Activity: Developing Treatment Packages and Intervention Plans

Directions: Use the following vignettes to design a treatment map, then identify the more appropriate combination of treatment components for the purposes of completing the assignment.

Vignette 1

Kim is a 6-year-old who has been recently diagnosed with autism. Since receiving this diagnosis, she has been receiving speech, occupational, and developmental therapy through Early Intervention Services. Those services consisted of 1 hour of each therapy per week. Kim has an extensive vocal repertoire, but her length of phrase utterance is only 1-2 words. She engages in age-appropriate daily living skills with the exception of eating.Currently, her mother reports that she is "extremely selective" with her food choices. When made to, Kim will consume a variety of flavors and textures such as bananas, cheese, chicken nuggets, yogurt, and peanut butter and jelly sandwiches, but it is always multi-hour-long struggle to get her to eat.

The only food Kim reliably requests and eats with her parents without running away or having a tantrum is McDonald's French fries. Whenever her parents try to feed her something else, she typically gets up and runs away from the table and throws a tantrum. If they continue to tell try to get her to eat, the behavior escalates and Kim will hit, kick, and bite her parents until they let her leave the table. They once resorted even to "tying her to her chair with a karate belt to get her to stay at the table." Since that incident, she won't even come to the table and now her parents just put out a plate of French fries for each meal on the coffee table and let her eat when she wants. It has now been 3 weeks since Kim has eaten anything other than French fries and her health is starting to suffer from having such a limited diet. This has resulted in her parents hiring you to decrease her food refusal behavior. Her doctor has confirmed that Kim has no known allergies to any foods and has no oral-motor deficits that might impact her ability to chew and swallow food. When you ask Kim why she doesn't want to each other food, she screams "it's yucky" and runs away. Based on the results of your functional behavior assessment (FBA), you determine this behavior is mostly likely maintained by socially-mediated negative reinforcement in the form of escape from having to consume non-preferred foods. Interestingly, your FBA suggests that the food refusal behavior is not maintained by socially-mediated positive reinforcement in the form of access to French fries, as the behavior only ever occurs when presented with non-preferred foods and immediately ends if the food is taken away, even when access to French fries is not provided.

Vignette 2

Johnny is a 12-year-old boy who attends public school in a large metropolitan city. He has a diagnosis of intellectual disability which manifests as extreme difficulty completing his school work. Johnny has also recently received a diagnosis of Oppositional Defiant Disorder. Aside from these diagnoses, Johnny shows strong social and conversational skills, and has a wide variety of interests including football, pro wrestling, drawing, and comic books.

Because of the behavior is exhibits while at school, Johnny is in a self-contained classroom with 11 other students who also engage in "inappropriate" behavior.The classroom contains one teacher and three teacher's aides. His teacher reports that Johnny frequently becomes violent with not only the classroom staff, but with the other students as well. This behavior typically takes the form of making threats towards others (e.g., "I'm going to beat you up till you can't move," "you're about to get smacked in the face"), throwing large objects (chairs, textbooks, laptop) at others, and physical aggression such as hitting and kicking others. On one occasion, the teacher reported that Johnny has threatened to stab her in the neck with a pencil. As a result of this threat, Johnny is on the verge of being expelled from the school unless he can get his behavior under control.

His teacher also notes that Johnny has not completed any of his school work during the last 6 weeks of the school year. He never does any homework outside of school and will often refuse to do any work during class time. The teacher notes that when she tries to get him to do work, he will typically argue with her until she leaves him alone and will often resort to violence if she persists.

While at school Johnny mostly keeps to himself and doesn't seem to have any friends in this classroom. Johnny spends most of his time at school reading things on the computer and watching online videos. Access to the computer is Johnny's most preferred activity as the computer he has at home does not work very well and has limited internet access. He will also gladly talk with anyone in the class about his favorite topics, though this rarely happens as most of the students do not seem to like interacting with one another and most of the classroom staff avoid Johnny from fear of his behavior.

From your direct observations, you have noted that the verbal threat always come before any acts of physical aggression. In addition, these behaviors tend to reliably occur when Johnny is made to do schoolwork for longer than approximately 5 minutes, or when he is told he cannot have or do something he wants to do. The results of your functional behavior assessment suggest that his aggressive behavior is likely maintained by socially-mediated positive reinforcement in the form of access to preferred items and activities, as well as socially-mediated negative reinforcement in the form of escape from non-preferred activities. Scatter plot data show that the escape-maintained behavior is more likely to occur during the four, hour-long instructional periods while the behavior maintained by access to tangible items most often occurs first thing in the morning, during lunch, during recess, and at the end of the day while cleaning up the classroom and waiting for the bus.