A Body in Motion

Dr. Frank Gresham (Figure 1) is a professor of psychology and director of the School Psychology Program at Louisiana State University (LSU). He received his PhD in psychology from the University of South Carolina in 1979 and has over 30 years of experience in the fields of school psychology, child clinical psychology, and special education.

OPEN IN VIEWER

Figure 1.

Frank Gresham.

Dr. Gresham has over 250 publications in the form of refereed journal articles, books, and book chapters. His research interests include social skills assessment and intervention with children and youth, emotional and behavioral disorders, specific learning disabilities, and intellectual disabilities. He has served as an editorial consultant on a variety of peer-reviewed journals in psychology and special education, was a standing panel member for the Institute of Education Sciences (Social and Behavioral Outcomes to Support Learning), and has received over $12 million in federal research funding. He is a recipient of the Senior Scientist Award from Division 16 (School Psychology) of the American Psychological Association for outstanding research contributions to the field of school psychology. He is a fellow of three divisions in the American Psychological Association (School Psychology, Clinical Child and Adolescent Psychology, and Evaluation, Measurement, and Statistics) and is a fellow of the American Association for the Advancement of Science.

In 2002, Dr. Gresham testified before the president’s Commission on Excellence in Special Education. The commission advises the White House on how to fund and handle special education policy. He has also been recognized in his field of work with numerous awards and honors, including the Senior Scientist Award from the American Psychological Association’s Division of School Psychology (2009) and the Lightner Witmer Award, also from the American Psychological Association, for outstanding scholarly research by a school psychologist (1982).

Dr. Gresham has expertise in the following areas: school psychology, special education, mental retardation and education, learning disabilities and behavioral disorders, and attention-deficit/hyperactivity disorder. He has earned an MEd in rehabilitation counseling and a PhD in psychology at the University of South Carolina, Columbia. The major areas of research include social skills assessment and training with children, behavioral consultation, and applied behavior analysis.

Marilyn Kaff and James Teagarden interviewed Dr. Gresham during a visit to LSU in the spring of 2012.

Intervention: Dr. Gresham, could you tell us how you got into the field of education of students with emotional/behavior disorders?

Gresham: I’ve thought about that question and I think I’ve got it figured out. It didn’t just happen by chance. I think the best explanation of how I originally got interested in this population goes all the way back years and years ago to my undergraduate days. I was a psychology major [and] I also minored in secondary education. My junior year I went to Georgia State University in Atlanta. I had taken all the required courses—motivation and emotion, learning and conditioning, personality, social psychology—all those kind of traditional psych courses. Nothing applied, though. None of those apply; those are like “rat” courses, “monkey” courses, and they’re not human courses typically.

I didn’t have any kind of applied coursework so I signed up for a course I noticed was being offered. It was an elective and it was offered for both graduate and undergraduate credit. It was called something like Principles of Behavior Modification and was taught by a very well-known person in the field, Ted Ayllon. Ted is Bolivian, so I walk into class the first day and I see this guy with a silk shirt and chains and bell-bottom pants. You have to remember this is the 1970s, so you get the fashion statement this guy is making, right? So here’s this wild, Bolivian, South American. Ted worked a number of years at Anna State Hospital in Illinois. He did a lot of work with Nate Azrin, who is very well known in the field. He was actually Jack Michael’s student at the University of Houston; that’s his academic background.

Anyway, I walk in the class and Ted Ayllon is showing a black-and-white video of all this behavioral modification they had done with schizophrenic patients at the state hospital. He showed, for example, how they shaped a woman up with cigarettes to stand there and hold a broom for hours and hours. He showed how it progressed, how they reinforced her for doing that, and then showed how they could extinguish that—make that behavior disappear, as if by magic, you know? I had never seen anything like that.

Then he showed us another video of a woman who was a towel hoarder. She had something like 600 towels in her room. He said, “Well, how we’re going to fix that is with stimulus satiation association and we’ll give her more towels.” Basically, by the end of the study, she’s throwing towels out in the hallway. She had something like two towels in her room, [down] from 600. That’s magical! Then he described another case study where a woman would wear like five dresses and four pair of pants, 10 bras, all of this clothing. He said the way we fixed that is we just weighed her every time she went to eat. They had the scale outside the cafeteria. It was kind of like a decelerating change of criteria. She’d get on the scale and they would tell her, “Nope, you weigh too much.” She’d get off and then take clothes off, get back on, and then they’d let her eat. They kept doing that progressively until she’s wearing one dress and one sweater. I had never seen anything like that before in my life—how you could turn behavior off and on like that. I guess that’s why I’m a life-long behaviorist. It really got me interested in people with very severe mental health issues. These were all psychotic, schizophrenic, paranoid patients who were hospitalized. I thought it was magical how you could change that severe behavior pattern by using pretty simple principles for behavior change. That really got me hooked in the behavior disorder (BD) field. I knew I had to work with people like this, people who have problems.

When I graduated from Georgia State in 1973, my first job was in the South Carolina Department of Corrections. I am from South Carolina originally, so I moved to Columbia, [South Carolina], and took the job in the South Carolina Department of Corrections in the education department. Basically my job was to crunch standardized test scores from the testing base of adult education. I worked primarily with youthful offenders. Youthful offenders were defined, I think at the time, up to age 25. I did education-related things—counseling, testing, and those types of things—with the youthful-offender prison population. Some were in minimal-security institutions, some were in medium-security institutions, and others were in maximum-security institutions. I got a pretty good taste of what that crowd was like. They interested me. I was interested in them. It was a population that I enjoyed working with, particularly educationally.

So, I did that and then around 1974, I said, “I need to get a more advanced degree.” I worked in a correction that is defined as law enforcement, basically. So, the DOJ, Department of Justice, said, “We’ll pay for your advanced degree, a master’s degree, if you promise after you get the degree to stay on in corrections or law enforcement in some way for 2 years. We’ll pay for it ‘full boat,’” which they did. And so I enrolled and got a master’s degree in rehabilitation and counseling in 1975 and I stayed on another 2 years, 3 years total, in the South Carolina Department of Corrections. That was a really valuable experience, working with that population. So, that was another way that I got hooked into the BD field. Working with the schizophrenics and the psychotics and then with incarcerated individuals—those two things, I think, together got me in the field.

Intervention: How would you describe your career in the field over the last 33-plus years?

Gresham: Tiring! Well, I don’t know. Let’s see where to start? Actually, I’ve done a lot of work in the area of social skills, so one thing, it might be of interest to some people is “How in the world did you get interested in that? You apparently have no social skills.” I’ve been told that, but anyway, the way I really got into it was kind of a backdoor way. I mean, in the area of social skills. Most school psychology programs are in colleges of education or departments of educational psychology. Our program here at LSU is in psychology. At the time I graduated from the program of school psychology in the Department of Psychology from the University of South Carolina, we had a requirement to write a comprehensive paper, and essentially it was like a Psychological Bulletin type of review. The idea behind that was, if you’re smart, this should be your literature review for your dissertation.

I didn’t know what to write about. I had some thoughts and so I went to one of the clinical faculty members who was on my committee, and I said, “Well you know, I have an idea about doing a paper on this.” He looked at me and he said, “Well, that’s really boring.” I said, “Thanks, I don’t think so.” He says, “Yeah, that’s boring. Why don’t you do it on something like social skills?” I said, “What are those?” So basically, I went and found out what those were. I read the entire literature on how to assess and intervene on an individual’s social behavior. A lot was adult research. Most of the child research in the area of social skills, at the time, was single-case design research. That’s how I kind of got into it. I wrote that review paper, which subsequently got published in Review of Educational Research in 1981.

So, that’s how I got into it. I read a lot of work by Dick Shores, Phil Strain, and Hill Walker. It was really interesting with Hill Walker, who now is a very good friend of mine. At the time, Hill had a center with the Department of Education in what was then called Bureau of Education of Handicapped, BEH. He had a grant through them, called Center at Oregon of Behavioral Educational Research. This was pre-Internet, “Pony Express” days, but I found out that you could buy these documents—all the studies that were done—and he did a ton of studies on social skills. I must’ve ordered 10 of those books. That’s how I got exposed to Hill Walker’s work. Hill had a profound influence on me in the area of social skills. Reading the ABA (applied behavior analysis) literature (Phil Strain’s stuff, Dick Shores), then reading Hill Walker’s stuff, got me hooked into the social skills thing. I obviously pursued that and still am.

But, also, secondarily, as kind of a side line, I got interested in the whole concept of treatment integrity or treatment fidelity. The reason I got interested in that was we spend a lot of time measuring the behavior that we are trying to change. We spend no time measuring the method we’re going use to change it. If we don’t measure that, then how in the world can you say x causes y? I got really interested in it from a logical perspective. I thought that was odd. Around 1982, I read an article that really influenced me by a woman named Lizette Peterson. She had an article in 1982 on treatment integrity, and she reviewed all the studies from 1968 to late 1970s. She found that basically only about 15% of all studies published measured treatment integrity. Well, I thought that was an abomination. I started doing reviews like that too. I’ve done three or four since then, and that number really hasn’t changed much. I’m thinking, how could you have a so-called science of behavior, how could you have a science of something, if you’re not measuring the independent variable—the variable that is supposed to change the behavior? I’ve always had a quibble, if not a fight, with people on that issue. So that’s how I got into the treatment integrity business. What else?

Intervention: I’m fascinated to find out!

Gresham: I don’t know, I’m trying to think of what else I’ve done! I’ll tell you a third area, now that I think about it. When I went to University of California (UC), Riverside, I worked with a very close friend of mine in college, Don McMillan. Don is obviously retired now, but Don was probably the preeminent person, in my opinion, in the area of mild retardation. He wrote kind of a classic textbook and went through two editions, called Mental Retardation in Society. The first one is white and the second one is gray. I think I used the white one when I was in graduate school when I took an MR (mental retardation) course along with another book, Robinson and Robinson, which is green.

So, I went to UC Riverside and was really interested in working with Don because I used his textbook, read his stuff. Don and I started writing Office of Special Education Programs (OSEP) grants. I was there for 14 years working with Don, and we must’ve had five or six OSEP grants. One thing that we were really interested in, and I attribute this to Don’s influence, was the relationship between what the state definition or guidelines were for our disabilities. For example, in California, to meet the criteria for a specific learning disability (LD), you had to show a discrepancy of 22 points or greater. So, to meet the definition of mental retardation, an IQ of less than 70 [was required] with deficit adaptive behavior and so on. We identified a group of kids through teacher referral, assessed them with a traditional battery—you know, Woodcock-Johnson, Peabody Individual Achievement Test, whatever, you name it—and then use for the LD population. For example, we identified a group of kids with a 22-point discrepancy, and we called them LD. We identified a group of kids with IQs of less than 70 and we called them MR with a deficit adaptive behavior. So, we had those groups identified and then we had kids we called “garden-variety low achievers,” who were nondiscrepant. Then we looked at how schools classified them. Guess what? The chi-squares were not significant. We found, for example, what happened was school districts are scared about the overrepresentation stuff. We found that a large number of kids who would’ve qualified and should’ve, if you went by the state criteria, been classified as mentally retarded were classified as LD, or they were not classified at all.

That really influenced me. Our main take away on that was, what good are state guidelines if you don’t use them? I’m not a qualitative researcher by any means, but we did some qualitative follow-up and asked placement teams, Why? I mean here’s a kid you called LD, and he clearly would meet the criteria for mental retardation. Why’d you do that? They told us pretty much there wasn’t any upside to calling them MR and there’s no downside for calling them LD. I said, “Well, okay. Good to know.”

Intervention: Makes you wonder if that doesn’t continue today.

Gresham: I think it does. What we do know is that the mean IQ of the LD population is decreasing, which means a lot of kids with lower IQs are getting into that category. Anyway, that was the third thing that I was interested in.

Intervention: If you were to consider what events, policies, innovations, and people have had the most influence in your professional life, what and who would they be?

Gresham: Yeah, with the people, I’ve mentioned several. With events, well obviously, everyone is going to go back to 94-142 in 1975 and saying that was a watershed event. It was. I also present a lot to the school psych groups, and I say, “If 94-142 was anything, it was a full employment act for school psychology.” It was Medicare/Medicaid all rolled into one for school psychology. Prior to that, some of the more progressive districts, better districts, had school psychologists and they were doing stuff, but some of the smaller districts, rural districts, they didn’t have school psychologists. Anyway, I call 94-142 that watershed event. That did it.

Then, staying with special education law, I think the ’97 reauthorization that talked about things like functional behavioral assessment (FBA), positive behavioral support (PBIS), this kind of thing, also had a big impact on how we do things, particularly for kids with EBD (emotional and behavioral disorders). When you think of FBAs, and PBIS, you don’t think of LD kids. You typically think of BD kids or ED (emotional disorder) kids. Then, I think, a crowning event was in 2004 with reauthorization of IDEA (Individuals with Disabilities Education Act), that brought in, at least in the language for LD, identification of RTI (response to intervention). That’s the first time we saw RTI in any legislation. I think those three federal laws had a profound impact on how we look at the world and how we do business.

Intervention: How do they impact the field, either positively or negatively?

Gresham: Well, I think positively they led to our ability to provide services for more kids who were in need of those services. We had not done that prior; I think that was a major positive event. I think a negative part, the other side of that coin, particularly as it relates to RTI, is that we had a mandate—no, not a mandate; you could choose to use RTI or not. Not many people at the time knew what RTI was, and less how to do it. If you read the law, the law doesn’t tell you how to do it. It just says that you can do it. A district can be left to their own devices to make up what they consider to be RTI. I think you can do good RTI and bad RTI. In a sense, RTI is a positive thing and in another sense, it’s a negative thing because there was no guidance or guidelines for it.

Intervention: What has had the biggest positive impact on the field overall?

Gresham: Biggest positive impact: I’ve been a big proponent of using the RTI concept for BD. It was originally written into the legislation for LD; that’s the only place you can find it. You can still use discrepancy; I don’t know why they left that in but they did, because that’s pretty invalid. But, if you don’t want to do that, you can do RTI. But there is nothing in the law that says what to do with ED or can we use it for them. I’ve been a big proponent for using the exact same kind of logic to identify kids with emotional behavioral disorders based on their failure to respond properly to an evidence-based, scientifically based intervention. It’s just that the target behaviors are different. The logic to me is exactly the same. Back in 1991, I wrote a paper that was posted in the School Psychology Review, and the title was “Resistance to Intervention: Alternative Means of Identifying Kids with EBD.” RTI really only came about around 2000, but some 9 years earlier, I kind of latched onto that concept. One reason I called it “Resistance to Intervention” was because if you ever work a lot with EBD kids, they’re pretty resistant to intervention, so that made sense for the population. Secondly, there’s this kind of esoteric concept in experimental analysis of behavior—not applied analysis, but with experimental analysis, which is the experimental side of ABA—which is based off of behavioral momentum. Behavioral momentum was kind of like a Newtonian physics analogy, where basically you’ve got a body at rest. A body that stays in motion, if you have a body with large mass, it takes a lot of force to move the momentum. So, I’m thinking about kids with BD, how does that relate to them? Well, they’ve got a big chunk of behavioral momentum. They’re rolling down the hill, like that stone in an Indiana Jones movie, and if you’ve got this weak intervention, it’s just going run over you. So, you better have a strong intervention to deal with these kids. What a great analogy for kids with EBD, particularly for kids with more externalizing behaviors—not maybe for those with internalizing problems, which is another issue—but particularly for kids with a lot of opposition, defiant conduct disorder, antisocial types of behaviors, which you might call externalizing behaviors. They have a long history, they’ve been reinforced over a long period of time, and they are highly resistant to intervention. That analogy really kind of intrigued me as it related to BD.

Intervention: You were talking about behavioral momentum. The SSRS (Social Skills Rating System), which you were instrumental in developing, unlike most behavior ratings, focused on positive and performance deficits, and I wonder if that was a conscious choice? Obviously it was strength based, but was that to address behavioral momentum? If you focus on positive behavior, it seems that you might get that kid rolling—the stone rolling—on a different path.

Gresham: A different path . . . I just take another interstate, one that’s not congested! John Maag writes a lot about positive replacement behavior. John’s on the right track with that, obviously. I had gone on that track, too. If you look at SSRS and SSIS (Social Skills Improvement System), we have social skills scales and subscales, and we have problem behavior scales and subscales. You can look at those in tandem and say, “Here’s the starting behavior and the problem behavior realm, and here would be an appropriate replacement behavior.” So, you can use those side by side. That’s the way we thought about constructing that scale because we thought that with only a strength-based scale, we’d be making the same mistake that Achenbach and others had made by only having problem behavior scales. We wanted to have a two-headed monster, so to speak. That was the idea behind it. The important distinction to make is the stage between acquisition and performance deficits, because the ways you remediate those are two entirely different strategies. In one, you assume the kid has no clue and you got to teach it, and in the other, well, he knows; he just doesn’t do it, so you got to use some kind of contingency management to make that happen. That’s a really important distinction. We try to operationalize that in SSRS and we also continue to how you might operationalize that in SSIS.

Intervention: You’ve talked about some of the positive impacts on the field. What are some things that have had a negative impact on the field?

Gresham: I think if I had to point to one, and this has always bothered me, it’s the definition of ED itself and the oxymoronic social maladjustment exclusion. I don’t know why we have not been able, since 1975, to change that. I just never understood why we can’t get together, as a field, sit down, lock people in the room, handcuff them to the desk, say, “You are not leaving or eating until we come up with a different definition that’s better.” We had a meeting maybe a year and a half ago in Washington, DC, where we were talking about that. It was all the usual suspects: Mike Nelson, Joe Webbe, Steve Forness, Mike Epstein—the inmates from the asylum have escaped! We sat in a room for a couple of days with Renee Bradley from OSEP and came up with a position paper on that. I don’t think that ever went anywhere. We have a lot of these things where we do things like that, but it doesn’t ever impact how we do business. That bothers me too: Why we can’t come up with a definition. I mean the DSM (Diagnostic and Statistical Manual of Mental Disorders), like it or leave it, at least it has a definition of every disorder that is contained in there. It has criteria that you are supposed to meet to be classified as that. Now, why can’t we have a DSM for EBD? It has never ceased to amaze me how we have not been able to do that as a field. To me, that’s a major negative. Some people may argue that just because you can define something doesn’t make it better. I don’t know. I think it might help.

You’ve seen this literature. Since 1975, we have never identified more than 1% of that population. In most estimates, though, the percentages of kids who would qualify for a psychological/psychiatric diagnosis is around 20%, 20 times what we are identifying. Something’s wrong with that.

The argument you hear is that unlike kids with, let’s say, depression, they can’t help that, but kids that have conduct disorders can help it. So you hear that volition argument. School administrators I don’t think want to not be able to expel a kid because they’re acting up. I think that is a problem. It relates to all those issues. It relates to how schools run, how administrators are able to deal with discipline problems; they don’t want their hands tied. I think all that goes together. I don’t know the treatment for that. It’s called early retirement!

Intervention: What do you see in the future for the field of education of children with emotional behavior disorders?

Gresham: People like Steve Forness and others are seeing much closer relationships with mental health. I think where we may be going in the future is adopting more of the mental health perspective. The way we have kind of worked historically over the years in EBD is like we do the education part of EBD, but if they need some mental health treatment, we’re going to send them over to mental health. Why are we doing that? Everybody talks about wraparound services. We’ll bring mental health into the school. What’s the best place to do mental health? It’s at the school. A famous bank robber was asked one time, “Why do you rob banks?” “Well, that’s where the money is!” Well, why do you do mental health in schools? That’s where the kids are!

I think we’re moving more toward a relationship with mental health, and school-based mental health services, not clinic-based mental health services. Why do we need to drive them across town? Why don’t we just use school as a mental health venue? It makes sense to me.

Intervention: I wonder, though, about the cost involved, with so many of the budget cuts.

Gresham: Yeah, I understand that. But, some of that money states use to provide mental health treatment services to kids in other places. Why can’t we use some of that money in the schools? Maybe that’s pie in the sky, but that’s the way I would like to see things go in the future, because I think it’s silly that we do education and you all do mental health.

Intervention: How could we facilitate that kind of move?

Gresham: A lot of it just has to be dialogue with the major players in that area. I think a lot of folks in our field are for that. Another problem, just to be critical of my field, is that a lot of school psychologists are not trained to do mental health work. A lot of them aren’t even trained to do ABA work-type stuff, social behavioral assessment work. Now, they’re all trained to give a Woodcock-Johnson, and they’re all trained in how to determine a discrepancy. This has not changed in the past 30 years, with about two thirds to three quarters of a school psychologist’s time spent on special education eligibility determination.

The RTI movement has influenced some school psychologists. I remember watching Rich Simpson’s oral history interview, and Rich said, “When I started out, I was a school psychologist. I didn’t want to spend the rest of my life giving IQ tests.” I can’t imagine waking up every Monday morning, thinking I’m going to have to give 20 tests this week and then spend all day Friday writing them up. I just can’t imagine doing that. I might just commit suicide.

Intervention: What are the competencies that a good EBD teacher needs to have?

Gresham: Well, I’m not a teacher trainer, but a great person to ask that question is a person like Joe Wehbe. That’s all that Joe does. He does research, but that’s what he does. I’ve noticed over the years that, in particularly general education, there are absolutely no required courses in teaching-training programs for classroom management. I think that’s an abomination. That’s not necessarily the case in the field of EBD, but it is certainly true in general education. Most of the problems that teachers complain about are discipline problems, not “I can’t teach reading” or “I don’t like the math book.” It’s what do I do with this kid who’s doing this? I think any teacher by the time that they go out and do student teaching or get their first job, they need to at least have experience in coursework, background, and classroom management, just basic classroom management.

Intervention: What advice would you have to those just entering the field—both teachers going in to working with kids with EBD and people entering higher education?

Gresham: I guess one thing I would say is that you better know what you’re getting into. You might have this kind of romantic love affair with this population because you’ve read about what they do. “Oh, that’d be cool working with these kids and turning them around.” The reality of it is, these are kids who are not easy to work with, and they are going to be many times very, very difficult to work with. They might be aggressive when you’re working with them. So, you just better be prepared to handle all of that. If you’re working with an EBD kid, you’re going to have problems with the kind of behaviors that they are likely to exhibit. But then, if you work with a kid with autism, you’re going to have a whole set of different problems. Those are two entirely separate populations. So, you kind of need to know what you’re getting into. That would be my main advice.

Intervention: How would you know that?

Gresham: I think the way that I would know that is trying to figure out a way I could go and observe a self-contained classroom with BD kids and see what they do on a day-to-day basis or go observe somebody running a training with a kid with autism. See what you’re getting into, how folks deal with noncompliance, how they deal with disruptive behavior, how they deal with off-task behavior, and so on. Just going in and seeing it is the best advice I think I can give them.

Intervention: What about someone heading into higher education?

Gresham: I think that depends on what kind of higher education institution you’re going to. If you were going into an institution that’s primarily training, I’d have one piece of advice. If you go into an institution that’s primarily research, Tier 1 research oriented, boy, I’d have a totally different piece of advice. So, which one do you want?

Intervention: Let’s have both. As a new faculty member in a teacher training institution, what advice might you give?

Gresham: Since I don’t work in that institution, I have a hard time answering that question. I can answer the second one easily. But, I have a hard time because I don’t come from that culture.

Second one’s easy. If you’re going into primarily a kind of research institution, you better, sure as heck, have a program of research and you better have it well laid out, well identified, and you better like it. It’s kind of like what they say when you do your dissertation—you better like the topic because you’re going to be sick of it by the time you’re finished. Same thing with a research program—you better have one, and you better have something unique to offer that and you should be able to pursue that over a long period of time. In my own personal example, I started out in graduate school getting interested in social skills, and I’m still doing it today. I haven’t gotten tired of it. If I had, I don’t know where I would be. So that’s really important to me. Also, the ability to mentor students doing that, you have to have that. You not only have to be able to do it yourself; you have to also be able to teach somebody else how to do it. To me, that’s the most important thing.

Intervention: That may apply to the teacher trainers as well.

Gresham: I think it would work for both cases. You can tell somebody how to teach something or you can show them, and then you can have them teach something and give them feedback on how they taught something. It’s kind of like how they teach surgeons: You read about one, you see one, and then you do one.

Intervention: Do you have anything to add that we didn’t ask?

Gresham: You guys asked a lot of questions! I can’t think of anything right now. I’ll wake up tonight and think of it.

Frank Gresham’s career may reflect Newton’s first law of motion: Every object in a state of uniform motion tends to remain in that state of motion unless an external force is applied to it. His more than three decades of effort to bring support for children is a model of service to the field. The authors thank Dr. Gresham for his willingness and talent in this ongoing effort as well as his southern hospitality to the authors.