Author: Barry Morgenstern

Sometimes I’ve seen programs that are teaching 20, 30, 50, or even 60 behavior change programs at the same time. When there are that many behavior change programs, many of them often are ineffective. But let’s assume that all / most of those behavior changes do seem effective. My question always is: Will the child still be able to do this skill in one year when you are no longer working on it?

Don Baer taught us that there are really only two choices when it comes to maintenance of behavior changes.

1. The behavior change meets a natural contingency that will maintain it in the future.
2. We program maintenance forever.

Most of the time we are not in a position that we will be able to maintain behavior changes forever. Therefore the main thing that matters is that the behavior change will eventually meet a natural contingency. BCBAs talk a lot about natural contingencies, but in practice I see very little effort put into this critical concept.

It’s great that he made an independent initiation to peers during lunch 3X for 5 consecutive days.  But…

Did you have to praise and say “Wow, that’s so great talking to your friends?”

Did you have to give tokens for talking?”

Did the peer respond in a way that was reinforcing to the child- so that it might maintain initiations in the future without intervention?

If you need other reinforcers / interventions at this time, that does NOT mean that the intervention is a failure. Just don’t fool yourself that you made a meaningful difference in the child’s life. This might have been an important step- but you aren’t there yet. If you don’t get to the point where it meets a natural contingency, it almost certainly won’t maintain in the long run and it won’t really matter.

People will want to tell you their wild stories of problem behavior. These stories can go on and on and on. They often involve people getting hurt, bodily fluids, dramatic episodes in public places, and other extreme situations. It is critical that we show empathy and try to understand what that person is experiencing. If people don’t think you understand, you won’t be able to develop the necessary rapport with them to be effective.

Now, of course, the main solution is effective assessment and treatment that produces long-term success. But that takes time.

What should you do right away? Just don’t let him do that! Lock up the iPad. Block him before he reaches in the toilet and grabs the feces. Skip going to the play group. Hold her hand so she doesn’t run in the street.

This seems obvious, but often it isn’t. People will ask you “What am I supposed to do? Never make him do his homework?” No, of course not. But it is critical to prevent (as much as possible) dramatic episodes while delivering effective assessment and treatment services that will lead to long term success.

A surprisingly effective procedure in the short run is just- Don’t let him do that.

Every reasonable behavior analyst has a lot of “stories.” A story will typically go something like this: When we started with Johnny, he wasn’t toilet trained, had no language, and engaged in severe aggression, self-injury, and tantrums. Now, after an intensive two years of intervention, Johnny is toilet trained, he says 30 words, and problem behaviors only occur rarely.

What’s wrong with that story?

The problem with stories like this is we have no way to know if Johnny did well in the intervention. Maybe this program was fantastic and a lower quality program would have achieved much less. But maybe this program sucked and even a reasonably high quality program could have achieved 10X as much.

Unfortunately, there is only a small amount of research on predictors of progress. Which means right now, no one can conduct an assessment and tell us what we should reasonably expect from a high-quality service. There are no standards for results. Instead, standards tend to focus on process. That involves things like “Is the curriculum science based? Are the staff trained well?” That’s good, but not good enough.

Behavior analysts tell their “stories” and think everything is great! They don’t have any reason to think they need to improve urgently. I can tell you from hard experience that many of us definitely do. The lack of standards for results is the enemy of the Poogi.

The long-term solution is to determine measurements of what “appropriate” or “reasonable” progress looks like. We need clear standards. Without them there is simply no way to do thorough quality control as a field.

But while we are waiting for the long-term solution, there is a LOT we can do in the short-term. Always be skeptical of your stories. Constantly seek additional opinions. Look at research on how others implement the same interventions. Is there something we can learn? Measure the rate of progress. Is it improving over time?

Constantly ask-What have we done to POOGI today?

About 20 years ago I was working with two new referrals for children with autism. The students were about 8- or 9- years old at the time. They both had significant problem behaviors, but nothing that was very extreme or that I hadn’t seen a thousand times before.

One thing was very different though. These two children had been previously treated by two different internationally known behavior analysts. The parents had shown me videos of the treatment, which was both impressive and clearly effective. It was great to see videos of people I had only read about performing treatment and I was sure I could learn a lot from them. Still, the children had clearly regressed after the therapy had ended.

These two children were successfully treated with great reductions in problem behavior to near zero levels and high levels of social validity from staff and parents that lasted for several years.

About 5 years later, for personal family reasons, I moved and had to transfer the cases to other professionals. I received follow-up communications from the parents of these two children. Both had serious regression and were again engaging in problem behavior. Only now, these behaviors were much more significant as they were older and bigger.

The same thing that had happened to the famous behavior analysts had happened to me. The treatments were clearly effective in the short-term, but they didn’t last in the long run. It is easy to be fooled by short-term success. Just look at any weight-loss ads with the before / after pictures. A very large portion of those people will not sustain the success. I believe the same is true with successful problem behavior treatment. Many will not sustain the success.

Yes, in order to be effective you have to reduce problem behavior now. Immediately. But if you don’t do it in a way that is sustainable in the long run, it won’t really matter much in terms of a socially significant impact on the child’s life. Now, when asked to treat problem behavior I’ll work on practical strategies to reduce problem behavior quickly. But 90% of my focus is on how to make sure the successful treatment lasts…