Helping Parents With Challenging Children

editor-in-chief

David H. Barlow, PhD

scientific
advisory board

Anne Marie Albano, PhD

Gillian Butler, PhD

David M. Clark, PhD

Edna B. Foa, PhD

Paul J. Frick, PhD

Jack M. Gorman, MD

Kirk Heilbrun, PhD

Programs That Work
Robert J. McMahon, PhD

Peter E. Nathan, PhD

Christine Maguth Nezu, PhD

Matthew K. Nock, PhD

Paul Salkovskis, PhD

Bonnie Spring, PhD

Helping Parents
With Challenging
Children
POSITIVE FAMILY INTERVENTION

F a c i l i t a t o r G u i d e

V. Mark Durand Meme Hieneman

2008
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Copyright 2008 by Oxford University Press, Inc.

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All rights reserved. No part of this publication may be reproduced,
stored in a retrieval system, or transmitted, in any form or by any means,
electronic, mechanical, photocopying, recording, or otherwise,
without the prior permission of Oxford University Press.

Library of Congress Cataloging-in-Publication Data

Durand, Vincent Mark.

Helping parents with challenging children: positive family intervention: facilitator guide/V. Mark Durand, Meme Hieneman.
p.; cm. (ProgramsThatWork)
Includes bibliographical references.
ISBN 978-0-19-533298-8 (pbk.: alk. paper) 1. Behavior disorders in childrenTreatment. 2. Problem childrenBehavior
modication. 3. Child psychotherapyParent participation. I. Hieneman, Meme. II. Title. III. Series: Programs that work.
[DNLM: 1. Child Behavior Disordersprevention & control. 2. Behavior Therapymethods. 3. Educationmethods.
4. Parentseducation. WS 350.6 D949h 2008]
RJ506.B44D89 2008
618.9289142dc22
2007048238
ISBN-13 978-0-19-533298-8 Paper

1 3 5 7 9 8 6 4 2

Printed in the United States of America

on acid-free paper

iv
About ProgramsThatWork

Stunning developments in health care have taken place over the last
several years, but many of our widely accepted interventions and strate-
gies in mental health and behavioral medicine have been brought into
question by research evidence as not only lacking benet but perhaps
inducing harm. Other strategies have been proven eective using the best
current standards of evidence, resulting in broad-based recommendations
to make these practices more available to the public. Several recent devel-
opments are behind this revolution. First, we have arrived at a much
deeper understanding of pathology, both psychological and physical,
which has led to the development of new, more precisely targeted inter-
ventions. Second, our increased understanding of developmental issues
allows a ner matching of interventions to developmental levels. Third,
our research methodologies have improved substantially, such that we
have reduced threats to internal and external validity, making the out-
comes more directly applicable to clinical situations. Fourth, governments
around the world, health care systems, and policymakers have decided
that the quality of care should improve, that it should be evidence-based,
and that it is in the publics interest to ensure that this happens (Barlow,
2004; Institute of Medicine, 2001).

Of course, the major stumbling block for clinicians everywhere is the

accessibility of newly developed evidence-based psychological interven-
tions. Workshops and books can go only so far in acquainting respon-
sible and conscientious practitioners with the latest behavioral health
care practices and their applicability to individual patients. This new
series, ProgramsThatWork, is devoted to communicating these excit-
ing new interventions to clinicians on the frontlines of practice.

v
 The manuals and workbooks in this series contain step-by-step, detailed
procedures for assessing and treating specic problems and diagnoses. But
this series also goes beyond the books and manuals by providing ancillary
materials that will approximate the supervisory process in assisting prac-
titioners in the implementation of these procedures in their practice.

In our emerging health care system, the growing consensus is that

evidence-based practice oers the most responsible course of action for
the mental health professional. All behavioral health care clinicians
deeply desire to provide the best possible care for their patients. In this
series, our aim is to close the dissemination and information gap and
make that possible.

This facilitator guide and the corresponding parent workbook target

parents of children with challenging behavior. Challenging behaviors
are common and disruptive to the lives of children and their families.
They can negatively aect a childs developmental progress and the
functioning of the entire family. Families struggling with behavior
problems may have diculty completing parent training and following
through with interventions.

This guide describes an innovative combination of approaches aimed at

assisting parents who have particular diculty implementing treatments
for their child. It uses the principles of applied behavior analysis and pos-
itive behavior support (PBS) to teach parents how to eectively address
their childs problem behavior. Cognitive restructuring techniques are
also taught to help parents take a more positive approach to their childs
behavior and developmental challenges. The guide outlines step-by-step
instructions for guiding parents through the PBS process and encourag-
ing optimistic thinking. The corresponding workbook includes all the
materials parents need to participate in the training and carry out the
intervention strategies.

The Positive Family Intervention program can be used for a range of

behavior problems and in conjunction with treatment for other disor-
ders. This guide will be a welcome addition to the literature for facilita-
tors working with challenging youth and their families.
David H. Barlow, Editor-in-Chief,
ProgramsThatWork
Boston, Massachusetts

vi
References

Barlow, D. H. (2004). Psychological treatments. American Psychologist, 59,

869878.
Institute of Medicine (2001). Crossing the quality chasm: A new health system
for the 21st century. Washington, DC: National Academy Press.

vii
Acknowledgments

A number of professionals guided and directed this work over the years
and we are deeply indebted to them. We would especially like to thank
Carolyn Kesslerwhose dissertation served as the pilot project for this
approachand the therapists who field-tested this protocol (Melissa
Zona, Shelley Clark, Laura Casper, and Kristin Knapp-Ines), as well as
Bobbie Vaughn who contributed to the early development of the proto-
col. We would also like to express our gratitude to the many parents who
have taken part in our research and taught us so much. Support and
funding from the University of South Florida St. Petersburg and the
U.S. Department of Education Office of Special Education Programs
assisted greatly with this work. The developmental editor for this book
Julia TerMaathelped wrestle and make sense of a tremendous amount
of information that went into these plans and we truly appreciate her
patience and guidance.

viii
Contents

Chapter 1 Introductory Information for Facilitators 1

Chapter 2 Identication and Assessment of Challenging

Behavior 15

Chapter 3 Session 1: Introduction and Goal Setting 21

Chapter 4 Session 2: Gathering Information 39

Chapter 5 Session 3: Analysis and Plan Design 53

Chapter 6 Session 4: Preventing Problems 63

Chapter 7 Session 5: Managing Consequences 75

Chapter 8 Session 6: Replacing Behavior 83

Chapter 9 Session 7: Putting the Behavior Support Plan

in Place 93

Chapter 10 Session 8: Monitoring Results and Wrap-up 107

PBS Resources 115

References 125

About the Authors 133

ix
This page intentionally left blank
Chapter 1 Introductory Information for Facilitators

Background Information and Purpose of This Program

This book is designed as a resource for professionals who work with

families that have a child who displays signicant challenging behaviors.
The program uses the principles of applied behavior analysis and posi-
tive behavior support (PBS) to address child behavior problems.
Challenging behaviorsincluding aggressive, disruptive, and socially
inappropriate behaviorsare highly prevalent, especially among chil-
dren with disabilities. These behaviors may disrupt all aspects of the
childrens and familys lives, including activities at home, in the commu-
nity, and at school. It is generally agreed that meaningful progress on
educational and social goals are in serious jeopardy unless challenging
behaviors can be signicantly reduced. In addition to the impact on the
childs progress, the eects of these behaviors on family life can be over-
whelming. Typically, families completely adjust their schedules and
life patterns to compensate for the disruption that ensues from these
behaviors. All aspects of a familys life may be negatively aected by a
childs behavior problems, from day-to-day activities such as shopping
to marital satisfaction (Plant & Sanders, 2007).

Unfortunately, the challenges posed by a child signicant behavior

problems and their eects on the family can interfere with the success
of behavioral parent training. These families are at increased risk for
dropping out of treatment or otherwise not fully participating in
intervention eorts (Durand, 2007). The program outlined in this
guide is designed to directly address these obstacles and assist families
in their eorts to help their children. We imbed into the treatment an
adaptation of cognitive-behavioral therapy (CBT) designed to train

1
 parents how to better approach their child, with the goal of helping
them persist with treatment until they experience success with the
intervention.

This program is designed to be used with family members who have

one or more children displaying severe challenging behavior. It is suit-
able for families with children of dierent ages, as young as 2 to 3 years
old to adult children living at home. It can also be used in conjunction
with treatment for developmental disabilities and other childhood dis-
orders in which challenging behavior becomes an important target of
treatment (for example, ADHD or oppositional deant disorder).
Research suggests that the interventions are eective across a range of
developmental disabilities, including autism spectrum disorders
(Durand, 2007). In addition, although participation by two parents is
desired, the intervention can be eective with one parent as well as with
single parents or extended family members (for example, grandparents
when they are the primary caregivers).

Information on Challenging Behavior

Challenging behaviors often represent a major obstacle for children with

disabilities in their eorts to fully participate in meaningful educational
and community activities. There is ample evidence that these behaviors
serve as obstacles when attempting to place children in community set-
tings (Eyman & Call, 1977; Jacobson, 1982), and they increase recidivism
signicantly for those individuals referred to crisis intervention programs
from community placements (Shoham-Vardi et al., 1996). Challenging
behavior has a negative impact on such important activities as family life
(Cole & Meyer, 1989), educational activities (Koegel & Covert, 1972),
and employment (Hayes, 1987). In one of the largest studies of its kind,
researchers examining almost 10,000 children found that the single best
predictor of early school failure was the presence of behavior problems
(Byrd & Weitzman, 1994). The presence of behavior problems was a bet-
ter predictor of school diiculties than factors such as poverty, speech
and hearing impairments, and low birth weight. One study found that
almost 40% of preschool teachers reported expelling a child each year
due to behavior problems (Gilliam & Shahar, 2006). Additionally, some

2
 problem behaviors can pose a physical threat to children and those who
work with them.

Assessing the nature and function of these behaviors is essential to suc-

cessful treatment planning; therefore, instruments to identify and assess
challenging behavior are addressed in Chapter 2.

Development of This Treatment Program and Evidence Base

The program outlined in this guide was initially developed at the

University at Albany, State University of New York, in the mid-1990s
and expanded at the University of South Florida, St. Petersburg, in the
mid-2000s. We have used information on behavioral function to teach
alternative behaviors and rearrange environments. This approach has
been enhanced and expanded by a number of researchers; when com-
bined with broader supports, it is collectively labeled positive behavior
support. The goal of our research was to substantially reduce challeng-
ing behavior in children and youth with developmental disabilities
in an eort to produce socially signicant improvements in the lives
of these individuals and their families. The background research on
positive approaches to reducing behavior problems revealed that,
despite clinical successes, some families were unable or unwilling to
complete the parent training required to intervene with their children.
Here we briey review the evidence base for the eectiveness of these
interventions followed by a summary of our work on improving reten-
tion and outcomes for these treatments.

Positive Behavior Support

Positive behavior support (PBS) is an approach based on the principles of

applied behavior analysis (ABA) designed to produce meaningful changes
in behavior within the context of typical environments and routines. The
aim was to couch eective ABA practices within a broader system of sup-
port that values the rights and needs of people with disabilities and par-
ticipation of stakeholders in the process. Instead of single interventions
(e.g., time-out, rewards), PBS involves multi-component treatment

3
 packages that combine the most eective strategies (Dunlap et al., 2000;
Horner et al., 1990; Koegel, Koegel, & Dunlap, 1996; Sugai et al., 2000).

PBS has a set of key features that will be introduced in Session 1 and
elaborated throughout this protocol. In this introductory section, we
provide a brief summary of those features with references to relevant lit-
erature to assist facilitators wishing to expand their knowledge. First,
PBS involves the identication of consequences maintaining problem
behavior and other associated environmental factors (Day, Horner, &
ONeill, 1994; Durand & Crimmins, 1988; Iwata, Dorsey, & Slifer,
1994; ONeill et al., 1997). Using a process of functional assessment,
the purposes a behavior is serving for the child may be gleaned
(e.g., gaining attention, avoiding diicult tasks). With this information,
more eective strategies can be identied that allow children to adapt
to environments and meet their needs in more productive ways (Carr
et al., 1999). Methods for collecting data and completing functional
assessment are presented in Sessions 1 through 3.

Second, PBS interventions involve a combination of components based

on the functional assessment: prevention, teaching, and management
(Durand, 1990; Hieneman, Childs, & Sergay, 2006). These components
are described in Sessions 4, 5, and 6. Prevention involves modifying cir-
cumstances that provoke problem behavior (i.e., antecedents, setting
events) to reduce temporarily the likelihood of the behavior (Horner,
Vaughn, Day, & Ard, 1996; Luiselli & Cameron, 1998). Demonstrations
of eective antecedent-based interventions have included curricular
modications (Dunlap, Kern-Dunlap, Clarke, & Robbins, 1991), incor-
poration of choice or preference (Blair, Umbreit, & Bos, 1999; Shogren,
Fagella-Luby, Bae, & Wehmeyer, 2005), and introduction of neutraliz-
ing routines to diminish problem behavior (Horner, Day, & Day, 1997).
Increasingly, preventive strategies are being used within the context
of family homes to improve overall structure (Boetcher, Koegel, &
McNerney, 2003; Bushbacher, Fox, & Clarke, 2004).

Teaching involves identifying specic replacement behaviors that serve

the same function as the problem behavior and encouraging a child
to use these behaviors in lieu of maladaptive behavior (Carr et al.,
1994; Durand, 1990; Meyer & Evans, 1990). Specic skills can include
independence in daily living skills, methods for tolerating situations

4
(e.g., waiting), andpossibly most importantcommunication.
Management involves controlling access to reinforcers (e.g., attention,
escape) so that they are available for only positive (not problem)
behavior. A foundation of PBS that combines its components and is
well documented in the research literature is functional communication
training (FCT). Because of its importance and level of empirical sup-
port, we will describe it in greater detail in the following section.

The nal feature of PBS that is consistently described in the literature

is an eort to achieve broader lifestyle changes, rather than just address-
ing discrete behavior (Risley, 1996). Because of this vision, PBS incor-
porates self-determination and person-centered planning (Kincaid,
1996; Wehmeyer, Baker, Blumberg, & Harrison, 2004), as well as an
explicit emphasis on collaboration among the people who will actually
implement the plan. Eorts to design and implement methods for eval-
uating improvements in quality of life (McClean, Grey, & McCracken,
2007; Smith-Bird & Turnbull, 2005) are beginning to emerge in the
literature, but team cooperation and lifestyle change have not been
implemented or investigated to the extent that other features have been
(Carr, 2007; Meyer & Evans, 1993; Snell, Voorhees, & Chen, 2005).
Further research in these areas is therefore warranted. Unlike the other
elements of PBS, these features are not addressed within particular ses-
sions of this guide but are instead interwoven through the materials by
encouraging involvement of other people in the process, calling atten-
tion to broad goals, and continually considering factors that might
make plan implementation more successful.

A great deal of research using single-subject designs supports the

eicacy of a range of positive behavioral parent training approaches to
reduce challenging behavior (e.g., Clarke, Dunlap, & Vaughn, 1999;
Dunlap & Fox, 1999; Koegel, Steibel, & Koegel, 1998; Lucyshyn,
Albin, & Nixon, 1997; Lucyshyn et al., 2007; Moes & Frea, 2000,
2002; Vaughn, Clarke, & Dunlap, 1997; Vaughn, Wilson, & Dunlap,
2002). Lucyshyn and colleagues, for example, reported on a 10-year
follow-up of their work with the family of one girl and found mainte-
nance of treatments gains (Lucyshyn et al., 2007). One comprehensive
analysis of the research on positive behavioral support concludes that
from one-half to two-thirds of the outcomes from single-subject studies
are successful when carried out completely (Carr et al., 1999). As a

5
 result, PBS has become the foundation of many intervention and par-
ent support practices (Hieneman, Childs, & Sergay, 2006; Lucyshyn,
Dunlap, & Albin, 2002); however, actual implementation of positive
behavior support with families in integrated, real-life situations is com-
plicated and requires attention to a variety of factors to be successful.

Functional Communication Training

One technique frequently used in positive behavior support plans

involves replacing behavior problems with more acceptable alternatives
an intervention called functional communication training (FCT).
FCT has received extensive empirical support in reducing the frequency
of challenging behavior. It involves assessing the function of chal-
lenging behaviors and teaching functionally equivalent responses, such as
communication, which serve the same function as the childs problem
behavior (e.g., Carr & Durand, 1985; Durand, 1990). FCT is now one
of the most commonly used interventions for challenging behavior
(Halle, Ostrosky, & Hemmeter, 2006; Matson, Dixon, & Matson, 2005).
FCT is one of the few skill-focused behavioral interventions cited as hav-
ing extensive support from initial eicacy studies (see Smith et al., 2007).

Durand and Carr (1992) compared the eectiveness of FCT with

time out from positive reinforcement for the attention-maintained
behavior problems in two groups of children. An initial nding was
that both interventions were successful in reducing these problem
behaviors. However, further analysis showed that, when the children
were in the presence of a teacher who was unaware of the dierent
interventions that had been used, only children who had received
FCT continued to display low levels of problem behavior. These chil-
dren continued to request (and receive) attention, which appeared to
account for the eectiveness of this intervention even with untrained
individuals.

Important comparative treatment research is now evaluating how

FCT compares with other behavioral interventions. Hanley and col-
leagues, for example, compared the eectiveness of FCT with non-
contingent reinforcement (NCR) on the multiple behavior problems
of two children (Hanley, Piazza, Fisher, Contrucci, & Maglieri, 1997).

6
 They found that both interventions initially reduced problem
behaviors but that the participants demonstrated a preference for
FCT. This advantagepreference by consumersis an important
aspect of clinical utility.

One study more directly addressed the ability of FCT to be successful

in typical community settingsa key goal of PBS. Durand (1999) eval-
uated the eectiveness of FCT as an intervention for the problem
behavior exhibited by ve children with severe disabilities both in
school and in the community. Following an assessment of the function
of their problem behavior, the children were taught to use assistive com-
munication devices in school to request the objects and activities that
presumably were maintaining their behavior. The results indicated that
not only did the children use their devices successfully, but the interven-
tion also reduced their problem behavior outside of school and with
untrained community members.

Limitations

Although evidence exists that PBS and, more specically, FCT can be
eective, there may be limits to its impact in community settings. These
limitations may be related to the acceptability of the treatments and/or
the degree to which the interventions are appropriate to the settings and
circumstances (Albin et al., 1996; Kazdin, 1981; Reimers, Wacker, &
Koeppl, 1987). Failure to design plans appropriately or provide suicient
support and guidance to follow through can impede generalization and
maintenance.

The usefulness of treatments outside of specially designed settings is an

essential component that will need to be more fully addressed in the
coming years. Too often for people with disabilities, interventions are
implemented that cannot be used in regular education classrooms or
in typical community settings. Two recent studies by Hieneman and
Dunlap (2000, 2001) surveyed individuals providing PBS in commu-
nity settings and resulted in the identication of a range of potential
factors contributing to its success and failure. Among those factors, the
buy-in and capacity of the individuals using the plans emerged as most
important.

7
 The applicability of these interventions to the broader population,
referred to as clinical utility, is of particular concern (Durand & Rost,
2005). Are our treatments eective with all families who have children
with severe behavior problems, or are there subgroups with whom we
are more or less successful? For example, how many families give
up on eorts to assist their children (Munro, 2007)? Our clinical
experience and research from other areas of study outside of the dis-
abilities eld suggest that up to 50% of families refuse participation in
parent training for a variety of reasons (e.g., Irvine et al., 1999). For
example, between 40% and 60% of families who begin treatment
related to child mental health issues terminate services prematurely
(Kazdin, 1996). It is unclear, however, how many families of children
with more severe cognitive and developmental disorders who begin
behavioral parent training drop out or otherwise do not complete
intervention.

To begin to answer this question, we conducted a review of the behav-

ioral intervention literature to more accurately gauge these rates
(Durand & Rost, 2005). Unfortunately, less than 3% of these studies
noted if participants dropped out from their research. In other words,
in more than 97% of these studies no mention was made of any partic-
ipants who did not nish treatment. In addition, none of the handful
of studies that did mention drop-out analyzed the characteristics of
those not completing the research, and no studies indicated whether
any participants or their guardians refused to participate. The relative
lack of information on attrition leaves open questions about the gener-
alizability of this research to the population of persons exhibiting chal-
lenging behavior. In other words, are behavioral interventions only
successful with highly motivated families and educators? We, as yet, do
not know the answer to this question.

To gather information on these children and their families, we conducted

a three-year longitudinal prospective study to examine factors that might
contribute to later behavior problems in young children and their impact
on families (Durand, 2001). One hundred forty children who were 3 years
of age and who had a cognitive and/or developmental disability and dis-
played behavior problems were identied and followed for up to three
years. A number of factors were measured to assess their role in predicting
which children would later display more severe behavior problems. These

8
 included measures of IQ, DSM-IV diagnosis, child behavior problems,
child adaptive skills (communication and social skills), and a variety of
family indicators (e.g., stress, attitudes, etc.).

The most signicant factor in predicting later behavior problems was

not the severity of a childs problems at age 3, nor was it the extent of
cognitive or adaptive behavior decits initially displayed by the child.
Rather, the best predictor of which children would have more severe
problems three years later was a measure of parental optimism or pes-
simism. In other words, parents who had limited condence in their
ability to inuence their childs behaviors by the time the child was
3 years of age were most likely to have children with more diicult
behaviors later in life. For example, if parents resisted placing
demands on their children for fear of escalating behavior problems,
then children were more likely to develop severe behavior problems as
they became older. This nding was true despite the fact that some of
the children with more optimistic parents initially had more severe
decits and behavior problems. It appeared that parental optimism
may have served as a protective factor for these children, and parental
pessimism may put a child more at risk for developing severe behav-
ior problems.

Our data on parental pessimism suggest that we may be overestimat-

ing our success rates if we report data only on those families who
complete our interventions. A more conservative view of our out-
comes is that behavioral interventions are eective with that portion
of the population who has the ability and/or the motivation to com-
plete all aspects of our intervention. Viewing the behavior of these
families from a functional perspectiveasking what it is about our
interventions that increase resistance and drop-out rates among some
familiescould result in an important reconceptualization of our
intervention process.

Positive Family Intervention

If an important obstacle to successful behavioral parent training is the

pessimistic attitudes of some family members, the logical next ques-
tion is, Can we intervene with these families in a way that will help

9
 them feel more optimistic about their abilities to work with their chil-
dren? In turn, if we can successfully intervene with these families to
assist them with this attitudinal barrier, will it help them continue
in and complete behavioral parent training, and will this lead to
improvements in child behavior? The answers to these questions have
been tested in a study of children with behavior problems and their
families.

The Positive Family Intervention Project is a multisite study designed

to develop and assess the eectiveness of a treatment package that
integrates cognitive-behavioral intervention with function-based
behavioral parent training (referred to as Positive Family
Intervention, or PFI). Families from throughout the Tampa Bay area
of Florida (through the University of South Florida, St. Petersburg)
and the Capital region in New York (through the University at
Albany, State University of New York) participated in this project.
At-risk families with high scores on our measure of pessimism were
assigned to one of two groups: 1) family members who received train-
ing in PBS for their child and 2) individuals who received PBS along
with a cognitive-behavioral component (PFI). We evaluated if PFI
would increase family participation in training and if it would suc-
cessfully prevent child behavior problems from escalating into more
severe problems. Follow-up of the children is being conducted up to
two years following initial intervention at home, and initial results
suggest that all families who successfully complete sessions observe
meaningful reductions in their childs challenging behaviors.

PFI is a clinically based approach to provide family members with the

skills they need to cope with the stressors associated with every day life
along with the added stress of having a child with signicant challenges.
More specically, we adapt cognitive-behavioral intervention techniques
to meet the specic needs of these families and combine this approach
with the components of PBS. Fortunately, there is work under way
addressing pessimism, through learned optimism, and the need for
some people to address feelings of being out of control. This research
appears to be an invaluable addition to our traditional approaches for
helping these families. Seligman (1998), for example, outlines a treat-
ment protocol that focuses on the way people view events and attempts
to provide them with more adaptive styles. Research on this cognitive-

10
 behavioral therapy approach suggests that signicant improvements can
be observed in persons with pessimistic styles, which, in turn, results in
improvements in such areas as depression.

PFI is an adaptation of PBS, integrating Seligmans work for use with

families of children with disabilities and challenging behavior. For
example, in our preliminary work, we nd that parents who score high
on a measure of pessimism might describe a childs diicult trip to the
supermarket this way: Shopping with my child is a disaster. On the
other hand, parents scoring high on optimism might describe it this
way: My child is not ready yet for long shopping trips. The former
pessimistic description suggests that the problem is pervasive (all shop-
ping is a problem) and permanent (shopping may never get better),
while the latter optimistic view is local (it is just long shopping trips
that are a problem) and temporary (someday he will be ready).
Presenting families with their styles of describing situations and having
them practice more adaptive optimistic stylesreferred to as positive
family interventionis proving to be successful. More than 70% of
pessimistic families who receive the added components in PFI follow
through with parent training.

Background of Facilitators

Facilititators require knowledge of the principles of applied behavior

analysis and positive behavioral support, as well as hands-on experience in
conducting functional behavior analyses and implementing multicom-
ponent interventions. In addition, it is helpful if facilitators have some
training in working with cognitive-behavioral therapy techniques.

Additional clinical skills, such as active listening, often need to be devel-

oped. With proper training, this program can be successfully delivered
by real-world providers, such as social workers, school counselors, and
applied behavior analysts.

In preparing to facilitate this program, facilitators should review the

objectives, content, and materials. If there are areas in which a facilita-
tor has limited experience or training, she should check the reference
list (at the back of this guide) or obtain additional training.

11
Outline of This Treatment Program

This treatment program is typically delivered in eight weekly sessions of

90 minutes each. More or less time can be spent on sessions as needed,
and follow-up sessions may be required. Each session builds on the con-
tent of the last; therefore, it is important to follow the order as outlined
in Table 1.1. Fidelity checklists are included in an appendix to assist with
treatment adherence. Throughout the sessions, this guide provides rec-
ommendations for using assessments with families; however, facilitators
might want to supplement these instruments with others discussed in
Chapter 2.

By the end of the program, parents will have worked through all ve
steps of positive behavior support: Step 1) Establish goals, Step 2) Gather
information, Step 3) Analyze patterns, Step 4) Develop a plan, and
Step 5) Monitor results. Throughout the sessions, parents engage in cog-
nitive-behavioral therapy to increase their optimism about their childs
behavior and their ability to follow through with the intervention.

In each session, the facilitator reviews the previous session and asks par-
ents if they have any questions regarding the content from the previous

Table 1.1 Outline of Treatment Protocol

Behavior Support Plan Cognitive-Behavioral Integration

Session #1 Introduction and Goal Setting Identify situations and associated self-talk
Session #2 Gathering Information Determine the consequences of beliefs on
behavior
Session #3 Analysis and Plan Design Use a distraction to interrupt negative
thinking
Session #4 Preventing Problems Dispute current thinking (accuracy and
impact)
Session #5 Managing Consequences Substitute with more positive, productive
thoughts
Session #6 Replacing Behavior Practice skills developed for recognizing and
modifying pessimistic self-talk
Session #7 Putting the Behavior Support Continue practicing skills developed for
Plan in Place recognizing and modifying pessimistic
self-talk
Session #8 Monitoring Results and Wrap-Up Help identify strategies to maintain positive
changes in self-talk

12
 week. The facilitator then goes over the parents Weekly Progress Report
and homework to determine what has been accomplished. If parents
have not completed all of the homework, the facilitator assists them in
doing so. Throughout this review, the facilitator provides feedback and
guides parents to consider other ideas as necessary.

Prior to, following, or during the homework review, the facilitator

leads the parents in a discussion of their self-talk for the previous
week. This is initiated by asking parents to share events they perceived
to be diicult and successful and then to describe what they were
thinking during those events. Each week, the facilitator presents a
new concept and guides the parents to examine their self-talk based
on the concept: consequences of negative thinking, disputation and
distraction methods, and, nally, reattribution. Once all of the ele-
ments have been addressed, the facilitator continues to review these
concepts for the remaining sessions of the training, helping parents to
evaluate and modify their thinking as necessary. These discussions are
also facilitated during the sessions by probing self-talk when it seems
to be relevant.

After outlining the goals of the session and presenting the content,
facilitators provide examples as needed and help parents to apply the
ideas to their own children, families, and circumstances. Facilitators
should encourage parents to write down the ideas they generate on the
homework forms in the workbook. Facilitators should also document
the relevant information shared by the participants in the notes sec-
tion of the delity checklists; these notes can then be used to facilitate
the Application sections that follow and provide a starting point for
future discussions. At the end of each session, facilitators go over the
homework instructions and forms, making sure parents are prepared
to complete them.

Working with Parents and Families

Sessions can be attended by individual parents or caregivers, or parents

and caregivers together as a team. Carrying out the intervention will
require the parent to involve other family members and people in
the childs life (e.g., teachers, grandparents, babysitters). Cooperation

13
 among those involved in the childs care is essential to the success of
the behavior plan. Troubleshooting with families and their teams might
be necessary if one or more members have diiculty collaborating
eectively.

Participants will vary in their background and ability to grasp the con-
cepts presented. Therefore, facilitators should pace material and adjust
their language based the needs of the participants. The examples used
should be relevant to the child and the family. It might be necessary for
facilitators periodically to shift between topics based on the participants
needs.

Use of the Workbook

The corresponding workbook aids parents in implementing this pro-

gram for their child. Every chapter of the workbook corresponds to a
session of treatment as outlined in the guide. It includes all of the mate-
rials parents will need to participate in the sessions, including goals for
each session, a review of the content to be covered in session, and
instructions and forms for completing the homework assignments.
Worksheets are included for each step of PBS, as well as Self-Talk
Journals for cognitive-behavioral therapy. In addition, Weekly Progress
Reports help track how families are using what they have learned and
any progress that is occurring with their childrens behavior. (Additional
copies of forms can be photocopied from the workbook as needed.)

As parents must act as the primary therapist with their child, use of the
workbook helps ensure their active participation. Encourage parents to
attend all the sessions and complete the homework. If parents are having
any trouble understanding, give additional examples or spend more time
as needed. Stress to parents that their persistence is crucial to successful
intervention of their childs behavior problems. As children with
signicant challenging behaviors often continue to need support, the
workbook is a valuable resource for parents to refer to after therapy has
ended.

14
Chapter 2 Identication and Assessment of Challenging
Behavior

Assessment is an essential feature of behavioral interventions and, there-

fore, of the Positive Family Intervention program. A number of assess-
ment instruments have been developed to 1) identify the nature and
severity of behavior problems and 2) identify the functions challenging
behaviors serve for these individuals (Durand & Christodulu, 2006).
Using these instruments, it is possible to identify children and families
in need of this type of intervention, select appropriate strategies based
on the purposes of behavior, and evaluate outcomes of intervention.
Assessment procedures for identifying behavioral problems and their
functions are generally placed into the following categories: interviews,
behavior rating scales, self-report measures, and direct observation pro-
cedures (Durand & Christodulu, 2006; Johnson, 1998; Paclawskyj,
Kurtz, & OConnor, 2004). The purpose of this chapter is to describe
various methods and instruments that may be used to assess behavior
and, therefore, maximize the eectiveness of this intervention.

Interviews

A history of how diculties develop helps determine the nature of the

presenting problem. To make an accurate assessment, it is essential to
gather information on the course and context of how behavior prob-
lems developed. However, because many individuals with disabilities
have diculties with language, relevant information is generally gath-
ered from interviews with family members or caregivers. Levitas and
Silka (2001) outline two dierent, but equally valid, approaches to
gathering information: a more traditional approach that begins with
the presenting problem and proceeds to a developmental history,

15
 and an alternative approach that starts with gathering a complete
developmental history and progresses to the current concern. A clear
advantage of conducting interviews is the ability to gather a signicant
amount of information in a short period of time (Rush, Bowman,
Eidman, Toole, & Mortenson, 2004).

Behavior Rating Scales

Administering rating scales to caregivers can be a cost-eective method

for obtaining reliable and valid assessment information (Matson et al.,
2003). Although behavior scales created for typically developing
childrensuch as the Child Behavior Checklist (CBCL) (Achenbach &
Edelbrock, 1991), the Preschool Behavior Questionnaire (Behar &
Stringeld, 1974), and the Conners Rating Scales-Revised (CRS-R)
(Conners, 1997)have been used with children and adolescents with
mild disabilities, the measures may be insensitive and inappropriate for
assessment of children with more severe impairments (Johnson, 1998).
The Developmental Behavior Checklist (DBC) (Einfeld & Tonge, 1989),
an adaptation to the CBCL, includes items more specic to children with
developmental disabilities. Two scales developed specically for use with
individuals with disabilities are the Behavior Problem Inventory (Rojahn,
1989) and the Aberrant Behavior Checklist (Aman & Singh, 1986). An
additional scale developed for the behavioral assessment of children and
adolescents with developmental disorders is the Nisonger Child Behavior
Rating Form (CBRF) (Aman, Tass, Rojahn, & Hammer, 1996).

The Scales of Independent Behavior-Revised (SIB-R) (Bruininks,

Woodcock, Weatherman, & Hill, 1996) is an adaptive skills assessment
covering the full range of skills across the lifespan (from infancy to
80 years and older). Several forms of the SIB-R are available for varying
needs: the Full Scale (includes assessment of motor skills, social interac-
tion and communication skills, personal living skills, and community
living skills), the Problem Behavior Scale (internalized maladaptive
behavior, asocial maladaptive behavior, externalized maladaptive
behavior), the Short Form, and the Early Developmental Scale (infancy
through 8 years). A General Maladaptive Behavior Index on the SIB-R
provides for an assessment of the severity of challenging behaviors.

16
 Rating scales typically have better psychometric properties than inter-
views and can recognize low-frequency behaviors. On the other hand,
rating scales rely on recollections, which are subjective in nature and
subject to bias (Rush et al., 2004).

Direct Observation Procedures

Behavioral observation is an instrumental part of assessment. Direct

observation can occur in either naturalistic conditions (e.g., observing
the child in her home) or analogue conditions (e.g., observing the
child in a setting similar to her home) (Bielecki & Swender, 2004).
Assessment in the natural environment is preferable as results of the
observation may generalize better across setting and time (Gettinger &
Kratochwill, 1987). Although structured observations yield more
objective and reliable data than subjective measures (e.g., interviews
and rating scales), conducting observations is generally more costly and
time-consuming. In addition, the presence of an observer can cause
reactivity with the individual being observed.

Important considerations for direct observation procedures are identify-

ing and operationally dening the target behaviors, determining the
duration of the observation session (e.g., frequently occurring behaviors
may be assessed in short observations, while infrequently occurring
behaviors require longer periods of observation), and selecting the
observation schedule (e.g., continuous vs. sampling) (Rush et al., 2004).
If there is uncertainty as to when a behavior occurs or under what con-
ditions, other assessments can be useful. In this protocol, we share a few
simple tools for gathering data on frequency, duration, and severity of
problem behavior, but the applied behavior analytic literature is replete
with other alternatives for direct observation that may be useful.

Functional Assessment

In addition to using assessment to identify the presence and severity of

challenging behavior, progress has been made in developing assessments
to determine the functions of these behaviors. Because many problem

17
 behaviors are related to behavioral function (e.g., escape from the
demands of others or seek attention from others), a comprehensive
assessment of maladaptive behavior should include a functional assess-
ment of behavior. A variety of techniques assist clinicians, educators,
and families in determining the role of antecedent and consequent
inuences on behavior. This information is essential for proper treat-
ment design.

There are a number of functional assessment strategies that are useful

for determining the function of behavior, including functional
analyses, ABC charts, and a variety of rating scales. A functional
analysismanipulating aspects of the environment to assess behavior
changeis frequently cited as the best method for determining the
function of a behavior problem (Mace, 1994). However, there are also
a number of issues to consider prior to conducting this type of assess-
ment (Durand, 1999). One issue is the ability to manipulate certain
conditions. There are certain inuences that you cant or wouldnt
manipulate or change in order to perform a functional analysis.
Factors such as some illnesses and disrupted family life can certainly
aect behavior problems, but they cant or shouldnt be turned on and
o to assess their inuence.

Another concern involves the ethics of conducting a functional analysis.

There are circumstances you could create that might prompt or increase
problem behavior, but would be distressful or even dangerous. In many
instances, deliberately increasing a severe behavior problem in order
to assess it (e.g., by reinforcing challenging behavior) can be questioned
on ethical grounds. In these cases, assessment that does not involve
manipulation (and subsequent increases in challenging behavior) would
be recommended (for a more detailed discussion of these issues, see
Durand, 1993).

One useful technique is referred to as an ABC assessment. In this assess-

ment, the events that immediately precede a behavior (A), the target
behavior (B), and the events that immediately follow a behavior (C) are
recorded. With this method, you can analyze patterns in the entries to
determine if there are particular circumstances in which the behavior is
more likely to occur. We provide open-ended ABC recording formats in
this protocol; however, there are other ABC formats that allow coding of

18
the circumstances surrounding the behavior (e.g., the Functional Analysis
Observation Form, ONeill et al., 1990). A scatter plot is a practical
tool for assessing low-frequency behaviors or behaviors that occur in
bursts, and it assists with identifying patterns of responding (Touchette,
MacDonald, & Langer, 1985). Scatter plots allow examination of the fre-
quency of behavioral occurrences across activities or times of day and are
also useful for recognizing changes in behavior patterns.

Interview formats designed specically for obtaining information on the

perceived functions of problem behavior and other variables (e.g., eco-
logical, curricular) that may be contributing to its occurrence are also
valuable. In our protocol, we simply provide a set of open-ended ques-
tions; however, there are other well-developed tools. Two examples, the
Questions About Behavioral Function (QABF) (Paclawskyj, Matson,
Rush, Smalls, & Vollmer, 2000) and the Functional Analysis Interview
Form (FAIF) (ONeill, Horner, Albin, Storey, & Sprague, 1990), are use-
ful alternatives to conducting analogue functional analyses.

The one rating scale with the most research support is the Motivation
Assessment Scale (MAS): a questionnaire that is administered to teach-
ers, paraprofessionals, family members, or anyone else who has a great
deal of contact with the child (Durand & Crimmins, 1988, 1992). The
MAS asks questions that determine where, when, and under what con-
ditions problem behaviors occur and determines their motivations. It is
available free online at http://www.monacoassociates.com/mas/
MAS.html. Information from the MAS, along with other forms of
functional behavioral assessments, is used to design plans for reducing
the behavior problems.

More research is needed for the tools described in this section in order
to demonstrate and improve their psychometric properties (e.g., relia-
bility and validity). In the meantime, however, they are the most useful
resources for assessing the nature and severity of problem behavior and
conducting functional assessments.

19
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Chapter 3 Session 1: Introduction and Goal Setting

(Corresponds to overview chapter and session 1 of the workbook)

Materials Needed

Self-Talk Journal Session 1 form

Establishing Goals form

Dening My Childs Behaviors of Concern form

Counting Behaviors form

Timing Behaviors form

Rating Behaviors form

Frequency Graph form

Weekly Progress Report form

Outline

Introduce the training program

Discuss importance of thoughts and feelings

Give background and denition of positive behavior support

(PBS) as foundation of the program

Present key features of PBS and the program

Give overview of PBS process

Discuss getting others involved

21
 Help parent establish goals

Dene behaviors of concern

Present options for keeping track of behavior

Discuss crisis planning (optional)

Assign homework

Introduction to Training

Explain the purpose of the sessions and what to expect over the course
of the training. Answer any questions as needed. You may want to use
the following dialogue:

The purpose of these sessions is to teach you how to understand and

address your childs problem behavior using the best available
scientically tested assessments and interventions. Because you are
such an important part of this process, we will also be getting to
know you and how you think about your childs behavior. By exam-
ining your self-talk, we hope to be able to help you be more produc-
tive and optimistic when approaching your childs behavior.

Remind the parent that anything he shares with you will be condential;
you will not repeat it to other people or use it in any way unless he gives
you permission. Let the parent know that you may take notes during the
session; the notes are simply to help you remember important things the
parent says so that you can discuss them later as needed.

Preview the overall agenda for the training sessions and the topics to be
addressed within this rst session. Refer to the parent workbook,
explaining how it will be used for homework and self-study.

Importance of Thoughts and Feelings

Tell the parent that the sessions will include discussions regarding his
thoughts and feelings and explain why this is important. The following
dialogue may be helpful:

22
 In addition to teaching you how to develop a plan for your child, we
will be asking you to share your thoughts and feelings about your
childs behavior. We do this for a couple of reasons. First, to help you
create a good plan for your child and family, we need to get to know
you and what is important to you. Second, we realize that our
thoughts can aect our feelings and behavior. Exploring your
perceptions as we go through the process may help you to be more
successful and better able to overcome any challenges you face.

Inform the parent that the way in which you will approach this is by
discussing what he thinks and feels during each of the sessions, as well
as having him record his thoughts and feelings between sessions.
Introduce the Self-Talk Journal (refer to the parent workbook). Provide
an opportunity for the parent to ask any questions.

Explain that during this session you will focus on identifying what the
parent thinks and feels when things are going well and when things are
particularly challenging. You will help the parent determine what situ-
ations prompt positive and negative self-talk.

Application

Have the parent list areas of diculty and success his child has. Give
him a choice of starting with the childs successes or diculties, and ask
him to pick a specic situation and to talk about what he thinks or feels
when it occurs. Record or have the parent record responses in the rst
two columns of the Self-Talk Journal. Do the same for the other area
(diculty or success).

Throughout the session, help the parent to recognize his thoughts and feel-
ings as well as the circumstances that precipitate them. This may be done
while he is relating his experiences by asking questions such as: What
were you thinking when that happened? Exactly what was going on that
made you feel that way? If the parent provides a vague reply (e.g., I was
thinking, oh no, here we go again ), ask him to explain what that means
to him. Keep asking questions (e.g., What do you mean? What do you
think is going to happen?) until the thoughts are explicit. Pay attention
to the parents body language as you discuss dierent topics. If the parent

23
 appears to be uncomfortable or resistant, prompt him to identify his self-
talk by saying something like You seem uncomfortable. What are you
thinking right now? These questions should be blended throughout the
session and not unnecessarily interrupt the ow of the training.

Positive Behavior Support

Explain that the approach used in this program is based on the princi-
ples of applied behavior analysis and, in particular, positive behavior
support (PBS). Briey describe its background. (The following sections
involve a great deal of lecture. It may be benecial to warn the parent
and explain that this will not be the norm throughout the training.) You
may want to use the following dialogue:

The particular set of approaches we will be using in our sessions is

based on the principles of applied behavior analysis and is commonly
referred to as positive behavior supportor PBS for short. PBS is a
research-based approach to supporting people with behavior problems
in their homes, schools, and communities. PBS was created for use
with children and adults with very serious behavior problems, with
an emphasis on teaching them replacement skills and designing set-
tings at home and at school to help them behave better. PBS has been
shown to be very eective with a range of persons and behavior prob-
lems; it is now widely accepted among educators and researchers.

Explain that, in the past, approaches were often trial and error eorts
that were reactive and focused on decreasing behavior. PBS oers a
practical, problem-solving approach that emphasizes important values
such as treating children with disabilities in ways similar to their non-
disabled peers. PBS helps us understand what causes childrens behavior
so we can select the right strategies to improve it.

Key Features of the Program

Next, describe and provide examples of the key features of the program
(i.e., positive behavior support) as outlined here.

24
Assessment

At the heart of PBS is the assumption that we need to know why a child
is misbehaving in order to design a successful plan. We can nd out why
children act out by looking at the situations that seem to set the stage
or provoke behavior problems and what the child may be gaining or
avoiding by misbehaving. By understanding why problem behaviors
occur (i.e., their purpose) and the situations that seem to set o these
behaviors, we are then able to develop eective solutions.

A great deal of research stands behind the PBS process as a way of gain-
ing an objective understanding of a childs behavior. There are several
methods we can use to try to nd out why a child is misbehaving as part
of a process called functional behavioral assessment (FBA). This can
involve structured observations by educators and other professionals
and the use of questionnaires; however, the process can often be imple-
mented less formally by parents and other care providers to successfully
understand a childs behavior. Part of the next few sessions will be
devoted to helping the parent understand his childs behavior using
dierent forms of FBA. Tell the parent that, just like detectives, we will
look for clues to understand his childs behavior better. Through this
process we will gure out when, where, with whom, and why the child
behaves in certain ways.

To illustrate, have the parent consider the following scenario:

Jerome, age 4, and his mother are in a convenience store. Jerome

begins taking packages o of the shelves and pouring the contents on
the oor. When his mother tries to intervene, he runs away and
laughs hysterically. Now why is he doing that?

What if we learn that Jeromes mother typically avoids taking Jerome

out in public and that, at home, the house is well child-proofed and he
does not have access to many interesting items? What if we notice that,
in addition to dumping the items, Jerome is also smelling and feeling
them? Or what if his mother admits that he and his uncle commonly
play a run-and-chase game where they try to keep items away from
each other? Knowing this additional information might help us (and
Jeromes mother) address Jeromes behavior more eectively (e.g., teach
him more appropriate ways to entertain himself in public places).

25
 (If appropriate, ask the parent if something like this has ever happened
to him and to consider how he would think or feel in this circumstance.)
Explain that our understanding of the possible purposes of behavior or
circumstances aecting behavior provides the basis for how we address
behavior. Knowing the patterns allows us to adjust particular circum-
stances and outcomes surrounding behavior. As we come to better
understand a child and his motivations, we are empowered to deal with
his behavior in a more positive and eective manner.

Prevention

Continue with a description of the role of prevention in PBS.

Understanding the patterns surrounding behavior allows us to adjust
aspects of the environment to create positive changes in behavior.
Sometimes behavior problems require immediate attention, and knowing
the situations that provoke these problems can help us craft short-term pre-
vention strategies. Prevention strategies can include avoiding particularly
dicult circumstances (e.g., seating a child away from a disruptive peer),
changing aspects of activities to make them more pleasurable (e.g., allow-
ing a child to listen to music while waiting), or providing reminders for the
child to use expected behavior (e.g., using visual cues to put toys away).
Temporarily making changes in certain types of circumstances can often
remove the trigger for behavior problems, making them less likely to occur.

Teaching

Explain that, although prevention is often helpful for producing short-

term changes in behavior, it does not empower a child to function more
eectively when faced with diculties. Long-term change in dicult
behaviors requires teaching children new skills. This program focuses on
helping children learn strategies to deal with challenging situations and
develop better ways to get their needs and wants met. Depending on the
situation, this may involve teaching a child skills for better communicat-
ing his needs, interacting with other people, dealing with stressful or
unpleasant circumstances, or becoming more independent in daily tasks.

26
Management

Describe the role of managing consequences. In addition to preventing

problems and teaching children more appropriate skills to replace prob-
lematic behavior, this program addresses how parents can manage their
reactions to a childs behavior so that they do not inadvertently encour-
age the problem. The goals are for parents to respond in ways that
strengthen positive behavior (e.g., providing attention only when the
child is actively engaged in a task) and to discourage outcomes of mis-
behavior that may be desirable to the child (e.g. not allowing the child
to leave an unpleasant situation when he acts inappropriately).

Because PBS emphasizes a positive approach, eorts to punish behavior

are discouraged. Research suggests that replacing problem behavior with
more adaptive skillsrather than just trying to stop behavior problems
is a highly eective strategy. Consequences such as time out, restriction,
or reprimands are therefore used sparingly, if at all.

Changing Lives

Explain that sometimes it is important to consider the bigger picture

when looking at making changes that improve behavior. PBS, and there-
fore this program, emphasizes trying to improve a childs overall well-being
in addition to addressing specic behavioral concerns and the immediate
circumstances surrounding problem behavior. The philosophy is that chil-
dren being happier and appropriately challenged can help improve their
daily behavior. Therefore, the intervention process may include creating
friendships and reassessing educational goals and home expectationsall
with an eye toward improving general life satisfaction. The PBS process
encourages parents to step back from the day-to-day crises to reconsider
how their families lead their lives and whats truly important.

Collaboration

Discuss the importance of collaboration in PBS. To be successful in

changing signicant child behavior problems, input and support from

27
 a variety of people who are important in the childs life are essential.
Cooperation and involvement are encouraged, therefore, not just from
both of the parents but also from other family members, teachers, ther-
apists, friends, and anyone else who could have an impact on what hap-
pens with a childs behavior. This type of working relationship requires
that everyone communicate openly with one another and develop plans
that make sense everywhere problems occur. Having shared goals and
responsibilities provides buy-in by everyone and helps improve the
likelihood of successful outcomes. This collaboration is essential for
understanding a childs behavior, putting strategies in place, and mak-
ing sure they work.

Overview of the PBS Process

Introduce the case study of Ben, explaining that the case will be used to
illustrate each of the ve main steps of the PBS process and be inter-
woven throughout the remainder of the sessions. (If Bens case study
would not be relevant to the participating parent, substitute another
example that includes all of the elements described in the case example
sections throughout the book). The initial description should include
the childs age, sex, strengths, challenges (and the impact of those chal-
lenges on the child and family), and family circumstances.

Case Study: Ben

Ben is 3 years old. He is an only child and lives with both of his
parents. His father works as a data programmer, and his mother
stays at home with him. Bens grandmother lives nearby and visits the
family almost daily. Ben attends a preschool program for children
with developmental delays and disabilities from 9:00 to 12:00 on
weekdays.

Ben loves to play alone, has a keen interest in animals, and is especially
good at working puzzles. Ben has very limited spoken language, using
only a few words and more often relying on sounds, gestures, and prob-
lem behaviors to get his needs met. Ben has extreme diculty with
changes in activities, routines, or settings. He often refuses attempts by
his parents or other children to play with him. When others interrupt

28
 his play or change his activity or routine, Ben cries, screams, and drops
to the oor. When he is required to go somewhere in the car, he resists
getting his shoes on and being taken to the car, and then he continues to
cry well into the trip. Ben eats very little at breakfast or lunch and is
usually extremely hungry by dinnertime. He then cries and screams
until his mother gives him something he wants to eat. He eats his food
while wandering around the house. Ben resists tooth brushing and is not
potty trained. His parents reluctantly admit that he still sleeps with
them every night.

The challenges posed by Bens disability and problem behavior leave his
parents very isolated and discouraged. They feel that they cannot go
places or spend time with family and friends. Other than school, they
try not to take Ben out. In fact, they take turns running errands,
leaving one parent to stay at home with Ben. They cannot leave Ben
with babysitters because they feel that nobody else can handle him. Bens
mother believes her husband is denying his disability and is frustrated
with her mother-in-laws frequent comments that Ben just needs proper
discipline. All of these things are creating tremendous stress on the
marriage and family.

Five Steps of PBS

Review the ve steps of PBS. PBS oers a creative, problem-solving

process for understanding why behavior occurs and dealing with it
eectively. The process involves ve general steps or components
focused on improving childrens behavior and families lives. The basics
of the ve steps are as follows:

Step 1) Establishing goals: dening the problem, including the

childs behaviors of concern and specic changes we want to occur

Step 2) Gathering information: watching the childs behavior and

talking to other people to understand why the child is behaving
in this manner

Step 3) Analyzing patterns: determining what circumstances are

aecting the childs behavior and what the child is getting or
avoiding as a result

29
 Step 4) Developing a plan: creating strategies to prevent prob-
lems, teaching the child better ways of behaving, and responding
appropriately to behaviors when they occur

Step 5) Monitoring results: reviewing progress to ensure that the

strategies are working and making changes as needed

Getting Others Involved

Explain the importance of collaboration in PBS, who should be involved,

and how to work together. The following dialogue may be helpful:

PBS is most eective when everyone who cares for and interacts with
a child is involved. This is because, working together, we can be
condent that everyone in the childs life agrees on the goals, shares
ideas and information openly, understands the patterns associated
with the childs behavior, and is committed to following through with
the plan. The PBS process works because everyone is learning together
and supporting one another.

The people who should be involved in the process include parents, fam-
ily members, teachers, friends, and others who interact with the child.
At minimum, this includes those who know the child best, see the
child on a daily basis, and will ultimately be using the plan. To work
together eectively, everyone must agree to participate, communicate
openly and respectfully, and resolve problems together as they arise.

Case Example: Bens Team

To make the PBS process work, both of Bens parents, his grandmother,
and preschool teacher needed to be included. This meant having family meet-
ings and communicating with his teacher through email and conferences.

Application

Ask the parent to consider briey who should be involved in the PBS
process and how to engage them. (If the parent discusses or alludes to

30
 any discrepancies in perspectives or practices [e.g., with an estranged
spouse] explore his thoughts or feelings.)

Establishing Goals

Explain the rationale for setting broad goals for childrens behaviors and
lives and provide examples of such goals. The following dialogue may
be used:

The rst step in the positive behavior support process is to create a clear,
positive vision for the future. Before trying to understand and address a
childs problem behavior, it is important to consider what broad goals
we want to achieve through our eorts. We may want to consider why
changing a childs behavior is so important and what we would ulti-
mately like to see in terms of changes in the childs life. Through this
process, we want to achieve more than just changing or stopping certain
behaviors; we want your child and your family to have better lives.

Broader life goals might focus on:

Improving a childs health or emotional state

Making it possible for a child to go more places or do more things

Giving a child more opportunities to make his own choices

Enhancing or expanding a childs friendships and other relationships

Improving family life in general

In establishing these goals, it is important to think about the childs

strengths and interests, as well as diculties. We can then build on the
childs strengths, as well as respond to his needs. Identifying goals
should be done with the child, family, and other people who care for
the child and are involved in his daily life.

Having a positive vision for the childs future gives the parent and other
family members hope and direction. Identifying these goals also builds
unity among those involved in the life of the child. The result is greater
optimism and motivation to make the changes needed, as well as better
outcomes for the future.

31
 Case Example: Bens Goals

Bens family developed the following goals: help him play with other
children and adults, better handle transitions and change, and ride in the
car and eat with the family without problem behavior. In addition, his
parents wanted him to develop more interests (beyond animals and
puzzles) and participate in typical childhood experiences, including
spending time with friends. They also wanted him to become more inde-
pendent with his self-care, to sleep alone, and to develop the skills he
needed to keep himself safe (e.g., looking out for trac). Bens parents
wanted to be able to enjoy life as a family without the constant stress pre-
sented by his problem behavior. They hoped to be able to go places and do
more things as a family and to reduce the conict in their lives.

Application

Taking into account the information presented in this section, have the
parent consider his childs strengths and challenges and identify at least
one goal he has for his child. (If discussion of the future prompts strong
feelings, explore the parents self-talk by saying something like, When
you think about the future, what comes to mind?) The goals should be
broad but objective, and they should include things such as increased
independence, community participation, and friendships. The goals
should be recorded on the Establishing Goals form in the workbook.

Defining Behaviors of Concern

Explain that an important beginning step in trying to understand the

patterns surrounding a childs behavior is to dene the specic behav-
iors that we are nding to be a problem and that we, therefore, want to
change. By dening behavior in this way, we can:

Look at the behavior and the possible inuences objectively (and

gather consistent information)

Be more consistent when trying to understand and deal with

behavior

32
 Make sure that everyone interacting with a child is addressing the
same concerns and is on the same page

A childs behavior should be dened in terms of what the child says or

does and in ways that are observable and measurable. The description
should be specic enough that everyone who is involved in the childs
life will immediately know the behavior when it occurs. The goal is to
describe behavior in enough detail that parents, spouses, mothers-in-
law, and others would all agree when it occurs.

(If appropriate, discuss the parents ability to be objective regarding his

childs behavior. Explore his assumptions or the labels he assigns to the
behavior.)

Criteria and Examples

Describe how to dene behavior objectively, providing examples of

clear and unclear denitions. Share the following criteria.

Well-dened behavior (that is free of labels and assumptions):

Describes what the behavior looks like

Describes what the behavior sounds like

May include typical examples of the behavior

Does not use words with unclear meaning

Give the following denition examples for tantrum behavior:

Clear denition: screaming accompanied by wildly waving arms, kicking

legs, lasting for at least one minute

Unclear denition: a loud t that causes everyone to look

Case Example: Bens Behaviors of Concern

Illustrate by dening the behaviors of concern for the case example:

Screaming, crying, and dropping to the oor (i.e., tantrums).

Use other examples as necessary and appropriate. Make sure the behav-
iors are objectively stated (in terms of what the child says or does).

33
Application

Have the parent dene one or more of his childs behaviors of concern
and record his denition(s) on the Dening My Childs Behaviors of
Concern form. ( You may also want to again discuss, if appropriate, the
parents ability to be objective regarding his childs behavior.) If the par-
ent identies multiple behaviors, help him to prioritize those behaviors
(e.g., the top three).

Keeping Track of Behavior

Explain that it is often helpful to get an estimate of how often or how

long a childs behaviors of concern are happening right from the start of
the PBS process. Establishing this baseline on how the child behaves
before implementing the PBS steps allows us to evaluate changes after
the plan has been put in place. This helps to conrm that what we are
doing is eective. Later on, we should be able to say with some assurance
that the childs behavior is improving and that the plan is working
(e.g., hitting has decreased from about ve times per day to about three).

To gather this information about a childs behavior before starting PBS,

we want to use the simplest method possible that will tell us how often,
how long, or how dicult a childs behavior is. Some options for
recording a childs behavior might include:

1. Counting the behavior (i.e., frequency): making note of every

time a child does the behavior

2. Timing the behavior (i.e., duration): recording how long a

behavior goes on

3. Rating the seriousness of the behavior (i.e., magnitude): using

some kind of scale (e.g., between 1 and 5) to estimate how often
the behavior occurred or how bad it was each day

If these methods seem too dicult or time-consuming, parents simply

can get a sample of behavior. This means limiting their recording to short
periods each day. For example, parents might just observe what happens
prior to the child going to sleep, rating how bedtime went. Go over the
variety of data collection forms found in the workbook: Counting

34
 Behaviors, Timing Behaviors, Rating Behaviors, and Frequency Graph.
See Figures 3.1. through 3.4 for example rows from each form (based on
the denition of Bens tantrums). Point out the pros and cons of each
instrument so the parent can select one that will work at home.

Date Start Time Stop Time Tallies Total

10/13 3:30 4:00 / / / 3

Figure 3.1
Completed Example Row of Counting Behaviors Form

Date Time Behavior Started Time Behavior stopped Total Time

10/13 3:30 4:00 30 min

Figure 3.2
Completed Example Row of Timing Behaviors Form

Date Time/Activity Behavior Rating Comments

10/13 3:30-4:00/snack 3 2 1 0 Was unable to open snack

package and had to ask for help

Figure 3.3
Completed Example Row of Rating Behaviors Form

10/13 10/14
10 10
9 9
8 8
7 7
6 6
5 5
4 4
3 3
2 2
1 1

Figure 3.4
Completed Example Rows of Frequency Graph Form

35
Application

If appropriate, have parent select a simple method for collecting base-

line data on his childs top-priority behaviors of concern. Review
the corresponding form in the workbook and make sure the parent is
condent in using it. If, for some reason, the parent is unable to collect
data, encourage him to at least do a Weekly Progress Report. Introduce
this form as a method of tracking changes in the childs behavior each
week. Make sure the parent understands how to complete it.

Crisis Planning (optional)

If the child is engaging in behavior that is placing himself or others at risk

or severely disrupting the environment, discuss with the parent ways to
ensure safety while developing the behavior support plan. Severe behavior
problems require agreed upon crisis management strategies. These may
also be needed at times when the child is not dangerous but is so disrup-
tive as to cause educators or caregivers to abandon behavior support plans.
In these cases, it may be necessary to remove the child from a situation,
block his behavior (e.g., stand between him and another child), hold onto
the child briey until he calms down, or get some help. This type of cri-
sis management is not intended to be a type of punishment, or even a
solution, but a temporary way to ensure the safety of children, families,
and homes until we develop a better plan. If these methods are required to
manage emergencies, they should be used cautiously (i.e., with the least
amount of verbal or physical force to make the child safe) and only long
enough for the child to regain control of his own behavior. Approvals from
all partiesparents, teachers, school administrationmust be obtained
prior to using any approach that would be considered restrictive.

Homework

Have parent keep Self-Talk Journal.

Have parent identify the people who will be participating in the PBS
process. Encourage parent to talk with them to help dene the childs
behavior and identify goals.

36
 Have parent complete the Dening Behavior form.
Have parent complete the Establishing Goals form.
Have parent complete selected data collection forms (e.g., Counting
Behaviors, Timing Behaviors, Rating Behaviors, Frequency Graph).

Have parent complete the Weekly Progress Report.

If needed, have parent develop a crisis plan.

37
This page intentionally left blank
Chapter 4 Session 2: Gathering Information

(Corresponds to session 2 of the workbook)

Materials Needed

Self-Talk Journal Session 2 form

Motivation Assessment Scale

Interview Form

Scatterplot form

Behavior Log

Information Gathering Plan

Outline

Preview agenda

Review homework

Explore the relationship between thoughts and behavior

Discuss the importance of assessing antecedents and consequences

for understanding behavior

Introduce the Motivation Assessment Scale

Introduce methods for gathering information

Review observing behavior

Review interviewing people

39
 Review recording information

Help parent choose an information-gathering strategy

Assign homework

Agenda Preview

Preview the agenda for this session as referred to in the outline. Add any
other items relevant to the parent.

Homework Review

Ask the parent if she has any questions about the previous session or the
workbook reading. Review homework forms for denition of behavior,
broad goals, and baseline data. (If the parent did not complete the
homework, help her to identify goals and problem behaviors, suggest-
ing that she review them with the other members of her team between
sessions.)

Ask about communications with family and others. Provide feedback.

Also review Weekly Progress Report.

Self-Talk Journal Review

Review the Self-Talk Journal and ask the parent to choose one success
and one diculty from the past week and read the entry (including the
situation and self-talk) aloud. If the parent is not comfortable reading
her journal, she may paraphrase it or let you read it. Note any pessimistic
thoughts. Ask the parent what the consequences were for the pessimistic
beliefs (e.g., So Jimmy was having a tantrum at the library, and you
were thinking, Im a bad Mom; I cant take him anywhere. What hap-
pened next? How did you respond to the tantrum?). Also note how the
parent describes her successes: whether she takes credit for good events
or attributes them to something else (e.g., good health, fewer demands).

40
Relationship Between Thoughts and Behavior

After identifying the consequences of the pessimistic beliefs, explain

the relationship between thoughts and behavior. Use the parents expe-
riences to clarify this relationship. The following dialogue might be
helpful:

Sometimes when we are feeling overwhelmed and frustrated and

begin thinking these negative thoughts (Its all my fault; things are
never going to get better), our behavior changes. We might give up
more easily or do things we know we shouldnt do. What we think
aects what we do.

Application

Have the parent select one of the negative beliefs she shared previ-
ously and identify the consequences of that belief (including how she
reacted to the situation). Have her record it in the Self-Talk Journal
as an example.

Throughout the session, help the parent to recognize her thoughts and
feelings, the circumstances that precipitate them, and the consequences
of those beliefs. This may be done while she is relating her experiences
by asking questions such as:

What exactly happened?

What were you thinking when that happened?

How did you react as a result of your thoughts or feelings?

Pay attention to the parents body language as you discuss dierent

topics. If the parent appears to be uncomfortable or resistant, prompt
her to identify her self-talk by saying something like, You seem
uncomfortable. What are you thinking right now? Be sure to probe
until the self-talk is explicit (i.e., statements rather than just labels).
These questions should be blended throughout the session and not
unnecessarily interrupt the ow of the training.

41
Understanding Behavior

Explain why collecting information (i.e., conducting a functional

behavioral assessment) is essential to eective intervention and the role
families should play in this process. Stress that at the heart of all
eective interventions is a clear understanding of the functions of the
behavior problem(s). Once priorities have been identied, the next step
is to conduct an assessment of what is triggering (antecedents) and
maintaining (consequences) these behaviors. Parents input is essential
at this stage, and the information they provide and obtain will assist in
designing a plan that ts best with their familys needs. You may want
to use the following dialogue in your discussion:

You serve as the eyes and ears of this important next step, allowing us
to get an insiders view of what goes on during a typical day and
night with your child. We need to begin to understand what things
seem to trigger behavior problems and why they might continue to
occur despite your best eorts. We will work together using some
simple tools: focusing on what is going on before your child misbe-
haves and what happens right after these incidents. This important
information will allow us to design ways to interact with your child
and will also help us to identify specic skills to teach your child that
will signicantly improve behavior.

Antecedents

When trying to determine what triggers or provokes behavior, we need to

consider the circumstances that exist before the problem behavior occurs.
This involves asking questions related to who, what, where, and when:

Who is around? (e.g., sister, friends, father, dog, neighbor)

What are the activities, demands, or expectations? (e.g., playing

with toys, cleaning room, getting dressed)

Where does it occur? (e.g, at home, in the car, at the store, at

Grandmas)

When does it occur? (e.g, in the morning, at dinner, after play dates)

42
 In addition to the immediate inuences on behavior problems, other
events or conditions can aect how a child will behave. These conditions
do not by themselves seem to trigger behavior problems, but they will
make these behaviors more likely to occur when the triggers are present.
Examples of more distant events or circumstances (sometimes called set-
ting events or establishing operations) that can inuence behavior are:

Physical conditions (e.g., pain, hunger, sickness, tiredness)

Events (e.g., changes in routines, family conict)

These types of conditions or events can have an eect on a childs gen-

eral demeanor and make her react more strongly to typical triggers.

Consequences

Understanding what consequences behaviors produce for a child is as

important to assessment as knowing what triggers behavior problems.
We need to inventory all typical responses and outcomes (conse-
quences), including formal reactions (e.g., using time-out) as well as
informal or unplanned reactions (e.g., saying stop that, trying to calm
the child with soothing words, or simply allowing the child to have her
way). The reactions of people who interact with a child on a day-to-day
basis may be reinforcing behavior problems either through 1) what a
child gets (i.e., positive reinforcement such as attention received for
misbehaving) or 2) what a child avoids (i.e., negative reinforcement
such as avoiding unpleasant demands).

(If appropriate, discuss how thoughts and feelings can serve as a mediator
to our reactions; for example, when we interpret a childs behavioror
the impact of her behaviorin a particular way, it may aect how
we react.)

Motivation Assessment Scale

Introduce the Motivation Assessment Scale and review its content

and format (see http://www.monacoassociates.com/mas/MAS.html).
Explain that it is a screening tool that helps us to pinpoint the function,

43
 or goal, of a childs problem behavior. By completing it, we can make
an educated guess regarding whether behavior is motivated by atten-
tion, tangibles, sensory outcomes, or escape.

Application

Have the parent complete the Motivation Assessment Scale on a

behavior of signicant concern, dening the context in which it
occurs. Explain that the answers reect hypotheses about what is
aecting the childs behavior. (Score the MAS for the family either at
this time or between sessions and share the results during the next
session.)

Introduction to Information Gathering

Explain that there are a variety of informal ways to collect information,

but the purpose should be to better understand the behaviors of con-
cern. You may want to use the following dialogue:

There are a number of dierent ways to nd out what is inuencing

your childs behaviors. Some of these techniques require a great deal of
time and need to be supervised closely by behavioral professionals.
Fortunately, we have less formal ways of nding out the same infor-
mation that can be just as eective. They include three general meth-
ods: observing behavior, interviewing people, and recording
information.

Emphasize that the purpose of information gathering is to understand

the causes and purposes of a childs behavior. Present each of the three
methods for gathering information as follows.

Observing Behavior

Discuss observing (simply paying attention) as a way of learning

more about a childs behavior. Provide examples of what parents
might notice (e.g., that problem behaviors seem to occur more

44
 frequently when the child is approached in a certain way or that
the child is able to avoid completing at least part of an activity she
dislikes through her behavior). Use the following dialogue in your
discussion:

There is nothing more valuable to us than the observations of a well-

informed parent. Once you know what to look for, your view of the
situations that lead up to problems and how things change after the
incident can be invaluable for designing plans. The trick is to watch
the child with objective eyes, not parent who deals with this child
every day eyes. You need to pay attention and take note of what is
happening around your childs behavior.

Explain that observing means noticing situations in which a child

behaves well, in addition to those in which she has diculty. We con-
sider who, what, where, and when (see questions under Antecedents)
and what a child gets or avoids as a result of the behavior. (If the parent
mentions ways that her thoughts and feelings cloud her observations,
explore possible self-statements regarding patterns she perceives.)

Use the following case example to illustrate the observation method.

Give other examples as appropriate and needed.

Case Example: Observing Bens Behavior

Bens parents decided to pay attention to times when Ben could change
activities without problems (e.g., when he was going to do something he
really liked) and compare them with times that were dicult. They also
wanted to look at playtime to try to gure out how involved they could get
in Bens play and how much they could do with him (e.g., sitting near
him, handing him toys) before he would resist. They thought that by look-
ing closely at those circumstances they could get a better idea of what was
inuencing his behavior.

Interviewing People

Explain interviewing to gather information. Talk about who should be

interviewed (i.e., those people who know the child well and interact
with her on a daily basis) and the types of questions interviews may

45
 include. Provide examples of questions (see Interview Form in the
workbook). Use the following dialogue to begin:

A simple and useful method of gathering information about a childs

behavior is to talk to other people who know the child well and inter-
act with her in a variety of situations. We should interview family
members, friends, and others who see the child frequently and are
familiar with the problem behavior, like teachers and babysitters.
Taking the opportunity to discuss concerns and get input from other
people allows us to better consider everyones perceptions and to
generate new ideas.

(If the parent discusses dierences in how people perceive her childs
behavior, prompt her to discuss those perceptions and how they con-
trast with her own.)

Tell the parent that, during the interviewing process, the following
should be explored:

Behavior patterns, considering who, what, where, and when

Distant events or conditions that might be aecting a childs

behavior

What happens after: the reactions to or results of the behavior

Suggest that it may be helpful for the parent to record what she learns
through these discussions, as sometimes it is easier to nd a pattern
when the information is down on paper. Explain that there are a vari-
ety of ways that can be used to record the responses (including the
Interview Form in the workbook).

Use the following case example to illustrate the interviewing method.

Share other examples of interviews as needed.

Case Example: Interviews about Ben

Bens parents decided to make individual lists of the times that things
were easy and hard for each of the parents with Ben. They could then
compare notes and discuss what was happening more objectively, looking
at the when, what, and where of their challenges with Ben. They decided
to ask the same of Bens teacher and grandmother.

46
Recording Information

Explain that recording what we discover from observing a child is often

an essential part of the intervention design process. It can also allow for
a more objective view of the behavior and circumstances surrounding it,
which will improve the quality of the assessment and, therefore, the
eectiveness of the strategies derived from that assessment. Keeping a
simple daily journal of the events of the day, or using more elaborate
methods to track details about a childs behavior (e.g., when, how often,
how long), can yield important insights.

Review the various methods that can be used to record information,

including Scatterplot forms and Behavior Logs. Refer the parent to the
data forms and completed examples in the workbook.

Scatterplot

We can record behavior in a way that helps us pinpoint the times

of day a childs behavior is most and least likely. With this system, we
simply mark whether or not a behavior occurs within a particular peri-
od of time. Using this information, we can narrow down when to look
more closely at the childs behavior and the circumstances around her
behavior. For example, if we were to look at an example that shows the
times of day Ben whines, we might want to focus our attention on the
early morning, midday, and just prior to dinnertime (see Figure 4.1).
Provide examples, and practice completing the Scatterplot form with
the parent as needed to reinforce this concept.

Behavior Logs

Behavior logs, or ABC charts, have a long history of use as an assess-

ment of a behaviors function in part because they are relatively easy
to use. When a behavioral problem occurs, we can record what hap-
pened before the incident (the antecedent, or A), a description of
the behavior itself (B), and what happened afterward (the conse-
quence, or C).

47
ScatterPlot

Child: _________Ben_____________
___ Behavior: ______________________________________
Screaming, crying, and dropping to the floor
Dates: _____
5/1___ through ______
5/10___
__
Record the times of day (and/or activities) in which the behavior might occur. Write in the dates for the
recording period in the rst row. When the behavior occurs, shade in the corresponding box.

Dates

Time Activity 5/1 5/2 5/3 5/4 5/5 5/6 5/7 5/8 5/9 5/10
78 Preparing for school
a.m.
89 Transition to school
a.m.
910 Arrival/centers
a.m.
1011 Outside
a.m. (transition)
1112 Swim/change
p.m.

121 Lunch
p.m.

12 Transition home
p.m.

23 Arrival home /
p.m. change

34 Home/play alone
p.m.

45 Play outside home

p.m.

56 Dinner
p.m.

67 Bath
p.m.

78 Bedtime
p.m.

Figure 4.1
Example of Completed Scatterplot
Source: Adapted from Touchette, MacDonald, & Langer, 1985.

48
 Behavior Log

Record situations in which your childs behavior is dicult, including specically what your child says
and does and what occurs before and after the behavior.

Antecedent Consequence
(Before Behavior) Behavior (After Behavior)

Bens mother asks him to put on Ben extends his body, Bens mother takes his shoes to
his shoes cries, and screams the car, letting him go in his
bare feet

Bens mother guides him from Ben cries and screams Classroom assistant hands him
the car into school a toy and brings him into the
class

Ben is told it is time to come Ben extends his body, Assistant waits for him to get
inside from the playground cries, screams, and then calm and then physically guides
drops to the ground him in

Bens mother sits down to play Ben extends his body, Bens mother says I just want
with him cries, and screams to play with you and then moves
away, leaving him alone

As dinner time nears, Bens Ben walks into the Bens mother quickly gives him
mother goes into the kitchen kitchen and begins to cry one of his favorite foods
and then scream

Bens father asks him to sit at Ben sits brieffy and then Bens mother asks him to come
the table to eat picks up his food and walks back or says dont you want to
around sit? and then lets him go

Figure 4.2
Example of Completed Behavior Log for Ben

49
 Provide examples of completed ABC recordings, and practice com-
pleting the Behavior Log form with the parent as needed to rein-
force this concept. Refer to the case example of a behavior log in
Figure 4.2.

Choosing a Strategy

Discuss how to select particular information-gathering tools and strate-

gies. Note that the Behavior Log provides a lot of important informa-
tion, but it also takes more time to complete than simple checklists
(e.g., for frequency, duration). Using another format such as the
Scatterplot rst might help us pinpoint the times of the day problem
behaviors are most likely and least likely to occur, making it possible to
plan recording for those times of day. Strategies for keeping a record
of the childs behavior should be selected (or designed) based on the
familys needs and situations. They should not be ridiculously time-
consuming or dicult, or parents will nd it hard to use them consis-
tently. Furthermore, they should capture the things the parent and
family are most concerned about.

Application

Prompt the parent to look over all of the tools for interviewing other
people and recording information presented in this session, discussing
the pros and cons of each. Help her select and plan strategies for gath-
ering information. Have her record ideas on the form provided in the
workbook (see Information Gathering Plan). Guide her to be realistic
about what she can do, even if it simply involves paying attention to a
particular situation and talking to a couple of people.

Homework

Have parent continue to keep Self-Talk Journal.

Have parent continue to complete the Weekly Progress Report.

50
 Have parent develop a plan for gathering information about the
childs behavior (e.g., using the Interview Form, Scatterplot, Behavior
Log, or some other format if appropriate).

Encourage parent to talk with family members and others to get their
input.

Have parent complete the MAS on the childs behavior(s), if it was

not completed during the session or if you want to complete
additional forms for other behaviors.

51
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Chapter 5 Session 3: Analysis and Plan Design

(Corresponds to session 3 of the workbook)

Materials Needed

Self-Talk Journal Session 3 form

Pattern Analysis Worksheet

Brainstorming Interventions form

Outline

Preview agenda

Review homework

Discuss the use of distraction for dealing with unproductive

self-talk

Teach parent how to use information to analyze patterns

Help parent to create hypotheses or summary statements

Use patterns to brainstorm intervention ideas

Assign homework

Agenda Preview

Preview the agenda for this session as referred to in the outline. Add any
other items relevant to the parent.

53
Homework Review

Ask the parent if he has any questions about the previous session or the
workbook readings.

Review information gathered through observing behavior, interviewing

people, and recording information. (If the parent did not gather much
information, let him know that it might be helpful to continue collect-
ing data to support or challenge the summary statements to be devel-
oped during this session.)

Review the results of the Motivation Assessment Scale and current

hypotheses about the childs behavior.

Ask about communications with family members and others. Provide

feedback. Review Weekly Progress Report.

Self-Talk Journal Review

Review the Self-Talk Journal and ask the parent to choose one success
and one diculty from the past week and share the entry (including the
situation, his self-talk, and the consequences of his self-talk). When the
parent has shared his entries, review how his thoughts and feelings
inuenced his behavior in each situation. For example, you might say
something like:

It sounds like you believe you are a bad father because you cant
control Mary during public outings, so you just avoid taking
her out at all. In the example you shared, your belief about
your parenting skills aected your decision to stay home rather
than take an opportunity to teach Mary how to behave in
public.

Point out any positive events the parent fails to take credit for, and
where credit is probably due (e.g., You had a couple of very success-
ful outings as a family; you must have done a lot to contribute to those
successes).

54
Use of Distraction

Explain that when we recognize that we are engaging in unproductive

self-talk, we may have to do something to interrupt that way of thinking
so we can handle situations more eectively. At those times, distraction
is helpful.

Distraction involves shifting our attention away from any pessimistic

thoughts during activities such as a meeting at school, dealing with a
behavior problem, or a stressful workday. This can be done with a vari-
ety of methods, for example:

Singing to oneself

Choosing a mantra (e.g., things will soon get better)

Writing down the belief and throwing the piece of paper away

Scheduling time to think through the belief (e.g., after work,

when the kids are in bed)

Reading a 3
5 note card that says STOP!

Application

Have the parent decide what distraction strategies he will use and in
what situations they might be helpful. Have him make a note of the
strategies he plans to use under the comments section of his Self-Talk
Journal. Throughout the session, help the parent to recognize his
thoughts and feelings, the circumstances that precipitate them, and the
consequences of his beliefs. Remind him to use distraction (e.g., You
are stating some negative ideas, how can you stop them?) when neces-
sary to interrupt unproductive thinking.

Pay attention to the parents body language as you discuss dierent topics.
If the parent appears to be uncomfortable or resistant, prompt him to iden-
tify his self-talk by saying something like, You seem uncomfortable. What
are you thinking right now? This discussion should be blended through-
out the session and not unnecessarily interrupt the ow of the training.

55
Analyzing Patterns

Explain that the purpose of analyzing information in this session is to

gure out patterns aecting the childs behavior. Reiterate what we are
looking for when reviewing the information, namely patterns related to
the circumstances (who, what, where, when) and the consequences of
the behavior. Provide examples of data and patterns as needed. You may
use the following dialogue to begin:

Remember that the information we collect will be used to try to

determine if there are patterns in your childs behavior problems.
This includes patterns in what happens before and after the behav-
ior. Usually, collecting information for a week or so is enough to
come up with rst guesses, although it may take longer to see clear
trends. We will continue to collect information until the patterns
are clear.

Stress that what we are looking for are patterns that repeat themselves
typical sequences that occur in dierent situations and on dierent
days. The goal is to identify situations that occur again and again, allow-
ing us to predict circumstances in which we are likely to see behavior
problems. In other words, we determine what situations are expected to
set the stage for behavior and what consequences, outcomes, or results
reliably follow the behavior. If we already have assumptions about what
is aecting a childs behavior (which is often the case), the purpose of
this step is to use the information we collect to either support or chal-
lenge those assumptions.

Explain to the parent that we need to review the assessment informa-

tion and respond to the following questions:

What are the circumstances (i.e., when, where, with whom, dur-
ing what activities) in which the behavior is most likely and least
likely to happen?

What are the typical outcomes and reactions (consequences) of

the behavior? That is, what does the child get or avoid through
his actions?

What would cause the child to behave this way, and what would
make the child stop?

56
 (If the parent oers an explanation such as she just cant help it for
the childs behavior, prompt him to consider the impact of that kind
of self-talk on his expectations of his child or on his reactions to the
behavior.)

Explain that behaviors can serve more than one function for a child.
Use the following dialogue:

It is important to remember that some behaviors can have more than

one purpose or function. For example, children might scream in one
situation to get the attention of people around them and scream at
another time to express their discomfort with an activity. Therefore, it
is important to identify not only the goals (i.e., functions) behaviors
achieve but also the circumstances in which those functions are
meaningful.

Provide examples as necessary and appropriate. For those examples and

the case example, list times, places, people, situations, and activities asso-
ciated with problem behavior and those in which problems rarely occur.
List consequences (reactions, results) that tend to follow behavior.

Case Example: Bens Patterns

Most likely to misbehave: sitting at dinner table; transitions to

the car, when getting ready to leave the house, between activities,
schedule changes within routines, when his mother or others try to play
with him

Least likely to misbehave: playing alone, tickle games, eating meals

(while walking around), going swimming (a type of transition), when
holding small toys (e.g., stued animals)

Results: mother leaves him alone, feeds him quickly, and lets him walk
around with food; limits trips in the car; and generally delays transitions

Broader Issues

Remind the parent to consider broader issues when identifying patterns.

As previously mentioned, in addition to the immediate events preceding
and following a childs behavior, there might be other conditions or more

57
 distant events that are inuencing the childs current behavior. These
might include:

Medical conditions (e.g., allergies or dietary problems result in

greater irritability, in general)

Activity patterns (e.g., too many activities lead to resistance when

asked to participate in family events)

Personal relationships (e.g., presence of a friend makes child more

willing to participate in activities)

Case Example: Bens Broader Issues

In addition to the immediate issues aecting Bens behavior, there were

other concerns. He had a restricted diet and poor sleep patterns, both of
which could have been aecting his behavior. Also, because of his problem
behavior, he did not have the opportunity to participate in the range of
typical activities or have the quality of relationships children his age
usually enjoy.

Creating Hypotheses or Summary Statements

Explain why it may be helpful to summarize patterns (i.e., to clarify

how behavior is inuenced by environmental conditions, to create a
usable format for intervention planning). Tell the parent that, once we
have identied circumstances that appear to precipitate and follow
behavior, it is often helpful to summarize these patterns in a phrase, sen-
tence, or short paragraph. The summary will then be used to guide our
intervention planning. The summary should include:

What sets the stage or triggers the childs behavior

What is the behavior of concern (i.e., what the child says

or does)

What occurs afterward (what the child gets or avoids as a result)

Provide an example of a summary statement (see the following case

example). The statement should include the context(s) in which behav-
iors are a problem, specic behaviors of concern, and the function(s)

58
 served by the behavior. Setting events might also be identied. The
statement should be specic, concise, and broadly applicable.

Case Example: Summary Statements for Ben

When Bens parents try to put his shoes on to leave the house, he screams,
cries, and drops to the oor. This delays the transition, forces his mother to
take him out without shoes, or results in her canceling the errand or getting
someone else to do it.

When his parents or peers try to play with Ben, he screams and cries; if
they dont back o, he turns his back on them or pushes them away.
Eventually, the children or family members back o, and Ben is able to
continue playing contentedly by himself.

When Ben doesnt eat well at breakfast and lunch, he screams and cries
as dinnertime approaches. If Mom doesnt feed him right away, he gets
louder and runs around the kitchen. As a result, she quickly prepares
him something he likes to eat. She often allows Ben to carry his food
around (rather than requiring him to sit with the family during meals).

Testing Hypotheses

Explain that it is sometimes necessary to test out hypotheses to verify their

accuracy. At times the patterns are clear, and it is easy to identify what is
triggering and maintaining a behavior. However, there are other times
when the circumstances surrounding behavior problems are more com-
plex. Tell the parent that, in this case, it might be helpful to test our
hypotheses, or best guesses, about the purposes of the behavior. We do this
by setting up situations we think might aect a childs behavior and see
what happens. Ultimately, the hypotheses will be conrmedor not
when we put the intervention into eect. If our strategies work, we were
right; if they dont, we need to investigate further to see if there is anything
we missed. See the following example of how to test a hypothesis.

Case Example: Testing Bens Hypothesis

To conrm one of Bens patterns, Bens mother could alternate requir-

ing and not requiring Ben to wear his shoes and see whether his tantrums
predictably occur.

59
Application

Have the parent look at all of the information collected so far and look
for patterns for each behavior category. Using the Pattern Analysis
Worksheet or a ip chart, ask the parent to consider the circumstances
(when, where, with whom, what activities) and consequences (what the
child gets or avoids as a result) of the behavior. If the patterns are not
clear, continue to probe (e.g., Does that happen every time? If not,
why?). If there is time, repeat this process for other behavior patterns.

Based on this information, help the parent to generate at least one

hypothesis or summary statement, including both the contexts and
functions of behavior. Have the parent record the hypothesis or sum-
mary statement on the Pattern Analysis Worksheet.

(Acknowledging that problem behavior might be related to parents inter-

actions with their child can be dicult for some parents, particularly when
such an acknowledgment would challenge longstanding beliefs. If the par-
ent has diculty accepting hypotheses that contradict his previous assump-
tions, explore this by questioning his self-talk surrounding that hypothesis.)

Using Patterns to Brainstorm Intervention Ideas

Describe how summary statements (hypotheses) provide the founda-

tion for intervention. Reiterate that we must understand a childs
behavior before we can begin to address it eectively. Once we have
gathered information and analyzed patterns, we should have a solid
understanding of:

The specic behaviors that concerns us

The alternative behaviors we would like to teach

The triggers for the childs best and worst behavior

The purpose or function of the childs behavior (what the child

gets or avoids as a result)

With this information in hand, we can design an eective intervention

for the childs behavior. Hopefully, our plans will also improve family
life in general.

60
Identifying Strategies

Introduce the components of a behavior support plan, and explain how

individualized strategies may be identied based on the hypotheses. Use
the following dialogue:

The behavior support plan is made up of strategies derived from the

hypothesis statements and designed so that a child no longer needs
problem behavior to achieve his wants and needs. We help children
learn and use more appropriate behaviors that work better and result
in positive outcomes for themand us! This might involve changing
our behavior (including how we react to our childrens behavior). It
might also involve changing things in the environment to set chil-
dren up for their best possible behavior.

The three general strategies that make up a behavior support plan are:

Prevention: preventing problems by changing circumstances that

trigger or set the stage for problem behavior

Management: providing rewarding outcomes for positive behavior

and managing consequences to avoid inadvertently rewarding
problem behavior

Replacement: teaching children more eective and appropriate

ways to communicate their needs and cope with dicult situations

Explain how we use the hypotheses to brainstorm strategies associated with

each of these areas. Because we can predict what events (i.e., antecedents
or setting events) precipitate a childs problem behavior, we are able to
develop eective prevention strategies. Because we have dened our
specic behavioral concerns and the circumstances aecting that behavior,
we can identify appropriate replacement behaviors. And, as we now recog-
nize what functions or purposes a childs behavior might be serving, we can
choose to respond in ways that encourage the right kinds of behavior.
Once we generate ideas for strategies, we might want to try them out (like
with the hypothesis testing) to make sure they work before integrating
them into our overall plan.

(If appropriate, guide the parent to recognize that changing his own
behavior might also involve changing his self-talk or his beliefs about
his childs behavior.)

61
 Present an example of a hypothesis (see summary statements for Ben in
earlier case example), and ask the parent to identify one or more strate-
gies to prevent problems, manage consequences, or replace behavior.
Share other examples as appropriate and necessary.

Application

Using one of the hypotheses or summary statements the parent devel-

oped, help him to generate ideas for intervention that include prevent-
ing problems, managing consequences, and replacing behaviors or
teaching skills. (If appropriate, discuss any self-talk that might be an
obstacle to generating ideas.) Have the parent jot these down on the
Brainstorming Interventions form or use ip chart paper. The parent
will build on these preliminary ideas in future sessions (4 through 6).

Homework

Have parent continue to keep Self-Talk Journal.

Have parent practice using the distraction strategies and record the
results in the Self-Talk Journal.

Remind parent to complete the Weekly Progress Report.

Have parent continue data collection using the method(s) selected in
Sessions 1 and 2.

Have parent complete the Pattern Analysis Worksheet.

Have parent complete the Brainstorming Interventions form.
Encourage parent to share summary statements and intervention ideas
with family members and others to get their input and agreement.

62
Chapter 6 Session 4: Preventing Problems

(Corresponds to session 4 of the workbook)

Materials Needed

Self-Talk Journal Session 4 form

Completed Brainstorming Interventions form

Preventing Problems Worksheet

Outline

Preview agenda

Review homework

Introduce the disputation process

Discuss circumstances that precipitate behavior

Present strategies for avoiding dicult situations

Present strategies for improving dicult situations

Present ways to provide a child with choices

Present strategies for prompting good behavior

Have parent identify prevention strategies

Assign homework

63
Agenda Preview

Preview agenda for this session. Review the brainstorming interventions

format (introduced in Session 3) pointing out which area will be
addressed during this session (preventing problems).

Homework Review

Ask the parent if she has any questions about the previous session or
workbook readings. Review homework: summary statements, strategies
based on hypotheses, and data collected. (If the parent was unable to
generate usable hypotheses, work with her to create or revise them.)

Ask about communications with family members and others. Provide

feedback. Review Weekly Progress Report.

Review parents Self-Talk Journal. Ask the parent to choose one success
and one diculty from the past week and share the entry (including the
situation, self-talk, and the consequences of the self-talk). Have the par-
ent describe how she used distraction when faced with pessimistic
beliefs and discuss how eective that strategy was in stopping the esca-
lation of those thoughts.

Disputation Process

Explain that there are strategies to help with pessimistic beliefs.

Introduce the process of disputation, a strategy for arguing or challeng-
ing a persons beliefs. Review the four steps and provide examples:

Step 1: Identify the negative belief (i.e., What exactly do you say
to yourself that is pessimistic?). For example, a parent might say
something like, Nothing I do makes a dierence with my childs
behavior.

Step 2: List evidence that supports or refutes the belief

(i.e., What makes you believe that to be true or false?). The
parent could acknowledge that her child is still having tantrums
every day; however, those tantrums do not go on as long or

64
 require her to restrain her child anymore. Therefore, her actions
are making a dierence. When she ignores her childs screaming,
it initially gets louder and more dramatic but then it stops.

Step 3: Find alternative explanations for the problem (i.e., Are

there other possible reasons or motives?). For example, the par-
ent might recognize that the tantrums are leftovers of the time
when she tried to soothe her child rather than withhold attention.
She might admit that she sometimes just soothes her child or
gives him what he wants to make the tantrums cease, particularly
when she is feeling inadequate as a parent. She might see that she
is still trying to teach her child more ecient and eective ways
of getting his needs met and, once these skills are rmly in her
childs repertoire, tantrums will not be necessary.

Step 4: Evaluate the usefulness of maintaining the belief (i.e., In

what ways does that belief benet you or others or improve the
situation?). Continuing with the example, the parent might now
understand that, when she thinks nothing I do makes a
dierence, she is more likely to give in or respond inconsistently,
which actually prolongs or strengthens her childs tantrums.

Application

Have the parent consider one of the negative beliefs she just shared
from her Self-Talk Journal. Guide her through the four steps to dispute
that belief. Help her record the information as an example in column 4
of her Self-Talk Journal.

Throughout the session, help the parent to recognize her thoughts and
feelings, the circumstances that precipitate them, and the consequences
of those beliefs. Make sure she is explicit in her descriptions. Guide her
through the disputation process as needed. This might be done while
she is relating her experiences by asking questions such as:

What exactly happened?

What were you thinking when that happened?

How did you react as a result of your thoughts or feelings?

65
 Do you think the belief is true? If so, why?

What are other reasons why that could have happened?

So, given all of this, is this belief helpful?

These elements should be blended throughout the session and not

unnecessarily interrupt the ow of the training. Pay attention to the
parents body language as you discuss dierent topics. If the parent
appears to be uncomfortable or resistant, prompt her to identify her
self-talk by saying something like You seem uncomfortable. What are
you thinking right now?

Circumstances that Precipitate Behavior

Discuss the role of circumstances that precipitate behavior. Tell the parent
that, as mentioned previously, a range of possible circumstances (referred
to as triggers, antecedents, or setting events) can prompt problem behav-
ior. These things can include physical discomfort, stressful situations,
withdrawal of attention, demands to do something, changes in routine,
and a variety of other issues. It is essential that these circumstancesand
those that prompt good behaviorbe identied so that a childs behavior
can be improved.

(If the parent describes ways in which she prompts problem behavior
through her interactions with the child [e.g., allowing anticipatory
stress to change how she interacts with her child, failing to plan ahead],
explore what she is thinking during those times and what impact those
thoughts might have.)

Explain that information obtained about the situations that seem to trig-
ger problem behavior can be used to rearrange the environment in ways
that can prevent problem behaviors from aring up. Have the parent ask
herself the following question: What could I change about this situa-
tion that would increase the chance that my child would behave better?

Problem behavior may be prevented through a variety of strategies,

including avoiding or improving dicult situations, providing choices,
or using methods to prompt more positive behavior. Review each of
these strategies with the parent.

66
Avoiding Difficult Situations

Describe how to avoid problem situations and, therefore, make problem

behavior less likely to occur. Use the following dialogue:

There are a number of ways behavior problems can be prevented, and

families are often well aware of how to do this. You might already
have made changes to how you do things at home to avoid problems;
however, we are going to discuss some strategies you can use as tempo-
rary measures until you can teach your child alternative behaviors.

Review the following types of strategies and examples to illustrate how

to avoid problem circumstances altogether:

1. If a child is disruptive in certain places, during certain activities,

or with particular peopleand these situations are unnecessary
avoid them (e.g., not shopping when stores are particularly busy,
not serving peas).

2. If changing aspects of a childs environment or interrupting a

childs routine causes disruption, keep the surroundings or sched-
ule as consistent as possible.

3. If sickness, tiredness, or hunger make a child more likely to

misbehave, address those conditions as best as possible, and avoid
typical triggers during those times (e.g., not asking the child to do
something dicult when she is tired).

4. If a childs problem behavior is thought to be attention-getting,

provide a great deal of unconditional attention throughout the day.

5. If a child misbehaves when asked to stop a favorite activity,

extend the time available to continue playing or engaging in a
preferred activity.

Sometimes avoiding dicult situations is an appropriate and respectful

way of responding to a childs needs and interests. However, preventing
problems by completely avoiding situations might not always be possi-
ble, such as when a child becomes upset when going to school or during
necessary personal hygiene tasks. Avoidance could also become a bad
habit, where parents have orchestrated a childs environment so much
that she never has to deal with any adversity, which is not natural or

67
 helpful. (If the parent is nding that she is avoiding going places or
doing things that she would enjoy, explore what she is saying to herself
regarding those situations and whether those thoughts are benecial.)

Improving Difficult Situations

Describe how to make situations that typically set the stage for problem
behavior better and, thereby, reduce problems. When it is not practical
or possible to avoid a task or situation that causes disruption, inserting
or embedding pleasant activities can make the whole task or situation
more enjoyable. Several examples of successful strategies include:

1. If a childs problem behavior occurs only during particular activi-

ties, change the most troublesome parts of those activities to create
a more positive experience (e.g., shorten the duration of a task,
make the task easier, add favorite music, or include a friend).

2. If a child misbehaves for attention, give her something fun to do

(e.g., a toy or a book) while waiting for us to interact with her again.

3. If interrupting favorite activities causes behavior problems to

occur, add a transition activity that is fun or involve the child
directly in the steps needed to move to the next activity (e.g.,
have her turn o the computer or put away a game). Or inform
the child of when the next opportunity for the favored activity
will be available.

(If the parent has negative thoughts about the possibility of making
these changes, guide her through the disputation process.)

How Parents Communicate

Emphasize that one important consideration in making dicult situa-

tions better is the way in which parents communicate their expectations
to children and interact with them in general. Not only what the parents
say is important but also the tone, body language, and kind of expressions
that they use. For example, if parents approach a child expecting
resistance, it might show on their faces and through their demeanors.

68
 Children quickly pick up on tension and respond in kind. Changing ones
style of communication can trigger cooperation and pleasant interactions
rather than resistance and negative behavior from children.

Providing Choices

Discuss how oering choices and providing a child with more control
over tasks and situations can be an eective way of preventing problem
behavior and encouraging positive behavior. There are a number of areas
where parents often make decisions for children that the children could
be making for themselves. In fact, this could be contributing to their dis-
ruptive behavior. Providing more opportunities to make choices can
build independence skills and foster good decision-making, as well as
reduce problem behavior. Some examples of ways to provide choices to
children are to allow them to decide:

Which toys they want to play with

Ways to organize their belongings

The order of activities for the day

Their own clothing (e.g., give choice of two outts)

Between meal or snack options

The people with whom they interact

To just say no once in a while

These choices might be presented verbally (e.g., by asking the child

which item or activity she wants) or through written words or pictures,
often displayed in choice menus.

Prompting Good Behavior

Explain that many children require help to know how to behave in par-
ticular circumstances. At rst a child might need an explanation about
what is expected in situations (e.g., You must use your inside voice
when at the store). Later on the child might still require prompts to

69
 remember to use this skill when actually in the situation. Written
reminders or pictures (e.g., pictures on storage boxes to show where toys
should be placed) can be useful reminders for children who do not
require constant verbal prompts. Review how to establish predictability,
use schedules, and give warnings. Provide examples (e.g., schedules, cue
cards) as appropriate for the parents child.

(If appropriate, discuss what the parent might need to say to herself to ade-
quately anticipate and prepare for changesi.e., the preparation for poten-
tially dicult circumstances may need to be mental, not just physical.)

Predictability

When a child faces a new situation, many problems can be prevented

by reviewing expectations for behavior (e.g., we dont touch other
children at the mall) and explaining what is going to happen next
(e.g., we will go to the drug store and then the toy store). Instruct par-
ents to clearly tell the child where they are going, who will be there, how
long the child will stay, and exactly how they want the child to behave.
Stress that it is important not to assume that children know how to do
what parents want them to do; they might have to be very clear about
the steps or sequences of skills required. One way this can be achieved
is through social stories. Give an example of how a social story might be
used to clarify expectations for a child:

We are going to the park. When we get there, I need you to hold my
hand while we are in the parking lot. You can climb on the jungle
gym, swing, and run around the playground, but you must stay on
the mulch. When it is time to leave the park, I want you to hold my
hand again while we go to the car. Afterward, if you have followed
these rules, we can stop for ice cream.

Scheduling

Younger children, those who have diculty with too much verbal
information, or those who tend to get anxious (and display problem
behavior) when routines change might benet from written or visual

70
 schedules to clarify upcoming events and activities. If appropriate, dis-
cuss with the parent whether she might want to provide these kinds of
schedules for her child. Schedules might include pictures that illustrate
the typical daily routines or drawings of special activities on a calendar.
When routines have to change or a child is required to wait, these
things may be indicated visually on the schedule (e.g., by moving the
activity down the schedule).

Warnings

Some children have problems when an activity goes on too long or they
have to wait. In this case, parents might warn the child that the end is
near (e.g., Were almost done; I think you can stay in your seat and
play with your toys for ve more minutes). Parents can also use timers
or countdowns (e.g., 3 minutes, 2 minutes, 1 minute) when nearing the
end of an activity.

Emphasize that, in general, the use of cues (subtle prompts to remind

children of expected behavior) can prevent a good deal of problem
behavior.

Identifying Prevention Strategies

Present a sample hypothesis (see the following case example) and ask the
parent to identify the circumstances preceding problem behavior
(antecedents and setting events) and strategies to prevent problems that
include avoiding or improving dicult situations, providing choices,
and prompting good behavior. Discuss how these strategies might be
put in place. Share other examples as necessary and appropriate.

Case Example: Hypothesis about Ben

When Bens parents try to put his shoes on to leave the house, he
screams, cries, and drops to the oor. It is especially bad when he is tired.
The tantrum delays the transition, forces his mother to take him out
without shoes, or results in her canceling the errand or getting someone
else to do it.

71
 Based on the summary statements for the case study, describe strategies
for preventing problems. The strategies might include avoiding prob-
lems, making dicult circumstances better, providing choices, or adding
cues to positive behavior. Provide visual examples of the strategies where
possible. Explain how prevention strategies might be faded over time as
the child gains skills necessary to cope with her circumstances.

Case Example: Prevention Strategies for Ben

Set up a schedule with pictures of Bens typical daily activities.

Prior to transitions (starting about 15 minutes prior to leaving),

remind him periodically of where he will be going by pointing to that pic-
ture on his schedule.

Explain what he needs to do when transitioning (e.g., When it is

time to go, I will help you put away your toys, get your shoes on, and take
your toy bag to the car). Remind him of fun things he can do or treats he
will receive where he is going.

Create a bag of special toys that Ben may take with him in the car when
he goes somewhere, and place a few of his favorites in the glove compart-
ment. Change out the toys periodically, and keep them only for transitions.

Schedule several dierent play sessions during and after school, and
include those sessions on Bens schedule. Alternate playing with mom or
teacher and playing independently (so that Ben can enjoy his time alone
during play also). Make the sessions very short, with only small attempts
to play with him (e.g., handing him a toy or simply playing with the toys
next to him without asking anything of him). Tell him exactly what you
want to do with him before play will be nished (e.g., after we nish this
puzzle together, I will let you play alone).

Have Ben eat meals and snacks only at the table. Provide Ben with
some of his favorite foods during breakfast and lunch (to encourage him to
eat). Prior to starting to prepare a meal, get Ben involved in an activity
he particularly likes to distract him from dinner preparation. Set the table
ahead of time, and do whatever preparations can be done earlier in the
day (when Ben is not hungry). When its time to eat, bring him to the
table explaining that he must sit to eat.

72
Application

Using a hypothesis or summary statement the parent developed about

her child, repeat the preceding exercise. Refer back to the initial ideas
for preventing problems recorded in the left column of the completed
Brainstorming Interventions form from Session 3. Continue to develop
ideas for avoiding or improving dicult situations, providing choices,
and prompting good behavior. Have the parent record these ideas on
the Preventing Problems Worksheet.

(Discuss how self-talk might interfere with the parents ability to design
and implement strategies to prevent problems.)

Homework

Have parent continue to keep Self-Talk Journal.

Have parent practice using the disputation process to replace
pessimistic beliefs.

Remind parent to complete the Weekly Progress Report.

Have parent complete the Preventing Problems Worksheet. Parent
should try some of these strategies and observe the impact on the
childs behavior (continue data collection using the methods selected
in Sessions 1 and 2).

Encourage parent to talk with family members and others to get their
input on prevention strategies.

73
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Chapter 7 Session 5: Managing Consequences

(Corresponds to session 5 of the workbook)

Materials Needed

Self-Talk Journal Session 5 form

Completed Brainstorming Interventions form

Managing Consequences Worksheet

Outline

Preview agenda

Review homework

Teach parent how to use armations

Discuss how reactions may maintain a childs behavior

Explain how to manage consequences

Have parent identify consequence strategies

Discuss taking precautions with using punishment (optional)

Assign homework

Preview Agenda

Preview the agenda for this session. Review the brainstorming interven-
tions format (introduced in Session 3), pointing out which area will be
addressed during this session (managing consequences).

75
Homework Review

Ask the parent if he has any questions about the previous session or
the workbook readings. Review the homeworkidentifying precipi-
tating circumstances and choosing strategies to prevent problem
behavior. (If the parent did not generate additional prevention strate-
gies, prompt him to do so using one of his hypothesis statements and
record these on the homework forms.)

Ask the parent about communications with family members and

others. Provide feedback. Review Weekly Progress Report.

Review the parents Self-Talk Journal. Ask the parent to choose one
success and one diculty from the past week and share the entry
(including the situation, self-talk, and consequences of the self-talk).
Have the parent describe how he disputed or distracted himself from
pessimistic beliefs.

Using Affirmations

Explain that, once we identify inaccurate and unproductive thoughts

and are able to stop them in process, it is benecial to then replace those
beliefs with positive self-talk. This is called substitution or reattribution.
In essence, we replace the pessimistic ideas with armations (e.g., This
is a dicult situation, and I am handling it well. I am a committed, lov-
ing parent.). These armations should be:

Stated in present tense (e.g., I am a gentle, but rm, parent vs.

I will be better next time)

Focused on solutions, stating what can be done to resolve a situa-

tion (e.g., I can explain calmly what I want him to do and guide
him, if necessary)

Both specic and comprehensive (i.e., clear and relate to

various situations in which pessimistic beliefs are likely
to arise)

Honest and practical (i.e., not resulting in false impressions or

unreasonable expectations)

76
Application

Have the parent consider one or more of the entries in his Self-Talk
Journal and identify an armation he might use to substitute the
pessimistic thinking. (Ask, What could you say to yourself in that
situation?) Have the parent record the armation in column 5 of his
Self-Talk Journal as an example.

Throughout the session, help the parent to recognize his thoughts and
feelings, the circumstances that precipitate them, and the conse-
quences of those beliefs. Pay attention to the parents body language as
you discuss dierent topics. If the parent appears to be uncomfortable
or resistant, prompt him to identify his self-talk by saying something
like, You seem uncomfortable. What are you thinking right now?
Guide him through the disputation process when appropriate or
prompt him to use distraction (e.g., You are stating some negative
ideas; how can you stop them?). Prompt the parent to substitute
pessimistic thoughts with positive armations. These elements should
be blended throughout the session and not unnecessarily interrupt the
ow of the training.

Maintaining Problem Behavior

Discuss how consequences (e.g., parental reactions) maintain behavior,

providing examples. What we say or do in response to a behavior as
well as what naturally occurs as a result of that behavior (e.g., the sound
hitting a window makes which pleases the child) can increase the like-
lihood that the behavior will continue to occur. For example:

Yelling or providing long explanations about why a behavior is a

problem just after the incident can reinforce the behavior with
attention (because any attention is better than none) rather than
being perceived as punitive or simply educational by the child.

Backing o from a demand because the child gets upset can also
reinforce the behavior because the child no longer has to com-
plete a seemingly unpleasant activity and, therefore, might cause
the child to act up again to avoid or escape demands.

77
 Giving in to a request for a toy, food, or an activity because the child
becomes increasingly demanding or disruptive will make that behav-
ior worthwhile and, therefore, likely increase the probability that the
behavior will occur in the future.

Ignoring certain kinds of behavior to avoid giving attention can

be counterproductive. If the behavior occurs because it feels,
looks, or sounds good to the child (e.g., hand apping) it might
be more likely to continue if left alone.

(If the parent feels that his reactions to the child [e.g., giving in to placate
the child] might be inadvertently encouraging problem behavior, prompt
him to consider what he is saying to himself at the point when he reacts
that way and what results might be maintaining his own behavior.)

Explain that identifying the specic consequences that appear to be

maintaining a childs problem behavior can help us to respond more
eectively. Have the parent ask himself the following question: How
can I respond to my childs behavior so that he gets the results he desires
more readily for good behavior than problem behavior?

Managing Consequences

Explain how to change consequences to promote positive behavior and

deter problem behavior. The ultimate goal when managing conse-
quences is to make sure a childs goals (i.e., the purposes or functions of
his behavior) are achieved through positive behavior rather than prob-
lem behavior (as well as ensuring that our reactions are not actually
feeding into the problem). Provide examples:

If a child misbehaves for attention, ask other people to interact

with the child only when he is behaving nicely. As soon as he
begins to act out, they should stop looking at the child or com-
menting on his behavior.

If a child acts up when he wants an activity, a toy, or other item,

make sure those things are available for positive, but not problem,
behavior (e.g., requiring the child to say or sign for something
before receiving it or allowing treats only after nishing dinner).

78
 If a child seems to enjoy the behavior itself (i.e., it feels good),
nd other ways for the child to get that same kind of stimulation
(e.g., dancing, manipulating toys instead of rocking and apping
hands).

If a child behaves badly to escape something he doesnt like, give

the child breaks or reduce the demands when he is behaving
appropriately, but try not to allow the child to avoid those situa-
tions otherwise (e.g., allowing the child to leave a restaurant and
go for a walk if he signs out).

Emphasize that, obviously, we do not have control of every conse-

quence of a childs behavior (e.g., attention strangers provide, the
feel good factor) in every situation; however, the modications we
make will still produce positive change. To have the most impact
when using consequences, we must strive to respond immediately
when behaviors occur (e.g., to reward positive behavior) and to be as
consistent as possible.

Identifying Consequence Strategies

Present a sample hypothesis (see the following case example). Ask the
parent to identify the consequences that appear to be maintaining the
problem behavior (what the child gets or avoids) and strategies to
manage consequences that include providing rewards only following pos-
itive behavior and withholding positive consequences in response to
behavior problems. Discuss how these strategies might be put in place.
Share other examples as appropriate and necessary.

Case Example: Hypothesis about Ben

When Bens parents try to put his shoes on to leave the house, he
screams, cries, and drops to the oor. It is especially bad when he is
tired. The tantrum delays the transition, forces his mother to take
him out without shoes, or results in her canceling the errand or
getting someone else to do it.

Based on the summary statement for the case study, describe how to
respond to the childs behaviorto provide reinforcement when he

79
 engages in positive or replacement behavior and to withhold reinforce-
ment when he engages in problem behavior. Be specic, and make sure the
example consequence strategies are functional and minimally intrusive.

Case Example: Responding to Bens Behavior

If Ben asks appropriately for a delay in a transition or a break from

playing with someone (e.g., by putting his hand up, by pointing to a
toy or puzzle piece, or by saying go), back o for one minute saying,
Okay, you need space; one more minute. (Allow some time in the
schedule for these brief delays.)

Praise Ben for transitioning and tolerating others participating in his

play, and acknowledge it is hard for him. Praise every little action he
does appropriately (e.g., standing, walking out the door, sitting in the
car or with a person, taking a puzzle piece). Provide little rewards
for going places and doing things without tantrums (e.g., a special
activity at school, a treat on an errand, time to play by himself ).

During a transition, if Ben refuses to leave or drops to the oor, guide

him gently but rmly to leave. Do not allow his behavior to delay the
transition. Ignore crying and screaming, and do not comment on his
behavior (e.g., Youre just being a baby or Im sitting here whether
you like it or not).

If he begins to cry or scream during play, encourage him to say go

(e.g., do you want me to go?) or put his hand up, helping him to do
it if necessary, and then back away. After a brief period, re-enter his
play, saying, I just want to play for a bit (e.g., just long enough to
hand him a toy). If he handles play without crying and screaming for
a short period (e.g., one minute), ask him if he would like to be
alone, prompt him to say go, and leave. Gradually extend the time
he is expected to play before he can ask someone to go.

Application

Using the hypotheses or summary statements the parent developed for his
child, repeat the preceding exercise. Refer back to the initial ideas for
managing consequences recorded in the center column of the completed

80
 Brainstorming Interventions form from Session 3. Continue to develop
ideas for reinforcing positive behavior and avoiding rewarding problem
behavior. Have the parent record these ideas on the Managing
Consequences Worksheet. Consider how these strategies might be put
in place.

(Guide the parent to consider self-talk that may make it dicult for
him to be consistent in managing the consequences he has identied
and how he might replace that self-talk.)

Use of Punishment

It is very common for parents to react negatively to behavior problems,

especially when they are tired or frustrated. If the parent uses punish-
ment to address behavior, and the use of these methods is interfering
with implementation of positive behavior support, engage in a discus-
sion of the concerns associated with punishment. Stress that, whether
this is simply an unplanned reaction to the behavior (e.g., yelling stop
that) or part of an ongoing punishment plan (e.g., using long time-outs,
spanking, or withholding favorite things), it is important to use punish-
ment strategies sparingly and with caution. This is because, among other
concerns, the eects of punishment are often limited and short-lived.

Discuss the following points:

Although punishment might interrupt the behavior, and the

childs initial response might be to stop being disruptive,
usually the behavior problems return again in the same
situation.

Children often learn when they will be punished (for example, by

Dad at home) and when they will not be punished (for example,
at a relatives house); therefore, they misbehave more in some
places.

A child may comply or stop a behavior quickly (but temporarily)

through punishment, reinforcing parents to use it again.

When punishment becomes less eective, there is a tendency to

use more severe forms (for example, yelling louder, spanking, or

81
 removing access to more and more favorite things). This escala-
tion of punishment can be dicult to stop.

Punishment focuses on what we want a child not to do, rather

than what we want a child to do in these situations.

Homework

Have parent continue to keep Self-Talk Journal.

Have parent continue practicing distraction and/or disputation
strategies.

Have parent develop and practice positive armations.

Remind parent to complete the Weekly Progress Report.
Have parent complete the Managing Consequences Worksheet. The
parent should try out these strategies and observe the impact they
have on the childs behavior (continue data collection using the
methods selected in Sessions 1 and 2).

Encourage parent to talk with family members and others to get their
input on consequence strategies.

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Chapter 8 Session 6: Replacing Behavior

(Corresponds to session 6 of the workbook)

Materials Needed

Self-Talk Journal

Completed Brainstorming Interventions form from Session 3

Replacing Behavior Worksheet

Teaching Plan form

Outline

Preview agenda

Review homework

Review and practice cognitive restructuring

Discuss replacing behavior

Have parent select replacement behaviors

Discuss how to teach a child skills

Assign homework

Agenda Preview

Preview the agenda for this session. Review the brainstorming interven-
tions format (introduced in Session 3), pointing out which area will be
addressed during this session (replacing behavior and teaching skills).

83
Homework Review

Ask the parent if she has any questions about the previous session or the
workbook readings.

Review the homeworkidentifying strategies to manage consequences

(providing and withholding rewards) and eorts to use these strategies
and outcomes. (If the parent did not generate additional strategies for
responding to her childs behavior, prompt her to do so using one of her
hypothesis statements and record these on the homework forms.)

Ask about communications with family members and others. Provide

feedback. Review Weekly Progress Report.

Review the parents Self-Talk Journal. Ask the parent to choose one suc-
cess and one diculty from the past week and share the entry (includ-
ing the situation, self-talk, and consequences of the self-talk). Have her
describe how she disputed or distracted herself from pessimistic beliefs
and what positive statements (i.e., armations) she used for substitu-
tion. Note: the statements should be honest and practical and be stated
in present tense (e.g., I am a gentle, but rm, parent), focused on
solutions (i.e., state what will be done to resolve a situation), and be
both specic and comprehensive (i.e., clear and relate to various situa-
tions in which pessimistic beliefs are likely to arise).

Cognitive Restructuring

Have the parent consider one or more of the entries in her Self-Talk
Journal and work through the entire process. Have her evaluate how she
is doing with the cognitive restructuring strategies (e.g., What is work-
ing well? What isnt working? How will you do things dierently next
time?). Then have her record her impressions in the comments section
of the Self-Talk Journal.

Throughout the session, remind the parent to identify any negative

thoughts or feelings, circumstances that precipitate them, and conse-
quences of those beliefs. Pay attention to the parents body language as
you discuss dierent topics. If the parent appears to be uncomfortable
or resistant, prompt her to identify her self-talk by saying something

84
 like, You seem uncomfortable. What are you thinking right now?
Encourage her to use disputation and/or distraction and to substitute
pessimistic thoughts with positive armations. These elements should
be blended throughout the session and not unnecessarily interrupt the
ow of the training.

Replacing Behavior

Discuss the importance of identifying positive skills to replace prob-

lem behaviors, types of skills we might select, and some considerations
in choosing replacement behaviors. Emphasize that, while problem
behavior is often frustrating and overwhelming to families, it is
important to recognize that the behavior is purposeful. Children mis-
behave because, at the moment, they lack appropriate and eective
skills to deal with unpleasant situations or to get what they want.
Problem behavior is typically communicativeit is a childs way of
telling other people that she needs something or wants something to
stop. Realizing that problem behavior is simply a means to an end
helps us nd other, more appropriate or desirable ways for the child
to behave and, therefore, replace problem behavior. (If the parents
beliefs about the childs capability to learn and use appropriate behav-
ior enters into the discussion, explore her self-talk and guide her to
create positive armations.)

A question that helps us identify specic replacement behaviors is:

What else could the child do to get what she needs, to avoid or delay
a dicult situation, or to deal with particular circumstances more
appropriately and eectively?

Replacement behaviors can include children requesting specic

items, activities, or types of interactions; completing chores or other
daily living tasks more independently; or simply learning to tolerate
unpleasant circumstances (e.g., having to wait) for periods of time.
For example:

If a child misbehaves when uncomfortable or upset, teach the

child how to address her own needs (e.g., breathe deeply when
anxious, get a drink when thirsty).

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 If a child has diculty with certain activities, encourage her to ask
for help, switch to another activity, or take periodic breaks.

If a child acts out when wanting attention, teach her how to begin
an interaction (e.g., by touching a persons hand or holding up a
toy) or to get involved in another activity until a person becomes
available.

If a child usually responds to having to give up preferred items or

toys with misbehavior (e.g., resisting putting away her favorite
magazine), teach her how to appropriately ask for the things back,
take turns sharing them with others, or put the items away herself.

In addition to these immediate ways of resolving problems and meeting

needs, we might also want to teach the child other life skills such as:

Social skills to use when interacting with other children (e.g., how
to join play or take turns in a game)

How to use toys or other items appropriately

Self care such as grooming

Leisure activities (e.g., hobbies) so the child can entertain herself

for periods of time

(If this discussion challenges the parents assumptions about skills the
child is capable of developing, explore her self-talk regarding the childs
capabilities.)

Competing with Problem Behavior

Explain that long-held habits can be dicult to change. Just as our own
patterns of behavior are hard to break, a child who is used to being
disruptive to communicate or to get her needs met might initially resist
eorts to change her behavior and feel frustrated that behaviors that
have worked previously are no longer working. For other, more appro-
priate behavior to replace problem behavior, the new behavior has to be
easy for the child to use and produce the same or similar outcomes. By
competing eectively with the problem behavior, a child learns that it

86
 might be easier to get what she wants by using the new behavior rather
than the old, inappropriate behavior. The payo is as good or better
for the new behavior and, therefore, outweighs the benets of using the
problem behavior.

For example, a childs screaming when she doesnt get her way with her
parents might be very eective because they give in immediately to stop
the screaming. If the parents try to get the child to say in a full sentence
I want ____ please and she has diculty speaking, it will certainly be
easier for her to scream. In this situation, it might be more appropriate to
simplify the expectation and require the child only to point to the item.
The parents could later expect her to say the word and then speak in a full
sentence. This way the child can be immediately successful and will be
more likely to communicate in an appropriate manner.

Selecting Replacement Behaviors

Present a sample hypothesis (see the following case example) and ask the
parent to think about both the function of the problem behavior and the
circumstances precipitating it. Have her identify positive behavior that
would replace the problem behavior. Discuss how these strategies might
be put in place. Share other examples as necessary and appropriate.

Case Example: Hypothesis about Ben

When Bens parents try to put his shoes on to leave the house, he
screams, cries, and drops to the oor. It is especially bad when he is tired.
The tantrum delays the transition, forces his mother to take him out
without shoes, or results in her canceling the errand or getting someone
else to do it.

Based on the summary statements for the case study, describe behav-
iors that could be taught to replace the childs problem behavior. The
behaviors should achieve the same function as the problem behavior
(and/or allow the child to cope better with the circumstances). The
behaviors should be clearly dened and be ecient and eective. For
example, the following are ways Bens parents taught him new behav-
iors to replace his problem behavior.

87
 Case Example: Replacing Bens Problem Behavior

Encourage Ben to ask for a brief delay in transitions by putting his

hand up or pointing to a puzzle piece (to indicate he wants to contin-
ue playing). To prompt him, say, What do you want? and physically
guide him through the movement.

Teach Ben to check his schedule prior to transitions. (The schedule will
be posted near his play area where he has access to it at all times.)
Have him put his puzzles or toys away prior to leaving.

Have him practice waiting for food for brief periods of time and
stopping activities to do something else (e.g., to wash his hands or wipe
his mouth). Encourage Ben to ask to continue activities: say, what do
you want? Help him point toward the activity and then say, Oh, you
want to play with the puzzle?

Practice playing with Ben by initially sitting beside him, then touch-
ing his toys, then handing him toys he needs, and eventually taking
turns with toys. Prompt him to say go or put his hand up when he
needs a break, and move away.

Have Ben practice eating at the table for short periods of time, provid-
ing praise and treats when he remains in his seat.

Application

Using the hypothesis or summary statement the parent developed,

repeat the preceding exercise. Refer back to the initial ideas for replacing
behavior recorded in the right column of the completed Brainstorming
Interventions form from Session 3. Continue to develop ideas for
replacement behaviors that would achieve the same function as the prob-
lem behavior (and/or allow the child to cope better with the circum-
stances). Have the parent record these ideas on the Replacing Behaviors
Worksheet. Consider how these strategies might be put in place.

(If appropriate, discuss any self-talk of the parent that would interfere
with the development of these skills for the child.)

88
Teaching Skills

Describe the basic steps for systematically teaching new skills, provid-
ing examples. The most important long-term approach for addressing
childrens behavioral concerns is to give them better ways to meet their
needs and handle dicult situations. In essence, positive behavior sup-
port is really about teachingguiding children to develop the skills
they need to be successful.

For many children, learning new behaviors takes more than simply
showing them or describing what we want them to do. Often times, new
skills must be presented in a systematic way for them to be eectively
learned. The following are steps for teaching skills (see case study for
examples of each step):

Step 1. Identify what exactly you want to teach (i.e., what you want your
child to say or do). Break it down into teachable units, and dene
the steps or components clearly. This is called a task analysis.

Step 2. Decide where, when, and with whom this skill is needed (e.g.,
when shopping in public, at meal times, or with grandparents).

Step 3. Arrange the environment to prompt the use of the skill, and
provide reminders, relying on natural cues whenever possible.

Step 4. Help your child to be successful in performing the skill by using

eective prompting methods such as:

Giving the child an example

Showing the child how to do it

Using gestures (e.g., pointing)

Physically guiding the child through the behavior

Step 5. Praise and reward use of the skill or progress in the right direction
(successive approximations). Correct errors, and withhold
rewards following mistakes and resistance.

Step 6. Gradually reduce your assistance, your feedback, and the

rewards you provide to lessen dependence and so that use of the
skill and the results it produces become their own reward.

89
 Consider examples of goals for behavior, and discuss how the parent
would teach the required skills.

Case Study: Teaching Ben Skills

Share an example of how to teach a replacement skill (e.g., transition-

ing), using the six steps described in the previous section.

Step 1: Bens parents identied that they wanted to teach Ben to transition
from the house or classroom to the car by having Ben:

1. Put away toys and other materials

2. Walk to his schedule and point to the picture indicating the next
activity

3. Put on his shoes (with assistance from his parent or teacher)

4. Pick up his car toys bag and take it with him

5. Walk calmly to the car and get in

Step 2: Bens parents decided this transitioning skill was needed any time
Ben must leave one place to go to another (e.g., from home, school,
or the store to the car).

Step 3: To provide cues for the skill, Bens parents put a small bag of
special car transition toys near the door but out of Bens reach.
They changed these toys periodically and whenever Ben seemed to
lose interest in them. Prior to each transition, they would point to
the bag and show Ben on his schedule where he would be going
(e.g., In a couple of minutes, we will be going to ____ ). They
also placed Bens shoes near the play area with the Velcro undone.
When it was time to leave, they would say, Time for ____
(e.g., school, store).

Step 4: Bens parents showed Ben the behavior they wanted from him.
Their plan was as follows:

If Ben does not respond to time for school by putting away

his toys, his parents model for him by putting one of his toys
away for him and saying, Your turn, Ben; put away _____
(whatever toy he has).

90
 They wait for him to respond to the cue or prompt. If he still
continues to play, they gesture and move the toy bin or
container closer, saying Put away ____ (and pointing in the
container).

If there is still no response, then they say, I will help you

Ben. This is hard. Put away ____, and guide Ben to drop
the toy in the bin. If he does not drop it, they say put
away and then pry the toy away and put it in the bin.
We can play later (after school). Then they have Ben
put on his shoes (or put them on for him) and get car
toys bag.

Step 5: Bens parents praised him frequently for putting his toys away
(even if the toy had to be put in hand-over-hand), getting up
and moving toward the door, picking up his toy bag, and leaving
his shoes on (e.g., Wow, you did it! You are walking with
mommy). If Ben made it to the car without a tantrum, they
gave him an extra toy (kept in glove compartment). Once in the
car, they said something every minute or two about sitting nicely
in the car. When he arrived at his destination without a
tantrum, they provided a special treat (e.g., fun activity at
school, treat on the errand). They made a schedule to show him
what he would get upon arrival to school. If Ben threw a
tantrum, they continued the sequence described in Step 4 and
made sure all toys got put away so there was complete closure
to activities. They would say one more puzzle piece or one
more animal, then we go. They ignored screaming, crying,
and dropping to the oor. They would say, It is hard to stop
playing. You can play later. They moved him through each
step with as little delay as possible, reassuring him along
the way.

Step 6: Bens parents waited longer and longer (e.g., adding a few seconds
each time) to praise or help Ben to put away his toys and get his
shoes on. They praised him for spontaneously using his schedule.
In the beginning, they limited transitions only to things Ben has
to do (e.g., school) or really likes to do (e.g., swimming), then
gradually added more activities.

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Application

Refer to the ideas the parent listed on the Replacing Behavior Worksheet.
Consider which replacement behaviors require systematically teaching the
child new skills. Choose one, and work through the preceding steps,
recording the information on the Teaching Plan form. (If appropriate,
discuss any self-talk of the parent that would interfere with the develop-
ment of these skills for the child.)

Homework

Have parent continue to keep Self-Talk Journal.

Have parent continue practicing distraction, disputation, and positive
armations.

Remind parent to complete the Weekly Progress Report.

Have parent complete the Replacing Behavior Worksheet. The parent
should try out these strategies and observe the impact they have on
the childs behavior (continue data collection using the methods
selected in Sessions 1 and 2).

Have parent complete the Teaching Plan form. The parent should try
teaching skills and observe their impact on the childs behavior.

Encourage parent to talk with family members and others to get their
input on replacing behavior and teaching skills.

92
Chapter 9 Session 7: Putting the Behavior Support Plan
in Place

(Corresponds to session 7 of the workbook)

Materials Needed

Self-Talk Journal

Behavior Support Plan form

Outline

Preview agenda

Review homework

Review self-talk and apply cognitive strategies

Introduce designing a behavior support plan

Discuss how to make sure the behavior support plan ts

Consider how the behavior support plan promotes lifestyle change

Help parent begin creating an action plan

Assign homework

Agenda Preview

Preview the agenda for this session. Explain that the focus of the session
will be on how to put the behavior support plan in place. The content
will include putting the plan into a usable format, choosing strategies

93
 that t the child and family, considering how the plan creates lifestyle
change, and making sure we have what we need to put our ideas into
action.

Homework Review

Ask parent if he has any questions about the previous session or the
readings. Review the homeworkselecting replacement behaviors and
eorts to teach skills. (If the parent did not generate additional strate-
gies for replacing the childs behavior, prompt him to do so using one
of the hypothesis statements and record these on the homework forms.)

Ask about communications with family members and others. Provide

feedback. Review Weekly Progress Report.

Review Self-Talk Journal, and ask the parent to choose one success and
one diculty from the past week and share the entry (including the
situation, self-talk, and consequences of the self-talk). Have the parent
describe how he disputed or distracted himself from pessimistic beliefs
and what positive statements (i.e., armations) he used for substitution.

Self-Talk Review and Application

Have the parent review his entire Self-Talk Journal (every form) and
look for themes or patterns. Ask him to evaluate how he is doing with
his self-talk (e.g., What is working well? What isnt working? How
will you do things dierently next time?). Have him record his
impressions in the comments section of his Self-Talk Journal.

Throughout the session, remind the parent to identify any negative

thoughts or feelings, circumstances that precipitate them, and
consequences of those beliefs. Pay attention to the parents body
language as you discuss dierent topics. If the parent appears to be
uncomfortable or resistant, prompt him to identify his self-talk by
saying something like, You seem uncomfortable. What are you think-
ing right now? Encourage him to use disputation and/or distraction
and to substitute pessimistic thoughts with positive armations. These

94
 elements should be blended throughout the session and not unnecessar-
ily interrupt the ow of the training.

Designing a Behavior Support Plan

Explain the importance of developing a comprehensive written behavior

support plan to help get it in place and to ensure that it will be used con-
sistently. Emphasize that once we understand the patterns surrounding
a childs behavior and have developed relevant interventions, identifying
and putting the strategies in place might seem to follow naturally; how-
ever, there are issues that will inuence how well the plan will be imple-
mented and, therefore, how eective it will be. These issues include:

The clarity of the plan

The degree to which the strategies t the child and family

The degree to which the plan produces positive lifestyle changes

The specic steps taken to put the plan into action

Integrating Components

Review the components of a comprehensive behavior support plan, and

provide examples. Explain that written behavior support plans are
important because they facilitate communication among the people
implementing them. They can be reviewed frequently to keep interven-
tions on course and revised as changes become necessary. Behavior
support plans should be based on our hypotheses or best guesses
(i.e., patterns identied in information gathering) and include the fol-
lowing components:

1. Strategies to prevent behavior problems (e.g., avoiding dicult

circumstances, making situations better, adding prompts for good
behavior)

2. Strategies for managing consequences (i.e., making sure rewards

are provided for positive behavior and not problem behavior)

95
 3. Strategies for systematically teaching replacement skills so that the
childs needs can be met through more appropriate means where
and when they are needed

Case Example: Behavior Support Plan for Ben

Review the behavior support plan for the case study of Ben (see
Figure 9.1.; a copy is provided in the workbook). If using another
example, provide a copy of a sample plan. The plan should include
(at minimum) goals, target behaviors, summary statements, strategies
for preventing problems, strategies for managing consequences, skills
for teaching replacement behavior, and a monitoring plan.

Application

Review the activities the parent completed in Sessions 1 through 6

(establishing team, identifying goals and target behaviors, developing
hypotheses, brainstorming interventions). Look over the Behavior
Support Plan form. Begin inserting appropriate information,
and make sure the parent is comfortable completing the plan as
homework.

Making Sure the Plan Fits

Discuss issues associated with a plans contextual t. When brainstorm-

ing possible strategies for addressing childrens behavior based on the
hypotheses, it may be evident that there are a variety of options from
which to choose. For example, there may be numerous ways to prevent
problems from occurring or several specic behaviors that may be
identied as replacement skills. When selecting among the possible
strategies, the best choices are the ones that are right for the child and
familythose that t their needs, skills, strengths, challenges, and
goals. For this reason, parents should discuss their concerns and ideas
with the child and other family members to get their input whenever
possible.

96
 Behavior Support Plan: Part 1

Childs Name: Ben Date: 10/1/07

Team Members: Who is involved in the process?

Bens parents, his grandmother, and his preschool teacher (also include friends at school and
in neighborhood and babysitter)

Intervention Settings: Where will the plan be used?

Home, school, community outings

Description of Problem Behavior: Baseline Estimate:

What does the child say or do? How often? How long?
Tantrums: screaming, crying, 5 times per day
dropping to the floor

Broad Goals: How would you like life to improve for your child and family?

Ben will play with other children and adults, handle transitions and change better, and ride in the car
and eat with the family without problem behavior.

Ben will develop more interests (beyond animals and puzzles) and participate in typical childhood
experiences, including spending time with friends.

Ben will become more independent with his self-care, sleep alone, and develop the skills he needs
to keep himself safe (e.g., looking out for traffic).

Bens parents will be able to enjoy life as a family without the constant stress presented by his
problem behavior. They hope to be able to go places and do more things as a family and to reduce
the conflict in their lives.

Summary Statements: Describe circumstances, behavior, and consequences (get/avoid).

When Bens parents try to put his shoes on to leave the house, Ben screams, cries, and drops to
the floor. This delays the transition, forces his mother to take him out without shoes, or results in
her canceling the errand or getting someone else to do it.

When his parents or peers try to play with Ben, he screams and cries; if they dont back off, he
turns his back on them or pushes them away. Eventually, the children or family members back off,
and Ben is able to continue playing contentedly by himself.

When Ben doesnt eat well at breakfast and lunch, he screams and cries as dinnertime approaches.
If Bens mother doesnt feed him right away, he might bang his head. As a result, she quickly
prepares him something he likes to eat. She often allows Ben to carry his food around (rather than
requiring him to sit with the family during meals).

Figure 9.1
Example of Completed Behavior Support Plan

97
 Behavior Support Plan: Part 2
Intervention Components: What strategies will be used (based on the summary statements)?
Prevention: What changes
will be made to avoid prob-
lems, make dicult situations
better, or prompt good
behavior?
Set up a schedule with pic-
tures of Bens typical daily
activities. Prior to transitions,
remind him of where he will
be going by pointing to that
picture on his schedule.
Explain what he needs to do
during the transition, using
consistent words. Remind him
of fun things he can do or
treats he will receive where
he is going.
Create a bag of special toys
that Ben may take with him
on outings, and place a few of
his favorites in the glove com-
partment. Change out the toys
periodically, and keep them
only for transitions.
Schedule play sessions during
and after school. Alternate
playing with others and play-
ing independently. Make the
sessions very short, with only
small attempts to play with
him or simply playing with
the toys next to him without
demands. Tell him exactly
what you want to do with
him before ending playtime.
Figure 9.1 continued
98
Management: How will you
respond to reward positive
behavior and not problem
behavior?
If Ben asks for a delay in
a transition or a break from
play appropriately, back off
for one minute, saying,
okay, you need space/one
minute.
Praise Ben for transitioning
and tolerating others playing
with him. Praise every action
he does well. Provide small
rewards for going places and
doing things without
tantrums.
During a transition, if Ben
refuses to leave or drops to
the floor, guide him gently
but firmly to leave. Do not
delay the transition. Ignore
crying and screaming.
If he plays without crying
and screaming for a short
period, ask him if he would
like to be alone, prompt him
to say go, and leave.
Gradually extend the time
he is expected to play before
asking someone to go. If he
begins to cry or scream
during play, remain in the
area until he asks go.
Allow Ben to leave the
Replacement: What skills will
be taught to replace the prob-
lem behavior?
Encourage Ben to ask for
a brief delay in transitions
by putting his hand up or
pointing to a toy (to indi-
cate he wants to continue
play). To prompt him, say,
What do you want? and
guide him through the
movement.
Teach Ben to check
his schedule prior to transi-
tions. Have him put his toys
away prior to leaving.
Have Ben practice waiting
for food for brief periods
of time and stopping activi-
ties to do something else.
Encourage Ben to ask to
continue by saying to him,
what do you want? Help
him point toward the activ-
ity and then say, Oh, you
want to play with
puzzle/animals.
Teach Ben to tolerate play
with other people by sitting
beside him, touching his toys,
handing him toys, and even-
tually taking turns with the
toys. Prompt him to say go
or put his hand up when he
needs a break.
 Behavior Support Plan: Part 2

Intervention Components: What strategies will be used (based on the summary statements)?
Have Ben eat meals and table during meals, but ask Have Ben practice eating at
snacks only at the table. him to put his food down the table for short periods
Provide Ben with some of his before he goes. If he refus- of time.
favorite foods during break- es, remove the food. When Teach Ben daily living skills,
fast and lunch. Before meal he is seated, return the such as tooth brushing and
preparation, get Ben involved food. Reward Ben for eat- potty training.
in an activity. (Set the table ing at the table with his
ahead of time, and do what- favorite foods.
ever preparations can be done
earlier in the day). When its
time to eat, bring him to the
table explaining that he must
sit to eat.

Crisis Management:
Is a plan needed to ensure the safety of your child, other people, and the surroundings? __X
__yes__no
If so, describe strategies:

If necessary, physically guide or carry Ben out of public places or unsafe situationsbeing careful to be
gentle but firm.

Other Support: What else can improve life for your child and your family?
Take Ben out to new places (e.g., a water park, playground, convenience store) periodically.

Find peers in the neighborhood and at school to play with Ben weekly; teach the children how to
enter his play without upsetting him.

Develop a plan for teaching Ben to use the potty (e.g., creating a schedule, using rewards) and self-
care skills (e.g., washing hands). Institute a regular bedtime routine.

Locate a babysitter for weekend dates. Become involved in a support group in the community.

Figure 9.1 continued

99
 Behavior Support Plan: Part 3

Action Plan Steps

Steps to be taken: Person responsible: Time to be completed

by:

Review the plan and get a Mom 10/7

commitment from other people who
care for Ben (e.g., family members,
teachers) to carry out the plan.
Create a picture schedule for Mom and Teacher 10/14
home and school (take pictures,
purchase supplies, and laminate).
Get oversized bag and new toys for Dad and Grandma 10/14
outings.

Monitoring :
How often will the plan be monitored? __x__daily __x__weekly __monthly __other
How will implementation and outcomes be evaluated?
Continue using scatterplot and ABC recording forms to evaluate changes in behavior. Keep
a daily journal that includes particularly successful and unsuccessful transitions, results of
attempts to play with Ben, and estimated times Ben remains at the dinner table. Meet
briefly with Bens teacher at the end of the school day on Fridays to discuss progress and
decide on changes to be made.
Monitoring methods (e.g., forms): Scatterplot, Behavior Log

Figure 9.1 continued

100
Whether behavior support plans are implemented as designed depends
on the commitment of the people using the plan and the degree to which
strategies are really doable. What we do to address a childs behavior
should be determined based on a consideration of resources and natural
patterns of family life. Things that need to be taken into account include:

Amount of time and energy implementing particular strategies

will require

Financial and material resources that will be necessary

Family values and roles, members relationships with one another,

cultural characteristics (i.e., making sure that whatever is designed
ts with the style of the whole family)

Typical routines, patterns, and traditions (i.e., trying to design the

plan to meld with the patterns that are comfortable for the other
family members)

Assess the degree to which the plan ts the child and family by look-
ing back at the strategies identied and considering the following
questions:

1. Does the team have enough time to put this in place?

2. Does the team have the energy to use it consistently?

3. Does the team have the resources it needs to make the plan
work?

4. Does the plan t given the familys values and needs?

5. Does the plan work within typical family routines?

6. Does everyone believe in the plan and agree to use it?

(Consider the parents current beliefs that might make implementing

the plan dicult, whether or not those beliefs can be altered and, if not,
how the plan might need to be modied.)

Case Example: Making Bens Plan Fit

Describe issues associated with contextual t for the case study child
and family, pointing these out in the behavior support plan. This

101
 should include any factors that would aect the design or implemen-
tation of the plan.

The primary challenges for Bens family were getting everyone on the
same page (including Grandma) and managing all the individual tasks
associated with the plan. It was important to make sure everyone had the
same goals and expectations and was adequately supported. Bens team
(parents, grandma, and teacher) agreed to meet and go over the plan
together, discussing any concerns, making sure everyone understood what
he or she was doing and why, and making adjustments to the plan as
needed to ensure buy-in. Then they all promised to follow through and
communicate openly about their concerns as time went by. They also dis-
cussed the fact that it might take time for the plan to work and that they
all needed to be patient. Bens mom talked to his teacher about how
overwhelmed she was with trying to create his schedule. His teacher
agreed to help Mom put it together after school while Dad watched Ben.
Bens mom found that trying to carry all of the dierent items to the car
was dicult, so she bought an oversized bag to use during transitions.

Promoting Lifestyle Change

Remind the parent that the primarily goal of positive behavior support
is not just to diminish problems but also to promote positive lifestyle
change. Discuss issues that should be considered in making sure that a
plan focuses on these broader goals. As we develop plans to address a
childs behavior, it may become evident that broader life issues are
aecting the childs behavior and will, therefore, need to be addressed
to produce positive changes. For example, if a child (or adult) is gen-
erally dissatised with the types of activities or circle of friends with
whom he interacts, those circumstance produce worse behavior over-
all. Some questions we might want to think about are:

1. Are there physical or medical conditions that need to be

addressed?

2. Is the child allowed to make choices and exert control over

important aspects of his life?

3. Do the childs current schedule and daily routines match his pre-
ferred style?

102
4. Are there aspects of the childs surroundings that need to be
changed?

5. Does the child have positive, non-instructional interactions (i.e.,

simply playing without placing demands on the child) with other
people?

Considering these questions, we might be able to make some broad

adjustments to a childs life that will improve his overall behavior
and even make using the other strategies less necessary. (If appropri-
ate, revisit the discussion regarding goals in the rst session,
considering whether and how the parents beliefs about his childs
future may have changed.)

Case Example: Improving Bens Life

Describe strategies for the case study directed at improving the broader
quality of life for the child or family (e.g., related to independence,
community participation, relationships), pointing out these things in
the behavior support plan.

Bens parents decided to start trying to take Ben out to new places (e.g., a
water park, playground, convenience store) once in a while to expose him
to new things. They also found a child from the neighborhood who was
willing to come over once a week to play with or around Ben; Bens
mom taught the child how to enter his play without upsetting him. The
same was done at school by his teacher with a child from another class.

Bens parents and teacher worked together to develop a plan for teach-
ing him to use the potty (e.g., creating a schedule, using rewards), and
they identied self-care skills (e.g., washing hands) they could teach
together using the steps for teaching skills described in Session 4. His
parents also instituted a regular bedtime routine to create a more con-
sistent, positive transition to bed at night.

Bens parents were able to nd an assistant at Bens preschool who was

willing to babysit periodically so that they could go out on dates
together. They also became involved in a support group in the commu-
nity so that they could foster relationships with other families and get
support when they needed it.

103
Application

Work with the parent to integrate all elements of the behavior sup-
port plan using the Behavior Support Plan form. Discuss issues relat-
ed to contextual t and identify strategies for lifestyle change while
constructing the plan. (If appropriate, ask the parent what he might
need to say to himself to believe in the plan and, therefore, follow
through.)

Creating an Action Plan

Explain the rationale for creating an action plan for getting the behavior
support strategies into place. Discuss issues that should be considered,
and provide examples. Explain that once we are satised with our plan for
dealing with a childs behavior, certain steps need to be taken to
implement the plan with some degree of consistency. Consistency is
important because hit and miss use of behavioral strategies can actually
be detrimental because problem behaviors could sometimes end up being
reinforced. To get the plan in place, it may be necessary to line up sup-
port from extended family, friends, babysitters, or teachers and to consid-
er how to draw in extra assistance for times that are too dicult to handle
alone. Preparations might also include changing schedules, setting up
methods to record changes in behavior over time, rearranging things at
home, or making other modications that can reduce some of the stress
associated with implementing the plan. By doing this type of preplan-
ning, the behavior support plan will be easier to put in place and adhere
to over time. (If the parent addresses attitudinal barriers that might inter-
fere with the plans implementation, ask him what steps need to be taken
to revise those beliefs.)

Case Example: Action Plan Steps for Ben

Describe or provide a written example of an action plan for the case

study (included in the Behavior Support Plan form). The action plan
should include what will be done, by whom, when, and/or how.

1. Review the plan, and get a commitment from other people who care
for Ben (e.g., family members, teachers) to carry out the plan.

104
 2. Work with Bens teacher to create a schedule for home and school that
includes transitions and play times. Decide beforehand who will get
what materials (e.g., Bens mother will get poster board, pictures of
settings or things that can represent activities for home, toys for the
bag, and some other reward to leave with the teacher; teacher will
take photographs of activities at school, get pictures of possible
rewards, and laminate the schedule for home and school).

3. Continue using the data collection procedures (scatterplot and ABC

recording) to monitor and evaluate how the plan is working.

4. Meet briey at the end of the school day on Fridays to discuss progress
and decide on changes to be made.

Application

Guide the parent to identify one or more action steps that need to be
implemented and to record them on his Behavior Support Plan form.

Homework

Have parent continue to keep Self-Talk Journal.

Have parent continue practicing distraction, disputation, and positive
armations.

Remind parent to complete the Weekly Progress Report.

Have parent complete the Behavior Support Plan, including developing
action plan steps for implementing the behavior support plan.

Encourage parent to talk with family members and others to get their
input on behavior and action plan steps.

105
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Chapter 10 Session 8: Monitoring Results and Wrap-up

(Corresponds to session 8 of the workbook)

Materials Needed

Self-Talk Journal

Monitoring Plan Worksheet

Monitoring Form

Outline

Preview agenda

Review homework

Review self-talk and apply cognitive strategies

Discuss monitoring the results of the plan

Discuss making adjustments over time

Wrap up the training

Agenda Preview

Preview the agenda for this session. Explain that the focus will be on
determining how to monitor the implementation and results of the
behavior support plan and making adjustments as needed to sustain the
outcomes over time.

107
Homework Review

Ask the parent if she has any questions about the previous session or the
workbook readings. Review the homeworkcomprehensive behavior
support plan, action plan for putting it in place, status of implement-
ing strategies and outcomes. (If the parent did not complete the behav-
ior support plan and action plan, assist her in recording at least the most
essential information.)

Ask about communications with family members and others. Provide

feedback. Review Weekly Progress Report.

Review the parents Self-Talk Journal, identifying the situations in

which she was successful and areas in which she is having diculty.
Have the parent describe how she disputed or distracted herself from
pessimistic beliefs and what positive statements (i.e., armations) she
used for substitution.

Self-Talk Review and Application

Have the parent review all her Self-Talk Journal sheets from the past
seven weeks and look for general themes and patterns. Ask her to
evaluate how she is doing with her self-talk (e.g., What is working
well? What isnt working? How will you do things dierently next
time?). Have her then record her impressions in the comments section
of the Self-Talk Journal. Help her to identify strategies to maintain
positive changes in self-talk (e.g., ongoing monitoring and feedback) or
to continue evaluating and addressing self-talk now that the sessions
will be ending.

Throughout the session, focus on areas of diculty, prompting

eective use of the cognitive restructuring methods. Pay attention to
the parents body language as you discuss dierent topics. If the par-
ent appears to be uncomfortable or resistant, prompt her to identify
her self-talk by saying something like, You seem uncomfortable.
What are you thinking right now? These elements should be blend-
ed throughout the session and not unnecessarily interrupt the ow of
the training.

108
Monitoring Results of the Plan

Discuss the importance of monitoring the results of our plans (e.g., to

make sure the plan is working, to provide those involved with the
positive feedback they need to stay motivated). Review what we
should look for to determine whether a behavior support plan is
working. Explain that it is important to track whether a behavior sup-
port plan is working and that evaluating progress objectively often
requires continuing to collect data. Sometimes changes in behavior
can be subtle or take some time to occur. Perceptions might not nec-
essarily match reality, and it can be very helpful to review the progress
across several weeks or even months and note changes that might not
be obvious on a day-to-day basis. In these cases, a system for record-
ing and reviewing results can provide the positive feedback necessary
to continue with the plan.

The goals of PBS, and therefore the target areas for monitoring, are not
only reductions in problem behaviors but also broader outcomes
related to a childs and familys quality of life. Here are some questions
to ask when monitoring results:

Are the childs problem behaviors decreasing in frequency or

intensity?

Is the child using replacement behaviors appropriately and more

than before?

Are we achieving the lifestyle-change goals we established in these

sessions?

Is the behavior support plan still working for the child and family
(i.e., does it t the circumstances and needs)?

The specic methods used to monitor these results can be quite

simple or more complex, as described in Session 1. For example, we
might use simple frequency counts to evaluate changes in behaviors of
concern, or we might use ratings or estimates of how well or often
replacement skills are used (e.g. 4 out of 5). For behaviors that occur
less often (e.g., once or twice a day), we can simply take note of when
they occur. However, if problems occur more frequently or they seem

109
 to be very complicated, it may be benecial to create a more involved
recording system. The people involved in using the plan could meet
periodically and look at the goals and target behaviors together to
evaluate broader outcomes.

Generally, the methods and timeline used should be based on how often
problems occurred before the plan was implemented. With this in
mind, we need to decide how often we will review the plan and out-
comes (e.g., if the child is hitting others on a daily basis, we would want
to review the data more often than for a child who has weekly
tantrums).

(If appropriate, explain to the parent that it is very easy to convince

ourselves that a plan is working or not working based on how we are
thinking or feeling instead of judging the plan on the objective evidence.
Discuss ways of avoiding this pattern.)

Case Example: Monitoring the Behavior Support Plan for Ben

Describe how the plan for the case study child could be monitored to
evaluate its eectiveness over time. Include the specic monitoring
strategies and schedule.

Bens parents kept:

A daily journal including when, where, and with whom Ben made
transitions and his accompanying problem behaviors

A brief log of their attempts to play with Ben (i.e., what they were
able to do with him)

An estimate of how long he remained seated with the family for

dinner each night

Application

Have the parent review the data she has collected to this point and
develop a plan for monitoring how the behavior support plan is used
and its outcomes for her child and family. Refer the parent to the
Monitoring Plan Worksheet in the workbook. Also have her consider

110
 when and how she will communicate with her family members and
others involved in her childs care to assess progress. Parents might want
to use the Monitoring Form provided in the workbook to track the
results of the behavior support plan.

Making Adjustments over Time

Explain that positive behavior support is an ongoing, problem-solving

approach (rather than a quick x). Discuss how life transitions and other
changes can prompt the need to review and adjust plans. Stress that PBS
is not something we do once and forget about. To be successful, plans
must be used consistently over time and modied as needs arise. While
initially it is important to be patient and not change the behavior support
plan too quickly, if signicant improvements have failed to occur after
several weeks, the plan should be revisited. Even the best plans occasion-
ally need to be revised.

Parents and others caring for the children should be continually asking
themselves what is working and what is not, and adjusting the plan as
needed. As time passes and children continue to develop, their needs and
the situations aecting their behavior change. Families might go through
transitions or life experiences that throw a wrench into the works. It is
important to recognize that changes in routines, circumstances, or lives
in general can prompt changes in childrens behavior. And as children go
through typical developmental changes (e.g., developing friendships,
starting school, learning new skills) or other unanticipated events, their
needs, and therefore our approach to dealing with them, will necessarily
change.

Parents need to take note of such changes and the impact they have on a
childs behavior, and they must be prepared to deal with them. Better yet,
they should anticipate and prepare for changes (e.g., taking children to
visit their new teachers, building the skills they need to play with friends),
avoiding unnecessary problems when possible. Parents can use the frame-
work of PBS and its tools over and over, repeating the process as needed.
In this way, parents can eectively support their children as they
encounter new situations and phases of their lives.

111
 Case Example: Outcomes of Bens Plan

Describe the outcomes of the case example, highlighting the types of

changes that occurred over time.

Within three weeks of putting the plan in place, Bens screaming and
crying during most transitions decreased just to whining and occurred
only about three times per week (and no longer than 30 seconds each
time). When Ben started speech therapy, however, transitions again
became a problem. When Ben knew he was headed to speech therapy at
either home or school, his tantrums escalated in severity and were much
longer. His parents, teachers, and therapists met to discuss this concern.
They reviewed the circumstances surrounding his behavior and possible
consequences. They determined that speech was particularly diicult for
Ben and decided to make some changes to reduce the demands. The strate-
gies included starting therapy sessions with activities they knew to be easier
for Ben, giving Ben periodic breaks, and adding special rewards when he
transitioned and participated well. These strategies were quite successful.

During play times, his mother and teacher were now able to sit with
him while he was playing and pick up and hand him toys. He usually
allowed them to remain with him for about two to three minutes
before saying go. He still wandered around the dinner table, but he
began putting his food down before leaving without reminders. His
parents were hopeful that he would start sitting with the family before
long. Ben even looked at his schedule and put his toys away sponta-
neously. He seemed to enjoy the predictability of knowing where he was
going and what would happen when he got there. Because of these
improvements, his parents felt condent beginning to expose Ben to
new people and places and tackling new skills such as sleeping alone
and potty training.

Application

Have the parent consider new behaviors of concern or upcoming

events, changes, or transitions that might inuence her childs behavior
and/or the appropriateness of the plan. Prompt the parent to describe
how the PBS process could be used to address those issues.

112
 Also, identify one or more ways the parent can continually assess the
plan, resolve problems, and make adjustments as needed. Have parents
record this information on the Monitoring Plan Worksheet.

Wrap-up to PBS Sessions

Reiterate the key themes of the training:

Self-talk aects the way a person feels and acts.

Replacing pessimistic beliefs with positive armations allows

parents to follow through with interventions and cope more
eectively with challenges.

PBS is collaborativeall those involved in a childs life should

work together.

PBS begins with an understanding of the circumstances that

aect the childs behavior and the purposes the behavior serves
for the child.

Sometimes problem behavior can be prevented by:

Anticipating dicult situations.

Avoiding or changing aspects of those situations.

Prompting the child to behave more appropriately.

Parents can manage their reactions so that they provide

their children with rewards for positive, and not problem,
behavior.

The most important element of a behavior support plan is to

replace problem behavior by teaching a child appropriate skills to
meet her needs.

Behavior support plans should be clear, reasonable, and focused

on important goals.

To be eective, behavior support plans must be used consistently

by all those involved.

113
 Behavior support plans must be monitored objectively on an
ongoing basis to determine their eectiveness and recognize when
adjustments are necessary.

Give an opportunity for the parent to ask additional questions or dis-

cuss any issues not adequately covered during the training. Provide
closure to the sessions (e.g., explaining the level and extent of
ongoing support available from your program). Make referrals to
other agencies or support groups as necessary. Thank the parent for
participating, and congratulate her on completing the program.

114
PBS Resources

Books/Articles

Carr, E. G., Dunlap, G., Horner, R., Koegel, R. L, Turnbull, A. P., Sailor,
W., Anderson, J. L., Albin, R. W., Koegel, L. K., & Fox, L. (2002).
Positive behavior support: Evolution of an applied science. Journal of
Positive Behavior Interventions, 4(1), 416.
Carr, E. G., Levin, L., McConnachie, G., Carlson, J. I., Kemp, D. C., &
Smith, C. E. (1994). Communication-based intervention for problem
behavior: A users guide for producing positive change. Baltimore, MD:
Paul H. Brookes Publishing.
Durand, V. M. (1990). Severe behavior problems: A functional communica-
tion training approach. New York: Guilford Press.
Durand, V. M. (1998). Sleep better! A guide to improving sleep for children
with special needs. Baltimore, MD: Paul H. Brookes Publishing.
Hieneman, M., Childs, K. E., & Sergay, J. (2006). Parenting with positive
behavior support: A practical guide to resolving your childs dicult
behavior. Baltimore, MD: Paul H. Brookes Publishing.
Hieneman, M., Nolan, M., Presley, J., De Turo, L., Roberson, W., &
Dunlap, G. (1999). Facilitators guide: Positive behavioral support. Positive
Behavioral Support Project, Florida Department of Education.
Koegel, L. K., Koegel, R. L., & Dunlap, G. (1996). Positive behavior sup-
port: Including people with dicult behavior in the community.
Baltimore, MD: Paul H. Brookes Publishing.
Lucyshyn, J. M., Dunlap, G., & Albin, R. W. (2002). Families and positive
behavior support: Addressing problem behavior in family contexts.
Baltimore, MD: Paul H. Brookes Publishing.
ONeill, R. E., Horner, R. H., Albin, R. W., Sprague, J. R., Storey, K., &
Newton, J. S. (1997). Functional assessment and program development
for problem behavior: A practical handbook. Pacic Grove, CA:
Brooks/Cole.

115
 Scotti, J. R., & Meyer, L. H. (1999). Behavioral intervention: Principles,
models, and practices. Baltimore, MD: Paul H. Brookes Publishing.
Sugai, G., Horner, R. H., Dunlap, G., Hieneman, M., Lewis, T. J., Nelson,
C. M., Scott, T., Liaupsin, C., Sailor, W., Turnbull, A. P., Turnbull,
H. R., Wickham, D., Ruef, M., & Wilcox, B. (1999). Applying positive
behavioral support and functional behavioral assessment in schools (TAG 1).
OSEP Center on Positive Behavioral Interventions and Supports.

Web Sites

Association for Positive Behavior Support (www.apbs.org)

Beach Center on Disability/PBS Program (www.beachcenter.org/pbs/
default.aspx)
Center for Evidence-Based Practice: Young Children with Challenging
Behavior (www.challengingbehavior.org)
Center on the Social and Emotional Foundations for Early Learning
(www.vanderbilt.edu/csefel)
OSEP Center on Positive Behavioral Interventions and Supports (www.
pbis.org)
Kansas Institute for Positive Behavior Support (www.kipbs.org)
Floridas Positive Behavior Support Project (http://pbs.fmhi.usf.edu)
Colorado Positive Behavior Support Initiative (www.cde.state.co.us/pbs)
Positive Behavior SupportNevada (www.pbsnv.org)
Journal of Positive Behavior Interventions (www.ingentaconnect.com/
content/proedcw/jpbi)
Scott, T. M., Liaupsin, C. J., & Nelson, C. M, (1999). Understanding prob-
lem behavior: An interactive tutorial. OSEP Center on Positive Behavioral
Intervention and Support & EDSRC, University of Kentucky
(http://serc.gws.uky.edu/pbis).

116
 Session 1: Introduction and Goal Setting
Client Name: _________________________ Date: ______________

Rate your delity to each session element on a scale of 1 to 7, with 1 indicating poor delity
and 7 indicating high delity.

___Introduce the training program

___Discuss importance of thoughts and feelings

___Give background and denition of positive behavior support (PBS) as foundation of the
program

___Present key features of PBS and the program

___Give overview of PBS process

___Discuss getting others involved

___Help parent establish goals

___Dene behaviors of concern

___Present options for keeping track of behavior

___Discuss crisis planning (optional)

___Assign homework

Notes:

117
 Session 2: Gathering Information
Client Name: _________________________ Date: ______________

Rate your delity to each session element on a scale of 1 to 7, with 1 indicating poor delity
and 7 indicating high delity.

___Preview agenda

___Review homework

___Explore the relationship between thoughts and behavior

___Discuss the importance of assessing antecedents and consequences for understanding

behavior

___Introduce the Motivation Assessment Scale

___Introduce methods for gathering information

___Review observing behavior

___Review interviewing people

___Review recording information

___Help parent choose an information-gathering strategy

___Assign homework

Notes:

118
 Session 3: Analysis and Plan Design
Client Name: _________________________ Date: ______________

Rate your delity to each session element on a scale of 1 to 7, with 1 indicating poor delity
and 7 indicating high delity.

___Preview agenda

___Review homework

___Discuss the use of distraction for dealing with unproductive self-talk

___Teach parent how to use information to analyze patterns

___Help parent to create hypotheses or summary statements

___Use patterns to brainstorm intervention ideas

___Assign homework

Notes:

119
 Session 4: Preventing Problems
Client Name: _________________________ Date: ______________

Rate your delity to each session element on a scale of 1 to 7, with 1 indicating poor delity
and 7 indicating high delity.

___Preview agenda

___Review homework

___Introduce the disputation process

___Discuss circumstances that precipitate behavior

___Present strategies for avoiding dicult situations

___Present strategies for improving dicult situations

___Present ways to provide a child with choices

___Present strategies for prompting good behavior

___Have parent identify prevention strategies

___Assign homework

Notes:

120
 Session 5: Managing Consequences
Client Name: _________________________ Date: ______________

Rate your delity to each session element on a scale of 1 to 7, with 1 indicating poor delity
and 7 indicating high delity.

___Preview agenda

___Review homework

___Teach parent how to use armations

___Discuss how reactions may maintain a childs behavior

___Explain how to manage consequences

___Have parent identify consequence strategies

___Discuss taking precautions with using punishment (optional)

___Assign homework

Notes:

121
 Session 6: Replacing Behavior
Client Name: _________________________ Date: ______________

Rate your delity to each session element on a scale of 1 to 7, with 1 indicating poor delity
and 7 indicating high delity.

___Preview agenda

___Review homework

___Review and practice cognitive restructuring

___Discuss replacing behavior

___Have parent select replacement behaviors

___Discuss how to teach a child skills

___Assign homework

Notes:

122
 Session 7: Putting the Behavior Support Plan in Place
Client Name: _________________________ Date: ______________

Rate your delity to each session element on a scale of 1 to 7, with 1 indicating poor delity
and 7 indicating high delity.

___Preview agenda

___Review homework

___Review self-talk and apply cognitive strategies

___Introduce designing a behavior support plan

___Discuss how to make sure the behavior support plan ts

___Consider how the behavior support plan promotes lifestyle change

___Help parent begin creating an action plan

___Assign homework

Notes:

123
 Session 8: Monitoring Results and Wrap-up
Client Name: _________________________ Date: ______________

Rate your delity to each session element on a scale of 1 to 7, with 1 indicating poor delity
and 7 indicating high delity.

___Preview agenda

___Review homework

___Review self-talk and apply cognitive strategies

___Discuss monitoring the results of the plan

___Discuss making adjustments over time

___Wrap up the training

Notes:

124
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About the Authors

V. Mark Durand, PhD, is a professor of psychology at the University of

South Florida St. Petersburg. He served in several administrative roles
during the past decade, including as founding Dean of Arts and
Sciences and as the Regional Vice Chancellor for Academic Aairs.
Durand previously was on the faculty at the University at Albany, State
University of New York, where he received the University Award for
Excellence in Teaching and founded the Albany Center for Autism and
Related Disabilities in the mid-1990s. Dr. Durand is a Fellow of the
American Psychological Association and has administered more than $4
million in federal research and training grants.

His published works include numerous books and more than 100 other
research publications. One book, Severe Behavior Problems: A Functional
Communication Training Approach, is the product of 10 years of empirical
research and outlines a novel treatment for problem behavior using com-
munication. Dr. Durand developed the Motivation Assessment Scale, a
functional behavioral assessment instrument that is now translated into 15
languages. He has also authored several bestselling textbooks, including
Abnormal Psychology: An Integrative Approach, and he published the rst
book on sleep disorders for children with disabilitiesSleep Better! A
Guide to Improving Sleep for Children with Special Needs. Dr. Durand
serves on the editorial boards of several journals, including Clinical
Psychology Review, Journal of Developmental and Physical Disabilities,
Journal of Positive Behavior Interventions, and Focus on Autism and Other
Developmental Disabilities. He was recently elected to the Panel of
Professional Advisors for the Autism Society of America.

Meme Hieneman, PhD, is the Director of the Positive Family

Intervention Project at the University of South Florida St. Petersburg.

133
 She has a PhD in Special Education and is nationally certied as a
behavior analyst. She has published a variety of articles and chapters in
the area of positive behavior support (PBS) and is the lead author of a
book titled Parenting with Positive Behavior Support: A Practical Guide
to Resolving Your Childs Dicult Behavior.

In her professional career, Hieneman has worked with children with

severe behavior problems for more than 20 years. She was a group home
manager, behavior specialist for a school district, sta member for a pro-
gram assisting families and professionals of children with autism, direc-
tor of a statewide project helping schools implement positive behavior
support, and co-training coordinator for the National Research and
Training Center on PBS.

134