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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: – – – – 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: – – – – – 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 • • • • • 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 • • • • 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: – – – – – – 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