Distributed and accumulated reinforcement arrangements: evaluations of efficacy and preference.

We assessed the efficacy of, and preference for, accumulated access to reinforcers, which allows uninterrupted engagement with the reinforcers but imposes an inherent delay required to first complete the task. Experiment 1 compared rates of task completion in 4 individuals who had been diagnosed with intellectual disabilities when reinforcement was distributed (i.e., 30-s access to the reinforcer delivered immediately after each response) and accumulated (i.e., 5-min access to the reinforcer after completion of multiple consecutive responses). Accumulated reinforcement produced response rates that equaled or exceeded rates during distributed reinforcement for 3 participants. Experiment 2 used a concurrent-chains schedule to examine preferences for each arrangement. All participants preferred delayed, accumulated access when the reinforcer was an activity. Three participants also preferred accumulated access to edible reinforcers. The collective results suggest that, despite the inherent delay, accumulated reinforcement is just as effective and is often preferred by learners over distributed reinforcement.

Everolimus and intensive behavioral therapy in an adolescent with tuberous sclerosis complex and severe behavior.

BACKGROUND: Self-injury and aggression have been reported in individuals with TSC (tuberous sclerosis complex), yet few data exist about treatment. Everolimus, an mTOR inhibitor, has been FDA-approved for subependymal giant cell astrocytomas (SEGAs) and renal angiomyolipomas in TSC. However, clinical use of everolimus with direct, real-time observations of self-injury and aggression in an individual with TSC has not been reported. METHODS: During an inpatient admission to a neurobehavioral unit, real-time measurements of behaviors and seizures were recorded. An interdisciplinary team used these data to make treatment decisions and applied behavioral and pharmacological treatments, one at a time, in order to evaluate their effects. RESULTS: Aggression and self-injury improved with applied behavioral analysis (ABA), lithium, and asenapine. Improvements in SEGA size, facial angiofibromas, seizures, and the most stable low rates of self-injury were observed during the interval of treatment with everolimus. CONCLUSION: Mechanism-based treatments in the setting of an evidence-based behavioral and psychopharmacological intervention program may be a model with utility for characterization and treatment of individuals with severe behavior and TSC.

Evaluation of response blocking and re-presentation in a competing stimulus assessment.

Competing stimulus assessments (CSA) have been used to identify stimuli that are associated with reduced levels of problem behavior, presumably as a function of reinforcer competition. Following a standard CSA in which stimuli simply were made available, 2 more CSAs were conducted with additional components designed to enhance reinforcer competition: re-presentation of stimuli and response blocking for self-injury. The results obtained from each CSA were validated in an extended treatment analysis. The study illustrates how the effects of additional components designed to enhance reinforcer competition can be evaluated efficiently in the context of a CSA.

Identifying empirically supported treatments for phobic avoidance in individuals with intellectual disabilities.

This paper reviews the literature regarding the treatment of phobic avoidance in individuals with intellectual disabilities. Criteria for classifying interventions as empirically supported, developed by the American Psychological Association (APA) Division 12 Task Force on Promotion and Dissemination of Psychological Procedures, were used. For studies employing single case experimental designs, criteria developed by APA Division 16 (Kratochwill & Stoiber, 2002; Shernoff, Kratochwill, & Stoiber, 2002) were used to supplement Division 12 criteria. Results indicate that behavioral treatment can be designated as a well-established treatment for phobic avoidance in individuals with intellectual disabilities.

Discrete Trial Instruction vs. Mand Training for Teaching Children With Autism to Make Requests.

The present study compared the effects of discrete trial instruction (DTI) and mand training on the acquisition of independent requests in 6 children with autism. Two multiple-probe designs across participants were conducted with 3 participants receiving mand training followed by DTI and the other 3 receiving DTI followed by mand training. Eye contact and challenging behaviors were also assessed across conditions. Results indicate that 5 of 6 participants made more independent requests and acquired requesting faster in the mand training condition, had slightly better eye contact in the DTI condition, and fewer challenging behaviors in the mand training condition. Overall, the results indicate that mand training is a more efficient method for teaching children with autism to make requests.

Assessment and treatment of problem behavior occasioned by interruption of free-operant behavior.

The current study describes the assessment and treatment of the problem behavior of 3 individuals with autism for whom initial functional analysis results were inconclusive. Subsequent analyses revealed that the interruption of free-operant behavior using "do" requests (Study 1) as well as "do" and "don't" requests (Study 2) occasioned problem behavior. Initially, treatment involved differential and noncontingent reinforcement without interruption. To make the intervention more sustainable in the natural environment (where interruptions are unavoidable), a two-component multiple-schedule arrangement was used to progressively increase the period of time in which ongoing activities would be interrupted. During generalization sessions, the intervention was applied across a variety of contexts and therapists.

Commitment to philosophy, teacher efficacy, and burnout among teachers of children with autism.

Variables that may be related to burnout in teachers of students with autism, including commitment to an underlying philosophy of a treatment and professional self-efficacy, were explored. Teachers using one of two different treatment approaches to autism participated: those using Applied Behavior Analysis (n = 34), and those using TEACCH (Treatment and Education of Autistic and Related Communication-Related Handicapped Children) (n = 30). Participants completed the Autism Treatment Philosophy Questionnaire, developed by the authors to differentiate between the philosophy of the approaches; Teacher Efficacy Scale, and Maslach Burnout Inventory. Results indicate a significant difference in philosophical commitment between the groups, but no differences in teaching efficacy or burnout. The relationship between a commitment to one's teaching approach and certain dimensions of teaching efficacy and burnout was found to be significant. Implications include the need for adequate training of teachers of students with autism.