Download Behavioral Approaches in Communicative Disorders

Behavioral Approaches in
Communicative Disorders
Christine A. Maul, Ph.D., CCC-SLP
Brooke R. Findley, M.A., CCC-SLP, BCBA
California Speech-Language-Hearing Association
2016 Annual Convention, Anaheim, California
Disclosure
• We do have a financial interest in the content
of this presentation
• We have co-authored a textbook, by the same
name as this presentation, which is available
for sale at this convention
• Approval of this presentation does not imply
the CSHA endorsement of course content,
specific products, or clinical procedures
Why the Behavioral Approach
• As therapists, SLPs strive to:
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Create nonexistent communicative behaviors
Increase existing communicative behaviors
Strengthen and sustain communicative behaviors
Decrease undesirable behaviors
• Undesirable communicative behaviors
• Behaviors that interfere with therapy
• We are agents of behavior change, and the field
of behaviorism is highly relevant to what we do
• Other reasons for knowing a bit about
behavioral approaches include:
–A high percentage of children with
language disorders also have a social
emotional behavior disorder (SEBD) of
some kind
• 50 – 70% (Redmond & Rice, 1998)
–SLPs are increasingly encountering
opportunities to collaborate with
Board Certified Behavior Analysts
(BCBAs)
The ABCs of Behaviorism
• One of the core tenets of this theoretical
approach is that behavior occurs within an
environmental context
• Repeated exposure environmental events
creates contingencies between:
– Antecedents
– Behaviors
– Consequences
Principles of Behaviorism
• Operant Conditioning
– The process through which people learn to
behave the way that they do
– Consequences shape and maintain behaviors
• Reinforcement – increases the occurrence of
a behavior
–Positive Reinforcement
–Negative Reinforcement
• Punishment – decreases the occurrence of a
behavior
• Differential Reinforcement
– Occurs when a specified response is reinforced and
another specified response is given no reinforcement
– Appropriate application of this principle should result
in desired behaviors increasing and undesirable
behaviors decreasing
• Stimulus Discrimination and Generalization
– Discrimination occurs when a response is given to a
specific discriminative stimulus (SD) because the
response has been previously reinforced in the
presence of that stimulus
– Generalization occurs when the same response is
given in the presence of stimuli that are similar, but
not entirely the same
APPLYING
BEHAVIORAL PRINCIPLES
TO TREATMENT
Step 1: Writing an Operationally
Defined Target Behavior
• Most of the organizations we work for require us
to do this
• The target behavior must be observable and
measureable
• Five components:
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The response topography
The level
The accuracy criterion
The stimuli
The setting
Response Topography
• Refers to the specific skill we are attempting to
teach our client
• Should be written in a way that clearly specifies
the form and structure of a response
• Should describe observable phenomena rather
than mentalistic constructs
Level
• This component specifies the level of difficulty
at which the target behavior will be taught
• For receptive language tasks, consider the
complexity of the selected antecedent stimuli
• For expressive language, articulation, voice,
and fluency tasks, consider the length of the
client’s response
• For some pragmatic language tasks, consider
specifying the length of time the client has to
engage in the target behavior
Accuracy Criterion
• The accuracy criterion specifies the precision
with which the client is expected to engage in
the target behavior
• Should include an indication as to when the
target behavior will be considered met
• The accuracy criterion should be tied directly to
the selected data collection method
Accuracy Criterion: Common
Measurement Methods
• —
Frequency Measures
– Involves tallying the number of times the client
engaged in the target behavior during a set time
period
• —
Durational Measures
– A measure of the amount of time the client is able to
engage in the target behavior
Accuracy Criterion: Common
Measurement Methods
• Latency Measures
– A measure of the length of time between
presentation of an antecedent stimulus and the
client’s response
• Derivative Measures
– The most commonly used derivative measure is
percentage data
Stimuli
• This component identifies the antecedent
stimuli that will be used to evoke the target
behavior
• Should be consistent across the treatment
sequence
• Should be thoughtfully considered to help
promote generalization
Setting
• This component specifies the environment in
which the client will be able to demonstrate
use of the target behavior
• Examples:
–The speech room
–The classroom
–The home setting
–At work
–Etc.
Testing Operational Definitions
• Operational definitions should be able to pass
the stranger test
• Ask yourself the following question:
• Can anyone who reads the definition of the target
behavior be able to reliably observe and measure its
occurrence?
Examples
• Make requests (RT) in three to five word phrases (e.g., I need _____., Can I
have _____?, etc.) (L) at a minimum rate of three times (AC) in two of three
consecutive center rotations in response to not having materials (ST)
needed to complete an activity (e.g., a pencil, scissors, etc.) in the classroom
(SE).
• Maintain eye contact (RT) for a total duration per session of
at least 4 minutes (AC) during a 10-minute conversation (L) with a peer (ST)
in the cafeteria (SE).
• Label (RT) pictures (ST) of common household items with an average
response latency of less than 3 seconds (AC) at the word level (L) in the
home setting (SE).
• Production of present progressive -ing (RT) in 3-5 word sentences (L) in
response to pictured stimuli paired with questions posed by the clinician
(ST) with 80% accuracy in 20 consecutive trials (A) in the speech room (SE).
PRACTICE: Writing Observable and
Measureable Target Behaviors
• Rewrite these incompletely described behaviors:
– Improve receptive language skills with 80% accuracy
– Use sign language to communicate with 90% accuracy
– Production of initial /m/ with 80% accuracy in 50 trials in
response to pictured stimuli in the clinic setting
– Drink without aspirating
– Maintain topics of conversation with 80% accuracy
Step 2: Take Baseline Measurements
of the Target Behavior
• Sometimes referred to as “present levels”
• Characteristics of baseline measures:
– Should be stable and reliable over time
– Should adequately sample the behavior
– Should be taken in all relevant settings
• Baseline procedures should be consistent with
what is specified in the target behavior; for
many target behaviors, discrete trials can be
conducted
What is a Discrete Trial?
• Based on the foundation of behavioral theory:
– Antecedent
– Behavior
– Consequence
• Much more about this when we talk about treatment
• For baseline procedures
– Present a stimulus item; wait for the response
– Record the behavior (correct, incorrect, no response)
– For baseline procedures, no “consequences” are given
contingent upon the correctness of the response
– Instead, give “noncontingent” reinforcement for
cooperative behavior
Here’s what a baseline discrete trial
looks like:
Place the stimulus picture in front of the client,
Ask the relevant predetermined question
Wait a few seconds for the client to respond
Record the response on the recording sheet
Pull the picture toward you, or remove it from
the subject’s view
• Wait for 2-3 seconds to mark the end of the trial
• Return to step 1 to initiate the next trial
• Reinforce noncontingently during the brief pause
between discrete trials
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Other Ways to Take a
Baseline Measure
• Observation in natural environments (often
appropriate for pragmatic language behaviors)
• Analysis of speech/language samples (for
many targets at the conversational level)
• With instruments (e.g., sound level meters or
Visi-Pitch for voice target behaviors)
PRACTICE: Taking Baseline Measures
• Refer to your rewritten target behaviors from
the previous exercise
• Pick one and decide upon an appropriate way
to conduct baseline measures for that target
behavior
Step 3: Begin Treatment,
Using
Discrete Trial Therapy
Discrete Trials during
Treatment
• Five components to discrete trial therapy:
– The antecedent
– The prompt
– The response
– The consequence
– The intertrial interval
REFER TO HANDOUTS GIVEN ON WEBSITE
SPECIFIC
TECHNIQUES
Antecedent-Based
Behavioral Techniques
• Modeling with required imitation
• Prompts
– Verbal prompts
• Partial modeling
• Phonemic cues
• Vocal emphasis
– Visual prompts
• Textual (written and printed stimuli)
• Positional
– Tactile-Kinesthetic
– Manual Guidance
FADE PROMPTS AS SOON AS POSSIBLE!!!!!!!
Simplifying the Target Behavior
• Shaping
– Successively shaping the target behavior (TB) over
time
– Define the terminal form of the TB
– Define successive approximations of the TB
– Reinforce successive approximations of the TB
• Chaining
– Forward chaining
– Backward chaining
Consequence-Based
Behavioral Techniques
• Positive Reinforcement: Delivering the
consequence for desired responses
– Preference assessments often a first step
– Unconditioned: Food and drink
– Conditioned
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Social reinforcement
Informative feedback
Token economies
Premack principle
• Corrective Feedback: Delivering the consequence
for undesired responses
Promoting Generalization and
Maintenance
CONSIDER THIS FROM THE VERY BEGINNING OF
THE TREATMENT PROCESS!!!!!
• Techniques for promoting generalization during
treatment:
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Choosing functional target behaviors
Varying the stimuli
Programming common stimuli
Teaching loosely
Providing an adequate number of exemplars
Fading reinforcement
• Techniques to promote maintenance in
natural settings
– Self-monitoring
– Contingency priming
– Working with significant others
• Intervention plans should:
– Be congruent with cultural beliefs and values of the client’s
household
– Capitalize on already existing strengths in interactions
between the client and others in the natural environment
– Reflect the input of the client and the client’s significant
others
– Include techniques that can be embedded in daily routines
COLLABORATION WITH BOARD
CERTIFIED BEHAVIOR ANALYSTS
(BCBAs)
What is collaboration?
• Collaboration is the process of working
together to ensure that shared objectives are
met
• SLPs and BCBAs engage in collaboration to
ensure that clients are able to demonstrate
progress toward goal acquisition
Why should SLPs and BCBAs
engage in collaboration?
• Professionals from both fields should be open
to engaging in collaboration because:
– There is an overlap in our scopes of practice
– It broadens our knowledge of evidence-based
practices
– We are required to by our governing organizations
– It helps promote functional outcomes for our
clients
Obstacles to Effective Collaboration
• A variety of obstacles can prevent effective
collaboration, including:
– Time and scheduling limitations
– Theoretical differences between practitioners
– Territorialism
• To address some of these obstacles, we must
first establish an open line of communication
Suggestions for Enhancing
Communication with BCBAs
• Attempt to speak one another’s language
• Ground recommendations in data
• Share the research base for your
recommendations
• Establish a time-efficient communication system
• Be open to providing and receiving feedback
• Understand that there will likely be
misconceptions
SLP Contributions
• SLPs knowledge of speech-language
development allows them to make multiple
contributions during the collaboration
process, including recommendations for:
– Developmentally appropriate goal selection
– Effective sequencing of goals
– Client-specific antecedent supports
– Selection of appropriate augmentative and
alternative communication (AAC) devices
BCBA Contributions
• BCBAs knowledge of behavioral principles
promotes their ability to:
– Determine the function of undesirable behaviors
– Decrease behaviors that interfere with the
provision of services
– Increase the occurrence of socially-significant
communicative behaviors
– Enhance the generalization and maintenance of
taught skills
Recommendations for Effective
Collaboration
• Value each other’s knowledge
• Encourage consistency in service provision
• Share accountability for successes and
setbacks
• Offer opportunities to observe sessions
• When possible, engage in co-teaching
• Refer when appropriate
Advantages of Successful Collaboration
• Successful collaboration is beneficial for all
involved in the therapeutic process
• It results in:
– Improved outcomes for clients and their families
– Increased opportunities for practitioners to
enhance their professional development
Questions & Comments