You are placed with a new client with multiple maladaptive behaviors. Where do you start? How do you prioritize behaviors to maximize treatment and minimize unnecessary treatments as per the ethical code for behavior analysts?
Ask yourself the following questions:
1. Does the behavior pose any danger to the client or others? Behaviors that cause harm or pose a serious threat to the learner or others’ personal safety or health must receive priority.
Example: Lily engages in several maladaptive behaviors; clinging to her parent’s legs in unfamiliar places, humming loudly, which often disrupts her class, and eye-gouging. The BCBA practitioner would likely prioritize eye-gouging behaviors.
2. How often does the problem behavior occur? How many opportunities will the learner have to use the new behavior you want to teach? How the behavior change or relevance of the new skill impacts the learner in other environments, as does how often they will contact reinforcement.
Example: Lexi engages in near-constant throat clearing and wrist tapping approximately 4 times daily. The BCBA practitioner wants to use a DRI deep-breathing procedure to replace the throat-clearing behavior. Throat-clearing behavior is more frequent than wrist tapping, and replacing the behavior with deep breathing will allow her to access environments that she was not able to with the disrupting throat- clearing; thus, she will contact natural forms of reinforcement more frequently.
3. How long-standing is the problem or skill deficit? A chronic behavior problem or skill deficit should take precedence over more recently developed problems or those that are displayed sporadically.
Example: Lynn has a learning history of elopement resulting in the withdrawal of academic demands. This behavior has resulted in her being placed in a self-contained special education program for over three years. She has recently started to swipe materials off of the instructional table. The BCBA practitioner would be wise to initially address the elopement behavior.
4. Will changing this behavior produce higher rates of reinforcement for the person? Behavior that results in higher, quality levels of reinforcement should take precedence over behaviors that produce lesser amounts of reinforcement for the learner.
Example: Lynn’s BCBA has successfully reduced elopement behavior by pairing the instructional table with reinforcement. The behavior technicians are now able to play with her at the table. Lynn’s mother has requested that she learn how to tie her shoes. The BCBA practitioner discusses prioritizing the reinforcement of appropriate learning behavior by embedding academic demands with play (high-probability request sequence) to reduce instances of material-swiping behavior. Appropriate learning behavior will enable Lynn to access higher rates of reinforcement than shoe-tying and will have longer-lasting effects.
5. What will be the relative importance of this target behavior to future skill development and independent functioning? Target behaviors should be judged in terms of their relation to other critical behaviors needed for optimal learning and development. Goals should be directly related to the development of independent functioning.
Example: Lily was taught to request her family’s attention by reaching out her hands and is no longer engaging in eye-gouging behavior. Although the BCBA has successfully extinguished this dangerous behavior, Lily needs a more functional mode of communication. The BCBA begins teaching Lily modified signs to mand for preferred items and activities. Manding is a critical behavior needed for communication with her social community and will promote learning and independence.
6. Will changing this behavior reduce negative or unwanted attention from others? Public displays or mannerisms of behavior may be prioritized if their reduction is likely to provide access to least-restrictive environments or other learning environments. *Be careful with this one. We never want to make behavior change just for the benefit of others; consider if a reduction of behavior will lead to increased quality of life for the individual.
Example: Lauren is a 5th-grade student with moderate academic and social delays. She is in an inclusive classroom without support. She engages in a high rate of hand flapping that, although it has not impeded her academic learning, is often disruptive to her peers. Her teacher has noticed that her peers have started to comment on her physical movements, and she believes that it may be a barrier to making friendships. The school BCBA implements a habit-reversal procedure with Lauren to decrease her hand stereotypy.
7. Will this new behavior produce reinforcement for significant others?
Behavior change supported by significant others is more likely to be reinforced in their natural environment. Be careful not to prioritize behaviors for change simply for the convenience of others.
Example: Lauren’s BCBA has successfully reduced hand-flapping behavior using a habit-reversal procedure. When discussing the goal’s success at an IEP, Lauren’s family tells the school team that all family members play musical instruments. After speaking with Lauren about preferences, they develop a procedure to teach her to play drums as a leisure activity. This goal is supported by her family and may result in her joining the band at school.
8. How likely is success in changing this target behavior? Some behaviors are more difficult to change than others. A good rule of thumb is to identify at least three sources of information that can help you to assess the likelihood of change. The research will assist in assessing the degree of success in changing a particular behavior about challenges. Other considerations include how experienced the practitioners are and to what extent the environment can effectively be controlled.
Example: Larry engages in hitting and crying behaviors. His school BCBA thinks that implementing a DRO will help to omit the hitting behavior. The BCBA researches and is concerned that behavior contrast may increase hitting at home once the DRO is implemented. He also finds that DROs may be challenging to implement, especially when starting with a very dense schedule. Since he has a brand new therapy team and he is only able to supervise Larry’s team two times a month, he decides that a DRO is not feasible. The BCBA decides to prioritize crying behavior by using an FCT procedure.
9. How much will it cost to change this behavior? Cost should be considered before implementing any systematic behavior change program. Consider financial cost, the cost of the practitioners, and the time that the behavior change system will “cost” the learner.