Behavioral Treatment Can Hide Problems

Why We Need to Aim for Natural Contingencies

In an old article on treatment of problem behavior, the researchers compared two treatments for problem behavior maintained by attention from adults.

The first treatment was a time-out. The second treatment was communication training which taught the children to say “Am I doing good work?” The researchers found that both treatments were highly successful.

But then the twist: The researchers had the children work with naïve adults who didn’t know the history. Under those conditions, the children who had previously had been treated with time-out went right back to problem behavior. The children treated with communication training remained successful in the new situation. The students who were originally treated with time-out became successful with the naïve adults after they received the communication treatment.

The article demonstrates how we can fool ourselves into thinking our treatment is more effective than it really is. All the time-out students were looking good. Imagine teachers raving about the student progress at IEP meetings. But all it takes is a novel person showing up and the behavior falls apart. In reality, treatments in practical settings are almost always dramatically more complicated than the article describes, which makes it even more difficult to maintain progress. It is not if the behavior will deteriorate, it’s when.

Now, do we believe all these children who experienced the brief communication training treatment were likely successful in the long-run? Not likely unless they got a lot more therapy.

But I do think the article beautifully captures what our ultimate goal should be. The behaviors we teach have to be effective in the real world. And in order to be effective, they must meet a natural contingency. That means it was reinforced without any specific person having to think about it or plan it. The children said, “Am I doing good work?” Then the naïve adult was able to respond in a way that was reinforcing to the child. No one had to train the adults to follow the behavior plan since most adults will naturally respond to “am I doing good work” with attention. There are many examples in the research literature, but not enough. If you don’t get to this point, the behavior is unlikely to maintain.

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