Low-Frequency, High-Intensity

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.

 

Behavior analytic services should only be delivered in the context of a professional relationship. Nothing written in this blog should be considered advice for any specific individual. The purpose of the blog is to share my experience, not to provide treatment. Please get advice from a professional before making changes to behavior analytic services being delivered. Nothing in this blog including comments or correspondence should be considered an agreement for Dr. Barry D. Morgenstern to provide services or establish a professional relationship outside of a formal agreement to do so. I attempt to write this blog in “plain English” and avoid technical jargon whenever possible. But all statements are meant to be consistent with behavior analytic literature, practice, and the professional code of ethics. If, for whatever reason, you think I’ve failed in the endeavor, let me know and I’ll consider your comments and make revisions, if appropriate. Feedback is always appreciated as I’m always trying to Poogi.

 

One of Those Days

What is the main reason we come to work each day? I believe it’s because we want to see the children make progress. Of course, I understand that it is a “synthesized contingency.” For example, few of us could afford to come to work if we didn’t get paid or receive other benefits. Still, seeing the children make progress is crucial. I believe that without effective programming, few people will be able to continue in this type of job over the long haul.

Now, one problem is that this benefit comes with emotional reactions. When things are going well, I feel great and extremely positive about our work. But if we have one of those days, suddenly, I feel sick and can barely make it to work. It may be that I go to extremes, but I think this is common. Learning to handle these feelings is critical for success in a field like ours. Parents often feel this too. They can be excited by one great session, and then depressed after witnessing one that doesn’t go great.

It is easy to take the positive approach when you are not the one working with the child day in and day out or are not the parent of the child. In my experience, supervisors tend to forget what it is like to have a tough session and are sometimes dismissive of staff and parents who are upset.

Yes, the vast majority of clients are going to make excellent progress in therapy based on applied behavior analysis. One of the biggest obstacles is handling the emotions that come from an occasional problematic session. Overlooking this issue can be a major cause of failure. I’ve often argued that this is so important it is necessary to have a plumber on call.

 

Behavior analytic services should only be delivered in the context of a professional relationship. Nothing written in this blog should be considered advice for any specific individual. The purpose of the blog is to share my experience, not to provide treatment. Please get advice from a professional before making changes to behavior analytic services being delivered. Nothing in this blog including comments or correspondence should be considered an agreement for Dr. Barry D. Morgenstern to provide services or establish a professional relationship outside of a formal agreement to do so. I attempt to write this blog in “plain English” and avoid technical jargon whenever possible. But all statements are meant to be consistent with behavior analytic literature, practice, and the professional code of ethics. If, for whatever reason, you think I’ve failed in the endeavor, let me know and I’ll consider your comments and make revisions, if appropriate. Feedback is always appreciated as I’m always trying to Poogi.

Where Is the….?

During the first 13 or 14 years of marriage, I never took off my wedding ring. Then, one day I was late for a meeting. I was running through the parking lot to get to my car, and the ring went flying off. I couldn’t find it. Later that evening, I bought a metal detector and searched the parking lot again–no luck. I asked in the school lost and found if anyone had turned it in. No luck, it was gone. After a few days, we went to a jewelry store and picked out a new wedding ring. A few days later, I noticed it was gone again. No idea where I lost it this time. This was starting to get expensive. Therefore, I went on Amazon and bought a package of 10 rings for $2. I still have several rings leftover and that was at least ten years ago.

When we are working with kids with autism, we often underestimate how likely it is that things will be misplaced during sessions. Misplaced supplies can ruin a session. We often think the solution is to be careful with supplies; put everything away when finished, and always maintain a neat and clean work environment. Sure, those are great habits that are very helpful, but not always possible. Some kids have a lot of energy and enjoy running around. Sometimes there are lots of people in an environment, making it difficult to keep all supplies in one spot. Sometimes you might have too much going on and misplace something critical.

A very helpful strategy is to have a bunch of cheap extras so that if you lose a couple, it is no big deal. Have a bunch of extra laminated cards you need for your session. Print extra worksheets, datasheets, or coloring pages. Make sure you have a stock of extra batteries, sound buttons, or crayons. Whatever is critical for the session to be successful, have extras. Especially if you can get them cheap, like 10 rings for $2.

Behavior analytic services should only be delivered in the context of a professional relationship. Nothing written in this blog should be considered advice for any specific individual. The purpose of the blog is to share my experience, not to provide treatment. Please get advice from a professional before making changes to behavior analytic services being delivered. Nothing in this blog including comments or correspondence should be considered an agreement for Dr. Barry D. Morgenstern to provide services or establish a professional relationship outside of a formal agreement to do so. I attempt to write this blog in “plain English” and avoid technical jargon whenever possible. But all statements are meant to be consistent with behavior analytic literature, practice, and the professional code of ethics. If, for whatever reason, you think I’ve failed in the endeavor, let me know and I’ll consider your comments and make revisions, if appropriate. Feedback is always appreciated as I’m always trying to Poogi.