Understanding Obsessive and Ritualistic Behaviors

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Many of our clients suffer from the need to engage in ritualistic behaviors as well as may perseverate on one topic or object. In the world of ABA, this is usually referred to as Ritualistic Behavior or Obsessive Behaviors. No matter its name, it causes a huge interruption in the life of the client and their entire family. Some examples of these include physical routines (needing to turn off the lights 10 times when leaving a room), needing to fix something that is not their version of correct (broccoli belongs on the right side of the plate and never on the left), staying on a strict schedule (showers only take place from 7-7:30pm), perseverating on a specific topic (talking only about dinosaurs), and needing specific questions answered by others (asking someone how old they are when you meet them). These types of behaviors can lead to crippling the client from engaging in everyday activities. They can also be detrimental to the family as a whole. It’s important to look into these behaviors as flexibility is a big part of everyday life.

First we should ask ourselves: Is this ritual or obsession really something we need to intervene on? Is the behavior affecting the client and the family in a way that cripples the individual from leading a functional life? If we sit back and really think about it, we all engage in rituals. I like to have coasters under my drinks; I like to have my coffee a specific way; I want my bed made the way I like it, etc. The first step is to determine whether intervention is needed and if the behavior is socially significant.

Once we are able to determine it needs to be treated, we need to define it. A loose definition would be engaging in or not engaging in a particular behavior persistently or repetitively in the same way each time. It may be helpful to create a list of the different examples the client engages in as the different behaviors may not be similar. This is where teamwork comes into play. It is important for BTs to be very involved in this. After all, BTs are seeing the clients the most amount of hours and probably see the most rituals during sessions. Communication with the manager or BCBA regarding examples will help the manager or BCBA create an all inclusive definition that everyone, including parents, can create. BTs, parents, teachers, siblings, managers, and BCBAs can all work together to come up with a definition everyone can follow. Evaluating this can be difficult but the best way to determine if a behavior is a ritual or obsession is to look at what happens if the behavior is blocked. If a client engages in tantrums or has difficulty getting away from a topic, it is best to mark this as an instance. Marking it and letting the manager or BCBA know about it can help create a more comprehensive definition so that we can ultimately dive into treatment.

Treatment is the next step but will be saved for a future article. All in all, rituals and obsessive behaviors in the clients we work with can be detrimental to both the client’s life and the life and well-being of their families. It’s important to determine if rituals or obsessive behaviors may be occurring and report to the manager or BCBA on the case. The manager or BCBA will then determine its significance and if it needs to be intervened on. The next step would include teamwork. Building a definition everyone can follow is imperative to creating an effective treatment plan that will ultimately help build a better life for our clients and their families.

 

Allyson Kroneberger, M.S., BCBA, LBA
Associate Clinical Director, Boston, MA

August 6, 2019