Friday, September 23, 2022

Good Ideas From ABA - ABC charts and task analysis

I'm not a fan of ABA, as people who regularly read my blog could probably surmise. But there are some good techniques that ABA therapy has popularized, that I think should be used by people who aren't using the rest of ABA. Two main ones that come to mind are ABC charts and task analysis.

ABC chart stands for antecedent, behaviour, consequence chart. Basically it's a way of recording episodes of unwanted behavior so you can observe patterns and figure out why the behaviour is happening. For example, let's say you have a child who has tantrums. Every time they have a tantrum, you fill out the chart.

Antecedent - What was going on just before they had the tantrum? What set it off?

Behaviour - What exactly are they doing? You wouldn't put "tantrum" here, but something like "screams, arches back, claws at mom's face".

Consequence - What did people do in reaction to the behavior? What happened next?

For example, in a classic inadvertent operant conditioning situation, you might have the antecedent be that you were in the store, the child asked for candy and you said no. Then the behaviour - they screamed and refused to move while saying "candy" over and over. And then the consequence, you gave in and bought them candy. Let's say each of the other tantrums all followed this pattern - child wanted something and was told no, child had a tantrum, child got the thing they wanted.

This would suggest that the tantrum behaviour is motivated by learning that having a tantrum is a good way to turn a "no" into a "yes", and therefore you can reduce tantrums over time by being consistent about making sure that they don't work to turn your no into a yes.

In contrast, what if the child only tantrums in the store, but not necessarily with a consistent trigger? One time they tantrummed when denied candy, another time they tantrummed when someone accidentally bumped into them, another time they tantrummed when the intercom turned on to announce a new sale on watermelons? And then you look at the consequence, and each time you left the store early and they calmed down.

That would suggest that they're not trying to get candy or other things like that with their tantrums. They might be trying to get out of the store, and regardless of their conscious intentions, it seems like the store is an upsetting situation for them. This could indicate sensory sensitivities of some sort, or social anxiety, or some other issue that tends to be triggered by the store's environment. They might benefit from bringing some sort of comfort tool with them to the store, or by going to a different store or shopping at a different time of day. Or maybe they'd just be better off waiting out in the car, if they're able to be left alone safely or if someone is available to supervise them.

Or, what if the antecedents are stuff like reminding them to go potty, taking away their plate once they've finished eating, telling them it's bedtime, etc? That suggests someone who has trouble with transitions - situations where they have to stop doing one thing and do something else instead. Maybe they need more advance warning. Maybe they need a schedule in a format accessible to them (written if they're literate, pictures if not) to let them know what is happening when.

So, ABC charts are useful. Especially when you aren't using them in an ABA mindset. In an ABA mindset, the tantrumming whenever they're in the store would probably lead to the conclusion that tantrums are motivated by escape and you should keep them in the store when they tantrum, but really, if they're trying to escape the store, you should be asking what it is about the store they want to escape from, and how to make them not want to escape the store, rather than just teaching them that they can't escape. Or, at the very least, teach them another way to escape the store instead of having a tantrum, such as saying "I need a break".

Next, task analysis. Task analysis means breaking down a task into its component steps. For example, getting a shirt on. First, you figure out if the shirt is the right side out and where the back of the neck should go. Then you pull your head through the head hole. Then you put one arm through its arm hole, and then the other arm through the other arm hole. And then you pull the bottom of the shirt down and smooth it out. This may not be the only way you could put a shirt on, but it's a way that works - if you follow these steps, you will end up wearing the shirt.

Which means that when you're teaching a child to put on their shirt, you can focus on teaching each of these steps one at a time. First, you might focus on just getting their arms through the arm holes, and do the rest of the steps for them. Then you might work on them putting their head through the shirt once you've found the right way for it to go. And then finally you teach them how to tell which way the shirt goes on. So, task analysis lets you take a complicated task and turn it into a bunch of simpler tasks that you can teach one at a time.

It also helps you identify exactly where the process is breaking down for a student - for example, maybe the kid can get their head through the shirt, but half the time their head comes out an arm hole instead of the neck hole. That means they're having trouble with the first step, figuring out which part of the shirt is the neck hole. Or maybe they can do the rest but can't get one arm through its arm hole because they have hemiplegia, so you need to modify the steps in some way so that they can get their stronger arm through without help and use it to help their weaker arm through its arm hole.

Again, it can be misused in ABA (and in general) - the most common mistake I see with task analysis is treating the sequence you've figured out as the one true way to do the thing. For example, you can tie your shoelaces before or after putting the shoes on, and either way can work just as well. If you put them on and then tie them it's easier to get the right tightness, but if you tie them first, you have more flexibility about the angle at which you're tying the shoes - for example, if you're too stiff or too uncertain about balance to comfortably reach your feet, you could tie your shoelaces, drop your shoes on the floor, and then step into them. But some therapists resist such modifications, because they have one way they teach shoe-tying. This ignores a lot of the second benefit of task analysis, identifying where the breakdown is, because they're not willing/able to fix that breakdown.

Another way that task analysis can be misused is having a rigid order of teaching the steps. The best way to teach the steps is to start with the easiest step for the student to do that they haven't already mastered, and move from there. This is very individual. One student might be great at tying things but struggle with lifting up one leg, so they're ready to learn to tie the shoelaces but still need help getting the shoe on their foot. Another student might be ready to learn how to pull shoes on their feet but nowhere near ready to tie shoelaces (this would be the usual NT progression). The best approach would be to teach those two kids the same steps in different orders, but some therapists only teach the steps in a specific order, such as backwards chaining, regardless of the relative difficulty of the steps. This can mean a kid getting hung up on one difficult step for a long time and frustrated with a lack of progress.