Functional Behavioral Assessment for a Boy With Duchenne Muscular Dystrophy and Problem Behavior

Indirect assessment

Indirect procedures included the examination of the student’s portfolio and structured interviews with his mother, the general education teacher, and the English language teacher. Portfolios are considered the principal way for exhibiting student work and performance data (Arter & Spandel, 1992). Portfolio assessment is designed to present a broader and more genuine picture of student’s learning and progress over time (De Fina, 1992). The examination of Philip’s portfolio provided valuable data regarding his overall academic achievement as reflected on his low marks in the first two years in school. Further assessments carried out by his SEN teacher shed light on specific strengths and vulnerabilities concerning his cognitive profile. Interviews are considered an appropriate complement to observation (Robson, 2002). Using a structured functional assessment interview form developed by the CECP (1998), answers regarding the topography, the duration, and the intensity of the problem behavior as well as certain factors that shape the classroom environment were obtained. The participants’ answers were recorded and fully transcribed by the authors. The analysis of interview data provided useful information for Philip’s behavioral profile. Given the limitations of indirect measures of assessment, best practice dictates never relying solely on such procedures (Sterling-Turner, Robinson, & Wilczynski, 2001). For that reason, the second step of the procedure involved direct observation.

Direct assessment

Direct assessment procedures entailed direct observation with the use of an individualized observation form and ABC forms. After the interviews that facilitated the concentration on specific settings, an individualized observation form was designed. An observation form that included a scatter plot was used because such an approach is designed to contribute in identifying patterns of response in natural settings (Touchette, MacDonald, & Langer, 1985). Speculating on the reasons for the occurrence of the problem behavior, an observation form that contained time intervals corresponding to activities was created. That was further justified by the fact that Philip’s school schedule changes from day to day, which means that the sequence of classes is not the same every day.

The analysis of data derived from the observation form revealed that Philip exhibited problem behavior more frequently during language and English language lessons as well as during breaks (see Figure 1). For example, on Wednesday, October 7, Philip exhibited problem behavior five times. To be more precise, the incidents occurred once during a language lesson, twice during an English language lesson, and during two out of three breaks. To our surprise, Philip, despite his movement difficulties, never showed such behaviors during the physical education lesson. At this point, we should underline that the physical education instructor had already made a number of adjustments and modifications to the social and physical environment to ensure Philip’s participation.

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Figure 1.

Scatter plot showing the occurrence of target behavior in each time interval (arrival, lessons, breaks, and departure).

Based on information gained through indirect and direct assessment procedures, observations were conducted using an ABC form. At this phase, it was decided to focus on activities that were more often related to Philip’s problem behaviors. Therefore, evidence observing Philip in the classroom during language and English language lessons and in the schoolyard during breaks was collected. Five such observations were conducted in various settings. The ABC forms were completed by the SEN teacher. Three examples of ABC observations are presented in Figure 2.

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Figure 2.

Three examples of ABC observations conducted in different settings (schoolyard, English class, and Language class).

The observations led to the development of a hypothesis concerning the probable function of Philip’s behavior. This step of the procedure carried special weight because well-developed hypotheses provide the foundation for effective PBI plans.

The manipulation of antecedent events

Among the antecedent events that triggered the problem behavior, one could find difficult tasks assigned by Philip’s teachers during the lesson. The difficulty could be related to the advanced academic level of an exercise and/or by Philip’s muscular weakness. The latter could happen in cases where Philip was asked to complete a writing task. Moreover, the fact that Philip’s classmates were playing soccer or other games he could not participate in could trigger violent reactions. The implementation of curricular and instructional modifications was decided for the manipulation of the antecedents. At first, Philip’s teachers were asked to modify the exercises that they assigned to Philip to keep up with Philip’s level of academic competence. They were further advised to prefer oral rather than written responses when possible. Moreover, a computer was placed in Philip’s classroom to facilitate his completion of written exercises (Philip was familiar with computer use). In this way, the elimination of the need to avoid a task or escape from it in an inappropriate manner was achievable. Endeavors were also made to underline the importance of gaining enough attention by his teachers who were asked to ensure that they offered him enough opportunities to equally participate in the lesson. The manipulation of antecedents related to Philip’s interactions at playtime was based on the teaching of replacement behaviors.

Replacement behaviors

To cope with the inappropriate behaviors that occurred in the classroom during language and English language lessons, apart from the instructional modifications, Philip was taught replacement behaviors, such as asking for help from his teachers whenever he encountered difficulty in accomplishing a given task. The desirable behavior was taught through a multicomponent approach that included incidental teaching, discussion strategies and skill autopsy, verbal prompts, feedback, and reinforcement. Eventual fading of procedures was gradually applied and Philip independently exhibited the skill taught. To the same end, Philip learned specific skills that would enable him to gain peer attention and approval through positive social initiations. The strategies that were used to enhance such social skills included modeling with video, preparing peer partners, verbal prompts, feedback, reinforcement, and fading. Within this framework, an active, but tailor-made, role was given to Philip during play time. An agreement was made with Philip and his classmates to take over the role of the goal keeper whenever they played soccer. Since then Phillip proudly wore his gloves and tried to save goals sitting on the ground, exhibiting such a behavior independently.

Consequence manipulation and reinforcement

A variety of consequence strategies were implemented. Philip was provided noncontingent attention throughout the day and the problem behaviors that functioned to gain attention were ignored. Regarding reinforcement, a behavioral contract was signed by Philip, his teachers, and his mother defining the kind of praise he would get for using desirable behaviors instead of the problem ones. It was clearly stated that Philip should show the following replacement behaviors: (a) to ask for help from his teacher by raising his hand whenever he encounters a difficult task instead of escaping and leaving his seat and (b) to kindly ask his friends to participate in their games during break.

It was agreed that Philip would gain a smiley face sticker at the end of every 45-min time period either if he completed his assignments on his own or if he asked for help by raising his hand. If he managed to gain a sticker for every 45-min period, his mother would take him to play soccer after school for 20 min. For exhibiting desirable behavior during breaks, he would be reinforced with a sticker of his favorite soccer team on a daily basis. To be more specific, Philip had to gain one tick for each break on a daily recording form to gain the sticker. However, more than this, his reinforcement would be the very participation in the game. If not so, he would lose these privileges. In the case Philip failed to gain five stickers, one for each 45-min period, he could not play soccer after school. Moreover, if he gathered fewer than three ticks, one for each break, he could not gain the sticker with his favorite soccer team for his collection.

Crisis management

PBS systems render additional classroom and individual student support strategies most effective and reduce the necessity for more individualized, intensive, or crisis supports (Hieneman, Dunlap, & Kincaid, 2005). Yet, given that planning and implementation may take some time, it may be necessary to use crisis procedures in the interim (Florida Department of Education, 1999). Thus, if a student’s behavior poses considerable risk to the self or others, the behavioral support plan may also need to include strategies to ensure safe and rapid de-escalation of the crisis. A crisis is defined as “a situation that requires an immediate, intrusive, or restrictive intervention to: 1) protect the student or others from serious injury; 2) safeguard physical property; and/or 3) deal with an acute disturbance of the teaching/learning process” (CECP, 2000, p. 16). Every crisis plan should be monitored closely to be revised if its necessity fails to diminish over time or provokes emotional reactions from the student (Florida Department of Education, 1999).

Given that Philip could exhibit extreme behaviors (e.g., throwing objects such as scissors), a crisis management plan was designed. According to this plan, when Philip falls down on the ground and cries, the teacher should approach him, try to calm him down, and have him sit up. The teacher should make sure that Philip’s classmates do not leave their activities to gather around him and give him attention. In this way, the plan was consistent with the aim of attention extinction. However, if the crisis lasts more than 2 min, the general education teacher should call the SEN teacher to walk Philip outside the classroom, as Philip’s and his classmates’ protection was considered the highest priority. Philip would not be allowed to rejoin the group until he was calm. Meanwhile, Philip would have the chance to work on self-management skills with the SEN teacher. The crisis management plan was designed as a tentative and emergency solution, which would hopefully withdraw.