Newsletter
Volume 29 | 2006 | Number 3
The Future of Applied Behavior Analysis Is under the Dome
By Dr. Patrick C. Friman
Applied behavior analysis (ABA) has flourished under the tails of the normal distribution of human social problems. For example, harnessing ABA to the normalization movement of the latter 20th century emptied many, and dramatically reduced the populations of most, residential treatment facilities for persons with severe developmental disabilities, thus allowing those individuals a much more normalized life. ABA based treatments have also been successful at reducing or eliminating extreme self-injurious behavior and improving severe deficits in self-care and communication skills in that population. ABA interventions have also significantly increased the velocity of development in children with autism spectrum disorders; expanded food preferences, intake, and self-feeding skills in children with life-threatening feeding disorders; and improved language skills and quality of life in persons with psychotic level mental disturbances. There are many other examples. Such successes represent the power of ABA to help and to heal. In many instances, ABA practitioners were the only professionals who would address such problems with non-medical interventions and thus ABA has often been the primary portal from the formerly bleak life of confinement and drastically limited possibilities to an improved life with multiple freedoms and rational optimism for the future for many persons with developmental disabilities and/or severe psychiatric conditions.
But these successes involve extreme problems in extreme populations—those found in the tails of the normal distribution. If ABA has the power to help and heal such extraordinary problems, it certainly has the power to do the same for the more mainstream problems that occur under the dome of that distribution. Skinner's vision of behavior analysis was that it would become a mainstream science relevant to virtually all behavior concerns afflicting human kind. That vision has not yet been realized. However, increased movement towards its realization could be obtained by extending the applications of behavior analysis out from the tails to the vastly more prevalent and less extreme problems under the dome.
A powerful method for facilitating this extension is affiliation of ABA with mainstream social service provision. Schools are a good example. All children go to school and thus ABA affiliation with school systems creates the possibility of expanding ABA services to all children. Over the past 20 or so years, the presence of ABA in the curriculums for training school psychologists has expanded and their roles have expanded too. In some school systems, ABA informed interventions are now being used in school- and even system-wide applications. Although there are limited examples of this, the number is increasing and it represents progress of the sort I am advocating here (e.g., Putnam, Handler, Ramirez-Platt, & Luiselli, 2003). Nonetheless, the current role of ABA in American education pales in comparison with the role Skinner envisioned in his writings and thus expansion of ABA in education is a key part of the agenda I am advocating.
Another example involves primary medical care. Virtually all persons in this country receive it and thus affiliation between ABA and primary medical providers presents an opportunity for extension of ABA-type services to all persons. The examples of such research are limited although they do exist (e.g., Warnes & Allen, 2005). Still, given the emphasis on primary health care in this country, the proportion of ABA-type research devoted to it is best described as infinitesimal.
As a subsidiary example, all children in this country receive primary medical services and abundant epidemiological evidence shows that primary providers are almost always the first professionals to learn of child behavior problems. Partnership between these providers and ABA professionals could result in behaviorally-oriented interventions being provided at the time of the first report, thus producing a heightened possibility of early successful resolution (e.g., Friman & Finney, 2003; Friman & Piazza, in press). In currently prevailing circumstances, however, most physicians have limited training and time for the delivery of effective early interventions for children with behavior problems, thus leaving the contingencies that produced the problems intact, increasing the probability of deterioration, and often creating a subsequent need for a higher level of care.
Home safety is another mainstream topic area that presents an opportunity for behavior analysts to influence mainstream America (e.g., Miltenberger et al., 2005). Unintended injury is one of the greatest threats to health and safety in this country. Such injury often results from environmental/behavioral interactions that, when viewed in retrospect, are almost always seen as having been modifiable to prevent injury. In other words, this area is a logical choice for ABA resources. Another example involves traffic safety. This is a country dominated by auto travel and health care statistics are dominated by injury and death resulting from problems at the wheel. Application of basic principles of behavior to the dynamics of road travel could enhance it in a number of ways, including not just accident reductions, but also reduced congestion, travel times, and angry interactions among drivers (e.g., Van Houten, Malenfant, Zhao, Ko, & Van Houten, 2005). Another example involves expanding the role of ABA in the provision of geriatric services. With the "graying of America" has come an enormous number and variety of behavior problems associated with aging including errant driving, dementia, incontinence, medical noncompliance, food refusal, and hygiene, to name just a few. Using submissions to the Journal of Applied Behavior Analysis as an index, it appears there is only a small number of behavior analytic researchers focused on geriatrics (e.g., Cox, Cox, & Cox, 2005; Engelman, Altus, Mosier, & Mathews, 2003).
One increasingly successful endeavor to expand ABA to mainstream America involves the general category of community psychology, a field that emerged early in the history of ABA (e.g., Briscoe, Hoffman, & Bailey, 1975) and continues to expand (e.g., see any issue of The Journal of Organizational Behavior Management). Yet when the scope of the construct referred to as community is considered, the proportion of relevant ABA level interest and endeavors seems disproportionately small, especially in comparison with the interest and endeavors ABA devotes to problems in the tails of the distribution.
There are many other examples of mainstream contexts in which behavior analysis could substantively contribute conceptual and empirical modifications that would produce more effective commerce between persons and their environments. Having said all this, I do not mean to say such efforts are not being put forth now, as indicated by the citations above (which were limited to a small number due to space constraints). But the effort put forth in the areas mentioned is typically dramatically less than the effort put forth to address problems in extreme populations. To have a mainstream presence, behavior analysis will have to adopt and increase the number of mainstream applications. In other words, it will have to expand its fortified encampments under the tails of the distribution and set up operations under the dome.
Correspondence may be addressed to:
- Patrick C. Friman, Ph.D., ABPP
- Clinical Services
- Youthcare Building
- Boys Town, NE 68010
- Phone: 402-498-3353
- Fax: 402-498-3375
- E-mail: frimanp@boystown.org
References
Briscoe, R. V., Hoffman, D. B., & Bailey, J. S. (1975). Behavioral community psychology: Training a community board to problem solve. Journal of Applied Behavior Analysis, 8, 157-168.
Cox, C. D., Cox, B. C., & Cox, D. J. (2005). Long-term benefits of prompts to use safety belts among drivers exiting senior communities. Journal of Applied Behavior Analysis, 38, 533-536.
Engelman, K. K., Altus, D. E., Mosier, M. C., & Mathews, R. M. (2003). Brief training to promote the use of less intrusive prompts by nursing assistants in a dementia care unit. Journal of Applied Behavior Analysis, 36, 129-132.
Friman, P. C., & Finney, J. W. (1993). Special section on behavioral pediatrics. Journal of Applied Behavior Analysis, 26, 421.
Friman, P. C., & Piazza, C. (in press). Behavioral pediatrics. In W. Fisher (Ed.), Handbook of Applied Behavior Analysis . New York: Guilford.
Miltenberger, R. G., Gatheridge, B. J., Satterlund, M. Egemo-Helm, K. R., Johnson, B. M., Jostad, C., Kelso, P. & Flessner, C. A. (2005). Teaching safety skills to children to prevent gun play: An evaluation of in situ training. Journal of Applied Behavior Analysis, 38, 395-398.
Putnam, R. F., Handler, M. W., Ramirez-Platt, C. M., & Luiselli, J. K. (2003). Improving student bus-riding behavior through a whole-school intervention. Journal of Applied Behavior Analysis, 36, 583-590.
Van Houten, R., Malenfant, J. E. L., Zhao, N., Ko, B., & Van Houten, J. (2005). Evaluation of two methods of prompting drivers to use specific exits on conflicts between vehicles at the critical exit. Journal of Applied Behavior Analysis, 38, 289-302.
Warnes, E. & Allen, K. D. (2005). Biofeedback treatment of paradoxical vocal fold motion and respiratory distress in an adolescent girl. Journal of Applied Behavior Analysis, 38, 529-532.