Top critical review
"New Ways" to Understanding Challenging Behavior
Reviewed in the United States on November 24, 2020
Overall this was a decent book that gave me some things to think about and to incorporate into my practice. I'm a Board Certified Behavior Analyst (BCBA) and have worked with all ages, specializing in working with people with challenging behaviors for the past 20 years. Recently, I have focused primarily on working within early intervention birth to three.
My main issue with this book is Chapter 6. Dr. Delahooke refers to "traditional behavioral approaches" in a way that resembles the behavior modification era (from the 70s-80s) and fails to give credit or acknowledge the advancements in this field now referred to Applied Behavior Analysis. Essentially, she describes this approach consisting of ignoring misbehavior and rewarding good behavior which is an antiquated look at behavioral assessment and intervention.
She outlines her Personalized Attunement approach as follows:
1. Prioritize the child's feeling of safety in a relationship.
2. Address the causes and triggers underlying the behaviors.
3. Help the child develop new ways to cope.
This sounds similar to how behavior analysts assess and intervene on challenging behaviors. We don't necessarily use these words; however, we would look at our rapport with the child and determine if we have a good/reinforcing relationship with the child and ask ourself "When we show up, does the child run TO us or AWAY from us?" If the child runs to us, then yes, we have a good rapport, aka "the child feels safe with us".
Addressing the causes and triggers underlying the challenging behavior is the heart of what we do as clinicians. We refer to this as an antecedent analysis which also involves assessing motivating operations (MOs). We always want to rule out pain, psychiatric, and other medical variables that could be contributing to the challenging behavior as well.
Finally, helping the child develop new ways to cope is also paramount to the work that we do. We refer to this as teaching a replacement behavior or skill. We want to teach the person another way to "cope" depending on the function (cause) of the challenging behavior taking into account triggers and MOs. The replacement behavior is individualized and may consist of learning a new skill (e.g., going to a cozy corner when feeling stressed, asking to take a break/walk if the environment is too loud/stimulating, or wearing noise cancelling headphones, etc) or learning to communicate a specific need or desire, and on and on. Sometimes, especially for younger children, this would involve "co-regulation" which consists of the child calming down with the assistance of a caregiver.
And yes, we love reinforcement because that is how behavior is learned and maintained. Reinforcement can be intrinsic or extrinsic.....think about your own behavior (anything you do or say) isn't it reinforced, even every once in a while, either intrinsically or extrinsically? There's nothing wrong with reinforcement unless it's only provided "artificially" (skittle anyone?) and not more naturally (a smile, a head nod, etc).
Anyway, I'm noticing a pattern in early intervention. "ABA" is the enemy and is often misunderstood and misrepresented and unfortunately the chapter in this book only perpetuates this.