Excerpts

Excerpt from Chapter 1

Understanding the Brain and Brain Injury

The brain is the supreme organ that directs everything an individual does. It makes it possible for a person to think, communicate, act, move about, create and BEHAVE. Behavior is a “product” of the brain and how the brain responds to the environment. Just as thinking, speech and movement can be disrupted by a brain injury, so too can a person’s behavior. The way a student responds to other people, reacts to overwhelming tasks, or feels about himself can be dramatically altered by a brain injury. The example below shows how a student’s performance may vary depending on the structure and format of each particular class.

Juan sustained a severe brain injury to his frontal lobes. Three years after the injury, he has difficulty working independently in his art class and completing assignments. He functions well in math class and reports that he knows exactly what he needs to do every day.

During art class, Juan has been getting in trouble with peers, talking back to his teacher, and walking out of the classroom. Art class involves unstructured projects in which students can work at their own pace. Lately, Juan feels that he never knows what he is supposed to do in art class.

By contrast, his math teacher states that he is doing well. His math teacher gives Juan a checklist each day with assignments that he needs to complete and checks on him every 10-15 minutes.

The brain is comprised of specialized centers that are connected by a complex system of pathways. The parts of the brain work together as an integrated unit. When any one component of the unit is not working properly, the entire system may be disrupted.

Excerpt from Chapter 2

Common Behaviors Following Brain Injury

There are many variables that cause or maintain these often debilitating behaviors. Initially, unwanted behaviors may be related to other physical, cognitive, and sensory deficits that are associated with brain injury. For example, verbal outbursts and physical aggression may be the direct or indirect result of frustration related to memory deficits, disorientation, slow processing, and/or poor communication skills. Challenging behaviors may also occur as a result of environmental factors, such as temperature, noise level, and lighting. For instance, a student who is sensitive to noise may bolt out of the room when several people in the room talk too loudly. Or, a student with an aversion to warm temperatures may show a tendency to be more aggressive during the summer.

Behavior usually is not the result of a single event, but a contribution of factors. Delayed Problems

When he was 10 years old, Sam fell off his bicycle and had a moderately severe concussion. Although he lost consciousness for a few seconds, Sam did not seem to have any major consequences from the fall. Throughout his remaining elementary years, Sam did okay in school. His teachers reported that he was a bit hyperactive and needed help completing written assignments. However, his parents and teachers agreed that Sam’s behaviors did not require special attention.

After Sam entered middle school, both his parents’ and teachers’ perspectives changed. Sam’s grades worsened. He rarely started or completed assignments, was often disruptive during lectures, and frequently roamed around the school. Initially, his parents thought that Sam was having trouble transitioning to the new middle school environment. However, his behavior did not improve.

Excerpt from Chapter 3

Overview of the Behavioral Approach

Applied Behavior Analysis (ABA) has been successfully used to improve classroom learning, promote participation in community activities, facilitate positive social interactions, and increase independent completion of everyday tasks. For over six decades, researchers have systematically examined the environmental variables that affect behavior. They have conducted research in both the laboratory and clinical settings. This research has led to the development of the principles of behavior. Today, these principles are applied to change numerous behaviors in many settings, including classrooms, therapy sessions, hospitals, homes, and job sites. ABA has helped individuals with many diagnoses eliminate bad habits, take medication regularly, manage stress, and maintain an exercise regimen.

Applied Behavior Analysis (ABA) is concerned with understanding and changing behavior to significantly improve the quality of an individual’s life.

One of the most significant aspects of Applied Behavior Analysis is its systematic approach to treatment. The approach involves clearly and precisely defined goals, objectives, and treatment plans. Specific objectives are broken down into responses that can be described in detail, observed on an ongoing basis, and evaluated to determine progress. This avoids subjective statements about a treatment’s effectiveness and a student’s performance.

Excerpt from Chapter 4

Identifying and Defining Behavior

Students may have several behaviors following a brain injury, that interfere with everyday activities. It is critical that the entire educational team be involved to identify and prioritize target behaviors. Each member offers different expertise and a different perspective on the student and on brain injury.

At times, members of the treatment team may have different ideas about which behaviors should be identified for change. Or, they may agree on a list of problem behaviors but not concur on which behaviors to change first. The following checklist can be used to discuss and prioritize behaviors of concern.

• Identifying Specific Target Behaviors
• Is the behavior harmful to the student or to others?
• How frequently is the behavior exhibited?
• Does the behavior interfere with everyday activities, such as activities of daily living, academic tasks, or transitions?
• Does the behavior limit positive interactions with peers, staff, and/or family members?
• Is the behavior age-appropriate?
• Does the behavior have a long history of occurrence?
• Is the behavior a problem for staff, therapists, teachers, or family members?
• Does the behavior lead to a chain of other challenging behaviors?
• Does the behavior limit community outings?
• Does the behavior interfere with the achievement of rehabilitation and/or educational goals?

Excerpt from Chapter 5

Observing and Recording Behavior

It can be difficult for teachers and parents to be objective when discussing their student or child’s problem behaviors because they are often the ones who are dealing with the behaviors on a daily basis.

Behavioral data collection involves observing the behavior and recording specific dimensions of the behavior. This systematic method enables the team to objectively measure the behavior, identify what is causing or maintaining the target behavior, decide how to most effectively change the behavior, evaluate the effectiveness of the intervention, and document the student’s improvement.

Data Collection Methods

Data collection can seem like an overwhelming and impossible task. However, there are several efficient data collection methods that are practical and easy to use in a busy classroom or at home. These methods include frequency, duration, momentary time-sampling, percent occurrence, and permanent product. Each method is briefly described with sample data sheets to illustrate how data are recorded and graphs to show how data are displayed.

Excerpt from Chapter 6

Types of Behavioral Assessment

Behavioral assessment is an essential and necessary step in designing effective interventions for students with unwanted behaviors in the classroom, therapy, home, or community setting. All behavior serves a purpose. Behavior may occur to get someone’s attention, to stop another person’s behavior, to express dissatisfaction, to communicate a desire or need, or to escape or avoid a particular activity or task. Behavior may also occur because it feels good or alleviates pain and discomfort.

Behavioral assessment is designed to determine the specific purpose or function of behavior by systematically observing and recording all environmental events and conditions that may cause or maintain the behavior. These environmental variables are clues as to what function the behavior serves for the student.

There are four main functions of behavior:

To escape or avoid an unpleasant task or interaction

Getting away from a situation or task that the student finds unpleasant is a function of behavior. Unwanted behavior, such as running out of the classroom or becoming disruptive when the teacher gives a student an instruction (i.e., to start working), results in a short break for the student.

To gain attention from other people

Interacting socially with other people is a function of behavior. A student may bang the desk or yell in order to get the teacher’s attention.

To gain access to a tangible item

Obtaining an item or gaining access to an activity is a function of behavior. A student may kick the wall until the teacher comes to her table and gets the lunch box that is across the room.

To satisfy a sensory or biological need

Obtaining sensory input or stimulation is a function of behavior. A student may hum extremely loudly or rock in a chair for sensory stimulation.

Behavior analysis aims to reduce behaviors that interfere with learning, restricts access to the community, limits social relationships, and causes personal harm or injury. The goal of ABA is also to promote behaviors that improve an individual’s quality of life.

Excerpt from Chapter 7

Practical Behavior Change Strategies:

Manipulating Antecedents

Antecedent-based interventions involve changing the events or variables that exist before the behavior occurs. These environmental changes decrease the likelihood of a challenging behavior occurring and increase the likelihood of a desired behavior occurring. Examples of antecedent-based interventions (also referred to as antecedent control) include the following:

• Providing reminders for upcoming tasks
• Reducing task demands
• Interspersing demands and social comments
• Choice-making

Recently, there has been an increasing emphasis on antecedent-based interventions in the fields of behavior analysis and brain injury rehabilitation. This focus has evolved from research that has demonstrated that antecedent-based strategies can effectively change a variety of behaviors across many settings. These interventions have been successful with students with autism, learning disabilities and brain injuries.

Excerpt from Chapter 8

Practical Behavior Change Strategies:

Providing Positive Consequences

The principle of reinforcement describes (1) what happens in the environment following the occurrence of a behavior and (2) how the behavior changes as a result of that event. In order for reinforcement to occur, something is added or taken away from the environment with a resulting increase in the target behavior. The following chart summarizes positive and negative reinforcement.

Excerpt from Chapter 9

Case Study: Antecedent-Based Treatment

John was a 14-year-old male who had a traumatic brain injury when he was six years old as the result of a motor vehicle crash. The records indicate that he had a closed head injury to the frontal lobe area. His teachers reported that he often became frustrated in class and left his seat to go into the hallway. While in the hallway, he disrupted other students. Due to these unwanted behaviors, John was suspended from school and was not allowed to return without a treatment plan. Subsequently, a behavior analyst was called to determine how to improve John’s behavior so that he could return to school and be successful.

Condition: Length of task antecedent analysis

Student: John

Target behavior: Bolting

Operational definition: Any instance in which the student stands up from his seat and takes more than one step away from his seat without returning.

Data collection: The frequency of bolting is collected after 1, 5, and 10 minutes after he has begun working on the assignment.

Excerpt from Conclusion

Many children and adolescents with brain injuries experience cognitive, physical, sensory, psychosocial, and behavioral changes that affect every facet of life. They often exhibit unwanted behaviors (i.e., aggression, inattention, bolting, and inappropriate language) that can negatively impact everyday functioning. These behaviors limit their participation in rehabilitation, home, school, and community activities. Applied Behavior Analysis (ABA) offers a scientific methodology for examining, measuring, and treating behavioral deficits. This methodology includes operational definitions of goals and treatments, functional outcomes, and systematic assessments.