One
of the most difficult tasks of parenting a child or
teaching children is dealing with problem behaviors.
Problem behaviors range from the simple temper tantrum
exhibited by a three year old all the way up to very
complex, harmful behaviors that we often see with
children who have serious emotional challenges.
Many
problem behaviors are just developmental issues and
if we ignore them, the child eventually gives up on
them from lack of reinforcement, or outgrows the behavior.
Oftentimes behaviors can be dealt with just through
a simple conversation.
However,
sometimes we encounter very challenging behaviors
in children that are a result of their developmental
delays rather than just typical childhood issues.
This is particularly true with children on the autism
spectrum. If you are parenting or working with a child
who has a persistent and inappropriate problem behavior,
you are faced with the challenge of how to make that
behavior go away.
Destructive,
inappropriate, self-mutilating, disrupting or harming
peers are not behaviors that should be ignored. As
tempting as it may be to use a punishment, we know
that in the long run, punishment-based schemes are
ineffective, have bad side-effects and sometimes make
the problem worse, especially in children with special
needs. So, how do you extinguish (get rid of) a problem
behavior without using a punishment? DRO schedules.
Differential Reinforcement of Other Behavior schedules
are non-aversive (not punishment-based) behavior management
protocol that will extinguish specific problem behaviors.
DRO
schedules can be very complicated or very simple.
In this part one article, we'll start with the most
simple reinforcement schedule and a relatively simple
target behavior so you can get an idea as to how these
work.
Let's
use the example of Gabe, a second grade student in
a self-contained classroom for children with autism.
Gabe has a difficult time dealing with transition
times in class. Frequently when it is time to move
from one center to the next, he falls out of his chair,
screaming and rolling around on the floor, kicking
at things and even using his feet to remove entire
shelves of books and toys. This is obviously very
disruptive behavior. The classroom currently deals
with it by having two paraprofessional aides restrain
the child, then physically pick him up and drag him
kicking and screaming to the next learning station,
where they would try to distract him with new and
exciting opportunities and they simply wait out the
meltdown. This behavior has been occurring for months.
The behavior is the primary reason that the child
is in a self-contained classroom as opposed to being
in a mainstream classroom with his regular education
peers. A DRO schedule could help extinguish this behavior
in a matter of weeks and quite possibly allow the
child to be mainstreamed in with his peers, at least
for a portion of the day. Let's look at how we would
set this up.
Step
1: Identify the target behavior. We will use the
example listed above of Gabe who falls out of his
chair screaming during transition times in the classroom.
We will define our target behavior as "rolling around
on the floor while screaming". This is the behavior
that we are trying to extinguish, or get rid of.
Step
2: Get a baseline on the frequency of occurrence.
This means we have to determine how often this behavior
is displayed. You literally are going to watch and
count, during the day, how often the child falls out
of his chair and rolls around on the floor screaming.
During this observation, you can continue to deal
with him as you normally do. Our purpose at this point
is simply to get a frequency count. This usually takes
a full day, but you might want to get a baseline count
for a couple of days if the behavior occurs infrequently.
Let's
say in this example that we discover the child, on
average, falls out of his chair and screams twice
an hour. Remember this is not an exact time, it's
just an average time. He may have actually gone a
full hour without falling out of his chair, or he
may have done it 3 times in an hour, but on average
over the course of the day or two it is about twice
an hour. So our baseline is once every 30 minutes.
We will use this time when we start the DRO schedule.
Step
3: Find a reinforcer. For this first example let's
start with a very simple reinforcer. Perhaps the child
really enjoys holding a truck for 5 minutes, or maybe
he enjoys putting on a headset and listening to some
music, or maybe it's that he gets to sit with an iPad
and play a game for a few minutes. Choose something
that he really enjoys doing, and doesn't get an option
to do or have very often - something special and enjoyable.
I'm
not a fan of using food reinforcers, particularly
candy. We cause a lot of problems by using food as
reinforcers in childhood. But, in extreme cases, you
might have to use a food reinforcer. Do not use food
reinforcers that contain sugar, corn syrup, or artificial
sweeteners. Perhaps you could use a small piece of
string cheese, a bit of rice cake, olives, dried apple
pieces or grapes.
We
will get into more complicated reinforcement schedules
later, but for this first example we will just focus
on using a simple and immediate reinforcer. So in
this example let's suppose that we're going to use
the putting on headphones and listening to music for
one song, as a reinforcer.
Step
4: Begin reinforcing the child for doing anything
other than the target behavior for half of the baseline
time. This means that we are going to literally
set a timer, that the child can see, for one half
of our baseline time.
In
this example, since Gabe falls out of his chair and
screams on the floor, on average, every 30 minutes,
we are going to start with our timer set for 15 minutes.
(half of 30 minutes). Make it very clear to the child
that if he can sit in his chair and not fall out and
scream on the floor by the time the timer goes off
then he can have the reward.
If
Gabe can go for the 15 minutes without falling out
of his chair and screaming on the floor you administer
the reward, immediately. Use lots of verbal praise.
Explain the fact that "YAY" he did it. "That
was awesome. I knew you could do it. Here's your music
player. As soon as that song is finished, let's go
again and I'm setting the timer for another 15 minutes".
Etc. etc. Be prepared that this will be a busy day.
Every 15 minutes, you will need to set the timer and
administer a reward - at least during the sections
of the day where this is an issue (perhaps lunch,
recess, or pull-out times are not an issue).
It
is important to remember that we are reinforcing the
absence of the target behavior. This means that the
child can do anything during that 15 minutes OTHER
than the target behavior. So even if he exhibits another
inappropriate behavior we still administer the reinforcer
at the end of the time period. If he turns to his
neighbor and spits on them, throws something across
the room, or any other inappropriate behavior, we
are going to ignore (apart from dealing with the offended
classmate and/or distracting and ignoring as appropriate)
those because our focus is on our one specific target
behavior. When the timer goes off, if he has not fallen
out of his chair screaming on the floor, he is administered
the reward.
If
the child has multiple behaviors, we will deal with
the other behaviors in order of importance. This week
we are just dealing with this one target behavior.
In
extreme cases, you may have to do something called
"forcing a success". This is where you put
the child in a situation where he physically cannot
express the behavior. Perhaps an aide would sit holding
him to the chair for the 15 minutes, or if your work
setting uses seat belts for restraint or he's just
simply in a chair that's designed so it cannot be
gotten out of. We use this in extreme situations when
children do not quite understand the relationship
between not doing the behavior and getting the reward.
Step
5: Increase the time between reinforcers. Each
day, increase the time by double. So on day two, I
will set the timer for 30 minute increments. On day
3, I'll set it for an hour and so on. You will increase
the time until the child can go for the entire morning
without the target behavior and eventually the entire
day. This may take several days or possibly even a
couple of weeks.
Any
time there is a failure, this will be ignored at the
time the behavior is expressed and we will wait for
the timer to go off before addressing it. For example,
if 5 minutes into our timer the child falls out of
his chair rolling and screaming on the floor we will
do our best to ignore that behavior - perhaps moving
our attention to other children, having a third-party
restrain him if needed so that he doesn't hurt himself
or others but ignore the behavior to the best of your
ability. When the timer goes off ten minutes later,
then we will say to the child unfortunately he did
not get the reward this time. Always try to sound
disappointed rather than angry. You are on his team. "I'm sure you'll get it the next time. Let's reset
our timer and go again."
If
you are having multiple failures, you will need to
shrink your time shorter. In the beginning it is critical
that you get a success, no matter how short you have
to start the time period. But even as you move along,
you may have to back up on the time, if you start
to see more than one failure in a row. Depending on
the behavior, it can take 1 - 3 weeks to see it extinguished.
But the protocol does work.
This
is the simplest form of DRO schedules. There are many
others - more complex and some that target very hard
to extinguish behaviors, such as self-stimulating
behaviors which are so reinforcing themselves. During
DRO behavior intervention, we also co-work on redirecting
anxiety, communication, and other issues that are
at the root of the target behavior. We'll deal with
some of these in a future discussion.