While we do want to teach the patient that we do not want them to engage in the challenging behavior, we also need to teach them what to do instead. Appropriate alternative behaviors can be taught to the patient to be used as a substitute for the problem behavior. We teach or prompt replacement behaviors before the challenging behavior occurs.
The single most important role of a behavior intervention for decreasing challenging behavior is to establish and maintain a functional replacement behavior. There are both ethical and practical reasons for this.
From an ethical standpoint, challenging behavior occurs because an individual wants something. Generally speaking, if they knew how to ask for it appropriately, they probably would. Therefore, if the behavior intervention successfully reduces the challenging behavior but does not replace it with a functionally equivalent replacement behavior, we may well have just eliminated the patient’s only means of communication – quite a serious error when working with a patient who is likely grappling with communication challenges.
Practically speaking, establishing a functionally equivalent replacement behavior just works better; if the patient has a more appropriate, lower-effort way of getting what they want, they are less likely to resort to challenging behavior to get it.
In the previous challenge, you may recall that we reviewed FCT, which is an antecedent intervention, as it happens before the behavior as a way to prevent the challenging behavior from occurring. FCT is also a way to teach replacement behaviors. The communication skills one acquires with FCT is what we want the patient to do to communicate their wants and needs instead of engaging in the challenging behavior.
FCT for attention might involve teaching the patient to ask for attention instead of displaying the challenging behavior to get it. Good options include requests such as:
Simple gestures, such as waving or tapping someone on the shoulder may also be useful options initially. Make sure that the particular types of attention you are teaching the patient to request are the ones that are actually preferred.
We added a new program, gaining attention. Because we've been noticing that he wants our attention, but he'll like, throw things, or doesn't know probably how to get your attention, so we're going to be teaching him to tap our shoulder as well as call our name when he wants our attention.
Make your burgers.
Yes, what do you want?
What do you want?
Oh, there you go! Very good, Jack!
Jack Riley is now gaining attention without prompts. When first teaching a new skill, a therapist as airless learning, which is prompting a child with the correct response. Four months ago, when gaining attention was taught, Jack Riley knew a gesture, physical and vocal prompt to do it. As time progressed, less prompting was needed, like using only a gesture problem or a partial vocal prompt.
This is going to be a fun program.
OK. Awww, look at you!
FCT for tangibles might include requests such as:
FCT for escape involves teaching the patient to ask for the cessation of whatever demands they do not like at the moment. Some options include requests such as:
Here is an example of the replacement behavior portion of a BIP for Josiah in the scenario from the end of the last two tutorials.
|Replacement Behavior Intervention Plan||Description|
|Functional Communication (tangible)||-Josiah will appropriately request preferred items / activities.|
|Functional Communication (escape)||-Josiah will request a break, help, or a decrease in the amount of demands being placed on him.|
-Josiah will complete (comply) with known requests within 10 seconds of when the instruction is given.
-Ensure that Josiah receives significant reinforcement for complying with demands.
Below is the full PDF again for reference.