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Functional Behavioral Analysis

Just because a person doesn’t talk, doesn’t mean they have nothing to say.

Working with Patients with Communication Disorders

Begin by assuming that all patients are competent, and adjust as needed. In patients with communication disorders, illness tends to present as a change in behavior or function. Often, the most direct way to discover the function of a behavior is to ask your patient. This step is often skipped because people make assumptions. If you ask, you may be surprised to get an important response. Attend to non‐verbal responses and give adequate time for a response. Offer supports, such as visuals, choices or augmentative and alternative communication devices.

If your patient does not use language, their behavior may be a form of communication. For example, someone who refuses to eat may be experiencing dysphagia or depression. Therefore, it is critical to document baseline behavior and function. If a new behavior makes a patient easier to care for, sometimes caregivers won’t think to mention it. For example, caregivers may not mention decreased activity level, amenorrhea or constipation. At every visit, ask your patient and their caregiver if there has been a change. If a behavior makes the patient more difficult to care for, the focus may be on eliminating the behavior. This can distract the team from thinking about what the patient is communicating. For example, if a patient bangs their head, the immediate concern may be to protect a patient from injury. The team may not consider the need for a dental, hearing or vision exam. Patients are particularly vulnerable when there is a change in caregivers or during transitions. Caregivers who don’t know a patient well can miss an important change. Clinicians can provide important continuity during these periods.

Functional Behavior Analysis (FBA)

FBA is a technique for interpreting behavior in people with communication disorders. It is especially useful in people with autism and intellectual disabilities. The basic principle of FBA is to choose a target behavior and then analyze patterns in what happens immediately before and after. For example, a caregiver may complain that their loved one has become combative. A FBA shows that the behavior begins within an hour of taking a newly prescribed medication. One of the side effects is headache. After changing the medication, the behavior stops.

Where to Get Help

If you need help interpreting or supporting the behavior of a person with a developmental disability, you may need a behaviorist, special educator, or speech therapist on your team. Therapists experienced in DD are typically accessed through university clinics, school districts, group homes, or the Department of Developmental Services system, (e.g. Regional Center). Therapists work with patients and caregivers in natural settings, such as their home or day program.

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