This article is the 6th post in a series by Dr. Teresa Camille Kolu, BCBA-D, about trauma-informed behavior analysis.
Children on the autism spectrum (or those affected by one of many other developmental challenges) are often less likely to advocate for themselves than their neurotypical peers. This is dangerous, and can mean that if an adult is giving them instructions, they might keep following the instruction – even when it hurts. A dear friend is giving thanks this week for her child’s swift treatment and recovery after he nearly died on a camping trip—when trained team leaders failed to recognize his signs of distress as he followed instructions to continue the hike while he gasped for air.
When our most vulnerable children and adults don’t have a voice, we caregivers and providers must document these risks first, then be ready to look and see (their signs of distress), listen (to their attempts to communicate), and respond, collaborating like someone’s life depends on it (because it just might).
In a few weeks, I will be speaking to parents at an upcoming event around Boulder and Broomfield, Colorado to educate family members and caregivers on what they need to expect from an ethical behavioral provider.
“Did you know”, I said to a mom helping organize this event, “that no one should ever write or enforce an IEP goal that says “Teresa will decrease protesting to 0 levels”? In fact, I would argue that we should not attempt to decrease even “inappropriate protesting” to low rates—at least, not before Teresa can effectively and reliably protest effectively in a way that others understand her.
As we discussed this idea, both mom and I were saddened to remember and revisit the years of similar IEP goals that focused on a target to decrease behavior when there was no meaningful alternative for the child. Regrettably and predictably, years later the child was a young teen who still used self-injurious behavior that was “escape-maintained”, to communicate to others that she needed a break. It hadn’t been successful to try to stop her from using these behaviors… because a lot of the time, they were the only things in her repertoire that worked to get her out of aversive situations. That is, it wasn’t successful UNTIL a new and meaningful skill was established and effective! Now she is learning to say “no thanks” or “not right now”: and now that she can protest effectively, the self injurious behavior is not nearly as necessary (or frequent) in her behavior stream.
Extinction alone is neither safe nor effective when we’re talking about learning a new behavior. Responsible behavior analysts use shaping and other techniques to build up new alternative skills that are just as, or even more, effective—and even more socially appropriate.
What about you?
Do you listen to what someone is communicating with their behavior? Do you document the risks of lacking appropriate functional communication, and note how these risks are compounded for individuals with delays or abuse histories or lack of family resources? Do you collaborate like someone’s life depends on it? To collaborate we must listen to what the other members of our team say, reaching out to people who have important or historical roles with the family or who are successful interacting with the child, although those providers may not typically have a seat at the “behavioral table”.
We love this story from June 2017 about the human chain quickly organized on a Panama City beach to save several lives at risk of drowning. Maybe it’s just easier to see how 100 people can save a person at risk of drowning than it is to see how 10 people collaborating on a risk assessment, functional assessment and behavioral and mental health plan can help prioritize a life-saving treatment agenda for our most vulnerable clients (whose behavioral cries for help can turn our stomachs).
One of our upcoming posts discusses the wealth of community members with whom we can collaborate.
When it counts, we expand our team.
Go back to school with further reading for behavior analysts:
As we get ready for back to school, so many of our clients struggle with communicating effectively to protest educational events they find aversive or too difficult, or manding (requesting) for assistance with their homework or educational materials.
If you’re a behavior analyst reading this post, you recognize the behavioral strategy of “differential reinforcement of alternative behavior” in the technique described above. Read more here about differential reinforcement and other function-based strategies to address escape-maintained challenging behavior. But as you read and think about these procedures, pay special attention to what the authors urge in their Behavior Analysis in Practice article: “It is a behavior analyst’s ethical responsibility to promote effective learning environments rather than teach individuals with disabilities to tolerate ineffective ones” (Geiger, Carr and LeBlanc, 2010).
P.S.: How is this post related to trauma? The children I discuss in this article are at greater risk for increased adverse experiences related to their autism and lack of functional communication, like many of your clients whose histories have common risk factors (autism, abuse, communication challenges, etc). If we do not document the greater risks to which they are subject, we risk exposing them to subsequent and graver risks that can compromise their educational opportunities, access to supportive communities, and quality of life… forever.
Thanks for reading, and please share your own ideas anytime.