The functions of self-injurious behavior: an experimental-epidemiological analysis

Behavioral Approaches to Assessment and Early Intervention for Severe Problem Behavior in Intellectual and Developmental Disabilities

This article summarizes the literature on prevalence and establishment of severe problem behavior in individuals with intellectual and developmental disabilities, empirical support for applied behavior analysis, and evidence-based behavioral assessment and treatment procedures. Early intervention and prevention approaches and the role of the pediatrician with regard to surveillance, early intervention, and coordination of care are discussed.

Advances in Our Understanding of Behavioral Intervention: 1980 to 2020 for Individuals Diagnosed with Autism Spectrum Disorder

There are three branches of science of behavior analysis [i.e., experimental analysis of behavior, behavior analysis, and applied behavior analysis (ABA)]. ABA can be defined as a systematic approach to understanding behavior of social interest. For the past 40 plus years, researchers have evaluated ABA and ABA based procedures (e.g., behavioral intervention) as they relate to individuals diagnosed with autism spectrum disorder (ASD) and have implemented behavioral intervention in clinical settings for individuals diagnosed with ASD. In this paper, we discuss some of the pivotal contributions in the field of ABA in research and clinical practice. Additionally, we provide recommendations for the science and clinical practice of behavioral intervention in the next 40 years.

A Preliminary Evaluation of Interrater Reliability and Concurrent Validity of Open-Ended Indirect Assessment

Indirect assessments are a commonly used component of functional behavior assessment by behavior analysts in practice who work with individuals with severe behavior disorders. Although used frequently, closed-ended indirect assessments have repeatedly been shown to have low to moderate interrater reliability and poor concurrent validity with functional analysis. Recently, the use of open-ended interviews has become more commonly adopted in applied clinical practice, despite no studies evaluating the psychometric properties of such assessments. In the present study, we evaluated the interrater reliability and concurrent validity of an open-ended functional assessment interview. We compared the results of two open-ended indirect assessments conducted with a common caregiver and subsequently conducted functional analyses in an attempt to validate hypotheses generated from the interviews. Interrater agreement for the open-ended interviews was higher than previous research on closed-ended interviews (75%); however, concurrent validity with functional analysis was relatively poor (50%). We discuss these findings in the context of assessment and treatment for severe behavior disorders, as well as best practice methods during functional behavior assessment.

The consecutive controlled case series: Design, data-analytics, and reporting methods supporting the study of generality

Single-case experimental designs (SCEDs) have proven invaluable in research and practice because they are optimal for asking many experimental questions relevant to the analysis of behavior. The consecutive controlled case series (CCCS) is a type of study in which a SCED is employed in a series of consecutively encountered cases that undergo a common procedure or share a common characteristic. Additional design elements, data-analytic, and reporting methods enable researchers to ask experimental questions relevant to the study of generality of procedures and processes. The current paper discusses the CCCS methodologies, including the retrospective, prospective, and randomized CCCS. These methodologies can be applied to examine the generality of clinical procedures (including their general efficacy, the limits of their generality, and variables that may mediate generality); study the epidemiology and phenomenology of clinical problems; and compare the efficacy of 2 clinical procedures within a randomized controlled trial combining SCEDs with randomized group designs.

Detecting and Classifying Self-injurious Behavior in Autism Spectrum Disorder Using Machine Learning Techniques

Traditional self-injurious behavior (SIB) management can place compliance demands on the caregiver and have low ecological validity and accuracy. To support an SIB monitoring system for autism spectrum disorder (ASD), we evaluated machine learning methods for detecting and distinguishing diverse SIB types. SIB episodes were captured with body-worn accelerometers from children with ASD and SIB. The highest detection accuracy was found with k-nearest neighbors and support vector machines (up to 99.1% for individuals and 94.6% for grouped participants), and classification efficiency was quite high (offline processing at ~ 0.1 ms/observation). Our results provide an initial step toward creating a continuous and objective smart SIB monitoring system, which could in turn facilitate the future care of a pervasive concern in ASD.

On the Standardization of the Functional Analysis

The functional analysis procedures described in the seminal Iwata et al. (1982/1994) study are prominent in the applied behavior analytic literature, having been replicated hundreds of times over the past 30 years (Beavers, Iwata, & Lerman, 2013; Hanley, McCord, Iwata, 2003). However, the extent to which particular components of this functional analysis model have become more or less prominent over time is not clear from these literature reviews. We therefore conducted a review of the functional analysis literature between the years of 1965 and 2016 to determine the trends in the usage of particular components over time and to determine if the published literature reflects a standardization of the manner in which functional analyses of problem behavior are conducted. Furthermore, we discuss whether or not this standardization of a functional analysis model is currently necessary.

Interview-Informed Synthesized Contingency Analysis (IISCA): Novel Interpretations and Future Directions

The functional analysis (FA) methodology was developed to provide an empirical basis for understanding the reinforcers contributing to the maintenance of problem behavior. Previous research has demonstrated that multiple formats have been established to address some areas, such as practicality, efficiency, and safety. We reviewed the research on a new replication and extension of the standard FA format, the interview-informed synthesized contingency analysis (IISCA) and its subsequent treatment. We discuss the efficiency and effectiveness of the IISCA across various populations, settings, topographies of problem behaviors, and maintaining functions across 17 studies. Common treatment trends, novel developments, and other critical intervention components are also reviewed. We provide suggestions for future directions and guidelines for practitioners when considering the use of the IISCA.

Interpreting functional analysis outcomes using automated nonparametric statistical analysis

Current methods employed to interpret functional analysis data include visual analysis and post-hoc visual inspection (PHVI). However, these methods may be biased by dataset complexity, hand calculations, and rater experience. We examined whether an automated approach using nonparametric rank-based statistics could increase the accuracy and efficiency of functional analysis data interpretation. We applied Automated Nonparametric Statistical Analysis (ANSA) to a sample of 65 published functional analyses for which additional experimental evidence was available to verify behavior function. Results showed that exact behavior function agreement between ANSA and the publications authors was 83.1%, exact agreement between ANSA and PHVI was 75.4%, and exact agreement across all 3 methods was 64.6%. These preliminary findings suggest that ANSA has the potential to support the data interpretation process. A web application that incorporates the calculations and rules utilized by ANSA is accessible at https://ansa.shinyapps.io/ansa/.

Treating destructive behavior reinforced by increased caregiver compliance with the participant's mands

Functional analyses sometimes do not identify momentary fluctuations in the function of destructive behavior (Bowman, Fisher, Thompson, & Piazza, 1997). In such cases, individuals may mand for the reinforcer that is currently most preferred and display destructive behavior if that mand goes unreinforced. In this study, we conducted a mand analysis to test whether destructive behavior functioned as a precurrent response that increased reinforcement for the participant's mands. We then evaluated a treatment that matched this function of destructive behavior by providing differential or time-based reinforcement of participant mands in accordance with multiple or chained schedules with reinforcement-schedule thinning. Decreases in destructive behavior averaged 97.4% across cases. We discuss these results relative to the importance of matching treatments for destructive behavior to operant functions for both traditional and idiosyncratic functions of destructive behavior.

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.

Evaluation of an Omnibus Mand in the Treatment of Multiply Controlled Destructive Behavior

Functional communication training is a commonly used and effective treatment for socially reinforced destructive behavior. However, when a functional analysis suggests that destructive behavior is multiply controlled (e.g., by attention, tangibles, and escape), teaching and evaluating separate functional communication responses (FCRs) can be time-consuming or only partially effective when failing to address multiple establishing operations that may occur simultaneously. We evaluated the use of an omnibus FCR or mand that produced access to attention, tangibles, and escape within each functional-analysis test condition for two boys with autism spectrum disorder who displayed multiply controlled destructive behavior. The omnibus-FCR treatment produced low rates of destructive behavior and high percentages of independent FCRs within each condition for both children, suggesting that such a treatment option may reduce destructive behavior and teach communication skills quickly prior to introducing other treatment components, such as teaching individual FCRs to address each unique function of destructive behavior.

Behavioral Treatment of Self-Injury: 2001 to 2016

Individuals diagnosed with intellectual and developmental disabilities (IDD) frequently exhibit self-injurious behavior (SIB). Previous research has examined the published literature on behavioral treatments of SIB from 1964-2000. Results suggested that these treatments were highly efficacious at decreasing SIB, particularly when based on the results of a functional assessment. The purpose of this review is to update, replicate, and extend the previous research. The current findings indicate an increase in studies reporting automatically maintained SIB as well as less efficacious treatments overall. Discussion of our conclusions and methods of SIB assessment and treatment are discussed, both as they relate to the previous review and for future directions.

Functional Behavioral Assessment-based interventions on adults' delusions, hallucinations and disorganized speech: A single case meta-analysis

The Functional Behavioral Assessment (FBA) approach involves the use of single-case designs (SCD) to study the problem behavior-environment contingencies and conduct interventions that consider this functional relationship. Although this approach has been considered an evidence-based practice (EBP) for the treatment of several psychological problems, no meta-analytic studies of FBA-based interventions on delusions, hallucinations and disorganized speech -commonly operationalized as "atypical vocalizations"- have been carried out. Therefore, the purpose of this study was to review and synthesize the results of FBA-based interventions on adults' atypical vocalizations. We conducted a systematic review and a multi-level meta-analysis of these interventions, using a recently developed effect size estimator for SCD studies (i.e., log response ratio). All the studies that met our eligibility criteria provided evidence supporting the effectiveness of FBA-based interventions on atypical vocalizations, with an overall average effect size of a 72% reduction. Both the publication year and the methodological quality were found to be significant moderators. Despite some methodological limitations, we can conclude that FBA-based interventions are effective to reduce atypical vocalizations. The implications of these results could be of interest for the mental health community.

Temper outbursts in Lowe syndrome: Characteristics, sequence, environmental context and comparison to Prader-Willi syndrome

BACKGROUND

There is limited research into the nature and aetiology of temper outbursts in people with intellectual disabilities. In this study, we describe the phenomenology and environmental context of temper outbursts in Lowe syndrome, a rare genetic syndrome in which outbursts are purportedly frequent.

METHOD

A temper outburst interview (TOI) was conducted with caregivers of seventeen individuals with Lowe syndrome to generate an account of the behavioural sequence, common antecedents and consequences of temper outbursts, and to enable comparisons with similar work on Prader-Willi syndrome.

RESULTS

Outbursts in Lowe syndrome were frequently triggered by thwarted goal-directed behaviour and were associated with high levels of physical aggression and property destruction.

CONCLUSIONS

Form and sequence of outbursts showed similarities to Prader-Willi syndrome and to behaviours reported in literature on typically developing children. The results highlight the importance of considering shared aetiology as well as syndrome-specific pathways in the development of outbursts.

The Big Four: Functional Assessment Research Informs Preventative Behavior Analysis

Current practice guidelines suggest that the assessment and treatment of challenging behavior should consist of conducting a functional behavior assessment following the onset of problem behavior. This assessment process can include indirect and direct assessment, as well as manipulation of variables to determine function. The purpose of this article is to outline a proposal that would add prevention practices to early intervention guidelines for problem behavior. Based on decades of research, the suggestion is to proactively teach children at risk for problem behavior to navigate four of the most common conditions that have been demonstrated to occasion problem behavior. Prevention is made a possibility because a large body of research examining the conditions under which challenging behavior occurs has been reliably replicated. Preventative approaches are an emerging phenomenon and reflect a progression in the practice of behavior analysis. Prevention may lead to acquisition of prosocial behavior before problems arise, to expedited and enhanced treatment, to increased access to favorable learning environments, and, we hope, to improvement in the quality of life for many children at risk for the development of problem behavior.

Evaluating the boundaries of analytic efficiency and control: A consecutive controlled case series of 26 functional analyses

We conducted this study to determine if the efficiency of the functional analysis could be improved without detrimental effects on control. In Experiment 1, we reanalyzed functional analyses conducted for the problem behavior of 18 children. We analyzed rates of problem behavior during the first 5 min and first 3 min of the original 10-min sessions and evaluated if changes in the level of control over problem behavior by the programmed contingency were evident from the analyses of shorter session duration. In Experiment 2, we conducted 8 consecutive functional analyses with 3-min sessions to further evaluate the utility of brief session durations. We found that control over problem behavior was demonstrated when conducting functional analyses with sessions as brief as 3 min.

Animal Models of Self-Injurious Behavior: An Update

Although self-injurious behavior is a common comorbid behavior problem among individuals with neurodevelopmental disorders, little is known about its etiology and underlying neurobiology. Interestingly, it shows up in various forms across patient groups with distinct genetic errors and diagnostic categories. This suggests that there may be shared neuropathology that confers vulnerability in these disparate groups. Convergent evidence from clinical pharmacotherapy, brain imaging studies, postmortem neurochemical analyses, and animal models indicates that dopaminergic insufficiency is a key contributing factor. This chapter provides an overview of studies in which animal models have been used to investigate the biochemical basis of self-injury and highlights the convergence in findings between these models and expression of self-injury in humans.

Baseline reinforcement rate and resurgence of destructive behavior

Concepts from behavioral momentum theory, along with some empirical findings, suggest that the rate of baseline reinforcement may contribute to the relapse of severe destructive behavior. With seven children who engaged in destructive behavior, we tested this hypothesis in the context of functional communication training by comparing the effects of different baseline reinforcement rates on resurgence during a treatment challenge (i.e., extinction). We observed convincing resurgence of destructive behavior in four of seven participants, and we observed more resurgence in the condition associated with high-rate baseline reinforcement (i.e., variable-interval 2 s in Experiment 1 or fixed-ratio 1 in Experiment 2) compared to a low-rate baseline reinforcement condition. We discuss the implications of these results relative to schedules of reinforcement in the treatment of destructive behavior and strategies to mitigate resurgence in clinical settings.

Coaching parents to assess and treat self-injurious behaviour via telehealth

The application of telehealth technology to conduct functional analysis (FA) and functional communication training (FCT) is emerging for children with developmental disabilities and behaviour support needs. The current study was designed to extend FA + FCT for self-injurious behaviour by using telehealth in home with parents as interventionists receiving real-time remote coaching. Two families with school-aged boys with developmental disabilities associated with intellectual disability participated, one with cerebral palsy and the other with autism spectrum disorder. Results indicated that parent-implemented FA + FCT via telehealth was effective for reducing self-injurious behaviour and increasing mands (communication requests) for both children. Both families successfully implemented the FA + FCT protocol with 95% overall fidelity via telehealth-supported coaching. Results are discussed in terms of their relationship to previous research, limitations and future directions.

Examining the influence of social-environmental variables on self-injurious behaviour in adolescent boys with fragile X syndrome

BACKGROUND

Individuals with fragile X syndrome (FXS), the most common known inherited form of intellectual disability, are at increased risk for showing specific forms of self-injurious behaviour (SIB) such as hand biting and head hitting, suggesting that biological factors associated with the syndrome confers increased risk for SIB. Few studies, however, have examined the extent to which social-environmental variables can influence the occurrence of these behaviours in this population.

METHOD

Twenty-two adolescent boys with FXS, aged 10 to 18 years were systematically exposed to seven environmental conditions in functional analyses of SIB conducted over 2 days at our research centre.

RESULTS

Fourteen (63.6%) boys with FXS engaged in SIB during the functional analyses. Ten (45.5%) boys engaged in SIB that was maintained by social-environmental variables, that is, gaining access to attention/tangibles and/or escaping from social interaction, task demands and/or transition demands. For two boys, SIB was undifferentiated across conditions, and for two boys, SIB appeared to be maintained by automatic reinforcement.

CONCLUSIONS

Social-environmental variables appeared to maintain SIB in a significant proportion of boys with FXS. Given that pharmacological treatments for SIB have limited efficacy in this population, the potential role of social-environmental factors on SIB should be examined before pharmacological treatments are implemented for these behaviours.

Frequency of pediatric traumatic cataract and simultaneous retinal detachment

PURPOSE

Traumatic cataract in children is a treatable cause of vision loss. In cases of simultaneous retinal detachment, the prognosis for visual recovery is often poor. The purpose of this study was to investigate risk factors for concurrent retinal detachment in patients with traumatic cataract.

METHODS

A retrospective review of patients diagnosed with traumatic cataract at Children's Hospital Colorado between 2005 and 2014 was conducted. Demographics, mechanism of injury, and incidence of retinal detachment were recorded. Logistic modeling with generalized estimating equations to account for correlation of eyes within patients was used to analyze associations between potential risk factors and retinal detachment.

RESULTS

A total of 62 total eyes with traumatic cataract were included: 52 patients presented with unilateral cataract; 5 presented with bilateral cataracts. Mean patient age was 8.4 ± 4.1 years (range, 0-16 years), and 83% of patients were male. A total of 9 eyes (14.5%) had comorbid retinal detachment. Traumatic cataracts caused by self-injurious hitting were more likely to present with simultaneous retinal detachment than those caused by other mechanisms of injury (OR = 24.0; 95% CI, 3.8-153.3; P = 0.0010).

CONCLUSIONS

Patients with traumatic cataract who display self-injurious behavior are at higher risk for concurrent retinal detachment. These patients can often only be examined under sedation. Ophthalmologists should counsel families of high-risk patients and consider involving retinal specialists in surgical planning.

Classification of injuries observed in functional classes of self-injurious behaviour

BACKGROUND

Limited research has examined how the functions of self-injurious behaviour (SIB) relate to the production of injuries and the location, type or severity of those injuries.

METHODS

Clinical and medical records were coded for 64 individuals hospitalised for SIB. When injuries were present, the physical properties of SIB and injuries were assessed across groups of individuals with automatically and socially maintained SIB.

RESULTS

Injuries were observed for 35 of the individuals who engaged in SIB. Individuals who engaged in a single form of SIB were more likely to have injuries (P < .05). Individuals with SIB maintained by automatic reinforcement had significantly more severe injuries to the head than those in the social group (q < .05, P = .0132, H = 12.54).

CONCLUSION

Although results are preliminary, the results provide evidence that the function of SIB may influence the severity and location of injuries produced.

Predicting Imminent Aggression Onset in Minimally-Verbal Youth with Autism Spectrum Disorder Using Preceding Physiological Signals

We test the hypothesis that changes in preceding physiological arousal can be used to predict imminent aggression proximally before it occurs in youth with autism spectrum disorder (ASD) who are minimally verbal (MV-ASD). We evaluate this hypothesis through statistical analyses performed on physiological biosensor data wirelessly recorded from 20 MV-ASD youth over 69 independent naturalistic observations in a hospital inpatient unit. Using ridge-regularized logistic regression, results demonstrate that, on average, our models are able to predict the onset of aggression 1 minute before it occurs using 3 minutes of prior data with a 0.71 AUC for global, and a 0.84 AUC for person-dependent models.

Using a Functional Analysis Followed by Differential Reinforcement and Extinction to Reduce Challenging Behaviors in Children With Smith-Magenis Syndrome

Smith-Magenis syndrome (SMS) is a genetic disorder, commonly caused by a 17p11.2 deletion, affecting the Retinoic Acid Induced 1 gene. It affects approximately 1 in 25,000 individuals, with over 90% engaging in challenging behaviors. Function-based treatments, using the principles of applied behavior analysis, have consistently been shown to decrease challenging behaviors exhibited by individuals with developmental delays. However, additional research is needed to determine the effects of these interventions with specific diagnostic subsets, including SMS. The current study identified the function of challenging behavior for 2 children with SMS and found a function-based treatment, consisting of differential reinforcement and extinction, reduced challenging behavior for both.

Extreme challenges: psychiatric inpatients with severe self-harming behavior in Norway: a national screening investigation

BACKGROUND

Extreme self-harming behavior is a major challenge for patients and health services. Nevertheless, this patient population is poorly described in research literature.

AIMS

The aim of this study was to assess the volume of patients with extensive psychiatric hospitalization due to extreme self-harming behaviors, the extent of severe medical sequelae, and collaboration problems within health services.

METHODS

In a national screening investigation, department managers in 83 adult psychiatric inpatient institutions across all health regions in Norway were invited to participate in a brief, prepared, telephone interview.

RESULTS

Sixty-one interviews were completed. Extensive hospitalization (prolonged or multiple) due to extreme self-harm was reported for the last year in all health regions and in 427 individual cases. Mean number of cases did not differ by region. Psychiatric hospitalizations were more frequent in hospital units than mental health centers. In 109 of the cases, self-harming behavior had severe medical consequences, including five deaths. In 122 of the cases, substantial collaboration problems within the health services were reported (disagreements on diagnosis, treatment needs and resources). Extensive (long-term) hospitalization was particularly associated with the combination of severe medical sequelae and collaboration problems.

CONCLUSION

This investigation confirms a noteworthy, nationwide, population of severely self-harming inpatients with extensive health service use, prevalent severe medical complications, and unsatisfactory collaboration within health services. These preliminary results are alarming, and indicate a need for more profound understanding of highly complex and severe cases.

Minimizing resurgence of destructive behavior using behavioral momentum theory

The resurgence of destructive behavior can occur during functional communication training (FCT) if the alternative response contacts a challenge (e.g., extinction). Behavioral momentum theory (BMT) suggests that refinements to FCT could mitigate resurgence of destructive behavior during periods of extinction. Following a functional analysis and treatment with FCT, we combined three refinements to FCT (i.e., the use of a lean schedule of reinforcement for destructive behavior during baseline, a lean schedule for the alternative response during FCT, and an increase in the duration of treatment) and compared the magnitude of resurgence relative to a condition in which FCT was implemented in a traditional manner. Results suggested that the combination of these three refinements to FCT was successful in decreasing the resurgence of destructive behavior during an extinction challenge. We discuss the implications of these findings, as well as areas for future research.

Reliability and Validity of Indirect Assessment Outcomes: Experts versus Caregivers

Clinicians often conduct indirect assessments (IAs; e.g., Durand & Crimmins, 1988; Iwata, DeLeon, & Roscoe, 2013; Matson & Vollmer, 1995) such as questionnaires and interviews with caregivers to gain information about the variables influencing problem behavior. However, researchers have found poor reliability and validity of IAs with respect to determining functional variables. There are numerous variables that might influence the efficacy of IAs as an assessment tool, one of which is the skill set of the person completing the IA. For example, it may be possible to increase the validity and reliability of IAs by having individuals with certain skill sets such as a background in behavior analysis and FBA ("experts") complete them. Thus, the purpose of this study was to compare the reliability (i.e., agreement with respect to function and specific IA questions) and validity (i.e., agreement between the outcome of IAs and a functional analysis) of IAs completed by caregivers and "experts" for each of eight children who emitted problem behavior. We found that experts were more likely than caregivers to agree on IA outcomes with respect to (a) overall interrater agreement, (b) item-by-item agreement, and (c) the highest-rated function(s) of problem behavior. Experts were also more likely to correctly identify the function(s), based on comparisons of the results of the IAs and FAs. In addition, caregivers were more likely to (a) disagree on hypothesized functions and (b) identify multiple incorrect functions. The use of experts for completing IAs could have significant impact on their utility and provide a novel method for more rapidly completing the FBA process and developing a function-based treatment.

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.

Brief Report: Self-Injurious Behaviors in Preschool Children with Autism Spectrum Disorder Compared to Other Developmental Delays and Disorders

We compared the prevalence of self-injurious behaviors (SIB) in preschoolers aged 30-68 months with autism spectrum disorder (ASD) (n = 691) versus other developmental delays and disorders (DD) (n = 977) accounting for sociodemographic, cognitive, and medical factors. SIB prevalence was higher in ASD versus all DD [adjusted odds-ratio (aOR) 2.13 (95% confidence interval (95% CI) 1.53, 2.97)]. In subgroup analyses, SIB prevalence was higher in ASD versus DD without ASD symptoms [aOR 4.42 (95% CI 2.66, 7.33)], but was similar between ASD and DD with ASD symptoms [aOR 1.09 (95% CI 0.68, 1.77)]. We confirmed higher prevalence of SIB in ASD versus DD, independent of confounders. In children with DD, SIB prevalence increased with more ASD symptoms. These findings are informative to clinicians, researchers, and policymakers.

Management of people with challenging behaviour

The term ‘challenging behaviour’ was introduced in North America in the 1980s, and was originally used to describe problematic behaviours in people with ‘mental retardation’ (learning disabilities). Challenging behaviour can, however, occur across the intellectual spectrum, being particularly prevalent in populations with psychiatric disorder.

Self-Injurious Behavior in Children With Developmental Disabilities: A Systematic Review of Behavioral Intervention Literature

We reviewed single-case research studies examining the effects of behavioral interventions for self-injurious behavior (SIB) in young children with autism and developmental disabilities. Systematic searches of electronic databases, journals, and reference lists identified 46 studies (66 participants younger than the age of 12) meeting inclusion criteria. Studies were examined based on (a) participant demographics, (b) topography and function of SIB, (c) type of functional behavior assessment (FBA), (d) intervention procedures and outcomes, and (e) experimental design and measurement. Intervention strategies were categorized as antecedent manipulations, teaching behavior, consequence-based procedures, and/or extinction procedures. Positive outcomes were reported for 78% of participants in the reviewed studies and 88% of the participants were diagnosed with autism. Results suggest the effectiveness of behavioral interventions to decrease SIB for young children with disabilities; however, the frequent use of packaged interventions without component analysis limits the conclusiveness of any treatment recommendation. Suggestions for future research are discussed.

Basing assessment and treatment of problem behavior on behavioral momentum theory: Analyses of behavioral persistence

The connection, or bridge, between applied and basic behavior analysis has been long-established (Hake, 1982; Mace & Critchfield, 2010). In this article, we describe how clinical decisions can be based more directly on behavioral processes and how basing clinical procedures on behavioral processes can lead to improved clinical outcomes. As a case in point, we describe how applied behavior analyses of maintenance, and specifically the long-term maintenance of treatment effects related to problem behavior, can be adjusted and potentially enhanced by basing treatment on Behavioral Momentum Theory. We provide a brief review of the literature including descriptions of two translational studies that proposed changes in how differential reinforcement of alternative behavior treatments are conducted based on Behavioral Momentum Theory. We then describe current clinical examples of how these translations are continuing to impact the definitions, designs, analyses, and treatment procedures used in our clinical practice.

Conducting Functional Communication Training in Home Settings: A Case Study and Recommendations for Practitioners

We coached a parent to conduct functional analysis and functional communication training (FCT) procedures in her home to reduce the destructive behavior displayed by her 2-year-old son. Descriptive assessment information and functional analysis results suggested that destructive behavior was maintained by escape from demands. After conducting a series of baseline probes, the parent implemented an FCT program to teach her son to comply with designated task requests and to mand for a break to play. Results showed that destructive behavior decreased and manding and independent task completion increased during FCT. Positive intervention outcomes were maintained for 1 year. Results are discussed with respect to developing an FCT program that is both efficient and acceptable for parents to implement in their homes.

Persistence and resistance to extinction in the domestic dog: Basic research and applications to canine training

This review summarizes the research investigating behavioral persistence and resistance to extinction in the dog. The first part of this paper reviews Behavioral Momentum Theory and its applications to Applied Behavior Analysis and training of pet dogs with persistent behavioral problems. I also highlight how research on Behavioral Momentum Theory can be applied to the training of detection dogs in an attempt to enhance detection performance in the presence of behavioral disruptors common in operational settings. In the second part of this review, I highlight more basic research on behavioral persistence with dogs, and how breed differences and experiences with humans as alternative sources of reinforcement can influence dogs' resistance to extinction of a target behavior. Applied Behavior Analysis and Behavior Momentum Theory have important applications for behavioral treatments to reduce the persistence of problem behavior in dogs and for the development of enhanced training methods that enhance the persistence of working dogs. Dogs can also be leveraged as natural models of stereotypic behavior and for exploring individual differences in behavioral persistence by evaluating breed and environmental variables associated with differences in canine persistance.

Effectiveness of Non-Pharmacological Interventions on Stereotyped and Repetitive Behaviors of Pre-school Children With Autism: A Systematic Review

Introduction:

The present study aimed to review the literature on non-pharmacological interventions used to treat stereotyped and repetitive behaviors by a systematic method.

Methods:

Two authors independently performed a search strategy on Medline/PubMed, Scopus and PsycINFO on English articles published up to April 23, 2014 with relevant search keywords. We also reviewed the bibliographies of retrieved articles and conference proceedings to obtain additional citations and references. We examined those articles that addressed non-pharmacological interventions on reducing stereotyped and repetitive behaviors in preschool children with autism. Four independent reviewers screened relevant articles for inclusion criteria and assessed the quality of eligible articles with CONSORT checklist.

Results:

In our search, 664 relevant articles were found. After removing duplicates and screening based on title, abstract, and full text, 15 high-quality studies were finally included in data analyses. The included articles were published from 1987 to 2013. Three studies were designed as A-B, two as A-B-A, and reminders as A-B-A-B. The data and results of 3 clinical trials were synthesized; two of them were parallel randomized clinical trial and another one was designed as cross-over. Interventions were completely heterogeneous in case studies, including non-contingent auditory stimulation, response interruption and redirection, teaching the children to request assistance on difficult tasks, family-implemented treatment for behavioral inflexibility with treatment approach, vocal or motor response interruption and redirection, brushing, water mist treatment, exposure response prevention, tangible reinforcement or social reinforcement, and music. Interventions in clinical trials included touch therapy, kata techniques training program, and aerobic exercise.

Conclusion:

The results of our review indicate that different kinds of non-pharmacological interventions can be used to treat repetitive behaviors in children with autism; however, sufficient evidence for their effectiveness does not exist. Future research using more precise methods (RCTs) can clarify which methods and techniques are effective in reducing repetitive behavior of children with autism.

Task as Reinforcer: a Reactive Alternative to Traditional Forms of Escape Extinction

Inappropriate behaviors, ranging from passive resistance to physical aggression, property destruction, or self-injurious behavior frequently function for escape from or avoidance of non-preferred activities. Proactive procedures have been shown to be only moderately effective without the use of escape extinction, but escape extinction can produce negative side effects, and efforts have been made to find alternatives. The current study tested the efficacy of a reactive procedure that may serve as an alternative to traditional forms of escape extinction. In a multiple baseline across behavioral excesses, non-preferred activities, and participants, a timeout from the opportunity to work effectively reduced behavioral excesses and increased compliance with non-preferred activities. With one participant, a multiple baseline was implemented across instructional targets, resulting in an increased rate of skill acquisition after "wait outs" were introduced to each program.