Behavioral medicine is a field that is very essential to the wellbeing of a person. It provides insight on the influence of behaviors on illness. In other words, it takes into consideration emotions, thoughts and how behavior can interconnect with biologic processes. It encourages healthy lifestyles through behavior interventions and promotes a decrease in healthcare cost. It is a field when invested in by a country can improve productivity and enhance economies through a healthier working population. Even though it can be helpful, the input of applied behavior analysis is yet to be fully integrated into medicine due to different factors. This reflection dive into some of the factors. It would be on how applied behavior analysis can be used in pediatrics, conveying medical issues found in behavior analytic treatment, the history of the connection between applied behavior analysis and behavioral medicine and handling diabetes mellitus with a behavior analytic approach.
Allen et al. (1993) reiterated that morbidity and mortality has moved from pathogens to behavioral and environmental pathogen (p.493). This is true as recent diabetes incidence has been attributed to lifestyle events. Diabetes can be managed with some behavioral interventions such as exercise and eating meals low in sugar. Another vital point raised was parents sometimes go to their pediatricians because of feeding and sleep issues (p.493). This is relatable because some toddlers can be picky eaters and may not sleep much at night. My son does not eat anything that does not taste sweet, and he loves to jump around at night and sleeps less at night. It is reassuring I am not the only parent going through that. The article also highlighted most pediatrician visits are issues with academic performances and behavior management (p.493). This is not surprising as toddlers are yet to learn how to manage their emotions and sometimes get overwhelmed. Hence, they may feel crying or sitting on the floor in a busy mall would get a parent’s attention or get what they want. Another notable point raised by the article was the fact that paediatricians do not refer clients to behaviour analysts even though they do not have enough time per visit to solve behaviour issues (p.494). This is understandable because applied behaviour analysis has been always associated with children with autism and developmental disabilities. These paediatricians may think a behaviour analyst cannot assist a child that does not fall into that category. In my opinion, behaviour analysts must do well to educate people on their scope of practice so it would be easier for paediatricians to approach them. The article highlighted paediatricians as being protective of their clients and families and do not like interventions that would reduce their interactions with their clients for long periods (p.495). I am aware behaviour analysts can work within hospitals if they are contracted so a time can be allocated for behavioural interventions. This may provide some sort of relief for the paediatricians as it is within the same facility. The article also highlighted paediatrician residency programmes do not teach their students to consider the learning history of the child (p.495). I am astonished by this because this is a vital part of a child’s development and understanding how circumstances such as parents over feeding their children and providing a lot of food due to cultural beliefs may help develop a plan to manage childhood obesity. Developing a relationship with paediatricians would help behaviour analysts serve children better and provide better relationships with families.
According to Copeland and Buch (2020) behavior analysts are not trained to recognize medical conditions (p.240). I am just wondering why behaviour analysts are not taught basic medicine as these can influence behaviour. For example, pain can make client non-compliant to behavioural interventions. Intense pain can make clients exhibit certain socially unwanted behaviour. The article also highlighted the need of the behaviour analyst to have all client’s medical history (p.240). This is very necessary for behaviour analysts as it helps them to know their limitations and work within scope of competence in accordance with the ethical code 1.05. It is important to note that behaviour analysts can provide appropriate intervention after knowing the full history of the client including medical and social history. Additionally, this article pointed out the importance of a medical checklist (p.241). It prevents the behaviour analyst from missing important information about medications and other demographics of the client. Knowing current or former medications of client can be helpful because certain psychotropic drugs can cause sedation and depression which can influence behaviour. This article also reiterated the need for behaviour analysts to note certain medical conditions when treating their clients such as weight loss or weight gain. For example, some people may use food as comfort and a way of escaping how they feel whiles others avoid eating when they are stressed or unhappy. When a behaviour analyst can identify certain medical conditions of their clients, they are able to refer their clients to appropriate clinicians that can help them.
Consequently, Greenwald et al. (2015) noted that research has seen the association of medical ailment and behavioral patterns (p.24). I know that stress can lead to high blood pressure and stroke when not managed properly and this can be induced by working constantly without taking breaks. The article also explored the concept ‘the whole is better that sum of its part’ (p.24). This statement resonates with the type of training I received in dental school. I was taught when treating people, I should treat them as a whole and not just the head and neck region. This is because certain diseases of the head and neck region could affect other organs. That is why collaboration with other fields is a necessity. This also applies to the field behaviour analysis where even though improving socially significant behaviours is the target, behaviour analysts should also look at all aspects of the client’s care. The article clearly defines medicine as a science that preserves the health of the body (p.27). However, I believe the goal of medicine is to maintain health of the body but does not cure or eradicate diseases because certain illnesses cannot be cured. Medicine deals with managing symptoms and not curing it. It also pointed out that medical personnel hardly used behavioural techniques (p.27). I agree with this statement because even though my first year of dental school, I took a course in behavioural science, I never used it in my practice. It also highlighted the fact that physicians in the medical field do not embrace behavioural treatment approaches (p.28). This was surprising because behavioural science is taught in medical and dental schools. Furthermore, behavioural science explains medicine as a vocation and how it can impact lives. It also teaches how doctors or dentists can practice efficiently.
Raiff et al. (2021) explored the impact of exercise and stress management on diabetes (p.241). Exercise is an observable and measurable behavior so data can easily be collected to check the effectiveness of it. This article showcased compulsive glucose testing behavior (p.241). This may be due to the need to ensure blood sugar is not too high or too low. If a person has a life-threatening event where the blood sugar was high or low and ended up in the hospital, the person is likely to have some form of compulsive glucose testing behaviour, so it does not happen again. The article also highlighted the use of written memos at designated areas to encourage children to be compliant in taking their medications (p.242). This is every innovative and easy to follow. This means people with autism and developmental disability can be taught to take their medication via a graphic prompt.
The article by Allen et al. (1993) provided a clear way applied behavior analysis (ABA) can be embodied into pediatrics which was good. Raiff et al. (2021) provided behavior interventions that could help manage diabetes effectively and efficiently. The article by Copeland and Buch (2020) showed how medicine and ABA can interact however it did not provide a solution to how the inadequate training of behavior analysts in basic medicine can be resolved. Greenwald et al. (2015) also proposed the need for collaboration with behavioral medicine but did not state how.
In conclusion, fusing ABA into healthcare can be beneficial to populations other than people with autism and developmental disability. Inter-disciplinary collaborations will help get more funds to research into the role of behavior in diseases.
References
Allen, K.D., Barone, V.J., & Kuhn, B.R. (1993). A behavioral prescription for promoting
applied behavior analysis within pediatrics. Journal of Applied Behavior Analysis, 26(4),
493-502.
Copeland, L., & Buch, G. (2020). Addressing medical issues in behavior analytic
treatment. Behavior Analysis in Practice, 13, 240-246.
Greenwald, A., Roose, K., & Williams, L. (2015). Applied behavior analysis and
behavioral medicine: History of the relationship and opportunities for renewed
collaboration. Behavior and Social Issues, 24, 23-38.
Raiff, B.R., Burrows, C., & Dwyer. M. (2021). Behavior-analytic approaches to the
management of diabetes mellitus: Current status and future directions. Behavior
Analysis in Practice, 14, 240-252.
So relatable. Great read
I see how ABA will boost compliance rates and general outcomes in physiotherapy.