POOGI for ABA

Sometimes, what a parent, teacher, or other stakeholder is most concerned about is a behavior that only occurs very rarely. Maybe the child engages in dangerous aggression, toileting accidents, or refusing to go to school. Under normal circumstances these types of referral problems might involve routine assessment and treatment procedures. But if these problems occur at a very low rate – say 1X per month–they become huge challenges for the assessment and treatment process.

First, it will usually be impossible for the BCBA to observe what is causing the problem. The odds of the problem happening during a session are remote. We can’t really work on problems we can’t see. Second, even if you are lucky enough to observe the problem, it often is very unclear how you might approach treatment. Normally, the initial step in treatment would be to figure out why the problem is occurring (i.e., functional assessment). While this may be possible with infrequent behaviors, it is very difficult. Third, it is very difficult to monitor progress. If you attempt an intervention, you will have to wait months to determine if the intervention is having an effect. What to do?

In this type of situation, the key is to dig a bit deeper into the specifics to find a way to work on the referral concern without all the negatives described above.

Some examples:

• If the child engages in severe aggression only rarely, are there other problem behaviors? Maybe he complains sometimes? Or yells sometimes? In all likelihood those behaviors are occurring for similar reasons. If you address some of the other, more common problem behaviors, it likely will have a big impact on the aggression too.
• If the child almost always uses the toilet well, but rarely she has accidents: Why? Maybe the adults always remind her to use the bathroom and accidents only occur when adults forget to provide a reminder. Or, she waits until the last second and rushes to go, and occasionally doesn’t make it in time.
• If the child usually goes to school without an issue and only rarely refuses. Why? Maybe he sleeps poorly, and only when extremely sleep deprived is school refusal a problem.
• If the problem is rare because it only occurs during unusual conditions (e.g., fire drill), then can you create additional opportunities to practice (e.g., audio recording of the alarm)?

Every situation might be different. But if you dig into the specifics of the situation, usually (certainly not always!) a practical way to address the referral complaint will emerge. What the stakeholder says is the actual problem may not be what you should actually focus on.

Polly was a 3-year-old girl referred for intervention in a preschool. She had well developed language for her age, but had lived abroad with her parents who were non-native speakers of English. Therefore, her language sounded unusual – especially for a 3-year-old. She was referred for the following concerns:

• She did not engage in cooperative play
• Never used peers’ names
• Did not touch peers
• She did not speak to peers
• She did not play on the playground equipment
• Most of her interactions were hanging onto the teacher and engaging in “baby behaviors” which appeared to be imitations of her 1-year old brother. These included baby talk, hand flapping, hopping, and speaking in incomplete sentences.

What would you do in this situation? Are you considering a social skills curriculum? Maybe an FBA or some type of behavior plan for the baby behaviors? Maybe training the peers to initiate to Polly? There are numerous plausible possibilities. I suspect that what Polly’s team decided to do would be unusual today. Polly’s team decided that they would simply prompt Polly to use the playground equipment, provide differential teacher attention for using the playground equipment, and then fade prompts. They also ignored problem behavior which occurred on the first few days they prompted her to use the equipment. The idea was the natural consequences of being around the peers would shape the other behaviors. What happened? All the other behaviors improved without any other interventions.

Does this story sound familiar? Maybe you heard it before as it is from this classic study. I think there are several valuable lessons we can learn from Polly’s story.

1. When you are presented with a whole list of problems, you don’t always have to address every single one. If you pick the right targets, you might get improvement in a wide variety of other important targets. Research has confirmed this finding under a wide variety of names for similar phenomena (e.g., collateral behaviors, pivotal response training, learning-to-learn, behavioral cusps, keystone behaviors).
2. Natural contingencies can produce appropriate behaviors in ways that are sometimes very hard to do when the adults contrive the contingencies.
3. Be careful deciding you are finished with the intervention. Although the team had successfully made the reinforcement more intermittent, and the teachers judged that her behavior had improved sufficiently, I’m not convinced that the team’s intervention plan for Polly was sufficient. During the 2^nd reversal phase Polly showed significant decreases in performance. This seems to show that while the natural contingencies were influencing her behavior, she was still not fully responding to peers like the other children in her class. Therefore, there was significant risk for regression. It seems likely that when Polly moved to a new class next year, she might have gone backward. Maybe the natural contingencies took over eventually, maybe not–no way to know.

I’d guess Polly is probably a bit older than me at this point, but if someone knows what happened to her I’d love them to contact me and let me know! I’ve always been inspired by Polly’s story.

In this important article from 1979, the authors summarized the literature on programming for difficult-to-teach learners including some learners with autism and other developmental disabilities. One of the important implications of that article was that recently (at the time) new teaching procedures had been developed that made certain types of skills possible to teach that previously most people had thought weren’t possible just a few years earlier.

One of the prominent examples in that paper was research on teaching learners with disabilities to tell the difference between a circle and ellipse. It took seven program revisions until the researchers found a successful procedure that was effective.

I think there are two valuable lessons we can learn here. First, recognize that we still sometimes assume that it’s impossible to teach difficult skills to certain learners. Sure, the first thing you attempt or the second thing you attempt might not be successful. But if you are using science-based procedures, what people think is impossible often becomes doable. As the researchers discovered, it can require many program revisions before finding an effective procedure. Don’t give up too easily.

Second, in addition to deciding if something is possible to teach, we also have to decide if it is worth teaching.  Articles like teaching the difference between a circle and ellipse are important for the scientific knowledge gained by the field, not for any significant improvement made in the lives of the people who learned to differentiate between the two shapes in those studies. It is unlikely their lives were any better as a result of learning the difference between a circle and ellipse. This is also still a problem today. Frequently, in schools we are tasked with helping learners with targets that no one thinks is going to make a difference in the student’s life. Yet, we develop those teaching programs anyway simply because it is part of the curriculum. There is limited time and limited resources to make a socially significant difference–we can’t afford the waste. It’s OK if people don’t agree.