Intervento del Prof. Peter Sturmey - Queens College City University of New York - alla Lectio Magistralis tenuta a Roma sabato 15 ottobre 2016 presso l'Università Pontificia Salesiana. L'evento è stato organizzato dalla Lega del Filo d'Oro in collaborazione con l'Università Pontificia Salesiana, il Politecnico delle Marche e l'Istituto Walden.
3. I Behavioral Characteristics
Fewer, low rates of behavior
Interfering behavior
Restricted range of reinforcers
Interfering medical issues
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4. Appropriate Goals
Skills
Functional Motor skills
Reaching, grasping, using wheelchair, walking etc.
Choice making
Social behavior
Eye contact, smiling, hugs, high fives etc.
Communication
Vocal
Augmented communication
Cards, books, ipads, etc
Assisting in self-help
Spoon feeding, Hands up when dressing
Components of bathing etc.
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5. Skills Teaching
Motor skills: Correa et al. (1985) Reaching -
grasping
N= 3, 2-4 year old
Severe / profound ID
blind
Developmental Quotients = 1-4 months
Used a noisy toy placed at mid-line
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6. Conditions
Baseline:
Experimenter sounded one of the toys, placed it in one of the three positions on
the lap tray, and waited up to 10 seconds for a reach-grasp
If the child did not respond, another criterion trial was presented with a different
toy.
Intervention
Graduated prompting
Fading from physical verbal no prompt
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8. Nabeyama & Sturmey (2010)
2 Physical Therapy aides
3 students with multiple disabilities
None walked independently
All had wheelchairs / complex braces
Special education setting
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9. Baseline
Experimenter instructed staff to take the student either from his classroom
doorway to a specified location
Stated the six required response components for correct posture and
guarding
Said, ‘‘Safely walk him to the [location],please.’’
The experimenter said nothing else
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10. Behavioral Skills Training Experimenter gave staff self-recording checklist and explained the six response components
Instructed him/her to walk the student safely to a specified location, and complete the self-
recording checklist
provided performance feedback, including positive statements on correct response components
and corrective statements on errors and reviewed correspondence and non-correspondence
between their respective checklists and explained the physical therapy
If the staff member performed fewer than six correct responses, the experimenter modeled the correct
response and instructed the staff to rehearse that correct response.
During modeling, the experimenter described the incorrectly implemented components and
instructed the staff member to observe as he demonstrated those correct responses and instructed the
staff member to guard the student during ambulation for one trial.
The experimenter then provided vocal or physical prompts for correct responses as he or she guarded
the student.
The experimenter provided descriptive feedback based on the preceding trial.
Modeling and rehearsal were terminated when the staff member completed two consecutive trials with
all six responses correct.
Sessions were terminated when the student completed the required distance or lost his balance
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11. Six-Step Task Analysis: The staff member …
(a) sat on a rolling stool;
(b) directly in front of Jacquel or to the right side of Cole and Steve
(c) lower back was aligned erect with the upper back and was
vertical;
(d) left hand was on the right side of Jaquel’s pelvis and hip orthosis
or Cole’s and Steve’s backs;
(e) right hand held the left side of Jaquel’s trunk, the right side
of Cole’s walker, or Steve’s right hand; and
(f) provided behavior-descriptive praise within 3 s of the student’s
completion of ambulation.
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12. Other features
Generalization probes to novel students
Second dependent variable = distance child
walked
Ratings of social validity
4-month follow-up
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15. Houwen et al. (2014):
Systematic review of teaching motor skills
Studies published 1982-2012 (MEDLINE, PsycINFO, ERIC, and CINAHL).
Coded study aim, design, sample characteristics, theoretical framework,
intervention, measurement tools and outcomes.
46/295 articles met inclusion criteria
40 single-subject designs
5 used a group design.
Behavioural techniques with (n = 21) or without (n = 15) assistive technology.
Outcomes
38 reported improvement in basic motor skills
8 reported improvement in recreational / other motor skills.
No negative effects
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16. Stimulus Preferences and Happiness
Rationales
Quality of life
Need reinforcers to teach
Methods
Stimulus preference assessments, not interviews / surveys
alone
Observe approach / avoidnace, engagement and affective
behavior (happy / sad behavior)
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17. Preference Assessments Methods
Why not use opinion?
Single
Multiple
Multiple without replacement
Trial-based
All use approach and avoidance responses
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18. Greene et al. (2000): Trial based
N=3 individuals with multiple disabilities
Person-centered planning v. single stimulus
preference methods
Stimuli presented 1-2 times per day in natural
environment
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20. Preference Assessments:
Not (Person-Centered)Guesses
Reid et al. (1999): compared preferences from person centered planning
and stimulus preferences
N = 4 adults with multiple and profound IDs.
Non-ambulatory, limited upper body movement
Physical disabilities, uncontrolled seizures
Considerable assistance with all activities of daily living
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21. Two preference assessment methods
Person-Centered Planning
Highly experiences professional staff, trained in PCP
All team members familiar with individual for extensive periods of time
Identified preferred leisure activities
11 systematic questions
“tell me a story when s/he was happy recently”
Stimulus Preference Assessment
Single-item preference assessment (Pace et al., 1985)
Record approach and avoidance responses
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25. Reid’s Studies on Happiness
Green & Reid (1996)
Observed happy and unhappy behaviors in 5 adults with profound ID
Conducted preferences assessments
Observed strong association between presence of preferred and non-
preferred activities and mood-related behavior
Replicated by several studies
Staff and multi-disciplinary team members are poor at identifying stimuli
associated with happy behavior
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32. Functional Assessment and Analysis
The major contribution of ABA to SIB
Carr (late 1970’s)
Easy v. difficult tasks
Low v. High attention
Iwata et al. (1982, 1984)
Understanding environmental control of SIB
Developing idiographic, effective, function-based treatments
Avoiding harmful treatments
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33. Schaefer (1970)
2 rhesus monkeys
Expt. 1: Shaped up “head banging”
Successive approximation
Reinforced with food
Brought under stimulus control of different person
Experimenter v. other person
Expt. 2
Shaped up head to cage
Took only 20 reinforcements
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41. Conclusion
Self-injury is strongly environmentally determined
Function can readily be detected in most cases using functional analysis
Most predictive for socially-mediated SIB
Least predictive for non-socially mediated SIB
Function predicts
Effective treatments
Harmful treatments
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42. Common critiques of experimental functional analyses
Take too long
Risks of injuries
Requires specialized skills
Typical Previous Practitioner Solutions
Use descriptive methods
Tolerate ambiguity
Sacrifice accuracy to an unknown extent
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43. Functional analysis takes place on the natural environment
Brief control and test conditions
Therapist presents trials that mimic Functional Assessment conditions
Tangible.
During control condition the therapist sits with the subject, who was playing with a preferred
leisure item.
Problem behavior produced no consequences.
During test condition the therapist removed the item from the subject’s possession and kept it
out of reach for 2 min.
If problem behavior occurred, the therapist gave the item back to the subject immediately.
If the subject leaves the seat the therapist followed him or her to maintain physical proximity but
did not interact with the subject in doing so
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44. Bloom et al. (2011)
• Investigated the convergent validity of trial-based
and experimental functional analyses
•N = 6
•Target behavior = aggression
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46. Rispoli et al. (2014)
Systematic Review of trial-based functional analysis
• Systematic searches of electronic databases, journals, citations of a seminal
study, and reference lists
• Resulted in 13 studies
• 36 full trial-based functional analyses
• N = 47 participants
• Mean age = 10 years (3-29 years)
• 62% autism
• 14 topographies of challenging behavior (47% aggression)
• classroom and home settings
• Implemented by teachers, service providers, or researchers.
• Functions identified in 35/36 cases
• 3 modifications needed
• A promising method
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47. Interview-Informed Contingency Analyses
(Hanley)
• Goal: To identify functions rapidly, accurately for use in practice
• Extensive training materials available here:
• https://practicalfunctionalassessment.com/about-2/
• Valutazione del sonno e intervento
• https://practicalfunctionalassessment.com/implementation-materials/
• Intervista a domande aperte per l’analisi funzionale
• https://practicalfunctionalassessment.com/implementation-materials/
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48. General Strategy (Hanley et al. 2014)
• Interview (40 minutes)
• Gail showed problem behavior when her mother divided attention and removed
toys
• Generate hypothesis
• Gail’s problem behavior was positively reinforced by mother’s attention and
access to toys
• Design synthesized test and control conditions
• Control: Continuous attention and toys, no demands
• Test: No attention or toys, except immediately after problem behavior
• Brief Reversal in 5 minute sessions
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52. Conclusions
• Approach highly robust across many individuals
• Efficient
• Interview (40 min) + IISCA (30 min in many cases
• May lead to effective treatment quickly
• Teach tolerance of delay to reinforcer
• Include requirement for more complex / effortful adaptive behavior, not just
waiting
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53. Critique
Very practical, easy technology to use
Applicable to persons with severe / profound ID
Limited external validity
Non-clinical population
No participants with mild / moderate MR
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54. DeLeon et al. (2003):
Idiosyncratic function
Grady, 14 year old boy w PID, visual impariments
Non-verbal, limited comprehension in wheel chair
Variety of problem behaviors
SIB, and disruption
Current analysis was aggression
hitting, pinching, scratching, pushing, or grabbing others.
Access to movement as reinforcer for aggression
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56. Function-based Treatment:
DRA + Extinction
Functional communication training (FCT)
Grady requested to be pushed using a battery-operated, press-activated,
voice-output device
Extinction phase 10, 1-min trials during which the therapist prompted
Grady to communicate to be pushed.
Aberrant behaviors were ignored
Pressing the voice-output device so that the recorded phrase (‘‘Push, please.’’)
was audible
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61. Kahng et al. (2002)
Quantitative analysis of behavioral research
35 years is provided 1964 to 2000
396 articles (706 participants)
Most participants
Male
severe/profound intellectual disability.
Trends
Reinforcement-based interventions has increased during the past decade
Punishment-based interventions has decreased slightly
Increased use of functional assessments.
Most behavioral treatments
highly effective
greater emphasis should be placed on prevention.
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68. Conclusion
Problem behavior is highly environmentally
influenced
Functions differ from person to person
Funtion predicts effective, ineffective and
harmful treatment
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69. IV. Management of Caregivers
Essential part of intervention
SIB is often a long-term, chronic problem
Often associated issues
Training
Must use behavioral skills training
Prevention
Skills training
Feedback
Implementation
Individual outcome
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70. Caregiver Training
ABA interventions depend crucially upon caregiver behavior
Large numbers of staff are employed
turnover is high
Many family members, supervisors and professionals are
Limited skill repertoire
Untrained
Inappropriately trained
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73. Important Clinical Issues
Use local policies / stated values to leverage implementation
PBS commitment
Time management
Have clear priorities
Don’t waste time on irrelevancies
Conducting an adequate FBA
Indirect methods are insufficient
Don’t spend time collecting irrelevant information
Conducting FBAs efficiently
Identify foolish barriers / excuses and move on to help the client
If you know the function, stop and write the treatment plan
If the plan is OK, don’t do an FBA, train the staff/ family
Identifying the real problem
Adequate FBA?
Adequate plan?
Adequate training
Organizational issues?
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74. Conclusions
ABA
Readily applicable to individuals with multiple disabilities
Skills
Taught using general principles
Happiness
A quality of life approach
A great prevention strategy
Challenging Behavior
Function based assessment and treatment
Train and support staff / family members
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