What Makes Aurora Behavior Services Different

As a clinical provider for many decades specializing in significant, persistent behavioral concerns to include children on the more complex ('profound') end of the autism spectrum, I've never needed or used edibles. Never. Aurora Behavior Services does not believe children should ever be put in a position to earn or lose access to food. Doing so is unethical while too often also teaching significant misrules connecting food to learning. When it's time to eat or have a snack, we eat. There is also no ‘time out’ from food.

This longstanding but misguided manipulation of food can also quickly lead to sometimes rather significant interfering (problem) behaviors driven by a child’s drive to maintain access to food and/or only be productive when food is available. Under such circumstances, edibles are no longer a ‘reinforcer’ and directly interfere with, rather than support, authentic child-centered independence and success.

My specific background also includes working with and supporting children with sometimes significant, sometimes medically connected, feeding needs. Aurora welcomes contacts for and referrals which include feeding related issues.

In this regard, it’s been my extended anecdotal experience that use of edibles can play a contributing and complicating factor when feeding, and especially, severe feeding issues exist. By engaging in a forensic behavior assessment process, I’ve also found that the previous misuse of edible (and other) reinforcement practices has become connected to some of the most substantial and high-risk behavioral needs across folks with whom I’ve been involved.

Edible use is not nuanced. There are ALWAYS other strong preferences, reinforcers and motivation available. How ongoing instruction and services are constructed can also strongly influence child motivation and success.

The argument that ‘food is the only thing he/she responds to’ relates less to the child and more to the adult’s clinical understanding of how to assess for and utilize what is often a wide range of child interests and preferences to include those which may be more stereotypical. The need to end the use of edibles reinforcers is, I believe, a 'universal.'

That too many BCBAs have mis-learned some of these processes is also not a reason to accept the use of poor and, often, counterproductive instructional and intervention strategies which are not consistently client centered, client friendly, compassionate or effective. The dependence on edible (and electronic) reinforcement can also deny a more compassionate and thoughtful individualization of services.

If the assessment process is inadequate; when behavioral planning is not child centered or individually aligned, just wave around a cookie. Doing this is the opposite of authentic behavioral analytic practice and inconsistent with the use of true reinforcers/strategies that help motivate success. It can also create significant negative side effects. Many parents/caregivers do not realize just how much junk food their child may be getting over a few hours each day in certain locations.

Parents/caregivers of children receiving services at Aurora, however, know their child will never be fed junk food or any other edible ‘reinforcer.’ Their child will never have their food controlled or withheld due to a need for it to be available as a ‘reinforcer.’ Their child will also never have their food withheld due to the occurrence of problem behavioral events.

This fundamental misuse of edible reinforcement is closely connected to the many decades old model of Discrete Trial Training (DTT) still used by far too many BCBAs and autism service agencies. The DTT model should be long past tense. It is overly intrusive, poorly individualized and focuses far more on the autism ‘diagnosis’ than compassionate child and family-centered individualized assessment and planning.

With this, the reality is that Applied Behavior Analysis was never designed just for persons with autism despite the machinations of so many currently providing behavior services. This mistaken belief is more relatively recent overall and frustrates me greatly every time I hear it. When used as intended, however, Applied Behavior Analysis can provide a powerfully positive model and instructional framework for children with ASD.

Authentic behavior analysis, as opposed to that which is associated with DTT, includes an emphasis on positive and effective environments, structure, interaction (by all involved), success, comprehensive ecological behavioral assessment, function/purpose of behavior, the prioritization of communication, social and adaptive competence and increased child independence/autonomy.

The first modern applications of behavior analysis started in the late 1950s and early '60s with one notable example being the1959 study by Allyon and Michael called the ‘Psychiatric Nurse as Behavioral Engineer.’ Using simple observational data, the authors developed incredibly effective plans for individuals with chronic mental illness to include schizophrenia that reduced repeat hospitalizations and the use of increasingly powerful medication dosages. They didn’t need food and DTT was still off in the future.

In my years of services and contact across a great many autism service agencies, I have found far too many serving children with autism who still lack functional communication (apart from their use of often increasingly intense and sometimes dangerous behaviors), who still need non-stop supervision to ensure their safety, even those still wearing diapers or pull ups as they approach or move past puberty.

If this is your experience, the problems and issues are not with your child but embedded in the services being delivered. Absolutely every child can be taught.

If services have not been successful, especially over time, or a child has had his or her services terminated due to persistent disruptive behavior, those children are not receiving the services most effective for and relevant to them. Above all, it is not the child.

How many of these children (and their families/caregivers) are receiving services based on the old and more intrusive DTT model?

How many of these children are receiving services closely intertwined with edibles and/or electronics because these are claimed to be the ‘only reinforcers the child likes?’

How many of these children have been receiving services for years but continue to exhibit higher risk and more intensive behavioral need?

How many still do not have functional communication?

How many are still struggling in social and community settings?

How many still need almost constant direct supervision?

The answer is way too many.

Behavior analysis is a comprehensive, rich clinical discipline. Aurora Behavior Services combines best practices in Applied Behavior Analysis and effective instruction via activity and movement based naturalistic instruction and intervention. (I will talk more about this in subsequent blogs.) And children who are accepted for services at Aurora will never be sent home or have their services terminated because of more challenging behavior needs.