Case Studies in Functional Assessment and Behavior Intervention Planning Jane I. Carlson, Ph.D., B.C.B.A. The May Institute www.mayinstitute.org Jake 2 1/2 years old Diagnosis: Autism Language: No functional speech, babbling with some approximations of words from songs and videos Problem Behavior: Tantrums, crying, selfinjury (head banging) Functional Assessment Tools Interview A-B-C Data Collection Direct Observation Interview Jake’s mother said, “He’s very hard to please. I have to give him what he wants or he’ll make a big scene.” Jake’s teacher said, “He really has a hard time if he can’t get a toy, either because another student has it or because he can’t get it himself. He also has problems if I take something away from him.” Sample A-B-C Data Antecedent Behavior Consequences Jake came into the playroom and another child had the alphabet blocks Jake threw himself on the floor and started screaming. I told Adam to share the blocks and gave half of them to Jake. He stopped tantrumming and played quietly with the blocks. Jake was in the classroom and wanted the penguin game. He couldn’t reach it. Jake started crying and I told Jake that he then fell to the floor and needed to ask for help. I banged his head 3 times. got him the game and he played by himself for about 15 minutes. Hypothesis Function: Tangible-seeking Contexts: Unable to independently access desired item. Desired item unavailable. Desired item taken away. Intervention Pivotal Response Teaching Graph See transparency (verbal responding, problem behavior) Outcomes Jake quickly learned about 50 words for preferred items. Jake learned to request spontaneously within a relatively short period of time. Jake’s age and the relatively short history of problem behavior precluded the need for multicomponent intervention. Jake was able to remain in an integrated preschool. Alexandra 11 years old Diagnosis: PDD-NOS, Bi-polar Disorder Language: Receptive and expressive language one SD below average. Problem Behavior: Aggression, stripping, destroying property, running out of classroom, screaming, scratching self. Functional Assessment Tools A-B-C Data Collection Everyday data collection Interview with teachers Sample A-B-C Data Antecedent Behavior Consequence I had just finished working with A. and gave her a worksheet to do independently. Alex screamed, “F--- you, I’m not doing any work.” She threw herself to the ground and started kicking the wall. She tantrummed for around 90 minutes. I had a staff take all the other kids out of the classroom. I stayed with Alex and maintained her safety until she finally calmed down. We had just finished gym class and were about to go back upstairs. Alex started running around the gym and I tried to stop her. Alex flopped to the floor and took her clothes off. When anyone approached her, she would kick and hit. She scratched her legs until she was bleeding and was extremely aggressive when we tried to apply first aid. Alex finally calmed down after about 2 hours. She got dressed and walked back up to the classroom to have lunch. Analysis of Everyday Data See graph on transparency (rating scale). Sample Interview Data Alex’s teacher said, “Nothing we’ve tried with her works. When she’s manic, she’s out of control and tantrums until she calms herself down. Two or three staff often have to stay with her for 2 hours or more until she’s calm.” Experimental FA Had to be stopped because the problem behavior was so severe that she was injuring staff and herself. Not enough data collected to develop hypothesis. Hypothesis Function: Attention-seeking Context: Teacher moves from instructing Alex to working with another student, moving from 1-1 attention to a group activity. Setting Event: Manic episodes related to bi-polar disorder Short-term Prevention One-to-one staffing during school day. Neutralizing routine for manic episodes. Noncontingent preferred activity with 1-1 staff every hour. Alex- Short-term Prevention 250 Base line Short-term Prevention Strategies 200 1 2 150 3 4 100 5 6 50 25 15 5 ay D D ay 1 0 Long-term Intervention Teach appropriate requests for attention Build tolerance for delay of reinforcement Social Skills Training Team approach to medication management. Alex- Percent of Ops. FCT 100 Baseline FCT 90 80 70 60 Line 1 50 40 30 20 10 25 23 21 19 17 15 13 11 9 7 5 3 1 0 Alex- Frequency of Problem Behavior by Mood Rating 180 160 140 120 100 3-D Column 1 80 3-D Column 2 3-D Column 3 60 40 20 0 1 2 3 4 5 Outcomes Overall reduction in the rate of problem behavior. Decreased time per day spent engaged in problem behavior. Reduction in problem behavior related to manic episodes. Increased use of Functional communication Increased participation in group activities. Tom 16 years old. Diagnosis: Autism Language skills: severe echolalia, appropriate responding to social questions with prompting, 2-3 word utterances to request preferred items. Problem behavior: Severe aggression (hitting, grabbing, biting), low frequency, high intensity, episodes require physical holding procedures. Functional Assessment Tools Interview with father and staff. A-B-C data collection Sample Interview Father said, “He’s really autistic. He gets something in his head and can’t let go of it. That’s when he gets really aggressive.” Teacher said, “If he starts asking for something that he can’t have that day, watch out. There’s going to be trouble.” Sample A-B-C Data Antecedent Behavior Consequence T. Was on the computer when it was time to go to the gym. T. Started screaming and then grabbed me and tried to bite my arm. We had to implement a seated team control for about 10 minutes until he was calm. T. Came in this morning asking for a Jetson’s video. I told him we don’t have that at school. T. Got very tense and started screaming, crying, and hitting himself. When I tried to stop him, he bit me 3 times. We had to hold him on the floor for about 15 minutes. He finally calmed down completely after about 30 minutes. Hypothesis Function: Tangible-seeking Context: Asking for something that is unavailable, moving from a highly preferred to a nonpreferred activity. Setting event: unknown at this time. Short-term prevention When an item is unavailable, offer him the choice of two other highly preferred items, activities. Use a “Now and Next” schedule for transitions. No computer for now. Tom- Episodes per Month 7 Intervention Baseline 6 5 Episodes 4 Physical Holds 3 2 1 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Long-Term Intervention Teach appropriate requesting to continue an activity. Teach appropriate requesting for tangibles. Teach tolerance for delay of reinforcement. Teach relaxation strategies. Outcomes Overall reduction in physical holding procedures during episodes. Reduction in the frequency of problem behavior. Increased ability to make alternate choices when preferred item is unavailable. Jack Age: 32 years Diagnosis: Autism, Mental Retardation Language ability: Nonverbal, can point to pictures to request preferred edibles, uses pointing and leading inconsistently. Problem Behavior: aggression (toward staff and other residents, hitting, pushing), self-injury (hitting and biting self). Functional Assessment Tools A-B-C data collection Experimental Functional Analysis Sample A-B-C Data Antecedent Behavior Consequence Jack seemed really tired today. He was sitting on the couch in the living room when D. came in and sat next to him. Jack hit D. 3 times, then D. got up and Jack hit and bit himself about 20 times. I sent Jack to his room and told him he couldn’t come back in the living room until he could be nice to his housemates. Jack had just gotten up and was finishing up his breakfast in the kitchen. I told him to empty the dishwasher. Jack hit me and tipped over the table. He then started hitting himself and biting himself. I told Jack to go to his room and wait until it was time to go to day program. Jack- Average Frequency of Problem Behavior 70 60 50 40 3-D Column 1 30 3-D Column 2 3-D Column 3 20 10 0 Low Sleep Sleep (6+ Hours) Jack- Functional Analysis of Problem Behavior 25 20 15 Escape Attention Tangible 10 Free Time 5 0 Day1 Day2 Day3 Day4 Day5 Day6 Hypothesis Function: Escape (demands, social avoidance) Context: Task demands (especially house chores), person coming into his space when he is agitated, presence of D. Setting Events: Noise and commotion, fatigue Short-term Prevention Scheduling Changes: limit contact with D., schedule AM and PM routines for calm. Modification in van procedure. Change AM and PM routines to accommodate preferences. Reduce task demands. TV in bedroom. Jack-Reversal Design Presence of D. in Group Home 120 Baseline "D" on Holiday Baseline "D" on Holiday 100 80 Line 1 60 40 20 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Long-term Intervention Teach appropriate “break” response. Teach appropriate requesting of personal space. Teach coping strategies (using headphones to minimize noise) Choice procedure for house chores with self-monitoring component. Jack- Frequency of Problem Behavior 90 INTERVENTION BL 80 70 60 Problem Behavior 50 Communication 40 30 20 10 0 1 5 9 13 17 21 25 29 33 37 41 45 49 Outcomes Discovered lack of sleep was related to D. Moved D. to different house. Decrease in problem behavior. Increase in time on task. Ability to complete schedule of house chores using self-monitoring.