I Love ABA!: assessment

Showing posts with label assessment. Show all posts

Tameika Meadows, BCBA, Blog Author

Fist things first: WHY is diagnosis important??

If you are seeing red flags or concerning behavior in your child, is it absolutely essential that you pursue a formal evaluation?

...Well, no.

But, the benefits of obtaining a diagnosis of Autism can include access to services/treatment/an IEP, access to specific funding or disability resources or support, possible reduction of parental/familial stress or anxiety about the child's behaviors or differences, and an increased understanding of your child's unique needs and motivations. Basically, the sooner you know what is causing the red flags you are observing, the sooner you can DO something about it.

Many Autistic adults report having gone through life feeling different, odd, or struggling socially, and express wishing they had known much earlier in life that they weren't "wrong", while everyone else was "right". It can be extremely helpful for a person to know how their brain works (and why), so even if as a parent you aren't concerned if your child could be Autistic, your child may want to know one day.

TIPS

· Ask questions about alllllll the things! Make a list before you even arrive, just to make sure you get all your concerns out when you are face to face with the clinician. This is the time to express your concerns and get answers

· Don’t over or under report. What I mean is, describe what typically happens as truthfully as possible. It will be very clear to the clinician if you are glossing over serious concerns, or if you are minimizing strengths

· Make sure your child (and you!) are in a good place for the appointment: fed, rested, calm, etc. While many parents bring along a tablet to keep their child entertained on the way to the appointment, keep in mind that tablet will have to be removed at some point. It may be a good idea to bring a less powerful reinforcer so you don’t push your child into a full tantrum right as the appointment starts

· Avoid jumping in to help/guide your child, or directing your child to attend to the assessor (e.g. “C’mon Ally, push the red car!”). I know, it’s hard to just sit and watch your child perform poorly. But that is exactly what the assessor needs to see. Don’t worry, there will be parts where the assessor needs your input.

· Don’t expect this whole process to be wrapped up in one 2-hour appointment. Proper assessment takes time, you may encounter waiting lists, and most likely there will be more than one office visit required.

WHAT TO EXPECT

Regardless of the diagnostic tool used, there are certain commonalities you can expect. To name a few:

· The “majority example”. If your child exhibits a certain behavior 5% of the time, and a different behavior the other 95% of the time, the assessor will focus on what they do 95% of the time.

· Difficulty leaving/separating from the caregiver, even if that person is in the same room. This is very common, don’t feel embarrassed if your child clings to you and refuses to interact with anyone else.

· “Who is this child?”. By this I mean it is very common for the child to behave differently during assessment than what the parent is used to seeing. If the child babbles at home, they may be silent during the appointment. If the child bites and pinches at home, they may be sweet as pie during the appointment. It is also important to understand that the assessor must make decisions based on what they are seeing. This is why the evaluator will likely have you complete multiple checklists or forms, so they can compare what you typically see against the snapshot of the child they are seeing.

· Super, super short attending to tasks (e.g. child stays seated for .5 seconds). VERY common. Don’t become fearful that the assessment will be ruined, or full of errors, because your child just flits from one task to another or will not participate in any tasks. This is actually part of what the assessor needs to see, and it provides valuable information about functioning.

· Don’t expect to get to the end of the appointment and hear the assessor say “Welp, he’s Autistic”. ALL of the data, scores, and observations must be compiled and analyzed, and this process takes time. While it is very okay to ask the evaluator their initial impressions, please give the evaluator time to properly review all of the data before confirming any diagnosis.

NEXT STEPS

· After the diagnostic appointment, it will likely be a few weeks (or longer) until a follow-up appointment. The follow-up appointment is where the evaluator reviews the results with you and will go in depth to discuss recommendations.

· The formal diagnostic report will be long, detailed, and jargony. Kind of like reading a technical manual upside down. Be prepared to ask questions, and then ask more questions, until you actually understand the clinician’s report.

· If your child is not diagnosed, sometimes this can mean additional diagnostic tools are recommended, the child may currently be on the cusp and another evaluation is recommended for the following year, or there may be other explanations for the red flags besides Autism.

· If your child is diagnosed, this just means that in most cases they now become eligible for a myriad of services. It does NOT mean anyone can predict their future, tell you they will never (fill in the blank), or tell you that (fill in the blank) will always be a struggle.

· Please be prepared for more delays. In a perfect world, families would move seamlessly from diagnosis to treatment. Unfortunately, in our actual world, there are far more people needing services than providers offering services. There may be a wait to access various therapies, get into your school districts Autism program, apply for SSI, etc.

*Recommended Reading: After the Diagnosis

*Here is a parent perspective of the diagnosis appointment

Tameika Meadows, BCBA, Blog Author

If just reading the words "The Report" gave you a migraine headache and some unpleasant stomach cramps, then sounds like you are already familiar with the report writing process ;-)

If you had no reaction, then let me introduce a part of the job description for a supervisor/BCBA: Report Writing.

In most scenarios, when you begin working with a new client there is an assessment process that concludes with writing up a formal report. Depending on the funder, this report needs to be updated at specific intervals, such as every 6 months.
The purpose of the report is to summarize the treatment plan, and justify the need for services (or with a progress report, to continue to justify the need for services).

For newly certified clinicians the learning curve of report writing can be quite steep (I know it was for me). The report may need to include specific sections such as: Client Demographic Information, Client Diagnosis, Current Medication, Current & Former Therapies, School Schedule, Assessment Results (complete with grids/graphs), Functional Behavior Assessment, Coordination of Care, Transition Planning, etc.

Having strong written communication skills helps, as does being adept at Case Conceptualization, and compiling the report from strong assessment results. If the assessment process was rushed, skimpy, or otherwise flawed, then don't expect to write a stunning report from that data. The data collected during the assessment process are the foundation for the report to come. Don't neglect to gather important information during Intake/Assessment, as this will cause problems down the road.

But first, a quick disclaimer: The clinical report is not a one-size-fits-all document. Your employer and/or the funding source will have specific requirements for how reports must be written. It's also important to consider the target audience: who is going to read the report? Reports are often written in very technical language that may be difficult for laypersons to understand, which means that someone needs to interpret the report to laypersons and review each section in detail. When in doubt, follow the report guidelines communicated to you by your employer, or the funding source.

So let's jump in to some very generalized tips to clinical report writing:

I already mentioned above, but before even starting the report the assessment data are KEY. Having organized, accurate information (including any graphs or data sheets) at your fingertips will save SO much time when sitting down to write the report. Random pieces of paper scattered all over your desk? Not so much.
Follow the template provided to you. Your employer should have given you a report template to use (which can often vary from one funder to the next). Following the template saves time, and decreases the chances you will have to make tons of edits later. If your employer embedded drop down menus into their template? Gold star for them. If you work for yourself, make a template. It saves time.
If possible (because this may not be your choice), use an electronic data management system for reports. An electronic system will store collected program data, and generate its own graphs, so when it comes time to update the initial report you will save SO much time by not having to enter all this information in yourself. Oh and by the way, the amount of time you can bill for report writing will be a drop in the bucket compared to how much time it takes you to write it. So saving time in this process will be suuuuuper important.
Always, always, always, always --> read your completed report multiple times before submitting. Be on the lookout for spelling errors, referring to a graph and then forgetting to include the graph, weird formatting glitches, dropped words/missed words, correct client name, etc. Trust me when I say you don't want to hand off a completed report to a family, school, or supervisor, and have them notice a really simple error that you missed. It's embarrassing.

A well written report presents a full snapshot of the client, and thoroughly lays out a plan of action (including the clinical reasoning for choosing the plan of action). Selected goals are developmentally appropriate for current abilities, behaviors targeted for reduction are identified and described, and any barriers to instruction/progress are clearly stated with a specific plan for how to overcome these barriers during the period of authorization for services.

*Resources:

Best Practices in Client Documentation

BACB Practice Guidelines

Papatola, K. J., & Lustig, S. L. (2016). Navigating a Managed Care Peer Review: Guidance for Clinicians Using Applied Behavior Analysis in the Treatment of Children on the Autism Spectrum.

Tameika Meadows, BCBA, Blog Author

Photo source: www.heatherwilsoninternational.com

Suggested Reading: Selecting Reinforcers

I once had a client who referred to things/activities/places that he really, realllllly, liked as his "favorite-favorite". As in, "French fries are my favorite- favorite". How cute is that??

Whether you are a parent or professional, I am quite sure a question you are regularly asking yourself is how to identify and properly build upon the child's motivation in order to teach them. In other words: 1) what is it that the individual wants, 2) what is the individual willing to do, and NOT willing to do for what they want, and 3) how can I use this knowledge to teach?

And here I am to answer those questions for you. Aren't you lucky :-)

Say hello to Preference Assessments.

What is a Preference Assessment? Basically, conducting a preference assessment on an individual will equip you with valuable (highly valuable) information about what they like, what they find enjoyable, and how much they like something You may already know that your son Nicholas likes trains, Barney, and toy cars. But do you know which one he likes the most? Do you know which one he satiates on the fastest? Do you know which one he likes the least? Wouldn't you like to know these things?

Ultimately, we are all teachers. If you're a parent, then you may be teaching your children respect, manners, or household chores. If you are a professional, you may be teaching your client to count, ride a bike, or to have a conversation. As a teacher, it is essential that you approach instruction thinking about "what's in it for this kid?". As the adult we can often get caught in the trap of "do this because I say so", or its unfortunate cousin, "just doing this should be its own reward". No and no.

When you approach instruction by first taking the time to determine what the learner is motivated for, and the degree of motivation (more on this in a sec), you win AND the learner wins. Obviously the learner wins because they are now highly motivated to comply with instruction in order to get what they want. You win because instead of an uphill battle with a child who just wants to get away from you, you now have an attentive and cooperative learner who is ready to be taught.

Now that you understand why preference assessments are so important, you may be thinking this is some magic technique that you do once, write the information down, and then you are free to get on with your teaching for the next few years.

No.

Proper use of preference assessments means you will conduct them regularly (interests will change!), you will be on the lookout for satiation (being "full" on the item), you will watch out for competing stimuli or items, you will make sure the response effort does not outweigh what is being offered, and you will understand that while a strong preference is usually an indicator of a potential reinforcer, this is not always the case. I have worked with clients who may LOVE to be praised, but no way are they going to work an entire therapy session just for praise. So once you have a list of highly preferred preferences (edibles, tangibles, activities, people, etc.) just know that not everything on that list may serve as a reinforcer. Remember that by definition, the stimuli must increase the future likelihood of a behavior to be called a reinforcer. So if you regularly give your little learner a sticker after they exhibit a specific behavior, and the behavior does not increase over time then guess what? Those stickers are not reinforcers.

I will often teach my staff to conduct brief preference assessments before each teaching block of trials (not session, trial). That is how much I value preference assessments, and approaching the learner with what they want. If you find yourself approaching the learner for instruction, and just reaching out and grabbing an item as their "reinforcer"...stop. Don't be a lazy instructor. Yes, preference assessments take time, they take practice to learn how to do them, and there is data collection involved. However, for your diligence and effort you get a super motivated and attentive learner to teach. I say that's a pretty good deal.

Here are your basic preference assessment options:

Observe and/or Interview - This can be done by simply observing what the learner freely does in an environment, and what they choose to engage with or do. Or, you can prime the area with items you think the learner enjoys or have previously seen them interact with. Then stand back and observe what they go to, and how long they interact with each item. You can also interview the parents, teacher, or the learner (if appropriate) to find out information about likes/dislikes and get a rating scale of preference. I usually collect the interview information via a simple form or checklist.
Structured presentation - Items are presented either in pairs or as a group, and the learner is told to "pick one". Items may or may not be replaced as the learner makes choices, depending on which type of preference assessment is being conducted: forced choice (paired method), multiple stimulus with replacement (MSW), or multiple stimulus without replacement (MSWO). Data is collected on how long the learner interacted with the item, as well as which item they selected (they cannot select multiple items), in order to calculate a hierarchy of preference.

*Resources:

Conducting Preference Assessments on Individuals with Developmental Disabilities

Increasing Accurate Preference Assessment Implementation

Training Staff to Implement Stimulus Preference Assessments

Tameika Meadows, BCBA, Blog Author

Related posts: VB MAPP and ABLLS-R

“Intake” is an information gathering process that ABA professionals (usually someone in a supervisory role) use with new clients to determine a few things:

What specific needs, strengths, and deficits does the client present with?
Determine the parent training and/or education that will be needed about the purpose of ABA, and the precise implementation of treatment
Get an idea of current functioning level, as well as past levels of functioning (has the child recently regressed? Are they currently experiencing a surge in language?)
Determine the best individualized treatment plan for the client

Intakes can be small, or quite large. Many companies have the supervisor who will be working with the client conduct the intake, or if it’s a smaller company, one person may handle all new client intakes (company owner). The intake process should be consistent across individuals, and needs to be lengthy enough to gather important information. Some companies only allow 1-2 hours for intake, which is not enough time at all. It isn’t uncommon that intake may stretch over a few days, especially if other care providers are interviewed or observed, such as the Speech Therapist.

I don’t recommend accepting a new client into your private practice or ABA program without conducting a proper intake assessment. The reason why is it will be difficult to properly create the treatment plan if you only have minimal information about the client. This can lead to poor quality “cookie cutter” programs where all clients who look like "this" get treatment 1, and all clients who look like "that" get treatment 2, etc. Even if important information can be obtained through a brief phone interview, these interviews are usually conducted by office staff. Office staff may have little to no knowledge of ABA treatment planning and often do not know how to gather the kind of information an ABA professional would need.

Most of my intakes take anywhere from 3-4 hours to a few days, and include lots of paperwork. I usually send much of the paperwork to the family in advance, to save time during our actual meeting. This way I can get more into interviewing and direct skill probing, since the background information questions have already been answered via a questionnaire, or form. This is also a great way to begin record review, by having the family or caregivers send you relevant information such as recent psychological reports, the initial evaluation (the report done by whoever diagnosed the child), recent IEP, etc., before you actually meet the client.

It won’t always be possible, but I recommend scheduling the intake visit at a time when the client will be present. Observation, interaction, and direct skill probing are critical to accurate intake, and you will need the client present in order to complete these steps. You also want to keep in mind that parent report can sometimes over or under exaggerate. If the child is actually present, you can test statements the parent has made, or probe for yourself. For example, the parents may state that the child always has a tantrum if they hear the word “no”. You could then set up a scenario where you tell the child “no” to something they want, and see if a tantrum occurs. If a tantrum does not occur, that would tell you there is a history of reinforcement tied to the behavior that is causing the problem behavior to be exhibited in one setting (toward the parents) and not in another (towards you).

A thorough intake assessment will give me much of the information I need to create a behavior plan, initial acquisition programs, and parent training documents. Of course I will need to keep getting to know the child and family dynamics, but much of what I need to know is revealed during intake: Is the house chaotic and disorganized? A routine and visual schedule will likely be necessary. Is the child incredibly aggressive towards their siblings, OR ignores their siblings completely? Social interaction programs, including involving their sibling and other peers, will need to be taught.. Do the parents reinforce problem behaviors in front of you? Parent training will be key. And so on……

The following is intended to be a guide to conducting intake assessments, and there is a link to a sample intake form below.

Conducting an Intake Assessment

Eligibility - This will vary greatly depending on the funding source, if you work independently, or if you work for an agency. Eligibility basically is determining if the client is eligible for services. Some funding sources require a diagnosis of Autism. Companies may require that families complete parent training before they can begin services. If you work independently, you may create your own eligibility criteria that families must meet in order to work with you. Things to discuss during this portion of the intake process include: How will the family pay for treatment? What is the client’s diagnosis (and are there secondary diagnoses)? How many hours per week of treatment is being requested? Do your experiences and expertise qualify you to work with this client (e.g., you have only worked with adult clients and this client is 3)?

Observation – This can include observation of parent/child interactions, as well as just observing the child. Observation should occur across environments, to gain more information about the child’s strengths and deficits. It may be necessary to explain to the family when your observation will begin, and what it will entail. I have met with families who tried to contrive scenarios during my observation or tell their child how to behave. To be most helpful, you should be a "fly on the wall" during your observation process. Sit in an unobtrusive place and refrain from speaking to the child or family. Take clear and detailed observation notes that reflect only what you saw (be objective). If you will be observing at the child’s school, this post may be helpful to read.

Interview – The interview portion of intake is where you want to find out as much relevant information as possible about the clients history, previous treatments, current treatments, functioning level, problem behaviors, skill deficits, etc. I have found that approaching the interview as a conversation, versus a stiff and formal Q&A session yields better responding. I typically give the parents forms to complete the interview portion before we meet, and then we can discuss them in detail during our face to face meeting. Be sure to interview all relevant caregivers. If there is a regular babysitter who spends 5 hours each day with the client, that person is a valuable source of information. Ask about all the people who spend significant amounts of time with the child, and see if you can interview these people as well. If appropriate, siblings can also be interviewed.

Assessment – The assessment process typically includes an assessment tool such as the Vineland, ABLLS-R, or VB-MAPP. These assessment tools will give a detailed snapshot of the clients skill functioning. Parents and caregivers often appreciate beginning ABA therapy with a detailed summary of their child’s performance across skill domains. Just like with observation, it may be necessary to explain to the parents the point of assessment, and what their role should be while you are assessing their child. Parents may try to prompt or help their child, such as telling the child “Say blue…c’mon, say blue. I know you can say blue”. It is difficult for parents to watch their child miss assessment responses or fail to respond, so be patient and help the parents understand why they cannot prompt responding.

Goals – Program goals can be created during the intake process. I approach goal setting with a team approach: I need to know from the parents what is important for them, and then I tell them what deficits I see. This is also a great opportunity to help the parents create goals for themselves, for example being able to implement a DRA procedure independently with their child. It isn’t unusual that the family may have goals in mind that are currently unrealistic. It may be necessary to help explain the pre-requisite skills necessary for a specific goal, as well as the required consistency across environments in order to see progress.

Policies & Procedures – If you work for a company, the intake process will often include signing important paperwork, completing contracts, or going through consent forms with the family. Even if you work independently I recommend using the intake process to go over your individual policies or rules, such as: Do you work with ill children? Do you work on holidays? Do you provide therapy materials and supplies? Do you transport clients in your vehicle? I recommend having these policies in writing, discussing them with the family, and then having them sign to indicate acknowledgement of the policies.

Parent Education – If you are conducting an intake assessment for a child who has never received ABA services before, the family may be completely unaware of what exactly ABA is, how it works, what you will do with their child, how intensive treatment will be, etc. I always include in my intake assessments a portion of time for the family to ask questions of me. I encourage them to ask me about my background, my training, my relevant work experiences, ABA, the treatment plan, what to expect from therapy, etc. Especially after a professional has interviewed them for a few hours, some families may be too intimidated to ask the important questions. Gentle nudging may be necessary, such as asking the family if they understand the commitment level required, or asking the family how program information will be shared with the school staff. This can often get a shy or reserved family comfortable enough to start asking questions. I also use this portion of the intake assessment to explain my expectations for the parents, and review my Parent Participation Policy.

Tameika Meadows, BCBA, Blog Author

Which of the items pictured above would be reinforcing to you?
It would probably depend on what I asked you to do, the time of day, if you were hungry, sleepy, tired, sad, etc. You probably wouldn’t wash my car if I offered to give you $1. But you might wash my car if I offered to give you $100 (…or maybe not, if you really hate washing cars).

ABA therapists use reinforcers to get the learner to comply, to sit, to attend, to transition, and many more various behaviors. It took me a while to learn that just because child A will work for something that doesn’t mean child B will. It seems like such an obvious thing to know, but as therapists we do tend to make sweeping generalizations about the kiddos we work with. Such as:

"All kids will work for candy… All kids will work to avoid a reprimand.....All kids like attention… All kids know who Dora or Spongebob is... All kids like tickles"

Every one of those statements is wrong, because they assume all kids are the same.

Choosing, selecting, and testing reinforcers takes skill and patience but the payoff is huge. Instead of being in a session with a child who is bored or defiant, you now are approaching the child with the knowledge of what they like and what they will work for…..because there is a difference.

I really like chocolate cupcakes, but I will not paint your house to get paid in chocolate cupcakes. There is a difference between your client liking something, and your client working for something. If you have been working with a client on a skill or set of skills for a long time without seeing progress, try changing your reinforcement. The child may have gotten bored with the reinforcement. Or maybe they like the item but not enough to do a difficult skill for it. They could have become satiated on the reinforcement (this happens very often with edible reinforcers).

A big issue I see happen frequently is someone else in the child’s life is giving them a similar reinforcer and the therapist doesn’t know. For example, the teacher at school keeps a candy dish full of Skittles in the room that the children have free access to. Its highly unlikely that you will be able to get your client to do challenging tasks to earn a Skittle, if they spent all day freely munching on Skittles. In behavior analytic terms this is called Bootleg Reinforcement. This can happen pretty often, so its important to make sure the reinforcement you are using is unique and the child doesn't have free access to it.

If you had just finished a big seafood platter and I offered you a hamburger, the hamburger probably wouldn’t seem too appetizing. Even if you love hamburgers I have to offer it to you at the right moment. To understand effective reinforcement, you have to understand how to manipulate M.O. (Motivating Operations). Once you can do that you are on your way to being an awesome therapist!

Here are a few procedures to select powerful, effective reinforcers:

Start by observing the child in a variety of settings- When I say “observe the child”, most therapists think I mean follow the child around the house. Observation is much bigger than that. Observe the child at the park, the grocery store, grandma’s house, in the classroom, at a birthday party, etc. Notice what the child gravitates to, what they touch, what they stare at, what they smile at, and what objects they pick up. Over time you will likely start to see patterns emerge that tell you what that child likes. A favorite observation tool of mine is to take a client to a toy store like Toys R Us. I just let them wander freely and I pay attention to what they look at, touch, or engage with. That gives me a great source of ideas as to what kind of items/toys that child likes.
Talk to caregivers and others- Talk to the child’s parents, teachers, other therapists, siblings, etc. Ask questions about what kind of toys/items your client likes. Try to use open ended questions, such as “What kind of movies does Tanisha like” versus a closed ended question like “Does Tanisha like movies”. Make sure you ask sensory related questions so you can learn what the child likes to see/hear/smell/touch. If appropriate, you can also just interview the child.
Test your ideas- Once you have an idea of what the child likes gather a few reinforcers together. Present the reinforcers to the child and pay attention to what they engage with longest. I am basically describing a Preference Assessment.
The only constant is change- This is probably the most important thing to remember: Your client’s interests and likes will change over time. Don't your interests change with time?? With some of my clients I change the toys in my goodie bag every few days because I know those children get bored quickly. On the other hand, I have one client I have been seeing over 2 years on a consultative basis. Every time I visit, she immediately requests that I play Hide & Seek with her which is a game she finds highly reinforcing. She never gets tired of it. Let the child indicate to you when its time to change your reinforcers. If they want to work for the trampoline every day, that’s great. However if one day they don’t want the trampoline you need to be ready to use another reinforcer. Keep a supply of reinforcing items with you that are interesting and vary in size, texture, color, etc. Don’t just show up to a session and grab what is in the home, and try and use that as a reinforcer. The items in the home are things that child sees everyday. You may be able to get the child to do easy tasks for the teddy bear you grab off their bed. But once you move to more difficult tasks, or once that child has a bad day, that teddy bear just isn’t going to cut it.
Have a stash of 24 Karat Gold reinforcers- That is just my own nickname for my super powerful reinforcers. I call them my “24 Karats”. As you spend time with your clients you get to know their personalities, and what they like. You learn what items they go insane over. Instead of mixing those items in with your other reinforcers, put them aside. Save them for really difficult sessions, like if the child is getting over a cold, didn’t get enough sleep, or you are teaching a very hard skill. Bring these items out sparingly. You want to keep the interest in these items high so when you bring them out the child is really excited. How do you know if a reinforcer is a “24 Karat”? Here are a few signs to look for:

You bring the item out of your goodie bag or your car, and the child immediately makes a beeline over to you and tries to take the item.
The child mands for the item when it is out of sight.
Watch facial expression: the child smiles, their eyes widen, or they give intense eye contact to the item. Here is a very simple trick: Place the reinforcer/random goodie on your palm so the child can see, and then close your palm tightly. If the child comes over to you and tries prying your hand open you are holding a 24 Karat!
When its time to put the reinforcer away the child resists giving the item up, cries, tantrums, or may even become aggressive. Therapists, be happy when you see this reaction because it tells you that the child really wants that item.
The child will drop an item they really like, in order to approach you when you are holding the 24 Karat.

Tameika Meadows, BCBA, Blog Author

Isn't Giada great?
I am a fan of her cooking shows "Everyday Italian" and "Giada At Home". She makes preparing elegant Italian dishes seem quite simple and easy to accomplish for amateur cooks like myself.

So what in the world does Giada have to do with FBA’s & behavior?

Some professionals in the field of ABA do clients a disservice when they cannot break down complicated, jargon- filled terminology to explain behavior in such a way that a busy parent with 3 kids or a stressed out 2^nd grade teacher can apply these techniques. If you are a professional reading this blog, understand that much of what you think up/write as an ABA professional will be implemented by someone other than you. You can spend hours writing an amazing intervention, but if you can't get the family members or teachers to carry out your intervention then what's the point?

Part of my responsibility as an ABA professional is to teach and train people at a level that makes ABA seem easy to understand and carry out. That is part of providing effective treatment to clients. A FBA, or a Functional Behavior Assessment is a behavior analytic tool that I will explain in this post (A FA, or Functional Analysis, is a more complex way to determine the function of a behavior by manipulating the environment. A full FA should always be conducted by an experienced ABA professional). Understanding an FBA is critical to any ABA program.

Now for the disclaimer:
A FBA is a tool used to determine the function of a behavior, and then design a function based intervention. This post is intended to be a brief introduction to the FBA process. If you are having behavioral issues with your child/client, it is always recommend you contact a Behavior Analyst to conduct a comprehensive FBA and design a behavioral intervention, rather than try to create an intervention yourself. To put it another way, watching “Everyday Italian” does not qualify me to open an Italian restaurant. It’s a basic understanding at a limited knowledge level.

To understand what an FBA is, first lets define behavior: A behavior is anything an organism does in response to a stimulus. To put it simply, behaviors are observable and/or measurable activities. By this definition, talking is a behavior and thinking is not because I can't observe someones thoughts.
All behavior occurs for a reason and the goal of an FBA is to discover that reason. Once the reason is discovered then an intervention, or plan of action, can be created. A FBA is needed anytime behavior reduction is desired.

A common question I get asked is “Do I have to get a FBA done in order to intervene on a behavior?" The answer is no, you do not. However, understand that without first doing a FBA to discover what is maintaining the behavior you are just guessing. You are then creating an intervention based on a guess.
In addition, research has shown that when people intervene on a behavior without first doing a FBA the focus tends to be on punishment. In other words the parent or professional is only focusing on stopping the behavior, and there is no emphasis on teaching replacement behaviors. A real life example of this I see all the time would be a parent who dislikes their child's self stimulatory behavior, such as repetitively sticking fingers into the mouth. Every time the parent sees the behavior, they pull the child's fingers out of the mouth. What is missing from this strategy is teaching the child what you want them to do instead of sucking on their fingers.

A FBA is conducted in order to reduce or extinguish challenging behaviors. Challenging behaviors can include aggression, tantrumming, noncompliance, self injurious behaviors (SIB's), elopement, self harm, cursing, skipping school, etc. In an ideal situation a qualified BCBA would be the person conducting the entire FBA process. Unfortunately that isn’t always possible. Some school districts or families cannot afford to hire a BCBA, or you might live in an area without access to BCBA's. BCBA's can be quite difficult to find depending on where you live.

A FBA has 3 basic steps:

Gather information, Consultation
Direct observation, Develop a hypothesis
Create plan of action, Consultation

Step 1: There are many ways to gather information about the child, the problem behaviors, the environment, and the possible function(s) of the behavior. I will typically conduct 1-2 interviews with the parents (or teacher, if a school requested a FBA), review the child's records (educational records, IEP, recent reports from a psychologist, physician, SLP, etc), and collect information from the parents about possible replacement behaviors. Its important to involve the parents in every step of the FBA process, as it helps ensure that the parents are active participants in the intervention. The goal at this point is to gather information about the problem behavior, when it occurs, how long it lasts, what does it look like, has it recently gotten worse, what tends to make it occur, and how do the parents react to the problem behavior. It can also be helpful to ask what strategies the parents have already tried to eliminate the behavior. To assist with the parent interview, I recommend using the FAST form (Functional Analysis Screening Tool), or the MAS (Motivation Assessment Scale).

Step 2: The next step is to directly observe the child engaging in the problem behavior. This can sometimes be difficult to do. Since I am a professional unknown to the child and have no history with them of reinforcing their problem behaviors, its very common that I will go out for an observation and the child will be a perfect little saint during my entire observation. This often irritates parents immensely! :-) I like to explain this phenomenon to parents by comparing it to taking your car into the shop for auto repair. The mechanic will often say "I don't hear that noise you're talking about", and inevitably as you drive away from the auto shop your car begins making the noise again. If you are able to actually observe the problem behavior, be sure to closely watch for the Antecedent and Consequence to the behavior. You can always try and schedule more observation visits, or you can ask the parents to videotape the behavior the next time it occurs. At this point you should have some ideas of the hypothesis of the problem behavior, based on what you have seen and the data you have collected. There are 4 main functions for any behavior: Gain attention or a Tangible item, Automatic reinforcement (sensory), Avoid or escape a demand or situation, and To communicate wants/needs. It isn't unusual for a behavior to serve multiple functions, although there is typically a main function (primary) and a lesser function (secondary).

Step 3: After the FBA is completed your next step is creating a Behavior Plan.

The behavior plan is your "plan of action", or the intervention that will reduce or eliminate the problem behavior. The plan to reduce the problem behavior is 50% of the intervention, and the other 50% is the plan to teach replacement behaviors. In other words, when the child stops engaging in the problem behavior what do you want them to do instead? The intervention you create will be directly connected to the function of the problem behavior. If a child is engaging in screaming to gain sensory input, then ignoring the screaming is a poor choice of a replacement behavior. A better choice would be to teach the child songs to sing, to match the need for vocal sensory input. Consultation is listed again for step 3 because it is critical to involve the parents as you develop the behavior plan and replacement behaviors. It isn't uncommon to come up with great, research proven replacement behaviors that one or both parents don't like. If the parent seems unsure or hesitant about the intervention you are suggesting then you need to find out why. What is it about the intervention that one or both of the parents don't agree with? For example, I worked with a parent a few years ago who did not want to use any planned ignoring procedures where her child would cry for extended periods of time. I explained the difference between planned ignoring for problem behavior and ignoring the child, as well as cited research, but the parent still disliked the planned procedure. So I redesigned the intervention. The problem behavior did eventually improve, but it took a much longer period of time. However, as an ABA professional I don't write behavior plans for myself. I write them for the client, so its imperative that the client is on board with the treatment I am recommending.

**Quick Tip: Doing an FBA and creating interventions can be a challenging process. Do not be discouraged if it takes time and repeated attempts to learn this skill. If you look online or in books you may find resources to guide you in designing a FBA, but they are just examples. Tyler's FBA and behavior plan cannot be applied to Jared; these children are not identical and their behavior plans should not be identical.
A FBA should be individualized to the child, as well as be viewed as acceptable by the people who must carry it out. The people closest to the child are the ones who ultimately determine the social validity and effectiveness of any behavioral intervention.

FBA: Function of Positive Reinforcement
FBA: Function of Negative Reinforcement
FBA: Function of Automatic Reinforcement

Tameika Meadows, BCBA, Blog Author

Tameika Meadows, BCBA, Blog Author

Tameika Meadows, BCBA, Blog Author

Tameika Meadows, BCBA, Blog Author

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Tameika Meadows, BCBA, Blog Author

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