One of the central principles of Applied Behavioral Analysis (ABA) is the use of reinforcement to bring about a change in behavior. In fact, the idea of using rewards or praise in exchange for a good behavior – for example, completing chores or behaving well at the mall – is a technique that parents across the world will be very familiar with.
For children with autism or developmental delay, the connection between a behavior and a reward is not always so clear, particularly if they haven’t experienced it before. As a result, we must often repeat the outcome (associating reward with the desired behavior) a number of times in order for it to become a learned behavior.
With ABA however, we often aren’t just looking at creating new types of behavior, but are also ‘breaking’ an already established problem behavior.
CASE STUDY: Going to the doctor’s
We recently treated a child at the centre who was very scared of going to the doctor’s office, and would throw terrible tantrums and scream whenever he went. His mother said she dreaded taking him because she knew how difficult it was for him. We knew that being able to go to the doctor without fear would greatly enhance the child’s health and his mother’s life, so we created a treatment program specifically targeting this.
In order to achieve this, the therapists ran a desensitization program that reinforced closer and closer approximations to whatever skills/behaviors the child needed to display at the doctor’s office. The process took about 8 months of daily practice, as there are many steps to a doctor’s visit which caused anxiety for the child – from driving to the appointment to sitting in the waiting room and finally actually being examined.
Each of the anxiety triggers needed to be addressed specifically. Our therapists rehearsed typical doctor visit activities with him, such as putting on a white coat, taking his temperature and blood pressure, listening to his heart beat, examining his eyes and using a tongue depressor to look down his throat. We shaped up from just touching the items to tolerating them being used for examining him, all the while being reinforced by his highly preferred items along with social praise. Visual cues helped him to understand the expectations (what step came next in the chain) to foster a sense of control and calm. We were really pleased when Mom came back to the center a few weeks ago and said he is now able to go to the doctor’s without the battle!
Tips for parents and health practitioners
While this was a lengthy treatment, it’s a great example of how ABA can use positive reinforcement to manage all types of problem behaviors, big or small that may be interfering with a child and family’s quality of life. If you’re currently going through a similar treatment program, here are my three key tips that will help you get the desired outcome as fast as possible.
Tip #1: Prepare by setting expectations
When it comes to managing behavior with positive reinforcement, expectations are crucial. You’ll need to be clear in your own mind what the incentives are, and communicate these to your child, ideally well in advance of a difficult moment.
Don’t worry about repeating yourself – your child may need a few times to connect these positive reinforcers with these new skills he is learning. The most important dimension of using positive reinforcement is its delivery. Your behavior analyst will guide you in how best to deliver the reinforcer. It’s important to stay consistent, be clear about the rules and to be transparent with the child. Also consider speaking to family members or anyone who might be around the child on a regular basis to make sure they are on board and not sabotaging your plan (grandma!).
Tip #2: Implement consistently
This technique won’t work if it’s part-time, so it’s important you stick to the rules you’ve set for yourself and your child in terms of what is expected and how it will be reinforced. This means resisting the temptation to give your child what they want or ignoring the behavior (as long as it’s not dangerous) that you want to discourage. Your response to a tantrum impacts the likelihood of that tantrum happening in the future. So again, consistency is really important.
Remember, you need to positively reinforce the behavior you want to encourage, like making an effort to calm down, so you can’t compromise on the rules if you aren’t getting the right response. If you do get into a situation where you feel like it’s just not working, it may be that the expectations need changing and that’s ok – just follow through on this instance and remember to reset with the new rule for next time. Backing out will risk losing the effect of future attempts, making poor behavior more likely.
Tip #3: Use a mix of verbal and visual cues to communicate your reinforcement
A good starting point when it comes to reward-giving for many parents of children with autism is work with a professional to do a proper preference assessment to identify a variety of items/activities that your child is motivated for. Initially it is not uncommon that your child’s most preferred reinforcer might be a favorite food. Using food if necessary should only be viewed as a short-term solution, and be replaced with other items/activities which can also be faded to natural social reinforcers such as praise, smiles and hugs.
Positive reinforcement can be used to help manage all kinds of undesired behavior, but remember that every child and every situation is different – and so will be the treatment if it is going to be effective. As such, it’s important that you work alongside your ABA treatment provider to make sure that you are using the most effective methods for your child.
Article Originally Published here: http://thinkinc.me/blog-post/tips-for-managing-problem-behaviors-using-positive-reinforcement/