By Matt Harrington, BCBA · Behaviorist Book Club · Clinical decision guide

Competing Stimulus Assessment vs. Standard Preference Assessment for Treatment of Automatically Reinforced Behavior

In This Guide

Side-by-Side Comparison
Clinical Decision Framework
Key Takeaways

One of the most consequential decisions a behavior analyst makes is not just what intervention to use, but how to approach the clinical question in the first place. For ethically assessing and addressing (or not) repetitive behavior, the difference between an evidence-based, individualized approach and a traditional, protocol-driven one can significantly impact outcomes.

This guide lays out the key factors side by side to support your clinical decision-making.

Side-by-Side Comparison

Factor	Evidence-Based Approach	Traditional Approach
Primary Purpose	Preference Assessment: Identifies relative preference among items and activities	Competing Stimulus Assessment: Identifies which items reduce automatically reinforced behavior
Relevance to Treatment	Preference Assessment: Informs reinforcer selection for skill building and alternative behavior programs	Competing Stimulus Assessment: Directly identifies materials for environmental enrichment and competing response treatments
Assessment Procedure	Preference Assessment: Presents items and measures approach, selection, or engagement without targeting a specific behavior	Competing Stimulus Assessment: Presents items and measures their effect on the rate of the target repetitive behavior
Outcome Measure	Preference Assessment: Percentage of trials selected or duration of engagement with each item	Competing Stimulus Assessment: Reduction in target behavior compared to a no-stimulus control condition
Relationship Between Results	Preference Assessment: High-preference items may or may not reduce the target behavior	Competing Stimulus Assessment: Effective competing stimuli may or may not be the individual's highest overall preferences
When Most Useful	Preference Assessment: When developing reinforcement systems for skill acquisition programs	Competing Stimulus Assessment: When developing treatments specifically targeting automatically reinforced behavior

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Clinical Decision Framework

Use this framework when approaching ethically assessing and addressing (or not) repetitive behavior in your practice:

Step 1: Is intervention warranted?

Does the data support a need for intervention? Is there a meaningful impact on the individual's quality of life, safety, or access to reinforcement?

YES → Proceed to assessment NO → Document reasoning, monitor

Step 2: Have you conducted an individualized assessment?

A functional assessment should guide intervention selection. Avoid defaulting to standard protocols without individual analysis. Consider environmental variables, setting events, and private events.

YES → Select evidence-based approach matched to function NO → Complete assessment first

Step 3: Is the individual/caregiver involved in decision-making?

Goals should be co-developed. Assent and informed consent are ethical requirements. The individual's preferences and values matter in selecting both goals and methods.

YES → Proceed with collaborative plan NO → Engage in shared decision-making

Step 4: Verify your approach

✓ Is your intervention matched to the assessed function?
✓ Are you using the least restrictive effective approach?
✓ Is assent being monitored throughout?
✓ Do you have a data collection plan?
✓ Is there a plan for generalization and maintenance?

Key Takeaways

Individualization is non-negotiable. The best approach for one individual may not be appropriate for another, even with the same topography.
Assessment drives intervention. Function-based approaches consistently outperform topography-based ones in the literature.
Ethics are active, not passive. Ethical practice requires ongoing analysis, not just initial compliance.
Document everything. Both the decision to intervene and the decision not to intervene require documentation and justification.
Stay current. The evidence base in this area is evolving. What was standard practice five years ago may not reflect current best practices.

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Workshop: Ethically Assessing and Addressing (or not) Repetitive Behavior — William H. Ahearn · 4 BACB Ethics CEUs · $105

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Clinical Disclaimer

All behavior-analytic intervention is individualized. The information on this page is for educational purposes and does not constitute clinical advice. Treatment decisions should be informed by the best available published research, individualized assessment, and obtained with the informed consent of the client or their legal guardian. Behavior analysts are responsible for practicing within the boundaries of their competence and adhering to the BACB Ethics Code for Behavior Analysts.