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How to stop thumb sucking and unwanted toddler behavior: Using duration on the Standard Celeration Chart

Rick Kubina
Jul 20, 2018 1:16:10 PM
 

Sarah joined the world like most other babies do, an uncomplicated pregnancy and a natural birth. Her parents Mike and Diana delighted in her arrival. Diana lobbied Mike to name the baby Sarah after her a beloved grandmother. Mike readily agreed.

Sarah grew and hit many developmental milestones. She engaged in behaviors typical of a toddler: playing with blocks, imitating the actions of her peers, and laughing at silly faces. Sarah enjoyed her parents and family as they did her.

At the age of three, however, Diana and Mike noticed Sarah sucking her thumb habitually. Sarah had a thumb sucking problem.

Thumb sucking itself does not pose a problem. Indeed, thumb sucking normally occurs in children and tends to disappear as they age. Yet children who suck their fingers beyond 2 to 4 years of age can experience several severe problems according to the American Dental Association:

  • misshapen mouth
  • improper development of the roof of the mouth
  • misaligned teeth

Thumb sucking can also attract social stigma for children who continue to engage in the behavior as they age.

Intervention Plan

Sarah spent time at a daycare facility as both her parents worked. The daycare had many excellent staff who supervised the children. Ms. Ashley had Sarah in her class and noticed the thumb sucking problem almost immediately. After consulting with Sarah’s parents, Ms. Ashley came up with a plan. First, she needed to collect baseline and document the degree of the problem.

Ms. Ashley observed Sarah during playtime. Playtime lasted 1 hour from 8:00 AM to 9:00 AM. During that time, Ms. Ashley had a timer and recorded the duration of thumb sucking.

Duration = "The elapsed time between the beginning and ending of a behavior" (Johnston & Pennypacker, 2009)
Duration = "The total extent of time in which a behavior occurs" (Cooper, Heron, & Heward, 2007)

Sarah sucked her thumb on and off during playtime. Ms. Ashley started the timer when Sarah placed her thumb in her mouth and stopped the timer after the thumb came out. The total duration for the one-hour daily observation came from all instances of starting and stopping across the hour.

Standard Celeration Chart (Data Display)

Ms. Ashley took the total duration of thumb sucking and placed it on the Standard Celeration Chart (SCC). All of her analysis occurred on the SCC and provided an abundance of visual and individual statistical information. The chart excels at analysis, interpretation, and communication of basic and applied experimental results.

First, a quick tutorial on the SCC. Notice the chart has dual vertical axes. The left vertical axis displays Count Per Minute. The left axis comes into play when someone wants to know the know the count, expressed as per minute, for the target behavior. Every observed behavior will have a count.

The right vertical axis contains a series of Counting Times, or the time interval spent counting a behavior. The right vertical axis also shows time for duration, latency, and a unique symbol called a counting time bar.

The Standard Celeration Chart accurately represents time. If time lessens or becomes shorter, the data (e.g., duration, latency) would go up. Conversely, if the time interval lengthened, the data would move downward illustrative of more time.

Take the example of a 60-second duration taken on Monday. The next day the duration reduces to 30. The SCC visually conveys the smaller amount of time by having the data move upward.

People familiar with viewing duration on a single axis linear graph tend to have an opposite perspective. Linear graphs start at 0 and the data rise as more time appears. Therefore, duration data trending upward communicates an expansion of time, the opposite view of the SCC.

An analogy may help remind people of how duration works on the chart. The following screenshot from a timer app demonstrates that more time means moving the spinner down while less time moves up.

 Figure 1. A screenshot showing a timer with spinner to shorten or lengthen the time interval.

The SCC in Figure 2 has Sarah’s thumb sucking duration data. Note the labeled blanks surrounding the SCC. The labeled blanks impart vital information regarding behavior (Performer, Age, Counted), data recording (Counter, Timer, Charter), management (Manager, Adviser, Supervisor), and the place (Organization, Division, Room) where measurement occurred.

The daily SCC also presents all behavioral data in real calendar time. A client who missed a day due to sickness or the weekend would have white space on the SCC. The analysts would see the person did not attend the session (or someone did not measure the behavior for a given day). Notice that Sarah went away for vacation with her parents and the annotation lines communicate Sarah’s absence.

On the SCC the backward slash (\) symbolizes duration. Each duration data has an associated time shown on the right vertical axis. The screenshot from Chartlytics, a CentralReach product, allows users to hover over each data point to display the time, an advantage of digitally displaying data.

 Figure 2. Chartlytics’ digital SCC.

 Data Analysis

Analysis of the SCC data offers behavior change agents a rich assortment of outstanding visual and statistical information. The information appears in a standard format so all chart readers quickly orient to essential chart elements. First, Sarah’s SCC immediately relays the who, what, and where of the intervention.

Sarah, a 3-year-old (Age) has a target behavior where she sucks her thumb during free time (Counted labeled blank = Free-do sucks thumb during free time). The “Free-do” in Counted labeled blank represents a “learning channel.”

The responsibility for counting, timing, and charting the behavior falls to Ms. Ashley as indicated in Counter, Timer, and Charter labeled blanks. Ms. Ashley also serves as the Manager or the person who works with the Performer, Sarah, on a daily basis.

The Adviser examines the data on a weekly basis and provides advice. Alison Holmes, who owns the daycare center, fills the role of the Adviser. A Supervisor would see charted data on a monthly time frame. No one has assumed that role for the current project.

The last pieces of information concern where the charted project takes place. Observation and intervention occur at Holmes Daycare (Organization), in the Toddlers Division in the Blue Room (Room).

The second significant part of the chart, the inside, contains data, conditions, goals, and all other relevant qualitative and quantitative information.

To begin, the yellow aim band across the chart spans 30 to 10 seconds. The aim band represents the goal or where Ms. Ashley sets intervention success.

The duration data start off in real time and each data point depicts a day’s worth of observation. By looking at a duration symbol and moving across to the right vertical axis, chart readers can determine the interval of time. With digital charts like Chartlytics, hovering over each duration data point reveals the specific time.

The duration data move across time in response to the current condition. The first condition begins with baseline. The celeration line drawn across the data shows almost no movement (i.e., looks flat). The lack of progress sparks Ms. Ashley into action and she implements her first intervention, delivering praise for instances when Sarah does not have her thumb in her mouth.

Visually inspecting the second condition exhibits a slight trend upward. On an SCC, duration trending upward means the total time for the behavior shortens.

Still, the gradual slope of progress indicates a need for change. Therefore, Ms. Ashley implemented the second condition, praising Sarah for when her thumb did not enter her mouth and giving her a small reward at the end of the session. The data show the second condition lasted over two weeks which included an absence due to a family vacation.

The last condition Ms. Ashley enacted called for the specific reinforcement of instances where Sarah had her hands occupied with a toy, other functional objects, or appropriate activity (e.g., clapping games). The last condition worked. The data show a sharp acceleration. Furthermore, the dotted projection line demonstrates Sarah will make her goal in less than a month.

Quantification = Next Level Analysis

The previous description of data contained only a visual analysis. However, the SCC also provides a full range of vital, precise statistics that portray changes across time.

The SCC above has celeration line drawn across the duration data. The following screenshot has the same data but with orange level lines fitted to each dataset per condition.

Figure 3. Chartlytics’ digital SCC screenshot with level lines turned on.

The quantification allows a behavior change agent to expertly determine the speed of behavior change (celeration) and the average amount of behavior change (level) for each condition.

The following table lays out the quantitative values for both celeration and level. The level values capture the average duration for each condition. The level numbers quantify the orange lines shown in the figure above.

  Level  Celeration 
Baseline 21.23 x1.02 per week
Praise “Thumb out of mouth” 18.54  x1.13 per week
Praise + Reward 12.11 x1.08 per week
Reinforce hands occupied with object 6.01 x1.77 per week

 

On average, in baseline Sarah sucked on her thumb for 21 minutes and 23 seconds during the one-hour observational period. Stated differently, 1/3 of the time Sarah had her thumb in her mouth.

Each successive condition has an intervention. The level contributes to an understanding of how much the amount of thumb sucking changed. Praising the thumb out of her mouth led to an average of 18 minutes and 54 seconds of the behavior. The next intervention, with a reward component, shortened the average time even more to 12 minutes and 11 seconds. The last condition worked very well, reducing thumb sucking to only 6 minutes and a 1 second.

While levels help behavior change agents get a handle on the average amount of behavior in a condition, the celeration values show how quickly the behavior changed across time. The higher the celeration value, the faster the duration data changed. When duration data accelerate, that means shorter and shorter durations.

The behavior in baseline barely changed at all. Anything at x1 celeration stays the same, and x1.02 per week differs very little from x1 per week.

The second condition had a celeration of x1.13 per week. In other words, duration length changed by growing 13% each week. Expressed in a different way, the durations got shorter or lessened at a weekly rate of 13%. While the next condition (i.e., Praise + Reward) didn’t yield a celeration as fast as the previous condition, when coupled with a higher level the intervention did have a more positive impact.

The final condition evoked the fastest change and highest celeration value, x1.77 per week.

Conclusion

The science of behavior contains a treasure trove of applied interventions ready to help people like Sarah. The Standard Celeration Chart equips behavior change agents with a robust measurement system that engenders analysis and subsequent decisions by virtue of a standard chart and a full array of individual behavior change statistics.

Ms. Ashley helped Sarah (true story, different names) stop her thumb sucking by trying several interventions and analyzing her data in a time efficient way. The personalization of data and rapid decoding of information promoted behavior change, aided problem solving, and facilitated the reduction of an unfavorable behavior. The SCC can help all behavior change agents navigate behavioral outcomes and exercise data science for individuals.

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