Give me my lunch!

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

 Gerring, J. P. (1986). Psychiatric sequelae of severe closed head injury. Pediatric Review, 8, 115-121.

 Luiselli, J. K., Gardner, R., Arons, M., McDonald, H., Madigan, C., Marchese, N., ... & Simon, M. (1998). Comprehensive community‐based education and neurorehabilitation for children and adolescents with traumatic brain injury. Behavioral Interventions, 13(3), 181-200.

 Rutter, M. (1977). Brain damage syndromes in childhood: concepts and findings. Journal of Psychology and Psychiatry, 18, 1-21.

 Slifer, K. J., Cataldo, M. F., Cataldo, M. D., Llorente, A. M., & Gerson, A. C. (1993). Behavior analysis of motion control for pediatric neuroimaging. Journal of applied behavior analysis, 26(4), 469-470.

 Skinner, B. F. (1938). The Behavior of Organisms: An Experimental Anaylsis. New York: Appleton-Century

 Thorndike, E. L. (1927). The law of effect. The American Journal of Psychology, 39, 212-222

 Ylvisaker,M., Turkstra, L., Coelho, C. A., Yorkston, K., Kennedy,M., Sohlberg, M. M., et al. (2007). Behavioral interventions for children and adults with behavior disorders after TBI: A systematic review of the evidence. Brain Injury, 21, 769–805.