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Self-Stimulatory Behaviors. Presenters: Brittain Coleman , MA, BCBA Behavior Analyst Tracy Palm , MS, BCBA Executive Director Transformations Autism Treatment Center. What is a Self-stimulatory behavior?. - PowerPoint PPT Presentation
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Self-Stimulatory BehaviorsPresenters:
Brittain Coleman, MA, BCBABehavior Analyst
Tracy Palm, MS, BCBAExecutive Director
Transformations Autism Treatment Center
What is a Self-stimulatory behavior?
• Stereotypy or self-stimulatory behavior refers to repetitive body movements or repetitive movement of objects
• Often observed in the following forms:– Visual– Auditory– Tactile– Vestibular– Taste– Smell
What do they look like?
• Visual: – Staring at lights or ceiling fans– Repetitive blinking– Moving fingers in front of the eyes– Hand-flapping– Gazing at nothing in particular– Tracking eyes– Peering out of the corners of eyes– Lining up objects– Turning on and off light switches
What do they look like?
• Auditory: – Vocalizing in the form of humming – Grunting, or high-pitched shrieking– Tapping ears or objects– Covering and uncovering ears– Snapping fingers– Making vocal sounds– Repeating vocal sequences – Repeating portions of videos, books or songs at inappropriate times
What do they look like?
• Tactile: – Scratching or rubbing the skin with one’s hands or with another object– Opening and closing fists– Tapping surfaces with fingers
• Vestibular: – Rocking front to back– Rocking side-to-side– Spinning– Jumping – Pacing
• Taste: – Placing body parts or objects in one’s mouth– Licking objects
• Smell: – Sniffing or smelling people or objects
What do they look like?
• In extreme instances, self-stimulatory behaviors may take on the form of self-injurious behavior:– Head banging– Eye poking– Hand biting
• Not all self-injurious behaviors are considered self-stimulating
Why do people engage in self-stimulatory behaviors?
• THE REAL ANSWER?...No one really knows for sure
Hypotheses:
• Hypotheses:– To calm themselves down
– To receive some sort of sensory input they need
– It releases opiate-like substances in the brain called beta-endorphins, which can produce either a euphoric or anesthetic effect
– Provides an extra dose of internal stimulation for children with ASD who feel under-stimulated
– Provides a feeling of tranquility for children who feel overstimulated
– Children who are hyposensitive, or under-responsive to stimuli, may demonstrate the opposite effects: self-stimulatory behaviors may actually increase arousal
So what have we done for self-stimulatory behaviors?
• Beginner Program:– This intervention will help an individual learn to do
alternative behaviors and decrease their self stimulatory behaviors.
– This intervention will allow the therapist/parent/caregiver etc. to assist the individual in decreasing their self stimulatory behavior
– This intervention uses positive reinforcement to teach an individual how to discriminate between an appropriate vs inappropriate time to engage in self-stimulatory behaviors
When is the individual ready to do this type of program?
• Does the child respond to multiple reinforcers?
• Does the child use a token system successfully?
• Does the child respond to delayed reinforcement?
• What is the functioning level of the individual?
Materials Needed
• Timer• Reinforcers • Token System
Steps to the intervention
• Determine a baseline– How often is the person currently doing the behavior?
• Pick your target time– This time should be slightly below the baseline time
• Determine your master criterion– Typically 3-5 successful sessions– If the individual has more than 5 unsuccessful sessions
then back the time down to the last previously successful time frame
• Increase the time in small increments in the beginning to create opportunities for success
Steps to the Intervention cont.
• Make the deal– Make sure to explain to the child what is expected and
what the reward will be– Use a token system once the child is able to work for
longer periods of time without primary reinforcers• Set the timer• Reward/Try Again• Increase the criterion as needed
What else do I need to teach?
• Replacement behaviors– Determine the function for the behavior then you can
determine an appropriate replacement behavior– Sensory/automatic
• Weighted or textured clothes, etc.– Positive Reinforcement/ Attention
• Asking for assistance, attention– Positive Reinforcement/ Access to Items or Activities
• Manding for items/activities– Negative Reinforcement
• Asking for a break• Asking for people to go away• Asking for something to stop
What does the data show?
Aug-09Sep-09Oct-09Nov-09Dec-09Jan-10 Feb-10Mar-10 Apr-10May-10Jun-100
20
40
60
80
100
120
140
160
180
Self Stimulatory Behaviors
Self Stimulatory Behaviors
Probe Seesions
Freq
uenc
y of
Uns
ucce
ssfu
l Int
erva
ls
11 year old boy, diagnosed with ASD
So what have I done for self-stimulatory behaviors?
• Expanded Program: – An intervention that aims to help an individual learn how
to control their own self stimulatory behaviors
– An intervention that allows the therapist/parent/caregiver etc. to some control over the individual’s self-stimulatory behavior
– An intervention that in a sense teaches an individual how to discriminate between an inappropriate time to engage in self-stimulatory behaviors
Participants
• 2 participants• Both have an Autism diagnosis• Both males• Age:
– Client #1: 6 yrs old– Client #2: 11 yrs old
• Skill level:– Client #1: High functioning, able to understand some basic
rules, some more complex language skills– Client #2: Low functioning, unable to understand basic rules,
limited language skills
Topographies
• Topographies:– Client #1: Vocal Stereotypy– Client #2: Hand-flapping, feet tapping,
repetitive head movements– Often individuals who engage in frequent self-
stimulatory behaviors engage in behaviors that are observed in a variety of topographies, therefore it is important to discuss and determine which or all of the behaviors are going to be targeted
What was involved?
• This intervention is comprised of several different components:– Basic Stimulus Discrimination– Systematic Phases– Token Economy– Response Cost– Reinforcement– Self Management– Time Management Technology
Stimulus Discrimination
• I utilized a basic red card and a basic green card to teach discrimination
• Red card signifies the time the individual was not allowed to engage in self-stimulatory behavior(s)
• Green card signifies the time the individual was allowed to freely engage in the targeted self-stimulatory behavior(s)
No Silly Noises
Quiet Body
OR
Yay! Silly Noises
OR
Red Card Means: No Silly Noises
1. 08:00 Did I have a quiet voice?Yes: Token No: Reset Timer & Tokens
2. 06:00 Did I have a quiet voice?Yes: Token No: Reset Timer & Tokens
3. 04:00 Did I have a quiet voice?Yes: Token No: Reset Timer & Tokens
4. 02:00 Did I have a quiet voice?Yes: Token No: Reset Timer & Tokens
5. 00:00 Did I have a quite voice?Yes: Token No: Reset Timer & Tokens
Yay! Break Time
Systematic Phases
• This intervention was designed to be implemented very carefully taking careful consideration of each step as progression (or lack there of) is made
Systematic PhasesPhase: Red Card Time Token Time
IntervalGreen Card
TimeCriteria for
Phase Change:1 10 seconds 2 seconds 10 min 3 RCC without
VS2 20 seconds 4 seconds 9 min 30 sec 3 RCC without
VS3 30 seconds 6 seconds 9 min 3 RCC without
VS6 1 minute 12 seconds 7 min 30 sec 4 RCC without
VS7 1 min 30 sec 18 seconds 7 min 4 RCC without
VS 8 2 min 24 seconds 6 min 30 sec 4 RCC without
VS17 8 min 1 min 36 sec 2 min 5 RCC without
VS18 9 min 1 min 48 sec 2 min 5 RCC without
VS19 10 min 2 minutes 2 min 5 RCC without
VS
= break in the phases RCC= Red Card Condition VS= Vocal Stereotypy
Token Economy
• It is essential that the individual be able to understand and navigate a token economy
• If the individual has not yet been taught a token economy this needs to be the first step taken– Even if an individual does have a learning history with a
token economy it is recommended to go back through the steps of pairing the tokens with reinforcers systematically
• For the two clients that have used this method a token economy with five tokens was used– The number of tokens is not crucial
Response Cost
• It was found that some degree of response cost was necessary for success
• In the beginning taking away one token for a single incidence of self-stimulatory behavior was tried
• However after assessment and consideration specifically for the two clients for which this intervention, it was determined removal of all of the tokens was the best approach
Reinforcement
• Preference assessments prior to starting are necessary for success
• Reinforcers are used as added incentive to continue to not engage in self-stimulatory behaviors, especially in the beginning phases
• The ultimate reinforcer used is the ability to freely engage in the self-stimulatory behavior
Self-Management
• This component is to aid in the success of the individual being able to utilize this intervention across a variety of settings
• If the individual is able to maintain and manage it all by him/herself it increases the quality and quantity of learning that is possible
• Throughout all of the phases of the intervention is it recommended to require the individual place their own tokens on the token board
• Once the individual satisfies the criteria for the final phase you should then move to the maintenance phase
Maintenance Phase
• The maintenance phase consists of the following:– Prompting the individual to:
• Monitor the time • “Asking” or determining themselves whether or not they
engaged in the behavior– If yes
» Delivering their own tokens– If no
» Not delivering a token» At this point elongating the time should be aversive
enough – Systematically fading those prompts until the individual
can independently maintain it all
Time Management Technology Used
• Timer– A timer was used to indicate the end of the red and
green card condition– The time was also used to monitor the increasing time to
know when to deliver the tokens
HOWEVER:If the resources are available:• A Motivaider is believed to be the better
technology of choice for the following reasons:– Constant monitoring of time is not necessary– More discretion
Refresher on Participants
• 2 participants• Both have an Autism diagnosis• Both males• Topographies:
– Client #1: Vocal Stereotypy– Client #2: Hand-flapping, feet tapping, repetitive head
movements• Age:
– Client #1: 6 yrs old– Client #2: 11 yrs old
• Skill level:– Client #1: High functioning, able to understand some basic
rules, some more complex language skills– Client #2: Low functioning, unable to understand basic rules,
limited language skills
Results
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 190
2
4
6
8
10
12
14
Vocal Sterotypy
YesNo
Phase
Freq
uenc
y of
Yes
' and
No'
s in
eac
h ph
ase
• Yes means the individual successfully did not engage in vocal stereotypy during that time frame
• No means the individual did engage in vocal stereotypy during that time frame
Results: Client #2
1 2 3 4 5 6 7 8 9 10 11 12 13 14 150
10
20
30
40
50
60
Physical Self-Stimulatory Behaviors
YesNo
Phase
Freq
uenc
y of
Yes
' and
No'
s in
eac
h ph
ase
• During the sessions that have increased frequency of “no’s” the data also showed an increase in problematic behaviors
• It was also noted that on during phases/sessions 3, 11, and 15 the clients mother reported the client not sleeping the night before
Questions?
Contact Information:
• Tracy Palm: Executive Directory– [email protected]
• Brittain Coleman: Behavior Analyst– [email protected]
Transformations Autism Treatment Center(901)-231-2931