Trauma can be difficult to define since each individual experiences and processes life events and trauma differently. Trauma can include abuse, neglect, domestic violence in the family, exposure to substance abuse, or divorce. Children with developmental disabilities are statistically at a higher risk to experiencing trauma than their typically developing peers (Rajamaran et al., 2022).
Evidence shows that trauma may impact the physiological and behavioral development of a child (Teicher et al., 2016) and therefore affect one’s response to environmental scenarios. For example, conducting all components of a traditional functional analysis for a child who has experienced neglect would be unethical and harmful (Ramajaran et al., 2022). In other words, imagine not being “informed” or not “assuming” trauma, and thereby placing a child in a room where they are meant to feel alone, for the sole purpose of identifying the function of a given behavior to be automatically reinforcing.
Trauma-Informed Care vs. Trauma-Assumed Care
Trauma-informed care suggests that the provider is aware of trauma experienced by the client, however we aren’t always notified of these events for many potential reasons. Trauma-assumed care is a proactive way of treating our clients, since statistics show that most adults have experienced at least one adverse childhood experience in their lifetime (ACEs; Felitti et al., 1998). We may not be informed of the trauma our clients have experienced during pre-analysis interviews, and it is unlikely that we observe the direct contingencies during these traumatic events. Behavior analysts must know that the impact of trauma has long-term effects on an individual’s psychological and behavioral health, and this should affect the way we teach and treat our clients.
Why is Everyone Talking About Trauma-Assumed Care Now? Recent research is directing behavior analysts to be mindful of their client’s past and to account for trauma when treatment planning and assessing. It is our ethical duty to include TIC in ABA because without doing so, we could be compromising our reputation as behavior analysts, as well as the effectiveness of the treatment we provide (Rajamaran et al., 2022).
A Clarification of Trauma-Assumed Care:
Trauma- assumed care in ABA is a proactive approach to intervention, accounting for the individual’s potential exposure to trauma. It means providing a therapeutic experience that is sensitive to the probability of trauma. This is different from “trauma-specific service,” in which the objective is to directly treat an individual for the trauma that they have experienced (DeCandia et al., 2014). It is our duty to “acknowledge trauma and its potential impact” (Ramajaran et al., 2022) when treating our clients.
Trauma’s Impact on Care
First, it is important that we are aware of where trauma comes from and that we may not ever know about the trauma that a child has experienced. For one, the odds increase that an individual with an intellectual or cognitive disability faces adverse childhood experiences (ACE) in their lifetime (McDonnell et al., 2019). Most of us are treating children on the spectrum or with other disabilities who have experienced trauma, but don’t have a way of describing and communicating that (McDonnell et al., 2019; Ramajaran et al., 2022).
A child engaging in severe or undesired behavior may be “adapting to and coping with past traumatic experiences” (Guarino et al., 2009; Ramajaran et al., 2022). A true behavior analyst understands that stimulus-stimulus pairing could have occurred between a traumatic event and another neutral stimulus. For example, if a child experienced physical abuse,undesirable behaviors could occur in the presence of adults who utilize physical or proximity prompts. (Ramajaran et al., 2002). As another example, it may be insensitive to utilize a response cost system with a child who was in foster care or who has lost a loved one. It’s important to know your learner and their history when assessing and treatment planning to first “do no harm” and to secondly, provide positive meaningful outcomes.
Choice in Trauma-Assumed Care
Secondly, providing an individual with choices has been one evidence-based practice as well as our ethical duty to promote socially valid treatment (BACB, 2020; DeCandia et al., 2014). The professional is providing the individual with a choice to not experience a potentially traumatizing stimulus or event, and instead involves the client in setting their goals, and with making decisions. Hanley (2010) has outlined a few ways to provide choices regarding the procedures and outcomes of an intervention for individuals who are less verbal. One approach includes using a concurrent operant preference assessment. Brower-Breitweisre (2008) gave autistic children the choice to learn through Applied Behavior Analysis (ABA) or Treatment and Education of Autistic and Communication Handicapped Children (TEACCH) through a concurrent operant preference assessment. Providing an individual with choices is crucial if we are concerned with one’s quality of life (Martin et al., 2006).
Trauma- Assumed Care and Assent:
In today’s ABA (Hanley, 2019), we worry about the child assenting to the procedures and the outcomes. Hanley instructs all BCBA’s to find the child’s state of happiness, relaxation, and engagement before demands are presented (2019). To acknowledge that trauma has occurred, we respond to noncompliance and aggressions with functional communication training and skill based treatments, by avoiding the overuse of extinction, and by keeping an open door policy so that individuals don’t feel threatened or forced to participate (Hanley, 2019). Trauma-assumed care is televisable, meaning that anyone watching would feel comfortable and sure that the individual in treatment is choosing to be there and is learning skills that improve their quality of life.
The theory that “the student is always right” also means that behavior should inform our decision making with the implementation of interventions (Keller, 1968). A child whose dangerous or maladaptive behavior continues to occur, isn’t learning the necessary replacement skills. Severe behaviors are a sign that there are communication and tolerance skills that are more socially significant than the skills that the child is likely to be avoiding and escaping. When a child is happy, relaxed, and engaged, the child has access to all reinforcers, including attention from adults and tangible reinforcers. Hanley (2019) encourages us to “forget the function” and treat maladaptive behavior as a skill deficit for communication and tolerance. By teaching pivotal skills such as omnibus mands, toleration of transitions and denial of reinforcers, we reveal opportunities for the child to learn in a safe environment (Ward et al., 2020).
References (not complete)
Martin TL, Yu CT, Martin GL, Fazzio D. On Choice, Preference, and Preference for Choice. Behav Anal Today. 2006;7(2):234-241. doi: 10.1037/h0100083. PMID: 23372459; PMCID: PMC3558524.
Written by Kristin Fayad, MA, MEd, BCBA, LBA