Aug 30, 2009

Behavior Modification

In my training and experience as a special education teacher I was immersed in behavior modification. During my training I was doing some volunteer work at an agency which served individuals with significant cognitive and physical disabilities. They relied solely on behavior modification. Upon leave I suggested to the director it might be nice to blend more a humanitarian approach with the behavior modification (which seemed quite harsh to me). He responded that they used behavior modification because "it works". As I applied my skills at managing behavior of children with disabilities, I realized he and I were both right. One can use behavior modification with the focus on the dignity, well being and respect for the person (s) one is trying to help change behavior. So, here is a simplified behavior modification approach that can be used with someone with dementia.
A. Antecedent: What occurs before the behavior?
B. Behavior
C. Consequence: what occurs as a result of the behavior?
Example from my life:
A. Antecedent: Phone rings when I am outside.
B. Behavior: Dwane answers the phone and forgets to tell me there was a phone call.
C. Consequence: I miss returning an important phone call.

While there are many complicated things one can do to change behavior, my favorite strategy and the one which prevents the most problems, is to change the environment to prevent the behavior and/or consequence. Since I cannot control Dwane and his memory, I chose to change the environment and pay an extra $5 to our phone company for caller id. Then, all I have to do is check the caller id to see who called, rather than rely on Dwane to remember to tell me.

This is the same strategy I implemented when I was parent of young children. I knew parents who wanted to teach their child "no" and would speak harshly to them and slap their hand if they reached to touch something breakable. I noticed this approach and decided to make my home "child friendly" by removing unnecessary breakable items. I am doing the same with my home now. I am making it "friendly" for someone with dementia by removing, changing, adding whatever I notice will better support his freedom and our serenity.

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