Ethics Part Two: More on the Right to Effective Treatment

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This is part two in a series on ethics and effective treatment. Part one can be found here.

 

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In Part One, I discussed the right to effective treatment as detailed by the Professional and Ethical Compliance Code for Behavior Analysts. An essential part of effective treatment is providing, as the code specifies, “scientifically supported, most-effective treatment procedures” (BACB, 2014). In order to do this, behavior analysts must contact the research literature to fully understand scientifically supported treatments. They should do this through reading journal articles, but also through attending workshops, trainings, and local conferences.
Reading journal articles should be a regular activity for behavior analysts. It is suggested that behavior analysts set aside two to four hours per week to read recent journals (Bailey & Burch, 2016, p. 24). This may seem like a lot of time, especially if you aren’t currently doing it. But this practice allows you to stay abreast of current research and have access to a broader range of possible interventions. You may also find it easier to follow through if you participate in a journal club (click here to see suggestions for that.).
Most of the behavior analytic research you’ll find is comprised of single-subject studies. You may get pushback from professionals or parents who are accustomed to seeing research with very large numbers of participants and an explanation of average results. It’s important to understand how to address those concerns in an accessible and accurate way. Here are some things to consider:
• Behavior analytic research does not utilize averages. Therefore, we learn a lot about the specific individuals who responded to an intervention, and can make a more accurate hypothesis about whether or not that intervention will work for a particular client. Furthermore, research based on averages doesn’t provide any information on the percentage of individuals who did not respond to the intervention and WHY they did not respond to the intervention. This is important information that we’re missing out on!
• Behavior analysis is focused on creating individualized interventions. We do not believe in a one-size-fits-all approach, but rather in a set of principles of behavior. Individualizing treatment means that we are looking at the environment, the basic characteristics of the individual, the motivations of the individual, and the functions of a behavior when creating an intervention. When you familiarize yourself with behavior analytic research, you are able to identify interventions that worked with individuals who similar characteristics to that of your particular client.
• Though behavior analysts utilize single subject research, we are fully aware that this does not mean an intervention that worked for a few subjects will work for everyone. This is why there is an important stress on replication of research. (Chiesa, 1994). This is also why it’s important to read several journal articles on the same subject, rather than simply reading one and considering yourself up to date.

 

The main takeaway here is that being familiar with the research is important in order to maintain an ethical practice. Supervisors should support this by providing suggestions for readings and modeling these behaviors. Organizations can support this by subscribing to journals and maintaining a small library for employees. You can support it by subscribing to journals, setting aside time to spend time reading journals, and participating in a journal club. It is incredibly important to our field, and to your practice.

 
Bailey, J. S., & Burch, M. R. (2016). Ethics for behavior analysts: 3rd edition. New York: Routledge.
Behavior Analyst Certification Board. (2014). Professional and ethical compliance code for behavior analysts.
Chiesa, M. (1994). Radical behaviorism: The philosophy and the science. Authors Cooperative.

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.

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Building Variability Into The Routine

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Several years ago, I was working with a 6-year-old boy we’ll call Terrence. Terrence was diagnosed with autism. He was a very playful child who was generally good-tempered, enjoyed playing with trains and watching TV, and posed few difficult behavior issues for his parents…until the day there was construction on their walk from the grocery store to their apartment and they decided to take a different route home. What happened next is what most people would call a full-blown meltdown: Terrence dropped to the ground, screaming and crying, and refused to move.

Many of the parents I work with have a similar story when it comes to their child with autism and an unexpected change in the routine. The change varies: the favorite flavor of fruit snacks is out of stock at the store or the babysitter greeted the child at the bus instead of the parent or they grew out of the coat they wore the past two winters… In fact, it can be difficult to anticipate exactly what specific routine may be a trigger for your learner. This is precisely why building variability into the routine can be helpful.

Here are a few things to consider:

First, think about the routines that are the most likely to be interrupted. Make a list of these so you can begin thinking about how to address those issues.
Second, work with your team (whether that means family or practitioners that work with your learner) to select 2-3 routines to focus on first.
Discuss how those routines would most likely be interrupted. For instance, a favorite TV show may be interrupted during election season or you may have a family function when the TV show is aired. In teaching your learner to be flexible with changes in routine, you will contrive changes that are likely to occur to give your learner quality practice.
Plan to vary the routine. Essentially, you are setting up the change in routine, but you will be prepared in advance to help your learner behave appropriately. (You’re much more likely to experience some success in this scenario than you would be if a change in routine occurs unexpectedly and/or last minute.)
Give your learner a vocabulary for what is happening. I teach many of my students the term “flexible.” I might say, “I appreciate how you’re being flexible right now” or “Sometimes when plans change we have to be flexible. This means…”
Reinforce appropriate behaviors related to flexibility! You want to be clear when they’ve made an appropriate, flexible response. In the planning phase, you can discuss what appropriate reinforcers might be for the routines you are targeting.
If you build in variations in routine and teach your learner some strategies for being flexible, you and your learner are much more likely to be successful in navigating unexpected changes.

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.

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Go Play! The Importance of Symbolic Play in Early Childhood

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This week’s post comes to us from Stephanny Freeman, PhD and Kristen Hayashida, MEd, BCBA, and Dr. Tanya Paparella, our partners on the Play Idea Cards app. Play Idea Cards is a full curriculum on teaching play – right in the palm of your hand! Check it out on the Apple App Store! 

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Most adults think of toy play as a natural part of childhood.  When my daughter was born, we were showered with plush animals, tea sets, and dress up clothes for her to use in play.  But what happens when the child does not find toy play to be natural?

Many children on the autism spectrum use toys non-functionally or repetitively.  When I ask parents of children with ASD to tell me about their child’s play they often say “he doesn’t know how to use toys appropriately!”  They then tell me about how the child may spin the wheels on the car while staring at the rotating objects.  They tell me about the specific scripts the child uses to carry out a routine with their toys and subsequent tantrums if the routine is disrupted.  Parents notice how this deficit in play impacts their ability to engage with peers or occupy their free time appropriately.

Symbolic play occurs when the child uses objects or actions to represent other objects or actions.  For example, a child using a doll as their baby and rocking the doll to sleep is an act of symbolic play.  The doll is not alive, but the child is representing a baby.  This skill is a core deficit in children with ASD.  This means that they do not “naturally” or “easily” acquire the ability to use toys to represent other things.  Development of symbolic play is crucial in early development and is tied to numerous subsequent skills:

Language: symbolic play is highly correlated to language development.  This means that the better the child’s ability to play representationally, the better the child’s language skills.  There is also emerging evidence to support symbolic play as having a causal relationship to language.  [Explanation].

Social Development: as neurotypical children continue their learning about symbolic play and through symbolic play, children with ASD often struggle to relate to their peers and understand their play schemes.  Some children with ASD may only engage peers in physical play (instead of symbolic play) or they may end up playing alone using their familiar play scripts.

Perspective-taking: symbolic play allows the child early opportunities to take on the perspective of another being.  If a child pretends to be a pirate, they being to talk and think of things a pirate might want/do.  This early practice with perspective-taking allows the child to use this skill when interacting with peers and adults.

Meta-cognition and Problem Solving Skills: meta-cognition is the ability to think about one’s own thinking.  This is an essential skill when solving problems and planning one’s time.  During play kids plan, organize and cognitively process through obstacles and mishaps with their toys.

Emotional Development: through symbolic play, children can practice expressing emotion through the scenes they create.  There is also some evidence suggesting that this early practice contributes to emotion understanding and empathy.

Clearly, children need play for growth and development.   However, for children with ASD the development of symbolic play may be difficult and, even thought of as WORK!

Given the numerous skills that come out of symbolic play, we urge parents of children with ASD to consider the importance of toy play.  Dedicate time and effort to engage your child in symbolic play.  It is usually not easy at first!  It might have been decades since you picked up an action figure and used him to fight off bad guys, but practice with your child.

Parents know that it is part of their job to help their child learn to read and do basic math.  They would not let their child escape those tasks because they are hard.  Please consider PLAY to be just as important and necessary for the child’s development.  Even if it is work at first, insist the child play with you and in time, improvements may come not only in toy play but also in so many other key areas of development.

Jarrold, C., Boucher, J., & Smith, P. (1993). Symbolic play in autism: A review. Journal of

Autism and Developmental Disorders, 23(2), 281-307.

Ungerer, J.A. & Sigman, M. (1981). Symbolic play and language comprehension in autistic

children. Journal of the American Academy of Child Psychiatry, 20, 318-337.

About The Authors

Dr. Stephanny Freeman is a clinical professor at UCLA, a licensed clinical psychologist, and Co-Directs the Early Childhood Partial Hospitalization Program (ECPHP).  For 20 years, she has educated children with ASD and other exceptionalities as a teacher, studied interventions for social emotional development, and designed curriculum and behavior plans in school and clinic settings.

Kristen Hayashida is a Board Certified Behavior Analyst at the UCLA Early Childhood Partial Hospitalization Program (ECPHP).  For the last 10 years she has served as a therapist, researcher and educator of children and families living with autism spectrum disorder through the treatment of problem behavior.

Dr. Tanya Paparella is a specialist in the field of autism having spent more than 20 years in intervention and research in autism. She is an Associate Clinical Professor in the Division of Child Psychiatry at UCLA, a licensed clinical psychologist, and Co-Director of UCLA’s Early Childhood Partial Hospitalization Program (ECPHP), an internationally recognized model treatment program for young children on the autism spectrum.

 

 

 

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Ethics Part One: Data Collection and The Right to Effective Treatment

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In the next few weeks I will be writing about ethics in the field of applied behavior analysis. This is the first part in a multi-part series.

Sometimes behavior analysts get a bad rap because we are so focused on the data. Somehow, there is a perception that writing down the numbers and graphing the information is “cold” or “unfeeling” towards the client. Over the course of my career, I’ve had more than one person say to me that I was more fun or more playful than they expected me to be as a behavior analyst. I’m not exactly sure where these misperceptions started, but today I want to get to the root of them.
As a BCBA, I am bound by the Professional and Ethical Compliance Code for Behavior Analysts. Within this code, it clearly states “Clients have a right to effective treatment.” This is something I take to heart every day in my work. And it’s the primary reason that I have my clipboard and am taking data. I want to ensure that the treatment I am introducing is actually effective. My data is what shows me when something is clearly not working, and allows me to be efficient with making changes the best benefit my client.
Clear, objective data allows me to be responsive to data and provide information in a responsible manner. Here are a few things to consider:
• When I graph data daily and look at that information, it’s very easy for me to see if a client’s performance has plateaued, is improving, or is actually getting worse. I can make adjustments based on the trend in the data.
• When all practitioners working with the client graph daily, I might (as the supervisor) see that the client is not performing as well with one practitioner. This might indicate that more training needs to occur. Or, I might see that one practitioner is getting far better results than the others. This might indicate that the practitioner is not recording data correctly or is doing something as part of the intervention that everyone should be doing.
• Data should be collected daily and the teaching programs should be clearly outlined. This way, if for some reason a practitioner abruptly stops working with the client or if the client moves, it is much easier for future practitioners to pick up where the last ones left off.
• Looking at data daily gives an idea of the individual client’s general trends in mastering new skills. For instance, last year I had a client who generally mastered new skills within one week, and his trend in the data was very consistent across all types of skills. So if we introduced a new program and he wasn’t mastering it for three weeks, it was an indication that we needed to re-evaluate what we were teaching or how we were teaching it. Being well-versed in your individual client’s learning patterns allows you to more clearly make individualized decisions!
We’d love to hear from you. What outcomes have you discovered in the relationship between being responsive to data and providing effective treatment for your clients?

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.

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