Dr. Iwata (REALLY LONG :p ! )

[Guest guest]

Hey guys it's Jenn. I was fortunate enough to go on Friday to Dr. Iwata's

presentation " Aggressive and Self-Injurious Behaviors- Assessment and

Treatment " . ELIJA, thank you so much for the opportunity to learn from Dr.

Iwata, he was just phenomenal! I never thought I could learn so much in one

day, this WAS NOT a workshop to miss.

This honestly is really a tough one to go over just because it is such a serious

subject and the presentation was so detailed and every detail was so vital that

trying to summarize it is almost impossible (not to mention Dr. Iwata urged us

to go to the source-his list of references in the handout-to appropriately learn

about the material he discussed with us, so if the most published author in the

Journal of Applied Behavior Analysis thinks he is watered down, my notes here

are REALLY far removed!)

My son currently does not have any SIB or aggressive behaviors but what we

learned could be applied to analyzing even stereotypic/repetitive behaviors,

also having an understanding of why learning occurs ( " assumption that behavior

problems are a learned phenomena " ) may help to reduce the chances of any of

these behaviors being learned.

What I hope to pass on to parents from my notes and Dr. Iwata's handout is a

little insight on 3 methods for conducting functional analyses (purpose= " to

identify what it is about the environment and Identify the variables of which

behavior is a function; discover 'cause-effect' relationship " goals=

understanding, treatment, and prevention) I know of a few parents that had

really wanted to go to this and couldn't so here's about half of what was

discussed:

Dr. Iwata talked to us about why learning occurs:

1. Positive Reinforcement ( " social positive reinforcement " -attention, access to

tangible materials; " automatic positive reinforcement " - sensory stimulation)

2. Negative (removal) Reinforcement ( " social negative reinforcement " - escape

form demands; " automatic negative reinforcement " - pain attention)

(isn't that amazing that all the behaviors ultimately boil down to these four

functions?-social positive, automatic positive; social negative, automatic

negative--crazy!)

Through positive and negative reinforcement (except in the case of Lesch Nyan

(?) Syndrome where SIB occurs as a result of a genetic disorder) inappropriate

behaviors, aggression, and SIB's may have been inadvertently shaped from

non-compliance (ex. given on " social negative(removal) reinforcement " ask child

to point to a cup, the learner doesn't respond (non-compliance) so you prompt

the child and ask point to the cup and the child now knocks everything off the

table (non-compliance now shaped into destructive behavior) you put the cup back

ask the child point to the cup the learner bites the teacher or hits their head

on the table so you tend to the child or your injury and terminate the session

(non-compliance shaped into destructive behavior shaped into aggression or SIB ,

the aggression or SIB has now been reinforced through " social negative

reinforcement " The child has learned that to get out of a task I just have to

" make someone bleed " as Dr. Iwata put it, I know that's not funny but it really

was when he said it)

Dr. Iwata went over (once again in great detail-and in plain english ;0) -each

step below) methods for conducting functional analyses: (from hand out)

1.. ANECDOTAL (indirect methods)- GENERAL CHARACTERISTICS: *focus on

circumstances under which behavior occurs * based on informant recall* *data

consists of verbal report (interview, checklist, rating scale)* STRENGTHS: a.

relative ease of implementation-little time and training required for

administration b. does not involve risk to client c. structured method for

gathering interview data d. potentially useful as initial guide to assessment

LIMITATIONS: a. highly subjective data b. poor reliability and questionable

validity c. insufficient for treatment development. SUGGESTIONS FOR

IMPLEMENTATION: a. use as a preliminary guide only b. use multiple, relevant

informants c. follow-up with direct observation (Dr. Iwata explained how this

assessment is JUST A LITTLE BETTER THAN DOING NOTHING!; this type of assessment

would not hold up in court but could be helpful in narrowing down the

establishing operation that is maintaining the behavior)

2.. DESCRIPTIVE (naturalistic) ANALYSIS -GENERAL CHARACTERISTICS: *direct

observation of circumstances under which behavior occurs* *usually conducted

under naturalistic conditions in relevant contexts* *data consist of narrative,

frequency, or conditional probability* PROCEDURAL VARIATIONS: scatter plot, ABC

analysis, Interval and time sampling STRENGTHS:a. more reliable than indirect

methods b. objective and (usually) quantitative data c. behavior sampled in

relevant settings d. identifies correlational relationships e. may be sufficient

for treatment development LIMITATIONS: a. often uninterpretable b. potential

risk to individual c. complexity and time requirements d. may not identify

effects of intermittent schedules e. irrelevant variables may mask relevant ones

(try to sort relevant from irrelevant, what happens the most isn't always the

most relevant!) f. caregivers may artificially suppress problem behavior,

thereby masking relevant variables g. correlational relationships not equal to

functional relationships SUGGESTIONS FOR IMPLEMENTATION: a. objective

definitions of behavior and context b. measurement scale sensitive to changes in

behavior c. adequate sampling of activities, settings, etc. d. use of repeated

observation

3.. FUNCTIONAL (experimental) ANALYSIS-GENERAL CHARACTERISTICS: *direct and

quantitative observation of behavior *conditions of observation are controlled

*comparison between at least one test and one control condition* PROCEDURAL

VARIATIONS: a. single v. multiple variable assessment b. antecedent and/or

consequence manipulations c. design (multielment, reversal, combined) d. length

of assessment (behavior or time referenced) e. data analysis STRENGTHS:

provides clear demonstration of a functional relationship b. high degreee of

environment control (can isolate multiple, intermittent, or subtle variables) c.

suggests short-term strategies for behavior management d. provides clear basis

for treatment development LIMITATIONS: potential risk to individual b.

complexity and time requirements c. requires control over assessment context d.

may not reveal all relevant environmental correlates SUGGESTIONS FOR

IMPLEMENTATION: a. conduct risk assessment b. obtain informed consent c. gather

preliminary assessment information (my note--utilizing INDIRECT and DESCRIPTIVE

analysis) d. make conditions highly discriminable e. begin with an " easy " case

f. videotape sessions for training and to monitor procedural fidelity

Number 3., Functional Analysis is the most precise and flexible although also

the most complex.

Problem behavior maintained by automatic negative reinforcement (pain

attention) cannot be assessed (since it is usually a medical condition,

discomfort, etc. ex. headache) some treatment options include: alleviate the

condition (noncontingent reinforcement) ,pain reduction, behavioral replacement

(establish alternative pain reduction response)

****REINFORCEMENT-BASED APPROACHES TO BEHAVIOR REDUCTION****

*eliminate the behavior's establishing operation (deprivation or aversive

stimulation)*

--noncontingent reinforcement NCR

*eliminate the behavior's maintaining contingency*

--extinction EXT (planned ignoring) ~(see note at bottom of this

post please)~

*replace the behavior with an alternative response*

--Differential reinforcement

***TREATMENT PROTOCOLS FOR BEHAVIOR PROBLEMS MAINTAINED BY

ATTENTION***

--Noncontingent Reinforcement (NCR rationale: the purpose of this procedure is

to decrease problem behavior by providing free access to reinforcers on a

scheduled basis)

--Extinction (EXT rationale: the purpose of this procedure is to decrease

problem behavior maintained by social reinforcement (ie attention, access to

preferred items, etc)

--Functional Communication Training (rationale: the purpose of this procecdure

is to teach an alternative response to gain access to positive reinforcement)

**TREATMENT PROTOCOLS FOR BEHAVIOR PROBLEMS MAINTAINED BY ESCAPE**

--Compliance Training (with extinction and behavioral momentum components.

Rationale: the purpose of this procedure is to reduce problem behavior

maintained by escape and to increase compliance

--Functional Communication Training: escape from instructions/tasks (with

extinction) Rationale: the purpose of this procedure is to teach an alternative

escape response

**TREATMENT PROTOCOLS FOR BEHAVIOR PROBLEMS MAINTAINED BY AUTOMATIC

REINFORCEMENT**

--Noncontingent Reinforcement: Access to alternative reinforcers (rationale: the

purpose of this procedure is to decrease problem behavior by providing free

access to alternative activities that directly produce their own reinforcers

--Sensory Extinction: rationale- the purpose of this procedure is to decrease

problem behavior by attenuating reinforcement directly produced by the response

--Differential Reinforcement of Alternative Behavior (DRA): Strengthening

leisure item manipulation (Rationale: the purpose of this procedure is to teach

alternative responses that directly produce their own reinforcers. It should be

used with individuals who engage in little or no independent object

manipulation~ie individuals for whom noncontingent access to leisure items

produces no therapeutic effect)

As you can see this conference was PACKED with vital information. What I've

provided above is a very chopped up version and only part of what was presented

to us by Dr. Iwata. Obviously if you are in a situation where aggression and SIB

is occurring you will first provide protection from harm to you and the learner

and to contact the proper professionals for assessment and treatment but I hope

these notes will help parents get a little insight on what it is the

professionals are doing or if they are doing enough (not just restraining and

medicating, not saying anyone says that's all they do and there may be

situations where that is appropriate, but I wonder if ABA is utilized enough. I

know in dealing with my pediatrician in the past she always suggests medication

before considering ABA, I understand she's only trying to help) Again, just an

amazing day. Thank you so much for that rare opportunity.

take care,

Jennica

EXTINCTION: I think it's really important to note that when you use extinction

(planned ignoring,--sounds so simple that way doesn't it?) keep in mind that the

behavior you are ignoring is going to increase in magnitude, frequency, and

variation (Extinction Burst) so it is critical to be VERY careful when you are

using extinction, consider all the variations of the behavior and make sure you

CAN follow through (otherwise you may accidentally reinforce a behavior that is

MUCH WORSE than the one you are trying to get rid of now), there are situations

where an extinction procedure IS NOT an option.