Monthly Archives: August 2014

Behavioural Gerontology

(Michelle E. Kelly, BCBA-D)

Behavioural Gerontology is the application of behaviour analysis to ageing and age-related issues. Behavioural Gerontology is also a Special Interest Group (SIG) of the Association for Behavior Analysis International (ABAI). The BG-SIG’s mission is to foster interest among behaviour analysts in addressing and researching ageing-related issues. Their website is http://bgsig.wordpress.com/; Facebook https://www.facebook.com/behavioralgerontology.

I was recently contacted by Dr Miranda Trahan (BCBA), a member of the BG-SIG, as we both share an interest in the application of behaviour analysis to dementia populations. Miranda runs Trahan Behavioural Services, an ABA service in the U.S. that focuses on keeping older adults with dementia independent for as long as possible. Goals include (i) teaching older adults and their caregivers the skills necessary to improve their quality of life; (ii) increasing appropriate behaviours; and (iii) manage challenging behaviours with individualized non-pharmacological interventions. Miranda writes blogs on the practical applications of ABA for people with dementia – these are well worth a read. For more information, check out her website and blog pages at – http://marandatrahan.com/.

For those of you who may not be familiar with the benefits of behaviour analysis for people with dementia  and their families, here is a snapshot of how ABA can be readily applied and hugely beneficial in remediating a number of concerns throughout the dementia journey.Dementia 1

About Dementia

Dementia is an umbrella term that describes a range of conditions that cause damage to the brain. There are many different causes of dementia including vascular dementia, fronto-temporal dementia, and the most common cause, Alzheimer’s disease. These are the diseases that cause the symptoms.

Dementia 2

Over 35.6 million people are currently living with dementia worldwide. This is estimated to almost double by 2030 to 65.7 million. Currently in Ireland there are approximately 48,000 people living with dementia (4,066 aged under 65). This figure is also expected to double to around 96,000 in the next 20 years. This means that increasingly greater numbers of people will require interventions and services to ensure they can live well with their diagnosis. It is important therefore, that behaviour analysts can identify relevant applications of their skills for working with people with dementia; and that people with dementia, their families, and health and social care professionals recognise the potential of behavioural interventions.

Behaviour Analysis at Diagnosis

At diagnosis a behaviour analyst is well placed to advise individuals with dementia and their families on changes that may be required, such as the adaptation of living environments, implementing schedules or routines, or changes in how people carry out their daily tasks.

Behaviour therapists are also particularly important at this stage.  There is considerable evidence that assuming the role of caregiver is stressful and that, as a result, caregivers may be at an increased risk for psychological health problems. Research shows that both Cognitive Behaviour Therapy (CBT) and Acceptance and Commitment Therapy (ACT) can help. For example, a group of psychologists in Spain recently published a report in PSIGE (Faculty of Psychology for Older People) on CBT and ACT indicating promising results for both, although preliminary findings suggest ACT may result in the most positive outcomes for carers.

More focus is required on the potential applications and effects of CBT and ACT for people with dementia themselves however, particularly given that around 60% are thought to experience anxiety or depression post-dementia diagnosis. Although some research indicated that a modified version of CBT (CBT-AD) was beneficial for treating people with dementia, a lot more research is needed.

All fun and Games

Early Interventions

At the early stages of the disease, there should be an emphasis on maintenance of existing abilities to compensate for decline. Focus should not be on what has been lost but rather on maximising existing capabilities.

In my own work, I implemented an early intervention called “Cognitive Rehabilitation” or CR with three people with early stage dementia. The intervention focused on individualised personal rehabilitation goals and implemented practical interventions and strategies. I worked on a 1:1 basis with participants once a week for about 8 weeks on goals that they identified as important to them. Examples included remembering names, phone numbers, appointments, or using a mobile phone. I used strategies such as discrete trial training, precision teaching, spaced retrieval, and errorless learning. I also encouraged the use of memory aids and routines, adapted environments, and worked on relaxation skills. After the intervention, each participant’s ratings of goal performance and satisfaction improved, as did carer ratings of their loved ones performance. Importantly, quality of life and cognitive function (as measured by standardised cognitive tests; MoCA and RBANS) also improved for participants from baseline to follow-up.

I am currently working with clinical psychologists and geriatricians to develop a CR manual, designed for use by psychologists and healthcare professionals working with people with dementia. I will provide further information when the manual is complete.

Moderate to Later Stage Dementia

Over 50% of people with dementia experience Behavioural and Psychological Symptoms of Dementia (BPSD) at some point; with more difficult symptoms often occurring in moderate to later stages. BPSDs include depressive symptoms, anxiety, apathy, sleep problems, irritability, psychosis, wandering, elation and agitation. These symptoms can be highly distressing, and may result in challenging behaviour. BPSDs are also associated with a more rapid rate of cognitive decline, greater impairment in activities of daily living, diminished quality of life, and can often be a reason for placement into residential care. Although there is little or no evidence to suggest that traditional antipsychotic medications have any utility in treating BPSDs, these are still the ‘go-to’ solution in most cases.

Behaviour analysts won’t be surprised to hear that a recent Cochrane Review (one of the highest standards of reviews in evidence-based medicine) concluded that Functional Assessments (FAs) for the management of challenging behaviour are a promising alternative to traditional BPSD management. With FAs, the behaviour analyst can determine the function of the challenging behaviour, and develop and evaluate hypothesis driven strategies that can aid family and staff to reduce and resolve the person’s distress and associated behavioural manifestations.

 
Behaviour Analyst Results

Communication difficulties are another area where behaviour analysts might intervene, particularly given that communication interventions are so commonly implemented by behaviour analysts in applied practice. Aphasia (a reduction in the ability to express or comprehend language) is common in moderate to later stages of dementia, meaning that alternative methods of communication are often required. Talking Mats, very similar to what most of us behaviour analysts know as PECS, are often used with people with dementia, and have been shown to be an effective method of communication. Behaviour analysts can not only train the individual in the use of Talking Mats or PECS, but can also train staff and family members to use them effectively.

Finally, improving activity engagement in residential and long term care is an area that can be addressed by behaviour analysis. In a study of 27 nursing homes (observed for 13 hours per day), 65% of residents’ time was spent doing nothing and only 12% in social activities. Low activity engagement was shown to be a result of weak stimulus control of activities, and was quite easily remediated with reinforcer sampling, modelling, and the implementation of schedules of reinforcement for activity engagement.

Suggested Journal Articles

Dwyer-Moore & Dixon (2007) – Functional Analysis and Treatment of Problem Behavior of Elderly Adults in Long-Term Care: Functional analyses were conducted for the problem behaviour of 3 older adults in a long-term care setting. Two of the problem behaviours were maintained by attention, and a third was maintained by escape from demands. Function-based interventions were implemented that resulted in decreases in problem behaviour in each case. Implications for the use of functional analysis and function-based interventions in the field of gerontology are discussed – http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2078575/

Trahan et al. (2011) – Behaviour Analytic Research on Dementia in Older Adults: It is estimated that 1 in 10 adults aged 65 years and older have been diagnosed with dementia, which is associated with numerous behavioral excesses and deficits. Despite the publication of a special section of the Journal of Applied Behavior Analysis (JABA) on behavioral gerontology (Iwata, 1986), there continues to be a paucity of behavior-analytic research with this population. This review compares the research published before and after the behavioral gerontology special section and evaluates the most recently published aging articles in JABAhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3177357/

Sample Lecture Slides

1210 Applied Behavior Analysis as a Treatment Framework for Various Dementias (1)

Training Caregivers of Elders with Dementia who Exhibit Challenging Behaviours to Take a Functional Approach – http://bgsig.files.wordpress.com/2011/03/talk_gutterson.pdf

Behaviour Analysis and Dementia in Ireland (directly related to the content above) http://behaviouranalysisinireland.wordpress.com/2013/11/01/dr-michelle-kelly-behaviour-analysis-and-dementia/

*Thanks to the Alzheimer Society of Ireland for the infographics on dementia.

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ABA Ireland Top 5 Recent Posts (24/08/2014)

Every week on our Facebook Page, members post dozens of post on topics related to Behaviour Analysis, its applications and related issues. One purpose of this blog is to highlight some of the most “liked” and useful posts in order to make them available to a wider audience.

5. Candy Waters’ Artwork
candy

Sandy Waters – mother of  the artist Candy Waters – recently posted some of her daughter’s impressive artwork. The posts proved popular and quickly attracted 50 likes from impressed ABA Ireland members.  Candy is a non-verbal 12 year old young lady with severe autism.   She has attracted media attention and has her own Facebook page.  To see more of her artwork and to learn more about Candy, follow the above link.

4. Denis O’Hora and Farm Safety

Dennis & IFA

ABA Ireland’s Denis O’Hora recently attracted media attention for his recently keynote address at the national conference on farm safety.  The conference was organised by the Health and Safety Authority, Teagasc, and the Farm Safety Partnership and took place in Kilkenny.

Agriland reported that Dr O’Hora addressed the importance of identifying  near-misses and acknowledging the stresses faced by lone farmers working :

Close calls, he said are much more common than deaths and are lead indicators. “We have to identify these near misses. We have to learn from farmers what is going on. Close calls are a moment where people can make a change.”

He said that farmers need to take the time to pay full attention to what they are doing and its not just stressful situations that cause distractions. “You’re working, thinking about the kids coming home at the weekend and how great it will be to see them, even this positive thought can take you out of the moment and distract you.”

Lone workers, across the board in industry, are more likely to be involved in safety incidents, he said. “Being self employed means you are the CEO, the plumber, the accountant, the site manager. And self employment tends to happen more in dangerous industries.

“Because you have all of these roles, you will be better at some than others. And the ones you are not so good at you tend to leave till last. It’s human nature. Each additional role increases stress. You’ve got to learn to work in a ‘wise’ way of working.”

3. Meme of the Week

We had several popular memes this week. Most of these were shared from Behaviour Man or the ICBSR . The most popular one featured Kermit the Frog and offered the following words of wisdom:

Kermit

Behaviour Man expanded on Kermit’s words by noting:

If an individual’s behavior continues to occur, it is very likely that this is a product of the reinforcing variables in their environment. If we have a close relationship to that individual, it is also very likely that our actions (behavior) may contribute to reinforcing their behavior–as we are a part of their environment. Until consistent change (on our behalf) is maintained in the environment, we are not likely to affect change in their behavior. Therefore, we must always look to ourselves as a possible cause (or reinforcing factor) of the behavior, and not blame the individual if the behavior continues to occur.

2.  The Ups and Downs of “Behaviorese”

Doireann O’Brien shared a really interesting article written by Andy Lattal and posted on the Aubrey Daniels Institute website.

Andy’s article described a debate within the field of behaviour analysis about the utility of what he terms “Behaviorese” – that is the “technical terms, neologisms, and acronyms” associated with the science of behaviour.  He notes that:

Such word usage is of great value to those within what we in behavior analysis call a particular “verbal community” (another such technical term …sigh). Within these communities, technical terms and expressions assume that everyone is on the same page with respect to their meaning. When people are, the terms work very well in communicating quickly and precisely. Huge problems can arise, however, when any “in crowd” lingo is used outside the verbal community in which it developed.  Confusion, apprehension, miscommunication, and failures to accomplish goals all can result when there is a mismatch between what the speaker is saying and the listener is hearing.

He describes the various opinions that are present within behaviour analysis to “Behaviorese” and then notes that:

The proof of the pudding, though, is in the eating. The real question is whether being able to describe a term with the precision found in the larger group’s use of that term makes any difference in how precisely the student applies the term in their research or practice.  One meaning of “understanding” is to do something, whether it is parrot a definition or implement a contingency. This requires research that we have not yet conducted.

 

1. Review Shows Big Increase in Science Backing Behavioural Therapy

autism speaks

The final post for this weeks came to ABA Ireland via Autism Speaks who reported on a new report indicating an increase in the quantity and quality of research supporting behavioural therapy for children with autism.  The report was compiled for the US Department of Health and Human Services’ Agency for Healthcare Research and Quality and is available here.

ahrq_banner

With regard to ABA, the review included:

RCTs of the UCLA/Lovaas-focused approach, a developmentally focused ESDM approach, aschool delivered training (LEAP), as well as prospective comparisons of eclectic variants of ABA approaches.

The authors found that:

Across approaches, children receiving early intensive behavioral and developmental interventions have demonstrated improvements in cognitive, language, adaptive,
and ASD impairments compared with children receiving low-intensity interventions and eclecticnon-ABA based intervention approaches.

They concluded that:

These improvements allow us to make some stronger conclusions about certain elements of
the behavioral intervention literature. Considerable and consistent evidence suggests that
early behavioral and developmental intervention based on the principles of ABA delivered in intensive (>15 hours per week) and comprehensive (i.e., addressing numerous areas of functioning) form can significantly affect the development of some children with ASD.

 

 

That’s all for this week.

All comments welcome.

While ABA Ireland has taken all reasonable steps to ensure the accuracy of the contents of this blog, it accepts no liability for the accuracy or quality of the information provided and no liability for this information being up-to-date or complete. Information is provided for educational and general purposes only and is not intended as a substitute for professional advice. Where ABA Ireland provides links to third-party websites, it accepts no liability for the content of these websites. The views of authors are their own and do not necessarily reflect the views of ABA Ireland or any organisations associated with the authors of posts.

ABA Ireland Top 5 Posts 17/08/2014

Every week on our Facebook Page, members post dozens of post on topics related to Behaviour Analysis, its applications and related issues. One purpose of this blog is to highlight some of the most “liked” and useful posts in order to make them available to a wider audience.

5. Introduction to RFT

Foxy Learning’s online tutorial on Relational Frame Theory is now 10 years old.   In those ten years, over 15,000 people have accessed the free tutorial to learn more about RFT and its applications.  If you have an interest in this area of behaviour analysis, it is well worth a visit.

Foxy RFT

4. Grace App Research Opportunities

Lisa Domican – creator of the Grace App – has kindly offered to provide ABA students with “free training, free codes for download and where needed a loan device” if they are interested in carrying out research into the App’s effectiveness.  Many app designers make unsubstantiated claims about the effectiveness of their products so it is great to see Lisa working with behaviour analysts to demonstrate the app’s benefits for people with communication difficulties. Hopefully, other designers will follow her example.

Grace Ap

3. Cookie Kid

One again, Behaviour Man has provided us with another ABA based Meme featuring a skeptical toddler coming to terms with the benefits of the differential reinforcement of alternative behaviours.

Cookie Kid

 

2.  Supernanny (and Lynn Koegel) tackle Autism

Lots of ABA Ireland members liked this online video of an episode of Supernanny in which Supernanny enlists the help of the well respected behaviour analyst Lynn Koegel to help a child with autism learn to communicate and manage his emotions better.


 

1. Sunday Express  – How a controversial therapy has changed my autistic daughter’s life

The final post that we’ll feature this week is an article from the UK based Sunday Express newspaper. An unfortunate headline aside, the article offers an excellent description of the benefits of ABA for children with autism.
Tracey Holliday and Freya

Contributors to the article include Tracey Halliday, Jane McCready (of ABA4all )and Dr Francesca degli Espinosa.  Autism parents and professionals in the UK are doing a great job of highlighting issues facing those who need access to ABA and addressing some of the misconceptions around the science. If you haven’t already liked the ABA4all page on Facebook, we recommend you do.

 

That’s all for this week.

All comments welcome.

While ABA Ireland has taken all reasonable steps to ensure the accuracy of the contents of this blog, it accepts no liability for the accuracy or quality of the information provided and no liability for this information being up-to-date or complete. Information is provided for educational and general purposes only and is not intended as a substitute for professional advice. Where ABA Ireland provides links to third-party websites, it accepts no liability for the content of these websites. The views of authors are their own and do not necessarily reflect the views of ABA Ireland or any organisations associated with the authors of posts.

Top 5 Recent Posts 10/08/2014

Every week on our Facebook Page, members post dozens of post on topics related to Behaviour Analysis, its applications and related issues. One purpose of this blog is to highlight some of the most “liked” posts in order to make them available to a wider audience.

5. FREE Workshops from Penn State ASD Conference

Darragh O’Regan shared an excellent resource made available by the organisers of the Penn State ASD Conference. Videos of hundreds of presentations made at the conference are available online and will be of use to ASD professionals and parents.

4. Professor Neville Blampied’s Sleep Presentation

Prof Blampied’s tour of Ireland’s universities seems to have been a success with good attendance reported at all of his workshops and presentations.  For those who were unable to attend, the Centre for Behaviour Analysis at Queen’s University recorded and uploaded his talk.  There are several other excellent video presentations available at the above link.

3. Diploma in Applied Behaviour Analysis

Keith Lyons posted a link to a new Diploma course in ABA that is being run by City Colleges in Dublin.  The course can be taken in vivo or online and promises to provide a solid introduction to behaviour analysis and its applications.

2.  The Lion King and Evidence Based Approaches

ABA’s own Superhero Behavior Man posted the below meme. It was later shared to ABA Ireland and proved popular!

Behaviour Man

1. Vince Carbone – ABA in Action

One of the most valuable and popular links posted over the past few weeks is a 1997 video featuring Vince Carbone of the Carbone Clinic working with a young child with autism. Over 7 weeks, the child moves from uncooperative and non-verbal to cooperative and verbal. It also shows Vincent working with the child’s mother to transfer the required skills to the child’s mother.

That’s all for this week.

All comments welcome.

While ABA Ireland has taken all reasonable steps to ensure the accuracy of the contents of this blog, it accepts no liability for the accuracy or quality of the information provided and no liability for this information being up-to-date or complete. Information is provided for educational and general purposes only and is not intended as a substitute for professional advice. Where ABA Ireland provides links to third-party websites, it accepts no liability for the content of these websites. The views of authors are their own and do not necessarily reflect the views of ABA Ireland or any organisations associated with the authors of posts.