What you see is what you get.

Many people have a mistaken understanding of just what it is that behavior analysts do, including some behavior analysts themselves, I’m afraid. They believe that we deal with problem behaviors, that we reduce problem behaviors. Well, I’m here to tell you today that we don’t. If all we did was reduce behaviors, and indeed we were successful at it, then at best we would create a nation of individuals who did nothing! What we do is teach skills, we teach replacement behaviors. That’s what we do!

This is important on so many levels. First of all, it is important because a focus on reduction of behaviors leads to the only two processes that actually reduce behavior: punishment and extinction. Both have side effects that often include emotional reactions and aggression. And the use of punishment can become habit-forming, leading to the types of egregious abuses that closed down many institutions in this country. (Why? If you deliver a punisher, and the person stops whatever it was they were doing, it reinforces you delivering that consequence in order to stop their undesired behavior—leading to more punisher delivery!) In any case, the use of procedures designed to reduce behaviors doesn’t make the individual of focus very happy, and it is often taxing on the person doing the procedure, if they do it right, because they must catch the individual doing wrong each and every time, and deliver the consequence!

Secondly, focusing on reducing behaviors isn’t person-centered; it doesn’t help the individual get what they want! From a behavioral perspective, people do things because of the consequences they produce. The individual gets something when he behaves this way, and taking it away (extinction) or providing an aversive consequence (punishment) doesn’t address the motivation and how to get it! By conducting a functional assessment (see “The squeaky wheel gets the pig.”), we can determine WHY a person engages in this behavior, and begin to answer the second biggest question: “What should they do instead”?

I remember the mother of a two-year old boy who shared with me that she was not able to go to Target, because her child would scream and tantrum so terribly that she was embarrassed and stressed, and would just leave the store. She had since simply avoided going there. Now, I believe in every mother’s right to enjoy the little slice of heaven that is Target, so this is a problem of importance. “What would you like him to do instead?” I asked. “Um, I guess sit in the cart quietly”, she answered. And that is what we set out to reinforce. Knowing that he would sit still for about 5 minutes before the chaos ensued, I instructed her to take along a bag of M&M’s or Skittles, give the boy one every 3 minutes, and say “I love the way you are sitting nicely in the cart” or something to that effect. Now, for those of you who are concerned about the use of edibles with humans, keep in mind that this child was quite young, and praise had no value…yet. It wasn’t long before the mother was calling me a miracle worker, as she had just come from a visit to Target with no tantrums, AND no M&Ms! I refused to take credit, as I had never even been able to accompany her on a trip to the store. She focused on a behavior she wanted to see (sitting nicely), and it increased! Even if the child screamed once in a while in the early stages of the process, I imagine the mother would be more focused on how many 3-minute intervals had passed without tantrums!

I have found that in data collection, coming home at the end of the day knowing that little Johnny did the right thing 3 times more than he did yesterday is so much more rewarding than knowing that he only screwed up one less time than the day before. Think how much happier middle management would be if they realized their job was really to catch people doing the right job, rather than catching those falling behind—all day, every day!

Again, most problem behaviors stem from a skill deficit–if the person could do something different in that situation, they would! I was once called to consult with Chad, a gentleman in his early 20’s who worked at a sheltered workshop, and would run out of the building several times a day, smiling and laughing at the staff as he did so. In addition to the fact that he wasn’t popular with the staff for this reason, there was also a safety concern, as trucks and buses were often coming through the parking lot, and he could get hit if he wasn’t paying attention during one of these elopements. When I met his mother for intake, he paced the kitchen waiting for my session to conclude, so he could go outside and walk and ride his bike, his favorite pastimes. Then I visited him at work, where he was to sit for 6 hours, often with little to do, as the work supply was inconsistent, depending on the individual’s functioning. So what did Chad want? A break, a chance to get out of the chair and stretch his legs! And what could he do instead of running out of the building, I asked myself? Ask for a break, and then walk around the inside of the building. And that is what we worked on, until he was asking for a break independently, and walking around the inside of the warehouse with minimal supervision. By concentrating my attention on increasing appropriate break requests, the elopement decreased!

I often refer to the analogy of the seesaw: by increasing desired behaviors, we simultaneously decrease the undesired behaviors they compete with. By focusing on replacement skills, we address the individual’s desires, teach them new ways to impact the world around them, and improve their lives. This is why behavior analysts teach communication, self-care skills, daily living skills, social skills, and academic skills. Because people with large skill sets are generally happier, and less likely to engage in problem behaviors! And by focusing on teaching and reinforcing such skills, we as caregivers are happier as well. Because after all, what you look for is what you will see, and what you see is what you get.

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Hold their hand.

 

I have noticed something, and confirmed it this past Halloween. Being in the field of ABA and special education for 10 years has made me aware of things that other don’t perceive. Things that other professionals, parents, and people who care for those with autism spectrum disorders see, but to the rest of the public go unnoticed.

I was standing in my friend’s driveway, hanging out and handing out candy as groups of children and parents came up. As one group walked away, I turned to the other guys and asked, “Did you notice the child with autism?” They hadn’t: “Which one?” The one in the cow costume, which seemed just a little young for the child’s age. The one whose mother had a hold of his hand the entire time, again seeming just a bit odd for the child’s age. The one who said “Thank you” in a somewhat stereotypic way, repeating it a few times. They hadn’t perceived any of these signs– to them, that child was just like every other. But he brought a smile to my face as he said trick or treat, for that very reason, and because he was enjoying himself.

Now it is wonderful that this young man doesn’t necessarily bring extra attention to himself– after all, autism doesn’t really have any tell-tale physical characteristics. And he was enjoying a holiday just like every other child I saw that evening. But I have seen the unfortunate side of  not recognizing signs of autism and the lack of compassion that can accompany this ignorance.

I was in Target several years ago, and overheard two employees talking. “Man!” said one to the other, “there’s a kid in the next aisle that needs a good smack! He’s knocking stuff down off the shelves, and spitting everywhere as he walks, and his mother isn’t doing anything about it!” I saw a mother with a boy of about 7 or 8, holding his hand in what I call “the death grip”, the firm grasp that many parents have when they take their special needs children out into the community. Immediately I knew, and a second later I actually recognized the child from a clinic at which I had worked. I thought to myself, “can’t they see that the boy has autism?”, and then I realized…no. They can’t.

Although by now I imagine most people are aware that autism exists– I mean, they have head the word– many are still ignorant to the signs, much less the details of everyday life that affect the parents of 1 in every 110 children. That is still less than 1% of children, and many people just haven’t been exposed. They don’t see what we see. They don’t see the parent rushing through the airport with a 10 year-old in the death grip and nod to themselves and say “autism”. And it certainly doesn’t occur to them when a 12 year-old boy drops to the floor in a full-blown meltdown in Wal-Mart. Too often, the response is an inconsiderate, ignorant, and un-welcomed, “that boy needs a good smack!” I know a parent who carried preprinted cards in her purse for such occasions. They stated “My child has autism, what’s your excuse?”

On a recent trip to do a presentation for parents, one parent expressed sadness at not being able to attend church, due to her child’s unpredictable behavior, and the lack of understanding and support from other churchgoers. After all, a physical disability can be seen, and the cause clearly explained, but we have too many ill-informed understandings of why behavior occurs, and the true  causes are often complex and temporally removed. Let us not forget that although autism is understood as a neuro-developmental disorder, its diagnosis is behavioral.

So what can we do? Educate. Disseminate. Share our stories, point things out to people. Get them involved in activities for causes that don’t currently affect them, as a means to expose and sensitize them. As professionals, we can offer our services to other community resources, such as churches– at the very least in the form of free workshops/meetings. I recently took my daughter to the clinic at Walgreen’s, and although she was not thrilled at having a throat culture taken with a cotton swab, the nurse practitioner was thrilled that “she didn’t scratch or bite me!”. When I told her that I was a behavior analyst, she actually suggested I could work with parents on preparing their children for office visits. That had never occurred to me for typical parents, though I have worked with individuals with disabilities on preparing for appointments. How many office visits, haircuts, etc could be made easier if the general public understood the challenges for a child with autism and had some idea what they might expect?

We have got to get the public there, helping them navigate through their ignorance, their misconceptions, their biases, and their fears. By doing so we can not only raise awareness, but create new supports for these children, for their parents, for the services that are so critical, for legislature that must be passed, for funding that must be raised. And to get them there, we will need to hold their hand.

 

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Check, check… is this thing on?

In a recent trip to Oxford, Mississippi to do a parent training, a colleague suggested I start a blog as a way to disseminate  the field of Applied Behavior Analysis, and to share some of the stories I tell when speaking. I have never thought of blogging before, and have only read a few while searching for things, but it’s worth a shot so here goes!

I guess a good start would be how I discovered ABA. I actually started out at FSU as a theatre major, but after two years I had lost the feeling you get in your stomach every time you see someone doing something you want to do (like I still feel when I see live music!). I was taking a Family Systems (or something like that) class as an elective, and I went to talk to the professor about my decision to change majors. I was considering education or psychology. I had always been interested in psychology, and was also inspired by some of the amazing teachers I had in high school. The professor told me that I would make more money in Psychology than I would in Education, given an equivalent degree, and that really sealed the deal at the age of 19.

I cracked open the course catalog to see what was available and saw the choices. When I saw the clinical psychology track, I shook my head. I just couldn’t see listening to a person complain about their life for two years or longer — I had faced my own family issues throughout middle and high school, and couldn’t imagine myself offering much compassion to someone else (get over it and find a solution!) Granted, this was just my vision of counseling, and certainly doesn’t reflect the actual field–but you can see where I was. Then I saw “Performance Management”: utilizing the principles of behavior to address the workplace. What? Making people’s jobs better through the principles of behavior? It sounded great! The courses included all the basic instruction in ABA, in addition to an Intro to I/O Psych class, and of course, the Performance Management class, taught by Jon Bailey.

Upon graduating, I didn’t really know where I was going. I couldn’t see myself in the business world just yet, with earrings, and my buzzed recently-bleached hair. I had read one article that described the use of the principles I had learned with children with Autism, but I hadn’t paid enough attention in school, honestly, to know if there were jobs in the field, and I wasn’t prepared for grad school just yet.

It wasn’t until a few years later that I really understood what I was meant to do. After my son Sage was born, I went to Orange County Public Schools looking for a job. After all, I had a degree, and they were desperate for teachers, I had heard. Turns out, you would need to check obituaries to find a job teaching Psychology, so my out-of-field choices were Technology (computers), or Exceptional Student Education. The choice was obvious. So, with no teaching experience, they put me in a portable with ten 3rd- and 4th-graders with behavior problems, and wished me luck. Immediately the terms reinforcement, contingencies, feedback, etc came swimming before me. I used stickers to reinforce behavior, I modified curriculum to make the work appropriate, I chased kids around the school with a walkie-talkie, until I learned how to keep them from bolting out of the classroom. And after 4 years of this (two at the elementary level, and two at the middle school level), my principal told me I focused too much on behavior.

So I made the transition to Behavior Analyst, taking classes on Saturdays with Dr. Jose Martinez-Diaz until I was eligible for certification. My first job was with an agency where I could consult with the very same school I had left as a teacher, only now I was able to bridge the gap between home and school. I had found a career.

The beautiful thing about ABA is its simplicity. At our core, we seek pleasure and avoid pain. Of course, there is much more to it than that, and there is a very technical language that I seemed at home with from the beginning, but the implications of this approach to human behavior reach into almost EVERY area humans are working, learning, playing, interacting, etc. ABA is really a science of problem solving, and most, if not all, problems involve someone doing something! And because of this, behavior analysts can offer some help. Because, after all, behavior is what we do!

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The squeaky wheel gets the pig

Maya Grace, my 5 year-old daughter, shared a wonderful story she heard last week at school. As I listened, I couldn’t help but see it as a behavioral fable, and so I will share the story, and the moral, here.

So it was that a young boy was spending the night at his grandparent’s farm. In the past, he had slept in his grandparent’s bed, but as he was growing older, he was to spend his first night in the “big boy bed” in the spare bedroom at the end of the hall. His grandmother read him a story, gave him a glass of water, tucked him in, gave him a kiss, and as she stood at the door, asked. “Now, are you going to be scared?” “Uh-uh,” the grandson replied, shaking his head. So, the grandmother turned off the light, “click”, closed the old door ,“creeeeeak”… when all of a sudden, “WAAAAH”!The grandmother opened the door, and asked “What’s the matter, were you scared?” “Maybe just a little bit…” answered the boy. “Do you want the cat to sleep with you”, asked the grandmother. “Uh-huh,” nodded the grandson. So, in came the cat to lay on the bed. The grandmother kissed the cat, kissed the boy, and as she stood at the door, asked, “Now, are you going to be scared?” “Uh-uh,” the grandson replied, shaking his head. So, the grandmother turned off the light, “click”, closed the old door ,“creeeeeak”… when all of a sudden, “WAAAAH”! “MEOW!”

{of course, children’s stories told aloud benefit from repetition, and fun sounds!}

The grandmother opened the door, and asked “What’s the matter, were you scared?” “Maybe just a little bit…” answered the boy. “Do you want the dog to sleep with you”, asked the grandmother. “Uh-huh,” nodded the grandson. So, in came the dog to lay on the bed, beside the boy and the cat. The grandmother kissed the dog, kissed the cat, kissed the boy, and as she stood at the door, asked, “Now, are you going to be scared?” “Uh-uh,” the grandson replied shaking his head. So, the grandmother turned off the light, “click”, closed the old door, “creeeeeak”… when all of a sudden, “WAAAAH”! “MEOW!” “WOOF!”

{The story continues this way with a pig and a horse joining the crowd, and each time the grandmother closes the door, it’s the same thing. Finally she has had enough, clears the animals out of the house, and the grandson joins his grandmother and grandfather in their bed}

The next night, the grandfather oiled the old door before the grandmother began tucking the boy into bed. The grandmother read the boy a story, gave him a glass of water, tucked him in, gave him a kiss and as she stood at the door, asked. “Now, are you going to be scared?” “Uh-huh,” nodded the grandson. “Uh-uh,” the grandson replied shaking his head. So, the grandmother turned off the light, “click”, closed the old door… {silence}, and not a peep was heard from the boy until morning.

So, whats the moral of the story? Diagnosis the problem before you intervene!! The grandmother assumed the child was afraid of being alone, and that having company would solve the bedtime issue, but he ended up right back in their bed that night! When all along, it was the creaky door that was the issue!

In the practice of Applied Behavior Analysis, great care is taken in the assessment stage to collect information about the relationship between behavior and the environment. Records are reviewed, caregivers are interviewed, the individual is observed in the natural environment, and –if indicated, a controlled functional analysis may be conducted. The function of behavior must be determined before a successful intervention can be developed. Otherwise, you’re just throwing barnyard animals at the problem!!

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