Unit V: Behaviour Problems and Management
5.1 Common behaviour problems in children
5.2 Assessment of problem behaviour
5.3 Functional analysis
5.4 Behaviour management techniques
5.5 Planning, Implementation and Evaluation of Behavioural Management Programme
5.1 Common behaviour problems in children
Behavior: Any observable and measurable activities is known as behavior.
Types Of Behavior
· Skill behavior :- Means which is socially accepted and it is an age appropriate.
· Problem behavior :- Means which is not socially accepted and it is not age appropriate.
Adaptive Behavior (Skill Behavior)
· The adaptive behavior in general refers to the way in which an individual function in his/her social environment.
· The AAMR (1977) defines adaptive behavior as the effectiveness or degree with which an individual meets the standard of personal independence and social responsibilities expected of his/her environment.
Types Of Skill Behavior
· Activities of daily living
· Reading and writing
· Number and time
· Domestic and social
· Pre- vocational and money
· Problem behavior is defined as those behaviors are not age inappropriate, socially not accepted, injurious to self and others and which is interfering teaching learning process.
Types Of Problem Behavior/Mal-Adaptive Behavior
· Violent And Distructive Behavior Example : tear books
· Temper Tantrums. Example : screams rolls on the floor .
· Misbehavior With Others .Example: Pulls object from others
· Self Injurious Behavior. Example : Head banging
· Repetitive Behaviors: Example: Rocks body, flapping hands.
· Odd Behavior. Example: Laughs or talk to self without reasons.
· Hyperactive Behaviors Example: Does not sit at one place for required time .
· Rebellious Behavior . Example: Refuses to obey command .
· Anti-Social Behaviors. Example: Steals ,cheats in games .
· Fears. Example: Fears of place ,person ,animals and object.
5.2 Assessment of problem behaviour
Occasionally, people react to situations in ways that are not effective for their health. Everyone does this to a certain degree. However, when the behavior is used to continuously avoid the perceived negative situation, maladaptation occurs.
In adaptive behavior, people rise to meet challenges in daily life. You might not want to get up and go to work, but you do. You might not want to take medication, but you realize you need these pills for a better quality of life, so you take them. Adaptive behavior is not just doing something you don’t like to do but it is facing challenges and finding ways to cope with needing to do things that you do not prefer.
Sometimes, we find strategies to deal with the things we don’t want to do. For example, you might not want to get up to that alarm to go to work but you know if you do, the reward will be a paycheck. You might find you will change jobs or negotiate a different start time, so you don’t have to wake so early. Some people will go as far as to change jobs, so they can look forward to going to work. Changing your mindset can help as with taking medication. If the medicine helps you and you can see the benefits, you will probably take it. If it comes with side effects, you can ask for a different formulation. The point is, you figure out a way to help yourself through life’s hurdles.
Maladaptive behavior can result when a person just does not see a path to their desired future. This can happen with any chronic illness or major lifestyle change. With maladaptive behavior, self-destructive actions are taken to avoid undesired situations.
One of the most used maladaptive behaviors is avoidance. Everyone uses this behavior at one time or another. This involves not doing something that should be done. It can be avoiding a person, like your healthcare professional, an activity, such as not performing a bowel program, or it can even be a thought such as not recognizing changes due to spinal cord injury. Avoidance becomes maladaptive when your physical or mental health is harmed or in danger of being harmed.
Avoidance seems like a simple solution because we have all used it so we all know how to do it. Which is that we just do not do something we should. However, it does result in anxiety and stress because we know we should be doing the exact thing we are avoiding. Developing a pattern of avoidance can lead to many mental health issues including anger outbursts or internalizing the anger, changes in socialization, lack of appetite, inability to sleep, low self-esteem and depression.
As these mental health issues build, they can convert to include physical components. At first, you might experience weight loss and fatigue.Several medical consequences have been attributed to the stress of avoidance: hypertension, ulcers, headaches, irritable bowel, muscle aches. Even the development of diabetes has been related to stress. Diabetes is at a higher risk for individuals with spinal cord injury as well.
Some individuals will develop maladaptive behavior by starting with avoidance and build into other, more intense maladaptive behavior. Others will just jump right into more detrimental types of maladaptive behavior including destructive behavior towards yourself.
Self-destructive behavior includes self-harm, eating disorders, and substance abuse. Self-harm is the physical destruction of the body that can appear in a variety of ways. Traditionally, self-harm is associated with the cutting of one’s own body. However, this behavior can be demonstrated in a variety of other ways as well. Examples can be pulling out hair, often seen with eyebrows, scratching, or burning. For individuals with spinal cord injury, it can be exhibited by creating, picking or keeping wounds from healing, refusal to follow needed activities such as catheterization, bowel program, or pressure releases.
Self-harm is caused by overwhelming stress, anxiety or depression. It is a coping mechanism as opposed to a compulsion. Occasionally, individuals with spinal cord injury, make a mistake and miss a catheterization time or get delayed in their bowel program. These oversights, although they still can lead to physical consequences, should not be confused with self-harm. We all error sometimes. Self-harm can be a one-time event or a pattern. It is caused by inner turmoil and can be self-punishing.
Eating disorders are a form of maladaptive behavior that cause self-harm. They can result in under or overweight issues which are particularly disastrous for individuals with spinal cord injury as both affect skin integrity, mobility, catheterization and bowel issues, body image and general health. Eating disorders can become diseases such as binge-eating, excessive dieting, bulimia, and attachment of well being to body image.
A person can use eating disorders as a method of gaining control in their life. If a person requires assistance for daily activities, using food can become a measure of control over their body. It can also be a temporary moment of taste pleasure when there is not much other perceived pleasure in life. Eating disorders are a result of stress, conflict, and anxiety which can be a result of spinal cord injury or other life crisis.
Substance abuse is the use of alcohol, prescribed or non-prescribed drugs or a combination to achieve a specific effect. Some people use these substances to numb the anxiety and stress perceived in their lives, others might use the substances for a complete blackout of life. As with other maladaptive behaviors, the goal is to create a false view of life where their problems and issues do not exist.
Substance abuse can lead to addiction which has been described as when the substance reaches a level where everyday life is affected. For some, this can be a dependence on alcohol to dependence on addictive medication. Some addictive substances, especially alcohol have been associated with suicide.
Knowing if someone has maladaptive behavior can be difficult to determine. Fortunately, you can get help from your health professional who can provide an in-office assessment. From that point, they can direct you to the most appropriate treatment plan if needed.
There are several ways to treat maladaptive behavior. A psychotherapist can help you discover the nature of the reason for your behavior as well as strategies to help you confront and deal with it.
5.3 Functional analysis
Functional Analysis of Behavior
· To identify the variables of which behavior is a function; to discover "cause-effect ”
relations (Skinner, 1953)
Functional behavioural assessment (FBA) is a precise description of a behaviour, its context, and its consequences, with the intent of better understanding the behaviour and those factors influencing it.
The purpose of the FBA of behaviour is to determine which contingencies maintain an individual‟s problem behaviour.
Approaches to assessment
1) Indirect Assessment
2) Direct Descriptive Assessment
3) Functional (Experimental) Analysis
These approaches differ in terms of the type of data collected and the extent to which environmental events are merely observed or actually manipulated during the course of assessment.
Indirect (Anecdotal) Methods
· Focus on circumstances under which behavior occurs
· Based on informant recall
· Data: verbal report (interview, checklist, rating scale)
· No risk to individual Simplicity (requires little skill)
· Efficiency (takes 10-30 min to complete)
· Structured method for gathering information
· Potentially useful as initial guide to assessment
· Highly subjective data – guesses
· Poor reliability and questionable validity
· Insufficient for treatment development
Suggestions for Implementation
· Use as preliminary guide only
· Use multiple, relevant informants
· Follow-up with functional analysis
Descriptive (Naturalistic) Analysis
· To identify naturally occurring, observable antecedents and consequences of behavior
· Define target behavior(s) to be observed
· Specify criteria for antecedent and consequent events
· Occurrence of B ➛ Record A, B, and C
· Organize A and C clusters
· Generate hypothesis based on A-C correlations with B
· Objective and (usually) quantitative data
· Behavior sampled in relevant settings
· Identifies correlations: “ When I see X, I also see Y ”
· Requires lengthy observation under varied conditions (event sampling problem)
· Typical environment is “ noisy, ” containing many antecedent and consequent events (which events are relevant?)
· Interpretation must be based on conditional probabilities
· Naturally occurring consequences may not be reinforcers
· Effects of intermittent schedules cannot be identified
· Irrelevant variables may mask relevant ones
· Outcomes appear to be biased
· Correlational relations ≠ functional relations
· Sneeze ➛” bless you”
Functional (Experimental) Analysis
When descriptive analysis yields ambiguous results, a functional analysis may be conducted to allow systematic introduction and removal of environmental events during predefined test and control conditions.
What are the goals of functional analysis?
a) Define the problem behavior
One of the first and most important steps when planning to assess and treat someone‟s problem behaviour is to objectively and specifically define that behaviour. A well-defined behaviour is important so the behaviour can be reliably or consistently observed and treatment can be administered as intended.
b) Identify possible causes of behaviour
General categories of causes include: (i) positive reinforcement or events, objects or sensory stimuli that, when they immediately follow a behaviour, result in an increase in rate of the behaviour (automatic reinforcement is included which refers to the occasions when the behaviour can be maintained by consequences delivered via the behaviour itself) and (ii) negative reinforcement or stimuli or events (e.g., demands, tasks, internal stimulation, attention) that, when removed immediately after a behaviour, increase its rate. The function matrix is a useful tool for identifying the possible causes or the ways that a behaviour was reinforced.
c) Predict when the problem behaviour will occur
Information gathered from functional analysis may allow prediction of the circumstances under which the problem behaviour is likely to happen and alter them in some way to decrease the likelihood of the problem behaviour.
d) Design effective treatment programmes
Consideration of the possible causal variables for the problem behaviour is important for the selection of effective treatment. Treatment will vary depending on the functional hypothesis or reason for the problem behaviour.
If one could specify which aspects of a procedure led to more problem behaviour, one should then be able to change the procedure so as to effect a reduction in problem behaviour.
· Direct and quantitative observation of behavior
· Conditions of observation are controlled
· Comparison between test and control conditions
· Data: frequency, duration, etc.
· Provides clear demonstration of cause-effect relations
· High degree of precision (isolates intermittent or subtle variables)
· Suggests short-term strategies for behavior management
· Provides clear basis for treatment development
Challenges to Functional Analysis Methodology
· Complexity of assessment: It’s too difficult
· Time constraints: It takes too much time
· Setting constraints: I don’t have a controlled setting
· High-risk behavior: It’s too dangerous
Functional analysis in action
Typical conditions in which levels of the problem behavior can be measured and compared include:
(a) attention condition wherein reprimands (e.g., “No, don‟t do that”) are delivered after each problem behaviour;
(b) tangible condition wherein a preferred object (e.g., toy, food) that is out-of-reach is given to the child following each problem behaviour;
(c) demand condition wherein a task is presented and following instances of the problem behaviour it is removed for a brief period;
(d) play condition wherein toys are provided, the therapist interacts positively with the child and any instances of the problem behaviour are ignored; and
(e) alone condition wherein the child is placed in a therapy room alone with no toys available. The alone and play conditions are typically used as a control or comparison conditions with the other conditions (i.e., demand, tangible, attention). These conditions can be conducted in a laboratory situation (analogue) or in the situation where the child‟s problem behaviour naturally occurs (e.g., classroom, home).
5.4 Behaviour management techniques
Behavioural Techniques In Managing Problem Behaviours
* 1. Changing the Antecedents: There are a number of antecedent (before) factors, in the presence of which, behaviour problems may tend to occur more.
These factors may include particular settings, situations, places, persons, times, specific demands placed on the child, task difficulty levels, methods of instructions used by the teacher, sudden change in routine, etc.
If the teacher can identify links between any of these factors and the occurrence of specific problem behaviours, then a simple avoidance, alteration or change of such factors may he sufficient to manage problem behaviours
* 2. Extinction/Ignoring: Extinction means removal of attention rewards permanently following a problem behaviour. Extinction is the nonreinforcement of a previously reinforced behavior. This procedure involves ignoring a behavior that is withholding reinforcing attention for a previously reinforced response. In all cases, when an inappropriate behavior is ignored, another behavior, which is appropriate, must be reinforced.
* 3. Time Out: Time out method includes removing the child from the reward or the reward from the child for a particular period of time following a problem behaviour Ensure that rewards or a rewarding situation is removed following the problem behaviour.
Types of Time Out
* Remove the child to an area in the class
* Remove the rewarding activity materials
* Place the child outside
* Head down position
* Seclude the child to an isolated room
* 4. Physical Restraint: Physical restraint involves restricting the physical movements of the child for sometime following a problem behaviour.
* 5. Response Cost: Another way of decreasing problem behaviours in children is to take away the rewards that the child has earned by performing specific good behaviours.
In other words, this technique involves the child to pay a fine or the cost for indulging in a problem behaviour by giving away some thing or event he has earned from showing desirable behaviours.
Response cost is a procedure in which a specific amount of available reinforcers is contingently withdrawn following a response in an attempt to decrease behavior. Response cost is often used with token economy programs. The response cost must be less than the total amount of number of reinforcers available (i.e., never go in the hole). Response cost procedures are often referred to as “fines.”
* 6. Overcorrection( RESTITUTION): The use of this technique will not only decrease problem behaviours in children, but also teach appropriate ways of behaving. When this technique is implemented, after the occurrence of a problem behaviour, the child is required to restore the disturbed situation to a state that is much better than what it was before the occurrence of the problem behaviour.
* 1. Restitutional overcorrection requires the student to correct the effects of his/her misbehavior by restoring the environment to better than its original condition.
* 2. Positive overcorrection requires the student to practice an appropriate behavior an abundant number of times.
* 3. Neutral practice overcorrection has a student repeat an action that is neither restitutional nor related to the desired behavior. This often takes the form of contingent exercise.
* 4. Full cleanliness training requires the student to excessively clean the result of wetting or soiling her/ himself
* 7. Conveying Displeasure: we use of THIS technique, the teacher is required to give clear verbal commands expressing displeasure to a child following occurrence of a specific problem behaviour.
* 8. Gradual Exposure for Fears: Graduated exposure techniques are especially used to decrease fears in children, either in the school or home setting.
* The procedure of graduated exposure involves a step by step gradual exposing of the child to a feared person, place, object or a situation
* 9. Differential Rewards:
1. Differential reward of opposite behaviour
2. Differential reward of other behaviour
3. Differential reward of low rate Behaviour
4. Differential reward of alternate behaviors
* 10. Self-management Techniques:
* 1. Self observation
* 2. Self recording techniques
* 3. Self cueing techniques
* 4. Self reward techniques
* 5. Correspondence training
* 6. Anger control technique
5.5 Planning, Implementation and Evaluation of Behavioural Management Programme
Behavior modification means changing human behavior by the application of Conditioning or other Learning techniques. (J.B Watson).
An assessment tool to collect anecdotal observational information over the course of several observation periods. As the problem behavior occurs, the observer records events that occurred right before the behavior (antecedents) and events that occurred just after the behavior (consequences). The information gathered in an ABC analysis helps identify events that are maintaining the challenging behavior, appropriate behaviors that are not reinforced, social skills that need to be learned, and environmental conditions that need modification.
STEPS INVOLVED IN BEHAVIOUR MANAGEMENT PROGRAMME (BMP)
1. Identification of problem behaviours
2. Statement of problem behaviours
3. Selection of problem behaviours
4. Identification of rewards
5. Recording baseline of the problem behaviours
6. Functional analysis of the problem behaviours
7. Development and implementation of behaviour management programmes
8. Evaluation of behaviour management programmes
STEPS IN IDENTIFYING PROBLEM BEHAVIORS
• Identification of problem behavior
• Direct testing
We use BASIC- MR for Assessing the problem behaviour
SELECTION OF PROBLEM BEHAVIOURS
* After identifying the various problem behaviours in a child, and after stating them in observable and measurable terms, you need to then select a specific problem behaviour which you want to change first. This step is called as prioritizing specific problem behaviours.
GUIDELINES FOR SELECTING AND PRIORITISING PROBLEM BEHAVIOURS
* 1.Choose only one or two
* 2. Easy to manage,
* 3. injurious to the child himself, or to others in his environment.
* 4. interfere most with the child's, or others classroom learning/teaching activities.
* 5. Choose specific problem behaviours for intervention only after due consideration about their relative frequency, duration or severity,
* 6. child to involve more in classroom/school learning activities.
* 7. consultation with the parents
IDENTIFICATION OF REWARDS
* Definition :“The event that happens after a behaviour which makes that behaviour to occur again in future is called 'reward".
Types of Rewards
* Primary Rewards
* Secondary / material Rewards
* Social Rewards
* Activity Rewards
* Token Rewards
HOW TO SELECT REWARDS FOR CHILDREN
* I. Observe the child's behaviour
* 2. Ask the child directly
* 3.Ask parents, caretakers or others who know the child
* 4. Use a Reward Preference Checklist
* 5. Elicit the child's reward history
* 6. Choose rewards which are easily available and dispensable
* 7. Use reward sampling techniques
* 8. Choose an appropriate reward
* 9. Choose a strong reward
* 10. Change of rewards
HOW TO GIVE REWARDS?
* Reward only desirable behaviours
* Reward clearly
* Reward Immediately
* Reward the desirable target behaviour each and every time after it occurs
* Reward in appropriate amounts
* Combine the use of social rewards along with other types of rewards
* Change the rewards
* Fading of rewards
RECORDING PROBLEM BEHAVIOURS
a]Event or frequency recording:
b] Duration recording
c] Interval recording
d] Time sampling
FUNCTIONAL ANALYSIS OF PROBLEM BEHAViOURS
One of the most simple model known as A-B-C model is presented below
* A. What happens immediately BEFORE the behaviour? This is called as ANTECEDENT factors.
* B. What happens DURING the behaviour?
This is called as BEHAVIOUR.
* C. What happens immediately AFTER the behaviour?
This is called as CONSEQUENCE factors.
Understanding 'Before' (antecedent) factors
* 1. When does the problem behaviour generally occur?
* 2. Are there particular times of the day when the problem behaviour tends to occur more
* 3. With whom does the problem behaviour occur?
* 4. Where does the problem behaviour occur?
* 5. Why did the problem behaviour occur?
Understanding 'During' (behaviour) factors
* 1. How many times does the problem behaviour occur?
* 2. For how long does the problem behaviour occur?
Understanding 'After' (consequence) factors.
* 1. What do people present in the environment exactly do to stop the specific problem behaviour?
* 2. What effect does the problem behaviour have on the given child or others?
* 3. How is the child benefitting by indulging in the problem behaviour?