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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

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Tameika Meadows, BCBA, Blog Author

If you're an ABA professional then you're likely already familiar with BST (Behavior Skills Training). 

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.

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Tameika Meadows, BCBA, Blog Author

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 Practice, 2(2), 22–31.

"The White Book", chapter 16

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Tameika Meadows, BCBA, Blog Author