The Mental Health Provider s Guide to Applied Behavior Analysis

Transcription

1 The Mental Health Provider s Guide to Applied Behavior Analysis 2 CE Hours By: Rene N. Ledford, MSW, LCSW, BCBA Learning objectives This workshop is designed to help you: Assess the distinguishing characteristics of applied behavior analysis. Apply potential applications of behavior analysis services. Explain the basic principals of learning and behavior change from the behavior analytic perspective. Identify basic behavior change procedures. Formulate informed decisions around referrals for behavior analysis services. Introduction Applied Behavior Analysis (ABA) previously known as behavior modification, is the application of operant and classical conditioning to modify human behaviors as part of a learning or treatment process. Behavior analysts focus on the observable relationship of behavior to the environment. Through assessing the relationship between a targeted behavior and the environment, the methods of ABA can be used to change that behavior. ABA shares many of the same goals with other mental health treatment approaches such as family system, psychodynamic, cognitivebehavioral, and solution-focused therapies. All strive to increase understanding of human behavior and help individuals, couples, and families improve the quality of their functioning. Where ABA differs is in its focus on clearly defined, measurable behaviors and their relationship to variables in within the environment. Definition of applied behavior analysis Applied behavior analysis developed from experimental analysis of behavior (EAB), which is the scientific study of principles of learning and behavior. B.F. Skinner, considered the founder of behavior analysis, first coined the term behavior analysis. He distinguished the field from others because of its focus on behavior itself, rather than behavior as a sign of something occurring at another level (e.g., mind). Whereas other disciplines seek to understand and target such things as thoughts and feelings, behavior analysis views biological and environmental variables as key determinants of behavior and behavior change. This focus on environmental events that change behavior is a defining feature of behavior analysis. While there is no definitive description of ABA, some are more accurate than others. Applied Behavior Analysis is a scientific approach to understanding, explaining, describing and predicting behavior. It systematically employs interventions, based on principals of learning, to improve behavior. A distinguishing feature of this field is that ongoing measurement of behavior occurs to both guide decisions about interventions and evaluate treatment effectiveness. As Cooper, Heron, and Heward (2007) define it: Applied Behavior Analysis is the science in which tactics derived from the principles of behavior are applied systematically to improve socially significant behavior and experimentation is used to identify the variables responsible for behavior change. Given that ABA is most often practiced with at-risk populations, some states have also developed regulatory definitions. For example Florida, one of the first states to define practice and establish certification for ABA practitioners, defined the practice of behavior analysis as: The design, implementation, and evaluation of systematic environmental modifications for the purpose of producing socially significant improvements in the understanding of human behavior. Based on the principles of behavior identified through the experimental analysis of behavior. The identification of functional relationships between behavior and environments. Direct observation and measurement of behavior and environment. Contextual factors, establishing operations, antecedent stimuli, positive reinforcers, and other consequences are used, based on identified functional relationships with the environment, in order to produce practical behavior change. Applied Behavior Analysis is also popularly referred to as Intensive Behavioral Intervention. There are actually differences between the two terms, but most parents and lay people use them in reference to an intense program of study for a person, usually a child, which utilizes principles from the field of Operant Conditioning (aka Behavior Modification). A popularly cited study by Ivar Lovaas in the 1980 s showed that the principles of ABA could be Applied Behavior Analysis in an intense program of behaviorally based instruction to treat children with Autism. The study showed that children with Autism could make dramatic progress when receiving a program of instruction of this type. Many techniques are often used in an ABA program; Discrete Trial Teaching (DTT) is one of the primary (but not the only) instructional methods used in ABA programs for children with Autism today. This technique is used to maximize learning and can be used to develop most skills including, cognitive, social, and behavioral, fine motor, play, social and self-help skills. DTT involves breaking down skills into small sub-skills and teaching each sub-skill, intensely, one at a time. It involves repeated practices with prompting and fading of prompts to insure the child s success. DTT also uses reinforcement to help shape and maintain positive behaviors and skills. Teaching in (and with) the natural environment is also a valuable method incorporated into many ABA programs today. As an individual develops, more advanced methods are added to improve verbal and social skills deficits as well. SocialWork.EliteCME.com Page 1

2 Characteristics of applied behavior analysis A paper by Baer, Wolf and Risley published in 1968 outlined the defining characteristics of Applied Behavior Analysis and established criteria for research in the field. These seven characteristics continue to define the discipline today and outline the elements of any ABA program: 1. Applied The behaviors chosen must have some social significance and have immediate importance to the person and to society. 2. Behavioral The behavior chosen must be the one in need of improvement, it must be measured, i.e., the environment and physical events should be recorded with precision, and there must be ongoing reliability checks of the persons conducting observation. 3. Analytic There must be a demonstrated functional relationship between the manipulated events and the target behavior. In other words, there should be clear and convincing evidence, through carefully collected data, that the intervention is responsible for a change in behavior. 4. Technological The techniques that one uses should be described completely enough to allow for duplication by another individual. 5. Conceptually Systematic There should be relevance to established and accepted principles (for example, the principle of operant conditioning.) Clearly describing the procedures and The principles of behavior they relate to helps expand the scope of what is learned and makes it easier to share and teach to others. 6. Effective The program should seek to change the targeted behavior to a meaningful degree and to the degree that is important to the individual and those in his/her environment. ABA also seeks to use procedures that will promote generalization and maintenance of the behavior change. 7. Generality A change in behavior should be seen in a wide variety of environments, or should spread to a wide variety of related or similar behaviors. Applications ABA technology has been applied to a variety of populations, behaviors, and in various programs and settings. There are thousands of published research studies that have demonstrated the effectiveness of applied behavior analysis in improving individual and social conditions. It can address a broad spectrum of human behavior and settings including: Children and adults with mental illness. Addictions. Workplace outcomes such as workplace safety. Autism and related disorders: ABA is widely recognized as a safe and effective treatment for autism. It has been endorsed by a number of state and federal agencies, including the U.S. Surgeon General and the New York State Department of Health. Over the last decade, the nation has seen a particularly dramatic increase in the use of ABA to help persons with autism live happy and productive lives. In particular, ABA principles and techniques can Behavior defined Simply put, behavior is anything an organism does that can be observed and measured. In fact, to be a behavior it must produce a measurable change in the environment. For example, being anxious would not be considered a behavior in ABA terms, whereas handwringing, heavy breathing, or verbalizations like, I am worried about going on that plane!, are measurable events that do produce some change in the environment. A response would be a single instance of behavior. Other examples include: Principals of behavior foster basic skills such as looking, listening and imitating, as well as complex skills such as reading, conversing and understanding another person s perspective. Developmental disabilities and learning disorders. Marital interactions. Language acquisition. Social and leisure skills. Health and fitness. Safety (e.g., motivating safety belt use). Functional skills (e.g., toilet training, activities of daily living). Parenting/child-rearing. Juvenile delinquency. Academic skills/education. Brain injury. AIDS prevention. Volunteering to help. Mowing the lawn. Cutting arm with razor blade. Complaining. Pulling out eye brow hair. Jumping rope. Putting on a seat belt. Procedures used in applied behavior analysis put into practice principles of behavior, which describe the functional relationship between behavior and controlling variables. The concept of operant behavior and operant conditioning are integral to the study and practice of applied behavior analysis. Operant behavior is behavior for which the probability of occurrence is determined by its history of consequences and thus is defined by the three-term contingency, which specifies the temporal and functional relationships between antecedents, stimuli, behavior, and consequences (Cooper, Heron, Heward, 2007). All procedures in applied behavior analysis involve the manipulation of one or more components of the three-term contingency. Next we will look at a few principles of behavior from which many behavior change procedures are derived. Behavior is the result of its consequences In the field of applied behavior analysis, the topography of behavior, (frequency, duration, intensity, etc.) is observed and measured, while occurrence and frequency of any behavior can be explained by, what are called, antecedents and consequences. The antecedent is what takes place prior to the behavior and is not always under the individual s control. The observable consequences of the behavior can often be controlled. The components then of any behavior are as follows: Antecedent: A verbal or physical stimulus that precedes a behavior in time, such as a command or request. This may come from the environment (e.g., extremely hot room), another person or may be internal to the person (e.g., stomachache). Behavior: The response. Consequence: What happens conditional to the behavior, i.e., a stimulus that follows a behavior in time. In some instances the Page 2 SocialWork.EliteCME.com

3 consequence is motivating to the person (e.g., praise, prize, food), in other cases a consequence may include such events as criticism, correction, denial of privileges, etc., which tend to decrease that behavior. For example, let s examine a situation that might commonly be shared in a couple s therapy session: Antecedent Wife asks husband if he will accompany her to the grocery store. Husband says NO. Behavior Wife nags, argues, etc. Consequence Irritated, the husband gives in and agrees to go. The consequences following a behavior determine whether the behavior will occur more frequently or less frequently in the future. In the example, how do you suppose the wife will act the next time her husband refuses a request? Correct, she is more likely to nag and argue because it has worked in the past since the consequence for such behavior has resulted in her receiving something she desired, namely her husband s compliance with her request. This illustrates the principal of reinforcement. Something is said to be a reinforcer if it increases the frequency of the behavior in the future. There are two types of reinforcement procedures or processes: Positive reinforcement: A process whereby an event that immediately follows a behavior serves to increase the frequency of that behavior in the future. Negative reinforcement: The reduction or termination of an aversive stimulus or event immediately following a behavior that increases the likelihood that behavior will occur again in the future. The husband s behavior illustrates the latter type of reinforcement. By giving in he effectively stops her annoying, nagging behavior. If the husband is more likely to acquiesce to his wife s requests when she nags and complains in the future, negative reinforcement is at work because he is more likely to give in to her request in the future so as to stop the nagging behavior. Now, let s say the husband ignored the wife s nagging behavior. If he stuck it out long enough she would stop nagging and give up. By ignoring and not giving her any attention, she is less likely to complain and nag in the future (or she may consult a divorce attorney.) Thus, any consequence that decreases the likelihood of a behavior s occurrence in the future is termed punishment. There are two types of punishment: Positive punishment (also known as Type I punishment): The application of an aversive stimulus or event following a behavior that results in a decrease in the behavior. Although this type occurs naturally in the environment (e.g., spanking, scolding), the formal use of this type of intervention, though very effective in the short term, is rarely used and is governed by strict ethical and legal guidelines. Negative punishment (also known as Type II punishment): The removal of positive reinforcement following a behavior, resulting in decreased likelihood that the behavior will occur in the future (e.g., time-out from reinforcement, point fines, or planned ignoring). The following chart summarizes the relationship between and effects of environmental stimuli and consequences in the process of behavior change. Give (new stimulus presented or added) Take (already present stimulus is terminated or removed) Behavior Change (Fig. 1) Increase Positive reinforcement Negative reinforcement Decrease Positive punishment Negative punishment Types of reinforcers We have already reviewed one principle upon which applied behavior analysis interventions are based; behavior is determined by its consequences through reinforcement or punishment. Since the goal of most behavior analytic interventions is to increase the frequency and/or quality of behaviors, we will focus on key concepts related to positive reinforcement. There are many types of reinforcers. Most people think of food reinforcers if a child performs a task, he earns some M and M s for example. However, behavior analysts not only seek to use the least restrictive and effective procedures for behavior change, they also try to use reinforcers that are most common and naturally occurring in that person s environment. The types of reinforcers include: Primary (AKA unconditioned or unlearned) These are reinforcing simply due to their biological importance and include such things as food, water, warmth, and sexual stimulation. In a state of deprivation they reinforce behavior automatically. Secondary (AKA conditioned or learned) These are neutral stimuli that acquire a reinforcing effect by being paired with other reinforcers. There are four subcategories of secondary reinforcers: Tangible reinforcers An object or activity that increases the future probability of a behavior when presented after the occurrence of behavior. Examples include trinkets, toys, stickers, etc. Activity-oriented reinforcers An event or privilege, such as being able to help the teacher or play a video game. These tend to be cost-efficient and easily man-aged. Social reinforcers Again, this is another cost-efficient and easily delivered reinforcer that is also closest to what would be present in the natural environment. Examples include physical contact (high-fives, hugs), sitting or standing close, or verbal affirmations (e.g., very good! ) and informational praise statements ( Wow, you got that basketball in the hoop on your first try!) Social reinforcement is paired with other types of reinforcers to assist with maintenance of the behavior change post treatment. Generalized reinforcer This type is not dependent on the person being deprived of a specific thing. It can be used to gain access to a wide variety of primary or secondary reinforcers. Our semi-weekly paycheck serves as a reinforcer, as do tokens. Factors influencing the effectiveness of reinforcement A person s history of reinforcement, his or her immediate environment and the level to which he or she is deprived of reinforcer(s) will affect reinforcement. Other critical factors that influence the effectiveness of positive reinforcement to change behavior include: Immediacy The positive consequence must occur immediately following the behavior or it may lose its ability to be rein-forcing. One might also inadvertently reinforce other behaviors that occurred in close proximity to the positive reinforcer. Example: Jenny is told that if she cleans her room she will get to go to McDonald s for dinner Friday night with the family. She does so the next 3 days, then Friday gets suspended from school for spitting on a peer. She is permitted to go out with the family to McDonald s since the mom wants to keep to her bargain. By doing so, it is possible that the school behavior will be inadvertently reinforced. SocialWork.EliteCME.com Page 3

4 Satiation Events and objects may lose their reinforcing value if presented too often or too close in proximity to the previous presentation. Think of the person who gets a job in a chocolate factory where they can eat all the chocolate they want. Doesn t sound convincing to you? Consider this: Example: Jamal is able to earn video game time if he practices his oboe before dinner. There was a substitute teacher at school and they spent most of the day playing video games on their computers. How motivated will he be to practice his oboe today? Individual differences There is a big difference between what constitutes a reward and a reinforcer. Rewards are events and objects that most people would classify as positive. To function as a reinforcer, it must be highly desirable to the individual under study or intervention and more importantly it must actually increase the frequency of the behavior it follows. This is why behavior analysts need to survey clients regarding their preferences and evaluate their continued relevance on a routine basis. Size The size of the reinforcer must be in proportion to the importance of the behavior. Thus, the more challenging and problematic the behavior, the more valuable the reward. Availability of reinforcing consequences One of the challenges to be addressed in developing behavior analysis interventions is to find enough positive consequences to immediately reinforce desired behaviors. In large group settings such as classrooms, for example, this can be particularly challenging. However, there are a number of techniques and strategies available to address this. Contingency Again, in order for an event or other stimuli to function as a reinforcer (or punishment), it must be presented contingent on the occurrence of the particular behavior. If it is easily available at other times, it will lose its ability to increase (or decrease) behavior. Example: Tomas is allowed to watch TV as long as he wishes when his father is home. His parents work different shifts so share just about equally on the amount of time they care for Tomas. His mother is frustrated when she watches Tomas because he continues to refuse to follow directions even when she takes away his TV privilege. Operant conditioning procedures What has been discussed up to this point illustrates the process of operant conditioning. Simply put, operant conditioning occurs when one of two actions take place, either (1) an event occurs following a behavior that increases the probability that the behavior will occur again in the future (reinforcement) or, (2) that behavior is followed by an event which decreases the probability of that behavior s future occurrence (punishment.) Next we will review some principles and methods for changing behavior. Schedules of reinforcement How often a reinforcer is presented following the occurrence of a behavior is called a schedule of reinforcement. Put another way, a schedule of reinforcement establishes the probability that a specific occurrence of behavior will produce reinforcement. There are two main types: Continuous A reinforcer is presented following every occurrence of the behavior. This is most effective for teaching new behaviors or strengthening a very low rate behavior, as it will quickly establish the functional relationship between the desired behavior and reinforcer. If terminated, the behaviors(s) previously reinforced will stop. Example: A child with autism is given a goldfish cracker every time she picks up a block. If that reinforcer is suddenly stopped, after a few tries, the child will also stop picking up the block when directed. Intermittent Reinforcement occurs occasionally, rather than every time. This is most effective for maintaining the occurrence of a behavior. Behaviors that are intermittently reinforced tend to be more stable and more likely to lead to maintenance of the response after treatment. In response maintenance, the person continues to perform the target behavior after interventions are terminated. Example: In the previous example, once the child has learned the relationship between the reinforcer and performance, the ABA practitioner will reduce the frequency of reinforcement and the behavior will probably continue to occur and eventually strengthen. Intermittent schedules of reinforcement vary from simple to complex. Some intermittent schedules reinforce behaviors based on the frequency of occurrence, while others are based on intervals of time between occurrences. They also vary as related to either the actual occurrence of behavior or the occurrence of the reinforcer. Variable schedules are used when constant and stable performance is desired. These simple schedules of reinforcement can be summarized as: Fixed ratio A response is reinforced after a set number of responses. The number of responses necessary to earn reinforcement does not change. A commonly used sales device nicely illustrates this kind of schedule: Example: For every lunch you purchase at a restaurant you get your frequent diner card punched. After every 10 purchases your next lunch is free. The punching of the card can be rein-forcing in itself and would be an example of continuous reinforcement. Getting a free lunch after 10 purchases, illustrates a fixed ratio schedule of reinforcement. Notice that the rate of responding, i.e., the frequency with which you have lunch at this restaurant will increase as you get closer to your free lunch and then decrease again once you get your free meal. Variable ratio In a variable ratio schedule, reinforcement is delivered based on a pre-established variable schedule. So in the example above, the diner might get a free lunch following the 2nd visit, then after 5 visits, then after 10 visits, then after 3 visits. You can see where this would be a more powerful schedule. Fixed interval In a fixed interval schedule, responses are reinforced based on a set period of time between responses. In this type of schedule, the response requirement is constant from one response to the next. Variable interval A variable interval schedule is the most powerful type of schedule. In this schedule, the first response to occur following a pre-determined period of time is rein-forced. Individuals will never know when they will be rein-forced and therefore will engage in that behavior more consistently over time in order not to miss the opportunity for reinforcement. More complex schedules of reinforcement include sequences of simple schedules, such as used in behavioral chaining, simultaneous schedules with one or more responses and differential schedules of reinforcement. Schedules of reinforcement must be thinned gradually to avoid decreased performance. Page 4 SocialWork.EliteCME.com

5 Developing new behaviors There are several procedures used to develop new behaviors including behavioral shaping, behavioral chaining, which links discrete responses in chains to form more complex behaviors, and imitation. We will next look at one of those procedures in detail. Shaping Shaping is a process for teaching more complex or difficult skills that are not currently in a person s repertoire. A terminal behavior that is too difficult or complex to learn all at once is identified. Successive approximations of that behavior are reinforced until the terminal behavior is demonstrated. Generally, the ABA practitioner will do the following in this type of procedure: Select the terminal (target) behavior As with all interventions, the selection of the behavior is an important step. Which one to target is not always clear. Many times there are multiple behaviors needing to be changed. ABA practitioners not only weigh the desires of a person and/or his or her significant others, but also the degree to which this will benefit the person, and his or her own independence, for example, in addition to the chance it will be a behavior recognized and reinforced in the natural environment. Determine the criterion for success Included in the need to identify a clear description of the target behavior, there will also need to be specific criterion for success. Do we consider the person successful once he or she demonstrates the behavior one time? Is the person successful if he or she accomplishes a task but it takes 2 hours to do it? Do we expect this change to last over a period of time? All of these considerations need to be identified from the outset. Perform an analysis of the response class This is done to identify the steps or units of performance required to ultimately accomplish the task or behavior. One type of shaping procedure that many people are familiar with uses behavioral chaining. A common example involves learning to brush teeth. Each discrete step in that task, from gathering the supplies, to rinsing the mouth to putting supplies away, must be clearly outlined. The overall level of proficiency with that set of responses will determine how discrete the steps must be. Identify the first behavior to reinforce The behavior chosen must already occur at a minimum level and it must be part of the terminal behavior the practitioner wants the person to ultimately master. Eliminate interfering stimuli Selecting the time and place for the shaping procedure is important so as to prevent distractions. Trying to teach a child how to write in cursive while other children are in playtime might prove to be a harmful distraction. Proceed in gradual steps and limit the number of steps at each level There is a delicate balance here as the practitioner gauges how much time to spend on each task, when to move on, and when to stay. Continue to reinforce the terminal behavior Reinforcement must continue until the previously mentioned criterion for success is met. Thereafter, the schedule of reinforcement will be thinned so as to promote maintenance of the behavior. Link the terminal behavior to other behaviors Where possible, it would be beneficial to link the new learned behavior to others. For example, the child who learns to write cursively may learn to do so while the teacher is lecturing. A note about fading When we talk about gradually thinning schedules of reinforcement we are talking about a technique called fading. Fading is the gradual removal of artificial consequences that were initially necessary to establish and maintain a behavior. Fading is also used to gradually change the antecedent stimulus, such as a prompt, by presenting or removing it gradually. Decreasing behavior with punishment As described earlier, punishment involves either the application, (or increase in the amount), of an aversive stimulus or the withdrawal, (or decrease in the level), of a reinforcer, contingent on the occurrence of a behavior, which results in a weakening of that behavior. Though extremely effective, behavior analysts remain cognizant of the sometimes undesirable effects of punishment such as: Escape and avoidance behaviors. Countercoercive behaviors in client such as aggression. An increase in the problem behavior in settings and situations where this behavior goes unpunished. Modeling of punishment behaviors. Long term emotional harm. The use of behavior reduction procedures is complicated and should only be conducted by qualified ABA practitioners often with additional oversight by a qualified supervisor. And they should be used in conjunction with interventions to increase appropriate replacement behavior. Many procedures require further approval and oversight by professional committees. Given these ethical considerations, coupled with complex implementation protocols, a full review of these procedures is beyond the scope of this training. Therefore, we will briefly review only a few interventions. Positive punishment Verbal reprimands In treatment, the statements used are thoughtfully planned with consistent, specific statements such as No, Don t do that! and they are used in combination with other techniques that serve to increase desired behaviors. Overcorrection There are several variations of this tactic but generally contingent on the occurrence of a problem behavior, the individual is required to expend effort in a behavior or task that is related to the problem behavior. For example, if the individual writes graffiti on his or her shelter bedroom he or she will have to clean it off the wall and paint the entire room. Response blocking Often used as part of the treatment package for self-injurious behavior, this procedure involves physical blocking of a dangerous behavior. Each time the individual exhibits a problem behavior, the individual is physically blocked from repeating that behavior. For example, as soon as a child pokes her eyes, her hands are blocked with the least amount of physical contact possible. Negative (Type II) punishment Time-out Time-out is the contingent withdrawal of access to positive reinforcers following a problem behavior. Often this procedure fails because there is insufficient positive reinforcement in that person s environment and/or the individual is given or has access to other reinforcement during the procedure. Planned ignoring This is a non-exclusionary type of time out where a consequence is withheld and as a result, some extent of the occurrence of the behavior is less likely to occur. Planned ignoring is a procedure that withholds reinforcement in the form of attention to reduce or weaken the behavior, let s say something like tantrums. If the procedure results in less frequent and/or less intense tantrumming episodes, we can say extinction has occurred. Response cost The contingent withdrawal of reinforcement following a behavior. For example, when you get a traffic ticket for speeding or when a child loses allowance or points for not doing his or her chores. SocialWork.EliteCME.com Page 5

6 Other methods for decreasing behavior There are several other interventions that are used to decrease or eliminate problem behaviors that including: Extinction Extinction is a procedure that discontinues reinforcement for a previously reinforced behavior. It reduces the frequency of that behavior by withholding reinforcement, The role of antecedents in behavior change Differential reinforcement Is used to reinforce behaviors other than the problem behavior so as to decrease and or replace that problem behavior with more functionally appropriate ones, and Antecedent interventions Which essentially promote the persons ability to successfully learn and engage in appropriate behaviors. These include such interventions as giving choices or changing seating arrangements to eliminate temptation to be disruptive. Until the last point we have mainly focused on the role consequences have in establishing, maintaining and changing behaviors. However, as described by the three-term contingency, antecedents always precede responses and they, too, can affect learning, as well as influence the strength of consequences. Stimulus control Stimulus control is the extent to which a behavior changes as a result of the presentation and removal of an antecedent stimulus, which has been established through operant conditioning. One type can be illustrated with the following example: If the wife in the previous example complains and nags fairly often, she may eventually serve as a discriminative stimulus. Whether she complains or not, over time just her presence may cause the husband to retreat and avoid her. Thus, we can say that there is stimulus control because when she is present, her husband s avoidant behavior is more likely to occur. Motivating operations Recent research has focused more on the effects of motivation on learning and behavior change. A motivating operation is an environmental variable that has two possible effects on behavior that appear to a have a strong, though not absolute, relationship with one another. 1. Value-altering: It will alter the reinforcing effect of a stimuli, object, or event. This will result in that stimulus becoming more or less effective. For example, being in a state of deprivation, e.g., extremely thirsty, will make drinking water for someone who doesn t particularly care for water, more appealing. 2. Behavior-altering: It will alter the momentary frequency of all behavior previously reinforced by those stimuli, objects, or events. The behavior will either increase or decrease in frequency, intensity, or latency as a result. For example, a person who is deprived is more likely to drink water to alleviate his or her thirst. A note about generalization Generalization is a term for several behavioral processes and outcomes. It is the spread of the changes in behavior derived from operant conditioning to other conditions or responses not previously exposed to the three-term contingency. There are two major types: Stimulus generalization This is a process where a response reinforced in one situation or in the presence of a particular stimulus increases in the presence of a physically similar but Implementation of behavior change programs With such a wide range of behaviors and individual differences, how does a behavior analyst decide which methods to use? Miller (1997) identified five tactics of behavioral strategy, which helps identify the most appropriate course of action. They include, in process order: Create a behavioral definition of the problem. Use a method for the direct observation of the behavior. Check the reliability and social validity of your observations. Use a single-subject experiment that rules out alternative explanations. Do a visual analysis of the data. At a minimum, when providing ABA services, the behavior analyst should do the following: Develop hypotheses regarding the need for treatment and recommended behavior change procedures. Select behavior change procedures that are based on hypotheses derived from the assessment process and consistent with principles of behavior and published research. Establish outcomes in concert with the client and/or his or her significant others. different stimulus. This explains why children confuse baby ducks with baby chicks or circles with ovals. Response generalization This occurs when an individual emits a response similar to another behavior that has been rein-forced. For example, Sheila has been praised for rinsing her toothbrush and putting it back in the holder after each use. When cleaning the bathroom, she begins to rinse the scrub brush and put it back in the sink cabinet upon completion of her chore. Make establishing and/or strengthening appropriate behaviors a priority if the plan calls for weakening or eliminating a behavior, procedures should be in place to establish or strengthen functionally equivalent behaviors. Identify the natural contingencies that will continue to support he behavior change post-treatment and design behavior change procedures that promote generalization and maintenance. Use various methods to gather, organize and interpret data before, during, and when possible, post-treatment. Graphically display data to guide treatment decisions and to communicate progress with the client and/or significant others. Page 6 SocialWork.EliteCME.com

7 Guidelines for selecting behavior analysts If you feel a client can benefit from Behavior Analysis services, guidelines for ethical practice, call for diligence in selecting and referring clients to an ABA practitioner. Formal credentialing in any profession affords some safeguards for the consumer this should be a consideration when screening for potential ABA providers. However, the demand for behavior analysis services often exceeds the availability of persons with the training and expertise to provide it. Remember that although formal credentialing ensures that an individual has met minimum competency standards, it does not ensure that the provider is a good match for the client or has the expertise with the particular issue or problem the client wishes to address. Likewise, as formal credentialing is relatively new, (in place on an international level only since 2000), there may be providers who are quite competent, but may still be in the process of obtaining certification. Though not all states regulate the practice of behavior analysis, one useful resource may be the registry of individuals at com who are credentialed as Board Certified Behavior Analysts or Board Certified Associate Behavior Analysts by the Behavior Analysis Certification Board. The Association for Behavior Analysis, while it does not credential practitioners, does accredit graduate programs and publishes the Directory of Graduate Training Programs in Behavior Analysis. These graduate programs are often good resources for behavior analysis services. As shared earlier, the practice of behavior analysis is broad. Many individuals may be certified, yet their practice experience may not adequately prepare them to work with all individuals. For example, a practitioner who has specialized in work with children with behavioral disorders would not be sufficiently qualified to work with individuals with autism. The Autism Special Interest Group of the Association for Behavior Analysis has established guidelines for consumers of applied behavior analysis services to individuals with autism and related disorders. They recommend that persons who claim to be qualified provide evidence of meeting the following minimum standards: Certification by the Behavior Analyst Certification Board or documented evidence of equivalent education, professional training, and supervised experience in applied behavior analysis. In addition to certification, at least one full calendar year, (fulltime equivalent of 1000 clock hours), of hands-on training in providing ABA services directly to children and/or adults with autism under the supervision of a Board Certified Behavior Analyst, or the equivalent with at least 5 years experience in ABA programming for individuals with autism. Further, consumers of ABA services should be aware of the following: Attending or giving workshops, taking courses, or getting brief, hands-on experience does not qualify a person to practice Applied Behavior Analysis effectively and ethically. Evidence of attendance and participation in professional meetings and conferences in behavior analysis is desirable; publications in peer-reviewed journals carry even more importance. Consumers who have concerns about the ethical behavior of individuals providing ABA services are strongly encouraged to contact the Behavior Analyst Certification Board in the case of BCBA or BCABA, and discipline-specific licensing boards in the case of those holding professional licensure. Remember that most code of ethics and state licensing regulations require that licensed mental health professionals practice only in areas consistent with their education and experience. ABA interventions for Autism There are a lot of ideas and perceptions about ABA, and many prepackaged plans that ostensibly provide a family with an ABA program. It is important to remember that there is no single program or plan that is ABA. The first step is in determining a child s needs and skill level is assessment. There are a number of assessments available and parents are encouraged to try to get an assessment that is as comprehensive as possible. This could include one or more of the following types of assessments: Diagnostic Assessment: A diagnostic assessment provides information related to your child s diagnosis and is completed by a licensed psychologist. A good clinician will differentiate your child s diagnosis from autism, Asperger s syndrome, or Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS). Diagnostic assessments should be conducted initially and then again each year. Common diagnostic assessments include the Autism Diagnostic Observation Schedule (ADOS), Autism Diagnostic Interview Revised (ADI-R), PDD Behavior Inventory (PDD-BI), Childhood Autism Rating Scale (CARS) and Gilliam Autism Rating Scale (GARS). Developmental Assessment: Norm-referenced developmental assessments provide information about how your child is developing in all areas compared to peers his or her own age. Developmental Assessments measure cognition, communication, motor, adaptive, and social skills. Some developmental assessments such as the Bayley Scales of Infant Development may only be completed by a licensed psychologist. However, other developmental scales may be implemented by anyone with advanced training in assessment. These assessments include but are not limited to The Battelle Developmental Inventory (BDI), Developmental Activities Screening Inventory-Second Edition (DASI-II), Developmental Assessment of Young Children (DAYC), and the Merrill-Palmer Revised Scales of Development (M-P-R). Domain Specific Assessment: Specialized assessments are available for each area of development. For example, a number of assessments exist for the sole purpose of assessing language development. These measures are utilized to determine specific information about a child s delay. For example, a developmental assessment may reveal that a child has delays in language and social skills. Subsequent assessment must then be completed in those areas in order to determine the nature and extent of the delay. You may find it beneficial to consult with specialists to assist you in meeting your child s needs within each domain. Typically speech and language pathologists assist with language and speech issues while physical therapists assist with gross motor and occupational therapists assist with fine motor. Neuropsychological Assessment: Neuropsychological assessments measure cognitive function and can only be administered by licensed psychologists. These measures are more accurate if your child speaks. However, appropriate measures for non-verbal children are available. Criterion-Referenced Assessments: Criterion-referenced assessments provide information about skills that in your child s repertoire. Criterion-referenced assessments are not designed to diagnose or to measure delay but rather to determine what skills your child is able to perform as well as what skills your child should learn next. Criterion-referenced assessments may be completed by anyone with advanced training in assessment. Additionally, criterion-referenced assessments are excellent to use for program development. Popular criterion-referenced assessments include The Brigance, the Assessment of Basic Language and Learning Skills (ABLLS), the Verbal Behavior SocialWork.EliteCME.com Page 7

8 Milestones Assessment and Placement Program (VB-MAPP), and the Hawaii Early Learning Profile (HELP). After the assessment process, there are a number of variations of interventions commonly used by behavior analysts in their interactions with autistic youth: Antecedent manipulation - modification of situational events that precede the target behavior. These alterations are designed to increase the likelihood of success of the targeted behavior. Examples include: prompt/fading procedures, behavioral momentum, contrived motivational operations, inter-trial intervals, incorporation special interests, etc. Behavioral treatment -programs designed to decrease problem behaviors and to increase functional alternative behaviors. Examples include: functional communication training, chaining, discrete trial training, generalization training, reinforcement, shaping, etc. Comprehensive intervention - low student to teacher ratio (1:1,or low as appropriate) in a variety of settings, including home school and community. Effective programs are based on a treatment manual, provide intensive treatment (25hrs/wk+), and include data-driven decision-making. Joint attention intervention - programs designed to teach a child to respond to the social bids of another, or to initiate joint attention interactions. Examples include: pointing to objects, showing items, activities to another, and following eye gaze. Modeling - adults or peers provide a demonstration of the target behavior; the student is expected to imitate. Thus, imitation skills are a necessary prerequisite to this type intervention. Modeling Conclusion is often combined with prompting and reinforcement strategies which can assist the student to acquire imitation skills. Naturalistic teaching strategies - use of child-initiated interactions to teach functional skills in the natural environment. This intervention requires providing a stimulating environment, modeling play, providing choices, encouraging conversation and rewarding reasonable attempts. Peer training - involves training peers without disabilities strategies for interacting (play and social) with children with autism. Some commonly known peer-training programs include: circle of friends, buddy skills, peer networks, etc. Pivotal response training - program designed to target specific, pivotal, behaviors that lead to improvement across a broad range of behaviors. These pivotal behaviors include: motivation to engage in social communication, self-initiation, self-management, responsiveness to multiple cues, etc. Schedules - teaching a student to follow a task list (picture- or word-based) through a series of activities or steps in order to complete a specific activity. Schedules are accompanied by other behavioral interventions, including reinforcement. Self-management - this treatment intervention teaches a student to regulate his or her behavior by recording the occurrence or non-occurrence of the target behavior, and secure reinforcement for doing so. Story-based interventions - involves a written description of the situations under which specific behaviors are expected to occur. The stories seek to teach the: who, what, when, where and why of social interactions to improve perspective taking. The field of Applied Behavior Analysis differentiates itself from other mental health disciplines by its focus on behavior and the interaction between behavior and the environment. In general, behavior is either strengthened or weakened by the consequences that follow. Events preceding behaviors can also have an affect on behavior. There are many human conditions that can benefit from applied behavior analysis services. In order to deliver effective and ethical service, practitioners of behavior analysis must, at a minimum, satisfy both educational training and supervised work experience requirements. Bibliography Association for Behavior Analysis. Baer, D.M., Wolf, M.M. and Risley, T. (1968). Current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis. 1, Behavior Analysis Certification Board Cooper, J.O., Heron, T.E., and Heward, W. I. (2007). Applied Behavior Analysis 2nd ed. Upper Saddle River, NJ: Pearson Prentice-Hall. Florida Department of Children and Families, Florida Behavior Analysis Certification Program. (1997). Task List and Knowledge, Skills, and Abilities List for Applied Behavior Analysis. James, C.L. (2002). The Teaching Oriented Model Pre-Service Manual. Lexington, NE. Innovative Teaching Systems. Michael, J.L. (1993). Concepts and Principles of Behavior Analysis. Kalamazoo, MI: Association for Behavior Analysis. Miller, L. K. (1997). Principles of Everyday Behavior Analysis. Pacific Grove, CA: Brooks/ Cole Publishing Company. Page 8 SocialWork.EliteCME.com

9 THE MENTAL HEALTH PROVIDER S GUIDE TO APPLIED BEHAVIOR ANALYSIS Final Examination Questions Select the best answer for each question and then proceed to SocialWork.EliteCME.com to complete your final examination. 1. ABA systematically employs, based on principals of learning, to improve behavior. a. Interventions. b. Critical junctures. c. Behavioral responses. d. Rehabilitation. 2. In ABA, the behavior chosen must be the one in need of improvement, it must be measured, i.e., the environment and physical events should be recorded with precision, and there must be ongoing reliability checks of the persons conducting. a. Research. b. Placebo data. c. Observation. d. Well-being checks. 3. is behavior for which the probability of occurrence is determined by its history of consequences and thus is defined by the three-term contingency, which specifies the temporal and functional relationships between antecedents, stimuli, behavior, and consequences. a. Observant behavior. b. Junk behavior. c. Sustainable behavior. d. Operant behavior. 4. The reduction or termination of an aversive stimulus or event immediately following a behavior that increases the likelihood that behavior will occur again in the future. a. Positive reinforcement. b. Negative reinforcement. c. Reduction intervention. d. Shaping intervention. 5. A response is reinforced after a set number of responses. The number of responses necessary to earn reinforcement does not change. This is called: a. Fixed ratio. b. Intermittent ratio. c. Operant ratio. d. Response ratio. 6. is a process for teaching more complex or difficult skills that are not currently in a person s repertoire. a. Shaping. b. Positive reinforcement. c. Negative reinforcement. d. Modeling. 7. is the gradual removal of artificial consequences that were initially necessary to establish and maintain a behavior. a. Retraction. b. Fading. c. Fracking. d. Negative consequences. 8. is a procedure that discontinues reinforcement for a previously reinforced behavior. It reduces the frequency of that behavior by withholding reinforcement. a. Extinction. b. Negative reinforcement. c. Positive reinforcement. d. Reduction. 9. A is an environmental variable that has two possible effects on behavior that appear to a have a strong, though not absolute, relationship with one another. a. Motivating operation. b. Behavioral variable. c. Behavioral factor. d. Shaping. 10. programs designed to teach a child to respond to the social bids of another, or to initiate joint attention interactions. Examples include: pointing to objects, showing items, activities to another, and following eye gaze. a. Peer trained. b. Story telling model. c. Joint attention intervention. d. Tangible intervention. SWUS02BA15 SocialWork.EliteCME.com Page 9