Table Of ContentAdriana Suzart Ungaretti Rossi
Ila Marques Porto Linares
Luiza Chagas Brandão Editors
Clinical
Behavior
Analysis
for Children
Clinical Behavior Analysis for Children
Adriana Suzart Ungaretti Rossi
Ila Marques Porto Linares
Luiza Chagas Brandão
Editors
Clinical Behavior Analysis
for Children
Editors
Adriana Suzart Ungaretti Rossi Ila Marques Porto Linares
Paradigma - Center for Behavioral Clinics Hospital
Sciences and Technology Universidade de São Paulo
São Paulo, Brazil São Paulo, Brazil
Luiza Chagas Brandão
Universidade de São Paulo
São Paulo, Brazil
0th edition: © Paradigma - Centro de Ciências do Comportamento 2020
ISBN 978-3-031-12246-0 ISBN 978-3-031-12247-7 (eBook)
https://doi.org/10.1007/978-3-031-12247-7
© Centro Paradigma 2020, 2022
Jointly published with Paradigma – Centro de Ciências e Tecnologia do Comportamento, São Paulo.
Original Portuguese edition published by Paradigma – Centro de Ciências e Tecnologia do
Comportamento, São Paulo, Brazil, 2020.
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Preface
Dear readers,
The purpose of this book is to present clinical behavior analysis for children as it
has been carried out and to describe elements that we consider fundamental to the
understanding and practical application of it. We understand that this is a dynamic
field that is constantly evolving, which can lead to different views of the same aspect
of therapeutic practice and also to the constant transformation of the elements that
make up the therapy. As editors, we chose to preserve the heterogeneity of perspec-
tives among the authors, since such divergences are representative of the current
state of the art of the therapy presented here.
We realize that our field has been constantly changing as theory and practice of
clinical behavior analysis are transformed. We suggest to all who propose to work
in this field to keep constantly updated, to keep up with these transformations, and
be able to work better and better.
Cheers,
Adriana, Ila, and Luiza
São Paulo, Brazil Adriana Suzart Ungaretti Rossi
Ila Marques Porto Linares
Luiza Chagas Brandão
v
Contents
1 Introduction to Clinical Behavior Analysis for Children . . . . . . . . . . 1
Adriana Suzart Ungaretti Rossi, Ila Marques Porto Linares,
and Luiza Chagas Brandão
2 The Clinical Behavior Analyst for Children . . . . . . . . . . . . . . . . . . . . . 9
Luiza Chagas Brandão and Márcia Helena da Silva Melo
3 Child Development from the Perspective of Behavior Analysis . . . . . 17
Tauane Gehm and Adriana Suzart Ungaretti Rossi
4 Biological Influences on the Development of Child Behavior . . . . . . . 33
Caio Borba Casella and Mauro Victor de Medeiros Filho
5 Clinical Assessment in Clinical Behavior Analysis for Children
and Definition of Therapeutic Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Ila Marques Porto Linares, Adriana Suzart Ungaretti Rossi,
Maíra P. Toscano, and Verena L. Hermann
6 Evidence-Based Psychotherapy in Childhood and Adolescence . . . . . 69
Jan Luiz Leonardi and José Luiz Dias Siqueira
7 Functional Play: Ways to Conduct and the Development
of Skills of the Clinical Behavior Analyst for Children . . . . . . . . . . . . 81
Ana Beatriz Chamati and Liane Dahás
8 Acceptance and Commitment Therapy: Interventions
with Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Aline Souza Simões, Raul Vaz Manzione, Desirée da Cruz Cassado,
and Mônica Geraldi Valentim
9 Introduction to Functional-Analytic Psychotherapy
with Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Cynthia Borges de Moura
vii
viii Contents
10 Levels of Therapeutic Intervention in Psychotherapy
with Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Cynthia Borges de Moura and Isabel Sá
11 Contact with Schools: Objectives, Limits, and Care . . . . . . . . . . . . . . 125
Ligia Lacava Barros and Carolina Toledo Piza
12 Interdisciplinary Work in the Care of Children . . . . . . . . . . . . . . . . . 133
Liane Jorge de Souza Dahás and Tiffany Moukbel Chaim Avancini
13 Functional Analysis of Interventions with Parents:
Parental Orientation or Parent Training? . . . . . . . . . . . . . . . . . . . . . . 145
Giovana Del Prette, Caroline Drehmer Pilatti,
Laura Malaguti Modernell, and Rodolfo Ribeiro Dib
14 Family Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Roberto Alves Banaco and Inaldo J. da Silva Júnior
15 Therapeutic Discharge as an Outcome of Clinical Behavior
Analysis for Children: Criteria and Process . . . . . . . . . . . . . . . . . . . . 175
Clarissa Moreira Pereira and Daniel Del Rey
16 Ethical Issues in Clinical Behavior Analysis for Children . . . . . . . . . 187
Lygia T. Durigon and Enzo B. Bissoli
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
Chapter 1
Introduction to Clinical Behavior Analysis
for Children
Adriana Suzart Ungaretti Rossi , Ila Marques Porto Linares ,
and Luiza Chagas Brandão
In the literature of behavior analysis, a considerable number of publications offer
clinical strategies to more effectively conduct the intervention with certain diagno-
ses (e.g., de Mattos Silvares, 2000; Silveira & Vermes, 2014), but there is still a lack
of consultation materials that address practical aspects of the performance of the
child behavior analytic therapist. The writing of this book was motivated by the
need for literature that discussed these practical aspects. Thus, this and the follow-
ing chapters compile material written by therapists who share their views on theo-
retical and practical aspects of the care of children and describe the stages and
challenges of the child psychotherapy process. It is worth noting that the population
whose care was sought to contemplate in this book is up to 12 years, taking, as the
upper limit, the definition of childhood of the Statute of the Child and Adolescent
(Estatuto da Criança e do Adolescente, 1990, p. 1).
The child behavior analytic therapist, as the name suggests, has his/her practice
based on the assumptions of behavior analysis, which, in turn, can be subdivided
into three interrelated areas in a continuous process of reciprocal influence, namely,
radical behaviorism, experimental analysis of behavior, and applied behavior analy-
sis. Radical behaviorism is the theoretical, historical, and philosophical arm of a
science that proposes to study behavior. Experimental behavior analysis, in turn, is
the arm in charge of producing and validating empirical data, by manipulating vari-
ables in controlled contexts. The experimental analysis of behavior aims to identify
behavioral patterns through the inductive method, seeking predictability and control
over the object of study. And, finally, the applied behavior analysis is the
A. S. U. Rossi (*) · L. Chagas Brandão
Paradigma – Center for Behavioral Sciences and Technology, São Paulo, Brazil
e-mail: [email protected]
I. M. P. Linares
Universidade de São Paulo, São Paulo, Brazil
e-mail: [email protected]; [email protected]
© The Author(s), under exclusive license to Springer Nature 1
Switzerland AG 2022
A. S. U. Rossi et al. (eds.), Clinical Behavior Analysis for Children,
https://doi.org/10.1007/978-3-031-12247-7_1
2 A. S. U. Rossi et al.
technological arm, related to the creation and administration of tools for social
intervention. Maintaining the dialogue with radical behaviorism and experimental
behavior analysis, the applied behavior analysis proposes to produce techniques that
guide the practice of professionals working in various contexts, including the child
psychotherapeutic context (Carvalho Neto, 2002; Skinner, 1974).
For behavior analysis, behavior is the interaction between organism and environ-
ment – be it biological, physical, or social – and behavioral problems can only be
understood by identifying the context in which they occur (Skinner, 1953/2003)1.
Since this individual is part of a social group, this group exercises ethical control
over each of its members, through its power to reinforce or punish. Within the
group, there are “controlling agencies”, which manipulate particular sets of vari-
ables, operating more successfully than the group in general in controlling the
behavior of individuals. Still according to Skinner (1953), these agencies are divided
into government, religion, economy, education, and psychotherapy. The latter exerts
control over the behavior of individuals, proposing to deal with emotional by-
products and operant behavior of the coercive control, exerted by the social group
over the individual.
Thus, the behavior analyst therapist understands that many complaints that lead
individuals (or family members) to seek psychotherapy are by-products of exces-
sive or inconsistent control of the environment (Skinner, 1953), primarily the family
and/or school. Associated with biological predispositions to the emergence of cer-
tain behavioral characteristics, behavioral excesses or deficits may result from
group control strategies on the individual. Therefore, to manage such forms of con-
trol that can bring harm to the individual and the group, the therapist needs to under-
stand and act on such environments.
Relevant Repertoire for the Child Therapist
Working with children differs in many ways from working with adolescents and
adults, so the therapist who proposes to work with children needs to study the idio-
syncrasies and characteristics of this universe, as well as develop specific reper-
toires for working with this age group. The different objectives and roles of the child
psychotherapist are discussed in greater depth throughout the book, but it is impor-
tant to emphasize that when working with children, this professional offers models
of appropriate behavior not only for the child but also for the parents, exposing
alternatives on how to relate more effectively with the child. Besides acting in a
remedial manner, i.e., when problem behaviors already exist, the child therapist also
has the opportunity to act on mental health problems in a preventive manner, mainly
because the child’s phase is of intense development. It is worth pointing out that,
1 The first date indicates the year of the original publication of the work, and the second date indi-
cates the edition consulted by the author, which will only be scored in the first citation of the work
in the text. In the following citations, only the date of original publication will be registered.
1 Introduction to Clinical Behavior Analysis for Children 3
regardless of the reason for the demand for therapy, the professional should always
reflect on his interventions in the light of the Code of Ethics of the Psychologist
(Código de Ética do Psicólogo, 2000), as well as in the light of the Skinnerian ethi-
cal system (Dittrich & Abib, 2004), considering the implications of his actions for
the individual and for the groups of which he is part.
In conducting the psychotherapeutic process, regardless of the age of the client,
the therapist has, as one of its objectives, to teach behavioral repertoires that allow
the client to deal with the consequences of aversive control exercised by the envi-
ronment, which are disabling or producers of suffering. In the care of children,
psychotherapy also aims to intervene directly on environments that exert control
over their behavior and that are producing undesirable by-products. Some examples
of these by-products are fear, anxiety, anger, and depression, as well as excessively
vigorous or excessively restricted behaviors (Skinner, 1953).
The development of therapeutic repertoire often occurs through classes, supervi-
sion, and discussions with more experienced therapists. To work with children, the
professional must develop technical knowledge, bonding skills, and management of
the therapeutic relationship, which differ from those necessary to work with adults
and adolescents. The child therapist also needs to develop skills to conduct the work
with parents and the school (Gadelha & de Menezes, 2008; Prado & Meyer, 2004),
as well as with other environments in which the child is inserted. In addition, the
therapist should also consider peculiarities inherent to the moment of development
of these people.
Currently, it is understood that the individual is in continuous development
throughout life, but there is emphasis on the study of childhood, since it is a time
marked by very rapid changes. Events that occur during this period may have a
decisive contribution to the biopsychosocial development of the individual (Papalia
& Olds, 2000). Thus, it is of great relevance that the therapist who works with this
public knows behavioral milestones of the various stages of development in child-
hood and thus identifies particularities that an individual presents in relation to what
would be expected in typical development, as well as different sensitivities that he
or she has to the environment. In addition, since such characteristics can impact the
possibilities of interaction of the subject with his environment, they should be con-
sidered, because they can facilitate or hinder the application of certain interventions,
as well as the learning of new responses during the therapeutic process.
Also making up the broad repertoire required of the child psychotherapist are
skills that allow access to private events and the management of operant behavior in
ways different from what is done with adults. To this end, tools derived from some
therapeutic systematizations, such as the third wave therapies – for example, accep-
tance and commitment therapy (Hayes et al., 2011), functional analytic psycho-
therapy (Kohlenberg & Tsai, 1991), and dialectical behavioral therapy (Linehan &
Dexter-Mazza, 2009) – may be useful to the professional.
In addition to the skills necessary to access private events, skills related to the
proposition of playful activities may also be of great relevance for the child thera-
pist. It is not uncommon among beginning therapists to observe a thirst for informa-
tion on playful strategies, such as suggestions of materials and activities that provide
