A Clinician's Guide to Helping Children Cope and Cooperate with Medical Care: An Applied Behavioral Approach

CHAPTER 2. Introduction to Applied Behavior Analysis and Behavior Principles

8 chapter 2 Introduction to Applied Behavior Analysis and Behavior Principles in this chapter • This chapter is devoted to a brief review of the essential definitions of terms, principles, and standards of evidence on which the assessment and intervention strategies described in subsequent chapters are based. • These principles, concepts, and procedures have broad generality across the challenging health care situations discussed in the chapters that follow and also apply to many other problems not specifically discussed in this book. 2.1. patient population and target problem(s) The information in this chapter applies to all populations of patients regardless of age, diagnosis, or developmental level. The chapter is devoted to an introduction of the fundamental terms, principles, and standards of evidence needed to understand and implement assessment and intervention strategies with all of the children, adolescents, young adults, and caregivers described in the remaining chapters. 2.2. assessment procedures Antecedent Assessment Antecedent assessment requires direct observation and recording of observational data to assess the environmental conditions and internal physiological states that are most frequently associated with problem behavior and those that are associated with positive behavior. This is initiated by applied behavior analysis and behavior principles 9 recording observations on an antecedent-behavior-consequence (ABC) data sheet (see fig. 2.1). Many helpful behavioral interventions involve proactive modification of the social and physical environment, as well as the individual’s physiological state, whenever possible, to prevent or minimize the occurrence of excessive distress and other unhelpful behavior, and to increase the probability of appropriate adaptive behavior. The ABC analysis helps to identify potentially controlling variables (social situations , environmental conditions, and physiological states), to generate hypotheses about what motivates behaviors of interest, and to select individual and/or environmental factors or features that might be productively targeted for modification using behavioral and cognitive-behavioral procedures. Reinforcer Assessment A reinforcer assessment helps to establish effective consequences for strengthening behavior for any particular individual. Such an assessment may be accomplished by having the primary caregiver indicate the child’s preferences on a checklist of potentially reinforcing items and activities for the child’s developmental level. Generally speaking, preferred items or activities (those that, if given a choice, the child will seek, select, and use) have the best potential as reinforcers to strengthen desirable behavior. There are many evidence-based approaches to reinforcer assessment, particularly for children with intellectual and developmental disabilities (IDD).1 The Reinforcer Assessment for Individuals with Severe Disabilities (RAISD)2 is presented as an example (see fig. 2.2). While this particular assessment was developed specifically for youth with IDD, the general categories are based on prior reinforcer surveys that were developed with adults, adolescents, and typically developing schoolchildren.3–6 Task Analysis A task analysis refers to breaking a complex behavior or task into component steps and then presenting them to the learner one step at a time and documenting how many of the steps can be accomplished before , during, and after formal behavioral intervention. The learner’s specific behavioral response to each step is recorded to establish a A B C Data Sheet Child’s Name: Date: i Observer: Time of Observation: i Time Antecedents Behavior Consequences Figure 2.1 Example of an antecedent-behavior-consequence observational data form. Based on work by Bijou, S.W., Peterson, R.F., & Ault, M.H. (1968). A method to integrate descriptive and experimental field studies at the level of data and empirical concepts. Journal of Applied Behavior Analysis, 1, 175–191 (see pp. 178–179). Student’s Name: Date: Recorder: The purpose of this structured interview is to get as much specific information as possible from the informants (e.g., teacher, parent, caregiver) as to what they believe would be useful reinforcers for the student. Therefore, this survey asks about categories of stimuli (e.g., visual, auditory). After the informant has generated a list of preferred stimuli, ask additional probe questions to get more specific information on the student’s preferences and the stimulus conditions under which the object or activity is most preferred (e.g., What specific TV shows are his favorite? What does she do when she plays with a mirror? Does she prefer to do this alone or with another person?) We would like to get some information on _______’s preferences for different items and activities. 1. Some children really enjoy looking at things such as a mirror, bright lights, shiny objects, spinning objects, TV, etc...