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Part 11 in Trauma-Informed Behavior Analysis: Very early learning relates to behavior much later (see end of post for several references)

02 Monday Oct 2017

Posted by kolubcbad in acquisition, adults, Behavior Analysis, behavior cusp, Behavioral Cusp, children, Education, ethics, extinction, learning, teaching behavior analysis, teaching ethics, trauma, Uncategorized, variability

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acquisition, acquisition predicts extinction, behavior analysis, behavior cusp, extinction, previous learning affects new learning, trauma, trauma-informed behavior analysis, variability, variability during acquisition predicts variability in extinction

Trigger warning: This topic is disturbing and sensitive, yet I wish more behavior analysts applied their science to this ugly real world problem.  Let’s face the hard thing together, by discussing some effects of initial learning on later behavior and learning. Several references are below for this topic: How acquisition predicts extinction; variability during acquisition and extinction. This article is Part 11 in a series on how behavior analysts can grow towards supporting children and adults affected by trauma, by Dr. Camille Kolu, Ph.D., BCBA-D.

Severely aversive experiences affect us for a long time. And acquisition can predict what someone’s behavior will look like during extinction (or how behavior will depend on original learning even long after those variables are “gone”). A BCBA recently asked me for references on this topic during SAFET logo letters onlya training I provided to an autism agency on how to provide safer and more appropriate supports for individuals affected by events we characterize as “traumatic”. Thank you to the BCBA for the excellent question!

At first try, we might have a hard time finding references and resources showing how a young child’s traumatic history leads to bizarre and challenging behavior much later in life. If this seems strange, consider how absurd it would be to suggest that caregivers are carefully documenting and reporting how they deprived a child of the food, comfort, diaper changes and other kinds of care the child needed as an infant or growing young person. These tragic events are usually documented after, not while, they occur (if ever). But at least scientists can get familiar with how early learning affects later learning, and behavior later in life. This helps us to make sense of otherwise bizarre behaviors, provide important contextual information to caregivers and decision makers, and even to inform our preventative treatment of behaviors that don’t seem related to the ongoing situation.

Behavior analysts or psychologists might relate this to how early learning conditions affect subsequent learning, or how the variables present during early learning exerts effects on behavior, after that situation is no longer present. This discussion is to provide some examples of literature that might be useful for behavior analysts interesting in exploring this topic.

In my work with children and adults after traumatic experiences before and during foster care (or other traumatic events including long duration life threatening illnesses or aversive experiences), I have been collecting data on the types of behaviors that “show up in the behavior stream and repertoire” of children who were exposed earlier – and in some cases much earlier- to situations of neglect and abuse. Continue reading →

Trauma-Informed Behavior Analysis, Part 3: Is It Ethical For Behavior Analysts to Treat “Trauma”?

05 Saturday Aug 2017

Posted by kolubcbad in adults, Behavior Analysis, behavior cusp, Behavioral Cusp, Community, Education, ethics, risk assessment, supervision, teaching behavior analysis, teaching ethics, trauma, Uncategorized

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behavior cusp, ethics, risk assessment, supervision, trauma

This is Part 3 in a series of how behavior analysts approach “trauma”, by Teresa Camille Kolu, Ph.D., BCBA-D.

Is It Ethical For Behavior Analysts to Treat “Trauma”?

Meaningful answers often depend on asking an appropriate question.

Since this “yes-or-no” question is not the least bit appropriate for many of us to answer “yes” to without more information, let’s start by refining our question.

Under what conditions would it be appropriate for a behavior analyst to treat someone whose behaviors relate to their adverse childhood experiences?

The question above is one way of asking the question, and your team might think of others. It also may help to check out Tuesday’s upcoming article on Behavioral Terminology Related to “Trauma”.

I’ve certainly seen some inappropriate, well-meaning, and harmful treatment of behavior when the children and people involved have been through adverse childhood (or other) experiences.

Part of my concern is that young behavior analysts may have come from a program that did not cover adequately the experimental basis of our field, including schedule effects or concepts like the molecular or molar view of behavior.

I think young behavior analysts who are smart and curious can get these things; they need to have better exposure in their classes (and online course sequences toward certification paths aren’t likely to bring this exposure) or groups (so ask your friendly local or skype article CEU club if you’d like to read an article like this one on the paradigm shift from the molecular to molar view in behavior analysis). This is why a supportive verbal community of reinforcement is so critical for developing behavior analysts (more on that later elsewhere on this site).

(Not sure how to look up pdf’s of articles? An easy way is to first look at the online journal list (for example, for JABA or JEAB) and first enter your search terms, then when you find the article, go to the journal’s archive and click on the issue where the article was published, and download the pdf. This works for all archived JABA and archived JEAB issues through 2012.)

That was fun; let’s get back to the scary stuff: inappropriate, well-meaning, and harmful treatment of behavior.

Sometimes an inexperienced behavior analyst treats only the “local function”, such as treating a behavior in your classroom that seems like it’s related to attention with pure extinction (e.g., without conducting a complete and appropriate functional assessment). This might seem appropriate without more information, but in clients with “trauma backgrounds” or exposure to serious past (or hidden and ongoing) childhood adverse experiences (such as disruptions in primary caregiving and exposure to abuse and neglect), this course of treatment may lead to further harmful escalation, or serious risks and side effects. There are other possibly more appropriate options such as differential reinforcement without extinction, or the preventative schedule approach I mentioned in a previous article. At the least we need to base decisions on better information.

In a classroom where I observed a child who had been through a series of terrible and neglectful situations, when his behavior was placed on attention extinction, he virtually lost all advocacy skills (e.g., stopped manding for help or showing his distress), was being abused by others and never reported it, and started hiding his self-injury which became more and more severe. These were some of the risks involved of using a procedure without evaluating the possible side effects given the child’s repertoire and the reinforcement available for his appropriate skills, and without collaborating with others who had access to the child’s history and current home situation (Compliance Code 2.03b).

The teacher was using the procedure recommended by a behavior analyst, but the BCBA did not know about the child’s history or home life (and did not ask). As I’ve said before, I am NOT asking anyone to stop a function-based approach!- but to demand the information you need to understand the larger context for behavior.

So what’s a behavior analyst to do?

I typically try to think first of ethics (asking, “should I be doing this?”) before diving into strategies (“what should I be doing?”). Here are some ethical considerations:

  1. Is this in my boundary of competence and based on my education, training, and supervised experience?

See Compliance Code 1.02a). If not, it’s a good idea to first seek continuing study, training, supervision and consultation (see Compliance Code 1.02b). I think the skill of reaching out to obtain supervision and mentorship when appropriate (e.g., accepting clients appropriately) may be an important behavior cusp critical to the future repertoires of behavior analysts trying to practice ethically.

  1. I think of ethical behavior analysis as practicing within my boundaries, yet at the same time as growing my boundaries of competence so that next year I will have expanded them and will be able to take a client I said no to this year.

Dr. LeBlanc and colleagues have an article on expanding the consumer base for behavior analytic services that is available for a CEU.

  1. Consider ethics and your own experience and resources carefully, before you begin treating trauma or accepting any kind of trauma-related client.

See 1 and 2 above, and remember not to give advice that stands in for services (e.g., 1.05a). Our responsibility is always to do no harm, and at times the side effects of inappropriate treatment may be riskier than doing nothing (2.09c). It is important to develop a relationship with a mentor who has been there and can assist you to apply new information to an exquisitely sensitive set of problems and clients. If not, arrange for appropriate consultation and referrals (2.03).

  1. All this goes for supervisors too:

Just like we should be careful before we accept a client for treatment, we accept a supervisee who is treating in a sensitive area only after considering our own defined area of competence (5.01). How will we communicate about and report risks (7.02) if we are not experienced enough to recognize and communicate about the risks of our own treatment (2.09)? Agencies may be under particular pressure to accept clients when there is funding, but there are serious risks of doing this too early or without appropriate in-house supervision.

  1. Be prepared for extensive collaboration:

I’ve talked to supervisors who have taken on trauma cases without completing assessments of risks and side effects (2.09c) or collaborating with other therapists the child is concurrently seeing, and this means they are already in danger of not being able to review and appraise effects of other treatments that might impact the goals of the program (2.09d).

Why do you need mentorship, education and experience under supervision first?

This is partly because after you accept a client (e.g., 2.01) whose service needs are consistent with your education and training, experience, resources and policies, your responsibilities are to everyone effected by your behavior analytic services. For example, once I started treating clients affected by trauma, I also found myself treating foster families’ other children to deal with the abuse the affected child talked about, the primary caregiver who used to be on drugs and was trying to demonstrate she could follow a plan and get her children back, and the social workers and other team members who didn’t understand schedule effects and were making placement decisions without data on behavior.

In an upcoming article we discuss some treatment approaches and how we can improve our supervision of BCBA’s treating these serious concerns. But first, next Tuesday covers some behavioral ways of talking about “trauma”. Stay tuned!

And as ever, this information is not a substitute for mentorship or supervision. This is intended for use in supporting behavior analysts to reach out to their own networks and supervisors and mentors, growing their boundaries of competence in an ethical and responsible way.

May we all keep expanding our repertoires.

 

The Behavior Cusp: A special instance of behavior change

30 Tuesday Oct 2012

Posted by kolubcbad in Behavior Analysis, Behavioral Cusp, Community, Education, Emergence, Social Interaction, Uncategorized

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behavior analysis, behavior cusp, building cooperative behavior, cusp, Don Baer, emergence, Jesus Rosales-Ruiz

“a cusp is a special instance of behavior change, a change crucial to what can come next”

~ Rosales-Ruiz and Baer, 1997

Behavior analysts define behavioral cusps as changes that have special features and special effects. Experiencing a behavioral cusp (examples to follow) exposes the learner to new reinforcers, new reinforcing environments and relationships, and gives rise to “generativeness”. In other words, after a learner has experienced a behavioral cusp, she may have access to richer experiences that may become enjoyable themselves or simply make it possible to access even more experiences and environments.

Learner example: A child experiences a behavior cusp

Timmy is a learner with communication delay and limited gross motor skills. He was two years old before he could use purposeful movements with his hands; it was frustrating for him to wave and gesture without others understanding “what he meant”. His mother often wore a desperate expression as she wondered what he needed or wanted, and as he screamed for hours on end she often exhausted her ideas and ended up holding him tightly and rocking him, still unable to understand but too tired to work on it anymore that day. One day, Timmy was able to extend his finger to point, and his mother understood exactly what he pointed at! She provided it immediately, and Timmy relaxed and smiled. They went around the apartment together, his mother joyfully exclaiming to name the things Timmy pointed at. A barrier was broken! A behavioral cusp, pointing at objects, had occurred and Timmy was now able to communicate with much less frustration. From there, he progressed within months to being able to point at different pictures on the same page. Timmy’s mother is thrilled to understand what he needs, and Timmy’s inconsolable screaming for hours at a time no longer occurs on a daily basis.

Learner example: An adult provider experiences a behavior cusp

Jean is a daycare provider. She has struggled with behavior management in her private daycare classroom, as children hit and bite each other at least weekly and often daily. Her management team has a no tolerance policy for these behaviors, but Jean and her co-workers in the classroom still wonder how to stop the behavior without constantly reprimanding the children. One weekend, Jean attended a seminar on positive parenting. She had planned to use the techniques with her teenage son, and was surprised when she listened to the instructor describe that the “attention pivot” technique was also useful in the classroom when children were motivated to acquire the attention of teachers. Jean implemented the technique in her daycare the next day, and by changing just one thing- the timing of when she began talking and turning toward a child – the everyday behaviors of pushing, whining, climbing on tables, and throwing toys diminished. Even more exciting to Jean, they diminished in less than an hour, and Jean’s classroom helpers easily saw what had changed in Jean’s technique. When she saw a child looking at another student who had a toy, Jean used to observe and wait until she needed to intervene (or stop the student from yanking it away). She used to say “stop!” or “No! We need to SHARE!” multiple times per day. After Jean changed her timing, she now turns to a child BEFORE “misbehavior” and she catches the child doing the right thing. When the other teachers noticed what had changed, they began trying it themselves, and soon the number of hitting and biting episodes had decreased to a rare few times per month, instead of daily.

The point of the story:

Sometimes behavior cusps occur on their own, during development. Other times, it becomes important for someone to assist a learner experience a cusp. In Timmy’s example, the cusp was engineered by providing many, many opportunities to practice the steps needed before pointing, and the behavior analyst used fluency training and shaping to provide this practice and make it enjoyable for Timmy.

DISCLAIMER: The preceding stories, and others on this site, are simply examples or vignettes; they do not constitute training, supervision, or a behavior plan. The resources on this site are not developed for a specific individual. It is recommended that before implementing any technique described here or in resources available on this site, a reader consult a qualified behavior analyst with experience related to the appropriate field and population.

RESOURCE: Check Imagine!’s calendar often for upcoming trainings.
Dr. Jeff Kupfer, Ph.D., BCBA-D, provides “Building Cooperative Behavior” class free to the Boulder and Broomfield communities on a monthly basis. Locations, times and contact information can be found on the Imagine! calendar (search for “Building Cooperative Behavior”).

http://www.imaginecolorado.org/Calendar.htm

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