Key Terms

KEY TERMS

The following is an abbreviated presentation of terms that will improve the ability to design and deliver effective treatment services. A complete Glossary of Behavior Support Terminology is available as a Special Offer to subscribers to the Treatment Plan database.

Applied Behavior Analysis: A philosophy of treatment based on data collection and the use of statistical tools to inform the treatment team about the course of treatment on an ongoing basis, thereby allowing frequent corrections of the treatment plan, in order to deliver optimal treatment services. Often confused with the Discrete Trial Training model created by Ivar Lovaas in the ‘70s (see below).


Behavior Barometer: A patented device invented by Steven Kossor to provide ongoing visual feedback to a child concerning behavior so that the child receives ongoing motivation to avoid misbehavior and maintain "good" behavior. Used throughout the world by children between the ages of 2 and 10, the Behavior Barometer is especially useful for the siblings of children who are receiving professional services at home (since they also need attention from a behavioral perspective in almost all cases).


Behavioral Rehearsal: Practicing the "goal" behavior with the child in a neutral (nonthreatening, private, similar if not identical) setting so that when the child is in the "real" setting, he/she can perform the practiced behavior more successfully. This is different from "Role Playing" (see below).


Bribery: Something you give before a bad behavior occurs which causes the bad behavior to occur. Never recommended for use by anybody.


Contingency Contracting: Creating a "you do this, and I’ll do that" agreement and following-through consistently, in order to change behavior patterns.

Procedure:

The procedure is described fully in the Glossary of Behavior Support Terminology that is available as a Special Offer for subscribers to the Treatment Plan database.

Contingent Exclusion: Directing the child to another location (less-stimulating setting) where the child’s irritability and agitation can be reduced through the use of calming techniques such as controlled deep breathing, counting, visual imagery suggestions or other interventions structured and supervised by an adult. The placement of a child in a setting alone is called "seclusion" and is not recommended by most professionals because it teaches the child virtually nothing and offers no substantive behavioral treatment.


Developmental, Individual-differences and Relationship-based (DIR) model: A treatment model created by Dr. Stanley Greenspan to address the needs of children with Autism spectrum disorders (including Asperger’s Syndrome) who are deficient in social skills. The DIR model includes "floor time" as a specific intervention modality which encourages the child to "open and close circles of communication" while the treatment provider encourages the child to focus more on human interactions (as opposed to "interactions" with objects).

Differential Reinforcement (DR): Reinforcing one (desired) behavior so that some other (undesirable) behavior is not reinforced (causing the undesirable behavior to decrease in frequency or intensity).


Differential reinforcement of alternate behavior (DRA): Reinforcement is delivered for behavior that is one of any alternatives to the target behavior.

Differential reinforcement of incompatible behavior (DRI): Systematically reinforcing a response that is fundamentally incompatible with a behavior targeted for reduction.

Differential reinforcement of low rates of behavior (DRL): Reinforcement is delivered when the number of responses in a specified period of time is less than or equal to a prescribed limit; encourages maintenance of a behavior at a predetermined rate lower than the baseline or naturally occurring rate

Differential reinforcement of other behavior (DRO): Reinforcement is delivered when the target behavior is not displayed for a specified period of time; any behavior other than the target behavior is specifically reinforced. This is also referred to as differential reinforcement of the omission of behavior

Discrete Trial Training (DTT): A treatment model in which a series of repeated presentations of a "stimulus" is made to the child and a specific "response" is required of the child. A succession of these pairings of stimulus and response occurs and the child is then told to "go play" as a reward. Critics of this approach have cited its use of behavior modification training to create discrete skills or behavioral responses without adequate concern for or attention to social skills development.

Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services: Frequently confused with "wraparound" services, especially in Pennsylvania. EPSDT services have been Federally mandated in the USA since 1989 and were implemented nationwide in the 1990s. EPSDT services are required under Federal law (see 42 US Code section 1396 a-d) to be available in every state to anyone with a disability who is under the age of 21 when prescribed to treat symptoms of a disability by a licensed practitioner (medical doctor, psychologist, psychiatrist) in that state. So-called "wraparound" services are neither required nor mandated by any law. The range of EPSDT services varies from state to state, and goes by different names, but all of the services are absolutely free to recipients of Medicaid (Medical Assistance) benefits. In Pennsylvania, Medical Assistance (MA) benefits can be easily obtained for any child with a disability who is under the age of 21, regardless of family income. For more information MA benefits in Pennsylvania, or EPSDT services in general, visit www.ibc-pa.org

Echolalia: Repeating ("echoing") a word or phrase without attempting to communicate a want or need.

Intensive Behavioral Treatment (IBT) model: A treatment model created by Steven Kossor to address the need to integrate behavioral training from a variety of perspectives in the treatment of children with Autism spectrum disorders, in order to obtain and retain funding for the treatment services from insurance companies that are increasingly wary of funding "life skills training." The IBT model incorporates elements of Discrete Trial Training and the DIR model within the context of a program emphasizing Applied Behavior Analysis to deliver a comprehensive intervention program.

Modeling: Showing the child what you want him/her to do. Demonstrate the desired response.

Negative Reinforcement: Something unpleasant that you take away after a good behavior occurs, which increases the probability that the good behavior is displayed again. The child must not want the negative reinforcement experience. Rarely recommended for use by professionals.

Positive Reinforcement: Something you give after a good behavior occurs which increases the probability that the good behavior is displayed again. The child must want the reinforcement (reward).

Prompting: Giving the child verbal, gestural, physical or other prompts to perform the desired behavior. Prompting should be done in a hierarchy, leading the child from a higher level of prompting (more intense) to a lower level of prompting (less intense). Verbal prompting is more intense than gestural prompting (moving your hands to signal "stop" or "wait"), for example, and giving a child a "to do" list is an even less-intense level of prompting. See the Hierarchy of Prompts paper for more information.

Punishment: Something you give after a bad behavior occurs, which decreases the probability that the bad behavior is displayed again (while you’re watching, anyway). The child does not learn what to do, only what not to do, and that is not especially helpful. Never recommended for use by professionals.

Role-Playing: Reversing roles (the child takes on the adult role and the adult takes on the child role). The adult approximates the behavior of the child (without becoming excessively animated) and then guides the child to respond in a mature, adult manner (as the child ought to be responded to by responsible adults). The child can learn to "stand in the adult’s shoes" through this procedure, but it presumes that the child has the capacity to do this "standing in the other person’s shoes." Many children with developmental disabilities cannot do this, so Role-Playing would be an inappropriate treatment modality for them.

Shaping: Rewarding (reinforcing) the child for making progress toward the goal. If you reward a child for taking a small step in the direction you want him/her to travel, he/she will be more motivated to take the next step(s). Your rewarding the child for taking a "step in the right direction" gives the child increased motivation to work toward the goal, and "shapes" their behavior to more efficiently achieve the goal.

Token Economy or Token Program: A behavioral reward system in which a child receives a "token" (star, poker chip, etc) from an adult (teacher, parent) because he/she has complied with his/her behavioral treatment program. At a later time (end of the day, end of the week, etc) the child can redeem the accumulated tokens to purchase items of interest at a "store" that stocks such items. Commonly used in institutions and prone to misuse by setting the "redemption time" too far in the future so that the child looses sight of the purpose of the tokens or feels that the effort needed to obtain a sufficient number of them is simply too great. Another very common misuse is to charge "fines" for misbehavior — taking away earned tokens, which usually undermines the effectiveness of the program.

Wraparound: A philosophy of treatment having no basis in law or regulation. This philosophy of treatment emphasizes the transfer of treatment skills to parents and other caretakers, frequently emphasizes a preference for utilizing cost-free nonprofessional "naturally occurring environmental supports" rather than the services of trained and experienced professionals, creates the expectation that treatment services to children with mental illnesses should be "time-limited" and that it is ethical and appropriate to arbitrarily impose a "titration schedule" (planned reduction in services) months in advance. Schools and other nonclinical entities endorse the "wraparound" philosophy as a means of including the child, family, school, community and other resources in a collaborative effort to deliver necessary services to children, and many clinicians are recognizing the importance of including naturally occurring environmental supports in the planning and delivery of mental health treatment services. However, vigilance by parents and advocacy organizations is needed because an overzealous endorsement of the "wraparound philosophy" by funding agencies and others can result in the inappropriate diversion, prevention and/or minimization of access to the Federally mandated entitlement to Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services.

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