Expanding Horizons: How Staying Connected with Developments in Behavior Analysis Transformed My Therapeutic Approach to Autistic Children

Dear blog reader,

We had the pleasure to initially get to know our next contributor when came to Belgium to share part of our journey during the Odysseus research program (2015-2020) at Ghent University (Belgium) after which she went on to take some of the concepts emerging from that programme at the time and apply and develop them on another continent (South America) and at a different scale. Her remarkable ability and willingness to engage with recent developments in the field generally and then make them her own in the applied arena aligns perfectly with the theme of cooperation and collaboration within behavior analysis that we are hoping to reflect within the current blog series. Moving forward together, and drawing on the strengths you find in various areas of the discipline, seems like a far better strategy than dismissing or ignoring the work of others outside of your particular silo. Adopting such a strategy can only be to the benefit of behavior analysis as a science and a technology. So join us in welcoming Dr Carolina Silveira de Almeida as she reflects on her own research story and journey to this point.

Colin and Dermot

About the author:

Dr Carolina Silveira de Almeida attained her Ph.D. and Masters degrees in Psychology (Behavior and Cognition) at the Federal University of São Carlos (UFSCar), during which time she also conducted a research visit at Ghent University in Belgium (UGent, Belgium). Carol’s primary interests lie in the application of Behavior Analysis (and in particular Relational Frame Theory) to the treatment of children with developmental delays. She currently works as a clinical director and supervisor for cases involving children with Autism Spectrum Disorder (ASD) in Bauru (in the state of Sao Paulo, Brazil) and with professionals seeking their certification as Behavior Analysts.

Expanding Horizons: How Staying Connected with Developments in Behavior Analysis Transformed My Therapeutic Approach to Autistic Children

I have always been captivated by the intersection between Applied Behavior Analysis and Autism. After a year of working as a therapist post-undergrad, I believed I had a solid grasp of behavior analysis (BA). However, this very experience fueled my desire to deepen my understanding. Opting for a master’s degree at the Federal University of São Carlos (UFSCar) in 2013, I embarked on a transformative journey. During this time, I met my future husband, Dr. João Henrique de Almeida (click here for a recent post to the series written by Dr. de Almeida), and discovered Relational Frame Theory (RFT). Surprisingly to me at the time, behavior analysts did not widely discuss this theory in Brazil a bit more than a decade ago. My introduction to RFT occurred during a BA conference for which I was part of the organizing committee at UFSCar, where Dr. de Almeida delivered a captivating talk on this subject. The theory and his eloquent presentation immediately ignited my curiosity.

After his talk, we scheduled weekly meetings to explore what we felt was the profoundness of the 2001 RFT book (Hayes et al., 2001). With each encounter, I stepped further into a territory that would later completely reshape my worldview. It might sound like an exaggeration, but I assure you that is how profound a transformation I felt that RFT brought to my professional career. Like the unique perspective of behavior-analytic science and philosophy (another significant discovery in my professional life) I felt that the perspective on verbal behavior presented by RFT illuminated human behavior’s complexities and significantly broadened my perspective on the world.

My passion for working with autistic children propelled me into a career as a clinical technician, and later as a clinical supervisor. It also fueled my ambition to pursue a Ph.D., focusing on perspective-taking from an RFT perspective within this population. During my doctoral degree, an unexpected crossroads emerged: a scholarship opportunity for me to study abroad in the United States coincided with my husband’s opportunity to become a visiting professor under the guidance of Dermot Barnes-Holmes in Belgium. We faced a dilemma – I yearned to gain experience in a renowned Applied Behavior Analysis (ABA) service clinic in the United States while at the same time, João advocated for the RFT insights that would be available to us in Belgium. After much deliberation, we decided to pursue Dermot’s acceptance, temporarily postponing my dream of visiting an ABA clinic for another opportunity.

The research group in Ghent during Carol and Joao’s visit

During my time at Ghent University, a period I consider one of the most remarkable in my life, I expressed gratitude to João every day for persuading me to go. Weekly conversations with the RFT research group in Ghent, led by Dermot and Yvonne, were critical to developing what is now my perspective on the behavior-analytic approach to language and cognition. The essence of this new perspective lay in the work being done by the group on what is now termed “updated RFT” (click here, here, and here, for previous blog posts by Dermot, Maithri Sivaraman, and Colin that describe and explore some of these updates). Finally comprehending what João had tried to convey long before, RFT emerged as a game-changer for me and my thinking. Its impact on my clinical practice with autistic children was soon evident. The benefits of viewing the subtle and complex dynamics of arbitrarily applicable relational responding in the kids we were working with through the lens of these updates became impossible to ignore. Incorporating what we had learned into our programs for language deficits seemed to offer a certain precision I did not see before. Moreover, observing tangible results that not only benefited the children but that also transformed the experiences of the clinicians I supervised and the families we worked with felt exciting.

Joao and Carol (left) with Yvonne and Dermot Barnes-Holmes (right) during a research trip in Brazil in 2017

Second, I uncovered a treasure equally valuable – the generosity extended by Dermot and Yvonne. Beyond their academic expertise, their acts of kindness left a permanent mark. From inviting us into their home to patiently guiding our theoretical and clinical thinking, their generosity was remarkable. It is often said that people may not remember the specifics of what you did or said, but they will never forget how you made them feel. In Dermot’s British formality and Yvonne’s playful Irish manner of speaking, I discovered how the updates in RFT could elevate the world of the children I had been working with.

After my experience in Belgium, I returned to Brazil with some great new friendships and a newfound passion and determination for the work. I took what I learned there and with the help of my new friends and collaborators, sought to apply it to the work I was developing for my PhD. When I started my PhD journey in 2015, like most ABA practitioners, I was really interested in what we could to do to most effectively teach our kids to engage in meaningful social interactions, from basic (e.g., the ability to follow the gaze of the person they are interacting with) to complex (e.g., the ability to perspective-take). What critical behavioral repertoires were missing (basic and complex alike)? And what could we do in our interventions to most helpfully assist these children overcome significant social barriers? After the stay in Belgium, the updates in RFT that were emerging from the group at the time helped us get a good grasp on what questions we could be asking. A new conceptual framework had been offered in an attempt to help researchers and practitioners to think about variables important for derived relational responding, called the multi-dimensional, multi-level (MDML) framework (Barnes-Holmes et al., 2017). With this framework in hand, we decided to see how useful (or not) it could be to guide our conceptual and empirical analyses. I won’t go into all the details here, but it might be useful to give one example in which we decided to use the framework to assess, then teach and develop relational repertoires we hypothesised might be important for completing a simple perspective-taking task.

We took two children with similar developmental profiles, one with a diagnosis of autism (we’ll call him Frank) and one without (let’s call her Clare) and used the MDML to ask what behavioral units might be required for a basic perspective taking repertoire. We then developed a set of tasks to evaluate this in the 2 children. Conceptually, work from the Ghent group suggested (through the lens of the MDML) that at a particular behavioral repertoire was likely critical in demonstrating basic levels of perspective taking (Kavanagh et al., 2020). So we started there and asked if this repertoire is not evident, can a child demonstrate basic perspective taking skills? And if not, would establishing such a repertoire facilitate this performance?

Clare demonstrated basic levels of the relevant repertoire immediately and performed well on the perspective taking test. Frank, on the other hand, only demonstrated very basic patterns of arbitrary relating (nowhere near the level Clare had), and as you might expect, failed the perspective taking test. So we implemented a training procedure with Frank that was designed to train and test derived relations of increasing complexity, guided by the MDML framework, up to the level we had highlighted in our initial conceptual analysis (and that was demonstrated by Clare). This initially took quite a while (almost every day for around 3 months) and many novel exemplars. But once it was in place, and we re-exposed Frank to our simple perspective-taking test, he passed with flying colors! Although these data are preliminary and will certainly need to be replicated, the findings seemed to provide some support for our initial idea (i.e., the role of a particular relational repertoire in perspective taking abilities) and also emphasised for me the possibilities of utilizing updates and developments in the field to guide the questions we were asking (in this case, the MDML). We are currently writing up this study to submit for peer review and exploring other ways in which the framework might be usefully employed as an assessment and intervention tool more broadly (click here for a pdf presentation of a workshop we gave in ABAI a couple of years ago presenting some of our efforts, and here for a short presentation at the same conference presenting the experiment I just talked about).

Carol with Dr Siri Ming during a recent trip Siri made to Brazil

At the same time, the journey to complete my BCBA-D certification became a challenging yet rewarding endeavor, and under the guidance of Dr. Siri Ming, I delved deep into more advanced studies. Through Dr. Ming’s kindness and invaluable guidance, I solidified my expertise and passion for ABA. The practical application of my knowledge took shape as I had the privilege of delivering services in several private clinics as well as opportunities to work directly with families. The collaborative nature of working with families and the dynamic environment of private clinics added a certain depth to my understanding of the diverse needs within the autism community. Throughout this phase, what I had learned from my time in Ghent remained integral to my practice. The precision in language programming and the nuanced understanding of derived relational responding, inspired by my exposure to updated RFT, continued to shape how I approached each case. And completing my BCBA-D certification marked a personal milestone – it solidified my commitment to, and passion for, providing effective and compassionate care to autistic individuals and their families.

Today, I aspire to continue to actively disseminate recent developments in behavior analysis to ABA service providers across Brazil and to develop practical tools that facilitate the seamless implementation of these advances, ensuring that ABA professionals can deliver nothing less than the best interventions promised to our children and their families. In the landscape of evidence-based practice, staying in contact with research developments emerging in behavior analysis seems so important for offering the highest quality of care to support autistic individuals. I hope my story might help to inspire others to never stop exploring the most recent advances emerging in the field and to contribute to those advances as well.

References

Barnes-Holmes, D., Barnes-Holmes, Y., Luciano, C., & McEnteggart, C. (2017). From the IRAP and REC model to a multi-dimensional multi-level framework for analysing the dynamics of arbitrarily applicable relational responding. Journal of Contextual Behavioral Science, 6, 434-445. https://doi.org/10.1016/j.jcbs.2017.08.001

Hayes, S.C., Barnes-Holmes, D., & Roche, B. (2001). Relational Frame Theory: A post-Skinnerian account of human language and cognition. Plenum.

Kavanagh, D., Barnes-Holmes, Y., & Barnes-Holmes, D. (2020). The study of perspective-taking: Contributions from mainstream psychology and behavior analysis. The Psychological Record, 70, 581-604. https://doi.org/10.1007/s40732-019-00356-3