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
Question
Behavior Deficits for Increase: The Mand and the Tact
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
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