Skip to main content
Social Sci LibreTexts

3: Treatment Implications Based on the Functional Assessment

Abstract: Consideration is given to the relevant factors involved in making treatment selections based on current research and function of the individual’s challenging behaviors. To put it all together, the design of treatment as reflected in behavior intervention plans is reviewed.

 

Focus Questions:

 

  • What treatment approaches challenging behaviors and increase appropriate behaviors?
  • Explain how knowledge of the function of problem behaviors can impact treatment decisions.

Treatment choices to decrease an individual’s challenging behavior are based on many factors, such as the function of behavior, empirically-based practices, ethical considerations, likelihood of the desired behavior being supported long-term by others in the natural environment, and the particulars for the case in question (e.g., context, quality of the environment, severity of the problem behavior, people present, resources available, setting, level of functioning, communication skills, etc.) (Spencer, Detrich, & Slocum, 2012). The severity and persistence of the individual’s challenging behavior may influence treatment decisions in terms of number of components in a treatment program, reinforcer magnitude or frequency, and staff/teacher training.

A primary factor considered in the design of effective treatments is the function of the challenging behavior (Kurtz et al., 2003; Repp, Felce, & Barton, 1988; Lancioni, Singh, O’Reilly, Sigafoos, & Didden, 2012; Matson, Neal, & Kozlowski, 2012; Mueller, Kosi, & Hine, 2011). Treatments based on the function of behavior, as analyzed from FA data, are more effective than non-function-based approaches to decrease individual’s challenging behavior (Carr & Durand, 1985). Incorrect selection of a treatment or design of a program based on an uninformed or faulty function of behavior may not help the individual learn new desired behaviors and/or may even make the problem worse, in some cases (Iwata, Pace, Cowdery, & Miltenberger, 1994). Thus, an ethical responsibility exists for the professional to make an informed decision based on all available assessment and background information, and a review of empirically-based intervention strategies.

Based on over a half century of research conducted since ABA was initiated, many empirically-based interventions have been developed and evaluated. Major treatment components for a well-designed Behavior Intervention Plan (BIP), or a written treatment document to address the individual’s challenging behavior include:

  1. Preventative efforts or antecedent-based treatment
  2. Actively increasing or teaching functionally equivalent replacement and other desirable behaviors
  3. Reactive procedures or, what to do when the challenging behavior occurs

These treatment components should be tailored to the specific function of the individual’s challenging behavior (e.g., tangible positive reinforcement, automatic reinforcement, negative reinforcement, attention positive reinforcement), consider contextual factors (e.g., available assistance, history factors, etc.), and ethical considerations. Specific procedures related to these treatment components will be briefly reviewed below and then more specific functionally-related treatments will be noted. This review only highlights the main treatment possibilities that have received a fairly extensive empirical support and is not exhaustive of the various treatment possibilities available. Also note that to be competent in delivering treatment, additional knowledge and experience is needed (see the Behavior Analyst Certification Board® for more at http://www.bacb.com/).

 

Prevention Efforts or Antecedent-based Treatment

 

The individual’s situation can be altered in ways that will eventually reduce the challenging behavior, potentially avoiding the need for reactive strategies. Prevention efforts can entail reducing the individual’s motivation for engaging in the challenging behavior and changing antecedent stimuli in the individual’s natural environment.

Noncontingent reinforcement (NCR) is a procedure to reduce the individual’s motivation for engaging in the challenging behaviors whereby the reinforcers for that behavior are provided freely according to a set time (e.g., every 5 min) before the individual engages in that behavior (Marcus & Vollmer, 1996; Vollmer, Marcus, & Ringdahl, 1995). NCR is an empirically validated approach for decreasing challenging behavior (Carr, Severtson, & Lepper, 2009) and may be one of the most frequently used reinforcement-based procedures (Matson et al., 2011). For example, if a student is acting out in the classroom to gain the attention of his classmates then, at the beginning of class before he acts out, give him a classroom job that garners a lot of attention to foster his desirable behavior (e.g., passing out handouts). This approach may reduce the individual’s motivation to engage in the undesired behavior and thereby make it less likely to occur. When using NCR, initially the reinforcer that is controlling the challenging behavior is delivered continuously or more frequently than the average baseline occurrence of the challenging behavior. Once the challenging behavior is reduced, then the frequency of presentation of the reinforcer can be gradually decreased to typically occurring levels (Tucker, Sigafoos, & Bushell, 1998).

Table 10: Summary of NCR Procedure
  1. Identify the reinforcers currently maintaining the individual’s challenging behavior (e.g., positive reinforcement, negative reinforcement) by conducting a functional assessment
  2. Schedule a frequent delivery of reinforcer according to time alone or independent of behavior
  3. Include an extinction component for when the problem behavior occurs
  4. Initially use a rich schedule of reinforcement and adjust it to lean as the challenging behavior decreases

 

Changing Antecedent Stimuli in the Natural Environment

 

A quick method of preventing the individual’s challenging behavior is to manipulate antecedent stimuli that control behavior (i.e., prompts). Antecedent stimuli include events, objects, or people that are present before the individual’s challenging behavior occurs. Stimuli in the environment that consistently precede the behavior can either be eliminated or changed to affect the likelihood of the behavior (Martin & Pear, 2011). For example, if the individual typically resists doing chores or is noncompliant then providing a choice of a variety of different chores for that person to choose from may be an effective solution (Call, Wacker, Ringdahl, Cooper-Brown, & Boelter, 2004). If the individual is escaping from difficult work or material because the reading level is too difficult (i.e., negative reinforcement), then provide more assistance or better instruction, or make the work easier (Sanford & Horner, 2013). Also for escape-maintained behavior, the demands or requests could be delivered less frequently (e.g., presenting demands once an hour instead of 20 times) and then, as the levels of the challenging behaviors remain low, gradually returned to typical levels (Lalli, Casey, & Kates, 1995). There is research to support the effectiveness of this procedure for decreasing the number of requests, known as demand fading, for escape-maintained challenging behaviors (see Pace, Iwata, Cowdery, Adree, & McIntyre, 1993; Penrod, Gardella, & Fernand, 2012).

Another strategy is to add stimuli into the situation in which the challenging behavior occurs to prompt or cue the individual’s desirable behaviors. For example, the likelihood of the desired behavior occurring may be increased by presenting preferred curricular activities (Foster-Johnson, Ferro, & Dunlap, 1994), background music (Desrochers, Oshlag, & Kennelly, 2014), activity choices (Rispoli et al., 2013), or models demonstrating desired behavior (Stokes & Kennedy, 1980).

Another method to change the antecedent stimuli involves an overall improvement of the quality of the individual’s environment, known as environmental enrichment (EE). EE entails increasing individuals’ access to preferred activities, people, or objects and providing a variety of choices available in their everyday environment. One of the earliest demonstrations of how EE can decrease problem behavior was conducted by Horner (1980). More recently, in a controlled randomized experiment, it has been shown that increasing sensorimotor experiences can have a beneficial effect on children with autism (Woo & Leon, 2013). Moreover, Ringdahl, Vollmer, Marcus, and Roane (1997) showed how three children with developmental disabilities chose an enriched environment over the opportunity to engage in self-injurious behavior when able to do either. Table 11 below illustrates how antecedent-based treatments can be geared to the function of the individual’s challenging behavior.

Table 11: Examples of basing antecedent treatments on the function of the individual’s challenging behavior
Challenging behavior Function of the Challenging Behavior Preventative Efforts or Antecedent-Based Treatments
Screaming Gets attention: “No, don’t scream” (Attention Positive Reinforcement) Provide frequent attention before the challenging behavior occurs
Hitting another child Gets toy (Tangible Positive Reinforcement) Provide free access to many toys
Spinning and rocking Sensory consequences (Automatic Reinforcement) Provide access to a swing
Pushing work away Gets out of work (Negative Reinforcement) Provide choices, give assistance, or provide work for less time

 

Actively increasing or teaching functionally equivalent replacement and other desirable behaviors

 

A main component of any treatment plan involves reinforcing a desirable behavior that serves the same purpose as the challenging behavior, called functionally equivalent replacement behavior. For instance, an individual’s vocal stereotypy that is maintained by sound may be decreased by encouraging play with auditory toys, a functionally equivalent replacement behavior (Rapp, 2007). An important consideration when selecting the functionally equivalent behavior is to ensure that the individual’s social community will support it or the individual is able to recruit reinforcement from others in his or her natural environment. Functional Communication Training (FCT) is an empirically validated treatment approach (Kurtz, Boelter, Jarmolowicz, Chin, & Hagopian, 2011) that involves teaching the individual to ask for stimuli, events, or people that serve the same function as the problem behavior (Carr & Durand, 1985; Falcomata, Wacker, Ringdahl, Vinquist, & Dutt, 2013). Teaching the individual to request the item that typically was delivered followed his or her challenging behavior in the past can be an effective strategy to decrease that behavior (Kurtz et al.; O’Reilly et al., 2012). The form of the verbal behavior should be tailored to the individual and easy to perform, with possibilities including vocal, sign, picture-card, gesture, or use of assistive technology devices (Mancil & Boman, 2010). For example, the individual may be taught to say “Stop” instead of engaging in self-injury during nonpreferred grooming activities (Steege et al., 1990). More examples of how a communication replacement behavior can be taught can be seen in the Table 12 below.

Table 12: Examples of communication responses related to the function of the individual’s challenging behavior being taught
Problem Behavior Screaming for Attention Hitting Others to be Sent to Another Room Grabbing Food Finger Flicking for Visual Stimulation
Replacement behavior that results in the same reinforcer Asking for attention Asking to go to another room Asking for food Clicking on a computer screen for an engaging video display

Consequence-based interventions work to decrease problem behavior by manipulating events and/or stimuli that occur immediately after particular behaviors. Since every treatment program should include positive reinforcement, the procedures used to identify positive reinforcers will be described. Then, commonly used practices schedules to administer reinforcement and extinction procedures to decrease challenging behavior will be reviewed.

 

Identification of Effective Reinforcers

 

The main ingredient for an effective behavior change program is positive reinforcement. A positive reinforcer is an object or event that increases the behavior it follows. As reviewed in Chapter 1, the principle of positive reinforcement states that when a positive reinforcer is delivered immediately after a behavior, that behavior is more likely to occur in future similar situations (Martin & Pear, 2011). Without consideration of positive reinforcement, the factors responsible for the individual’s challenging behavior may still maintain it, despite efforts to curtail that behavior. Additionally, programming reinforcers to increase the individual’s desirable behavior may result in the challenging behaviors being ‘supplanted’ or over-ridden since increasing one behavior will naturally eliminate the likelihood of engaging in other behaviors that are reinforced less or cannot occur at the same time. Application of a positive reinforcement procedure is not only an effective practice but also an ethically sound step to include in any intervention program. There are several considerations when using a reinforcement procedure, including: (a) incorporating knowledge of the function for the individual’s challenging behavior into treatment design; (b) validating that the consequence is indeed a reinforcer (be-it positive reinforcer or negative reinforcer); and (c) maximizing the individual’s motivation for that reinforcer.

It is important to demonstrate that the consequence you believe acts as a reinforcer does indeed do so. The most accurate way to ensure that you have identified an effective positive reinforcer is to conduct a reinforcer test. A reinforcer test involves experimentally comparing levels of the behavior in phases where the item being evaluated is delivered immediately after the behavior to that in another phase where the consequence is provided just according to a set time such as every 5 s or noncontingently (Cooper et al., 2007). This test may entail using an ABAB research design (Martin & Pear, 2011) where the A phase consists of a series of sessions where noncontingent delivery of the item being tested occurs and in B phase consists of a series of sessions where the consequence is provided following each occurrence of that behavior. These phases are alternated in an ABAB fashion to rule out confounding variables or alternative explanations for the findings. If levels of the behavior are higher when the item is delivered contingently (phase B) compared to when it is not (phase A), then that item has been demonstrated to function as a positive reinforcer. See the Table 13 below for an example of how the effectiveness of treatment can be evaluated using an ABAB research design.

Chapter3_03.png

 

Table 13: Example of graphed data with an ABAB research design demonstrating that the reinforcer delivered immediately after the behavior during the treatment or B phase increases that behavior as compared to the noncontingent delivery condition or baseline phase.

preference assessment is an efficient method to identify a potential reinforcer by evaluating the individual’s choice for a variety of objects, events, or stimuli (Cooper et al., 2007). One type of preference assessment is a paired-stimulus assessment (Fisher et al., 1992). A paired-stimulus assessment involves identifying the stimulus the individual chooses most when pairs of stimuli are presented across trials (See the Table below for the preference assessment procedure).

Table 14: Example of a preference assessment procedure
  1. Identify 5-8 items that you think the individual might prefer based on interviews with that person or people in that person’s life or from observations of activities that the individual engages in most frequently.
  2. Design a data sheet that lists all possible pairs of the items and alternate the sides that each item is presented on to counterbalance side preferences the individual might display e.g., A B and B A
  3. Sitting at a desk or table, present each pair of items approximately 2 ft apart from each other and 1 ft in front of the person, making sure the person’s hands are not near either item so that a clear test of what the person selects can be made.
  4. Wait 5 s for the person to pick one. Do not provide any praise because this may affect the person’s choice on subsequent trials. Allow 5 s to manipulate the item.
  5. Once all pairs have been presented, calculate the percent each item was selected by counting the number of times each item was selected by the person and dividing by the total number of times it was presented and multiplying by 100.
  6. Rank order the items from most to least preferred and use the most preferred items for training purposes.

Note: If the person has never had the item before, allow the person to ‘sample’ the item before the preference assessment is conducted.

Note: Preferences will vary from time to time and so conducting a brief preference assessment before every training session will ensure that your preference-based procedures are maximally effective.

Reinforcers may vary in their effectiveness in increasing desired behavior depending on whether the individual has had recent access to them (North & Iwata, 2005; McGinnis, Houchins-Juárez, McDaniel, & Kennedy, 2010). Motivating conditions, such as satiation (having too much of something) or deprivation (having too little of something), can alter the probability of behavior that leads to that reinforcer (Michael, 2000). For example, you really liked a particular song when it first came out and used to change the station to locate it, but now that it has been playing on the radio for several weeks, you no longer enjoy listening to it. Instead, you turn to another station to avoid having to listen to it one more time. Likewise, if a child, who typically is disruptive in a certain class to garner the attention of his peers is provided with ample social interaction with peers prior to that class, he may not engage in the disruptive behavior to achieve the same ends.

Through use of an FA approach, the reinforcer maintaining the challenging behavior can be identified. Once it is known what that reinforcer is, it can be incorporated into a behavior intervention program to increase desired behavior. However, as Carter (2010) found with an adult male being treated for escape maintained noncompliance, a highly preferred positive reinforcer may also reduce that behavior even without the use of extinction (no longer providing the negative reinforcer).

Differential reinforcement procedures can be used to eliminate or decrease the individual’s challenging behavior. This type of reinforcement schedule, or rule when to provide reinforcement, consists of the application of both positive reinforcement and extinction procedures. Extinction refers to the removal of the usual reinforcer following the behavior, which decreases future occurrences of that behavior (Martin & Pear, 2011). Differential reinforcement of zero rates (DRO)involves providing a reinforcer when no instances of the challenging behavior occur during a period of time. For instance, to decrease thumb sucking, every 10 min when the child does not engage in thumb sucking, he gets his favorite toy. Differential reinforcement of incompatible behavior (DRI) involves reinforcing a desired behavior that cannot occur at the same time as the challenging behavior (Martin & Pear, 2011). For instance, the therapist can provide a reinforcer when the person speaks in normal conversation level and does not scream. If a specific incompatible behavior that the individual performs cannot be readily identified, differential reinforcement of alternative behavior (DRA) may be used where a desirable behavior displayed by the individual is reinforced. For example, turning pages of a magazine could be reinforced to decrease the likelihood of an individual engaging in self-injury by hitting her head with her hand. Both turning pages and self-injury could be done at the same time, but that is unlikely to occur.

There are also differential reinforcement schedules to reduce, but not necessarily completely eliminate a behavior altogether, that can be used when some amount of behavior is alright. Differential reinforcement of low rates—spaced responding (DRL-spaced responding) entails providing the reinforcer after a period of time when no instances of the challenging behavior have occurred and then the behavior occurs. For instance, to slow down someone’s rate of eating, she could be allowed to take a bite after 3 s of the previous bite of food. Differential reinforcement of low rates—limited (DRL-limited) is when the challenging behavior is less than a specified amount following a set time period (Martin & Pear, 2011). A child in the classroom may excessively raise her hand to ask to use the restroom every half hour where instead, once after two hours of not asking is reinforced.

Table 15: A summary of schedules of reinforcement to decrease challenging behaviors
Schedule Procedure
Noncontingent Reinforcement (NCR) Noncontingent delivery of reinforcer e.g., delivering positive attention every 5 min when no instances of attention-maintained challenging behavior have occurred.
Differential Reinforcement of Zero Responding (DRO) Reinforcer is provided only if the behavior has not occurred within a specific period. e.g., delivering a reinforcer if no instances of aggression occur during the hour.
Differential Reinforcement of Incompatible Responding (DRI) Reinforcer is provided for a behavior that is incompatible, or that cannot occur at the same time as the behavior to be decreased. e.g., reinforcing in-seat behavior to decrease out-of-seat
Differential Reinforcement of Alternative Behavior (DRA) Reinforcer is provided for a desirable behavior that is not necessarily incompatible with the behavior to be decreased. e.g., reinforcing completion of puzzle to reduce head hitting.
Spaced Responding DRL Following an interval in which the behavior does not occur, and instance of the behavior is required for reinforcement. e.g., making cookies once a week since more frequently would neither be healthy nor desirable.
DRL—Limited Reinforcer is delivered provided that the # of behaviors that occurred was < some maximum #. e.g., delivering a reinforcer when five or less instances of throat clearing occur in an hour.

Differential reinforcement has been shown to be a highly useful treatment choice. Differential reinforcement may be just as effective as NCR in decreasing challenging behavior (Allison et al., 2012) and can be applied in the classroom (LeGray, Dufrene, Mercer, Olmi, & Sterling, 2013). Differential reinforcement, in conjunction with other treatments, has been effectively used to decrease a variety of behaviors, such as sensory reinforced eye brow plucking (Nuernberger, Vargo, & Ringdahl, 2013) and pica, or the ingestion of nonedible substances (Hagopian, González, Rivet, Triggs, & Clark, 2011). Differential reinforcement has been shown to be as effective as a punishment procedure (response cost) in reducing tics of children with Tourette syndrome and, as such, would ethically be the preferred treatment (Capriotti, Brandt, Rickftts, Espii, &Woods, 2012). See the Table 16 below for the steps involved in conducting a differential reinforcement procedure.

Table 16: Steps to conduct a differential reinforcement procedure
Steps:

 

  1. Define the problem behavior
  2. Conduct baseline assessment to measure levels of the challenging behavior
  3. Identify the function of the problem behavior through functional assessment
  4. Identify reinforcer
  5. Select type of differential reinforcement (DRO, DRI, DRA, DRL)
  6. Define the behavior to be reinforced
  7. Set reinforcement schedule based on baseline rate of the problem behavior to ensure a high rate of reinforcement
  8. Set criterion to fade reinforcement or regress to previous steps
  9. Wean the individual from the program by gradually removing the procedures

See http://­autismpdc.­fpg.­unc.­edu for more information

 

Reactive procedures or what to do when the challenging behavior occurs

 

An extinction procedure involves no longer providing the reinforcer maintaining the challenging behavior such that the behavior is less likely in future similar situations (Martin & Pear, 2011). The reinforcer maintaining the individual’s challenging behavior must be identified and no longer provided. Thus, when the individual’s challenging behavior is being maintained by attention then attention extinction should be used. For escape-maintained behavior, escape extinction, or not removing the task or demand (and, possibly, using guided assistance for the individual to engage in the task) is employed. An FA to determine what is maintaining the individual’s challenging behavior is essential to be able to accurately remove the reinforcer maintaining the challenging behavior and thereby effectively use an extinction procedure. Iwata, Pace, Cowdery, and Miltenberger (1994) describe how not correctly removing the reinforcer maintaining the individual’s challenging behavior can actually worsen it.

A known phenomenon that occurs when implementing an extinction procedure is extinction burstwhereby the behavior being extinguished gets “worse before it gets better.” That is, emotional behaviors and aggression, in addition to an increase in severity of the challenging behavior may occur (Martin & Pear, 2011). It is important to inform others about this phenomenon to ensure that they continue implementing the program and do not inadvertently reinforce the individual’s problem behavior and make it worse (i.e., treatment integrity is maintained).

An effective and ethical approach is to combine extinction with positive intervention strategies (e.g., differential reinforcement). Out of a sample of 42 cases of treatment for individuals with challenging behavior, Lerman, Iwata, and Wallace (1999) counted the number in which an extinction burst was identified and examined whether positive procedures included in the treatment package lessened the likelihood of extinction bursts. The researchers found substantially fewer cases of extinction burst (i.e., 15%) when positive procedures were incorporated as compared to when only an extinction procedure was used (i.e., 62%).

Although there are ethical concerns with using any decelerative procedure, sometimes extinction must be used to effectively decrease the individual’s problem behavior. In a study by Patal et al. (2002) two types of differential reinforcement procedures were not effective until escape extinction was added with three children receiving treatment for feeding disorders. See Table 17 below for methods to increase the effectiveness of an extinction procedure.

Table 17: Steps to increase the effectiveness of an extinction procedure
  1. Assess the function of the problem behavior and do not provide that reinforcer following the problem behavior.
  2. Combine extinction with a differential reinforcement procedure and use the reinforcer that was maintaining the problem behavior to increase a desirable behavior.
  3. Inform others involved in the program about the possibility of extinction burst and how not to provide a reinforcer following the behavior.

Table 18 summarizes in example format the three main treatment approaches used for each main environmental reason for challenging behavior.

Table 18: Summary of treatment strategies based on function of behavior
  Tangible Positive Reinforcement Attention Positive Reinforcement Automatic Positive Reinforcement Negative Social Reinforcement Automatic Negative Reinforcement
Example of Problem Behavior Grabbing other’s food at mealtimes Running away at school such that teachers try to catch Thumb sucking Spitting at others when they come too close Too much noise
Reinforcement for Desired Behavior Use tangible reinforcers e.g., preferred food Use attention reinforcers e.g., praise Use sensory reinforcers e.g., soft fur to touch Use escape reinforcer Use escape reinforcer
Functional Replacement Behavior “Give me ___” or signing more “Look at me!” or waving hello “I like touching this” or thumbs up “Go away” or shaking head “Please take it away” or making a pushing motion
Prevention Enriched env, NCR Enriched env., NCR, rules Increase stimulation/NCR, Enriched env Task choice, high prob. task, demand fading Reduce aversiveness
Instruction Teach desirable behavior, differential reinforcement, functional communication training Teach desirable behavior, differential reinforcement, functional communication training Teach desirable behavior, differential reinforcement, functional communication training Teach desirable behavior, differential reinforcement, functional communication training Teach desirable behavior, differential reinforcement, functional communication training
Reactive Tangible extinction Attention extinction Automatic extinction, response blocking Escape extinction Escape extinction, response blocking

 

Generalization & Maintenance of Treatment Effects

 

Generalization and maintenance of treatment effects is an essential component to address once: (a) the individual’s desired behavior is occurring at desired levels; (b) the problem has been reduced; and (c) treatment has been removed. There are three important types of generalization or spill-over effects that occur once treatment or training has ended (Martin & Pear, 2011). Stimulus generalization is the extent to which the desired behaviors occur across stimuli, setting, and people. For example, after successfully learning how to ask for help when faced with a difficult task at work, the individual is now able to do likewise when at home. Response generalization is the extent to which behaviors other than the taught behavior occur. For example, after the resident of a group home has been taught to greet visitors with a “Hello” and a handshake (instead of a hug), she also has begun appropriately asking visitors to enter the house and to sit in the living room. Lastly, response maintenance is when the desired behaviors taught occur long after the training has been completed (e.g., weeks, months, or years).

Stokes and Baer (1977) wrote their pivotal review of the published research examining generalization and concluded that generalization needs to be planned for during intervention to ensure that it occurs. Although much research on ways to promote generalization of treatment gains has occurred over the years, more remains to be done (Falcomata & Wacker, 2013). A review of methods to promote generalization is beyond the scope of this book. The reader is encouraged to consult other sources such Baer (1981) or Goldstein and Martens (2000) for more information.

 

Evaluation of Treatment Effectiveness

 

A comprehensive evaluation of the effectiveness of treatment for a particular client/student case should include the following:

  • Client/student’s behavior change in the desired direction compared to baseline
  • An increase in reinforcers or enriched experiences for the individual, such as more community experiences and a less restrictive environment for the individual
  • Generalization of desired behaviors and continued reduction of challenging behaviors across time (response maintenance)
  • Social validity or the treatment is acceptable to the individual and significant others in terms of goals, procedures, and outcome (Wolf, 1978)
  • Cost-effectiveness or whether the benefits associated with treatment implement outweigh the costs

 

Designing a Behavior Intervention Plan (BIP)

 

To “put it all together,” it is useful to carefully consider the components of a complete behavior intervention plan. Cautilli, Riley-Tillman, and Thomas (2001) detail the characteristics and content for a well-written, high-quality behavior intervention plan and describe many of the following as essential components:

  1. A statement of the objectives and goals of the program
  2. Behavior definition of the challenging behavior and any desired behavior that will be specifically reinforced
  3. Assessment procedures used (e.g., functional assessment, assessment of adaptive behaviors, reinforcer or preference assessments) with a brief description of the findings
  4. Data collection and analysis procedures (e.g., the behavior recording and sampling procedures used and graphical analyses included)
  5. Functional hypothesis or maintaining variable(s) for the challenging behavior should be described with the following noted:
  6. Antecedent & setting events for the problem behavior
  7. Maintaining variables for the challenging behavior (e.g., attention positive reinforcement, escape from demands)
  8. Functional replacement behavior defined and procedures used to increase or teach it
  9. A step-by-step plan of how and when the following procedures will be performed and by whom:
  10. Antecedent-based interventions
  11. Consequence-based interventions (e.g., differential reinforcement of incompatible behavior/alternative behavior/other behavior)
  12. Generalization & maintenance
  13. Emergency procedures specified
  14. Plan revision information
  15. Treatment integrity checks or procedures used to ensure the behavior intervention plan or BIP is being implemented as intended and to provide reinforcer to those individual who are implementing it correctly.
  16. Training procedures (how staff/teachers/parents will be taught to implement the BIP)
  17. Informed consent from the parent/guardian and the individual (or assent)
  18. Cautilli et al. (2001) also recommend that the BIP should be written at a 9th grade level to ensure that it is understood by all involved.
Table 19: Example of a Behavior Intervention Plan (BIP)

Student: Tobin

Date: January, 2014

Background: The problem concerns the high rate of off-task behavior of a 12-year-old male with autism spectrum disorder. No previous BIP. Teacher made the referral. Challenging behavior has been occurring for past 6 months. This challenging behavior interferes with Tobin’s learning and that of other children in the classroom.
Past strategies: Teacher talked to him about his behavior, sending him to the principal, separating him from other students—all of these were ineffective at decreasing Tobin’s problem behavior.
Behavioral Definition: Off-task behavior defined as talking with peers, walking around room, or engaging in activities other than those that have been assigned (e.g., singing instead of reading, playing with objects in his desk when he should be completing a written assignment).
Behavioral Objective: To increase on-task behavior to 90% of intervals during academic periods (e.g., reading, math, social studies) for 7 consecutive days.

Assessments

Baseline Data: Observations occurred during two 30-min observations in the classroom where during every 30 s, the presence or absence of the challenging behavior is noted (known as an interval recording procedure). Tobin engaged in on-task behavior during 20% and 27% of observed intervals, respectively.

Function of the Behavior: During classroom instruction and individual assignments, Tobin engages in off-task behavior to gain peer attention (attention positive reinforcement) and escape task demands (negative reinforcement—activity).

Past Research: Differential reinforcement procedures has been successfully used to increase desirable behavior for children in the classroom (Kodak, Miltenberger, & Romaniuk, 2003; Neidert, Iwata, & Dozier, 2005; Vance, Gresham, & Dart, 2012).

Intervention Procedure: The intervention procedures for Tobin will consist of changing the antecedent conditions by providing Tobin with positive reinforcement for on-task behavior and attention extinction for off-task behavior.

Preventative:

  1. Tobin will be moved further from the group of students with whom he usually socializes during class.
  2. When he enters the classroom, Tobin’s teacher will remind him of the consequences of staying on-task.
  3. Tobin’s teacher and teacher’s aide will provide attention (e.g., “Wow, you are sitting nice”) every 2 min (noncontingent reinforcement).

Positive reinforcement for on-task behavior (replacement behavior):

  1. Tobin and his teacher will prepare a written plan (known as a behavior contract) specifying that Toby will earn 5 extra min to interact with peers when his on-task behavior during a class period is at or above 80% of observed intervals.
  2. When Tobin is on-task, Tobin’s teacher will provide verbal praise (quietly and unobtrusively) at least four times during each class session (DRI)

Reactive: When Tobin is off-task, he will have no access to socializing with peers during individual assignments, and he will be redirected to complete his assignments (attention extinction and escape extinction).

Planning for Generalization: Once Tobin meets the behavioral objective, the reinforcement schedule will be weaned by successively increasing the requirement to 85% and then 90%, of intervals of on-task behavior. Reminders will also be delivered less and less.

Evaluation of Effectiveness: Tobin’s percent on-task behavior during intervention was 85% of the intervals compared to 27% during baseline.

Resources & References for Procedures in this BIP:

Kodak, T., Miltenberger, R. G., & Romaniuk, C. (2003). A comparison of differential reinforcement and noncontingent reinforcement for the treatment of a child’s multiply controlled problem behavior. Behavioral Interventions18(4), 267-278. doi:10.1002/­bin.143

Neidert, P. L., Iwata, B. A., & Dozier, C. L. (2005). Treatment of multiply controlled problem behavior with procedural variations of differential reinforcement. Exceptionality13(1), 45-53. doi:10.­1207/­s15327035­ex1301_6

Vance, M. J., Gresham, F. M., & Dart, E. H. (2012). Relative effectiveness of DRO and self-monitoring in a general education classroom. Journal Of Applied School Psychology28(1), 89-109. doi:10.­1080/­15377903.­2012.­643758

A best practice when designing a behavior intervention plan to address an individual’s challenging behavior is to use current research-based assessment practices and interventions to guide the approach selected. The Individuals with Disabilities Education Improvement Act (IDEIA, 2004) and ethical practices require that professionals who work with students with disabilities maintain currency with empirically-based assessments and interventions. As the field progresses new and more effective procedures are discovered and revealed to better care for the needs of individuals with developmental disabilities. As one resource to consult, the “What Works Clearinghouse” serves as an online review of evidence-based interventions in education as evaluated by the Institute of Education Science (http://ies.ed.gov/ncee/wwc/news.aspx?sid=8). In this resource, published research concerning common intervention approaches are reviewed according to a standard and report outcomes (e.g., effect size) in relation to the scientific strength of the evidence so that informed selections about treatment practices can be made.

 

Special Education Perspective: Positive Behavioral Support and Response to Intervention

 

Positive Behavior Support (PBS) is generally the first and most appropriate choice at a school-wide level for intervention in schools for children with challenging behaviors. PBS has long been recognized as a prevention approach to undesirable behaviors (Vaughn & Bos, 2009). PBS is often taught in teacher education training programs as the preferred treatment approach in public school classrooms, rather than the use of punishment. Quite simply, PBS is a focus on the desired behavior, rather than focusing on the undesirable or challenging behavior. PBS requires the teacher and other related professionals to systematically look for positive behavior. This is generally accomplished with the use of social, tangible, or verbal reinforcers specific to the desired behavior, such as saying when Mary has her head down and is quietly reading the passage, “Thank you for your attention to the task, Mary.” Teachers in the classroom can use such positive reinforcers to encourage positive behavior and to focus attention on a model of appropriate behavior. As another example, a token economy in the classroom can be employed where children can accumulate points or tickets for desirable behavior that can be turned in for free time, a special lunch with a friend, a free pass on one homework assignment, or other positive reinforcers. Other prevention approaches include teaching children conflict resolution and interpersonal problem solving. Some curricula include aspects of character education and principles for teaching social skills (Vaughn & Bos, 2009).

Within recent years, professionals in public school settings have also used an approach called Response to Intervention (RTI). RTI was mandated by federal law (IDEIA, 2004) as a means of not allowing children to fail either behaviorally or academically without access to a variety of research-based interventions individualized for that particular child. RTI requires all professionals to monitor academic and social skills on an ongoing basis, collecting data on performance of every child, and reviewing that data with a team of related professionals. The intent of RTI is to prevent problems or to quickly intervene before a child loses skills. Monitoring occurs at three levels or tiers. Those tiers are:

Tier 1: screen for behavior problems, introduce interventions, convey expectations

Tier 2: provide supports and feedback for students with similar behavior problems

Tier 3: provide more specific and intense interventions for students whose behavior has not improved (Vaughn & Bos, 2009)

PBS and RTI work in conjunction with one another and the focus of both approaches is on prevention of problems or preventing the severity of a problem existing without research based responses individualized to the child.

Completing an FA will assist in identifying the function of the student’s challenging behavior resulting in the design of the best treatment for that situation. The knowledge gained by implementing an FA will provide the basis for an effective behavior intervention plan which is an essential component of the student’s Individualized Education Program (IEP). The Individualized Education Program (IEP) serves as the foundation of the educational plan for each student with disabilities. The IEP is a strategic planning document that should be far reaching in its educational impact. An IEP identifies a student’s unique strengths and needs and how the school will strategically address those needs (New York State Department of Education, 2010, p.3). It is a legal document, designed and agreed upon by all members of the educational team, including the family of the student with disabilities. The key components of the IEP rest upon the concept of individualization. As stated in the Council for Exceptional Children (CEC) professional standards:

…special educators are active and resourceful in seeking to understand how primary language, culture, and familial backgrounds interact with the individual’s exceptional condition to impact the individual’s academic and social abilities, attitudes, values, interests, and career options. The understanding of these learning differences and their possible interactions provide the foundation upon which special educators individualize instruction to provide meaningful and challenging learning for individuals with exceptional learning needs. CEC, 2011, Content Standards, Standard 3

One essential component of the IEP is listing the positive behavioral supports needed by the child. A careful FA analysis is critical to identifying those positive behavioral supports that will help guide the professional to developing the child’s desirable behaviors in the classroom, clinics, in social environments, and at home.

 

Summary

 

The design of effective intervention is based on identification of the maintaining variables for the individual’s problem behavior as gathered from a FA. The core of a treatment package should include preventative measures, teaching a replacement behavior that serves the same function as the challenging behavior, reinforcing desirable behavior, and a procedure in place for when that behavior does occur. A behavior intervention plan provides a written form of the treatment for others in the individual’s natural environment to follow to assist the individual with learning desirable behaviors.

 

Discussion Questions

 

  1. What factors must be considered when designing an effective intervention?
  2. Explain how treatment is designed based on the function of the challenging behavior. Give examples for how treatments will differ when an individual’s challenging behavior is maintained by attention positive reinforcement versus negative reinforcement.
  3. What are five ways to determine if intervention is effective?

 

Exercise: Complete the Behavior Intervention Plan (BIP)

 

Instructions: Read the teacher’s referral below and complete a BIP based on the information. You can add details as needed to fully address the components of the BIP. Speculate on the function of Juan’s challenging behavior and design a plausible treatment based on that function.

Teacher Referral Report: Juan is a 13-year-old boy with cerebral palsy and intellectual disability. He is in an 8 to 1 classroom. His communication skills are very basic. When he does talk, he whispers. Almost all of his speech repeats what was just said to him (echolalia). Even when he engages in echolalia his intelligibility is poor because he whispers. Occasionally he will kick me or other adults at a table (during groups), but it is lightly and infrequent. He will sometimes also throw things but this has only happened about three times this year. I am most concerned about his lack of any participation in any class activities or conversations. When he is asked to do something he will often just sit there and, less often, he will sometimes rock and hum during the morning meeting when it is his turn to come to the front of the class to review the day, he will come to the front of the classroom, but will then just stand there.

Student: Date:
Background:

 

 

 

Past strategies:

 

 

 

Behavioral Definition:

 

 

 

Behavioral Objective:

 

 

 

Assessments

Baseline Data:

 

 

 

Function of the Behavior:

 

 

 

Past Research:

 

 

 

Intervention Procedure:

 

 

 

Preventative:

 

 

 

Positive reinforcer:

 

 

 

Reactive:

 

 

 

Planning for Generalization:

 

 

 

Evaluation of Effectiveness:

 

 

 

Resources & References for Procedures in this BIP: