SORKC: Behavior Analysis

Most in neuropsychology prefer a model developed by Dr. Fred Kanfer.  In his approach, behavior analysis involves filling in the terms in the behavioral equation:

1. S – Antecedent or prior pattern of stimulation. More recently these elements are seen as the contextual patterns of influence. It is what happens BEFORE the behavior of focus.
2. O – Organismic or biological state that may be influencing a pattern of behavior of concern. For example, changes in perception associated with dementia or recent changes in medication.
3. R – The response that is the focus of the analysis. The litmus test for a definition of a response is that it uses verbs and is sufficiently detailed that you could describe it to another person and they would immediately recognize the pattern.
4. K - The contingency between the response and the consequences that occur when the response occurs.  If every time the behavior occurs the consequence is attention and attention that is not being provided for alternative patterns that is a powerful contingency relationship.
5. C - The events that follow the behavior or the consequences of the behavior. This has major influence in perpetuating the pattern.

As in most problem solving 80% of the solution is in a precise definition of the problem.  The SORKC model provides a framework for doing just that. However, these methods must fit in a person-centered approach that avoids making a dementia patient an object. Between 70% and 80% of the challenging behaviors presented by dementia patients are product of a lower threshold for stress and the deficit in their ability to organize their response. With neurological decline comes a reduced capacity to cope with stress without our help.

Behavior is contextual and rarely the product of a single cause.  To try to explain behavior in terms of chemicals, stimuli or events subsequent to the behavior is a fool’s errand. All behavior is a product of multiple factors and our challenge is to isolate those factors. More often than not, that entails formulating a hypothesis with the elements of SORKC and then testing.

If the context of behavior is poorly defined any effort to resolve the problem becomes random trial and error. The first step is to define the antecedent conditions (S) associated with the behavior of focus. The question is what happened immediately before the problem behavior.  Who was involved?  What time of day? The more detail, the better.  The word trigger is often misused and leads to leaping to conclusions. Biological and cognitive events (O) must be considered. Has there been a change in medication? What was the patient’s likely perception of the antecedent events? Is there a urinary tract infection? The response (R) is the challenging behavior and the more descriptive and action oriented the language the better. After obtaining a good description of the response we must always ask this question: What is the alternative or preferred response. If the patient is hanging around the nurse’s station we have to ask what we want them to do as an alternative. So R must include BOTH the problem behavior and our preferred alternative.

All people, including dementia patients, are heavily influenced by the consequences of their behavior.  Otherwise we would all still be in trees. The relationship between the response and its consequences is K and the consequence is C. When all behavior is ignored and approaching the nurse’s station leads to attention that is a contingency (K) and that must change if we want the behavior to change.

We can never really manage the behavior of others.  We can all only manage the context.  We can change what happens before, what happens during and what happens after the behavior. We must understand the context fully. Because people are marvelously adaptable the behavior may then change unless biological factors, including neurological factors, prevent it.