Whose behavior needed to be fixed? The kids’ or the parents’??

At a recent family meeting, I had put an item on the agenda- listening to mom and dad so we don’t have to repeat ourselves. In the past week, I had noticed that I was having to say things many more items than usual and my husband and I had both raised our voice more often. So I brought this up in a problem solving format with all 4 of us- two kids, my husband, and myself. Everyone was given a chance to propose solutions- no matter how off the wall.

I expected the conversation about listening better to go one of two ways when the kids are allowed to make the call: either all about earning rewards, or about getting trouble. One extreme or the other. But I sat quietly and let my little ones (ages 7 and 4) have the floor and share what they thought would fix this issue we were having. Things started to go down the punishment lane- maybe we should lose allowance when we don’t listen- and I shut that down. I told them that allowance is not tied to their behavior and we wouldn’t be making changes to our allowance system. Then things got interesting. My FOUR year old shared that her pre-kindergarten teacher would say “1, 2, 3, eyes on me” and then the kids would listen to her. So my littlest suggested a change to MY behavior to fix the problem. So the 7 year jumps in and says “Remember how you used to do silly poses to get our attention? Maybe you can do that again.” Again – they wanted to change the PARENTS’ behavior, not their own. I was all in on this train of thought. I suggested I use things I used to do consistently when we were in full-on virtual school mode- clapping patterns, hand gestures, silly voices- to get their attention before asking them to do something. That way they are actually listening the first time and we won’t have to repeat ourselves. As a family, we agreed the solution to the problem of the kids not listening was to make a change to Mom & Dad’s behavior- we would do something to make sure we had their attention FIRST and then tell them whatever we needed them to hear.

This is not a new and noteworthy idea. But it is a good idea! I’ve even written about it before here: https://www.parentingwithaba.org/get-my-kids-to-listen-part-1/. Here’s an excerpt from that to help you (and me) remember: Get their attention first. We have to interrupt whatever is currently going on- and somehow win that battle for attention from something they prefer more than listening to mom giving instructions. I mean, what could be more fun than listening to mom giving instructions? Oh- everything? I see.

  1. Be silly. Interrupt with silliness. Make silly faces, silly poses, or use different voices. Get their attention AND a smile on their face before you even start to give instructions.
  2. Start with a joke, then give the instructions.
  3. Say something absurd. Instead of “Go wash your hands” try “Go wash your earlobes”. Let your kids correct you- now they have said the instructions themselves! “Oh silly me. Wash your hands, not your earlobes!”

By letting the kids help come up with this solution, they’ve been all in. If we do anything to get their attention first, they freeze and make big eyes and stare at us. It’s a little overboard with the dramatics, which I find hilarious and awesome. And when I forget, they will say “1, 2, 3, eyes on me” to me as a reminder. So far things are better in my house with no major reward system, no punishments or loss of allowance, no big drama. We just needed to talk through a problem and whose behavior needed a change? Not the kids. It was the parents’ behavior that was changed this time (and most of the time if we’re honest with ourselves here). What things to do you use to get your kids’ attention? What works for you?

Leanne Page, MEd, BCBA, is the author of Parenting with Science: Behavior Analysis Saves Mom’s Sanity. As a Behavior Analyst and a mom of two little girls, she wanted to share behavior analysis with a population who could really use it- parents!

Leanne’s writing can be found in Parenting with Science and Parenting with ABA as well as a few other sites. She is a monthly contributor to bSci21.com, guest host for the Dr. Kim Live show, and has contributed to other websites as well.

Leanne has worked with children with disabilities for over 10 years. She earned both her Bachelor’s and Master’s degrees from Texas A&M University. She also completed ABA coursework through the University of North Texas before earning her BCBA certification in 2011. Leanne has worked as a special educator of both elementary and high school self-contained, inclusion, general education, and resource settings.

Leanne also has managed a center providing ABA services to children in 1:1 and small group settings. She has extensive experience in school and teacher training, therapist training, parent training, and providing direct services to children and families in a center-based or in-home therapy setting.

Leanne is now located in Dallas, Texas and is available for: distance BCBA and BCaBA supervision, parent training, speaking opportunities, and consultation. She can be reached via Facebook or at Lpagebcba@gmail.com.

In The Event Of Crisis

When it comes to the treatment or reduction of challenging, disruptive, dangerous problem behaviors, regardless of the setting or populations served, this will often be referred to as “Crisis Intervention”.

This concept is far broader than ABA, as many institutions and facilities will create, monitor, and implement crisis interventions whether anyone on site has received ABA training, credentialing, or licensure, or not (examples: police, schools, daycares, residential settings, prisons, etc.).

Being such a broad topic, that can look about 10,000 different ways depending on the setting and availability of highly trained specialists, it should come as no surprise that crisis behavior scenarios frequently result in injury or even death. If you do some online searches for news stories related to seclusion and restraint, regardless of the setting, you will see what I mean.

This issue is also larger than disability.

Yes, most of the horror stories we see on the news where someone was seriously injured during a restraint DO involve people with disabilities (whether it was known at the time, or not). But in the absence of disability or mental health issues, crisis management can still lead to serious injury or death. That could be for the person(s) responding to the crisis, or to the person(s) having the crisis.

This is a very weighty and complex topic, and I can’t possibly cover everything anyone should know about crisis intervention. However, due to the seriousness of crisis scenarios and the increased risk of harm (again, for the person intervening, the person or having a crisis, or even both of those people), I very much want to share some resources and information about managing behavioral crises.

First, some terms. Here is my favorite definition of a crisis:

A time of intense difficulty, trouble, or danger; a time when a difficult or important decision must be made.

During a behavioral crisis, the individual is having intense difficulty or trouble. They are having a hard time (not giving you a hard time). Decisions must be made, not just regarding what to do RIGHT NOW, but in the future, in case this happens again. Which, without the proper supports in place, the crisis event is highly likely to happen again.

Viewing a crisis through this lens takes the responsibility off of the individual having the crisis, and onto the supports in place (or lack thereof). When a crisis event occurs, ask yourself these questions:

     1. Does this individual know how to safely de-escalate during a crisis event?

     2. If yes, then why are they not using that tool?

Truly individualized and effective de-escalation tools are best understood as the means by which an individual in a crisis state can identify they are approaching a crisis state, select a de-escalation method, implement the method, and lastly evaluate how well the method worked once they are calm again.

Depending on the setting, availability of support help, and the understanding of de-escalation (or lack thereof), this “returning to neutral” process can take minutes, hours, days, or may not occur at all. It may involve a team of people, a caregiver or support person, or happen independently. When it doesn’t occur at all, that typically results in emergency room visits or admittance into an inpatient facility.

I do not know your work setting, the populations you serve, or your job title, but if you are reading this post I have to assume you have either experienced a crisis event with a client/student/etc. or want to be equipped if it should happen.

Right here I have to point out a very common myth, that can be quite dangerous when people believe it: In the field of ABA, clients who exhibit (or have a history of exhibiting) highly violent or dangerous problem behaviors may be classified as exhibiting “severe behavior”. It is a myth that only severe behavior clients can have crisis events. That is not true at all. Clients with non-violent or less disruptive problem behaviors, under the right set of combined circumstances, could have a behavioral crisis. For example, what if their home routine is significantly disrupted, they are ill, dealing with a change of medication, and also recently started puberty? These setting events when combined, could trigger a crisis event. For this reason, it is important for professionals and practitioners to be properly trained and equipped for crisis conditions, far before they are needed.

Now I want to speak specifically to ABA implementers (RBT’s, paraprofessionals, etc.) who work directly with clients: If you are working with clients where you are regularly responding to crisis events or working with clients with a known history of crisis events, you should be following the policies of the physical management training you received. If you have not received any physical management training, then you should not be working with those clients. It is dangerous for you, and dangerous for them.

Again, crisis events could potentially happen at any time, with any client/student/etc. It would be unwise to think “Oh I don’t work with severe behavior individuals, so this doesn’t apply to me”. For ANY of us (disabled or not, mental health issues or not) the right set of circumstances could trigger a crisis event.

If you were in the midst of a crisis event, who would you want helping you? Someone reacting on impulse or instinct, or someone who has been thoroughly and properly trained on safe de-escalation?

So what can be done? Glad you asked.

There are many, many crisis intervention and de-escalation resources readily available. If you are not in the position to set policy or choose employee trainings, you can still request additional training from your employer and send them recommendations of evidence-based methodologies. You can also always communicate when you feel ill-equipped or prepared to work with a specific student/client/etc. or feel unsafe.

Research shows that in the absence of individualized, evidence- based crisis interventions, individuals will contact injury to self and others (Burke, Hagan-Burke, & Sugai, 2003), receipt of medications with serious side-effects that rarely correct the causes of the behaviors (Frazier et al, 2011), receipt of intrusive, ineffective interventions that are punishment-led (Brown et al, 2008), and increased negative interactions (Lawson & O’Brien, 1994).

In ‘Effects of Function-Based Crisis Intervention on theSevere Challenging Behavior of Students with Autism ‘, the following procedures are recommended for crisis intervention planning-

Be cognizant of crisis needs and function when designing a behavior plan for students with crisis behaviors, and operationally describe steps to be taken for each phase of escalation. When describing these steps, be aware of the behavioral function. Change the quality of reinforcement delivered between appropriate and inappropriate behavior, and prompt appropriate behavior before providing access to calming activities. Train staff to competence on the intervention strategies (which most often includes role play scenarios during training, not just discussion/lecture). 

*Recommended Resources (please share!):

~Find the number for the mental health crisis/emergency support services in your state, and save it in your cell phone

~For caregivers, if your child is on medication the Physician/Psychiatrist will likely have an after-hours or emergency help desk. Save that number in your cell phone

https://www.pcmasolutions.com/

https://www.marcus.org/autism-training/crisis-prevention-program

Crisis Intervention Strategies

Prevention of Crisis Behavior

Crisis Help in Georgia

ASD & Crisis Behaviors

Handbook of Crisis Intervention and Developmental Disabilities

ASD & De-Escalation 

Crisis Prevention Institute 

ASD & Stages of Behavioral Escalation

Nationally Certified Crisis Training Providers

About The Author: Tameika Meadows, BCBA

“I’ve been providing ABA therapy services to young children with Autism since early 2003. My career in ABA began when I stumbled upon a flyer on my college campus for what I assumed was a babysitting job. The job turned out to be an entry level ABA therapy position working with an adorable little boy with Autism. This would prove to be the unplanned beginning of a passionate career for me.

From those early days in the field, I am now an author, blogger, Consultant/Supervisor, and I regularly lead intensive training sessions for ABA staff and parents. If you are interested in my consultation services, or just have questions about the blog: contact me here.”

This piece originally appeared at www.iloveaba.com

Parenting For Joy

Editor’s note:  Autism Awareness month is becoming a call to action from the autism and neurodivergent communities for change from the rest of society. In this edited excerpt from their upcoming book with Different Roads, co-authors Shahla Ala’i-Rosales and Peggy Heinkel-Wolfe offer a specific call to action to both parents and professionals—to seek and maintain joy’s radiating energy in our relationships with our children.

Parents have the responsibility of raising their children with autism the best they can. This journey is part of how we all develop as humans—nurturing children in ways that honor their humanity and invite full, rich lives. Ala’i-Rosales and Heinkel-Wolfe’s upcoming book offers a roadmap for a joyful and sustainable parenting journey. The heart of this journey relies on learning, connecting, and loving. Each power informs the other and each amplifies the other. And each power is essential for meaningful and courageous parenting.

Ala’i-Rosales is a researcher, clinician, and associate professor of applied behavior analysis at the University of North Texas. Heinkel-Wolfe is a journalist and parent of an adult son with autism.

Joy gives us wings! ― Abdul-Baha

“Up, up and awaaay!” all three family members said at once, laughing. A young boy’s mother bent over and pulled her toddler close to her feet, tucking her hands under his arms and around his torso. She looked up toward her husband and the camera, broke into a grin, and turned back to look at her son. “Ready?” she said, smiling eagerly. The boy looked up at her, saying “Up . . .” Then he, too, looked up at the camera toward his father before looking back up at his mother to say his version of “away.” She squealed with satisfaction at his words and his gaze, swinging him back and forth under the protection of her long legs and out into the space of the family kitchen. The little boy had the lopsided grin kids often get when they are proud of something they did and know everyone else is, too. The father cheered from behind the camera. As his mother set him back on the floor to start another round, the little boy clapped his hands. This was a fun game.

One might think that the important thing about this moment was the boy’s talking (it was), or him engaging in shared attention with both his mom and dad (it was), or his mom learning when to help him with prompts and how to fade and let him fly on his own (it was), or his parents learning how to break up activities so they will be reinforcing and encourage happy progress (it was) or his parents taking video clips so that they could analyze them to see how they could do things better (it was) or that his family was in such a sweet and collaborative relationship with his intervention team that they wanted to share their progress (it was). Each one of those things is important and together, synergistically, they achieved the ultimate importance: they were happy together.

Shahla has seen many short, joyful home videos from the families she’s worked with over the years. On first viewing, these happy moments look almost magical. And they are, but that joyful magic comes with planning and purpose. Parents and professionals can learn how to approach relationships with their autistic child with intention. Children should, and can, make happy progress across all the places they live, learn, and play–home, school, and clinic. It is often helpful for families and professionals to make short videos of such moments and interactions across places. Back in the clinic or at home, they watch the clips together to talk about what the videos show and discuss what they mean and how the information can give direction. Joyful moments go by fast. Video clips can help us observe all the little things that are happening so we can find ways to expand the moments and the joy.

Let’s imagine another moment. A father and his preschooler are roughhousing on the floor with an oversized pillow. The father raises the pillow high above his head and says “Pop!” To the boy’s laughter and delight, his father drops the pillow on top of him and gently wiggles it as the little boy rolls from side to side. After a few rounds, father raises the pillow and looks at his son expectantly. The boy looks up at his father to say “Pop!” Down comes the wiggly pillow. They continue the game until the father gets a little winded. After all, it is a big pillow. He sits back on his knees for a moment, breathing heavily, but smiling and laughing. He asks his son if he is getting tired. But the boy rolls back over to look up at his dad again, still smiling and points to the pillow with eyebrows raised. Father recovers his energy as quickly as he can. The son has learned new sounds, and the father has learned a game that has motivated his child and how to time the learning. They are both having fun.

The father learned that this game not only encourages his child’s vocal speech but it was also one of the first times his child persisted to keep their interaction going. Their time together was becoming emotionally valuable. The father was learning how to arrange happy activities so that the two of them could move together in harmony. He learned the principles of responding to him with help from the team. He knew how to approach his son with kindness and how to encourage his son’s approach to him and how to keep that momentum going. He understood the importance of his son’s assent in whatever activity they did together. He also recognized his son’s agency—his ability to act independently and make his own choices freely—as well as his own agency as they learned to move together in the world.

In creating the game of pillow pop, parent and child found their own dance. Each moved with their own tune in time and space, and their tunes came together in harmony. When joy guides our choices, each person can be themselves, be together with others, and make progress. We can recognize that individuals have different reinforcers in a joint activity and that there is the potential to also develop and share reinforcers in these joint activities. And with strengthening bonds, this might simply come to mean enjoying being in each other’s company.

In another composite example, we consider a mother gently approaching her toddler with a sock puppet. The little boy is sitting on his knees on top of a bed, looking out the window, and flicking his fingers in his peripheral vision. The mother is oblivious to all of that, the boy is two years old and, although the movements are a little different, he’s doing what toddlers do. She begins to sing a children’s song that incorporates different animal sounds, sounds she discovered that her son loves to explore. After a moment, he joins her in making the animal sounds in the song. Then, he turns toward her and gently places his hands on her face. She’s singing for him. He reciprocates with his gaze and his caress, both actions full of appreciation and tenderness.

Family members might dream of the activities that they will enjoy together with their children as they learn and grow. Mothers and fathers and siblings may not have imagined singing sock puppets, playing pillow pop, or organizing kitchen swing games. But these examples here show the possibilities when we open up to one another and enjoy each other’s company. Our joy in our child and our family helps us rethink what is easy, what is hard, and what is progress. 

All children can learn about the way into joyful relationships and, with grace, the dance continues as they grow up. This dance of human relationships is one that we all compose, first among members of our family, and then our schoolmates and, finally, out in the community. Shahla will always remember a film from the Anne Sullivan School in in Peru. The team knew they could help a young autistic boy at their school, but he would have to learn to ride the city bus across town by himself, including making several transfers along the way. The team worked out a training program for the boy to learn the way on the city buses, but the training program didn’t formally include anyone in the community at large. Still, the drivers and other passengers got to know the boy, this newest traveling member of their community, and they prompted him through the transfers from time to time. Through that shared dance, they amplified the community’s caring relationships. 

When joy is present, we recognize the caring approach of others toward us and the need for kindness in our own approach toward others. We recognize the mutual assent within our togetherness, and the agency each of us enjoys in that togetherness. Joy isn’t a material good, but an energy found in curiosity, truth, affection, and insight. Once we recognize the radiating energy that joy brings, we will notice when it is missing and seek it out. Joy occupies those spaces where we are present and looking for the good. Like hope and love, joy is sacred.

“When there is so much hate and so much resistance to truth and justice, joy is itself is an act of resistance.” ― Nicolas O’Rourke

Photo Credit: Bruno Nascimento c/o Unsplash

Compassionate ABA

Compassion requires three actions: listening, understanding, and acting. ABA is a compassionate practice by definition, because behavior analysts are trained to do each of these actions in very specific ways.

Listening is necessary for consent. Behavior analysts are required by ethical and professional guidelines to ensure informed consent prior to implementing assessment or intervention. Informed consent includes demonstrating that you understand what you are agreeing to, so behavior analysts should be listening to clients and their parents/guardians to determine if this understanding exists. If they are really consenting, clients or their parents/guardians will always be in control of the goals targeted and strategies of intervention.

Understanding occurs through the functional perspective taken by behavior analysts, which means that they take the time to learn and understand why behavior is happening or not happening. After listening to what is important to and for the client, the next step is to assess behavior. Put simply, the behavior analyst endeavors to get into their client’s shoes and figure out why they are acting the way they are acting. The assumption is always that the individual has good reasons for their behavior, and if those actions are going to change, we need to figure out how to replace them or make them less necessary, more efficient, or easier. We assume that people are right about their interactions with the world. If anything needs to change, it is the world, and not the person.

Acting is done through the development of interventions designed to improve the client’s situation and experience, based on the priorities established by the client through listening and consent. Behavior analysts hold social validity to be a very important value, in that not only should behavior change be meaningful and helpful to the individual who is changing their behavior, but the ways in which behavior is changed must also be acceptable. Behavioral interventions are not done to people, but with them, to help them meet their own goals in ways that they find reasonable.

Consent, assessment, and intervention meet the three requirements for compassion – listening to someone to hear what is concerning them, attempting to understand or feel their distress, and then doing something to alleviate their problems. Failure to take steps to listen to concerns and understand behavior takes the “analysis” out of the practice and reduces it to a collection of tricks that sometimes work but often don’t, and sometimes even make things worse. Unfortunately, sometimes poor training or supervision, or simple unethical practice, results in behavior analysis that is not compassionate and that reflects badly on the whole field.

Consider two scenarios that could happen when a well-meaning behavior analyst meets a new client for the first time, and finds that the client engages in high rates of stereotypy:

● Behavior analyst A draws upon her experience and determines that the levels of stereotypy that the client engages in will likely be disruptive in school and other community environments. She informs the family that stereotypy is inappropriate and teaches the parents to implement a comprehensive plan that includes environmental enrichment, positive reinforcement for periods of time when stereotypy does not occur, and asks them to collect data throughout the day on levels of stereotypy. Then she leaves with a promise to return in a week to evaluate their progress. The parents call the agency and say that they don’t think ABA is for them.

● Behavior analyst B has a lengthy conversation with the family about their preferred activities as a family. She asks them what they love to do with their child, and finds that they all enjoy going to the playground but that they usually reserve that activity for chilly days or early evenings and that they have been going less and less. When this is explored a bit further, they share somewhat reluctantly that both parents are uncomfortable when other parents and children stare when their child engages in stereotypy. The behavior analyst asks what they would like to do about this, if anything, or if they feel that their current strategy is working for them. The parents ask if they can think about it, and the behavior analyst agrees to discuss at next week’s meeting. In the meantime, she leaves them with some websites about functional assessment to look over. At the following week’s meeting, the parents say that they would like to prioritize other issues over stereotypy at this time, but they would like to learn more about functional assessment to see if it could help them to understand stereotypy a bit better.

In these scenarios, behavior analyst A provided a set of interventions that are not aversive and potentially not difficult for a trained professional to implement, but perhaps overwhelming to a family newly introduced to ABA. She prioritized the goals for intervention based on her experience rather than the family’s needs and preferences, without taking the time to listen to them and ensure consent. She also did not assess or attempt to understand the behavior and instead attempted to swiftly take action to reduce it. In addition, she did not attempt to determine if the interventions were acceptable to the parents or the child. If the family did choose to continue with her plan, it is possible that stereotypy might have decreased, but it is also possible that her plan would fail to meet the function of the behavior, resulting in unnecessary stress and a poor experience for the child. Ultimately, the family decided that this approach did not fit with their needs and they lost out on all of the potential benefits of well-implemented ABA for other areas of their child’s life, such as improving communication and independence.

By contrast, behavior analyst B moved slowly. She did not start by trying to identify problems, but by listening to the family by exploring their strengths and reinforcers, providing her with knowledge about how to connect with the child and parents and how to create a fun, warm, and enjoyable experience for everyone. She allowed them to share what makes it difficult for them to enjoy those reinforcers, and she opened the door to helping them with this issue if that is what they want. She did not provide a solution without consent or assessment, however. She left them with information and time to think, and the family was comfortable to have her return and continue to explore what would be best for their child in the context of their family. Ultimately, by listening and assessing, this behavior analyst has a chance of eventually acting and providing truly compassionate service and care to this client and family.

Both behavior analysts mean well. Both want what is best for their client. Neither behavior analyst wants to frighten families, make children cry, or take away what they enjoy. Both have rich resources at their disposal, but only one will likely be able to share those resources and meet her goals and the goals of the family. Practicing with compassion keeps communication open, but failure to demonstrate compassion by not listening and not understanding can result in a closed door and a great loss for the family and the field.

When practiced correctly and compassionately, ABA includes several features. First and foremost, there is a continuous emphasis on client and family input. Goals, strategies, and outcome measures are determined in consultation with the individuals who will be affected by the intervention. This includes not only the individual person receiving services, but those who love that person as well. Taking a broad viewpoint that includes the whole family is an important part of compassion.

Next, not only should behavior analysts obtain consent as mentioned earlier, but they should also be sure to get assent from clients who are not able to legally consent. Assent is a less formal version of consent that can be given by children or individuals who have cognitive differences that make it impossible for them to truly consent. Due to the extreme nature of the behavior of some individuals who receive behavior analysis services, at times assent is not obtained for safety reasons. This should only occur during times of crisis when the individual and/or those around them is in true danger. Any such occurrence should be immediately followed by obtaining consent and then conducting assessment and analysis of ways to prevent crises from occurring in the future. Interventions should be acceptable to all parties, including the individual receiving services. Again, many individuals who receive ABA services cannot verbally express assent, but the behavior analyst should be skilled enough to recognize behavioral indicators of assent or lack of assent, and adjust their actions accordingly.

Compassionate behavior analysts are also flexible. They recognize that there are changing circumstances in clients’ and their families’ lives, and that sometimes even effective plans need to be adjusted. They also recognize when sometimes despite their own best intentions, their efforts are not working well and they are willing to step back, reevaluate, and adjust approaches as needed. Behavior analysts should also be honest about what they can offer, their competence and comfort level with what is being asked of them, and how clients and families can best participate in their own services. Finally, it is crucial for behavior analysts to make human connections with the families they serve. Many behavior analysts find it easy to connect with their clients through their reinforcers and successes, but it is also important to maintain a connection with the rest of the people in their clients’ lives by showing interest and concern for them.

One final thought is that compassion can be a two-way street. Behavior analysts can most successfully connect with the client and family when the effort to connect is reciprocated. Although it is up to the behavior analyst to attempt to make the family comfortable in sharing their needs and preferences, sometimes we don’t know what we don’t know. Even the most compassionate and skilled professional might miss something, so families and if possible, clients, should speak up and let them know if that is the case. It is also important to be clear about whether or not consent and assent are being given. If the behavior analyst is not asking for consent, it is perfectly acceptable for the client or family member to pause the interaction and discuss what the limits of implied consent may be in any individual situation. Finally, families who demonstrate flexibility, connection, and honesty in return and who are open about any reservations or discomforts are allowing for the maintenance of a longer-term and more productive relationship, which will only help their loved one more.

References Consulted

Behavior Analyst Certification Board. (2014). Professional and ethical compliance code for
behavior analysts. Author.

Callahan, K., Foxx, R. M., Swierczynski, A., Aerts, X., Mehta, S., McComb, M. E., Nichols, S. M., Segal, G., Donald, A., & Sharma, R. (2019). Behavioral artistry: Examining the relationship between the interpersonal skills and effective practice repertoires of applied behavior analysis practitioners. Journal of Autism and Developmental Disorders, 49(9), 3557-3570.

LeBlanc, L. A., Taylor, B. A., & Marchese, N. V. (2019). The training experiences of behavior analysts: Compassionate care and therapeutic relationships with caregivers. Behavior Analysis in Practice, 13, 1-7.

Taylor, B. A., LeBlanc, L. A., & Nosik, M. R. (2018). Compassionate care in behavior analytic treatment: Can outcomes be enhanced by attending to relationships with caregivers? Behavior Analysis in Practice, 12(3), 654–666.

About The Author

Dana Reinecke is a doctoral level Board-Certified Behavior Analyst (BCBA-D) and a New York State Licensed Behavior Analyst (LBA). Dana is a Core Faculty member and Associate Chair in the Applied Behavior Analysis department at Capella University. She is also co-owner of SupervisorABA, an online platform for BACB supervision curriculum and documentation. Dana provides training and consultation to school districts, private schools, agencies, and families for individuals with disabilities. She has presented original research and workshops on the treatment of autism and applications of ABA at regional, national, and international conferences. She has published her research in peer-reviewed journals, written chapters in published books, and co-edited books on ABA and autism. Current areas of research include use of technology to support students with and without disabilities and online teaching strategies for effective college and graduate education. Dana is actively involved in the New York State Association for Behavior Analysis (NYSABA), and is currently serving as Past President (2019-2020).

The Joy of Genuine Progress: Remote Teaching and Flashcards

This week’s blog comes to us from Kate Connell, the creator of the Picture My Picture flashcard collection. Visit our site to learn more! 

Having three boys at home for three months in 2020 I understand the challenge of remote learning. There were certainly moments of chaos and times that felt overwhelming. But in the mix were also many great moments where I observed genuine progress. Those “ah ha” times, when something previously unclear or unknown was understood, were deeply satisfying. To all the parents and carers out there that are remote teaching right now, all power to you. A key lesson that I learnt was that dedicated learning time is more effective when it is fun. Enter – flashcards. 

Why use flashcards at home?

Flashcards are an ideal tool for teaching kids at home because they are visual. Using visuals can increase the rate at which your child learns  as well as their ability to comprehend, remember and retrieve information. You don’t need to be a qualified therapist or teacher to use flashcards.  

What can flashcards teach?

Flashcards can assist with your child’s learning in many ways. They support language development and can also assist with emotional regulation, critical thinking and memory.  

How do I use flashcards at home?

Flashcards are a very flexible teaching tool. A wide range of activities can be applied to the one set.  They are suitable for pre-school children right through to more advanced learners. The types of activities you can use flashcards for include pairing, sorting, naming, describing and performing. 

Pairing activities

The act of pairing, grouping two or more associated things, assists your child’s ability to reason because to successfully make a pair they need to use systematic steps to arrive at a conclusion. 

A set of ‘Go Togethers’ flashcards is a great resource for learning about pairing. It typically consists of pairs of associated images, such as shoe/sock and bowl/spoon. A fun activity is placing four cards on a table and then having your child match the card handed to them (such as the bucket) with the one on the table (such as the spade). You can talk about the cards as you’re playing “Yes! The stamp goes with the envelope.”

Sorting

Sorting things by type (such as color, shape or purpose) is a skill that develops your child’s language and maths abilities. It is crucial for being able to relate, store and recall words. A set of Categories flashcards is ideal for learning how to sort. It typically consists of a range of categories (e.g. transport, furniture, clothes), with a number of cards per category (e.g. bus, plane, motorbike, ferry and car). 

There are many learning activities you can try with Categories. One is placing five cards on a table from five different categories (eg animals, instruments, transport, food and clothes). Then passing your child the remaining cards from these categories, one by one, and asking them to place the card they are holding on top of the card on the table to which it belongs. So the horse goes on top of the dog and the piano goes on top of the violin etc. 

Naming

Enhancing your child’s vocabulary supports their ability to grasp and express ideas clearly. It also enhances their capacity for abstract thinking. A large set of Nouns flashcards is ideally suited to vocabulary building. It typically consists of many different types of nouns such as animals, occupations and locations.

A very simple activity you can do with the Nouns set is to have your child name the image on the card they are shown, such as “Cat” or “Blender”. Once successful, encourage them to create a sentence relating to the image they are shown (eg “The milk is white”). A Nouns Set can also act as a spring-board for discussing topics in detail such as a swimming pool. You might ask “What do you like about going to the swimming pool?” or “What do we need to take to the swimming pool?”

Performing

The act of performing fosters creative self-expression in your child. Performers have to be critical thinkers, problems solvers and good listeners. Performing is particularly helpful when teaching your child how to regulate their emotions so that they’re calmer and better able to navigate relationships. 

Emotions flashcards can be used to encourage performing. You might ask your child to perform the emotion shown on the card or to enact a brief scenario relating to the emotion such as licking an ice cream then dropping it and feeling sad. Or you might enact a scenario yourself such as opening a present and have your child choose the relevant emotion card from a range of cards. 

Flashcards provide a valuable and accessible resource when teaching your child remotely. They can assist with learning in many ways and each set has a multitude of different uses. By keeping it playful and fun you keep your child engaged and with that engagement comes the learning. 

About The Author

Kate is the owner of Picture My Picture, an international business which specializes in educational flashcards. She is the mother of three boys, Christopher, Louis and Tom. Christopher is on the spectrum of Autism. The flashcard based teaching program she oversaw in the early years of his life was the inspiration for the business she owns today. 

Focus on Generalization and Maintenance

On more than one occasion, I’ve been in the situation that a student will only demonstrate a skill in my presence. And I’ve heard from other colleagues that they have had similar experiences. This is highly problematic. When it happens with one of my students, there is only one person I can blame: myself.  A skill that a student can only demonstrate in my presence is a pretty useless skill and does nothing to promote independence.

So what do you do when you find yourself in this situation? You reteach, with a focus on generalization. This means that, from the very beginning, you are teaching with a wide variety of materials, varying your instructions, asking other adults to help teach the skill, and demonstrating its use in a variety of environments. Preparing activities takes more time on the front-end for the teacher, but saves a ton of time later because your student is more likely to actually master the skill. (Generalization, after all, does show true mastery.)

Hopefully, you don’t have to do this, though. Hopefully, you’ve focused on generalization from the first time you taught the skill. You may see generalization built into materials you already use, such as 300-Noun List at AVB press.

Another commonly cited issue teachers of children with autism encounter is failure to maintain a skill. In my mind, generalization and maintenance go hand-in-hand, in that they require you to plan ahead and consider how, when, and where you will practice acquired skills. Here are a few tips that may help you with maintenance of skills:

  • Create note cards of all mastered skills. During the course of a session, go through the note cards and set aside any missed questions or activities. You might need to do booster sessions on these. (This can also be an opportunity for extending generalization by presenting the questions with different materials, phrases, environments, or people.)
  • Set an alert on your phone to remind you to do a maintenance test two weeks, four weeks, and eight weeks after the student has mastered the skill.
  • Create a space on your data sheets for maintenance tasks to help you remember not only to build maintenance into your programs, but also to take data on maintenance.

Considering generalization and maintenance from the outset of any teaching procedure is incredibly important. Often, when working with students with special needs, we are working with students who are already one or more grade levels behind their typically developing peers. Failing to teach generalization and maintenance, then having to reteach, is a waste of your students’ time.


Written by Sam Blanco, PhD, LBA, BCBA

Sam is an ABA provider for school-aged students in Brooklyn, New York. Working in education for over 15 years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges and the Senior Clinical Strategist at Encore Support Services.

Cultural Competency in ABA Practice

The Behavior Analyst Certification Board (BACB) on their website lists credentialed behavior analysts from 99 countries spanning across 6 continents. Behavior analysts and consumers of behavior analysis are now establishing footprints across the globe. Each of these countries comes with its own set of cultural practices and norms. Leon Megginson, author of Small Business Management said, “it is not the strongest, or the most intelligent who survives, but the one most responsive to change”. Considering the high rates of global migration and the international dissemination that our field desires, practitioners find themselves serving an increasingly diverse population. A recent article in Behavior Analysis in Practice by Andrea Dennison and colleagues highlights the variations in cultural norms, caregiver and practitioner linguistic competencies that a culturally competent ABA therapist must consider when designing a home program.

What are the barriers?

The Professional and Ethical Compliance Code for Behavior Analysts from the Behavior Analyst Certification Board requires that behavior analysts consider the role of culture in service delivery (BACB code 1.05c), involve clients and families in treatment process (BACB code 4.02), and individualize the treatment plan to meet client needs (BACB code 4.03). Yet the BACB Fourth Edition Task List and the upcoming Fifth Edition Task List which define the scope of practice of a credentialed behavior analyst do not make much mention of culture – which means that training programs do not typically include cultural competence. Dennison and colleagues (2019) identified several barriers in ABA treatment for culturally and linguistically diverse families and highlighted ways to overcome them.

Do we hold stereotypes?

With the influence of the media or the people around us, we tend to categorize people into social groups and create a simplified conception of the group based on some assumptions – we create stereotypes and hold prejudices. Implicit biases held by a practitioner towards certain cultural sub-groups may result in a subtle, yet observable bias towards the client, and adversely impact treatment outcomes. Dennison et al (2019) suggest that a practitioner’s “self-reflection and introspection regarding cultural attitudes and practices towards clients” may be a first step towards undoing these biases.

Are we aware of cultural norms?

Practitioners often find themselves in a variety of contexts and situations with varying contingencies. Each culture comes with its own set of learned behaviors, beliefs, and norms. Dennison and colleagues add that some cultures might prefer a warm, informal discussion with a service provider prior to a formal meeting to discuss goals. A violation of this might seem off-putting to the client, and conversely, such an expectation for an informal discussion might catch the analyst unaware. In some cultures even a simple handshake for greeting might be offensive They recommend that practitioners monitor clients for signs of discomfort or displeasure during the course of the treatment to identify whether a cultural norm has been violated.

What to do when a practitioner doesn’t speak the home language of the client?

A language mismatch between the practitioner’s language and the home language of the client might lead to information loss. A client might not be able to completely express their priorities in terms of the services they need. Dennison urges practitioners to make every attempt to invite a bilingual practitioner or interpreter either in-person or online, to future family meetings. Providing the family with access to ABA textbooks written in their home language might be a good way to introduce ABA terminology and lead to better acceptability of services delivered. The authors caution against using loosely translated words; online tools might not be ideal for activities that require precise definitions.

Cultural analysis

“A cultural analysis involves an individual analysis of the cultural factors affecting an individual’s environment and the resulting contingency”, the authors add. A re-assessment of priorities in goals might be warranted, and a cultural analysis might inform what behaviors are identified as the primary targets for intervention. Dennison refers to the importance of social etiquette and the value placed on conflict avoidance in Latin cultures as an example. Measuring social validity might give the analyst information about whether the family sees the behavior change as meaningful.

Empathy grows as we learn

Try not to stigmatize immigrant families as “uncaring” for not seeking services earlier. Several socioeconomic stressors such as lack of housing and transportation availability likely play a role in their decision. The authors urge practitioners to empathize with these families and add that attempts to empathize can be made even if the practitioner and family do not share a common home language.

Finally, the lack of diversity in research with the omission of demographic details such as language and ethnicity of participants in scientific publications overlooks the critical value of such information. This calls for a shift in the field towards intentionally inclusive subject recruitment and the reporting of such information.

A culturally competent behavior analyst is not one who knows everything there is to know about every culture. This would be impossible. It is someone who can acknowledge that patterns of cultural difference may be present, and are then able to view a situation from a different cultural perspective than one’s own. Maintaining a curiosity about each client’s culture, and having an open dialogue with them about their background, ethnicity, and belief system can result in a positive outcome for the client and the analyst.

“If we are going to live with our deepest differences then we must learn about one another.”  ― Deborah J. Levine

References

Dennison, A., Lund, E., Brodhead, M., Mejia, L., Armenta, A., & Leal, J. (2019). Delivering Home-Supported Applied Behavior Analysis Therapies to Culturally and Linguistically Diverse Families. Behavior Analysis in Practice, OnlineFirst, 1-12.


About The Author

Maithri Sivaraman is a BCBA with a Masters in Psychology from the University of Madras and holds a Graduate Certificate in ABA from the University of North Texas. She is currently a doctoral student in Psychology at Ghent University, Belgium. Prior to this position, Maithri provided behavior analytic services to children with autism and other developmental disabilities in Chennai, India. She is the recipient of a dissemination grant from the Behavior Analysis Certification Board (BACB) to train caregivers in function-based assessments and intervention for problem behavior in India. She has presented papers at international conferences, published articles in peer-reviewed journals and has authored a column for the ‘Autism Network’, India’s quarterly autism journal. She is the International Dissemination Coordinator of the Association for Science in Autism Treatment (ASAT) and a member of the Distinguished Scholars Group of the Cambridge Center for Behavioral Studies.

ABA Journal Club: A Response from Dana Reinecke

A quote from this week's ABA Journal Club response from Dana Renecke

Welcome back to ABA Journal Club! One of the tenets of ABA is to provide evidence-based practice. The best way to help us do this is to keep up with the literature! Each month, Sam Blanco, PhD, LBA, BCBA will select one journal article and provide discussion questions for professionals working within the ABA community. The following week another ABA professional will respond to Sam’s questions and provide further insight and a different perspective on the piece.

Check out last week’s discussion questions here!

Behavior analysts engage in many different professional activities, many of which are more or less likely given specific clinical or research settings. For example, some behavior analysts who work with individuals with disabilities are likely to conduct preference assessments and use token economies, while those who work with organizations are less likely to use these technologies. One part of the behavior analyst’s repertoire that is always important, however, is the careful and accurate collection of data. This skill set is necessary for understanding and assessing behavior, as well as for ongoing monitoring of the effectiveness of behavioral interventions. 

It is important to understand not just how to measure behavior, but when to use each type of measure.  LeBlanc, Raetz, Sellers, and Carr (2016) describe some of the critical questions that should be considered when choosing a measurement procedure and offer a clinical decision-making model to guide behavior analysts in making these choices.  This article is useful for helping trainees to practice choosing measurement procedures, and reminding more experienced behavior analysts about the considerations involved in measurement. 

LeBlanc, L. A., Raetz, P. B., Sellers, T. P., & Carr, J. E. (2016). A proposed model for selecting measurement procedures for the assessment and treatment of problem behavior. Behavior analysis in practice9(1), 77-83.

Why is this article important for practitioners to read?

Measurement of behavior is one of the most important activities that a behavior analyst engages in.  Without accurate, meaningful measurement, assessment of both behavior and intervention effectiveness is impossible.  Trainees should read this article to learn about the important variables involved in choosing appropriate measurement systems, and more seasoned behavior analysts should read it to remind themselves about those variables.  Even though the article is focused on the measurement of problem behavior, the same principles can be applied to the measurement of behavior targeted for increase.

The model proposed by the authors incorporates several variables (such as observability of behavior and personnel resources.) Are there any other variables you might consider when selecting a measurement procedure?

Length of observation period might be a relevant factor in choosing a measurement procedure.  Consideration of the availability of resources may be influenced by the goal for how much observation is desired.  To use the case example provided by the authors, Joey’s teacher and aide might not be able to continuously record his work engagement throughout the day, but one of them might be able to do so for a limited sample of each day.  They could choose to conduct continuous measurement during a sample interval, and compare it to the longer period of discontinuous measurement to ensure that the discontinuous measure does not result in an over- or under-estimate of behavior. 

Table 1 clearly outlines each form of measurement along with strengths and limitations. Discuss the forms of measurement you frequently use and the limitations to incorporating other forms into your current practice.

As a consultant, I need to measure behavior based on limited samples when I can observe, and I also need to design data collection plans for the staff who are there for the rest of the week.  Staff are often responsible for more than one student, and may not have the resources to conduct continuous event recording.  Behavior is also often not discrete (e.g., crying) or occurs too frequently to count (e.g., stereotypy).  I often use partial-interval recording when I consult in school programs.  This allows for a very easy, non-intrusive overview of the pattern of behavior across the school day.  Another common measure is duration of behavior, because it is also relatively easy to start a timer when behavior begins, and stop it when it ends.  Frequency data are pretty rare in my practice, and reserved for low-frequency behavior that only occurs under specific circumstances.

In Figure 1, the authors provide a flow chart for easily selecting the most appropriate form of measurement. Many of the questions are directly related to observer resources. In this article, the term “resources” relates directly to the ability of personnel to continuously monitor the behavior. Are there any other factors you would consider in relation to personnel? If yes, how do you typically address those factors?

When training staff to collect data, it’s important to acknowledge any unintended bias.  Depending on the staff member’s level of experience, I will conduct more or less frequent IOA to reduce the risk of observer drift, and will also regularly review behavioral definitions to ensure that we are still talking about the same thing.

In discussing the behavior being measured, the authors write: “If the behavior can occur at any time, consider all dimensions of the response and select the ones that are most critically important to fully capture the important features of the behavior and the potential change in the behavior that may occur due to intervention” (p. 81).  How do you determine which dimensions of the response are the most critically important? Can you think of an example?

The importance of each dimension of the behavior will depend on the situation, the behavior, and the target or goal for the behavior.  For example, if a student is able to answer social questions but only does so after a delay, we would want to target, and therefore measure, latency to respond instead of frequency.  Or, a learner might engage in several very brief tantrums throughout the day.  In that case, I would expect that duration would be less important, and frequency a more meaningful measure.  By contrast, if a learner engages in one or two very long tantrums per week, we would want to measure duration and possibly intensity, rather than highlighting frequency.

One of the limitations of this paper is that the model it presents has not been empirically tested. What might such an empirical study look like?

One possible way to validate this model would be to provide several experienced behavior analysts with some case studies, and ask them to use the model to recommend measurement procedures for each case study.  High levels of agreement between the behavior analysts might indicate some validity for the model.  Further validity could be achieved by using the model to select measures, and then conducting those measures and comparing them to true values (e.g., permanent products or continuously-collected event recording).


About The Author

Dana Reinecke, Ph.D., BCBA-D is a doctoral level Board-Certified Behavior Analyst (BCBA-D) and a New York State Licensed Behavior Analyst (LBA).   Dana is a Core Faculty member in the Applied Behavior Analysis department at Capella University.  She is also co-owner of SupervisorABA, an online platform for BACB supervision curriculum, forms, and hours tracking.  Dana provides training and consultation to school districts, private schools, agencies, and families for individuals with disabilities. She has published her research in peer-reviewed journals, written chapters in published books, and co-edited books on ABA and autism.  Current areas of research include use of technology to support students with and without disabilities, self-management training of college students with disabilities, and online teaching strategies for effective college and graduate education.  Dana is actively involved in the New York State Association for Behavior Analysis (NYSABA).

Misconceptions About Reinforcement

ABA often gets a bad rap due to misunderstandings about reinforcement. In my career alone, I’ve had people tell me that people are not like rats and pigeons, that reinforcement harms intrinsic motivation, and that when I do produce behavior change, it has nothing to do with ABA but with my abilities as a teacher. Today, I’d like to clear up some misconceptions about reinforcement.

Reinforcement is not equivalent to rewards.

Reinforcement is anything that occurs immediately following a behavior that increases the future likelihood of that behavior. For instance, I am more likely to say hello to my neighbor down the street because in the past he has responded by saying “hello” back to me. However, I do not say hello to my next-door neighbor because she has never responded to my greeting. My history of reinforcement with the neighbor down the street increases the likelihood that I will greet him upon seeing him.

Reinforcement occurs in the natural environment all the time, whether we are conscious of it or not.

We are reinforced by paychecks for going to work, by our favorite dessert for visiting a restaurant 30 minutes out of our way, by compliments when we get a new haircut and more. ABA utilizes reinforcement when an individual is not acquiring skills in order to help them learn. And when ABA is implemented correctly, reinforcement should be as close to naturally occurring reinforcers as possible and should be reduced systematically over time to levels that would naturally occur in their environment.

Reinforcement works for dogs and for humans.

The previous two points illustrate that humans do respond to reinforcement, and decades of scientific research back that up. Comparing the work behavior analysts do with humans to the work behavior analysts do with other animals is not far off base. What is off base is using such a comparison to imply that behavior analysts treat people with disabilities like dogs. As with other professionals who work with individuals with disabilities, (such as speech therapists, physical therapists, nurses, etc.) most behavior analysts are professionals who put a lot of time, care, and love into their work.

Reinforcement is individualized.

Everything we do in ABA is individualized because human beings are wonderfully complex creatures that cannot be characterized by statistics, averages, or norms. One of my students may find stickers reinforcing; another may show no interest. One student may find listening to music reinforcing; another may cover his ears and ask me to turn it off. In ABA, we seek to find the items and activities that are motivating for individuals; then use those as tools not only for reinforcement but for increasing skills and broadening interests and opportunities. In an ideal ABA session, my students spend a lot of time engaging with items and activities that they enjoy while also learning and growing.

It’s easy to fall prey to misconceptions about reinforcement, but such misconceptions can make it impossible for us to understand how to alter the environment in order to provide the best possible outcomes for our students. As Skinner put it, “The ideal of behaviorism is to eliminate coercion: to apply controls by changing the environment in such a way as to reinforce the kind of behavior that benefits everyone.”

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WRITTEN BY SAM BLANCO, PhD, LBA, BCBA

Sam is an ABA provider for students ages 3-15 in NYC. Working in education for twelve years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges. You can read more of Sam’s posts for DRTL here!

ABA Journal Club # 6: A Response From Robyn Catagnus, EdD, LBS, BCBA-D and Elizabeth Hughes Fong, M.A., BCBA, LBS

One of the tenets of ABA is to provide evidence-based practice. The best way to help us do this is to keep up with the literature! Each month, Sam Blanco, PhD, LBA, BCBA will select one journal article and provide discussion questions for professionals working within the ABA community. The following week another ABA professional will respond to Sam’s questions and provide further insight and a different perspective on the piece.

This month’s response comes from Robyn Catagnus, EdD, LBS, BCBA-D and Elizabeth Hughes Fong, M.A., BCBA, LBS. Sam’s original blog can be seen here.

  • How does Skinner’s definition of culture differ from how you typically consider culture?

Fong: I think that Skinner did a nice job of linking a person’s actions and beliefs within the context of their environment.  At times, I feel it’s an oversimplification of a term, and behavior analysts should explore (on a deeper level) what that means. It defines culture, but lacks in helping us to understand it, or on a more practical level, what this means for our practice of ABA. I’m in agreement that our histories and the contingencies that we come into contact with shape who we are.  But as clinicians, what does this mean? When I think of culture, I consider things like history, contingencies and the environment in which the person operates, but I also try to draw out more information about what this means for my work as a clinician – if at all.  Culture is deep and rich, and sometimes I feel that relying on just Skinner’s definition doesn’t take all this into consideration. We can take that as a starting point, on how to conceptualize culture, but we need to go further into truly trying to understand what it is. Some interesting articles to review on the topic are: Muchon de Melo, C., & de Rose, J. C. (2013). The concept of culture in skinnerian Radical Behaviorism: Debates and controversies. European Journal of Behavior Analysis14(2), 321-328; Glenn, S. S. (2004). Individual behavior, culture, and social change. The Behavior Analyst27(2), 133-151.

  • Have you encountered situations in which by cultural contingencies impacted an intervention you planned? What might you have done differently if you could go back in time?

Catagnus: I’d like to share the story of two of my colleagues, Stacee Leatherman and Ashley Knochel. They are both doing really important work in this area that exemplifies this issue. And, you’ll likely see their papers on the topics published soon, so this will be a preview. Stacee was a therapist working with a family from a different country that had immigrated to her local area. She reported at a recent ABAI conference event that she felt ill-prepared by her behavior analytic training to adequately assess and intervene in a culturally appropriate way. The family ultimately left ABA services, and Stacee went to the literature to see what their consulting group could have done to better serve the family. She found almost no relevant empirical research in ABA journals that addressed implementation or culturally adapted interventions with non-Western families of children with Autism. We recently submitted a manuscript presenting her findings and making some recommendations of our own.

Leatherman, S., Catagnus, R. M., Brown, T. W., Moore, J., Torres, I. (2019). A systematic review of strategies to improve treatment services provided by cross-cultural practitioners working with individuals with autism spectrum disorder. (Manuscript in preparation).

Ashlee, along with co-researchers, has conducted one of the rare empirical studies of ABA with non-Western learners (and is submitting this manuscript soon). She was working in Ghana at a school for children with ASD. She helped the teachers implement a common behavior analytic technique, behavior specific praise. She did so in a way that is typical here in her culture in the US, in terms of using language to label the behavior, specifically, vocally, and with excitement. For cultural reasons, the way she’d learned to conduct the procedure in her culture caused a decrease in the desired behavior of working on task! So, she met with the stakeholders in the setting, engaged in culturally sensitive and humble question asking, and was able to collaboratively identify why the commonly used approach was not culturally appropriate or helpful – why it was detrimental to learning. Together, they revised the way the reinforcement was delivered, assured it was culturally correct, and the on-task behavior improved, and the staff reported feeling that Ashley’s interactions were culturally relevant. The outcome, and consultation process, was impactful. This is some of the first empirical data I’ve seen to explain how ABA interventions repeated ‘the way we learned to do them in our own culture’ can negatively impact those we service if we don’t approach the planning and implementation in a culturally interactive and open way.

Knochel, A., Blair, K. C., Sofarelli, R. (2019). Culturally focused classroom staff training to increase praise for Ghanaian students with autism spectrum disorders. (Manuscript in preparation).

  • Do you currently engage in any of the suggestions the authors provide for self-reflection? What has been your experience with self-reflection?

Catagnus: I regularly engage in self-reflection in the forms of mindfulness practice and formal meditation. In fact, I developed a mindfulness and ABA course at TCSPP and get to regularly talk about this with our students. I think and talk about my own cultural frameworks and background regularly, too, because of the types of research and implementation we conduct for culturally relevant pedagogy at the University. Luckily, the work that I do is immersive in terms of cultural topics, and I continue to develop my self-awareness. I also seek out experiences of diversity, by traveling, engaging in study abroad programs for myself and creating them for my students. I’ve worked with amazing local early educators in South Africa, visited cultural and academic sites in Denmark, taken classes in Spain, and am about to do visit Singapore, Malaysia, Vietnam, and Qatar. Developing relationships with people around the world has helped me stay reflective and to grow personally and professionally. Learning never stops for this process.

  • Do your current functional assessments incorporate cultural variables? If not, what can you change to improve your functional assessment process?

Fong: I do not think most FAs incorporate cultural variables. While the principles of ABA might be considered to be universal, the way in which we complete an FA is very Eurocentric.  Most of the places I have worked at present the FAI in English and if another language is required a translator is used. The translator may or may not have the clinical understanding to accurately communicate the question. Also, some of the questions are more direct, closed ended.  Some culture may do better by telling a story. Generally, there are no questions that directly address culture – for example, preference on pronouns, holidays, languages used, the role of the clinician in the family’s mind, background information about caretakers, what behaviors are reinforced/valued by a culture and which are not, etc.  I think incorporating things like this, into FAs would help to make them more culturally sensitive. Maybe each culture, create their own? I will ask clients if there is thing anything else that they feel that I should know, which might be relevant to intervention. Sometimes I prompt for information about language, holidays, manners, norms, preferences, etc. A good article on the topic is: Tanaka-Matsumi, J., Seiden, D. Y., & Lam, K. N. (1996). The Culturally Informed Functional Assessment (CIFA) Interview: A strategy for cross-cultural behavioral practice. Cognitive and Behavioral Practice3(2), 215-233.

  • One of the recommendations by the authors is to use readily available resources. What resources are available to you? How can your organization better provide resources to help behavior analysts address cultural variables?

Fong: I like this family therapy book – McGoldrick, M., Giordano, J., & Garcia-Preto, N. (Eds.). (2005). Ethnicity and family therapy. Guilford Press. The Special Interest Groups (SIG) of ABAI are another good resource, I’ve found that people are responsive if you email them questions.  There is also the Culture and Diversity SIG of ABAI. I also tend to look outside the ABA, to fields such as psychology, who have done a superior job addressing the need to examine the role that culture plays in treatment. Recently, there has been an increase in behavior analytic articles and presentations addressing culture, so I try to read those.           

Catagnus: TCSPP has an institutional learning outcome related to diversity, so we embed learning, resources, assignments and outcome measures throughout our program. It is a deeply held value and a strong focus of our program. For this reason, our students often research topics related to culture, diversity, and inclusion. They have access to carefully curated curricular materials like articles, books, lectures, and tutorials on many different related topics. Our classes are regularly evaluated and updated to represent more global perspectives. And, the process of students’ learning is supported from the day they start until graduation, with the goal of developing their own resources and skills in cultural awareness. We are also implementing some innovative advising and learning laboratory programs to further help students connect with personal resources for cultural competence.

  • The authors suggest the use of social validity surveys as one method for addressing cultural values. How can you incorporate this into your current practice?

Fong: I think, by just asking a client/family member/guardian if they agree with the goals and treatment suggestions would be a good start. Incorporating more relevant people into intervention planning would also be a good step.  I tend to get better participation in data collection when I do this, as well (i.e. buy-in).

Catagnus: Bobbie Gallagher and a few of us from TCSPP recently published a paper that addressed the cultural values of females with limited language (LL) and autism (ASD), and their families and nurses. The study was designed to gather social validity about what strategies would be doable, preferable, and acceptable to communicate with women with LL and ASD during a gynecological exam. These women are at risk because, statistically, they don’t access this important health service very often, if at all. The study gathered quantitative and qualitative data about concerns, fears, and preferences for how women could be more effectively and respectfully involved in the process of a diagnostic exam. As Bobbie wrote, “Identifying strategies with a higher rate of social validity, or acceptance of treatment prior to implementation, may assist future researchers in conducting studies on the effectiveness of those strategies.”

Gallagher, B.J., Flynn, S.D., Catagnus, R.M., Griffith, A. (2019). Social validity of strategies to assist females with ASD during gynecological examinations. Journal of Developmental and Physical Disabilities. https://doi.org/10.1007/s10882-018-9654-5

  • The authors state that one limitation of their article is that they did not provide systematic guidelines for working with culturally diverse clients. If you were going to introduce such guidelines, what might you include?

Fong: I think the guidelines I referenced here: Hughes Fong, E., & Tanaka, S. (2013). Multicultural Alliance of Behavior Analysis Standards for Cultural Competence in Behavior Analysis. The International Journal of Behavioral Consultation and Therapy. 8(2): 17-19. Are a good start.  APA did a fantastic job on their guidelines – so again looking at other fields to see what they have done (https://www.apa.org/about/policy/multicultural-guidelines) and learning from other fields would be helpful.

Catagnus: Ashely Knochel, Kwang-Sun Blair, Stacee Leatherman, and I are working on a manuscript now related to this topic. We hope to provide the ABA community with a systematic review of relevant cultural adaptation models, highlighting one that is most useful as a framework to guide the process. We recommend that ABA look to other fields that have created and researched frameworks or developed guidelines. Examples include Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations from the APA, and AMA Code of Medical Ethics’ Opinion on Cultural Sensitivity and Ethnic Disparities in Care.


About The Authors

Dr. Robyn Catagnus is an expert on learning and behavior change. A board-certified behavior analyst, she is an associate professor, associate chair, and former national chair of Behavior Analysis at The Chicago School of Professional Psychology. She’s owned and operated a successful behavior consulting firm and held executive roles in behavioral health and educational technology organizations. As a management consultant and researcher, she also develops human capital initiatives to improve organizational behavior.

Dr. Catagnus’ helps educators promote inclusion, success, performance, and growth. She is a trustee of the Cambridge Center for Behavioral Studies; reviewer for the Diversity in Behavior Analysis section of the APA journal Behavior Analysis: Research and Practice; reviewer for Behavior Analysis in Practice, and former member of the editorial board for Perspectives on Behavior Science. Dr. Catagnus has degrees in instruction and technology, education, leadership and strategy, and a certificate in mindfulness.

Ms. Hughes Fong has over two decades of experience in the fields of behavioral health, education, and management. Her educational background is in clinical and counseling psychology and applied behavior analysis. She is currently a PhD candidate studying Clinical Psychology with a concentration in Forensic Psychology.

In 2011, Ms. Hughes Fong founded Multicultural Alliance of Behavior Analysts (MultiABA), now call the Diversity and Culture SIG. This is a special interest group of the Association of Behavior Analysis International (ABAI). Ms. Hughes Fong is the founder of “Diversity in Behavior Analysis” a section in Behavior Analysis Research and Practice, and serves as an Associate Editor for the journal. Ms. Hughes Fong, also serves on the Executive Committee for the American Psychological Association’s (APA) Division 35, as the Website Coordinator. She has been a reviewer for Behavior Analysis: Research and Practice, Behavior Analysis in Practice, and the National Multicultural Conference and Summit. She is also a “Distinguished Scholar” with the Cambridge Center for Behavioral Studies, and a member Association for Behavior Analysis International (ABAI)  Diversity, Respect, and Inclusion Task Force

In addition, to Ms. Hughes Fong activities, she is a Board-Certified Behavior Analyst and licensed as a Behavior Specialist in Pennsylvania, a trainer in the Pennsylvania Bureau of Autism’s Functional Behavior Analysis training, and has received training certificates in the area of Trauma-Focused Cognitive Behavior Therapy and Trauma-Focused Cognitive Behavior Therapy Childhood Traumatic Grief. In addition, she received her level one certification in Pivotal Response Training and Gottman Couples Therapy. Her primary areas of interest are in the application of ABA to multicultural populations, telehealth, social validity, health and behavior analysis, and examining child custody and parental competency when a child has developmental disabilities.