Lauren Moskowitz, Ph.D., discusses the complex aspects of challenging behaviors and the importance of conducting a thorough functional behavioral analysis to create effective treatment plans. The talk underscores the importance of recognizing challenging behaviors as learned communication techniques and describes varying situational contexts that can serve as antecedents to challenging behaviors and outbursts. The discussion includes an overview of the key components of functional behavior assessments and subsequent treatment strategies and techniques via relatable, practical examples.
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Handouts are online at: http://www.ariconference.com/webinars/moskowicz.pdf
In this presentation:
5:02 – Understanding challenging behaviors
13:14 – Functions of communication as challenging behaviors
16:15 – Flowchart – Context of challenging behaviors
22:02 – Functional Behavior Assessment (FBA)
25:11 – 47:11 – FBA Examples
47:19 – Treatment Strategies
49:34 – 1:08:05 – Treatment strategy examples
1:08:17 – 1:13:33 – Examples of intervention based on FBA
Challenging behaviors that co-occur with autism for some individuals include aggression, self-injury, property destruction, noncompliance, tantrum behavior, etc. (2:25). These behaviors, just like any other, are learned through association, modeling, and observation (5:13) and are adapted to serve a specific purpose or function (6:49). Because communication difficulties are a core symptom of autism, challenging behaviors are generally understood as functions of communication in individuals with autism (13:14). However, as with all behaviors, they can be modified with positive supports (6:35).
To understand and treat these behaviors, it is essential to remember that they “do not occur in a vacuum” (7:45) but instead depend on context and environmental surroundings (i.e. social settings, physical discomfort, etc.). The presenter gives a framework showing the context leading up to behaviors and subsequent consequences (16:15). Viewing challenging behaviors through this lens provides clinicians and families with four different levels where intervention can take place (20:13):
- Setting events (17:38) – “Broad contextual factor that makes an antecedent more or less likely to trigger a certain behavior” (i.e., social, physical, or mental settings)
- Antecedents – Anything which can potentially trigger a specific behavior (i.e. demands)
Functional Behavior Assessments (FBA) are conducted to determine context (setting events + antecedents) and function of an individual’s behavior (21:30). FBAs generally include interviews (25:13), direct observation (36:24), checklists and questionnaires (43:40), and functional analysis (experiment to verify the function of behavior) (22:02). Because behavioral context and function vary greatly across individual lived experiences, proper treatment and intervention plans should be created in concert with a Functional Behavior Assessment (47:20).
Behavioral treatments generally involve a combination of three strategies (48:08):
- Prevention (49:34) – Altering setting events and antecedents
- Replacement (57:54) – Teaching replacement communication behaviors and coping skills, etc.
- Response (1:02:50) – Consequence-based, focused on positive reinforcement for good behaviors
The presenter closes with example intervention scenarios based on various behavioral functions such as gaining attention (1:09:32), gaining preferred items or activities (1:11:00), or escaping a demand (1:11:55) and emphasizes again that challenging behaviors serve a function.
Lauren Moskowitz, Ph.D., is an Assistant Professor of Psychology at St. John’s University. She received her B.S. from Cornell University and her M.A. and Ph.D. in Clinical Psychology from Stony Brook University. She completed her internship at NYU Child Study Center and Bellevue Hospital and her postdoctoral fellowship at NYU Child Study Center. Her research focuses on behavioral assessment and intervention for children with autism spectrum disorders and other developmental disabilities (DD) in naturalistic contexts, intervention for parents of children with ASD and DD, and cognitive-behavioral therapy with children and adolescents.