The Autism Society Event and Education Recordings Archive

In this presentation, we will review the process to develop a positive behavior support plan. We will present tools that parents and professionals can use to discover the function of challenging behavior for individuals with ASD. We will discuss the benefits and barriers associated when implementing this process in community based settings. Finally, we will present 3 cases where the implementation of positive behavior supports resulted in significant increases in quality of life for 3 young people with ASD. Autism is a life-long developmental disability that impacts an individual's communication and social skills. Furthermore, individuals with autism exhibit repetitive motor movements and odd rituals such as repetitive hand flapping, or insisting that the physical aspects of a room remain in precise order. In addition to these core symptoms, many individuals with autism exhibit severe self-injurious, aggressive, or non-compliant behavior. In fact, these challenges create the most difficult aspects of the disorder for many parents and professionals. In some cases, families and professionals are left reacting to such behaviors rather than teaching new ways to respond to difficult situations. Such drastic measures can be avoided when teams implement a functional behavior assessment and develop a positive behavior support plan. This process helps teams move from reaction to pro-action. The process of completing a functional behavior assessment includes three essential steps (O'Neill, Horner, Albin, Sprague, Storey, & Newton, 1997). They are: 1. Team Interview and Record Review 2. Systematic Observation of the Behavior in Natural and (Sometimes) in Contrived Situations 3. Behavior Hypothesis Development

In this case, the term ‘function' does not describe a person's abilities, as in understanding their ‘functioning level.' Instead, the term function refers to a description of how the behavior works in a given environment to achieve a specific purpose. Thus, the term ‘function' in FBA is a description of how and how well a behavior works to assist a person in achieving their needs.

At the heart of a functional behavior assessment is a problem solving approach that includes multiple methods of team learning. When a team completes an FBA, they study the behavior in many different ways from understanding what the team currently knows about the behavior (team interviews), to studying the behavior in the natural environment (systematic observation) to sometimes studying the behavior in contrived or experimental environments. The team learns how to work together and learn from each other in a coordinated dance that is mutually supportive and informative. In addition, they are truly assessing the subtle environmental factors that trigger the challenging behavior. According to Tilly et al. (p. 3, 1998), “The process involved in [Functional Behavior Assessment], is not a procedural one. Indeed, FBA is not a set of procedures and protocols, but instead is an integrated problem-solving approach to creating educational supports and interventions with a high likelihood of success. The FBA process is flexible in that different procedures might be used under different circumstances.”

The process of completing an FBA results in a clearer understanding of the behavior and that, in turn, leads to a coordinated, multi-component behavior intervention plan. Additionally, those closest to the problem complete the process. This represents a departure from former ways of addressing problem behavior where reactive strategies were developed by consultants or psychologists who did not “live with” the problem. In this case, the student's team completes the entire process. The five steps from functional behavior assessment to behavior intervention plan development, evaluation and revision are:

Problem identification and definition – The team moves from general descriptions of emotional states, to specific, behaviorally defined definitions of challenging behaviors. For example a team may move from referring to a behavior as ‘angry and disruptive,' to a fine-grained description, such as, “When Lonny is told ‘no,' he will hit and grab others and fall to the floor.”

Problem analysis – The team completes interviews and observations so that they can understand the connection between the person, the environment where the behavior occurs, and the needs that the behavior meets for the person. For example, “When Lonny asks for a desired object or activity and is told ‘no' he will hit, bite, and scratch in order to get the object or activity he desires.”

Intervention development – Once the team identifies the connection between the person, behavior, and environment, they develop a multi-component intervention plan. Such a plan uses individually tailored strategies to 1.) prevent the problem from occurring, 2.) teach the person a new way to get their needs met, and 3.) respond to the problem behavior in a new way so that it becomes inefficient and unnecessary in meeting the person's original need.

Monitoring progress and evaluating outcomes – This process is based on the large literature in applied behavior analysis. As such, it is critical to evaluate the success of the plan by tracking whether or not the problem behavior decreased, the new replacement behavior increased, and, finally, the person's quality of life is better.

Intervention revision as indicated by monitoring and evaluation – Inevitably, the behavior plan will require revision as the person and environmental contexts change. If, for example, a team finds, that the person has not decreased the frequency of challenging behavior, then the team would be required to revise the behavior intervention plan until they see a reduction in the problem behavior (Lohrman-O'Rourke, et al., 1999; Tilly, et al. 1998; McConnell, Hilvitz, & Cox, 1998; Vaughn, Dunlap, Fox, Clarke, & Bucy, 1997; Fox, Vaughn, Dunlap, & Bucy, 1997).

When an interdisciplinary team completes the process it has the opportunity to learn more effective ways of teaching students with autism and coordinating varied and diverse services. Team members who are open to the process find that they have to change their own behavior in order to support the change of the student they are supporting (Chapman, Kincaid, Shannon, Schall, & Harrower, 2002). There are four critical and required areas of intervention in multi-component positive behavior support plans. They are:

Preventing Strategies: Such strategies are designed to change the environment so that the person does not have to use the behavior to get their needs met. Teams consider if they can change the environment so that they can eliminate, block, neutralize, or otherwise change the triggers or ‘antecedents' that lead to problem behavior.

Teaching New Behaviors Strategies: These strategies are designed to replace the problem behavior with a new, more efficient and effective, adaptive behavior. Instead of hitting, a team might develop a method to teach a person to ask for a break. The behaviors that a team must teach fall into three categories. They are: 1.) Direct replacement behaviors that will replace the problem behavior. 2.) General behaviors that will increase the person's success in the environment. 3.) Coping and tolerance behaviors that will increase the persons ability to cope with frustrating or challenging times.

Responding to New Behaviors Strategies: These strategies provide a road map for the team to reinforce and respond to the new behaviors. For example, consider a case where the function of the person's behavior is to escape a task. A replacement behavior for hitting in that case is ‘asking for a break.' In order for this to be an effective replacement behavior, all team members, including family and school providers, must agree to give the person a break when they request it. This part of a behavior intervention plan directs the team specifically how to respond to new behaviors, so that they reinforce adaptive behaviors.

Responding to Challenging Behaviors including Crisis Management Plan: If Lonny's team is trying to replace his hitting with the behavior of asking for a break, they must also have a way to respond to his hitting that a.) does not result in a break, and b.) reminds him that there is a better way to ask for a break. Thus this section of a behavior intervention plan teaches the team how to respond to a person when the problem behavior does occur. In addition to responding to the challenging behavior, sometimes it is necessary to implement a crisis management plan that will keep the person and those around them safe. In the case of positive behavior support plans, the role of the crisis management plan is to keep the person and other around them safe, not to attempt to change behavior with punitive or reactive management.

The dramatic changes that occur in the life of a person with ASD as a result of the implementation of a positive behavior support plan are impressive and demonstrate the best of team collaboration. In this session we will end by presenting 3 cases where positive behavior supports resulted in increases in adaptive behavior and significant decreases in challenging behavior.

Learning Objectives: