Health and Psychology

I've posted on this before, but it's still fall and a relatively new school year so it's time again.  Behavior therapy, quite simply, is a therapy designed to change a specific behavior.  It does not change thoughts or feelings.  It does not require the assent of the person getting the treatment, although a lot of people will explain to a child or adult what they are doing and why.  It can be done with animals in addition to people.  The behavior must be described in clear behavioral terms, including what happens prior to the behavior, what happens after the behavior, and what training protocols, reinforcement schedules and monitoring procedures will be used.  It is the preferred method of treatment for work with animals, developmentally delayed, autistic, hyperactive, oppositional, and aggressive.  For individuals with specific habit based behavior problems-such as wanting to stop smoking or lose weight, it may also be a preferred method.

When working with children and animals, there are some premises.  The first is that the child or animal is not to be "in charge" and that there is some "trainer" that has determined what behavior is acceptable or not.  The "trainer" can be a parent, therapist, teacher, care provider, or anyone with a working knowledge of behavior treatment. Training must take into account the physical capabilities of the individual being trained.  I might be able to teach my fish to go through an obstacle course, but I'm not going to be able to teach him to fly.  I'll be able to teach my cat to use the toilet, but not a one year old infant.  Training works through a series of reinforcements.  Adults and children can improve behaviors and function as their own "trainers."

This does not mean I think of children as animals.  It is not a cruel or punative process.  It is not disrespectful.  It is the way language is taught in all cultures around the globe.  It is highly effective when used correctly.  It can be used incorrectly.

The average behavior specialist will spend about two years working with animals in training prior to working with humans.  The purpose is to learn timing, nonverbal commands, reinforcement techniques, correction techniques, and a variety of methods of shaping, chaining (linking behaviors) and modeling of behaviors.  When behavior specialists work with people and have not worked with animals, they will frequently rely on verbal commands, verbal reinforcers, and verbal corrections and will lapse into discussions and explanations.

So the example I give is the "behavior specialist" talking to a child..."Johnny, why aren't you sitting?  All the other children are sitting."  And the same example working with Rover, the dog..."Rover, why aren't you sitting?  All the other dogs are sitting."    Many can recognize the problem with the discussion with Rover, not as many with the problem with the discussion with Johnny.  So the experience of working with animals helps to clarify the model for the trainer.  

When you read a behavior plan, which is a written plan of the behavior to be changed by the behavior therapist, it should be clear from the plan about what specific behavior is to be targeted, what the intervention is, what reinforcement and correction will be used, and how it will be monitored. The plan will not have the child responsible for the behavior change.  It will have a clear designated "trainer" or team of trainers that are responsible for the behavior change.   

I read behavior plans, also known as 504 plans, often.  Many of them do not have a clear description of the behavior, many do not have clear interventions and many have the child in charge.  Here's an example:  "Johnny doesn't turn in his homework, is aggressive with others at school and is disrespectful of the teacher.  Johnny will turn in his homework, stop hitting and kicking others, and be respectful.  If Johnny engages in inappropriate behavior, he will be reminded and then sent to time out if he doesn't comply."   That's not a behavior plan.  First there are multiple behaviors being targeted.  Second there is no identified trainer.  Additionally there is no clear intervention.Finally, Johnny is expected to be in charge of his behavior.

So here's what a behavior plan is supposed to look like:  

1.  Targeted behavior:  Johnny completes his homework but does not turn it in.  He has failed to turn in homework on time at all in the past 2 weeks.

2.  Anticedent:  Johnny is expected to turn in his homework by the end of the day without being reminded.  Johnny "forgets" and the homework is not turned in.

3.  Intervention:  The teacher will ask Johnny to find his homework and put it in a basket when he comes into class.  Over a training period to last no more than 10 class days she will gradually fade the asking request by just making eye contact and pointing to the designated homework location.  If needed, she can return to a verbal prompt.

4.  Monitoring:  The teacher will say "Good" each time Johnny puts completed homework in the basket on time.  She will monitor homework completion rates and assist with training to standard if needed.

Thats a behavior plan.  Johnny is not in charge.  The teacher is in charge.  The teacher has a training plan and a strategy for monitoring and intervention.  There's a time line for monitoring and a method to assess success.  After one behavior is complete, a new behavior can be focused on in short order, such as not hitting or kicking others in line.

Lots of behaviors can be changed in this fashion.  Johnny can think or feel however he does about the behavior. How he thinks and feels isn't relevant.  In some types of therapy, how Johnny thinks and feels is very relevant, but not in this type of therapy.  I'm working with a client on losing weight and increasing execise.  The client is doing all the monitoring.  I could also have electronic monitoring where calories expended were recorded, and a place where foods were logged, but I don't need to do that.  The client is clear with the behavior she wants to change.  The client has an idea about how to eat adequately and how to exercise.  Her physician has no issues with her losing weight or exercising.  I'm just helping her to train a new behavior.  While she logs the behaviors of eating and exercise, I'm the one in charge of reviewing them for patterns and for intervention strategies.  Because the client is an adult, and is compliant with the behavior goals, I can have her do part of the plan on her own.  I'm still responsible for the plan, it's implementation, the reinforcement and how to change the plan if it isn't working.

To get help with any behavior you want to change in yourself or your child, feel free to contact our office.