The treatment note I wrote from my last session included the subject line: “in 1 instant __ ran out of the therapy room during the 50 minute session” and I was proud of it. Simply put, my client is what we call a “runner.” Where functional language lacks, replaced behaviors exist, and in order to provide any communicative feedback my client often jumps, gestures, cries, screams, squeezes my legs, or, in many cases, runs.
I have had clients in the past that did not have the language to produce wants and needs distinctly, and in an attempt to communicate, acted out in behaviors not considered appropriate for a structured setting like therapy or school. Luckily, I have had a wonderful educational background regarding the behavioral aspects of therapy to guide me in my practice.
I have a supervisor that always emphasizes the ABCs of all actions: “A” being the antecedent, “B” being the behavior and “C” being the consequence. Pulling out some classic behavioral psychology here, but essentially everyone does this contingency in forming behaviors and attitudes. Your mom asks you to clean your room and you don’t, so she’s going to get upset and ask why you didn’t clean it. Perhaps you take your dog out for a walk and he goes to the bathroom, so in approval of his actions you say, “good boy!”
So let’s actually talk about something relatable here: Let’s say I want my client to sit in his chair (A), and in response to my request, he does it! (B) I will reward him with verbal gratification like, “good job!” and, “I love your sitting!” (C)
Based on research, people are more responsive to positive feedback than negative feedback, which totally makes sense! So in turn, this is where prompting comes in. Let’s say I want my client to sit in his chair (A), but instead he runs away (B). I am going to make sure he observes my disapproval with a verbal response such as “no” or “uh uh” or maybe something visual like crossing my arms, or my favorite, the stink eye (C). The next time I want him to sit in his chair, I will give him the most prompts available in order to make him successful. I ask him to sit in his chair again (A), guide him to the chair and point to the seat. If he sits! (B), I’ll respond, “Wow! Great sitting! Good Job!” (C)
Sitting in a seat may sound incredibly unrelated to speech therapy, but really how unrelated is it to children with intellectual disabilities struggling in class to follow one step directions? The line between behavioral therapy and speech therapy can sometimes be thin and perhaps touchy. Yes, behaviorists can assist with language, and yes, speech therapists can enforce good behaviors, but where there is overlap, there is opportunity to work with more professionals.
As a guest speaker, a BCBA (Board Certified Behavioral Analysis) therapist came into our class to talk about behavioral therapists and speech therapists working with the same patients. Often, the overlap occurs with children with Autism Spectrum Disorder (ASD), in which behaviors may cloud the ability to communicate academically and functionally. Their services often include using an AAC device or perhaps a picture exchange system.
In conclusion, no other professional has the linguistic basis and background knowledge to guide a child through language and speech development that speech-language pathologists and speech therapists do, while certified behavioral therapists have the understanding and knowledge to reinforce self-care, motor development and play skills. While these aspects are all equally important in daily activities and academics, the ability to make the individual therapies overlap could be incredibly beneficial to the child to increase carryover of the many types of therapies learned.
Maul, C. A., Findley, B. R., & Adams, A. N. (n.d.). Behavioral principles in communicative disorders: Applications to assessment and treatment.