Russell J. Kormann, Ph.D. Director - Project NSTM Rutgers, The State University of New Jersey

1. Managing the Behavior of Children with DD or Autism and Severe Behavior: What the ____ Are We Supposed to Do?? Russell J. Kormann, Ph.D. Director - Project NSTM Rutgers, The State University of New Jersey Westwood Regional School District

2. Who is Kormann?? Licensed Clinical Psychologist State Certified School Psychologist Served Autism/DD Community since 1986 Director of Project: Natural Setting Therapeutic Management Director of Rutgers School Consultation Program-Serving 20 School Districts Regular Presenter and Consultant to Autism New Jersey (COSAC) Fellow: American Association For Intellectual Disabilities All Around Good Guy (Good Looking Too!)

3. Project: NSTM • A DDD funded, community-based intervention program serving individuals with developmental disabilities/Autism and behavioral challenges and their families. • NSTM seeks to transform the environment in which the “problems” are identified (i.e. the home) into a therapeutic one.

4. Meet Phillip

6. THE MESS THAT IS ‘PROFESSIONAL INPUT’ PEERS Can we keep him home? Who do we listen to? (Consult with?) PHYSICAL THERAPIST I want to be like everybody else OCCUPATIONAL THERAPIST PSYCHIATRIST VOCATIONAL COUNSELOR SOCIAL WORKER PERSON WITH DD BEHAVIOR CONSULTANT PARENTS NEUROLOGIST LAWYER PHYSICIAN SPEECH THERAPIST RELATIVES TEACHER PSYCHOLOGIST NEIGHBORHOOD

7. WHO IS THE EXPERT? • Physician • Behavioral Consultant • Teacher • Parent

8. THE BEHAVIORAL CONSULTANT • An individual with training in Applied Behavior Analysis (ABA) • An individual with experience utilizing ABA skills in natural settings • BUT… Can the expert REALLY know your home situation??? • So…Can he/she really be the expert?

9. So then…Who is the Expert??

10. YOU ARE!!

11. GUESS WHO MUST DO THE WORK?? THE EXPERT

12. CriticalIssues

13. Issue #1 Behavioral “Tips” Never Work

14. Reactive -- Responding to a behavioral event which is occurring RIGHT NOW! • Act as firefighters • Always running to put out the next fire

15. BURNOUT Stress Problem Solving Expectations Support Communication

16. Proactive-- Intervening before a behavioral event takes place. • Forces us to think of ways to prevent fires

17. REFERRAL BIAS Student with DD or Autism

18. FOUR FACTOR ASSESSMENT SYSTEM BEHAVIOR MANAGER PERSON If other than, or in addition to “Person” 1.Parent 2. Direct Care Staff 3. Parent Surrogate Individual with a Developmental Disability TargetProblem ENVIRONMENT 1. People (ex. Parents, Neighbors) 2. Places (Ex. Home, Neighborhood) 3. Routine/Schedule SYSTEM SYSTEM = THE GLOBAL CLIMATE IN WHICH THE OTHER THREE FACTORS EXIST i.e. Federal (IDEA, HCFA regs), State (Licensing Regulations & Budgets), County (Zoning Laws), Treatment Philosophies .

19. APPLIED BEHAVIOR ANALYSIS A TREATMENT APPROACH THAT ATTEMPTS TO OBSERVE, IDENTIFY, AND UNDERSTAND BEHAVIOR IN A WAY WHICH ALLOWS US TO CHANGE IT FOR THE INDIVIDUAL’S BENEFIT

20. Assumptions of ABA 1. Concentrates on observable behavior only. 2. Behavior, adaptive and maladaptive, is learned. 3. People behave to satisfy needs/wants.

21. Issue #2 Behavior Must Be Understood BeforeWe Can Do Anything!

22. Issue #3 A Big “Chunk” of Behavior is Learned and Functional

23. Issue #4 Therefore..it is Understandable and Logical

24. FUNCTIONAL ASSESSMENT A series of reports describing behavioral incidents as they occurred. These reports include a description of the variables that were in place before the incident began as well as those that followed the incident. A functional assessment, therefore allows one to understand the "function" which that behavior may have served for the individual. ANTECEDENT (SETTING EVENT) -The stimulus situation(s) which are associated with a behavior's presentation. BEHAVIOR -Choosing and operationally defining the behavior. CONSEQUENCE -The stimulus situation(s) which followed the behavior.

25. Issue #5 Your Child Has Reinforcers..The Negative Behavior Hasn’t Stopped

26. ANTECEDENT CHANGES

27. Individual Factors • Psychiatric/Neurological Conditions • Medications (side effects & changes) • Syndromes (Asperger’s) • Abilities/Disabilities • Schedules & Preferences

28. What “Sets Up” a Behavior? 1. An individual’s routine or schedule: What’s in it, in what order does each activity occur & does the person like his/her routine? 2. A person’s abilities: what is he/she good at? 3. A person’s disabilities: what’s hard for him/her? 4. What is the physical configuration of the person’s home environment? 5. Parent preparation 6. General response style of parents.

29. CONTINGENCY MANAGEMENT

30. Contingency Management Options • There is a Requirement of Making Positive Behavior “Worthwhile” • Reinforcement Based Behavior Plans • Effective Use of Naturally Occurring Reinforcers - We MUST be Creative - Use people, activities and locations that are special • Importance of Differentially Based Outcomes • Have to Make the Negative Behavior Less “Valuable” than the Positive

31. Issue #6 Consequating (Punishing) Negative Behavior Doesn’t Work!

32. PROBLEMS WITH PUNISHMENT 1. Slows Behavior--Does not necessarily eliminate it. *How long does effect last?* *Have you ever had to repeat the punishment?* 2. Individuals Tend to Habituate to Punishment. *May require one to continually increase severity of punisher.* 3. Generates Escape Behavior *Child may start to avoid you.* 4. Punishment Does Not Teach New Behavior *Does not promote the acquisition of adaptive behavior.* 5. Provides a Model for Inappropriate Behavior *Ever had a second child begin to act like the problem kid?*

33. Issue #7 Reinforcement is Good! The Goal is to Reverse the Value of Neg. & Pos. Behavior

34. THE PRINCIPLE OF REINFORCEMENT An increase in the occurrence of a behavior when it is immediately followed by some event AREINFORCER– Anything that increases or maintains a behavior KEY CONCEPTS TO REMEMBER: FOLLOWS INCREASES IF/THEN SITUATION

35. THINGS YOU CAN DO AT HOME • Catch ‘em Being Good • Always connect outcome to behavior • Think about behavior “functionally” • Set up the environment to be successful • Prepare, Prepare, Prepare • Have a crisis plan

36. REMEMBER…… • The Goal is to Make Positive Behavior Valuable • And to Make Negative Behavior “Worthless” • Is Changing Behavior Worth Paying For?? • It Better Be….Or They Won’t Change!! • Always Be on the “Lookout” for the Good Stuff…it’s There…if you Look Hard !

37. All Right We Get it BUT…… • We’re exhausted • We don’t have the energy or the help to do this ALL the time • The behavioral approach doesn’t always work…..sometimes he/she just doesn’t care! • His/her behavior PISSESS ME OFF • It is causing other problems in my house (other kids modeling, marital problems, etc)

38. All Right We Get it BUT…… • Did I mention that I am PISSED OFF?? • Oh, yeah, and BURNED OUT??? And Stay Tuned Because Summer is Coming………………

39. Yeah, But School is Ending and Summer is Coming…… • Summer represents a HUGE change in daily routine • What plans have you made to replace your child’s daily activities • Your child might not know or care about the calendar….Monday June 29 is just Monday for him/her and that means getting on a bus and going somewhere • If there is no camp/summer program, it is important to develop a “schedule” for your child at home

40. What the Heck Am I Gonna Do All Day???…… • Try and develop a few scheduled activities in the morning and several in the afternoon (it doesn’t have to a million things and they don’t have to be complicated) • What you are trying to accomplish is a summer routine during which both you and your child has an idea about what is going to happen during the day (or evening) • It gives you some comfort in knowing that there is a plan for the day and its not just 100 hours of Sponge Bob!

41. What the Heck Am I Gonna Do All Day???…… • This then gives you the opportunity to reinforce your child for positive behavior centered on these activities • Set up mini-contracts based on these activities: “Remember, Bobby, as soon as we finish coloring these three pages, we’ll take a walk to the 7-Eleven for a piece of gum.” • Use as many people and places outside of the home as you can to make the summer schedule attractive to both your child and YOU….it shouldn’t be just locking you up in the house waiting for bed time (starting at 9AM)

42. Project NSTM Services • Individual Behavioral Support Services • Group Training in Behavior Management, Staff Communication & Burnout • On-Site Behavioral Consultation Contracts Contact: Russell J. Kormann, Ph.D. Director - Project NSTM Rutgers, The State University 797 Hoes Lane West Piscataway, NJ 08854-8022 732-445-2704 kormann@rci.rutgers.edu