As an aspiring Clinical Psychologist, one of the areas I may
choose to work in is Clinical Neuropsychology. This may involve working with
individuals who have sustained a traumatic brain injury (TBI). When one thinks
of brain damage, physical impairment typically comes to mind. However, a TBI is
commonly associated with behavioural dysfunction such as impulsiveness, non-compliance,
disinhibition, aggression and property destruction (Gerring, 1986, Rutter
1977). Applied behavioural analysis (ABA) may be beneficial as a component of
an individual’s rehabilitation.
ABA attempts to control behaviour, changing it in desirable
ways by providing appropriate antecedents or consequences of that behaviour.
The ultimate goal is to decrease negative behaviours and increase positive
behaviours (Ylvisaker et al., 2007). For example, imagine I have a client
called James. Following his brain injury, he has the tendency to shout inappropriately
and excessively. Now the target behaviour has been identified, the functional
relations have to be identified. Functional relations are ABA jargon for the
link between a particular environmental trigger (antecedents and consequences)
and behaviour. During my observation of James, I notice that he shouts more
when he is made to wait for things he wants (such as lunch). In an effort to calm
him down, staff assist James before any other client. Thus, the behaviour is
being reinforced and the frequency of James’ shouting is maintained or even
made worse (Skinner, 1938)
My intervention would involve extinction. I would ask staff
to ignore James’ shouting. Therefore, the attention he gets from shouting (the reinforcer)
is withheld. Extinction alone can be a very slow and frustrating process. In
this particular situation, James’ shouting may initially increase which is
something staff will understandably want to avoid! Nobody wants to be shouted
at, let’s be honest! Differential
Reinforcement of Incompatible behaviour (DRI) may be a better strategy. It’s
completely impossible for James to wait patiently and calmly as the same time
as shouting his head off. The principles of ABA suggest that staff ignore the
shouting but reinforce the calm behaviour. For example, James could get extra
custard on his apple crumble at lunchtime if he is calm. Everybody loves
custard! Thorndike’s Law of Effect assumes that the positive consequence of
extra custard will increase the probability of James waiting patiently for his
lunch (Thorndike, 1927).
ABA has proved very useful, particularly in children with
TBI (Slifer et al. 1993). The use of a token system is particularly popular
(Luiselli et al., 1998) where tokens are awarded for adherence to
rehabilitation unit rules and regimes. ABA is relatively simple to implement provided
the basic principles are followed. It provides an exciting and innovative way
for clinicians to tackle the behavioural problems associated with traumatic
brain injury. Naturally, none of us want to be in the position where we are
recovering from a brain injury, but as a Clinical Psychologist in the making,
the potential use of ABA in rehabilitation is very exciting!
Philippa Mundy
References
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