ABA: EVALUATION &TREATMENT
OF CHALLENGING BEHAVIORS
October 11, 2013
Todd Kopelman, PhD, BCBA
What are “Challenging Behaviors?”
Interfere with:
 Parent-child, sibling interactions
 Student’s ability to learn, socialize &
participate in classroom routines.
 Teacher’s ability to instruct.
 Adult’s ability to obtain/maintain employment,
stable housing, social relationships
Challenging Behaviors
1.
2.
3.
4.
5.
Noncompliance – active (refusal), passive (off-task), or
combination
Aggression
Tantrums
Destruction
Self-injurious behavior
www.statesman.com
Path to Negative Outcomes
• Reduced learning opportunities
• Academic difficulties, retention, suspension, drop-
out, unemployment, substance abuse (Carr et al., 1991;
Wehby et al., 1993 Lipsey & Derzon, 1998, CBHC.org)
• Teacher and parent burnout
(Hastings & Bham, 2003)
http://world.edu/unhappy-teacher-bad-apple-tree/
ABA: What is it?
Not ABBA!
What is ABA?
John Watson (“Little Albert”)
www.glogster.com
Burrhus Frederick Skinner (1904-1990)
Interested in understanding behavior as a function of
environmental histories of reinforcing consequences.
Applied Behavior Analysis
A systematic and experimental approach for evaluating the
effects of changes in the environment on a person’s
behavior
ABA
• Behavioral principles often incorporated into other
therapeutic approaches (CBT, ACT, VB, PCIT, etc)
• 1000’s peer-reviewed studies using ABA procedures
published across different ages, settings, diagnoses,
behaviors
ABA: An Evidence-Based Treatment
• Surgeon General Report
• American Academy of Neurology
• American Academy of Family Pediatrics
• American Academy of Occupational Therapy Association
• American Psychological Association
• American Speech-Language Hearing Association
• Society for Developmental and Behavioral Pediatrics
• Autism Society of America
• National Institute of Child Health & Human Development
• National Institute of Mental Health
Core Components of ABA
• Applied (Socially significant)
• Environment-behavior relationships
• Technological (detailed & clear procedures)
• Single subject design (Small N’s)
• Observable behaviors
Do We Intervene?
www.simpsonscrazy.com
Do We Intervene?
www.ocregister.com
Do We Intervene?
Autisminnb.blogspot.com
Core Components of ABA
• Applied (Socially significant)
• Environment-behavior relationships
• Technological (detailed & clear procedures)
• Single subject design
• Observable behaviors
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Home
2/4/13
Methyophenadate 10mg
2/8/13
No Meds
2/11/13
Focalin 5mg/clonidine
2/13/13
Ins to him
2/18/13
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Facalin 10mg
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Day Treatment
School 1 Hr
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Percentage of Instructional Time
Out of Instructional Control
120
100
80
60
40
Out of Control
Linear (Out of Control)
20
0
Dates / Changes in Interventions
Function
• Function: the reason why problematic
behavior continues to occur.
• Social function: environmental events
that maintain problematic behavior.
• Automatic function: internal events
maintain problematic behavior
• Treatment is based on identified
function, not on topography.
Rationale for Function-Based Treatment
Once the function of the problem behavior
is known, treatment involves:
• Disrupting the response-reinforcer relation
(e.g., extinction)
• Providing a known reinforcer contingent on
the desired behavior (e.g., DRA)
Maintaining Events
• Positive reinforcement: a “gain”
function
• Social attention, tangibles, preferred
items
• Negative reinforcement: an “escape”
function
• Nonpreferred activities, tasks
• Automatic reinforcement: unknown or
intrinsic
Functional Approach to Behavior:
The Basics
http://bookwag.com/2013/03/6-actors-who-have-played-sherlock-holmes/
Determining Function
Functional
Analysis
Direct
Observation
Indirect
Measures
Determining Function of Behavior
Indirect Measures
Behavioral Interview or Checklist
• Topography of behavior
• Times of day
• Activities
• Settings
• People present
• Antecedents
• Consequences
• Biological Variables
• Medications
Determining Function of Behavior
• Direct Observation: Scatter Plot Analysis
Time
Mon
Tues
Wed
Thurs
Fri
Activity
8:00-8:30
Hygiene
Tasks
8:30-9:00
Bus
9:00-9:30
Leisure Time
9:30-10:00
M, W, F sort
silverware
Functional Analysis (“Gold Standard”)
• Experimentally tests hypotheses regarding
variables that maintain problem behavior
• Actively manipulate antecedents and
consequences surrounding behavior
• Observations are conducted within an
experimental design to demonstrate functional
control.
Functional Analysis Procedures
• Manipulate attention, escape, and access to preferred
items or activities.
• Contrast with a control condition (free play).
• Conduct 5-minute analogue conditions within an
experimental design.
• Continue until a consistent pattern of behavior is
identified.
Functional Analysis Procedures
• Condition 1: Free play
• Control condition
• Access to preferred items and social attention
• No demands
• Problem behavior ignored
• Appropriate behavior reinforced
Functional Analysis Procedures (continued)
• Condition 2: Escape
• Task demand presented
• Brief break for problem behavior
• Condition 3: Attention
• Client ignored
• Social attention provided for problem behavior
• Condition 4: Tangible
• Removal of tangible
• Access to tangible given for problem behavior
Brief Functional Analysis
We Identified the Function…Now What?
Common Treatment Components
1. Reinforcement-based procedures
• Differential Reinforcement
• DRA/DRC (FCT), DRI, DRL/DRH, DRO
• Noncontingent Reinforcement (NCR)
2. Extinction-based procedures
3. Punishment-based procedures
4. Antecedent-based procedures
Common Treatment Components
• Uncommon to use single treatment procedure
• Individualized packages (e.g., combination of antecedent,
reinforcement, extinction procedures)
• Goals of a treatment plan should be parsimony & internal
consistency (treatments matched to function)
Applied Behavior Analysis
Pros
Cons
 Effective
 Effortful
 Empowers parents
(Can predict & control bx)
 Inconsistent
reimbursement
 Cost effective
 Inconsistent Access;
Geographic Lottery
ABA in Iowa: From Research to Practice
The Case for Behavioral Telehealth
Urgent Need for Behavioral Interventions
•Applied behavior analysis (ABA) is an evidencebased treatment for challenging behavior in ASD
•Access to ABA is inconsistent
Strategies for Intervention
•Use functional analysis (FA) and functional
communication training (FCT), to replace problem
behavior with social communication
•Train parents to use FA/FCT with their children
under the direction of a behavioral consultant
•Use telehealth to reach underserved areas
In-Home ABA
Clinic Telehealth ABA
Home Telehealth ABA
Sheldon
Armstrong
Fertile
Oelwein
Cedar
Rapids
Irwin
Bettendorf
Fairfield
Centerville
Keokuk
Average distance from I.C. = 122 miles
Home Telehealth Eligibility Criteria
Children 18 to 83 months of age with:
 Autism Spectrum Disorder diagnosis
 Significant challenging behaviors (e.g., aggression,
destruction, SIB, repetitive behaviors, severe
tantrums)
 Reside in IA at start of study
Referrals from CHSC or UI clinics
Behavioral Procedures
• Weekly 60-min telehealth sessions from UI
Children’s Hospital to family home
• Parents conduct all sessions with child with
telehealth coaching from behavior therapist
• All sessions recorded, scored, & graphed
• Participation lasts up to 6 months
• RCT design in home-based project
• Immediate vs wait control assignment
General Procedures (cont.)
Clinic & Home-Based ABA Telehealth:
Functional Analysis: Iwata et al.
(1982/1994) procedures; multielement
design
• Assessment: Goal is to identify function
of child’s target behavior(s)
Functional Communication Training: Carr &
Durand, 1985.
• Treatment: Goal is to replace problem
behavior with appropriate
communication that serves same
function
Behavioral Telehealth Successes
• Reduction in problem behavior through telehealth
averages over 90%, comparable to ABA provided
in vivo when therapists visit the home
• High treatment acceptability
• Average weekly cost of delivering telehealth was
$60 per participant, compared to $291 if
consultants traveled to provide coaching on site
or in home
• Increased accessibility to rural areas of state
Statewide Behavior Resources
• UIHC (Outpatient & Day Treatment Programs)
• Adult Psychiatry Clinic (Jodi Tate/Todd Kopelman)
• ITABS (Susan Smith)
• Money Follows the Person
Challenging Behavior Teams
• Each AEA has a Challenging Behavior Team (CBT)
• “Top tier” experts in FBA & BIP
• Local school team can request consultation
• Parents can ask school if CBT is involved!
Board Certified Behavior Analysts
• http://www.bacb.com/ (Can look up IA providers)
• Certified to conduct behavior assessments and
interventions
• BCBA’s work in school, residential, hospital, and private
practice
• Certification requires Masters in behavior analysis or
closely related field & 225 graduate hrs of instruction in
behavior analysis + 15oo hrs supervised experience &
examination