Keeping the A First in ABA – Using Antecedents

This is the third of three reports from the 2011 annual meeting of the Maryland Association for Behavior Analysis (MABA).

You won’t get through an introductory presentation about Applied Behavior Analysis without reference to the ABCs – Antecedents, Behaviors, Consequences.  We’re taught early to capture information about these three things to analyze in order to develop a hypothesis about the function of your child’s behavior.  So we get a picture about what happens immediately before and after a behavior occurs.  But then what happens more often that not is we think about how to change the consequences.  How can we change our reactions to a behavior to change how likely it is to occur in the future?

A question we sometimes forget to ask is ‘how can we change the antecedents?’  Can we change the environment to prevent an undesirable behavior from occuring in the first place?  When my daughter was six, she would scream whenever I put a particular saucepan on the stove.  I immediately tried to run a consequence-based program toward changing how she reacted to the saucepan.   And then I slapped myself upside the head.   We had a lot higher priority skills to worry about.   So I banished the saucepan for some months, the tantrums disappeared and we worked on communication skills instead.    When the pan came back out, her aversion to it had disappeared on its own.  Picking the right battles is a big part of manipulating antecedents.

An emphasis on antecedents was a big part of what impressed me about Dr. Gregory Hanley’s MABA presentation about treatment for pediatric sleep disorders. 
 

Hanley, a BCBA and a researcher at Western New England University, focused on antecedents of a good reason.   In treating sleep disorders, sleep is not the target behavior.   Falling asleep is the target behavior and sleep is the rewarding consequence of that behavior.  So what are the variables you can change in the child’s environment?   The conditions that immediately precede falling asleep.  So simple, but I’d never thought of it that way.

Hanley noted the first antecedent to consider is one you can’t see – the child’s circadian rhythms.  He showed a chart (from the research of Richard Ferber MD) that demonstrates a peak of activity for kids right before bed time.   Don’t believe it? Come visit my 11 year old at 8pm.  So you don’t start trying to increase sleep with earlier bedtimes – you’ll put your child in bed in the middle of this ‘forbidden zone’ of high activity.   Instead, Hanley recommends putting them to bed an hour later than you currently do.

Sounds counterintuitive?   Later bedtimes to increase sleep?   It works for two reasons.   First it gets the interfering circadian rhythm antecedent out of the way.   Just as important, it increases the value of the reinforcer – sleep.   The key thing to remember is that it’s not permanent.  Start later at night to establish a smooth sleep routine, then fade the time back in ten minute increments toward your target bedtime.

Which other antecedents may need key changes to improve sleep will vary from child to child.  But Hanley gave us principles for thinking about them.  

1) You want the child to go to sleep easily then also not have night wakings (seriously, we were tortured by these for years).  So you need to make sure the antecedents for sleep will be there in the middle of the night.  For instance, white noise machines that run all night are better than radios, music boxes or wave-sound machines with timers.  If night lights are needed, no timers on them either.

2) You want to ensure the routine includes no people.  Singing, cuddling or reading before bedtime are great, but they need to be over before the child actually falls asleep.  If the child is dependent on you at the moment of sleep, they’ll need you again at 2 am.  And again at 4.   All that might be OK, if your boss didn’t also depend you at 8.

3) You want to ensure the antecedents of sleep are portable -- unless you never want to leave your home again.   If it doesn’t fit in a suitcase, don’t build a sleep program around it.

Following these principles, it’s easier to get the As right in a sleep program.  I think we’re wise if we carefully consider the A first in other ABA programs too.

Wil Gehne