ABA ethics dilemmas are commonplace in our field. While the Behavior Analysis Certification Board (BACB) has created guidelines for such matters, real world scenarios do not often fit into the examples provided. In day to day practice, we are faced with complex challenges that require both an accurate interpretation of the guidelines, and also, a fair amount of independent judgment for the situations that aren’t black and white (which, let’s face it, a ton of them are not so cut and dry). We need help and collaboration to make the right decisions.
Avoiding an ABA ethics dilemma
We hosted a webinar to give BCBAs a chance to air their questions anonymously to Amanda Kelly – a talented BCBA-D with many years of experience with ABA ethics. There was one question in particular that kept coming up – and it’s one most BCBAs working with individuals with autism will face pretty regularly. We wanted to share this question and Kelly’s feedback in hopes that it will help some of you face this dilemma:
“What should a BCBA do when a family chooses to follow another professionals’ recommendation, when that advice differs from, or is in direct conflict with, the principles of the behavior program?”
Kelly gave participants two great scenarios.
ABA ethics use case #1
The first thing to acknowledge is that the family has the right to determine a course of action based on their assessment of the information they have available to them. It is easy to get frustrated, but at the end of the day, neither you, nor the parents, nor the other professional is intentionally doing anything to harm the child. If you believe that their advice is incorrect, the most effective and ethical option available to you is to help the parents understand that it is incorrect. How do you do that? With data, of course! Evaluate the recommendation and put legitimate parameters around how you are going to measure its supposed effectiveness.
Kelly discussed the example of a family who wanted to start folic acid to make their son “less irritable” and she asked, “What does “irritable” look like? Is he going to sleep more? Are we going to have a decrease in aggressive behavior? What are we hoping to see change?”
It is acceptable to tell the parents that a specific method is not something you would recommend and explain exactly how and why you suggest an alternative.
If they are adamant about using this recommended method, and it isn’t harmful, you want to be a collaborating asset in the process. Help them set the parameters around it, look for observable changes and talk about the results (or lack thereof). If it works, great! We just learned something new for this client. If it doesn’t, then we have evidence that allows you to say, “let’s pull this approach back in and try what I suggested before.”
ABA ethics use case #2
You could also set up an alternating treatment design. For example, you could tell your client, “Let’s try that approach for five days and then my recommended approach for five days. We will throw them in a hat and each day pull out the intervention we are going to use and collect/graph some data.”
For example, if a teacher wants to use a certain method (and you do not), Kelly recommends that you collaborate with the teacher on both methods. By working together, you are validating each other’s professional expertise. In the end, you will study the data together. If the teacher’s method does not work you can nicely state that the method you recommended had a better effect and work to create a plan around that method together.
There are many ways to collaborate, even if there are disagreements. If the intervention is not harmful, you just want to make sure a system is set up to collect the data that can drive accurate decisions. By doing this, the entire team may become more versed in data collection and appropriate treatment decisions as a result. Remember, we are always looking to shape the behavior of everyone that we work with, not just our specified client.