Assessment Requests

A. Case Study 1- Mile Crafone

1. Biopsychosocial history
   Identifying information: Mike Crafone is a 4-year-old boy. He has an older sister whom he
   lives with, together with his mother and grandmother.
   Present symptoms of a behavioral disorder: Crafone’s mother reports that the boy flaps his
   hands and squeals often. He hits his head with fists and bangs his head on surfaces, which has
   even led to him breaking one of his teeth. He often runs away from his mother in public places.
   Crafone sometimes repeats words that people say to him, but other times, he does not repeat
   them. He also does not spontaneously produce words. At the age of four, he still cannot complete
   self-help routines expected at his age, such as putting on his slip-on shoes. Crafone is also a
   picky eater and is not toilet-trained.
   Past History of Treatment: Crafone was identified as having a developmental delay at the age
   of 2.5. At the age of 3.5 years, he was diagnosed with an autism spectrum disorder. Crafone is
   physically healthy.
   Implications for Behavior Analytic Services
   Crafone has been diagnosed with an autism spectrum disorder. He needs behavior
   analytic services to help reinforce, replace, and help develop certain behaviors. With the
   information provided, it is clear some of the issues that the child is struggling with based on the
   mother’s explanation. However, a functional behavior assessment is necessary. The behavior
   analyst needs to spend more time with Crafone, observe his behavior, and even identify his

ASSESSMENT REQUESTS 3
communication skills and level. Visits to his home and school are necessary. It is clear that he
has not been regular with his school routine due to transport challenges. However, these visits
will help in the assessment and eventual development of a plan.
Recommendations
Crafone needs early intervention to help him cultivate fundamental skills and behavior
necessary for independent living and proper social functioning. From a behavior analyst
perspective, the boy needs to go through Applied Behavior Analysis (ABA) therapy. The
specialist will use the Antecedent-Behavior-Consequence (ABC) therapy model. The antecedent
entails identifying the actions leading up to the behavior; this could be physical, verbal, or
related to an environmental stimulus (Young, 2020). The behavior or response to the antecedent
is observed. The consequence entails the follow-up, which could be a reinforcement once a
behavior is completed. ABC helps pinpoint the root cause of certain behaviors and how the
consequences or follow-up actions could potentially affect the behavioral outcomes.

2. Prioritization of target behaviors
   The prioritization of behavior will be based on the potential impact that the behavior has
   on the health problem. The list below shows the target behaviors stating with the one that will be
   assessed first in the order they will follow each other up to the last behavior to be assessed:
   i. Complete self-help routines appropriate for children at the age of four years
   ii. The child will not flap his hands
   iii. The child will speak softly without squealing
   iv. The child will produce words on his own
   v. Will refrain from injurious behaviors such as banging his head

ASSESSMENT REQUESTS 4
vi. Request for items by actually speaking and using words to express himself
vii. Toilet training
viii. The child will eat well
The social validity of the above list was measured by examining maintenance. In the
course of my practice, I have realized that clients maintain certain behavior interventions over
time. So, while coming up with the list, I first considered target behavior that will be adopted
first and maintained in a given environment. Maintenance of behavior-analytic interventions is
important in determining target behaviors that will persist and those that will be unlearned if not
consistently reinforced.

3. Proposed assessment sequence
   Assessment will include observation. The child will be observed while at home and in
   school. The analyst will interact with the child, take an object away from them and wait for them
   to ask for it. As the child points at the object, the analyst will mention its name many times and
   see if the child will repeat it.
   Behavioral excesses in ABA refer to behaviors that occur many times or that a child
   exhibits consistently, while behavioral deficits are behaviors that a child does not engage in
   because they were never learned or the skill was never mastered (Powers et al., 2011).
   Assessments will be conducted only in the context of a defined professional-client role.
   BACB code of conduct provides guidelines on how to relate with a client, and these will be
   adhered to strictly (B. A. C. B, 2014). For instance, the assessment will be in school, at home, or
   in public if a child is accompanied by a caregiver. The language used when interacting with the

ASSESSMENT REQUESTS 5
client will be age-appropriate. For instance, this is a four-year-old child whose language has not
yet fully developed. Thus, the language used will be simple to enhance understanding.

4. Preference assessment
   Assessment format
   Specific activity Time taken Comment
   Direct behavioral assessment-look out for
   behavior excesses. Such behaviors may include
   flapping hands and gazing at one place for a
   long time

20 minutes Comment on the child’s
behavior. For example, how
many times do the hands flap

Direct observation in school
Look out for behaviors such as the child
randomly speaking in a class by repeating
words spoken by other students or the teacher

20 minutes Look out for behavior
excesses. For example, how
many times does the child
repeat words spoken by
others

Engage the child in activities
 Let them try putting on slide shoes
 Take away an object from them, such as
a ball, and wait for them to ask for it.
mention the name of the object and
observe to see if they repeat the word
 Talk to the child and see if they respond

20 minutes Comment on the number of
times that the child repeats
words spoken to them. When
do they finally repeat the
word? Note changes in the
environment

ASSESSMENT REQUESTS 6

B. Case study 2- Earl Bird

1. Biopsychosocial history
   Identifying information: Earl Bird is a 12-year-old boy. He is the firstborn in a family of three
   children. He has younger twin sisters. He lives with his father and mother.
   Present symptoms of a behavioral disorder: parents report that Earl yells profanities in public
   spaces. He has physically attacked family members. In fact, one of his sisters has stitches after he
   pushed her off a slide. He tries to be private about his social life. He loves video games and
   anime. He also does not like games or anything that he considers “babyish.” His grades vary
   dramatically, but he performs well in standardized tests in school when he tries. In school, Earl’s
   behavior causes problems. For instance, he has been suspended for getting into a fight and then
   “talking back” to the principal.
   Past History of Treatment: Earl was diagnosed with oppositional defiant disorder by his
   family’s psychiatrist. For the last two years, he has been attending individual and family
   counseling. According to the family therapist, Earl needs work on his social skills hence the need
   for behavior analyst service. A report from the pediatrician shows that he is physically healthy
   and is proceeding through puberty at a developmentally appropriate rate. Remarkably, he is in a
   regular classroom and does not receive any special education services. He also has not received
   any Applied Behavior Analysis (ABA) services in the past.
   Implications for Behavior Analytic Services
   Oppositional defiant disorder (ODD) is one of the behavioral disorders that is diagnosed
   after a child presents with defiance, negativity, aggression, resentment, and frequent outbursts,
   and similar symptoms as identified in DSM-V for more than six months (Ghosh et al., 2017).

ASSESSMENT REQUESTS 7
When dealing with such a child as a behavior analyst, there are multiple therapies that can be
used to treat the disorder. However, there is no one-size-fits-all treatment when it comes to
addressing ODD. Hence every behavior analyst must observe an individual child and then come
up with a personalized treatment plan to address the specific problem behaviors exhibited by the
child.
Recommendations
Earl requires a combination of therapies consisting of social skills programs and problem-
solving training. I recommend social skills programs because Earl is struggling with his social
skills. He does not know how to behave in public. He also does not know how to talk to people
in authority, and this explains why he “talked back” to the principal. Such social issues can be
corrected through training. If he goes through these programs, positive behavior will be
reinforced and rewarded while negative behavior discouraged. He also needs therapy to mold his
problem-solving skills. He entered into a fight in school and even pushed his sister down a slide.
He needs to learn how to control his anger and solve problems with people without resulting in
violence.

2. Prioritization of target behaviors
   The criteria that will be used to select and prioritize target behavior are amenability to change
   and potential impact on the child’s behavioral development. Target behavior will be addressed in
   this order, starting with the most prioritized ones to the ones that will be assessed last:
   i. The child will be warm and stop being hostile and aggressive towards others.
   ii. Obedience
   iii. Kindness

ASSESSMENT REQUESTS 8
iv. The child will deal with others well and make friends
v. Anger control
vi. The child will comply with rules
The social validity of the list was measured directly through consumer preference, which
entails consumers’ own choice of interventions. The reason for allowing a client to choose their
own order of intervention is that in my experience with children, they value some autonomy.
Further, research has shown that children prefer a situation in which they are allowed to choose
as opposed to where they follow directions given by an adult (Carroll & Peter,2014).

3. Proposed assessment sequence
   In-person assessment by observing and directly interacting with the child. First, the child will
   be directly observed at home and at school while noting vital factors of the environment and how
   the patient reacts to them. The child’s interactions with the sisters, parents, teachers, and peers
   while at school will be monitored. The aim is to observe the child in their natural environment as
   this is where the child will improve as opposed to at the therapist’s office. Some of the theories
   developed during observation, such as the child have ODD, and behaviors such as the child yell
   profanities while in public, will be tested. For instance, the analyst will say or do triggering
   things to see how Earl will react. The other way is to gauge his feelings about the triggers or
   what he sees in public that makes him yell certain profanities. Teachers will be interviewed to
   get a clear understanding of the child’s behavior. Notes of the family therapist will be reviewed.
   The child will be asked to explain the rationale or logic behind their own behavior. For instance,
   why do they fight or engage in violent behavior? These activities will be aimed at identifying
   behavioral deficits and excesses.

ASSESSMENT REQUESTS 9
Behavioral excesses in ABA refer to behaviors that occur many times or that a child
exhibits consistently, while behavioral deficits are behaviors that a child does not engage in
because they were never learned or the skill was never mastered (Powers et al., 2011).
Intervention procedures include first creating a list of the two categories of behavior and then
creating a plan on how to reinforce the positive ones and help the child unlearn those that affect
their development in a negative way.
Further, in selecting procedures and treatment plans, knowledge will be based on
scientific knowledge. BACB code of conduct requires that behavior analysts rely on knowledge
and skills that are founded on research and scientifically proven when treating or developing
treatment plans for their clients (B. A. C. B, 2014).

4. Preference assessment
   Assessment procedure
   Specific activity Time taken comment
   Direct observation at home
   Watch as the client interacts with his sisters (notice behaviors or
   actions from the sister that either excite or annoy him)
   Notice when the client yells and actions or objects that cause the
   behavior

20 minutes Comment on
actions or
situations
that provoke
the client
making him
to yell or
become
violent

ASSESSMENT REQUESTS 10
Direct observation at school
Watch the client in the classroom (notice how he interacts with
peers noting any difficulties or lack of them in interacting with
peers)
Observe how the client interacts with teachers

20 minutes Notice if the
child is
friendly
towards the
peers

Directly interact with the client
Ask the client to explain his actions towards his sisters, peers,
and teachers (refer to what was noted earlier on during direct
observations both at home and in school)

30 minutes Note
situations or
thoughts that
drive certain
behaviors

Parent training
Studies show that procedures of behavior management are
difficult for parents to implement while outside the training
setting or when with the behavior analyst. As such, it is
important to train the parent as they will spend more time with
the child hence the need for them to understand their role in
treatment.
Parents will be made aware of their roles or how to effectively
interact with the child even as they go through treatment. For
example, in the beginning, it is important to avoid actions that
make the child become aggressive until they can be trained on
how to regulate their emotions and behavior.

15 minutes Equip the
parent with
skills and
knowledge
necessary to
help the
child
succeed in
changing his
behavior.

ASSESSMENT REQUESTS 11

References

B. A. C. B (2014). Professional and ethical compliance code for behavior analysts.
Carroll, R. A., & Peter, C. C. S. (2014). Methods for assessing social validity of behavioral
intervention plans for children with attention deficit hyperactivity disorder. Acta de
Investigación Psicológica, 4(3), 1642-1656.
Danforth, J. S. (2016). A flow chart of behavior management strategies for families of children
with co-occurring attention-deficit hyperactivity disorder and conduct problem
behavior. Behavior analysis in practice, 9(1), 64-76.
Ghosh, A., Ray, A., & Basu, A. (2017). Oppositional defiant disorder: current
insight. Psychology research and behavior management.
Powers, M. D., Palmieri, M. J., D’Eramo, K. S., & Powers, K. M. (2011). Evidence-based
treatment of behavioral excesses and deficits for individuals with autism spectrum
disorders. In Evidence-based practices and treatments for children with autism (pp. 55-
92). Springer, Boston, MA.
Young, S. D. (2020). The adaptive behavioral components (ABC) model for planning
longitudinal behavioral technology-based health interventions: A theoretical
framework. Journal of Medical Internet Research, 22(6), e15563.