Piece de Resistance

When children with autism, or anyone for that matter, have difficulty following medical procedural requests, physicians are often forced to use restraint, sedation, or anesthesia, which can be problematic not only because it increases the levels of stress for the child, but also because doing so can alter test results themselves.

Children don’t do things you want them to do for the same reasons adults don’t; they have minds of their own and they choose not to. All of us find ourselves wanting to do certain things that we resist doing due to fear.

This resistance to change is the clay one works with as a therapist. On the deepest level, you could say that resistance is all there is, as Merleau-Ponty pointed out when he said that “we exist by virtue of our resistance to the world.”

But, one of my favorite quotes about resistance comes from the pen of the great systems thinker and one of my all-time heroes, Jay Haley, who said that,

there is no such thing as resistant clients, only incompetent therapists.

To Jay, clients were always willing; it was the therapist’s job to unlock the mystery of why they didn’t.

In the field, applied behavior analysts don’t talk about resistance very much, but, like all therapists, they spend their careers devising methods to overcome it. Theoretical quantitative behavior analysts do talk about resistance quite a bit though, and they have devised a theory called “behavioral momentum” to partially address the phenomenon.

In behavior analytic lingo (come on, this is fun), behavioral momentum theory can be described succinctly as: the change in response rates under conditions of disruption (Bx) relative to baseline response rates (Bo) are directly related to the force or magnitude of disruption (f) and inversely related to the rate of reinforcement in a stimulus context (r).

I will spare you the pretty formula, but it is rather pretty, trust me.

You Newtonians out there (you know who you are) will recognize this as a simple restatement of Newton’s second law. To say it in a truly simplistic way, if you throw an object its momentum will be determined by how hard you throw it and how much gets in its way. Or, in other words, if you get your butt off the chair it is more likely that the rest of your body will come along with you.

In a recent JABA article, some researchers at the Universite de Lille in the Nord de France led two boys with autism who had typically refused (or, we would say, had a history of noncompliance) to follow medical and dental examination requests through a behavioral momentum strategy.

The strategy, as the best strategies tend to be, was very simple: they had each of the children’s mothers present her child with a series of requests that each child had a history of complying well with, such as “turn,” “do this,” or “clap your hands.” Following the child complying with each of these requests, and of course providing reinforcement for doing so, the children were asked to do something they previously (during baseline) had refused to do, such as open their mouths for a dental examination.

Lo and behold, when the presumably obnoxious task was preceded by a series of non-noxious tasks, both children complied significantly more with the noxious requests.

So, bottom line, when you have a run of positive things happening to you, you are more likely to take a risk on the next thing, even if previously you hadn’t cared to.

One of the nice things about behavior analysis is that the techniques we use are ones we can easily try on ourselves, something that brain surgeons don’t often get to do. So the next time you find yourself avoiding something you want to do but can’t seem to bring yourself to do, try working up some behavioral momentum by preceding the noxious task with a series of pleasurable ones.

[Rivière, Vinca, Becquet, M., Peltret, E., Facon, B., and Darcheville, J., Increasing compliance with medical examination requests directed to children with autism: effects of a high-probability request procedure. Journal of Applied Behavior Analysis, 2011, 44, 193-197.]