The Plan the Family Cannot Follow
A behavior analyst develops a plan for a 6-year-old with severe tantrums at home. The plan requires the mother to implement a differential reinforcement of alternative behavior procedure with a token board, deliver planned ignoring for tantrums lasting under two minutes, and conduct a 10-minute priming session before every transition, seven days a week. The mother works two jobs, cares for two younger children, and speaks limited English. She agrees to everything in the meeting and signs the consent. Two weeks later, the data show no change in tantrum frequency, and the mother has stopped completing the token board. She reports she "forgot" and that the tantrums happen mostly when she is cooking dinner and the younger children are crying. She has not told the analyst she finds the plan unworkable.
1. Diagnose why the plan failed, using treatment integrity, social validity, and contextual fit. What assumptions did the analyst make?
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The plan failed on contextual fit and social validity before it failed on treatment integrity. The analyst designed a seven-day, multi-component protocol that assumes a caregiver with predictable time, one child to manage, and English-language materials. The mother's actual context - two jobs, two younger children, dinner-time chaos, limited English - makes the protocol close to impossible to run as written.
Treatment integrity is the visible symptom: the token board stopped. But low integrity here is informative rather than blameworthy. The analyst assumed that verbal agreement plus a signature equals commitment and capacity, and did not assess whether the plan was acceptable, feasible, and culturally and linguistically appropriate. The mother did not disclose her difficulty, which is common when a professional presents a plan as the expert's recommendation and the caregiver fears judgment or losing services.
The timing detail is the most useful information in the case: tantrums cluster during dinner preparation. That is an antecedent context the plan never addressed, and priming before every transition is irrelevant to it.
2. Redesign the plan around the family's actual context, and describe how you would assess integrity and acceptability going forward.
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Redesign around the high-risk moment rather than the whole day. Options: (1) a dinner-time routine with a predictable sequence and a simple visual cue the mother can point to; (2) an antecedent arrangement such as preparing a preferred activity for the child during the last 15 minutes of cooking, or involving the child in a simple cooking task; (3) a single, low-effort DRA - one alternative response the mother can reinforce with a brief, high-value activity rather than a token board requiring tracking; (4) reduce the plan to one or two components implemented only at dinner initially, then expand if it works.
Translate all materials into the family's preferred language, use interpreter support at meetings, and ask the mother to walk through the plan and identify barriers before signing. Assess social validity with a brief rating of acceptability, feasibility, and perceived effectiveness, and ask directly, "What would make this hard to do?" rather than "Do you have questions?" Assess integrity with a simple checklist the mother completes or a brief weekly phone check, and treat low integrity as a design problem to solve collaboratively, not a compliance failure. Monitor tantrum frequency at dinner specifically, and use a changing-criterion or component-analysis design to see which element is doing the work.