Brain Injury Professional – Volume 13, Issue 2: Special Issues on Applied Behavioral Analysis

Featured open access content
Comprehending Aggressive Behavior Following A Brain Injury: An Explanatory Framework For Neurobehavior
Jeff Kupfer, PhD, Peter R. Killeen, PhD, & Randall D. Buzan, MD

Content currently available in print only
Antecedent Interventions and the Management of Behavioral Dysregulation
Ron Allen, PhD, BCBA, CBIS and Tom Hall, MA, CBIS-T

Acceptance Commitment Therapy: The Time to ACT Is Now
Dixie Eastridge, MA, BCBA, CBIS

 Differential Reinforcement of Alternative Behavior in the Social Networking Website Facebook
Zach Maple, MA, LPC, BCBA and Leigh Schrimpf, MS, BCBA

Tutorial for Creating Cumulative Graphs in MS Excel 2007
Leigh Schrimpf, MS, BCBA

Message from the Guest Editor

img_0255 randy-buzan-photo

Jeff Kupfer, PhD and Randall D. Buzan, MD

Behavior analytic approaches have been widely used to treat persons with brain injuries since the 1980’s, kicked off a decade earlier by the remarkable research of Murray Sidman. Sidman developed early technology for patients with aphasia leading to the discovery and analysis of emergent stimulus classes and equivalent relations (Sidman, Stoddard, Mohr, & Leicester, 1971). Sidman (1994) reflected:

 Since many of the patients could not speak or write intelligibly, we had to devise ways to investigate their language comprehension without requiring them to speak or write. To this end, we adapted the matching-to-sample procedure, which was originally developed to study the behavior of nonhumans. Using this procedure, we were able to evaluate how well the patients could relate text, objects, and pictures to words that they heard, saw, or touched.

Sidman’s research was groundbreaking in the area of conditional discrimination and contextual control of behavior, but Applied Behavior Analysis (ABA) ultimately became the preferred approach in neurobehavior treatment, addressing severe agitated behaviors via environmental modification.

The scope of ABA is broad and its impact on brain injury treatment is reflected in the growing research literature. On the website of the Cambridge Center for Behavioral Studies (www.behavior.org), for example, a bibliography lists over 100 articles related to ABA treatments for persons with brain injury. Interestingly, more research articles relate to teaching and skill acquisition than to reducing challenging behavior – belying ABA’s more frequent association with behavior management strategies. (Parenthetically, complete reprints of Sidman’s early research on aphasia can be found on this same website.)

In spite of a robust literature on the subject, skill acquisition treatment in TBI is still underutilized. This may devolve from the fact that most of the teaching and skill acquisition research is published in ABA related journals rather than rehabilitation or brain injury journals. In addition, some still consider ABA a “collection of techniques” to be used in limited situations (e.g., behavioral dysregulation), not appreciating its larger utility in the rehabilitation process.

The roles of consequences and contexts in the regulation of behavior have received considerable attention in behavior analysis and have great applicability in the treatment of TBI. This edition of Brain Injury Professional showcases articles on conceptual issues about behavior and brain injury that we hope will stimulate discussion and expand the scope of neurobehavior rehabilitation.

We start with an examination of the historical perspective of “causes of behavior”, pointing out that materialistic accounts of behavior following brain injury, although important, comprise only a portion of a complete explanation for behavior (Kupfer, Killeen, and Buzan). The authors argue that a more complete explanation should include an examination of triggers, functions, and formal models used to talk about these various causes of behavior.

Allen and Hall then review antecedent interventions in treating persons with brain injury and suggest that an understanding of the role of the limbic system is critical for understanding the contexts of antecedent events and consequences.

Eastridge provides an introduction to Acceptance Commitment Therapy (ACT) by tracing its origins to behavior therapy and cognitive behavior therapy. ACT paves the way to integrating mindfulness approaches to treating persons with brain injury within a functional contextualism model.

Of course no special edition of a publication featuring behavior analysis would be complete without at least one single-subject design experiment. Maple and Schrimpf provide an example of how the effects of responses by “followers” in social media may contribute to shaping appropriate and inappropriate “posts” by a young man with brain injury. This study uses cumulative graphing techniques to describe the daily changes in posting activities as variables are systematically introduced.

Cumulative graphing has been used in ABA to show the effects of treatment variables and other important events that may influence responding. Schrimpf provides a brief tutorial on how to develop cumulative graphs using Excel spreadsheets which can be edited and used in a variety of ways to describe long term treatment effects in neurobehavioral rehabilitation.

Finally, Mozzoni provides an excellent book review of Susan Schneider’s The Science of Consequences which examines the role of conspicuous and inconspicuous environmental consequences and how they influence genetic predispositions, “genes x environment” interactions, and the effect on the brain and body.

We hope you enjoy this collection of articles that may enrich your work with TBI patients.

References:

Sidman, M. Equivalence relations and behavior: A research story. Boston, MA: Authors Cooperative, Inc, 1994.

Sidman, M., Stoddard, L.T., Mohr, J.P., Leicester, J. Behavioral studies of aphasia: Methods of investigation and analysis. Neuropsychologia 1971; 9:119-140.

about the guest editors: 

Jeff Kupfer, PhD received his doctoral degree in psychology from the University of Florida, specializing in the experimental analysis of behavior. He has conducted research in animal models of complex learning and psychopathology, as well as research examining environmental influences on bipedal travel in persons with visual loss. Jeff is a licensed psychologist in Massachusetts, Colorado, and Nebraska, a doctoral-level Board Certified Behavior Analyst, and a lecturer at the University of Colorado-Denver. He was the first president of the Four Corners Association for Behavior Analysis, and is a founder and Trustee for the Cambridge Center for Behavioral Studies. Jeff has been practicing behavior analysis since 1984 specializing in the treatment of severe behavioral disorders in persons with brain injury, developmental disabilities, mental illness, and other neurologically-based disorders. He has published in the areas of behavior analysis, pharmacology, and visual impairments, and has served as a guest reviewer for professional journals. Jeff is a consultant for Imagine Behavioral Health Services and Learning Services Neurobehavioral Institute – West in Colorado.

Randall Buzan, MD graduated summa cum laude from the University of Michigan with a BS in Psychology, Alpha Omega Alpha from U-M Medical School, and completed his psychiatry residency at the University of Colorado and analytic training at the Denver Institute. He completed a fellowship in psychopharmacology at the University of Colorado and another mini-fellowship in electroconvulsive therapy at Duke. He joined the psychiatry faculty at the medical school and did psychopharmacology and neuropsychiatry research for 9 years. Randy served as a peer reviewer for the Journal of Neuropsychiatry, is a Distinguished Fellow of the American Psychiatric Association, and has published 25 papers and book chapters and presented nationally on treatment of brain injury and developmental disabilities. Randy consulted for 24 years at two Colorado’s Regional Centers for ID individuals, and continues to consult at Craig Hospital and Learning Services on TBI and spinal cord injury.

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