'Twinkle Twinkle Little Star'...How I Wonder Why We Bother - with thoughts on the exam, training, and reinforcement

How many programs are still using large amounts of time teaching children to sing Twinkle Twinkle Little Star and other specific childhood (or adult) favorites? These are long used, very tired, heavily drilled and memorized routines which more often have been densely reinforced as standalones objective. Edibles? Electronics? Both should vanish from reinforcer menus and 'instructional' strategies. It is time for Behavior Analysis to take a big step forward.

As a quick but relevant aside, our field must stop using edibles and electronics as principal 1:1 reinforcers. These items are typically not reinforcers at all but items of specific and sometimes rather intense perseveration to often include shaped escape/withdrawal and/or access functions. When it comes to a point that if your iPad battery going dead risks immediate child escalation, it is NOT a reinforcer. When the child does not accept, or barely accepts, anything else, the electronics (or edibles) are NOT a reinforcer. All he or she is primarily 'learning' is how to get the perseverative item returned. And, yes, there are always many other reinforcers and systems for reinforcement/motivation available that will work.

Over 40+ years of providing clinical behavioral services to kiddos (and adults) with often very high intensity and more persistent needs, I have never used either. Not once. (Ok, I know electronics were not available 40 or so years ago, but food has always been there and electronics have now been available for quite awhile!)

Over the years, I can no longer count how many times I've been told either 'his/her reinforcers are always changing' and/or 'food/electronics are the only thing that works.' I will say directly that neither is ever correct and that there are always alternatives. Folks who consider either of the above statements accurate need better assessment/observational strategies and/or probe techniques. The field also must stop thinking about reinforcement as only 1:1 exchanges. I plan to write more about this soon but, for now, let's head back to my original post.

Consider how much time is often used to teach a song or two at the cost of more naturalized, individualized and socially valid objectives. If a child enjoys singing, which is possible but should never be assumed because other children may, such activities could easily be embedded and used as part of the reinforcement system for other and/or related goals then faded as per a correct application of the Principles of Reinforcement. Attempts at effective instruction must not be built around constant one-to-one reinforcer exchanges, super high preference items/activities or one objective at a time

How about functional communication and child initiation based on individualized high EO objectives? This should be a primary and first focus connected to the Right to Effective Treatment. Does the child who is now learning to sing have any functional communication apart, maybe, from manding for very high preference items? If the answer is still 'no,' the program is far more likely misprioritized while using available time inefficiently.

And I am not talking about Sundberg's time poorly targeted construct to generate '25 spontaneous mands' during individual sessions. This exercise more often becomes a routine of basic echoics rather than authentic, individualized manding. "Say 'open;" "Open" whether or not the child even wants to go into that area. This, since manding needs an individualized FBA and Preference Assessment (consider the FCT model) towards increased relevance, functional communicative intent and linking high, naturally occurring EOs.

I also strongly believe that it is time to lose the discrete trial training framework largely altogether. Behavior analytic and educational research literature is far beyond the older and less efficient DTT. DTT elements may instead be considered one possible strategy rather than any kind of therapeutic continuum or treatment model. Of course, it is the DTT model which is most often taught to BA majors and those working through the VCS. Training curriculums need to be updated to prioritize Applied Behavior Analysis rather than such smaller component pieces

More active consideration of and adherence to the Relevance of Behavior rule would help that refocus. Combining this with Baer, Wolf and Risely's Seven Dimensions, particularly that of Effectiveness and Applied, will also assist in identifying more individualized person-centered and socially valid priorities. I believe our field still has a ways to go before we meet some of the most basic expectations of that seminal article from 1968.

A large part of current gaps is, I believe, related to the reality that beyond exam scheduling and fees, neither the BACB nor the ABAI take any real or primary responsibility for quality control or a consistent vetting and follow up process for graduate programs and BCBA supervisors. Even though the BCBA exam first time pass rates remain historically low and specific graduate programs themselves have even lower first time pass rates, there has been not any unique focus on why or how to make needed corrections. At the least, I am certainly not aware of any such effort...

I'm also not aware of any other certification or licensing bodies from CNAs to MDs, CPAs, PTAs or RNs who do not also generate test prep, study and review material. The field of Applied Behavior Analysis has long struggled with explicit and accountable models for mentorship and entry level support. With regards to mentor teachers in the field of education; that is, those certified by their school districts to support student teachers, the timeline is often at least 5 years of consecutive classroom teaching with consistently strong evaluations and documented productivity.

It is only the BACB who fundamentally tells BA majors and BCBA candidates to find whomever they can for supervision so long as that person completed the 8 supervision CEUs. One positive change has been that first year BCBAs must now at least have a senior BCBA overseeing their supervision should they take on BCBA or BCaBA supervisees. This is a good first step but for the lack of more specific expectations for the senior BCBA supervisors. Frankly, I do not believe a first year BCBA should be supervising anybody but their team RBTs and then doing that with support. A new BCBA should have at least 2, maybe 3, consistent years of effective and documented clinical service before taking on any BCBA/BCaBA supervisees.

A reality is that first year teachers do not apply to be Department Chairs, first year RNs do not become Directors of Nursing and first year MDs are still many more years from being able to enter private practice. But young, first year BCBAs who may have taken several tries to pass the BCBA exam too often then instantly become CEOs, 'founders,' clinical directors and test prep 'experts' rather than starting as entry level clinicians in order to learn the science, art and applications of Applied Behavior Analysis

There certainly are pockets of strength and excellence in BCBA training and support. But it's inconsistent and lacks the continuity which should be offered via a professional certification. And with so very many 'autism agencies' just about everywhere, even stronger BCBAs can too often wind up with caseloads that they may barely be able to manage - barely able to manage ethically or effectively - let alone be able to also provide consistent BCBA/BCaBA field supervision/training followed by mentorship to new BCBA and BCaBAs.

Agencies might consider separating and coordinating these two job descriptions. This would mean hiring BCBAs as either (1) clinical providers; or (2) more senior and experienced BCBA/BCBA-Ds as BCBA/BCaBA clinical field supervisors (which should remain a billable position) and as a support for the younger, less experienced clinical BCBA providers.

While this latter category would not likely or consistently reflect direct billable time, it could hugely contribute to the quality of an agency's overall behavioral capacity while helping to enhance the implementation of both BIPs and family supports. Providing younger, less experienced BCBAs increased support and resources should also help retain quality clinicians. And that can save both money and stress.