The Basics of Behavior Modification

The seminar-workshop entitled “Caring for Caregivers”, was held at the Asian Social Institute, Malate Manila on October 16, 2010. ASP Trustee, Ging Viado, gave a talk on Behavior Modification Strategies.

Ging Viado presenting 3 kinds of autism’s triad of impairments

Ging Viado is a mother of a 24-year-old adult with autism. She conducts lectures on autism to parents and professionals, and facilitates support groups for moms with special children. She manages and owns a special school, GS Option House for Autism and Related Disorders, located in Biñan Laguna.

She gave an overview of autism’s triad of impairments: (a) communication (delay in the development of speech/the lack of speech), (b) social interaction (difficulty making friends/reading social cues) and (c) behavior (adapting to the environment).

Behavior refers to one’s response to various stimuli or inputs, i.e. the action of a system in relation to its environment. Children with autism usually have sensory processing deficits and therefore respond to their environment differently, oftentimes inappropriately. All behaviors occur for a reason and usually have a communicative intent.

Behavior modification strategies can help families and caregivers manage inappropriate behaviors and teach more appropriate responses through control or modification of the environment, and by reinforcing desired behaviors.

Commonly Manifested Behaviors (REFERENCE: INDEX)

These are some of the usual problem behaviors of a child with autism:

1. Resistance to change

The child will quite openly reject, either verbally or physically, changes in his environment which confuse him or which he cannot adapt to. He may also move away, appear not to be attending or ignore requests.

2. Obsessive and Rigid Behaviors

Obsessions are often displayed as an excessive interest in a topic or which the child may talk about whenever the opportunity allows. If he is obsessed with an object, he will repeatedly engage in ritualistic play with the object. The child may discard or ignore anything that does not involve his/her interest.

3. Aggressive and Destructive Behaviors

Physical aggression and destructive behavior can take many forms including hitting, kicking, biting, pulling hair, scratching or purposely breaking items. Aggression can also be verbal: shouting, insulting or hurtful.

4. “Cut-Off” Behaviors

The child who is often cutting off is quiet, not disruptive. He may engage in self-stimulatory behavior e.g. flicking his fingers, rocking, humming to drown out stimuli he cannot cope with or to calm himself.

5. Tantrums

Tantrums usually involve loud screaming and/or crying, with the child throwing himself on the floor or against the wall. The level of emotional upset can appear severe.

6. Manipulative Behaviors

The most common methods that a child uses to manipulate his environment are non-compliance, verbalization, physical resistance, screaming and crying.

7. Attention-seeking Behaviors

Attention-seeking could take the form of shouting, purposely breaking rules, being aggressive and destructive or constantly requesting for help.

8. Physical mannerisms and self-stimulatory Behaviors

SSBs are the child’s way of getting the sensory stimulation his brain needs. The need for joint stimulation may manifest as repeated flapping of hands, rocking, jumping; Visual stimulation twiddling fingers in front of the eyes, gazing quickly at moving objects, blinking. Auditory stimulation frequently involves tapping of different substances, or making the same sound repeatedly.

9. Problems with functional skills

Lack of skills or inappropriate functional behavior can be seen across the different skill areas e.g. eating, dressing, bathing, washing, communication, social interaction, etc. For example, in the area of eating: the child may eat nothing because he can’t unwrap his food and doesn’t know how to ask help or he may reject the food if it is not what he wants.

10. Lack of awareness of danger

The child may jump into a swimming pool even though he is unable to swim or may dash across the road with no attempt to look or wait.

11. Avoidance Behavior

The child is physically withdrawing himself from the disliked situation through running away or hiding in toilets.

Here are some of the various strategies for modifying behavior:

1. Cause and Effect Strategy - “Demand-Reward” or “First-Then” system helps the child develop compliance and trust, and reinforces desired behaviors.

Example: Sit first, then candy; if you finish your job you can play blocks;

First do writing, second reading then you can watch TV.

2. Graded Change Technique – Is a systematic approach of shaping the child’s obsession to objects, topics, interest, rituals or routines. Modification of obsessive behaviors is done in small phases until appropriate behavior is achieved.

Example: The child is obsessed with his favorite racing car that he cannot sleep without it.

Gradually increase the distance between the child and the car every night until the CWA can sleep without the object

3. Desensitization - Is the gradual introduction and exposure to the particular feared object or event and pairing it with something he likes so he associates it with something positive.

Example: The 6 years old child does not eat rice; he prefers to eat only cookies throughout the day. But the parents want him to learn how to eat rice.

v 1st Day - taste the rice then reward 1 bar of chocolate
v 2nd Day - 1 pc of rice then ¾ bar of chocolate
v 3rd Day - 2pcs of rice then ½ bar of chocolate
v 4th Day - 1/16 tbsp of rice then ¼ bar of chocolate
v 5th Day - 1/18 tbsp of rice then 1/18 bar of chocolate
v 6th Day - 1/4 tbsp of rice then a bit of chocolate
v 7th Day - ½ tbsp of rice then social praises
v 8th Day - 1 tbsp of rice then social praises and so on…

4. What to do Stories

This is the use of a visual and written representation that gives clear information about what may happen and what the child is expected to do in a new place or situation. This is a step-by-step procedure that helps make new situations more predictable for the child thereby decreasing frustration and resistance to changes in his environment.

Example:

Michael had great difficulty stopping what he was doing to listen to the teacher’s directions. A simple what to do story was written for him:

Mrs. MacGregor claps her hands when it is time to pay attention.

I hear Mrs. MacGregor clap her hands

I will put my pencil down.

I will put my hands on my knees.

I will look at Mrs. MacGregor face.

I will listen to what she says.

Social Stories - are written for high functioning students with problems in adapting to social situations. It is usually a 2 to 3 paragraph story composed of:

· Descriptive sentences which describe the situation in terms of “wh”: where the situation takes place, who is involved, what they are doing, and why they may be doing it

· Perspective sentences which give a peek into the minds of those involved in the story; they provide details about the emotions and thoughts of others.

· Directive sentences which suggest desired responses tailored to the individual.

· Control sentences are authored by the student himself as something of a mnemonic device -- a sentence to help him remember the story or deal with the situation. These are not used in every story and are typically used only with fairly high functioning children.

5. Error Free Learning - Use of positive directions with statements that tell the child what to do rather not what to do (use positive statement rather than negative).

Example: If he does run when he is outside tell him to walk only instead of stop running or no running.

Take note: that we may use NO, if the child is in danger or aggressive behavior.

6. Contracting – The child assumes responsibility for his/her behavior. A contract is a written agreement between the child and adult. A target behavior is identified and consequences are explained.

Example: I promised to listen to my teacher and be good by Day 1 to Day 5

(Put check mark if GOOD and Put a cross mark if BAD)

Good (check mark) can play on computer

Bad (cross mark) no computer

Signed by: Teacher and Child

7. Extinction Strategies

Ignoring – do not react to the behavior, simply pass with no comment at all when the behavior occurs. Usually used to extinguish attention-getting behaviors, expect an increase in severity or intensity of behavior before it disappears.

Turning Away - moving the equipment from the table, holding the child’s hand down gently and turning your head away for 10 seconds or so.

Separation - Alternatively turning the child’s chair away from a desired group activity e.g. singing

Time Out – putting the child in a separate location e.g. a corner or outside until he is ready to participate or behave appropriately.

8. Taking away privileges

* (e.g. class snack, free play or any other favorite activities).

* Sit or No Watching TV

9. Differential Informational Feedback

– the following chart illustrates some phrases that can be used to give the child positive reinforcement or directive feedback

CORRECT & GOOD ATTENDING

WOW

BEAUTIFUL

YOU GOT IT

GREAT LISTENING

PERFECT

YOU FIGURED IT OUT

YOU’RE SMART

TERRIFIC

GOOD DOING

ALL RIGHT

SUPER JOB

THAT’S WONDERFUL

CORRECT BUT POOR ATTENDING

THAT’S RIGHT

CORRECT

OK

YEAH

YOU CAN DO IT BETTER

YEP

GOOD

ALL RIGHT

MMM-UHMM

PRETTY GOOD

GOOD JOB, BUT….

THAT’S NICE

INCORRECT BUT GOOD ATTENDING

GOOD TRY, BUT…

ALMOST

USE BOTH HANDS

DO IT WHEN I DO IT

LET’S TRY IT AGAIN

YOU’RE GETTING CLOSE

CLOSE, BUT…

THAT’S NOT THE….

UH-UH

NOPE

NOT QUITE

SHAKE HEAD NO

NO RESPONSE OR INCORRECT WITH POOR ATTENDING

YOU NEED TO PAY ATTENTION

YOU NEED TO LISTEN

NO

WAKE-UP

YOU’RE NOT LISTENING

YOU’RE NOT PAYING ATTENTION

YOU NEED TO TRY

LISTEN!!!

PAY ATTENTION!!!

I’M ASKING YOU A QUESTION

YOU NEED TO ANSWER

HELLO!!!

REFERENCE: P.35 OF THE BOOK: A WORK IN PROGRESS BY RON LEAF AND JOHN MCEACHIN

Tone of voice, facial expression and use of tangible reinforcers further clarifies reinforcement.

Other strategies are Modeling, Chaining, Offering an Alternative, Verbal Prompt, Giving Chances and Natural Consequences.

Lastly, Behavior Modification can be successful with the following: Structured activities, Specific/ clear words, drills and most importantly, REMAIN CALM AND BE CONSISTENT.