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Results
#1. Jermaine, a 7-year-old child, has been fully potty trained for three years and has consistently demonstrated significant progress in his self-help and independent living skills, which are approaching age-typical levels. Suddenly, over a period of five consecutive nights, Jermaine begins to wet his bed. This is a novel and unexpected behavioral change given his history of successful potty training. As a Board Certified Behavior Analyst (BCBA), what is the first and most crucial action you should take when encountering such an abrupt and unexplained regression in a client’s previously mastered skill?
The correct answer is Suggest that Jermaines parents consult a medical professional The ethical guidelines for BCBAs eg BACB Professional and Ethical Compliance Code for Behavior Analysts mandate that behavior analysts rule out medical and biological causes for sudden significant and unexplained changes in behavior before proceeding with behavioral assessment or intervention In Jermaines case a child who has been consistently potty trained for three years suddenly beginning to wet the bed multiple nights in a row is a red flag for a potential underlying medical issue eg urinary tract infection diabetes sleep apnea or other physicalphysiological causes It is outside the scope of practice for a BCBA to diagnose or treat medical conditions but it is within our ethical responsibility to recognize when a medical consultation is necessary and to make that recommendation This ensures the clients health and safety are prioritized Lets consider why the other options are incorrect Interview Jermaines parents to identify recent changes in his daily routine or environment While this would be a logical step in a comprehensive functional behavioral assessment FBA it should only occur after medical causes have been ruled out Starting an FBA without considering medical factors could delay appropriate medical treatment if a health issue is present Reimplement the original potty training procedure that was successful three years ago This is inappropriate for several reasons First it assumes the problem is behavioral without ruling out medical causes Second interventions should always be based on a current and thorough behavior assessment not simply a reuse of a past procedure as the variables maintaining the behavior might have changed or a new behavior might require a different approach Simply plagiarizing past interventions is not best practice Immediately develop and implement a punishment procedure for bedwetting This is the worst and most ethically unsound option Jumping directly to a punishment procedure without any assessment especially when a medical cause is highly suspected is unethical and potentially harmful Punishment should be a last resort implemented only after thorough assessment consideration of less restrictive alternatives and a clear understanding of the function of the behavior none of which have occurred here Furthermore it completely ignores the possibility of a medical etiology for the behavior
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