Module 6: Assessment Procedures

Behavior Analyst Certification Board Registered Behavior Technician™ (RBT®) Task List 2nd ed.

B-01 Conduct preference assessments

B-02 Assist with individualized assessment procedures (e.g. curriculum-based, developmental, social skills)

B-03 Assist with functional assessment procedures

Introduction

        In previous modules we have discussed how to use a variety of strategies to foster skill acquisition with clients in areas such as academics, daily living skills, social and communication skills. We have also discussed the need to decrease challenging behavior that interferes with a client’s progress towards living a healthy, enriched and independent life. This module will provide a general overview of how a BCBA assesses a client’s current skill level and function(s) of their challenging behavior, to determine goal areas and objectives to target in a treatment plan and how a paraprofessional plays an important role in these assessments. Preference Assessments As we have reviewed in previous modules, the addition of a reinforcer increases the behavior that it follows (positive reinforcement). Therefore, the identification of potential reinforcers to use in a treatment plan is necessary for client learning. Preference assessments are a method for identifying potential reinforcers. Because preferences, and in turn, reinforcers are person specific assessment is necessary. Preferences may vary from day to day, per environment, change in age, or time of day. Therefore, preference assessments are conducted before teaching a client as well as throughout the treatment process. The purpose of these assessments is to identify stimuli that are likely to serve as reinforcers. It is also important to reiterate that preferred items are not necessarily reinforcers. Remember that a stimulus is only a reinforcer if it increases the behavior that it follows. There are several methods used to identify and rank client specific preferences to use as potential reinforcers for skill acquisition and behavior reduction programs. Potential Reinforcers: Assessing Preference When preparing for preference assessments, one may consider developmentally appropriate items or activities. Depending upon the client’s current communication repertoire, the items or activities to be assessed can be presented as actual items, pictures, or vocal or written descriptions during the assessment process. Interview. An interview consists of the paraprofessional to ask the client questions regarding their preferences. This can be done by asking open ended questions regarding preferences (e.g. “What are your favorite toys?”), providing choices (e.g., “Do you like salt and vinegar potato chips or sour cream and onion potato chips,” “Do you like playing outside or playing inside”), or having the client rank their preferences from most to least preferred (Cooper, Heron & Heward, 2007). When using this method, it is important to consider the language abilities of the client. Other modes of communication (e.g. pictures, writing) may be appropriate for the staff to use or accept as a response. Asking family members or friends of the client may also be an option to identify preferences. Although the interview can be a quick procedure for identifying preferences, consideration should be given to the accuracy of reporting preferences. If the report is likely to be inaccurate one may choose to by pass this method or only use this method as a stepping stone to determine items for further assessment via other methods described below. It is also important to note that these responses would need to be verified by a paraprofessionals data collection on the target behavior. For instance, the data would confirm this method was effective if it increases the target behavior and it would render it ineffective if the target behavior failed to increase contingent upon providing an identified stimulus. Providing Choices Before Responding. With this method, paraprofessionals may present an array of potential reinforcer choices. The number of choices presented will depend on the client. Selection of one of these choices occurs before an activity or task and access to this choice is provided contingent upon the criteria set for completion of the activity or task (Cooper, Heron & Heward, 2007). Using this method requires prior identification of a preferred item list to present as choices (e.g., via the interview method). This method uses the Premack Principle (Module 4) in which access to a preferred activity is provided upon the completion of a lesser preferred activity. For example, a paraprofessional may present two preferred choices, “swings or go for a walk?” If the client selected swings, the paraprofessional would state, “First, clean up. Then we can go on the swings.” Once the child cleaned up, they would be granted access to the swings for a specified period. Again, paraprofessionals data collection on the target behavior will determine whether or not this method is effective by monitoring if the target behavior increases over time. Free Operant Assessment. This method identifies a client’s preference by providing non-contingent access to activities and items and measuring the duration that the client engages with each activity or item. Preferences are then ranked by length of engagement with each activity or item. Longer durations indicate a high preference for the item or activity (Cooper, Heron & Heward, p. 2007). There are two free operant observation methods. During a contrived free operant observation, the paraprofessional may set-up the environment to provide access to several potential preferred items or activities after providing exposure to the items or activities, so the client knows what each item is and what it does. Duration of engagement with each item or activity is measured to identify highly preferred items and activities. During a naturalistic free operant observation, the client is observed within their own environment. Items and activitiesthat naturally occur or are naturally accessible within the client’s environment are identified and duration of engagement with each item or activity is measured and ranked (Cooper, Heron & Heward, 2007). Trial Based Methods. Single Stimulus Assessment. Using this method, multiple stimuli are presented one at a time and in randomized rotation. The client’s reaction to each stimulus, frequency of touches, and duration of engagement are measured. Rejection of the stimulus is also recorded (Cooper, Heron & Heward, 2007). Stimuli are then ranked based on the measurements listed above. Paired Stimulus Assessment. Two stimuli are presented simultaneously and in a randomized rotation while data are recorded regarding which stimulus was chosen. In addition, several trials should be presented to assess all potential pairs repeatedly, presented on both the left and right side. For clients with a side preference the stimuli, may be lined up vertically rather than side by side (top and bottom rather than left and right). Following the assessment, the stimuli that were chosen most often are ranked higher (Cooper, Heron & Heward, 2007). This method has been proven effective in various research studies (e.g., Pace et al., 1985), but it can require several sessions to ultimately determine the rankings. https://www.youtube.com/watch?v=tXY4VFMi0KI Multiple Stimulus Assessment. As opposed to single or paired stimulus assessments, multiple stimuli preference assessments present three or more stimuli simultaneously in a randomized rotation. Data are recorded and ranked in the same way as the paired stimuli preference assessment. https://www.youtube.com/watch?v=4hRet6DcJ10 In-the-Moment Reinforcer Analysis. Repeated trial based methods like those described above, may be one of the most effective ways to identify preference, but they may not be the most efficient. In-the moment reinforcer analysis (Leaf et al., 2018) uses a client’s response towards an item and engagement with an item and measures it against the frequency of correct responding during skill acquisition trials. During this method, it is recommended that choices are presented throughout the training session, and access to a choice should not be provided for more than 70% of trials within the teaching set. Because this assessment is done within a teaching session, there is a decrease in total assessment time in comparison to other assessments such as the paired stimulus assessment (Leaf et al., 2018).

Skill Assessments

        There are many assessment tools used to determine skill acquisition goals and objectives. Two common assessment tools used by BCBAs are The Verbal Behavior Milestones Assessment and Placement Program (Sundberg, 2008) and the Assessment of Basic Language and Learning Skills®-Revised (Partington, 2010). These criterion-referenced assessment tools assess various skills to determine future curriculum and interventions. Under the supervision ofa BCBA a paraprofessional will be trained to run and collect data using these assessments. The BCBA will then review the results and design programs to address the necessary skill deficits. The Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP) There are five components of the VB-MAPP (Sundberg, 2008): 1. The VB-MAPP Milestones Assessment assesses necessary milestone language skills: mand, tact, echoic, intraverbal, listener, motor imitation, independent play, social and social play, visual perceptual and matching-to-sample, linguistic structure, group and classroom skills, and early academics. These milestone skills are grouped by developmental levels (0-18 months, 18-30 months, and 30-48 months). 2. The VB-MAPP Barriers Assessment assesses 24 potential barriers to learning and language. These barriers include deficits in the areas of the Milestones Assessment along with assessments of reinforcement on behavior, prompt dependency, failure to generalize, deficits in social skills, among others. If a barrier is identified through this assessment, more formal assessments (i.e. functional assessment or functional analysis) may be necessary. These additional assessment procedures will be discussed later in this module. 3. VB-MAPP Transition Assessment assesses the criteria necessary to determine if the client is making effective progress and can transition to a less restrictive environment. By combining the scores from the Milestones and Barriers assessment and assessing various social, communication, and daily living skills, the results from this portion of the assessment is valuable for an educational team when making decisions regarding a client’s school placement. 4. The VB-MAPP Task Analysis and Skills Tracking is a list of nearly 900 skills within a task analysis to assist clinicians in identifying skills necessary to meet target skills. Included within this portion of the assessment is a description of activities that can be used to maintain and generalize skills in a variety of environments. 5. The VB-MAPP Placement and Individualized Education Plan (IEP) goals portion of the assessment assists with identifying necessary IEP or treatment plan goals for the client. Within this assessment, skills can be assessed by formal testing, observation, and/or timed observation. Each section of the assessment indicates the best assessment method recommended for each portion of the assessment. Once the assessment and scoring of each skill has been summarized the results fall into needs associated with three different levels:

Level 1: Early learner. More intensive intervention is required. Level 2: Intervention is required, however, the format with which that the intervention occurs does not have to be as intensive as that of a level one learner (e.g. DTT combined with incidental teaching, exposure to peers).

Level 3: Learners are more advanced, and the focus of the intervention should include expanding manding, tacting, listener responses, and developing more complex mands and intraverbals.

Assessment of Basic Language and Learning Skills- Revised (ABLLS®-R) This assessment consists of 25 categories and is similar to the VB-MAPP in that it assesses the required skills for use of language within a client’s environment. Although both assessments identify developmentally appropriate skills, the ABLLS®-R does not assess the typical sequence of developmental milestones as the VB-MAPP does. The ABLLS®-R assesses for motivation, responses to complex stimuli, generalization, spontaneity of language, fluency, joint attention, learner readiness, social skills development and imitation (Partington, p. 3-6). Skills can be assessed using direct observation, testing, or interview. Results from the assessment are tracked on a grid and can be updated in subsequent re-assessments. Re- assessment should occur at least yearly (Partington, p. 19).

Functional Assessments

         A Functional Behavior Assessment (FBA) is used to hypothesize the environmental cause of a challenging behavior. The purpose of an FBA is to a) identify antecedents that evoke behavior, b) identify consequences that maintain behavior, and c) identify replacement behaviors for the challenging behavior. By assessing the antecedent, behavior, and consequence contingency assessors will hypothesize the function of challenging behavior. Please recall that in Module 4, we learned that the 4 functions of behavior are: tangible, escape, attention, and automatic. Understanding why a behavior occurs (function) makes it easier to determine an effective treatment that will alter antecedent variables and/or consequence variables and teach an alternative behavior that can be reinforced with the same reinforcer that was maintaining the challenging behavior, all working together to render the challenging behavior irrelevant, ineffective, and/or inefficient (Cooper, Heron &  Heward, 2007). A BCBA is trained and qualified to conduct an FBA and a paraprofessional may assist these professionals with portions of this assessment under a BCBAs supervision. The following components of an FBA will assist in identifying which function I may be maintaining the undesirable behavior. An FBA may consist of the following methods: Indirect Assessments Indirect assessment may include open or close ended interviews of the client, parents, teachers, or others involved with the client. These interview questions should inquire about the antecedents, and consequences of the target behavior. In addition, questions should also inquire when (e.g. time of day) and where (e.g. setting) the behavior occurs. Past and current strategies (either effective or ineffective) should also be identified during this type of interview (Cooper, Heron & Heward, 2007). It is best to perform these interviews in person so that follow-up questions may be asked to clarify responses. Direct Assessments Direct assessment includes direct observation of the behavior occurring in the natural setting. During that observation, a more objective analysis of the behavior that may not be gathered during indirect assessments can occur. This involves fully defining the behavior of interest and the exact events that evoke or maintain the behavior. During this observation data are collected on the antecedents, behavior, and consequences (known as A-B-C data) that occurred (Cooper, Heron & Heward, 2007). A-B-C will collect their own A-B-C data and may also ask that a paraprofessional collect A-B-C data during sessions as well. These data from the indirect and direct assessments are then reviewed and interpreted by a BCBA. The results outline common antecedents that evoke the behavior, and common consequences that maintain the behavior (the hypothesized function). Functional Analysis If the above-mentioned functional assessment procedures do not assist in determine a function of the challenging behavior in question, a BCBA will use the information gathered from the FBA to design and conduct a functional analysis. A functional analysis (FA) is a method in which antecedents and consequences like those that have been observed in the natural environment are presented in a systematic manner so that their separate effects on the challenging behavior can be observed and measured (Cooper, Heron & Heward, 2007). Data collected during an FA are then graphed an analyzed to determine which consequence or combination of consequences is reinforcing the challenging behavior. Function Based Intervention When a function has been hypothesized, the BCBA must create a Behavior Reduction Plan. In Module 4, we reviewed potential strategies that can be used to teach desirable behavior to replace challenging behavior (e.g. Functional Communication Training, Differential Reinforcement). These strategies would be included in the behavior reduction plan. In addition, the antecedent strategies (manipulation of motivating operations and discriminative stimuli) and recommended consequent procedures (reinforcement, extinction, and/or punishment) also discussed in Module 4, would be included as part of the behavior reduction plan.   Quiz

References

Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied Behavior Analysis (2nd ed.). Columbus, OH: Merrill Prentice Hall. Leaf, J., Leaf, R., Leaf, J.A., Alcalay, A., Ravid, D., Dale, S., Kassardijan, A., Tsuji, K., Taubman, M., McEachin, J., Oppenheim-Leaf, M. (2018). Comparing Paired-Stimulus Preference Assessments with In-the-Moment Reinforcer Analysis on Skill Acquisition: A Preliminary Investigation. Focus on Autism and Other Developmental Disabilities, 33(1), 14-24. Pace, G. M., Ivancic, M. T., Edwards, G. L., Iwata, B. A., & Page, T. J. (1985). Assessment of stimulus preference and reinforcer value with profoundly retarded individuals. Journal of Applied Behavior Analysis, 18(3), 249-255. Partington, J. (2010). Assessment of Basic Language and Learning Skills-Revised (The ABLLS®-R) Version 3.2. Pleasant Hill, CA: Behavior Analysts, Inc. Sundberg, M. (2008). VB-MAPP Verbal Behavior Milestones Assessment and Placement Program Protocol. Concord, CA: AVB Press.