unlocking support behavior analysis and pediatric ibd care

Are you familiar with terms like behavior therapy, behavioral therapy, or applied behavior analysis (ABA)? What about the acronym BCBA? In this blog post, you're about to uncover how behavioral therapy, a field that may still be relatively unfamiliar to some, holds the potential to make a profound positive impact on the lives of pediatric IBD Warriors. Join me as I sit down with my husband, Bryce Fournier, a Board Certified Behavior Analyst (BCBA), to explore the transformative impact of behavior analysis on the landscape of IBD. Together, we'll uncover what behavior analysis entails, its potential influence on the realm of IBD, the burgeoning growth of the field, and how parents may be able to connect with a BCBA for invaluable assistance with behavioral challenges. Bryce has actually been a guest of IBD Connect's blog previously, where he was able to share about his personal experience growing up with a sister diagnosed with Crohn's disease at a young age. A link to this interview can be found at the bottom of this post. I'm thrilled to welcome him back to the blog to discuss the potential benefits of behavioral therapy for those with IBD. Please, enjoy the interview!

Can you please introduce yourself for those who have not read your previous interview? Tell us a little bit about yourself, your family, and your connection to IBD Connect!

Sure. My name is Bryce, and I am the son of IBD Connect's founder and director, Lisa Fournier. I am married to Emily, IBD Connect's blog writer and media director. Currently, I am a behavior analyst and work in the public school system supporting students with Autism and other behavioral needs. In my personal life, I enjoy working out, playing with my fifteen month-old son, and going on walks with my family.

You mentioned that you were a behavior analyst. What is behavior analysis? Can you please tell us a little bit more about what you do? What does your job entail?

Absolutely. Behavior analysis is the applied field of study that uses research-based, behavioral strategies, including principles of reinforcement, to increase adaptive and prosocial behaviors and decrease challenging and interfering behaviors. Behavior analysts need a masters or doctoral degree and must pass an exam to be board certified in order to practice. A behavior analyst can work in a variety of different settings, including: clinics, group homes, hospitals, nursing homes, schools, and offices/places of work that need help with behavior and/or organization. Many behavior analysts opt to specialize in working with individuals with autism spectrum disorder, serving in diverse settings such as public schools, private schools, group homes, or directly within the patient's home environment. Personally, I work in a public school, supporting the social, emotional, and behavioral needs of students on my caseload. I work primarily with students with autism and other developmental disorders but support students with other diagnoses who need behavioral support as well. In short, I try to increase prosocial behaviors (communication, following directions, sharing, completing classwork, etc.) and decrease problem behaviors (tantrums, biting, hitting, etc.) in students on my caseload.

Is the behavior analysis field currently working with patients with IBD? How is behavior analysis relevant to IBD patients? Does this field work with other populations with chronic diseases and disorders?

The applied behavior analysis field is indirectly working with patients with IBD. As we know, anxiety and depression can often co-occur with IBD, especially when social aspects of a person's life are affected by the disorder. The field of behavior analysis currently works with patients with anxiety and depression through different therapies, such as Cognitive Behavioral Therapy and Acceptance and Commitment Therapy. Additionally, a done in 2008 revealed that children and adolescents diagnosed with IBD are at a higher risk of displaying behavioral dysfunction, family dynamic issues, social problems, and nonadherence to treatment regimen than a healthy control group. Although the field of behavior analysis has not yet begun supporting IBD patients in a significant way, behavior analysis has been a successful treatment for behavior dysfunction, improving family dynamics, and nonadherence to treatment regimens within other populations (e.g. mental health needs, substance use, etc.), therefore behavioral therapy may be beneficial to a pediatric patient with IBD struggling in one of these domains.

You mentioned that you work with the social, emotional, and behavioral needs of the children on your caseload. Can you please clarify how you do this? Do you feel that behavior analysis could help IBD patients in those domains? How so?

Absolutely I do. As previously discussed, the field is already adept at working with individuals diagnosed with anxiety and depression, conditions that often accompany chronic illnesses and affect a significant portion of the population. When addressing the social needs of my students, I prioritize the development of essential social skills, such as interpreting social cues and norms. Additionally, I provide guidance in emotional regulation and equip students with coping mechanisms for managing challenging emotions. Finally, in supporting behavioral needs, I help create an individualized treatment plan aimed at decreasing levels of challenging behaviors and teaching important skills. Applying these principles to pediatric patients with IBD, we can similarly focus on teaching social skills, particularly crucial for children who may miss out on social interactions due to hospitalizations and limited community engagement. Moreover, we can offer support for emotional and behavioral challenges faced by both children and their parents. Drawing from our experience in working with populations dealing with behavioral and family dysfunction, as well as those struggling with treatment adherence, we are well-equipped to assist patients with IBD and their families in navigating these complex dynamics.

Could you offer examples of specific applied behavioral interventions that have proven successful in supporting individuals you've worked with? How applicable are these interventions to patients with IBD and their families, and how adaptable are they across different age groups?

Of course! I've developed an intervention focused on teaching autistic clients how to swallow pills and manage medications by gradually introducing small mock pills. Success is reinforced with preferred items or activities, and the size of the pill is systematically increased over time. This approach has been successfully implemented with both young children and high-schoolers.

Moreover, I recently conducted a research study published in the Journal of Applied Behavior Analysis, which utilized a behavioral treatment package to promote moderate-intensity physical activity in adults. These interventions demonstrate remarkable adaptability across age groups and hold potential applicability for individuals with IBD. Given the importance of medication adherence and regular exercise within this population, these strategies could prove beneficial.

How important is parental involvement in implementing behavioral interventions for children? What strategies do you recommend for parents struggling with behavioral challenges with their children diagnosed with IBD?

As the primary implementers and monitors of behavioral interventions on a day-to-day basis, parents play a pivotal role in the effectiveness of the interventions I prescribe. I consistently observe the greatest strides in client progress when parents are actively engaged in implementing the behavioral strategies I establish. Although my advice should not be used in lieu of behavioral or medical treatment, for parents struggling with their children's challenging behaviors due to some aspect of an IBD diagnosis, I would recommend using something called differential reinforcement to try to decrease challenging behaviors. Differential reinforcement has four key aspects that make it effective. Let's take a look at an example using a hypothetical situation. In this hypothetical scenario, your child throws a tantrum whenever it is time to take his oral medication. First, you, as the parent, should identify the positive behavior you want to see. In this example, the positive behavior you would like to see is that your child swallows the medication. Second, you should identify the challenging behavior you do not want to see. In this case, that would be your child's tantrum! Third, identify a reinforcer or reward for successful swallowing of the medication. If your child likes reading a certain book with you, eating a certain snack, or playing a certain game, this could be the reward your child will receive if the medication is swallowed. Anything your child likes and frequently enjoys could be used as a reinforcer. Fourth, and finally, identify the response for the negative behavior (i.e. the tantrum) that you will implement should your child not swallow the medication. This could be simply ignoring the tantrum while keeping the child safe, as well as continuing to present the medication demand intermittently until the child takes the medicine. In this hypothetical example, you, the parent, would communicate the potential reward for swallowing the medication to your child. If your child goes into tantrum behaviors, your response to this behavior would be to stay calm and keep your child safe while ignoring the tantrum. You would represent the mediation every minute or so until the child cooperates. Again, I have to mention that this is simply an example showing how differential reinforcement works and that this example is hypothetical and does not constitute behavioral advice. It should not replace therapy from a contracted BCBA or medical provider.

As children with IBD transition into young adulthood, how does behavior analysis continue to play a role in supporting their evolving needs and challenges?

As highlighted earlier, the field of behavior analysis is already highly adept at assisting various population groups grappling with anxiety and depression, two conditions that have the potential to arise as children with IBD transition into young adulthood. Moreover, employing behavioral strategies can facilitate the adoption of healthy habits and lifestyle adjustments crucial for effective treatment, including fostering habits like balanced nutrition and regular exercise. Furthermore, established therapeutic approaches like Cognitive Behavioral Therapy and Acceptance and Commitment Therapy have proven effective in supporting many young adults contending with anxiety and depression, offering promising avenues for managing the emotional complexities often associated with IBD.

How do you see the field of behavior analysis growing and expanding further into the treatment of patients with IBD?

I envision the field expanding in several key areas. Firstly, we're witnessing a concerning rise in young children being diagnosed with IBD, yet we have only a limited understanding of the potential long-term impacts on their mental health. I believe there's a need for tailored interventions that can effectively support these young patients. Therapies like cognitive behavioral therapy and acceptance and commitment therapy have the potential to adapt and better cater to the unique needs of IBD patients, offering targeted support for their mental well-being. Secondly, as mentioned previously, behavior analysis has the potential to help with medication adherence and the transitioning of the responsibility for treatment from parents to the children as children become adults themselves. Behavioral analysis can play a pivotal role in fostering autonomy! Finally, in my opinion, the field of behavior analysis has the potential to emerge as a valuable tool in addressing family dynamics impacted by IBD.

Do you have any words of advice or hope for parents of children having difficulties coping with a new IBD diagnosis?

Yes, I do. First, know that you shouldn't have to navigate a new IBD diagnosis in the family alone! IBD Connect offers support groups and resources to help navigate the stress and emotional turmoil that a new IBD diagnosis can bring. Second, if your child is having behavioral challenges, please understand that this is not unexpected. Remember that behavioral challenges are very changeable and can significantly improve over time, especially with appropriate treatment and as children mature. Third, the field of behavior analysis continues to expand, offering enhanced support for diverse populations, including those grappling with chronic illnesses like IBD. If you feel as though your child may benefit from a professional's guidance, don't be afraid to take the first step in getting help. Finally, by using simple reinforcement strategies and encouraging an overall healthy lifestyle that focuses on diet, exercise, time outdoors, social supports, and the treatment plan and guidance of your child's medical team, parents can help their children mitigate many of the psychological effects that may come from an IBD diagnosis.

Finally, how can parents seeking support for a child experiencing behavioral or mental health challenges find the assistance they need?

Parents seeking support for a child experiencing behavioral or mental health challenges can benefit from consulting with a Board Certified Behavior Analyst (BCBA). A BCBA can provide evidence-based interventions rooted in cognitive-behavioral therapy (CBT) and acceptance and commitment therapy (ACT), tailored to the child's needs. Look online for a clinic or clinician specializing in these therapies, or talk with your child's pediatrician. A clinician trained in CBT or ACT can offer guidance on implementing behavior management strategies, teaching coping skills, and fostering emotional regulation. Additionally, online resources such as reputable websites and forums, can offer valuable information and support. Many ABA providers have parents guides on their websites.

Here's one geared toward parents:Here's a resource for pill swallowing:As we wrap up our interview with Bryce, I trust that this discussion has provided you with valuable insights into the rapidly evolving realm of applied behavior analysis and its potential to bring about positive change in the lives of pediatric IBD patients and their families. Bryce's thoughtful, insightful answers truly showcase his passion for behavioral therapy and his willingness to help IBD patients and families. Thank you Bryce for an incredible interview! As a side note, Bryce's expertise in behavior analysis has significantly contributed to the growth and development of IBD Connect. Notably, his ideas and educational background played a pivotal role in shaping the structure of IBD Connect's current twelve-week Healthy Breakfast Challenge. Before we conclude, I want to remind everyone that if you are looking for more information or would like to receive support, please feel free to contact me or another member of the IBD Connect team. My email is linked at the bottom of this page, and you can always contact us through our website as well. Additionally, even though today's post was not clinically heavy, I still want to remind everyone not to use this page as a substitute for a professional medical opinion. For more detailed information regarding IBD or if you have questions pertaining to your child's individual treatment plan, please seek out the professional medical advice of your child's doctor. And as always, stay strong IBD Warriors/IBD Warrior parents!