Analysis of unexpected disruptive effects of contingent food reinforcement on automatically maintained self-injury.

Research has identified treatment-responsive and treatment-resistant subtypes of automatically maintained self-injurious behavior (ASIB) based on patterns of responding in the functional analysis (FA) reflecting its sensitivity to disruption by alternative reinforcement, and the presence of self-restraint. Rooker et al. (2019) unexpectedly observed reductions in treatment-resistant self-injury while participants performed an operant task. The current study further examined this in nine participants with treatment-resistant ASIB in an example of discovery-based research. An operant task engendering high rates of responding (switch-pressing) to produce food, reduced self-injury across all participants, and eliminated self-injury for some participants under certain schedules. Although this finding must be replicated and evaluated over longer time periods, it provides some evidence that alternative reinforcement can disrupt self-injury in these treatment-resistant subtypes under some conditions. Reinforcer and response competition are discussed as possible mechanisms underlying these disruptive effects, as are the potential implications of these findings regarding treatment.

Accumulated and distributed response-reinforcer arrangements during the treatment of escape-maintained problem behavior.

Contingent positive reinforcement has proven more effective in treating escape-maintained problem behavior than contingent negative reinforcement, particularly when problem behavior continues to produce escape. However, this research has overwhelmingly used distributed-reinforcement arrangements, where tasks and reinforcer access are interspersed throughout the work period. An alternative to interspersal involves allowing the individual to accumulate and then receive a larger quantity of reinforcement once work requirements are completed; this is known as an accumulated-reinforcement arrangement. The current study examined the efficacy of, and preference for positive (food) and negative (break) reinforcement contingencies delivered in accumulated and distributed arrangements in the treatment of escape-maintained problem behavior. In Experiment 1, accumulated break was preferred for 4 of 5 participants and accumulated food was preferred for 3 of 5. In Experiment 2, accumulated break was similarly effective to distributed break for 3 of 5 participants and accumulated and distributed food were equally effective for 4 participants.

Evaluation of accepted and rejected submissions in the Journal of Applied Behavior Analysis: Gender and experience.

Researchers have examined factors of authors such as sex of author, gender identity, and seniority within the field of behavior analysis to determine if any biases towards a certain group existed. Most recently, Kranak et al. (2020) found that women and new authors are well-represented in the Journal of Applied Behavior Analysis (JABA). However, that analysis included only published manuscripts. Thus, the degree to which these subpopulations are proportionally represented is unknown, because that analysis was unable to determine how often these subpopulations are submitting manuscripts. Therefore, the purpose of the current investigation was to extend Kranak et al. and analyze all accepted and rejected manuscripts submitted to JABA from 2015 - 2019. Results indicated that women and men had nearly identical acceptance rates during this time period, whereas veteran authors' acceptance rate was nearly 2.5 times greater than that of new authors. Implications for publishing, reviewing, and research mentorship practices are discussed.

Prevalence of renewal of problem behavior: Replication and extension to an inpatient setting.

Individuals with intellectual and developmental disabilities who exhibit problem behavior often receive behavioral assessment and treatment in specialized inpatient and outpatient clinics. However, problem behavior sometimes reemerges as a function of changes in contexts and stimulus conditions, such as returning to the home environment. This reemergence is called renewal. Recently, Muething et al. (2020) found that renewal occurred in over half (67%) of cases from an outpatient clinic. Their sample was obtained exclusively from an outpatient setting and despite the applied relevance of renewal, its clinical prevalence in other populations is unknown. Accordingly, we replicated Muething et al.'s procedures and analyzed renewal in 37 inpatient treatment applications across 34 cases via consecutive-controlled case series. Renewal was present in 59% of cases; however, we found that renewal occurred in only 24% of context changes compared to 42% reported by Muething et al. Various factors related to the prevalence of renewal were evaluated.

A Clinical Demonstration of Correlational and Experimental Analyses of Precursor Behavior.

Individuals with intellectual and developmental disabilities are at an increased risk for engaging in severe problem behavior, which is often preceded by less intense precursor behaviors. These precursor behaviors may be a viable option as target behaviors for functional analyses in situations where evoking severe problem behavior is not ideal. We identified precursor behaviors through a correlational analysis and confirmed their membership in the same response class as more severe problem behavior through an experimental analysis.

Correspondence between Fail-Safe k and Dual-Criteria Methods: Analysis of Data Series Stability.

Barnard-Brak, Richman, Little, and Yang (Behaviour Research and Therapy, 102, 8-15, 2018) developed a structured-criteria metric, fail-safe k, which quantifies the stability of data series within single-case experimental designs (SCEDs) using published baseline and treatment data. Fail-safe k suggests the optimal point in time to change phases (e.g., move from Phase B to Phase C, reverse back to Phase A). However, this tool has not been tested with clinical data obtained in the course of care. Thus, the purpose of the current study was to replicate the procedures described by Barnard-Brak et al. with clinical data. We also evaluated the correspondence between the fail-safe k metric with outcomes obtained via dual-criteria and conservative-dual criteria methods, which are empirically supported methods for evaluating data-series trends within SCEDs. Our results provide some degree of support for use of this approach as a research tool with clinical data, in particular when evaluating small or medium treatment effect sizes, but further research is needed before this can be used widely by practitioners.

Initial outcomes of an augmented competing stimulus assessment.

Competing stimulus assessments (CSAs) are designed to identify stimuli that, when made freely available, reduce problem behavior. Although CSAs have demonstrated utility, identifying competing stimuli can be difficult for some individuals. The current study describes outcomes from an augmented CSA (A-CSA) for 6 consecutively encountered cases with treatment-resistant subtypes of automatically maintained problem behavior. When test stimuli were made freely available, only between 0 and 1 effective competing stimuli were identified for each case. Prompting and response blocking were temporarily employed in succession to promote engagement with stimuli and disrupt problem behavior. When those procedures were withdrawn and stimuli made freely available, the number of effective competing stimuli increased in all 6 cases. Findings suggest that procedures designed to promote engagement and disrupt problem behavior may allow the A-CSA to be a platform not only for identifying competing stimuli, but also for actively establishing competing stimuli.

Authorship trends in the Journal of Applied Behavior Analysis: An update.

The Journal of Applied Behavior Analysis (JABA) is considered the flagship journal for the discipline of applied behavior analysis. Thus, popular research topics and other publication trends within JABA reflect the current cultural and scientific contingencies governing the field of behavior analysis. Researchers have previously quantified a number of authorship trends in JABA (and other behavior-analytic journals) across a number of variables, such as gender identity and sex of author, country of origin, or seniority within the field (Dunlap et al., 1998) to examine demographic and organizational factors associated with successful publication in JABA. These analyses ought to be conducted continuously to monitor trends and detect any potential biases (e.g., sexism). Accordingly, the purpose of the present investigation was to replicate previous research in this area (e.g., Dymond et al., 2000) and provide an update of current publication trends within JABA. Implications for future research and publishing practices are discussed.

Evaluating sources of baseline data using dual-criteria and conservative dual-criteria methods: A quantitative analysis.

Scheithauer et al. (2020) recently demonstrated that differences in the source of baseline data extracted from a functional analysis (FA) may not affect subsequent clinical decision-making in comparison to a standard baseline. These outcomes warrant additional quantitative examination, as correspondence of visual analysis has sometimes been reported to be unreliable. In the current study, we quantified the occurrence of false positives within a dataset of FA and baseline data using the dual-criteria (DC) and conservative dual-criteria (CDC) methods. Results of this quantitative analysis suggest that false positives were more likely when using FA data (rather than original baseline data) as the initial treatment baseline. However, both sources of baseline data may have acceptably low levels of false positives for practical use. Overall, the findings provide preliminary quantitative support for the conclusion that determinations of effective treatment may be easily obtained using different sources of baseline data.

Using dual-criteria methods to supplement visual inspection: Replication and extension.

The dual-criteria and conservative dual-criteria methods effectively supplement visual analysis with both simulated and published datasets. However, extant research evaluating the probability of observing false positive outcomes with published data may be affected by case selection bias and publication bias. Thus, the probability of obtaining false positive outcomes using these methods with data collected in the course of clinical care is unknown. We extracted baseline data from clinical datasets using a consecutive controlled case-series design and calculated the proportion of false positive outcomes for baseline phases of various lengths. Results replicated previous findings from Lanovaz, Huxley, and Dufour (2017), as the proportion of false positive outcomes generally decreased as the number of points in Phase B (but not Phase A) increased using both methods. Extending these findings, results also revealed differences in the rate of false positive outcomes across different types of baselines.

Injury characteristics across functional classes of self-injurious behavior.

Self-injurious behavior (SIB) is inherently problematic because it can lead to injuries, including those that are quite severe and may result in loss of function or permanent disfigurement. The current study replicated and extended Rooker et al. (2018) by classifying the physical characteristics of injuries across groups of individuals with automatically maintained SIB (ASIB Subtypes 2 and 3) and socially maintained SIB. Individuals with Subtype 2 ASIB had the most frequent and severe injuries. Further, an inverse relation was found between the level of differentiation in the functional analysis and the number of injuries across groups. Studying the response products of SIB (the injuries) documents the risks associated with SIB, justifies the need for research and the intensive intervention, and advances knowledge of SIB. Additional research is needed to replicate these findings, and determine the variables that produce different characteristics of injury secondary to SIB.

Sensitivity to Changing Environmental Conditions across Individuals with Subtype 2 Automatically Reinforced and Socially Reinforced Self-injury.

Automatically reinforced Subtype 2 self-injurious behavior (ASIB) has been characterized as showing insensitivity to competing reinforcement contingencies in the contexts of both functional analyses and in treatment using reinforcement alone (Hagopian, Rooker, &Yenokyan, 2018). One question is whether this insensitivity is specific to Subtype 2 ASIB as response class in these contexts or whether it is represents a generalized response tendency of the individual that is evident across other response classes. To examine this question, we compared responding on a single-operant task under changing reinforcement schedules for three individuals with Subtype 2 ASIB, relative to a comparison group of three individuals with socially reinforced SIB (which is characterized by sensitivity to changes in reinforcement contingencies). As hypothesized, all individuals showed sensitivity to changes in contingencies. These results provide preliminary support that the insensitivity of Subtype 2 ASIB is a property specific to that response class in these contexts rather than a generalized response tendency of the individual.

Behavioral treatment of automatically reinforced SIB: 1982 - 2015.

Some individuals diagnosed with intellectual and developmental disabilities engage in automatically reinforced self-injurious behavior (SIB). For these individuals, identifying effective treatments may be difficult due to the nature of the reinforcement contingency. The purpose of this study was to review the literature on the treatment of automatically reinforced SIB to determine commonalities in procedures that produced effective and ineffective treatment outcomes, as well as historical trends in the treatment of this class of SIB. Results of this review indicated that there were many high-quality studies on this topic, but also a wide range in the quality of studies. As for effective treatments, noncontingent reinforcement (the most common treatment component) was found to be more effective when informed by a competing stimulus assessment rather than a preference assessment. Suggestions to improve the quality of the published record and areas in which additional research is needed are discussed.

Identifying predictive behavioral markers: A demonstration using automatically reinforced self-injurious behavior.

Predictive biomarkers (PBioMs) are objective biological measures that predict response to medical treatments for diseases. The current study translates methods used in the field of precision medicine to identify PBioMs to identify parallel predictive behavioral markers (PBMs), defined as objective behavioral measures that predict response to treatment. We demonstrate the utility of this approach by examining the accuracy of two PBMs for automatically reinforced self-injurious behavior (ASIB). Results of the analysis indicated both functioned as good to excellent PBMs. We discuss the compatibility of this approach with applied behavior analysis, describe methods to identify additional PBMs, and posit that variables related to the mechanisms of problem behavior and putative mechanism of treatment action hold the most promise as potential PBMs. We discuss how this technology could guide individualized treatment selection, inform our understanding of problem behavior and mechanisms of treatment action, and help determine the conditional effectiveness of clinical procedures.

Noncontingent reinforcement for the treatment of severe problem behavior: An analysis of 27 consecutive applications.

Noncontingent reinforcement (NCR) is a commonly used treatment for severe problem behavior displayed by individuals with intellectual and developmental disabilities. The current study sought to extend the literature by reporting outcomes achieved with 27 consecutive applications of NCR as the primary treatment for severe problem behavior. All applications of NCR were included regardless of treatment outcome to minimize selection bias favoring successful cases. Participants ranged in age from 5 to 33 years. We analyzed the results across behavioral function and with regard to the use of functional versus alternative reinforcers. NCR effectively treated problem behavior maintained by social reinforcement in 14 of 15 applications, using either the functional reinforcer or alternative reinforcers. When we implemented NCR to treat problem behavior maintained by automatic reinforcement, we often had to add other treatment components to produce clinically significant effects (five of nine applications). Results provide information on the effectiveness and limitations of NCR as treatment for severe problem behavior.

Further analysis of subtypes of automatically reinforced SIB: A replication and quantitative analysis of published datasets.

Hagopian, Rooker, and Zarcone (2015) evaluated a model for subtyping automatically reinforced self-injurious behavior (SIB) based on its sensitivity to changes in functional analysis conditions and the presence of self-restraint. The current study tested the generality of the model by applying it to all datasets of automatically reinforced SIB published from 1982 to 2015. We identified 49 datasets that included sufficient data to permit subtyping. Similar to the original study, Subtype-1 SIB was generally amenable to treatment using reinforcement alone, whereas Subtype-2 SIB was not. Conclusions could not be drawn about Subtype-3 SIB due to the small number of datasets. Nevertheless, the findings support the generality of the model and suggest that sensitivity of SIB to disruption by alternative reinforcement is an important dimension of automatically reinforced SIB. Findings also suggest that automatically reinforced SIB should no longer be considered a single category and that additional research is needed to better understand and treat Subtype-2 SIB.

REDUCING AMBIGUITY IN THE FUNCTIONAL ASSESSMENT OF PROBLEM BEHAVIOR.

Severe problem behavior (e.g., self-injury and aggression) remains among the most serious challenges for the habilitation of persons with intellectual disabilities and is a significant obstacle to community integration. The current standard of behavior analytic treatment for problem behavior in this population consists of a functional assessment and treatment model. Within that model, the first step is to assess the behavior-environment relations that give rise to and maintain problem behavior, a functional behavioral assessment. Conventional methods of assessing behavioral function include indirect, descriptive, and experimental assessments of problem behavior. Clinical investigators have produced a rich literature demonstrating the relative effectiveness for each method, but in clinical practice, each can produce ambiguous or difficult-to-interpret outcomes that may impede treatment development. This paper outlines potential sources of variability in assessment outcomes and then reviews the evidence on strategies for avoiding ambiguous outcomes and/or clarifying initially ambiguous results. The end result for each assessment method is a set of best practice guidelines, given the available evidence, for conducting the initial assessment.

Delineating subtypes of self-injurious behavior maintained by automatic reinforcement.

Self-injurious behavior (SIB) is maintained by automatic reinforcement in roughly 25% of cases. Automatically reinforced SIB typically has been considered a single functional category, and is less understood than socially reinforced SIB. Subtyping automatically reinforced SIB into functional categories has the potential to guide the development of more targeted interventions and increase our understanding of its biological underpinnings. The current study involved an analysis of 39 individuals with automatically reinforced SIB and a comparison group of 13 individuals with socially reinforced SIB. Automatically reinforced SIB was categorized into 3 subtypes based on patterns of responding in the functional analysis and the presence of self-restraint. These response features were selected as the basis for subtyping on the premise that they could reflect functional properties of SIB unique to each subtype. Analysis of treatment data revealed important differences across subtypes and provides preliminary support to warrant additional research on this proposed subtyping model.

Functional communication training with and without alternative reinforcement and punishment: an analysis of 58 applications.

Functional communication training (FCT) is an empirically supported treatment for problem behavior displayed by individuals with intellectual disabilities. Hagopian, Fisher, Sullivan, Acquisto, and LeBlanc (1998) analyzed 25 applications of FCT and showed that extinction was a necessary component of FCT, but sometimes punishment was needed to maintain low levels of problem behavior. The current consecutive case series summarized data from 58 applications of FCT in more recent cases. This analysis extended and updated Hagopian et al. by examining FCT when used in combination with alternative reinforcement (noncontingent and differential reinforcement) and multiple schedules during schedule thinning. Although it is difficult to make direct comparisons with the 1998 study, the results of the current case series analysis suggest that FCT can be enhanced when used in combination with alternative reinforcement and when multiple schedules are used during schedule thinning.

Effects of fixed versus random condition sequencing during multielement functional analyses.

It has been suggested that a fixed condition sequence might facilitate differential responding during multielement functional analyses (FAs) by capitalizing on or limiting sequence effects (Iwata, Pace, et al., 1994); however, the effects of condition sequence have not been examined empirically. We conducted fixed- and random-sequence FAs for 7 individuals with developmental disabilities to determine the relative effects that sequence may have on assessment outcomes. Experimental conditions during the fixed sequence were conducted in the following order: ignore, attention, play, and demand; condition order during the random sequence was determined randomly. Results showed that sequence had no influence on the FA outcomes for 3 subjects, whereas differential responding emerged either faster (1 subject) or only (3 subjects) under the fixed sequence for the remaining subjects. These results suggest that the fixed sequence, a simple modification, should be used when conducting multielement FAs to accommodate the influence of establishing operations across assessment conditions.