an ABA Program. The focus of behavior management is to decrease inappropriate behavior.

Defining Behavior

What is ‘Behavior’?

A behavior is anything a person says or does. Practically speaking, if you can see it, feel it, hear it, or observe it in any way, it is behavior. Some behaviors are more appropriate than others.

What is Problem Behavior?

Behavior that is less appropriate is often referred to as problem behavior. Problem behavior is any behavior that needs to be reduced or eliminated, because it:

  • A) Interferes with a person’s ability to learn,
  • B) Limits the frequency and quality of social interactions,
  • C) Causes property damage,
  • D) Results in injury, or
  • E) Otherwise harms a person.

Some common forms of problem behavior that require intervention include:

Stereotypy: Which is repetitive, purposeless, often rhythmic movements, such as body rocking, toe walking and hand flapping.

Self-Injury: Which is any behavior which causes bodily harm to the individual such as head banging, hair pulling, self-biting.

Aggression: Which is any behavior that may cause injury to others or damage to the environment such as hitting, kicking, throwing, or scratching.

Other common problem behavior: include inappropriate vocalizations, such as cursing, screaming or whining. Or inappropriate actions such as climbing on furniture or wandering away from adults.

Problem behavior can vary in severity with some being relatively mild in which no real damage is done and the child is able to meet educational demands. That being said these behaviors have the potential to worsen over time and may require immediate intervention even though the initial severity is relatively mild. Moreover, such mild problem behavior can limit the quality of social interactions by increasing the likelihood of more reprimands than praise.

Example (mild behavior escalating to a more severe behavior):

A child doesn’t like to do their homework, and each time the child’s parents ask them to do their homework the child pushes their backpack aside. Recently when asked to work on homework, the child picked up their back pack, threw it and it hit a younger sibling in the arm causing a large bruise. This situation highlights the importance of immediate intervention with what initially may appear to be a mild problem behavior ‘pushing the backpack aside’. In this situation the behavior has increased in severity, which resulted in injury to another person.

Problem behaviors that are considered to be severe result in A) Tissue damage, B) Serious property damage, C)Interfere with a child’s ability to learn, D) Result in removal from school or educational setting, and E) Limit opportunities for social interaction. In these cases the problem behavior must be addressed immediately.

An important part of defining problem behavior is identifying the reasons that the behavior is considered problematic.

Identifying Reasons Behavior is Problematic:

Frequency: The behavior is appropriate in limited form, but may become inappropriate when repeated frequently. An example is a child who has learned to go ask to go the bathroom at school, however, the child is now saying it every few minutes throughout the day. Asking to go to the bathroom in and of itself is not a problem, it is because of the frequency of the request that the behavior is problematic. (The frequency of the request is interfering with the child’s ability to learn)

Context: Some behavior is only problematic when it occurs in an inappropriate context. In other words, the specific behavior is problematic in some contexts but not in others. For example, a child that frequently repeats lines from their favorite movie, the verbal stereotypy is not a problem at home, but it is very distracting to other kids at school and it is interfering with the ability of those children to learn.

Topography: Topography is the form of the behavior; what it looks like or sounds like. Hair pulling and self-hitting are problem behaviors due to the topography of the problem behavior. These problems are easily observed and may cause injury to someone.

Intensity: Refers to the degree of a behavior. For example, a child really likes talking to their friends about their favorite interest (dinosaurs, trucks, gaming), but when the child does it is with such intensity that the child doesn’t pause to allow the friends to talk, thereby monopolizing the conversation resulting in the other children beginning to avoid interaction. In this case talking about the favorite interest is only a problem because of the intensity of the behavior because it is limiting the opportunities for social interactions.

It is important to understand and identify the reason a behavior is considered problematic, in order to correctly manage the behavior.

Operational Definitions of Behavior:

An operational definition is a clear, concise, accurate statement that specifies the exact details of the observable problem behavior. Operational definitions are a crucial component to the element of Data Collection in an ABA therapy program. Data collection being the written record of the behavior that is documented by the therapist in the child’s log book.

Example:

In therapy sessions a child has been engaging in aggressive behaviors with the therapist. The BCBA requests that the therapist take data on the aggressive behaviors. If the therapist were to only consider general definitions of aggressive behavior, which is anything a person says or does that causes harm to others or results in property damage, data collection for such a broadly defined behavior would be difficult. Using this definition the therapist would be required to record each definition of hitting, spitting, pulling hair, biting, scratching, pushing, kicking, throwing objects, or any behavior that the child does that may cause injury to self, others, or property. This may seem simple enough, but what if the child only grabbed the therapist’s hair, but did not pull it? What if the child hit the therapist, but it didn’t hurt? Would it be recorded as aggression if the child put their open mouth on the therapist’s arm but didn’t actually bite? What if the child accidentally scratched the therapist when reaching for their pencil? The answer to these questions cannot be found in the general definition of aggression. In this example, aggression has been so broadly defined (anything a person says or does that causes harm to others or results in property damage) that it leads to difficulty taking data. It also leads to inconsistencies between therapists due to the reliance on subjective decision making. This is particularly troublesome because program supervisors make many decisions about a child’s treatment based upon data collection.

Operational definitions increase the reliability and accuracy of data because an operational definition is a clear, concise statement that specifies exactly what behavior is to be observed. Moreover, operational definitions help to ensure clear communication and consistent observation. Operational definitions may also include statements that specify what behaviors to exclude (sometimes called non-examples) from Data Collection. For example, if the child engages in aggression the BCBA will provide the therapists with an operational definition of each aggressive behavior that requires data collection. These operational definitions are individualized for each child.

Example:

The child engages in biting behavior. Using an operational definition of biting the BCBA has defined this behavior as the child placing their open mouth on another’s body, with teeth contacting the skin or clothing. It does not include placing a closed mouth on another’s body, or an open mouth on another’s body without teeth to skin or clothing contact. It is important to note that this operational definition of biting does not require the child to close or attempt to close their mouth for the behavior to be recorded as biting. This clear, concise definition of biting behavior has increased the clarity of the aggressive behavior and will assist the therapists in accurate data collection.

Example:

Operational Definition: Visual Stereotypy problem behavior. The BCBA has clearly defined the visual stereotypy as the child placing their hands or objects within 6 inches of their face, and looking at them out of their peripheral vision, either stationary or if moving them back and forth. The clarity of the specific operational definition provides everyone working with the child an objective description of the behavior.

Problem behaviors are often based on the topography. The topography of the behavior is one dimension of the problem behavior that is most readily observable, so, it allows independent observers to equally identify the same behavior. Operational Definitions  specifically describe what a behavior looks like, and are necessary for accurate data collection and clear communication. However, it is important to realize that an operational definition does not define the function of the behavior, or the reason why the behavior is occurring.

Although clear operational definitions are critical to accurate data collection the function of the behavior is critical to the behavior assessment and intervention.


Functions of Behavior

Understanding the function of a problem behavior is necessary in order to assess and create an intervention for a problem behavior.

What is Function of Behavior?

The function of behavior is the reason the behavior is occurring. It is the consequence that is maintaining the behavior. All behavior occurs because it has been reinforced, that is, because it has resulted in the presentation of a preferred stimulus–or the removal or avoidance of an aversive stimulus. So practically speaking, the function of a behavior is the reinforcer or consequence that maintains the behavior.

Example:

In the past when the child has said, “I want chips” the child has received chips. The behavior of asking for chips is reinforced by the consequence of receiving the chips, which makes it more likely that the child will increase the behavior. In this example, asking for chips is a function of receiving chips.

Determining the function or cause of behavior requires that the reinforcer maintaining the behavior is identified as well as the source of that reinforcement. In the above example the reinforcer is getting chips, and the source of reinforcement is the parent giving the chips.

The two variables of reinforcer plus the source of reinforcement equal the four functions of behavior noted in this lesson.

Types of Reinforcement?

Reinforcement is the procedure of providing consequences for a behavior that increases or maintains the strength of a given behavior. There are two types of reinforcement: Positive reinforcement and negative reinforcement.

Positive Reinforcement: In positive reinforcement a behavior is strengthened by the receipt, addition, presentation, or increased intensity of any stimulus following an occurrence of that behavior. In other words, the addition of the stimulus as a consequence to the behavior results in an increased frequency of behavior over time.

Example:

The child really likes chocolate chip cookies. One morning the child saw their favorite cookies on the top shelf in the pantry and the child could not reach the cookies, so they began to whine. The parent heard the child whining and got the cookies down from the shelf and gave the child a cookie. The behavior of whining was positively reinforced by the receipt of a cookie. Because of this when the child sees and wants the chocolate chip cookie in the future they will be more inclined to whine in order to get what they want.

Negative Reinforcement: In negative reinforcement a behavior is strengthened due to the removal, termination, or avoidance of an aversive stimulus following an occurrence of the behavior. In other words the behavior is more likely to occur again in the future because it resulted in the removal or avoidance of an aversive stimulus or something the person didn’t like.

Example:

A child throws tantrums. In this case the child does not like to take baths, and dislikes it so much that when the parent says, “it’s time to take a bath” the child throws themselves on the floor screaming and crying. This behavior makes it difficult for the parent to get the child into the bathtub, so the parent usually waits five or ten minutes for the child to stop crying before starting the bath. The tantrum behavior was negatively reinforced because the bath was delayed. Because of this the child is more likely to throw a tantrum when a parent says, “it’s time for a bath” because it delays taking the bath by at least five minutes.

It is important to note that the difference between positive and negative reinforcement is in the application of the stimulus. That is whether the stimulus has been added or removed upon occurrence of the behavior. It does not refer to the actual stimulus itself which may seem or appear to be preferred or aversive.

Additionally, both positive or negative reinforcement may maintain problem behavior. Likewise positive and negative reinforcement may work in combination to maintain a behavior, in these cases behavior is strengthened by two things happening when the behavior occurs: 1) The addition of a preferred stimulus and 2) The removal or avoidance of an aversive stimulus. In other words, the behavior is more likely to occur again in the future because it results in the presentation of something preferred and the avoidance of something aversive at the same time.

Example:

A child loves to play outside on their swing, indeed they enjoy playing outside so much that when a parent calls them to come inside and clean their room the child runs away. The child is a very fast runner and it is difficult for the parent to catch them. So when the child runs, the parent waits a few minutes before trying to bring them inside. As a result, the child gets to play outside a little longer and at the same time delays having to clean their room. The running behavior is reinforced by the positive reinforcer of getting to play outside longer and additionally reinforced by the negative reinforcer of delaying the task of cleaning their room.

In addition to identifying whether the function of behavior is by positive or negative reinforcement it is also important to identify the source of reinforcement.

Sources of Reinforcement?

There are two sources of reinforcement.

Socially Mediated Reinforcement: With socially mediated reinforcement the reinforcer is provided by another person. In other words, another person is either providing the preferred stimulus or removing an aversive stimulus that is reinforcing the problem behavior.

Example:

A child has the problematic behavior of hitting. The child’s favorite toy is a helicopter, and they rarely go anywhere without it. The child’s sibling also likes the helicopter and will take the child’s helicopter if they cannot find their own toy. When the sibling takes the helicopter away the child hits their sibling. The sibling starts crying, drops the toy and runs to tell their parents. When the sibling runs off the child picks up the toy and starts playing again. This is an example of socially mediated reinforcement, because the reinforcer is delivered by another person.

Automatic Reinforcement: In the case of automatic reinforcement the reinforcement is not provided by another person, instead it is produced by the behavior itself. In other words, the behavior itself is reinforcing. 

Example:

A child has the problematic behavior of head banging. The child suffered from frequent headaches and whenever the child has a headache they bang their head against the wall. The child does this because with each bang of their head on the wall, the pain of the headache momentarily disappears. This is an example of automatic reinforcement because the problem behavior of head banging is reinforced by the banging itself, the banging independent of another person temporarily relieved the pain.

Applying the Four Functions of Behavior:

Each function of behavior is a combination of one type of reinforcement (either positive or negative) and one source of reinforcement (either socially mediated or automatic)

Social Positive Reinforcement: As implied by the name social positive reinforcement is socially mediated, or in other words provided by another person and it is a positive type of reinforcement (i.e., results in a preferred stimulus). In Social Positive Reinforcement problem behavior is strengthened when someone delivers a positive reinforcer following an occurrence of the problem behavior.

Common forms of Social Positive Reinforcement:

Vocal Attention: Attention can include vocal attention such as reprimands, statements of concern, lectures or discussions regarding the problem behavior.

Physical Attention: Which can include patting, rubbing, or spanking.

Facial Expressions: Such as just making eye contact with the child, glaring, a look of concern, raised eyebrow, etc.

Body Language: A simple flinch or gasp may also be sufficient attention to maintain a problem behavior.

Access to Tangible Items: Tangible items can include toys, or other preferred objects such as a car, or vacuum as well as food and drink, and include access to preferred activities such as going outside, swimming, playing a game, watching tv or coloring. In social positive reinforcement, behavior is strengthened when someone delivers these tangible items contingent upon the problem behavior.

Such events such as reprimands or spanking may not be preferred by adults, but it is important to note that preferences vary from one person to another and just because a stimulus seems aversive to one it may not be aversive to another.

Example-Attention Functions a Reinforcer:

A child has the behavior of biting. When the phone rings, the child’s mother leaves the room to answer it. While she is gone, the child bites their sibling on the arm. The sibling cries and calls for their mother. The mother returns to the room and tell’s the child “No biting!”. In this example the socially mediated source of reinforcement is the mother and the positive reinforcement is comprised of the siblings crying and the mother returning to the room to reprimand them.

Example-Tangible Items Function a Reinforcer:

A child wants cookies on the top shelf of the pantry and cannot reach them. The child whines. In response the parent retrieves the cookies from the shelf and gives the child a cookie. The cookie is the tangible reinforcer and the source of reinforcement is the parent.

Social Negative Reinforcement: 

As implied by the name social negative reinforcement is socially mediated, or in other words provided by another person and it is a negative type of reinforcement (i.e., results in the removal or avoidance of an aversive stimulus). In Social Negative Reinforcement problem behavior is strengthened when someone removes or delays an aversive stimulus following an occurrence of the problem behavior.

Common forms of Social Negative Reinforcement:

Escaping from Demands: In which someone allows the person to escape from an instruction contingent upon the problem behavior. Demands or instructions could include asking the person to: complete academic tasks, or completing self-help activities, or chores. Even talking to the child could be a demand if a response is expected. With Social Negative Reinforcement problem behavior is strengthened when someone removes or delays the demands contingent upon the problem behavior.

Escaping from an Aversive Setting: In which someone allows the person to escape from an unpleasant setting contingent upon the problem behavior. There are many different settings that a child could find aversive and want to leave. Such as, school or a church or library, or a grocery store, any setting could potentially be aversive and is dependent upon the unique desires of the individual child. As with escape from demands, here too the problem behavior is strengthened when someone removes the setting contingent upon the problem behavior.

Escaping from Sensory Stimuli: In which someone allows the person to escape from or avoid an unpleasant sensory stimuli contingent upon the problem behavior. Almost any sensory stimulus may be considered aversive. It could be loud sounds, strong smells, the smell or taste of certain foods, a bright or flashing light, tickles, tight hugs, swinging on a swing or spinning on a merry-go-round. Any one of these could be an aversive stimuli for a given child. Here too the problem behavior is strengthened when someone removes the setting contingent upon the problem behavior.

Example of Social Negative Reinforcement:

A child throws tantrums. The child’s tantrums are reinforced by social negative reinforcement (the delaying of bath time) contingent upon the child problem behavior of throwing tantrums. In this example the source of the reinforcement is the parent and the negative reinforcer is the delay of bath time.

Example of Social Negative Reinforcement in Setting:

A child has a problem with screaming. The child doesn’t like the benches at their church. The benches are uncomfortable and the child doesn’t like to sit on them for more than a few minutes. After a while, the child becomes agitated and starts screaming. A parent takes the child out of then church. The screaming behavior is reinforced by the parent removing the child from the aversive setting contingent upon the problem behavior. In this example, the negative reinforcer is the removal from the setting and the source of reinforcement is the parent.

Example of Social Negative Reinforcement in Sensory Stimuli:

A child has a problem with self-injurious behavior. The child does not like the sound of loud appliances, and every time someone vacuums the child scratches their own arms. When the person sees the child hurting themselves, they turn the vacuum off and wait to vacuum when the child is not home. The child’s self-injury is maintained by Social Negative Reinforcement in the form of the person vacuuming as the source and the removal of the vacuum (which is the negative reinforcer) contingent upon the behavior of scratching.

Automatic Positive Reinforcement: 

In automatic positive reinforcement the problem behavior itself produces the preferred sensory stimuli. A person does not present the reinforcer, instead the behavior is self-reinforcing because it produces a sight, taste, sound, feel, smell or motion that is a preferred stimuli to the child. In many cases automatic positive reinforcement maintains stereotypical behaviors. However, it is important to note that stereotypy simply means repetitive behavior which may be maintained by any of the four types of reinforcement. Just because a behavior occurs repetitively and produces a sensory stimulus it does not mean that it is reinforced by the sensory stimulus it produces. Rather, stereotypical behavior may be maintained by other consequences such as a reprimand or other forms of attention.

Common forms of Automatic Positive Reinforcement:

Reinforcing Sensory Stimuli: It could be the look of fingers waving, a sound such as “choo-choo”, a smell such as play clay, the taste of sweat, the feeling of carpet or the motion of spinning in a chair. In these and other cases the problem behavior itself produces a pleasant sensory stimuli and thus is reinforced by the behavior.

Example of Automatic Positive Reinforcement:

A child is disruptive. At school, the child jumps up from their desk and runs across the room to sniff the markers at the teachers desk. The markers smell like different types of fruit. After the child sniff’s all of the markers the child runs back to their seat, again disrupting the class. This disruptive behavior is maintained by automatic positive reinforcement in the form of the pleasant smell of the markers.  Alternately, this same behavior can be reinforced through Social Positive Reinforcement as well, for example if the teacher intervenes in the behavior and directs the child to their own markers at their desk. In which case the teacher is the source of reinforcement and the reinforcement is in the form of attention received through the correction.

In the above example the problem behavior is the same, however one is self-reinforcing and the other has an outside source of reinforcement.

Automatic Negative Reinforcement:

Automatic negative reinforcement is similar to automatic positive reinforcement in that oftentimes it involves sensory stimuli, however because it is negative reinforcement the stimuli is removed instead of added.

Common forms of Automatic Negative Reinforcement:

Relief from a Painful Stimulus: Here the behavior itself is reinforcing because it removes a painful stimulus such as a headache, toothache or stomachache. For example, a child could engage in biting to relieve a toothache.

Escape from Sight, Sound, Taste, Touch, Smell or Motion that is Disliked: Here the behavior itself is reinforcing because it removes an aversive stimulus. For example, a child may pull their jacket over their heads to escape a bright light, plug their ears and hum loudly to avoid the sound of the school bell, or stuff cotton balls in their nose to avoid a smell, or spit food out to avoid an unpleasant taste or texture, wear gloves to avoid the feel of dirt, or jump off a merry-go-round to escape the spinning motion. The problem behavior itself provides escape from an aversive sensory stimulus.

Example:

A child bangs their head against the wall. This behavior is an example of automatic negative reinforcement because the behavior itself is self-reinforcing in that it temporarily provides relief from the pain of the headache.

Identifying the Function of a Problem Behavior:

Determining the function of a problem behavior is essential to creating an effective intervention for the problem behavior. An effective intervention for a problem behavior has two goals: 1) The reduction or elimination of the problem behavior, and 2) the building of alternative appropriate behaviors that serve the same function as the problem behavior.

Antecedent: The child wants a cookie
Behavior: The child whines for the cookie
Consequence: The child receives the cookie from a parent

To begin the intervention process the functional behavior must be identified. In the above case, the functional behavior has been identified as Social Positive Reinforcement, in the form of a tangible item (the cookie) and the source has been identified as the parent. Knowing the function of the child’s whining allows the BCBA to accomplish the first goal of effective intervention which is to reduce or eliminate the problem behavior. In other words, the BCBA will develop an intervention that will eliminate the presentation of the cookie contingent upon the child’s whining behavior. This intervention will likely result in a reduction of the child’s whining behavior. However, the child still likes cookies and wants a cookie. The child does not currently have any appropriate skills in their repertoire to obtain a cookie and because of this another behavior is likely to emerge to take the place of whining or serve as a function of whining to get a cookie. Often times this replacement behavior is also problematic. For example, the whining could be replaced with screaming, crying, hitting, banging their head, or climbing shelves. This is why the second goal of building an appropriate alternative behavior to serve the same function of the problem behavior is necessary.

At this point the BCBA may instruct the therapist to say, “cookie please”. If saying, “cookie please” reliably results in getting a cookie the child will not need to whine or cry or conduct any other problem behavior to get a cookie. Instead, the child will use the new appropriate alternative behavior of requesting “cookie please”.

It is important to remember that the function of the behavior is not problematic but rather it is the intensity, frequency, topography, or context of the behavior that makes it problematic. So, by identifying the function of the problem behavior the BCBA can determine appropriate alternative behaviors as new targets for skill repertoire building that can be used to replace the problem behavior.

When determining the function of a particular problem behavior that problem behavior is considered to be the target behavior. In this process the BCBA will conduct a Functional Behavior Assessment/Analysis (FBA).

Functional Behavior Analysis:

An FBA is a systematic evaluation of the Antecedents and Consequences of the Target Behavior, that determines why the Target Behavior is occurring, that is, to determine its function. In other words, during a Functional Behavior Analysis or FBA, the BCBA will look closely at the Antecedents to the Target Behavior and the Consequences that the child receives following the target behavior in order to determine the function of behavior.

Indirect Assessments: When conducting an indirect assessment the BCBA interviews people who know the child the best and observe problem behavior most frequently. This includes asking parents, teachers and therapists about the antecedents and consequences they observe when the problem behavior occurs.

Example:

The whining behavior. The parent has informed the BCBA that the child is whining nearly every day. To this, the supervisor asks the parent several questions to ascertain the function of the behavior. The interview might look like this:

BCBA: “When is the child most likely to whine?”

Parent: “I guess she whines most when he/she is hungry”

BCBA: “What is usually happening just before the whining starts?”

Parent: “I’m usually in the kitchen cooking, I keep the pantry door open because it’s easier to get what I need, but whenever he/she sees the cookies the whining starts. I try to keep them on the top shelf where they cannot be reached, otherwise the whole box would be gone in a day”

BCBA: “And what do you do when he/she starts whining?”

Parent” I usually give her/him a cookie to eat while waiting for the meal”

The information gleaned from this interview will help the BCBA determine the function of the whining behavior and create an intervention.

Descriptive Assessments: In a descriptive assessment the BCBA observes and collects data on the Antecedents, Behavior, and Consequences in order to identify the function of the problem behavior. This is often referred to as “collecting ABC Data”. Therapists may be asked to collect ABC Data to assist in this process. To do this, the child is observed in the natural environment where the behavior is likely to occur and then for each instance of the target behavior the following is recorded:

Antecedent: Or what occurred immediately prior to the behavior
Behavior: The target behavior being measured
Consequence: What occurred immediately following the behavior

Example of How to Collect ABC Data:

Hitting behavior. The child is sitting in the living room with their sibling. The child is playing with their favorite toy and their sibling with another toy. All of a sudden the younger sibling grabs the child’s toy and starts playing with both toys. In response, the child hits the sibling who then drops the toy, starts crying and runs for their mother. When the sibling runs off the child grabs the toy and begins to play with it again. In this example, the target behavior is hitting. The antecedent is the sibling taking away the toy, and the consequence of the behavior is getting the toy back.

This descriptive assessment allows the BCBA to look for patterns in the observed Antecedents and Consequences of the problem behavior recorded in the ABC data. This information will assist the BCBA in identifying the correct function of behavior

Experimental Functional Analysis: An experimental functional analysis is used when either the indirect or descriptive assessments do not clearly indicate a function for the behavior problem. These are conducted by the BCBA. With this analysis the BCBA will manipulate the Antecedents and Consequences associated with the problem behavior in order to identify the maintaining reinforcer. In other words, the BCBA will set up several different scenarios or conditions to present to the child. For each condition different Antecedents and Consequences are provided for the target behavior. The child is more likely to engage in the problem behavior during those conditions that include the antecedents and consequences maintaining the problem behavior.

The Most Common Conditions Included in an Experimental Functional Analysis:

The Play Condition: In the Play condition the child is given lots of attention, toys to play with and no demands placed on them. If the target behavior occurs it is ignored.

Problem behavior maintained by socially mediated reinforcement is unlikely to occur in the play condition because the child already has anything they might want regardless of the problem behavior. Problem behavior that is automatically reinforced may still occur during the play condition.

The Demand Condition: In the Demand condition the chid is presented with several tasks to complete, and is allowed a break from those tasks when the problem behavior occurs.

If the problem behavior is maintained by social negative reinforcement than in the form of escape from demands, than the behavior is likely to occur during this condition than in any other condition.

The Attention Condition: In the Attention condition, the child is ignored until the problem behavior occurs at which time attention is given to the child for the behavior.

If the function of the behavior is social positive reinforcement in the form of attention than it is most likely to occur in this condition.

The Alone Condition: In the Alone condition, the child is ignored completely regardless of the problem behavior.

Problem behavior should only occur in this condition if it is maintained by automatic reinforcement.

The Tangible Condition: In the Tangible condition the child is provided with a non-preferred toy but given a preferred toy contingent upon the problem behavior.

Problem behavior maintained by Social Positive Reinforcement in the form of access to preferred toys, is most likely to occur in during this condition than in any other condition.

Review:

Once the Functional Behavior Assessment has been completed the BCBA will interpret the data and identify the function of problem behavior and develop an intervention plan based on the results of the FBA.


Antecedent Based Interventions

The natural progression from identifying the Function of Behavior and conducting a Functional Behavior Assessment or FBA is to apply that information in therapy sessions through interventions. Interventions are intended to decrease problem behavior and are a critical component of behavior management. One method for those interventions is Antecedent Based.

What is an Antecedent Based Intervention?

An antecedent based intervention is one that is designed to prevent the problem behavior from occurring by eliminating the SDs or EOs that are evoking the problem behavior. Practically speaking, this involves removing any stimuli that contribute to the problem behavior and providing reinforcers before the problem behavior occurs so that the child is no longer motivated to engage in the problem behavior.

How Does Elimination of Antecedent Stimuli Prevent Problem Behavior:

An SD is a stimulus in the presence of which a particular Response will be reinforced, and in the absence of which that Response will not be reinforced. As a result the child responds in the presence of the SD but not in the absence of the SD. Antecedent modifications involve removing the SD from the environment so that the problem behavior is less likely to occur.

An EO is an Antecedent condition that momentarily increases motivation for a particular object or event, and as such evokes behavior that has produced the object or event in the past. As a result the child is more motivated to respond when the EO is present than when it is absent. Antecedent modifications involve removing the EO so the child is less motivated to engage in the problem behavior.

Example SD removal:

If the SD for a child’s hair pulling is seeing the therapists long hair than the SD can be eliminated by having the therapist wear a hat to cover the long hair. In the absence of the SD ‘long hair’ the problem behavior ‘hair pulling’ is less likely to occur.

The same general procedure is used to eliminate the establishing operations for problem behaviors.

Example EO removal:

A child get’s a cookie when they whine. The EO of being hungry makes it more likely that the child will whine because the child is more motivated to get cookies. The EO can be eliminated by giving the child frequent snacks to minimize their hunger. In the absence of the EO ‘being hungry’ the problem behavior ‘whining’ is less likely to occur.

Four Types of Antecedent Based Interventions:

Non-Contingent Reinforcement

Non-contingent reinforcement is the delivery of functional reinforcers on a time-based schedule, independent of the problem behavior. Practically speaking, non-contingent reinforcement is the frequent presentation of the reinforcer maintaining the problem behavior regardless of whether or not that problem behavior actually occurs.

Looking closer at the components of non-contingent reinforcement a functional reinforcer is the object or event that is maintaining the problem behavior. So if the problem behavior is maintained by access to a toy, than the toy is the functional reinforcer. In non-coningent reinforcement the reinforcer is delivered on a time-based schedule. This means that delivery of the reinforcer does NOT depend on the occurrence of problem behavior. Instead, the toy is delivered whenever a specific amount of time has passed such as every three minutes or forty seconds. The amount of time that elapses between each instance of reinforcement on the time-based schedule is based on the frequency of the problem behavior. The reinforcement interval will be shorter than the time that typically elapses between episodes of the problem behavior. This means that if the problem behavior typically occurs every five minutes or so than the reinforcer (toy or item) would be provided to the child more frequently than every five minutes. Given this time-based schedule the reinforcer is presented independent of the problem behavior. This means that the reinforcer is provided solely on the time-based schedule regardless of whether or not the problem behavior occurs.

The exception to this is if the problem behavior occurs at exactly the same time the therapist should have provided the reinforcer according to the time-based schedule. If this happens, the therapist should wait five seconds before providing the reinforcer. This prevents the therapist from unintentionally reinforcing and strengthening the problem behavior.

Non-contingent reinforcement works by eliminating the EO (establishing operation) for the problem behavior. As a result, it is important that the reinforcer is provided more frequently than the behavior occurs. If the problem behavior occurs very frequently, the reinforcer may have to be provided continuously. Once the problem behavior decreases to an acceptable level than the time-based schedule of reinforcement is gradually increased until it reaches a naturally occurring schedule.

Non-contingent Reinforcement and Social Positive Reinforcement: Let’s consider an example of non-contingent reinforcement to decrease a child’s attention maintained biting.

Example: 

The child engages in biting approximately every minute so initially the therapist provides the child with attention every 40 seconds regardless of the problem behavior. Soon the child is no longer motivated to bite their therapist in order to get attention because the child already has access to the reinforcer they want. Over the next several days, the child’s biting behavior occurs less frequently as the therapist gradually increases the time between reinforcer delivery from every 40 seconds, to every minute, 2 minutes, 3minutes, and so on. Eventually, the therapist is providing attention every ten minutes and the child is no longer biting.

In this example the functional reinforcer is attention and was provided independent of the behavior on a time-based schedule. Initially every 40 seconds. The child’s problem behavior with biting was maintained by social positive reinforcement in the form of attention so the therapist provided the child attention non-contingently during treatment. Had the problem behavior been maintained through access to a tangible item the therapist would have used the same process but instead would have provided access to a specific toy, snack or activity that the child wanted instead of the attention.

Non-contingent Reinforcement and Social Negative Reinforcement: Non-contingent reinforcement can also be used to decrease problem behaviors maintained by socially mediated negative reinforcement. In these cases, escape from the aversive demand, setting, or sensory stimulus is provided on a time-based schedule independent of the problem behavior.

Example: 

The child bangs their head approximately every 5 minutes in order to escape from demands. So the therapist provides the child a break from work every 3 minutes regardless of the problem behavior. If the problem behavior was maintained by escape from a setting the therapist would allow the child to leave the setting on a time-based schedule. Similarly if a problem behavior is maintained by escape from a sensory stimuli the therapist would provide relief from the sound, taste, touch, etc. on a time-based schedule independent of the problem behavior.

Non-contingent Reinforcement and Automatic Positive Reinforcement: Non-contingent reinforcement can also be used to decrease problem behaviors maintained by automatic positive reinforcement.

Example: 

The child is constantly waving their fingers in front of their face, because they like the way it looks. In order to decrease the visual stereotypy the therapist provides the child with colorful videos to watch regardless of the problem behavior.

Non-contingent Reinforcement and Automatic Negative Reinforcement: Non-contingent reinforcement can also be used to decrease problem behaviors maintained by automatic negative reinforcement.

Example: 

The child has dry itchy skin, as a result the child often scratches at their skin until they bleed. In order to decrease the child’s scratching the therapist puts lotion on the child every 30 mintues regardless of the problem behavior.

No matter what the function of behavior is the non-contingent reinforcement always involves presenting the maintaining reinforcer independent of the problem behavior.

Demand Fading

Demand Fading is another Antecedent Based Intervention designed specifically to reduce problem behavior maintained by Social Negative Reinforcement in the form of escape from demands. Demand Fading is the gradual increase in demand requirements before providing a functional reinforcer. In other words, the therapist gradually steps up the requirements of demands that the child must perform in order to receive a reinforcer.

Initially, only a single demand is presented followed by the functional reinforcer (a break from the demand). The break is provided even if the child makes an incorrect or prompted response and it is provided independent of the problem behavior. Once the problem behavior decreases to an acceptable level the number of demands is gradually increased until the demands occur at a natural rate.

Demand Fading works by eliminating the Establishing Operation (EO) for the problem behavior. The initial reduction of the demands presented reduces the aversiveness of the demand context. If the demand context is less aversive the child is less motivated to escape it.

Example: 

The child will often scream, spit, and gag when asked to eat new food. In order to decrease these problem behaviors the therapist initially provides a break from the meal following 1 bite of food. Soon, the child is no longer motivated to scream, spit or gag to escape the meal. Over the next several days the child’s inappropriate behavior at mealtime remains at low levels when allowed a break following a single bite. On the fourth day the therapist gradually increases the number of bites required before providing a break, from 1 bite to 2 bites of food. The child continues to take the bites without spitting, screaming or gagging. After a few days of success with the 2 bite ratio, the therapist increases the demands and requires that the child eat 4 bites before allowing a break from the meal. The child continues to eat the food without any inappropriate behavior so on day eight the therapist provides the child a break following 6 bites of food. The therapist continues to increase the number of bites the child has to take in order to receive a break from the meal until an entire meal is presented and the child is no longer screaming, spitting or gagging.

In this example, the problem behavior was maintained by Social Negative Reinforcement (removal of the stimuli by another person) in the form of escape from demands. So the number of demands presented before escape or a break was provided was initially significantly reduced and increased only after the problem behavior decreased.

Task Modification

Task Modification is another antecedent based intervention designed specifically to reduce problem behavior maintained by social negative reinforcement in the form of escape from demands. Task Modification involves changing some aspect of the task, so the task is less aversive to the child. Task modification works by eliminating the EO (establishing operation) for the problem behavior. If the demand context is less aversive the child is less motivated to escape it.

Task Modification may involve changes to any aspect of the demand context such as the stimulus materials, order of task presentation, task difficulty, instructional location, or any other change to the task that reduces the aversiveness of the demand context such as allowing the child to select which tasks will be presented. Once the problem behavior decreases to an acceptable level the modifications are gradually eliminated until the task no longer differs from naturally occurring tasks.

Example:

A child’s problem behavior with property destruction. The child tears up the paper every time the therapist asks the child to do their math worksheet. In order to reduce this problem behavior the therapist has copied the homework onto a sheet of colored paper and added fun stickers next to each math problem. Once the child no longer rips the worksheet, the therapist gradually removes the number of stickers and lightens the color of the paper until the original math worksheet with no stickers is presented to the child.

In this example, the problem behavior was maintained by Social Negative Reinforcement in the form of escape from demands, so the stimulus materials were modified during treatment. The addition of the child’s favorite color and stickers to the worksheet reduced the aversiveness of the task.

Other modifications the therapist could have used include: providing a math sheet with easier math problems, choosing a more desirable location (such as outdoors on a trampoline), or letting the child choose the order of homework completion with the math sheet last.

Behavioral Momentum

Behavioral Momentum is another antecedent based intervention designed specifically to reduce problem behavior maintained by social negative reinforcement.

Behavioral Momentum is the presentation of several High Probability demands to a single Low Probability demand, resulting in an increased likelihood that the Low Probability demand will occur. Behavioral momentum is also referred to as the High P/Low P sequence of instruction.

  • High Probability Demand (High P): Is a demand that is very likely to occur, and does not evoke problem behavior. In other words, mastered responses that are relatively easy for the child are high probability demands.
  • Low Probability Demand (Low P): Is a demand that is unlikely to occur, and does evoke problem behavior. In other words, acquisition responses that are relatively difficult for the child are low probability demands.

Behavioral Momentum works by eliminating the Establishing Operation (EO) for the problem behavior if the demand context is less aversive the child is less motivated to escape it.

Increasing the number of High P demands reduces the aversiveness of the Low P demands. Initially, several High P demands are presented along with a single Low P demand. Once the problem behavior decreases the number of High P demands are decreased and the number of Low P demands are increased. This continues as the problem behavior decreases until only Low P demands are presented. it is important to note that the Low P/High P sequence of demands is presented very rapidly with two to three seconds maximum between each demand, to build momentum in responding.

Example:

The child maintains crying. The child has learned to say the name of several different animals when each is shown to them without protesting or crying (this is referred to as ‘tacting’). The child is currently learning to tact a new target, ‘giraffe’. However, each time the therapist presents a picture of a giraffe in mass trials the child immediately starts crying. On day one of the intervention the therapist presents the child with several consecutive trials of mastered items: T1) monkey,  T2) elephant, T3) bird, T4) snake, and T5) zebra followed by one trial of the target item T6) ‘giraffe’.

Soon, the child is no longer crying when presented a picture of the giraffe because the task is less aversive when preceded by several consecutive easy tasks.

For the next couple of days the therapist continues to present 5 High P demand trials followed by  1 Low P demand trial (Target Item). On the third day, the therapist presents 3 High P demand trials followed by 1 Low P demand trial (Target Item). The crying remains at low levels as the trials maintain a 3 to 1 ratio. On the fifth day that ratio changes to 1 to 1. The child continues to respond to the target item without crying when it is preceded by a single High P demand. After a few more days, the therapist no longer presents mastered items before presenting the target item. At this point the target is presented alone and the child is no longer crying.

Behavioral Momentum can also be used to decrease problem behavior maintained by an escape from an aversive setting or sensory stimulus. If the problem behavior is maintained by an aversive setting the therapist would take the child to several High P settings that the child is likely to enter and not scream in, followed by 1 Low P demand (the aversive setting).

Example Aversive Setting:

The child screams and runs away from the therapist in order to avoid going into church. The therapist takes the child into the curch’s playground, nursery and library before taking her into the main entrance of the church.

Similarly if the aversion was Sensory Stimuli the therapist would present several non-aversive stimuli prior to presenting the aversive sound, smell, sight, touch or motion.

Example Sensory Stimuli:

The child runs away each time they are asked to identify broccoli because they do not like the way it smells. So the therapist first presents a flower, scented markers, and cinnamon sticks prior to presenting the aversive stimuli (broccoli).

Review:

Antecedent Based Interventions focus on changing the environment and interactions with the child before the problem behavior occurs in order to prevent it from happening and include Non-Contingent Reinforcement, Demand Fading, Task Modification and Behavioral Momentum.


Consequence Based Interventions

What are Consequence Based Interventions?

Consequence Based Interventions are interventions designed to weaken the problem behavior in one of two ways:

  1. By eliminating the reinforcer maintaining the problem behavior, or
  2. By providing an aversive consequence contingent upon the occurrence of the problem behavior.

Practically speaking, consequences are manipulated so the problem behavior no longer results in favorable objects or events for the child. In other words, the behavior is no longer reinforced. The other option is to provide aversive consequences for the problem behavior so the child is no longer motivated to engage in the problem behavior; meaning the behavior results in unfavorable consequences.

Eliminating the Reinforcer:

Behavior occurs because it is reinforced, which means that problem behavior occurs when it is reinforced but does not occur when it is not reinforced. Eliminating the maintaining reinforcer can eliminate problem behavior. For example, if a child’s spitting behavior is reinforced by seeing their parent’s horrified expression, then the reinforcer can be eliminated by having their parents maintain a neutral expression when the child spits. In the absence of the reinforcer, the behavior is less likely to occur.

Aversive Consequences:

Similarly, behavior occurs when it is followed by the presentation of a preferred stimulus or the removal of an aversive stimulus. Consequences for problem behavior may also include providing aversive consequences contingent on the occurrence of the behavior. Behavior is weakened when it is followed by the presentation of an aversive stimulus or the removal of a preferred stimulus. As a result the child is not motivated to respond when the consequence for the behavior is unfavorable to the child.

Example:

A child’s whining behavior has been reinforced in the past. The child wants cookies from the top shelf in the pantry. Unable to reach the cookies the child whines. The parent then gets the cookies and provides the child with a cookie.

In the child’s therapy sessions the child can earn tokens that allows them to purchase stickers from the therapist. Every time the child whines the therapist takes one of these tokens away. Following the aversive consequence of losing a token the problem behavior of whining is less likely to occur.

Types of Consequence Based Intervention:

Extinction:

Extinction procedures focus on eliminating the maintaining reinforcer. Extinction is the process in which previously reinforced behavior no longer results in reinforcing consequences, and therefore the behavior stops occurring or the frequency of problem behavior is reduced because it is no longer reinforced. So, if problem behavior is maintained by access to a toy, than an extinction procedure would involve no longer giving the child a toy when they engage in the problem behavior. Extinction works by eliminating the functional reinforcer for the problem behavior. Therefore it is important that the reinforcer is accurately identified through an FBA (or Functional Behavior Assessment). Implementation of extinction is different for each function of problem behavior.

Extinction Characteristics:

Gradual Decrease: Extinction behavior generally results in a gradual decrease of behavior rather than an immediate or rapid reduction. It may take several days or weeks before a problem behavior ultimately stops.

Spontaneous Recovery: Spontaneous recovery is when a behavior that has been previously extinguished occurs again in circumstances in which it was previously reinforced. Practically speaking, spontaneous recovery is when the problem behavior occurs again, even after it has not occurred for some time. If spontaneous recover occurs and the behavior is not being reinforced the behavior will extinguish again very quickly. However, if spontaneous recovery occurs and the behavior is being reinforced than the behavior is strengthened. As a result it is important to continue to implement the extinction procedure as long as the desire is to have the behavior extinguished.

Example:

A child’s whining behavior. The behavior was extinguished by no longer providing the desired item (a cookie). Because of this the child has not whined for several weeks, however, the child recently whined when they observed a parent eating a cookie. If the parent were to provide the child a cookie, the whining behavior would be reinforced, increasing the likelihood of future whining. Alternately, if the behavior is not reinforced and the extinction procedure is continued than the behavior is likely to rapidly extinguish.

Extinction Burst: An extinction burst is when the behavior on extinction briefly increases in frequency, duration or intensity before it decreases and stops. Essentially what this means is an extinction burst is when the behavior on extinction actually worsens before it gets better.

Example:

A child’s whining behavior is on extinction, (i.e., the whining behavior no longer results in access to cookies). Initially, the frequency, the intensity, and the duration of the behavior increase with the child whining more, louder and longer. New problem behaviors emerge (novel responses) as the child starts screaming and jumping in addition to whining. Aggressive behaviors also occur when the child starts crying and hitting their parent when they do not receive their wanted item (cookies). As long as the reinforcer (a cookie) is not provided, the problem behavior and the other new responses that emerged during the extinction burst will eventually decrease and stop. However if the problem behavior is reinforced (the child getting a cookie) following an extinction burst the problem behavior and any other responses that emerged during the burst are strengthened, making all of those responses more likely to occur the next time the child wants their reinforcer (i.e., cookie).

Novel Responses: May occur when extinction is initially implemented. Novel responses are behaviors that do not typically occur in a particular situation. Novel responses may include: Emotional responses such as crying, Aggressive responses such as hitting.

This highlights the importance of continuing extinction once it has been implemented to avoid reinforcing louder, longer and more frequent whining, jumping, crying, and hitting.

Extinction Application Using the Four Functions of Behavior:

Social Positive Reinforcement: A child’s pinching behavior is maintained by attention. The BCBA has conducted an FBA and has determined that the therapists attention is maintaining the problem behavior. Extinction is implemented and the therapist no longer provides attention of any kind when the child pinches. The therapist does not flinch, make eye contact, talk or reprimand the child. After a while, the child is no longer pinching. In this example, the functional reinforcer “attention” was no longer provided following the occurrence of problem behavior. This is considered extinction for attention maintained problem behavior; frequently called planned ignoring because the therapist plans to ignore the behavior. If the behavior is maintained by access to items, the specific snack, toy or activity that previously reinforced the behavior is withheld.

Social Negative Reinforcement: Extinction can also be used for behaviors maintained by social negative reinforcement. In these cases escape from the aversive demand, setting or sensory stimulus is the functional reinforcer so during extinction escape is not allowed.

Example:

A child’s hitting behavior is reinforced by social negative reinforcement or in other words as determined by the BCBAs FBA the child’s hitting behavior is reinforced by escape from demands. In working with the therapist the child has been hitting to avoid completing a task. The therapist is teaching the child to answer social questions. The therapist asks, “what is your name”. In response the child hits the therapist, because in the past hitting was reinforced by a break in demands. Now, using extinction the therapist does not allow the child to take a break, but rather continues to present demands when the child hits. After the child hits, the therapist repeats the question, “what is your name”. The therapist continues to repeat the question and prompts, “say Name” to ensure compliance with the demand as long as the child continues to hit. After a while, the child is no longer hitting when asked social questions.

If the problem behavior  is maintained by escape from a setting than the therapist would keep the child in that setting when the problem behavior occurs. Similarly, if the problem behavior is reinforced by sensory stimuli than the therapist would continue to present the stimulus when problem behavior occurs.

Automatic Positive Reinforcement: Problem behavior maintained by automatic positive reinforcement can also be decreased with an extinction intervention. Sensory extinction is another name for problem behavior reinforced by automatic positive reinforcement. Sensory extinction involves elimination of the preferred stimulus that is produced by the problem behavior.

Example:

A child is expressing disruptive problem behavior. The BCBA has determined through an FBA that the behavior is reinforced maintained by automatic positive reinforcement, and in this example case it is in the form of the child abruptly leaving their desk, running to the teacher’s desk to sniff the scented markers. After sniffing all of the markers the child runs back to their desk.  In order to decrease the child’s disruptive behavior the teacher replaces the fruit smelling markers with markers that do not have an odor. Now, when the child runs across the room and sniffs the markers the behavior does not result in a pleasant smell. After a while the child is no longer disrupting the class to smell the markers. In this example the reinforcer was eliminated by replacing the fruit scented markers with markers that had no odor.

However, it is not always possible to eliminate the reinforcer for automatically maintained behavior, because automatic reinforcement is produced by the behavior itself rather than by another person which means that it can be extremely difficult to eliminate the reinforcer of the problem behavior. For example, is not possible to eliminate how it feels when a child spins in a chair or how it sounds when a child says “choo choo” or how it looks when a child pokes his eyes. In these cases instead of eliminating the reinforcer the production of the sensory stimulus is blocked. Response blocking is an extinction procedure in which the source of the sensory reinforcement is blocked. In other words response blocking involves eliminating the access to the reinforcer by blocking the response.

Example:

A child is expressing self-injurious behavior by poking themselves in the eye. Specifically, the child closes their eyes and then pokes the corner of their eye. The BCBA has conducted an FBA which has determined that the eye poking is automatically reinforced by the bright, colorful images it produces. The therapist cannot eliminate the images produced by the eye poking so extinction is implemented in the form of response blocking. Now when the child starts to lift their hand toward their face to poke their eye the therapist intervenes by placing their hand over the child’s so that the child cannot reach their eye. The source of the reinforcement (eye poking) is blocked by the therapist in order to eliminate the sensory stimulus (the bright colorful pictures).

Automatic Negative Reinforcement: Problem behavior maintained by automatic negative reinforcement can also be decreased with an elimination intervention. The same procedures sensory extinction and response blocking that are used to eliminate behaviors maintained by automatic positive reinforcement can be used to decrease problem behaviors maintained by automatic negative reinforcement.

Example:

A child is displaying self-injurious behavior. Any time the child’s mother cooks fish, the child runs to the bathroom, grabs several cotton balls and stuffs them up his nose (often causing it to bleed). The BCBAs FBA revealed that the child’s self-injurious behavior is maintained by automatic negative reinforcement in the form of escape from the aversive smell of the fish. In order to decrease this behavior the mother has replaced the regular cotton balls with cotton balls that smell like fish. Now, when the child runs to put cotton balls in his nose the escape from the smell becomes impossible and eliminates escape from the aversive stimulus. After a while, the child is no longer hurting themselves by stuffing cotton balls up their nose.

Just like automatic positive reinforcement it is not always possible to eliminate the reinforcer for automatic negative reinforcement.

Example:

A child’s problem behavior is head banging. The child bangs their head against the wall, often causing bruising and swelling. An FBA has determined that the automatic negative reinforcement produces momentary relief from headache pain. The therapist cannot eliminate the brief pain relief produced by the head banging so extinction is implemented in the form of response blocking. Now, when the child starts to bang their head the therapist moves the child away from the wall so they cannot reach it. The source of the reinforcement “head banging” is blocked by the therapist in order to eliminate the reinforcing sensory stimulus, “momentary pain relief”.

No matter what the function is extinction involves eliminating the reinforcer maintaining the problem behavior.

Response Cost:

Response Cost procedures focus on behavior reduction by providing aversive consequences to reduce problem behavior when the behavior occurs. Specifically, a response reduction procedure in which behavior is weakened by the removal of a specified amount of a reinforcer, contingent upon the occurrence of the problem behavior. In other words, the frequency of problem behavior is reduced because it results in the loss of a preferred stimulus. So when the problem behavior occurs, the therapist takes away a token, or a snack, toys or a preferred activity or indeed any preferred reinforcer that child may have. Response cost works by providing an aversive consequence for the problem behavior. As a result, it is not necessary to identify the function of problem behavior prior to implementing a response cost procedure. And the procedure is the same regardless of the function of problem behavior.

Example:

A child displays pushing behavior. Currently, the child earns one token for each correct response they make in their object labeling program,  they must earn ten tokens before they can exchange them for a preferred activity. However, every time the child pushes their therapist the therapist removes one token from the token board. Soon, the child is no longer pushing their therapist. Note that the function of the pushing behavior is not specified. Regardless of whether the child’s pushing was maintained by socially mediated or automatic positive or negative reinforcement the aversive consequence (of losing tokens) resulted in a decrease of problem behavior.

In this example, the token was the reinforcer that was removed contingent upon the occurrence of the behavior. However, any reinforcer that is easily removed including the opportunity to access a specified reinforcer can be used during Response Cost.

Example:

A child displays stereotypy. At school the child is provided with 5 minutes of computer time for completing each in-class assignment. However, the child frequently disrupts the class with repeatedly singing or humming their favorite song while working on those assignments. The program supervisor implements a Response Cost intervention for the child’s stereotypy. With the intervention, each time the child hums or sings during an assignment they lose 1 minute of computer time. Soon, the child is no longer singing or humming while working on assignments. The aversive consequence of losing computer time is enough to reduce the problem behavior regardless of the function of the problem behavior.

Time Out:

Time Out procedures focus on behavior reduction. Specifically, Time Out is a response reduction procedure in which behavior is weakened by the brief removal of all sources of Social Positive Reinforcement contingent upon the occurrence of the problem behavior. Practically speaking, the frequency of problem behavior is reduced because it results in a brief period of time in which the child is denied access to all preferred stimuli.

The removal of all sources of socially mediated positive reinforcement includes removing all current reinforcers that the child has access to as well as preventing the child from gaining access to any additional reinforcers during the time-out period. So when the problem behavior occurs the therapist removes the child from any ongoing activity, preferred stimuli and attention for a few minutes. Since time-out involves time out from positive reinforcement this intervention is only effective for behavior maintained by social positive reinforcers and is not used to decrease behaviors maintained by automatic reinforcement or social negative reinforcement.

If the problem behavior is maintained by escape from an aversive setting, stimulus or demand than removing the child to a time-out is reinforcing the behavior and not reducing it. Likewise, if the function of behavior is automatic than eliminating socially mediated reinforcers will have no effect on the problem behavior. Time out is only effective when it involves a shift from a more preferred environment to a less preferred environment. Moreover, time out is contingent upon problem behavior. This means that time out is only implemented following the occurrence of problem behavior and not at any other time. In addition, the time out period should be brief. A child should only be removed from reinforcing activities, preferred stimuli and attention for a very short period of time. Typically, 1 to 10 minutes. At the end of the time out period the child is returned to the original environment and activity where the problem behavior occurred.

However, if the child is engaging in problem behavior at the end of the time out period than time out is extended by an additional 15 seconds.

There are three types of time out:

Non-Exclusionary: Is leaving the child in the room where the problem behavior occurred, but removing the child from any ongoing activities as well as other positive reinforcers.

Example:

Following problem behavior the therapist slides the child and their chair away from the painting table (the current activity) and out of reach of any other preferred toys for 1 minute. When a BCBA specifies the use of time out, it is typically non-exclusionary time out.

Exclusionary: Is removing the child from the room where the problem behavior occurred, and taking the child to another place for brief period of time. In this way, all sources of positive reinforcement are removed. An example of this would be a teacher asking the ABA to take the child to the hallway or another classroom following a problem behavior. Exclusionary time out is a more intrusive intervention and is rarely specified by a BCBA.

Secclusionary: Is removing the child from the room where the problem behavior occurred and closing the child in a separate room alone. This type of time out will never be specified by the BCBA. And the child should never be left alone for any reason.

Remember, time out is only effective in reducing problem behavior maintained by social positive reinforcement.

Example:

A child displays the problem behavior of inappropriate language. The child frequently yells curse words when playing on the playground. Each time the child swears, the therapist walks the child to the side of the playground and has the child sit in the grass for three minutes. During the three minutes the therapist continues to interact with the other children and does not provide attention to the child. At the end of the 3 minutes the therapist tells the child that they can come back now.  After a few days, the child is no longer swearing at their friends. In this example, the child’s language was maintained by socially mediated positive reinforcement in the form of attention. And the time out involved removing the child from the play activities, removing access to the playground and eliminating attention.

Example:

A child is displaying screaming behavior. The child screams at their friends when they want their toys. The BCBA implemented a time out procedure for the child’s screaming. As a result each time the child screams at their friends the therapist has the child sit in a chair in the corner of the playroom for five minutes. At the end of five minutes the child is still screaming so the therapist continues the time out until the child has been quiet for 15 seconds. The therapist than brings the child back to the play area and lets them continue playing with their friends. Soon, the child is no longer screaming at their friends. The aversive consequence of losing access to all socially mediated reinforcers reduced the child’s screaming.

Example: 

The therapist is teaching a child to say sounds and presents cards as the stimulus for the sound. The child swipes the card off the table when the card is presented thereby delaying the demand. The behavior is maintained by social negative reinforcement by escape from demands when during the lesson the delay occurred when the therapist had to retrieve the card and again when after several attempts the therapist allows the child a break from the lesson. The child engaged in the problem behavior because it resulted in a delay of demands.

Example:

Again the child is swiping cards off the table, an inappropriate behavior that has been maintained by escape from demands. However this time the therapist has implemented a consequence based intervention to decrease the child’s problem behavior. When the therapist presented the SD to the child and the child swiped the card away, the therapist immediately provided the demand again with a new card instead of waiting to retrieve the swiped card along with a prompt to help ensure the child answered correctly. This time there was no delay in demands and the problem behavior decreased. This intervention involved escape extinction, or in other words the extinction of escape behavior. Specific to this example, the reinforcer was removed which had been the delay received upon swiping the cards off the table.

 


Replacement Behavior Based Interventions

What is Replacement Behavior Based Intervention?

Replacement behavior based interventions are designed to teach a child an appropriate substitute for problem behavior by eliminating reinforcement for problem behavior and providing reinforcement for a replacement behavior.  In other words, appropriate behavior is reinforced while problem behavior is extinguished. This process is referred to as differential reinforcement.

What is Differential Reinforcement?

Differential reinforcement is the combination of two consequence manipulations. Reinforcement of the replacement behavior and extinction of the problem behavior. Behavior occurs because it is reinforced. As a result of differential reinforcement the replacement behavior is more likely to occur because it is reinforced while the problem behavior is less likely to occur because it is not reinforced.

Example:

A child has the problem behavior of spitting. This is reinforced by seeing their parent’s horrified expression. The reinforcer can be eliminated by having the parent’s maintain a neutral expression. In the absence of the reinforcer “horrified expression” the problem behavior “spitting” is less likely to occur. In addition to extinguishing the problem behavior the therapist/and parents also praise the child when they sip water from their cup (the replacement behavior). The new behavior is more likely to occur because it produces a reinforcer in the form of social praise.

The specific elements of differential reinforcement were extinction of the problem behavior by eliminating the parent’s horrified expression and reinforcement of the replacement behavior by providing social praise. The intervention works by manipulating the consequences for problem and replacement behaviors. It is considered a replacement based intervention because the focus in on increasing appropriate behavior in addition to decreasing problem behavior.

Three Types of Replacement Behavior Based Interventions:

(DRO) Differential Reinforcement of Other Behavior: Differential reinforcement of other behavior is the delivery of reinforcers on an interval schedule, contingent on the absence of the problem behavior. With DRO, a specific replacement behavior is not identified, rather any appropriate behavior other than the problem behavior is reinforced. Practically speaking, if during a specified period of time the problem behavior occurs reinforcement is withheld however if the problem behavior doesn’t occur than reinforcement is provided.

With DRO the reinforcement is delivered on an interval schedule. A reinforcement schedule specifies when the therapist will provide reinforcement for a behavior. An interval schedule is a schedule of reinforcement in which the first response after a specified interval is reinforced. So when implementing DRO reinforcement (SR) is provided at the end of the interval as long as appropriate behavior is occurring. In DRO a specific replacement behavior is not required. Any appropriate behavior suffices. And that behavior will be reinforced or strengthened to replace the inappropriate behavior.

The interval schedule of the reinforcement is determined by the frequency of the problem behavior. So, the more frequently the problem behavior occurs than the shorter the interval should be. This means that if the problem behavior occurs approximately every ten minutes than the interval should be less than every ten minutes. Once the problem behavior decreases to an acceptable level the interval schedule of reinforcement is gradually increased until it reaches a naturally occurring schedule.

There are several components of DRO that must be determined, including:

Two Types of Reinforcers Used in Replacement Behavior Based Interventions:

Reinforcers may either be functional or competing.

  • A Functional Reinforcer is an object or event that is maintaining the problem behavior. So if problem behavior is maintained by attention than attention is the functional reinforcer. Differential Reinforcement Procedures are typically more effective when functional reinforcers are used because the child is already motivated to get the reinforcer. However, functional reinforcers may be difficult to provide contingent upon the problem behavior. In that case a Competing Reinforcer can be used.
  • A Competing Reinforcer is a preferred object or event that inhibits problem behavior. So if a child likes to listen to music and does not engage in problem behavior while listening to music than music is a competing reinforcer. A competing reinforcer may also be a reinforcer that is more powerful than the functional reinforcer maintaining the problem behavior. For example, if a child’s pinching behavior is maintained by attention in the form of a reprimand access to a preferred snack may be a more powerful reinforcer than a reprimand. In this case, the reinforcer for not pinching is better than the reinforcer provided when engaging in the problem behavior

Two Types of Interval Schedules of Reinforcement Used in Differential Reinforcement of Other Behavior:

The second component of DRO is determining which kind of interval schedule to use. There are two types of interval schedules of reinforcement that may be used in DRO intervention. Momentary and Whole Interval

  • A Momentary Interval Schedule is when the reinforcer is delivered if the child is not engaging in the problem behavior at the end of the time interval. This means that the child may engage in problem behavior during the time interval and still receive the reinforcer as long as the problem behavior does not occur at the end of the interval.
  • A Whole Interval Schedule is when the reinforcer is delivered contingent on the absence of problem behavior throughout the interval. This means the reinforcer is only delivered if the child is not engaging in the problem behavior at all during the entire interval. Whole interval schedules are typically more effective and more commonly used than momentary schedules. However, after the problem behavior has been reduced using a whole interval schedule and the interval has been increased to a much longer duration momentary schedules may be effective.

The Difference Between a “Resetting” and “Non-Resetting” Differential Reinforcement of Other Behavior Intervention:

The third and final component of a DRO is whether or not the DRO intervention  has a resetting feature. This component applies only if the DRO has a Whole Interval schedule of reinforcement. If the DRO has a resetting feature than the DRO interval is restarted contingent upon the occurrence of the problem behavior. For example, if the DRO is 1 minute and the child engages in problem behavior after 45 seconds than the reinforcer is not delivered and the reinforcement interval is restarted to zero and the new minute starts. If the DRO intervention is non-resetting than the DRO interval is not restarted upon the occurrence of problem behavior. This means that if the DRO interval is 1 minute in duration and the child engages in problem behavior after 45 seconds the reinforcement interval is not reset. Instead the remaining 15 seconds of the 1 minute interval passes and a reinforcer is NOT provided because problem behavior occurred. The next 1 minute interval than follows.

(DRA) Differential Reinforcement of Alternative Behavior: Differential reinforcement of alternate behavior is the delivery of reinforcers contingent on an alternative response. With DRA a specific replacement behavior is identified and only that specific behavior is reinforced. Practically speaking, DRA involves delivery of reinforcers for an alternative response and extinction for problem behavior. In DRA the reinforcer is contingent upon the occurrence of an alternative response. This means that if the problem behavior occurs than the functional reinforcer is withheld, however if the alternative response occurs than reinforcement is provided. However if the problem behavior and the alternative response occur simultaneously than therapist should not provide the reinforcer at that time, instead the therapist should wait for the alternative response to occur without the problem behavior in order to provide the reinforcer. In this way, the therapist does not accidentally reinforce the problem behavior.

DRA works by increasing an alternative response that can replace a problem behavior. Initially, an alternative response is reinforced on a continuous schedule. Recall, that a continuous schedule of reinforcement is used when establishing or teaching new behaviors and involves reinforcing every occurrence of the alternate behavior. This means that a reinforcer is delivered every time the child engages in the alternative response. Once the child is engaging in the response independently and the problem behavior decreases to an acceptable level an intermittent schedule of reinforcement is applied. Recall that an intermittent schedule of reinforcement is used to maintain behaviors that are already established or mastered and involves reinforcing some occurrences of a specific behavior, but not all occurrences of that behavior. This means that once the alternative response has been strengthened you might only provide reinforcement very fourth or fifth time it occurs.

As with DRO the first component of DRA procedure that must be determined is the type of reinforcer to be delivered. Reinforcers can either be functional or competing. As previously discussed differential reinforcement is typically more effective when functional reinforcers are used, however, competing reinforcers may be used when functional reinforcers are difficult to provide.

The next component of the DRA is to establish the type of replacement behavior to be reinforced. Replacement behaviors can either be alternative, communicative, or incompatible.

Three Types of Replacement Behaviors used in Differential Reinforcement of Alternative Behavior:

  • Alternative Behavior: Is a specific desirable behavior that is reinforced by either the functional or competing reinforcer. It does not involve requesting the reinforcer and is not incompatible with the problem behavior. For example if the problem behavior is attention maintained pinching an alternative response may be humming.
  • Communicative Behavior: Is when the child requests access to the reinforcer maintaining the problem behavior. A communicative response could be the child asking for attention, a toy, or even a break from work. This means that the alternative response specifies the functional reinforcer to be provided. For example, if the problem behavior is maintained by attention, a communicated response could include the child saying  watch me. When the alternative response is communicative the procedure is often referred to as Differential Reinforcement of Communicative Behavior: DRC. It is also referred to as Functional Communicative Training: FCT. Because the child is taught to engage in a communicative response that produces the same reinforcing consequence that was maintaining the problem behavior. Communicative responses are useful because they specify what reinforcer should be provided.
  • Incompatible Response: Is a specific desirable behavior that is physically incompatible with the problem behavior, so that both responses cannot occur at the same time. For example, if the problem behavior is yelling an incompatible behavior could be whispering, likewise if the problem behavior is spitting food, an incompatible response could be chewing and swallowing the food. When the alternative response is incompatible the procedure may be referred to as Differential Reinforcement of Incompatible Behavior: DRI. Incompatible responses are useful when the problem behavior tends to co-occur with other alternative responses. By reinforcing an incompatible behavior the problem behavior is never accidentally reinforced because it happened at the same time as the replacement behavior.

No matter what kind of replacement behavior is reinforced: Alternative, communicative or Incompatible they are all forms of DRA and the procedure is the same

(DRL) Differential Reinforcement of Low Rates of Behavior: DRL is the delivery of reinforcers contingent on a reduced rate of problem behavior. With DRL, the replacement behavior is a lower frequency of the problem behavior. Practically speaking, reinforcement is provided when the problem behavior occurs less frequently during a specified period of time and reinforcement is not provided when the behavior occurs at a high rate. DRL is useful when low rates of problem behavior are acceptable. Some behavior is problematic due to the frequency in which the behavior occurs, in other words the behavior would be appropriate in a single or limited occurrence but it becomes problematic when it is repeated frequently.

Example:

A child has just learned to raise their hand and ask to go to the bathroom when they need to use the bathroom at school. However, the child is now saying it every few minutes throughout the day. Asking to go to the bathroom is not a problematic behavior in itself, rather it is problematic because it is happening so frequently that it is interfering with the child’s ability to learn.

Other replacement behaviors including those that are strengthened in DRA may become problematic if they occur too frequently. For example, frequently asking for breaks, the teacher’s attention, access to toys, a snack or playtime can all be problematic if they occur at high rates. DRL does not eliminate the behavior, instead it reduces the frequency or rate of occurrence of the behavior. There are two types of reinforcement schedules used in differential reinforcement of low rates of behavior.

Two Types of Reinforcement Schedules Used in Differential Reinforcement of Low Rates of Behavior:

Full Session: In the Full Session DRL reinforcement is provided if the problem behavior occurs less than a specified number of times throughout the entire session.

Example:

A child is asking to go to the bathroom 20 times per day. In a full session DRL the child is allowed to play at the park after school if the requests are 15 or less per day. If the child asks more than 15 times in a day, than the child is not allowed to play at the park after school.

Spaced Responding: In the Spaced Responding DRL reinforcement is provided for the problem behavior if a specific amount of time has passed since an occurrence of the problem behavior. If a specified amount of time has not passed than reinforcement is not provided for the problem behavior.

Example:

A child is requesting scented markers every 30 seconds. In a spaced responding DRL the child is provided with the markers only if they wait at least 40 seconds after the last request. If the child raises their hand prior to the 40 seconds than the reinforcer is not provided.

How Each Replacement Behavior Based Intervention can be Used for Each of the  Four Functions of Behavior:

We will now look at how DRO is applied for each of the four functions of behavior

Social Positive Reinforcement:

DRO: An example of DRO (Differential Reinforcement of Other Behavior) for the Socially Mediated Positively Reinforced behavior for a child’s attention maintained pinching behavior. This example has a Functional Reinforcer, A Whole Interval Schedule and a Resetting Feature.

Example: 

The child engages in pinching approximately every minute. Initially the therapist provides the child with attention every 30 seconds that the child doesn’t engage in the problem behavior. In addition, the therapist resets the timer each time the child engages in pinching during the 30 second interval. The therapist does not provide any attention for pinching or when restarting the time. Soon the child is no longer pinching the therapist in order to get attention because pinching no longer results in attention. Rather the absence of pinching produces the reinforcement that the child wants. Over the next several days the child’s pinching behavior remains at low levels as the therapist gradually increases the interval from 30 seconds, to a minute, to 2 minutes and so on until the therapist is providing attention after 10 minutes of no pinching.

If a problem behavior is maintained by access to a tangible item (such as a toy, snack or activity) than access is provided contingent on the absence of the problem behavior.

Another example of DRO for socially mediated positive reinforced behavior through access to a tangible item. This example has a Whole Interval schedule and no resetting feature.

Example:

The child engages in hitting. The child frequently plays with their younger sibling, with the same toys. When the sibling takes a toy away the child hits their sibling. The sibling starts crying, drops the toy and runs to tell their parent. When the sibling runs off, the child picks up the toy and begins playing with it. Now, with the implementation of the DRO the therapist gives the child following every ten minutes of play in which the child does not hit their sibling. In addition when the child does hit their sibling the therapist grabs any toy that the sibling drops and keeps that toy for the remainder of the ten minute interval. At the end of the ten minute interval the therapist does not give the child a toy because of the hitting during the interval. Instead the next ten minute interval begins. Since the DRO in this example has no resetting feature the therapist does not restart the timer when the child hits. So, if the child hits their sibling 5 minutes into the second interval but doesn’t hit again for the remainder of the interval the therapist would give the child a toy at the end of the next interval (end of the 3rd interval). By withholding the reinforcer for the hitting behavior (the dropped toys), the hitting is extinguished. In addition, other behavior is reinforced when the therapist give the child a toy after 10 minutes without hitting. After several play sessions the child is no longer hitting their sibling in order to get the toys. Again, in this example the DRO includes a whole interval schedule with no reset. The child cannot hit the entire ten minutes in order to get the toy. And because there is no resetting feature the timer does not reset when the child hits.

DRA: An example of DRO (Differential Reinforcement of Alternative Behavior) for the Socially Mediated Positively Reinforced behavior for a child’s access to a tangible item maintained hitting behavior.

Example:

A DRA has been implemented so that when the child hits their sibling for the toys, the therapist picks up the toys the sibling drops after being hit. In addition, the therapist gives the child a toy each time the child touches their siblings shoulder. Soon, the child is no longer hitting to receive toys because hitting no longer results in access to the desired item, rather touching their siblings shoulder produces the wanted reinforcer. Over the next several days the child’s hitting behavior remains at low levels so the therapist no longer provides a toy every time the child touches their sibling’s shoulder. In this example, the functional reinforcer (a toy) was provided contingent upon the occurrence of an alternative response (touching siblings shoulder).

In the case of a problem behavior maintained by attention, the therapist would provide attention contingent upon the Alternative, communicative, or incompatible response.

DRL: DRL (Differential Reinforcement of Low Rates of Behavior) for the Socially Mediated Positively Reinforced behavior maintained by access to a tangible item.

Example: 

The child has learned to ask for cookies as a replacement for whining. Now, the child is no longer whining for cookies, but they are now asking for cookies every ten minutes. A DRL procedure is used to decrease the rate of asking for cookies. As a result the therapist only gives the child a cookie if eleven minutes have passed since the last request. If the child asks again before 11 minutes has passed, than the therapist does not provide the reinforcer. Soon the child is waiting at least 11 minutes to ask for a cookie. Over the next several days the child’s requesting behavior remains at low rates as the therapist increases the interval from 11 minutes in duration, to 13 minutes, 15, 20 and so on, until the therapist is only providing cookies when requests are spaced out 30 minutes. In this example, the functional reinforcer, cookies, was provided contingent on low rates of the problem behavior. Asking for cookies in a spaced responding DRL.

In the case of problem behavior maintained by access to attention the therapist would provide attention contingent upon a lower rate of problem behavior.

Social Negative Reinforcement:

DRO: DRO (Differential Reinforcement of Other Behavior) for Socially Mediated Negatively Reinforced behavior for a child’s problem behavior results in the therapist not providing escape from a demand, setting or sensory stimulus contingent on the problem behavior. Rather the functional reinforcer is provided contingent on the absence of problem behavior for a specified period of time. The following example has a whole interval schedule with a resetting feature.

Example: 

The child crawls under the table approximately every ten minutes to escape from their lessons. So the therapist provides a break from work every 8 minutes in the absence of the problem behavior, in addition the therapist continues to provide instructions and prompts to ensure compliance and restarts the interval each time the problem behavior occurs. Soon the child is no longer crawling under the table to escape their lessons.

If the problem behavior is maintained by escape from a setting than the therapist would allow the child to leave that setting on an interval schedule contingent on the absence of the problem behavior. Similarly, if the behavior is maintained by escape from a sensory stimulus the therapist would remove that sound, smell, sight, touch or motion on an interval schedule contingent upon the absence of the problem behavior.

DRA: Can also be used to decrease problem behavior maintained by social negative reinforcement. In these cases escape from the aversive demand, setting or sensory stimulus is no longer provided contingent on problem behavior.  Rather the functional reinforcer is provided contingent on a specified replacement behavior.

Example:

A child scratches themselves every time a parent turns on the vacuum, as a result, the parent typically turns the vacuum off. An FBA revealed that the self-injurious behavior is maintained by social negative reinforcement in the form of  escape from the aversive sound of the vacuum cleaner. A DRA was implemented so now when the child scratches themselves the parent no longer turns off the vacuum cleaner. In addition, the therapist prompts the child to say off. The parent turns the vacuum cleaner off each time the child say’s off. Soon, the child is no longer scratching themselves and is saying “off” when the vacuum cleaner is turned on. In this example, the specified replacement behavior is a communicative response in which the child requested the functional reinforcer to turn the vacuum off.

Recall, that this type of DRA may also be referred to as DRC or the Differential Reinforcement of Communicative Behavior or FCT Functional Communication Training, because the replacement behavior is communicative.

If the problem behavior is maintained by escape from a setting, the therapist would allow the child to leave the setting contingent upon the occurrence of a specified replacement behavior. Similarly, if the problem behavior is escape from demands, the therapist would provide a break contingent on occurrence of a specified alternative, communicative or incompatible response.

Example:

Decrease inappropriate mealtime behavior. The child spits their food out  every time the therapist gives the child a bite to eat. In order to decrease this problem behavior the therapist provides a break from the meal contingent on chewing and swallowing the bite of food. In addition, the therapist continues to provide bites of food and prompts to chew the bite each time the child spits their food out. Soon, the child is no longer motivated to spit to escape the meal, because spitting is no longer reinforced. Instead, the child is chewing and swallowing the food because that produces the functional reinforcer (a break from the meal). In this example, the specified replacement behavior (chewing and swallowing) is incompatible with the problem behavior of spitting. Recall, this type of DRA may also be called a DRI because the replacement behavior is incompatible with the problem behavior.

DRL: DRL (Differential Reinforcement of Low Rates of Behavior) for the Socially Mediated Negatively Reinforced behavior. In these cases escape from the aversive demand, setting or sensory stimulus is no longer provided contingent on high rates of problem behavior. Rather, the functional reinforcer is provided contingent on lower rates of problem behavior.

Example: 

The child requests a break approximately every minute in order to escape from their lessons. In order to reduce the frequency of their requests the therapist implements a DRL with a Spaced Response Schedule. In other words, the child is only give a break if she waits 2 minutes between requests. In addition, the therapist continues to provide instruction and prompts to ensure compliance each time the child asks for a break before the specified amount of time has passed. Soon, the child is asking for breaks less frequently.

If the problem behavior is maintained by escape from a setting, the therapist would allow the child to leave that setting on an interval schedule contingent upon a lower rate of the problem behavior. Similarly, if the problem behavior is maintained by escape from a sensory stimuli than the therapist would remove that specific sound, smell, sight, touch or motion contingent on low rates of problem behavior.

Automatic Positive Reinforcement:

DRO: DRO (Differential Reinforcement of Other Behavior) can also be used to reduce problem behavior maintained by Automatic Positive Reinforcement.

Example: 

The child frequently closes their eyes and pokes at the corner of their eye. An FBA (Functional Behavior Analysis) has determined that the eye poking behavior is automatically reinforced by the colorful images it produces. In order to decrease the self-injurious behavior a DRO (Differential Reinforcement of Other Behavior) is implemented. Therapists cannot eliminate the images produced by the eye poking, so extinction is implemented in the form of response blocking. Now, when the child starts to lift their hand towards his face to poke their eye, the therapist places their hand above the child’s so they cannot complete the motion and reach their eye. In addition the therapist provides a token, a competing reinforcer,  contingent upon the absence of problem behavior.

Since the child’s self injurious behavior occurs almost constantly the initial interval  schedule is 5 seconds in duration. This means that the therapist provides a token following each 5 second interval in which the child does not attempt to poke their eye. Since the interval is so short it is difficult for the therapist to reset the interval each time the behavior occurs so a non-resetting DRO is implemented. Over the next few days the child’s self-injurious behavior decreased and is often going 5 seconds or more without poking their eye. On the third day the therapist gradually increased the interval from 5 seconds to 10 seconds. The behavior continues to decrease often going 10 seconds or more without engaging in problem behavior. After a few days of success with the 10 second interval the therapist increases the requirement to 15 seconds in order for the child to receive a token. The child’s self injury continues to decrease, so on day 8 the therapist increases the interval to thirty seconds.  The therapist continues to increase the amount of time the child must refrain from self injury in order to receive a token until the interval has increased to one hour in duration. In this example, the intervention for problem behavior included a whole interval DRO that was non-resetting. In addition a competing reinforcer was used because the functional reinforcer (the colorful images produced by the eye poking) could not be reproduced in the absence of eye poking. Finally, the extinction component of the DRO involved response blocking.

DRA: DRA (Differential Reinforcement of Alternative Behavior) can also be used to treat problem behavior mediated by automatic positive reinforcement.

Example:

A child has the problem behavior of disrupting their classroom (previous marker sniffing examples apply here). An FBA revealed that the disruptive behavior is maintained by automatic positive reinforcement in the form of the pleasant smell of the markers. In order to decrease this disruptive behavior a DRA has been implemented. The teacher replaced the fruit scented markers with unscented markers. This results in the disruptive behavior no longer being automatically reinforced. The pleasant smell is no longer a result of the sniffing. In addition, when the child sits quietly and raises their hand the therapist gives the child the fruit scented markers. After a while, the child is no longer disrupting the class. Instead, the child sits quietly at their desk and raises their hand.

In this example the replacement behavior is an incompatible response, in other words the two behaviors cannot occur simultaneously

DRL: DRL (Differential Reinforcement of Low Rates of Behavior) for the Automatically Mediated Positive Reinforced behavior.

Example: 

The child has the problem behavior of stereotypy. In this particular case the child sings/hums their favorite songs while working at their desk. The high rate of this behavior has become distracting to classmates. In order to decrease the child’s stereotypy a Full Session DRL with a competing reinforcer (computer time) procedure has been implemented. If the child can sing/hum 4 or less times in the school day, the child will receive 5 minutes of computer time. Alternately, if the child sings/hums more than 4 times per day the computer time is not received. As a result the child is still singing and humming at their desk, but rarely more than 3 times per day.

Automatic Negative Reinforcement:

DRO: DRO (Differential Reinforcement of Other Behavior) can also be used to reduce problem behavior maintained by Automatic Negative Reinforcement. In these cases escape from aversive sensory stimulus is no longer provided contingent on problem behavior. Rather, a reinforcer is provided contingent on the absence of problem behavior for a specified period of time.

Example: 

The child turns off the classroom lights several times a day to escape the bright lights of the classroom, so the therapist lets the child play on the computer only if they can go 30 minutes without turning off the lights. If the child does turn off the lights, than the therapist immediately turns the lights back on and resets the time interval. Soon the child is no longer turning the lights off.

In this example, the therapist is providing a competing reinforcer (computer time) during a whole interval DRO with a resetting feature.

DRA: DRA (Differential Reinforcement of Alternative Behavior) can also be used to treat problem behavior automatic negative reinforcement. The same procedures: extinction of the problem behavior and reinforcement of the replacement behavior, that are used to treat automatic positive reinforcement can be used to decrease problem behavior maintained by automatic negative reinforcement.

Example:

A child has the problem behavior of self-injury. The child’s favorite playground activity is sitting on the merry. However, the child hates sitting on the merry-go-round when it is in motion. So when any of the other children get on the merry-go-round and start spinning it the child jumps off and has injured themselves several times when doing this. Recently the injuries required stitches. An FBA reveals that the behavior is maintained by automatic negative reinforcement in the form of escape from the spinning motion. The therapist cannot eliminate the reinforcer produced by jumping off the merry-go-round so extinction is implemented in the form of response blocking. Now, when the child tries to jump off the merry-go-round the therapist blocks their attempt to jump, in addition, the therapist stops the merry-go-round every time the child yell’s “stop”. Initially, the therapist prompts the child to “say stop”, but fades the prompts as the child begins to say “stop” independently. After a while the child is no longer hurting themselves jumping off the merry-go-round while it is spinning.

In this example, the replacement behavior is a communicative response, which was strengthened by the functional reinforcer escaping the spinning motion of the merry-go-round.

DRL: DRL (Differential Reinforcement of Low Rates of Behavior) for Automatically Mediated Positive Reinforced behavior.

Example: 

The child self-harms, scratching their arms and legs so frequently that they create open sores on their skin. An FBA has demonstrated that the behavior is maintained by escape from sensory stimulus. Specifically, the child has dry itchy skin, and scratches to relieve itchy sensation. The child generally scratches 10 times per session. In order to reduce the rate of scratching a DRL has been implemented using a full session schedule and a competing reinforcer. If the child can scratch 8 or less times per session they are given access to their favorite video game. However, if the child scratches more than 8 times than the reinforcer is not provided. Once the child is consistently scratching themselves fewer than 8 times per session the therapist decreases the number of allowed incidents to further decrease the problem behavior, meaning that on day three, 6 occurrences are allowed, on day five 4 occurrences and so on until the behavior is occurring at such a low rate that it is no longer problematic.

Review:

There are several different types of replacement behavior interventions: DRO (Differential Reinforcement of Other Behavior), DRA (Differential Reinforcement of Alternate Behavior, and DRL (Differential Reinforcement of Low Rates of Behavior).  Each of these replacement behavior based interventions strengthen a different type of replacement behavior. Any other behavior not the problem behavior in a DRO, a specified behavior in a DRA and an acceptable rate of problem behavior in a DRL. However all of the replacement behavior interventions are designed to teach the child an appropriate alternate behavior by eliminating reinforcers for the problem behavior and providing reinforcers for the replacement behavior.


The Behavior Intervention Plan

In previous Behavior Management lessons we learned about Functions of Behavior, how problem behavior can be identified using a Functional Behavior Assessment and how to implement three types of Behavioral Interventions: Antecedent Based Interventions, Consequence Based Interventions, and Replacement Behavior Based Interventions. This lesson will teach you how to interpret the Program BCBA’s written instructions so the behavioral intervention design can correctly be implemented.

It is particularly critical that Behavior Intervention is consistent and it is very important that consistency is part of behavioral intervention procedures. For this reason it is important that the behavior intervention plan or BIP, is interpreted correctly and implemented consistently by everyone working with the child. This lesson will teach you how to interpret everything on the BIP form so that the BCBAs instructions are clearly understood.

The Purpose and Necessary Components of an Effective Behavior Intervention Plan:

A Behavior Intervention Plan is a detailed, written description of the problem behavior and the treatment designed to decrease the behavior. The format and structure of a BIP may vary but the information included will remain the same.

An effective BIP will include three basic sections:

The Identification of the Target Behavior and Its Function: The Target Behavior that the plan was designed to treat will be clearly identified here.

This will include the Date that the BIP was designed, the Target Behavior and operational definition of that behavior and the Function of Behavior that was determined by an FBA or Functional Behavior Assessment. In this example the functions of behavior are abbreviated to save space. So if behavior is maintained by socially mediated positive reinforcement in the form of attention it is said to have an attention function and “attention” is circled on the BIP. Behavior maintained by social positive reinforcement maintained by access to tangible item is said to have a tangible function and “access to tangible” is circled. For behavior maintained by social negative reinforcement of any kind the escape/avoidance function is circled on the BIP. Finally behavior maintained by any automatic reinforcement will have the automatic function circled. It is important to note that the BCBA may use these abbreviations when discussing the functions of behavior.

Example:

A child has the problem behavior of biting their therapists. The BCBA conducted an FBA and determined that the child’s behavior is maintained by Social Positive Reinforcement in the form of attention. On the form this would look like:

A Description of the Intervention: The next section in a BIP provides a detailed description of the interventions designed to reduce the target problem behavior. As you may recall the most effective treatment is one that includes antecedent modifications, consequence manipulations and replacement behaviors to be increased.

  • The Antecedent Modification Section of the BIP specifies how the therapist and caregivers will change the environment and their interactions with the child before the behavior happens in order to prevent the occurrence of the target problem behavior.

Example:

In the biting example, the BCBA has specified Non-Contingent Reinforcement (NCR) as the Antecedent Modification for the biting. Recall that non-contingent reinforcement is the frequent presentation of the reinforcer maintaining the problem behavior on a time based schedule of reinforcement regardless of whether or not the problem behavior occurs. So if NCR is used to decrease the biting behavior the BIP will specify the type of reinforcer and the schedule of reinforcement to be used. In this case the reinforcer is attention and the schedule of reinforcement is very 30 seconds throughout the session.

  • The Replacement Behaviors Section of the BIP specifies the alternative or replacement for the problem behavior. These alternative behaviors are strengthened through reinforcement. A replacement behavior may be an Alternative, Incompatible, or Communicative Response. It may also be a Lower Rate of the problem behavior or any other behavior that is not problematic. Often times the replacement behavior is functionally equivalent to the problem behavior. A detailed description of the replacement behavior to be strengthened will be listed here. It will also indicate the reinforcer and the reinforcement schedule.

Example:

In the biting example, the BCBA has specified the Replacement Behavior as the child saying “talk to me” for the attention maintained problem behavior. This replacement behavior is to be reinforced with attention every time the child says “talk to me”. The replacement behavior of saying “talk to me” is functionally equivalent to the biting behavior, because it results in the desired stimulus (attention). So in implementing this intervention the therapist reinforces the replacement behavior by providing attention when the child says “talk to me”.

  • The Consequence Manipulations section of the BIP describes exactly what the therapist should do after the problem behavior occurs. This section of the BIP includes a detailed description of the consequence based intervention designed to reduce problem behavior.

Example:

In the biting example, the BCBA has specified Extinction as the Consequence Manipulation for the attention maintained biting. The BCBA has specified that all instances of biting are to be ignored. It is important to note that replacement behavior based interventions combine the consequences of reinforcement and extinction in order to strengthen the replacement behavior and weaken the problem behavior. As a result replacement behavior based interventions will include a detailed description of the reinforcer and reinforcement schedule for the replacement behavior in the replacement section of the BIP. In addition, a detailed description of the consequence for the problem behavior will be listed in the Consequence Manipulation section of the BIP. So, since DRC is being used to decrease the child’s attention maintained biting behavior by strengthening the behavior of saying “talk to me” while extinguishing the target problem behavior of biting, the consequence manipulation section of the BIP specifies that extinction should be applied following each occurrence of the biting behavior. The consequence for the target behavior is extinction and the therapist will ignore all instances of biting.

A Description of the Data Collection Requirement: The final section of the BIP provides guidelines for data collection, including the Recording Method, the Recording Measure the Summary Measure and Observation period. Due to the complex nature of this section this will be covered elsewhere in the learning.

Recall that the most effective treatment is one that includes Antecedent Modifications, Consequence Manipulations and Replacement Behaviors to be increased. As a result it is likely that the BIP for problem behavior will include a combination of two or more interventions. In the BIP example, it included the Antecedent Intervention of NCR as well as the replacement behavior of DCR (the DRC combined reinforcement of a communicative response) with the Consequence Manipulation of Extinction of the target problem behavior. As a result the child is provided with attention when they say “talk to me” and is not provided attention when they bite.

It is important to note that a BCBA is more likely to specify some interventions than others. Antecedent Based Interventions and Differential Reinforcement Procedures are the least intrusive intervention and therefore more likely to be included on a BIP. Consequence Based Interventions, particularly Response Cost and Time Out are significantly more intrusive interventions and will only be included on a BIP if other interventions have failed to work. In addition, Extinction, Response Cost, and Time Out will always be combined with a Replacement Behavior Based Intervention.

Prohibited & Emergency Interventions:

There are several interventions that are prohibited by state and federal law.

Extremely invasive interventions (NOT used to decrease problem behavior):

  • Restraint: Restraint is the physical or mechanical restriction of movement, and specifically it involves a person restricting movement, such as holding a child’s hand down so they cannot hit, or using equipment to hold a child down.
  • Seclusion: Seclusion involves placing a child in a room by themselves
  • Aversive Stimuli: Involves presenting an aversive stimuli to a child contingent on problem behavior. An example would be spanking a child when they engage in inappropriate language.

While these interventions are never used as a strategy to decrease problem behavior the BIP may include the use of Emergency Intervention. Emergency interventions are temporary emergency procedures used only in behavioral emergencies when the child is in imminent danger of seriously injuring themselves or hurting another person. For example, restraint may be used as a temporary emergency procedure if a child was about to run into a busy street. The therapist could temporarily restrain the child to prevent serous injury.

Since Emergency Interventions involve extremely intrusive procedures and the laws governing these procedures may vary across locations this generalized training will not include implementation of emergency interventions. However, it is essential that you are trained to identify behavior emergencies, and to implement appropriate emergency intervention procedures by the BCBA.

A therapist should not being working with a child with Autism until this training has been received.

Review:

This lesson has reviewed the necessary components of a Behavior Intervention Plan, and the three major types of intervention that are used to decrease problem behavior. As a therapist it is essential to have a good understanding of the different types of interventions because therapists will be required to implement behavior intervention for a variety of problem behaviors. In order to effectively implement behavior intervention plans a therapist must be reliable, consistent and tenacious. An intervention will only be successful when it is implemented exactly as described in the BIP, including reliable implementation of antecedent modifications, consequence manipulations, and strategies to strengthen replacement behaviors. An intervention must be implemented consistently, every time, without exception. Finally, problem behavior can get worse before it gets better and interventions can be difficult, effortful, and time-consuming to implement. However, perseverance will pay off and in the long run problem behavior will decrease and intervention will become less effortful to implement.

It is important to note that this lesson has focused on interpreting the Behavior Intervention Plan, while displaying a commonly used sample, however, BIP’s can and do vary between and among institutions and BCBA’s, however the elements of a BIP will remain consistent regardless of the formatting differences

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Skill Repertoire Building Data Collection

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