Special Issue on Positive Behavioural Support: Efficacy

The emergence of positive behav-ior support (PBS) has presented somechallenges and opportunities for ap-plied behavior analysis. In a recentreview and critique of positive behav-ior support, Johnston, Foxx, Jacob-son, Green, and Mulick (2006) ac-knowledge that the success of PBS ingarnering support in schools, agen-cies that service individuals with de-velopmental disabilities, and stateand federal agencies, and suggestsome behaviors to be emulated byapplied behavior analysis in order togarner similar support. However,they recommend that PBS shouldnot be embraced by behavior analystsbecause it poses a threat to the fieldand is less effective than appliedbehavior analysis. Before this recom-mendation is embraced by behavioranalysts, it is important to considerthe ramifications of a split betweenPBS and behavior analysis, particu-larly given that PBS has its origins inbehavior analysis and is conceptual-ized by prominent adherents of thePBS model to be a type of orextension of applied behavior analy-sis (Dunlap, 2006; Horner, 2000). Ipropose that PBS should not bedismissed but should be viewed asan opportunity by the field of appliedbehavior analysis to reach its goal oflarge-scale adoption. A continuedstrong relation between PBS andbehavior analysis may actually ac-complish the broadest disseminationand adoption of effective behavioraltechnology. It will also benefit PBSby keeping it grounded in the con-ceptual system that fostered its de-velopment.PBS is clearly still in its formativestages; in fact the executive board ofthe Association for Positive BehaviorSupport currently is working to de-velop a comprehensive definition ofPBS and to define the roles for theorganization (C. Anderson, personalcommunication, November 2, 2006).As is true in any organization—eventhe Association for Behavior Analy-sis—different members may espousedifferent perspectives on issues suchas the relation between PBS andother perspectives, training models,and so on. This in itself has been thesource of many challenges, and per-haps misunderstandings, for those inthe behavior analysis community.For example, Johnston et al. (2006)emphasize the negative views of PBSresearchers toward behavior analysis.However, many leaders, trainers, andresearchers in PBS have a favorableview of behavior analysis, considerthemselves to be behavior analysts,and continue to publish in behavioraljournals such as the Journal ofApplied Behavior Analysis and TheBehavior Analyst. Thus, although thissituation has been viewed pessimisti-cally by Johnston et al., I believe thatthere are significant grounds forhaving an optimistic view about thefuture relation between PBS andapplied behavior analysis. BecausePBS is in its formative stages and isrooted in behavior analysis, the field

Spivakovsky et al. (2023) questioned the effectiveness of Positive Behaviour Support as an intervention for reducing challenging behaviour and the use of restrictive practices as a behaviour management approach. This article responds to their critique. We argue that the literature supports the effectiveness of Positive Behaviour Support when it is properly implemented. As employees of a Positive Behaviour Support service provider, our position is also supported by our experience of the use of Positive Behaviour Support and its beneficial outcomes. To ensure a high level of fidelity in the implementation of Positive Behaviour Support, it needs to align with the elements that underpin Positive Behaviour Support (i.e., elements of applied behaviour analysis, person-centred practice, human rights, system change) rather than simply implementing Positive Behaviour Support to meet existing legislative requirements. In conclusion, when Positive Behaviour Support service provision and implementation in Australia is correctly aligned with the core components of Positive Behaviour Support, positive outcomes for people with disabilities, including a reduction in the use of restrictive practices, can be achieved.

The term positive behaviour support (PBS) is used to describe the integration of the contemporary ideology of disability service provision with the clinical framework of applied behaviour analysis (ABA). Assent, the participation consent of those not legally able to consent, has gained recent popularity in the fields of ABA and PBS. The goal of assent-based ABA and PBS is a person-centered approach to assessment, intervention, and all other decision-making. In this model, the learner’s assent withdrawal for participation is honored, whether it be a vocal ‘no’ or a non-vocal expression of verbal behaviour. There is currently a limited subset of studies that mention or utilize assent with learners in ABA or PBS. The lack of published research can make assent-based practices seem to be a choice of the practitioner. The authors of this manuscript seek to further define assent, illuminate the necessity of assent-based practices, and offer assent-based procedures in ABA- and PBS-based intervention.

Positive Behavior Support has been shown to be effective in minimizing challenging behavior. Therefore training staff in Positive Behaviour Support would appear to be helpful in improving support to people with challenging behavior. The purpose of this review was to evaluate the research on the outcomes of Positive Behavior Support training. There are no other published reviews of Positive Behavior Support training outcomes. Searches were carried out using key words to identify studies which reported on Positive Behavior Support training. Following this, studies were evaluated against criteria for inclusion. 14 studies were identified by the review. Six studies focused on outcomes for staff. Four focused on outcomes for service users. Four studies reported outcomes for both staff and service users. Staff outcomes included changes in skills, confidence, knowledge, attributions and emotional responses. Service user outcomes demonstrated reduction in levels of challenging behaviour, but no evidence of change in quality of life was evident in the one study that evaluated this. Research demonstrates that Positive Behavior Support training has had a positive impact on knowledge, emotional responding, and attributions of staff. In addition, there is evidence of reductions in levels of challenging behaviour from service users. However, no evidence was found for Positive Behavior Support training having a positive impact on quality of life for service users.

Challenging behaviour can be a common feature of Huntington’s disease (HD); however the presenting behaviours and their root causes can differ widely from patient to patient. A positive behaviour support...

Positive behaviour support features prominently in Australian state and federal disability policy, and with the move to the National Disability Insurance Scheme (NDIS), and the continuing role of the states in safeguarding the rights of people with disabilities, the representation of positive behaviour support in Australian policy is an important consideration. Extending a recent review of Australian state positive behaviour support policies, this study examined the NDIS quality and safeguarding framework. Using the concept of policy diffusion, the subject of restrictive practices was used to argue the risks associated with the representation of positive behaviour support in current Australian disability policy. This examination revealed that while positive behaviour support is aligned to the founding principles of the NDIS, it is represented inaccurately in NDIS policy. Further, policies for positive behaviour support are predominantly aligned to restrictive practices and contain inaccurate definitions of positive behaviour support. There is support for imitation and coercion in the diffusion (or “spread”) of positive behaviour support policy in Australia, and the potential ramifications for jurisdictions implementing positive behaviour support policy without considering the accuracy of how positive behaviour support is presented is discussed.

The purpose of this study was to investigate the effects of an individualized positive behavior support on challenging behavior(self-injurious·aggressive behaviors and transition refusal behaviors) and alterative behavior(requesting and transition-related compliance behaviors) of a middle school student with autism spectrum disorder. The subject of this study was a student with autism spectrum disorder in 9th grade who was enrolled in a special school. The individualized positive behavior support was implemented utilizing multiple design across behaviors. The collected data were analyzed for interventional effects through visual analysis(the average and range, the trend of data using the split-middle line and percentage of non-overlapping data points; PND). The results of this study were as follows: First, individualized positive behavior support was effective reducing the self-injurious·aggressive behaviors and transition refusal behaviors of the target student. Second, the individualized positive behavior support was effective increasing the requesting and transition-related compliance behaviors. The results of the study were discussed in terms of intervention based on functional behavior assessment, multi-element intervention strategies, the use of evidence-based practice considering the characteristics of autistic disorders, and positive behavior support based on a collaborative team approach.

Effects of staff provided positive behaviour support (PBS) for individuals with intellectual disabilities are unclear. Using a multicentre non-randomised cluster controlled design, 26 teams of residential group homes, including 245 staff members of 167 individuals with intellectual disabilities, were allocated to a PBS or control group. Conducting multilevel analyses (n = 123) we examined individuals' changes in irritability, other challenging behaviours and quality of life. Compared to controls, irritability did not significantly decrease more in the intervention group, but lethargic behaviours did. Personal development and self-determination significantly increased. Irritability of individuals in the PBS group with higher levels of irritability or lower levels of intellectual disability significantly reduced more compared to controls. PBS was effective in reducing irritability of individuals with severe levels of irritability or intellectual disabilities. Moreover, PBS decreased lethargic behaviours and improved several domains of quality of life.

Positive behavior support (PBS) and functional behavioral assessment (FBA) are two significant concepts of the 1997 amendments to the Individuals with Disabilities Education Act. These two concepts are not new, but they are important for improving the quality of efforts to educate children and youth with disabilities. The purposes of this article are to describe (a) the context in which PBS and FBA are needed and (b) definitions and features of PBS and FBA. An important message is that positive behavioral interventions and supports involve the whole school, and successful implementation emphasizes the identification, adoption, and sustained use of effective policies, systems, data-based decision making, and practices. Systems-level challenges are also discussed.

Positive behavior support (PBS) is an evidence-based approach for supporting adaptive behavior and addressing behavioral challenges. It is critical that families have access to effective evidence-based behavior support practices for both intervention and prevention because they lead to better outcomes for families, and counter-productive family management practices have been shown to further escalate children’s behavioral challenges. PBS has been demonstrated to be effective with individual children with serious behavior challenges in family homes and features of PBS are evident in common family-based intervention approaches. Unfortunately, complete application of PBS in family contexts has not been fully explored or conceptualized. The purpose of this paper is to define the core features of PBS including lifestyle enhancement, assessment-based intervention, and comprehensive support plans (i.e., including strategies for prevention, teaching, and management). Examples of how the features of PBS are currently being employed within the field of PBS and within other evidence-based parent education and support programs are provided. Suggestions for how collaboration, assessment, data-based decision making, comprehensive intervention, and tiered approaches to service delivery may be used to enhance behavioral support for families are offered. Lastly, future directions for research and practice are recommended.

Challenging behaviors of toddlers and preschoolers have begun to occupy a position of conspicuous concern among professionals in the fields of child development, early education, and children's mental health. While this was not the case as recently as one decade ago, it is now understood that concerns regarding challenging behavior are well grounded. For instance, it is abundantly clear that challenging behaviors can interfere with optimal social-emotional and intellectual development, that challenging behaviors that persist beyond early childhood can be increasingly resistant to subsequent intervention, and that the unfavorable sequelae of challenging behaviors can last for long periods of time, even into adulthood. Therefore, recent years have brought considerable attention to efforts to understand challenging behaviors in young children and, especially, to improve efforts of prevention and intervention. Challenging behaviorhas been defined by Smith and Fox (2003) as “any repeated pattern of behavior, or perception of behavior, that interferes with or is at risk of interfering with optimal learning or engagement in pro-social interactions with peers and adults” (p. 5). This definition positions challenging behavior as a phenomenon that is noteworthy because of the effects it produces on the child's interaction with the environment and, especially, the social environment. Smith and Fox continued by listing some of the behavioral topographies that are commonly categorized as challenging. These include externalizing behaviors such as prolonged tantrums, physical and verbal aggression, property destruction, self-injury, and disruptive motor and vocal responding (such as screaming and persistent echolalia). They may also include internalizing behaviors such as noncompliance and severe withdrawal. It should be pointed out that the term challenging behaviors is used commonly in the field of early childhood (and in other contexts) and is directly analogous to the term problem behaviors, which is more typically adopted when referring to difficulties with older populations.KeywordsProblem BehaviorChild CareChallenging BehaviorBehavior SupportFunctional Communication TrainingThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

This chapter outlines the development, significance, and relevance of applied behaviour analysis to the Positive Behaviour Support (PBS) field, with a focus on school education. This includes a discussion about the relevance of functional perspectives to all tiers of support, and the areas in need of further research. First, the authors define Applied Behaviour Analysis (ABA) and describe its theoretical and methodological principles. This clearly identifies the purpose and terminology of ABA within the Australian context. Second, they explain how ABA has been embodied in the general perspectives of PBS and acknowledge the development of PBS across diverse contexts. Third, they explain how ABA continues to be represented in Australian school-based initiatives and interventions that are aligned with evidence-based practice principles. Fourth, they define function-based support and discuss its evidence base. They briefly review the core features of School-wide Positive Behaviour Support (SWPBS), including (a) the selection and use of practical interventions that are (b) delivered as part of a multi-tiered system of support and (c) promote improvements in the overall quality of life for individuals. They describe why a functional perspective to understanding behaviour is central to all tiers of SWPBS. Additionally, the key processes that are required for function-based support are briefly discussed, including collecting behavioural data, screening, monitoring, and evaluation. Fifth, they identify the points of congruence between a functional perspective and other extant approaches that address learning and behavioural support within Australian schools. This focuses on teaching and learning practices, and the measurements of learning. Sixth, they outline a pathway for expanding the use of function-based interventions in school settings in Australia, with reference to initiatives such as function-based ‘thinking’. They conclude the chapter with suggested areas for future research in Australia.

Person Focused Training is introduced as a model of service delivery for people with severe challenging behaviours. It is defined as training and supporting staff to conduct functional assessments and to design and implement positive behavioural support for specific individuals with challenging behaviours. Longitudinal outcome data are presented from 138 behaviour support plans developed by staff over a seven year period were analysed to determine reductions in frequency of challenging behaviours. Degree of behaviour change was determined across topography of behaviour, gender, age, level of disability, location of residence and role of course participant. Results indicate that the implementation by staff of behaviour support plans are associated with significant improvement in 77% of cases at an average follow-up of 22 months after implementation of support plans. Only location of residence was identified as related to reduction in challenging behaviours with large residential centres being associated with lower rates of behavioural improvement. It is argued that Person Focused training may represent an alternative to existing models of supporting individuals with challenging behaviours. The implications of front-line staff designing and implementing behaviour support plans for the organisation of services and the role of the clinical psychologist are considered.

Accessible summary Sensory integration is about how our brain receives and processes information so we can make sense of our everyday life. Behavioural interventions is a term used to describe how to teach people to increase useful behaviours or decrease behaviours that are challenging. Some people with severe learning disabilities can have behaviour that challenges and this can be difficult to manage. To manage behaviours that challenge restrictive interventions have been used such as people being given medication, or being held by others against their will. Instead of using these restrictive interventions we can use sensory strategies and a low stimulus environment which have been found to be successful in managing behaviours that challenge. AbstractIntroductionAdults with complex needs and severe learning disability present as a serious management problem within the community. Restrictive interventions are often used to manage adults with these issues, even though best practice recommends the use of positive behaviour support. Positive behaviour support involves functional analysis, but it does not specifically focus on sensory integration difficulties as a contributing factor to challenging behaviour.MethodsA systematic search of the literature was completed using a range of electronic databases, an electronic search, hand search and review of reference lists. Seven relevant studies were identified. These studies were critically appraised and analysed. However, the extent of research was limited and the procedural quality variable, some distinct themes, arose.ResultsOut of the seven intervention studies included in this review, two studies used sensory integration therapy, three employed multi‐element behavioural intervention, one utilised environmental stimulation within a multifactor behavioural intervention approach and one used sensory strategies within a structured behavioural intervention programme. The participants across the final seven papers reviewed consisted mainly of males with a high incidence of participants presenting with ASD. A range of assessment tools and outcome measures were used.ConclusionsThe use of restrictive intervention is still an issue in practice. Nearly all the studies reviewed stressed the issue of placing individuals with severe challenging behaviour in the community. Behavioural studies have successfully utilised sensory integration strategies within a structured behavioural format to manage challenging behaviour in a community setting for adults with a learning disability.

PurposeResearch highlights that antipsychotic medications are prescribed more in people with Intellectual Disability (ID) without a diagnosis of severe mental illness. Despite non-pharmacological interventions recommended as alternatives, their application can be challenging due to heterogeneity of the patient group. The purpose of this paper is to discuss application of quality improvement (QI) methodology in adapting interventions, aiming to reduce challenging behaviour of people with ID, thereby reducing use of antipsychotic medication.Design/methodology/approachTwo interventions were introduced as “tests of change”; an “Attention-Deficit Hyperactivity Disorder (ADHD) clinic” and “Positive Behaviour Support (PBS) clinic”. Process (Clinical Global Impression (CGI) and Modified Overt Aggression Scale (MOAS)) and outcome measures (total antipsychotic use) were used to assess the interventions, with each being reviewed as per QI methodology guidelines.FindingsThere was an improvement in CGI scores for both interventions. MOAS scores reduced for those attending the ADHD clinic, resulting in reductions of antipsychotic medication. MOAS scores did not reduce for the PBS clinic, so there was no reduction in medication for this group.Originality/valueBased on the introduction of pilot clinics, this paper provides a commentary on how QI interventions can be used to evaluate and adapt evidence-based interventions, in managing the needs of patients with ID. It further highlights the importance of the diagnosis of ADHD in patients with ID and challenging behaviour. Although PBS is recommended to manage challenging behaviour, this paper demonstrates the importance of continuous evaluation of behavioural interventions. There is currently no existing literature investigating use of QI methodology to reduce challenging behaviour in ID populations, emphasising scope for future research and service evaluation.