ABA in the Treatment of Aggressive Behavior Disorder and Lack of Impulse Control

Aggressive and impulsive behavior can be controlled through the use of applied behavior analysis techniques designed to limit the reinforcement offered through the use of such behaviors and to alternatively reinforce more socially acceptable methods for communicating and attracting attention.

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There is no particular psychiatric diagnosis for aggressive behavior disorder, but aggression often occurs as a symptom of many other psychological issues, including:

  • Autism Spectrum Disorder (ASD)
  • Conduct disorder
  • Oppositional defiant disorder
  • Intermittent explosive disorder

Applied behavior analysts often work with patients experiencing all of these, and many other, psychological issues that lead to a rise in aggression, so having the right techniques to address aggressive behavior is important to ABAs no matter what type of patients they work with.

Aggression and Impulse Control are Among the Most Difficult Behaviors to Alter

Impulsiveness and aggression tend to be self-reinforcing behaviors in most social contexts because they provoke an immediate reaction. A child who is hungry, for example, may scream or hit a caregiver to convey that desire. The normal human reaction to such behavior is to address it quickly. But even if this reaction is a punishment, it is an action that gives the child a sign that the tantrum is having an effect. When food is eventually delivered, as surely it must be, the consequences of the violent display are further cemented.

A 1999 study of aggressive behavior clearly demonstrated the connection and hypothesized that the small, immediate reinforcement at each act of aggression was overriding the larger, but more delayed reinforcement that was offered by traditional punishment and reward systems.

This finding complicates the application of many traditional ABA techniques, which rely heavily on such methods.

In the years since, however, behavior analysts have developed a number of different techniques that are particularly applicable to blunting aggression and impulsiveness.

Recognizing the typical attention-getting payoff that violence engenders, ABAs now train caregivers to carefully offer no outward reaction to overt aggression. Even if they are being hit or yelled at, teachers and parents are taught to offer what is called neutral redirection instead of delivering punishment or physical restraint.

Neutral redirection teaches caregivers to avoid displaying reaction or making eye contact, essentially refusing to acknowledge the aggression. They are taught not even to flinch if being hit. Instead, the only response is to calmly guide the child to engage in a socially acceptable alternative behavior… for instance, to get the attention of an adult, the child might be instructed to tap the person on the arm and say “Excuse me” instead of screaming loudly or throwing objects.

Only when the child engages in the instructed alternative will the caregiver actually provide direct acknowledgement and attention.

In cases where the behavior is demanding something inappropriate—for instance, a snack outside of designated meal times—an additional step in neutral redirection might involve offering a visual indicator of some sort that acknowledges the request, while signaling that a delay will happen before it will be satisfied. A timer or hand signal could be used to signal that the reinforcement will be delivered, even if it is not immediate.

Such steps have been found to be effective methods to relate larger, positive reinforcement to alternative behaviors while working to extinguish aggressive behaviors.

Positive feedback is another common behavior analysis technique that has been specially adapted to work on clients with poor impulse control. While in most cases, ABAs link feedback to the completion of a proper behavior, the issue with impulsiveness is that any sort of positive feedback after an outburst may serve to reinforce the poor behavior.

In these cases, when a situation which seems likely to result in an outburst is approaching—meal times, perhaps—the ABA or caregiver might begin offering praise and positive feedback before any sort of behavior related to that antecedent. By verbally offering positive cues rewarding good behavior even beforehand, the patient learns to associate the reward with the appropriate behavior.

Aggression Becomes More Dangerous as Patients Become Older

Of course, aggressive behavior is not limited to children. Although a 2015 report by research firm Burning Glass shows that around 30 percent of ABAs work within the educational system, and that nearly half are involved almost exclusively with ASD patients, there are also behavior analysts who have to handle adult patients with aggression and impulse control options.

These populations are far more dangerous and require special techniques to manage. The neutral response technique, which calls for ignoring aggressive acts, might work just fine when the aggression is in the form of a third grader kicking the therapist’s shins, but it’s another matter when working with a violent 200-pound felon in a state prison facility.

In criminal justice and adult care settings like rehabilitation centers or geriatric care facilities, ABAs fall back on other methods of blunting aggressive behavior, such as implementing contingency management systems.

Contingency management systems are a form of operant conditioning that exercises stimulus control and delayed positive reinforcement to alter behaviors. This system works well in adult populations where a delay can be logically explained to the participants. Frequently, a form of token economy will be used, offering vouchers or other types of counters as the immediate reward for good behavior; the tokens can then be exchanged for more concrete rewards later on, which reinforces good impulse control. Any lapses can result in tokens being taken away in the interim.

A 2014 meta-analysis found that such systems have been effective in prisons to encourage:

  • Pro-social behaviors
  • Increased interest in educational opportunities
  • Improved uptake of work assignments

Prepare for a Career Treating Aggression and Impulsivity

Aggression and impulsive control issues are found in many of the populations that ABAs work with regularly, including criminals, patients with ASD, and geriatric patients. In the course of their careers, it is likely that every ABA will find themselves in a situation that requires handling aggressive or impulsive behavior.

Many of the core techniques for handling such issues will come with obtaining an advanced degree in psychology, education, or applied behavior analysis. A master’s or higher is required in one of those fields in order to be eligible for a Board Certified Behavior Analyst (BCBA®®) certification from the Behavior Analyst Certification Board. A BCBA®® is required in almost all positions that will end up dealing with aggressive patients.

A particularly valuable aspect of the BCBA®® certification in dealing with aggression issues is the firm practice and ethical guidelines offered by the BACB. Learning these guidelines is a core part of acquiring a BCBA®®. In situations where patients are particularly difficult and dangerous, close adherence to the standards is particularly important.

Since many of the aggression and impulse control patients that ABAs deal with are special needs children within school systems, a great way to get experience before going through your master’s program is to become certified for a teacher assistant or para-educator role at a local school, or for a volunteer position. Most schools are eager for assistance, and special needs classrooms are a good place to get exposure to aggression issues. There’s also a good chance of observing a practicing ABA in action dealing with such problems.

More Information on Treating Aggression and Impulsiveness with Applied Behavior Analysis

Volunteer Match – A resource for finding volunteer opportunities, including those in schools or with autism treatment programs where aggressive patients may be found.

Talk About Curing Autism Aggression Management Resources – TACA is a non-profit organization dedicated to empowering, educating, and supporting families affected by autism. They have a dedicated resource page for managing aggressive ASD patients.

The ABA Toolbox – A resource site outlining many common ABA treatment techniques, including a number for addressing aggressive and impulsive behaviors.

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