Enhancing Interdisciplinary Collaboration in an Entry to School Program: A Case Study Addressing Interfering Behaviours
Vanessa Pilieci, M.ADS, R.B.A. (Ont.), BCBA1; Samantha Milligan, MScOT, OT Reg. (Ont.)2; Daniella Manna, SLP Reg. CASLPO2; Janicka Auguste, B.A., CDA (Hons.)2; Taryn Eickmeier, Ph.D.2; Melany Cox, M.H.Sc., Reg. CASLPO, SLP (c)2
1Lake Ridge Community Support Services, Whitby, Ontario, Canada
2Grandview Kids, Durham Region, Ontario, Canada
Contact us
Vanessa Pilieci, M.ADS, R.B.A. (Ont.), BCBA
Behaviour Consultant, Lake Ridge Community Support Services
Tel: (226)-221-7268
Email: vpilieci@lrcss.com
Samantha Milligan, MScOT, OT Reg. (Ont.)
Occupational Therapist, Grandview Kids
Tel: (289)-675-3730
Daniella Manna SLP Reg. CASLPO
Speech-Language Pathologist, Grandview Kids
Office: (437)-703-9996
Additional information on the Individual Support Plan
Assessment
Direct and indirect assessments were completed to determine the potential function of the child’s behaviour. Indirect assessments included interviews with caregivers and the Questions about Behaviour Function (QABF) tool, completed by caregivers. Direct assessment included direct observation of the child, including Antecedent-Behaviour-Consequence (ABC) data collection and frequency tracking.
Indirect assessment results are summarized in the graph below
Direct assessment results are summarized as follows
Antecedent-Behaviour-Consequence (ABC) Data Collection: this data provides information about likely triggers (i.e., antecedents) for the behaviours, and the events (i.e., consequences) that immediately follow the behaviours. ABC data was collected from February 26, 2024 to March 14, 2024. Baseline frequency data was collected from March 19th, 2024 to May 13, 2024
Common triggers for tantrums and biting included:
- Transitioning from one activity to another.
- When a preferred item was removed.
- When a peer approached and tried to take or touch an item she had.
- When a preferred item was not available.
- When staff are not able to identify the specific item that she wants (e.g., she may ask for ‘toy’ and if staff give her a toy that she does not want, she may engage in a tantrum).
The common triggers for tantrums and biting observed in the ETS program were consistent with caregiver reports of common triggers at home.
Common consequences of tantrums and biting included:
- Group facilitator intervening and attempting to block the behaviour.
- Prompting and modeling appropriate communication (e.g., my turn, more time, I want).
Baseline data results are summarized in the graph below
Additional assessments and observations for relevant skills and needs
Informal observational assessments were completed to gather information on her sensory processing needs and regulation skills; communication skills, including expressive language, receptive language, and social interaction. The team also had access to her Preschool Speech and Language program assessments.
In addition, a formal assessment was completed (ETS Skills and Supports Tool) to identify areas of needs and skills to be taught. This tool was designed to identify important skills related to school readiness across the ETS six key areas: Communication, Behaviour Self-Management/Self-Regulation, Functional Routines, Social Skills, Play Skills, and Pre-Academics. The Tool is scored using a 0-2 criteria scale. A score of 2 (highest score) for any given skill indicates that a child is either fully independent with the skill or has developed the skill to a level expected for a child entering school for the first time. A score of 1 indicates that a child is exhibiting some skills in this area and requires some support, or this skill is not consistently demonstrated. A score of 0 (lowest score) indicates that a child requires full support to complete the skill or is not yet demonstrating the skill.
Interpretation
Based on the objective and subjective assessment data, it is hypothesized that she engages in tantrums and biting to gain access to preferred items/activities and/or to escape an aversive situation. These behaviours are communicative and function as a means of requesting and protesting. In addition, she presents with generalized sensory differences which impact her regulation skills and therefore impacts her response to undesirable events or situations.
Collaborative discussions regarding the function of her behaviours, child-specific factors (e.g., sensory processing differences), and initial scores on the ETS Skills and Supports Tool helped to inform the following goals for interventions:
Skills to increase:
- Communication: She will use her words, a gesture or point to a visual (e.g., PIXON communication board, choice board) to communicate her wants and needs without engaging in interfering behaviour. This includes the following:
- Protesting: independently and appropriately protest to express dislike (e.g., “I don’t want to do that”, “hey, that’s mine”,).
- Seeking help when needed: independently seeks help when needed (e.g., asking for help if a peer touches/takes a toy).
- To appropriately express how she is feeling (e.g., “I’m mad/sad/hungry/tired”).
- Transitions: She will successfully transition between activities (e.g., from preferred to non-preferred/neutral activities, to and from the classroom) without engaging in interfering behaviour with support from a visual.
- Waiting: She will learn to tolerate waiting for requested items or activities, through the use of a visual and timer, with adult support.
- Sharing and turn taking with peers: She will tolerate sharing and turn taking with peers, with adult support and the use of visuals and timers.
- Regulation: She will learn strategies to help calm herself down when she becomes dysregulated. This can be done independently or prompted and during calm moments or during instances of dysregulation. Strategies that were taught included:
- Deep breathing
- Using the calm corner to take a break
- Using a sensory toy to squeeze
- Chewelry
- Weighted animal
- Weighted vest
- Co-regulation
Behaviours to decrease:
- Tantrum: Any instance where the learner exhibits a combination of two or more behaviours for a duration of 10 seconds or longer. This may include; crying/screaming, spitting, flopping, SIB (i.e., self-biting and/or head hitting onto floor), throwing items/toys, and/or hitting, pushing, biting others. The tantrum will end when the learner displays none of the above behaviours for a duration of 30 seconds or longer. Each instance will be counted separately and the length of behaviour will be recorded each time as either under 5 minutes (<5), under 10 minutes (<10) or over 10 minutes (>10). Each behaviour that occurred within the tantrum will be tracked once by circling the letter corresponding to the behaviour that occurred.
- Biting: Any instance the learner attempts to or makes deliberate contact with her mouth to a peer/adult by opening her mouth and teeth to make contact with anybody, with or without closing her jaw. This does not include instances where she is eating. Each instance will be counted separately.
Results
Overall, interfering behaviours (tantrums, biting) decreased while targeted skills (communication, self-regulation, sharing, turn-taking, waiting) increased following the implementation of the team’s individualized support plan.
Pre- and post-intervention data results are summarized in the below graphs and tables
Entry to School Skills and Supports Tool
Summary of relevant domains
| Domain | Max Score | Initial Score | Final Score |
|---|---|---|---|
| Communication | 18 | 2 | 12 |
| Behaviour Self-Management | 6 | 2 | 5 |
| Social Skils and Play | 16 | 7 | 9 |
| Total | 40 | 11 | 26 |
Skill development of targeted goals is summarized in the graphs below
