One of the most difficult problems that BCBAs can face is working with learners who have high-intensity problem behaviors that don’t occur very often. I’ve seen several situations where the behavior occurs rarely, but when it does, it can lead to serious injuries. Treatment is necessary, but assessing the behavior is difficult.
If problem behaviors occur frequently, you can assess those behaviors and determine why they are occurring. That’s essential to developing an effective plan. But if the behavior only happens one time per month, there won’t be a lot of opportunities to see the behavior. This makes it difficult to determine why the behaviors occur.
Several strategies are commonly recommended for this problem. These might include a variety of procedures like conducting assessments over long periods, focusing on precursor behaviors that are related to the problem behaviors, and taking detailed notes or videos when the behaviors do occur. Another common strategy is to look for events that are remote in time but may be related to the problem behaviors (e.g., sleep, ear infections, menstrual cycles). The key here is that we are looking for why the problem behavior occurs. BCBAs often see this as detective work. Can we figure out why the behavior occurs? But there is one commonly overlooked reason why the problem behaviors occur so rarely: The people working with the individual are great at preventing problem behaviors.
When individuals engage in dangerous behaviors, parents and staff are highly motivated to prevent those problems from occurring. They tend to develop all kinds of tricks to make sure the learner doesn’t engage in the high-intensity behaviors. I call these tricks the limitations. This might include a wide variety of strategies that might be perfectly appropriate like offering choices or avoiding loud noises.
Whenever I’m faced with a situation of low-frequency, high-intensity problem behaviors, one of the first things I’ll look for is if there are prevention strategies in place. If you ask, people might say no because they might not even realize they are using them. One great way to test is to see what happens when a novel untrained person works with the learner. In my experience, if you look for prevention strategies, you will almost always find them.
The potential problem is that it is extremely difficult to be perfect at preventing problem behaviors. That’s when you potentially have a dangerous incident. Therefore, while prevention can be appropriate, is not a long-term solution. The only real long-term solution to problem behaviors is to teach the learner effective skills to handle life’s difficulties. How do you know what situations are critical to teach? Often the answer is to find the limitations.