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National Autism Center Report

2 Oct
This just came up on my radar, and I thought I would check it out.
Before I even get into anything about the report itself, I do want to mention that actually getting a copy of the report involves submitting your name, email and state. I looked for any privacy notices regarding this information, but didn’t see any. So before even reading it, I resolved that I was going to mention this hoop that everyone must jump through. I think it is needless and detrimental to the stated primary mission of the organization which is to help professionals and families of individuals with autism. If you’re going to release the report to the public, then release it. If you’re going to harvest information from people who want to see the information, then be explicit about that.
Having said that, I went ahead and submitted my information, trusting that I wouldn’t be spammed into oblivion. I then download all 3 of the options and began reading.

The Seclusion and Restraint Issue

12 Mar
The steady and increasing drumbeat of disability advocates is zeroing in on the use of seclusion and restraints in the school system. My friends over at change.org are leading the charge along with a number of others, if you check out their links.
While this has been an issue for a few decades, I think I can safely say that it has begun to approach critical mass. Changes are being made around the country, in the state of Georgia and in my own school system. Keep in mind that corporal punishment was still pretty common in many Georgia districts until relatively recently.

Before diving into the fray, let me give you a bit of my own personal history on the subject. I’ve already written abit of my own old school background on the subject of spanking. My first real exposure to the practice in special education was when I was a para at the local psychoeducational center about 15 years ago. Basically the guideline for time-out was when the student was hurting others or destroying property. The same goes for restraint. Basically, it makes sense to me that if a child of 9 is severely emotionally disturbed and is beating the crap out of another student (or teacher) that physical intervention is warranted. If he/she is throwing a chair or gouging out their own eye, I’m trying to wrap my mind around how I might help the child or others without the laying on of hands. I already know the answer to that, which I’ll share in a moment.

But we did use restraint and seclusion using guidelines and training from the Crisis Prevention Institute. We also used life space interviews after a student got out of time out. The procedures that we followed at the psychoed were, in my opinion, second to none. But seclusion and restraint were NOt our methods of choice. We relied an a very robust arsenal of positive behavioral supports, because you simply can not teach a classroom where everyone is in timeout. It took a lot of personnel to moniter the rooms, as well as the risk of personal injury. So in our class at the time, we had a point sheet/token economy, a level system, a group reward/contingency program, therapeutic rec/leisure and generally tried to make the climate as positive and rewarding as possible. so when a student had to go to time out, they were really and truly missing out on something. On top of that, I introduced a sort of “punch-out” token economy that was more immediate. The effect of that, was that I could take up the token card instead of ejecting the student while reinforcing everyone else. So it was a time-out-in-place. But the student always got reinforced when they were ready to rejoin the group/task. By the end of that year, I rarely ever, ever had to put a kid in time-out or lay hands on them in our class. However, the practice of restraint and seclusion did end up costing me personally and dearly that year.

While I was being a para for a teacher of mostly middle school students. the teacher of the younger kids was having major problems with one of her 9 year-old students. so the director made the decision to move me in that class to help deal with that student. That lasted about 2 days. He was a pretty wild kid, and I did end up having to hold him on the ground quite a lot. He was small, but extraordinarily fast and strong which is why they decided a big male was needed to help handle things. In hindsight, this was not necessarily the best thing. And it turned out to be a very bad thing. One day, after he had been particular trying, it was finally the end of the day and time for him to get on the bus to go home. So we went out to the bus, but instead of getting on the bus, he took off like a shot through a crowded end-of-school parking lot and towards the very busy end-of-the-day-traffic street. The teacher was in hot pursuit and so was I (we already had the rest of the kids on their buses). She told me to call the police, which is what I should of done. But I didn’t. To be perfectly honest, I had had it with this kid and was at the end of my rope. I was going to get him. While there was an element of danger for the kid with buses and cars, that might not have been the only reason I went after him. I caught up to him and made a lunge to go for the final grab. And that was it.

I have no idea exactly what happened, but it was all over for me. My knee somehow got terribly twisted and I went down hard and heavy. It could have been the uneven grass we were on or the sudden swerve the kid took and me being too stupid and reckless. At that moment, the true idiocy of my actions caught up and washed rght over me in a wave of pain. And I would spend the next few hours in an emergency room. Nothing was broken, but I had some ligments that were badly torn. That was it for my running career. To this very day, that knee will sometimes bother me for wierd and strange reasons. Losing weight definitely has helped keep me from limping and gimping around. But it is a persistent reminder of the folly inherent within restraint practices. At least by school teachers, no matter how young and fit.

My next job was at a psychiatric hospital in a child and adolescent unit. Even though it was the late 1990’s it seemed like the 1980’s sometimes the way it was run, especially in the area of behavior management. When I arrived, there were lots of people who were experts on therapy and behavior but none of them were behaviorists. The social workers were into family systems, the behavior specialist was actually specialized more with those who had been sexually abused and the doctor/psychiatrist was into psychoanalytical therapy while being supported by the MD’s and nurses with lots of psychotropic medications. seclusion and restraint was used quite regularly, but it is hard to imagine not using it with some of the severe behaviors that warranted being hospitalized. I saw it all while I was there, but since it was a locked facility, I never had to chase anyone down. Plus the health service technicians did all of the physical work. And sometimes that meant a 5 point restraint system under a doctor’s order. While there was a token economy and level system in place, it was not used very well. So I did use other contingencies that I had control over, like access to a computer lab. The kids loved the computer lab and I had the best hardware and software money could buy at the time. I had a $7,000 budget! So I had resources to apply towards behavior and teaching. If a kid acted up in my class, he/she was simply removed to time-out or more medication.

But the big issue/movement in the 1990’s was deinstitutionalization, which meant that the C&A unit was closed and I lost my job. I’ll have to write more sometime about the repercussions of that movement. Suffice to say that the present movement towards not using seclusion and restraints is a direct result of that battle that was mostly won by the advocates. Most of the cases that were served by a huge (and expensive) team of doctors, nurses, behavior specialists, recreation specialists, psycholigists and social workers are now being served by the school system and mostly one teacher and a para. So the teachers are being held responsible for behaviors and clients that they are not trained to care for. Is it any wonder that there is abuse and mistakes and serious consequences?

When I first started here, most of the kids were fairly moderate. We were community-based, which involved going into the community almost everyday to a job or community site. My kids loved getting on the bus and getting off the school campus. So did I and the paras. The contingency was simply that if a kid acted up, he didn’t get to go out that day. And that was usually sufficient. Today, the climate has changed. Community-based instruction is quickly disappearing. We go out maybe once or twice a week. The shift has been toward academics and the Standards. True, we try to work on life skills and weave the content with the skills but some standards and skills simply do not line up. And the level of severity of the disabilities has become more acute. Many of these students would have been under the care of a team of doctors, nurses, psychologists and specialists back in 1970’s and ’80’s. But those facilities went away the same time as the C&A unit. Now it is all me.

The schools are poorly equipped to deal with severe behavior probloems. The state charges schools with the primary mission of educating students in a curriculum that is largely aimed at getting students into college. Any other agenda is secondary to that primary mission of an academic education. How effective a given school system is in that one single mission is up for discussion. I agree that schools do need to focus on this one thing (and learn to do it well) while providing a safe and humane environment for all learners. There should also be options for vocational and life skills, but that is another discussion. The point is, is that when it comes to dealing with behaviors that result in the school becoming unsafe for students, there needs to be some options. And right now, I see the only possible option is calling the police, which is what I should have done 15 years ago. We were located right next to the police station at the time! I do believe in teaching students with behavior problems, but I learned very early on that when a child is in the midst of a full meltdown or tantrum, there is no learning or teaching that is going on.
Actually, there is one other option that might work. That is to convert all of the time-out and seclusion rooms into places that lock from the inside. Then when a student is out of control and getting assaultive, the teachers can seclude themselves. Or perhaps fixing the valium dispenser in the teacher’s lounge would work.

Seriously, I do support the work of those advocating for more and better humane treatment of students, generally speaking. But just as there were adverse consequences to pushing everyone out of institutions and into the community, there will be adverse consequences for making seclusion and restraint forbidden practices. I hope that the movement results in a more positive climate within schools and classrooms, but I don’t think it will result in the sort of programs envisioned by most people. What made states move to deinstitutionalize was that they saw they could save a ton of money. The result was a lot of mentally ill homeless people and many of them being served within jails and prisons. Sure, many were better off in group homes. Many weren’t. A 10 minute period in seclusion often allows the student to remain in school the rest of the day. If the police are called, will the result be the same?

I’m going to go ahead and attach my seclusion/time-out procedure so that you can feel free to review it. I’m open to criticism about it if there is anything wrong with it. Of course, if you are against seclusion/time-out under any and every circumstance then you won’t like it no matter what the policy is! But the alternative of having the student removed indefinitely, or having people hospitalized is not very attractive. It would wonderful if everyone was extensively trained and supported, but that hasn’t ever happened even in the most ideal of circumstances and conditions. With serious budget constraints across the country, professional development is the first thing that gets tossed out the window, followed closely by para and behavioral support.

Using Video: Information is Power

9 Jun

Since school is out, I’ve been having the time of my life, exploring new mediums and modes of expression and teaching. I took over an hour of footage before school let out and am taking some time to edit and post them to TeacherTube. But I’m also connecting within the YouTube community. I’m planning on doing more creative things on YouTube, which means not everything will be as “professional.”

The great thing is watching what other people are doing and how they are doing it. I was talking to an assistant principal awhile back and letting her know some of the things I was doing. “You mean they have educational videos on YouTube?”

Yes, yea they do. In fact, YouTube is a treasure trove of knowledge and information. Yeah, I subscribe to an X-men cartoon channel and Al Yankovic’s “White and Nerdy” video is among my favorites along with the Guacamole Ukulele song. Kind of a theme going on there.

But there is a world of knowledge out there waiting to be discovered. My one subscriber, so far, is Dr. Melvin Koplow aka drmdk. His YouTube channel is here. There’s some good information there, as he got the idea to videotape short interviews with doctors and experts from a variety of fields and disciplines, making medical information available to anyone. The information is fascinating and cutting edge and he is truly on to something. I will warn you that it helps to have a keen interest in the content, as the interviews and videos are a bit on the dry side, but they are also less than 10 minutes long each. And in these videos, especially in the autism section, you can see what the doctors and experts say.

While information and knowledge is power, it’s up to individuals to decide whether or not they want to be ignorant. Hat tip to Liz who found a good article about the costs of unproven and sometimes dangerous treatments for autism. Dr. MDK does cut through much of this with a number of his videos on the subject. In fact, one of the the reasons Dr. MDK started making these videos is linked to Liz’s latest blog entry here. You can see Dr. MDK talking about why he’s making these videos here. He talks about how there are ghostwriters done by people who didn’t even do the work or research. There is something about having a face and a voice attached to the information instead of just a written page.

And that’s part of what I’m doing. I’m putting myself out there, where you can see what I’m doing and who I am with real, actual students. You see who I am. This isn’t just some anonymous blogger anymore. It’s someone more real. Back when I posted my Fleecing article, I initially got a lot of comments from people who agreed with it, but as time wore on, more and more parents started commenting and many of them stated how these controversial therapies had helped or cured their kids.

Where’s the before and after YouTube videos?

I have some that I’m working on, and you can judge for yourself. Before and after videos are one reasonable measure of validity, according to Kazdin’s authoritative work on single-case research designs. But I haven’t seen any. Why isn’t this very simple method used to lend at least a minimum of validity to any of these treatments? Because there is none? That’s not to say that method alone would be sufficient to prove anything as much as support some of the ideas. Yes, YouTube could be a vehicle for helping promote legitimate treatments for autism. You can look and see several videos of kids getting behavioral therapy and track the progress yourself of some of the kids.

There’s good information out there, it’s just a matter of finding it. Or better still, creating it.

D.

Discrete Trial Training (DTT)

4 Jun

In making my course for teachers and paras for students with severe disabilities, I’ve been looking for content related to what we do in the classroom. Today I decided to work on Discrete Trial Teaching (DTT) sometimes also called Discrete Trial Instruction (DTI). Same thing, different name.

I prefer video over text alone, so I went first to TeacherTube, since the school system doesn’t block that site. However, the only video there on the subject is the one I posted. Oh well. YouTube is a better source for videos on anything and a search there was much more fruitful. Here’s one working with a very young child. No matter the age, the same rules always apply. Keep the instruction consistent, reinforce independent responses, and record the responses for data analysis. The YouTube video gives very comprehensive, yet concise instruction on the topic and I’d love to use it.

There is also a series of Lovaas training videos on YouTube which are much more advanced, behaviorally speaking, but the one listed above gives a better overview in a lot less time . Part 1 shows how not to do it in the beginning, which you can see from the comments elicited strong reactions from a few viewers. It’s a bit dated, but you get a good view of a purer form of DTT from the Lovaas people. There are many YouTube videos in a variety of languages worth looking at and these are mostly used for and by parents. Teachers and paras really need to tap into this information, too.

Typing in “ABA” reveals a lot of videos showing it in action, mostly with very young children with autism. DTT is not the same thing as Applied Behavior Analysis (ABA). ABA is more of a global description of a system. It’s sort of like referring to “rain” as “weather.” Yes, rain is weather, but it’s only one aspect of weather and even precipitation. Weather encompasses all manner of meteorological events including wind current, barometric pressure and the jet stream. ABA encompasses a whole lot more topography beyond just DTT, but a lot of people outside the field confuse the two.

I recently put a couple more videos up showing some of what I do with a type of DTT here and here. This is also serving as a sort of tutorial in modeling for para instruction at the same time instructing the student. I probably need to make a more explicit para training video since that is a big issue for most special ed teachers.

I like DTT because it is straightforward, and something that paras can learn and do pretty easily. It can yield some good data and works well with short-term IEP objectives. It is something that is not expensive to set up, and it is accessible to anyone who wants to learn how to do it.

Catherine Maurice’s Behavior Intervention for Young Children remains one of the best and most accessible resources on the subject even though she makes the common mistake of confusing ABA with DTT. Many of these interventions can be used with older students with severe autism and you’ll recognize what we do in the videos compared to what is done with the youngsters. It’s only been within the last 10 years that DTT really took off in the autism community, so students in high school were probably never exposed to this behavioral technology at a younger age.

D.

RTI & POI

7 Sep

Here’s a couple more new acronyms to add to your lexicon. These are not limited to special education. No, they are coming to regular education classrooms nationwide and especially (as far as I know) to the state of Georgia.

RTI is Response To Intervention, which is the latest buzzword burning across all levels of the educational spectrum. In fact, my blog traffic will probably jump just because I’m referencing it. Everyone is talking about it, or at least writing about it so I though I would throw in my two cents. POI is Pyramid Of Interventions, which might be Georgia’s tricky take on RTI. Here, the two seem to be used together and the state is basically mandating that the RTI/POI approach be used effective immediately. We just had a recent faculty presentation on it, and it certainly caused a lot of buzz amongst the teachers. At least for the regular teachers.

What RTI basically involves is a sort of approach that behaviorists have always used. Basically, if a student is falling behind in a subject, the teacher begins collecting data and tracks the students’ progress. There are some interventions that the teacher can try such as peer tutoring, extra practice, a graphic organizer or some other instructional strategy in order to help the student progress in the curriculum. If the student fails to respond to the intervention, then another intervention is attempted and the student is tracked some more. If the student makes progress, that’s great! If they do not, you progress up a level on the pyramid of intervention (POI). The intent is to keep students from falling behind and to keep them from having to go into special education. The goal is to have less than 5% of the school population in special education as opposed to the present rate which is about 13% in our system. This is a procedure not altogether foreign to most special educators because we tend to be more behaviorally oriented. However, the general education teachers are not from behaviorist backgrounds, so they almost instantly begin thinking in terms of learning styles, modalities, multiple intelligence and other assorted theories that may be very nice but are not really shown to be efficacious according to any sort of empirical research.

What really makes the regular ed. teachers groan (especially at the high school level) is the increased paperwork this is going to involve. Much of the load that us special educators have been carrying for years is being shifted to the regular teachers. And for a high school teacher who may teach 150 students per day, this is VERY substantial! This is why a collaborative model of instruction begins making more and more sense because well-trained special educators can help with the data collection and interpretation as well as help implement research-based interventions that might yield some results. However, this does not appear to be the way things are shaping up from what I can see in my school. Special education seems to be more and more marginalized, and the emphasis seems to be on trying to bypass and eliminate that exceptional subgroup altogether. Hey, if kids can learn better, I’m all for it! I have other areas I can (and will) teach. But regular education has been struggling with the load they already have. Increasing the non-teaching paperwork burden on those folks will not improve the special educator’s lot, nor will it improve teaching quality. It might make an already severe teaching shortage even moreso. Plus their concept of “research-based” is sort of loose compared to what I’m used to seeing in special education literature.

If you haven’t heard of RTI, you need to bone up on it. I’ll extend on the topic more (because we were guaranteed more in-service meetings on it) and provide a few resources to look at.

 

I also want to talk about ED in 08 at some point.

dick

Going back in time for Spaz

23 May

Jackie stopped by and asked:

If you could go back in time for Spaz, what do you think should have been done to better his outcome (in any and all areas you care to comment on).

Wow. That’s so tough, but I think it’s important for any parents who do have children with severe autism and behavior problems. It’s important to realize that back in 1985, when Spaz was born, no one knew much about autism, let alone interventions and services. So just being born later will improve the prognosis for most kids. Spaz was born 12 weeks premature, so he’s actually lucky just to be alive. Even 30 years ago, that may not have been the case.

 

First off, I’ll say there is no substitute for diligence as a parent. What I mean by that, is holding firm to behavioral expectations like a dog on to a bone. I’m drawing from my own experience as a parent here, and therapies come and go but parental consistency is the one thing that stays the same. Hopefully. Jane and I were hyper vigilant early on, and this paid off as Thomas grew older. And this leads to a second thing: you can not do it alone. Jane does an excellent job and takes the bulk of the credit but I’m in there as well. It helped being in the field and actually trying out some interventions that I was learning about, like floortime, discrete trial, pivotal response training, ABA, augmentative communication, PECS and video modeling.

 

If I had to recommend one publication for parents who are seeking peer-reviewed literature on Autism, it would be Focus on Autism and other Developmental Disabilities. This is a journal but it has stuff that an everyday parent would find interesting. Jane would get it before me, and read the entire thing before she’d let me have it. The Journal of Applied Behavior Analysis is okay, but it quite technical and not specific to disabilities and autism. The Journal of Positive Behavior Interventions is another journal of practical interest, especially for teachers.

 

The reason why I recommend knowing the literature is because the temptation towards fads in inescapable. So many people are out to cash in on the epidemic, that if you have little to on knowledge, you’ll become just another proof of PT Barnum’s maxim.

 

Jackie mentioned in her comment that her son has many of the behaviors Spaz has. Keep in mind, Spaz has actually improved and matured since I got him 6 years ago. I went to work on his most serious behaviors, which were hitting, kicking and scratching the crap out of all of us. Almost all of that aggression is gone, now. Now we’re working on the spitting, self-gagging, biting stuff and potty training. We still have a long way to go, but one has to understand how far we’ve come. So if a child of 8 years is where Spaz is now at 21, there’s time for making even more improvement. Sort the behaviors from the most severe, and work on them accordingly. Be aware that new behaviors can and will probably pop up and have to be dealt with.

 

Boys and masturbation: I’m not quite ready to go there, but it is something to look forward to into the teenage years! Spaz’s wiring seems to have spared him this ultimate of self-stim behaviors or maybe it just hasn’t hit yet.

 

One thing that really helped Spaz and Thomas was being around peers. Not necessarily non-disabled peers, but peers who were a bit higher functioning that were social. It’s when Spaz got interested in making friends that he really made strides with the aggression. It was the same for Thomas and the potty training. Once he got around classmates who were all potty trained, that was it for him.

 

Spaz has had access to all sorts of therapies including OT, PT and speech. His mother really has done well taking him out, enrolling him in activities and making his life as full as can be. But he still has a tendency to tear the house apart.

 

It’s hard to say what I would do with a younger Spaz. Sometimes I think I should have went after the potty training more aggressively myself earlier on, but I was still acquiring knowledge myself. I did the best I could with the physical and mental resources that I had. And really, that’s all any parent or teacher can do. It’s interesting to think about what we might do differently, and I hope I’m doing things better nowadays. That’s why I prefer looking forward to looking back. I know I made mistakes back there and that’s where I’d prefer to leave them, while carrying the lessons forward.

dick

Autistic Whisperer

30 Dec

I’ve enjoyed this blog over the past year. It’s allowed me to think out and consider some new things and actually “meet” some pretty cool people.

Of course sometimes things I write are a bit raw and edgy and generate no small amount of emotion. This might be one of those.

This past week has been Dog Whisperer week on the National Geographic channel. Ceser Milan describes himself as a dog psychologist who treats dogs and trains humans. He big three essentials for a balanced dog are Discipline, Exercise and Affection. He goes around, helping people with wild, aggressive dogs or nervous dogs or dogs that otherwise have some sort of behavioral problem. He then talks to the owner, meets the dog and then attempts to treat the dog while training the owner in his methods. Milan is using behavioral techniques but they involve much more dog-cognition than what most dog trainers and behaviorists would use. He often talks about dominance and submission in the context of pack behavior.

I was especially interested in seeing how Milan taught the human owners to control their dogs. Ceser is good at what he does. He’s excellent. But his greatest skill is transferring his knowledge and skill to the real owners so that they can do what he does in order to have a more balanced dog. And that is what he does time after time.

I know I’ll get busted by the “people-first” crowd in this for looking at kids and comparing them to dogs. I say people treat their pets like kids and that’s a big part of the problem when it comes to raising their pets. However there are many comparisons that are inescapable. As are the results of using similar techniques in dealing with dogs and kids. Hear me out.

First off, Milan often tells owners that when their dogs are being aggressive or exciting not to talk to them. Talking adds to the excitement level and makes them more agitated.

Hello? This is exactly what I’ve tried to express to paras, teachers and parents when their kids are going into meltdown/tantrum mode. Basically, when a kid is into an emotional meltdown, talking and yelling add to confusion. This is true even of higher functioning people, as I discovered back in the days when I worked in the psychoed and the hospital. That principal still works today.

Many of these dogs were adopted from pounds and shelters and have histories of abuse and neglect. He says that you can not help the dog if you feel sorry for them because you will be constantly projecting weakness instead of leadership. Owners like to make excuses for their pets and for some, their sympathies often are major contributors to the dog’s bad behaviors. I see this all the time with students with disabilities and their caregivers. Yes, the kid has disabilities, but having low expectations makes them more disabled! I watched a mom at an autism support Christmas dinner we had do everything for her son who was 18 and we exchanged a word or two. She did almost everything but chew the food for him! The boy is functioning in a moderate severe range even though he’s able to read at about the 6th grade level. What made this behavior more shocking to me is that she is a para for some of my ex-students at Northside High school! She knows better and even complains about other parents and teachers who do the same thing! AAAAHHHHHH!

She didn’t welcome my criticism.

I often crawl up a caregiver’s butt for being too helpful and hovering thus creating “learned helplessness.” Which leads to another principle…

Ceser Milan often tells owners that their dog needs lots of stimulations and challenges. This is especially true for those with high energy and high intelligence. And so it is with our kids. So much misbehavior occurs when our kids are bored. They need and want to be challenged which is enabling. And really, that is our primary job as caregivers is to be enablers for our students and children.

Christmas time is filled with all sorts of opportunities for bad behaviors with all of the stimulations, crowds, attractions, sweets and pitfalls for adults as well as children. Thomas has had a few meltdowns which happen mostly when he is tired or hungry. And during them meltdowns I’ve actually tried out some Dog Whisperer techniques. Even the “Tssst” while pointing that he uses. And you know what? It works. At least until he imiatates this with his younger brother.

People often criticize behaviorists for treating people like animals. I’m here to tell you that enabling my children to behave more like humans and less like animals is the proper and humane thing to do. It’s our job as adult to bring up and raise children into adults with instruction and support and correction when necessary. I don’t want my children or students to behave like animals. But animals and children both need assistance in an environment that is sometimes antagonistic to their needs. It should not be surprising that the techniques would overlap.

After doing a bit of research, I’m aware of the controversies surrounding some of Milan’s techniques. I’m not advocating using choke chains on kids or the use of the flooding technique that he uses to treat many of the issues the dogs he works with has. Neither do I advocate approaching aggressive dogs or even aggressive kids if they are strange to you. However, being quietly assertive and setting boundaries, providing security through leadership, and being proactive are all just good practices when dealing with all children and those with autism in particular. Say whatever you will about some of the dog whisperer’s methods, his ethic of never giving up and always learning is a good lesson for us all.

What if it were one of your kids?: Escape Extinction

1 Oct

I remember hearing another telling a story one time about when her son, Ricky, was at the clinic to get his shot in preparation for going to school so he was about 4 years old. His mother had prepped him, and told him why they were there and promised Ricky a trip to McDonald’s afterward. So when Ricky walked into the clinic he was actually in a pretty good mood. There happened to meet another little boy about his age. “Are you here to get your shot, too?” he asked the little boy.

That boy’s mother had NOT told her son why he was there and the result was a temper tantrum. My question to you: what should this mother do? Should she give in to his crying and demanding to go home? Should she try to entice him with McDonald’s? The boy was clearly not negotiating. He was crying, kicking and throwing himself on the floor.

Are there any other parents or teachers who have encountered this sort of behavior? Are there any other parents who have a child who is not keen to get up out of bed in the morning to go to school? Am I the only one?

One reader suggests ignoring as a legitimate intervention in such circumstances. When the function of the behavior is to escape demands, escape responsibility or even escape consequences, ignoring is completely inappropriate. I’m not necessarily talking about overt behaviors like tantrums as much as refusing to move. If your child doesn’t get out of bed in time to go to school, and refuses to comply and he is allowed to sleep in, you are reinforcing noncompliant behavior. Who wouldn’t rather sleep in?

Thomas is such a textbook case of this. Monday through Friday, it is a chore to get him up at 6:15 to catch a 6:45 bus. He acts like he just can’t stay awake and sometimes complains that he feels sick. But, being the mean parents we are, we FORCE the boy out of bed and MAKE him go to school! This is non negotiable. Ignoring is not an option.

Guess what happens on Saturday morning? Does he sleep in? Does he take advantage of the opportunity to rest and sleep? No, he is up at 5:30!! Heck, we might even let him stay up and hour or two later on Friday just to see if he might sleep in. Not a chance. But we are not quite as rigid on this point, although I’ve been sorely tempted to keep in his room until 7:30 just because he can’t be left alone. But we just deal with it. Jane does mostly.

If a person refuses to do something, they may be trying to access attention. Then ignoring is a legitimate extinction technique, because it is matched to the function.

In the case of Jim, attention was not the function of his noncompliant behavior. How do I know? Because he could be left in the room completely alone and he would be perfectly content to sit in the chair with his head down between his knees all day long. Attention from people is not real high on his agenda. He’d rather people left him alone and there are more times than not when I can totally relate!

So we have a situation where a student is not only escaping demands but also getting access to some sort of automatic reinforcement. The first thing is to get the attention of the person. In Jim’s case it involved shutting down the whole vestibular feedback he had going on by leaning over his chair. The intent was that by gently tipping his chair forward he would just stand up. making guidance a lot easier. Instead, he rolled on the floor.

Upon some reflection, I now realize that what I wanted to do was put the escape behavior on extinction. The only way to do that is to block escape. Ignoring works when attention is the maintaining factor. Since I couldn’t get Jim to go to his class and he was too big to carry there, that is when I did some other work with him. In this case, trying new foods was a much higher demand activity than what the other class was doing which was basically watching a movie. And there was the key.

As a youngin’ I didn’t always want to go to school either. But I rarely ever missed a day because I lived on the farm. Farming involved MUCH higher demands than schoolwork ever could. Dad wouldn’t hesitate to dump me out of bed and kick my posterior out to the barn if I had a notion to skip school. So yes, I am pretty old school.

Many kids today have absolutely no concept of authority. Mine do. If one of my own kids refuses to follow a teacher’s instruction and dumping him out of the desk does any good, I say it’s okay. Parents nowadays are unwilling to project authority, and then wonder why their kids are brats.

I expect my sons’ teachers to follow through on what they say. If they threaten consequences, then there had better be some consequences. Failure to do so merely trains the student to ignore adults. This is how students begin training adults, as they begin putting parenting behaviors on extinction! Ignore a parent long enough and they will throw up their hands and say “What’s the use?”

So how do you put escape behavior on extinction? By not allowing the escape. And anyone who has spent more than a few weeks with a student can tell most of the time whether a student is trying to escape or gain access to something. You know who in your class loves attention. You also know the ones who will do anything to get out of doing work. It is possible to have both things in play at thesame time.

I’m not saying I haven’t made mistakes. Maybe I should spend a week chronicling my biggest snafus. I don’t care how much of a behaviorist one is, kids don’t come with an instruction manual and each one will present something new and interesting. That’s one of the reasons I stay.

dick

Why I am Such a Data Hound

18 Sep

Yes, I am. Most special ed. teachers in the county know it and I’m sure I am the butt of many jokes because of it. I have worked over many a SLP, OT and even the PT folks about data, or more likely, the lack of it. They travel around to different schools, so word gets out. I travel to different schools occasionally, and may get up on the data-high-horse if I’m feeling particularly brash. and of course, my own kids have different teachers every year so the infamy spreads far and wise.

I wasn’t always this way. However, very early on in my Master’s program I had an instructor who was teaching applied behavior analysis and something clicked. I did several mini-interventions, kept track of my data points and was delighted to see when things worked. Since I was using behavioral interventions, that was most of the time. B. F. Skinner once joked about how behaviorists were always in a better mood than any other psychological clinicians because their stuff was working and they knew it! Keeping score is the best and most efficient way of knowing if what you are doing is working.

However, the pretest, post test model that NCLB currently relies on to keep score is highly flawed. The biggest problem I have with it is that it takes only one measurement per year (at most). What if the child isn’t learning and the score goes down? You have no idea, until the next year! An entire year could be going down the drain. Fortunately, most good teachers actually assess as they go along on a regular basis. At least when it comes to spelling or reading or writing or mathematics. However, when it comes to behavior, no one seems to keep track of much of anything. Getting teachers to do it is like pulling teeth. The thing is, behavior plays a huge and crucial part of what goes on within a classroom. There is not a teacher alive who will tell you that classroom conduct and behavior are not important. There’s enough examples of what happens when the behaviors get out of control. They can make a teacher’s life miserable! It is the bane of most brand new teachers and all of the substitutes. Ask a sub what makes for a bad experience: Is it kids who can’t read? Is it kids who can’t add? Is it kids who are less than bright? No, it is kids who misbehave!

Just like academics, tracking behavior is the key to working on it. You track reading or spelling performance and hopefully want to see signs of improvement. Same goes with behavior. And this means keeping some sort of data on a regular basis.

I’m trying to work with Thomas’ para and gently ease her into the role of data collector as well as facilitator. My operatives at his school tell me that there is a significant amount of hovering going on, which is what most paras do when they don’t know what else to do. Their main qualification is that they care. Caring is important, but paras deserve to have more knowledge and tools at their disposal which means some investment of time and yes, money. Training materials and trainers cost money. I’ve learned over the years that a modest investment in equipping paras pays huge dividends in how the students are treated and the advancements they make. Unfortunately my data lacks sufficient fidelity and reliability measures to get published, but I have results that show students doubling their level of independence simply by virtue of having a trained para versus an untrained one. You see what a bit of data can do? I can show the effectiveness of what a person is doing. Or it can show that things need to be done differently. For instance, we had been taking data on Spaz for years and years and had notice little appreciable change in the number of agressive (pinch, kick, hit, spit, scratch, grab) behaviors per day. It was all over the place and variable depending on the season, the day, and the phases of the moon, or so it seemed. We were getting no where. I did a full-blown FBA and started working on everything I could think of to bring him around.

With an erratic data path, it’s hard to see anything at all. He might only scratch and kick 5 times one day but then be up to 50 times the next and then back down into the 20’s and 30’s for a few days before depressing and spiking. The Excel trendline showed that there was a slightest of inclines in the data path. I stayed with it. His neurologist stayed with it along with me, loving my graphs. Then we hit paydirt. Something happened that we would never have anticipated. Spaz discovered friends. He liked having friends and wanted friends. Especially girlfriends. And we noticed that his aggression began plummeting when we had some higher functioning girls around who volunteered to help with some of the wheelchair kids. We heaped on other rewards, too, but that was the turn. Those girls wouldn’t have anything to do with him if he was being aggressive, but once he found his charm, he discovered his social life improved dramatically.

Now it comes to me, I might be able to use that for a few other things with him.

The point of this was that just the exercise of keeping behavioral data put me in tune with what was going on throughout the day. I was able to see changes much quicker than doing an annual assessment, and if I could spot a trend early, I could either promote or suppress things in the environment to enhance positive change. A body can not do that if they are unaware of what is going on. Keeping data is the way to increase awareness. Ideally, a teacher could do this everyday on every student. But that’s not realistic, especially in a class of 25+. This is why having trained paras is important because they can help with this while a teacher is delivering instruction.

Here’s a shocker: I don’t really take data at home. I have tried to track some things that happen or don’t happen, but for the most part, I believe home should be more relaxed. I do keep a strict record of finances, but not of behaviors of my family. The idiot assistant principal at that last meeting actually suggested that I take data at home so they wouldn’t have to do it at school. Problem is, talking out, being out of his seat, bothering classmates, not doing schoolwork, being off task….anyone else see a problem with keeping track of these behaviors (which the school is complaining about) at home? What an idiot. God help the school she ever becomes principal for. But at school, as a teacher, I am a voracious data collector. With the kids I have, it is the only way to know anything.

One last thing about data collection, and why I like it:

In addition to paras and teachers improving what they do simply by virtue of keeping track, this also applies to students, themselves. Students can actually be trained to monitor their own behavior, and this is actually the ideal. Then all the teacher or para has to do is occasionally check for reliability and provide feedback. The functional goal of any behavioral program is to teach students to monitor and regulate their own behavior. Teaching them to keep their own data is an efficient way to do this. But teachers who don’t know how to take behavioral data will have a difficult time training their students to do it just like a teacher who can’t add will have difficulty teaching math to students.

I know some of you who are also closet data hounds. Any of you bloggers out there check your stats? Better yet, any bloggers who do not check your stats?

‘Nuff said!

 

dick

 

I don’t know whty, but I just wanted to link to an autism resource where other data hounds exist.  So here you go!!

 

IEP Process: Functional Behavior Assessments

22 Aug

I’m coming back to this series because of something I saw related to the FBA today that bugged me in a major way.

We stopped in during our community time to see Bella, who you might remember from last year. Bella has a different teacher at the psychoed center this year. She apparently had a hard summer, and I noticed she had some new fresh scratches on her face. She is not riding the bus because of behaviors there. Last year she put her head through the window. She also has issues related to aggression, cursing, compliance and staying in the classroom.

Her old teacher from last year is actually functioning as the psyhoed behavior specialist, which is amazing. She is fairly competent in managing her own students, but had no idea what a FBA was. I asked to see Bella’s FBA and it was a 7 line abomination that did not include any of the behaviors listed above including the self-injurious behaviors. The behavior intervention plan was not much better. In addition, none of the behavioral goals included any of the above targets, except for the cursing. I was hoping to find something useful to jog my memory from last year. The Present Level of Performance included the list of behaviors that Bella had exhibited while at the psychoed last year.

So, let’s talk about this FBA and ex/tend from my previous treatment when discussing the BIP.

IDEA 1997 says that if the student has behaviors that impede his/her ability to learn or the learning of others. As far as I know, IDEA 2004 does not change, alter or clarify that in any way. Clarification would be helpful as there are no guidelines for exactly how to do it. So I’ll tell how *I* do it.

The first step is to identify the target behaviors and to define them such that there would be no confusion as to what an observer is looking at when they see them. For instance, self-injurious behavior would be defined as striking, scratching, pinching or poking self with sufficient force as to cause bruising, bleeding or injury.

The next step is to assess duration, severity and frequency of the behavior as well as to assess context and consequences of a target. One way to do that is to use a checklist assessment or two, such as the FAST or the MAST, which are screening tools that can help identify the function of a behavior. Along with this, tracking the target behaviors with some sort of data collection system is essential for identifying the intent of the behaviors. Interviews with parents and other teachers are also essential features of a thorough and meaningful assessment. Reading past records, IEP’s and psychologicals can also produce some meaningful data. This also must include any and all medical data which can yield critical information.

Once all of this data is gathered, it is possible to begin writing the FBA. A proper FBA will include a description of the student and the reason why they have a BIP and an FBA. The Behaviors are listed and defined and then relevant background is presented. I’ll usually included medical information in this introduction.

Then I briefly describe the methods used for assessments. This includes what instruments are used, procedures for observations, what other materials were gathered and who was interviewed. The background and method lay the groundwork when it comes time to do a new FBA. A person can follow a similar method and merely add to the background as needed. The method also provides sufficient credibility to the process which would be crucial if courts have to get involved.

Next, I write about the results of the evaluation, going into sufficient detail as to present the data and information in a manner that would guide a reader to a logical conclusion as to the function. I’ll include a sample data sheet, scores from assessments, and any graphs and charts here. I’m also going to reveal the apparent function of the behavior here and do it so explicitly that no one can miss it in underlined, bold type e.g.

When Bella wishes to gain access to attention she will engage in self-injurious behavior such as scratching her face until she bleeds.

Finally, I write a discussion section which includes any recommendations for intervention and any concerns about the FBA. For instance, many behaviors may be multiply controlled and require different handling depending on the context or function. If there was any key information I was unable to include, I would state that here.

Basically, I’m following a format that is not altogether unlike a research article. Using this background/intro-method-results-discussion format gives me enough structure without being overly stifling. Again, this is me the writer talking. But as a parent, it would be much easier and much more interesting reading a thorough treatment of my child’s behavior than some stupid form with blanks filled in. My FBA’s become useful tools for teachers, parents and anyone who deals with a student who has behavior challenges. Neurologists and doctors have looked at and used my FBAs to make recommendations. It is very much like a sort of psychological, but more useful for looking at day-to-day behavior challenges.

A bad FBA is not worth the paper it is printed on and is a complete waste of time and space. I’m amazed more of these have not been challenged by court systems. But again, while the law says schools have to do them, they gave no guidance HOW to do it.

So I may be spending some time at the psychoed educating them. But first I’m going to see if I can speak with our new county behavior intervention specialist. Afterall, that is part of what she was hired for!

dick