Resurgence of destructive behavior following decreases in alternative reinforcement: A prospective analysis.

Basic and retrospective translational research has shown that the magnitude of resurgence is determined by the size of the decrease in alternative reinforcement, with larger decreases producing more resurgence. However, this finding has not been evaluated prospectively with a clinical population. In Experiment 1, five participants experienced a fixed progression of reinforcement schedule-thinning steps during treatment of their destructive behavior. Resurgence occurred infrequently across steps and participants, and when resurgence did occur, its clinical meaningfulness was often minimal. In Experiment 2, five new participants experienced these same schedule-thinning steps but in a counterbalanced order. Resurgence occurred most often and was generally largest with larger decreases in alternative reinforcement programmed earlier in the evaluation. Large decreases in alternative reinforcement may be more problematic clinically when they occur earlier in treatment. Whether larger transitions can be recommended in the clinic following the success of smaller ones will require additional research.

A demonstration of incorporating discriminative stimuli into an AAC device during functional communication training.

Functional communication training (FCT) is an effective intervention for teaching communication responses and reducing challenging behavior. One limitation of FCT is that frequent reinforcement may be impractical or impossible in many situations. Recently, Mitteer et al. published a tutorial in the journal AAC that provided video models on how to implement an empirically supported strategy for thinning reinforcement during FCT, known as FCT with discriminative stimuli, when teaching with an augmentative and alternative communication (AAC) device. However, no study has empirically evaluated the approach described in that tutorial. This paper details a case study using several single-case experimental designs to teach a non-vocal autistic adult who did not use speech to communicate requests only when reinforcement was signaled to be available by the color of the AAC icons. We demonstrated the efficacy of this approach with unique pairs of discriminative stimuli for tangible and edible items, thinning reinforcement for each stimulus class independently. We then rapidly transferred stimulus control to new icons and integrated both classes of stimuli into a single AAC grid. This first demonstration of embedding discriminative stimuli into an AAC device represents a promising advancement for individuals who do not use speech and may not readily respond to delay or denial cues.

Additional Comments on the Use of Contingent Electric Skin Shock.

Prior to the ABAI member vote to decide between two alternative position statements on contingent electric skin shock (CESS), the current authors helped draft a consensus statement supporting the abolition of CESS. In this commentary, we provide additional, supporting information for that consensus statement by (1) showing that the extant literature does not support the supposition that CESS is more efficacious than less-intrusive interventions; (2) providing data showing that implementing interventions that are less intrusive than CESS does not lead to overreliance on the use of physical or mechanical restraint to control destructive behavior; and (3) discussing the ethical and public relations issues that arise when behavior analysts use painful skin shock to reduce destructive behavior in persons with autism or intellectual disability.

Resurgence of destructive behavior following differential rates of alternative reinforcement.

Behavioral momentum theory (BMT) suggests that resurgence of destructive behavior may be at least partly determined by the rate of alternative reinforcement, with lean schedules of reinforcement producing less resurgence than dense schedules. Findings from basic and translational studies have been mixed, and the effects of alternative reinforcement rate on resurgence remain unclear. In the current study, we conducted a within-subject evaluation of resurgence during extinction with four children following functional communication training using dense and lean (BMT-informed) schedules of alternative reinforcement. We observed no reliable differences in resurgence across the dense and lean conditions. We discuss implications of these findings in relation to future research using quantitative analyses to evaluate the relative effects of alternative reinforcement rate and other BMT-based strategies for mitigating resurgence in applied settings.

Evaluation of a Telehealth Training Package to Remotely Teach Caregivers to Conduct Discrete-Trial Instruction.

The present study evaluated the effectiveness of using telehealth technologies to remotely train caregivers of children with ASD to conduct discrete-trial instruction (DTI). We used a multiple-baseline-across-participants design to evaluate caregiver correct implementation of the DTI procedures and child emission of independent correct tacts as dependent measures. We observed robust and immediate improvements for all three caregivers and two of three children. Treatment effects were maintained during follow-up and generalization probes. We discuss the benefits of telehealth technologies and other remote treatment applications.

Basic and applied research on extinction bursts.

Discontinuation of the contingency between a response and its reinforcer sometimes produces a temporary increase in the response before its rate decreases, a phenomenon called the extinction burst. Prior clinical and basic studies on the prevalence of the extinction burst provide highly disparate estimates. Existing theories on the extinction burst fail to account for the dynamic nature of this phenomenon, and the basic behavioral processes that control response bursting remain poorly understood. In this paper, we first review the basic and applied literature on the extinction burst. We then describe a recent refinement of the concatenated matching law called the temporally weighted matching law that appears to resolve the above-mentioned issues regarding the extinction burst. We present illustrative translational data based conceptually on the model. Finally, we discuss specific recommendations derived from the temporally weighted matching law regarding procedures clinicians could implement to potentially mitigate or prevent extinction bursts.

Further evaluation of treatment duration on the resurgence of destructive behavior.

Translation of promising procedures for mitigating treatment relapse has received considerable attention recently from researchers across the basic-applied continuum. One procedure that has demonstrated mixed support involves increasing the duration of treatment as a strategy for blunting resurgence. In a recent translational study, Greer et al. (2020) failed to detect a mitigation effect of increased treatment duration on the resurgence of destructive behavior. However, design limitations may have been responsible. The present study corrected these limitations by (a) employing a sequential design to decrease the possibility of multiple-treatment interference, (b) evaluating more treatment durations, (c) arranging treatments of fixed durations, and (d) conducting treatments of more extreme duration in a different clinical sample. Despite these improvements in experimental rigor and the testing of more extreme boundary conditions, the present study also failed to detect a mitigation effect of increased treatment duration. Likely explanations are discussed.

Conducting Translational Research in the Context of Patient Care.

Although much has been written on the importance of translational research for bridging the continuum of basic science to clinical practice, few authors have described how such work can be carried out practically when working with patient populations in the context of ongoing clinical service delivery, where the priorities for patient care can sometimes conflict with the methods and goals of translational research. In this article, we explore some of the considerations for conducting this type of work while balancing clinical responsibilities that ensure high-quality patient care. We also discuss strategies we have found to jointly facilitate translational research and improve routine, clinical service delivery. A primary goal of this article is to encourage others working in applied settings to contribute to the increasingly important role that translational research plays in our science and practice by helping to better characterize and potentially lessen or remove barriers that may have impeded such investigations in the past.

Translating quantitative theories of behavior into improved clinical treatments for problem behavior.

The most important advancement in the treatment of destructive behavior has been the development of the functional analysis, which is used to prescribe effective treatments like functional communication training. Although this approach can be highly effective, extinction bursts and forms of treatment relapse commonly occur when function-based treatments are implemented by caregivers in natural community settings. In recent years, researchers have increasingly applied quantitative theories of behavior like behavioral momentum theory (BMT) and the temporally weighted matching law (TWML) to understand, prevent, or mitigate extinction bursts and treatment relapse. In this paper, we describe BMT and TWML and selectively review the basic, translational, and applied research supporting and opposing each theory. Then, we describe how function-based treatments may be refined based on these theories to improve the effectiveness, generality, and durability of function-based treatments for individuals with autism spectrum and related disorders who display problem behavior.

Procedures for determining and then modifying the extinction component of multiple schedules for destructive behavior.

As a component of reinforcer schedule thinning following functional communication training, multiple schedules of reinforcement produce desirable rates and patterns of communication responses as an alternative response to destructive behavior. However, reinforcement schedule thinning is a gradual process that can take many sessions to obtain therapeutic goals. The desired outcome is that manding occurs only during signaled intervals of reinforcement with a sufficiently lean terminal schedule of reinforcement availability and low rates of destructive behavior. The purposes of this study were to (a) evaluate an assessment for informing the initial duration of extinction for alternative responding, (b) evaluate the utility of competing stimuli during extinction for alternative responding, and (c) assess a method for fading the availability of competing stimuli. With these procedures, all 4 participants experienced terminal schedules of reinforcement with rapid, robust reductions in destructive behavior soon after baseline. We discuss the implications and directions for future research.

Resurgence Following Traditional and Interdependent Differential Reinforcement of Alternative Behavior.

Clinicians frequently prescribe functional communication training (FCT) as a treatment for severe destructive behavior. Recent research has shown that FCT treatments are susceptible to treatment relapse in the form of resurgence of destructive behavior when individuals contact periods in which reinforcers are unavailable. Results of preliminary studies suggest that teaching multiple response alternatives can mitigate the resurgence of target behavior. The current evaluation serves as a preliminary study in which we used a laboratory arrangement to evaluate the effects of a novel approach to training multiple alternative responses on the resurgence of target behavior. Findings showed that multiple-response training did not decrease resurgence of target responding consistently; however, it increased the total amount of target and alternative responding observed during the resurgence phase and decreased the overall probability of the target response.

Promoting the emergence of tacting three-digit numerals through a chain prompt combined with matrix training.

Children with autism spectrum disorder (ASD) have difficulty generalizing from directly trained responses to untrained responses (i.e., emergent responding). In this study, we used a chain prompt combined with matrix training to teach 2 participants with ASD to tact 192 three-digit numerals. We used a multiple-baseline design across matrices to evaluate the treatment effects on trained and untrained tacts of numerals. Both participants mastered all numerals exposed to training and all numerals not exposed to training after 3 to 5 sixteen-trial sessions per matrix. One participant learned to tact 8 numerals for each 1 numeral exposed to direct training, and the other participant learned to tact 12 numerals for each 1 numeral exposed to direct training. We discuss these results relative to the effectiveness and efficiency of our chain prompt combined with matrix training for teaching tacting skills for targets with shared stimulus properties that facilitate generalization to untrained targets.

Assessment of children's and caregivers' preferences for treatments for escape-maintained problem behavior.

This study assessed children's and caregivers' preferences for various arrangements of negative reinforcement, including differential negative reinforcement of an alternative behavior (DNRA), noncontingent escape (NCE), and escape extinction. In the first treatment comparison, the DNRA and NCE treatments similarly decreased problem behavior, but all 3 children preferred DNRA. By contrast, 3 of 4 caregivers preferred escape extinction, likely due to increased compliance in this condition. In a second treatment comparision with 1 child, a multiple schedule and then a chained schedule were introduced to increase the practically of the initial DNRA treatment. The child continued to prefer the treatment with contingent reinforcement in both comparisons, and his caregivers preferred the chained schedule. Results further support the selection of treatments that include contingent reinforcement, and the evaluation serves as a model for progressing through treatment options until child and caregiver preferences align.

Postural control may drive the development of other domains in infancy.

BACKGROUND: To examine differences in sitting posture in infants at low- and high-risk for autism spectrum disorder and to establish the relationship between sitting postural control and other developmental domains. METHODS: A total of 19 infants participated in the study. Eight infants at high-risk and 11 infants at low-risk for autism spectrum disorder. Sitting posture at 6 months was evaluated using a force platform while center of pressure data were acquired. We utilized traditional tools of center of pressure analysis, such as range, median frequency and frequency dispersion, as well as non-linear tools such as Sample Entropy for both the medial-lateral and anterior-posterior directions. At 12 months we used the Mullen Scales of Early Learning, the Communication and Symbolic Behavior Scales Developmental Profile™ and the Ages and Stages Questionnaire, the personal-social subscale. FINDINGS: At 6 months none of the postural control measures showed statistically significant differences between groups. Infants at high-risk presented significantly lower scores in all behavioral domains than infants at low-risk at 12 months with fair effect sizes. Certain measures of postural control at 6 months could predict language and visual reception behavior at 12 months. INTERPRETATION: Infants at high-risk for autism spectrum disorder present with delays in social, communication and language behavior as well as altered postural control in the first year of life. The present data support the possibility that motor skills and specifically postural control may drive the development in other domains.

A randomized clinical trial of a virtual-training program for teaching applied-behavior-analysis skills to parents of children with autism spectrum disorder.

Parents play an important role in the treatment of their children's symptoms of autism spectrum disorder (ASD); thus, developing effective, efficient, socially acceptable, and accessible procedures for training parents to implement applied-behavior-analysis (ABA) interventions is critically important. One potential approach involves delivering training via a virtual private network (VPN) over the internet (Fisher et al., 2014). In this study, we conducted a randomized clinical trial to evaluate a virtual parent-training program with e-learning modules and scripted role-play via a VPN. We evaluated parent implementation of ABA skills using direct-observation measures in structured-work and play-based training contexts. Parents in the treatment group showed large, statistically significant improvements on all dependent measures; those in the waitlist-control group did not. Parents rated the training as highly socially acceptable. Results add to the growing literature on the efficacy and acceptability of virtually delivered training in ABA.

Procedures and Accuracy of Discontinuous Measurement of Problem Behavior in Common Practice of Applied Behavior Analysis.

Discontinuous measurement involves dividing an observation into intervals and recording whether a behavior occurred during some or all of each interval (i.e., interval recording) or at the exact time of observation (i.e., momentary time sampling; MTS). Collecting discontinuous data is often easier for observers than collecting continuous data, but it also produces more measurement error. Smaller intervals (e.g., 5 s, 10 s, 15 s) tend to produce less error but may not be used in everyday practice. This study examined the most common intervals used by a large sample of data collectors and evaluated the effect of these intervals on measurement error. The most commonly used intervals fell between 2 and 5 min. We then analyzed over 800 sessions to evaluate the correspondence between continuous and discontinuous data at each commonly used interval. Intervals of 3 min or less produced the greatest correspondence, and MTS outperformed interval recording.

Using e-learning modules to teach ongoing-visual inspection of functional analyses.

Despite the effectiveness of function-based treatments, most clinicians do not conduct functional analyses (FA). The time required to conduct an FA is a major barrier preventing their use. One way to increase FA efficiency is to discontinue the analysis as soon as it has produced clear results. Saini et al. (2018) evaluated a structured procedure for ongoing-visual inspection of FAs and found that it produced accurate interpretations while averaging 40% fewer sessions than author interpretation. This study evaluated the efficacy of an e-learning module for training registered behavior technicians (RBTs) to implement ongoing visual inspection of FAs. Following training, 5 of the 6 participants showed mastery of ongoing visual inspection, and the final participant did so with the addition of supplemental procedures. We discuss how this training may increase the efficiency of FAs by teaching individuals who are less experienced in FA methodology when to seek supervision from a supervising Board Certified Behavior Analyst® (BCBA).

Treating food selectivity as resistance to change in children with autism spectrum disorder.

Change-resistant behavior, such as rigid and selective food consumption, is a core symptom of autism that can have significant negative consequences for the child (Flygare Wallén et al., 2018; Levy et al., 2019). In the current study, we used a matching-law-based intervention (Fisher et al., 2019) to treat the change-resistant feeding behavior of 7 young children with autism. The feeder gave the participant a choice between a change-resistant and an alternative food during free- and asymmetrical-choice conditions. Alternative-food consumption increased for 2 participants during asymmetrical choice when the feeder provided a preferred item for consuming the alternative food and no programmed consequence for consuming the change-resistant food. Alternative-food consumption increased for the other 5 participants after the feeder exposed at least 1 food to single choice in which the feeder guided the participant to put the bite of alternative food in his or her mouth if he or she did not do so within 8 s of presentation. Effects of the single-choice contingencies maintained during reversals and generalized to other alternative foods the feeder did not expose to single choice. These results are important because participants consumed alternative foods even when their change-resistant foods were present, which is similar to typical mealtime contexts in which children have choices among foods.

Resurgence following differential reinforcement of alternative behavior implemented with and without extinction.

In the clinic, differential reinforcement of alternative behavior (DRA) often involves programming extinction for destructive behavior while reinforcing an alternative form of communication (e.g., a functional communication response); however, implementing extinction can be unsafe or impractical under some circumstances. Quantitative theories of resurgence (i.e., Behavioral Momentum Theory and Resurgence as Choice) predict differences in the efficacy of treatments that do and do not involve extinction of target responding when reinforcement conditions maintaining alternative responding worsen. We tested these predictions by examining resurgence following two DRA conditions in which we equated rates of reinforcement. In DRA without extinction, target and alternative behavior produced reinforcement. In DRA with extinction plus noncontingent reinforcement, only alternative behavior produced reinforcement. We conducted this study in a reverse-translation sequence, first with participants who engaged in destructive behavior (Experiment 1) and then in a laboratory setting with rats (Experiment 2). Across both experiments, we observed proportionally lower levels of target responding during and following the DRA condition that arranged extinction for the target response. However, levels of resurgence were similar following both arrangements.