Episode 20: The Anti-Science of Positive Behaviour Support with Dr Nathan Blenkush

Views expressed by guests of the ABA and PT Podcast are their own. Episode description Positive Behaviour Support underpins the National Disability Insurance Scheme in Australia, and it is sold to schools and governments around the world as an evidence-based way to address behaviour problems. Where did it come from, and what happens when its “reinforcement only, for everyone” promise meets the most severe and treatment-resistant behaviour? Mandy’s guest is Dr Nathan Blenkush, licensed psychologist, BCBA-D, and Assistant Executive Director and Clinical Director of the Judge Rotenberg Educational Center in Massachusetts, where he has worked for more than two decades with some of the most severe behaviour disorders. Dr Blenkush traces PBS from the non-aversive movement of the 1980s through its fusion with normalisation and inclusion, explains why renaming extinction “planned ignoring” severs a procedure from its research base, and sets out what the 2006 critique by Johnston, Foxx, Jacobson, Green and Mulick argued. He then turns to the clinical consequences: weak dependent variables like office referrals, antecedent-only interventions that avoid the problem rather than treat it, and the cost of inaction for patients who end up restrained thousands of times or chemically restrained because an effective procedure has been ruled out in advance. Mandy closes with her own story: the time-out procedure that ended her daughter’s extreme tantrums and self-injury within a month, and what that made possible in the twenty years since. In this episode • Where PBS came from: the 1980s non-aversive movement, normalisation and inclusion, and the packaging of a label • Renaming phenomena: why “planned ignoring” has no research trail • Johnston and colleagues (2006): nothing new in methodology or phenomena • Watering down the core principles when non-professionals implement behavioural procedures • Why “one size fits all” is the real danger: the patient who left JRC and died of blood and bone infections • Over 5,000 restraints in several years, then none • What “evidence based” should require: dependent variables, specificity, measurement • Antecedent control is a derivation of consequences, not a long-term solution • The impoverished environment: what avoiding every difficult situation costs a child • Defining “severe”: outcome, resistance to treatment, size and strength of the person • The assent and reinforcement-only movement inside ABA itself • Invisible aversive contingencies: the rumble strip and the bicycle • The cost of inaction: restraint, PRN antipsychotics and deferral to psychiatry • Mandy’s story: Juliet, the time-out procedure, and the café About the guest Dr Nathan Blenkush is a licensed psychologist and Board Certified Behavior Analyst at the doctoral level. He earned his PhD in psychology from the University of Wisconsin-Milwaukee under Dr Jay Moore and later completed a respecialisation in clinical psychology. At the Judge Rotenberg Educational Center he has served as clinician, Director of Research and Clinical Director, and is now Assistant Executive Director and Clinical Director with oversight of more than 340 patients. He has taught graduate ABA courses at Simmons College, provided editorial support to behaviour-analytic journals, and presented at ABAI for more than twenty years. His research includes the risks of antipsychotic medication, the effects of discontinuing antipsychotics, and automatic measurement of behaviour with wearable sensors. He presented at the International Precision Teaching Conference in 2007. References and resources Foxx, R. M. (2005). Severe aggressive and self-destructive behavior: The myth of the nonaversive treatment of severe behavior. In J. W. Jacobson, R. M. Foxx, & J. A. Mulick (Eds.), Controversial therapies for developmental disabilities: Fad, fashion, and science in professional practice (pp. 295–310). Lawrence Erlbaum. Johnston, J. M., Foxx, R. M., Jacobson, J. W., Green, G., & Mulick, J. A. (2006). Positive behavior support and applied behavior analysis. The Behavior Analyst, 29(1), 51–74. https://doi.org/10.1007/BF03392117 Mulick, J. A., & Butter, E. M. (2005). Positive behavior support: A paternalistic utopian delusion. In J. W. Jacobson, R. M. Foxx, & J. A. Mulick (Eds.), Controversial therapies for developmental disabilities (pp. 385–404). Lawrence Erlbaum. Van Houten, R., Axelrod, S., Bailey, J. S., Favell, J. E., Foxx, R. M., Iwata, B. A., & Lovaas, O. I. (1988). The right to effective behavioral treatment. Journal of Applied Behavior Analysis, 21(4), 381–384. https://doi.org/10.1901/jaba.1988.21-381 Blenkush, N. A., & O’Neill, J. (2020). Contingent skin-shock treatment in 173 cases of severe problem be...