Review of Behavioral Principles in Communicative Disorders by Maul, Findley, and Adams

The American Speech–Language–Hearing Association (2016) charges speech–language pathologists (SLPs) with treating a wide variety of communication disorders and impairments. Because all communication is behavior, it is only logical for a text whose primary audience is SLPs to focus on principles of behavior, including their applications in assessing and treating communication challenges. Behavioral Principles in Communicative Disorders, by Maul, Findley, and Adams (2016), attempts to bridge the fields of speech–language pathology and applied behavior analysis (ABA) by providing a comprehensive overview of Skinner’s behaviorism, the principles of behavior, and ABA-based strategies for improving client outcomes.

Does the Field Need a New Book on Behavioral Principles for SLPs?

The presence of several competently written and widely adopted ABA textbooks (e.g., Alberto & Troutman, 2013; Cooper, Heron, & Heward, 2007; Mayer, Sulzer-Azaroff, & Wallace, 2012) begs the question of why the authors felt it necessary to create an ABA text that is geared specifically toward practicing SLPs. There are several pragmatic reasons why a book like this belongs in the marketplace. As most readers of Perspectives on Behavior Science are no doubt aware, the field of ABA has developed a robust array of empirically supported treatments for individuals with serious communicative impairments, most notably those with autism spectrum disorder (ASD; Wong et al., 2015). Because SLPs are often the primary service delivery providers of communication interventions to individuals with communication challenges, a text that exposes SLPs to strategies based in ABA makes a potentially valuable contribution to the field. Moreover, Skinner’s (1957) analysis of verbal behavior, which is the focus of Chapter 2, provides a conceptually sound framework for SLPs to understand the contingencies underlying basic to advanced verbal episodes.

Although the subject matter of this book is no doubt relevant to practicing SLPs, it is increasingly unlikely that SLPs will be exposed to the book’s content through alternative texts offered in typical ABA graduate training programs. As of 2016, the Behavior Analyst Certification Board no longer recognizes graduate programs in speech–language pathology as fulfilling the degree requirement for the Board Certified Behavior Analyst (BCBA) credential. Consequently, fewer SLPs in training are likely to receive comprehensive exposure to ABA in their graduate coursework, let alone Skinner’s (1957) Verbal Behavior. Alternatively, a user-friendly text geared toward the competencies of practicing SLPs is more likely to be adopted within SLP programs and to provide exposure to ABA for SLPs who otherwise would not benefit from this content.

Some behavior analysts may regard SLP graduate training as insufficient to confer the competencies necessary to design, implement, and monitor behaviorally based communication treatment programs with fidelity. In reality, SLPs are primarily responsible for these tasks within most clinical and educational environments. If we believe, as a discipline, in the value of availing ABA technology to all who could benefit from it, we must encourage strategies for scaling up ABA interventions in typical settings where collaboration among BCBAs and nonbehavioral professionals is the norm (Kelly & Tincani, 2013). A willingness to design ABA interventions that work within existing cultural environments translates into broader dissemination and greater acceptance of ABA and better outcomes for our consumers (Critchfield, 2015).

Behavioral Principles in Communication Disorders extends a fruitful history of collaboration between behavior analysts and SLPs. The Picture Exchange Communication System (Frost & Bondy, 2002)—one of the most widely adopted, empirically supported communication treatments for individuals with ASD (Ganz, Davis, Lund, Goodwyn, & Simpson, 2012; Wong et al., 2015)—was developed through a collaboration between Lori Frost, an SLP, and Andy Bondy, a behavior analyst. Sundberg’s (2008) popular Verbal Behavior Milestones Assessment and Placement Program, based in Skinner’s (1957) analysis of verbal behavior, includes a developmentally appropriate echoic skills assessment developed by Barbara Esch, an SLP. Now defunct, the Journal of Speech and Language Pathology and Applied Behavior Analysis (http://psycnet.apa.org/PsycARTICLES/journal/slp) published conceptual and empirical articles authored by scholars of both fields. To the extent that this book accomplishes its goal of bridging the fields of ABA and speech–language pathology, it may increase the likelihood of similar future collaborations among behaviorally inclined SLPs and behavior–analytic practitioners.

Organization and Content of the Book

The book is organized into 10 chapters. It begins with an overview of behaviorism, including the basic principles of behavior, followed by a comprehensive chapter on Skinner’s analysis of verbal behavior, along with chapters on measurement and observation systems, functional behavior assessment, discrete trial teaching (DTT), strategies for teaching new behavior, generalization and maintenance of behavior, decreasing undesirable behavior, single-case experimental designs, and ethical considerations in research and clinical practice. Because the book is written primarily for SLPs with little background in or knowledge of ABA, the sequencing of the content, beginning with basic concepts and principles, progressing to applications, and ending with ethical considerations, is logical. Each chapter includes helpful tables and figures and concludes with a useful outlined summary and application exercises.

Chapter 1 provides an introduction to behaviorism and introduces readers to the principles of reinforcement and punishment, the definitions of which are repeated throughout the book. The chapter begins with a historical overview of behaviorism, differentiating Pavlov’s and Watson’s foundational work from Skinner’s behaviorism. Later, the chapter outlines the development of behavior modification, including a few of the early seminal applied experiments on operant conditioning to improve social and communicative behaviors, which laid the groundwork for contemporary ABA. The chapter offers a straightforward, if somewhat abridged, definition of contemporary ABA as a scientific approach that is applied, behavioral, and analytic. The authors cogently explain how ABA is relevant to practicing SLPs, the role of BCBAs in multidisciplinary teams, and how SLPs and BCBAs can collaborate in multidisciplinary teams.

Skinner’s (1957) analysis of verbal behavior as a framework for understanding communication is the focus of Chapter 2. Sufficiently covering this topic is no easy task given that the book’s audience is unlikely to be very familiar with Skinner’s approach and will likely expect that any approach will account for a wide array of communication styles that SLPs encounter in their practice. The placement of this critical content early in the book logically emphasizes the foundational role of Skinner’s analysis of verbal behavior in the role and function of SLPs. The chapter opens with a concise yet easy to understand definition of verbal behavior, including Skinner’s concepts of the verbal episode, the verbal repertoire, and response strength. The chapter progresses into definitions of the primary verbal operants, followed by an extended discussion of the role of autoclitics in verbal behavior. As critics contend that Skinner’s analysis is too simplistic to account for most verbal behavior (e.g., Chomsky, 1959), it was satisfying to see in-depth coverage of more advanced verbal behavior concepts, including extended mands and tacts, quantifying and qualifying autoclitics, autoclitic mands, grammatical ordering, and impure verbal operants. Chapter 2 concludes with the implications of Skinner’s verbal behavior for assessment and treatment, including the important premise that communication interventions should proceed from a functional, rather than a purely topographical, account of verbal behavior. Overall, the chapter accomplishes its goal of providing an accessible and comprehensive overview of verbal behavior.

The remaining chapters of the book delve into more practical issues in the behaviorally based assessment and treatment of communication disorders. Chapter 3, “Defining and Measuring Behaviors,” follows a format similar to that of other ABA texts in describing how practitioners can operationally define target behaviors (with measurable goals), coupled with a description of commonly used measurement and observation systems (i.e., frequency, duration, latency, and interval systems). This information is followed by an overview of observation methods specific to communicative disorders, including verbal interaction sampling, a strategy for recording speaker–listener interactions during verbal episodes. This chapter concludes with a basic overview of baseline data collection strategies, graphing, and visual analysis of data. Overall, this chapter adequately overviews how SLPs can define, observe, record, graph, and analyze communicative responses. Given the comprehensive coverage of Skinner’s verbal behavior in Chapter 2, it was surprising to see few examples in the chapter of strategies to record verbal operants commonly taught within verbal behavior programs.

Chapter 4 focuses on functional behavioral assessment (FBA) in the treatment of communication disorders. To provide a context for the purposes of conducting FBA, the chapter introduces the concept of the environmental (i.e., reinforcement) contingency, including definitions of reinforcement, discriminative stimuli, and motivating operations. Importantly, the authors stress that FBA should be conducted only by individuals with expertise in ABA and FBA techniques (e.g., BCBAs) and that SLPs may be called upon to collaborate with expert practitioners in the FBA process. Thus, it is evident that the authors intend to provide an informational overview of FBA rather than a prescriptive guide on how to implement FBA. The chapter proceeds to describe the major categories of FBA strategies: indirect methods, direct observations, and functional analysis, including the specific techniques within these strategies. Overall, the authors provide a useful overview of the FBA process, with information that will enable SLPs to support BCBAs as interdisciplinary team members.

Given that SLPs commonly implement DTT in their therapeutic practice, Chapter 5 presents DTT as a framework for teaching new verbal behavior skills. The authors provide an overview of the basic elements of DTT—the antecedent, prompt, response, consequence, and intertrial interval—along with a discussion of probing techniques to evaluate clients’ independent performances of verbal responses in generalized settings. Chapter 6 focuses on other techniques for teaching new communicative behaviors. This chapter begins with a comprehensive overview of antecedent strategies, including examples of prompting strategies that SLPs may use to teach vocal communication skills. The remainder of the chapter discusses shaping, chaining, and the use of positive and negative reinforcement to develop new communicative repertoires. Throughout the chapter, it was impressive to see many concrete, specific examples of prompting and other strategies that SLPs may use to teach a variety of vocal behavior skills. The DTT protocol templates, completed protocols, and data sheet templates could be very helpful to practitioners and emphasize the strategies described.

We were pleased to see a separate section of the book focusing on generalization and maintenance of behavior, the topics featured in Chapter 7. Following a description of the basic types of generalization, the authors present strategies for promoting the generalization of communicative responses across stimuli and settings. As speech–language therapy is often conducted in clinical situations with the expectation that learned skills will generalize across environments and response classes, the authors illustrate the importance of actively programming for the generalization of skills from the onset of training. Their description of strategies for promoting generalization borrows heavily from Stokes and Baer’s (1977) seminal paper on the topic and closely mirrors the content of other ABA texts. The chapter concludes with a critical discussion of the importance of working closely with families and incorporating natural routines in promoting the generalization and maintenance of client skills.

Chapter 8 reviews strategies for reducing undesirable communicative behaviors. Importantly, the authors adopt a functional perspective, as they emphasize that undesirable behaviors are likely to be evoked and reinforced by events in the environment, and thus an FBA is a necessary first step in developing successful behavior reduction strategies. The chapter continues to describe antecedent interventions to reduce challenging behaviors, including the use of response-independent schedules of reinforcement and high-probability request sequences. Next, the authors engage readers in a thoughtful discussion of punishment, emphasizing a functional rather than a traditional definition of punishment, along with potential detrimental side effects and ethical guidelines for clinicians in using punishment following failure of less intrusive techniques. The last sections of the chapter contain a concise overview of differential reinforcement to reduce problem responses and, finally, a brief discussion of functional communication training.

In Chapter 9, the authors provide the rationale for, defining features of, and major types of single-case research designs to evaluate the effects of communicative interventions. Given that the book focuses on clinical strategies to treat communicative disorders, it was a little surprising to see a chapter in the book devoted exclusively to research design. However, because the chapter adopts a practical, clinically informed approach to the topic, the majority of readers will find the information useful and applicable in their clinical practice. This chapter begins by defining, comparing, and contrasting science with pseudoscience, which is useful given the prevalence of pseudoscientific interventions in the fields of SLP and ASD more broadly. This is followed by a description of basic research terminology, a description of the defining features of group and single-case research designs, and an in-depth discussion of the most commonly used single-case research designs.

Finally, Chapter 10 explores ethical considerations in research and clinical practice. Much of the content of the chapter, including the history of research abuses in the United States, the subsequent legal protections for research subjects, and issues of informed consent, could be found in any chapter dealing with research methods in the social and behavioral sciences. The chapter includes a useful comparison of ethical standards for SLPs and BCBAs, along with an overview of clients’ rights in speech–language therapy and the rights of clients to effective therapeutic treatment.

Conclusions

The authors of Behavioral Principles in Communicative Disorders intended to create an accessible text that would bridge the fields of ABA and speech–language pathology. In writing a comprehensive, accessible, and relevant guide to ABA geared toward SLPs in training, Maul et al. have more than satisfactorily accomplished their goal. Because ABA practitioners and SLPs frequently collaborate in interdisciplinary teams in support of individuals with communicative disorders, we believe that this text makes a unique and valuable contribution to both fields. We sincerely hope that the book will serve as a catalyst for future collaborations between ABA and speech–language pathology, as it broadens a mutual understanding of speech–language pathology and ABA.

We noted a few areas for improvement for the authors to consider should they wish to publish a second edition of the book. Most of the book’s examples of communicative responses were those of vocal behavior. Given the prevalence of use and strong empirical support for augmentative and alternative (AAC) systems in teaching communication to nonvocal learners (Wong et al., 2015), a future edition would benefit from more comprehensive coverage of AAC systems, including considerations for modality selection and empirically supported teaching strategies. Although we were impressed with the book’s coverage of DTT in Chapter 5, a future edition would benefit from additional coverage of naturalistic teaching strategies, another beneficial component of evidence-based speech–language therapy and ABA (Wong et al., 2015). There were some minor technical inaccuracies in some of the terminology used and in some of the conceptual discussions; however, these were minor, may only be detected by one with extensive expertise in the specific topic areas, and would not likely affect the general application of behavior analysis to the treatment of communication deficits. We recommend reading the book in its entirety as opposed to individual chapters to get a more comprehensive sense of the behavior–analytic approach. Finally, we think that adding some more specific references and resources at the end of each chapter could be beneficial for the SLP or behavior analyst who would like to more extensively research the topics discussed.

Interdisciplinary collaboration is a necessary component of behavior–analytic service delivery. Done well, interdisciplinary collaboration improves consumer outcomes and enhances the scalability of ABA interventions. We applaud Maul et al. for writing a book to support productive collaborative relationships between BCBAs and SLPs in clinical settings. The book sets an example for how BCBAs and their behaviorally inclined colleagues in a variety of disciplines can work together with mutual benefit.