Week 5: Assessing Problem Behavior- Integrating Compassion with Best Practices

Dr. Nuse

Hi All! Welcome to our Week 5 lecture podcast. This week I took the liberty to expand a bit on our assigned reading from Cipani to also incorporate some modern day views on functional behavior assessment of problem behavior. Specifically, I wanted to highlight the work coming out of Hanley's group. Before we get started, I do want to be transparent and share that my dissertation involved Hanley's IISCA process in addition to the enhanced choice model of treatment. That being said, I think it's a valuable body of work and it complements well with Cipani's model.

Dr. Nuse

When we think about effective applied behavior analysis, or ABA, compassion may not immediately come to mind, but it should. Incorporating compassion into ABA practices is not just idealistic—it's essential for ensuring client outcomes that are both meaningful and respectful. Scholars like Ghaemmaghami and colleagues argue that prioritizing client safety, dignity, and rapport can fundamentally improve treatment outcomes. Yet historically, the field has struggled in this area. Early ABA approaches—while highly effective at modifying external behaviors—often neglected the subjective experiences of the very clients these treatments aimed to help.

Dr. Nuse

One clear example of this oversight lies in the heavy reliance on procedures that elicited extreme emotional distress or burst behaviors without adequately considering the client's emotional experience or perception of control. Although such methods were grounded in efficacy, they frequently overlooked the broader harm caused by ignoring emotional and social impacts. Unfortunately, the idea of compassion was almost relegated to being an "optional bonus" rather than a requirement embedded into every treatment plan.

Dr. Nuse

More recently, trauma-sensitive methodologies have emerged as an alternative approach. These methods emphasize respecting client autonomy and prioritizing their preferences wherever possible. For instance, allowing clients to withdraw their assent during treatment—effectively providing them a way to say "no"—introduces an important layer of empowerment. Rather than forcing compliance, this approach encourages a collaborative dynamic between practitioner and client, rooted in mutual respect. It acknowledges that every individual’s suffering and well-being are interconnected aspects of treatment success.

Dr. Nuse

To ensure interventions fully align with client needs, open-ended interviews have become indispensable. Unlike more rigid, closed-inquiry forms, these interviews offer practitioners a glimpse into the client's own insights and lived experiences, ensuring personalized treatment plans. Research shows that open-ended formats consistently reveal deeper, more actionable data when compared to canned surveys or one-size-fits-all questionnaires. It’s within these conversations that clients can truly teach us about their world.

Dr. Nuse

I’ll share something personal—an experience that dramatically shifted how I approach teaching and mentorship in ABA. Early in my career, I once conducted a student demonstration that focused solely on procedural fidelity—ensuring techniques were executed exactly as prescribed. My focus was on perfection, but I failed to consider the student's unique emotional response to the rigidity of what I was asking. Predictably, the student became visibly uncomfortable, even resistant, which affected their performance. Looking back, it was clear that my adherence to protocol had come at the expense of their dignity and emotional needs. That moment taught me that balance matters. Fidelity is essential, yes, but it must always be paired with compassion and understanding. After all, strict protocols hold little value if they come at the cost of the very rapport needed for learning—or treatment—to succeed.

Dr. Nuse

Functional analysis is one of the cornerstones of behavior assessment, yet traditionally it has faced criticism for being too time-consuming or too artificial to apply seamlessly to real-world settings. But an innovative approach by Hanley and colleagues, known as the interview-informed synthesized contingency analysis, or IISCA, has begun to change that. The IISCA method redefines efficiency in functional analyses by significantly shortening the time needed to identify variables controlling problem behavior.

Dr. Nuse

A traditional functional analysis relies on multiple test conditions to isolate the effects of specific contingencies, which, while thorough, is not always practical when time and resources are limited. By contrast, IISCA streamlines this process. It employs open-ended interviews with caregivers to design a single synthesized test condition reflecting real-world triggers and reinforcers, paired with a carefully matched control condition. This tailored approach allows practitioners to quickly and accurately pinpoint the functions of problem behavior—often within a matter of minutes rather than hours.

Dr. Nuse

Equally important is the ecological validity that the IISCA method brings to the table. By tailoring analyses to the specific contexts that caregivers describe, we can design interventions that fit seamlessly into everyday routines. This alignment isn’t just practical—it’s also deeply compassionate. After all, the goal of behavior analysis is not only to reduce problematic behaviors but to do so in a way that minimizes stress and disruption for clients and their families.

Dr. Nuse

Let me share a case to illustrate this approach in action. A few years ago, I worked with a family whose six-year-old child consistently displayed severe tantrums during mealtime. Using traditional methods would have required extensive observation and lengthy series of analyses, adding undue stress to an already overwhelmed family. Instead, we applied the IISCA framework. Through a single session informed by interviews, we identified that the tantrums stemmed from a combination of demand avoidance and an unmet need for parental attention. Within days, the family was able to implement targeted strategies—such as clear task breakdowns paired with reinforcement for calm behaviors—resulting in a dramatic reduction in tantrums. This wasn’t just an academic victory; it was a life-changing moment for the family, who finally felt relief and regained a sense of normalcy in their home.

Dr. Nuse

Ultimately, efficiency and compassion go hand in hand when it comes to functional analyses. Methods like IISCA exemplify how our field can balance scientific rigor with the real-world contexts in which we operate, offering solutions that are not just effective but also accessible and humane.

Dr. Nuse

As we approach the conclusion of this episode, let’s pivot to some of the advanced methods that integrate science, compassion, and collaboration to truly transform the assessment and treatment of severe problem behaviors.

Dr. Nuse

A vital first step in any functional behavioral assessment, or FBA, lies in data collection. Dr. Ennio Cipani’s systematic five-step collection approach is particularly illuminating here. It starts by obtaining a baseline measurement of observable problem behaviors before moving into advanced techniques like A-B-C analyses. This process allows us to categorize not just the "what" of behaviors but the contextual "why" behind them, forming a foundation for effective intervention. A meticulous A-B-C analysis helps identify the antecedents triggering problem behaviors, the behaviors themselves, and their consequences—patterns that inform precise, actionable treatment plans. It’s a methodical approach, ensuring we don’t overlook subtle, yet critical, variables shaping behavior.

Dr. Nuse

But as we design interventions, we must also move beyond data and into the heart of every treatment: collaboration. Research consistently shows that involving parents in the treatment loop significantly enhances effectiveness. For instance, as documented by Hanley and his team, parent-implemented treatments for children with severe problem behaviors not only reduced those behaviors but also built critical functional communication skills. Let’s take an example from a case where a disruptive child had been throwing objects to escape learning tasks—an all-too-common scenario. By integrating parent-mediated reinforcement and simple communication training at home, compliance to tasks rose significantly, while the maladaptive behavior plummeted.

Dr. Nuse

When customizing interventions for less frequent problem behaviors, like those documented by Hanley in Functional Analysis frameworks, practitioners face unique challenges. Take the instance of an adolescent whose low-rate but dangerous behavior was triggered only under highly specific conditions—avoiding particular academic demands. Traditional interventions, which rely on frequent behavioral samples, may struggle here. Instead, tailored methods such as open-ended interviews informed a precise functional analysis, ultimately validating that task difficulty alone was the trigger. This knowledge enabled the development of a gradual skill-building program with lower difficulty tasks to bridge that gap. As a result, the behavior was addressed before it escalated into a habitual pattern.

Dr. Nuse

As I reflect on these advanced techniques, what stands out most is their ability to combine technical expertise with empathy and practicality. ABA has always been a powerful science, but the ongoing emphasis on client dignity, collaborative care, and adaptive solutions takes it to another level. It underscores that, in this field, precision does not have to come at the expense of compassion.

Dr. Nuse

And on that note, we’ll wrap things up for today. Remember, the best practices in behavior analysis aren’t static—they evolve with every client interaction and scientific discovery. Thank you for joining me on this journey. I look forward to our continued exploration of these vital topics. Until next time, take care!