Autism Q and A: Positive Behavior Support

by Dawn Hendricks

Autism spectrum disorder (ASD) impacts people in many ways. ASD may impact a person’s ability to socially interact, communicate effectively, learn new skills, and process sensory information. The pervasiveness of ASD and the array of challenges may result in the individual exhibiting interfering behaviors such as hitting, screaming, running away, or inflicting injury to himself.

All behavior is functional; it serves a purpose for the person. If professionals, parents, and friends can understand why individuals demonstrate a specific challenging behavior and what causes or triggers it, then positive behavior supports can be used to help individuals participate at home, in school, and in communities. Positive behavior supports can prevent a behavior from occurring or teach the individual a new functional skill to replace it.

 

Question: What is positive behavior support?

Answer:Positive behavior support is an all-encompassing system of behavior management. Behavior is supported through a structured plan that positively addresses the person’s behavior as well as his or her quality of life. Positive behavior support is based in the principles of applied behavior analysis (ABA) and involves understanding factors that impact behavior including antecedents and consequences. Further, it is embedded in the values of person centered planning. Person centered values require intervention and support tailor-made to meet the individuals needs and unique goals and movement towards community and social involvement and personal choice.

The fundamental philosophy of positive behavior support is that most behavior, problem or adaptive, serves a specific function or purpose in the individual’s life. In order to change that behavior we must assess the function of the problem behavior and replace it with a functional skill, such as a communication or social skill, that will have the same outcome. With this view, it is important to understand that problem behavior is not something that has to be suppressed; instead, problem behavior is a form of communication that has a function in the life of the person who displays it.

 

Question: What is meant by function of a behavior?

Answer: Individuals with ASD may communicate many different messages with their behaviors. Those who support them may find it overwhelming to consider all the possible messages that a person is trying to communicate. However, it is possible using applied behavior analysis to understand the messages that a person is saying with his or her behavior.

The messages that a person is communicating usually can be narrowed down to five basic messages or purposes. Those messages are: a) seeking attention from others; b) seeking something tangible like an item, activity, or food; c) seeking sensory input from the action itself; d) avoiding a person, task, item, or environment; or e) demonstrating medical discomfort.

Behavior, therefore, has purpose and is established as a way of 'communicating' one of these five basic messages. In order for the problem behavior to be replaced with a different behavior, support personnel must figure out which of the basic functions are relevant for a particular behavior and teach the individual a new positive behavior to replace the challenging one.

 

Question: Doesn't all interfering behavior have the same function?

Answer: The critical thing to remember is that the function of a behavior is individual. The same behavior may not serve the same function for two different individuals with ASD. It is critical to determine what the specific function is for each person.

A behavior may have multiple functions for a person or the person may display different behaviors for the same reason or purpose. The educator, parent, or support person must take the time to fully understand why the behavior occurs and to be as specific as possible. For example, Juan may hit himself, and the team may determine that he does so to gain access to something. Determining what he wants access to and when he wants access will help create an effective plan for Juan.

 

Question: Please describe what is meant by consequences and antecedents of a behavior.

Answer: As noted previously, principles of ABA are used when implementing positive behavior supports. There are two primary principles impacting behavior -- the antecedents and the consequences.

Consequences, also known as reinforcement, strengthen behavior. Often, a person’s problem behavior has been reinforced unknowingly. Behavior that is reinforced is maintained and continues. The behavior becomes established as a way of ‘requesting’ something specific. In order to replace that behavior with a different behavior, support personnel have to figure out what is reinforcing the person’s specific behavior. In other words, what is the individual getting or avoiding when the behavior is exhibited? What can be taught to the individual as a new way to request for that consequence?

In addition to understanding the consequences present after a behavior has occurred, the events that come before the behavior (that trigger its occurrence) need to be understood. These events, called antecedents, will help identify the functions that the person is requesting with the problem behavior. For example, if Juan’s problem behavior mostly happens after he is left alone; his parent might guess that he is seeking attention. If his problem behavior usually happens after he is given a task that he does not like, then his teacher might guess that he is avoiding the task.

There are two types of triggers that may impact the presence of a problem behavior. The ones described above, antecedents, act like fast triggers. In other words, problem behaviors follow them immediately. The other types of triggers are called setting events. Setting events are slow triggers to the behavior. They are conditions that set up the possibility a behavior may occur, but do not set off the behavior at that moment. In Juan’s case, imagine if his problem behavior occurred after he was left alone. We might hypothesize that Juan was seeking attention. What if the only time he displayed the behavior was when he was left alone in school and his schedule had changed? What if he does not display problem behavior when he is left alone at school and his schedule has not changed? We might then hypothesize that changes in his schedule seem to make it more likely that Juan will display problem behavior, but only if his schedule changed and he is left alone. Examples of setting events are illness, pain, fatigue, having had an undesirable event occur, or a change in schedule.

Question: What is the positive behavior support process?

 Answer: The positive behavior support process involves multiple steps and includes activities that help determine the function of the behavior as well as development of a behavior support plan. These steps are:

1. Determine the definition of the interfering behavior.
The first step in identifying the function of problem behavior is to concretely define the behavior in question. This definition should describe the behavior specifically and all individuals involved should be able to identify the occurrence of the behavior.

2. Determine the function of the behavior.
Sometimes the function of the behavior will be obvious. For example, Shauna cries when the television is turned off. This function is clear as is the driving antecedent. Shauna wants access to the television! Other times, in order to identify the function of behaviors, a functional behavior assessment (FBA) will need to be completed. When doing an FBA, gather information and collect data through observations and interviews to understand the function, the driving triggers, and maintaining consequences of the behavior.

To identify the function of the behavior, a summary of findings from the information and data gathered should be used to formulate a hypothesis outlining the belief as to why and when the problem behavior occurs. The hypothesis should identify the setting event, antecedent, consequence, and function for each behavior.

3. Develop a positive behavior support plan.
Once you have an understanding of the function of the interfering behavior, develop a plan that explicitly outlines what to do to proactively prevent the behavior and/or identify the skills to be taught to replace the behavior. With a positive behavior support plan, when appropriate, be proactive and avert the problem behavior through antecedent and environmental supports. For example, if Shauna demonstrates problem behavior after the television is turned off, outline steps in her plan to prepare her for the termination of this activity. Additionally, the plan should identify how to replace the behavior with an adaptive behavior that will result in the same outcome. For example, if the function of Juan’s behavior is to gain attention, then the new behavior should result in the same outcome. Therefore, teaching that functional skill, requesting attention and access to a person, will be a major part of Juan’s PBS plan. Finally, his plan will include specific instructions for team members to reinforce the new behavior and respond if the problem behavior occurs again. For Shauna, the plan will outline how to reinforce her when appropriate behavior is demonstrated when the television is turned off, and will also outline what to do if she cries.

4. Implement the plan.
Now that a plan is developed, team members will need to implement the plan across environments. It is important that anyone who provides support to the person be familiar with the plan and implement each step consistently. This may require some training of team members.

5. Monitor and evaluate.
To determine whether the plan is working, data should be collected and analyzed. Data helps determine if the person is developing new, positive skills and can be taken on the problem behavior occurrence and/or on new behaviors being taught. Juan’s teacher makes a tally mark each time he asks for attention while Shauna’s mother makes a check each time she cries when the television is turned off. Team members analyze the data frequently to ensure the plan is effective and the person is being supported. If positive behaviors are not being learned, the team will need to make changes to the plan.

Summary

Individuals with ASD may demonstrate problem behavior for a myriad of reasons. Positive behavior supports may be implemented to help a person reduce the occurrence of such behaviors and participate in the home, community, and school. All behavior is functional. Thus, it is critical that teams who support students with challenging behavior assess the function of the behavior and determine what causes it to occur. Based on this information, positive behavior supports are identified that explicitly outline what to do to proactively prevent the behavior and/or identify the skills to be taught to replace the behavior. Positive behavior supports teach functional behaviors that will result in long term behavior change and assist individuals in their future success.

Additional information and resources

Bambara, L. M. & Knoster, T.P.  (2009).  Designing Positive Behavior Support Plans (2nd ed.).  American Association on Mental Retardation: Washington, DC.

Carr, E.G., Horner, R. H., Turnbull, A. P., Marquis, J. G., McLaughlin, D. M., McAtee, M. L., Smith C. E., Ryan, K. A., Ruef, M. B., Doolabh, A., & Braddock, D.  (1999). Positive Behavior Support for People with Developmental Disabilities: A Research Synthesis.  Washington, DC: AAMR.

Hieneman, M., Childs, K., & Sergay, J.  (2006). Parenting with Positive Behavior Support: A Practical Guide to Resolving Your Child’s Difficult Behavior.  Baltimore: Brookes.

Horner, R. H.  (2000). Positive behavior supports.  Focus on Autism and Other Developmental Disabilities, 15, 97-105.

Machalicek, W., O’Reilly, M. F., Beretvas, N., Sigafoos, J., & Lancioni, G. E.  (2007).  A review of interventions to reduce challenging behavior in school settings for students with autism spectrum disorders.  Research in Autism Spectrum Disorders, 1, 229-246. 

For additional information on ACE please go to our website: www.vcuautismcenter.org

Contributors for this issue: Katherine Inge, Ph.D. & Dawn Hendricks, Ph.D.

Editor: Becky Boswell, M.B.A.

Information for this Frequently Asked Questions (FAQ) is from Virginia Commonwealth University's Autism Center for Excellence (VCU-ACE), which is funded by the Virginia State Department of Education (Grant # 881-61172-H027A100107). Virginia Commonwealth University is an equal opportunity/affirmative action institution providing access to education and employment without regard to age, race, color, national origin, gender, religion, sexual orientation, veteran's status, political affiliation, or disability. If special accommodations or language translation are needed contact (804) 828-1851 VOICE -- (804) 828-2494 TTY.