But We Tried That Already!

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But we tried that already” is a statement I hear very often from new clients as I start working with their child, and explaining to the parents the specific strategies and interventions I will be recommending.

Often the statement is said with exasperation and frustration, like “Don’t tell me to try things that I know won’t work!”. New clients often come to me with specific expectations that I will unveil these space age, highly complicated, magical ways to fix behavior that the average person could never dare to dream up. In a way, this is true. It isn’t often that I work with a client who is familiar with DRA, Extinction, or Task Analysis when I first meet them. However, much of what I bring to the table in consultation with a new client will be very simple, very basic changes to what the parents are already doing.
Most of the time, the devil is in the details.

Do I meet parents who are just doing everything wrong? Yes. But it’s much more typical that I meet parents who need to make small tweaks in order to bring about true behavioral change.

This post was inspired by a conversation I had with a colleague the other day, during a pairing session. My colleague pointed out how quickly we were able to get a child to sit in a chair. This is a child who, we were told during intake, never sits down willingly and refuses to sit to eat. Attempts to make him sit are met with severe tantrums. After a morning of playing with the child, blowing bubbles, and just getting to know him, we were able to pair sitting down with reinforcement (Fruit Loops cereal). So there was no “making him sit”. It was a choice: if you sit, here are some Fruit Loops. If you don’t sit, the Fruit Loops go away. It took probably 15 seconds for the child to make this connection, and then quickly sit down. Which was rewarded with praise, Fruit Loops, clapping, and bubbles.
This success led to my colleague asking me why is it that we as professionals can get our clients to quickly perform behaviors that their parents/caregivers struggle to teach over months or even years. What’s the explanation for that? Well, there are several explanations to what seems like such a simple question.

It isn’t that what you are trying as a parent is all wrong, or all ineffective. Usually, there are many things you are doing right. If you are not seeing the behavior change you want to see, it often means something about your intervention is ineffective--- too much, too little, too often, not often enough, etc. The job of the BCBA you are working with is to help you locate the barrier, and remove it. I like to call this “Troubleshooting”.

Throw away the idea that you have no idea how to change your child’s behavior: that’s not true. You just need some guidance as to how to apply scientific strategies to what you are doing. So please allow me to speak for all the supervisors and BCBA’s out there and say “I know you already tried this, but let’s try it again”. Be open-minded to the idea that it isn’t what you are doing that’s ineffective, it just could be how you’re doing it.

Ready for some Troubleshooting 101? Here are some common reasons why the BCBA who just met your son last week can get him to do things you can’t get him to do:

1.       Learning History (History of Reinforcement) – You have a unique learning history with your child that I do not have as the ABA professional. This works to my benefit, as I have a blank slate with your child. With you, your child knows “when I cry, mom does _____” or “if I scream, dad does _____”. With me, the child doesn’t know yet how I will react to what they do. So I am not coming in and trying to fix previous errors, I am coming in with no learning history at all. This is a big reason why your child often responds better to new teachers, new therapists, etc., than they do to you.
2.        Instructional Control/Consistency – Instructional Control  is basically moving from your child running the house and being in control, to you running your home. Inconsistency kills instructional control. How consistent are you with behavior change? Using the example above of getting a new client to independently sit in a chair, we were prepared to work on that skill as much as we needed to. That means carving out time to practice over the next 30 minutes, a day, 2 days, whatever it takes. You can’t get “tired” of behavior change...... If you want to see the results, you have to put in the work.
3.       Persistence - When parents say to me “But we tried that already!” my response is often “For how long?”. For many parents, your intervention just needed more time to succeed.  Usually what I see parents do is decide to get serious about behavior change, try a strategy, see it not work after a day or two, and then give up on the strategy and never try it again. How do you know the strategy just didn’t need some tweaking? Or maybe the child needed to be taught some pre-requisite skills? Or maybe YOU were following the strategy but your spouse was not (see point #2).
4.      Reward/Incentive – Other than “because I said so” why should your child do what you say? What is the child’s payoff for compliance with your instructions? Have you thought about that? I wouldn’t approach any of my clients to give a demand without first determining what happens when they comply. For some of them, it may just be attention or praise (“Hey, nice listening David!”). For some of them, the payoff needs to be much bigger than that…..maybe time on the swing, a walk outside, or playing on their iPad. We ALL contact desired things when we perform specific behaviors such as going to work (paycheck), kissing our husband (kiss or hug back), or letting someone cut in line at the grocery store (a smile, a thank you). Your child is no different, in that they also expect to get something out of their effort. 
5.        Negative Reinforcement – Think of negative reinforcement as seeking to avoid or escape something that is non-preferred or unpleasant. So let’s say every time you try and make your 3 year old sit down at the dinner table, he cries, screams, and turns red. Since you love him and don’t like to see him unhappy, you quickly stop trying to make him sit and allow him to walk around the house chewing on a piece of bread instead of sitting down and eating the piece of bread. In this scenario, you were just negatively reinforced. The problem with this is that over time in order for you to avoid/escape tantrumming, you have taught your son he does not have to sit down to eat.

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