Principles of Applied Behavior Analysis in Neurorehabilitation

What is Applied Behavior Analysis?

Applied Behavior Analysis (ABA) attempts to solve socially important behavior problems by providing antecedents and/or consequences that change behavior. Behavior analysis is: applied to important real world problems rather than theory; behavioral, meaning it is observable and can be reliably quantified; analytic, in that control of the behavior can be demonstrated using single case designs (Barlow & Hersen 1984); technological, meaning that the methods can be completely identified and described by relating methods to concepts; effective, by showing meaningful changes in socially relevant behaviors; generalized to other related behaviors and durable over time (Baer, Wolf & Risley 1968).

ABA is based upon learning theory and quantification of observable behaviors. Its goals include: measurement and description, understanding and prediction, application and control, and replication of effects. Through continuous measurement ABA therapists quantify the learner’s performance on a goal during each therapy session so that they know if their treatment is working or needs revision. Ogden Lindsley (1990) noted that if a learner is not making progress, the failure is not in the learner but in the teaching method. ABA focuses on behavior, emphasizes environmental events and relies on precise descriptions of the procedures so that others may continue the treatment or replicate the teaching method. Past events are considered part of the person’s learning history rather than the “cause” of behavior.What is important is to understand the function of the behavior. Often when a person has difficulty making themselves understood they use their behavior as a way to communicate. Behavioral challenges are common in brain injury. Frontal lobe injuries frequently result in reduced social skills and impulsive behaviors that may be considered not: civil, social, healthy or even legal.

Behavior is maintained by its consequences, behavior that is not reinforced will extinguish. Before it extinguishes though behavior may escalate. When we are searching for solutions we have high variability in our behavior until a solution is found. In this case the environment selects behavior, which is what happens to us all under natural contingencies. Once we have the solution our behavioral variability narrows as behavior becomes more efficient. Consider this example: A client with a trachea tube (can’t speak) is experiencing pain in physical therapy (PT), they moan, squirm, cry, and wince but it does not result in immediate escape. One day the person smacks the therapist and the PT stops on the spot. Next day the person winces and swings, the PT can respond to the wince and reinforce that as the signal to stop or reinforce the swing. Which signal would you want your client to learn to use? They are both forms of physical communication.

It is vital for effective treatment to understand the function of challenging behaviors. A functional assessment systematically examines the variables maintaining the behavior in terms of: escape, attention, access to tangible items and self-stimulation. Results are used to design treatments to replace the challenging behaviors with functionally equivalent behaviors and/or functional communication skills that are adaptive and socially acceptable.

Clearly individuals with brain injury can benefit from effective instruction and behavior analytic interventions. Research supporting that premise is being presented at national conferences (Association for Behavior Analysis International and the North American Brain Injury Society), and published in a variety of journals. Under the best of conditions, changing behavior takes time. The combination of a brain injury and limited treatment time make it imperative that effective and efficient treatments for persons with brain injury be developed. Behavior Analysis offers an evidence-based treatment methodology accessible to clinicians to use to in helping the growing population of people who experience catastrophic brain injuries.

References

Baer, D. M., Wolf, M. M., and Risley, T. R. (1968). Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, pp. 1, 91-97.

Barlow, D. H., and Hersen M. (1984). Single Case Experimental Designs: Strategies for Studying Behavior Change 2^nd edition. Pergamon Press New York.

Lindsley, O. R. (1990). Precision teaching: By teachers for children. Teaching Exceptional Children, pp. 22(3), 10-15.

This article was contributed by:

Michael P. Mozzoni Ph.D., BCBA-D, CBIST, Applied NeuroBehavioral Services

Michael Mozzoni is a licensed, board certified, doctorate-level behavior analyst and certified brain injury specialist trainer who has worked with people with brain injuries since 1985. He holds a doctorate in applied behavior analysis from Florida State University and a master’s degree in experimental psychology from Harvard University. He has served as treasurer for both the American Congress of Rehabilitation Medicine Interdisciplinary Special Interest Group and Academy for the Certification of Brain Injury Specialists. He is a board member of the Behavioral Health Center of Excellence, and the Behavior Analysis Certification Board examination committee. Mike also has served as a member of the editorial boards of Behavioral Interventions, Journal of Applied Behavior Analysis (ad hoc) and Brain Injury (ad hoc). He has served as an adjunct professor in the ABA department at the Chicago School for Professional Psychology and University of Arkansas at Little Rock. He has numerous awards, publications and presentations in the areas of: Brain Injury Rehabilitation, Employee Turnover, Behavior Management, Skill Acquisition, and Environmental Hardening.