Dr. Kolu BCBA-D Cusp Emergence Blog Post 8.26.2021

https://cuspemergence.com/

• have difficulties calming down when under pressure

• have difficulties using “appropriate” behaviors even after years of programmed reinforcement for using them

• have mental health concerns that have never been appropriately addressed because my behavior masks my needs

• have medical problems that are going unaddressed because my providers have never asked me about my trauma history, despite it being a fact that it confers serious medical risks. (See the incomparable Nadine Burke Harris talk about her work on this, and the amazing takeaways, in her classic TED Talk– or see some of her research and outcomes on using screening tools)

• be more likely to use certain “challenging behaviors”

• and find it more reinforcing, even important, to use behaviors you would describe as challenging

• use behaviors that are more resistant to change than you are used to as an instructor, therapist, parent, supervisor or friend

• find certain interventions painful, difficult, or harmful

• find some kinds of social interactions difficult or painful

• have trouble controlling some of my bodily functions, but may not be able to describe to you why

• experience “triggers” in the environment that you can’t see (but that an experienced provider could locate, document, and learn to help me explore or move with, as appropriate)

• experience some times of the day, week, month, or year that are marked by aversive events for me that you won’t know about

• may not be able to explain WHY this time is difficult or why I am using an “old pattern of behavior”

• find it more difficult to perform, or to learn and remember new things than others of my age, skill level, or occupation – even if “on a good day” I can do this just fine. (By the way, have you read The Four Agreements? Do you know how important it is to take nothing personally and know that others are doing their best (and how critical it is for you to do the same)? If not go check it out.

• use occasional behavior that is mistaken as “ADHD” or “ODD”, or more, but that is actually related to how I was mistreated

• have been given misdiagnoses, treatments that didn’t work, or medications that made my problems worse or that interacted with each other in harmful ways that hurt my body and cognitive function

• attempt to advocate but get ignored when I try to communicate pain, mistreatment, or a medical concern

• be more likely to experience FUTURE trauma because of what I faced before

• lack a reinforcing and useful repertoire (e.g., full complement of skills and things to enjoy), especially if I faced treatments that just tried to “teach me a replacement behavior” for a few challenging things I did, instead of understand and grow me as a person in the context of my own community, needs and desires for my future

• be part of a long line of marginalized people or one of multiple generations exposed to trauma

• have a chance to change our lineage… if you help

Prather, W., & Golden, J. A. (2009). A behavioral perspective of childhood trauma and attachment issues: Toward alternative treatment approaches for children with a history of abuse. International Journal of Behavioral Consultation and Therapy, 5(1), 56-74. http://dx.doi.org/10.1037/h0100872

Rajaraman, A., Austin, J.L., Gover, H.C., Cammilleri, A.P., Donnelly, D.R. and Hanley, G.P. (2022), Toward trauma-informed applications of behavior analysis. Jnl of Applied Behav Analysis, 55: 40-61. https://doi.org/10.1002/jaba.881

1. " First, behavior analysts may be hesitant to discuss trauma due to conceptual confusion and interpretive difficulty regarding the phenomenon. As with physical trauma, the causes of psychological trauma are extrinsic to the individual. However, the effect of experiencing traumatic events is generally conceptualized as an internal response to an aversive external event (DeCandia et al., 2014)"

2. "A second difficulty in incorporating trauma into a behavior analytic account has to do with our conceptualization of causes. As with anxiety, processes such as stimulus equivalence, derived relational responding, and stimulus generalization (Friman et al., 1998a; Friman & Dymond, 2020) may prove useful in explaining the persistence of trauma responses (e.g., emotional outbursts, blunted affect, -) months or years after the traumatic event(s). However, interpreting trauma through a behavior analytic lens and applying that interpretation in practice are two different behavioral repertoires, and it is possible that we are better at the former than the latter."

3. "The third potential barrier to incorporating trauma into behavior analytic research and practice has to do with evidence"

Rajaraman, A., Austin, J.L., Gover, H.C., Cammilleri, A.P., Donnelly, D.R. and Hanley, G.P. (2022), Toward trauma-informed applications of behavior analysis. Jnl of Applied Behav Analysis, 55: 40-61. https://doi.org/10.1002/jaba.881

"Clients may also routinely experience potentially traumatizing events during the course of ABA treatment. Some examples include transitioning to a residential facility away from home, staff and peer turnover in service settings, or being repeatedly physically restrained or secluded during episodes of dangerous behavior. Behavior analysts may not currently have methods to ascertain pervasive behavioral impacts of such events, but they all may constitute traumatic experiences." Rajaraman, 2022)

"...clients receiving ABA services may have undocumented histories of trauma. The overwhelming majority of practicing behavior analysts (78%) provide services to individuals diagnosed with intellectual and developmental disabilities (Behavior Analyst Certification Board®, 2020; LeBlanc et al., 2012). Given (a) the high prevalence of ACEs among children (Darnell et al., 2019); (b) the differentially greater risk for trauma among individuals with intellectual and developmental disabilities (Hibbard et al., 2007; Kerns et al., 2015); (c) the notion that communication deficits are a core feature of developmental disabilities like autism spectrum disorder (Ahearn & Tiger, 2013); and (d) the fact that most contemporary measures of trauma involve some form of verbal report (e.g., Cocozza et al., 2005; Morrissey et al., 2005), it is both possible and probable that there are clients who arrive at the doorstep of ABA services with a history of trauma that will remain unknown to the service provider." (Rajaraman, 2022)

Contraindicated Behavior Analytic Intervention

https://cuspemergence.com/2020/09/08/contraindicated-behavioral-procedures-after-trauma/

1. For a client who has experienced previous food insecurity, food related abuse or neglect, and/or severe food deprivation: One potentially contraindicated procedure is using edible reinforcers.

2. For a client who has been involved in previous sexual abuse (including when the client also makes allegations): One contraindicated procedure is assigning a 1:1 without additional oversight.

3. For a client who has experienced medical complications from sexual or physical trauma (e.g., this could include incontinence, fecal smearing or related concerns, etc): One contraindicated procedure is conducting toilet training without oversight from a medical professional, additional training or consultation by someone with expertise in this circumstance, etc.

4. For a client who has experienced previous neglect or adverse circumstances (such as deaths of parents, removal from unsafe conditions, or experiencing war, dangerous immigration or poverty related issues), resulting in deprivation of basic needs and social interaction: Some potentially contraindicated procedures involve attention related extinction, differential reinforcement of appropriate versus inappropriate requests, or time out from attention reinforcement.

5. For a client who has been affected by physical and/or sexual abuse, behaviors and circumstances consistent with reactive attachment disorder, or multiple and changing caregivers in childhood: One potentially contraindicated procedure might be contingent praise statements to establish compliance related behaviors.

https://theautismhelper.com/podcast/episode-154-trauma-informed-applied-behavior-analysis-with-dr-camille-kolu-bcba-d/

We will be talking a lot about how Trauma Informed Care interacts with our Ethics in the RBT Ethics section!

This training program is based on the RBT Task List (2nd ed.) and is designed to meet the 40-hour training requirement for RBT certification. The program is offered independent of the BACB.