“I’m not trying to change people. All I want to do
is change the world in which they live.”
B.F. Skinner
During the 1980s, I was coordinator of an ABA day and residential program that served children and youths with severe behavior and communication disorders (the SBCD Program) at Vermont Achievement Center. The demographic leaned heavily toward male students. We had mostly kids who would be diagnosed as level 3 autism today along with both rare and common trisomies. We also had one student (“M”) with Duchenne Muscular Dystrophy who was rapidly losing muscle function. To keep this group engaged and productive, we provided a dynamic interactive curriculum, an approach requiring many hands for which we tapped the resources of the local Retired Senior Volunteer Program (RSVP).
Enter Grandpa John. John Arnold was a kindly gentleman who came to Vermont from the Big Apple as a young man to work in the Civilian Conservation Corps during the depression (CCC… the folks who built the Long Trail shelters), liked it here, and stayed. At that point, M was already non-ambulatory and was losing hand function. Grandpa John became M’s arms, legs, and hands, ensuring his ongoing access to activities and materials.
Periodically, John would put his hand on my shoulder and say “Dave, these boys are doing the best they can”. He was right, of course, but at the time, I did not appreciate the full import of that statement. I’ve given it deeper consideration since. There is an unspoken part to Grandpa John’s pronouncement. It reads as follows: “Dave, these boys are doing the best they can [given the circumstances]”. M was indeed doing the best he could. John was the circumstance that enabled him to do so.
Arguably, our core mission as behavior analysts, is to teach skills that expand individual agency. To that mission, there is a corollary that speaks to Skinner’s statement. “We” don’t change people. People learn in response to changes in their environments (changes in the world around them). So, to the core mission to structure the environment (change the world) so people can learn best, we expand the mission to structure the environment as well (change the world) so that people can best use the agency they already possess. In other words, we must continuously broaden our engagement in the art and science of circumstance. That’s what Grandpa John was doing with M and that’s how M, along with all the other boys, was doing the best he could. People really do their best when they can… it’s making the “can” part happen that’s the challenge.
So, there are implications here for humans whose repertoires and the independence to deploy those repertoires are declining rather than expanding. What’s a behavior analyst to do? Design and provide supportive circumstances, of course, for people with degenerative diseases and geriatric decline who are either losing skills or losing the independent ability to use the skills they do retain. In the early days of applied practice much effort and creativity went into the design of functional alternatives to support as much independence as possible. Velcro replaced laces for those whose fingers could not tie. Coin templates replaced computational math for getting a snack out of a machine (I’m dating myself here… replaced by the debit card). Not all functional alternatives are things. Today, there are a multitude of electronic interfaces amenable to easy access. We also can, do, and should design simplified efficient physical routines so that individuals with constrained physical capacities can access reinforcement.
We are still very young as an applied science. Our therapeutic roots lie in deinstitutionalization and in teaching significantly disabled children, but we have yet to fully flower. I am heartened by increasing attention in the literature to support across the lifespan, including end of life. The better we get at supporting function in the face of decline, the circumstantial evidence will speak for itself.
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