I am very pleased indeed to introduce Dr. Sarah Cassidy, of Smithsfield Clinic and Maynooth University, Ireland. Sarah is one of those amazing people who leave you scratching your head trying to fathom how they manage to cram 48 hours of productivity into every 24 hours. She is an Educational Psychologist and Behavior Analyst who runs her own very busy Child Psychology clinic for children with a wide variety of concerns, lectures on the Educational Psychology programs at Maynooth University, is co-owner of on online company (RaiseYourIQ.com), is very active in promoting behavior analysis in public domains, while at the same time being a supermom to her young family. Sarah is a very engaging public speaker with a pragmatic understanding of the promises and challenges of transferring and adapting knowledge from lab research work to the acid test of real-world domains. She is an excellent example to all scientist-practitioners of all genders, not just female. Enjoy this great blog. – Dr. Ian Tyndall, University of Chichester, UK
Why Bridgework matters and Yes, we can raise your IQ. Dr. Sarah Cassidy
Bridgework matters. It is something that behavior analysts need to take a lot more seriously and indeed to make far more intensive attempts to work together with other clinicians, scientists, educators and other allied professionals. Ultimately, what matters most in this field is doing good science and creating interventions that actually work in real time for real people. If we get caught up too much in the language, the ‘correct’ theoretical perspective and the politics that goes along with all of that, then there is a danger that we might forget what we came here for in the first place; to foster meaningful changes in the lives of populations of people who most need our help. Most of us came to psychology with the naïve and perhaps idealistic notion that we could actually help real people. Well, we cannot do that if we never leave the lab or the ivory tower. In this blog, I’m going to talk a little bit about how I came to doing this work, how I believe passionately in bridgework and how I believe Relational Frame Theory (RFT) has uncovered the fundamental building blocks that lay underneath what intelligent behavior is (See Cassidy, Roche & O’Hora, 2010 for conceptual analysis, See Cassidy, Roche & Hayes, 2011, for the first empirical paper demonstrating the efficacy of this approach). While our research has primarily applied these building blocks to improving intellectual skills thus far, there is good reason to believe that relational training interventions have scope for improving a wide array of psychological difficulties faced by modern society. As this is a blog, a more casual approach will be taken than in other papers in an attempt stimulate a freer discussion of the grey areas of this work because it is only in an open discourse that we can really begin to separate the wheat from the chaff. And when we can discuss amongst our peers the parts of interventions that we understand in functional ways, alongside of our observations and hunches that we cannot yet fully explain and then merge all of that information together with the experiences of knowledgeable others, then and only then, can we truly begin to chip away at the mysterious iceberg of the human condition.
Firstly, I have a confession to make. I was not always a behavior analyst. I came to behavior analysis out of a frustration that in my work as an educational psychologist in Ireland, all we seemed to be doing was diagnosing learning and emotional/behavioral difficulties. We never seemed to be doing any interventions. I wondered why we were doing assessments when we were not then following those assessments up with meaningful and effective interventions. Now don’t get me wrong, assessment is a necessary first step in determining how best to devise any good support plans and I’m a staunch supporter of early assessment and intervention. Who isn’t? Also, I think that parents and teachers are amazing human beings who are usually doing their very best with extremely limited resources. In fact, I think parents should be given a superhero cape and maybe a halo as they leave the hospital with their newborn babies because that is what they will need to do the job of rearing an entire human person! And even if we doubled or tripled every teacher’s salary right now, it still would not in any way be commensurate with all of the tremendous work that they do on a daily basis. But I was struck by the fact that my job included going into schools, meeting parents and teachers, conducting an assessment with a child, and then making a list of recommendations for how parents and teachers could best support any identified learning or emotional/behavioral difficulties uncovered. But what good is this list if it is not followed by meaningful and effective action? How can we take these actions when there is a real poverty in what we are recommending for any sort of learning difficulty? Of course, the quality of the learning support available also varied hugely from teacher to teacher, school to school and county to county. It seemed that there simply was no agreement on which strategies worked best and/or how to carry them out even in cases where there was agreement. It also seemed that the education system and the health services were so often involved in a gigantic game of ‘pass the parcel’ that nobody was actually doing the interventions even when we did know what would work. So when there was a need to send a child on to the health service for further investigation of any sort of neurodevelopmental or mental health difficulties or to query any type of difficulties (e.g., speech and language, occupational therapy, etc), children would be placed on a waiting list that was so long that if they did not start out with the mental health difficulty, they could certainly have one by the time they navigated the hugely frustrating health service to access supports! And even once they were accepted by a local health service, they might only be given one block of therapy. Both schools and health services in Ireland (and I’m sure this isn’t unique to Ireland) seem to be so poorly resourced that even with the best of intentions, the interventions that are there cannot always be carried out in an efficient or effective manner. It was this frustration that led me to investigate doing further research on developing effective behavioral interventions. These are the circumstances that led me to seek out working with Dr. Bryan Roche, which converted me to a behavior analyst and an RFT afficionado almost immediately, and sealed my fate at commencing a PhD under his supervision.
Our work, together with many others in the RFT community, has shown that relational frame training interventions are useful for increasing a variety of skills. Our specific work relates to fostering increases in IQ (i.e., Intelligence Quotient) using an on-line RFT intervention that we refer to as SMART (Strengthening Mental Abilities Using Relational Training). We have now demonstrated that RFT can increase IQ scores on standardised psycho-educational assessment measures. We’ve seen that these IQ rises are not only maintained four years later, but in some instances that they continued to rise. Other RFT researchers (e.g., Hayes & Stewart, 2016) have demonstrated that SMART training has yielded better outcomes on a range of measures (e.g., IQ scores, literacy, numeracy, spelling, attention skills, etc) than other well known and respected computer coding programmes (i.e., Scratch) that are widely considered to be very helpful for improving problem solving ability. We’ve seen that raising young persons’ IQ scores is not just isolated to the IQ test itself, but that fostering these rises has an impact on students’ scholastic ability on completely separate measures of academic skills). In addition, the scholastic ability measures were administered online and were scored by a completely blind third party psychometric testing company. These results showed that the experimental group had statistically significant rises in reading, mathematics and overall educational aptitude. Such studies (see also Colbert, Tyndall, Roche & Cassidy, 2018) have endeavored to answer a number of previous criticisms of the work because the both IQ testers and the teachers administering the training and testing were blind to the students’ group membership. The IQ rises seen in the experimental group in the Colbert et al. (2018) study were large and statistically significant. The randomly assigned control group saw no IQ rises.
It’s also important to note that these findings are not isolated to increasing IQ scores of Irish school children of a certain age. Indeed, Amd and Roche (2017), demonstrated that students who received the most training in SMART showed significant IQ gains on the Ravens Matrices (RPM) in a group of social disadvantaged children in Bangladesh. We have some, as yet unpublished work showing that we can increase literacy, spelling, attention skills and scores on self reported measures of self esteem in adults returning to education (Cassidy, Roche, Gannon and Tyndall, in preparation). We also have some work showing significant improvements in IQ score, tests of every day attention and working memory) with larger groups of students in Abu Dhabi (Roche, Grey, Cassidy, Colbert and Stewart, in preparation) as compared to matched controls. Finally, a study has recently shown that improvements are also seen on measures of response fluency on IQ tests after using SMART training.
As the reader can see, in a typically behavior analytic fashion, we have been slowly building our groundwork, understanding how our foundation works before building upwards. We have been building these bridges, though admittedly firstly with others that are also within the behavior analytic tradition. (And watch this space for some really exciting upcoming collaborations with Dr. Nanni Presti in Sicily, Italy and with Dr. Lisa Coyne at McLean Hospital, Harvard University Medical School, as well as several others with Dr. Ian Tyndall). But Shane McLoughlin is right in his blog that we need to do more bridgework with those outside of the behavior analytic tradition. While the body of research that supports the efficacy of SMART training is growing quickly, we need to go a lot further than this. We have spent too long inadvertently alienating other psychologists and clinicians in an effort to get there first or to be most right. Those behaviorists criticizing this work to date on the grounds that the numbers are small may not understand how time and labour intensive it is to individually administer an IQ test. After all, behavior analysts have not typically been interested in constructs like IQ. A cognitive psychologist, on the other hand, would likely understand very well the importance of understanding the numbers that contribute to a full scale IQ and how scoring high or low in certain indices might have meaning in lots of other areas of a person’s life. However, those cognitive folk who are also criticizing this work on the grounds that the n numbers are too small may not understand that this is sometimes a necessary part of understanding functionally every single piece of what we are doing in an intervention before we upscale and spread our wings to larger groups and to different populations. This is precisely why behavior analysts often work with single subject designs. If we go too fast or with a group that is too big, we run the risk of not understanding all the variables at play and thus having poor control of the intervention. However, if we borrow from the vast information pool of our cognitive friends and if they can have respect for our functional ways, we might just get some place that is useful for all of the people that attend our services, irrespective of their tradition.
Are there still a great many hurdles to cross? Yes, of course there are and there are certainly many pieces that still need to be worked out in relation to issues like optimal numbers in a room during group administrations or if that matters. We would also like to know the effect of teacher versus parent in the room versus no supervision at all during the training. I also have a hunch that teacher or parent “buy-in” may matter more than we would like to think, though this should come as no surprise to any parent or teacher trying to preach to the converted in any arena (health, exercise or the benefits of a good night’s sleep!). These are all empirical questions and I hope that, in the spirit of scientific enquiry, we can begin to answer them.
To answer these questions, the labbies (i.e., lab researchers) and the ivory tower nerds need to step into the ecologically valid real world settings of clinics and schools. We need to borrow from each other’s expertise to create meaningful and effective interventions that do not just work in labs or textbooks, but also that work in real life settings with real live people who are complicated and noisy. The behaviorists need to stop shaming the other psychologist on the playground for their use of “bad” language. The cognitive folk need to remember that the modern behavior analyst is not the same as what was represented in One Flew Over the Cuckoo’s Nest or The Clockwork Orange. But the modern behavior analyst is still interested in prediction and control, not for the sake of prediction and control, but for helping people to reach their individual human potential, wherever that potential might lay.
If we are to find the answers to our questions and to many other unanswered scientific questions, we need to keep on doing the digging and the risking of wrongness in an effort to find what works best for individual n’s and yes, for large n’s too. Of course, there may be some limits to human learning (See Steve Hayes’, 1993 response to Howard Lerner’s chapter on human development, two-headed arrows and wrong-headed questions) but how arrogant is it to assume that we already know where those limits are? We do not and we will not, until we reach them.