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Hello, and thank you for joining us today for Part three of the “Understanding and Addressing Challenging Behaviors of Individuals with Complex Needs” webinar series.  My name is Wendy Szakacs and I am the Regional Coach for Autism and Low Incidence at OCALI in the northeast and eastern parts of Ohio.

And I am Chris Filler, the coordinator of the Lifespan Transition Center at OCALI, the Ohio Center for Autism and Low Incidence. We serve families, educators and professionals working with individuals with autism, low incidence disabilities, and complex needs.

This series will teach you a systematic process for addressing and changing challenging behaviors.  We will be building your knowledge step by step through each of the webinars in this 5 part series.  Today we will examine the details of the underlying causes of behavior.

For those of you that are working through the process with someone you know or support, since the last webinar, you identified a general set of antecedents that occur before the identified behavior and a group of consequences that are occurring after the behavior. You also looked at a number of key areas that could contain challenges that underlie and drive the behavior the person is experiencing. These areas include learning challenges; environmental mismatch; behavior and biological factors; social, emotional and communication challenges;  and issues surrounding motivation.

Finally, you summarized those challenges on section one of the Intervention Form.  Today, we are going to go deeper into the A-B-C area of the functional behavior assessment. In this section, we are going to further break down the antecedent and consequence areas to better understand what is occurring and where interventions need to target. When attempting to understand challenging behaviors of individuals with more complex needs, it is often necessary to look even more closely at factors surrounding behavior. Important information may be buried very deep below the surface, much like the bottom of that iceberg that we compared behaviors to in previous webinars.

In webinar two, we discussed antecedents and described them as those things occurring before a behavior and having an influence on the behavior. Today we will break down that even further and describe antecedents as either “setting events” or “triggers”. Setting events are those things that happen before a behavior and make the behavior more likely to occur, but are not directly related to the behavior. Antecedents can also be “triggers”. These are things that happen close to the occurrence of the behavior and have a direct impact to the behavior. Consequences. In webinar two, we also discussed consequences as those things that occur after a behavior that either increase or decrease the chances the behavior will occur again.  This leads us to a discussion on “reinforcement”, which are those things that will increase the chances of the behavior occurring again and help maintain the behavior in the future. Identifying setting events, triggers, and reinforcement allows you to discover the reasons why a behavior developed and why it continues. These reasons become the hypothesis that will be the target of the intervention plan.  All these steps of identifying and connecting events to behaviors can take time, patience and practice! So to help you better understand this portion of the plan, we will discuss each of the components individually.

Lets start with setting events.  Again, these factors do not directly cause the behavior to occur but they do make it more likely to happen.  An example might be like when someone is tired and they can be described as having a “short fuse”.  It may take very little to set that person off!  Or think about this in relation to a school day routine. Maybe dad’s alarm didn’t go off this morning and so everyone is running a little late and rushing around to get breakfast, get dressed, and out the door on time.  This affects Davey by making him anxious and a little fussy as he goes through his rushed home routine.  However, when Davey gets to school and as he approaches journal time, which is a challenging task for him, he throws his journal and pen across the room while yelling he’s not doing journal today. Teachers and peers are surprised, because Davey although has never really liked journal time, he has never really reacted that strongly before.  “Being late”, in this scenario, is identified as a “setting event” to throwing his book and yelling. If Davey had not been agitated from being rushed and late, the behavior might not have occurred, or it may have been less intense.

So here is a list that includes items that have frequently been reported as setting events to behaviors.  Do they look familiar? I bet they do! Hunger, thirst, sensory/biological challenges and changes in routines can make a person’s mood more fragile and more susceptible to the triggers they encounter. How can we support the individual when one of these setting events takes place?  One way is to share information between home and school in a non-judgmental fashion. Sometimes families schedules’ do not run smoothly. Sometimes teachers are unexpectedly absent. It is the realities of life. School personnel, employers, caregivers, and families need to have a reliable, trusting, and respectful communication system to share this information. If the support staff or family knows a setting event has occurred, then interventions can be implemented and hopefully challenging behaviors can be avoided or made less intense.

Now Triggers. These are things that happen and can immediately set into motion a challenging behavioral episode.  An example might be when a child has taken a favorite toy away from him. He immediately starts to cry. The act of taking away the toy is the trigger to crying. On this slide you see examples that may be triggers for some individuals. Be aware of an individual’s triggers allows you to be prepared with support interventions and also helps identify what new skills and coping systems need to be taught so the person can start learning to regulate his actions and reactions. And sometimes, yes, setting events and triggers can look similar. Understanding how these events fit into the escalation of behavior for the specific person in the particular situation allows one to determine just what role the events play in the targeted scenario.

Now let’s examine reinforcement.  These are events that occur either purposefully, or unintentionally, that encourage a person to continue or repeat a behavior.  An example: Maybe you have a system for earning time on the computer or earning money to increase homework completion without the fight.  That would be a purposeful, planned reinforcement.   Or…. if when I make my bed I usually get $5, the likelihood that I will continue to make my bed in the future is increased. The money in this case is reinforcement. Now, here is an example of unintentional reinforcement.  A student wants the teachers attention…and the student wants that attention badly! Raising his hand, jumping up in his seat and making a little noise does not seem to work. But when he shouts out “Teacher I need Help”, she quickly comes to his side, not only assist but also to quiet him. This shouting seemed to work really well for the student the first time, so he tried it again the next day and the next day, and the next with similar results! In this case,  although she does not approve of his methods to gain attention, the teacher has inadvertently reinforced the shouting behavior by giving him the attention he wants.  So sometimes, reinforcement is an effective and positive pre-determined process. But sometimes we need to look more closely for those events that may be unknowingly providing the person with reinforcement and thus maintaining the challenging behaviors. Once those are identified, we are able to teach and reinforce the new skills and the desired behaviors. That is part of the intervention plan we will be developing.

Now we’ll talk about punishment, which is what people sometimes attempt to use to stop a behavior.  This is not a positive approach and not recommended but it important to understand. Punishment might be purposeful, such as losing recess or getting grounded for not finishing work because of acting out in class. However, punishment can also be inadvertent. Consider this example. Students are working in groups as assigned which creates an expected noise level in the room. It is necessary for the teacher to clap his hands loudly to gain the student’s attention. The clapping is just a signal for most student, however, for the student with a hearing sensitivity, this can be very painful. Over time, the clapping might prevent the student from being willing to engage in a group time because of the predictable painful sensory experience that follows the group work. While this example seems extreme, it shows how a typical activity could take the form of punishment.  Further, research shows that punishment may work for a short time, but will not have lasting effects, does not teach new skills and can make it difficult to develop a trusting, respectful relationship. Therefore, the support plans that we will develop in a future webinar will only include reinforcement and other positive approaches. Some of you may be thinking…..”If only there was some generic list, amazing assessment tool or magic to help complete this section”! But there is not….especially when dealing with challenging behaviors of individuals with complex needs.  It takes hard work to figure this out.  We need to be detectives and really examine what is happening with this individual in this situation for this behavior.  Then we must work through the same process for other challenging behaviors to finally be able to teach the skills that have the potential to make positive change.

Let’s move on and look at Molly’s A-B-C with the addition of setting events, triggers and reinforcement.  We can see that Molly’s setting events include Mondays, which may be due to the change of routine. Another setting event is when Molly is not able to finish what she is doing and is rushed to the next activity.  These events do not directly cause the screaming, but they make Molly more anxious and less able to tolerate what is coming next.  Her triggers appear to be entering circle time, and being touched, and a specific classmate named Shelly who is very friendly, but overwhelming.  Now, lets move on to the consequence side. What do we see that reinforces the challenging behavior?  We see that when Molly screams, people move away from her, she gets to take a break, and she might get to return to the work she was upset about leaving unfinished earlier.  So let’s create the hypothesis about Molly’s screaming behavior.  First, we know that the screaming behavior occurs around circle time because that is a time when she is close to others and we now know she doesn’t like being touched.  Circle time is a time when academic demands increase and we know academics are hard for Molly. We also know that Molly leaves a preferred activity to come to circle time for a non-preferred activity. And finally we discovered that circle time means there are no choices or alternatives offered.  So when Molly starts screaming what happens? On the consequence side we find that people move to allow her space that is comfortable. She often leaves the circle that means she leaves the difficult academic activities behind. In addition, she can return to the table activities that she enjoys. Many people would sum this up as “Molly screams to avoid demands or to gain desired items or activities”. However, until you know what she is avoiding and why, or what she wants and why, you cannot create an individualized support plan.

Let’s take just a few minutes to review the process thus far. To complete the FBA chart, you first define a measureable, observable behavior.  Then you identify antecedent events, including setting events and triggers. Next, you identify consequences and reinforcing events.  From this information the hypothesis statement is developed which identifies the factors that increase or decrease the occurrence of the challenging behavior. All the work up to this point is necessary in order to assure that the plan that is developed includes strategies designed to address the setting events, triggers and reinforcers of the targeted behavior.  

After you complete the extensive FBA worksheet, it is time to return to the Intervention form and review section one. After closer examination of the events surrounding and underlying the behavior, additional information that was discovered will need to be added to that section before moving further in the plan. Look again at Molly’s extensive FBA sheet with the identified setting events, triggers, and reinforcement, and the hypothesis statement. Several additional pieces of information were identified and added to section.  This includes the underlying difficulty she has with communication skills, especially in an emotional situation. It also includes the challenges she faces in the circle time environment due to the lack of structure or predictability.  You can see on the slide where these were added in red.

Now it is time to complete section 2 of the Intervention form.  You will be summarizing the information from the hypothesis and section one to prioritize the most important underlying contributors to the behavior.  Theses are identified as setting events, triggers, or reinforcers. As we discussed before , Molly’s setting events include schedule changes from the weekend, not being able to finish an activity before transitioning,  and the frustration that builds when trying to communicate. Triggers to the behavior include circle time, which means sitting close to Shelly and being touched and the presentation of academic activities.  Finally, after she starts screaming, Molly is assisted to leave or escape the situation that she does not like and also gains access to activities she prefers and personal space. This summarizes what is happening to influence Molly’s screaming at circle time.  Keep in mind that this is a working document.  It’s okay to start with just a little information and then add to it as you figure out more.  Reasoning out how to support challenging behaviors is an ongoing process that you will get more comfortable with as you practice it.

As we discussed in the previous webinars, if you have chosen to practice this process with the forms included in the downloadable file, you will now be able to work on identifying the antecedents that are setting events and triggers as well as identify reinforcing consequences. This information will allow you to develop the hypothesis about the behavior.

After completing the extensive FBA form, review section one of the intervention form, add any new information discovered and then in section 2, summarize the possible underlying contributors to the behavior. After you complete this portion of the process you will be ready for Webinar 4. See you then.