Applied Behavior Analysis (ABA) is a science wherein procedures, based on basic principles, are applied to important matters of everyday life in order to help individuals increase functional skills, while decreasing problematic ones (Cooper, Heron, & Heward, 2007.) Most notably, ABA has been utilized to improve the quality of life for children with developmental disabilities, specifically children who have been diagnosed with Autism Spectrum Disorder. ABA teaching strategies have been highly successful in improving functional communication skills, self-help skills and social skills. Moreover, they have been extremely successful at helping to decrease maladaptive-problematic behaviors such as physical aggression, repetitive self-stimulation, and self-injurious behaviors.
B.F. Skinner’s analysis of verbal behavior (1957) suggests that language is behavior and can be thought using behavioral procedures (e.g. reinforcement). Arguably, one of the most important skills we all first naturally learn is asking for things we want. This produces an immediate and specific response. That is, we get what we want! Many individuals with developmental disabilities have learned problematic ways to request (mand) for the things they want. These include physical aggression, self-stimulatory behavior, and self-injurious behavior. For instance, an individual may collapse on the floor, kicking and screaming when his/her favorite television show is turned off. A concerned caregiver will typically turn the television back on, console the individual or find another way to make the individual happy and calm. In this way, the caregiver has reinforced the problematic request (the mand) of the individual to restart the television show.
Research from thirty years ago suggested replacing problematic ways of requesting with more appropriate forms. This is known as Functional Communication Training (Carr & Durand, 1985) or mand training. This involves teaching individuals an appropriate alternative way to request for the things they want instead of the problematic ones. The form of the request can be utilized through vocal, signs, picture exchange system (such as PECS), or any augmentative device (vocal output systems).
In August 2014, the Services for the UnderServed in New York was awarded a federal Balanced Incentive Program Innovation Fund grant (BIP) to transfer the technology of ABA generally used with children to adults with developmental disabilities. Services for the UnderServed (SUS) is a nonprofit human services agency who serves individuals and families with a wide range of challenges; mental illness, intellectual/developmental disabilities, HIV/AIDS and veterans compounded by histories of homelessness, substance abuse, poverty and unemployment.
The BIP grant is looking to transition individuals over the age of 21 in the borough of Brooklyn from institutional care placements to individual residential alternatives (IRA) or other less restrictive placements and avoid reliance on long-term care services. The BIP grant specifically targets individuals living at home in the community with significant high risk for placement in an institutional setting, individuals being discharged from residential school setting out of state and individuals being discharged from NYS Developmental Centers.
The main objectives of the project are to decrease poly pharmacology, decrease visits to the emergency room and hospitalization due to maladaptive behavior by increasing functional communication skills, teaching age appropriate leisure skills using ABA technology.
The behavior staff at SUS began screening individuals from a state intermediate care facility in August. The individuals transitioned to SUS in October 2014. During this time, preference assessments and functional analysis were conducted to develop effective treatment plans that included high preference items and activities for the BIP participants. Direct care staff were trained with specific behavior techniques for 15 individuals. Preferred items and activities were also purchased and made available to the individuals upon returning from their day habilitation program. Behavior technicians trained caregivers to pair themselves with the delivery of preferred items and activities for each of the clients participating in the BIP grant. During the screening process, individual’s communication systems were assessed and forms of communication were identified for each client.
The individuals demonstrated a wide range of communication skills. Approximately 9 of the individuals were able to communicate using vocal speech. They were able to request basic wants and needs, label common items and objects in their environment and engage in beginning communication skills. Two of the clients used minimal vocal communication skills with high rates of maladaptive behaviors. The last four clients were nonverbal and were learning to mand (request) using ASL (American Sign Language) in addition, they also engaged in moderate frequency of maladaptive behaviors on a daily basis.
The behavior technicians began the treatment session with one manding session (Sundberg & Partington, 1998) daily during snack time at the residence with the clients that were non-verbal. The behavior technician was seated at a table with preferred food items for the assigned individual he/she was paired with during the session. In addition, the assigned program specialist was also present during the teaching session. The behavior technician would present 2 preferred items to the individual. Once the individual declared his/her choice, the behavior technician would vocally or physically prompt the correct form of the mand either vocally or using ASL. Data were collected on each presentation of the item being requested. Prompts were faded as needed based on the motivation of the individual for the item being presented. Additional data were collected daily on targeted challenging behaviors. The behavior intervention specialist would then review these data to determine if challenging behaviors were decreased due to the manding intervention.
The findings across the four individuals who were non-verbal show a range of 3%-67% decrease in challenging behaviors once the manding intervention was implemented. These findings suggest that when individuals with limited communication skills were provided the opportunity to request their specific preferred items, the frequency of maladaptive behaviors were decreased, therefore demonstrating that ABA technology is an effective intervention for decreasing challenging behaviors such as aggression, self-injury and self-stimulatory behaviors.
In summary, ABA is a hard science that teaches replacement skills to individuals with disabilities who have developed a maladaptive manding repertoire over their lifetime. The preliminary results from the BIP grant suggest that adults with developmental disabilities can benefit from the technology of ABA, along with the use of Skinner’s analysis of verbal behavior (VB). Moreover, they can improve the lives of those with limited communication skills. ABA/VB should be considered best practices for teaching adults with disabilities so that they can continue to grow and change over time in the least restrictive environments.
Vivian Attanasio, BCBA, is Director of BIP, James O’Brien, BCBA, is an ABA Consultant, and Amy Bukzspan, BCBA, is a Behavior Intervention Specialist at Services for the UnderServed Inc. For more information, contact Vivian Attanasio at vattanasio@sus.org or visit www.sus.org.
References
Carr, E.G., & Durand, V.M. (1985). Reducing behavior problem through functional communication training. Journal of Applied Behavior Analysis, 33, 53-71.
Cooper, J.O., Heron, T.E., & Heward, W.L. (2007). Applied behavior analysis: 2nd edition. Upper Saddle River: New Jersey: Pearson Prentice Hall.
Skinner, B. F. (1957). Verbal behavior. New York: Appleton-Century Croft
Sundberg, M. L, & Partington, J. (1998). Teaching language to children with autism or other developmental disabilities. Pleasant Hill, CA: Behavior Analyst Inc.
