To the BCBA with a Hammer: 3 Areas You Might Be Over-Targeting
Abraham Maslow is famous for having produced the quote “To the man with a hammer, everything looks like a nail.” The quote suggests that if someone only has one tool or one way of thinking, they tend to solve every problem in the same way, even if that approach isn’t the right one.
As BCBAs, we have the tendency to do the same in regard to clinical decision making.
The good news is that we’re trying to solve a clinical problem and come up with the correct intervention that works. The bad news is that we sometimes can be uni-faceted when selecting those interventions. We have the potential to have a few “preferred” or “fall back” interventions, it seems, that are over utilized and often introduced at the wrong time or when we’re running out of clinical ideas.
This week I’m going to quickly walk you through three areas that I think BCBAs “overuse”. I include the word “overuse” rather reluctantly—hence the quotations. The reason I’m reluctant? Because the three areas that I’m about to mention are ones that certainly should be targeted…when the timing and context is right. Unfortunately, however, BCBAs frequently tend to do one of three things with them. They 1) introduce them too quickly before the learner is ready, 2) overemphasize their importance over the learner’s other programs, or 3) throw them in as a last resort when ideas are scarce.
So, without further ado here are my three areas that I think we over-zealously overuse, over-program for, over-utilize, overdo, over-introduce, and…well…under understand (there I went for it):
Visual schedules and token economies. These interventions are priceless tools in helping learners understand the passage of time and predict future reinforcers. However, I can’t count the number of times I’ve seen visual schedules and token economies used as an intervention for kiddos who probably didn’t need them or weren’t ready for them. These were usually cases where the learner lacked the basic joint attention skills to even look at the visual schedule, let alone use it. Their communication was minimal and their ability to tolerate the removal of a preferred item was even shakier. Yet, they were required to pull off pictures of each activity that day from a velcro board.
On the other hand, I’ve also seen many instances where the learner understands fully how time passes. Yet the same kind of picture board is used. They may even tolerate waiting for extended periods of time and simply needed a more advanced and developed system for measuring time and reinforcement such as telling time, reading a timer, using a calendar, or reading a to-do list. Check out these easy to read articles on how to use visual schedules the right way:
Emotions. Maybe you’ve seen this before. Imagine this: A learner who hasn’t developed the functional communication skills to communicate basic wants and needs. Now imagine, that they have a program in place where—when the iPad is removed and they get upset—they’re prompted to pull off a picture from a velcro board of a “sad face” emoticon. Under the sad emoticon it says “I feel sad”. The problem behavior continues to occur, their need for the iPad goes uncommunicated (or is under-targeted), they’ve learned to pull a velcro thing off of another velcro thing (a fine motor “win”, I guess), but they still don’t know what “sad” means.
Again, teaching the concepts surrounding emotions is important. But, as clinicians, we’re passionate and compassionate. Sometimes we tend to over-assume that every problem behavior comes from an inability to express ones emotions. That could be true. But that also could be because we—as clinicians and as a field—tend to be relationally rewarded by other people. As a field, we value the emotional well-being of others. That means, as a field we possess a thing called compassion.
And what do we, as compassionate clinicians, do? We attempt to alleviate the emotional pain of the little ones we help. Bravo! But, what do compassionate clinicians sometimes over-do? They sometimes think that every problem behavior is a result of deep emotional pain.
Watch your own personal biases. Be compassionate…and parsimonious. Sometimes that kiddo just wants the iPad. Teach them the words.
Classroom and Circle Time. We talk about how important it is for the learner to have the right component skills in place before we embark on the grand adventure of toileting, emotions, colors, and visual schedules. However, there is a general skill area where clinicians tend to skip working on the necessary component skills more than all the others. They tend to throw a kiddo in a social setting (classroom, circle time, etc.) before they are ready. While the other kids follow the lead of the instructor, the learner sits in a chair, maybe interested in other things, maybe overwhelmed, maybe not sitting at all, maybe miserable.
A couple of thoughts here...First, for clinicians and families, socialization and school are sometimes a sign that we’ve done our job. It’s often the end goal that we talk about in our parent trainings. Second, like we talked about above, clinicians are “relationally” driven people. We want to equip our learners so that they can establish meaningful connections with others. That’s good stuff because many of us derive a great deal of joy from our relationships. On the flip side, we can overdo it here. Sometimes we jump the gun. We can over-assume that the quality of every kiddo’s life comes down—simply—to the number of peers they are surrounded with. Because we value relationships with others so much, we throw them into a group of with their peers. For a clinician, it’s so reinforcing for us to see a kiddo sitting on a little chair with other little kiddos. That’s okay. But sometimes it isn’t the time for that. Sometimes we do it because it makes us feel good.
Instead of putting a kiddo in circle time, take the time to teach the component skills! Even more importantly, take the time to pair peers and peer settings with reinforcement. Programming for socialization, classroom, and circle times should be driven by how reinforcing they are for your learners—not by how reinforcing they are for you.
In closing, all of the above is a result of a few things that I plan to dive into deeper at a later date. First, as clinicians we sometimes don’t know when to introduce something. Second, we sometimes don’t have access to quality clinical ideas. But, third, sometimes we carry our own implicit biases in addition to the programs we want to teach.
Something for you to chew on for the weekend.