Intensive ABA Services
By Kristine Safaryan, BCABA
Lovaas Institute – Los Angeles
Jimmy is a sweet, bright, and energetic 7-year-old boy. He enjoys all paper and pencil tasks and art skills such as writing, tracing, coloring and cutting. He also loves a variety of social reinforcers such as tickles or getting tossed into the air. Jimmy currently receives approximately 40 hours per week of one-to-one behavioral intervention in his home and school environments. He attends a special education first-grade classroom half-day, where he is accompanied by a one-to-one ABA instructor. The home program focuses on teaching Jimmy functional communication skills through vocal communication (his spontaneous language currently consists of one-word utterances) and picture exchange, increasing cooperation, generalizing previously acquired skills, and reducing/extinguishing inappropriate behaviors such as protest and climbing behaviors. Jimmy has received both clinic- and consultation-based ABA services across two service providers since he was 3 years of age. He currently receives clinic-based services from the Lovaas Institute.
Jimmy exhibited a variety of inappropriate and maladaptive behaviors such as tantrums (falling to the floor and crying), non-compliance, stereotypy (repetitive gross motor movements with his body, gazing, and vocalizations), aggression (hitting instructors with open and closed fist), and climbing behavior (on doorframes, windowsills, stair rails, bookshelves, refrigerator, intercom, etc.). The climbing behavior was of utmost concern to his parents and the treatment team because it became increasingly dangerous. Not only was this behavior taking away from treatment time, he was finding higher and more dangerous places to climb. The instructors were spending a majority of their sessions chasing after him in order to block this behavior.
Many of our clients exhibit challenging behaviors that are potentially dangerous to others or themselves. It is imperative that the function of these behaviors be identified and an appropriate intervention be implemented in order to decrease or extinguish the behavior as quickly as possible. When brainstorming interventions, it is extremely important that the entire team participates, and that not only instructors but also parents are willing and able to follow through with the decided-upon procedure.
Initially, a response block procedure was implemented (i.e., attempt to block/inhibit the climbing). The reactive intervention included a verbal reprimand and a physical prompt (i.e., "down" paired with physical removal). This intervention was deemed ineffective as Jimmy began to look toward the instructor prior to climbing and smiled or giggled when physically prompted down. In addition, Jimmy responded to the pressure on his body and it appeared that the physical removal was reinforcing (increasing) the climbing behavior.
Based on data collection and analysis, it was determined that the function of the behavior had become attention-seeking. An intervention to place the behavior on attention-extinction (i.e., to ignore the climbing) was introduced, however it became increasingly difficult to implement due to the severity of the climbing behavior. Jimmy fell to the floor from the top of the doorframe several times and landed on his head (he did not cry, but continued his attempts to climb). He developed a pattern where when he heard the doorbell, he automatically ran to the doorframe across from the front door and climbed. Jimmy climbed the doorframe of his walk-in closet door and swung himself to the top shelf of the closet (the majority of the climbing behavior occurred on the doorframe of his walk-in closet). Then, he would sit on the shelf for extended periods of time until he attempted to climb again. To assess different treatment conditions, we attempted to conduct programs while he was on the shelf, but we found he was more cooperative while sitting on the shelf than in the chair. This ruled out task-avoidance as a function of this behavior.
A true attention-extinction procedure was no longer feasible (or ethical) due to the severity of the climbing behavior. We simply could not ignore the behavior since he could easily fall and hurt himself.
Since an extinction procedure was becoming difficult to implement, it was recommended that the team deliver a higher rate of reinforcement and attention for appropriate behavior (differential reinforcement of other behaviors [DRO]). A pull-up bar was placed on the doorframe of his treatment room. Jimmy was prompted to request the bar and was allowed to climb for approximately 10-15 seconds. The bar was removed from the doorframe between requests. Jimmy was allowed to climb appropriately, but he was required to request climbing verbally or by using his picture communication system. This would provide a more appropriate alternate behavior (differential reinforcement of alternate behaviors [DRA]). The response-block procedure was still utilized outside of the treatment room for his own safety. Jimmy was required to request the "bar" instead of "climbing," since the goal was to eventually fade out the bar. We did not want him to think that climbing (other than on playground equipment) was appropriate or acceptable. Jimmy quickly learned the response requirement and began to initiate spontaneous requests of the bar. A high rate of spontaneous requests for "bar" was observed. Climbing behavior across environments began to reduce. His parents reported that he would vocally request the bar during parent-directed time.
Currently, Jimmy is required to complete work tasks in order to earn access to the climbing bar. If he exhibits climbing behavior away from the bar, a picture of the bar is placed on a "NOT RIGHT NOW" board (indicating restricted activities) for approximately 45 minutes to 1 hour and he is directed to a non-preferred activity. Inappropriate climbing behavior has been at near-zero levels for approximately 6 months.
Our goal continues to be to fade the presence of the climbing bar. In order to do this, we will make the bar icon available less frequently and then eventually fade it out of Jimmy's picture communication system. Opportunities to climb in appropriate environments (e.g., the playground) will need to be scheduled into his day or week. Simultaneously, vocal requests of "bar" will be redirected. Jimmy will gain access to a different, highly preferred activity. He will be highly reinforced for engaging in this activity. Because of what we learned from the functional analysis, reinforcement will probably include attention.
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The names of all children in this newsletter have been changed in respect for family confidentiality.
Puppet Teacher! Have a stuffed puppet praise and tickle the child. Have the puppet give the instructions.
Mandy! Sing Barry Manilow songs with either a good or an outrageously bad voice.
Funky Dancing! Sing and dance to really funky songs. Hold the child in your arms, or on your feet.
Cookie Monster Praise! Practice your imitations of kid show actors, such as Barney, Goofy, or Cookie Monster. Give praise in their voices.
Hair Torture! Lay the child down and gently sweep your hair over their face with "oh, no" or whatever to let them know it is coming.
Harry is in a regular second grade class with minimal support from a confederate aide. One day during reading centers with Harry's teacher, the kids read a story about a messy pig. Harry's teacher asked the kids whether they would want a pig for a pet. All of the kids said "yes," except for Harry. When asked why, he laughed and said if HE were to get another pet, he would get a "riding bull" because it would be a lot more fun than just a messy pig.
4-year-old Deron was playing with a peer, when the peer suddenly announced that he was going to use the bathroom. Deron declared that he, too, was going to use the bathroom and followed his peer. Upon entering the bathroom, Deron worked furiously to pull down his pants. He quickly turned around, only to discover that his peer had beat him to the toilet. Assessing the situation for a brief moment, he nonchalantly stated, "Still go," walked over to the side of the toilet, and began to aim in the small space left by his seated peer...His aim was impeccable.