I get lots of requests for information from people outside of the field of ABA, like speech therapists, educators, psychologists, social workers, etc. Which is surprising, but pretty cool.

There are many, many professionals who regularly come into contact with BCBA's, and would like to learn more from these BCBA's, but are not quite sure the best way to do so.
Trust me, I understand: sometimes the way BCBA's speak or behave can be confusing to people outside of the field. In our defense, most of us spent our days talking to other ABA professionals and so our ability to collaborate across disciplines or to explain concepts simply can get rusty.

Print out and share the handout below with anyone you think could benefit from this information, or maybe had a previous negative experience interacting with a BCBA.
ABA conferences and journal articles can be daunting if you are not in this field, so the best way to learn about ABA is to chat up the BCBA. So please allow me to help make that chat easier!

*Free Handout: Knowing What to Expect From a BCBA

Maladaptive - Incomplete, inadequate, or faulty adaptation; unsuitably adapted or adapting poorly

I had a colleague once who brought to my attention that our supervisees seemed to love to throw around the word "maladaptive" in their reports. It had almost become like a buzzword for saying "inappropriate". Like, "maladaptive tantrum behavior" or "maladaptive social functioning". My colleague's response to this was genius, IMO, and changed the way I view this word: Maladaptive to who?? 
As in, the client's tantrums are maladaptive...to who? The client's toy throwing is maladaptive...to who??? Certainly not the client.

See, the word maladaptive implies that there is something defective, or wrong, about the behavior. However, to the person engaging in the behavior it is very much serving a purpose and meeting a need.

So if I am 4- year- old little Tara and I cannot readily communicate, I now have to come up with some other way to get what I want. Oh I know, how about screaming? If screaming leads to adult attention, followed by accessing things I want, then how exactly is my screaming maladaptive?

Before throwing around buzz words, or using overly technical language to sound impressive, try thinking through what you really mean to say when describing behavior.

The irony is I think it's extremely "adaptive" to come up with a method to be understood. ;-)
Kids are so much smarter than we give them credit for, whether or not we like what they choose to do.

Clearly, when I think of "reinforcing" I think of doughnuts.

Positive reinforcement has lots of precise definitions, but a very simple way of understanding it is: why you do it again.

After buying your wife roses once, why do it again?
After visiting an exclusive spa, why do it again?
After having 1 bite of delicious ice cream, why do it again?

We do something again, because of reinforcement. Something reinforced, or strengthened, our behavior to drive us to repeat the behavior seeking to contact that same reinforcement.

Whether you came to this blog as a parent or professional, we all should a common goal of seeking to build upon or expand reinforcers.

Reinforcement is the reason why my clients learn what words like "Match", "Sort", or "Give me" mean. It's why they choose to use language rather than hit me when I upset them. It's also why you got up and went to work today, and why you answer a ringing telephone.

For most of the kids I work with, when I first meet them they have minimal reinforcers. They often spend their time wandering around the home, making noises or sounds, engaging in repetitive behaviors that adults quickly redirect, and being heavily dependent upon other people to make fun things happen.

Through intervention combined with valuable systems of reinforcement, these same kids learn to:

- request desired items or activities, instead of angrily crying until someone figures out what they want
-replace harmful behaviors with hobbies, skills, or leisure activities
-let someone know when an activity is boring, or when they just don't want to do it anymore
-get another person to engage with them, play with them, or talk to them

It's very easy to focus solely on teaching skills or reducing problem behaviors. These things are important. Highly important. But a life is not built upon performing skills, or keeping your hands to yourself.
If someone went to your home and removed every activity or object you find reinforcing (cell phone, coffee, laptop, a good book, etc.), you probably would not want to live in that home anymore. It might start to feel more like a prison or jail, than a home. Okay....so think about how a child with special needs may feel when they have so few reinforcers that they are allowed to contact, or know how to request. Sounds like a pretty dull life, doesn't it?

Intervention should be about more than just fixating on deficits, it should also look to improve overall life functioning. I know for my life, my reinforcers are pretty darn important to my overall satisfaction, mood, and temperament. I'm guessing it's the same for your life.

Building a history of reinforcement, builds an enriched life. As you are working on teaching your child, student, or client to tie their shoes, say "please", or complete math problems, I'd also suggest systematically working to increase their reinforcers, which improves quality of life.

*Suggested Reading: "The Hidden Curriculum for Understanding Unstated Rules in Social Situations for Adolescents and Young Adults"

The hidden curriculum can be defined as those invisible and unspoken rules of  society/community that we are all expected to follow, and often face negative reactions for failing to follow.

Examples? Sure:

*During checkout, the cashier may ask if you found everything ok. It's a way of being polite. They do not expect you to say "No, I couldn't find milk, eggs, flour, or lemons. Come help me find them"

*It's fine if a toddler on a plane is loudly singing the ABC song to himself. If he's still loudly singing 10 minutes later, his parents will start getting some very angry looks from other passengers 

*Do not ever get onto an elevator and stand with your back to the door, directly facing the other people on the elevator

*When you see a "free samples" sign, it is fine to take one. It is much less fine to take 5

*Any look towards another person that exceeds a few seconds is considered "staring". People may make an odd face at you if you don't break off the stare when they catch you

And on, and on, and on.

Teaching play skills? Sure, we have a program for that. How about language? Not a problem. Toileting? Of course. But the difficulty with teaching hidden curriculum is in its very unclear shades of gray. If typically developing adults have a hard time navigating invisible social waters, then how well do you think a child with Autism will do?

I think another difficulty with teaching in this invisible domain of social skills, is trying to do so within a structured therapy session. Social skills don't always fit into neat boxes, or a jam-packed therapy session from 2-4. To work on these areas of gray we need to go OUT THERE.
Out there is simply into the child's community, where they live, work, play, or attend school. It is often through being out and about with my clients that I see areas of deficit I was previously unaware of, and think to myself "Ooooo, we need to work on that".

Yet another difficulty with teaching in this invisible domain is that the wrong answer is not always obvious. Just think of someone you know who is a bit abrasive or loud. At social gatherings, you can see other people giving each other the side eye, obsessively checking their watch, or clearly saying lies to leave a conversation with that abrasive or loud person. But does the person seem to notice those cues? Not always, no. Unless someone plainly says "Hey look: you are shouting and spraying spit on my shirt, and you're also kind of ignorant and boring. I don't want to talk to you anymore", that person may never truly understand how others perceive them. And it's unlikely that will happen, because it would be extremely rude to tell someone that! So the person does not get the blunt feedback they need, because to give that blunt feedback would make the other person seem abrasive and rude.

Social skills are difficult. Like, Jenga difficult.

So what can be done?

  • Realize that this invisible area of social development will not magically descend upon your child like fairy dust. It will likely need to be taught, very intentionally, and with lots of generalization/real life examples.
  • Don't expect it to be easy, or simple. It won't be.
  • As much as you can, expose your child to same age peers. I spend a lot of time at work watching kids interact, and the results can be hilarious. Kids say things adults would never say, but that kids with poor social skills need to hear. Like: "Oh my GOSH you already said that like 4 times! I don't care".
  • Evidence based strategies such as video modeling and social strips/social stories can be particularly helpful to break down complex social skill instruction, particularly if the learner has the communicative and cognitive ability to follow a story.
  • Stop being so nice to your child. I'm not saying be a jerk, but the honest feedback your child gets on the playground won't exactly be dipped in sugar first. Practice giving in the moment feedback when your child interrupts someone, stands too close, or smells like they need a shower.
  • If you are already receiving ABA therapy services, ask if social groups are an option.
  • Make sure your child understands that social rules are a complicated matter. Almost every social rule has an "except when...." caveat. This is not a concept that will be helped by black and white thinking; flexible thinking will be key.

For more information about Hidden Curriculum, look for the publications of Brenda Smith Myles

Photo source: www.pinterest.com

There are many reasons why I stop working with clients: sometimes they move, they lose their funding, they improve to the degree they no longer need for my services (oh happy day!), or for personal reasons the family needs to take a break from treatment services. Then there is another category of why people quit therapy, it's like that dark, wooded area in the back of the park that no one likes to talk about.

Sometimes clients halt treatment because they started ABA services expecting Happiness, and instead all they got was Therapy.

Maybe you are a parent who tried ABA therapy for your child, but to your surprise, the child cried a lot. Or their behaviors grew worse. Or tantrums grew more severe. You probably thought to yourself, "Hey! What's going on here? This is not what I signed up for". Actually, it is.

Now's a good time for a disclaimer:

"Therapy" is a treatment intended to help alleviate symptoms of, or to relieve the more debilitating impact of, a particular issue, challenge, disorder, or disease. Therapy is not synonymous with being treated poorly, being treated unethically, or being convinced you need something that you really don't need. If you had bad, poor, or horrific experiences with therapy, it's likely that was not actually therapy, rather it was some unethical and harmful service being sold to you as a therapy. 

End disclaimer.

Now that we have a solid definition of therapy, what should parents realistically expect when initiating any new therapy (occupational therapy, speech therapy, ABA therapy, mental health counseling, etc.)?

*Difficulty - Therapy is difficult because areas of deficit are being targeted. The very things selected to work on are things the client either cannot do, or cannot do well.
*New challenges - By its very nature, therapy must challenge the client. If therapy does not push/challenge the client, then that is not real therapy.
*Resistance - All the science geeks: you know that every action has an equal and opposite reaction, right? Okay, so what happens when a therapist challenges the client in an area that is already weak? It's called resistance. Or the ABA team may refer to it as, problem behavior.
*Commitment Requirement - ABA therapy is not a free sample at the grocery store, or a trial sized bottle of shampoo. You get out what you put in, and commitment is required for progress to stick around. Canceling sessions, starting sessions late, continuing to reinforce problem behavior, or comforting the child through a tantrum, will all have an impact on the overall effectiveness of treatment.

Do you see happy in that list? No. 
Does that mean I'm saying therapy is all bad, all the time, and you and your child will hate it? Definitely not. 
But what I am being very intentional in saying is that the GOAL of therapy is not "happy". The therapy team will develop many treatment goals (and that process should include you as the parent) designed to improve quality of life, and quality therapists do strive to be fun, engaging, exciting, animated, and playful so that therapy sessions are reinforcing. What we do not strive to do, is keep your child happy all the time. There will be sessions with tears, or tantrums, or angry throwing/ripping of therapy materials. This does not shock us as treatment professionals, nor should it shock you as the parent. 

Treatment is hard. Treatment will take you out of your comfort zone. Treatment will push your boundaries. Treatment will impact the whole household, not just the child receiving therapy. Significant gains must be accomplished through significant amounts of work. The therapist will work hard, you the parent will work hard, and your child will work hard. If this is sounding unreasonable to you, or unacceptable, then it's likely therapy is not a good choice..... And that is okay. 

What's most important is knowing the reality of therapy, what it is and is not, before you jump into it.

Photo source: www.tombruetttherapy.com

Photo source: www.linkedin.com, www.chicagotribune.com

*Recommended post: Professionalism

Confrontation is not a bad word, but it sure makes people UN-comfortable.

As BCBA's/therapists/ABA professionals, the need to confront an issue is pretty much a job requirement.
If you're a RBT, you may find yourself needing to confront your BCBA. If you're a BCBA, you may need to confront a parent of a client.

None of us are really exempt here, unless you are totally cool with people walking all over you. If that's fine with you, then I wish you the best of luck and you can stop reading now.

For the rest of us, part of being a professional will involve having to resolve conflict or disagreement with other people in a respectful way. As in, having to arrange a sit down meeting between THAT parent and the ABA team over issues that have been simmering for weeks. Yeah.....super not fun.

No one really told me pre-certification that a big part of my job would be conflict resolution, but it kind of is. On a regular basis. Not just when things completely fall apart, but longgg before they reach that point.

I've learned from experience that the way you approach resolution can either guarantee a disaster or help prevent one. Here's what I mean:

To confront, means to face up to or deal with a difficult situation or problem.

To establish and maintain boundaries, means to mark or designate a dividing line; to clearly set a limit.

Wow. Those definitions make things pretty clear. It's a far more effective use of your time, not to mention less stressful, to focus on communicating your boundaries, than to ping pong from one confrontation fire to the next.

So as a professional, how do you establish and maintain boundaries to avoid reaching a place where you now must confront someone? By thinking through the following:

Where do I draw the line as an individual professionally, both personally (unique personal preferences) and ethically?
Once I have decided on my "boundary lines", which of these will I die for? (translation: which boundaries are the most critical)
How am I doing at clearly informing people about my boundaries?
Do I let people know when they have crossed a boundary (follow up: Then how will they know??)?
When someone repeatedly crosses a boundary I have made clear, how do I resolve the issue calmly and quickly?
If someone repeatedly crosses my boundary, is the problem with my boundary? Is the problem with me? Or is the problem with them?

Over the years, I've had angry and tight-lipped confrontations with supervisors, employers, supervisees, and parents/caregivers of clients. I have also clearly explained my boundaries, and then quickly alerted someone when they crossed/stepped on one. I much prefer the latter.
Especially for an ongoing relationship, like a supervisor you work with across multiple cases, it's better to win the relationship than to win the argument.

Just to name a few examples, as an ABA professional it's important to define for yourself where your boundaries are regarding:

  • Types of clients you will serve
  • Schedule/Availability (desired work load)
  • Training/Learning preferences
  • Communication/Correction preferences (this one is a biggie)
  • Opportunities for promotion/raises/recognition
  • Multi-disciplinary collaboration
  • Dealing with uninvolved or resistant consumers/clients
  • Creating that work/life dividing line; Maintaining balance

Instead of spending energy on very impressively worded (we do love our jargon, don't we?) confrontations, choosing to have a respectful discussion about boundaries moves you closer to maintaining the relationship.
If people don't want to work with you, even if you won the argument you definitely lost the war.

Photo source: www.addicted2success.com

*Recommended Reading: Getting Parent Buy-In

Trialability - The degree to which an innovation is perceived as better than the idea it supersedes; how easily potential adopters can explore the innovation. 

Trialability basically refers to "How much will it cost me to give this a try?".
ABA therapy can be a difficult thing to "try". It isn't like tasting a food sample at the mall, or watching the first 5 minutes of a new sitcom to see if you like it. The costs of ABA are many, and for some, quite high.

To name a few, ABA therapy will demand:
Time, Materials, Mental Energy, Physical Energy, Training, Working Through/Past Discomfort

As professionals, we do consumers a disservice when we do not properly enlighten them, from the onset of services, of the hard work that is necessary for ABA therapy to be effective. I have worked with families who started treatment with a "Ok..guess we'll try this" kind of attitude, and to put it nicely: we didn't work together very long.

Am I saying every consumer needs to be an ABA expert before they pursue treatment? No. But its like training the body for physical exertion: jumping in with a minimum level of commitment will almost certainly lead to quitting as soon as things get tough or painful.
Photo source: www.rocketcitymom.com

What causes some problem behaviors to rapidly escalate in regards to severity/intensity, duration, or frequency? What is pumping these behaviors up?

I usually don't meet potential clients when problem behaviors are mild, occur sometimes, or are of low intensity. I don't hear a lot of statements like "She rarely tantrums, it's not that big of a deal.....We'd appreciate some help though. When you get around to it". Nope.

Far more often when people reach out for help it is because that annoying or frustrating problem behavior that started off small, has now pumped up into this Goliath -size problem that may or may not be occurring across settings. The behavior has become such a challenge, that it's clear professional help is needed.
The child used to tantrum, and now they tantrum AND bite. Or the child used to refuse to eat peas, now they won't eat anything green OR round in shape. Etc., etc.

So what happened? Most likely 1 of 2 things. Or 2 things (Just one can happen, or both can happen):

#1 The problem behavior was fed, and/or #2 Nothing else was.

Want me to elaborate? Well, I'm going to anyway.

Thing #1 - Problem behaviors grow or stick around based on what maintains them, or the available reinforcement . So giggling when your toddler throws a spoon during dinner, or buying your son a candy bar at the store because he started screaming....these things likely do not seem like reinforcement at the time, but if the behavior begins to increase then reinforcement is doing its magic. Here is a particularly unpleasant little chain of events I see often: The child cries when told to clean up toys, and mom or dad ignore and keep the demand on. The child flops to the ground and screams when told to clean up toys, and mom or dad ignore and keep the demand on. The child punches mom or dad in the legs when told to clean up toys, and mom or dad.....yell "No! Don't you hit me" and lecture the child and forget to keep that demand on. Uh-oh. What usually happens next in that scenario is the child has now learned that the quickest and most efficient way to get out of that dreaded clean up task is to punch mom or dad pretty hard. THIS is how super intense problem behavior can seem to appear overnight. I know its hard, but you have to be careful not to give a big reaction when your child suddenly increases the intensity of their problem behavior. We professionals see this from time to time in our therapy sessions, but we know if we "ride that wave" and just hold on, the new problem behavior likely won't stick around.

Thing #2 -  Persistent problem behaviors are trying to tell you something. It can require some detective work , but it will so be worth the effort to get to the root of the problem. Is your child trying to gain your attention? Are they hoping to avoid a challenging task? What about wanting you to give them something in a public place? This might help you when addressing problem behavior: remind yourself that underneath the behavior is a valid need. Buried underneath the tantrum, or spitting, or ear-splitting screams, your child is expressing or requesting something. The tricky part is determining what the heck that is! When problem behaviors suddenly seem to pump it up out of nowhere, think of that as your child saying, "Wow, what do I have to DO to get this need met??!". Here is another unpleasant little chain of events I see often: Mom or Dad successfully get rid of problem behavior A, and then the child begins problem behavior B. Mom or Dad successfully get rid of problem behavior B, and then the child begins problem behavior C. Mom or Dad....... are you seeing the pattern? The child keeps pulling out new variations of the problem behavior because the underlying root of the problem has not been addressed. And if it hasn't been addressed, then how can be it strengthened/reinforced so it will stick around? Learning new skills goes hand in hand with behavior reduction, because you don't just want to teach the child what to stop. You also want to teach him/her what to start.

Being careful to address thing #1 & thing #2 when evaluating problem behavior makes its far less likely you will end up in a situation where the behavior balloons up to a huge issue, seemingly overnight.
When in doubt, reach out for professional help. A qualified professional can work with you to reveal how multiple small steps along the way worked like multiple strings tying up into a huge knot, and then help create a plan to untangle that knot.

*Recommend Resource: ABA Inside Track discuss Functional Communication Training, which is a great tool for reducing problem behaviors

If you're an ABA professional then you're likely already familiar with BST (Behavior Skills Training). If you are not, here is an amazing resource link to get up to speed.

The 4 basic steps of BST are as follows: Instruction, Modeling, Rehearsal, & Feedback.
Lather, rinse, and repeat as needed.

I LOVE utilizing BST with supervisees and direct staff, but also when intensively targeting parent training. Such as with a case that has low hours, so instead of traditional therapy we utilize more of a parent coaching model.
BST is super effective, and makes you look like a genius who can teach anything to anyone. If it sounds like I'm overselling, shut up. No I'm not. BST really is that amazing.

If your parent training strategies could use some help, or aren't always super effective (particularly in producing long lasting change) then keep reading for some rock star parent training tips!

Here is each BST step explained in a bit more detail:

Instruction – You are most likely already doing this. Put simply, this is telling the parent what to do. The problem is, many professionals start and end at this step. As in, "Well I told the parent what to do like 8 times already, but they still aren't doing it!". Effective teaching should include more than just telling
Modeling – Put simply, this is SHOWING the parent what to do. I need to go beyond just putting up a visual, or walking the parent through a transition, as much as possible I need to show the parent what to do with their actual child, in the actual target situation. Meaning, if I am teaching the parent how to reduce meltdowns at Publix, then we need to go to Publix. 
Rehearsal – How often do we (I'm including myself here) forget about this step? This is one I have to remind myself to do, because my tendency is to jump in and model, but then I neglect to allow the other person to practice while I watch. If you're like me, you have already learned that skipping this step is no bueno. We all like to practice new behaviors to ensure mastery, especially complex behavior chains. And most of the things you teach to parents will meet the criteria of a complex behavior chain. 
Feedback – This last step also can be overlooked, or forgotten. I find that most of my supervisees struggle with giving immediate feedback. Meaning, tell the person what to correct while they can still change it. Don't wait until the parent has completed the entire toileting procedure with their child to tell them they did the 1st step wrong. That's extremely frustrating! It also makes it more unlikely that the parent will perform the behavior correctly when you are not around, because you just let them practice errors. Just like we do with our clients, be sure to provide both positive praise statements and corrective feedback. 

Here are a few examples of BST in action:
Behavior: Transitioning child to therapy table
Instruction: Explain to the parent exactly what they need to do. Be sure to ask for questions, and answer them fully
Modeling: Show the parent exactly how you want them to transition the child
Rehearsal: Say to the parent "Your Turn". Observe closely
Feedback: Both in the moment and once they are done, give the parent specific information about what went great and what needs improvement. Skip the jargon, or define any terms used. Also be sure to ask the parent where they need more help, or if any part is confusing

Behavior: Implementing a Manding Trial with the child
Instruction: Explain to the parent exactly what they need to do. Identify needed materials. Be sure to ask for questions, and answer them fully
Modeling: Show the parent exactly how to run a Manding Trial
Rehearsal: Say to the parent "Your Turn". Observe closely
Feedback: Both in the moment and once they are done, give the parent specific information about what went great and what needs improvement. Skip the jargon, or define any terms used. Also be sure to ask the parent where they need more help, or if any part is confusing

If BST makes parent training ridiculously easy, then its always effective all the time, right? Wrong. Here are some common parent training pitfalls I see all the time, that can hinder the effectiveness of your BST procedures - 

Common Parent Training Errors

  1. Not enough training examples: The child regularly has meltdowns at grocery stores, so you spend 2 hours inside a Publix with the parent. Whew....they should never have that problem again. Ummm, no. What about when the child has problem behaviors at Kroger, or Sams Club, or Whole Foods? Each store is different and may have differing maintaining variables, so the parent will likely need practice in each store. If this is not possible then at least during the instructions phase talk the parent through how to address the behavior across different settings.
  2. Not enough practice: Very closely related to the previous point, is letting the parent briefly jump in for rehearsal and then immediately you take over the session again. When I see this with my staff, I usually say to them: "YOU are not the one who needs to learn this. You already did that". Remember who the student is in parent training (the parent). They need lots and lots of practice under the watchful eyes of the team, on an ongoing basis. 
  3. Letting the parent practice errors: Would you let your client practice errors? No, right? Well then why would you sit back and let the parent practice errors? Errors impede learning. Sometimes staff allow this because they feel too awkward or hesitant to correct the parent. Again, would you correct your client? Then what is the difference? You are teaching the parent a new behavior, and in order to learn effectively they need error correction procedures.
  4. Failure to teach concept of Reinforcement: This is a big one. Many times when I follow up with a parent about their parent training I hear, "He/she just won't do (target behavior) when you guys aren't around!". Further digging usually reveals what the actual problem is....their child expects to contact (gasp!) some reinforcement for their behavior. Many parents do not understand this, and so they approach the child outside of therapy sessions with a complex and difficult demand, that can earn...nothing. Not surprisingly, the child immediately kicks off problem behaviors. Take the time to make sure the parent understands reinforcement is the glue that makes behaviors stick. It needs to be immediate, differential, and valuable to be most effective.
  5. Failure to select socially valid parent training goals: Yes, parent training should have goals like any other intervention. This is the #1 error I see, so I'll discuss it last. As the BCBA/supervisor do you tell the parents what their parent goals are? I hope not. Social validity basically means that the individuals/stakeholders requesting the treatment agree that the treatment is important and helpful to them. In order to do that, I have to work together with the parents to create parent training goals. This also provides opportunity to identify unrealistic goals ("I want her to always be happy"), or to help parents understand how concretely a skill needs to be broken down to intervene on it. If the parent you are working with has no input on parent goals, or refuses to participate in the goal selection process, then unfortunately, you have a bigger problem on your hands.

Bottom line: If the parents cannot produce the same, or at least similar, behavior change results as the ABA team when they are alone with their child then parent training needs to be modified. It needs to be revised, increased, or a common pitfall has not been addressed yet. The same way you wouldn't blame the learner for not learning, you shouldn't blame the parent for ineffective parent training. Review the BST guidelines, and come up with a new plan that works for the parent.

You can call it motivation, drive, desire, "the big payoff", or any other name, but Motivating Operations, or M.O., basically refers to the invisible and frantic magical fairies hidden underneath your behavior and secretly impacting why you do what you do.

For ABA practitioners, why is this such an important concept to know about, understand, and then apply nearly every day? Take a look at this example:

Example A- ABA therapist arrives at child's home for therapy session, immediately walks in to child tantrumming for popcorn and not wearing any pants. Therapist silently redirects the child away from the kitchen to the therapy room and prompts the child to put their pants on. Therapist then prompts the still screaming child to sit at the therapy table, and begins teaching. Multiple fully prompted trials later, the child earns a break. The therapist offers a choice between Legos and playing with clay. The child chooses neither. The therapist then prompts a forced choice of going outside. Outside the child is whining, irritable, and repeatedly attempts to run back into the house. The therapist blocks and redirects all attempts to go indoors, and tries several times to get the child interested in playing basketball using full physical prompting.

If this example summarized just the first 20 minutes of the therapy session, how do you think the session would go overall? Pretty not great would be my guess.
Now, take a look at this example where the therapist constantly followed or contrived the child's motivation:

Example B- ABA therapist arrives at child's home for therapy session, immediately walks in to child tantrumming for popcorn and not wearing any pants. The therapist uses this opportunity to target manding, and asks the parent to give her the popcorn. The therapist then shows the child the popcorn, models the label ("PUH- POPCORN"), and withholds the popcorn. After the child successfully mands and receives some popcorn, the therapist puts more in a baggie and says "Come with me, and you can have more!" and walks to the therapy room. The child quickly follows. Once in the therapy room the therapist takes some moments to interact and pair with the child before beginning instruction. At the therapy table, the child works well to earn more popcorn. The therapist offers a choice between juice (the popcorn likely made the child thirsty), or Legos. The child chooses juice. The therapist explains "FIRST pants, THEN juice". The child complies with putting pants on, in order to get some juice. Once in the kitchen the therapist lines up 3 kinds of juice so the child can choose which one he wants. The therapist then pours a pretend cup of juice, and gives some to a baby doll everytime the child drinks. The child laughs, and then wants a turn giving the doll juice. 

Are you seeing the differences? No? No worries, I'll point them out:

  • Successful therapists think on their feet - You will not always work with your clients in the most ideal circumstances. That's life. A big part of what I do is being able to quickly scan a situation, alter my game plan based on what I see, and then alter my game plan some more based on how the child responds. You can't get stuck in tunnel vision where all that matters are your session goals. What if materials are missing? What if its a parent training session and they aren't home yet? What if the grandparents are in town and want to watch the session? You have to roll with it!
  • Successful therapists know when to let a kid have a bad day - So you get to the home and the child is half naked and screaming over popcorn. Are they not allowed to have a bad day?? When you're angry do you always want to wear pants? I didn't think so. Don't make the mistake of arriving to the session and thinking its your job to immediately get things under control. What does the child learn from you prompting them straight into work? Why not use the real life situation unfolding in front of you to teach communication, or to teach the parents how to handle the behavior themselves? We can allll-ways squeeze in more Parent Training. 
  • Successful therapists ALWAYS think about "What does the client get out of this?"- I don't present any instruction or directive to my clients without first establishing in my mind why they should do it. Compliance for the sake of compliance is great, but just like the rest of us most of my kiddos need a reason to clap hands....or come upstairs...or walk with me. Are you just barking out orders to your clients, or are you making sure they are aware of what reinforcement waits right behind your demands?
  • Successful therapists can take the written programs and embed them into any task - This is something I spend a lot of time helping my staff improve upon, because I think it is one of the most critical things they can learn. Teaching is not just what occurs when you are reading SD's off your data sheet. Teaching can happen anywhere, anytime. Part of thinking on your feet will require that you develop the skill of making anything therapeutic. This means being able to alter your original game plan but still keep your original goals in mind. It also means doing what the child wants to do, and ninja-sleuth style sneaking your targets into it. NOT blocking the child from what they want to do and prompting them to do your thing. 
  • Successful therapists focus on relationship, more than trials: Which is more important at the end of the therapy session, that your data sheet is fully completed or that the child is calm, engaged, and excited about you returning? I can hear you saying, "Well, can I get both of those?". Mmmmm, not always no. Sometimes you may run less trials then you need to, or spend less time at the therapy table, or not even probe some of those new targets. But, you get some amazing eye contact while playing with bubbles, or the child reaches for your hand as you walk down the hallway, or you get to show the parent a better way to get the child to stay seated during lunch. Your job is far more than filling out a data sheet.

Getting this concept of motivation (I mean really getting it), and knowing how to follow/contrive motivation will help any ABA practitioner be more effective, have less aversive relationships with your clients, and lower stress or frustration when therapy sessions get chaotic

Whenever one of my staff calls me up after a session to tell me how horribly it went, after some digging and open-ended questions, what I usually hear are a series of missed opportunities to capture motivation and use it wisely. In other words, the client was definitely motivated to do some stuff....just not any of the stuff you wanted them to do. Instead of using that, the staff just implemented a lot of heavy handed prompting. 
Is the client desperately clinging to Mom? Have Mom join the session. A sibling is having a loud play date just down the hall from the therapy room? Let your client work for breaks to go join the play date. Dad is in the kitchen baking amazing- smelling- yet- totally- distracting cookies? Have the client join Dad and help cook, while also targeting fine motor (mixing), one step directions ("Get the spoon") and self-help skills (pouring a cup of milk). 

Don't fight against your clients M.O., use it!

*References/Recommended Reading:

Langthorne, P., & McGill, P. (2009). A Tutorial on the Concept of the Motivating Operation and its Importance to Application. Behavior Analysis in Practice2(2), 22–31.

"The White Book", chapter 16

Copyright T. Meadows 2011. All original content on this blog is protected by copyright. Powered by Blogger.
Back to Top