OAARSN Book Review

Carr, E.G. et al, Communication-Based Intervention for Problem Behavior: A User's Guide for Producing Positive Change (Baltimore: P.H. Brookes Publishing Company, 1994. Pp. xxiii + 251).

"Communication-based intervention" refers to methods that reduce or eliminate problem behaviour by teaching an individual specific forms of communication (p.3). When the individual is free of problem behaviours, then s/he can function in different community situations from which s/he was previously excluded.

Six major themes are explored (pp.4-5):

1. Problem behaviour usually serves a purpose for the person displaying it

2. Functional assessment is used to identify the purpose of problem behaviour

3. The goal of intervention is education, not simply behaviour reduction

4. Problem behaviour typically serves many purposes and therefore requires many interventions

5. Intervention involves changing social systems, not individuals

6. Lifestyle change is the ultimate goal of intervention.

The intervention model is based on a longitudinal study of 100+ individuals with autism and mental retardation with severe behaviour difficulties over a ten-year period. Another 100 individuals were tested in the community more recently. Three are described in depth, to show how the model changed their lives.

THE MODEL:

functional communication training -----> choice making ------> social communication = improved behaviour

Communication-Based Intervention is intended for everyone in the individual's life, including families, teachers, residential staff, job coaches as well as behaviour specialists, speech-language pathologists, residential and vocational administrators, psychologists and for students studying behaviour management.

The book is well structured. Chapter 1 gives a synopsis of the major ideas, and Chapter 2 discusses five crisis management strategies. The third chapter explains the scientific basis for the approach taken, while Chapters 4 to 6 examine assessment procedures with examples. Chapter 7 highlights the main theme of the book, namely that intervention means building rapport and changing relationships, the ways in which people with and without disabilities interact with one another. Chapter 8 looks at the importance of broadening an individual's social repertoire so that he/she acquires new skills to replace problem behaviour. Chapter 9 shows the need to change social systems to provide good outcomes. Intervention should be carried out in the community where the person lives and opportunities for communication and social interaction are important. Chapters 10, 11 and 12 illustrate the key strategies of building tolerance for delay of reinforcement, and of providing choices. Chapter 13 is concerned with "generalization" and Chapter 14 with "maintenance."

As a sibling of a young man with autism, I find the book helpful and relevant. My brother's use of Facilitated Communicating, on an EPSON computer with voice output, has allowed him to overcome many problem behaviours and to participate in community life, especially recreation and travel, things that were previously impossible. Because we know how important friends, holidays and recreation are to him and that he can control himself, these outings have become a source of joy for all.

Communication-Based Intervention is quite readable despite its textbook appearance. Its case studies are useful and interesting. Terms are clearly defined and highlighted checklists are provided. Up-to-date literature is provided as a resource guide but does not intrude in the text. Thus the work is both a good academic and practical "hands on book." A good index is included. The long section on functional assessment and the field study techniques are less readable for the lay person. Important lessons for me include the importance of varying routines and not becoming boring or repetitive.

- Reviewed by Victoria Bloomfield in WWASnews February 1996***