Advanced Behavior Analysis

Addressing Inconsequential Behaviors

As behavior analysts, we are formally trained to analyze only what is observable and measurable. While that has value in the right contexts, it’s also important to identify internal states that may be driving behavior. This helps us get to the root of the issue, rather than simply just addressing the tip of the iceberg (e.g. behaviors we can physically see).

 

When a child is dysregulated, feels unsafe, or is lacking connection, they may engage in what we perceive as “maladaptive behaviors”. In reality, this could be the nervous system’s way of producing a stress response. Perhaps the child does not have the emotional maturity or communication skills to behave in a way that is functional or appropriate.  Our goal is to identify a child’s developmental level and teach them adaptive and functional skills in a way that makes sense to them.

 

Representation of an iceberg - 90 percent underwater

Consider that behaviors which adults may perceive as annoying or disruptive may be the child’s way of seeking regulation. As parents and caregivers, we are our child’s co-regulator. It is our responsibility to help them engage in healthy behaviors to keep their sensory systems happy. 

Happy child on a later summers evening

 When we set up an environment that is safe, connected,  and reinforcing, our kids are less likely to engage in “maladaptive” behaviors. This doesn’t mean that adults have to entertain their kids 24/7. But we can try to provide options and resources to help them develop independent and positive play skills.

Delivering Effective Praise

When we deliver praise that is detailed and specifically targeting a certain behavior, it increases the reinforcing value of a positive statement, and helps our children gain confidence and self worth. Instead of throwing out a “good job!” Or “nice work!” Try to think of something more direct, sincere and encouraging.

Delivering effective praise ABA Therapy

 

Offering specific praise helps our kiddos identify and develop unique skills and behaviors that they possess within themselves. It’s also a good idea to follow a “good job” with “did you have fun doing that?” Or “are you proud of yourself?” So often, kids perform to gain approval from or to appease adults. Let’s teach them to do things because it brings them joy and a sense of self-satisfaction and pride.

“did you have fun doing that?” Or “are you proud of yourself?”

 

If you feel like your kid is trying hard to learn a new skill or to modify a negative behavior, encourage them by letting them know you have their back. Draw them in. “You’re working so hard on staying calm! Next time let’s try to take some deep breaths. I’m here for you.” Even if they push you away (with their words or actions) always let them know you are their safe space.

What is ABA?

Applied behavior analysis (ABA) is best known for its success in treating individuals with autism spectrum disorder (ASD) and other developmental disabilities (e.g., Down syndrome, intellectual disabilities). Treatment in this area is effective across an individual’s lifespan (i.e., childhood, adolescence, adulthood). In young children with developmental disabilities such as ASD, the goal of intensive, comprehensive intervention is to improve cognitive, language, social, and self-help skills. Decades of research have shown that intensive ABA treatment is the most successful approach for children with autism, and it is widely recognized by a number
of sources including the U.S. Surgeon General, the American Academy of Pediatrics, and the National Institute of Mental Health. When applied to older individuals, ABA involves teaching behaviors essential to functioning effectively in the home, school, and community. ABA can also decrease severe problem behaviors that endanger health and safety, and limit educational, residential, or vocational options. (BACB, 2021)

ABA is a science devoted to understanding and improving human behavior. ABA focuses on socially significant behaviors and research-based strategies to improve targeted behaviors by using objective description, measurement, and experimentation to demonstrate reliable relations between interventions and the behavioral improvements (Cooper, Heron, & Heward, 2017).

Music lesson with kids

Applied behavior analysis focuses on the prediction and control of socially important behavior. Behavior includes anything an individual does while interacting with the environment, including observable behavior and private events. ABA focuses on objective measurement and analysis of the environmental variables of which problem and appropriate behaviors are functions (Fisher & Piazza, 2015)

Fisher, W.W. and Piazza, C.C. (2015). Applied Behavior Analysis. In The Encyclopedia of Clinical Psychology (eds R.L. Cautin and S.O. Lilienfeld). https://doi.org/10.1002/9781118625392.wbecp205

 

The “Why” of Behavior

From a clinical standpoint, behavior is classified in terms of its function. A behavioral function can also be considered the “why” of a behavior. When a behavior is observed, a behavior analyst or technician will look at the behavior with what occurred immediately before and after. This helps us identify a pattern and therefore, a function. Looking at the antecedent (what happened before the behavior) and the consequence (what happened after the behavior), the analyst or technician will then make a  hypothesis regarding the function of the behavior. We call this an ABC analysis and it’s a tried and true method that can easily be replicated by parents. 

The Why of BehaviorThe 4 functions of behavior include sensory (or automatic) escape, attention, and access to tangibles. A good way to remember this is the acronym S.E.A.T. 

When the function of a behavior is escape, the child may be engaging in a particular behavior to escape a demand or a variety of non-preferred situations. When a child engages in behavior for the function of attention, they are seeking the attention of others to reinforce their behavior. This attention could be positive or negative attention. When a child engages in behavior for the function of access, they are wanting to gain access to an item, a location, a person, or any other environmental stimulus. Finally, a child could engage in behavior within the function of automatic reinforcement. Automatic reinforcement can also be known as sensory, as the behavior is taking place to fulfill a sensory need. Automatically reinforcing behaviors are just how they sound, they automatically produce reinforcement for the child, typically in the form of sensory input or stimulation. Oftentimes, some or all of these functions can work together to maintain a behavior. I child might behave to escape a demand in order to access a desired tangible item or activity. 

Why is it important that we consider and hypothesize the function of a child’s behavior? 

Figuring out the function of the behavior guides interventions for responding to the behavior. For example, if a child engaged in protesting behavior to gain access to a cookie, the technician may prompt communication to gain access to the cookie rather than granting access by protesting for it. Similarly, if a child was engaging in maladaptive behavior within the function of escape, the therapist may require completion of part of the demand before allowing the child to engage in other activities. 

The functions of behavior guide interventionists and technicians to respond to behaviors appropriately to shape them into more functional responses and behaviors. Analysts may ask questions to parents or other stakeholders to gather anecdotal data on potential functions of behavior. 

When identifying functions of behaviors and responding accordingly, it’s important to always remember that behavior is communication. Respecting human dignity and bodily autonomy should always take precedence in any intervention or protocol.

Presume Competence


“Rather than labeling individuals as “low functioning” or “high functioning,” we should recognize that people with autism vary in their ability to demonstrate competence. Our responsibility is then to presume, find, and strengthen that competence. “ John P Hussman, Hussman Institute for Autism

One of the first and most important steps in preserving dignity and improving the lives of autistic individuals begins with presuming competence. This means understanding that everyone has the ability to think, feel and grow, even if not immediately obvious on the outside. Behavior is communication. Behavior does not just happen randomly.

Presuming competence means that we respect that behavior is motivated by a number of factors, including: a physiological need, physical discomfort, frustration, the need to communicate, sensory needs, etc. Behaviors which are observable to us may be communicating a more covert event taking place for the individual.

Allowing constant unrestricted access to communication systems (i.e. AAC, PECS etc.) is imperative. Presuming competence means that we assume the person is attempting to communicate through their behavior, and offer a mode of communication with the necessary assistance to help meet their need. A lack of verbal language does not necessarily equate low intelligence. Language delays or difficulties may not always stem from cognitive deficits.

The Evolution of Modern ABA Therapy

Applied Behavior Analysis (ABA) has experienced significant growth since its beginning in the 1970s. The milestones of ABA therapy growth have come from unparalleled education, embraced positivity, public awareness, and continued acceptance. Unfortunately, many Autistic adults recollect negative memories with their own ABA therapy from childhood. 

Previously practiced ABA therapy included the following techniques. 

-Forced prolonged eye contact

-Withholding basic needs (such as access to food/drink)

-Entirely restricting access to self-stimulatory behaviors

 -Forcibly extinguishing other uniquely autistic traits  

Traditional Applied Behavior Analysis promised parents that, following intensive therapy, their child would be “indistinguishable” from their peers. While ABA does certainly improve communication, social and adaptive living skills, it does NOT extinguish Autism (nor should it). 

If your child is receiving ABA therapy which involves any of the methods mentioned above, that is a huge red flag to begin searching for a new provider immediately. 

Modern Applied Behavior Analysis typically functions as part of a comprehensive treatment package for children with special needs rather than the sole source of therapy. A treatment solution may involve speech therapy, occupational and sensory integration therapy, psychotherapy, and more. Treatment is entirely individualized, as opposed to the one size fits all antiquated ABA approach. 

 

ABA therapy has always focused on shaping behaviors and skills to encourage independence. Over the years, treatment has shifted focus from coercion and punishment procedures to positive encouragement and reinforcement. Positivity while continuing to expanding the capacity to respect bodily autonomy and neurodiversity. 

Some individuals remember ABA therapy as strictly table work, training one to respond to specific cues to receive reinforcement. While table work is often still part of therapy in the form of discrete trial training (DTT), ABA therapy also encompasses the use of naturalistic and incidental teaching strategies to use motivation within the natural environment to encourage skill acquisition. 

Previous ABA therapy interventions have also been said to increase prompt dependency and promote unnatural, robotic responses. However, current ABA practices focus on using least to most intrusive prompting methods and systematically fading prompts to encourage individual independence. While prompts are still utilized within ABA therapy, the systematic fading allows for continued learning in scenarios outside the learning environment, providing access to generalization and skills maintenance.

While ABA therapy has continued to evolve, so have the ethical principles to support ethical treatment within the field. The Behavior Analyst Certification Board (BACB) functions as the governing board for behavior analysts and behavior technicians administering ABA therapy. The ethical code for behavior analysts and behavior technicians has received many updates over the years to include the most current and ethical practices within behavior analysis. All BCBA’s and RBT’s are thoroughly trained in accordance with this moral code to ensure quality and ethical treatment for those receiving behavioral therapy. The ethical code focuses on the following core principles; benefiting others, treating others with dignity, compassion, and respect, behaving with integrity, and ensuring the competence of interventionists (BACB, 2021). With the guidance of this code and following the most recent research and recommendations within behavior analysis, the field is continuing to evolve to provide the most ethical and responsible treatment.

Promoting Autism Acceptance in Society

Autistic children are extremely capable of developing skills that help them live their “best life”. The individual characteristics that each child possesses should be championed and capitalized upon. By no means should their uniqueness be taken away while developing a plan to help your child live within the boundaries of this great big world.  

Nervousness

We strive to help children develop themselves while respecting the differing abilities they possess. For example, it is critical to understand that stimming (or self-stimulation) is an important human behavior that helps with emotional and sensory regulation. To some degree or another, every human uses repetitive physical movements or vocalizations to help them cope with all levels of feelings. Have you ever heard someone hum a tune while working? Or how about bouncing their foot under the table at dinner? 
We respect the bodily autonomy of children by listening to their voices and their physical cues. Our team does their best to use the least intrusive and least restrictive measures to help children learn, cope and grow. We want to see all autistic humans successfully included in classrooms, social settings, and workplaces.
Autism awareness is essential, but Autism acceptance is crucial for promoting widespread inclusion in society. Acceptance encourages empathy and understanding, which will, in turn, promote change. To help this change occur, we strive to provide education and insight on the autistic experience.

Suggestions for inclusivity:
-Spend time learning about autism
-Listen to autistic voices
-Presume competence
-Invite autistic peers to parties and events
-Demonstrate understanding instead of pity
-Identify areas of interest and utilize that as a teaching strategy or social interaction
-Create a flexible environment by offering choices
-Encourage children to invite neurodiverse peers to participate in play, even if the child seems uninterested or disengaged…their participation matters
-Be mindful of sensory sensitivities

Early Signs of Autism

Detecting Autism Early

Child playing with parents

As your child develops, you will often look for specific benchmark traits that show your child is progressing normally. These traits include responding to their name, reacting to facial expressions, babbling, or imitating others. 

Parents are usually quite aware of how their child is growing in relation to other children.  

Dad and Son at Working in the ShopPediatricians also look for specific developmental traits with each of their patients. When your pediatrician begins to evaluate if a child is showing early signs of autism, they will analyze how your child is developing compared to typical development.

For example, at six months, a child should be able to copy sounds, enjoy playing with others, respond to their name, and also respond to the emotions of others. 

By twelve months, a child should begin to use simple gestures, repeat and say small words such as “mama” or “dada,” play simple games and respond to verbal requests (CDC, 2019). These social and communication milestones are evaluated by a pediatrician when determining if a child could be showing signs of autism. Autism signs tested by pediatrician

There are many early signs of autism that parents should be aware of when monitoring their children. These include avoiding eye contact, having little interest in interaction with caregivers or peers, limited displays of language, distress from changes in routine, lack of peer imitation skills, and loss of previously gained skills (AAP, 2019). 

If you notice some of these traits, get your child evaluated for autism by a pediatrician soon.  

In some cases, parents will disagree with their pediatrician regarding a potential diagnosis of autism. If there is a disagreement, it is advisable to seek a second opinion of another specialist. There could also be cases where a child’s primary care provider decides to refer the child to seek an assessment from a specialist. Pediatrician testing for development

In any case, seeking a second opinion or seeking further information could be advisable for everyone. 

While a parent will typically monitor for real-world development, a pediatrician will conduct a developmental screening, typically at 9 months, 18 months and 30 months (CDC, 2019)

Additionally, the American Association of Pediatrics recommends that children be evaluated for autism at ages 18 and 24 months (AAP, 2019). 

This screening process will consist of a series of questions to determine where the child is at. Assessments that could be used include Autism Diagnosis Interview (AID – R), Autism Diagnostic Observation Schedule (ADOS – G), Childhood Autism Rating Scale (CARS), or Gilliam Autism Rating Scale – 2nd edition (GARS – 2). 

References 

CDC. (n.d.). Early Warning Signs of Autism Spectrum Disorder. cdc.gov. 

 

Centers for Disease Control and Prevention. (2020, February 11). Screening and Diagnosis of Autism Spectrum Disorder for Healthcare Providers.  

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