ABA in the Treatment of Aggression and Impulse Control

Applied behavior analysts are health care professionals who use research and analysis to understand why behavior occurs. They apply behavior interventions based on ABA, or applied behavior analysis. Their skills can benefit many different behavior disorders and can help increase social functioning and well-being. Often, applied behavior analysts have been associated with creating applied solutions to behavior problems experienced by children and adults with autism spectrum disorders and other developmental disorders. Aggressive behaviors and impulsiveness are not in and of themselves developmental disorders. Instead, they are behaviors or symptoms which can co-occur with a diagnosis of developmental disorders, psychological disorders, or conditions of aging, like Alzheimer’s and dementia.

Related resource: Top 15 Best Applied Behavior Analysis Online Programs

–Which Diagnoses Can Express Aggressive Behavior, Anger, and Impulsiveness as Symptoms?

While any person can become aggressive or struggle with impulsive behavior, ABA specialists often see patients with aggression and poor impulse control with diagnoses that include:

  • Conduct disorder
  • Oppositional defiant disorder
  • Intermittent explosive disorder
  • Autism Spectrum Disorder (ASD)

–Behavioral Challenges With Aggression and Impulse Control

Aggression and impulsive behavior provoke immediate reactions from others. A child with limited verbal ability who is uncomfortably cold or hungry may cry out or strike a family member or instructor to be fed or warmed up. Caregivers will naturally respond quickly to such signs of distress. Even if the child is punished instead of having their needs met, the behavior still produced a quick response. In this way, the behavior is rewarded. A 1999 study published in the Journal of Applied Behavior Analysis found that children with impulse control responded to small, immediate reinforcing responses such as access to food or television.

–Behavioral Issues Related to Aggression and Impulse Control Have Behavioral Solutions

Quick attention rewards provided to children or others with aggressive behaviors or poor impulse control caused challenges for applied behavior analysts. After recognizing that the quick rewards of attention and having their needs met only served to increase undesirable aggressive behavior, analysts developed a strategy of no reward and no acknowledgment of aggression. Instead, caregivers are trained to use a technique called neutral redirection.

Using Neutral Redirection to Control Aggression and Poor Impulse Control

Caregivers using neutral redirection are instructed never to respond to aggressive behavior and impulses with punishment or meeting the child’s needs. They are trained to calmly redirect the child to use socially-acceptable behavior to signal their needs. For example, the child may be told to tap their caregiver on the arm or use hand gestures to communicate needs. Caregivers are also taught not to reward the aggressive impulse with direct eye contact.

If the child is expressing an inappropriate need, a second step can be added. For instance, if a child aggressively demands a snack outside of mealtime, the caregiver can use visual indicators that acknowledge the request but indicate that the need will be met at a later time.

Neutral redirection’s goals are to provide positive reinforcement for impulse control and to provide rewards for the desired alternative, non-aggressive and non-impulsive behaviors.

Positive Feedback to Reward Non-Aggressive Behaviors

Recognizing that any direct feedback following aggressive behavior can reinforce the behavior, ABAs have also developed methods of providing positive feedback for improved impulse control. Positive feedback works best, ABAs report, when it is provided during stressful times that can cause aggressive outbursts. Praise and positive reinforcement can be offered before any outburst occurs and can help to build more appropriate, non-aggressive behavior.

–Working With Adults With Aggressive Behavior and Poor Impulse Control

Some applied behavior analysts work with adults who are involved in the criminal justice system or adult care environments. Adults with impulse control problems and aggressive behavior issues are more dangerous than children. Behavior modification techniques for adults that help to reduce aggressive behavior include contingency management systems.

Among prison populations, a token economy is one of the most prevalent contingency management systems. Tokens or vouchers are awarded for non-aggressive, socially appropriate behavior. Tokens are removed for any lapse in anger control or impulse management.

A 2014 study published in the Journal of Criminal Justice and Behavior found that contingency management programs produced positive results in prison populations, including:

  • Improved work assignments
  • Increased pro-social behaviors
  • Improved involvement in educational programs

–Preparing for a Career Working With Individuals With Aggression and Impulse Control as an Applied Behavior Analyst

If you are training to become an applied behavior analyst, and particularly if you are planning to become a Board Certified Behavior Analyst (BCBA), you already know that you will experience angry, aggressive behavior. No matter whether you will be working with children with Autism Spectrum Disorder (ASD), or with older patients experiencing dementia, or as part of the criminal justice system, you will encounter aggressive, inappropriate behavior that could present a danger to you and the patient.

Your education at the undergraduate and graduate level will provide you with evidence-based interventions that you can implement as you begin your career. If you are entering graduate school to receive your master’s degree, you will be engaging in your practicum, or performing an internship or volunteer service. You can gain exposure to common aggressive behaviors, and observe experienced ABAs in applying solutions to the behavior problems.

–Further Reading on Applied Behavior Analysis In the Treatment of Aggression and Impulse Control

The ABA Toolbox provides many resources for ABAs, including information on positive behavior supports, response training, and token economies.

The Talk About Curing Autism organization features an article about “Dealing With Aggression in ASD” by Holly Bortfield.

ABAs who are interested in working with older patients will want to read the Alzheimer’s Association’s web resources for caregivers on aggression and anger in patients with Alzheimer’s and dementia.

ChildMind.org offers a simple guide of “dos and don’ts” for parents of young children with aggressive behaviors and anger control issues.

If you are interested in working in the juvenile corrections system, Corrections One’s article on “Understanding Aggression in the Juvenile Inmate” by Tracy Barnhart provides an in-depth perspective on causes of inmate aggression and behaviorally-based solutions.