JLBTC Training Notes - Autism Spectrum Disorder (ASD) PDF

JUNO LOVE BEHAVIORAL THERAPY CENTER (JLBTC) DAY 1 – ASD AND ABA AUTISM SPECTRUM DISORDER (ASD) - A neurodevelopmental disorder characterized by lack of social and emotional skills, repetitive behaviors, problems in speech and language, and motor...

JUNO LOVE BEHAVIORAL THERAPY CENTER (JLBTC) DAY 1 – ASD AND ABA AUTISM SPECTRUM DISORDER (ASD) - A neurodevelopmental disorder characterized by lack of social and emotional skills, repetitive behaviors, problems in speech and language, and motor skills. 4 COMPOSITIONS OF AUSTISM SPECTRUM DISORDER (ASD) ▪ Asperger’s Syndrome ▪ Autistic Disorder ▪ Childhood Disintegrative Disorder ▪ Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) FACTS ABOUT AUTISM - The Centers for Disease Control (CDC) Prevention and Autism Developmental Disease Monitoring (ADDM) Network estimated autism’s prevalence as 1 in 36 children (worldwide) - ASD is reported to occur in ALL racial, ethnic, and socioeconomic groups. - ASD is nearly four (4) times more common in boys than in girls. - ASD estimates 1% of the total world population SIGNS/SYMPTOMS No joint attention skills Repetitive behaviors/tasks No eye contacts Echolalia (Repeating words heard from another person or themselves) Lining up toys or flipping objects Greeting rituals Needing to take same route Indifference to pain/temperature Have adverse response to specific sounds or textures Excessive smelling or touching of objects Visual fascination with lights or movement Catatonia CAUSES There is no one cause of autism, just as there is no one type of autism Over the last 5 years, scientists have identified a number of rare gene changes or mutations associated with autism. Hereditability (37%-90%); Genetic Mutation (15%) Most causes of autism, however, appear to be caused by a combination of autism risk genes and environmental factors influencing early brain development. Environmental factors include: Advanced age at time of conception (both mother and father) Maternal illness during pregnancy Certain difficulties during birth, particularly those involving periods of oxygen deprivation to the baby’s brain A growing body of research suggests that a woman can reduce her risk of having a child with autism by taking prenatal vitamins containing folic acid and/or eating a diet rich in folic acid (at least 600 mcg a day) during the months before and after conception It can start with 18 months, but in most cases: 2-3-year-old children. TREATMENTS BIOLOGICAL BASED NON-BIOLOGICAL BASED BIOMED APPLIED BEHAVIORAL ANALYSIS (ABA) GLUTEN-FREE/CASEIN-FREE (GF/CF) DIET OCCUPATIONAL THERAPY (OT) ONE-ON-ONE AUDITORY INTEGRATION TRAINING SPEECH THERAPY STEM CELL SPECIAL EDUCATION (SPED) CLASS/GROUP APPLIED BEHAVIORAL ANALYSIS (ABA) THERAPY A kind of evidence-based practice or behavior therapy for people with autism and other developmental disorders. Its goal is to build appropriate behaviors and eliminate inappropriate ones. Children can also learn new skills and improve their social interactions. Highlights the value of REWARDS SYSTEM. Its foundation are the theories of Ivan Pavlov and BF Skinner. ADVANTAGES Dynamic Programming – the program is adjustable depending on the child’s level of creativity (pwedeng babaan or taasan ng ABA therapist yung intensity ng program depending sa kung ano lang yung kaya ng bata) o Ratio: 1:1 (1 teacher: 1 child) o Hours: 1-2 hours (PH), Whole day (Other Countries) o No. of Learning Opportunities: Variety (A child can learn a variety of skills with an ABA therapist) THE UMBRELLA OF ABA STRUCTURED NATURALISTIC (Adult/Clinician-led) (Child/Client-driven) Discrete Trial Teaching (DTT) Pivotal Response Training (PRT) Verbal Behavior (VB) Natural Environment Training (NET) Others Incidental Teaching STRUCTURED VS NATURALISTIC TEACHING STRATEGIES HIGHLY STRUCTURED NATURALISTIC TEACHING Structure of the Session Highly-structured, Loosely-structured, Adult/Clinician led Child/Client led Settings Usually seated with Varied, naturally occurring minimal distractions settings Materials Chosen by clinician Chosen by child Number of Teaching Mass trials Fewer Trials Trials Reinforcers Not necessarily related to Functionally and meaningfully teaching activity related to reinforced behaviors STRUCTURED BEHAVIORAL PROGRAMS Rely on discrete trial teaching (DTT) procedures Some use of naturalistic behavior procedures Structured curriculums May be center or home-based Intensive number of hours with 1:1 therapist 1. DISCRETE TRIAL TRAINING (DTT) A training that involves teaching a skill to a child in a structured manner or more simple steps. This involves breaking down tasks separately or doing a step-by-step process than performing big tasks. 3 PARTS OF DISCRETE TRIAL TRAINING (DTT) A. SD or Discriminative Stimulus (Antecedent) ▪ The stimulus/action performed by the therapist/clinician to encourage behavior ▪ This signals to the student that a given response will be reinforced. ▪ Instructions or signals given by therapist It should be: a. Clear and consistent b. Free of extraneous information (Short and concise instructions) c. Slightly louder than normal tone of delivery B. Prompting/Response ▪ A form of assistance given to help ensure that a child responds correctly ▪ This teaches the child how they should respond to the SD ▪ May be given if the therapist sees that the child is not able to respond or the child responds incorrectly after delivering an SD ▪ It should be delivered immediately after the SD ▪ Example: Pointing a card as the correct answer C. Reinforcement or Correction ▪ Also known as Reward ▪ Reinforcement must be given whether the child responds independently or with the help of a prompt. ▪ If the same reinforcement is given, it will be less effective ▪ Right Response = Reinforcement ▪ Wrong response = corrective procedure It should be: a. Given immediately after a correct response b. Enthusiastic or involved manner c. Varied reward  HOW TO DEAL WITH A CHILD’S INCORRECT RESPONSE/S? A. Informational NO – should be delivered in a neutral or affirming tone. B. Leaving out informational NO – pausing for a moment without giving reinforcement or prompting, but does not say NO. 2. Verbal Behavior (VB) o This is an approach to teaching communication using the principles of ABA in addition to the work of BF Skinner. o The method behind verbal behavior is to teach language based on this function. o Has shown to be highly successful in children with autism when combined with other therapy approaches such as Discrete Trial Training. ANTECEDENT VERBAL OPERANT CONSEQUENCE Motivating Mand Directly Effective: Operation (Request) A child comes into the kitchen where a mother is, and says “I want milk.” The mother opens the fridge and give a glass of milk Verbal Echoic Social: behavior of (Imitation/Repetition) A teacher says to a student, “Milk in Italian is another person Latte.” The student repeats “Milk in Italian is (same content) Latte.” The teacher says “Correct.” - Repetition/Imitating of words Feature of the Tact Social: physical (Labeling) A child looks into a fridge, turns to his mother environment and says, “We have milk.” The mother says, “That’s right; this afternoon, I went to a grocery shop” - Labeling what they see in the environment Verbal Intraverbal Social: behavior of (Asking/Questioning) A father asks his son, “What is white and is another person drinkable?” The child replies, “Milk.” The (different father says, “what a smart boy.” content) - Asking questions that a child must answer A person’s own Autoclitic Directly effective: verbal behavior A child comes back from his skiing class and tells his mother, “I really want a cup of hot milk.” The mother pours him a glass of hot milk. - Higher form of making request (Gagawin lahat ng bata makuha lang yung gusto niya) NATURALISTIC BEHAVIORAL PROGRAMS 1. Pivotal Response Treatment (PRT) o The focus of this approach was to increase "pivotal" skills a child would need to be successful. o Those areas include motivation, responding to multiple cues, and initiating social interactions. o Pivotal Response Treatment is a large part of the Early Start Denver Model approach that is implemented at The Missing Peace. STRUCTURED TEACHING TECHNIQUE NATURALISTIC TEACHING TECHNIQUE (DTT – Discrete Trial Training) (PRT – Pivotal Response Treatment) Teaching motor imitation: Teaching motor imitation: Prompt imitation of actions (e.g clap A child likes cars. Prompt imitation of hands) actions using preferred toy (e.g. drive car) = = Reinforce correct response with edible or Reinforce correct response with car toy preferred toy Teaching identification of colors: Teaching identification of colors: Using shapes in different colors A child likes playing play dough. Use play- = dough with different color pieces. Reinforce correct color with edible or = preferred toy Reinforce correct color by offering the playdough of the color identified Teaching identification of familiar Teaching identification of familiar objects: objects: Using flashcards with photos of familiar Play with familiar people people = = Reinforce correct name with tickles and Reinforce correct name with edible or cuddles from that person preferred toy 2. Natural Environment Training (NET) o An ABA approach in which teaching trials happen within the natural environment, such as when playing at the dinner table, or while at the store. o This approach focuses on a child's immediate interests and activities and uses those motivations to guide the teaching session. REASONS TO TEACH LANGUAGE IN THE NATURAL ENVIRONMENT: ▪ Since responses are selected based on the student's motivation they may be learned (acquired) more quickly. ▪ Best condition to teach manding (requesting). ▪ Uses stimuli, prompt strategies, and reinforcers that are already present in the student's natural environment.  ▪ Teaching can be conducted by everyone the student interacts with (e.g., teachers, parents, peers). ▪ Typically associated with less aversive conditions and therefore less problem behavior (Koegel, Koegel, & Surratt, 1992) ▪ Interactions can more easily represent typical conversational exchanges (i.e., can more easily mix across different response types on a natural way). ▪ Less need for specific strategies for generalization since the settings in which the responses are taught are the settings in which most responses will later be required. 3. Incidental Teaching (IT) o Not a therapy in itself, but a naturalistic teaching technique used in some therapies, particularly ABA programs. o When teachers (or parents) are using incidental teaching, they use naturally occurring opportunities for learning like playtime, to develop children's skills. o They reinforce children's attempts to behave in a desired way the closer the children get to the desired behavior. Note: Ang core ng INCIDENTAL TEACHING is creating a setting wherein yung bata makakapag-request. Example: Put a cookie jar sa lugar na hindi abot ng bata. Mostly, pag yung bata ayaw magsalita, they're gonna take the risk para abutin mo yung jar. However, in incidental teaching, kapag yung bata kinuha yung kamay mo to signal na kunin mo yung jar, turuan mo muna dapat yung bata to say na "I want cookies", then pag nasabi nya, doon mo palang gagawin yung request niya.  JUNO LOVE BEHAVIORAL THERAPY CENTER (JLBTC) DAY 2 – BASIC SKILLS (ABA THERAPISTS) ABA THERAPISTS ABA professionals work in the domain of Behavior. We observe, study, manage, teach, or reduce behaviors. The job duties of an ABA Therapist aren't necessarily confined to sitting at a table, holding up picture cards, and delivering bits of candy. QUALIFICATIONS OF ABA THERAPISTS Education o Holder of BA/BS degree in the following fields: Applied Behavior Analysis, Psychology, Child Development, Education, and other related fields. o Holder of certification for ABA coursework at an undergraduate level or BCABA. o Graduate students that are looking for hands-on experience. o Junior or Senior students of the above-mentioned fields. Experience o The best candidates have previous experience in ABA and working with children with Autism Spectrum Disorder (ASD). o Has work experience with pre-school age children. o Has work experience with children of the same age as your child. o Undergraduates that want hands- on experience. PERSONAL CHARACTERISTICS OF ABA THERAPISTS Enjoys teaching and interacting with children. Can you see her playing with your child? Has a high-energy level. Sessions with children with autism can be very tiring; does she have what it takes? Can work independently. Can take and process directions from others. Able to take constructive observations and suggestions. Is she flexible and open-minded enough to accept criticisms or at least try out any suggestions that you have? Must be reliable. Can you rely on her to be responsive even during off-hours? If she cancels a lot of sessions she might not be fit for your needs. Does not see the job as just a paycheck but more of a passion, deep interest, or good deed. MAIN RESPONSIBILITIES OF ABA THERAPISTS Establish strong rapport with the client Teach appropriate skills to the assigned clients Manage client's disruptive behaviors  Record data Efficiently implement and execute the session programs designed by the Program Manager Train the client's family on behavior management and generalization of skills Ensure the client's safety and wellness throughout the session Regularly formulate session notes and provide a progress report to the client ABBREVIATIONS (JUNO) COMPANY ABA JLBTC Juno Love Behavioral Therapy Center ABA Applied Behavioral Analysis TX Therapist/Teacher DTT Discrete Trial Training CX Client VB Verbal Behavior PM Program manager NET Natural Environment Training MT Monthly Training PRT Pivotal Response Training PR Progress Report IT Incidental Teaching IEP Individualized Education Plan SD Discriminative Stimulus R Reinforcers R/B Response/Behavior OTT Of The Time C/F Consequence/Feedback YO Years Old P Prompt AUTISM SLP Speech and Language Pathologist SpED Special Education TEACCH Treatment and Education of Autistic and Related Communication Disorders VOC-ED Vocational Education PBS Positive Behavioral Support  JUNO LOVE BEHAVIORAL THERAPY CENTER (JLBTC) DAY 3 – BEHAVIOR MANAGEMENT Come at least 15 minutes earlier than session time. o Coming in early will provide more time for preparation and relaxation. o You may also take this time to wash up or change clothing if necessary. o Remember that good preparation will most likely result in a happy session. Greet the family members and the client. o Simple ways to greet clients: ▪ "Hi/Hello Mam/Sir/Kuya/Ate!" ▪ "Good morning/afternoon/evening!" o How do we properly address our clients? ▪ Better to use "Mam/Sir" ▪ Instead of Mommy/Daddy/Yaya Ensure the cleanliness and safety of the session area. o Check the session area for possible hazards ▪ Small Items on the floor (choking hazards) ▪ Sharp objects ▪ Electrical outlets ▪ Soft beddings ▪ Cords/wires ▪ Hot surfaces ▪ Toxic substances/meds ▪ Open bathroom doors ▪ Furniture for climbing ▪ Door hinges/railings Prepare the therapy materials. o What to prepare: ▪ Session furniture: table, chairs, potty-trainer ▪ Program materials: 3-D, 2-D, books, schedule boards, visual cues, file folders, and worksheets. ▪ Reinforcers: Food and containers, tangibles/toys, interactive play materials, tokens ▪ Data collection materials: client's folder, score sheets, pens, monthly program sheets, session notes, review/maintenance list, BAF/ABC Chart. ▪ Session monitoring forms Inspect the client's physical appearance. o Do ocular inspection of the client's: ▪ Head: bumps or cuts ▪ Face: bruises, cuts, wounds, insect bites, other injuries ▪ Arms and legs: bruises, cuts, wounds, insect bites, other injuries ▪ Trunk: bruises, cuts, wounds, insect bites, other injuries ▪ Eyes: pink eyes/sore eyes  Conduct your session and maintain positive momentum all throughout. o Follow the program strategies carefully. ▪ Session routine ▪ Number of trials ▪ Reinforcement schedule ▪ Program criterion ▪ Program phases o Sandwich more challenging programs in between easy programs: ▪ Ratio: 3:1 End your session right. o End the session on a positive note, either with interactive play or the client's preferred activity. o Sing or bid goodbye to the child after the last program or activity. o We are not permitted to cut the session time to ensure a 2-hour session time. Properly endorse the client back to the family. o Bring the client back to the caregiver, parent or family members and inform them that the session has already ended. Keep the therapy area and session materials in place. o Keep the following items in place: ▪ Session furniture: table, chairs, potty-trainer ▪ Program materials: 3-D, 2-D, books, schedule boards, visual cues, file folders, worksheets. ▪ Reinforcers: food and containers, tangibles/toys, interactive play materials, tokens ▪ Data collection materials: client's folder, score sheets, pens, monthly program sheets, session notes, review items list. ▪ Session monitoring forms Update the session notes. o Fill-out and accomplish the following forms: ▪ Session notes ▪ Monthly Programs Sheets ▪ Score Sheets ▪ Review/Maintenance sheets ▪ BAF/ABC Chart Meet shortly with the client and family. o After the session, meet with the family members to discuss the following: ▪ Daily session flow ▪ Positive and disruptive behaviors observed during session ▪ Progress in programs (be very objective) ▪ Ways to generalize the target skills at home ▪ Addressing disruptive behaviors at home o Average discussion time: ▪ 15-30 minutes only.  JUNO LOVE BEHAVIORAL THERAPY CENTER (JLBTC) DAY 4 – MANAGING DISRUPTIVE BEHAVIORS BEHAVIORS = COMMUNICATION All behaviors (adaptive or maladaptive) are a form of communication. The question is, what are our children communicating when they engage in problem behavior? DEVELOPMENTAL DELAYS 1. Communication 2. Cognition 3. Motor WHAT IS BEHAVIOR? Behavior is everything a person does. Behavior refers to all behaviors, not just problem behaviors. All behavior is learned. Behavior is an action that is observable and measurable. DEFINE BEHAVIOR IN CLEAR TERMS Examples: Julia hits other students during PE class Julia is aggressive when she does not get her way Michael blurts out and makes inappropriate Michael is disruptive comments during classroom discussions. Jenny leaves her assigned area without Jenny is hyperactive/impulsive permission. Jenny only completes small portions of her work. Jenny blurts out answers without raising her hand. ABCs OF BEHAVIOR 1. ANTECEDENT - What happens just before a problem behavior occurs (time of day, who is present, during what event/subject/task). 2. BEHAVIOR - What the student does that is observable. Written in concrete terms. 3. CONSEQUENCES - What typically happens after the behavior occurs. Indicates what maintains the behavior. A-B-C PRACTICE Situation 1: Joe throws his pencil and rips his paper during math whenever he is given double-digit math problems. This results in him getting sent to the office. ANTECEDENT BEHAVIOR CONSEQUENCE Given double- digit math Joe throws his pencil and Him getting sent to the problems rips his paper office. Situation 2: Nancy cries during reading time whenever she has to work by herself. This results in the teacher sitting and reading with her. ANTECEDENT BEHAVIOR CONSEQUENCE During reading time Nancy cries Teacher sitting and whenever she has to work reading with her. by herself. SETTING EVENT Event that occurs at another time that increases the likelihood the child will have challenging behavior. Setting events serve to "set the child up” to have challenging behavior. Can be biological, physical or socio-cultural (e.g., had a previous argument or fight, lack of sleep, lack of breakfast, not feeling well, etc.) o Note: Not the main trigger, nag-aadd lang sa behavior. Situation 3: When Jenny misses her 12:30 medication & teachers present multiple task demands, she makes negative self-statements & writes profane language on her assignments. Teaching staff typically send her to the office with a discipline referral for being disrespectful. SETTING EVENT ANTECEDENT BEHAVIOR CONSEQUENCE Misses 12:30 Teachers Jenny makes negative Teacher sends medication make multiple self-statements & writes Jenny to office for tasks demands profane language being disrespectful ACTIVITY: Think of a major challenging behavior that you often observe from a child. Try to establish its timeline by writing its antecedent and consequence. Emman’s caregiver was lost in his sight. During class, Emman hears a song that he hates hearing. Then, Emman covers his ears and pushes away everyone while looking for his mother during the whole session. Afterwards, the teacher gives him a time off and separates him from the whole class until he calms down. SETTING EVENT ANTECEDENT BEHAVIOR CONSEQUENCE Emman’s Emman hears Emman covers his ears The teacher gives caregiver was lost a song that he and pushes away him a time off and in his sight. hates hearing. everyone while looking separates him from for his mother. the whole class. FUNCTIONS OF BEHAVIOR Why is My Child Doing That?! What function does this behavior serve? What needs are my child trying to meet by using this behavior? Why Do People Behave? Modeling? Accident? Instinct? Condition? Why Do People Continue Behaving? FUNCTIONS (S.E.A.T) 1. SENSORY An individual may be engaging in a behavior to give himself some type of internal sensation that is pleasing or remove an internal sensation that is averse. These behaviors are sometimes known as self-stimulatory. HOW TO KNOW IF IT'S SENSORY: Refer to your ABC data. If the behavior is occurring in a wide range of settings, with a wide variety of consequences, and sometimes occurs while the individual is alone, it may be a sensory behavior. 2. ESCAPE/AVOIDANCE An individual may be engaging in a behavior in order to escape a situation, activity, or person. Escape behaviors may not always be to get out of a task, it may be to escape a specific part of the environment. HOW TO KNOW IF IT'S ESCAPE/AVOIDANCE: Refer to your ABC data. If the consequence that follows the target behavior usually a change in an environmental contingency, it may be an escape behavior. 3. ATTENTION An individual may be engaging in a behavior in order to access attention from other students, teachers, or other people. The attention can be positive or negative. HOW TO KNOW IF IT'S ATTENTION: Refer to your ABC data. If the consequence that follows the target behavior usually involves another person, it may be an attention function. 4. TANGIBLE NEEDS An individual may be engaging in a behavior in order to access an item or activity. The consequence may involve a break or attention but consistently involves access to an item. HOW TO KNOW IF IT'S TANGIBLE NEED: Refer to your ABC data. If the consequence that follows the target behavior consistently involves access to a preferred item or activity, it may be an access to tangible behavior. Case 1: Jeremy has been taking his clothes off in the classroom. During a structured observation, the therapist noticed that when the time for art approaches, Jeremy gets really agitated. When the teacher announces, "Time to clean up to go to art," Jeremy will throw himself on the floor and start pulling his shirt off. It has now gotten to the point where he quickly pulls his socks and pants off, as well, so the office will call his mother to take him home. ANTECEDENT BEHAVIOR CONSEQUENCE FUNCTION Art Class Taking Clothes Off Office will call his Escape/Avoidance mother to take him home Case 2: Carlos is a seventh grader with low functioning autism He has been hitting girls when he goes to lunch or gym, though not hard. They are affectionately referred to as "love pats." He occasionally hits a boy with long hair, but his focus is usually girls. He usually grins after he has done it. ANTECEDENT BEHAVIOR CONSEQUENCE FUNCTION Presence of Hitting girls (love pats) Grins after doing it Attention girls HOW DO WE EFFECTIVELY MANAGE DISRUPTIVE BEHAVIORS? Target CHALLENGING Behaviors Behaviors that we wish to reduce or eliminate: o Physical aggression o Self-injurious behavior o Nail biting o Property destruction o Verbal aggression o Spitting o Elopement o Etc. Will this response Increase or Decrease the Problematic Behavior? Soothing Verbal Reprimand Spanking Time Out Note: IT DEPENDS ON THE STUDENT'S RESPONSE! We often assign value to consequences based on what we think BUT what we need to do is look thru the student's eyes (Function of Behavior) Choosing an Intervention Knowing the function of a behavior determines how we react to it. After function is determined, an appropriate intervention can be put in place. PROACTIVE VS. REACTIVE ANTECEDENT BEHAVIOR CONSEQUENCE PROACTIVE APPROACH REACTIVE APPROACH (What to do before the (What to do during/after the behavior) behavior) A. PROACTIVE APPROACH o Manipulating antecedent events (the environment) to make behavior less likely to occur. B. REACTIVE APPROACH o Reactive strategies are used after the behavior occurs o Temporarily stops / suppresses inappropriate behavior PROACTIVE STRATEGIES 1. PREPARATION Social Stories Video Modeling 2. BALANCING ACTIVITIES EASY TASKS DIFFICULT TASKS FINAL SCHEDULE Washing hands Body parts Stringing beads Stringing beads Colors Washing hands Tracing letters Copying name Body parts Singing songs Tracing letters Etc. Singing songs Colors So on. 3. ACCOMMODATIONS/MODIFICATION ACCOMMODATION o This refers to the actual teaching supports and services that the student may require to successfully demonstrate learning. ▪ Sign language interpreters for students who are deaf; ▪ Computer text-to-speech computer - based systems for students with visual impairments or Dyslexia ▪ Extended time for students with fine motor limitations, visual impairments, or learning disabilities ▪ Large-print books and worksheets for students with visual impairments. MODIFICATION o Modifications are made for students with disabilities who are unable to comprehend all of the content an instructor is teaching. ▪ For example, assignments might be reduced in number and modified significantly for an elementary school student with cognitive impairments. ▪ Second language exemptions ▪ Withdrawal for specific skills ▪ Including student in same activity but individualizing the expectations and materials 4. ECOLOGICAL ARRANGEMENTS Consider which factors might be a potential setting event or trigger: o The location o The work stations o The materials o Environmental pollutants – (noises, etc.) o Time of day o Length of activity o Nature of Material 5. PROVIDING VISUAL SUPPORTS Visual Supports Choice Boards First/Then Board  Schedule Boards 6. TEACH REPLACEMENT SKILLS ATTENTION o Appropriate initiation skills o Peer relationships o Talent-skills ESCAPE/AVOIDANCE o Following instructions o Negotiation o Request for break or rest TANGIBLE NEED o Increase Verbalization o Argumentative Telecommunication o Pecs (Pics, Visual Support, Etc.) SENSORY o Leisure or Play Skills REACTIVE STRATEGIES POSITIVE REINFORCEMENT EXTINCTION PUNISHMENT Reward the student for Planned ignoring Reprimands demonstrating good Response blocking behaviors Time out Catch the child doing something good 1. POSITIVE REINFORCEMENT FORMS OF REWARDS: o Social Praises o Social Gestures o Tangibles ▪ Food ▪ Drinks ▪ Toys ▪ Tokens BREAKS  2. PLANNED IGNORING (EXTINCTION) Withholding desired social attention following inappropriate behavior display while still maintaining appropriate supervision. Example: Staff member showing no reaction after being cursed at or called a name. Used only when safe and appropriate Extinction Curve o When a behavior is under extinction, it increases first, then gradually drops off. o Be persistent. o Everybody should be on the same page (every person, setting, including family). o Extinction procedures cannot treat dangerous behaviors. 3. VERBAL REPRIMAND (PUNISHMENT) A verbal command to stop a given behavior. o "Stop!" o "No!" Verbal reprimands should be brief, firm and to the point. Do not yell or show frustration, anxiety, fear. 4. RESPONSE BLOCKING/INTERRUPTION (PUNISHMENT) Physically block an attempt to engage in a behavior. This is done by intercepting the blow without holding onto the individual in anyway. o Stepping between two individuals o Placing pillow between his or her head and floor o Placing arm out to absorb an SIB blow from making contact 5. TIME-OUT (PUNISHMENT) Time Out involves removing an individual from an otherwise reinforcing situation until he or she is calm. During TO, the individual either remains in the same room or goes out of the room. Specific rules apply and must be followed as written: o When to use o For how long o Release time INTERVENTION PLAN PROACTIVE o Use a visual schedule that lists the activities that Kevin will engage in before bed. Briefly prime him by pointing to each picture at the beginning of the bed time routine so he sees and begins to understand the sequence of events.  o Plan the schedule so that highly preferred activities follow the activities he may find aversive (i.e., brushing teeth). This way he sees that good things will come after teeth brushing. o Use a timer to indicate how long teeth brushing will occur, OR count aloud to him to a predetermined # so that he knows when the activity will end. REACTIVE o Imbed choices (e.g.., green versus red toothbrush, mint versus bubblegum toothpaste) throughout the teeth brushing routine so that he has some control over the activity’s proceedings. o Only allow him to engage in certain highly preferred activities after brushing his teeth or after allowing his teacher to brush his teeth. o NEVER allow him to escape or avoid teeth brushing. Pick him up off the floor and bring him into the bathroom. o Hold up a preferred activity in the opposite hand of the toothbrush. When he calms remind him, "first brush your teeth, then (preferred activity)". JUNO LOVE BEHAVIORAL THERAPY CENTER (JLBTC) DAY 5 – MASS TRIAL, PROMPT, REINFORCEMENT MASS TRIAL AND RANDOM ROTATION GENERAL PROGRAM CRITERION o 2 X 100% - Mass Trial (MT) / o 2 X 100% - Random Rotation (RR) MASS TRIAL (MT) Simply means you are asking the target multiple times in a repetitive manner. Example: Repeating the instructions FORMULA 1. Prompt 2. Prompt 3. Prompt 4. Prompt 5. Test RANDOM ROTATION (RR) is when you teach targets in a random order and do not use repetition. FORMULA 1. Negative/No Response/Test 2. Negative/No Response/Test 3. Prompt 4. Prompt/Test 5. Test PROMPT Prompts are instructions, gestures, demonstrations, touches, or other things that we arrange or do to increase the likelihood that children will make correct responses. In other words, it is a specific form of assistance given by an adult before or as the learner attempts to use a skill. Prompting procedures provide a systematic way of providing and removing prompts so that the learner begins to perform skills independently. These procedures rely on reinforcing correct responses that are both prompted and not prompted. TYPES OF PROMPT 1. GESTURAL PROMPT Using a gesture or any type of action the learner can observe the instructor doing, such as pointing, reaching, or nodding, to give information about the correct response.  2. FULL PHYSICAL PROMPT Physically guiding the learner's hands to complete the task thoroughly. Also known as hand-over-hand assistance and is considered the most intrusive prompt. 3. PARTIAL PHYSICAL PROMPT The instructor provides some assistance to guide the learner through part of the requested activity. It is less intrusive than a full physical prompt. 4. VERBAL PROMPT A verbal prompt involves telling the learner the answer, giving a verbal cue, such as, the beginning sound of the answer, and/or giving the direction more than once. 5. VISUAL PROMPT A visual prompt is a picture or cue that the student sees which provides information about the correct answer. Can involve a visual schedule, video, photograph, drawing, flashing a card with the right answer, etc. 6. POSITIONAL PROMPT A positional prompt involves the instructor placing the correct response closest to the learner or in a manner that assists in giving information about the answer. 7. MODELING PROMPT The kid should imitate what the teacher/therapist does Example: you ask a kid to do gestures like drinking in a cup, the kid should imitate your action (sabay nyong gagawin) ✓ It is important to always use the least amount of prompting necessary to accomplish the goal and the least intrusive whenever possible. ✓ You want to avoid having the learner become "prompt-dependent," relying on the prompt to get the job done. ✓ You can utilize prompts when the learner is about to respond with an incorrect response, responds with an incorrect response, or doesn't respond at all (~3 sec). ✓ There are various types of prompts, to accommodate different learning styles and abilities. REINFORCEMENT It is a reward that occurs after a behavior. It is anything that motivates or encourages your child. Any environmental event that maintains or strengthens an action or behavior. It can include praise, special activities, music, toys and food. WHY REINFORCEMENT? 1. To teach new skills. 2. To build self-esteem. 3. To increase independence. 4. To motivate your child that can result in quicker learning times and to reduce frustration. TYPES OF REINFORCEMENT 1. SOCIAL PRAISE OR ATTENTION Often describes the most natural type of reinforcement. o Examples: smiles, hugs, kisses, tickling, high fives, and cheering, verbal praise Verbal Praise should always describe the behavior o Example: "Great job cleaning up the toys, Jack!" instead of " Great job, Jack!" Verbal Praise is easy to deliver and available and should always be paired with other reinforcement. Some respond to verbal praise and others need more obvious reinforcement to stay motivated. 2. TANGIBLE ITEMS Tangible reinforcement includes favorite: toys, blankets, trading cards, sensory items and may include food. These can be very powerful reinforcers for children, especially when they are not readily available during other parts of the child's day. o REMEMBER: when an item is always available, the child may become bored easily! The child should only receive the item on conditions where your child attempts or follows through on their task. The limit on using this type of reinforcement is that it can be costly to consistently be searching for items and toys that the child finds rewarding. 3. FAVORITE ACTIVITIES If your child has favourite activities, consider using these as reinforcements for appropriate behaviours or when a specific task is completed. o Examples: Going to the park, watching a video, bouncing on a therapy ball etc. These are fun for both the parents and the child and promote social interaction. Works well with children who are able to wait before getting their reward. 4. FOOD REINFORCERS Using food reinforcement may work well for children who are not yet responding to verbal praise and are not yet motivated by items or activities. Consider the foods your child prefers. Do they prefer sweet snacks or salty foods? OR do their preferences have to do with textures?  Before using food reinforcers, take into consideration the nutritional value of the food. It is important to move towards more natural reinforcement when it is possible. This is because it is not common that get a goldfish cracker for being well behaved. 5. TOKEN ECONOMY SYSTEM When a token is provided after a desired behavior. Once the child has collected a predetermined number of tokens, he can trade them in for an item or activity that he desires. Money is a classic example of a token economy. It can be used to buy reinforcements such as food, housing and entertainment. ✓ Observe what types of toys/activities your child is most interested in. o Run and climb or quiet play? o Sweet snacks or salty foods? ✓ Provide choices where possible to determine your child's favorites. ✓ Once you determine your child's favorite reinforcers, you are ready to begin using them to teach new skills or to increase desired behaviors NOTE: When introducing a new or difficult task, it is important to provide reinforcement for any degree of completion. This will help your child to keep trying and to understand what is required to get his reinforcement. o Example: If your child has trouble sitting at the table for mealtime. o Initially your child may require reinforcement for coming and sitting down even if they need assistance from an adult to do so. Reinforcement for coming over to the table may include a desired activity or a piece of a desired snack paired with a lot of verbal praise. While remaining at the table, the child should be reinforced from time to time for appropriate behaviors even if assistance is required Set the child up for success! o Example: using the same example from above, a child may initially have 1 minute at the table and gradually the expectation would raise and the time at the table would increase. Always tell your child what they have done well Always use social reinforcement even if you are using tangible reinforcement as well FADING The gradual removal of prompting/assistance This is so that the child does not associate the reward as part of the task itself. Then the child will expect the reinforcement every time that task is completed. After a skill has been learned, there should be a natural expectation that your child follows through without needing to be reinforced every time the skill is completed. Both the number of times that you reinforce your child and the form of reinforcement you use should be faded. Eventually the food items you use should be exchanged with more social rewards. NEGATIVE EFFECTS OF REINFORCEMENT It is important that just as reinforcement works for behaving appropriately, it also reinforces negative behavior. o Example: If your child is screaming for a chocolate bar in the grocery store, and then you reinforce him by buying it for him, you have then reinforced his inappropriate behavior. The behavior then happens again. o The best thing to do is to ignore the undesired behavior and once he learns his behavior will not get him what he wants, the undesired behavior will stop.