A Survey of Why and How Clinicians Change Reinforcers During Teaching Sessions

Introduction

Reinforcement is a cornerstone of Applied Behavior Analysis (ABA), helping shape and maintain desired behaviors in clients. Identifying effective reinforcers is critical, but preferences can change rapidly. This uncertainty raises an important question: How do clinicians decide when and why to switch reinforcers during teaching sessions?

A recent study by Morris, Conine, Slanzi, Kronfi, and Etchison (2024) explores this issue by surveying behavior analysts on their real-time decision-making regarding reinforcers. Their findings highlight the practical strategies clinicians use and offer insights into improving teaching sessions.

By understanding these patterns, behavior analysts can enhance learning outcomes, minimize problem behavior, and keep clients engaged in therapy.

Methods: How the Study Was Conducted

This study surveyed behavior analysts working with children with autism spectrum disorder (ASD). Participants included professionals across different certification levels:

• Registered Behavior Technicians (RBTs)
• Board Certified Assistant Behavior Analysts (BCaBAs)
• Board Certified Behavior Analysts (BCBAs)
• Doctoral-Level BCBAs (BCBA-Ds)

The survey aimed to capture:

1. How clinicians typically identify reinforcers
2. Whether and how often they change reinforcers during teaching sessions
3. Their reasons for switching reinforcers

Data collection was conducted through an online survey, distributed via email campaigns and snowball sampling.

Key Findings

1. How Clinicians Identify Reinforcers

To ensure reinforcement remains effective, clinicians must first determine which stimuli their clients find motivating. The study revealed that clinicians commonly use these methods:

• Asking parents or caregivers about client preferences
• Asking clients directly when they are verbally or gesturally communicative
• Observing client behavior to assess spontaneous choices
• Conducting formal preference assessments, such as:
  • Paired-Stimulus Preference Assessments (PSPA)
  • Multiple-Stimulus Without Replacement (MSWO)
  • Free-operant preference assessments

Interestingly, informal methods (asking and observing clients) were used almost daily, while formal preference assessments were conducted less than once a month.

2. Do Clinicians Change Reinforcers During Teaching Sessions?

Yes—90% of clinicians reported they change reinforcers during sessions.

The likelihood of making changes varied:

• Board-Certified Behavior Analysts (BCBAs) and BCBA-Ds were more likely to adjust reinforcers than RBTs.
• There was no significant difference based on client age, diagnosis, or service goals.

This suggests that adjusting reinforcers is a widely accepted practice across the field, regardless of specific client characteristics.

3. Why Do Clinicians Change Reinforcers?

Clinicians identified several key reasons for switching reinforcers in the middle of a session:

1. Client mands (requests) for a different reinforcer

2. Client reaches for another stimulus instead

3. Client refuses the current reinforcer

4. Signs of satiation occur, such as:

   • A decrease in enthusiasm for the reinforcer
   • Slower response to tasks

5. Problem behavior emerges when using a reinforcer

These findings emphasize the dynamic nature of reinforcement—what works initially may not remain effective throughout an entire session.

4. How Do Clinicians Choose a New Reinforcer?

When selecting an alternative reinforcement, behavior analysts commonly rely on:

• Client communication (e.g., pointing, requesting, or signaling preference)
• Trial and error (offering different choices until the client responds positively)
• Rotating multiple reinforcers (to avoid overuse and maintain motivation)
• Observing behavioral indicators of interest

This flexibility enables clinicians to maintain engagement while avoiding frustration or disinterest.

Practical Applications for Behavior Analysts

Based on these findings, behavior analysts can incorporate these best practices into their sessions:

1. Use Multiple Methods to Identify Reinforcers

• Conduct regular preference assessments to refresh the list of potential reinforcers.
• Observe spontaneous client choices to identify emerging preferences.
• Gather input from parents, caregivers, and other professionals working with the client.

2. Monitor Satiation and Response Patterns

• Watch for changes in client enthusiasm when delivering reinforcement.
• Establish a varied reinforcement pool to prevent overuse of specific stimuli.
• Use a reinforcement schedule that encourages novelty, keeping motivation high.

3. Adjust Reinforcers Based on Client Feedback

• If a client mand is appropriate, honor their request for a new reinforcer.
• If a client refuses a reinforcer, swap it out to maintain participation.
• Use behavioral cues (e.g., reaching, avoiding, or engagement levels) to guide decisions on reinforcer changes.

Conclusion

The study by Morris et al. (2024) sheds light on how behavior analysts dynamically change reinforcers during teaching sessions to keep clients motivated and engaged. Since 90% of clinicians report adjusting reinforcers, it's clear that flexibility is an essential skill in behavior analysis.

By regularly assessing preferences, monitoring for satiation, and responding to client behavior, clinicians can improve the effectiveness of reinforcement strategies. These findings reinforce the importance of ongoing observation and adaptability in ABA practice.

For a full breakdown of the research, check out the original study: https://doi.org/10.1007/s40617-023-00847-4.