Hi and welcome to “What Works Wednesdays” where we share a success story from one of our clinical cases.
Our intent is to show readers how successful ABA can be. Today’s success story is not about a clinical case but rather a personal case.
As some of our readers may know, Missy has a brother with autism and intellectual disabilities. Mac is also non-verbal which complicates the intervention process.
When Mac was in his early 20s, he moved in to a group home with 5 other men. Mac engaged in inappropriate touching during mealtimes. He touched their plates, he pushed their drinks, and he touched his roommates. When he did this, staff put Mac in timeout until the end of the meal and then Mac was allowed to eat his meal alone.
After several weeks, the staff called Missy to report that the inappropriate mealtime behavior had become a serious problem and that state rules required roommates to eat together. Thus, they needed an intervention so that Mac could eat with his roommates. They had concern that their timeout technique was not working.
Missy provided them with some important background information. When Mac was very young, like many children with autism, he engaged in challenging behaviors during mealtime. To decrease family stress, their mother fed Mac separately from the rest of the family. Thus, Mac had developed a strong preference for eating in isolation with abundant space on either side of him.
Missy explained to them how to develop an appropriate behavior intervention plan: a) modify antecedents to prevent challenging behavior; b) teach appropriate/replacement behaviors; and c1) modify consequences to stop reinforcing challenging behaviors; and c2) begin or increase reinforcement for appropriate behaviors.
Modify Antecedents to Prevent Challenging Behaviors
Staff planned to do a variety of things to prevent Mac from touching his roommates, their food, and their drinks.
- At the beginning of the meal, they asked Mac where he would like to sit. He often chose to eat at the bar adjacent to where the rest of the roommates were eating.
- Chips (a highly preferred food for Mac) were offered at the table. Mac could only have chips when he sat at the table with everyone else.
Teach Appropriate/Replacement Behaviors
The staff also taught Mac to communicate instead of using challenging behavior to get his needs met.
- They taught Mac to ask (using gestures) to sit in a different place.
- They taught Mac to ask for additional space (using gestures) when he felt crowded.
Reinforce Appropriate Behaviors
Staff also focused on reinforcing Mac for engaging in good mealtime behaviors.
- They provided him with attention (praise and high fives) when he was eating appropriately.
- They provided him with chips when he sat at the table with everyone else.
Staff stopped reinforcing Mac’s challenging behaviors.
- When Mac touched other people, their food, or their beverages, staff did not allow Mac to eat alone.
- Staff did not allow Mac to leave the area when he touched other people or their food and drink.
- Staff only allowed Mac to leave the table when he asked to move or when he asked to sit somewhere else.
Mac now lives in a home with 2 other roommates. He eats at the table with his roommates. The table is large so that Mac has ample space. When Mac comes to visit Missy and her family, he eats at the table with the children but he asks them to make extra space for him. When Mac eats out in restaurants with Missy and her family, they always ask him where he would like to sit before the meal begins. If the table is large enough, he asks to sit at the end. If the table is small and he feels crowded, he asks to sit at an adjacent table so that he can interact with his family but still have ample space to feel comfortable.
Staff originally tried to use a timeout procedure to address Mac’s inappropriate mealtime behavior. Staff failed to notice that Mac wanted to eat alone. When they used the timeout procedure it actually had a reinforcing effect: Mac’s inappropriate mealtime behavior increased because they gave him what he wanted when he misbehaved. Additionally, the timeout intervention did not teach Mac any new skills. He still prefers to eat alone or with ample space around him but now he has learned how to communicate his preferences so that he does not have to engage in challenging behavior to get his way.
Thus, when addressing challenging behavior, we must first understand why the behavior is happening. It is then, that an appropriate intervention may be developed to effectively address the behavior.