Saturday, 12 December 2015

Positive Behaviour Support is Applied Behaviour Analysis with add ons

Great marketing. 
[summarised]...."Got an autistic person in your life?  Use this "positive behaviour support" thing.  By using it, you teach the person how to cope better.  In positive, relationship-forming ways."

Doesn't that sound great.
Or is it?

Well, positive behaviour support is another name for Applied Behaviour Analysis, with a few add-ons. That video at the top makes it clear that this is what it is.

It starts with the assumption that autistic people display "challenging behaviour", because we can't think of a good way to simply ask for things.

This is not true.  Adding that by 'ask', I'm including all forms of  communication, of which distress behaviour is one form. I've yet to find an autistic person who cannot ask for something. The problem is that most teams don't 'speak autism', which is its own language, culture and identity.

That's a bit of a problem, isn't it, when a whole behaviour programme is designed to address that particular situation.  That the behaviourist is able to detect the problem, and has the answers.

Whilst the BILD video does not mention autism directly, BILD are absolutely clear that positive behaviour support is meant to also be used for autistic people.

Suppose I'm in a café.  Here is my experience of being in that café.  Genuinely deafening, genuinely painful.   Two minutes.  Needs sound.  Turn the sound up to maximum. 

In that setting, my brain is literally overheating, internally. The pain is real and physical.

OK, watched the two minutes?   Is the child just in need of a better way to cope with the sensory pain?  Suppose we took the child's favourite things away from them, and bribed the child with them so they stayed in the café and behaved nicely? The only way they get those favourite things is to do as they are told.  Endure the pain, little Jonny.  Endure the sensory hell, little Jonny.  Behave more nicely, or you don't get the only thing that allows you to cope at all....your favourite things.  After all, we are not punishing the child (directly).  (Just coercing them to endure pain in a really non-confrontational way).

I can imagine some of the behaviourists claiming, "But, Ann, that's not what happens! We take sensory needs into account, honest guv!".  I'd believe it...but in reality what I see, relentlessly from PBS and ABA teams, is them guessing...or asking the parent.  To give one of a book-ful of examples, I went in to reassess a situation that had gone very wrong.  It had been handled by an individual who appears in the credits of that BILD video.  The team had assessed Person X for days.  Invented a plan.  Instigated the plan.  Person X then had such a meltdown that it became a very major safeguarding situation indeed.  "But we have a PBS plan.  We're following the plan!", said the staff.  For sure they did.  I observed Person X for half an hour and noted a number of sensory and movement processing difficulties.  I asked where those were on the plan.  "Oh, we didn't know about those", they said.  I observed Person X's accommodation, without them being present in it, and identified where Person X would sit, work, stay away from.  "But how did you know?", said the team.


I get fed up with it.  Yes, there's some good and experienced professionals out there who are respectful about working with us, ready to learn, acknowledge their limitations, and do a good job.  I won't for one minute claim otherwise.

But commissioners pay a fortune for this stuff, and too much of the time they might as well be picking out random answers from a hat.  You see, non-autistic people quite literally cannot see and hear what autistic people see and hear and sense, etc.  It's pure guesswork.  Autistic specialists work to decode behaviour and environment, and speak the same language as the autistic person.  End result - may not be perfect, but by heck it's better than guessing or asking the parents.  We should ask the autistic person who is being assessed, and realise their answer may not be in words.

Yet nearly everyone in PBS is so nice.  Endlessly nice.  After all, it's a really Nice behaviour support plan.

Or is it. 

Actually, little Jonny may be in a lot of pain.  If we want to stop pain, we take the source of the pain away, by using our absolute best teams to detect the possible problems.  We do not bribe the child to put up with the pain, because we didn't spot the source of the pain.

I do hope that is more clear.   It's not challenging behaviour.  It's distress behaviour.  Be a good carer/parent and stop putting your young person in pain.  Learn about autism instead.  Engage with autistic experts.