This article is the fourth installment in a series on trauma-informed behavior analysis, by Dr. Teresa Camille Kolu, Ph.D., BCBA-D.
Is “trauma” a behavioral term?
“Trauma” is a buzzword lately. As several people recently noted on behavior analytic forums, it seems as though schools and other entities are requiring “trauma-informed care” from people tasked with providing behavioral interventions, yet it isn’t clear whether trauma actually presents as anything different than the reinforcement history, or a client’s past, that would be explored routinely in any old behavior assessment.
On a recent facebook post in a behavior analytic group, one person posted, “Trauma”, “trauma-informed”, etc, is [just] the new buzzword to get grant funding and sell product”. Another poster chimed in, “Trauma? What’s the behaviors [sic] of concern? What’s the function?” This seems to imply that if we know the current function of behavior, what more do we need to know? It suggests that the resulting treatment path is likely to be no different than that for a “typically developing child” of the same age and an apparently similar behavioral repertoire.
The implication in the social media posts above seems to be, “what’s the big deal?” In other words, trauma is thought of as some in the behavior analysis community as simply another sexy concept that is meant to sell and sound good, rather than being something critical to appreciate (and to suggest differential treatment based on its presence or absence).
As a behavior analyst who has treated children and adults exposed to serious and adverse childhood experiences, I have come to appreciate that the current function is NOT the only important thing to know before treating someone’s challenging behavior patterns, or helping an adoptive parent cope with challenges a mental health therapist might call “reactive attachment”.
So what’s a BCBA to do? 1. Use a functional approach (but don’t base treatment solely on the momentary function)
Appreciate that no one is suggesting you should skip a functional approach. On the contrary, consider for a moment that someone’s long and complicated reinforcement and conditioning history is very much the stuff of good behavior analysis. We often forget that it was originally Skinner himself, and not Iwata, who first discussed a functional analysis of behavior in the context of its environment, and even functional analysis of mentalistic or psychological terms. The behavioral environment entails a person’s history, and in the case of adverse childhood experiences, these can make a difference for a long, long time.
2. Get more information about the events behind the “trauma”
Help others to operationalize and break down what you mean by trauma, instead of using “trauma” as an explanatory term. As we’re already tasked to do in conducting a behavior assessment, learn what happened in the past that might relate to the current behavior stream. For example, if adverse childhood experiences were present, obtain more information about when, where, and in whose presence the challenges occurred. Document evidence that the child’s developmental trajectory is atypical, if this is present.
3. Draw connections to behavior analytic terminology
Perhaps the child was removed from primary caregivers at age 2 and again at age 3 and 4, or perhaps they experienced sexual abuse, exposed to drugs of abuse in utero and modeled until age 5, or the child is not eating, toileting or sleeping on track. A behavior analyst can discuss these as disruption in primary schedules of reinforcement or social reinforcement, behavioral experiences or aspects of the environment that are likely challenging for any child (e.g., removal from multiple homes), or the presence of non-age typical intrusions, deficits or excesses in the behavior stream. In “trauma-related” childhoods, there was often pairing between caregiver-related variables and everyday items and schedules that met (or did not meet) a child’s needs. Documenting these pairings (or conditioning histories) can go a long way toward helping a behavior analyst arrange “preventative schedules” when function-based treatment finally begins.
As we acknowledge we don’t know everything, we will be more open to listening to families about their experiences, open to collecting data that assist us to make data-based decisions and continue to individualize our function-based treatment, and form collaborative alliances with others who have been there.
Let’s keep learning together. Let me know what you have learned in your treatment of this challenging but important area of clinical behavior analysis.