NADD Bulletin Volume X Number 4 Article 1

Complete listing

A Context-Based Model of Problem Behavior

Edward G. Carr, Ph.D.

Many individuals with autism and mental retardation exhibit serious problem behaviors such as aggression, self-injury, property destruction, and tantrums. These behaviors have a profoundly negative impact on quality of life, not only for the person displaying the behavior but also for members of their family. Problem behavior limits opportunities for community living, employment, school inclusion, and social relationships as well as demoralizing family members, frightening teachers, and alienating peers (Koegel, Koegel, & Dunlap, 1996). For these reasons, much research has been devoted to understanding the motivation behind such behavior (an assessment issue) and linking treatments to motivation (an intervention issue).

In the research literature, motivation is often equated with the reinforcing/maintaining consequences of problem behavior or, in lay terms, with the function or purpose of the behavior. Data suggest that problem behavior serves multiple purposes and can be maintained by attention from others (e.g., Durand, Crimmins, Caulfield, & Taylor, 1989), escape from aversive task demands (e.g., Carr, Newsom, & Binkoff, 1980), escape from social interaction (e.g., Taylor & Carr, 1992), access to preferred tangible items (Durand & Crimmins, 1988), and sensory reinforcement generated by the behavior itself (Favell, McGimsey, & Schell, 1982). Thus, a young girl may scream and tantrum to get her mother to attend to her, escape having to do an unpleasant chore, frighten away other people with whom she does not wish to interact, get her mother to give her food or purchase a desired toy, or display the behavior simply because it is enjoyable to perform (intrinsically reinforcing). All are possible functions of the behavior.

Function does not occur in a vacuum. It is determined by context. That is, the purpose of problem behavior varies according to specific features of the context in which the behavior is displayed. Thus, by analyzing context, we may better understand the motivation behind problem behavior and be in a stronger position to design meaningful interventions. We have hypothesized that problem behavior is related to two classes of contextual factors: discriminative stimuli and setting events (Carr & Smith, 1995). A discriminative stimulus is a discrete event that is positively correlated with reinforcement of behavior (Skinner, 1938) and, therefore, is likely to trigger the behavior. A setting event is a variable that influences ongoing (discriminative) stimulus-response relationships (Bijou & Baer, 1978).

In illustration, consider a young boy with autism who is aggressive towards others. On some days, when he is presented with a difficult (and presumably aversive) academic demand such as a color naming task (the discriminative stimulus or trigger), he responds by hitting his teacher and peers. His teacher immediately terminates the task. On other days, when given the same task, he is compliant. His teacher reinforces him with praise following successful completion of the task. In order to understand why the boy is aggressive one day and compliant the next day, even though the task remained the same, we need to search for broader variables, specifically, setting events that co-occur with the discriminative stimuli. We may find that, on days when the boy was aggressive, he was fatigued. On days when he was compliant, he was well rested. Fatigue, then, would constitute a setting event for problem behavior. The example just described illustrates what is referred to as a four-term contingency for understanding problem behavior (Carr, 1994). The four terms in the model are: the setting event (i.e., fatigue), the discriminative (trigger) stimulus (i.e., the task demand), the response (i.e., aggressive 

behavior), and the reinforcing (motivating) consequence (i.e., termination of the aversive task following aggression). This model links motivation to context. Specifically, fatigue makes the color naming task much more aversive than it usually is. Therefore, the termination of the task, following an aggressive outburst, is powerfully reinforcing. Hence, in the future, when the boy is fatigued and is confronted with the task, he will be more likely to respond aggressively because of past reinforcement for doing so. In contrast, if the boy is well rested (absence of setting event), the task is much less aversive. Hence, the motivation to escape the task (level of reinforcement) is lower and, therefore, the display of aggressive behavior becomes less likely.

The important role of context in the four-term contingency highlights the necessity for identifying the broad array of contextual variables that can impact problem behavior and help explain its motivation. Three major categories of context variables have been identified in the literature: social, activities/routines, and biological. Social factors include variables such as communication difficulties, being denied access to desired items, and relationship problems. Activities/routines include factors related to task preferences (e.g., tasks that are difficult, boring, or too long), having to wait, changes in routines, and transitions. Biological factors include variables such as medication side effects, illness, and body states. It is possible to systematically assess the likelihood that a particular variable within each of the three context categories will set off episodes of problem behavior (McAtee, Carr, & Schulte, 2004).

We have been researching the impact of context on problem behavior and have accumulated data documenting a relationship between a number of commonly encountered contexts and aggression, self-injury, property destruction, and tantrums. First, we have demonstrated an association between relationship quality (rapport) and problem behavior. Specifically, if a person with disabilities and their caregiver have poor rapport with one another, problem behavior is likely; if they have good rapport, problem behavior is unlikely (Magito McLaughlin & Carr, 2005). Second, there is a close association between pain and discomfort (due to illness or physiological state), and problem behavior. Specifically, higher levels of pain and discomfort are correlated with episodes of aggression, self-injury, and tantrums whereas lower levels are not (Carr & Owen-DeSchryver, in press; Carr, Smith, Giacin, Whelan, & Pancari, 2003). Finally, mood influences the likelihood of problem behavior. Thus, when individuals are initially judged to be in a bad mood, they are much more likely to engage in severe problem behavior when they are subsequently confronted with task demands than when they are initially judged to be in a good mood (Carr, Magito McLaughlin, Giacobbe-Grieco, & Smith, 2003). In sum, the systematic assessment and identification of relevant contexts provides information that is useful in predicting when serious problem behavior is likely to occur.

Our current research uses detailed assessment information to build intervention strategies that address motivational issues pertinent to each identified context. This context-based model of intervention can be summarized as follows: avoid, mitigate, and cope (Carr, 2003). Consider an earlier mentioned context example, “having to wait,” or, more concretely, “having to wait in line.” A family may report that frequent problem behavior associated with this context makes it impossible for them to go shopping together, limiting their access to many community venues. When appropriate, the family could avoid this situation (e.g., going shopping during “slow” periods when lines are short or nonexistent). If the situation could not be avoided, it might be mitigated/altered (e.g., the child is noncontingently given a favorite toy to play with or a special treat to eat in order to “kill time” while waiting in line). Finally, the child could be taught a coping skill such as learning to quietly sing songs with his/her mom while waiting, learning to communicate a request to move to a new location (e.g., “Can I look at the video games while you wait in line?”), or learning to self-regulate (e.g., putting a check mark on a sheet of paper for every 30 seconds of good behavior and later receiving rewards proportional in size to the number of check marks). Each of these three strategies is sensitive to the plausible escape motivated function of problem behavior in this context and each seeks, through different means, to deal with the putative aversiveness of having to wait. Given the large number of contexts that have been identified relevant to problem behavior, it is evident that a context-based model generates many opportunities for expanding the nature of interventions across a wide variety of situations and multiple motivational functions.

In sum, a model of problem behavior that systematically links motivation to context has potential for greatly increasing our understanding of the factors likely to set off episodes of serious problem behavior. Also, a knowledge of context can be heuristic in making transparent a variety of plausible intervention strategies. Finally, by ameliorating behavior in contexts that are deemed important by both family members as well as the person with autism, we have an opportunity to improve family quality of life, a key consideration in supporting people with serious behavior challenges.

 

References

Bijou, S. W., & Baer, D. M. (l978).  Behavior analysis of child development.  Englewood Cliffs, NJ:  Prentice-Hall. 

Carr, E. G. (1994). Emerging themes in the functional analysis of problem behavior. Journal of Applied Behavior Analysis, 27, 393-399. 

Carr, E. G. (2003, November). The four-term contingency: A context-based model of problem behavior in autism. Keynote address presented at the annual conference of the New York State Association for Behavior Analysis, Saratoga Springs, NY.

Carr, E. G., Magito McLaughlin, D., Giacobbe-Grieco, T., & Smith, C. E. (2003). Using mood ratings and mood induction in assessment and intervention for severe problem behavior. American Journal on Mental Retardation, 108, 32-55.

Carr, E. G., Newsom, C. D., & Binkoff, J. A. (1980).  Escape as a factor in the aggressive behavior of two retarded children.  Journal of Applied Behavior Analysis, 13, 101-117.

Carr, E. G., & Owen-DeSchryver, J. S. (in press). Physical illness, pain, and problem behavior in minimally verbal people with developmental disabilities. Journal of Autism and Developmental Disorders.

Carr, E. G., & Smith, C. E. (1995).  Biological setting events for self-injury.  Mental Retardation and Developmental Disabilities Research Reviews, 1, 94-98.

Carr, E. G., & Smith, C. E., Giacin, T. A., Whelan, B. M., & Pancari, J. (2003).  Menstrual discomfort as a biological setting event for severe problem behavior: Assessment and intervention. American Journal on Mental Retardation, 108, 117-133.

Durand, V. M., & Crimmins, D. B. (1988).  Identifying the variables maintaining self-injurious behavior. Journal of Autism and Developmental Disorders, 18, 99-117.

Durand, V. M., Crimmins, D. B., Caulfield, M., & Taylor, J. (1989).  Reinforcer 

assessment I: Using problem behavior to select reinforcers.  Journal of The Association for Persons with Severe Handicaps, 14, 113-126.

Favell, J. E., McGimsey, J. F., & Schell, R. M. (1982).  Treatment of self-injury by 

providing alternate sensory activities.  Analysis and Intervention in 

Developmental Disabilities, 2, 83-104.

Koegel, L. K., Koegel, R. L., & Dunlap, G. (1996).  Positive behavioral support:

Including people with difficult behavior in the community.  Baltimore: Paul H. Brookes.

Magito McLaughlin, D., & Carr, E. G. (2005). Quality of rapport as a setting event for problem behavior: Assessment and intervention. Journal of Positive Behavior Interventions, 7,  68-91.

McAtee, M., Carr, E. G., & Schulte, C. (2004). A Contextual Assessment Inventory for problem behavior: Initial development. Journal of Positive Behavior Interventions, 6, 148-165.

Skinner, B. F. (1938).  The behavior of organisms.  New York:  Appleton-Century-Crofts.

Taylor, J. C., & Carr, E. G. (1992).  Severe problem behaviors related to social interaction. I: Attention seeking and social avoidance.  Behavior Modification, 16, 305-335.