Intervention Procedures For Slp (No. 2)

Front 1

Guidelines for Reward schedules

Back 1

1) Always begin w/Continuous; if using ratio, time should be very small time;
2) Change to fixed intermittent ASAP
3) Increase fixed interval slowly - until learned
4) Switch to variable - as soon as have opportunity to do so;
5) Schedule changes should be small, gradual steps (client's behavior/reactions will let you know if switching too fast);
6) Early learning - never beg. trmt w/intermittent
7) Interval schs work better w/groups

Front 2

Reward Quantity

Back 2

Best to give reward in SMALLEST quantity possible to achieve your goal

Front 3

Why give reward in smallest quantity possible?

Back 3

Want to avoid satiation, and
Smaller reward means less time away from therapy

Also: want to vary quantity of reward w/i reason

Front 4

Strongest combination

Back 4

Variable schedule with a VARIED quantity

E.g., slot machines (VI, done by computers)

Front 5

Final with regard to reward quantity

Back 5

Where a reward works well, don't use it again for a few weeks! Why? Because child will tire of it quickly.

Front 6

Reward Immediacy

Back 6

Should be given immediately after performance of desired behavior on part of client

Front 7

Reward Immediacy - research

Back 7

Research shows that as interval increases between behavior and reward, the reinforcement power of the reward DECREASES; you want instead for child to have no way of misjudging why reward was being given in the first place

Front 8

Reward Variability

Back 8

E.g., return to specific restaurant

No one wants the same rewards each time

Using the same rewards can seem like the same thing over again

Should vary rewards even if it seems to be working

Front 9

Reward Variability 2 of 2

Back 9

Giver of reward also influences how effective reward is

Here, it's o.k. to use your relationship (as long as one has been established)

Problem occurs when trying to use presumed status to get child to do things

Front 10

Symbolic reward system (SRS)

Back 10

As SLP, cannot always be involved in giving rewards each time a behavior is performed; problems occur when try to use rewards on large basis - Thus - SRS follows

Front 11

SRS

Back 11

Child receives reward symbol and continues task w/o spending a lot of time

Front 12

Token

Back 12

SRS - later exchanged for real reward (e.g., token economy system)

Gold stars, poker chip, check on paper, buttons -- anything that can be counted

Works very well

Front 13

Advantages of Token System

Back 13

1) Avoids satiation
2) Works well w/children who don't respond to social reinforcement, but not as limiting as primary reinforcers
3) tokens easy and quick to administer (takes little time away from Tx)
4) Usu. very immediate form of a reward
5) Allows individualization to child's needs

Front 14

Problems with Token Systems

Back 14

1) Some clients do not respond well in waiting for reinforcement (Esp. low fxn child)
2) Reward at end is often not reinforcing enough to get client to respond correctly ea. time(s) [can fix by changing reward]
3) Often clinician's make the token the reward - which is valueless; must be rewarding for client
4) Losing some tokens is often no big deal
5) Where child+ have to sacrifice fairness OR individualization
6) Token are difficult to fade (don't exist in real world)

Front 15

Negative Reinforcement (NR)

Back 15

Behavior is followed by the removal of an unpleasant event (getting rid of unpleasant event) = (increases or) strengthens behavior

Front 16

Examples of NR

Back 16

Kid had to get 5 good /r/ sounds bef leaving Tx

Put up umbrella in rain
Swat fly
Scratching itch
Torture
Baby cries, bottle = mom NR

Front 17

Punishment

Back 17

Where punishment is "applying something negative"
Punishment decreases the strength of a behavior (unlike NR, which INCREASES a behavior)

Front 18

Why are NR & punishment often mixed up?

Back 18

In NR, remove something that's negative

NR always preceded by something that is punishing

Front 19

Why is NR not used in therapy?

Back 19

Because with NR, you have to remove something that is punishing

So, NR is not OFTEN used in Tx

Front 20

Methods of Weakening Behavior - overview

Back 20

Extinction
Punishment

Front 21

Extinction

Back 21

PPL perform undesireable behavior because they've been rewarded for same in past

Can reduce undesirable behavior by making certain you don't reward that behavior

DEF: removal of those rewarding consequences that normally follow behavior

Front 22

Common ways to accomplish
Extinction

Back 22

1) Ignore behavior (most common)
2) Satiation - creating opportunities for negative practice (NP)

Front 23

Negative Practice NP

Back 23

Force a person to do something undesirable more than they would like to do it

E.g., caught smoking - forced to smoke until sick

Front 24

Extinction Burst

Back 24

When start Extinction, thru either method initially behavior not decrease - in fact, tends to increase -- called EB

Many people give up - but this actually STRENGTHENS the core behavior

Front 25

Examples of EB

Back 25

Lightswitch that won't come on - keep turning it on and off
Vending machine - hit it
EB very common with crying babies

Front 26

How well does Extinction work?

Back 26

If you can ID the rewards and then withdraw them - can use extinction

Front 27

Problems with Extinction

Back 27

May not be able to stop all the rewards the child is getting

E.g., child being ignored in class by teacher, other kids don't ignore it

Front 28

Punishment

Back 28

Has neg connotation in our society
Includes wide array - not all are severe
Spans harsh to mild

Front 29

Types of Punishment

Back 29

Timeout
Response Cost
Physical punishment
Verbal and Social Punishment

Front 30

Timeout TO

Back 30

Remove client from attractive and rewarding activity, event or situation for certain time period immediately after performance of u/d behavior

Front 31

Guidelines for Timeout

Back 31

1) Removal must be immediate
2) AR area so no reward exists
3) Any contact should be UNEMOTIONAL
4) Never leave in TO for too long
* want child to return as soon as u/d beh ends
* TO only punishes for 1st few mins - thereafter, may punish appropriate beh
* give generous reward for acting appropriately (so as to contrast w/TO)
*Don't scold or criticize client while in TO (which tends to be NR)
*Talk about choice - they chose it so make sure they realize their choice

Front 32

Response Cost RC

Back 32

Rewarding stimulation are remove from the child;
Price of U/D beh
Often used when working with kids, as threat (if you do __ again, we won't do ___ later on)
RC is not a bad choice because it lets the child know about consequences for behs

Front 33

Problem with RC

Back 33

Once the child has been punished, lose control over the child
This is one reason parents use it so poorly (children learn)

Front 34

Guidelines for RC
1 of 2

Back 34

1) Don't threaten something you don't intend to do
2) make sure child is rewarded enough to want to change their beh
3) Pair threat with ability to achieve positive reward (use pos + NR)
4) make contingent punishment close in time to the u/d beh

Front 35

Guidelines for RC (cont.)
2 of 2

Back 35

5) try to make the punishment fit the crime
6) Punishment as small as possible while still having an affect
7) make sure child knows that he is in control of his fate
8) make sure child understands his alternatives at all times
9) don't use RC too often or it will lose its effectiveness
10) RC works well with Token Systems

Front 36

Physical punishment PP

Back 36

With TO & RC are taking away positive - with PP, are presenting something NEGATIVE
PP is least preferred method by most professionals

Front 37

Psychologists have studied and PP - results . . .

Back 37

1) PP often SUPPRESSES an u/d beh but doesn't CHANGE it
Our Goal = to change beh; often u/d beh occurs once PP has ended - e.g., shock treatment in stuttering treatment
2) other substitute beh may develop; e.g., happens in many children - psychology of ending ticks
3) produces emotional responses in person being punished - i.e., unnecessary anxiety & fear - but not purpose in beh
4) person who administers the PP becomes recipient of regression & hostility (where client is hostile, goal not realized)
5) generalization gradient: client avoids u/d beh but also avoids other closely related behs - or may stop participating
6) satiation to punishment often develops - such as in abusive relationships
7) client may enjoy the attention - e.g., for many abused child, only att'n they get is PP

Front 38

Why use PP?

Back 38

May be necessary:
1) young child doing something dangerous
2) bully - from POV of caretaker - let bully child know there are other possibilities out there

Front 39

If going to use, PP - follow these guidelines

Back 39

1) be matter of fact and non-emotional
Why? where you show emotion, is 2ndy reinforcer; want child to understand the connx btwn his action & beh
2) Try not to raise your voice
-- yelling has little affect - always the unknown and cannot move forward from there
3) don't wait for the neg beh to end - otherwise PP may not have as much effect
4) be consistent in your threats - may want to warn

Front 40

Verbal & Social Punishment (VSP)

Back 40

Outgrowth of PP
Applying something neg
Can be very effective - but MUST be used correctly (see reasons to use PP)

Front 41

How to use VSP correctly

Back 41

1) no emotions involved
2) use facial expressions - not voice
3) Can use your relationship w/child (e.g., let child sit and scream while clinician engages in something interesting to child - may cause child to realize world doesn't revolve around them)
Ignore child
Let child KNOW when they are wrong - don't say "o.k." when child is wrong
Goal in Spch Tx = errorless learning

Front 42

3rd way to Strenghthen and/or Weaken a behavior

Back 42

1) Rewarding Incompatible Undesirable Behaviors (RIDB)
2) Situation Control

Front 43

Use RIDB

Back 43

Often, a client's u/d beh can be replaced by appropriate beh that is directly opposite to u/d beh

E.g., child who always plays alone is rewarded for playing with others

Reward a response that is directly opposite
E.g., Tx in stuttering is based on this principle - you reward fluent speech

Front 44

Situation Control (SC)

Back 44

Only want to decrease beh in certain situations (reduce or weaken)
Teach discrimination btwn permissible and non-permissible situations for a given beh
Set up differentiation
What we're doing is setting up a Discriminative Stimulus (sets up occasion for a particular response & by using SC you are creating DS)

Front 45

More on DS

Back 45

Particular restaurant where no other restaurant will do

Dr. Klien's study area at college

With client, we are trying to build a new ___ via DS

Front 46

How use DS?

Back 46

1) verbally instruct client then differentially reinforce & punish
2) provide client w/practice in doing both

Ultimately, client will learn discrimination you're trying to build

Front 47

III. Developing New Behavior - overview

Back 47

With SRC model, we've previously dealt only with "C" now were shifting to "S"
Will manipulate "S" to develop new behavior
Only 1 method we know of - PROMPTING

Front 48

Prompting

Back 48

Very impt., but often misunderstood
DEF: Refers to providing a client with any cues necessary to help them to perform a new behavior

Front 49

Cues . .

Back 49

are called prompts

Front 50

Problem with prompts?

Back 50

There exists an almost unlimited # and type of prompts; the difficulty comes in choosing the appropriate prompts to teach what you want to teach

Learning to use prompts is a very vital ability that separates therapist from technician

Front 51

Six possible dimensions of prompting

Back 51

Auditory-Verbal (A-V)
Auditory non-Verbal (A-NV)
Visual written prompts (V-W)
Visual non-written prompts (V-NW)
Manual prompts (move/situate client) - MP
Proprioceptive OR Kinesthetic (P or K)

Front 52

Levels of Prompting: A-V
(1 of 3)

Back 52

Instructional prompts
Client's verbal instruction as to how to do something
E.g., put tongue behind teeth

Front 53

Instructional Prompts (cont.)

Back 53

Most common type of prompt
Keep in mind, the child may be unable to do what asked - thus, IP are ineffective in changing beh.
IP does let client know what to expect
However - NOT EFFECTIVE alone esp. given our client pop (low fxn'g)

Front 54

Levels of Prompting: A-V
(2 of 3)

Back 54

Auditory-Modeling (A-M)
AKA Imitation learning
Modeling can be visual or
auditory
A-M is one of the more effective procedures for teaching A NEW BEHAVIOR

Front 55

Auditory-Modeling

Back 55

Here, you demonstrate beh. & reward client for successfully trying to imitate beh
Not as easy as it sounds
4 conditions necessary for modeling to work (see ff cards)

Front 56

4 Conditions for A-M to work

Back 56

1) Learner has to attend to and perceive the distinctive cues of the model

E.g., with severe MR, cannot AT - so useless to model here

Front 57

4 Conditions for A-M to work: 2 of 4

Back 57

2) Learner must be able to retain model by coding it internally in some way

How? Recall visual image, repeat it, create way to try to retain
Why have to retain? Because there's a time lage btwn time given & time repeated

Again, w/severe MR, not usable due to inability to retain
One way to do w/MR, can self-talk to decribe model while at same time doing modeling

Front 58

4 Conditions for A-M to work: 3 of 4

Back 58

3) Learner must be able to reproduce MOTORICALLY the model

E.g., person w/CP may be unable to reproduce model

Front 59

4 Conditions for A-M to work: 4 of 4

Back 59

must be enought incentive or REINFORCEMENT present in order to make sure the learner will attempt the model

Client may have to stretch to get beh. -- so must offer an incentive to get them to do so

Front 60

Generally about modeling

Back 60

Can be done in a # of ways - not only by clinician - but can use, e.g., puppet, movies, story characters, most of time is clinician though

After client has imitated a beh, & can imitate well, want to start FADING that model

Front 61

Problem with modeling

Back 61

Low fxn client/s:
Remember that client pop we see are deficient imitators -- they haven't gotten it yet (even thou they've seen others do it)
may have to TRAIN client in basic imitation (they may have no imitatitve ability present)

Front 62

Levels of Prompting: A-V
Imagery or Conceptualization

Back 62

Could put in visual category too
here, create an image that client can understand to help them to realize what you want them to do

E.g., old tyme imagery: PB on roof of mouth

Front 63

Imagery (cont.)

Back 63

Very strong prompt if you can find an image or concept the client will/can relate to

Tend not to use this enough

But - impt. to realize, that the concept is only as good as ability of client to understand that concept

Front 64

Levels of Prompting: A-NV

Back 64

Anything that's auditory but non-verbal to get client to do what you want them to

E.g., use of bell, timer that buzzes, metronome (old tech)

Front 65

A-NV (cont.)

Back 65

Not use often at present
Dr. Klien uses A-NV at transfer & generalization phase to get from less than to 100% accuracy
Tech: monitor, and stop each time incorrect - should reward ea. time if all you do is stop them (e.g., ring bell on each correct production)

Here, the prompt is also the REINFORCER
Very often, a reinforcer can end up being a prompt
E.g., child screaming in store -give child toy - child quiets - thus, toy becomes prompt to tell child to cry in a store

Front 66

Levels of Prompting: V-Written

Back 66

Here, use reading to get help toward correct response

E.g., show word written on paper "Teapot" (may be showing object teapot at same time too - because you may not use only one prompt at a time)

Front 67

Levels of Prompting: V-Non-written

Back 67

Anything that's not written; like objects, pictures, or "look in mirror" to client

Front 68

Levels of Prompting: Proprioceptive / Kinesthetic

Back 68

Def: proprioception = knowledge of (via senses) your body's position in space
Kinesthetic = muscular awareness, internal cues

Here, internal cues that can be use to try to help a person respond in a particular way
E.g., with voice, learn to relax VF, but goal is to learn the feel of it internally
Here, have means of creating an internal prompt but done by client via senses

Front 69

Levels of Prompting: Manual prompting

Back 69

Combination of visual & proprioceptive-kinesthetic cues
E.g., moving client's hand to teapot; "doing it" for the client, also called "HOH" hand over hand assistance; other ex., push finger on top of tongue to get /k/ sound

Front 70

Overall Goal of Prompting

Back 70

Getting client ot the point where they perform beh. some of the time or even once

We know that once beh. has been performed can increase it's production via beh. mngmt procedures

Front 71

Things to keep in mind with prompting . .

Back 71

Tend to use 1+ dimensions @ a time in real world
E.g., adult w/CVA would use: "What is this? You say it." Instructional and A-V (while holding object - teapot - and card with "teapot" written on it)
What's this? A teapot. Now you say it.

Front 72

Will need to know for next test

Back 72

Clinician's stimulus
client's response
Tell what's working

In AN, must be systematic - AN every word in every activity

Front 73

Dimensions of prompting

Back 73

Any clue given by clinician can be either uni-dimensional or multi-dimensional

Even w/i a given dimension, cuse can be uni-level or multi-level

Listen to me (Instru & A-V). Say teapot (Instru & A-V)
What's this (showing picture of teapot)? Pour water in cup from teapot.
VERY RARE to use uni-level or uni-dimensional cues

Front 74

How many cues should you use?

Back 74

As many as need to get them to perform the target beh

Front 75

Ultimate goal. . .

Back 75

To bring client to point where they can be reinforced

Front 76

When you use TOO MANY prompts. . .

Back 76

Will be difficult to get rid of them later on

Front 77

When you use TOO FEW prompts. . .

Back 77

may not work at all - no target beh.

Front 78

Guidelines for using Prompts

Back 78

1) Develop prompts for individual client
2) use only as many prompts as you need (easier to get rid of later on)
3) Don't be wary of using manual/physical prompt because you have many dimensions being used at once (Oft. most effective?)
4) Aft. client performs beh - start withdrawing the prompts -very slowly in well-thought out and sequenced way (methodological) = FADING

Front 79

Fading

Back 79

Aft. client performs beh - start withdrawing the prompts -very slowly in well-thought out and sequenced way (methodological) = FADING

If fade too quickly, client will regress

Front 80

One more type of prompt - CHAINING

Back 80

Helping a person to learn a new more complex beh by using behs. already learned

Front 81

Experiential prompt

Back 81

Chaining is a type of experiential prompt? Here, you use client's past experience/learning

The past learned beh becomes a cue for the new beh

Front 82

3 instances where you want to use Chaining OVERVIEW

Back 82

1) Sequential
2) Add element
3) Make easier using current knowledge

Front 83

Chaining: Sequential

Back 83

Where client already learned to perform 2 or more separate behs but you want to teach to perform them one right after another in correct order
E.g., getting dressed (compilation)

Front 84

Chaining: Add Element

Back 84

When client has learned a sequence of beh but you want to teach to ADD an element to the sequence
E.g., child can count to 20 but not above - will start at going to 21, once learned will go to 22, etc.

Front 85

Chaining: Make easier using current knowledge

Back 85

Want previously learned beh to make it easier to produce new behs
E.g., esophageal speech use single breath to produce 2nd phoneme production (experiential prompt)

Front 86

In all cases with chaining. . .

Back 86

Setting up situation where performance of one response prompts or sets the occasion for another response

Front 87

2 Types of Chaining: Overview

Back 87

1) Reverse chaining
2) Forward chaining

Front 88

Reverse chaining

Back 88

Learn backward/reverse order
Here, have client learn from the LAST behavior backwards to first
E.g., dressing - show order of 1st 5 events, then do last one on own; then help with 1st 4 events, do last 2 on own; then help with 1st 3, etc.

Front 89

Important with Reverse Chaining

Back 89

Having client practice a sequence of behavior that he knows the sequence - here start with LAST element

Front 90

Forward chaining

Back 90

Theory's the same as Reverse chaining, but go in opposite direction
E.g., prompt "What's first?" then you help thru the rest of the steps - he does no. 1, then prompt with remaining and lessen the amount of help being provided

Front 91

Example of where use forward chaining. . .

Back 91

Teaching a child how to count

Front 92

Overall with chaining

Back 92

Teaching a person to learn a new more complex beh by starting with a known beh

Front 93

Benefits of Reverse Chaining 1 of 4

Back 93

1) Client has greatest opportunity to practice steps leading to completion of target beh: seems logical; with Forward chaining not practicing steps

Front 94

Benefits of Reverse Chaining 2 of 4

Back 94

2) Most opportunity for client's reward for final beh

Front 95

Benefits of Reverse Chaining 3 of 4

Back 95

3) Might make sense to child since final goal beh is included

Front 96

Benefits of Reverse Chaining 4 of 4

Back 96

4) Often easier to maintain attention longer using Reverse Chaining

Front 97

Guidelines for using Chaining 1 of 6

Back 97

1) the separate behs or links in chain must be learned bef they can be linked together

Front 98

Guidelines for using Chaining 2 of 6

Back 98

2) Learner must learn and execute each link in proper sequence

Front 99

Guidelines for using Chaining 3 of 6

Back 99

3) Links in chain must be performed in close time succession - this helps to ensure that links are learned - primary reason for mistakes in using chaining want chain itself to be the prompt (want automatic beh) -- e.g., where know 1-5 but not 6, start with 1-6, then once learned move on to 7

Front 100

Guidelines for using Chaining 4 of 6

Back 100

4) Sequence of beh should be repeated until you're sure the beh has been learned -- goal = automatic

Front 101

Guidelines for using Chaining 5 of 6

Back 101

5) Make sure there's reinforcement available for client after completing the final link in the chain

Front 102

Guidelines for using Chaining 6 of 6

Back 102

6) Whenever possible, use beh chains that are already learned to teach new beh
E.g., child can count only to 5; goal is to count to 10, could start at 6, but per this guideline , use 1-5, then 6

Front 103

What about when you've tried all prompts, and reinforcers and nothing works?

Back 103

Change Expected Response (ER) part of model

Front 104

Changing ER

Back 104

Last thing you can do in order to change beh

DEF: Accept a beh from a client that is less than what we would've originally targeted

On accepting this beh our hope is that we can build the beh up; manipulate Tx goals - interim levels of response

Front 105

Two Therapeutic Procedures that Change ER

Back 105

1) Hierarchy analysis, and
2) Shaping (or successive approximation)

Front 106

Hierarchy Analysis (HA)

Back 106

Def: the development of a series of logical well-organized interim levels of response leading to final target

E.g., child runs around all the time; goal = sit in chair for 15 mins

Front 107

HA of getting child to sit in chair for 15 mins

Back 107

Reward for touching chair
Sit in chair momentarily
Sit in chair for 5 secs
Sit in chair for 10 secs
Sit in chair for 10-20 secs
Sit in chair for 30 secs
Sit in chair for 1 min
Sit in chair for 2.5 mins
Sit in chair for 5 mins
Sit in chair for 10 mins
Sit in chair for 15 mins one time
Sit in chair for 15 mins 2 times
Sit in chair for 15 mins on regular basis
Key = come up with interim goals

Front 108

Where you have performed a HA. . .

Back 108

Level of ER
From simple to complex
99% of the Tx you do sill require a HA
Have to think it out beforehand

Front 109

Shaping (aka Successive Approximation)

Back 109

Breaking down tasks into another step DURING the Tx session

Shaping DEF: reinforcing a client for performing a beh that APPROXIMATES the desired beh

Not perfectly per original goal - E.g., instead of pointing to a dog (which is goal), puts hand on table in front of dog - thus, have created an interim step
Must be closer to target, but not quite there (recall - this is done during the Tx session) - here you are changing your hierarchy

Front 110

When to do HA v. Shaping

Back 110

HA done before you see the client (preplanned)

Shaping done while you are seeing the client (spontaneous)

Front 111

Guidelines for using Shaping

Back 111

1) Approximation has to be reinforced after its execution - or the client may not know what he has done?
2) Don't reinforce an approximation for too long OR client will never move on

Front 112

The Tx Continuum

Back 112

Prompting (multiple <--> Few/none)

Reinforcement (heavy <--> light)

Expected Response (simple <--> complex)

Front 113

Therapeutic Trouble Shooting: 3 choices

Back 113

1) manipulate the stimulus
2) manipulate the consequence
3) alter expectations for response

Front 114

Manipulate the stimulus

Back 114

Change level of prompting
Add
Subtract
Change type or dimension (visual, auditory, etc.)
Use what client already knows (chaining)

Front 115

Manipulate the consequence

Back 115

Positive or Negative
Reinforcement or punishment, including:
Type
Schedule
Quantity

Front 116

Alter expectations for response

Back 116

Make task easier through:
Hierarchy analysis (thru preplanning)
Shaping (spontaneously)

Front 117

Task analysis

Back 117

Which area is Tx breaking down? - one of the 3, find out thru Task Analysis or strategy you've already done working? Think about levels, prompts & reinforcement

DEF: the breaking down of any learning on beh into its component parts

Front 118

When using TA look at . .

Back 118

Where the client is
Where you want him to be, and
Steps necessary to get him there

Front 119

How is TA different that HA?

Back 119

With TA not thinking about prompts yet

If just doing HA, you're not considering prompts, etc.
Some of the steps in TA will not involve a change in client's beh
TA is CREATING A SERIES OF STEPS that will lead to the new beh
May just change level of prompts or level of reinforcement

Front 120

Rules/Guidelines for TA

Back 120

1) Never move from more than one category (e.g., level of prompting multi to few) at a time

2) Try not to move more than one step at a time (e.g., don't get rid of 2 prompts at once - stay at heavy prompting for awhile)

Front 121

Main problem in Tx

Back 121

Trying to eliminate too many categories at same time