Behaviour Change Interventions
Understanding how behaviour works and why a certain behaviour is occurring then allows us to change the environment in such a way that leads to behaviour change. These changes are known as behaviour change interventions.
Behaviour is maintained by what happens before and what happens after it. It is therefore those two variables that we need to look at, and change, to elicit behavioural change.
Antecedent Interventions
An antecedent is what happens directly before the behaviour. Interventions that take place before the behaviour occurs are known as antecedent interventions. This can include doing things that decrease the individual’s motivation to engage in behaviour in the first place. For example, if a behaviour is occurring to gain attention, giving frequent and regular attention consistently means an individual is less likely to need to engage in behaviour to gain attention, because they are getting it already. We can also increase choice making, which would then decrease behaviours to gain access to items, activities or people.
Communicating a rule can also be an effective antecedent intervention. In behavioural terms, a rule is essentially the knowledge of the consequence of engaging in a behaviour (in an if this, then that statement). Setting and reminding an individual of a rule, and therefore indicating whether a behaviour would lead to reinforcement or punishment, can lead to behavioural change.
There are many different antecedent interventions, too many to discuss here, but can also include ‘high probability request sequences’, the use of visuals and timers, introducing a structured timetable with breaks factored in, and so much more.
Skill Building Interventions
Teaching a skill is another type of antecedent intervention, aimed at teaching an individual a way to gain what they want in a more appropriate way. One way an individual can do this is to communicate that they want attention, a tangible, an escape, or break, or to engage in some kind of sensory activity. This is called ‘Functional Communication Training’ and involves teaching an individual to use a type of communication tool. This can be spoken words, or can be visuals (e.g. PECS or a choice board), which may be laminated pictures or an AAC app on a tablet or phone, signing (e.g. Makaton), or even the use of buttons that are associated with a specific thing.
Other skills you can teach include teaching an individual how to access what they want in a more appropriate way. For example, if an individual wants attention, we can teach them to tap a teacher’s shoulder instead of shouting and screaming. Or to gain access to play, we can teach them how to initiate play with peers in an appropriate way. Or to take themselves to a quiet space if they are feeling overwhelmed by their environment and want an escape.
Extinction
Now we have considered intervening before the behaviour has occurred, now let’s consider consequence interventions, or changing the way we respond to behaviours. As we know, all behaviours are either reinforced or punished. Behaviours that continue to occur are, in some way, being reinforced. In other words, an individual is getting something from engaging in the behaviour. This is the function of that behaviour.
The simplest way to stop a behaviour occurring, then, would be to simply stop the individual from accessing that reinforcement, and therefore the behaviour will stop over time. For example, if a behaviour is occurring to gain attention, ignoring the behaviour will lead to the behaviour stopping, and the individual trying new behaviours to try and get the attention. The aim at this point is to select an appropriate behaviour and reinforce that instead. That will therefore increase and become the way the individual then gets attention.
However, there is a downside to extinction. Consider for a moment that it’s 30 degrees outside and you are standing in front of a vending machine. In order to get a nice cold beverage, you put in a coin, pull a lever, and a can of delicious soda is dispensed. You’ve done this for years, and that’s how it’s always worked. You use this machine frequently and have never had any issues with it. But today, you put the coin in, pull the lever, and… nothing. You don’t get that can of soda. What do you do? Chances are, you pull the lever again. Then a keep doing it for a few seconds. You pull it harder. Still nothing. Frustrated, you now kick the machine. Still nothing. You walk away after a few minutes, frustrated, looking for a shop that sells drinks. This is how extinction works in reality. At first, you’re most likely going to see an increase in behaviours, in the short term. This is known as an extinction burst. Then, you’ll often see a variability in behaviours (e.g. kicking the machine), until something works and that’s the behaviour that the individual will use next time they want that thing. It’s therefore important to consider readiness for behavioural change. If an intervention is likely to include an element of extinction, which is often the case, are you prepared to take the risk of an increase in behaviour, or will that not be manageable?
Differential Reinforcement Procedures
It would be very inconvenient if extinction was the only consequence intervention! If you had to extinguish all negative behaviours and just hope the individual chooses the behaviour you want, and then you can reinforce that. Luckily, that isn’t the case. We can teach an appropriate way of engaging in the behaviour and increase the likelihood of this appropriate behaviour occurring by reinforcing that behaviour. The process of reinforcing one behaviour, and not other behaviours, is known as differential reinforcement.
There are many different kinds of differential reinforcement. These are the most common types:
Differential Reinforcement of Other Behaviours (DRO)
This is the process of reinforcing any behaviours that is not the behaviour in question. This is most commonly on a time schedule, and reinforcement is provided if the behaviour did not occur in the time period before it. For example, if the behaviour you are targeting to eliminate is hitting peers, you can provide reinforcement every 5 minutes if the individual did not hit their peers. The issue with this, however, is that if they shouted, kicked and spat at their peers, you would still reinforce the behaviour under a DRO procedure. For this reason, this is rarely used.
Differential Reinforcement of Alternative Behaviours (DRA)
DRA is when you reinforce any alternative behaviour. For example, an individual runs out of the classroom whenever they want a break. Instead, you reinforce when they point to a visual that says break, and then provide them with a break from the task at hand, in a quiet location.
Differential Reinforcement of Incompatible Behaviours (DRI)
DRI is when you reinforce a behaviour that an individual cannot do at the same time as the behaviour in question. For example, if you are targeting out of seat behaviour in class, you would then reinforce whenever the child is in their seat. Someone is not able to be in their seat and out of their seat at the same time.
Differential Reinforcement of Lower Rates of Behaviours (DRL)
This is when you reinforce behaviours when its frequency is lower than a predetermined criterion. This criterion can decrease over time, so that the behaviour gradually decreases over time. This is used for behaviours that are socially appropriate but are occurring at a rate that is not socially acceptable. For example, calling the teachers name is an acceptable behaviour that we wouldn’t want to eliminate, but if it’s happening 100 times an hour, we may want to decrease it. We can set a criterion, to begin with, of 90 times. Each hour, if they say the teacher’s name 90 times or less, we reinforce. This can be gradually reduced to an acceptable amount over time.
Differential Reinforcement of Higher Rates of Behaviours (DRH)
This is almost the same as a DRL procedure, except you reinforce if the behaviour occurs more frequently than a pre-set criterion. This is for behaviours you want to see more of. For example, reading or writing speed if you want to become quicker at these.
Implement Rules and Contingency Contracts
In behavioural terms, a rule is essentially the knowledge of the consequence of engaging in a behaviour. For example, if I punch a police officer, I will likely be arrested. Alternatively, if I study for my exam, I’m likely to get good grades.
Setting and reminding an individual of a rule, and therefore indicating whether a behaviour would lead to reinforcement or punishment, can lead to behavioural change. The knowledge that a crime will lead to a fine or prison sentence is enough for most people to not engage in those behaviours. Knowing when an assignment is due is likely to elicit the response of handing work in on or before that due date more likely. As if you don’t, you may lose your job, or a client, or get kicked out of school.
In addition to setting rules, we can also create agreements, known as contingency contracts, to encourage an individual to abide by a rule. For example, you can agree that if they break the rule, you can take away their phone or iPad for a set number of days. In short, it is an agreement to behave in a certain way and providing knowledge of the consequences of following the rule, and/or breaking the rule.
Self-Management
Self-management involves setting a goal, and then monitoring our own behaviour, while putting in place rewards or punishers for engaging in certain behaviours. For example, we can have a timer that goes off at set intervals when studying. Whenever it goes off, we then check whether we are studying or doing something else. If we are doing something else, we don’t access the reinforcement. If we are studying, we do. This could be as simple as an M&M from a bowl sitting on the side. Alternatively, we can create a journal, and check in and out at each day, setting goals for the day in the morning, and checking how we did at the end of the day. If we achieved our goal, then we get to watch an episode of our favourite TV show before bed.
Group Contingencies and Vicarious Learning
Learning from others can be powerful. We don’t need to experience the consequence of a behaviour to know what will happen if we engage in it. We can observe other people behaving, and what happens to them. Have you ever been in line to order a drink, and the person in front of you orders the same drink you are? Unfortunately, they are told that the drink is not available, and are offered an alternative, which they gladly accept. It’s now your turn to order your drink. Do you order the drink you originally wanted, knowing it’s not available? Most people wouldn’t. This is known as vicarious learning or learning from others.
Groups can also be powerful, and tie into vicarious learning. Being in a group, working towards a common goal, often leads to changes in behaviour. There is a certain amount of accountability there. In specialist schools, there is a therapeutic game called ‘The Good Behaviour Game’. The premise is simple. Split the class into groups, set 3-4 rules (e.g. staying in your seat, keeping on task, not talking to peers…), anyone that breaks a rule loses a point for their team. At the end, the group with the most points wins. Rule breakers are often reprimanded by their peers, and to avoid the negative attention, the individual stops engaging in the rule breaking behaviour.
Punishment Procedures
Up til now, we have mostly focused on reinforcement procedures, and in practise, reinforcement is used far more than punishment procedures. Even when talking about decreasing a behaviour, we would tend to put the behaviour that challenges on extinction, and then use a differential reinforcement procedure to increase the likelihood of the positive behaviour occurring more in the future. That sounds odd, when in behavioural terms, punishment decreases a behaviour. Why shouldn’t that be the first thing that’s used?
There are a number of reasons why this is the case. Punishment procedures have been used in the past. Small electric shocks were given for problem behaviour. It did in fact decrease that behaviour, but what we also saw was one of two things. One, the individual was then scared, and withdrew, or two, the individual pushed boundaries to break rules in clever ways. They didn’t learn that there are appropriate ways to get what they are looking for. It often damaged relationships, and many of these procedures went on to be abused.
Punishment procedures today are used as a last resort. When all else fails, and for behaviours that cause serious harm to the individual or others. Extreme physical aggression or self-injurious behaviours. But they are not used in isolation. They are used in conjunction with positive reinforcement procedures, for the most efficient change. However, in most cases, punishment is not an ethical option, and will mostly not be considered.
Other Important Considerations
Those are the most commonly used behavioural interventions. It is important to note, however, that there are reasons that behaviour may occur that is not part of a behavioural function, that needs to also be considered. Health considerations is a major one. Pain can cause anyone to behave in ways they don’t usually behave. And when that pain or health condition is treated, the behaviour often reduces or completely goes away. Epilepsy and seizures are known to effect behaviour, before, during and afterwards, and should be considered as part of a functional behaviour assessment.
In addition, we also discussed earlier how readiness for behavioural change intervention is important to consider. Extinction procedures can result in increases in behaviour in the short term, as well as variability in behaviours, and therefore risk needs to be assessed prior to any intervention, especially when the behaviours involve risks of harm to the individual or others. It is best to introduce behavioural change strategies gradually, over time. Don’t go too quickly. Slow and steady may not always win the race, but they will get there, and the change is far more sustainable.
It’s also important to note that behavioural contingencies can change. Many times, an individual’s behavioural presentation will be completely different in one setting compared to another. The process of an adult, for example, moving to an environment that is more conducive to their needs, can often itself lead to a significant reduction in behaviours. Some settings, such as school, can be very high demand, and therefore lead to a higher frequency of behaviours to a low demand setting. Consider each individual environment, and the contingencies at play in each environment.
Lastly, maintaining behaviour change is not always as simple as it may seem. Strategies needs to be implemented consistently across settings and over time. Behaviour can change over time, as well, as just because one behaviour functions one way now, doesn’t mean it will function the same way in the future. Consider what is reinforcing or punishing a behaviour at that specific moment, and intervene accordingly.
If you would like support to design and implement behavioural strategies and interventions, contact us to arrange a free 30-minute consultation to discover how we can help.