Developing a Behavior Modification Program
It is almost never ideal for a family member to act as a therapist
or behavior modifier. However, there are situations in which it might be helpful for
all members of the family to understand the principles underlying a behavior-management
Management programs can apply to all levels of head injured patients.
You may think your loved one will be offended by what appears to be a
child-oriented approach. Is is true that the procedures resemble techniques used
with children with behavior problems. However, you can remind your loved one that
life is based on contracts, and this is what is being set up - a behavior contract.
If he can understand that this is necessary for him to get through the real world, he
should be more agreeable to follow through.
What are the problem areas?
To take an organized approach to behavioral change, you must first
determine what areas you want to address. Start by making a comprehensive list of
all the problems. Divide this list into "Things I want him to do" and
"Things I want him to stop doing"
Where should we begin?
You might start by choosing five areas that have been deemed
absolutely necessary to change. You will need to collect baseline data so you can
obtain objective information regarding the rate and intensity. Collecting the data
requires that you count the number of times a particular behavior occurs.
Examples are described in the following charts. Click
Who should carry out the program?
It is most practical for the person who has the greatest contact
with the head injured individual to monitor the program. You must be sure the person
doing the recording is willing to stick to the plan and enforce the program. It is
very important to carry through with whatever consequences have been set up.
What basic principles do we need to know?
Very difficult or severe behavior problems will require
professional intervention. If you experience difficulty learning or applying these
principles, you should consult a mental health professional. It will take time to
set up a program which works best for your loved one. It is best to begin with just
one behavior. This will help you from becoming overwhelmed. The following
terms are some that you will need to know and be able to apply to your family member:
are defined as events that follow a behavior and either strengthen or weaken that
behavior. Consequences that follow a behavior and result in an increase or
strengthening of that behavior are called reinforcers. Consequences
that follow a behavior and cause that behavior to decrease or weaken are called punishers.
Consequences that increase or
strengthen behavior include:
Paycheck - a paycheck is a consequence that strengthens the behavior of
going to work each day.
Positive comments/compliments - Each time 12 year old Chris washes the
dishes, his mother says "Chris, you did a great job!" This comment
strengthens the likelihood that Chris will repeat the behavior of washing the dishes in
Consequences that decrease or
weaken behavior include:
Traffic tickets - Receiving a ticket for speeding should decrease or
weaken the behavior of driving too fast.
Missing a doctor's appointment - each time you miss an appointment and
do not call, you are charged for a visit. The behavior of not calling is decreased.
Events or consequences that increase or strengthen a desired behavior are
referred to as positive reinforcers. Any behavior that is followed by reinforcing
events is likely to reoccur. Positive reinforcement (reinforcing events) can
strengthen both desired (appropriate) and undesired (inappropriate) behavior. The
following are examples:
Linda had difficulty controlling her inappropriate language. Each
time she cursed, either parent would respond by snickering, smiling, or touching her
shoulder and saying, "Linda, you should not talk that way." It was noted
that her inappropriate language would increase in frequency. The increase in
behavior was due to the manner in which her parents responded to the swearing. They
looked astounded and surprised. This gave Linda the attention she was seeking.
Joe's parents wanted to continue a cognitive rehab. program at home.
Joe frequently threw tantrums during these attempts. His parents divided the
two hour cognitive rehab. program into eight 15-minute sections. Each time Joe
cooperated for a 15 minute period of time, he was rewarded with a poker chip. At the
end of the day, Joe could exchange these chips for a trip to the mall, time watching TV,
renting a video, or other activities he enjoyed. Joe's time on cognitive tasks
increased significantly through the use of positive reinforcement.
Types of reinforcers
Primary or unlearned reinforcers - are things
which include food, drinks, toys and pleasurable activities. They are unlearned
because they are naturally pleasurable.
Secondary or learned reinforcers - include
such things as tokens, money, stars on a paper, grades. A child learns when he
brings home good grades, he receives a primary reinforcer such as a toy or ice cream.
Punishment Punishment is not the best
process for altering behavior. When the use of punishment is necessary, punishment
should be administered immediately after the inappropriate behavior. You should
always provide a warning so the family member understands the consequences. In
addition, you should always be consistent and never threaten to punish without following
The most effective punishment is the removal of a positive
reinforcer.In the example above, this would be accomplished by taking back tokens from Joe
for hitting his brother. Because Joe wants the tokens, he will be less likely to hit
How do we set up the Behavior Program?
If your loved one has been participating in an inpatient behavior
modification program, ask the therapist to modify it for home. If this is not the
case, you can follow the following steps:
Put priorities on the behaviors you want to change.
Initially, address only one or two behaviors.
Collect baseline data with which you will be able to know if you are
Determine the reinforcers. Use primary or unlearned reinforcers at
first, and then graduate to tokens or points that can be traded for primary
Maintain a chart so that everyone can see exactly what is going on -
both you and the head-injured loved one.
Be consistent and follow through with the plan. If the behavior is
not reinforced each time, learning will be very slow.
Make sure that you deliver the reinforcement immediately after the
desired behavior. Also, make sure that the family member understands the connection
between his behavior and the reinforcement.
Learn to recognize the signs that indicate you need to modify the
program. You may need to increase the amount of reinforcement to obtain a change.
You may need to add a different reinforcer if the head injured person does
not appear motivated to receive this particular reward.