Application of a terminal schedule probe method to inform schedule thinning with multiple schedules.

Multiple schedules are effective at decreasing challenging behavior and maintaining alternative behavior at acceptable levels. Currently, no conclusive guidance is available for empirically deriving multiple-schedule components (continuous reinforcement for alternative behavior and extinction for challenging behavior [discriminative stimulus] and extinction for both alternative and challenging behavior [delta stimulus]) during the schedule-thinning process. In the current investigation, we describe a terminal schedule probe method to determine delta stimulus starting points and strategies for subsequent schedule-thinning progressions to reach caregiver-informed terminal schedules. We review schedule-thinning outcomes for a clinical cohort using a consecutive controlled case series approach and report results for two groups: One group included applications of terminal probe thinning (n = 24), and the other involved traditional dense-to-lean thinning (n = 18). Outcomes suggest that the terminal schedule probe method produced effective treatments with less resurgence of challenging behavior and leaner, more feasible, multiple schedules.

Repetitive Speech and Problem Behavior: Functional Analysis of Precurrent Contingencies.

When mands and problem behavior co-occur within an individual's repertoire, a functional analysis of precurrent contingencies helps to identify any relation between the two responses, as well as the function of problem behavior. Repetitive behaviors may function similarly to mands and also co-occur with problem behavior; particularly when repetitive behavior is blocked, or when caregivers refrain from participating in repetitive behavior episodes (e.g., the repetitive behavior involves a verbal or physical interaction with a caregiver). The current study presents assessment and treatment results for two participants diagnosed with autism, who demonstrated repetitive speech and problem behavior. Informal observations suggested that problem behavior occurred when an adult failed to emit a specific response to the participant's repetitive speech. Functional analysis results confirmed the informal observations and suggested that problem behavior functioned as a precurrent response to increase the probability of reinforcement for repetitive speech. We report treatment results and discuss the application of precurrent contingency analyses for problem behavior and repetitive behavior.

Functional Analysis and Chained Schedule Treatment of Elopement in Teens with Autism Spectrum Disorder.

Elopement is one of the most common forms of problem behavior for individuals with autism spectrum disorder (ASD) and is associated with the greatest probability of a lethal outcome. This study evaluated the effects of a function-based treatment package on elopement for two teenage boys with ASD who eloped frequently from caregivers. Functional analyses (FA) identified the variables that evoked and maintained each teen's elopement. Treatment involved a chained schedule comprised primarily of empirically derived differential reinforcement of other behavior (DRO), functional communication training (FCT), and extinction procedures. The treatment produced clinically significant decreases in elopement for both teens. Decreases in elopement maintained when the treatment evaluation was extended to additional contexts. The current study extends the literature on assessment and treatment of elopement and chained schedule treatments that involve both DRO and FCT.

Using Telehealth to Program Generalization of Caregiver Behavior.

Stokes and Baer, Journal of Applied Behavior Analysis, 10(2), 349-367 (1977) provided guidelines to assist practitioners with programming for the generalization of behavior change. Despite the suggestions provided in their seminal paper, generalization remains an often overlooked area within behavior analytic research and practice. In addition, few studies have described explicit strategies to program for the generalization of caregiver behaviors that are consistent with interventions to reduce child challenging behavior. In the current discussion, we describe how telehealth provides a potential avenue for practitioners to focus on generalization. Telehealth helps practitioners access behavior-change agents, materials, and contexts that they may not directly contact in educational and clinical environments. Using telehealth to target these areas early on, and throughout treatment for child challenging behavior, may facilitate more rapid treatment success and maintenance. We provide a case example to demonstrate the use of telehealth to program the generalization of a mother's treatment plan implementation to reduce the severe challenging behavior of an adolescent. We report clinically and socially significant outcomes related to caregiver fidelity and challenging behavior reduction.

Collateral Effects of Behavioral Treatment for Problem Behavior on Caregiver Stress.

When individuals with autism and intellectual and developmental disabilities exhibit severe problem behavior, assessment and treatment are often warranted. Parents of such individuals are at high risk for developing parenting stress. In this study, 194 parents completed the Parenting Stress Index-Short Form at their child's time of admission to and discharge from inpatient or outpatient treatment for severe problem behavior. Parent stress was examined in relation to rate and function of child problem behavior as determined via functional analysis. Repeated measures analyses of variance were conducted, and differential effects were observed when child participants exhibited an attention, automatic, or mands function for problem behavior. These findings highlight the importance of considering function of problem behavior in relation to parenting stress.

Family Accommodation and Severe Problem Behavior: Considering Family-Based Interventions to Expand Function-Based Treatment.

Family involvement in routines that exacerbate and maintain child anxiety is referred to as family accommodation. Family involvement is also related to maintenance of severe problem behavior (SPB) demonstrated by children with intellectual and developmental disabilities (IDD). Family members may deliver attention, tangible items, or remove aversive task demands that produce temporary cessation, or avoidance of SPB, but long-term maintenance. This Clinical Perspectives article describes parallels between the treatment of family accommodation in child anxiety and the assessment and treatment process for SPB. Suggestions are described for borrowing the concept of family accommodation to help caregivers of children who demonstrate SPB begin to approach previously avoided contexts. A case vignette is provided to illustrate strategies for targeting family accommodation as an expansion of function-based treatments for SPB.

Using Extinction to Increase Behavior: Capitalizing on Extinction-Induced Response Variability to Establish Mands With Autoclitic Frames.

Members (behaviors) of a response class are equivalent in that they produce the same functional reinforcer. Oftentimes, some members of a response class occur at higher rates than others. This can be problematic when the members that occur at high rates are socially inappropriate (e.g., self-injury, aggression, or disruption). The participant in this study was a 16-year-old female diagnosed with autism spectrum disorder who demonstrated aggression, one-word mands, and mands with autoclitic frames. In a series of contingency reversals, we placed 2 behaviors on extinction (e.g., aggression and one-word mands), which resulted in extinction-induced variability. Capitalizing on extinction-induced variability, we reinforced a different behavior (e.g., mands with autoclitic frames). The results confirmed that (a) the rate of responding for each topography was a function of extinction-induced response variability and differential reinforcement and (b) all response topographies belonged to the same response class. These results provide empirical support for the use of extinction-induced variability to differentially increase the rate of socially appropriate behaviors while decreasing socially inappropriate behaviors that belong to the same response class.

Rapid Assessment of Attention Types for the Treatment of Attention-Maintained Problem Behavior.

In the current study, we expanded previously described attention assessment procedures (e.g., Piazza et al., 1999) to create a rapid assessment of attention types (RAAT) suitable for clinical and educational settings. The RAAT was developed to identify a form of attention most likely to reinforce functionally equivalent alternatives to problem behavior. We describe the procedures for conducting a RAAT, as well as the results of a treatment evaluation that included two attention types from the RAAT, programmed to increase prosocial alternative behaviors.

Functional analysis and treatment of problem behavior related to mands for rearrangement.

This study is a systematic replication of a functional analysis (FA) of the relation between mands and problem behavior. We extended treatment approaches for this problem behavior function, and describe the treatment of problem behavior related to mands for rearrangement demonstrated by a 12-year-old girl with autism spectrum disorder and Smith-Magenis syndrome. The mands consisted of requests for others to change their body positioning or proximity, or rearrange items back to their original position. An FA confirmed the relation between problem behavior and mand compliance, and functional communication training with extinction decreased problem behavior and increased functional communication responses. Problem behavior remained low as gradually longer nonreinforcement periods were introduced using a multiple schedule.

Parent-informed test-control functional analysis and treatment of problem behavior related to combined establishing operations.

PURPOSE: Analog functional analysis (FA) represents the gold standard practice in the functional assessment of problem behavior. In some cases, modifications to typical FA test conditions are required to isolate the environmental variables that evoke and maintain problem behavior. The purpose of the current study was to describe the development of an individualized FA test condition that included combined establishing operations (EOs). METHODS: After an inconclusive standard FA, an individualized FA was conducted based on semi-structured descriptive assessment data collected by parents in the home setting. RESULTS: The individualized test-control combined EO FA produced clearly differentiated results that informed a function-based treatment. CONCLUSIONS: Based on the results of the current study and other similar lines of contemporary research on FA methodology, strategies are discussed for gathering data to inform individualized FA test conditions and derived treatments.

Assessment of the relationship between self-reported cognitive distortions and adult ADHD, anxiety, depression, and hopelessness.

The current chart review study examined the relationship between self-reported cognitive distortions, attention-deficit/hyperactivity disorder (ADHD) symptoms, and co-occurring symptoms of depression and anxiety in a clinical sample of adults diagnosed with ADHD. Thirty subjects completed inventories measuring cognitive distortions, ADHD, anxiety, depression, and hopelessness as part of the standard diagnostic evaluation protocol used in a university-based outpatient clinic specializing in adult ADHD. A series of correlational analyses were conducted to assess the relationship between self-reported cognitive distortions, ADHD, anxiety, depression, and hopelessness. Results indicated a significant, positive correlation between self-reported cognitive distortions and ADHD. Responses to individual items on the measure of cognitive distortions were tabulated to identify the prevalence of specific cognitive distortion categories, with Perfectionism emerging as the most frequently endorsed. Further clinical implications of these findings are discussed.

Social Validity Assessment of Training Methods to Improve Treatment Integrity of Special Education Service Providers.

We report the results of a social validity assessment that was administered to special education service providers (N = 44) to document the acceptability and effectiveness ratings of several treatment integrity training methods. The participants judged performance feedback as the most likely method to improve their treatment integrity, followed by avoidance (negative reinforcement) of supervision meetings, online training, and financial incentive. Performance feedback was also rank-ordered as most effective among the four training methods. We discuss the merits of social validity assessment in designing programs for enhancing treatment integrity among practitioners within educational and clinical settings.