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Introduction

Positive behavior support (PBS) helps an individual change his or her lifestyle in a direction that gives everyone the opportunity to enjoy improved quality of life (Carr et al., 2002). It also works to render problem behaviors that are irrelevant, inefficient, and ineffective by helping an individual achieve his or her goals in a socially acceptable manner, thus reducing or eliminating episodes of problem behaviors (Carr et al., 2002). PBS works to:

• Prevent challenging behaviors by changing the environment and/or changing the task
• Reinforce positive behaviors via positive reinforcement, negative reinforcement, & fading
• Teach replacement behaviors and
• Reduce challenging behavior

Theory:

Applied behavior analysis is the process of systematically applying interventions based upon the principles of learning theory to improve socially significant behaviors to a meaningful degree, and to demonstrate that the interventions employed are responsible for the improvement in behavior (Baer, Wolf & Risley, 1968; Sulzer-Azaroff & Mayer, 1991).

Evidence:

Upon reviewing the evidence there were no particular studies that applied to our specific population; however, we found evidence that demonstrates the effectiveness of using Positive Behavior Support (PBS) in children with autism and anxiety. According to the article, (PBS) can be used to decrease anxiety and problem behavior. A study by Moskowitz, Walsh, Mulder, McLaughlin, Hajcak, Carr, and Zarcone (2017) determined the effectiveness of PBS through incorporating individualized strategies from PBS. The study included 3 participants that were school-aged children who have been diagnosed with autism. The study used the Functional Assessment Interview and all sessions were conducted within the natural context of the participant’s ongoing routine. Based on caregiver report and direct observations, the primary function of each child’s problem behavior was to escape or avoid an anxiety-provoking situation. After the final baseline observation, parents reviewed results of the assessment and were able to choose interventions to implement at home such as positive reinforcement, differential reinforcement, and escape extinction. The results offered support for using a multimethod approach to assess and decrease anxiety and related problem behaviors.

Case Study:

Clint is a 25 year old male who goaltends for the Florida Panthers hockey team. About a month ago, his neck was slashed with another player’s skate during a game, almost killing him. Following this incident, he is plagued by PTSD, alcoholism, OCD, and has made a suicide attempt. Previously, playing hockey gave Clint a feeling of purpose; however, now he no longer believes that he is capable of returning to work. Clint is having outbursts of frustration towards his wife due to his anxiety. He has participated in multiple OT sessions but is now being educated on positive behavior support strategies to better problem-solve and overcome the anxiety that is hindering his performance.

Intervention Plan

Problem statement:

Client engages in maladaptive behaviors secondary to anxiety symptoms.

2 long term goals

• Client will implement 2 out of 3 positive replacement behaviors in 4 weeks for social participation.
• Client will improve social participation by reducing outbursts to 1 per week using positive replacement behaviors in 4 weeks.

3 short term goals

• Client will identify 3 triggers to his outbursts in 2 weeks for social participation.
• Client will identify 3 positive replacement behaviors for managing his outbursts in 2 weeks for social participation.
• Client’s wife will provide positive reinforcement when he appropriately responds to his triggers in 2 weeks for social participation.

Intervention format: Positive Behavior Support; individually

Description of setting: Self-pay Outpatient Clinic

Supplies: None

Agenda

• Client interview (5 min)
• Educate the client on PBS (10 minutes)
• Discuss triggers and possible replacement behaviors (20 minutes)
• Overview of session (10 minutes)

Documentation

S:  Client stated that he has been having outbursts towards his wife when he begins to feel anxiety. He reported that she nags him about household chores and that when he begins to feel like he is going to have an outburst she makes it worse and makes him feel like he is going to explode.

O: Client engaged in a 45 minute treatment session of positive behavior support. The client was educated on PBS. The client then discussed situations which triggers his outbursts and possible positive behaviors that could replace his outbursts. His wife joined the session during the overview and was educated on how to positively reinforce the client when he appropriately responds to his anxiety.

A: Client demonstrated eagerness to improve his behaviors when he arrived at the session. He is aware of his challenging behavior and shows good potential of improving through use of positive behavior support.

P: Client would benefit from OT once a week for 1 month to continue use of PBS. The family will benefit from education on the different methods that will help with changing problem behaviors.

References

Baer, D., Wolf, M., & Risley, R. (1968). Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 1, 91-97.

Carr, E. G., Dunlap, G., Horner, R. H., Koegel, R. L., Turnbull, A. P., Sailor, W., … & Fox, L. (2002). Positive behavior support: Evolution of an applied science. Journal of positive behavior interventions, 4(1), 4-16.

Moskowitz, L. J., Walsh, C. E., Mulder, E., McLaughlin, D. M., Hajcak, G., Carr, E. G., & Zarcone, J. R. (2017). Intervention for anxiety and problem behavior in children with autism spectrum disorder and intellectual disability. Journal of Autism and Developmental Disorders, 47(12), 3930-3948. http://dx.doi.org.ezproxy.fiu.edu/10.1007/s10803-017-3070-z Retrieved from http://ezproxy.fiu.edu/login?url=https://search-proquest-com.ezproxy.fiu.edu/docview/1970300389?accountid=10901

Sulzer-Azaroff, B. & Mayer, R. (1991). Behavior analysis for lasting change. Fort Worth, TX : Holt, Reinhart & Winston, Inc.