psyc 164

Psychology 164

Functional Assessment

A bit of background…

Outside of teaching, over the past 15-20 years, I’ve also worked as a

behavioural consultant, working with children and youth with a variety

of designations and behavioural difficulties, and adults with psychological disorders or

relationship difficulties. I’ve also applied behaviour analytic techniques to increase

safer sex in youth and to help teach children abduction prevention skills.

Of all of the services I provide, I’m most often asked to complete a functional

assessment, and arguably, it is the most important piece when attempting to

understand the function of a behaviour and creating a treatment. For those of you

in business, the functional assessment can be likened to researching consumer

behaviour and developing a product or service based on the relationship between the

environment and the consumer.

A quick note: The purpose of this module is to introduce you to the idea of

functional assessment…just make sure you understand the general components

of it, and don’t worry about being able to develop treatments, etc. That would

definitely not be expected of you this early on. ☺

What is a Functional Assessment?

 A functional assessment is a thorough investigation into the specific antecedents, and consequences for a particular behaviour. In the assessment, the individual’s physical and mental state, medications, motivations, internal and external environment are examined to find patterns that may be used to form the basis for an intervention. It involves both indirect and direct observations, data collection and follow-up. I’ve used a case to highlight how it is done…

First: Indirect Observations

 Indirect Observation: May consist of any or all of the following:  Interviews – First point of contact, interview people in the individual’s

environment and the individual him/herself to find out when, where, with whom and what the antecedents, behaviours and consequences are. Helpful as it gives us a basic understanding of some potentially critical variables, medications, designations and other critical information. Here’s an example of some of the things that may be asked at an intake interview:

 https://waismancow.wiscweb.wisc.edu/wp- content/uploads/sites/148/2017/07/sample-functional-behavioral-assessment.pdf

 Behaviour rating scales: Here’s an example of a checklist designed to highlight the possibility of ADHD

(see next slide for an example)

 Rating Scales: example of a scale used to rate depression

 http://www.assessmentpsychology.com/HAM-D.pdf

Antecedent Questions

• When does B occur?

• Where does it usually occur?

• Who is present when it occurs?

• What activities or events precede it?

• What do other people say or do before it occurs?

• Does individual engage in any other behaviors prior?

• When, where and with whom is the behaviour least likely to occur?

Consequence Questions

• What happens immediately after behaviour occurs?

• What do you do when the problem occurs?

• What do other people do when problem occurs?

• What does the individual get, avoid or get out of following the behaviour?

Hypothesis Formation

 Following the indirect observation/assessment, we would summarize the likely ABC interactions in the form of a hypothesis…

 Form a hypothesis: We form a preliminary hypothesis about the most likely antecedents, behaviours and consequences. Usually one to two sentences. For example:

When Matthew wakes up in the middle of the night to a soiled diaper, and he has recently experienced a growth spurt rendering his antipsychotic medication less effective, he smears his feces on the wall, which is followed by parental attention and bathing Matthew.

Please read the following summaries of two interviews I had with the daycare staff and the child’s mother concerning a very disruptive behaviour. It is by no means an exhaustive account, but enough to give you an understanding of how the process works. ☺ After you’ve read the two interviews, try to formulate a hypothesis, noting most likely ABC relationships.

Case Study: Indirect Observation: Interview

with Daycare Staff  CJ is a five year old student at a local daycare. He enjoys reading (very

advanced academically) drawing, science experiments and art. His dislikes being outside IMMENSELY. Part of the difficulty is that his gross motor skills aren’t particularly well-developed, so he doesn’t run as fast as some of his friends and his hand-eye coordination is also a little immature meaning that he doesn’t throw and catch the ball as well as his friends. The last outside time of the day starts about 30 minutes before parents start to arrive for pick-up. CJ, who knows how to tell time, waits for about 20 minutes, then asks to go inside. If staff refuse, he climbs to the top of the climber and begins to yell obscenities at the top of his lungs. He becomes even louder when he sees parents start to arrive. Each day a staff member has to go up there and physically remove him from the climber, drag him inside, and keep him in the circle room until he quiets down, or until the parents have gone (his mom is always the last to arrive, often late). CJ is not currently on any medications, no allergies and no other medical concerns. He does not have a diagnosis, but his behaviour is of concern to staff. His mother is apparently not supportive of the staff and actively encourages her child to be “spirited” while at daycare, laughing when the staff describe various incidents that occur during the day.

Summary from interview with CJs

mother:

• CJ’s mother states that she does not agree with the “tyrannical” rules at the daycare. She states that she does not understand why CJ can not go in by himself if he doesn’t want to stay outside. She states that he is independent and far brighter than the other children, so why would he want to go outside and play baby games when he could be inside creating. Asked if he goes outside much at home, the mother states that he goes outside some, but that he likes to take a book or art outside with him. Asked if he swears at home, she laughs and says “Oh yes, he can put me to shame!” There is no identified consequence for swearing at home; instead it is labeled as “freedom of speech.” Asked if there are any concerns at home, she states that a “couple of times” CJ urinated or defecated on his father’s papers when he was angry, but was quick to defend CJ’s actions by saying he had every right to be upset with his father (expletives). At this point, CJ’s mother declined further interview saying, “It’s the daycare’s fault, let them expend the time and energy to solve it! Things are fine here.”

Hypothesis So what might our hypothesis be?

• Some key antecedents appear to be:

• Outside time

• Time of day

• Refusal of a request to go inside

• The key behaviour seems to be:

• Climbing to the top of the climber

• Shouting swear words loudly enough to be heard in parking lot

• The key consequences appear to be:

• Teacher attention

• Is able to go inside (which appears to be a preferred place)

• Now let’s proceed to a direct observation and see how closely it matches our hypothesis

Direct Observation

 Okay…so now that we have a basic understanding about what we’re dealing with, we need to do a direct observation ourselves and take data.

 Direct Observation: Our initial observations usually use an observation data sheet (writing down what the behaviour is and the specific antecedents and consequences, as well as larger context, and others in the environment. The purpose is to observe long enough to avoid reactivity and to see a pattern with respect to the ABCs. Once you have a better understanding of the ABCs involved you can switch to a behavioural checklist, which is usually used by staff or parents as well to take data during the treatment phase for basis of comparison.

Observational Records

• Observation Data Sheet

More information…

 In the second record (the checklist) you’ll note all of the key antecedents and consequences are broken down into specifics – each has its own row. Each time a behaviour occurs, the analyst or the teacher or the parent just needs to check off any of the ABCs that apply in that specific instance. Over time, the pattern of Xs on the page gives a clear visual about which antecedents and behaviours are MOST present when the behaviour occurs.

 Read the following summary of my direct observation of CJ and see if you can complete a behavioural checklist like the one on slide 14.

Direct Observations: Summary –  The swearing occurred on the climber on 7 of the days for my 10 day

observation. Each time it started between 4:10 – 4:20 PM and followed a denied request to go in only on four occasions. The tirade would typically last between 10 – 15 minutes until the staff became admittedly uncomfortable and had to take action. The other six occasions were not preceded by a denied request, simply a look at his watch. There were variable staff, and behaviour did not seem dependent on any particular staff. On five of the occasions he had previously been asked to play by some of his preferred peers (within 10 minutes before). His response was “no” followed by hiding behaviour and scowling. It was also observed that after about 15 minutes during other outside play times (before lunch, for example) CJ would also start swearing both on and off the climber. On the three days where swearing did not occur while outside, chalk art and water play were available options outside. Typical consequences for swearing were staff reprimand and physical removal inside to circle room, required to sit on chair in the middle of the room without staff or peer interaction. Should be noted that time-out room has many bright posters with poems, stories and experiments on them and provide a clear view to outside. Children giggling, gasping in shock and otherwise providing attention occurred on six of the occasions.

Data Checklist for CJ Direct

Assessment

Compare and Contrast

 Note that I left space for myself to include antecedents, behaviours or consequences observed that may not have been mentioned during my interviews with staff. I’ve included those in red.

 Check our observations against the hypothesis: If there is agreement, proceed to next step. If not, then we need to go back to the indirect method and re-interview, showing them our data. Once we have agreement and have established any remaining variables, re-phrase our hypothesis and continue to next step.

 In our case, the data is mostly similar, but peers asking to play and peer attention following the behaviour gives us an indication that peers are actually an important piece of the assessment, here. Other critical discoveries are the absence of the behaviour when chalk, etc. is brought outside and the information about the time out space being really bright and engaging.

At this point…

• There are enough differences that we would likely return to the staff and talk about what we observed. Sometimes, the staff will

immediately recognize what you’ve observed and just say they

forgot about that component. Other times, there was something

happening the week you observed that brought up different

variables than normal. This information is critical, because you

don’t want to develop treatment based on something that only

occurred that week. You may go back and observe at this point.

• You can see with this example that by conducting a thorough functional assessment, the treatment essentially creates itself. This highlights the importance of really investigating the functional relationships between the antecedents, behaviours and consequences. I’m often told “the behaviour is happening out of nowhere” – that’s never the case. Behaviour (good or bad) happens because it has a function for that individual.

Treatment

 Develop treatment plan: You might be able to see how conducting a thorough functional assessment allows you to spot immediate patterns that make intervention strategies practically leap off the page. For example:  Their use of “time-out” actually reinforces the swearing

behaviour by allowing CJ to escape.

 Presence of items from inside reduce swearing to zero

 Muscle strength and eye-hand coordination is an issue causing CJ to refuse friend requests to play tag and catch

 These are just a few, so….

Treatment

 Positively reinforce play outside for 5-7 minutes by allowing CJ to go inside and bring one preferred item outside. Initially this happens every day. Over time, number of minutes before being allowed to go in increases and number of days per week decreases. Eventually, CJ was expected to play outside for the duration of outside time from Monday-Thursday and on Friday he could have an inside-out day, bringing anything he wanted outside.

Treatment cont’d

• The climber was shut down 5 minutes before parents started to arrive. This removed the antecedent of the

climber and therefore parent visibility, and increased

response effort to try and get up there (a board covering

the ladder made it nearly impossible).

• A physiotherapist showed staff some skills they could work on with CJ to increase eye-hand coordination and

physical stamina. This made being outside more

reinforcing as he could keep up with peers.

Data, data, data

 Data: Why such a large focus?  Data helps modifier develop treatment plan that will work!

 Can have measurable outcome of real behaviour change

 Data can act as reinforcer or prompt for both modifiers and client

 Data is taken all the way through baseline and treatment phases so that the team can objectively measure whether the behaviour actually changed.

Follow-up

• Follow-up:

• A good modifier always revisits clients several times to make sure the program is working, help revise if it needs

changes, to provide further training

• A recommendation is 2, 4 and 6 weeks post treatment initiation. If after 6 weeks the behaviour is still managed

effectively, it can be considered effective. ☺

Importance of Understanding how

Biology and Behaviour Interact

 Typical Development versus Behavioural Difficulty

If you are considering working with children or adults in this capacity, I would strongly

recommend taking a lifespan development course or a course on child development. It is

important to have an excellent understanding of typical behaviour before you can truly

identify behaviour that may be outside the norm. I often get calls to assess children who are

behaving perfectly within the norm for their developmental age.☺

 Interaction of Drugs and Behaviour

 An understanding of brain areas and functioning, particularly as it relates to some of the more common designations, is important, as is an understanding of what role the medications for those disorders have. For example, a program designed for an individual with a designation of ADHD who is not on medication will look different from one that is, due to the drug effects on behaviour.