A significant and sometimes overlooked contributor to the effectiveness of applied behavior analysis is the process itself. By rigorously pursuing a consistent, observable course of treatment, ABAs are able to logically and scientifically come to a conclusive judgment on the efficacy of any particular technique or treatment, and apply it systematically to help their patients.
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This emphasis on scientific observation and experimentation has existed since the earliest days of the practice. B.F. Skinner, one of the earliest proponents of radical behaviorism, insisted that behaviors were attributable to environmental factors and motivations, which could be established by systematic experimental manipulation, such as that conducted in a Skinner Box.
Key to understanding the function of behavior analysis is understanding the ABCs that govern all behavior:
- Antecedent – The prompt, or initial situation, leading to a behavior.
- Behavior – The action or behavior in response to the antecedent.
- Consequence – The reinforcement mechanism associated with the behavior.
To analyze and alter problematic behaviors, or to encourage beneficial ones, the behavior analyst has to correctly identify each of the ABCs and successfully interpret how they are related to one another. In the simplest cases found in textbooks, this is elementary:
- A: A student with ADHD feels ignored in their class in school.
- B: The student randomly speaks out in class.
- C: The teacher admonishes the student, providing the attention that they were looking for.
In the real world, it can be more challenging to uncover the factors contributing to such behaviors:
- A: A student with no history of behavioral issues has recently had a younger sibling born into their family. At home, the child feels ignored and displaced.
- B: The student randomly speaks out in class.
- C: The teacher admonishes the student. Eventually, the parents will be contacted, who will talk with the student about the outbursts, providing the attention they were looking for.
Drawing on training and experience, the ABA must not only spot all of these factors, but correctly interpret them as being related, in order to figure out where to begin modifying them to alter the behavior.
Today, these steps are broken down into an informal loop:
- Functional Behavior Assessment (FBA)
- Behavior Intervention Plan (BIP) / Individual Education Plan (IEP)
- Ongoing Assessment
The Functional Behavior Assessment Establishes the Environment and Behaviors
Although different branches of behavior analysis may use slightly different terminology for this step, every behavior analyst begins a case by conducting an FBA – functional behavior assessment.
Much of the FBA is likely to be conducted in person and by direct observation and interview of the patient. The ABA may choose to begin by simply observing the patient during an average day, quietly noting important factors of the environment and how the patient reacts to them. Interactions with their ordinary caregivers and other people they encounter during the day will be monitored. In order to successfully intervene in problem behaviors, the ABA understands that the patient will have to improve in their natural environment, not just in the controlled environment of an exam room or clinic.
By directly interacting with the patient, the ABA can test some of the theories they have developed during other observation or from caregiver reports. The ABA might intentionally say something that has been, in the past, been a trigger for aggression or acting out, simply to gauge the patient’s response. Or they might assess how the patient feels about these triggers, asking them to provide the reasoning behind their own behavior.
But observation and interaction are not the only ways to gather information. The ABA will probably interview teachers, parents, or other people the patient interacts with regularly.
They may also review medical records and behavioral incident reports.
If the patient has already been under care, the ABA will discuss the case with anyone else who has treated them, and review notes and progress from previous BIPs (behavior intervention plans) or IEPs (individualized education programs).
The FBA will result in a list of problematic behaviors that have been carefully observed and defined by the ABA. These lead to the development of the Behavior Intervention Plan.
The Behavior Intervention Plan Lays Out Strategies for Modifying Behavior
The BIP is the master plan formulated by the behavior analyst for altering the environment or consequences.
In schools, according to definitions established by the Federal IDEA (Individuals with Disabilities Education Act), a BIP is either accompanied with or supplanted by a document called an Individualized Education Plan, or IEP. The IEP will typically cover topics and activities beyond just behavior, but the ABA working on the case will establish the behavior modification aspects of the plan in coordination with other education and healthcare professionals working on the case.
The BIP or IEP establishes the overall strategy and the specific tactics to be used in altering the patient’s behavior.
BIPs are often more formal than FBAs. They will be typed up on a form that lists the problematic behaviors drawn from the FBA together with a list of objectives that that ABA has established for the patient. The objectives will typically be related to the behaviors but are often stair-stepped toward addressing the problem, rather than simply eliminating it. Complex behavioral issues might be solved piece by piece; for instance, a student that frequently speaks out of turn in class might be given a target of reducing these instances from ten or twelve times a week down to four or five.
The BIP will also have preventative strategies designed to help accomplish the objectives. In the disruptive student example, for instance, the ABA might have determined that part of the cause of the outbursts is that the student doesn’t feel heard. The BIP might call for the teacher to have structured sessions each day with the student where they can give their feedback. If the student successfully restricts themselves to speaking during these appropriate moments for two weeks, they might be rewarded with their choice of a game to play during free time.
Alternative actions are usually also outlined, ways to encourage the patient to channel their impulses. For instance, if the disruptive student forgets and has an outburst, the teacher might be instructed to calmly remind them to raise their hand instead.
By clearly outlining actual steps to take and behavior thresholds to monitor, the BIP assists both the patient and those they interact with in establishing a functional pattern for addressing issues.
Ongoing Behavioral Assessment Continues Through the Treatment Process
In a sense, the FBA segment of the process never really ends. Observation and assessment of the patient is ongoing and leads to changes in the BIP. Each adjustment in treatment yields a positive, negative, or neutral result in behavior. These continuing observations lead to a confirmation or reassessment of the ABA’s theories of patient behavior and may result in new techniques or reveal problems that had been buried by the initial issues.
In fact, in complex cases, the FBA/BIP may be structured as a sort of experiment, designed to isolate the actual cause of the behavior in the first iteration. Only after a period of continuing observation of the outcomes will the ABA establish a definitive therapeutic approach.
The degree of involvement the ABA has directly will depend on the patient and course of treatment. Some ABAs will primarily work directly with the patient, implementing therapy plans in a clinical environment. Otherwise, they act as more of a resource for parents and caregivers, supervising or advising the hands-on aspects of the therapy. These ABAs might check in only periodically for reviews, a sort of mini-FBA based on reporting and brief observations.
This process will continue for as long as the patient is under care. In the best cases, the interaction will tail off as the behavior or learning improves. This is called “extinction” when it results in the disappearance of problem behavior, or “acquisition” when new skills and behaviors are successfully taught.
The cycle of observation, analysis, and reinforcement is much of what makes applied behavior analysis effective, and is common to every domain and treatment that uses it, even when the particular steps or techniques vary.