This is the first of the ABA Treatment Series. It will be a series that is for ABA professionals, but I will try to explain things so that all who read can understand these concepts!! As always… I want to advance our science and help EVERYONE to understand how it works and how to provide ethical and empathetic care for ALL!!
I have had a few different children that I have worked with in the past that were diagnosed with Oppositional Defiant Disorder (ODD). I have one recent client that was a bit older and “high functioning”. I have found that most of my clients diagnosed with ODD are what is considered ”high functioning” (although that is not my favorite term!). He was a challenge, but OH HOW SWEET it is when you can reduce those oppositional behaviors and create a positive working relationship with them, when everyone else who has tried has failed.
First, I would like to say that I am a firm believer in parent training to “put myself out of a job”. It is important to make sure that the parents can intervene on problem behaviors and understand our science so that they can reduce behaviors in their home and keep them managed. Parent training in this case was EXTREMELY important, because, what some of you may not know, ODD is a behavior disorder. This means that it cannot be fixed with medication and is likely created/supported by the environment. So how do we change it? In my case, the youth was in out-of-home placement and I trained the caregiver on the interventions we used. The caregiver was AMAZING and we were able to work together to create a great plan that worked in both settings to transfer that control to the family home much easier (generalization will have to be a whole other blog lol). We were able to get this child from Crisis placement to placement back in the family home with the caregiver.
How was this done? What interventions were used?
I would like to talk about positive behavior support and what that means. This type of support is hard for many parents/guardians who were raised with an authoritarian style themselves (meaning what authority says….goes). Positive behavior support focuses on socially significant behaviors (meaning behaviors that are important for day-to-day life for the client and those who are around them). The most important part is that positive behavior support is PERSON based treatment. We do not talk about the person, we talk with them. We do not do things because they work for us, but because they work best for the person with whom we are currently working. Last, we see family/caregivers as partners and take what they say into consideration when choosing and managing treatment. To summarize from a class that I took recently on ODD,
“If it is not working for the client/child, then it is not working for you”-Amelia Bowler,BCBA
I have found that with an ODD diagnosis, we have to keep motivation high! Find something that works for the client and the family. Something that the client will be motivated to work for and that the family can easily implement with their lifestyle. This is hard with an ODD diagnosis. Typically, in our science, we use preference assessments to target things that will motivate our clients. I usually stay away from this with this diagnosis because the client will likely change their choice of reinforcer (what they want to work for) as an oppositional behavior. I will typically use observation, family interview, an informal interview with the client and a reinforcer survey with the client to get an idea of all of the things that they would like to work to earn. This will help provide me with options for the client when they change the reinforcer mid earn. You can then provide them with available choices.
Also, if you have a client who is able, use a general reinforcer, such as money/tokens/tickets that they can cash in at the end of an earning period. This will allow them to earn, but then choose what they want after they’ve earned. This gives them full control of choosing their item when they earn. I have used actual cash (from the parents) and token systems with tokens/tickets as the general reinforcer, with a “reinforcer store”. The reinforcer store is a bin full of things that I know that the client likes and it allows the client to earn tickets and choose items based off of the tickets they earned in that period. You can switch out items in your “store” on a weekly basis to keep the motivation hgh as well, so they are not choosing from the same things. Keeping motivation high is essential!
After we find out what motivates our client... what's next??!!
We, as ABA practitioners should take into consideration that life just is not so structured in the family home most times. Most parents do their best to keep structure, but what if they run out of milk for dinner and need to go to the store with a child who does not do well with transition? It is IMPERATIVE to train the natural environment and caregivers. Although we have seen interventions work in the past, as an ABA professional, it does NOT mean that it will work with this client/family. This is Positive Behavior Support!! Realizing that we must flex and if it is not working for the client/family, then it is NOT working for us! Modify our approach and find an approach that is still focused on triggers, behaviors, and consequences (ABCs for ABA professionals) and WHY the behavior is happening (base intervention on function) and you will find success!!!
I love this science! It is my passion and what I was put here on this Earth to do!! I have seen it work in different settings, with different diagnoses, with animals, with weight loss, in business, and in every aspect of life!! Oppositional behaviors are necessary for our children/clients to find their own voices, learn judgement, and create autonomy in their lives, BUT when those behaviors are interfering with their safety and quality of life, we must intervene.
If you are working with any diagnosis, not just ODD, please just remember that if it is not working for “them”, it is not working for you! Meet in the middle and stay person centered!
Let me know your thoughts! I would love to hear from other ABA professionals about your experiences!!!
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