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A Child’s Right to Positive Behavioral Interventions

Autism Spectrum Disorders (ASDs) are complex neurobiological disorders of early brain development. The deficits associated with ASDs may affect many aspects of individuals’ lives including socialization, such as developing relationships, communication, and activities of daily living. Government statistics suggest the prevalence of the rate of autism is increasing 10-17 percent annually. Currently, an average of one in 150 children in the United States has an autism spectrum diagnosis. The national prevalence of Autism is 60-70 per 10,000. The ratio of males is 4:1. The ratio of females is 8:1. Sibling incidence is 15:1. Autism Spectrum Disorders estimated at approximately 5.6 per 1,000 children in the United States.

As the incidence of individuals with ASD increases, it is critical for caregivers and educators to understand the behavioral challenges that surround the diagnosis. An individual with autism may experience problems with verbal fluency, attention, differentiated responses, inability to initiate or cease action, as well as difficulties regulating and modifying behavior.

Cognitive and communicative abilities among individuals with ASDs may range significantly. In order to create optimal social and academic environments for individuals with an ASD diagnosis we must understand the needs of each child and implement treatment based on empirically based interventions.

Academic services and procedures required under the Individuals with Disabilities Education Act (IDEA) are designed to ensure that: (1) challenging behaviors are addressed through positive behavioral interventions, (2) children are not improperly disciplined for conduct related to their disabilities, and (3) children with disabilities receive free and appropriate public education (FAPE) even if properly excluded from school for disciplinary reasons. Children with disabilities in preschool may never be suspended or expelled from school (N.J.A.C. 6A:14-2.8(a)(1)).

Whenever the behavior of a child with a disability interferes with the learning of a child or others, the child’s Individualized Education Plan (IEP) team must consider for inclusion in the child’s IEP “positive behavioral interventions and supports” and “other strategies” (which are often described in a “behavioral intervention plan”) to address that behavior (20 U.S.C. ∫ 1414(d)(3)(B)(i); 34 C.E.R. ∫). A child with a disability must be re-evaluated whenever the child’s functional performance, including behavior, warrants a reevaluation (20 U.S.C. ∫ (a)(2)(A)(i);34 C.E.R. ∫). Such evaluations should assist the IEP team in determining what services or accommodations are necessary to enable the child to be educated with his or her non-disabled peers (20 U.S.C. ∫ 1414 (b)(2)(A)(ii); 34 C.E.R. ∫), and, where appropriate, must include a “functional behavioral assessment” (20 U.S.C. ∫1414 (b)(2)(A); 34 C.E.R.∫). In addition to positive strategies and interventions, the IEP should include any modifications to the Code of Student Conduct, which are necessary for the student (20 U.S.C. ∫1414 (d)(1)(A)(ii)(IV) 34 C.E.R.∫).

Functional behavior assessment (FBA) can be conducted to aide educators in understanding the child’s academic and social needs. The purpose of a “functional behavioral assessment” is to identify the functions of an individual’s challenging behavior in order to develop positive behavioral interventions and supports to address aberrant behavior. The topography of the behavior must be clearly defined. Once the targeted behaviors are defined, a hypothesis of the function of those behaviors must be developed.

“The FBA is generally conducted in a collaborative fashion, bringing together input from the child and a variety of individuals who work and interact with the child. It uses a child-centered approach based on the understanding that behavior serves a particular function for each child and that effective interventions must be tailored to address the function played by the behavior within the context in which the individual child lives and learns and in light of the child’s unique strengths and needs. An FBA should be conducted by a professional who can demonstrate (e.g., through a specialized degree or credential) experience, knowledge and skill in positive behavior support, which include training in applied behavior analysis” (Education Law Center, 2008).

“Once the FBA is complete, the IEP team will develop a “behavioral intervention plan” (BIP) for the child, which will include positive strategies to address the behavior. The BIP can include a variety of program accommodations, modifications, supports, and services to improve the child’s behavior. The BIP should be designed to accomplish four outcomes: (a) improve environmental conditions to prevent problem behaviors; (b) teach the student new skills to enable the student to achieve the same function in a socially appropriate manner; (c) reinforce desired behaviors, including newly-taught replacement skills; and (d) use strategies to defuse problem behavior effectively and in ways that preserves the student’s dignity” (Education Law Center, 2008).

Applied Behavior Analysis (ABA) is an evidenced-based treatment for improving the functioning of children diagnosed with autism. It addresses the core deficits of ASDs including verbal and non-verbal communication, social interaction, restrictive repetitive behaviors, inflexibility, daily living skills, and peer relationships to name a few. ABA has been successfully used for over 30 years. Today, the techniques and strategies of ABA have created a new look for behavioral interventions and the treatment of autism in homes, schools, and community settings.

Today, Applied Behavior Analysis (ABA) is supported by research as being effective in increasing social competencies of individuals diagnosed with Autism and behavioral challenges. ABA can modify behavior through the processes of assessment, intervention, data collection, and responsive programming.

ABA is characterized by more naturalistic techniques whose emphasis is making meaningful changes in the lives of individuals. More recently, there has been a trend to move away from using highly structured and rigid environments towards natural settings (home, school, community). ABA interventions are designed to not only change the behavior of the targeted individual, but also changes the behaviors of those in direct contact with the individual (parents, educators, peers). Naturalistic methods of ABA that incorporate other individuals include modeling, incidental teaching (IT), pivotal response training (PRT).

Modeling is valuable technique if an individual is capable of imitation. It can be useful in the initial phases of instruction when a skill is just being acquired. A significant amount of literature exists supporting the role of peer models and their ability to bring about socially appropriate behaviors in children with autism.

Incidental teaching (IT) methods can be used in the natural environment to help a child expand their verbal repertoire. Initiations put forth by the child are met with response that typically requires an additional interaction, prior to being reinforced with the desired item.

Pivotal response training (PRT) is characterized by a set of instructional strategies that are brief, specific, and focus on activities chosen by child. The method also utilizes contingent reinforcement directly related to the desired behavior, and attempts at the desired behavior. PRT has recently been shown to cause significant improvement in the communication and interactions of toddlers.

Innovative uses of technology are a “new look” in the treatment of autism. One such device Technology Assisted Classroom Teaching (TACT) and Technology, Observation, and Parent Support (TOPS), developed by the Center for Neurological and Neurodevelopmental Health (CNNH), located in Gibbsboro, NJ, is a remote behavior capture system. The system allows access to professional support and expertise.

This technology utilizes a small camera and computer to efficiently record target behavior, antecedents, and consequences. Behavior and teaching can be viewed in real time over Health Insurance Portability and Accountability Act (HIPAA) compliant Internet portals. Behavior can also be captured and reviewed at a later date by a Board-Certified Behavior Analyst (BCBA) or other clinicians if needed.

The technology approach reduces reactance effects and distractions of an extra observer in the physical environment. It is cost effective, as there are no travel expenses, or expenses of a consultant traveling to the setting when the target behavior may not occur. TACT/TOPS also allow for regular data collection and feedback to foster education, progress, and success.

Techniques such as direct observation, antecedent-based strategies (what to do before the behavior occurs), modeling, shaping, use of peers, positive behavior supports (visuals, incentive systems), and functional communication interventions foster natural, practical learning across settings. Emphasis is placed on utilizing the individual’s preferences and activity choices. Focus on adaptive and functional skills aide methods in generalizing across environments and individuals.

Prior to understanding the practical uses of ABA in treating autism spectrum disorders, it is important to understand what constitutes normal and aberrant behavior, as well as what behavior is exactly. Behavior can only be exhibited by living organisms and provides a function such as: 1) attention, 2) access to preferred items/tangibles, 3) escape, 4) avoidance, and 5) automatic reinforcement (an internal reinforcer).

 

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