Author: Barry Morgenstern

During the first 13 or 14 years of marriage, I never took off my wedding ring. Then, one day I was late for a meeting. I was running through the parking lot to get to my car, and the ring went flying off. I couldn’t find it. Later that evening, I bought a metal detector and searched the parking lot again–no luck. I asked in the school lost and found if anyone had turned it in. No luck, it was gone. After a few days, we went to a jewelry store and picked out a new wedding ring. A few days later, I noticed it was gone again. No idea where I lost it this time. This was starting to get expensive. Therefore, I went on Amazon and bought a package of 10 rings for $2. I still have several rings leftover and that was at least ten years ago.

When we are working with kids with autism, we often underestimate how likely it is that things will be misplaced during sessions. Misplaced supplies can ruin a session. We often think the solution is to be careful with supplies; put everything away when finished, and always maintain a neat and clean work environment. Sure, those are great habits that are very helpful, but not always possible. Some kids have a lot of energy and enjoy running around. Sometimes there are lots of people in an environment, making it difficult to keep all supplies in one spot. Sometimes you might have too much going on and misplace something critical.

A very helpful strategy is to have a bunch of cheap extras so that if you lose a couple, it is no big deal. Have a bunch of extra laminated cards you need for your session. Print extra worksheets, datasheets, or coloring pages. Make sure you have a stock of extra batteries, sound buttons, or crayons. Whatever is critical for the session to be successful, have extras. Especially if you can get them cheap, like 10 rings for $2.

In science fiction, an engineer will frequently tell an authority figure how long it will take to do repairs after a disaster: “It will take at least an hour.” Then the authority figure says, “You have ten minutes,” and somehow the engineer finishes the task in time.

The thing is, when you have a complex problem, no one knows exactly how long it will take. Since there is substantial variability between different children with autism it can make this problem more challenging. In addition, most of us are generally bad at estimating time. In most cases, we don’t have a science-based way to make a good prediction of how long it is going to take to solve a complex problem. Even when we have data like that, they are limited and typically don’t include the full solution to the problem like ensuring generalization of the skills and maintenance. Also, it is rarely under practical conditions like a school with many different goals being implemented over a relatively long time.

Even though we don’t have great science-based ways to predict how long things are going to take, there is an expectation that we can do that. In addition, people assume that those estimates are padded; if the captain demands it, we can increase how fast we solve those problems. This leads to several concerning issues like making it difficult to judge the effectiveness of a program.

If a client starts with a baseline of 10 and increases to 25 in one year, we should evaluate that. Unfortunately, we don’t measure that way. Instead, we try to predict how much progress the client “should” make in one year.  So, if we predicted that the client’s data would increase from 10 to 20, people will likely judge the client as having made excellent progress. On the other hand, if the goal was 50, we say the client didn’t do very well. The level of progress didn’t change. Just the comparison to our initial prediction.

The internet is uncertain of who originally said it, but “predictions are generally very difficult to make–especially about the future.” In the field of behavior analysis, we can often predict accurately whether a client is likely to be successful or not successful with a particular behavior change program. We aren’t very good at predicting how much will be able to be accomplished in a particular amount of time. This is especially true when there are lots of competing goals happening at the same time.

We are much better at making predictions when the behavior changes are small and the expected time frame is short. Ideally, we work as much as possible in that realm. Set small goals that can be met quickly, and frequently write new ones. That method of working might not be possible in every environment, but if you work at it creatively, you can do this in more places than you might think.

I once worked at a school where two new children, both recently diagnosed with autism, were placed in a preschool classroom. Both children were not yet talking and had significant problem behaviors.  This was in February. The special education director told me that there was no money to hire paraprofessionals for those students until the next school year in September. “Can you give the teacher some strategies to use for a few months?” Nope, can’t do it.

Often people will make unreasonable requests of BCBAs that wouldn’t be asked of other professions. No hospital administrator would ask a surgeon to work without nurses, sterilized equipment, or an operating room because the surgeon needs those things to be safe and effective.

The same is not true for BCBAs. Frequently, people will make unreasonable requests where you are unlikely to be successful.  As I have discussed before, don’t do it. When it doesn’t work, no one will remember that you said beforehand that it wasn’t a good idea and that other resources were needed.

The key is not to be afraid to say no even if there is huge pressure from everyone, even your boss. Don’t start behavior change programs that you know aren’t going to be successful due to inadequate resources. There is a lot to learn about negotiation, but the most important thing to know is to not be afraid to walk away from any deal that doesn’t make sense.

Those two children where I turned down the case got services sooner than September. I recently met one of them doing very well in an adult program. Saying “no” was much better than pretending like they were getting real services.

When selecting alternative behaviors for children with severe problem behavior, a common strategy is to teach “coping skills.” Now teaching children coping skills can be an extremely important life skill. But as usual, the details matter a lot.

This classic Honeymooners skit does a nice job of explaining the problem with some coping skills instruction. Ralph learns a strategy to control his anger. First, say the phrase “Pins and Needles, Needles and Pins, a Happy Man is a Man Who Grins.” Then, put a big smile on your face and say, “What am I mad about?” You won’t be able to remember. But Ralph learns when you have a major stressor like the landlord raising the rent 15%, it is not that easy. I especially love when Norton attempts to prompt the coping skill. Ralph’s reaction is exactly what you’ll see many kids do when teachers attempt to prompt kids to use a coping skill.

Don’t try this at home. It doesn’t work. Sure, you may be able to talk yourself out of a minor annoyance from time to time with some “coping skills.” As a rule, though, trying to talk yourself out of negative emotions doesn’t usually work and can make the negative feelings more intense.

True coping skills involve teaching children how to manage emotions and respond in a way that consistent with your values, not avoid negative emotions. That’s very different from the way that these skills are often taught in practice.

Therefore, programs that emphasize teaching coping skills like relaxation training, deep breathing, and squeezing a stress ball are not likely to make much of a difference. They can be appropriate at times (e.g., as an alternative behavior that will be directly reinforced), but in my view, it is likely other aspects of the intervention that are doing the heavy lifting in making the program effective.

I used to be one of the expert evaluators that would give an opinion on whether a program was “appropriate” or “not appropriate.” I almost never agree to do these any longer, even though it can certainly help children get better programming–sometimes. I just didn’t enjoy the work. I’d rather be the person doing the programming and let someone else evaluate my work. I’ll Poogi more that way, too.

By law, schools are supposed to provide children with disabilities FAPE (Free Appropriate Public Education). But what does “appropriate” look like? Parents of children with disabilities and school districts often don’t agree on what “appropriate” means.  There is a lot of legal opinion on this topic that I don’t intend to get into here. For now, the main point is that there is no agreed-upon standard to determine if a program is appropriate.

There are some generally accepted rules. For example, the school district is not required to provide the “best,” only what is appropriate. On the other hand, if a child is making no progress or very minimal progress, the program is clearly “not appropriate.” This is an adversarial process; the district and parents will often fight about who are the appropriate experts to settle the dispute.

When you have a subjective standard like this, it is impossible to prevent huge biases from entering into the decision. This is especially true when large sums of money are involved (e.g., if the results of the evaluation determine whether or not a student is outplaced to a private school). That’s why there is so much fighting over who is the appropriate expert. Their biases (and I think who is paying them) can have a huge impact on what their opinion might contain.

What would be an example of a huge bias? Well, there are lots of things that BCBAs do not agree on easily; PECS vs Sign Language, IISCA vs. Traditional Functional Analysis, or VB MAPP vs. PEAK. Sometimes the person on the other side is from a different profession, which makes the conflict even more difficult.

The key lesson for me is that these decisions are rarely decided based solely on data (even if the primary decision-makers are BCBAs). I’ve seen terrible programs survive an evaluation as appropriate. I’ve seen excellent programs deemed as not appropriate. It is not enough to master data analysis; we must learn to work in complex social environments, too.

There isn’t an easy answer if you are stuck in one of these conflicts. But I can offer at least one small, yet helpful tip. People might say the decision is based on science and data, but that is rarely the case. The reinforcers controlling the decision are complex and usually have very little to do with the child. As soon as you realize that, you can better work to advocate for the child in a way that truly is based on science and data.