How Do You Know When You are Finished?

Suggested Criteria for the Treatment of Problem Behaviors

I believe that one of the hardest problems in the treatment of problem behaviors is identifying the criteria for success. On the one hand, we want to ensure the long-term success of our clients. That implies we should set very high standards for defining success. On the other hand, should we expect perfection? Don’t typically developing children have a tantrum once in a while? Are we being unreasonable? I’m skeptical of many of the criteria that are frequently used. Many of them are necessary, but not sufficient. In my view, you need to achieve the following seven outcomes in order to demonstrate successful treatment that is likely to make a real difference in a person’s life:

1. The behavior problems have been substantially reduced: OK, maybe it doesn’t have to be perfect, but if we didn’t reduce the behavior problems at all, it is hard to argue that we did very much. In addition, we need to collect these types of data to direct daily treatment decision making. Some research articles define “successful” treatment as a reduction in problem behaviors by a certain percent. As a practitioner, that doesn’t make any sense to me. We know it is possible to dramatically reduce problem behaviors and still have huge problems.

2. Appropriate alternative behaviors have been increased: Sure, it is great that the problem behavior is reduced. But if you haven’t increased appropriate alternative behaviors, it is very hard to see how it would last over time without maintaining the program forever. In addition, no practitioner decides that people doing nothing is an acceptable goal. If all that happened is the adults have been shaped to avoid problems, like the parent who tells his child he doesn’t have to do any homework, most people wouldn’t consider that very successful.

3. The treatment is occurring under practical conditions: Sure, it is probably necessary to treat problem behavior under specialized conditions some of the time. But eventually, we have to return to practical conditions. If the behavior change has only been demonstrated for in 5-15-minute sessions or under very special conditions, you aren’t there yet.

4. The behavior change maintains over time: Everyone is happy that the severe problem behavior has been successfully treated. But the hard part is maintaining the change over time. This is a frequent problem. Who cares if the behavior was substantially reduced, only to come back later?

5. The program has a high level of social validity: It is essential that the stakeholders have high levels of support for the goals, procedures, and outcomes of the program. If not, they are not like provide the necessary support over time. Of course, it is possible to have high social validity with all of the above criteria met, yet still have significant problems.

6. The appropriate alternative behaviors are occurring under natural communities of reinforcement: It is wonderful if we have achieved a high level of success with behavioral intervention. But if the reinforcement doesn’t occur under natural conditions, it is likely a short-term success. No one can maintain a behavior change forever with contrived contingencies. Eventually, it almost always becomes impossible to maintain behavior changes if they don’t occur naturally. I believe the only long-term possibility is natural reinforcement.

7. The person is flexible enough to change their own behavior when the situation changes– As frustrating as it is, sometimes even a natural contingency is not enough. In the real world, things change all the time. If the person can’t change with them, the behavior problems are likely to come back.

Of course, there are some clients with some behavior problems where all of these criteria are not possible with the current state of knowledge in the field. But if you don’t have a good idea of what success looks like, it is hard to Poogi.