Health and problem behavior among people with intellectual disabilities.
Rule out hidden illness first or your FBA may chase the wrong function.
01Research in Context
What this study did
Smith et al. (2010) wrote a narrative review. They looked at people with intellectual disability.
They asked: can hidden health problems keep problem behaviors alive through reinforcement?
The team urged BCBAs to invite nurses or doctors to the functional assessment table.
What they found
The review found that pain, reflux, constipation, or ear infections can act like reinforcers.
A child may hit his head because an earache stops when he lies down. The earache is the payoff.
If we miss the illness, our FBA will blame the wrong function and our plan will fail.
How this fits with other research
Connell et al. (2004) said the same thing earlier, but only for feeding problems. The 2010 paper widens the lens to any health issue.
Parsons et al. (2019) later counted the problems: adults with ID plus autism often have epilepsy, sleep, and heart issues. Their data back up the 2010 warning.
Germansky et al. (2020) showed parents can run solid FAs at home. Add their caregiver model to E’s health screen and you get a family-powered, nurse-approved FBA.
Why it matters
Before you write an FBA, add a one-page health checklist for parents and nurses. Ask about sleep, pain, reflux, seizures, and medications. If any box is ticked, get a medical consult first. This five-minute step can save months of failed behavior plans and spare the client from pain.
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02At a glance
03Original abstract
Good health significantly improves a person's quality of life. However, people with intellectual disabilities disproportionately have more health problems than the general population. Further complicating the matter is that people with more severe disabilities often cannot verbalize health complications they are experiencing, which leads to health problems being undiagnosed and untreated. It is plausible these conditions can interact with reinforcement contingencies to maintain problem behavior because of the increased incidence of health problems among people with intellectual disabilities. This paper reviews common health problems influencing problem behavior and reinforcement processes. A clear implication of this review is the need for comprehensive functional assessments of problem behavior involving behavior analysts and health professionals.
Behavior analysis in practice, 2010 · doi:10.1007/BF03391759