Based on interviews with Annie’s parents and direct observation in Annie’s home and school, the first behavior to target is skin picking.  When Annie picks her skin, she uses the forefinger of one hand to scratch and dig at the skin of her arms and legs.  She has only been observed to pick at the skin on her arms and legs.  The behavior occurs mostly during down times: while waiting, while watching television, while in her bedroom alone.  A brief functional analysis was conducted and revealed that skin picking never occurred during attention, escape, or tangible conditions.  The behavior only occurred during alone conditions.  

The second issue of concern identified by the parents and confirmed via observation is Annie’s lack of functional speech.  After consulting with Annie’s speech pathologist, it was determined that Annie is capable of vocal speech.  She echoes simple words spoken by others and has a strong echoic repertoire of one-syllable words.  She does not currently use vocal speech to get her needs and wants met or to identify things in her environment.  During the observation, there were multiple occurrences of Annie pulling her mother and father into the kitchen and pointing at the refrigerator.  If her parents did not guess what she wanted in the first or second try, Annie would jump up and down and start screaming, getting louder and louder until her parents guessed correctly.  This episode went on for as long as 10-15 minutes.  The episodes ended only when her parents correctly guessed the item she wanted.

Her parents report that Annie’s favorite foods are pretzels, raisins, cheese crackers, apples, and grapes. They said that they can get her to “do almost anything” for some grapes.  She also likes to drink chocolate milk and apple juice.  For fun, she plays with toys and watches television.  Her favorite toys are little animals and little dolls (she collects them), tiny furniture.  Her parents report that Annie loves “tiny” things.  When she watches television, she usually watches Teen Titans Go or Littlest Pet Shop.  She has an iPad her parents control her access to.  She sometimes watches YouTube videos on her iPad.  She also enjoys swimming and swinging outside.

Referral

Parent/Guardian Name(s): Juan and Maria Rodriguez

Client name: Annabelle “Annie” Rodriguez

Client Age: 7 Gender: Female

Current diagnoses: Moderate Intellectual Disability, Autism Spectrum Disorder, GERD

Brief description of behaviors of concern: Annie’s most frequent and most worrisome behavior is skin picking.  She picks at her skin using her fingers and creates open sores on her arms and legs.  At any given time, she has several open sores on her body.  This has led to skin infections in the past.  She often does this when she is watching television or alone in her room.

The second concern is her lack of speech.  She is able to repeat words she hears others say, but does not initiate communication on her own.  If she gets frustrated, she will jump up and down and scream until someone figures out what it is she wants.  She usually leads people around the house and points at things if she wants something.  It is getting harder and harder to understand what she wants.

Assessment for the behaviors identified in the referral (See Referral Formhttps://kapextmediassl-a.akamaihd.net/artsSCi/PS365/PS365_1807D/PS365_ReferralForm.docx  and Brief Summary of the Functional Behavior Assessment (https://kapextmediassl-a.akamaihd.net/artsSCi/PS365/PS365_1807D/PS365_BriefSummaryFBA.docx)

You are ready to begin your intervention plan, but you need to get the parents’ approval first. In a meeting with the parents, you describe your behavior intervention plan and provide a rationale for your intervention choices.

Question 

Behavior Excess for Decrease: Skin Picking

1. Operationally Define the target behavior by writing a 1–2 sentence that meets all of the following criteria: 
   • Observable
   • Passes the “Dead Man’s” test and the “stranger” test
   • Uses no labels or hypothetical constructs
2. Explain the difference between habit behaviors and behaviors controlled by social reinforcers. Include examples. 
3. Explain how you plan to implement all four components of habit reversal with Annie. Include a specific competing response.
4. Explain why you expect this procedure to be effective, including a description of the applicable behavioral principles that explain why habit procedures work to reduce habit behaviors.
5.  Including a description of the applicable behavioral principles that explain why habit procedures work to reduce habit behaviors.

Question

Behavior Deficits for Increase: The Mand and the Tact

1. Begin by explaining to the parents the difference between the behavioral view of language and the cognitive view of language. 
2. Accurately represent the behavioral view of how language is learned.
3. Define the two verbal operants you plan to teach, i.e., the mand and the tact. 
4. Clearly differentiate between the two by providing examples for the parents. Your definitions should include the controlling antecedents and consequences for each verbal operant.
5. Identify which verbal operant you will teach first and explain your rationale for this choice.
6. Explain your procedures for teaching each verbal operant. Include details of what a typical teaching session would look like.
   • In your description of how you will teach a mand, identify:
     • A specific mand to teach
     • How you will set up the relevant motivating operation
     • A description of how you will use shaping to teach the new verbal operant
     • Include how you will prompt and differentially reinforce the mand (identifying the reinforcement to be used).
     • How you will fade your prompts
   • In your description of how you will teach a tact, identify:
     • A specific tact to teach
     • How you will set up the relevant discriminative stimuli
     • A description of how you will use shaping to teach the new verbal operant
     • Include how you will prompt and differentially reinforce the tact (identifying the reinforcement to be used).
     • How you will fade your prompts

Reference 

Cooper, J. O., Heron, T. E., & Heward, W. L. (2019). Applied Behavior Analysis (3rd ed.). Pearson Education (US). https://purdueuniversityglobal.vitalsource.com/books/9780134798769