Communication-Based Intervention for Problem Behavior: A User's Guide for Producing Positive Change - Softcover

Carr Ph.D., Edward; Levin M.A., Len; McConnachie Ph.D., Gene; Carlson M.A., Jane; Kemp Ph.D., Duane; Smith "Ph.D. BCBA-D", Christopher

Softcover

ISBN 10: 1557661596 ISBN 13: 9781557661593

Publisher: Brookes Publishing, 1994

Synopsis

Based on extensive field-testing and the dual principles that problem behavior often serves a purpose for the individual displaying it and that intervention should take place in the community, this user-friendly manual details methods for conducting functional assessments, communication-based intervention strategies, procedures for facilitating generalization and maintenance, and crisis management tactics.

Useful for handling intense behavior problems, this book will be invaluable for educators, supported employment and group home staff, behavior specialists, psychologists, social workers, physical and occupational therapists, medical staff, speech-language pathologists, family members, and others working with people who have developmental disabilities. Also included are case studies and checklists of things to do to ensure success.

About this title

About the Author:

Edward G. Carr, Ph.D., was Professor of Psychology at the State University of New York at Stony Brook, and a research scientist at the Developmental Disabilities Institute on Long island, New York. He worked in the field of developmental disabilities for over 25 years and contributed over 100 publications to the professional literature, primarily in the areas of problem behavior and communication. Dr. Carr lectured extensively and gave workshops throughout the U.S., Canada, and Europe. He served on the editorial boards of 12 journals in the field of developmental disabilities and behavior analysis. Dr. Carr was a Fellow of the American Psychological Association and was listed in American Men and Women of Science. In 1981, he received a Certificate of Commendation from the Autism Society of America for his work on problem behavior, and in 1982 he received an award from the International Society for Research on Aggression for his book In Response to Aggression (co-authored with A.P. Goldstein, W.S. Davidson, and P. Wehr).

Len Levin, M.A., is an applied behavior specialist at the Developmental Disabilities Institute. He has been working with children with developmental disabilities for more than 10 years. Mr. Levin has provided technical assistance to service agencies throughout the New York metropolitan area. He was the on-site director for the clinical outcome project that provided the empirical evidence supporting many of the ideas and procedures described in this book.

Gene McConnachie, Ph.D., served as the director for several clinical research projects for the Research and Training Center on Positive Behavioral Support, and as a research associate at the Developmental Disabilities Institute. His interests include the development of intervention for aggression in children and youth, applications of behavior analysis to pediatric populations, and the processes that affect the maintenance of intervention effectiveness.

Jane I. Carlson, M.A., has been a special education teacher in both public and private school programs for people with disabilities. She is presently a Research Associate at the State University of New York at Stony Brook and directs several projects addressing intervention for severe problem behaviors and issues of community integration. Ms. Carlson has presented research and given workshops on these topics throughout the U.S. and Europe.

Duane C. Kemp, Ph.D., is Clinical Director of Adult Residential Services at the Developmental Disabilities Institute and is responsible for program planning in psychology, communication, vocational services, and staff training. He has worked in the field of developmental disabilities for over 16 years and has provided inservice training and workshops throughout the U.S. and Europe.

Dr. Smith is a New York State Licensed Psychologist. He has worked with children and adults with a variety of disabilities for over 20 years. His clinical and research interests include assessing and treating challenging behavior and functional communication training,

Excerpt. © Reprinted by permission. All rights reserved.:

Excerpted from Communication-Based Intervention for Problem Behavior: A User's Guide for Producing Positive Change, by Edward G. Carr, Ph.D., Len Levin, M.A., Gene McConnachie, Ph.D., Jane I. Carlson, M.A., Duane C. Kemp, Ph.D., & Christopher E. Smith, M.A.

Copyright © 1994 by Paul H. Brookes Publishing Co. All rights reserved.

Preliminary Considerations

The purpose of this book is to describe a communication-based intervention for severe problem behavior in persons with developmental disabilities. We need to be clear about what each of the terms used in the preceding sentence means. "Communication-based intervention" refers to an approach that reduces or eliminates problem behavior by teaching an individual specific forms of communication. Because the communicative forms that are taught are more effective ways of influencing others than the problem behavior, they eventually replace the problem behavior itself. Although the intervention of "communication training" is central to the approach, other interventions are also involved and that is why we use the term "communication-based" rather than simply "communication." By communication training, we mean that individuals are taught specific language forms, including, for example, speech, signing, and gestures that can be used to influence other people in order to achieve important goals. Severe problem behavior includes intense forms of aggression (punching, scratching, biting, and kicking others), self-injury (head-banging, self-biting, and self-slapping), property destruction, and tantrums (prolonged screaming and crying, often accompanied by one or more of the other forms of problem behavior just described). "People with developmental disabilities," in this book, typically refers to those people with mental retardation or autism, although we have also used the intervention approach with people with aphasia , neurological impairments, brain damage, developmental delays, and schizophrenia.

Major Themes

Six major themes recur throughout the book, which we now introduce.

Problem Behavior Usually Serves a Purpose for the Person Displaying It

You are probably used to hearing problem behavior described as "aberrant," "random," "psychotic," or "maladaptive." We think that these terms are misleading. To the contrary, problem behavior can be adaptive and that is why it is displayed so often. If a young girl learns that the only way to get her father's undivided attention is by banging her head against the table, then head-banging becomes a useful and adaptive response because it guarantees that the girl will receive continued contact with and influence over a very important person in her life.

Functional Assessment is Used to Identify the Purpose of Problem Behavior

Because problem behavior is typically purposeful, you cannot change it successfully in the long run without trying to discover what the purpose of the behavior is. This process is referred to in the scientific literature as "functional analysis" or functional assessment." To continue with our example, you may be able to suppress the young girl's head- banging temporarily by shouting at her to stop, but such punishment does not take into consideration why the girl is head-banging in the first place. Sooner or later, she will crave her father's attention again and she will resume head-banging. Therefore, if you want to help her in the long run, you must discover the reason for her head-banging, in this example, attention-seeking. Then you will be in a position to help her by teaching her new ways of getting her father's attention, for example, by talking to him.

The Goal of Intervention is Education, Not Simply Behavior Reduction

The most important implication of functional assessment is that intervention for problem behavior involves education. Because problem behavior often serves a purpose for the individual displaying it, the main goal of intervention is to teach the individual new ways of influencing other people so that problem behaviors are no longer necessary. This educational approach contrasts sharply with more traditional approaches that have focused on eliminating or reducing problem behavior without considering what types of skills must be learned to bring about the permanent replacement of problem behavior.

Problem Behavior Typically Serves Many Purposes and Therefore Requires Many Interventions

Problem behavior does not occur in a vacuum, It occurs in a social context. In the social context of the community, problem behavior tends to serve many purposes. For example, the young girl described earlier may bang her head to get her father's attention when she is at home, bite her classmate to get her teacher to stop asking her to do schoolwork, and throw a tantrum to get her mother to buy her a chocolate bar in the supermarket. The three contexts (home, school, supermarket) evoke problem behaviors that serve different purposes (attention-seeking, escape from work, and obtaining desired foods, respectively). Because problem behavior can serve many different purposes, it is almost a certainty that multicomponent interventions will be needed. In other words, it is usually wrong to think that you can affect all of an individual's severe problem behavior in the community by using a single intervention procedure.

Intervention Involves Changing Social Systems, Not Individuals

Because social context is so important, intervention is not something that you do to a person who has disabilities, rather it is something that you do with a person who has disabilities. This is especially true when operating within a communication-based model of intervention. For communication to be successful, both people must be motivated to interact with one another. After all, given a choice, we all prefer to interact with people whose company we prefer and with whom we have a good relationship. Therefore, interpersonal factors such as rapport and shared interests become important considerations. In this context intervention does not mean applying specific procedures to change the behavior of the person with disabilities. Instead, it implies the process of mutual give and take and of reciprocal influence, which lead to desirable behavior change on the part of everyone involved. In short, intervention involves altering social systems, not individuals.

Lifestyle Change is the Ultimate Goal of Intervention

The broader goal of intervention is to produce change that positively affects how people live their lives. Reducing problem behavior is not enough, particularly if the only result is to produce a quiet, docile individual who does not bother parents, teachers, or others. Problem behavior, more often than not, emerges from a background of exclusion, segregation, lack of personal control, and impoverished lifestyles. Therefore, interventions for problem behavior need to improve the life of the person with disabilities so that he or she is no longer excluded, segregated, and controlled by others. Successful interventions allow a person with disabilities to influence others without having to resort to problem behavior. Most important, successful interventions permit an individual to participate directly in the community, and have more social, vocational, and leisure opportunities than ever before. These opportunities do not occur in "special settings," exclusive to disability but, rather, in the wider world of people who do not have disabilities. Lifestyle change is the ultimate goal of intervention.

About this Book

Intended Audience

We have field tested the various components that make up this book and have found the material to be useful for teachers, parent trainers, behavior specialists, speech-language pathologists, residential and vocational administrators, and psychologists. Parents, residential staff, and job coaches have also found the material helpful, but, unless they have some prior background in behavior modification and methods of functional assessment, they required support and consultation from the professionals listed above. This book is also intended for use in behavior management courses in special education, human development, and child clinical psychology.

How to Use this Book

For the most part, we have used a format in which the background and rationale of a particular component of our approach are first introduced, followed by examples of how the component may be put into practice, then commentary on important considerations to bear in mind when implementing the component, and finally a checklist of the critical elements that go into the successful use of the component.

We have avoided the use of a "cookbook" approach to intervention with severe problem behavior. In fact, intervention does not generally occur in a set order, proceeding from component to component. Instead, the various procedures in our model should be viewed not as a recipe but as an array of options, only some of which may be relevant in a specific individual. For example, some individuals may show few escape-motivated problem behaviors. For them, the embedding procedures described later will play little, if any, role in intervention. In contrast, procedures such as rapport-building, and generalization and maintenance tactics are important for all individuals. The decision of which components to use with an individual is typically the result of consensus established by discussion among parents, teachers, and other concerned individuals. Important, too, as discussed in the later section on choice-making, the individuals with disabilities themselves influence the decision process through the choices they make and the impact that they have on other people in their social system (family, school, neighborhood).

In sum, our position is that intervention is a gradual process that unfolds over time. It is not a good idea to establish an intervention protocol at the beginning and remain rigidly committed to it. Instead, as the individual's life expands and becomes more varied and more community-based, it will be necessary to confront new issues that were not present at the start. Thus, additional assessments will have to be made and new interventions designed. We have purposely written this book to reflect the evolving nature of assessment and intervention in real life.

Although our approach to intervention is undoubtedly behavioral, we have chosen to minimize the use of jargon. Repeatedly, parents as well as many professionals have told us in field tests that the use of technical language is distracting and annoying. Therefore, although we introduce behavioral concepts in various places throughout the book, we have generally tried to express ideas in general terms. This tactic sometimes leads to the use of mentalistic language (talking about the "purpose" of problem behavior rather than reinforcers, functions, and maintaining variables). We hope our behavioral colleagues will support our use of nontechnical language. Our aim, simply stated, is to create a user-friendly product to help professionals of diverse orientations and training to communicate with one another as well as with the parents and others with whom they consult.

Appropriate use of Communication-Based Intervention

The approach that we describe is likely to be effective in intervening with many instances of problem behavior. However, it will not be effective in all instances. Too much is still unknown about problem behavior to expect that any approach will be universally effective. Generally, a communication-based approach is relevant to instances of problem behavior that are influenced by attention from others, escape from unpleasant situations, and attainment of tangible items such as foods and toys, as well as preferred activities. There are, however, other variables that have been identified or proposed in the scientific literature as also being important. You should be aware of some of these variables so that you do not misapply the procedures described in this book. To that end, a brief discussion is in order, followed by a short reference list that will direct you to additional information.

There are at least three important variables other than those listed above that have been identified as controlling severe problem behavior and for which our intervention model is not relevant.

These are sensory, homeostatic, and organic factors. By "sensory," we mean that self-injury, for example, may be maintained by the sensory stimulation that it produces (Favell, McGimsey, & Schell, 1982). For instance a child may repeatedly poke him-or herself in the eye because this produces interesting patterns of visual effects called phosphenes. (You can demonstrate this effect for yourself by closing your eyes and pressing your eyeballs with your fingers for a few seconds.) By "homeostatic," we mean that sometimes self-injury is a response to too little or too much stimulations from the environment (Guess & Carr, 1991). If the environment offers very little stimulation, then the child may generate his or her own stimulation by head-banging or face-slapping, for example. Alternatively, if the environment is overstimulating (with too much noise or too many people), then the child may attempt to block out the extra stimulation by engaging in various forms of self-injury. Finally, by "organic," we mean that self-injury may sometimes be the result of certain biological factors (Carr, 1977; Cataldo & Harris, 1982; Lowry & Sovner, 1992; Schroeder, Rojahn, Mulick, & Schroeder, 1990). For example, some scientists have suggested that certain instances of self-injury may represent a type of a addictive behavior. The idea is that each time the individual bangs his or her head, for example, opiate-like substances are released into the bloodstream, producing a natural "high." Therefore, the individual becomes addicted to his or her own behavior because of the pleasant effects that result from it. In this example, the use of opiate blockers, such as the drug naltrexone, may be a fruitful intervention (Barrett, Feinstein, & Hole, 1989; Herman et al, 1987; Sandman, Barron, & Colman, 1990). Assessment of and intervention planning for problem behavior controlled by sensory, homeostatic, or organic factors are complicated and require professional consultation.

It is worth repeating that the types of problem behavior discussed in this book are not controlled by sensory, homeostatic, or organic factors. However, the problems that we do discuss are very common and, fortunately, responsive to communication-based intervention.

There is one other point worth emphasizing about the appropriate use of communication-based intervention. Specifically, the model that we describe is not meant to replace a general language curriculum, although it can certainly be an important part of such a curriculum. A comprehensive curriculum must address a large number of issues involving expressive and receptive language skills applied across many different social contexts. These issues have been dealt with expertly by others (Goetz, Schuler, & Sailor, 1981; Hart & Risley, 1978; Mirenda, Iacono, & Williams, 1990; Musselwhite & St. Lou...

About this edition

• Publisher: Brookes Publishing
• Publication date: 1994
• ISBN 10: 1557661596
• ISBN 13: 9781557661593
• Binding: Paperback
• Edition number: 1
• Number of pages: 282