Welcome to our section on Positive Behaviour Supports (PBS). This PBS section is a place where families and caregivers can come for information on how to create a better quality of life and reduce problem behaviours for the people they support. I have blended the following information from an edited extract of my Masters Research Project (Lusignan, 2010) and through video presentations done by Dr. Pat Mirenda, Professor of Education at UBC, who is a thought leader in the realm of Positive Behaviour Supports. At the bottom of the page there is a number of excellent links related to PBS.
When a family has a child with an intellectual disability who has problem behaviours, it can be stressful on the child, the parents, the child’s workers, and the community (Binnendyk et al., 2009). Accordingly, it is wise to employ PBS early, because as a child ages, behaviours can become more ingrained (Dunlap & Fox, 2009) and evolve into a serious situation that gives rise to aggressive, destructive, and self-injurious behaviour (Koegal, Koegal, Kellegrew, & Mullen, 2006). If a child has an early PBS intervention, it can reduce problem behavior, because in young children the negative behavior repertoires are not as entrenched. In addition, it is easier to determine the function of a younger child’s behaviour, and children with aggressive behaviours are easier to manage when they are smaller (Dunlap & Fox, 2009). At the same time, a PBS plan can be effective even if starting later in life.
Positive Behaviour Supports “emerged from three major sources: (a) Applied Behavior Analysis, (b) the normalization/inclusion movement, and (c) person-centred values” (Carr et al., 2002, p. 5). PBS is also guided by values of dignity and choice infused into three processes: “person-centered planning, self-determination and the wrap-around approach” (Carr et al., 2002, p. 6). Rather than focusing on problem behaviour, the focus of PBS is on improving quality of life. The “guiding hypotheses” behind PBS is that, “If an individual’s needs are met, then quality of life will improve, and the problem behaviours will be reduced or eliminated altogether” (Carr et al., 2002, p. 6). This basic tenet of improving quality of life sets the stage for additional learning while at the same time ensuring that the context is appropriate to foster quality of life. Changing entrenched problem behaviours can take a great deal of effort and therefore a PBS intervention requires a team approach (Anderson, Russo, Dunlap, & Albin, 2006). Furthermore, PBS plans should have a life-span perspective that follows people throughout the transitions and vicissitudes of life. This life-span perspective “views intervention as a never ending systemic process that evolves” (Carr et al., 2002, p. 7).
One element of PBS investigation is the identification and analysis of “setting events” that are a predictor of problem behaviour in the future (Horner, Vaughn, Day, & Ard, 2006). Examples of setting events are a poor night’s sleep, a change in routine, or sickness. Setting events can also manifest in the way a task is presented or in the environment around a person (Dunlap & Fox, 2009; Taylor & Bailey, 2006). Some setting events contain contextual variables that can create problem behavior. Examples are menses, a bad mood, or an inability to communicate (Carr, Reeve, & Magito-Mclaughlin, 2006).
Generally speaking, antecedents are events that occur directly before the behavior (Glasberg, 2006). “Antecedent events are [also] any actions that evoke challenging behavior or, alternatively, desirable behavior . . . [and can be caused by] requests or demands, materials, the presence of particular people, and even odors, sounds and tactile events” (Dunlap & Fox, 2009, p. 59). Some antecedents can be changed to prevent problem behavior, while other antecedents cannot be avoided because they cannot be changed. Furthermore, some antecedents are automatic and reside within a person. Examples are self-stimulatory behavior such as rocking back and forth (Glasberg, 2006).
People need predictability and choice. People with disabilities can often be given predictability by using picture symbols that are arranged into important routines or a daily, weekly or monthly schedule that will give them information as they need it. Schedules are especially important if people have memory issues and the schedules wil give them to ability to remind themselves throughout the day. When making schedules it is wise to have choices for people to pick from so they have some control over their life.
Functional Communication Training is an antecedent intervention that seeks to teach socially appropriate ways to communicate that serves the same function as the problem behavior (Singer & Wang, 2009). A person can be taught more acceptable ways to request attention, such as using a picture symbol for the request (Dunlap & Fox, 2009). If a socially appropriate way to communicate is easier than problem behavior as a way to get needs met, then a person’s behavior is likely to change (Carr et al., 1999). Teaching communication skills is important to a person with an intellectual disability, so that they can “issue requests, express desires and feelings, share comments about the environment, receive and transmit information, and develop interpersonal rapport and relationships” (Dunlap & Fox, 2009, p. 38). Teaching communication skills can be achieved through signing, picture symbols, talking computers, and assistive language devices (Wacker et al., 2006), and as technology evolves, through the use of ubiquitous devices such as smart telephones (B. Fossett, personal communication, June 9, 2010).
If a person can be taught to make requests in a socially acceptable manner, then this “pivotal response” (Wacker et al., 2006, p. 53) could change the way people with intellectual disabilities and the people around them interact because of the more positive ways of dealing with each other. It is called a pivotal response because the targeting of the pivotal behavior, such as teaching communication, can obviate other inappropriate behaviors and the newly acquired skills can generalize to other environments and settings (Schreibman, Stahmer, & Pierce, 2006).
Dr. Mirenda in the above video says that "teaching is the most important thing we can do." In advance of teaching, it is important to know the reason behind the problem behaviour. In fact, the literature suggests that the importance of conducting a functional behaviour assessment (FBA) before designing an intervention cannot be overstated (Binnendyk et al., 2009; Haring & De Vault, 2006; Wacker, Peck, Derby, Berg, & Harding, 2006). An FBA, is simply a rigorous investigation into the reason behind the behaviour.
A functional assessment can be carried out in one of three ways: by indirectly observing a person’s behaviour, by directly observing behaviour, or by functional analysis. Indirect observation involves gathering information about setting events, antecedents, behaviour, and consequences through interviews of people associated with the person with a disability. Direct observation involves a professional interventionist watching and collecting data to determine the functions of behavior. A functional analysis involves experimental manipulating of variables to test a hypothesis about the reason behind the behavior (Carr et al., 1999).
The motivation for problem behaviour in people with intellectual disabilities comes from as many as 16 sources, but there are four main functions of behaviour: to escape/avoid an undesired activity or request, to seek attention, to engage with a desired item or activity, and to receive sensory reinforcement (Carr et al., 1999). Once a functional assessment is completed, a hypothesis about the function of behavior is the start of a PBS plan and points the way to an appropriate intervention strategy (Dunlap & Fox, 2009). PBS interventions include interspersal training, expansion of choice, and curricular modification (Carr et al., 1999). Interspersal training involves such activities as varying tasks (p. 13), using picture schedules, telling social stories, and doing pre-task requesting (Dunlap & Fox, 2009). During instruction, regard is given to “task length, task outcomes, and clarity of instructions” (Carr et al., 1999, p. 13).
In the above video, Dr. Mirenda talks about the importance of helping people to build a better quality of life. As has been previously stated, rather than focusing on problem behaviour, the focus of PBS is on improving quality of life. The “guiding hypotheses” behind PBS is that, “If an individual’s needs are met, then quality of life will improve, and the problem behaviours will be reduced or eliminated altogether” (Carr et al., 2002, p. 6). In this video, Dr. Miranda gives the example of how we are often reactive when behaviour happens and a s a result, we begin to restrict what a person can do. Consequently, a person's life gets smaller and smaller. Instead of restricting people, we should be looking to increase the quality of life and help people to have bigger and broader lives and intentionally experimenting with activities to provide people with a bigger life experience from which to choose.
At CVS, we are seeking to ensure that everyone in our agency has some general knowledge of PBS, others in leadership positions in our agency will have more knowledge and in more challenging situations we will enlist the experience and expertise of Behavioural Consultants. We expect that our skill set as an organization will grow over time and we will be able to better serve people with complex challenges. In fact, our Strategic Plan has prioritized the goals of CVS becoming a learning organization and becoming more skilled at using PBS.