Preferences and Preference Assessments

1. Preference Assessments

Preference assessments are tools used to systematically identify preferred stimuli that may function as reinforcers for your patient.

Preference assessments consist of a variety of tools that can be used to help identify what stimuli a patient may prefer. Once identified, the stimuli can be used as a possible reinforcer within a therapy session.

In addition to identifying general preferences, a preference assessment can help determine what stimuli may be considered highly preferred as compared to stimuli that may be less preferred. This helps to establish a possible hierarchy of stimuli that can be used as reinforcers.

Why do we need preference assessments?

• To determine what items may function as reinforcers
• Effective reinforcers increase the likelihood that the patient will engage in the same desired behavior in the future.

big idea

A key element to any successful behavior change program is identifying effective reinforcers for a given patient.

The best treatment interventions will only be successful if the patient is motivated enough to respond. Balance must be maintained between the patient’s response effort and the available reinforcement. When there is an imbalance in this equation, it is likely that challenges will arise. If a high response effort demand is presented with low reinforcement, it is likely that the patient will not be motivated to put forth the effort.

The use of effective reinforcers increases the likelihood that the desired behavior will occur again in the future. In addition, a substantial amount of research has proven that preference assessments are much more effective at predicting which stimuli will be effective reinforcers than using professional or parental judgment alone.

think about it

Consider your own preferences. How have they changed over time? Do you like things now that you didn’t like as a kid? Or maybe you don’t like things you used to love? For example, did you previously hate broccoli and now you like it? Or did you previously love playing with dolls or action figures and now you don’t?

think about it

How do your preferences change day to day? For instance, do you sometimes crave spaghetti for dinner, and other nights want a burger?

term to know

Preference Assessment

A tool used to systematically identify preferred stimuli that may function as reinforcers for your patient

2. Characteristics of Preference

Let’s start by discussing what we already know about preference.

First, we know that preferences change over time. That is, what may be an effective reinforcer early one morning may not be an effective reinforcer later on in that afternoon. Many variables may come into play that can alter the preferences of a patient.

EXAMPLE

During Colin’s first therapy session of the day, the behavior technician conducts a preference assessment. The assessment finds Colin has a high preference for bubbles. The behavior technician uses bubbles as an effective reinforcer across the morning therapy session. When the next behavior technician comes in several hours later, Colin does not select bubbles within the preference assessment. Bubbles are no longer identified as an effective reinforcer.

Next, we know that presenting items alone versus in competition with other preferred items can affect their preference, too.

EXAMPLE

If one million dollars was offered to an individual it might function as an effective reinforcer. But, if that million dollars was presented along with a two-million-dollar option, the individual would likely then choose the two million. This doesn’t mean that one million wouldn’t still be a very effective reinforcer!

We also know that changes in a patient's environment can also affect their preferences at any given time. It’s important to assess preferences so alternatives can be identified.

EXAMPLE

Geoff loves to go outside on his breaks and play basketball. If the weather outside is rainy or too hot, Geoff may no longer demonstrate a strong desire or preference to play basketball on that given day. In such a case, it would be important to assess preference to identify a potent alternative reinforcer.

It’s important to also note that research has proven that a person’s self-report is also not as reliable as a physical choice response. For example, a patient with limited communication skills may simply be used to asking for the same thing over and over. However, they may actually choose something entirely different when given the chance to indicate their preference with a physical choice response.

EXAMPLE

Before starting a lesson, the behavior technician asks, “What do you want to play when we are done?” Amanda always says, “Puzzles.” But if the behavior technician presents both a puzzle and an alternative item, Amanda will often select the other choice.

So, when we consider what we already know about preferences, it becomes clear that we need to be sure to assess a patient’s preferences often so that we are identifying and presenting stimuli that will, in fact, function as powerful reinforcers for the patient..

We must assess preferences often! Here are some things to keep in mind:

• As we discussed, preferences change over time and with other environmental influences.
• It is important to conduct preference assessments frequently to ensure effective reinforcers are identified.
• The behavior technician should conduct preference assessments several times across the therapy session. and generally, prior to the start of each lesson.