Parent/Home: NY Team Contact: Phil Smith, WIHD

Phone - 914-493-6926

Classification: Autistic Placement: Segregated 6:1:2 class

Note behavior with definition/description, frequency, and severity (5-point scale, with 1 as mild and 5 as most severe).

1. Grabbing and touching necks and faces – occurs multiple times every day (ranges from 4 to 10 incidents per day), severity 2-3. This behavior makes other people uncomfortable, causes occasional minor injuries, is socially stigmatizing, disrupts activities, causes people to avoid him, and peers react with agitation or aggression when grabbed.
2. Biting – bites other people, often when they react negatively to being grabbed or while they are trying to give Stephen work to do, occurs 2 to 3 times per week, severity 4. Biting causes physical injury including significant bruising and in several cases breaking the skin.
3. Spitting – spits in the face of staff and peers, generally occurs 3 to 5 times per week, severity 3. While not specifically dangerous, others find the behavior disgusting; some victims respond with aggression or other escalating maladaptive behaviors.
4. Running away – leaves classroom without permission and attempts to leave building (has succeeded twice), occurs 2 to 3 times per week, severity 3. Most incidents result in disruption of classroom activity and require additional school personnel to intervene and assist teacher. Efforts to leave building represent a significant safety concern.

Intervention target from above list with rationale: Grabbing and touching others was identified as the primary target, first because it is the most frequently occurring behavior, and second because it serves as a precursor to biting and spitting.

Student Strengths: Uses the computer effectively and enjoys this activity. Also likes to play the piano. Able to work effectively for up to 15 minutes when presented tasks that involve a discrete activity within his ability level.

Relevant History (e.g. social factors, health, medications, previous treatments): Has received numerous evaluations relating to the diagnosis of autism; he has been in segregated class placements for children with severe disabilities his entire life.

List persons to be involved in student’s program and planning:

Coordinating teacher

Social worker

Speech therapist

School psychologist

Technology teacher

Classroom paraprofessional

Parent

Hypothesis: In a range of settings and circumstances during the day, Stephen engages in inappropriate touching and grabbing behaviors to gain the attention of others. Escape from difficult work appears to be a secondary influence on this and related behaviors.

Analog assessment hypothesis: Stephen will be less likely to engage in these behaviors when he is socially engaged, receiving frequent praise and attention, spending minimal time in crowded areas (cafeteria), and with more staff supervision of his interaction with peers.

1. Prevention Strategies

• Decrease Stephen’s time in cafeteria – on three days of week when staffing allows, coordinating teacher will bring him back to classroom when he is finished eating. For remainder of lunch period, Stephen will be allowed to work on computer or other preferred activities with one other peer who is rarely a target of his inappropriate behaviors.
• Staff working with Stephen will provide frequent reminders in a neutral tone – "keep your hands down" or "where do your hands have to be?" Coordinating teacher to make arrangements with other teaching staff.
• Frequent prompts and directions – at first sign of Stephen approaching others, all staff will direct him to shake hands as a greeting. Stephen will be prompted as needed and recipients will be prompted to respond. Principal to ensure all teaching staff are familiar with this procedure.
• Provide high levels of non-contingent attention – whenever possible, have those around Stephen greet him when they see him. Coordinating teacher will recruit assistance of other teachers in nearby classrooms and building staff to spontaneously greet Stephen when they pass him in hallway or otherwise encounter him during the day.

1. Environmental and Instructional Enhancements:

• Increase Stephen’s time on the computer – to be arranged by each of his teachers.
• Pair Stephen with unlikely targets during preferred social activities – to be arranged by each of his teachers.
• Teach peers who are frequent targets appropriate ways to greet and redirect Stephens’s "assaults" to greetings — initial instruction to be developed and provided by social worker, generalization to school settings to be supervised by classroom staff.
• Increase opportunities for reciprocal interaction – to be arranged by each of his teachers.
• Expand range of activities in which Stephen is involved – to be organized by his coordinating teacher with assistance from the technology teacher.
• Involve Stephen in activities that require him to introduce himself – to be arranged by coordinating teacher with principal and office staff.
• Elicit cooperation and ensure involvement of other school staff and family – to be arranged by the school social worker.

1. Immediate Consequences

• Crisis plan – Ensure safety of others, release Stephen’s grasp, and have him sit quietly until calm.
• Minimize reinforcement for behaviors – Staff need to remain calm during incidents, minimize reactions or attention, staff should not comment on his behavior when it is happening, remain neutral, and remove him from social situation. When he becomes calm, re-introduce him to group instruction.

• Stephen will use a consistent and reliable to gain and maintain the attention of others.
• Stephen will approach and greet others appropriately, on his own initiative (i.e., without prompting or other social supports).
• Stephen will alternate turns with others on several non-verbal activities.
• Stephen will ask "How am I doing?" to solicit feedback when working.
• Stephen will use a self-initiated distraction routine to keep hands occupied while waiting.
• Stephen will request breaks during prolonged activities.
• Stephen will request an alternative task when presented with a non-preferred activity.

Since Stephen’s touching and grabbing were assessed to be motivated primarily by social attention, the first four alternative behaviors were selected to serve as socially acceptable means of accessing attention. The self-initiated distraction routine was intended to "keep him busy" in circumstances where the behavior might have occurred previously. The final two alternative behaviors address the secondary function of escaping prolonged or non-preferred tasks.

• Use of consistent means of gaining and maintaining the attention of others — taught in the classroom during group instruction times and in speech therapy sessions.
• Approach and greeting routine — taught during weekly classroom sessions run by the social worker on one of the days when Stephen and peers return early from lunch.
• Turn-taking— taught in the classroom during individual and small group activity times.
• Soliciting feedback when working—taught in the classroom during group instruction times and during speech therapy sessions.
• Distraction routine to keep hands occupied while waiting—activities developed during one-to-one time with technology teacher, activities generalized to community settings by coordinating teacher.
• Requests for breaks or alternative tasks when presented with a non-preferred activity—initially taught during speech therapy sessions, generalized to selected classroom activities.

3. Who will be responsible for conducting the training sessions?

 

Coordinating teacher, social worker, speech therapist and technology teacher.

 

4. Describe how the team will evaluate whether and when the student uses the alternative behavior(s):

Speech therapist will use a chart to monitor Stephen’s mastery level of new social and verbal skills. Scatter Plot will be maintained by the coordinating teacher to evaluate frequency of challenging behaviors. A second scatter plot will be kept by the classroom paraprofessional to monitor Stephen’s use of the alternative behaviors as they generalize to hallway, classroom and cafeteria settings.

• Using the above plan, Stephen showed a decrease in frequency of his grabbing and touching at school. During the second week, the behavior occurred one to two times per day compared to the baseline of four to ten, and the escalation to more problematic behaviors occurred only once (second day of the week). By the end of two months, grabbing and touching occurred less than once per week.
• At home, the behavior had always occurred less frequently, although exact counts were not available. After two months, Stephen’s parents described him as consistently more responsive to social interaction at home.
• The team working with Stephen felt it was important that he be considered for an augmentative communication device. Prior to intervention, he was judged to be a poor candidate; this was due in part to the fact that his behaviors caused others to judge him as uninterested in social interaction.