Important note: Fictionalized clients are used to demonstrate the skill items in the second half of the task list, sections F-I. They make the most sense when read in order. Please remember that there is not substitute for real-life supervision and consultation. Get your case-specific advice from professionals – not from the internet! These examples are just that – examples of how behavior analytic skills might be applied.
Case example: Jada is an elementary school student. She experiences Level 3 Autism Spectrum Disorder (ASD). Level 3 is the severity level of Autism which is characterized by “requiring very substantial support.” Jada has also been diagnosed with a severe Intellectual Disability (ID). Jada has just transferred to a private school for individuals with global needs. She loves all kinds of play and messy activities, such as finger paint and water play. She also enjoys swinging on the playground, eating popcorn, and watching Disney movies. She loves to be read to, and laughs when staff make dramatic gestures while reading picture books. Jada does not use any vocal speech. She makes noises sometimes, such as humming. Jada engages in motor stimming, including upper body tensing and flapping her arms. Jada engages in severe challenging behavior, including self injury (hand to head and head to surface) and aggression (including hitting and biting). Jada has a mom, dad, and older brother living together in one home. Jada’s family has advocated for her to attend a private program, and they are excited for her to get high quality services. Jada’s new behavior analyst is Dr. Brown-Davis, who is a BCBA-D employed by the private program.
Example of Item H-5: Dr. Brown-Davis considers that Jada’s behavior change program might include some challenges related to unwanted effects. For example, tangible access treatment sessions could become challenging if Jada satiates on a particular tangible reinforcer. To manage this possibility, Jada’s programming includes limits on tangible reinforcers and frequent rotation of preferred items. Dr. Brown-Davis knows that extinction generally includes response variation and increases in intensity of behavior. Jada’s programming includes reinforcement-focused interventions in addition to some extinction components, which will likely reduce the unwanted effects of extinction. If punishment were to be used, Jada’s programming would be closely supervised and used in conjunction with reinforcement in order to ensure high fidelity, and to minimize the potential for generalized avoidance.
Case example: Donovan is a high school student. He has been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD). He attends a public school and has been placed in a support program for students with social/emotional/behavioral needs. Donovan enjoys playing video games and drawing in his sketchbook. He would like to be a welder when he is an adult. Academic achievement and attendance have been challenges for Donovan historically, and he is currently not on track to graduate with his peers due to missed work and failing grades in several classes. Donovan’s team has identified challenges including frequent non-attendance to school, walking the halls during class times, non-attendance at expected guidance appointments, and non-completion of classwork. Donovan lives with his mother and older brother. Donovan’s mother is concerned about her son’s school challenges and expresses frustration about his “lack of commitment” to his education. She wants Donovan to understand how important it is to graduate from high school. Donovan’s behavior analyst is Ms. Bailey, who has just started contracting with Donovan’s school district through the agency she works for.
Example of Item H-5: Ms. Bailey’s plan to reinforce Donovan’s replacement behaviors includes contingency contracting and the use of points redeemable for preferred items/activities (the points are generalized conditioned reinforcers). Ms. Bailey carefully monitors whether the available options continue to function as reinforcers for Donovan’s replacement behaviors. If Donovan became satiated on (for example) playing basketball with peers, or having free time with friends, then it is likely that the intervention would largely cease to be effective.
Donovan’s plan also involves group contingencies in place for his classroom. Ms. Bailey knows that some group contingency options have the potential of incentivizing inappropriate behavior between peers. She monitors for this closely, in collaboration with the teacher. When considering punishment options such as exclusionary time-out or overcorrection, Ms. Bailey gives thought to whether these interventions might result in the classroom or the staff becoming aversive to Donovan themselves. If this happened, Donovan’s already challenging school attendance might be worsened. Ms. Bailey also considers whether it would be realistic to supervise Donovan’s program very closely to avoid overuse or overgeneralization of punishment by staff. For example, if staff started using time-out during non-preferred demands, they could accidentally reinforce the challenging behavior.