Children who are Deaf or hard of hearing are more likely to exhibit challenging behavior, which can be both internal (such as anxiety, depression, and social withdrawal) and external (such as property destruction or aggression). One of the primary risk factors for the development of challenging behavior in this population is language deprivation, as these children may not have access to language and struggle to communicate their wants and needs effectively. This can lead to challenging behavior becoming their primary method of communication, rather than learning to express themselves using words and phrases like “I want” or “Stop that”.
One method for managing challenging behavior in deaf and hard of hearing children is to implement Applied Behavior Analysis (ABA) interventions. This involves determining the root causes of the challenging behavior through a thorough analysis and developing personalized interventions that target those causes. The goal of ABA is to teach children new skills and behaviors to help them communicate their needs effectively and minimize the occurrence of challenging behavior.
What is Applied Behavior Analysis (ABA)?
Applied Behavior Analysis (ABA) is a scientific discipline which uses the principles of learning theory to improve socially significant behaviors. It is often used in educational settings to help children with learning disabilities and other special needs reach their academic goals. ABA focuses on identifying the underlying causes of challenging behavior and developing individualized interventions to address those causes. This may involve teaching the child new communication skills, such as sign language or the use of assistive technology, to help them express their needs and wants more effectively.
Additionally, ABA may involve teaching the child replacement behaviors, such as requesting help or taking a break, to replace challenging behavior. Through ABA interventions, children who are deaf or hard of hearing can learn new skills and improve their communication abilities, which can ultimately lead to a reduction in challenging behavior and improved quality of life.
Is “Deaf ABA” a field?
You may be wondering why the term “Deaf ABA” is used. After all, we don’t refer to “Russian ABA” or “American ABA” based on a person’s country of origin. However, it’s important to recognize that deaf and hard of hearing children cannot be taught using the same methods as hearing children who are unable to hear. “Regular ABA” is not suitable for working with deaf kids. Deaf children experience the world in a fundamentally different way than their hearing peers. Their development, understanding of the world, ability to communicate, and support needs are all unique. Deaf ABA presents unique opportunities to learn about human behavior, language development and the way we function in the world.
Okay, so you understand why it’s important to distinguish what Deaf ABA is… but can we truly call it a field? The point at which an area of research becomes a field is somewhat subjective and depends on a wide variety of factors. According to the National Science Foundation, a field is defined as “a community of researchers who share a common set of research problems and methods, and who communicate and collaborate with each other regularly” (NSF, 2020).
For example, the field of ABA emerged from research on the principles of behavior and their applications in various settings. As the body of research and practical applications grew, professional organizations like the Behavior Analyst Certification Board (BACB) were established, along with training programs and standards for practice. Deaf ABA is an area of study that is currently in its emerging stage and has yet to establish well-defined theories, practices, or standards. Despite being researched for over 50 years, there is still much to be explored in this field. Signs of Communication, LLC is committed to being at the forefront of supporting more Deaf individuals to become experts in the field. By doing so, we hope to contribute to the development and advancement of Deaf ABA and support Deaf people everywhere.
What is Evidence Based Practice?
According to the Behavior Analyst Certification Board (BACB), evidence-based practice in behavior analysis refers to the integration of the best available research evidence, clinical expertise, and client values to inform clinical decision-making and treatment planning. The BACB emphasizes the importance of using research evidence as a foundation for clinical decision-making, but also recognizes the importance of clinical expertise in applying that evidence to individual cases. They highlight the importance of considering client values and preferences in treatment planning and decision-making. When integrated, these components form the foundation of evidence-based practice, which is tailored to meet the unique needs of individuals receiving services.
When considering the use of Deaf ABA, it is crucial to conduct a comprehensive evaluation of the evidence for the effectiveness of ABA strategies with Deaf individuals. This evaluation should be informed by both personal competence and clinical reasoning skills, as well as clinical experience. Additionally, the values and preferences of the individual and their family must be incorporated into the decision-making process. By breaking down each of these components, we can determine whether or not Deaf ABA is an evidence-based practice.
Client Values & Perspectives
Including the individual’s values and preferences as part of evidence-based practice means taking into account their unique beliefs, attitudes, and opinions when making decisions about their treatment. This includes respecting their cultural and linguistic background, their personal goals and priorities, and their level of comfort with different types of interventions.
Including the values and preferences of Deaf individuals as part of evidence-based practice is particularly important because Deaf culture and language are unique and distinct from the dominant hearing culture. For example, many Deaf individuals prefer to communicate through sign language rather than spoken language, and may have different cultural beliefs and practices. Clinicians who are working with Deaf individuals must be aware of and respectful of these differences, and should incorporate them into the decision-making process when developing interventions.
This may involve working with the individual and their family to identify specific goals and priorities, as well as consulting with Deaf cultural experts to ensure that interventions are culturally appropriate and respectful. By including the values and preferences of Deaf individuals, clinicians can help to ensure that interventions are effective, culturally sensitive, and respectful of the individual’s unique needs and circumstances.
Clinical Reasoning & Judgment
Using clinical judgement and clinical expertise is particularly important when working with Deaf individuals because their communication needs and cultural context are unique and different from the mainstream hearing culture. Clinicians working with Deaf individuals should have specialized knowledge and training in Deaf culture and language, as well as the ability to communicate effectively in sign language.
In addition, they should have experience working with the particular population and be familiar with the range of potential challenges and barriers that may arise. They must recognize that Deaf individuals may have different communication preferences, social experiences, and attitudes towards hearing people, and should use their clinical judgement to tailor their interventions accordingly. Deaf individuals may experience unique forms of trauma related to their experience of language deprivation, communication barriers, or discrimination.
By combining their clinical judgement and expertise with the available evidence, clinicians can develop individualized treatment plans that are culturally sensitive, linguistically appropriate, and respectful of the individual’s unique needs and circumstances. If you have no prior experience working with Deaf individuals, it is important to educate yourself on Deaf culture, language, and community. This can be done through reading articles, attending workshops or training sessions, or consulting with experienced professionals in the field. This is something that we offer here at Signs of Communication, LLC.
Research Evidence
It is important to note that ABA therapy has been used with Deaf and hard of hearing individuals for over 50 years, with a significant amount of research published on the topic. While most of the research has been published in behavior analytic literature, such as the Journal of Applied Behavior Analysis, The Analysis of Verbal Behavior, and The Experimental Analysis of Behavior, there are also articles published in other journals. Additionally, there are many articles that have been published outside of behavior analytic literature that utilize ABA principles and techniques, although they may not be clearly labeled as such. As time goes on, expect to see some of these broken down into more information from us!
Dr. J. Grayson Osborne was a pioneer in the use of Applied Behavior Analysis (ABA) with the Deaf Community. He conducted research at the New Mexico School for the Deaf in the late 1960s and published several articles in the Journal of Applied Behavior Analysis (JABA) in 1969. One of these articles was titled “Free-time as a reinforcer in the management of classroom behavior” and focused on six Deaf students in a classroom setting. The study involved providing reinforcement in the form of free time to the students for remaining seated in the classroom. The results showed a significant improvement in the amount of time the students spent seated, rather than getting up and leaving their chairs. This research was one of the earliest examples of the use of ABA techniques with the Deaf community.
The author states that “If the aversiveness of the regular classroom environment is granted […] the presentation of free-time may have constituted an escape conditioning procedure. That is, by remaining seated for a given period of time, the subjects could escape seat work and the teacher’s formal presentation for a 5-min period, while those who had been out of their seats in the preceding segment had to continue working” (Osborne, 1969). He also suggests that the free-time periods could have been positive reinforcers because the students had the opportunity to chat with peers or get water.
It’s important to consider the context and cultural factors as well. In the 1960s, when Dr. Osborne conducted his research, it was likely that these students had little exposure to American Sign Language in their home environments and may not have been allowed to sign during class. The fact that free time was a highly valued reinforcer for the Deaf students in Dr. Osborne’s study could also be related to the lack of language access and social interaction opportunities they experienced in the classroom. Without access to a shared language and communication modality, students may have had fewer opportunities to engage in social interaction and play during class time, making free time all the more desirable.
Additionally, their initial out-of-seat behavior may have been reinforced as a method of escape from classwork because if they were not looking at their teacher, they likely had no idea what she was saying. Thus, when implementing ABA strategies with Deaf individuals, it’s important to consider the cultural and linguistic factors that may contribute to challenging behaviors, as well as the individual’s preferences and values regarding communication and social interaction.
Bibliography
The following is a list of 50+ Applied Behavior Analysis studies with Deaf and hard of hearing individuals. As time goes on, we plan to describe more of these studies and the lessons learned from them. This is not a complete list… but it’s hopefully enough to get you thinking!
Osborne J. G. (1969). An inexpensive token. Journal of applied behavior analysis, 2(2), 100. https://doi.org/10.1901/jaba.1969.2-100
Osborne, J.G. (1969). Free-time as a reinforcer in the management of classroom behavior. Journal of applied behavior analysis, 2 2, 113-8 .
Osborne, J. G., & Wageman, R. M. (1969). Some operant conditioning techniques and their use in schools for the deaf. American Annals of the Deaf, 741-753.
Craig, H.B., & Holland, A.L. (1970). Reinforcement of visual attending in classrooms for deaf children. Journal of applied behavior analysis, 3 2, 97-109 . https://pubmed.ncbi.nlm.nih.gov/16795251/
Mira, M.P. (1972). Behavior Modification Applied to Training Young Deaf Children. Exceptional Children, 39, 225 – 229.
Garrard, K.R., & Saxon, S.A. (1973). Preparation of a disturbed deaf child for therapy: a case description in behavior shaping. The Journal of speech and hearing disorders, 38 4, 502-9 .
Martin, J.E., & Sachs, D.A. (1973). The effects of visual feedback on the fine motor behavior of a deaf cerebral palsied child. The Journal of nervous and mental disease, 157 1, 59-62 .
Wilson, M.D. and McReynolds, L.V. (1973), A PROCEDURE FOR INCREASING ORAL READING RATE IN HARD-OF-HEARING CHILDREN. Journal of Applied Behavior Analysis, 6: 231-239. https://doi.org/10.1901/jaba.1973.6-231
Bennett, C.W. (1974), ARTICULATION TRAINING OF TWO HEARING-IMPAIRED GIRLS. Journal of Applied Behavior Analysis, 7: 439-445. https://doi.org/10.1901/jaba.1974.7-439
Forehand, R., Cheney, T., & Yoder, P. (1974). Parent behavior training: Effects on the non-compliance of a deaf child. Journal of Behavior Therapy and Experimental Psychiatry, 5, 281-283.
Smeets, P.M., & Striefel, S. (1975). The effects of different reinforcement conditions on the test performance of multihandicapped deaf children. Journal of applied behavior analysis, 8 1, 83-9 .
Sundberg, M. L., Michael, J., & Peterson, N. (1977). Sign language: A behavioral analysis and applications. Western Michigan University Behavioral Monograph #1.
Sundberg, M. L. (1978c). New directions for deaf education. Western Michigan University Behavioral Monograph #8, Kalamazoo, MI.
Heward, W.L., & Eachus, H.T. (1979). Acquisition of adjectives and adverbs in sentences written by hearing impaired and aphasic children. Journal of applied behavior analysis, 12 3, 391-400 .
Sundberg, M. L. (1980). Developing a verbal repertoire using sign language and Skinner’s analysis of verbal behavior. Western Michigan University.
Van Houten, R., & Nau, P.A. (1980). A comparison of the effects of fixed and variable ratio schedules of reinforcement on the behavior of deaf children. Journal of applied behavior analysis, 13 1, 13-21 .
https://pubmed.ncbi.nlm.nih.gov/7364692/
Tucker, D. J., & Berry, G. W. (1980). Teaching severely multihandicapped students to put on their own hearing aids. Journal of applied behavior analysis, 13(1), 65–75. https://doi.org/10.1901/jaba.1980.13-65
Hundert, J. (1982). Training teachers in generalized writing of behavior modification programs for multihandicapped deaf children. Journal of applied behavior analysis, 15 1, 111-22 .
https://pubmed.ncbi.nlm.nih.gov/6212568/
Jones, T.W. (1984). Behavior Modification Studies with Hearing-Impaired Students: A Review. American Annals of the Deaf, 129, 451 – 458.
https://pubmed.ncbi.nlm.nih.gov/6398627/
Berg, W.K., & Wacker, D.P. (1989). Evaluation of tactile prompts with a student who is deaf, blind, and mentally retarded. Journal of applied behavior analysis, 22 1, 93-9 .
https://pubmed.ncbi.nlm.nih.gov/2708177/
Mathy-Laikko, P., Iacono, T., Ratcliff, A., Villarruel, F., Yoder, D.E., & Vanderheiden, G.C. (1989). Teaching a Child with Multiple Disabilities to Use a Tactile Augmentative Communication Device. Augmentative and Alternative Communication, 5, 249-256.
Luiselli, J. K. (1989). Behavioral feeding intervention with deaf-blind, multihandicapped children. Child & family behavior therapy, 10(4), 49-62.
Barnes, D., McCullagh, P. D., & Keenan, M. (1990). Equivalence class formation in non-hearing impaired children and hearing impaired children. The Analysis of verbal behavior, 8, 19–30. https://doi.org/10.1007/BF03392844
Selinske, J. E., Greer, R. D., & Lodhi, S. (1991). A functional analysis of the comprehensive application of behavior analysis to schooling. Journal of Applied Behavior Analysis, 24(1), 107-117.
Rasing, E.J., & Duker, P.C. (1992). Effects of a multifaceted training procedure on the acquisition and generalization of social behaviors in language-disabled deaf children. Journal of applied behavior analysis, 25 3, 723-34 .
Rasing, E.J. (1993), EFFECTS OF A MULTIFACETED TRAINING PROCEDURE ON THE SOCIAL BEHAVIORS OF HEARING-IMPAIRED CHILDREN WITH SEVERE LANGUAGE DISABILITIES: A REPLICATION. Journal of Applied Behavior Analysis, 26: 405-406. https://doi.org/10.1901/jaba.1993.26-405
Stromer, R., Mackay, H.A., Howell, S.R., McVay, A.A. and Flusser, D. (1996), TEACHING COMPUTER-BASED SPELLING TO INDIVIDUALS WITH DEVELOPMENTAL AND HEARING DISABILITIES: TRANSFER OF STIMULUS CONTROL TO WRITING TASKS. Journal of Applied Behavior Analysis, 29: 25-42. https://doi.org/10.1901/jaba.1996.29-25
Ducharme, D. E., & Holborn, S. W. (1997). Programming generalization of social skills in preschool children with hearing impairments. Journal of applied behavior analysis, 30(4), 639–651. https://doi.org/10.1901/jaba.1997.30-639
Thompson, R. H., McKerchar, P. M., & Dancho, K. A. (2004). The effects of delayed physical prompts and reinforcement on infant sign language acquisition. Journal of applied behavior analysis, 37(3), 379-383.
Easterbrooks, S., & Handley, C.M. (2005). Behavior Change in a Student With a Dual Diagnosis of Deafness and Pervasive Development Disorder: A Case Study. American Annals of the Deaf, 150, 401 – 407.
Crockett, J. L., & Hagopian, L. P. (2006). Prompting procedures as establishing operations for escape‐maintained behavior. Behavioral Interventions: Theory & Practice in Residential & Community‐Based Clinical Programs, 21(1), 65-71.
Dempsey, D. J. (2007). An experimental analysis of opportunity and communication response form in a child with autism and hearing impairments. University of North Texas.
Thompson, R. H., Cotnoir‐Bichelman, N. M., McKerchar, P. M., Tate, T. L., & Dancho, K. A. (2007). Enhancing early communication through infant sign training. Journal of applied behavior analysis, 40(1), 15-23.
Malandraki, G. A., & Okalidou, A. (2007). The application of PECS in a deaf child with autism: A case study. Focus on Autism and Other Developmental Disabilities, 22(1), 23-32
Almeida-Verdu, A. C., Huziwara, E. M., de Souza, D. G., De Rose, J. C., Bevilacqua, M. C., Lopes, J., Jr, Alves, C. O., & McIlvane, W. J. (2008). Relational learning in children with deafness and cochlear implants. Journal of the experimental analysis of behavior, 89(3), 407–424. https://doi.org/10.1901/jeab.2008-89-407
Sinnott, C. (2009). Program-wide Behavior Support Plans for Programs Serving Students Who Are Deaf or Hard of Hearing in Illinois. American Annals of the Deaf, 154, 293 – 299.
Fossett, B. (2010). Positive behavior support for deaf children with developmental disabilities and severe problem behavior (Doctoral dissertation, University of British Columbia).
Normand, M. P., Machado, M. A., Hustyi, K. M., & Morley, A. J. (2011). Infant sign training and functional analysis. Journal of Applied Behavior Analysis, 44(2), 305-314.
Guardino, C., & Antia, S. D. (2012). Modifying the classroom environment to increase engagement and decrease disruption with students who are deaf or hard of hearing. Journal of Deaf Studies and Deaf Education, 17(4), 518-533.
Zane, T., Carlson, T.M., Estep, T.M., & Quinn, T. (2014). Using Functional Assessment to Treat Behavior Problems of Deaf and Hard of Hearing Children Diagnosed with Autism Spectrum Disorder. American Annals of the Deaf, 158, 555 – 566.
Bracken, M., & Rohrer, N. (2014). Using an adapted form of the Picture Exchange Communication System to increase independent requesting in deafblind adults with learning disabilities. Research in developmental disabilities, 35(2), 269-277.
Golfeto, R.M., & de Souza, D.D. (2015). Sentence production after listener and echoic training by prelingual deaf children with cochlear implants. Journal of applied behavior analysis, 48 2, 363-75 .
Gann, C.J., Gaines, S., Antia, S.D., Umbreit, J., & Liaupsin, C.J. (2015). Evaluating the Effects of Function-Based Interventions With Deaf or Hard-of-Hearing Students. Journal of deaf studies and deaf education, 20 3, 252-65 .
Nannemann, A. C., Bruce, S. M., & Covelli, A. (2017). Positive behavior supports for a young adult with CHARGE syndrome. Journal of Visual Impairment & Blindness, 111(2), 175-179.
Bruce, S. M., Bashinski, S. M., Covelli, A. J., Bernstein, V., Zatta, M. C., & Briggs, S. (2018). Positive behavior supports for individuals who are deafblind with CHARGE syndrome. Journal of Visual Impairment & Blindness, 112(5), 497-560.
Hassinen, L., & Lappalainen, R. (2018). Acceptance and commitment therapy using finnish sign language: Training counselors in signed ACT for the deaf–A pilot study. Journal of Contextual Behavioral Science, 8, 74-81.
Yasin, M. H. M., Khairuddin, K. F., Haslam, F. M., & Marripan, R. A. (2019). Implementation of Token Economic Techniques in Modifying the Disruptive Behavior of Hearing Impairment Students.
Ripple, Hailey E., “Exploring the utility of brief functional analyses procedures for individuals with CHARGE syndrome” (2019). Theses and Dissertations. 2183. https://scholarsjunction.msstate.edu/td/2183
Ivy, S., Robbins, A., & Kerr, M. G. (2020). Adapted Picture Exchange Communication System using tangible symbols for young learners with significant multiple disabilities. Augmentative and Alternative Communication, 36(3), 166-178.
Brown, L. (2020). Development of an ABA Tool Kit for Audiologists to Increase Hearing Aid Wear Time in Individuals with Autism.
Davis, C. R., & Axe, J. B. (2021). Analyzing Consequence Variables Within the High-Probability Instructional Sequence for a Child Diagnosed With CHARGE Syndrome. Behavior analysis in practice, 14(2), 352–359. https://doi.org/10.1007/s40617-020-00524-w
Studts, C. R., Jacobs, J. A., Bush, M. L., Lowman, J., Westgate, P. M., & Creel, L. M. (2022). Behavioral Parent Training for Families With Young Deaf or Hard of Hearing Children Followed in Hearing Health Care. Journal of speech, language, and hearing research : JSLHR, 65(10), 3646–3660. https://doi.org/10.1044/2022_JSLHR-22-00055
Anderson, M. N. (2022). Evaluating virtual training methods to train caregivers of individuals with CHARGE syndrome to conduct brief functional analyses conditions.
Longo, A., Reeve, K. F., Jennings, A. M., Vladescu, J. C., Reeve, S. A., & Colasurdo, C. R. (2022). Comparing stimulus equivalence‐based instruction to self‐study of videos to teach examples of sign language to adults. Behavioral Interventions, 37(3), 713-731.
