POOGI for ABA

The first time you drove a car, you probably started out in a parking lot. There, you learned what it felt like to turn the wheel properly, and how much pressure to put on the gas and brakes. Then, you started driving slowly on some streets that weren’t very busy. Finally, you learned to drive on busy city streets and highways. At some point in the learning process, you practiced driving at night or in bad weather. No one would realistically expect someone with no driving experience to be able to handle difficult driving situations on the first day.

Yet, that is often what is expected of children with disabilities who engage in problem behaviors, especially if you work in public schools. The only long-term effective treatment for problem behaviors is to teach the appropriate social skills. When you work in schools, the expectation is that once the behavior plan is written, the BCBA will provide training to all team members, and then the plan will be implemented across the whole day in every situation from the first day.

That’s the equivalent of expecting someone to drive in bad weather at night through city or highway traffic on their first day driving. It is just unrealistic to expect that it will be safe and effective.

Now, many school professionals and BCBAs will tell you that they have successfully implemented behavior plans everywhere, all the time, from the first day. It certainly can be done–sometimes. The major way that this is usually accomplished is what I call limitations or Greg Hanley calls “Behavior Mollification.” Specifically, this involves doing all sorts of things to prevent problems from occurring. Examples might include reducing the amount of academics required or not refusing requests. That’s probably appropriate as a part of treatment in some cases, especially at the beginning. But I’ve seen situations where people are using dozens of different strategies to prevent problems. Then, because the behavior has been reduced or eliminated, they think the treatment was successful.

Of course, these methods do not lead to long term success as it is not likely to generalize to different situations or last over time. Eventually, we have to teach children the skills needed for them to be successful under real world conditions. That is how you judge success, not whether the staff can mollify everything to prevent problems.

About decade ago, I had two students who were having difficulty with pronouns and made requests like, “Can you have some juice?” This is a common problem with children with autism. I did a review of the research literature and the treatment manuals, but there wasn’t much out there to use as a guide to set up a teaching program. After trying an enormous number of ways to teach these skills, the teams eventually came up with an effective procedure by making a few logical tweaks to standard methods of how to teach pronouns. Both of the students learned to use pronouns, and everyone was excited.

Since it was so effective, I decided that it would be worth publishing the procedures. It ended up taking many, many years. That journey involved teaching pronouns to probably 15-20 more students, and then getting feedback from numerous professionals and journal editors. We ran into numerous problems: The three students we taught pronouns to in a school district, but couldn’t get consent for the research; The student who was almost finished, but the school year ran out; The treatment integrity problems in two of the home programs; The student who moved in the middle of learning pronouns; The complexity of the early versions was unnecessary, and journal editors insisted it be simplified. And on and on. Finally, we had one student who learned the pronouns well with all of the controls, and we published the paper.

By the time it was ready to be published, I didn’t know what to do about the list of people who really should have been thanked. The list was so long it would have been absurd to include in such a short paper. And the procedure is not complete.  The outcome we achieved is really just a promising first step. To achieve fully generalized use of pronouns takes a lot more work than the initial first step we published. And, our procedures are not perfect. In a recent clinical case of a student who needed to learn pronouns, the mom said to me,” but why don’t you …?” Turns out, her suggestion was a great improvement in the procedures.

The lesson I take from the pronoun journey is that you can’t Poogi everything. My problem was that I had an intense full-time job that had nothing to do with publishing journal articles on pronouns. This was a time-consuming side project. There were hundreds of follow up ideas that a serious researcher would need to consider to make it an effective technology. I was working on POOGI-ing lots of other aspects of practice too.

I would have made a lot more progress if I had just picked one or two things to focus on. If you remember that most things don’t matter in the long run, it is easier to focus. The POOGI should really be about focused attention on a very small number of things that will have a big impact, not trying to improve everything all the time.

If you are interested in the nitty-gritty of how the pronoun procedures work, it was published here, or you can contact me.

Most of us learned in graduate school that it is essential to be able to speak two languages. We need to be able to speak the technological and scientific language of applied behavior analysis, but we also need to be able to talk like humans. You need scientific talk for precise communication and to structure problem solving. You need talk like a human to work with people.

BCBAs should never tell a parent,

“The first step in teaching him to mand is to capture or contrive the relevant motivating operation.”

We say something like this instead:

“The first step in getting him to ask for things he wants is to create a situation where he obviously really wants something. For example, what if you take his favorite toy and keep it in sight, but on a high shelf where he can’t reach it?”

Although that seems obvious, it isn’t always easy to switch your language back and forth depending on your current audience. But at least we understand that we should when it comes to technological and scientific language.

Sometimes, language that sounds human-friendly is actually scientific. For example, why are there so many kids with initial referral paperwork that says that the child does not engage in problem behaviors, but then when we meet the child, there are an enormous number of problem behaviors?

I suspect it is because unless the child engages in dangerous self-injurious behaviors or aggression, parents often don’t perceive their child has having “problem behaviors.” Problem behaviors just sounds awful. Instead of asking about “problem behavior,” I might ask questions like,

“What does your child already do that you would like him to do more?”

“What does he do that you would like him to do less?”

Old school.

It is easy to become lazy and callous with our language. Thinking through how to say things in a way that will build rapport and understanding potentially has big benefits.