Data-Based Decisions: Using
Data to Determine the Effects
of an Intervention with an
Aggressive Adolescent male
Linda Heitzman-Powell
University of Kansas Medical Center
Rachel White
Integrated Behavioral Technologies, Inc.
Introduction

Despite the efficacy of employing functionbased treatments, non-specific strategies
designed to decrease challenging behaviors
are implicated under certain conditions:
◦ when maintaining variables cannot be identified or
controlled,
◦ when the challenging behavior must be reduced
rapidly,
◦ when function based treatment is not sufficient
enough (Lerman & Vorndran, 2002), or
◦ when the target behaviors are unresponsive to
reinforcement techniques (Luiselli, 1984).
Meet Jonathan

Jonathan received a diagnosis of Autism when he was
four years old. Jonathan has a history of severe
aggression, observed both in home and at school. He
also has a history of chronic ear infections. His
aggression appears to escalate when he is experiencing
an infection in his ears. His school aggression was severe
enough to warrant a placement in LakeMary Center, an
alternative placement for children whom are not able to
be served in their home school setting. His home
aggression was severe enough that a case manager
recommended therapeutic foster-care placement. In
June, his current case manager began the reintegration
process with in-home behavioral supports. Jonathan
currently is on multiple medications to manage his
aggressions.

Interview
◦ Parent
◦ Caregivers
◦ School

Observation
◦ School
◦ Home
 Real-time data collection
 Frequency
 Duration
 Intensity
 ABC data

Operational Definitions

Intensity Scale

Defining Data

Jonathan engages in a series of behaviors that
disrupt his, and others, environments. These
behaviors include repetitive vocalizations,
hitting, spitting, self-injury, injury to others
and property destruction. An event will be
considered over when Jonathan has exhibited
a quiet body (hands, feet, mouth, and voice)
for at least 5 minutes. A new event will be
recorded if at least 5 minutes have passed
since the end of a previous event.
Intensity Scale










1 = pacing or perseverative statements (“moo
moo”)
2 = crying or whining
3 = jumping or stomping
4 = screaming or yelling
5 = kicking or tripping
6 = property damage or slamming objects
7 = hitting, grabbing or pushing
8 = scratching or pinching
9 = biting
10 = self-injurious behavior

Frequency
◦ Number per day

Intensity
◦ Based on scale with behavioral anchors

Duration
◦ Based on time
July-August
Medication Change Only
Frequency per Day
10
9
8
7
6
5
4
3
2
1
0
1 2 3 4 5 6 7 8 9 1011121314151617181920212223242526272829303132333435363738394041424344454647
10
Average Intensity per Day
9
8
7
6
5
4
3
2
1
0
1 2 3 4 5 6 7 8 9 1011121314151617181920212223242526272829303132333435363738394041424344454647
 Function-based
Intervention
◦ Possible functions (suggested by
observation and ABC data)
 Escape from non-preferred activities
 Access to tangible reinforcers

Functional Communication Training
◦ Escape
 “No thank you” for immediate removal of nonpreferred activities
◦ Access
 “Water (or any other item he might want)
please”
◦ However, escape and access to reinforcers were
not always plausible (e.g., activities regarding
personal hygiene, access to dangerous materials)
125
121
117
113
109
105
101
97
93
89
85
81
77
73
8
69
65
61
57
53
49
45
41
37
33
29
25
21
17
13
9
9
5
1
Frequency per Day
10
BL Ave per day; range 29-86 per month
FCT
7
6
5
4
3
2
1
0
125
121
117
113
109
105
101
97
93
89
85
81
77
73
69
65
61
57
53
49
45
41
37
33
29
25
21
17
13
9
5
1
Ave. Intensity
10
BL Ave Intensity
9
8
7
6
5
4
3
2
1
0


Access to reinforcers not contingent upon
any particular behavior – delivered on a
continuous schedule
No-demand
10
BL
FCT
NCR/No Demand
9
Frequency per Day
8
7
6
5
4
3
2
1
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39
10
BL
FCT
NCR/No Demand
9
8
7
Ave. Intensity
6
5
4
3
2
1
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39
10
BL
FCT
NCR/No Demand
Schedule
9
Frequency per Day
8
7
6
5
4
3
2
1
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38
10
BL
FCT
NCR/No Demand
Schedule
9
8
7
Ave. Intensity
6
5
4
3
2
1
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38
106
103
100
Quiet Room
97
94
91
88
85
82
79
Extinction
76
73
70
67
64
61
58
55
FCT NCR/No Demand
Schedule
52
49
46
43
40
37
34
31
28
25
22
19
16
13
10
10
7
4
1
Ave. Intensity
BL
In-Patient
9
8
7
6
5
4
3
2
1
0
106
103
100
Quiet Room
97
94
91
88
85
82
79
Extinction
76
73
70
67
64
61
58
55
FCT NCR/No Demand
Schedule
52
49
46
43
40
37
34
31
28
25
22
19
16
13
10
10
7
4
1
Frequency per Day
BL
In-Patient
9
8
7
6
5
4
3
2
1
0
Contingent Effort



One of the more acceptable and less aversive
procedures to de-escalate challenging behavior is
contingent effort (Luce, Delquadri, & Hall, 1980).
Several studies demonstrated the effectiveness of
contingent effort in decreasing challenging
behavior beyond or in the absence of reinforcement
based intervention. (Experiment I; Luce et al., 1980).
Additionally, contingent effort (stacking rings)
significantly decreased aggression in both
residential and classroom settings (Jackson,
Tyminski, Frederick, Neary, & Luce, 2005).
Contingent Effort (cont.)


Despite successful uses of de-escalation
procedures, these studies were conducted
at residential or school settings and the
extent to which the effectiveness and
utility of contingent effort as a deescalation procedure at home setting has
not been well reported.
Therefore, the present study examined the
effectiveness of an existing de-escalation
procedure (Jackson et al., 2005) modified
for use in the home.
Setting and Materials


Intervention was conducted at home and
during family community outings
Materials:
◦ 1 ring stacking base
◦ 5 color rings
Procedures

Design
◦ Baseline (non-effective contingency management
& FCT)
 Alternating Treatments
◦ Treatment
 Changing Criterion

Initially, during the treatment phase, on the
first occurrence of aggression, the child was:
◦ Prompted to move to a designated room by
parents or staff
◦ Instructed to sit down and engage in a deescalation contingent effort (i.e., stacking rings).
◦ Required to complete the task calmly (no
incidents of aggression) for a period of two
minutes.
Procedures (cont.)

As aggression began to decrease, the criterion
for contacting “ring stacking” changed:
◦ Pre-cursor behaviors were targeted
 1st criterion change targeted 3 instances of verbal escalation
 2nd criterion change targeted 2 instances of verbal escalation
 3rd criterion change targeted 1 instance of verbal escalation


If any incidents of aggression occurred during all
criterion phases, the task was re-presented until he
completed the task with no aggressive incidents for
two minutes.
Rings and the stacking base were available when
the child went on an outing
Data Recording


An Antecedent-Behavior-Consequence
(ABC) chart was filled out by parents or staff
upon the occurrence of aggression.
Aggression was defined as any attempt to
hit, scratch, pinch, bite, kick, grab or push a
person.
◦ Intensity of each aggressive episode was scored
on a scale of 1 to 10
◦ Duration data was also recorded
All Recorded Incidents
Intervention - Changing Criterion
Contingent Effort
10
Med. Changes, FCT, No Demand
Antecedent Control, Consequential
Control, etc., Time-out
Aggressions
3
Pre-Cursors
2
9
1
8
7
6
5
4
3
2
1
0
Months
av
e.
04
Se
p
O
ct
No
v
De
Ja c
n06
Fe
b
M
ar
Ap
r
Ju
l
Au
g
Ju
n
-1
Fe
b
M
ar
Ap
r
M
ay
100
95
90
85
80
75
70
65
60
55
50
45
40
35
30
25
20
15
10
5
0
-5
Baseline for Contingent Effort
Ju
l-0
4
Au
g
Se
p
O
ct
No
v
De
Ja c
n05
Number of Incidences
True BL
(Med change only)
Number of aggressive episodes
Average intensity

Behaviors
◦ Silliness
◦ Non-compliance
◦ Inappropriate Language

Conditions
◦ Access
 Contingent upon expression of the behavior, the
student was given the item for 15s
◦ Escape
 Contingent upon expression of the behavior, the
materials were removed and the student was given
escape from the task 15s
◦ Play
 No demands; free access to reinforcers

Attention
◦ Noncontingent Reinforcement
 Timer set for 20m
 When the timer goes off, Mom/Dad spend 2-3 minutes
◦ Functional Communication
 Teaching
 Teach phrases such as “look at me”, “play with me” etc.
 In the presence of a NO-demand situation (free-time)
 Model functional communication
 Require an imitative response

Escape
◦ Extinction
 In the presence of a demand:
 Do not attend or respond
 Continue to present demand
Function-based Intervention
16
14
12
Aggression
Precursors
Frequency
10
8
6
4
2
0
June
06
July
Aug
Sept
Oct
Nov
Dec
Jan
'07
Feb March April May June
July
Aug
Sept
Oct
Nov
Dec
Results – Function-based Intervention


Reduced overall number of aggressive behaviors
from around 4 episodes per month to 0-6 (first
month only) by the end of the reporting period.
The intervention also reduced pre-cursor behaviors
from between 10 and 14 to between 0 and 4 per
month.
Discussion



Contingent effort can be effectively
implemented in a home setting even when
trained staff are not readily available.
The same procedure has been successfully
implemented at his school given the
success at home.
As the challenging behavior is decreasing,
the focus of the intervention needs to shift
from decreasing challenging behavior to
function-based interventions.
Discussion (cont.)

Staffing needs
◦ 2004-2005
 1:1 25+ hours per week
 8-10+ hours per month from consultant
◦ 2005-2006
 1:1 15-25 hours per week
 4-6 hours per month from consultant
◦ 2007
 1:1 10-15 hours per week
 2-4 hours per month from consultant
◦ 2008-2009
 1:1 <10 hours per week
 As needed (approximately 2 visits in 2 years)
References




Jackson, A., Tyminski, J., Frederick, L., Neary, P., & Luce, S.
(2005, May). Decreasing aggressive behavior: Utilization of
contingent effort as a de-escalation procedure. Poster session
presented at the annual meeting of the Association for
Behavior Analysis, Chicago, IL.
Lerman, D. C. & Vorndran (2002). On the status of knowledge
for using punishment: Implications for treating behavior
disorders. Journal of Applied Behavior Analysis, 35, 431-464.
Luce, S. C., Delquadri, J., & Hall, R.V. (1980). Contingent
exercise: A mild but powerful procedure for suppressing
inappropriate verbal and aggressive behavior. Journal of
Applied Behavior Analysis, 13, 583-594.
Luiselli, J. K. (1984). Therapeutic effects of brief contingent
effort on severe behavior disorders in children with
developmental disabilities. Journal of Clinical Child Psychology,
13, 257-262.
Contact Information
Linda Heitzman-Powell
lhpowell@ku.edu
University of Kansas Medical Center
3901 Rainbow Blvd.
Phone (913) 945-6604
Rachel White
rachelwhite@ibt-inc.org