Problems that Only Occur Rarely

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.

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.