+Evidence Based Practice
University of Utah
Training School Psychologists to be Experts in Evidence Based Practices for Tertiary Students with Serious Emotional
Disturbance/Behavior Disorders
By Mary Beth Pummel
2.18.2009
US Office of Education 84.325K
H325K080308
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Prevention and Intervention with
Young Children’s Challenging
Behavior: Perspectives Regarding
Current Knowledge
 Center
for Evidence-based Practice: Young
Children with Challenging Behaviors
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Center for Evidence-based
Practice: Young Children with
Challenging Behaviors

Attempts to bridge the gap between what is known about
effective practices and what practices children with
challenging behavior actually receive

“serious and persistent challenging behaviors in early
childhood are associated with subsequent problems in
socialization, school adjustment, school success, and
educational and vocational adaptation in adolescence and
adulthood”
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Early Challenging Behaviors

“Any repeated pattern of behavior, or perception of
behavior, that interferes with or is at risk of interfering with
optimal learning or engagement in pro-social interactions
with peers and adults.” (Smith & Fox 2003)

Important to identify, prevent and resolve challenging
behaviors as early as possible

Limited understanding across disciplines regarding what is
known about early challenging behaviors with respect to
prevention and intervention

May be difficult to distinguish serious problem behaviors if
one is not aware of the course of typical behavioral
topographies (tantrums)
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Center for Evidence-based
Practice: Young Children with
Challenging Behaviors

Created to promote research, training and the dissemination
of knowledge pertaining to challenging behaviors

The purpose of the center was “to establish a concise, databased summary of the most prominent features of current
knowledge as they relate to the presence and impact and, in
particular, intervention with and prevention of young
children’s challenging behaviors”

Reviews of current literature

Summarize current knowledge

Increase awareness across professional disciplines,
researchers, policy makers and advocates
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General Approach to Developing
Summary Statements

Focus on practical peer-reviewed descriptive, experimental,
and quasi-experimental research

Data were examined based on replicability, generality, and
utility and weighed in relation to internal validity, external
validity, and social and ecological validity

The statements were considered in relation to cultural, ethnic,
geographic, and economic representativeness
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Focus of Concern

Challenging behaviors of young children

3 content areas

Presence and Impact

Prevention

Intervention

Definition of challenging behaviors: “Any repeated pattern
of behavior, or perception of behavior, that interferes with or
is at risk of interfering with optimal learning or engagement
in pro-social interactions with peers and adults” (Smith & Fox
2003)

Definition of Young Children: Birth through 5

Included social, environmental, educational, therapeutic, and
interactional variables
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Degrees of Evidence

Evidence-based Practice


“Practices that are informed by research, in which the
characteristics and consequences of environmental variables are
empirically established and the relationship directly informs what
a practitioner can do to produce a desired outcome” (Dunst,
Trivette, & Cutspec, 2002)
Presence of evidence depended on the extent to which a
preponderance of data clearly and consistently supported a
discernable message related to the content area
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Literature Review and Consensus
Building Procedures

Reviews of the Literature

Search of data bases (ERIC, PsycINFO, Medline) using keywords
such as prevention, intervention, challenging behaviors,
maladaptive behavior, etc.

Hand searches using reference sections from source documents
and journals that were likely to include articles related to
challenging behaviors and young children

Internet search engines (Google)

Summaries of finding were sent to authorities in the field with
requests to point out any sources that may have been missed
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Literature Review and Consensus
Building Procedures

Consensus Building Procedures

Participants were asked to select one content area as their
primary focus

3 content area teams were formed based on the primary focus

Teams generated 3 to 5 summary statements for their content
area

Summary statements were independently reviewed by the other
two teams
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Presence and Impact of
Challenging Behaviors

Summary Statement 1
 When children with significant problems are neither
identified in a timely manner nor given appropriate
education and treatment, their problems tend to be long
lasting, requiring more intensive services and resources over
time. Moreover, when the challenging behavior of young
children is not addressed in an appropriate and timely way,
the future likelihood increases for poor academic outcomes,
peer rejection, adult mental health concerns, and adverse
effects on their families, their services providers, and their
communities
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Presence and Impact of
Challenging Behaviors

Increased risk of school failure, marginalized adult lives
characterized by violence, abuse, loneliness and anxiety

National Longitudinal Transition Study – 2 (Wagner, Cameto, & Newman,
2003)

A longitudinal post-high school follow-up study of students who
received special education services

Those with severe behavior disorders had the lowest grade
point average

50% failed one or more courses in their most recent school
year

66% failed the competency exam for their grade level

Only 1/3 completed high school

Subgroup of severe behavior disorders had the highest dropout
rate of any disability category
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Presence and Impact of
Challenging Behaviors

Development and remediation of these severe behavioral
problems

Early appearing behavior problems in a child’s preschool career
are the single best predictor of delinquency in adolescence,
school dropout, gang membership, adult incarceration and early
death

The stability of challenging behavior over a decade is equal to
that for intelligence

If challenging behavior toward other and property is not altered
by the end of 3rd grade it should be treated as a chronic condition

Children with challenging behaviors of families characterized by
coercive interactions are the most likely subgroup to develop a
life course of antisocial behavior
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Presence and Impact of
Challenging Behaviors

Costs of unchecked challenging behavior include






Early and persistent peer rejection
Mostly punitive contacts with teachers
Unpleasant family interaction patterns
Predictable school failure
Lack of community integration
Macro- and Micro-level Variables






Maternal depression
Poverty
Community violence
Seldom praise for appropriate behavior
Seldom afforded effective academic instruction
Often subject to ineffective, reactive, punitive interventions from
teachers
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Presence and Impact of
Challenging Behaviors

Summary Statement 2
 Although some systems and tools for early identification of
children with challenging behaviors are available, the actual
identification of these children and provision of appropriate
services are very low

The best estimates indicate 10-20% of the preschool
population experiences significant challenging behaviors

Factors contributing to underidentification and lack of
intervention for young children with challenging behaviors


Fewer than 1/3 of children eligible to receive mandated Medicaid
screening actually receive a full Early and Periodic Screening,
Diagnostic and Treatment and even fewer receive a screen that
includes behavioral health
More than 50% of states report that few or no behavioral health
services are offered under Medicaid
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Presence and Impact of
Challenging Behaviors

More factors contributing to underidentification and lack of
intervention for young children with challenging behaviors

Most pediatricians don’t have the time nor the expertise to detect
and refer for behavioral issues

Studies that have followed Head Start children suggest there may
be a bias against identifying children with behavioral problems

Only 1-2% of preschoolers access any mental health services

Longitudinal research on birth through 2 children with special
needs indicates a wide discrepancy between caregivers’ ratings
of behavioral issues and eligibility based on social/behavioral
concerns

Underuse of mental health services is expanded by race and
ethnicity
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Prevention of Challenging
Behaviors

A variety of child and family risk factors contribute to early
onset conduct disorders including:

Lack of prenatal care

Low birth weight

Maternal depression

Early temperament difficulties in infants

Developmental disabilities

Early behavioral and adjustment problems

Inconsistent and harsh parenting
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Prevention of Challenging
Behaviors

Summary Statement 1
 Children and their families who access mental and physical
care are less likely to have behavioral and social problems

Follow-up data (15 years later) from a randomized study that
provided the provision of prenatal and early intervention
services to single, poor mothers showed lower rates of child
abuse or neglect, less reliance on public assistance, fewer
instances of running away, fewer arrests and convictions.
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Prevention of Challenging
Behaviors

Summary Statement 2
 Children who experience nurturing and positive parenting
are more likely to have healthy relationships and reduced
problem behavior

Low income families that were provided child and family
development services through Early Head Start

children that are more engaged with their parents

fewer negative interactions during structured play

children had less aggressive behavior

parents were more emotionally supportive

parents provided more support for language development

these effects were strongest when Early Head Start was applied
using a mixed approach with both home-based and center-based
services
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Prevention of Challenging
Behaviors

Summary Statement 3
 Children who experience high quality early education
environments and caregiver interactions are more likely to
have better social competence outcomes and fewer behavior
problems

61% of children birth to 6 spend part of their day in a home
care or early education environment

Longitudinal data suggest that children who experienced
higher teacher-child closeness in kindergarten
demonstrated higher levels of social and behavioral
competence in 2nd grade
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Intervention with Challenging
Behaviors

Intervention refers to procedures that caregivers use to
reduce the challenging behaviors of individual young
children

Statements provided are derived mostly from experimental
single-subject designs. Therefore, the number of participants
and the process of selection raise some concerns about the
generalizability of the findings
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Intervention with Challenging
Behaviors

Summary Statement 1
 Intervention based on a functional assessment of the relation
between the challenging behaviors and the child’s
environment are effective for reducing challenging behaviors
of young children

Challenging behaviors are usually predictable responses to
specific antecedent and consequent events in the
environment

Functional assessment is used to gather information about
the antecedent and consequent events associated with,
motivational purpose and function of the challenging
behavior
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Intervention with Challenging
Behaviors


Interventions can be individualized based on the assessment
information

Modify antecedent events

Modify consequences

Provide instruction on specific communication or social
interaction skills
Interventions designed to address the function of the
behavior are more durable and effective
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Intervention with Challenging
Behaviors

Summary Statement 2
 Teaching procedures have been demonstrated to be effective
in developing children’s skills and reducing challenging
behaviors

Teaching young children skills that can replace the
challenging behaviors are the most effective, scientifically
based interventions available


Language or social skills

Self-management skills
Replacement behaviors are also an essential part of a
comprehensive behavioral intervention plan
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Intervention with Challenging
Behaviors

Summary Statement 3
 Interventions involving alterations to features of the child’s
activities and the child’s social and physical environment
have been demonstrated to reduce challenging behaviors

Antecedent-based interventions increase the probability that
appropriate behaviors will occur and reduce the probability
that challenging behaviors will occur

Antecedent-based interventions also increase the
opportunities to reinforce appropriate behavior

Antecedent-based interventions

Use of choice

Embedding preferences into difficult activities
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Intervention with Challenging
Behaviors

Antecedent-based interventions

Use of choice

Embedding preferences into difficult activities

Changes in classroom environmental arrangement

Changes in instructional variables

Implementing an activity schedule

Altering instructions
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Intervention with Challenging
Behaviors

Summary Statement 4
 Multicomponent interventions implemented over time and
across multiple relevant environments can produce durable,
generalized increases in prosocial behavior and reductions
in challenging behaviors

Multicomponent interventions include antecedent-based and
consequent-based intervention strategies to decrease the
occurrence of challenging behaviors
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Intervention with Challenging
Behaviors

Summary Statement 5
 Family involvement in the planning and implementation of
interventions facilitates durable reductions in challenging
behaviors of young children

Family members have a significant role in the social,
emotional and behavioral development of young children

Parent training and family support are important mechanisms
for resolving challenging behaviors

Parent involvement and family support have been mandated as
necessary to service delivery under Part C of Individuals with
Disabilities Education Act (IDEA)
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Discussion: Status of Research

Little empirical work related to intervention strategies for
infants and toddlers

Little is known about the subgroup of children who have
good behavioral outcomes in the absence of obvious
intervention

Most of the current research is based on small-scale studies
that include relatively few settings, intervention agents, and
child/family participants. Concerns about the
generalizability of findings to diverse populations and within
natural settings.

Little is known about the influence of culture, language and
ethnicity on challenging behaviors, prevention &
intervention
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Discussion: Status of Research

A reasonable fraction of empirically based studies have
relied on indirect measures of behavior such as ratings of
child behavior by caregivers

Little research has been conducted on the long-term
outcomes of intervention on challenging behaviors

The majority of intervention research has focused on
individual variables rather than systems components,
program procedures, and public policies that support the use
of evidence-based practices
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Discussion: Future Directions

A quest for meaningful impact, so that solutions identified in the
research will benefit large portions of society or single
individuals in life-altering ways




A commitment to placing solutions about the strictures of science, and
obliging research designs to conform to the situation


Direct observation of challenging behaviors
Assessment of social validity of intervention goals
Assessment of positive life style changes associated with the
reduction of challenging behaviors
Matching the questions, contexts, and the designs will ensure the most
meaningful results
An emphasis on ecological validity, with a recognition that solutions in
analog contexts are not solutions to real human problems
 Interventions should be made deliverable in real world contexts
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Discussion: Future Directions

A commitment to collaborate with colleagues, students, the
community, and particularly research participants, reflecting
an understanding that ideas and solutions are social,
communal phenomena


Child, family and service provider consumers helped articulate
the challenging behaviors of concern, interventions to be used
and the means for determining success
An assertion that ideas and data are more important than
ideologies – implying an openness to all potentially useful
perspectives, conceptualizations, and the knowledge from
divergent disciplines

The future research agenda should encourage and support
multidisciplinary efforts