Client: that he has run away on occasion

Client:  a 16 year-old boy (Adam) with Asperger’s
disorder.

Problem
Behaviors: verbal violence, physical violence to objects and irrational
behaviors such as running away. (Threatening his parents and brother with
violence and running away if they deny his requests. There have been episodes
that he has run away on occasion and broken furniture and windows in the house
when his requests were denied or he been told not to do things.)

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In this case the aim is to decrease
Adam’s problematic behavior by using some behavioral techniques. Before we plan
the intervention, we need to find target behaviors that we will work on.

Target Behaviors: Using question
sentences such as ‘Can I…’ or asking for something nicely by using the word
‘please’.

Secondly, we will apply functional
analysis to see what are the ABCs (antecedent, behavior, consequence) of the
problematic behavior.

Antecedents:
Being denied by his parents and/or brother after a request, being told not to
do things.

Behavior:
Non-compliance, threatening with violence and running away, and breaking
furniture and windows.

Consequences:
His parents are worn out and afraid of him.

As the next step we need to find a
technique to decrease the problematic behavior and increase the target
behavior. In this case, the best technique will be differential reinforcement
of alternative behavior.

Differential reinforcement is a very
effective technique in order to decrease undesirable behaviors. While using
this technique we need to consider two components of it:

1.      Providing
reinforcement: selected items as reinforcers should be provided to client
contingently when the problem behavior does not occur or occurs at a reduced
rate,

2.      Withholding
reinforcement: selected items as reinforcers should be taken away as much as
possible from the environment when the problem behavior occurs.

Differential reinforcement of
alternative behavior is commonly used to decrease noncompliant behavior. Before
starting the intervention with this technique, a behavior that is a desirable
alternative to the problem behavior should be selected. The desirable
alternative behavior should not be too complicated or too difficult and should
be already in client’s repertoire not to have any problems of adopting the
selected desirable behavior.

During the intervention, the item or
items serve/s as reinforcer/s should be presented in any occurrence of
desirable alternative behavior or if the problem behavior is reduced.

According to what is explained above, the
desirable (alternative) behavior should be already in client’s repertoire and
should require equal or less effort than the problem behavior. However, in this
case, we have no access to client’s repertoire and we will have to assume that
the target behavior will require less effort.

Our alternative behavior that is
selected to increase -as defined above- will be starting requests with ‘Can
I..’ and using word ‘please’ at the end of the request sentence.

Normally, to be able to detect a
reinforcer we needed to conduct stimulus preference assessment, however, we
have no contact with the client so we need to check the previous observation.

The previous observation shows that he
was using his iphone and video games most of the time. Therefore, we assume
that iphone and video games are preferred items and we can use them as
reinforcers. Also the access for reinforcers will be no longer than 2 hours
after they are presented.

Next, we need to define the schedules of
reinforcements. Since we are using DRA, in the beginning, reinforcements will
be contingent; will be given after each occurrence of desirable (target)
behavior. After the first successful outcome of the intervention (if the
problematic behavior occurs at a reduced rate or if the selected behavior occurs
at least 1time instead of problem behavior) we will start thinning the
reinforcement (the reinforcement will no longer be contingent.

Thinning procedure: Variable-ratio scale
will be used instead of contingent reinforcement.

As mentioned above, we will start the
intervention by presenting the reinforcement after each occurrence of target (alternative)
behavior. Then according to the checklist that parents will fill out, if the
first phase of the intervention works successfully and we can reduce the problematic
behavior (if the problem behavior occurs only 80% at a time instead of 100% or
the selected behavior occurs 20% at a time) the reinforcements will be
presented after 2 occurrences of target behavior. Later, if we see that there
is no problem with adopting the selected behavior according to the checklist
and the problem behavior was successfully reduced below the rated of 60%, then
reinforcements will be presented after 4 occurrences of target behavior. If the
occurrences of the selected behaviors are more than occurrences of problematic
behavior (below 50% of problematic behavior, over 50% of selected behavior)
then we will present the reinforcement after 6 occurrences of selected
behavior. At the end, f there is a significant decrease on problematic behavior
(occurrence below the rates of 20%) and significant increase on selected
alternative behavior (occurrence over the rates of 80%) then we will only
present the reinforcement after 8 occurrences of selected behavior. We will
continue this procedure until the problem behavior reduces below the rates of
5% (almost no occurrence) and the selected behavior occurs over the rates of
95% at a time (full adoption).

By thinning the reinforcement as given
above, we aim to generalize the target behavior into natural settings without
any expectation of reinforcement.

However, if there are any increases of
the problem behavior after we record 50% decrease on problem behavior, then we
will go back to the beginning of the thinning process until the problem
behavior successfully reduces to 50% again.

Moreover, after he starts developing the
target behavior, he is likely to develop better relations with his parents and
his brother and will earn his sister’s (that he is getting along well)
appreciation more. Therefore, we expect him to be more successful at his school
and develop better social skills.

All those positive outcomes of
developing the target behavior will be the generalized conditioned reinforcers
of our intervention.

As the DRA using methods require, we
need to use extinction in our intervention to be able to strengthen the target
behavior and decrease the number of occurrences of problem behavior.

Definition of extinction in general is
blocking the access to reinforcers for selected amount of time after each
occurrence of problem behavior.

In our intervention, we will block the
access to Iphone and video games for 30 minutes if non-compliance, aggression,
verbal violence, and/or physical violence towards parents and/or brother occur.

The extinction duration should not be
long because it may cause grater occurrence of problem behavior or may cause
occurrences of different problem behaviors such as negative emotional
reactions.

However, if we do not observe any
decrease of problem behavior after 30 minutes of extinction, then, we can
enlarge the duration of extinction procedure to 1 hour or more according to the
reduction rates of problem behavior.

If we detect any negative outcome of
extinction procedure no matter how long the duration is, then we need to
withhold the procedure and try to reduce the problem behavior only by
presenting the reinforcement. Therefore, we need to work on the aggressive
behavior to prevent the negative outcomes of extinction procedure by directing
the client to a professional therapist who is specialized in this specific
area. If we can manage to prevent the negative outcomes, then we need to start
implementing the extinction procedure again but with low durations. For
example, at first, we will block the access to the reinforcers only for 10
minutes after each occurrence of problem behavior. Then if the problem behavior
starts reducing, we can enlarge the duration of extinction up to 30 minutes if
there is no negative outcome. 

Moreover, punishment (another technique
to decrease the problem behavior) can be applied during the intervention.

Punishment has two components: Positive
punishment and negative punishment.

Positive punishment is applied by adding
stimuli to the environment to reduce the undesirable behavior. It consists of
reprimands (“don’t do it”, “no”), response blocking, contingent exercise, and
overcorrection – restitutional overcorrection, positive practice
overcorrection.

And negative punishment is removing
stimuli from the environment to reduce the undesirable problem behavior. It
consists of time out – non-exclusion time out, exclusion time out, and response
cost.

In this intervention, we could apply
positive punishment by adding contingent exercise or restitutional
overcorrection since we may receive negative outcomes due to client’s
aggressive behaviors (disadvantages rather than advantages). Contingent
exercise technique could include more task demands at school. If the problem
behavior occurs more than 50% at a time every day, then we can ask the
teacher/s at school to give more home assignments for the next day. And
restitutional overcorrection technique could be applied if there is any
occurrence of physical violence towards objects. If the client hits, throws or
breaks any object, he has to clean the mess he makes and/or repair the objects
he beaks and also he has to clean the whole house afterwards.

 The
advantages of these techniques would be less likelihood of receiving negative
outcome after application of punishment, reducing the aggressive behavior,
reducing physical violation and therefore verbal violation, and better grades
at school.

Or we could apply negative punishment by
adding direct fine response cost technique.

Definition of direct fine technique is
fining specific amounts of positive reinforcement (1).  For example as explained in the reinforcement
procedure, we will present the reinforcement after occurrences of selected
alternative behavior however, he will only have access to the reinforcers at a
reduced duration if the problem behavior occurs (he can only have access to
iphone and/or video games for 1 hour and 30 minutes instead of 2 full hours).

The advantages of this technique is that
it can be combined with other intervention techniques, easy to apply, and
convenient.

However, in this case, application of punishment
procedures (positive or negative) would have more disadvantages than
advantages. For example, punishment procedure might cause bigger issues like
self harm, harm to others, emotional breakdown etc.., and this may cause
failure of the whole intervention. That is why, in this intervention, we will
not consider applying punishment techniques.

Overall, we need to consider what kind
of involvement do we expect from parents and how are we going to make sure that
they implement the treatment plan correctly.

First of all, we need to consider the
fact that his parents are worn out and afraid of him, and he does not have good
relation with his brother. The only person he gets along is his sister.

Before we do that, we need to consider
the fact that he has access to items and he escapes from tasks he does not like
as a result of his parents fear of him.

In the intervention we need to make sure
that his parents maintain stronger attitude towards him in daily basis and will
be able to block the access to items and get him back on tasks that he tries to
escape. Whenever he engages in problem behaviors, they should keep their
attitude and should not show any weakness that he can take advantage of. They
need to be aware of the time durations and try not to extend or limit the
durations of reinforcement and/or extinction.

To be able to make sure that they
implement the treatment plan correctly, we will ask them to fill a checklist
after each occurrence of problem behavior and target behavior and after each
implementation of reinforcement and extinction (with durations).

We should also consider the fact that
the only person he seems to get along with is his sister and in the
intervention we can observe the relational differences that he has with his
sister to see to in which ways they get along with and how, so we can work on
those behavioral attitudes and try his parents to adopt to those attitudes to
be able to get along with him even after the intervention. 

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