Behavioral Assessment M I Khaleel M.Phil 2nd Year Trainee Department of Clinical Psychology LGGRIMH - Tezpur
[email protected] Moderator
Mr. Ranjan Kumar Date: 20-01-2016
Introduction • Behavioral assessment emphasizes the measurement of simultaneous causal variables and environmental response contingency, using empirically validated assessment instruments • behavioral assessment includes a group of methods and instruments that measure behavioral changes through direct and indirect observation of lie ts’ behavior problems and the variables that maintain those problems.
Assessment of variables that cause or maintain a client problem often exist in an i dividual’s external environment, assessment of covert events (e.g., cognitions, physiological responses) have been incorporated within a behavioral assessment framework. Data collected during behavioral assessment must be synthesized by the clinician and this synthesis, in the form of a behavioral clinical case formulation, often guides treatment selection.
THEORETICAL BASES • Behavioral assessment is attached to behavior therapy and, like behavior therapy, developed from basic behavioral research. • Behavioral psychology has basically divided into two related models of learning: respondent conditioning and operant conditioning.
• Treatment methods based on respondent conditioning principles would later be refined by Mary Cover Jones, Joseph Wolpe, and others. • The operant, or instrumental, model of learning is illustrated by the work of E. L. Thorndike and B. F. Skinner. Thorndike found that learning occurred when behavior was instrumental in, or had the effect of, achieving a reward. • Thorndike called this principle the Law of Effect. Skinner extended Thor dike’s work by identifying the effects of specific types of consequences on behavior
• Behavioral principles, initially studied in animal laboratories, formed the foundation of behavior therapy and have guided the development of behavioral assessment methods. • Because antecedent events and response contingencies shape and affect an i dividual’s behaviors.
• Goal of behavioral assessment is to identify those events and contingencies that maintain behavior. • Antecedent events and response contingencies that maintain the rate of behavior are called controlling or maintaining variables.
Objectives of behavioral assessment • The primary objectives of behavioral assessment include • 1.Identifying target behavior problems (i.e., the whether the problems involve behavioral excesses or deficits • 2.Causal and moderating variables that influence target behavior dimensions • 3.Immediate, intermediate, and ultimate intervention goals • 4.Any adaptive or appropriate alternative behaviors to the target behaviors.
• In addition, behavioral assessment data form the foundation for a functional analysis, suggest appropriate intervention strategies, can be used to evaluate ongoing intervention efforts, may identify therapy process variables that can affect treatment outcome, and can inform diagnostic decision making • The ultimate goal of behavioral assessment is to increase the validity of clinical judgments to facilitate clear formulation and treatment selection.
Utility of Behavioral Assessment 1. Increase the validity of clinical judgments 2. Obtain informed consent from client 3.Select an appropriate assessment method (e.g., direct observation, indirect observation, psycho physiological measurement) 4.Determine if consultation and referral are appropriate (e.g., determine if medication consultation with a psychiatrist is appropriate when working with a child diagnosed with attention deficits)
5. Development of a clinical case formulation • a. Identify behavior problems and their interrelations • b. Identify causal variables and their interrelations 6. Design of intervention programs
• a. Identify client intervention goals and strengths • b.Identify variables that may moderate intervention effects (e.g., occupational status, family support, other life stressors) • c. Assess client knowledge of goals, problems, and interventions • d. Evaluate any medical complications that could affect intervention process or outcomes • e. Identify potential side effects of intervention • f. Assess acceptability of intervention plan for client • g. Assess time and financial constraints of therapist and patient
7. Intervention process evaluation • a. Evaluate intervention adherence, cooperation, and satisfaction • b. Evaluate client–therapist interaction and rapport 8. Intervention outcome evaluation (immediate, intermediate, and ultimate intervention goals) 9.Diagnosis (behavioral assessment strategies can be used to increase the validity of information on which diagnosis is made)
10. Predicting behavior (e.g., dangerousness and self-harm assessment) 11. Informed consent (i.e., inform clients and other relevant parties about the strategies, goals, and rationale of assessment) 12. Nonclinical goals • a. Theory development (e.g., evaluating learning models for behavior problems) • b. Assessment instrument development and evaluation • c. Development and testing of causal models of behavior disorders
METHODS OF BEHAVIORAL ASSESSMENT • A distinctive feature of the behavioral assessment paradigm is the variety of assessment methods available to the behavioral assessor. A. Behavioral Observation B. Behavioral Rating Scales and Behavioral Checklists C. Psycho physiological Assessment D. Self-Monitoring E. Self-Report Instruments ( Behavioral Interviews)
• A. Behavioral Observation • 1. Naturalistic Behavioral Observation Naturalistic behavioral observation is a behavioral assessment method in which an individual is observed in his or her natural environment (e.g., home, school, work), usually in a context that is most associated with a problem behavior. Typically, observations are made on a predetermined schedule by one or more observers.
• 2. Analogue Behavioral Observation • Analogue behavioral observation is a behavioral assessment method in which a clinician observes a lie t’s behavior in a restricted environment (e.g., a waiting room, play room, clinical setting) to assess variables hypothesized to influence behavior. Although analogue assessment is a direct measure of behavior, the target behavior is observed outside of the i dividual’s natural environment. • All forms of analogue behavioral assessment require a coding or rating system in which the assessor quantifies a dimension of behavior.
• B. Behavioral Rating Scales and Behavioral Checklists • A behavioral rating scale is an assessment instrument completed by a clinician or a third party (e.g., significant other, teacher, parent, peer) that includes items that assess one or more targeted client behaviors. • A behavioral checklist includes fewer items and may include dichotomously scored response options. • Many behavior rating scales and behavioral checklists have been standardized using a normative sample of individuals and aggregate raw data into standardized scale scores or global scores.
• Behavioral rating scales are frequently divided into two classifications • Narrow band behavior rating scales include items that sample from a small number of domains and are not intended to be global measures of an i dividual’s behavior • Broad band behavior rating scales usually include more items, sample from a wider spectrum of behaviors, and are often used to screen for more than one disorder or behavioral syndrome.
• C. Psychophysiological Assessment • Psychophysiological assessment involves recording and quantifying various physiological responses in controlled conditions using electromechanical equipment (e.g., electromyography, electroencephalography, electrodermal activity, respiratory activity, electrocardiography) • Which response or response system is measured depends on the purpose of the assessment. • It used to assess autonomic balance (e.g., heart rate, diastolic blood pressure,), habituation to environmental stimuli, reactivity to traumatic imagery, orientation response, and other physiological systems.
• D. Self-Monitoring • Sometimes neither naturalistic nor analogue behavioral observation methods are possible. • Some behavior may occur only in private (e.g., vomiting in a client diagnosed with bulimia nervosa), may not be directly observable • Self-monitoring refers to any assessment method in which clients record observations of their own behavior to a recording form.
• Most self-monitoring recording instruments are designed to maximize the chance of observing a functional relation between a behavior and an extrinsic variable. A common self-monitoring record is an A-B-C log. • An A-B-C log is a serial record of the antecedent events (A) that occur prior to the behavior (B) and the consequences (C) or events that follow the behavior. • AB- C logs are useful in identifying environmental events that are functionally related with a problem behavior. Variants of the A-B-C log are the basis of most self monitoring recording forms
• E. Self-Report Instruments • 1. Behavioral Interviews • A behavioral interview is a set of structured or semi-structured queries designed to elicit responses regarding (1) one or more overt target behaviors, (2) behavior–environment interactions, (3) the most relevant behavioral dimensions, and (4) relations of the behavior( s) with hypothesized maintaining variables. • Behavioral interviews differ from traditional clinical interviews in that they are structured, focus on overt behavior and behavior– environment interactions, are sensitive to situational sources of behavioral variance, focus on current rather than historical behaviors and determinants
Behavior Analysis Performa • It is used in behavioral therapy unit for behavior assessment. • It includes following queries • Initial analysis of the problem situation: • Behavioural Excess: (frequency, occurrence & duration under conditions, it is socially sanctioned?) • E.g. Violent and aggressive behaviour, temper tantrums, misbehaviour with others, hyperactivity, odd behaviour, rebellious behaviour, self injurious behaviour, repetitive behaviour, abusive language, socially inappropriate talk, anger, disinhibition, impulsivity, stealing, etc. •
• Behavioural Deficit: (sufficient frequency, adequate intensity appropriate form & under socially expected condition. • Deficit in activities of daily living, communication, social skills, initiation, etc. • Behavioural Assets (non problematic behaviour): (any segment of the pt.’s activities can be used as an asset for building new behaviour).e.g. specific ability, Interest.
• Clarification of the problem situation: (antecedent event & triggers in internal & external environment) • List of negative cognition & the behaviour following the antecedent events & consequences that occur to the pt. & significant others due to occurrence of the problem:
• Motivational Analysis: • Describe the specific factors that maintain the problem behaviors of the client: • List out the specific reinforcing events that help i ai tai i g pt.’s ehaviors: • Which person/s has the most effective control over the pt.’s ehavior?
• What are the major aversive stimuli for the pt. in his/her day to day life situations? What are the consequences he/she avoids? • What specific reinforcement can be utilized for improving/teaching adaptive behaviour? In what areas & by what means can be positive sequences arranged to improve desire behaviour?
• Developmental Analysis: • Biological Changes: • What are the limitations in the pt.’s physical functioning that affects current behaviour (defective vision, hearing difficulties, learning difficulty & residual symptoms)? • How do these limitations initiate & maintain undesirable behaviours? • When & how did the biological limitation develop? How did they affect lie t’s life patterns & attitudes? • How the biological change does influences treatment?
Sociological change: • What are characteristics of the pt’s social milieu? • How does the home & neighborhood react to pt’s problem? • What are changes in pt.’s society? What are the consequences of these changes in pt.’s current behavior? ( marriage, job loss/change, migration)
• What are pt.’s reactions to these changes? • Are the pt.’s roles congruent to one another? Are the behavioral deficits due to the changes? Are these conflicts due to value systems of the pt.’s early & later environments? • Do the problematic behaviors manifest in one or all the social changes? • How can identified social factors be brought into treatment program?
• Behavioral changes: • Pre-morbidly did the client do the pt. show deviant or maladaptive behavior? If so, what were they? • Do identified biological, social events in pt.’s life seen relevant to these behavioral changes? • Where these changes characterized? Emergence of new behavior/ changes in intensity or frequency of the established behavior/ on occurrence of previous behavior.
• Analysis of self control: • How does pt. control problem behavior? Through manipulation of self or others. • Were there any aversive consequences? Have these consequences reduce the frequency & intensity of the pt.’s behavior or increases or modified (legal consequences) • Does the pt. avoid or indulge in substitute behavior in order to gain satisfaction?
• Is there correspondence between pt. verbalized the degree of self control & observation by others? • In the pt’s environment which prevailing conditions or persons influence hi/her controlling behavior? • To what extent can the pt.’s self controlling behavior be used in the treatment programme?
• Under what conditions were these changes first noticed? Have the generalized to other setting? • Were these ha ges due to the pt.’s e posure to significant individual from whom he/she learnt the pattern & modes of reinforcement? Is there a role odel for pt.’s ehaviour i the social environment?
• Analysis of social relationship: pt.’s family environment & relationship with significant others • Who are the significant people in the pt’s environment? To whom is the pt. most responsive? Who reinforces/promote problem behavior? Who opposed them? • How does the significant other influence pt.’s behavior? • What are the expectation of the pt. & significant others from each other? • How can significant others can be used in the treatment programme?
• Analysis of Social-Cultural – Physical Environment: • What are the norms in pt.’s socio cultural milieu regarding the target behavior? • Are these norms similar across the various environment in which the pt. interact? If not what are these difference? • What are limitation in the pt.’s environment which his/her opportunities for reinforcement? • Does his/her milieu regard psychological procedure as appropriate procedure in helping the pt. with his/her problem?
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