A Discussion of Positive Behavior Support and Applied Behavior Analysis in the Context of Autism Spectrum Disorder in the UK and Ireland

This article addresses the relationship between applied behavior analysis (ABA) and the emergence of positive behavior support (PBS) in context of autism spectrum disorder (ASD) in the UK and Ireland. Two overarching issues that are salient in this discussion are professional training and certification. To date, there has been a lack of standardized training or statutory requirements to practice PBS despite proponents insisting that its practice should be grounded in behavior analytic principles. Furthermore, there is an undercurrent of anti-ABA bias fueled by misinterpretation and unsubstantiated anecdotal claims used to promote an alternative "value based" approach to managing behavior.

Can the Behaviour Intervention Plan Quality Evaluation, Version 2, be simplified for use by stakeholders with limited experience of positive behaviour support?

BACKGROUND

Behaviour support plan (BSP) quality auditing tools like the Behaviour Intervention Plan Quality Evaluation, Version 2 (BIPQEII), assess the quality of a BSP from the perspective of technical compliance with behavioural principles. However, these principles may be inaccessible to interested stakeholders with limited experience and knowledge of positive behaviour support (PBS). The aim of this study was to test if a simplified version of the BIPQEII [the Behaviour Support Plan Audit Tool (BSPA-tool)] offers a reliable and valid assessment of a BSP's technical compliance with behavioural principles when used by professional stakeholders with varying levels of PBS experience and knowledge.

METHODS

Four scorers rated 50 de-identified BSPs using the BSPA-tool, with one scorer also rating the BSPs using the BIPQEII. Four weeks later, each scorer rated 25 of the 50 BSPs again using the BSPA-tool. Prior to BSP scoring, a group of PBS practitioners provided feedback on the BSPA-tool's content validity.

RESULTS

The BSPA-tool was found to have acceptable content and parallel-form validity; however, acceptable internal consistency and inter-rater and intra-rater reliability were dependent on PBS experience/knowledge, that is, scorers with more experience/knowledge achieved more acceptable levels of reliability.

CONCLUSIONS

This study confirms that even with simplification, BSP quality auditing tools based on technical compliance with behavioural principles are still only accessible to stakeholders with extensive experience/knowledge of PBS. To engage less-experienced stakeholders in BSP quality auditing processes, new audit tools need to be developed that focus on other aspects of BSP quality (e.g. readability and consultation).

The Behaviour Support Elements Checklist: Profiling intervention elements in community-based behaviour support for sexualised behavior after acquired brain injury

BACKGROUND

The challenges associated with behavior dysregulation post acquired brain injury (ABI) are well documented. In a previous publication, we described a case series in which sexualized behavior post-ABI was reduced using multi-element behavior support interventions. In this publication, we describe the intervention elements used, as summarized using a one-page recording tool: The Behavior Support Elements Checklist (BSEC).

INSTRUMENT

The BSEC contains three categories indicating the target for change: the individual with ABI, their support network members, or other environmental aspects. Each category lists a number of elements being used in the routine practice of a community-based behavior support service.

RESULTS

In total, 173 intervention elements were recommended, averaging seven per participant. Elements from all three categories were routinely incorporated into interventions, but changes to the (category) environment were rated by clinicians as most effective in changing behavior; some elements (e.g., meaningful activities) were considered more effective than others (e.g., ABI education).

CONCLUSIONS

The BSEC could assist service agencies and researchers to record and analyze clinician practices to improve service delivery, detect professional development needs, and steer resource allocation. Although the BSEC reflects the context in which it was constructed, it could readily be adapted to other service contexts.

School-wide positive behavioral interventions and supports and students with extensive support needs: a scoping review

School-wide Positive Behavioral Interventions and Supports (SWPBIS) is an inclusive multi-tiered system of behavioral supports that has been widely adopted by K-12 schools in the United States. SWPBIS focuses on creating safe, equitable, and inclusive school environments and has been linked to both positive behavioral and academic outcomes for students and improved perceptions of efficacy and job satisfaction for school personnel. However, there remain concerns about the involvement of students with extensive support needs (ESN) in SWPBIS despite calls to action in 2006 and 2016 for research in this area. Addressing these concerns, we conducted a scoping review to examine the current research literature on SWPBIS and students with ESN. We found that only 10 studies have been conducted since the 2006 call to action. Studies primarily focused on stakeholder perspectives regarding the importance or availability of SWPBIS for students with ESN. Although few studies examined SWPBIS effectiveness, findings from these studies lend support to the effectiveness of Tier 1 SWPBIS for students with ESN. We describe several key implications for supporting the inclusion of students with ESN in SWPBIS and future research initiatives.

Schoolwide positive behavioural interventions and supports and human rights: transforming our educational systems into levers for social justice

Positive behaviour support and schoolwide positive behavioural interventions and supports (PBIS) emerged in response to the misuse of behavioural theory and ableism in educational systems. Yet even with these advances, inequitable outcomes based on ability and race persist. The purpose of this article is to describe an equity-centred schoolwide PBIS approach that harnesses behavioural theory and the PBIS framework to focus specifically on systems change to lead to equitable outcomes. There is emerging evidence of promise for increasing racial equity in student outcomes, and implications and suggestions are provided to increase equity by disability status. In providing practitioners with clear steps to reduce ableism and racism in educational systems, this line of research stands to benefit all students and families.

A systematic review of training methods to increase staff's knowledge and implementation of positive behaviour support in residential and day settings for individuals with intellectual and developmental disabilities

Behaviour support plans (BSPs), if accurately implemented, have been found to increase skills and decrease challenging behaviour of individuals with intellectual and developmental disabilities. Training is essential for staff to acquire the skills necessary for accurate implementation. The aim of this systematic literature review was to evaluate procedures used to train staff in Positive Behaviour Support (PBS), on both knowledge of PBS and implementation of BSPs. Systematic searches of 4 databases identified 18 studies as meeting criteria. Findings indicate that description alone was not consistently effective in increasing knowledge and should be used in combination with other training strategies. Staff's implementation of BSPs were increased by different combinations of the following training components: description, feedback, modelling, role-play, monitory incentive, and escape contingency. To identify evidenced based practice when training staff on BSPs, it is necessary to evaluate active and feasible training components from current training models.

Educational Interventions for Children and Youth with Autism: A 40-Year Perspective

Commemorating the 40 th anniversary of the Diagnostic and Statistical Manual (DSM) III, the purpose of this commentary is to describe school-based and school-relevant interventions and instructional approaches for children and youth with autism that have been developed and employed during that time period. The commentary begins with a brief description of foundational research that provides an historical context. Research themes shaped by science, ethics, social policy, and the changes in the DSM provide an organization for describing the evolution of intervention and instructional practices over the four previous decades. The commentary concludes with a discussion of school-contextual variables that influence implementation and the promise of the "iSciences" for closing the research to practice gap in the future.

Positive Behavioral Support: New Foci in the Management of Challenging Behaviors

Individuals with visual impairments and multiple disabilities often exhibit severe problem behaviors that interfere with their acquisition of skills, limit access to integrated community settings, and cause harm to themselves or others. This article describes a new approach to behavioral control that uses positive intervention strategies, bases treatment on functional assessments of challenging responses, and emphasizes broad changes in the life-styles of individuals.

Positive behaviour support in frontotemporal dementia: A pilot study

Frontotemporal dementia (FTD) is a progressive neurodegenerative brain condition clinically characterized by marked changes in behaviour that impact the individuals' relationships and community participation, and present challenges for families. Family carers of individuals with FTD find apathy and disinhibition particularly challenging leading to high levels of stress and burden. Positive behaviour support (PBS) as a behaviour intervention framework has never been trialled in FTD. This pilot study examined the functional basis of apathetic and disinhibited behaviours in four FTD dyads and explored the acceptability of a PBS intervention. The PBS programme was provided by an occupational therapist in the participants' homes. Measures collected at baseline and post-intervention (M = 3.9 months) assessed: function of behaviours, challenging behaviours, and qualitative outcomes pertaining to the acceptability of the PBS approach. PBS was an acceptable intervention for all four dyads. "Sensory" and "tangible" were the most common functions contributing to the maintenance of behaviour changes, and aspects of apathetic and disinhibited behaviours improved following intervention. This study demonstrates the acceptability and potential benefit of a PBS programme to provide support in FTD. A more rigorous trial will be an important next step in developing improved services tailored to the needs of this unique population.

Emotion regulation and intervention in adults with autism spectrum disorder: a synthesis of the literature

Purpose

Emotion regulation is an ongoing multiprocess phenomenon and is a challenging developmental task to acquire in individuals with autism spectrum disorder (ASD) who have different neurobiological profiles and emotion regulation problems. The purpose of this paper is to review recent literature to understand the neurobiological and psychological perspective of emotion regulation in ASD, while converging themes of psychosocial interventions and existing best practices on emotion regulation within this heterogeneous population are reviewed and discussed in consideration of intellectual disability (ID).

Design/methodology/approach

Review of recent literature and common empirically supported interventions addressing emotional regulation implemented in individuals with and without ASD, and with and without ID were included in the electronic database search through PubMed, EBSChost, Science Direct, Wiley Online Library, GALE and SAGE. Search terms used included autism, ID, cognitive control, executive function, sensory processing/intervention, emotion regulation, cognitive behavior therapy, mindfulness, social stories, positive behavior support and behavior therapy.

Findings

Neural systems governing emotion regulation can be divided into “top-down” and “bottom-up” processing. Prefrontal cortex, cognitive and attentional control are critical for effective emotion regulation. Individuals with ASD, and with ID show impairments in these areas have problems with emotion regulation. Targeted psychosocial intervention need to consider bottom-up and top-down processes of emotion regulation, and that standardized interventions require adaptations.

Originality/value

There are limited studies looking into understanding the neurobiological and psychological perspective of emotion regulation in ASD and linking them to interventions. This review highlights psychosocial interventions that are important for further research, investigation and development as treatment in this population is limited.

Building an Ecology of Support: A Case Study of One Young Woman with Severe Problem Behaviors Living in the Community

This case study describes 30 months in the life of a young woman with a history of life-threatening self-injurious behaviors (SIB) who moved from a large public institution to her community. Quantitative and qualitative research methods were employed to provide a nonexperimental description of her behavior and lifestyle in the community. Quantitative measurements included: (a) activity patterns, (b) social network, (c) self-injurious behaviors, (d) aggression against others, and (e) staff changes. Qualitative results emerged from semistructured interviews and participant observations conducted over a 6-month period. Together, these data revealed a young woman actively involved in a lifestyle characterized by an increase in the frequency and diversity of activities performed in the community. Problem behaviors occurred at low levels for extended periods, yet there continued to be times with major regression. Qualitative results also indicate a general reduction in the intensity of self-injurious behaviors. Results are discussed in terms of the importance of multicomponent positive interventions, the need to design environments that promote lifestyle changes, and the value of collaboratively employing quantitative and qualitative research methods.

Positive Behavior Support as a Model for Promoting Educational Inclusion

Positive behavior support (PBS) has been advanced as a model for effectively managing behavior in school settings and facilitating inclusive education. Numerous systems adaptations and administrative supports, however, are necessary for the successful application of PBS in the schools. This article identifies difficulties in the application of best practices within current school systems, and considers federal and state laws, school system organization, the roles of teachers and administrators, and other factors that are relevant for inclusive education. Issues pertinent to the application of PBS are discussed, and practical steps for achieving progress are recommended.

Parent-Professional Partnership in Behavioral Support: A Qualitative Analysis of One Family's Experience

Behavioral support with families is a multifaceted endeavor that should be studied from the various perspectives that affect its feasibility, efficacy, and potential to produce outcomes that are durable and meaningful to people's lives. This study describes a qualitative analysis of one family's experience during a 10-month process of assessment and intervention for the behavioral challenges of a boy with multiple and severe disabilities. Data collection included an audiojournal recorded by the boy's mother and a series of semistructured interviews with both parents and the boy's older brother. The data were synthesized to chronicle the impressions of the family relating to the phases of the positive behavioral support process. The data yielded two pervasive themes that describe the impact of the problem behavior on the family and the effects of the behavioral support process on the child and his family. Together, with a companion article that presents the procedures and quantitative analyses (Vaughn et al., 1997), the methods and findings from this study offer a broader view of behavioral support than has been evident in the literature thus far. The findings are presented as a heuristic for researchers to engage in participatory investigations that can illuminate important features of support processes with the intention of increasing responsiveness to consumers (e.g., families) and enhancing the benefits of community-based support efforts.

Science and Practice in Behavioral Intervention: Meaningful Outcomes, Research Validity, and Usable Knowledge

Many professional journals publish research reports of interventions for persons with developmental disabilities which traditionally have been expected to fulfill two quite different functions. First, this research literature is the scientific data base to support the validity of recommended most promising practices. Second, these same reports are expected to be a source of information to guide the efforts of practitioners to implement those most promising practices. In a parallel fashion, the experimental method has been used both to test intervention hypotheses in research studies and as an evaluation model for practitioners in evaluating applications in typical settings. This paper explores the extent to which it is reasonable or practical to expect conventional experimental methodologies and research reports to perform this dual purpose. Recommendations are made for research and practice that require multiple perspectives and approaches better suited to a human science.

Integrating Choice-Making Opportunities within Teacher-Assigned Academic Tasks to Facilitate the Performance of Children with Autism

Providing opportunities to make choices has received increasing support as an antecedent intervention to improve the performance of students with disabilities. Additional research in this area is needed to determine under what circumstances the application of choice making as a curricular intervention is appropriate and produces meaningful outcomes. The present study extended this line of research and investigated how providing choice opportunities to children with autism impacted their performance during teacher-assigned homework activities. An ABAB design was utilized to evaluate the effects of choice making (student vs. tutor) on the academic performance of four children with autism. Results showed that providing students with opportunities to make choices regarding the order of task completion and use of stimulus materials improved participants' accuracy, productivity, affect, and reduced their disruptive behaviors. These findings support the use of child choice as a teaching strategy to improve the academic performance of children with autism during curricular activities. The functional properties of choice making and considerations for its use as a curricular-based antecedent intervention are discussed.

Outcomes of Behavior Support Training to an Agency Providing Residential and Vocational Support to Persons with Developmental Disabilities

The development of behavior support strategies in the homes and workplaces of persons with disabilities remains a challenge. This report presents a study of behavior support training for a residential and vocational support agency. Three training sessions were provided to managerial and direct-care staff, during which trainees worked in teams to plan or complete functional assessments and behavior support plans for focus persons supported by the agency. Before training, there were no complete functional assessments for the focus persons but there were behavior support plans for two of the focus persons. Posttraining, functional assessments and behavior support plans were either developed or improved to meet the standards for best practice for all focus persons. One behavior support plan was not written until approximately one year after the completion of the training sessions. The frequency of problem behavior was reduced for all focus persons. The limitations and strengths of this approach are described herein for clinicians and researchers.

Reduction of Severe Problem Behavior in Community Employment Using an Hypothesis-Driven Multicomponent Intervention Approach

Individuals with severe problem behavior typically are excluded from integration efforts involving community employment. This study examined one strategy for reducing severe problem behavior in an employment situation. The strategy involved three factors: (a) interventions were chosen based on hypotheses about the maintaining variables for the problem behavior (hypothesis-driven model); (b) a multicomponent intervention package was used that included some combination of functional communication training, building rapport, making choices, embedding demands, and building tolerance for delay of reinforcement; and (c) measures of latency to problem behavior and percentage of work steps completed were used instead of the more traditional measure of frequency. The results demonstrated both an increase in the time spent in the employment situation without problem behavior and increases in completion of work steps to maximum. Social validation of these results was provided by employment site management. The value of this strategy for addressing the obstacles to assessment, measurement, and intervention for severe problem behavior in community employment situations was discussed.

Educational Support for Students with Severe Problem Behaviors in Oregon: A Descriptive Analysis from the 1987–1988 School Year

Oregon has been identified as a leader in maintaining students with severe disabilities in regular school environments (Danielson & Bellamy, 1989). This paper presents descriptive data from a survey completed by teachers of students with severe disabilities in Oregon during 1988. The survey was designed to determine if students with severe disabilities who engage in problem behaviors are placed in regular school settings in Oregon, and what organizational variables were used to assist such students to be part of regular schools. The survey of teachers working with students with severe disabilities was conducted in collaboration with the Oregon Department of Education. Seventy-five percent of the teachers responded to the survey. They identified 184 students as having severe intellectual disabilities and severe problem behaviors (0.4% of all students in the state receiving special education support). The teachers reported that the major extra support for students with severe problem behaviors was in the form of additional teaching assistants. The teachers reported that they did not feel adequately prepared in their preservice training to deal with students with severe problem behaviors, and did not feel there were adequate resources for supporting such students. When queried about educational outcomes, however, the teachers reported that over 90% of students with severe problem behavior spent some portion of each school day socially integrated with students who were not disabled, and that over 40% of the students with problem behaviors spent some time each week physically integrated through community-based instruction. The paper discusses the challenge faced by schools as they attempt to build the capacity to support students with more significant behavior problems.

Self-Determination for Individuals with the Most Severe Disabilities: Moving beyond Chimera

Individuals with the most severe disabilities may be unsuccessful in effecting changes in their environment for various reasons. Because of limitations in cognitive and expressive language skills, their attempts at communicating may be overlooked or misunderstood, or may be knowingly or inadvertently obstructed. Consequently, self-determination is often dependent on our interpretation of what people with the most severe disabilities are communicating. This article explores the implications of making interpretations, the need for such interpretations, and the dangers. Current progress in supporting and promoting self-determination are acknowledged. It is suggested that although these procedures may be intended to increase self-determination, they do not automatically do so. In fact, they may function to limit self-determination. Strategies and methodologies must be critically evaluated to ensure that such efforts reflect the tenets and spirit of self-determination.

Parent-Professional Partnership in Behavioral Support: A Case Study of Community-Based Intervention

In this study and a companion article (Fox et al., 1997), we present an investigation that uses multiple research perspectives to study community-based, family-centered behavioral support. This study describes the intervention strategies and quantitative analyses that were used to address the challenging behaviors of a boy with severe disabilities. A collaborative team that included the boy's mother designed and implemented functional assessments and hypothesis-based interventions in three settings: a drive-through bank, a large grocery store, and a fast food restaurant. Data showed that the interventions reduced problem behaviors in all three settings and that concomitant increases were observed in desirable mother-child interactions. Specific tantrums associated with transitions through doorways were decreased substantially. Social validation data supported the efficacy and feasibility of the support strategies. This quantitative analysis provides further testimony for the use of positive behavioral support in complex, public environments.

Positive Behavior Support for Individuals with Behavior Challenges

Individual positive behavior support (PBS) is a process that combines evidence-based practices from applied behavior analysis (ABA) and other disciplines to resolve behavioral challenges and improve independence, participation, and overall quality of life of individuals living and learning in complex community environments. Its features include lifestyle enhancement, collaboration with typical caregivers, tracking progress via meaningful measures, comprehensive function-based interventions, striving for contextual fit, and ensuring buy-in and implementation. This article will summarize the features and illustrate with a case example. • Engaging caregivers to take an active role in behavioral intervention • Designing interventions that work effectively within natural routines • Addressing lifestyle changes, as well as more discrete behavior changes • Creating strategies that are durable, reducing dependence on professionals.

The effectiveness of using reinforcements in the classroom on the academic achievement of students with intellectual disabilities

The purpose of this study was to compare the effectiveness of two kinds of reinforcements, tangible reinforcements and social reinforcements, on the academic achievement of eighth-grade female students with intellectual disabilities in the science subject. The study was an experimental method by pretest, with a control group. The participants of the study comprised 45 female students with intellectual disabilities from three different middle schools in the province of Tehran. The multistage cluster method was chosen to determine the sample. The Wechsler intelligence test for matching the groups in terms of IQ and teacher-applied tests were used for all students to measure the progress of students in science. Data were analyzed by one-way analysis of variance. The results showed that (a) there was a significant difference in the academic achievement scores of the groups after applying the intervention and (b) the mean difference in achievement scores for the tangible reinforcements group was significantly higher than the social reinforcement group and the control group. Also the mean scores for the social reinforcement group were significantly higher than the control group.

Problem Behaviour as Communication

Individuals with intellectual disabilities commonly engage in a variety of problematic behaviours such as aggression and self-injury. This paper discusses the value of using a communicative model to study these behaviour problems. First, the reciprocal nature of behaviour problems is outlined. Next, research on the use of functional communication training as a treatment for behaviour problems is reviewed in terms of its initial effectiveness, generalisation, and maintenance, as well as the mechanisms responsible for behaviour change. Finally, recommendations are made for future research and training efforts aimed at reducing severe behaviour problems.

Implantation du Soutien au comportement positif (SCP) dans les écoles québécoises

This paper presents a first assessment of the implementation of Positive Behavioural Interventions and Supports (PBIS), translated into French as Soutien au comportement positif (SCP), in elementary and secondary schools in Quebec. The SCP proposes the establishment of a support system in terms of behaviour management throughout the school to create an environment conducive to learning. The results indicate that it is possible to implement SCP with fidelity in elementary and secondary schools in Quebec; however, fidelity of implementation seems to depend on the leadership of school principals.

State policies and practices in behavior supports for persons with intellectual and developmental disabilities in the United States: a national survey

Providing effective behavioral supports to decrease challenging behavior and replace it with appropriate alternative skills is essential to meeting the needs of many individuals with intellectual and developmental disabilities (IDD). It is also necessary for fulfilling the requirements of Medicaid-funded individual support plans and is important for moral, ethical, and societal reasons. Unfortunately, there is no national standard for behavioral support practices or source of information on the status of behavior support policies, practices, and services for adults with IDD at either state or national levels. The collection of comprehensive data on state behavior support definitions, provider qualifications, training, and oversight requirements is a necessary starting point for the development of plans to address needed policy and practice changes. This survey is the first national assessment of state policies and practices regarding the definition and delivery of behavior support services to people with intellectual and developmental disabilities receiving publicly financed supports in the United States.

Contribution of occupational therapists in positive behaviour support

AIM

Positive behaviour support employs specific strategies which aim to both reduce the incidence of behaviours of concern and enhance the quality of life of people with intellectual disabilities. This study aims to identify activities and experiences of occupational therapists working in behaviour support contexts to understand how they see their contributions in this area.

METHODS

Semi-structured interviews were undertaken with 10 occupational therapists who have provided behaviour support for people with intellectual disabilities. Audio recordings were transcribed verbatim and thematically analysed.

RESULTS

Three major themes emerged from the interview data: contextualising and understanding behaviour; occupational therapy - why and how?; and 'challenges, strengths and expanding horizons'.

CONCLUSIONS

Participants saw themselves as providing an occupational perspective in the delivery of behaviour support, to individuals with behaviour support needs. They highlighted that this was achieved utilising their skills and knowledge about positive behaviour support strategies. Their approaches were seen as drawing on: their understanding of neurological function and how it relates to a person's occupational engagement; combining occupationally focussed approaches with behavioural analysis methodology to guide practice; and advocating for person-centred interventions. These observations form the basis for exploring ways in which occupational therapists can advance their contributions in positive behaviour support settings.

An evaluation of an intervention sequence outline in positive behaviour support for people with autism and severe escape-motivated challenging behaviour

BACKGROUND

Positive behaviour support emphasises the impact of contextual variables to enhance participation, choice, and quality of life. This study evaluates a sequence for implementing changes to key contextual variables for 4 individuals. Interventions were maintained and data collection continued over a 3-year period.

METHOD

Functional assessments were conducted with 4 individuals with exceptionally severe challenging behaviours. Interventions were based on the multi-element model of behavioural support (LaVigna & Willis, 2005a). Dependent variables were behavioural ratings of (1) frequency, (2) episodic severity, (3) episodic management difficulty, and measures of (4) mental health status, and (5) quality of life. The intervention sequence was low arousal environment, rapport building, predictability, functionally equivalent skills teaching, and differential reinforcement strategies.

RESULTS

Substantial reductions in target behaviours were observed, along with incremental improvement in mental health scores and quality-of-life scores.

CONCLUSION

The study demonstrates the efficacy of positive behaviour support for people with exceptionally severe behaviour in individually designed services.

Positive behavior support and applied behavior analysis

This article reviews the origins and characteristics of the positive behavior support (PBS) movement and examines those features in the context of the field of applied behavior analysis (ABA). We raise a number of concerns about PBS as an approach to delivery of behavioral services and its impact on how ABA is viewed by those in human services. We also consider the features of PBS that have facilitated its broad dissemination and how ABA might benefit from emulating certain practices of the PBS movement.

On the relation between applied behavior analysis and positive behavioral support

Anderson and Freeman (2000) recently defined positive behavioral support (PBS) as a systematic approach to the delivery of clinical and educational services that is rooted in behavior analysis. However, the recent literature contains varied definitions of PBS as well as discrepant notions regarding the relation between applied behavior analysis and PBS. After summarizing common definitional characteristics of PBS from the literature, we conclude that PBS is comprised almost exclusively of techniques and values originating in applied behavior analysis. We then discuss the relations between applied behavior analysis and PBS that have been proposed in the literature. Finally, we discuss possible implications of considering PBS a field separate from applied behavior analysis.

Positive behavior support: Expanding the application of applied behavior analysis

Positive behavior support (PBS) is an approach to providing services to individuals who exhibit challenging behavior. Since its inception in the early 1990s, PBS has received increasing attention from the behavior-analytic community. Some behavior analysts have embraced this approach, but others have voiced questions and concerns. In this paper we describe the framework of PBS and show that it is consistent with the tenets of behavior analysis. Also, we illustrate how the framework of PBS might be used to guide practitioners and researchers in the field of applied behavior analysis. We hope to demonstrate that PBS offers useful suggestions regarding how applied behavior analysts can design and evaluate effective programs for people with developmental disabilities or behavioral challenges.

"Replacing" problem behavior: an analysis of tactical alternatives

A number of textbooks and professional volumes in applied behavior analysis suggest that interventions designed primarily to decrease a problem behavior should routinely be accompanied by efforts to increase the frequency of at least one appropriate behavior. Some sources describe the objective of this tactic as "replacing" the problem behavior. This paper considers rationales that might underlie this advice, as well as reasons why a general rule to this effect is inappropriate. This review reveals that although there may well be good reasons for considering this tactic, their rationales are often not well articulated and may even be unsound. It is also the case that there are good reasons why this tactic may not always be necessary, thus conflicting with an argument for a general rule.

Single Participant Studies in Positive Behaviour Support for Parents of Individuals With Brain Injuries

Three single participant studies examined effects of in-home parent-implemented Positive Behaviour Support (PBS) interventions on behaviour of individuals with brain injuries. Parental and independent observations of morning routine behaviour or problem behaviour (viz., noncompliance during meals or morning routines, yelling, kicking, swearing, and so on) were taken during baselines and PBS interventions, which consisted of person-centred functional assessments of behaviour, emphasis on changing behavioural antecedents, parent participation in assessing, treating, and evaluating behaviour change, and in-home parent coaching and support. Results show decreased problem behaviour or improved morning routine behaviour, which corroborate and add to the few studies that applied similar parent-implemented interventions. Future comparative studies between PBS and out-patient interventions are indicated.

The dilemmas of residential care staff working with the challenging behaviour of people with learning disabilities

OBJECTIVES

To investigate residential care staff beliefs and feelings about the challenging behaviour of adults with learning disabilities in their care, and how they perceive these beliefs and feelings to have developed over time.

DESIGN

A qualitative study using thematic analysis.

METHODS

A group of 18 staff from 10 different residential services participated in indepth semi-structured interviews. Transcripts were analysed according to thematic analysis techniques drawn from interpretative phenomenological analysis (IPA) and grounded theory. The analysis was then subjected to scrutiny by participants using a respondent validation survey.

RESULTS

Staff talked of dilemmas about whether challenging behaviour should be seen as a 'communication' of need or as a 'behaviour problem', how to balance a 'firm' response with 'kindness', and how to deal with unpleasant feelings evoked by the work, especially fear and frustration. Over time, staff reported overcoming initial fears of the client by 'getting to know them', or alternatively, avoiding the client, 'cutting off' emotionally, or protecting themselves with safety procedures.

CONCLUSIONS

The analysis suggests that staffs are troubled by the limitations of a narrow behavioural discourse. Staff development and training based on richer approaches that integrate behavioural ideas with a value-based philosophy, might allow staff to respond to needs expressed by behaviour without fear of reinforcing it. Services should attend to staff emotional reactions to their work, to help them maintain nonavoidant coping strategies.