He is non-verbal and does not communicate through sign or other forms of communication but does gesture toward desired item/activity.
According to school/medical records, he functions in the severe impaired range of intellectual functioning.
He has a seizure disorder that is poorly controlled.
He has no identified problems with his upper extremities or fine motor skills.
Both parents signed a HIPPA privacy release form to allow us to share Bobby’s story for research purposes only @ Spalding University.
Functional Assessment Interview (FAI) Bobby’s school has contracted us to address Bobby’s behavior so that he may continue his education & work on his educational goals set forth in his IEP. Information gathered while conducting FAI with Ms. Wild (Bobby’s teacher). Bobby is in a self-contained classroom. Bobby is resistant to seat work or other task demands that require him to sit. A recent incident involved his teacher physically prompting Bobby to sit in a seat & he bit his teacher on the shoulder, drawing blood. The task was apparently discarded by the teacher in seeking first aid & Bobby went to a “time out” space. Since this incident, Bobby has attempted to bite his teacher several times when approached with a task demand.
Functional Analysis Screening Tool (FAST) Part I Client: Bobby H. Date: January 28,2011 Informant: Ms. Wild (teacher) Interviewer: Melisa Trent 1. Informant-Client Relationship 1. Indicate your relationship to the client: Parent [ x] Teacher 2. How long have you known the client? Teacher/ 6months 3. Do you interact with client daily? _[x ]Yes [ ]No 4. In what situations do you usually interact with the client? [x ]Meals (lunch)[ x] Academic training [x ]Leisure activities [x] Self care (bathrm) 2. Problem Behavior Information 1. Problem behavior [check and describe]: [x] Aggression: has bit teacher, drawing blood; continues to try & bite teacher to get out of task demands. [x] Disruptive behavior: resistant to seat work, will not stay in his seat to complete a task. Disrupts the class by continually getting out of his seat. 3. Frequency: [x ]Hourly [ ]Daily [ ]Weekly [ ]Less 4. Severity: [ ]mild: disruptive but little risk to property or health [ ]moderate: property damage or minor injury [ x ]severe: significant threat to health or safety
FAST part II 5. Situations in which the problem behavior is most likely: Days/Times: M-F during school hours , 8:15a-3p , Settings/Activities: “In the classroom, when I place a task demand on Bobby or physically touch him to stay seated in his chair.” Persons present: Ms. W. (Bobby’s teacher) 6.Situations in which the problem behavior is least likely: Days/Times: “per Mom, biting doesn’t happen @ home.” Settings/Activities: at home or away from school. Persons present: parents & sibling. 7.What is usually happening to the client right before the problem? Behavior occurs? “I am asking Bobby to complete his work at his desk or if I physically prompt him to stay in his seat, he will try & bite me.” 8. What usually happens to the client right after the problem behavior occurs? “Bobby gets out of doing what is asked of him.” 9. How do you handle the behavior when it occurs? I put him in “time-out.” Away from the other children. He is in his own area for a least 5 minutes.” Comments: “My first concern for Bobby, the other children & myself is safety first. Secondly, I want Bobby to stay in school & get and education & work towards the goals set forth for him in his IEP.”
FAST Part III 1. Does the client usually engage in the problem behavior when he/she is being ignored or when caregivers are paying attention to someone else? [ ] Yes [ ]No [x] N/A 2. Does the client usually engage in the problem behavior when requests for preferred activities [games, snacks] are denied or when these items are taken away? [x ]Yes [ ]No [ ]N/A 3. When the problem behavior occurs, do you or other caregivers usually try to calm the client down or try to engage the client in preferred activities? [ x] Yes [ ]No [ ]N/A 4. Is the client usually well behaved when he/she is getting lots of attention or when preferred items or activities are freely available? [ x] Yes [ ]No [ ]N/A 5. Is the client resistant when asked to perform a task or to participate in group activities? [x ]Yes [ ]No [ ]N/A 6. Does the client usually engage in the problem behavior when asked to perform a task or to participate in group activities? [ x] Yes [ ]No [ ]N/A 7. When the problem behavior occurs, is the client usually given a break from tasks? [x ]Yes [ ]No [ ]N/A
FAST part IV 8. Is the client usually well behaved when he/she is not required to do anything? [ x] Yes [ ]No [ ]N/A 9.Does the problem behavior seem to be a “ritual” or habit, repeatedly occurring the same way? [ ] Yes [ ]No [x] N/A 10. Does the client usually engage in the problem behavior even when no one is around or watching? [ ]Yes [x ]No [ ]N/A 11. Does the client prefer engaging in the problem behavior over other types of leisure activities? [ ]Yes [x] No [ ]N/A 12. Does the problem behavior appear to provide some sort of sensory stimulation? [ ]Yes [x ]No N/A 13. Does the client usually engage in the problem behavior more often when he/she is ill? [ ]Yes [ x] No [ ]N/A 14. Is the problem behavior cyclical, occurring at high rates for several days and then stopping? [ ]Yes [x ]No [ ]N/A 15. Does the client have recurrent painful conditions such as ear infections or allergies? If so, please list: Bobby was reported to have a seizure disorder that has been poorly controlled. Per Mom, they have been referred to a Neurologist for testing.
Motivation Assessment Scale (MAS) Part I Motivation Assessment Scale (MAS) 1986 V. Mark Durand, Ph.D. Name: Bobby H. Rater: Ms. Wild (Bobby’s teacher) Date: 1/28/2011 Behavior Description: Not staying seated in his chair to do his school work, and when teacher physically prompts Bobby to sit and do his work, he tries to bite her. This goes on several times through out the day. Disrupts classroom instruction for other children. Setting Description: Contained classroom with 7 other children with learning disabilities. Instructions: The Motivation Assessment Scale is a questionnaire designed to identify those situations in which an individual is likely to behavior in certain ways. From this information, more informed decisions can be made concerning the selection of appropriate reinforcers and treatments. To complete the MAS, select one behavior that is of particular interest. It is important that you identify the behavior very specifically. "Aggressive", for example, is not as good a description as "hits his sister". Once you have specified the behavior to be rated, read each question carefully and circle the one number that best describes your observations of this behavior. 0=Never, 1=Almost Never, 2=Seldom, 3=Half the Time, 4=Usually, 5=Almost Always, 6=Always Questions Answers 1. Would the behavior occur continuously, over and over, if this person were left alone for long periods of time? (For example, several hours) 0 1 2 3 4 5 6 2. Does the behavior occur following a request to perform a difficult task? 0 1 2 3 4 5 6 3. Does the behavior seem to occur in response to you talking to other persons in the room? 0 1 2 3 4 5 6 4. Does the behavior ever occur to get a toy, food, or activity that this person has been told that he or she can't have? 0 1 2 3 4 5 6 5. Would the behavior occur repeatedly, in the same way, for very long periods of time, if no one were around? (For example, rocking back and forth for over an hour.) 0 1 2 3 4 5 6 6. Does the behavior occur when any request is made of this person? 0 1 2 3 4 5 6 7. Does the behavior occur whenever you stop attending to this person? 0 1 2 3 4 5 6
MAS Part II 8. Does the behavior occur when you take away a favorite toy, food, or activity? 0 1 2 3 4 5 6 9. Does it appear to you that this person enjoys performing the behavior? (It feels, tastes, looks, smells, and/or sounds pleasing.) 0 1 2 3 4 5 6 10. Does this person seem to do the behavior to upset or annoy you when you are trying to get him or her to do what you ask? 0 1 2 3 4 5 6 11. Does this person seem to do the behavior to upset or annoy you when you are not paying attention to him or her? (For example, if you are sitting in a separate room, interacting with another person.) 0 1 2 3 4 5 6 12. Does the behavior stop occurring shortly after you give this person the toy, food, or activity he or she has requested? 0 1 2 3 4 5 6 13. When the behavior is occurring, does this person seem calm and unaware of anything else going on around him or her? 0 1 2 3 4 5 6 14. Does the behavior stop occurring shortly after (one to five minutes) you stop working or making demands of this person? 0 1 2 3 4 5 6 15. Does this person seem to do the behavior to get you to spend some time with him or her? 0 1 2 3 4 5 6 16. Does the behavior seem to occur when this person has been told that he or she can't do something he or she had wanted to do? 0 1 2 3 4 5 6 Sensory Escape Attention Tangible 1. __0___ 2. _6___ 3. _0___ 4. 5____ 5. _ 0__ 6. 6____ 7. _0____ 8. 5____ 9. 4 ____ 10. _5____ 11. 0____ 12. 6_____ 13._ _1___ 14. 6_____ 15. 0_____ 16. 6_____ Total Score =_____ 5___ _____ __22___ 0 22 Mean Score =1 5.5 0 5.5 (divide the total score by 4) Relative Ranking: *ESCAPE & TANGIBLE* both can be considered as influences that may be causing Bobby’s behaviors. (high score to low score) If there is a tie for the highest score or if the means of the top two categories are within .25 to .50 points (and you have clearly specified the behavior and setting), then both are considered as influences that may be causing the problem behavior to continue.
Target Behavior Defined Biting: making contact, or attempting to make contact, with the teeth to another person’s skin. May or may not leave teeth indentations and/or draw blood. Successful Bite
Data Interpretation According to the data, Bobby is biting his teachers between 9-12 times per day. Bobby’s target behavior of biting appears to be maintained by socially mediated negative reinforcement in the form of escape from non-preferred tasks. In other words, Bobby is able to get what he wants by being physically aggressive. He has learned that to get out of completing a task, he can bite his teachers, who then, understandably, stop trying to get Bobby to complete his task.
Recommendations to Client-Part I Current Repertoire – Bobby currently has no form of communication at this time other than gesturing towards a preferred item. Supporting Environments – Bobby spends time at home and at school with most of his aggressive behavior being displayed at school. Therapist recommendation: Functional Communication Training by teaching Bobby the sign for “break.
Recommendations to Client-Part II Rationale- FCT has been shown to dramatically decrease aggression in clients who have no way to communicate their wants or needs. It places them in an active role during treatment by teaching them to control the delivery of reinforcement rather than teaching them to be passive recipients of consequences delivered by a teacher/parent/caregiver. Control of the delivery of reinforcement is as important in FCT as the amount or schedule of reinforcement received.
Target Intervention Outcomes Eliminate Bobby’s biting and teach FCT – sign for “break” to build client’s repertoire with a more appropriate form of communication. Long term goals (not in this plan) – if Bobby learns the effectiveness of one sign (break) he can learn other signs for food or to communicate other wants and needs that will help him live a more productive happier life.
Environmental Changes Ensure that FCT taught at school will be utilized in the home setting. Currently there are few task demands placed on Bobby at home. Therapists will ensure that the same treatment is taught to both parents and teachers to promote generalization in both settings.
Contingencies for Behavior Change The teacher is avoiding Bobby’s biting behavior by allowing him to escape the tasks. By implementing the FCT (“break”) the teacher and the classroom benefit from Bobby’s newly acquired form of communication by creating an environment in which Bobby no longer escapes task demands through aggressive behaviors.
Antecedent-Based Interventions Antecedent= refers to the temporal relation of stimuli or events coming before an occurrence of behavior. Antecedent Intervention= to identify behavior-change tactics based on contingency-independent antecedent stimuli. Research supports the use of Antecedent Interventions, suggesting with proper implementation problem behaviors will diminish and appropriate behaviors can be established. Examples of Behavior Challenge and Antecedent Interventions That Might Address Them: Nonverbal (“Bobby”) child causes disruptions (biting teachers) when presented with a task demand; Teach the child the FCT, sign for “break”, before presenting tasks. Nonverbal child (“Bobby”) engages in biting teacher when presented with a task demand; Use Planned Ignoring &extinction during episodes of physical aggression & continue with task demand until the child demonstrates the sign for “break”.
FCT Teaching Procedure Terminal Goal: Client will engage in an academic task demand for one minute intervals without displaying aggression. First Step: Through a series of discrete trials we reinforced sitting starting with 10-second intervals. After the 10-second interval, therapist gestures the sign for “break”, stands up from table and says “time for break”, allowing Bobby time to get up from the table or play about as desired. After Bobby receives the 30-second break, the therapist returns to the table with the established reinforcer present, giving Bobby an additional 10-seconds with the reinforcer for sitting in the chair. After Bobby has mastered the sitting we will introduce a very simple task demand, such as field of 1 matching. As soon as Bobby completes the matching, therapist will sign “break” and say “time for break”, getting up from the table and allowing Bobby free time for 30-seconds. Now that Bobby has been introduced to the sign for “break”, a hand over hand prompting will be used to teach the sign to Bobby. Throughout the series of trials we will fade the prompts until mastery is achieved. Lastly, we will train the classroom staff on the procedures.
Reinforcement Contingency Based on the information provided by the FAST, MAS and direct observations, the reinforcer= escape from a task demand. Presented problem behavior: The client engages in physical aggression (i.e biting teacher) when presented with a task demand. In the past, the client has been reinforced by being sent to “timeout” after biting the teacher. Intervention included: teacher will use Planned Ignoring- a procedure for implementing time out in which social reinforcers, in this case socially mediated negative attention, is withheld for a brief period contingent on the occurrence of the target behavior. Goal: Once the sign for “break” has been taught to the client, the client will receive a 30-second break from the task demand each time the client appropriately demonstrates the sign and does not engage in the target behavior (biting).
Possible Unwanted Effects of the Use of Reinforcement Once the child has mastered the sign for “break”, the child may generalize this sign for other means of communication (e.g “I want”, “I need”, etc). When presented with a task demand the child may use the sign on a continuous basis to escape from task demand as he has done in the past. In order to prevent Bobby from using the sign for “break” continuously, we will thin the schedule of reinforcement and only reinforce a 30-second break intermittently.
Punishment & Possible Unwanted Side Effects from the use of Punishment With the use of Planned Ignoring, the child may begin to engage in self-injurious behavior (i.e biting self, head banging, etc), if unable to escape the task demand or receive attention.
Possible Reinforcers & Use of Extinction Since the behavior is being maintained by escape from a task demand, the reinforcer is the “break” at which point the child is able to have 30-seconds of free-time to play with favorite toy, to walk around the classroom, etc. Use of Extinction to decrease biting and physical aggression and increase completion of task demands, and communication through the use of signing for a “break”.
Social Validity After Intervention an interview was conducted with classroom staff to determine the effectiveness of the treatment for Bobby. (i.e “Did you find the use of FCT to be effective in reducing Bobby’s biting?”)
The Impact of ABA!!! Good example of the influence we can have on parents and their children... http://www.youtube.com/watch?v=ukiZwejTO1I
References Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied Behavior Analysis. Pearson. 2nd Edition. Wacker, D. P., et al. (1990). A component analysis of functional communication training across three topographies of severe behavior problems. Journal of applied behavior analysis, 23, 417-429.