My course opens for the semester today. Next up…principles of developing, strengthening and maintaining behavior.

In behavior analysis, we learn that these tasks often accompany its counterpart which is decreasing responses that are maladaptive, problematic or destructive to an individual in treatment. It is important to understand why we are trying change a problematic behavior but perhaps even more important is developing a new behavior in its place. In many cases this means teaching the skills needed in order to acquire desired change. It is even more important to understand we are not trying to change a person to something they are not but rather helping them achieve a meaningful outcome that is important to them.

I sat in on a continuing education class this past week on the topic of social skills training for individuals with ASD. It could also be useful for individuals with various other DSM-5 diagnoses in which there are disturbances within interpersonal relationships.

The presenter had us begin the class with an experiential activity. The class was divided in to three groups and told there were different types of candy hidden throughout the room. The goal was to find as much candy as possible when each group was instructed to begin the task. Group one was able to begin first. A minute later group two was able to begin looking for the candy while group one could continue in the search. After two minutes group three could begin the task if they could find any candy left.

It is probably not surprising to hear group one had found the majority of the candy and group two had gathered the rest. It is also not surprising that group three was not able to find candy. It was what the presenter instructed them to do next that was the take away to this experience. They told group three to approach the others and ask to have some of the candy.

The various types of candy represents all of social behavior elements important for interpersonal relationships. Group one represents neurotypical individuals without skill deficits. Group two represents individuals with mild deficits and group three represents individuals with severe social disturbances. Group three most certainly felt the limitation on some level before they even attempted the task. They could understand to some degree that this limitation impacted them in their environment. If that wasn’t enough they were then faced with improving their candy situation themselves by interacting with the group who did not experience this limitation.

I don’t know about you but if I was in this scenario over and over again after a period of time I would probably say something not so nice like give me some candy now damn it! You already have enough. Or I might just go up and take the whole freaking pile to hell with it. I have the candy now but I still don’t feel great. So I might throw the candy across the room or maybe just throw it all away because I don’t deserve it. Hopefully you can see the cycle going on here…

In order to be an advocate for individuals we must not forget the overwhelming task of learning behavior we have never experienced. More over begin to understand how problematic behavior has formed to serve a person in the absence of something else. All behavior is communication with our environment.

The primary professor for my ABA program shared a great testimony of this in my Foundations of Behavior course. Dr. Jose Martinez-Diaz spoke of an individual he worked with in this area of social development. He described an adult who had been referred to his care after a second suicide attempt with little to no improvement in his wellness goal. This individual had a history of chronic depression with little to no social interaction who self reported himself as withdrawn from the world. The person in this testimony may have had some type of DSM-5 diagnosis but a specific disorder was not mentioned in the testimony. What Dr. Martinez-Diaz did shared was that this individual grew up in a home with one parent who themselves struggled with severe mental illness. As a child the individual did not experience healthy parental attachment nor learned social skills for relationships from an early age. He came to Jose after several clinicians and having seen a psychiatrist with no improvement. Medication had not been effective, cognitive talk therapy not helpful and the now second recent suicide attempt. This individual stated they had never developed close relationships with others, was lonely, lived alone and felt an inability to connect with others. The meaningful outcome for them would be to experience a close relationship with a significant other.

After assessment Dr. Martinez-Diaz determined this individual had severe deficits in social skills. Assessment in the direct natural environment observing them attempt interactions with others. While many of us know how to initiate appropriate social interaction this individual did not. He literally approached an introductory conversation with hello I’m lonely, I want to get married and have sex with you. Seems self sabotaging right? But it wasn’t to him.

None of these other therapies had been effective because it wasn’t targeting the function of the problematic behavior, observing it directly and then teaching the behavior necessary for their desired outcome.

The intervention plan identified the deficits present and the goals for teaching these skills. The individual spent intensive time with the behavioral staff with training in conversational activities with contingency of reinforcement toward acquisition. He was trained on appropriate hygiene, conversational skills, role playing video recorded sessions practicing asking open ended questions and play back of inappropriate conversation examples. Play back of his improvement with making eye contact and active listening skills. These tasks were broken down in to small steps and as each element was mastered the next set of social skills was introduced. The final phase of the treatment consisted of the individual wearing a hearing device while walking through the college campus. Staff would instruct the individual to approach a trained volunteer and introduce himself. They would coach him on what to say next and so forth. Data was collected throughout the treatment on his progress. The final phase was to encourage him to generalize the skills learned to his natural environment.

Within two weeks of ending the final phase of treatment the individual reported that he had successfully scheduled a first date. Within a month he came back to Dr. Martinez-Diaz with a different problem. He had met two people and he now had too many dates for it not to conflict. Jose’s response was he no longer needed him!

This was a pivotal change in the persons life. He was able to overcome a limitation that was holding him back from meaningful connection with other people. Suicidal ideation was no longer present because he had developed behavior that he had not experienced without help. My professor and treatment team had quite literally saved a life.

Which is why he is so passionate about teaching applied behavior analysis.

Loved By Grace,

Aimee

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