Teaching language skills is one of the most frequent needs for children with autism, but also one of the most misunderstood skillsets amongst both parents and practitioners. The desire to hear your learner speak in full sentences can be overwhelming, making it especially difficult to take a step back and consider what it means to communicate and how communication skills develop in neurotypical children. Many times we get hung up on what a child should be capable of communicating at a certain age, rather than focusing on what they are capable of communicating at this stage of development.

Many practitioners and curricula utilize Brown’s Stages of Language Development.* Brown described the first five stages of language development in terms of the child’s “mean length of utterance” (or MLU) as well as the structure of their utterances.

From aacinstitute.org

Sometimes it is necessary to compare a child to his or her same-age peers in order to receive services or measure progress, but it can be detrimental to focus on what a child should be doing at a specific age instead of supporting them and reinforcing them for progress within their current stage.

Research has suggested that teaching beyond the child’s current stage results in errors, lack of comprehension, and difficulty with retention. Here are some common errors you may have witnessed:

• The child learns the phrase “I want _____ please.” This phrase is fine for “I want juice, please” or “I want Brobee, please,” but it loses meaning when overgeneralized to “I want jump, please” or “I want play, please.” It’s better to allow your learner to acquire hundreds of 1-2 word mands (or requests) before expecting them to speak in simple noun+verb mands.
• The child learns to imitate only when the word “say” is used. Then the child makes statements such as “say how are you today,” as a greeting or “say I’m sorry,” when they bump into someone accidentally. Here, the child clearly has some understanding of when the phrases should be used without understanding the meanings of the individual words within each phrase.
• The child learns easily overgeneralized words such as “more.” This is useful at times, but the child can start using it for everything. Instead of saying “cookie” he’ll say “more.” Instead of saying “train,” he’ll say “more.” And he may say “more” when the desired item is not present, leaving the caregiver frustrated as he/she tries to guess what the child is requesting. Moreover, as language begins to develop, he may misuse it by saying things such as “more up, please.”
• The child learns to say “Hello, how are you today?” upon seeing a person entering a room. A child comes into the classroom and the learner looks up, says “Hello, how are you today?” The child responds, “Great! Look at the cool sticker I got!” Your learner then doesn’t respond at all, or may say “fine,” as he has practiced conversations of greeting.

These are only a few of the common language errors you may see. While you may want your learner to speak in longer sentences, your goal should be to have them communicate effectively. With this goal in mind, it becomes essential to support them at their current stage, which means it’s essential to assess them and understand how to help them make progress.

This is why I always use the VB-MAPP to assess each child and make decisions about language instruction. I need to have a full understanding of how the learner is using language, and then move them through each stage in a clear progression. I may want the child to say “Hello, how are you today?” But when I teach them that, do they understand those individual words? Do they comprehend what today means as opposed to yesterday or tomorrow? Do they generalize the use of “how” to other questions?

As you make treatment decisions for your learner, think about their current stage and talk about how to support your child with both a Speech Language Pathologist and an ABA therapist.

*Brown, R. (1973). A first language: The early stages. London: George Allen & Unwin Ltd.

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.

If I were to ask you right now, what types of activities does your learner like to do, and what types of activities is your learner resistant to, you’d probably be able to respond pretty quickly to both questions. For instance, you might say, my son loves to practice addition facts, but he is resistant to working on spelling homework. Or you might say, my student enjoys passing out papers in class but is resistant to lining up with the rest of the class when it’s time to go to lunch.

You can use this information to increase the likelihood of compliance for those tasks your learner does not like. First, let’s call the tasks your learner enjoys high-p tasks (or high probability tasks) and the tasks your learner does not enjoy the low-p tasks (or low probability tasks). Once you have identified high-p and low-p tasks, you can use this information to produce behavioral momentum.

So what might this look like? Let’s take our first example of the learner who liked to practice addition facts, but is resistant to spelling. The conversation might look like this:

Parent: 2 + 4
Son: 6
Parent: 3 + 5
Son: 8
Parent: 4 + 3
Son: 7
Parent: Spell “apple.”
Son: A-P-P-L-E

Behavioral momentum is quite a broad topic. The conversation above is an example of just one element of behavioral momentum: a high-probability (or high-p) request sequence. This is “an antecedent intervention in which two to five easy tasks with a known history of learner compliance (high-p request) are presented in quick succession immediately before requesting the target task, the low-p request” (Cooper, Heron, & Heward, 2007, p. 492).

By providing several sequences such as the one above, you can practice all of the spelling words without fighting him to sit down at the table and practice only spelling for ten to fifteen minutes.

With the example of the young girl who likes to hand out papers but doesn’t like lining up before lunch, it might look something like this:

Teacher: Can you take this paper to Lucy?
Student takes paper to Lucy.
Teacher: Can you give this one to Marcos?
Student takes paper to Marcos.
Teacher: Nice work. Can you stand behind Henry?
Student gets in line behind Henry.

It should be noted that the goal is to move the low-p tasks to high-p tasks. We don’t want the learner to always require two to five high-p tasks before they engage in the low-p task! You can do this by decreasing the number of high-p tasks before giving a low-p task, or by increasing the number of low-p tasks. For instance, maybe the first learner is responding quickly each time his parent gives him a spelling word, so the parent can start giving two spelling words after the series of high-p tasks, then systematically increase the number of spelling words over time.

Overall, the high-p request sequence is an easy-to-implement strategy that can improve compliance and reduce stress for all parties involved.

REFERENCES

Cooper J.O, Heron T.E, & Heward W.L. Applied behavior analysis (2nd ed.) Upper Saddle River, NJ: Pearson, 2007.

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.

This month’s ASAT feature comes to us from Alice Walkup, MS, BCBA. To learn more about ASAT, please visit their website at www.asatonline.org. You can also sign up for ASAT’s free newsletter, Science in Autism Treatment, and like them on Facebook! You can read more of our ASAT featured posts here.

How does a behavior consultant who is invested in the child’s best outcome encourage parents to actively participate in home-based intervention?

Answered by Alice Walkup, MS, BCBA

For many parents of children with autism, participation in a home-based behavioral intervention program may seem overwhelming. In addition to managing and advocating for the child’s various services, parents may find it difficult to attend to the needs of other family members, their spouses, and their jobs. Participating in their child’s home-based program can certainly seem like one more responsibility for which there simply is not enough time. It is important to appreciate that other commonly-endorsed autism therapies, such as occupational or speech therapy, do not usually require the same level of time, energy and parental involvement that an intensive behavioral intervention program does.

Understanding And Assessing Barriers To Participation

When you conduct the intake interview (and likely throughout the consultative relationship), it is important to take note of any potential barriers to the parents’ participation. Education level, socio-economic status, competing responsibilities, other family members in the home, cultural beliefs, and beliefs about autism and autism treatments are just a few factors to consider. It is also important to keep in mind that parents may be unaware that the skills of children with autism (e.g., communication, compliance) do not automatically generalize from therapists to parents. As such, it is important for consultants to gauge the willingness and motivation of family members to be active participants in their child’s intervention program (Taylor & Fisher, 2010).

From the outset, it is important to explain to parents that they will be a critical part of their child’s learning and will be shown how they can help the child practice what they’ve been taught during therapy sessions. Parents may also hold misconceptions regarding behavioral intervention, such as a belief that behavioral techniques are based exclusively on punishment. Explaining the intervention process at the outset will help eliminate such concerns. A final point to consider is that many parents of children with autism experience their own psychological challenges, such as depression and anxiety. Some research suggests that mothers with depressive characteristics do not acquire as much information and skills during parent training as mothers without depressive characteristics (Gelfand, Teti, Seiner, & Jameson, 1996; Cicchett, Rogosch, & Toth, 2000). Such issues may present challenges for consultants but once identified can be taken into consideration when individualizing consultation and the scope of the home-based intervention. It may also become clear during the intake process that referral to other services or resources are warranted.

Setting The Stage For Success

When working with a new family, there are many strategies you can employ to build a collaborative, open relationship from the outset. These include:

• asking questions that will help you better understand the parents’ experiences as they relate to supporting their child with autism. Such questions may include asking what other services/therapies the child has received (or is still receiving), what supports (community, family and individual) are available to the parents, and what they see as their biggest challenges related to parenting a child with autism
• being an attentive and compassionate listener
• minimizing “behaviorspeak,” including clinical terms and acronyms with which the parent is unfamiliar. When explaining behavioral principles, it may help to use simpler, every-day examples to illustrate the concepts
• explaining the intervention process and what a typical session may look like
• using language that fosters a cooperative spirit; for example, saying, “we as a team” instead of “you” when discussing the home-based intervention

Goal Selection

When meeting with parents for the first time, encourage them to identify the hopes and fears they have for their child as doing so will help guide intervention planning and goals. It is equally important to identify goals that are most relevant to the family such as eating, sleeping, and community-based goals (Taylor & Fisher, 2010). This conversation should address both short- and long-term goals for the child, such as playing with friends, sitting appropriately in church, or attending college. With this knowledge, the consultant can assist parents in identifying their top three most important goals. One strategy for longer-term goals is to give each a name, such as “Project Friendship” for a socialization goal, as it will serve as a reminder to focus on the big picture. Once these are identified, the shorter-term goals and associated skills to be taught can be more easily defined, and the parents can see how they are supporting the longer-term goal. After selecting initial teaching targets and determining appropriate instructional strategies, the behavioral team will begin implementation. Keep in mind that some parents may challenge your typical approaches to behavior change, such as finding it difficult to tolerate extinction bursts, appreciating the need for direct teaching of desired skills, or using edible reinforcers. This again highlights the critical importance of discussing the intervention process and teaching strategies with parents at the outset. You can also explain their potential roles as teachers and that they will be included in their child’s teaching at the appropriate time. Doing so will help foster a more collaborative relationship and help parents better anticipate and understand their roles in the behavioral intervention process.

Promoting Enduring Participation

Once parents agree to be involved in their child’s home-based intervention, many factors can potentially influence their adherence to behavioral programs and their participation. Continued parent participation can be impacted by parental perceptions of themselves as effective in behavior change, confidence in the treatment approach, and by the degree to which the child is accepted in the family and community, among other variables (Moore & Symons, 2011). When engaging parents in the teaching process, the key is setting them up to be successful. Start with a smaller goal that the child has already mastered with the in-home therapists so that parents leave the teaching interaction feeling effective in promoting behavior change in their child. Utilizing best practices for training that incorporate modeling, rehearsal, and feedback will provide parents with valuable opportunities to both observe and practice teaching the targeted skill to their child. Tracking and graphing their progress in addition to the child’s, then taking the time to review it with them regularly, is a good strategy to provide encouragement throughout the intervention process.

Parents and consultants should also consider whether or not the funding source for child’s in-home services requires parent participation (and to what degree). Currently, some funding sources place a significant emphasis on training the parents to be effective at-home therapists and require behavior consultants to teach parents therapeutic skills to a level of mastery that they can do so. Parents can be asked to implement programs and collect data, and the consultant must report the level of parent involvement to the funding source. In extreme cases, in-home services have actually been terminated due to a lack of parent participation. While it is often more effective to appeal to parents on a more personal level when encouraging their involvement, this requirement and the potential loss of services should be discussed.

Behavior consultants providing in-home services are tasked with addressing a child’s needs within an existing, and sometimes challenging, family dynamic. The ideal in-home behavioral intervention program would include extensive and high-quality parent participation during therapy sessions; however, this may not always be possible. As such, we must individualize the type and extent of parent involvement on a case-by-case basis and employ our skills as consultants to encourage and maintain active parent participation, where possible. Despite the challenges that may accompany our efforts, it’s important to remember that, at the end of the day, we are all working towards the same goal: ensuring the best possible outcomes for the child.

References

Cicchetti, D., Rogosch, F. A., & Toth, S. L. (2000). The efficacy of toddler–parent psychotherapy for fostering cognitive development of offspring in depressed mothers. Journal of Abnormal Child Psychology, 28, 135-148.

Gelfand, D. M., Teti, D. M., Seiner, S. A., & Jameson, P. B. (1996). Helping mothers fight depression: evaluation of a home-based intervention program for depressed mothers and their infants. Journal of Clinical Child Psychology, 25, 406-422.

Moore, T. R., & Symons, F. J. (2011). Adherence to treatment in a behavioral intervention curriculum for parents of children with autism spectrum disorder. Behavior Modification, 35, 570-594.

Taylor, B. A., & Fisher, J. (2010). Three important things to consider when starting intervention for a child diagnosed with autism. Behavior Analysis in Practice, 3, 52-53.

Citation for this article:

Walkup, A. (2012). How does a behavior consultant who is invested in the child’s best outcome encourage parents to actively participate in home-based intervention? Science in Autism Treatment, 9(4), 4-6.

About The Author

Alice M Walkup, MS, BCBA currently resides in Los Angeles, CA where she practices behavior analysis with clinical populations. 

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. Next week, another ABA professional will respond to Sam’s questions and provide further insight and a different perspective on the piece.

One of my favorite parts of my job is training people who are working to become BCBAs. There is an immense amount of content for my supervisees to learn, and one of the key aspects of this is to understand how to implement all of the new concepts they’re learning within the context of an actual case. This is often far more challenging than it might appear at first blush. I frequently supervise students pursuing their BCBA, and I require each one of them to read LeBlanc, Raetz, Sellers, & Carr (2016) because it provides a clear model for clinical decision-making.

This month’s article:

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 practice, 9(1), 77-83

This month’s questions:

• Why is this article important for practitioners to read?
• 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?
• 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.
• 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?
• 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?
• 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?

Check back next week for our ABA Journal Club response post from Dana Reinecke. Let us know what your thoughts are on Facebook and Instagram!

About The Author

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.

This month’s response comes from Dr. Bryan J. Blair. The original discussion questions can be found in last week’s post. Don’t forget to let us know your thoughts on our Facebook page!

One of my early applied behavior analysis (ABA) supervisors used to say that the hardest part of his job was changing direct care staff behavior so that the staff would comply with administrative policies and to ensure the consistent implementation of treatment plans.  He certainly did not mean to imply that developing effective interventions for severely challenging and dangerous behavior, such as aggression and self-injury, was easy or formulaic.  But he rightly noted how challenging it can be to train and supervise staff using the same behavior analytic principles that we use directly with clients in clinical settings.  The article for the ABA Journal Club, An Assessment-Based Solution to a Human-Service Employee Performance Problem (Carr, Wilder, Majdalany, Mathisen, & Strain, 2013), tackles this supremely relevant issue by providing us with an empirical analysis of a tool that can be used in the process of improving staff performance.

One of the defining features of interventions based on applied behavior analysis is that the procedures and protocols rely on objective operational definitions of the world around us and that the natural world is continually empirically analyzed to ensure that treatments are relevant and effective.  As ABA practitioners, we have realized great success in this approach for developing and implementing treatments and interventions for a vast array of skill deficits and challenging behaviors.  However, far too often we fail to use these same guiding and controlling principles when training and supervising the professionals who directly implement ABA technologies.  As Dr. Blanco noted, the vast majority of trained Board Certified Behavior Analysts (BCBAs) have received little formal training in the management and supervision of direct care professionals, so it is ultimately not overly surprising that many BCBAs struggle with using the principles of ABA to develop staff skillsets.

However, that will soon change!  As of January 2022, the Behavior Analyst Certification Board’s (BACB) 5th Edition Task List (BACB, 2017b) and Verified Course Sequence Coursework Requirements (BACB, 2017b) will include content related to staff supervision and training.  Graduate programs will be required to develop academic content that targets supervisory skills and strategies associated with training direct care professionals and BCBA supervisors will need to address these areas in supervised fieldwork settings.  This is certainly a welcome development and I am optimistic that these new requirements will lead to practicing behavior analysts who are better equipped with skills that can be applied to staff supervision and performance management.

Early in my career, along with several colleagues, I developed a new direct staff observation and feedback protocol using a partial-interval observation and data collection system that allowed for empirical analysis of the performance of an individual staff person over time.  Prior to the development of the system, we relied on more subjective and anecdotal observational strategies that limited our ability to provide meaningful, timely, accurate, valid, and relevant feedback to staff in order to develop their clinical and administrative skills.  The new tool allowed us to graph staff performance data over time and visually analyze the data to determine objective performance levels across a variety of defined skills, and this visual presentation of behavior was shared with the staff themselves so that they could see their own behavioral changes over time as well.  The summarized data were included in staff evaluations and referenced during supervision and mentoring meetings.  The PDC-HS provides behavior analysts with an opportunity to screen for deficits in strategic and systemic supervision practices (as opposed to more tactical procedures such as directly observing the implementation of a discrete trial training protocol) and I feel that such a tool is essential when developing staff observation and feedback systems.  Had we used such a tool in conjunction with our more direct observation tool, we may have identified agency-level holes in training, mentoring, and supervisory practices that resulted in staff performance that didn’t meet the expected clinical standards.  In essence, by using the PDC-HS, we might have identified other contributing factors to poor performance that might not have been easily identified by direct in-vivo observations.

In addition, the PDC-HS provides behavior analysts who supervise staff with directly applicable empirical references that can be used to further support the development of staff supervision and feedback systems.  BCBAs are well aware of the fact that we must always use evidence-based interventions for clients of ABA interventions and services (BACB, 2014); however, given the fact that many practicing behavior analysts have received little formal training on staff supervision, it is imperative to provide the field of ABA with tools to help facilitate the process of staff performance management.

Coincidentally (or perhaps because of the pervasiveness of this skill deficit), when I supervised a team of ABA therapists who shared an office space, I too needed to address cleanliness and orderliness of the shared space with a simple behavior analytic intervention (i.e., a gamified group reinforcement system).  Again, however, had I used the PDC-HS tool, the intervention would most likely have better reflected the setting events, training and supervision deficits, and functions of the skill deficit (or motivative deficit).  Given the rapid expansion of direct ABA therapy in a variety of unstructured settings where supervision from a BCBA might occur less frequently than in a clinic (e.g., in a general education classroom or in the client’s home), I agree that systematic replications can and should address the fidelity of the implementation of teaching protocols and behavioral interventions.  Such replications would provide supervisors with much-needed clarification regarding the conditions and systems that control certain behaviors that interfere with the effective implementation of behavior analytic interventions.

As Dr. Blanco noted in her remarks about the article and the PDC-HS, BCBAs must be well-versed in effective and individualized staff supervision and performance management strategies and tactics.  BCBAs are highly encouraged to develop their own tools to facilitate the consistent application of principles of ABA to such supervision, and tools like the PDC-HS can be used to help frame staff skill and performance deficits that might otherwise be difficult to analyze.

References

Behavior Analyst Certification Board. (2017a).  BCBA/BCaBA coursework requirements based on the BCBA/BCaBA Task List (5th ed.). Retrieved from: https://www.bacb.com/wp-content/uploads/2017/09/170113-BCBA-BCaBA-coursework-requirements-5th-ed.pdf

Behavior Analyst Certification Board. (2017b).  BCBA/BCaBA task list (5th ed.). Littleton, CO: Author. Retrieved from:  https://www.bacb.com/wp-content/uploads/2017/09/170113-BCBA-BCaBA-task-list-5th-ed-.pdf

Behavior Analyst Certification Board. (2014). Professional and ethical compliance code for behavior analysts. Littleton, CO: Author.  Retrieved from: https://www.bacb.com/wp-content/uploads/BACB-Compliance-Code-english_190318.pdf

Carr, J. E., Wilder, D. A., Majdalany, L., Mathisen, D., & Strain, L. A. (2013). An assessment-based solution to a human-service employee performance problem. Behavior Analysis in Practice, 6(1), 16-32.  doi: 10.1007/BF03391789

About The Author

Dr. Bryan J. Blair is a licensed behavior analyst (MA), Board Certified Behavior Analyst, and is currently an Assistant Professor at Long Island University – Brooklyn where he is also the coordinator of the Applied Behavior Analysis graduate certificate and supervised fieldwork programs.  He has worked with children and adults with developmental disabilities and other clinical disorders for over 15 years in a variety of settings.  For more information or to contact Dr. Blair please see his website:  https://ww.bryanjblair.com.

This month’s ASAT feature comes to us from Ennio Cipani, Ph.D. To learn more about ASAT, please visit their website at www.asatonline.org. You can also sign up for ASAT’s free newsletter, Science in Autism Treatment, and like them on Facebook! You can read more of our ASAT featured posts here.

I am a new teacher who will have a student with some self-injurious behavior entering my classroom next year. Although his behavioral intervention will be overseen by a board-certified behavior analyst, I would like a general understanding of how certain behaviors develop into self-injury.

Like yourself, many teachers will have contact with students with autism and/or intellectual disabilities who engage in severe and intense forms of self-injury. Indeed, these self-destructive acts seem to defy any reasonable explanation. Common explanations for a student who engages in self-injury have often disregarded an environmental analysis of antecedents (i.e., the events that take place right before the behavior occurs). In some cases, statements are made such as “It comes out of nowhere,” or “She does it because she has autism/intellectual disabilities.”

A behavior analytic model shows us that challenging behavior is functional (i.e., serves a purpose) for the individual and can indeed explain even cases where self-injury has reached such dangerous intensity that it results in soft tissue damage, concussions, etc. But, as you asked, how do such dangerous behaviors develop? Research and anecdotal reports from families have demonstrated that mild forms of self-injurious behavior can start innocuously, and over time, become dangerous in terms of their effect on the person’s health and welfare.

Let’s consider a hypothetical student to demonstrate how events in the student’s environment can reinforce and shape severe self-injurious behavior. Initially, tantrum and screaming behaviors are effective (functional) in producing a desired outcome. These behaviors can result in access to desired items and events, such as candy or a preferred activity or in escape from aversive conditions, suchn this mont as demands to turn off electronics or complete a non-preferred task. In other words, the tantrum and screaming are effective in producing access to reinforcement.

Although the adult responding to such behaviors may feel uncomfortable about “giving in”, tantrum behaviors produce a very uncomfortable and aversive condition for the adult, who then relents in order to get the student to stop the behavior. In what can quickly become a vicious cycle, the student engages in challenging behavior to obtain a desired result. That behavior creates discomfort for the adult. The adult gives the student what he/she wants and the challenging behavior ceases.

How then does an extreme exacerbation of intensity develop and/or the form of the initial challenging behavior change? One scenario is that during one of these tantrums where the desired result has not yet been delivered, the student slaps him or herself. After a brief amount of attention, e.g., “Stop doing that, you are hurting yourself,” the desired outcome also is produced. As you can see, hitting oneself has now become more adaptive than a tantrum of long duration. As the milder forms of behavior fail to result in the desired outcome, behavior intended to obtain reinforcement can become more varied. Regrettably, the teacher now responds to a more intense variation of challenging behavior. The form that achieved the student’s desired result is the increased intensity of self-injury. What was previously a slap to the leg could now transform to multiple slaps to multiple areas of one’s body.

You may have observed that the self-injury often involves hits/slaps to the face/head. Why would this be the case? Ask yourself this: Are you more likely to intervene if the hitting occurs to one’s thigh area or the face? This could result in adults providing reinforcement more quickly or ceasing to place a particular demand on the child when the self-injury is directed at the face or head. If a more dangerous form of self-injury becomes more efficient than milder forms of the behavior at accessing the reinforcer, the probability that the child will engage in the extreme form of the behavior to access that particular reinforcer increases.

In summary, self-injurious behaviors, like other forms of behaviors, can serve a variety of environmental functions, involving both access (to something) and escape/avoidance (from something). The Cipani Behavioral Classification System (BCS) is a pioneering function-based classification system for categorizing problem target behaviors for education and mental health settings (Cipani & Cipani, 2017). It provides a standard framework for identifying functions of problem behavior. This unique diagnostic classification system identifies the four basic (operant) behavior functions (originally specified in Cipani,1990,1994). It then derives 13 different function-based categories within those four functions.

A functional perspective of self-injurious behaviors can lead to a more effective and efficient treatment. It is important to examine the environmental variables that occur at the time of the self-injurious behavior to determine the function of the behavior. If that function can be determined, then the student can be taught safer, socially acceptable ways to get his or her needs met. Your board-certified behavior analyst should be able to assist you in developing a comprehensive set of strategies based on the underlying function that the self-injury serves for your student.

References

Cipani, E. (1990). The communicative function hypothesis: An operant behavior perspective. Journal of Behavior Therapy and Experimental Psychiatry, 21, 239-247.
Cipani, E. (1994). Treating children’s severe behavior disorders: A behavioral diagnostic system. Journal of Behavior Therapy and Experimental Psychiatry, 25, 293-300.
Cipani, E., & Cipani, A. (2017). A behavioral classification system for problem behaviors in schools: Diagnostic manual (1st edition). New York: Springer Publishing.

Editor’s Note: This article has been adapted and shortened with permission from Behavior Development Solutions and the author. Please see the “Ask Cipani” column to read more articles authored by Dr. Cipani. For more information about functional analysis, please see a previously published Clinical Corner article authored by Dr. Robert LaRue.

About The Author

Ennio Cipani, Ph.D. is a licensed psychologist since 1983 in California. Dr. Cipani has been doing in-home and in-school behavioral consultation for families facing child problem behaviors since 1982. He has published numerous articles, chapters, books and software in the areas of child behavior management and parent and teacher behavioral consultation. His most recent book (Cipani & Cipani, 2019); Cipani Behavioral Classification System for Children and Adolescents: Diagnostic Manual (2nd edition) can be obtained for free in pdf form by emailing him at ennioc26@hotmail.com