Antecedent Manipulations
Transcription
Antecedent Manipulations
Merrill Winston, Ph.D., BCBA-D Professional Crisis Management Association Copyright 2013 PCMA, Inc. 1 iPad only Kindle PC Mac Paperback and ePub Copyright 2013 PCMA, Inc. 2 Adventures in Special Education! The movie! Still “Winning” Copyright 2013 PCMA, Inc. 3 Antecedent Manipulations: What are we talking about? The role of antecedent manipulations in treatment Antecedent manipulations AS treatment Why are antecedent manipulations so prevalent? Copyright 2013 PCMA, Inc. 4 Person-centered planning gone wild Elimination of aversives as antecedent manipulations (or providing constant reinforcers) How can we make better decisions regarding the elimination of aversives? What is reasonable? What is unreasonable? How else can we deal with aversives? Copyright 2013 PCMA, Inc. 5 These can be very broad and may include immediate antecedents, altering motivation, changing general aspects of the environment, and changing staff behavior Immediate antecedents: “Triggers” Being told “no” being asked to wait, certain noises, certain places, certain people, certain hairstyles Copyright 2013 PCMA, Inc. 6 Altering Motivating Operations: keeping deprivation low by supplying very high rates (sometimes unrealistic rates) of reinforcement Changing general aspects of the environment: rearranging classrooms, changing the general noise level, this would include prostheticizing the environment Copyright 2013 PCMA, Inc. 7 Changing staff behavior counts as antecedent manipulations as well: This might include approaching people differently, changing proximity, changing interaction styles, minimizing coercive interactions, changing the way staff members prompt individuals, etc. Copyright 2013 PCMA, Inc. 8 Certainly, antecedent manipulations can comprise an important part of behavioral treatment, but there is a tendency to overemphasize these manipulations because: THEY DO NOT REQUIRE THAT YOU TEACH THE PERSON ANYTHING! People who are uncertain about WHICH BEHAVIORS to teach and HOW to teach them will often use antecedent manipulations as a crutch. Copyright 2013 PCMA, Inc. 9 There is absolutely nothing wrong with using antecedent manipulations as PART of a wellrounded treatment program It’s even quite reasonable to go a bit “heavy” on antecedent manipulations to gain quick control of a dangerous behavior problem until more skill-acquisition based measures can be put into place Copyright 2013 PCMA, Inc. 10 Sure these can lead to stable behavior, but how difficult is it to maintain these manipulations no matter where the person goes? How specialized does the person’s physical and social environment have to become to “support” them? Copyright 2013 PCMA, Inc. 11 They can work immediately They require very little analysis They require no time spent teaching skills Anyone can implement them It makes it appear as though we are helping the person “get better.” They reflect an understanding of the person’s likes and dislikes, which is generally a good thing to know about a person. Copyright 2013 PCMA, Inc. 12 Person centered planning (PCP) does NOT mean that we blindly do whatever the person wants all the time and always eliminate or avoid what the person doesn’t want. This is NOT how some people interpret PCP however… Merrill: Why has Jeffery been sitting in the grass doing self-stim with a shiny DVD in the sun sitting in the grass for 3 hours at his “day-treatment program?” Copyright 2013 PCMA, Inc. 13 Staff at day treatment program: Oh, that’s his choice… He sure was well behaved…. Merrill: Why is James being driven around by staff in the van 4 hours per day? Staff: That’s his choice… Copyright 2013 PCMA, Inc. 14 You may notice that when a client “chooses” to sit naked in the front yard waving at the people passing by that this is no longer “their choice.” There is nothing wrong with giving people some control over their lives. However, NONE of us has control over every aspect. We must be cautious about any strategy or choice that may decrease the response effort/responsibility of a provider agency/staff Copyright 2013 PCMA, Inc. 15 Rolando exhibited severe aggression, SIB, and cigarette butt pica at the residential facility and he had injured many staff members and himself over many years His frail, elderly mother said she had absolutely no problem managing him at home by herself…We visited her home… Copyright 2013 PCMA, Inc. 16 He was transported home in a modified station wagon with a police barrier separating the back seat from the front seat… There were barrel bolt slide locks on the outside of the passenger doors… There was a wrought-iron ceiling to floor partition (bars) separating the kitchen from the rest of the home Rolando ran around the house naked from the pool to his bedroom all day and would get Cuban pastries through the bars of the kitchen Copyright 2013 PCMA, Inc. 17 Rolando was VERY happy and safe at home… Was it wrong for mom to resort to these measures given her circumstances? Did Rolando learn anything that might help him in different settings? Is this person-centered treatment? Is it “wrong” in any absolute sense? Copyright 2013 PCMA, Inc. 18 Justine would eat anything she could find on the floor She could not be left alone even for a moment because of the behavior We crushed the motivation to engage in pica by giving her a fanny-pack filled with puffed rice While wearing the fanny-pack….no pica! Is this the optimal long-term solution? Copyright 2013 PCMA, Inc. 19 The elimination of reinforcers that are more powerful than Superman, Batman, Spiderman and The Incredible Hulk put together Copyright 2013 PCMA, Inc. 20 Copyright 2013 PCMA, Inc. 21 Zach loved TV, but he loved it a little too much Anytime he saw one he would try to play videos If you stopped him…..Crisis! If he accessed it calmly, and it was time to stop….Crisis! Solution: The teacher removed the TV from the classroom Copyright 2013 PCMA, Inc. 22 Although some manipulations involve altering motivation to engage in problem behavior by upping the reinforcement available, or eliminating über reinforcers, many manipulations involve simply eliminating aversives It is reasonable to eliminate some, but do we attempt to eliminate all? How do we determine where to stop? What is reasonable? What is unreasonable? Copyright 2013 PCMA, Inc. 23 A Quote on the matter…. “Trying to eliminate ALL aversives is a road you don’t want to travel. It’s poorly lit, filled with potholes and it gets narrower the further you travel.” Merrill Winston---5 seconds ago… Copyright 2013 PCMA, Inc. 24 Some people eliminate so many aversives that soon we are “walking on eggshells” Then we are walking on cotton balls on top of eggshells on top of mouse-traps If we are not careful we can end up creating a situation in which the individual’s world starts collapsing in on them and they may become more and more sensitive to smaller and smaller aversives… Copyright 2013 PCMA, Inc. 25 It can be tough to determine where to draw the line, but I like to turn to… “The Grid of Acceptability!” Copyright 2013 PCMA, Inc. 26 Situation Behavior Reasonable Unreasonable Unacceptable Unreasonable Reasonable 1 2 3 Unacceptable Copyright 2013 PCMA, Inc. 27 1: A reasonable reaction (behavior) to an unacceptable situation. (What is reasonable for the individual will depend in large part on their level of functioning and skill level) An individual bites, but only when attacked by another individual An individual begins to pound on furniture when other clients are screaming Is it a situation that would cause you to possibly lose it? Copyright 2013 PCMA, Inc. 28 2: An unreasonable reaction to an unreasonable situation (an unreasonable situation is “not very nice” but something that could possibly be tolerated) Many problems fall into this category. Joey is playing with the fire-truck, Billy grabs it from him Joey commandeers a police car and clocks Billy in the head with it! (may be borderline unreasonable/unacceptable depending on severity) Copyright 2013 PCMA, Inc. 29 3: An unacceptable reaction to a reasonable situation Ricky begins to engage in self-injurious eyegouging (unacceptable behavior) whenever he hears another student coughing (reasonable situation) Do we buy a case of Robitussin for the entire classroom as an antecedent manipulation? Copyright 2013 PCMA, Inc. 30 Most of the time we are working with people who show unacceptable or unreasonable behavior in response to either unreasonable or reasonable situations There are times, however, when WE say that the person has a “behavior problem” but when you look at some of the unacceptable situations that happen to people with disabilities, it’s hard to say that the client’s behavior is truly unreasonable/unacceptable Copyright 2013 PCMA, Inc. 31 Is the event something that happens to most people? Is the event likely to be encountered by the person on a regular or semi-regular basis? Is the occurrence of the event difficult to control for or does it occur frequently but unpredictably? Example: One individual becomes agitated when he hears the word “hello!” Example: Mommy takes 20 extra minutes getting home because she can’t take any right turns! Copyright 2013 PCMA, Inc. 32 Eliminating aversives, although one of the most popular ways of dealing with them, is just one of a number of strategies that can be used when faced with these problems… Copyright 2013 PCMA, Inc. 33 Procrastinate Eliminate Terminate Compensate Acclimate Tolerate Copyright 2013 PCMA, Inc. 34 Copyright 2013 PCMA, Inc. 35 This is a good strategy for things that eventually need to happen, but you want to give the person the ability to delay it. We all have things that we know we eventually HAVE to face. Still, when given the ability to put things off we value it. You cannot evit the invevitable…but you can delay it…. You will have to set limits on how many times someone can delay or for how long, but given the choice of being able to delay or have to do something now, it’s a nice choice to have Copyright 2013 PCMA, Inc. 36 Copyright 2013 PCMA, Inc. 37 Easily the most overused, but this is good for situations that are simply intolerable for anyone or for gaining quick control over a bad situation until a comprehensive treatment plan can be put into place This is not so much “treatment” as it is “support” Copyright 2013 PCMA, Inc. 38 Copyright 2013 PCMA, Inc. 39 This is when we teach the person how to stop the aversive in an appropriate manner (replacement behavior) It is reasonable to allow people the means to stop things they don’t like under certain circumstances Terminate may not always be possible but there are other strategies that can be used when it isn’t Once the terminating behavior is “solid” one can start thinking about other strategies Copyright 2013 PCMA, Inc. 40 Copyright 2013 PCMA, Inc. 41 Nothing makes a bad thing suck less like MO’ MONEY! We will tend to “put up with” things we don’t like if there is another reinforcer concurrently available Listening to music while running Having the TV on while working Posting to facebook on your iPhone while Merrill is droning on and on… Copyright 2013 PCMA, Inc. 42 Sometimes just raising the general level of reinforcement can reduce the aversive nature of some events For sibling rivalry types of problems you can make powerful reinforcers freely available ONLY when the siblings are together Copyright 2013 PCMA, Inc. 43 Copyright 2013 PCMA, Inc. 44 This is essentially habituation This particular strategy, like compensate does not require the person to learn new skills but it does require the aversive to be repeatedly presented This must be done in a manner in which the aversive is presented purposely, carefully and systematically (brief reinforcer removal) It’s best to have something that can be somewhat varied in duration or intensity (fire alarm recording) Copyright 2013 PCMA, Inc. 45 Copyright 2013 PCMA, Inc. 46 This is easily the toughest of the bunch, but one of the most valuable This is different from acclimate because with acclimate you simply get “used to it” and it doesn’t bother you very much anymore Tolerating is where the event still bothers you very much but you “keep your $%*! together” Copyright 2013 PCMA, Inc. 47 You might want to think of tolerating as a commodity that gets “used up” that is, you only have so much of it. You’re on my last nerve That was the straw that broke the camel’s back It is something that you can get better at. Many of the other “Ates” can work to together to make tolerating easier Copyright 2013 PCMA, Inc. 48 We DO want to be careful, however, that we are not attempting to teach people to “tolerate the intolerable.” We wouldn’t do it, why should people with disabilities. Copyright 2013 PCMA, Inc. 49 In addition to these strategies, there are a couple of general skills that can help with almost any kind of situation in which we must be exposed to aversives Learning to stay relaxed when already calm Learning to GET relaxed when already upset (much harder) Copyright 2013 PCMA, Inc. 50 Steve Ward and Terry Grimes: Calm Counts Wholechildconsulting.com Copyright 2013 PCMA, Inc. 51 This is quite a bit harder, and like learning to stay relaxed it requires using a hierarchy of upsetting events and a strong repertoire of self-calming behaviors (breathing deep, covering one’s ears, engaging in soothing types of self-stim, progressive muscle relaxation, etc…) I wouldn’t attempt this until the individual can tolerate the presentation of an aversive when already calm… Copyright 2013 PCMA, Inc. 52 There’s nothing wrong with some antecedent manipulations as PART of treatment Be wary of behavior plans that tend to weigh too heavily on antecedent manipulations Simply eliminating unpleasant things, making desirable things continuously available, and preventing contact with potent reinforcers creates highly restrictive lives Teaching people to effectively cope with strong reinforcers and strong aversives enables them to be more successful in more situations Copyright 2013 PCMA, Inc. 53