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Description of Services Offered
Initial Screening:
The Initial Screening is a document that asks questions about the child and his or her behavior, communication, and brief history of therapy and diagnosis. It incorporates the Initial Verbal Behavior Assessment (Behavior Analysts Inc. 1998), and a Descriptive Functional Assessment, (Center for Self Injury, 1999). This information is used to give the assessor information about a child and general areas of strengths and weaknesses.
A Descriptive Functional Assessment is a process by which information about a particular behavior (or class of behaviors) is investigated and the controlling environmental variables (functions) of behavior are identified. Once these variables or functions are identified they can be manipulated so that behavior changes. The behavior change procedures selected are directly the result of the functional assessment process and are consistent with Applied Behavior Analysis and it's supporting body of literature.
The Initial Verbal Behavior Assessment (Behavior Analysis Inc.;1998) describes a child's overall cooperation with adults, social interaction, and primarily communication in the areas of requesting, labeling, receptive identification, conversational skills, and both vocal and motor imitation. The results allow for the selection of an initial formal response form and preliminary selection of goals that will directly lead to communication consistent with Applied Behavior Analysis and it's body of supporting literature.
The results of the Initial Screening allow the assessor to summarize a person's ability to communicate, choose an initial response form, (i.e. sign, vocal, picture), and begin to suggest specific areas of skill acquisition. Furthermore, it suggests causes (functions) of problem behaviors and possible first steps to correct these behaviors.
Assessment:
An assessment is usually conducted at the individuals residence or school and typically includes the parents and therapists that are involved with the person. An assessment can include the following areas (described below):
Interview
Observation
Discussion
Demonstration
Goals and Program Recommendations
Interview:
During this phase, the assessor typically reviews the Initial Screening with the individuals that filled it out. This may include the parents, therapists and other care-givers that interact with the child. The assessor may ask for clarification on some issues that are found on the initial screening, they may ask for specific examples of a skill or problem area, and they may ask for parents and therapists to demonstrate a skill area with the child, teaching technique or to deliver a typical consequence. Furthermore, the assessor will ask questions related to parent and therapist expectations of their child. For example, what do they ultimately want for their child, what are they looking for in their family relationship, in their therapist interactions, and in their programming.
What can be gained from this phase?
- A specific response form such as sign, vocal, picture exchange.
- Initial target/goal areas that will allow the child to be more successful.
- An understanding of some behavior-environment relationships, and some relationships that will need to be changed.
- An understanding of some common situations that may predict problem behaviors.
Observation:
During this phase, the assessor will observe the child. These observations may include typical play time, typical therapy time, typical interactions with parents and siblings, while they are alone, while they are having fun etc. The assessor wants to be able to observe the behaviors that were described through the interview process so that he or she can estimate the functional relationships during the interaction and see if other behavior-environment interactions that were described may be functionally related earlier discussions and/or observations and vise-versa. During this time, the assessor may also collect data on behavior.
Discussion:
The discussion is a summary of the initial screening, the interview and observation. It will describe what the assessor has found in terms of behavior-environment relationships. For example, it may include the following:
- Why a child tantrums when it is time to do work, or throw things when they are left alone for a period of time, etc.
- Why present learning may be difficult for the child, or why they have not acquired a specific skill area.
- May also include a description and/or training in the verbal operants and their relationship to the child.
- Describe what the recommended response form may be and why it was chosen.
- What the long term outcome may be and steps to accomplish this.
Demonstration:
After the discussion, the assessor will want to demonstrate the specific areas that were discussed. This process serves at least two functions: 1. establishes what therapy should look like and how to conduct it and 2. teaches others how to do the specific task or skill area. It is important for the assessor to demonstrate what they are attempting to accomplish and how to accomplish the skill areas. During this time, other variables that were unknown can be found and considered. Furthermore, the most powerful way to identify functions of inappropriate behavior is through direct manipulations of the consequences that are believed to be the function of these behaviors and antecedent conditions that set the occasion for behavior to occur. In this way, a plan to reduce the behavior is directly tied to the function of the behavior and has the best chance of successfully reducing the behavior.
Goals and Program Recommendations:
Except for the following generic recommendations, a child's program goals and recommendations are specific to that child.
- Use a Verbal Behavior approach to organize your goals and continue the use of VB to teach your child and therapists.
- Use good teaching to teach your goals
- Do mand training many times per day
- Do pairing, and continue to do pairing
- Don't think that your child has to "get it", consider that they will "get it" once we figure out how to effectively teach it.
- Have fun teaching your child and learn what they are teaching you about their learning.
Program Writeup Example
BEHAVIOR & COMMUNICATION THERAPY INC.
Helping Children and Adults with Developmental Disabilities
Student: __________
D.O.B.: _______
Date of Observation: _______
_______is a _______year old male child who was referred for behavior and communication issues.
Brief History:
_______was diagnosed with Autism and ADHD at the age of four. His records indicate a long history of behaviors related to autism and ADHD which include hyperactivity and significant deficits in the areas of communication, social interaction, , appropriate play skills, and others to be discussed later. Furthermore, records show that many interventions have been implemented but have resulted in minimal success in decreasing inappropriate, stereotypical, injurious behaviors and increase appropriate functional skills, appropriate play skills, and independent communication. This information can be found in his previous Medical reports, Psychoeducational reports, therapy reports, etc.
Initial Assessment:
Prior to the assessment, Mrs. _______completed an intake package that included the following: medical information, a brief functional assessment, and the Initial Verbal Behavior assessment. This information confirmed the continued need for behavior programming to reduce inappropriate behavior and also build a formal communication repertoire. During observation, questions related to the above information were asked, _______was observed, and teaching situations tested. The following is a summary:
Inappropriate Behaviors:
These behaviors include and are not limited to the following 4 areas:
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| Self-Injury |
Aggression |
Property Destruction |
Other |
| Hits head with fist/hand |
Hit others |
Pushing toys off tables |
Screaming |
| Bite self: arm or leg |
Kick Others |
Running into walls/doors |
Smearing blood |
| Pinch Self: arm |
Pull Hair |
Breaking/destroying objects |
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| Hitting Legs |
Pinch/scratch others |
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| Biting Lips |
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Based upon information obtained through the brief Functional Assessment questionnaire and observation:
- _______has a long history of engaging in these behaviors and no records obtained indicate procedures to decrease these behaviors or to teach functionally alternative behaviors including communication.
- The intensity and frequency of these behaviors:
a. Have resulted in tissue damage and scarring on the left and right arms and legs, property destruction, and injury to others.
b. Are dangerous to his own health and the health of others.
- These behaviors are maintained by a number of reasons and are more likely to occur when:
a. Unpreferred activities are presented
b. A favorite toy, game, or activity is taken away or when he can not have access to these items or events.
c. To get a reaction from a care provider.
d. As a self-stimulatory activity.
- These behaviors are pervasive. They affect almost every situation of ______ daily life from home situations to school.
- _______has no formal mode of communication. _______will point to something he wants or lead people by the hand to get what he wants. A formal mode of communication would allow _______to acquire the items and activities he wants and allow him to remove aversive situations in a more appropriate manner.
The results of the Initial Verbal Behavior Assessment (Behavior Analysis Inc.; 1998) describes a child's overall cooperation with adults, social interaction, and primarily communication in the areas of requesting, labeling, receptive identification, conversational skills, and both vocal and motor imitation.
Cooperation: _______is reported to be significantly uncooperative during most situations that do not involve what he wants to do (i.e. classroom routines, teaching situations, functional daily living chores, etc.). He may engage in inappropriate behavior (such as aggression and self injurious behavior) when demands are placed on him. He will however , engage in simple and easy responses for a powerful reinforcer. During observation, _______did engage in a few simple responses to gain access to a preferred activity.
Requests: Generally, _______finds his own reinforcers by searching the environment. It is reported that _______will pull people to what he wants, he will also become upset when he can't get what he wants. Presently, _______has no formal way to make requests.
Imitation (including Vocal): It is reported that _______will imitate a few gross motor movements and will repeat a few specific sounds and words. This was observed during assessment.
Receptive: It is reported that _______will follow a few instructions related to daily routines. Furthermore, during observation _______was able to follow teacher directions to sit next to a reinforcing item when told.
Match to Sample: It is reported that _______can match most items and do some block designs.
Receptive by Feature, Function or Class: _______does not presently identify items by feature, function or class.
Labeling: _______cannot label items or actions.
Conversational Skills: _______cannot fill in missing words or converse with others. It is reported that sometimes he will fill in missing letters during the "ABC's" song.
Social Interaction: It is reported that _______will physically approach others to initiate an interaction and may bring adults to reinforcers. However, _______does not seek out or initiate interactions with others most of the time.
Letters and Numbers: It is reported that _______can identify at least 15 letters/numbers in a match to sample format.
Play: _______does not play or manipulate toys as designed.
Recommendations and Rationale:
- Topography of Communication: I recommend that sign language be chosen as a formal mode of communication in the beginning stages of acquisition. It is likely that _______will communicate vocally given the right teaching environment and curriculum. Presently however, he does not imitate many words or sounds and words and sounds are difficult to prompt. Moreover, requiring him to say something now has the possibility of increasing frustration. Sign language can be prompted and thus is easier for a teacher to teach it. Moreover, unlike a picture exchange system of communication, _______will be able to 'carry is words with him'. Vocal responding is probable and should be the final outcome of any communication approach for _______. A curriculum designed to start communication in sign language and change to vocal at the right time is appropriate.
- Manding (requesting): I recommend that sign language begin immediately and the first signs be items and activities that _______wants thus, building a requesting repertoire. _______has no formal way to acquire the items and activities he wants other than pulling people to them. Furthermore, frustration will occur when a caregiver cannot deliver a favorite item or activity because they do not know what he wants although the caregiver begins to "guess". Occurrences of inappropriate behavior are more likely in these situations. What is common (and was observed) are caregivers becoming more aware of subtle behavior changes that allow them to "know" what he wants (i.e. he becomes less self-injurious or aggressive as mom moves closer to the "movie" cabinet). This reduces _______frustration momentarily but typically after inappropriate behavior has already occurred and again, this is not a formal mode of communication
- Procedures to reduce inappropriate behavior. _______self-injurious, aggressive, and property destructive behaviors are maintained by access to items, activities, and attention and to avoid or escape aversive situations. In other words, the occurrence of these behaviors increases if _______can not get a favorite toy or activity or if he wants someone to pay attention to him. In most teaching situations, these behaviors are likely because it is difficult for _______to be an effective and successful learner. He becomes frustrated and behaving inappropriately typically reduces the demand to perform not to mention that caregivers (parents, teachers etc.) are now trying to stop the behavior instead of teaching more functional skills. Based upon the relationship between environmental factors (toys, activities, people, demands and how they are acquired or removed) and inappropriate behavior (functional assessment) the following are recommended:
- Compliance training: this is simple following directions. A number of behavior principles are used to increase acquisition which should include:
- Prompt and prompt fading. Guidance that allow _______to be successful. These prompts should be reduced upon successive approximations of correct responding (shaping).
- Errorless teaching practices: includes prompting, differential reinforcement, stimulus fading.
- differential reinforcement: reinforcing with a preferred item/activity after completion of appropriate behavior.
- stimulus fading: following easy and simple directions before harder more complex directions are given (should include prompting).
- Manipulation of the motivation to behave inappropriately
- Mand (request) training: communication starting with requests reduces the need to behave inappropriately and increases appropriate successful communication.
- Replacement behaviors. Behaviors that serve the same function (reason) that the inappropriate behaviors serve. For example, _______may become frustrated and engage in inappropriate behaviors when he tries to acquire something he wants. Teaching him to sign or vocalize for this item would replace these behaviors by :
- Teaching a functional alternative (sign/vocal) to acquire the item and not giving the item for inappropriate behavior. To be successful, the items outlined in 2. i - iii above need to be followed.
- issues: initially applying physical prompts to teach may increase aggression, self injury, and property destruction.
- Compliance (see above).
- initially applying physical prompts to teach may increase aggression, self injury, and property destruction.
- Teaching a functional alternative to acquire attention.
- issues initially applying physical prompts to teach may increase aggression, self injury, and property destruction.
_______may engage in severe self injurious behavior to gain attention. It would not be our recommendation to ignore these behaviors and thus will warrant other reduction procedures when they occur and teach 'attention getting' behavior when he is NOT engaging in inappropriate behavior to get attention.
- Teaching a functional alternative to remove unwanted tasks or demands.
- Issues: initially, applying prompts may increase inappropriate behaviors.
- teaching these behaviors too early in _______curriculum will allow him to remove most teaching situations until learning becomes more fun.
- Pairing: teachers should begin teaching a language rich curriculum by being present with _______and his favorite activities, talking in a pleasant manner, and delivering _______favorite toys, food, and activities during the initial stages of a program. In this way, they become 'associated' with his favorite toys and activities. Eventually (usually in a short period of time- days), the teacher becomes part of the fun that _______has. _______begins to see the teacher as a fun person to be with thus reducing the inappropriate behaviors associated with teacher demands and increasing the opportunities to interact appropriately.
- Reduction procedures: not withstanding the positive approaches to teaching appropriate replacement behaviors and communication, there will still be a continued need to design and implement procedures that will suppress the inappropriate behaviors when they occur. _______has scars and bruises on his arms and legs form biting, scratching, pinching and kicking himself. Furthermore, _______ parents have consulted with Medical Doctors which has resulted in ___________ taking many medications, some of which are to help control the intensity of these behaviors. It was reported that a Riftin Chair was used to restrain _______when his behavior would get out of control in one of his previous school settings. It has been further reported that restraint is used to control these behaviors in the home (i.e. holding him until he is calm). It is my opinion, given the lack of communication, and the intensity and severity of these behaviors over a period of years that some type of blocking will continue to be necessary to reduce these behaviors. These reduction procedures alone will not be sufficient to eliminate these behaviors. These procedures will need to be one component in a comprehensive treatment plan that also focuses on acquisition of replacement skills (as outlined above) that consist of basic compliance and communication.
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