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Discontinue 'Sensory' Strategies in BIPs; SIB and Related Behaviors are not 'Due to' ASD

SIB is not unique to ASD. 'Sensory regulation' (et al.) is a mentalism rather than behavior analytic function. Often and so identified 'sensory' interventions are also not behavior analytic but potentially very reinforcing to at-risk behavior... More significant self-injurious behaviors to include head banging/hitting connect to a number of environmental events and interactions with functional relationships across settings. A primary driver for self-injury and other related behavior events for individuals are significant communication deficits as connected to communicative intent and function This dynamic directly relates to the Matching Law which recognizes that certain behavioral events, like self-injury, can be extremely response efficient ways of getting attention and establishing function (See: The Natural Language Paradigm by Bob Koegel; The Communication Hypothesis by Ted Carr and Mark Wolery - to start) Self-injury and other at-risk behaviors are more common to those with significant communication deficits and not specifically autism. This is yet another autism stereotype and myth far too quickly shared. These types of more significant behavioral events do not typically represent an internal need for 'sensory self-regulation.' Such presumptions more often drive interventions based on behavioral topography and not the individual. In my experience, this approach also risks unintentionally extending and reinforcing dangerous patterns while creating a type of circular reasoning. Self-injury and other more significant externalizing behaviors must first have an ecological functional behavior assessment which is not be driven by the diagnosis or related stereotypes but based on functional need and individual realities There are four researched based functions in Behavior Analysis: 1. Attention; 2. Access (tangible is but one aspect): 3. Escape/avoidance; 4. Automatic Reinforcement (that which is not socially mediated - and 'sensory' is not informative) No matter how many persons create how many 'functions' to push how many alternative methods, the above are the 4 research-based functions. Alternative categories to include 'sensory self-regulation...' and related are more often mentalistic. A relevant aside; I do not, do not allow when able, and strongly do not recommend the use of iPads or edibles as either reinforcers or to be requested as alternative behaviors Food should never have to be earned - or, therefore, lost - and iPads can instantly lose any reinforcing capacity becoming items of escape and perseveration (as does food)…even if allowing increased ease of use for adults BCBAs should not implement, or put in a BIP, interventions as hugging, deep pressure or related. First is that these are not behavior analytic, not part of BCBA training and are pseudoscientific. Second is that they presume topography over a functional assessment and can, themselves, become very reinforcing of sometimes at-risk behavior

'Sensory programs' are not within our scope or boundaries of practice. And a point a lot of BCBAs and agencies may not consider is that such 'sensory based' elements are also not the behavioral services authorized by relevant insurance companies. If BCBAs engage in 'sensory' practices and utilize 'sensory' interventions, they are no longer providing behavioral services. If they then bill for behavioral services for that authorized period, it could be considered fraudulent. But most important is that in doing this, BCBAs are not providing quality, evidence-based practices in behavior analysis to the best benefit of our clients and their families / caregivers. Having an OT, or other interdisciplinary professional, on a behavioral services team can be worthwhile. But it does not mean the team becomes that professional's agenda or that the other professional has primary finalizing input. The supervising BCBA has the final say over and responsibility for behavioral services and the BIP. It is the supervising BCBA who must be absolutely certain they are providing empirically supported, evidence-based behavioral analytic services


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