Rachel | Quelaag

Applied Behavioral Analysis is a practice that utilizes Radical Behaviorism. ABA was pioneered by Ivar Lovaas in the 60ies, but the principals of Skinner’s Radical Behaviorism predates him. It focuses on understanding human motivation, behavior, and environmental conditions. We do this by measuring the behavior, by recording the:

- Frequency refers to the number of times a behavior occurs during a particular time period.

- Duration refers to how long a particular behavior lasts.

- Latency refers to how much time passes between a prompt of some kind and the occurrence of the behavior.

- Intensity refers to the force with which a behavior occurs.

Next we have to understand the motivation behind the behavior:

- Sensory (Can be used to soothe)

- Escape-maintained

- Attention-maintained

- Tangible (Food, play, etc)

Some behaviors can be misleading, and require “qualitative data” (the feelings of the client) to make sense of the intention. For example: You can have two children engaging in the same behavior, but they have different reasons for it.

Child 1 could be hitting a class mate because a condition was established: their teacher will remove them from class as punishment (but this punishment may be desirable for the child as they no longer have to be in class) — this is classified as “avoidant behavior”, as the child is avoiding the classroom by acting aggressive.

Child 2 could be hitting a class mate because they love engaging with their classmate socially, or find the interaction fun — this is classified as “attention-seeking behavior”.

Private ABA practices have differing curriculums based on how the BCBA (Board Certified Behavioral Analyst) runs their clinic. It is using the Radical Behavior principles to understand, predict, and change behavior. HOWEVER, what is defined as “problematic behavior” is incredibly subjective and this is where I feel there is room for abuse. Many clinicians will also misunderstand the key motivator of the behavior which can cause distress. If child 1 is punished for suffering, it will cause trauma.

If a BCBA focuses on the parent’s request of “decreasing problematic behavior in a classroom” to make the parent and teacher’s lives easier, it can ignore the distress and discomfort of the client/patient/child as some clinicians are only concerned about “number going down”.

For example: If you have a client hitting other children in the classroom at a frequency of 20+ times a day, the goal is to make that number go down. But there can be many different “antecedents of behavior”, and if you misidentify what is causing the “problem behavior” you can cause additional distress.

Antecedent is the precursor. In this fake client’s case we could say the antecedent is loud noise in a small room. The distress causes a client to hit so they can avoid the classroom (avoidant behavior). Therefore, noise canceling headphones or DBT/CBT/AIM/ACT interventions (which is emotional support and regulation) can help make the frequency of this behavior decrease. For some clinicians, it seems that excessive force, unrealistic expectations, or punishment are frequently used to make “number go down”. There’s also the factor that classrooms are impacted and many kids are forced to exist in stressful environments.

This goes directly against the state exam that is used to get an ABA license. When I took it, a huge cornerstone of the exam focuses on using *POSITIVE REINFORCEMENT ONLY* to encourage behaviors. If you need a child to sit still and not hit, set milestones and rewards. Removal or restraint should only be used if someone is a direct danger to themselves or others. This rule can be confusing because sometimes (especially in my non-verbal client’s cases) clients use “hitting” as a means to communicate to me or others. It just means I have to teach a new way to communicate (ASL/ESL). These people shouldn’t be restrained if they’re acting out of distress: that only increases a stress response.

This bleeds over into the systemic criticism of ABA: It shouldn’t be a client’s responsibility to advocate for one’s self, or to learn how to hold a pencil / talk / read etc. If someone has a deficit they shouldn’t be forced to improve for the sake of independence: their systems should take care of them. However, that isn’t how society works. It requires clinicians to arm their clients with ways to advocate for themselves, but also to push for more social programs in their private lives. A lot of the doctors I worked with were towing the line between politics and healthcare - trying to get more social care for groups who need it, but also making sure their clients had skills and boundaries so they couldn’t be taken advantage of by other clinicians or their schools.

As a clinician I have had to be present in legal cases to help represent and advocate for my clients, it can be a lot and it really depends on the clinic’s ethos when a child gets care. Unfortunately it seems helpful clinics that are client-first seem to be rare, and it has been jarring to see how much abuse is occurring.