Dr. Jennifer FosterPsychologist, Coordinator of Mental Health

ProgramsPerth Amboy Public Schools

AgendaBrief Overview of Disruptive Behavior

DisordersOppositional Defiant DisordersConduct Disorders (Early & Late Onset)Disruptive Behavior Disorders (NOS)

ABC’s of BehaviorFunctions of BehaviorManagement of Acute and Chronic

Behavioral ProblemsCPI Crisis Development Model

District Referral Process

What is a Disruptive Behavior Disorder?Attention-Deficit Disorders and Disruptive

Behavior Disorders are the two categories considered under “Disruptive Behavior Disorder”

Disruptive Behavior Disorders are broken down into to 3 major categories of mental health disordersOppositional Defiant DisorderConduct Disorder (Early & Late Onset)Disruptive Behavior Disorder (NOS)

Oppositional Defiant Disorder (ODD) Diagnostic Criteria

A persistent pattern of defiant, angry, antagonistic, hostile, irritable, or vindictive behavior

Most often directed toward authority figures

Pattern of behavior must be present for 6 months

Extremely difficult to manage due to confrontational nature

Behavior must be causing significant problems, in school and in relationships with family and friends

ODD Diagnostic CriteriaMust have 4 of 8 symptoms occurring

frequentlyLoses temperArgues with adultsActively defies or refuses to comply with

adult’s requests or rulesDeliberately annoys peopleBlames others for own mistakes or misbehaviorTouchy and easily annoyed by othersAngry and resentfulSpiteful of vindictive

ODD Signs & SymptomsStubborn and noncompliantContentious and argumentativeQuick to shift blameHighly DefensiveSee demands as unreasonablePassive aggressive/systematically ignore othersRefusal to negotiateDeliberate annoyance of othersThreatens/intimidates othersVerbally aggressivePresent with low self-concept or inflated self-

esteem

Oppositional Defiant DisorderAverage age of onset is 6 years old,

symptoms can be seen in children as early as 3 years old

Symptoms usually manifests by 8 years old, with most children diagnosed during preadolesence

Early onset of ODD is more likely to persist and lead to subsequent development of CD

More prevalent in males than females prior to puberty, but evens out in adolescence

Comorbid with:CD, learning disabilities, ADHD,

depression, anxiety80%+ with ODD have comorbid ADHD65% with ADHD have comorbid ODD

Criteria for Conduct Disorder (CD)A repetitive and persistent pattern of

behavior that involves violation of age appropriate social norms and the rights of others

Four categories of aggressive behaviors and violations of rules and age appropriate normsAggression toward people and animalsDestruction of propertyDeceitfulness or theftSerious violations of rules

Criteria for CD (Cont.)At least 3 of the 15 items, present for 12

monthsOf which one symptom in the past 6 months

Significant impairment in social, academic, or occupational functioning

Differences in age of onsetEarly Childhood Onset—onset of at least one

criterion characteristic of CD prior to age 10 Outcomes are poor, ingrained behavior is highly

resistantAdolescence Onset—absence of any criteria

characteristic prior to the age of 10 More resilient b/c they developed better coping

skills at earlier age

Signs & Symptoms of CDAggressive behavior that harms or threatens

other people or animals (i.e., physical altercations, intimidation, bullying)

Destructive behavior that damages or destroys property

Manipulation via lying, deceitTheftTruancy or other serious violations of rulesEarly tobacco, alcohol, and substance use and

abusePrecocious sexual activityShow little remorse for their actions, empathy, or

concern for the thought or feelings of othersRead hostile intent in the actions of others,

reactiveFake feelings to get lesser consequence, seek to

blame others

Disruptive Behavior Disorder Not Otherwise Specified (DBD NOS)

This category of DBD was created for children who demonstrate similar behaviors as children with ODD or CD but do not display the same frequency /severity and only met one or two of the behavior criteria for this disorder.

Like ODD and CD, this disorder causes significant impairment in the child’s life.

ABC’s of BehaviorAntecedent

Behavior

Consequence

The Dance of BehaviorAntecedent Behavior Consequence

Teacher giving lesson Child raises hand Teacher continues with lesson

Teacher continues with lesson Child calls out Teacher asks child to quiet down

Teacher asks child to quiet down Child keeps talking Teacher moves onto another activity, singing and dancing, and asks the class to stand up

Teacher moves onto another activity, singing and dancing, and asks the class to stand up

Child refuses to stand up Teacher asks child to stand up

Teacher asks child to stand up Child refuses and remains seated on the floor

Teacher walks over to child and tries to physically pick him up

Teacher walks over to child and tries to physically pick him up

Child becomes weightless as teacher tries to lift him

Teacher whispers, “Either I can pick you up like mommies pick up their little babies or you can stand up on your own,” in his ear.

Teacher whispers, “Either I can pick you up like mommies pick up their little babies or you can stand up on your own,” in his ear.

Child stands up Teacher continues with activity

Teacher continues with activity Child is cooperating and enjoying himself

The song and dance ends and teacher says, “okay, now we are going to sing the color song”

Antecedent Behavior Consequence

The song and dance ends and teacher says, “okay, now we are going to sing the color song”

Child calls out “I win, I win, I win” Teacher asks children to sit down on the floor

Teacher asks children to sit down on the floor

Child sits down Teacher passes out colored blocks

Teacher passes out colored blocks

Child calls out “I want orange, I want orange”

Teacher gives the child an Orange block

Teacher gives the child an Orange block

Child is happy and shows his blocks to his friend

Teacher realizes that the color orange is not in the song and asks the child for the block back

Teacher realizes that the color orange is not in the song and asks the child for the block back

Child puts block behind his back and says “no”

Teacher tries to grab the block out of child’s hand

Teacher tries to grab the block out of child’s hand

Child holds on to the block tight and tries to pull it away from the teacher

Teacher tells child there is no orange in the song, and tries to give him a blue block instead

Teacher tells child there is no orange in the song, and tries to give him a blue block instead

Child refuses to give her the orange block

Teacher tells child that he can keep the orange block on the floor next to him, but he has to use the blue block

Teacher tells child that he can keep the orange block on the floor next to him, but he has to use the blue block

Child puts the orange block by his side on the floor and takes the blue block

Teacher begins song with children

Functional AnalysisDetermining the function of the behavior

The process of gathering information to determine the relations between variables, particularly functional relations

Looking to answer the question “What is the function of the behavior?”

A functional relationship exists when a cause and effect relationship between variables has been experimentally established

Trying to find what contingencies maintain the behaviorCan be environmentalCan be “internal” environmental effects

Must “listen” or observe behavior to determine causes!

Primary Functions of BehaviorEscape/Avoidance:

from person, task, environment, etc.behavior usually occurs in response to specific person,

event or requests to perform activity.Tangible:

desire for a specific item or activitybehavior often occurs when something has been denied

or taken away -- it is not person or event specificAttention (positive or negative):

desire for attention from peers, adults, can include “power”

behaviors usually occurs when specific individuals are present -- may be all the time if the desire is for attention from peers -- it is person specific -- not event or location.

Sensory: the behavior feels good or meets a sensory need. behaviors occur anytime, anywhere--not person, event or

location specific but may occur more often when under stress

Functions of BehaviorBehaviors may result from a combination of functionEscape and sensory are often related to

circumstances that are stressful or boringAttention and escape may result from

difficult/boring curricular demands and not much attention

Tangible in combination with any of the others may be a result of boredom.

Combinations of 2 or more functions require a careful look at curricular requirements, basic classroom management, and availability of noncontingent reinforcement.

Questions To Be Answered. . .1. What are the setting events (i.e., conditions

that alter the probability of a behavior occurring

2. What are the antecedents of the challenging behavior (i.e., specific events that precede a behavior)?

3. What are the consequences for the challenging behavior, which may reinforce it?

4. What does the student gain?5. What does the student avoid?

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When Samantha misses her 12:30 medication & teachers present multiple task demands, she makes negative self-statements & writes profane language on her assignments. Teaching staff typically send her to the office with a discipline referral for being disrespectful.

Setting event Antecedent Response Consequence

Misses 12:30medication

Teachersmake

multipletask demands

Semantha makesnegative self-statements &

writes profanelanguage

Teacher sendsSamantha to

office for beingdisrespectful

What function?Avoid difficult tasks

Setting event Antecedent Response Consequence

Caesar isteased severaltimes about his

hair by his friends before

class

His teacherstares at his hair in class

Caesar askshis teacher what she’sstaring at

His teachersends him to

in-school detention

Caesar has dyed his hair three colors & is teased several times by his friends before class. When he enters the class, his teacher stares at his hair. Caesar immediately says “what are you staring at?” His teacher immediately sends him to in-school detention. What function?

Escape adult &peer attention

Setting event Antecedent Response Consequence

Cleo is new to the 6th grade, & English is her second language. When another student approaches & says something to her in English, Cleo turns away. The other student walks away. This happens several times during the day.

New student Studentapproaches &

speaks inEnglish

Cleo turns away

Other student walks

away

What function?Escape peer attention

Setting event Antecedent Response Consequence

When his teacher asks him what the capitol city of a country is, Napoleon gives the correct answers. His teacher praises his correct answer, & tells him he may work by himself or a friend on the rest of the assignment.

None Teacher askswhat capitolcity of countryis

Napoleongive correctanswer

Teacher givesverbal praise & time to workwith a friend

What function?Access peer &adult attention

Setting event Antecedent Response Consequence

As Manny is walking, other kids look at him & say “what’s up?” He looks back and says: “Who ya lookin’ at?!” “Ya want some of this?!” “Ya talkin’ to me?!” Kids shake their heads & call him “weirdo.”

?? Look at him.“What’s up!”

“Who yalookin’ at?”“Ya wantSome?” “Yatalkin’ to me?

Kids shakeheads & call him “weirdo”

What function?Access peer attention

Describing the Problem Behavior?1. Note the type of problem behavior2. Note where the problem behavior

occurs3. Note when the problem behavior

occurs4. Note characteristics of the setting

and events related to the problem behavior

5. Note situations or personal events that might induce the behavior

include actions of others that increase or trigger the behavior.

6. Note the consequences associated with the problem behavior.

7. Once this is understood, you can test a hypothesis

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Developing/Testing a HypothesisDevelop a hypothesis based on the

information gatheredTest the Hypothesis—Experimentally

evaluating precisely whether the antecedents and consequences that may control behavior, actually do.

Testing the hypothesis is important because important information may have been overlooked during data collection

Intended to reveal what is likely to be an effective intervention before moving to the intervention stage

Example of hypothesis statementWhen he misses breakfast & peers tease

him about his walk, Caesar calls them names & hits them. Teasing stops.

Setting Events TriggeringAntecedents

MaintainingConsequences

ProblemBehavior

Hypothesis Statement

Missesbreakfast.

Teasedby peers.

Name calling &Hits.

Teasingstops.

Function

Escape negative social contact

Function

Escape aversive social contact

Once you have a have a hypothesis, you can experiment with interventions

The Conflict Cycle

Crisis Development Model (CPI, 2005)

Crisis Development/Behavior Levels

Staff Attitudes/Approaches

AnxietyDefensiveActing Out-Person

Tension Reduction

SupportiveDirectiveNon-Violent Physical

Crisis Intervention (last resort)

Therapeutic Rapport

INTEGRATED EXPERIENCE: The concept that behaviors and attitudes of staff impact the behaviors and attitudes of those in their care

Proactive ApproachesMaintain sufficient personal spaceAwareness of non-verbal cues from body

languageIt’s not what you say, but how you say itSet LimitsEmpathetic Listening

When Responding…Do Don’t

Remain CalmIsolate the SituationEnforce LimitsListenBe aware of Non-Verbal

cuesBe consistent

OverreactGet into power strugglesMake false promisesFake attentionBe threateningUse jargon—tends to

confuse and frustrate

Effective EnvironmentsProblem behaviors are irrelevant

Aversive events are removedAccess to positive events are more common

Problem behaviors are inefficientAppropriate behavioral alternatives availableAppropriate behavioral alternatives are taught

Problem behaviors are ineffectiveProblem behaviors are not rewarded

District Behavioral Referral ProcessSpeak to your student’s Child Study Team Case Manager

and/or Crisis Counselor to determine if a referral is warranted.

Children diagnosed with Autism are an automatic referral.

If the student sees a Crisis Counselor, the referral is submitted by the student’s Crisis Counselor

If there is no Crisis Counselor assigned, then the case manager should complete the form

Once submitted & reviewed, a behavioral consultant will be assigned to the case and contact the Crisis Counselor/Case Manager

Initial observations will be conductedA meeting will be coordinated with the consultant/crisis

counselor and/or case manager, and teacherRecommendations will be made. This may or may not

include the decision to conduct a functional behavioral assessment and develop a behavior plan.

Case follow-up will continue throughout the process.

Questions??

Contact InformationDr. Jennifer FosterPsychologist, Coordinator of Mental Health

ProgramsOffice: Department of Special

Services/Administration BuildingEmail: jennfoster@paps.net (best way to

contact)Phone: 732-376-6200 Ext. 30234Fax: 732-826-4932