The Cigna Group · NYSE:CI
The Cigna — Investor Presentation (2012)
52 slides from The Cigna's investor presentation, 2012
Slide 1: Preventing and Responding to Challenging Behaviors in the Home
Preventing and Responding to Challenging Behaviors in the Home Michael Boardman, MA, BCBA
Slide 2: Learning Objectives
Learning Objectives 1. Understanding Problem Behaviors 2. A behavior analytic perspective on behavior 3. Defining and observing problem behavior 4. Four functions (or causes) of problem behavior 5. Preventing and responding to problem behaviors based on their function(s)
Slide 3: Part I: Understanding Problem Behaviors
PART I: Understanding Problem Behaviors
Slide 4: Examples of Problem Behaviors
Examples of Problem Behaviors • Michael drops to the floor and screams when his parents and teachers ask him to do something • Lucy opens and closes doors and cabinets upwards of 40 times per minute whenever she has free time • Jessica elopes from her home and walks about her neighborhood unless som
Slide 5: Impact on Child
Impact on Child • Affects the health and safety of the child and others • Violates the rights of others • Impedes upon the child’s ability to function successfully and develop friendships • Interferes with learning
Slide 6: Behaviors = Communication
Behaviors = Communication All behaviors (adaptive or maladaptive) are a form of communication. The question is, what are our children communicating when they engage in problem behavior?
Slide 7: Developmental Delays: Communication
Developmental Delays: Communication A child who has limited means of requesting preferred items/ activities, assistance, termination of an activity, or other forms of attention from an adult or peer often develop maladaptive behaviors as a way to compensate for their inability to communicate success
Slide 8: Developmental Delays: Cognitive
Developmental Delays: Cognitive A child with a cognitive delay: • may not understand our verbal directions (e.g., never respond to “come here” on “no”) • may be unable to understand how his actions effect the materials and people in his environment (e.g., flipping tables over to see it’s trajectory)
Slide 9: Developmental Delays: Motor
Developmental Delays: Motor A child who has motor delays that affect his or her ability to access and explore their environment successfully, may compensate by engaging in problem behavior as a means of accessing reinforcement for themselves (e.g., flapping hands in front of face) and from others (e
Slide 10: Part II: Explanation of behavior from a behavior analytic perspective
Part II: Explanation of behavior from a behavior analytic perspective
Slide 11: Behavior is affected by antecedents and consequences
Behavioral research has shown that behavior is affected by what comes before it (antecedents) and what comes after it (consequences).
Slide 12: Antecedent (Example)
Antecedent (Example) You want to be better about sending your mother a mother’s day card so you write yourself a note and post it on the refrigerator door two weeks in advance. Five days before mother’s day you buy your mother a card and send it out. It arrives on time. (The ways in which you struct
Slide 13: Consequence
Consequence Each time you wash the dishes your significant other gives you massive hugs and kisses. You do the dishes every time they need cleaning. (The responses you get from the significant people in your life following a particular behavior influence your subsequent engagement in that behavior.)
Slide 14: A-B-C Contingency
A-B-C Contingency • Behaviorists refer to the inter- relationship between a behavior(B) and its antecedents(A) and consequences (C) as the 3-term contingency or A-B-C contingency.
Slide 15: The ABC Contingency is Everywhere
The ABC Contingency is Everywhere Everyday examples of the ABC contingency in early childhood are vast and abundant. • Some are adaptive and result in – easy access to reinforcement, – the development and/or maintenance of friendships, – further opportunities for learning and skill development, etc.
Slide 16: Adaptive Forms
Adaptive Forms Antecedent Behavior Consequence Difficult puzzle Ana asks for Mother helps, “help” Ana finishes puzzle Full stomach Max says, “I’m Parents excuse done him from the table
Slide 17: Maladaptive Forms
Maladaptive Forms Antecedent Behavior Consequence a peer’s long hair hair pulling TA sits with Molly (TA sits with Molly) and TA, Susan, sitting with another child
Slide 18: Molly
Molly Molly, a non-verbal 4 year old girl who attends a preschool program, pulls her peers’ hair throughout the day. Based on observation, whenever the TA sits with another child (antecedent event), Molly pulls the hair of her nearest peer (behavior) and the TA comes and sits with Molly giving her a
Slide 19: Why Does Molly Continue to Pull Hair?
Why Does Molly Continue to Pull Hair? For Molly, hair-pulling in the presence of a peer often results in opportunities to sit with and receive attention from the TA. Molly’s maladaptive behavior of hair-pulling has a history of being reinforced (inadvertently) by the TA. It is a behavior she maintai
Slide 20: Maladaptive Forms
Maladaptive Forms Antecedent Behavior Consequence Presentation of Dropping to floor, Removal of toothbrush followed crying toothbrush by verbal direction of “time to brush your teeth”
Slide 21: Kevin
Kevin Kevin is a 4-year old boy with limited verbal skills who drops to the floor and cries when it is time to brush his teeth. Whenever one of his parents is holding his toothbrush and says, “it’s time to brush your teeth” (antecedent), Kevin drops to the floor and begins to kick and cry (behavior)
Slide 22: Why Does Kevin Continue to Drop to the Floor and Scream?
Why Does Kevin Continue to Drop to the Floor and Scream? For Kevin, dropping to the floor following his parents demands to brush his teeth, results in his escape from the task and access to the toys in his room. Kevin’s maladaptive behavior of dropping to the floor and screaming has a history of bei
Slide 23: Part III: Description and Observation of Problem Behaviors
Part III: Description and Observation of Problem Behaviors
Slide 24: How do we describe problem behavior?
How do we describe problem behavior? 1. Define the problem behavior 2. Observe the behavior 3. Collect data
Slide 25: 1. Define the problem behavior
1. Define the problem behavior • A behavioral definition should be: – objective, assuring that specific instances of the behavior can be reliably observed and recorded – clear, assuring that it is readable, unambiguous, and easily paraphrased – complete, delineating what is and what is not the behav
Slide 26: A Behavioral Definition Should Answer the Following Questions
A Behavioral Definition Should Answer the Following Questions: – What is the behavior? – When does the behavior occur? – How often does it occur? – What is the intensity of the behavior? – With whom does the behavior occur?
Slide 27: When writing behavioral definitions, avoid
When writing behavioral definitions, avoid: – drawing inferences of the behavior (e.g., “non-compliant”) – using mentalistic terms to describe the behavior (e.g., “anger”, “frustration”, “sadness”)
Slide 28: Examples: Good Definitions
Examples Good Definitions: •Michael drops to the floor and screams loudly for 10 minutes everyday before bath time. •When there is downtime at home (i.e., her parents are busy and no demands are placed on her), Lucy opens and closes the cabinet doors as many as 100 times in a 10 minute period until
Slide 29: Examples: Poor Definitions
Examples Poor Definitions: •Michael tantrums •Lucy engages in repetitive play.
Slide 30: 2. Observe the behavior and identify antecedents and consequences
2. Observe the behavior as it occurs in the environment and identify its antecedents and consequences As with the behavioral definition, describe in detail what happened before the problem behavior occurred and what happened after the problem behavior occurred. Again, avoid drawing inferences about
Slide 31: Good Descriptions
Good Descriptions • Antecedent -- Michael’s mother tells him, “it’s time for bath”, and asks him to clean up his toys in his room. • Consequence – Michael’s mother tells him he can have 5 more minutes to play with his toys. Michael gets up off the floor, stops screaming and plays with his toys. • An
Slide 32: Poor Descriptions
Poor Descriptions • Antecedent – Michael is angry – Consequence – Michael gets his way • Antecedent – Lucy is bored – Consequence – Lucy plays with the cabinets
Slide 33: 3. Collect ABC Data
3. Collect ABC Data Collecting ABC data will allow you to determine the function of (or reason for) the problem behavior and plan strategies to reduce and replace the problem behavior.
Slide 34: Collect ABC Data
Collect ABC Data • Keep a running log or data sheet of each occurrence of the problem behavior. Right down the time of the behavior, what occurred before the behavior, and what occurred following the behavior. Over time, this data will provide information with regards to the types of environmental e
Slide 35: ABC Data Sheet: Example
ABC Data Sheet: Example Child: Kevin Data Collector(s): Mom and Classroom Teacher Date/Time Antecedent Behavior Consequence 2.5.04/8:30am Sitting in car on Hand-flapping No socially the way to school and/or humming mediated Duration: 5 min. consequence 2.5.05/8:55 Walking from car Duration: 30 sec.
Slide 36: ABC Data Sheet continued
Date/Time Antecedent Behavior Consequence 2.5.04/10-:05 Morning meeting Duration: 1 min. Peer tells him to at school stop. Kevin does not look at peeri in response and continues to hand flap and hum. 2.5.04/10:10 Morning meeting Duration: 45 sec. TA blocks his at school hands and Kevin stops hand- f
Slide 37: Part IV: Four functions (or causes) of all behavior
PART IV: Four functions (or causes) of all behavior
Slide 38: Functions of Behavior
Functions of Behavior According to behavior analysts, humans engage in behaviors for one of 4 reasons. Of the 4 reasons, two are mediated and reinforced through others in the individual’s environment: – socially mediated positive reinforcement (attention, tangible) – socially mediated negative reinf
Slide 39: Socially Mediated Positive Reinforcement
Socially Mediated Positive Reinforcement The consequence is the delivery of something by another individual following a behavior that increases the likelihood that the behavior will occur in the future: – Attention (hugs, conversation, smile, praise) – Activities (video games, board games, sports) –
Slide 40: Socially Mediated Negative Reinforcement
Socially Mediated Negative Reinforcement The consequence is the removal of something aversive by another individual following a behavior that increases the likelihood that the behavior will occur in the future: – Escape or removal of non-preferred demands – Avoidance or postponement of non-preferred
Slide 41: Automatic Positive Reinforcement
Automatic Positive Reinforcement The consequence results from one’s own body movement or activities that produce a feeling that increases the likelihood that the individual will engage in the behavior in the future. – Self-stimulatory behaviors (e.g., hand flapping, rocking, mouthing, hair twirling,
Slide 42: Part V: How to Prevent and Respond Based on Maintaining Functions
Part V. HOW TO PREVENT AND RESPOND TO PROBLEM BEHAVIORS BASED ON THEIR MAINTAINING FUNCTIONS
Slide 43: Behaviors maintained by Socially Mediated Positive Reinforcement
Preventing and Responding to Behaviors maintained by SOCIALLY MEDIATED POSITIVE REINFORCEMENT (Attention or Tangible): – Create a rich, reinforcing environment and provide lots of attention (praise, smiles, hugs, tickles) for all appropriate behavior – Teach an appropriate means of requesting attent
Slide 44: Example
Example • Whenever Molly pulls her peers’ hair during circle time, the TA, Susan, diverts her attention from the child she is sitting with, explains the classroom rules and how it’s not nice to pull hair, and sits next to Molly for the remainder of the activity. • One would hypothesize from this pro
Slide 45: Intervention Plan
INTERVENTION PLAN • Provide Molly with lots of attention in the form of verbal praise, hugs, social gestures (thumbs up, smiles, high-fives) throughout circle time contingent upon non-occurrences of hair pulling • Teach Molly an appropriate means for requesting attention from Susan and other preferr
Slide 46: Behaviors maintained by Socially Mediated Negative Reinforcement
Preventing and Responding to Behaviors maintained by SOCIALLY MEDIATED NEGATIVE REINFORCEMENT (Escape or Avoidance): • Create a visual schedule, allowing the child the opportunity to anticipate future activities • Create reinforcement contingencies wherein the child receives positive reinforcement i
Slide 47: Example
Example • Whenever one of his parents is holding his toothbrush and says, “it’s time to brush your teeth”, Kevin drops to the floor and begins to kick his legs and cry which results in the parent removing the toothbrush consoling him until he stops crying, and letting him play in his room. • One wou
Slide 48: Intervention Plan
INTERVENTION PLAN • Create a vertically displayed picture schedule that lists the activities that Kevin will engage in before bed. Briefly prime him by pointing to each picture at the beginning of the bed time routine so he sees and begins to understand the sequence of events. Plan the schedule so t
Slide 49: Behaviors maintained by Automatic Positive Reinforcement
Preventing and Responding to Behaviors maintained by AUTOMATIC POSITIVE REINFORCEMENT (Self Stimulation): - Provide an activity rich environment to reduce the likelihood that the child will engage in self-stimulation over play – Provide activities that produce a similar reinforcing stimulation eithe
Slide 50: Example
Example • Ryan is a 10-year old boy who flaps his hands and hums loudly periodically throughout the day. Based on his parents ABC data, it occurs most often when he is physically transitioning from one activity to the next, sitting in the car and the train and waiting on the subway platform, during
Slide 51: Intervention Plan
Intervention Plan • Teach Ryan to carry a back-pack with preferred items that he can choose from and engage with during periods of downtime (e.g., transitions, waiting for transportation or upcoming activities) • Engage Ryan in conversation prior to activities that typically precede the hand-flappin
Slide 52: Conclusion and questions
This concludes the presentation piece of today’s workshop. For the next 15 minutes I am happy to take questions from the audience.