Co-morbidity and FBA

In conducting a functional behavioral assessment, some of the first questions to address via indirect assessment are in regards to the individual’s medical history including diagnosis (or diagnoses), current medications, sleeping patterns, eating habits, etc… The primary reason for this is so the person conducting the assessment can determine how each of these factors, individually or combined, effect the behavior(s) being assessed.  It is important to differentiate between behaviors which can be targeted for change through behavioral intervention and behaviors which manifest as a function of a disorder or possibly a medication used to treat a disorder.  For example, years ago I worked with a student with PDD-NOS who consistently put his head on his desk and subsequently fell asleep every day when it was time for independent reading comprehension tasks.  Because reading comprehension was a weakness for him and he had a history of engaging in behavior to escape difficult work demands it appeared the behavior was escape motivated.  Upon discussing this with the parent however, I learned that the student also had a diagnosis of bipolar disorder for which he was on medication that made him tired when it began to wear off.  Had I attempted to intervene on the behavior I would probably have been unsuccessful and could have potentially set the occasion for a more severe problem behavior.  Instead, we rearranged the student’s schedule slightly for a few days, and found that he put his head down on his desk and subsequently fell asleep at the same time of day during different activities.  His doctor was able to rearrange his medication schedule, making him more alert throughout his school day.    

Perhaps the best way to mitigate the complicating factor of co-morbidity is to stay well informed.  Thoroughly interviewing parents on diagnoses, medications, and side effects is often the best place to start, and sometimes, depending on communicative abilities, the individual may have input as well.  (For example, several years ago my brother, who has ADHD was struggling academically and told me it would be easier for him to focus at school if he wasn’t always hungry.  My mother and I at the time thought he was eating breakfast at school.  We later discovered that his medication was suppressing his appetite, so he wasn’t eating much in the mornings.  He started eating prior to taking his medication and his focus improved resulting in an improvement in his academic performance.)   In some cases it may even be helpful to get a release to speak with an individual’s doctor and in many cases it can be helpful to do your own research, whether on potential side effects of medication or likely manifestations of a disorder.

I think what it basically comes down to is the point that was made in the video about Occam’s razor, that the simplest solution is best.  If a child is exhibiting pica for example, one should seek to determine if there is a medical etiology; perhaps a nutrient deficiency due to a limited diet or a current medication; prior to looking for a more complex explanation.  The rule of parsimony should always apply in behavior analytic research; one should always rule out the simplest explanations prior to looking for more complex explanations for behavior.