He squeals loudly and lets all of his body weight collapse to the floor (“flopping”), as he covers his face with his hands and hums to himself. He is still for several seconds, making quiet humming sounds. Then he suddenly stands up, looks around the room and darts toward the front door. A parent quickly runs over to keep him from trying to leave the home, and steers him back to the living room by his shoulders telling him “We’re staying in here”. Once back in the living room, within a span of several minutes he repeatedly tries to jump on the couch, eat lint from the carpet, and stand on the coffee table. All of these attempts are interrupted or blocked by a parent. Throughout the entire observation, he makes continuous vocal sounds, some sound like “eeeeee-eeee” and others are short, high - pitched squeals or shouts (“Ahh!”).

This is a brief scenario describing a client I observed recently during an intake, but really these descriptors could describe multiple children I work with…bounces, climbs, puts items in mouth, quick and sudden movements, crawling or laying on the floor, vocal sterotypy, etc. These are often referred to as “sensory issues”, “unmet sensory needs”, “sensory seeking/avoiding”, or “stims”.

If you're new to these terms like “sensory issues” or “stims”, maybe you have no idea what I’m talking about. If so, check out this visual aid:  

I think what people mean when they say “Is it sensory or behavior” is really “Does this individual have something in their body that feels too high or low right now, OR are they just acting up”. There is an assumption that “sensory issues” mean the child needs to do something active or calming, but “behavior” is just about pushing buttons. The misuse of both of these terms must be quite confusing for a layperson to understand.

There are a few things that are important to understand about sensory issues from an ABA perspective …..which if you are here, you must want an ABA perspective:

  • We focus on behavior. Saying the word “sensory” can mean many different things to different people, so to keep it clear and simple we focus on what we can see and/or measure.
  • So if we label something a “behavior” and not a “sensory issue”, then what does that mean? It means we view behaviors as gaining or avoiding something. If I pull out my phone to play Candy Crush anytime I have to wait in a line (which I do, by the way), I’m bored, and me going for a video game is a way to alleviate that boredom. What if I didn’t have my phone? Well, I might twirl my hair, bite at my nails, or tap my foot. Depending on my options, my behavior may look very different. However the reason, or the WHY, of  my behavior is the same.
  • Speaking of the WHY, or function, if we don’t consider sensory issues to be separate from behaviors then what are they? We ABA people would call them Automatic Reinforcement maintained behaviors. 
  • The intervention needs to be clinically sound. Blanket, or general, interventions like "Just put on her weighted vest when she gets hyper" aren't going to cut it. I know blanket strategies are easier, faster, and more accepted by direct staff/teachers, but they also are a toss up. Will they work? Maybe. ....and maybe not. True behavior intervention needs to be valid and tied to the function of the behavior, as well as empirically supported.
  • Vague or poorly defined words like “sensory issues”, “overly stimmy”, “sensory diet”, “sensory protocol”, etc., are pretty hard to implement. If I tell you “Everytime Dominic starts acting stimmy, let him do sensory exercises”, would you know what that meant? Most likely not, which is why ABA people use clear and objective language to define our interventions.

Are you now wondering then what in the world CAN you  do about these self-stimulatory, automatic reinforcement maintained behaviors? Well, wonder no more:

Select and define the behavior you want to target---be specific (“climbing furniture” not “hyperactivity”)
Conduct a FBA  to determine the function(s)
Now that you know the function, select a replacement behavior (what the child will do instead of climbing furniture, mouthing items, standing on the kitchen counter, etc.). The replacement behavior needs to provide the same function payoff, and if possible should be topographically similar
Decide how to teach the replacement behavior, and block/redirect the target behavior
Make sure all relevant caregivers and staff know how to implement your intervention, and what to do both before and after the target behavior occurs
Evaluate your plan, review the data, and if necessary make changes

Lastly, there are 2 super-duper important things to understand as it relates to automatic reinforcement maintained behaviors:
  1. Never deliver the specified treatment/stimuli contingent upon problem behavior. You want to teach your clients to request or initiate appropriate ways to meet their automatic reinforcement needs, not teach them that “bored in the classroom” + ”start mouthing all my pencils”= “now I am in the hallway sucking on a lollipop”.
  2. I don’t advise targeting behaviors for reduction just because they are repetitive in nature. First ask yourself, is the behavior harmful? Is it causing impairments at school? Is it interfering with the child's ability to interact with others?  I also suggest reading about how a teen with Autism describes her need to engage in “stims”.

References/Recommended Reading:

Morrison, Heather; Roscoe, Eileen M; Atwell, Amy. (2001). An Evaluation of Antecedent Exercise on Behavior Maintained by Automatic Reinforcement using a Three Component Multiple Schedule. Journal of Applied Behavior Analysis. 42. 523-41.

Roberts-Gwinn, Michelle M; Luiten, LeAnn; Derby, K Mark; Johnson, Tania A; Weber, Kimberly. (2001) Identification of competing reinforcers for behavior maintained by automatic reinforcement. Journal of Positive Behavior Interventions.3.2. 83.

Piazza, Cathleen C.; Fisher, Wayne W.; Hanley, Gregory P.; LeBlanc, Linda A.; Worsdell, April S.(1998) Treatment of Pica through Multiple Analyses of its Reinforcing Functions. Journal of Applied Behavior Analysis.31.2. 165-189

Goh. H., Iwata. B.A., Shore, B.A., DeLeon, I.G.. Lerman. D.C., Ulrich. S.M., &
Smith. R.G. (1995). An analysis of the reinforcing properties of hand mouthing. Journal
of Applied Behavior Analysis. 28. 269-283

Lang, R., O’Reilly, M., Healy, O., Rispoli, M., Lydon, H., Streusand, W., Davis, T., Kang, S., Sigafoos, J., Lancioni, G., Didden, R., & Giesbers (2012). Sensory integration therapy for autism spectrum disorders: A Systematic review. Research in Autism Spectrum Disorders, 6, 1004-1018

*Recommended reading: Are you a great supervisor?

I’ve received a few emails lately from new BCBA’s asking some questions about organization/case management, or just how to add more hours to the day :-) and it gave me the idea to start sharing posts full of helpful tips or advice to people who are new to case management. Thanks for the idea guys!

Once you spend so much time, effort, and studying hours to complete your BCBA or BCaBA certification you are then quickly expected to be able to perform a wide variety of behavior analytic skills. For some people, they may have limited supervisory experience before they complete certification. So it can be very intimidating and nerve wracking to suddenly have a team of staff that you must manage and oversee, and a laundry list of administrative duties to complete each month.  I personally think this is a skill anyone can learn, as long as they are teachable and have the right attitude. 

Written communication is a skill that is becoming increasingly important for supervisors in this field, as many of us are working remotely with clients, or working with multiple funding sources. Multiple funding sources = multiple expectations for reporting progress. Having remote consultation clients means spending lots of time sending files and documents to your clients, instead of making face to face visits to explain your treatment plan. Being able to conceptualize clinically sound treatment, translate it from jargon to terms everyday people can understand, and then concisely summarize that information in a document, protocol, or report, is a very complex skillset. Those who can do this skill well are often admired (and usually quickly promoted), and those who struggle with this skill can be seen as unqualified or inept at their job, which may not be true at all. 

For some supervisors, effective written communication is no easy task. Most of us have worked with someone who comes across very differently in writing than they do in person. People will make assumptions about your ability to perform your job based on the way you can communicate in written form. It may not be fair, but it happens.

To perform your job as a BCBA you will regularly need to write/create Behavior Plans, reports, skill acquisition programs, staff training resources, parent training resources, and on and on. Don’t let deficits with written communication hold you back from exciting promotions or career advancement opportunities. Strive to be a well-rounded BCBA.  

Here are some helpful tips & strategies for developing excellent written communication skills:

  •          Remember the 7 Dimensions of ABA? Keep your writing technological- Technological means you are using plain and clear explanations, always defining jargon as you go.  Why say in an email to a consumer “I am concerned about your clinical nonadherence to the previously agreed upon treatment plan” when you can say “Let’s discuss how I can help you stick to the Behavior Plan!”. Parents want to like us, and they want to work well with us, but we sometimes make that difficult when we communicate at them and not to them. Don’t hide behind your jargon; it won’t come across well.
  •  Know your audience- This is something I had to painstakingly learn, and it is so important. Who are you writing to? A parent? An insurance company? A Special Education Director? Your writing style should fit the audience. You want to explain and justify thoroughly, but also briefly. If you are sending a 16 page progress report to the insurance company, do you really think they are going to read all of that? No seriously, do you really think they are going to read all of that? 
  •  Watch your tone- I had to learn this one as well. Be careful of communicating via email with parents or clients when you are frustrated or irritated about their performance. Because guess what? It can creep into your email. You may think you are being professional and straight to the point, but the email will read as if you are fuming. It’s better to just wait until you calm down to communicate. Keep in mind that emotions can come across in a text or email just like they can when speaking.
  •  Stick to facts- Your documents and reports need to be somewhat formal (formality will vary depending on the audience) and professional. Your language, delivery style, and content should give the reader a positive impression of your clinical abilities. This can be done by writing in a manner that presents facts, provides justification to support those facts, and is transparent. You can add your clinical impressions, but those also need to come across as factual statements, and not personal opinions. 
  •  You are a BCBA- This is a short tip, but I proofread lots of clinical documents as a supervisor. I see a lot of mentalistic explanations for behavior, or faulty reasoning such as “I think he did this because….”, or “The behavior just happened…..”, or “The child felt angry so she….”. Yikes! None of those are ok. We are not psychics or tarot card readers. We cannot write in a report that we know what our client was thinking.
  •  Proofread, proofread, proofread! – If you haven’t seen this yet, you will: You are sent a report from a new client’s previous provider and several pages of the report refer to the client as “Nathan”, but the client’s name is actually “Rashad”. Oops. Super embarrassing. Don’t think this can never happen to you. I see clinical mistakes in client documents all the time, and as a busy BCBA I understand how it can happen. When you are up at 3 a.m. writing 2 reports at once, mistakes happen. We’re only human. This is why it’s so important to triple check your documents, as you don’t want to come across as careless or unprofessional. 

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