Toward a functional analysis of self-injury

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.

A Feasibility Randomized Clinical Trial of a Structured Function-Based Intervention for Elopement in Children with Autism Spectrum Disorder

Elopement is a common and dangerous concern in autism spectrum disorder (ASD). There is evidence that behavior analytic treatments can successfully treat elopement, but the research is limited due to small samples and treatment components varying across studies. The current study evaluated the feasibility of studying a manualized intervention for elopement, based on strategies from single-subject research, in a randomized clinical trial with 24 individuals with ASD. Results demonstrated that recruitment was feasible; the manual was acceptable to parents; and therapists followed the manual with high-integrity. Initial efficacy results measured by the Aberrant Behavior Checklist, Clinical Global Impression Scale, and a Home Elopement Safety Checklist suggested improvement in the treatment group that should be studied in future research.

Long-term functional stability of problem behavior exposed to psychotropic medications

Psychopharmacological and behavioral interventions are often combined in the treatment of problem behavior in people with intellectual and developmental disability (IDD). However, little is known about the interaction between medication pharmacodynamics and behavior function. A better understanding of these mechanisms could serve as the conceptual foundation for combined interventions. The current analysis is a systematic replication of Valdovinos et al. (2009). We conducted continuous functional analyses within analogue reversal and parametric analyses monitoring the impact of various dosages of primarily antipsychotic medications on problem behavior and its function. Four individuals with IDD and problem behavior who were also receiving psychotropic medications participated. Medication adjustments produced small to negligible decreases in problem behavior, and behavior function remained largely unchanged through the 14 medication adjustments evaluated. The continuous functional analysis helped to identify what could be delayed medication effects on problem behavior. The clinical and methodological implications of this replication are discussed.

Treatment Acceptability for Interventions Addressing Challenging Behavior Among Chinese Caregivers of Children with Autism Spectrum Disorder

The present study evaluated treatment acceptability for behavioral interventions addressing challenging behaviors with Chinese caregivers of children with autism spectrum disorder. Factors influencing treatment acceptability (i.e., severity of challenging behavior and Chinese child-rearing values) were investigated. Caregivers of children aged 2-12 years (N = 216) participated in this survey study. Results suggest that caregivers found positive strategies including noncontingent reinforcement and positive reinforcement the most acceptable; punishment-based strategies were rated as the least acceptable. Furthermore, positive punishment was perceived as more acceptable for severe challenging behavior. Caregivers who endorsed training were more likely to find positive strategies acceptable, whereas those who endorsed shaming were more likely to rate punishment-based strategies as more acceptable. Implications for future research and culturally competent behavioral treatments in Chinese context are provided.

Formative applications of ongoing visual inspection for trial-based functional analysis: A proof of concept

Trial-based functional analysis (TBFA) possesses many strategic advantages which make it an ideal candidate for adoption in applied settings. Notwithstanding, some aspects of the analysis remain underdeveloped, including structured guidelines for interacting with obtained data reliably in formative and summative ways. The purpose of this study was to adapt existing ongoing visual-inspection (OVI) criteria to match the idiosyncrasies of TBFA and then to assess their practical utility in applied settings. Thus, we first drafted OVI criteria appropriate for trial-based FA (i.e., TB-OVI). Then, we trained 5 caregivers to conduct TBFAs of their children's challenging behavior and to react to their data as they obtained it, using the TB-OVI criteria as their guide. Finally, we validated interpretations of TBFA outcomes based on TB-OVI criteria through effective intervention. Across 5 participants and 7 opportunities, function-based interventions successfully eliminated challenging behavior.

Electromyography of diurnal bruxism during assessment and treatment

Diurnal bruxism among individuals with intellectual disabilities is often measured on the basis of its auditory products, thereby precluding the contingent presentation of stimuli during silent bruxism events. Electromyography (EMG) offers a technological solution to the identification of all bruxism events. EMG has not been previously evaluated in nonvocal clients with intellectual disabilities in the context of functional analysis and treatment. In the current series of analyses, we suggest a set of methods to implement EMG technology with this population. In Analysis 1, we propose a strategy for systematically identifying bruxism events. In Analysis 2 we evaluate an EMG staff-training package with naïve interventionists without past experience with EMG technology. Finally, Analysis 3 presents a practical example of this method during the functional analysis and treatment of a client with frequent diurnal bruxism.

Decreasing motor stereotypy with competing stimuli and tasks: Analysis of prompted engagement and response blocking

Competing stimulus assessments (CSAs) are used to empirically identify stimuli associated with low levels of problem behavior. For some individuals with automatically maintained behavior, it can be difficult to identify effective competing stimuli. Recent research shows that prompting engagement and response blocking can be employed during the CSA to obtain significant reductions in problem behavior. The purpose of the present study was to replicate and extend prior research on the use of these tactics not only with competing stimuli, but also competing tasks, which require the active completion of a discrete response or response sequence. In addition, the current study validated the results of these pretreatment assessments in an extended treatment analysis, and examined the isolated and combined effects of prompting and response blocking within a component analysis. Future research directions and implications for clinical practice are discussed.

Psychotherapy outcome research: Implications of a new clinical taxonomy

Since the publication of DSM-III in 1980, the scientist-practitioner gap in clinical psychology has expanded, as almost all outcome research in clinical psychology has been on diagnosed mental disorders within a medical model using drug trial methodologies, whereas most practising clinicians undertake functional analyses and case formulations of clinical psychological problems (CPPs) and then apply tailored interventions within an ongoing hypothesis-testing methodology. But comparatively reliable assessment and generalizable conclusions in psychotherapy outcome research require a comprehensive theory-derived conception or operational definition of 'CPPs', standardized functional analyses, and a taxonomy of CPPs comparable to DSM's listings of mental disorders. An alternative conception and taxonomy of CPPs have recently been proposed, offering improvements in the reliability and generalizability of case formulation-based psychotherapy outcome research. It conceives of CPPs as instances of the formation and operation of self-sustaining problem-maintaining circles (PMCs) of psychological-level causal elements-that is, at the level of cognitions, behaviours, emotions, and events or situations (stimuli). The paper describes this new conception of CPPs, a subsequent nascent taxonomy of evidence-based PMCs which standardizes the underlying mechanisms that maintain CPPs, and ensuing benefits to research (as well as to practice) in clinical psychology. These benefits include being able to encompass all treatment-worthy CPPs, not just diagnosable mental disorders; to assess theory-derived intervention strategies, not just arbitrary therapy bundles; and to directly feed back into psychological theories, not just expand an atheoretical list of patented "evidence supported therapies."

Verbal Ability, Behavior Problems, and Mother-Child Relationship Quality in Autism Spectrum Disorder

This study examined differences in mother-child relationship quality and parent-rated child behavior problems based on child verbal status (i.e., minimally verbal versus verbal) in mothers and their adolescent and adult children with autism spectrum disorder (n = 219 dyads; child M_age = 25.38 years, SD = 10.22). Relationship quality was assessed via parent-reported maternal burden and mother-child closeness, and coded speech samples ascertaining maternal critical and positive remarks regarding the child. Groups did not differ in relationship quality. The verbal group was more likely to display disruptive and socially inappropriate behaviors, but otherwise the groups did not differ in behavior problems. Verbal status moderated the relationship between behavior problems and negative (maternal burden, critical remarks) but not positive (mother-child closeness, positive remarks) aspects of relationship quality.

Randomized controlled trial of seminar-based training on accurate and general implementation of practical functional assessments

General and long-term outcomes of functional analysis training have not yet been reported. Within a randomized control trial, we trained 18 behavior analytic practitioners to interview caregivers, design and then conduct a personalized analysis as a part of a practical functional assessment (PFA). Participants were randomly assigned to groups, and those who experienced the seminar prior to conducting PFA with a confederate demonstrated more component skills than those who were provided the same materials but did not experience the seminar (mean scores: 87%, 36% respectively). Participants who experienced the seminar considered the training valuable and reported greater confidence in their ability to achieve control in an analysis. Several participants then conducted a PFA with a client who engaged in SPB. Results showed that skills transferred to these authentic applications. Results suggest that a seminar-based training can increase practitioners' ability to functionally analyze problem behavior and leads to subsequent analytic activity.

Examining stereotypy in naturalistic contexts: Differential reinforcement and context-specific redirection

This study examined stereotypy in naturalistic classroom contexts (i.e., academic programming, leisure skill acquisition) with differential reinforcement of contextually appropriate behavior (DRA). When stereotypy was problematic, redirection to the ongoing activity was provided. Contextually appropriate behavior and stereotypy were measured across all contexts prior to redirecting stereotypy to contextually appropriate behavior. Low levels of stereotypy were observed during the DRA in at least 2 contexts for all 5 participants. Context-specific redirection was added to the DRA if stereotypy persisted, and decreased stereotypy in 9 of the 10 evaluations. The results suggest that stereotypy might not be problematic in all contexts when DRA is present and redirection to contextually relevant appropriate behavior is an effective strategy.

Assessment and treatment of tracheostomy tube manipulation: Effects of competing stimuli and protective equipment

Functional analyses (FA) are widely used in the assessment and treatment of problem behavior. However, with limited exceptions, the procedures are rarely applied to potentially dangerous behaviors involving medical equipment. The current study replicated and extended procedures previously used by Kurtz and Chin (2004) to assess and treat tracheostomy tube manipulation in a 5-year-old boy diagnosed with extensive medical and developmental conditions. FA results indicated that tracheostomy tube manipulation (i.e., touching, pulling, occluding) was automatically maintained. An augmented competing stimulus assessment was conducted to identify stimuli associated with low levels of tracheostomy tube manipulation and elevated levels of item engagement. A treatment package consisting of noncontingent access to competing stimuli with prompting and continuous application of protective equipment produced significant reductions in tracheostomy tube manipulation, as well as significant increases in toy engagement.

Integration of experimental functional analysis procedural advancements: Progressing from brief to extended experimental analyses

Despite the utility of experimental functional analysis methodology, not all applications produce differentiated results. Factors such as interaction effects or methodological inefficiencies may compromise the likelihood of obtaining differentiated outcomes. Various studies have addressed methods to improve the efficiency of experimental functional analysis methodology (e.g., analysis of within-session responding). In the current study, we describe an updated model for progressing from brief to extended experimental analyses. The model incorporates several procedural refinements developed over the past 20+ years of experimental functional analysis research and additional conditions to confirm or annul findings. We present data for 20 participants who were referred for assessment and treatment of a variety of behavior problems (e.g., stereotypy, aggression, self-injury). We generally terminated the analyses when response patterns were consistent with established best-practice functional analysis methodology. Results showed conclusive interpretations were obtained for 100% of participants.

An intensive telehealth assessment and treatment model for an adult with developmental disabilities

Over the last decade, the provision of applied behavior analysis (ABA) services within a telehealth delivery format has had a flourishing literature base. Research has demonstrated that caregivers can successfully conduct functional analyses and functional communication training to treat challenging behavior with coaching from practitioners via telehealth. Previous limitations include research that has only been conducted with children, typically in 1hr, weekly meetings, so the utility of providing ABA therapy via telehealth across the lifespan is unknown. Additionally, the effects of a more intensive treatment format delivered via telehealth has not been evaluated. The purpose of the current study was to coach caregivers to conduct the assessment and treatment process for a young man with developmental disabilities using an intensive-outpatient model in a telehealth format. Functional analysis procedures led to the development of a function-based treatment to reduce challenging behavior and increase functional communication. Caregivers demonstrated high procedural integrity across all phases of the study and found the intervention highly acceptable and effective. Areas for future research and directions are discussed.

Understanding, Assessing, and Intervening with Emotion Dysregulation in Autism Spectrum Disorder: A Developmental Perspective

This article provides a comprehensive review of emotion dysregulation (ED) in individuals with autism spectrum disorder (ASD). The authors describe ED from a developmental perspective, and highlight how aberrations in social development and a restricted-repetitive repertoire of behaviors, render individuals with ASD more vulnerable to ED. The article also summarizes how ED in children and adolescents with ASD has been measured and conceptualized in research and clinic settings. Evidence-based pharmacologic and cognitive behavioral interventions targeting ED in ASD are summarized, with a focus on how such approaches are tailored to the developmental needs of individuals with ASD.

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.

Examination of alternative-response discrimination training and resurgence in rats

Resurgence is an increase in a previously reinforced behavior following a worsening of conditions for a more recently reinforced behavior. Discrimination training is incorporated into treatment for problem behavior to prevent treatment adherence failures that may result in resurgence. There is evidence that resurgence may be reduced when a stimulus that signals alternative-response extinction is present compared with absent; however, the generality of this effect is unknown given the limited testing conditions. The goal of the present experiments was to further examine the effects of such stimuli in a reverse-translational evaluation using rats. Target responding was reinforced in baseline and then placed on extinction in the following discrimination-training phase. An alternative response was differentially reinforced in a two-component multiple schedule where one stimulus (i.e., S^D) signaled alternative-response reinforcement and the other (i.e., S^Δ) signaled extinction. Experiment 1 assessed resurgence in both the S^Δ and S^D when alternative reinforcement was removed. Experiment 2 evaluated resurgence under conditions that better approximated those used in the clinic in which the alternative-response S^Δ was present or absent. The S^Δ failed to suppress target responding during resurgence testing in both experiments. These findings suggest that the conditions under which an alternative-response S^Δ will successfully mitigate resurgence may be limited and require further research.

Increasing passive compliance to wearing a facemask in children with autism spectrum disorder

The current study taught 6 children with autism spectrum disorder (ASD) to increase passive compliance of wearing a facemask across sequentially increasing durations of time. A changing-criterion design embedded within a nonconcurrent multiple baseline design was used to evaluate the effectiveness of a resetting differential reinforcement of other behavior (DRO) without escape extinction procedure on passive compliance. Terminal probe sessions determined DRO fading intervals. Results showed that 2 participants acquired mastery level passive compliance (30 min) without fading during the initial baseline sessions. The remaining 4 participants acquired mastery level passive compliance following fading intervals within the DRO intervention. Participants' passive compliance generalized across 2 novel settings. This study replicates previous studies and extends empirical support for the use of DRO without escape extinction interventions for increasing passive compliance with medical devices in children with ASD.

A comparison of function- and nonfunction-based extinction treatments for inappropriate mealtime behavior

Previous literature supports the use of functional analyses to prescribe treatments for children with feeding disorders (Bachmeyer et al., 2009). Nevertheless, clinicians often train caregivers to use healthy contingencies, independent of whether those contingencies are function based. However, it is unclear whether including nonfunction-based contingencies differentially affects inappropriate mealtime behavior. In the current investigation, the caregivers of 3 children with feeding disorders provided escape from bites and drinks and attention following inappropriate mealtime behavior. Results of a functional analysis showed escape from bites or drinks, but not attention, reinforced inappropriate mealtime behavior. We then tested the effects of escape extinction when the feeder either provided or withheld attention following inappropriate mealtime behavior. Inappropriate mealtime behavior decreased and acceptance increased when the feeder implemented escape extinction independent of whether they provided or withheld attention. We discuss the implications of including nonfunction-based components in the treatment of pediatric feeding disorders.

Functional Analysis and Noncontingent Reinforcement With Extinction in the Treatment of Perseverative Speech

The present study evaluated the effectiveness of noncontingent reinforcement combined with extinction in the treatment of perseverative speech of an 11-year-old boy with autism spectrum disorder. Following a functional analysis that suggested perseverative speech was maintained by attention, treatment was introduced and consisted of delivering attention on a fixed-time schedule and placing perseverative speech on extinction. The intervention resulted in a 98.5% decrease in perseverative speech, which maintained over a 28-month period.

A comparison of brief and extended session duration functional analyses

Many behavior analysts do not conduct a functional analysis (FA) prior to treatment in a clinical setting (e.g., Roscoe et al., 2015). When asked for an explanation, respondents commonly report that an FA is too time consuming. One way to address this perceived constraint is to evaluate the utility of an abbreviated FA with 5-min session durations. In the current study, 2 independent FAs, 1 with 5-min sessions and 1 with 10-min sessions, were conducted for the problem behavior of 5 individuals diagnosed with autism spectrum disorder (ASD). For all participants, the 5- and 10-min session duration FAs yielded the same identified function of problem behavior: escape from demands. A brief differential reinforcement of alternative behavior (DRA) analysis was subsequently conducted and found to be effective at decreasing problem behavior and increasing an appropriate communication response across participants. These findings demonstrate the utility of conducting an FA using briefer session durations followed by a brief DRA analysis.

A Tutorial for the Design and Use of Assessment-Based Instruction in Practice

Assessment-based instruction can increase the efficacy and efficiency of skill acquisition by using learner data to select an intervention procedure from a comparison of potential interventions. Although there are many published examples of assessments that guide the selection of skill-acquisition procedures, there are limited resources available to practitioners to guide the development of assessments for use in practice. This article describes a sequence of steps that Board Certified Behavior Analysts can follow to design and use assessment-based instruction in practice. These steps include (a) pick a topic to evaluate, (b) identify interventions to include in the assessment, (c) identify target behavior, (d) select an experimental design, (e) select a skill and targets, (f) equate noncritical procedures across conditions, (g) design templates for data collection, (h) conduct the assessment, and (i) use assessment results to guide practice. Included in these steps are examples and materials for how to conduct components of assessment-based instruction.

Evaluating the Effects of Instructional Prompts and Strategic Incremental Rehearsal on the Letter Identification Mastery of Two Typically Developing Kindergarteners

Letter identification impacts the developmental progression of future reading skills. In this study, we evaluated the effects of instructional prompts on letter identification in a single-subject design for 2 kindergarten students who experienced difficulties with letter identification skills. In Phase 1, we evaluated the number of letters participants correctly identified without instructional prompts, and in Phase 2, we evaluated the effects of 2 different instructional prompts and rewards. Phase 3 evaluated the combined effects of strategic incremental rehearsal (SIR) and the most effective instructional prompt identified in Phase 2. Results showed that an effective, yet different instructional prompt was identified for each participant and that SIR plus an instructional prompt was effective for further increasing both participants' correct letter identification. The results of this study demonstrated a useful and effective method for identifying instructional prompts, strategies, or other interventions that improve students' academic responding.

Evaluating the Effects of Computer-Based Instruction on Trial-Based Functional Analyses Procedures

Children who engage in problem behavior are often educated in the public schools. A trial-based functional analysis (TBFA) is an experimental functional analysis whereby conditions are embedded into scheduled activities of the school day to identify environmental variables responsible for problem behavior. To be included in this process, it is important that staff are trained effectively and efficiently. Computer-based instruction (CBI) offers several advantages as a staff training tool including less training time, less required supervision, and permits self-paced and individualized training. The efficacy of CBI on procedures of TBFA to practitioners remains unknown. We evaluated the efficacy of CBI teaching procedures of TBFA with 20 practitioners. Results indicate that CBI is an effective and efficient staff training procedure as post-test scores increased following the CBI training across participants with a mean training duration of less than an hour. Three practitioners successfully implemented four conditions of a TBFA with a confederate following CBI training. Following completion of the study, respondents ranked procedures of the CBI as socially valid.

Noncontingent reinforcement: Arbitrary versus maintaining reinforcers for escape-maintained problem behavior

Noncontingent reinforcement (NCR) involves the delivery of maintaining reinforcers on a time-dependent schedule and often includes extinction. However, arbitrary reinforcers may be equally efficacious during NCR without extinction for treating escape-maintained problem behavior. The purpose of this study was to extend previous research on NCR by evaluating the relative efficacy of NCR without extinction and comparing maintaining versus arbitrary reinforcers for 4 individuals with escape-maintained problem behavior. Two different NCR conditions, NCR using the maintaining reinforcer (escape) and NCR using an arbitrary reinforcer (an edible), were evaluated using multielement and reversal designs. Treatment effects varied across participants. Results for 2 participants showed a reduction in problem behavior during NCR without extinction with both the arbitrary and maintaining reinforcers. For 1 participant, results showed a reduction in problem behavior with both the arbitrary and maintaining reinforcers only when extinction was added to NCR. For the 4th participant, the maintaining reinforcer was effective during NCR without extinction, but the arbitrary reinforcer was ineffective.

The Impact of Applied Behavior Analysis to Address Mealtime Behaviors of Concern Among Individuals with Autism Spectrum Disorder

Feeding difficulties among individuals with autism spectrum disorder are common. The science of applied behavior analysis (ABA) has been employed to address these difficulties. Ample publications exist that demonstrate that ABA is consistently effective in increasing the consumption of new foods and drinks, increasing chewing and swallowing behavior, decreasing problem behavior at mealtime, and improving skills such as self-feeding. This article details the application of the basic principles of ABA, reinforcement, extinction, and punishment to treat feeding difficulties.

Synthesizing the Multiple-Probe Experimental Design With the PEAK Relational Training System in Applied Settings

The scientist-practitioner model necessitates embedding experimental designs within applied practice. This technical report describes a procedure for embedding a multiple-probe experimental design within the PEAK Relational Training System across all four PEAK modules. Baseline probes provide a direct test of target skills negatively endorsed within the PEAK assessment battery and can provide an estimate of skill acquisition in the absence of direct training. Temporal staggering of the probes maintains the fidelity of the experimental design and allows for the design to evolve along with learner skill acquisition. Achievement of mastery criteria demonstrates the efficacy of programming, and failure to achieve mastery can be remedied through programming adjustments that can be captured within the design. We additionally conducted a field test of the design with a child with disabilities, supporting the viability of this procedure within applied settings.

The Use of Demand Assessments: A Brief Review and Practical Guide

It is important for practitioners to first conduct an indirect demand assessment to identify appropriate stimuli to include during the direct demand assessment. Information obtained from an indirect demand assessment is useful not only for identifying which demands to evaluate during the direct assessment but also for selecting stimuli associated with each demand. Conducting an indirect demand assessment with caregivers provides practitioners the opportunity to identify whether specific demand stimuli are associated with more challenging behavior (e.g., writing with a pen vs. a pencil) and whether demand presentation may be an establishing operation for challenging behavior (e.g., presenting one math problem at a time vs. presenting an entire math worksheet). The purpose of this article is to review the current literature on demand assessment procedures and to provide practitioners with a practical guide for conducting demand assessments in clinical settings. We provide a summary of our findings along with a brief description of the procedures used for implementing the indirect and direct demand assessments. Further, we created a decision-making guide to help practitioners select which type of demand assessment to conduct with their clients.

A Randomized Controlled Trial of Functional Communication Training via Telehealth for Young Children with Autism Spectrum Disorder

Many children with autism spectrum disorder (ASD) have problem behaviors that interfere with learning and social interaction. This randomized controlled trial compared treatment with functional communication training (FCT) to "treatment as usual" for young children with ASD (n = 38, ages 21-84 months). FCT was conducted by parents with training and real-time coaching provided by behavioral consultants using telehealth. FCT treatment via telehealth achieved a mean reduction in problem behavior of 98% compared to limited behavioral improvement in children receiving "treatment as usual" during a 12-week period. Social communication and task completion also improved. For children with ASD and moderate to severe behavior problems, parent-implemented FCT using telehealth significantly reduced problem behavior while ongoing interventions typically did not.

Interobserver agreement: A preliminary investigation into how much is enough?

Interobserver agreement (IOA) is important for research and practice, and supports the consistency of behavioral data (Kahng et al., 2011). Although general parameters for how much IOA is needed have been suggested (Bailey & Burch, 2018), it is unknown if the total number of sessions with IOA might impact the IOA coefficient. In this study, IOA was reanalyzed using functional analysis data at various cutoffs. Obtained IOA from these analyses was then compared to the original IOA. Overall, results suggested that, at least when using highly trained observers in a structured clinical setting, there were no significant differences in IOA across cutoffs. However, IOA was sensitive to overall rate of responding in the functional analysis. These data are encouraging, particularly for practitioners, because they provide preliminary support that the amount of sessions with IOA may not be as important as the consistency of the data.

Meta-analysis: Pharmacologic Treatment of Restricted and Repetitive Behaviors in Autism Spectrum Disorders

OBJECTIVE

To examine the efficacy of pharmacological treatments for restricted and repetitive behaviors (RRB) in autism spectrum disorders (ASD).

METHOD

We searched PubMed, Embase, and CENTRAL to identify all double-blind, randomized, placebo-controlled trials that examined the efficacy of pharmacological agents in the treatment of ASD and measured RRB as an outcome. Our primary outcome was the standardized mean difference in rating scales of RRB.

RESULTS

We identified 64 randomized, placebo-controlled trials involving 3,499 participants with ASD. Antipsychotics significantly improved RRB outcomes compared to placebo (standardized mean difference [SMD] = 0.28, 95% CIs = 0.08-0.49), z = 2.77, p = .01) demonstrating a small effect size. Larger significant positive effects on RRB in ASD were seen in individual studies with fluvoxamine, buspirone, bumetanide, divalproex, guanfacine, and folinic acid that have not been replicated. Other frequently studied pharmacological treatments in ASD including oxytocin, omega-3 fatty acids, selective serotonin reuptake inhibitors (SSRI), and methylphenidate did not demonstrate significant benefit in reducing RRB compared to placebo (oxytocin: SMD = 0.23, 95% CI = -0.01 to 0.47, z = 1.85, p = .06; omega-3 fatty acids: SMD = 0.19, 95% CI = -0.05 to 0.43, z = 1.54, p = .12; SSRI: SMD = 0.09, 95% CI = -0.21 to 0.39, z = 0.60, p = .56; methylphenidate: SMD = 0.18, 95% CI = -0.11 to 0.46, z = 1.23, p = .22).

CONCLUSION

The results of the present meta-analysis suggest that currently available pharmacological agents have at best only a modest benefit for the treatment of RRB in ASD, with the most evidence supporting antipsychotic medications. Additional randomized controlled trials with standardized study designs and consistent and specific assessment tools for RRB are needed to further understand how we can best help ameliorate these behaviors in individuals with ASD.

Parent-implemented brief functional analysis and treatment with coaching via telehealth

We evaluated the use of parent-implemented brief functional analyses in the home with coaching delivered via telehealth. Parents of 7 children with autism conducted functional analyses of their child's challenging behavior. For 4 participants, the brief functional analysis provided information regarding the function of the child's challenging behavior. A full functional analysis indicated a social function for 1 participant. The brief functional analysis yielded false positive results and subsequent assessment indicated an automatic function for another participant. The final participant did not engage in sufficient rates of challenging behavior to provide information regarding the function of the child's challenging behavior. Treatment evaluations occurred with 4 participants; these evaluations provided support for the results of the functional analysis. Together with previous research, the results indicate that parent-implemented brief functional analyses, followed by additional assessment as needed, may be an effective method for assessing and treating challenging behavior via telehealth.

The Safety and Effectiveness of High-Dose Propranolol as a Treatment for Challenging Behaviors in Individuals With Autism Spectrum Disorders

PURPOSE/BACKGROUND

Individuals with autism spectrum disorders present with social communication deficits and a rigid adherence to sameness. Along with these symptoms, many individuals also present with severe challenging behaviors that place themselves as well as their families and communities at risk for injury. For these individuals, new and effective treatments are acutely needed. Propranolol has been used worldwide for over 50 years. Its primary indication is for hypertension, but there is evidence that, at higher doses, propranolol inhibits rage and anger through its effects on the central nervous system. This effect has been demonstrated in a variety of neuropsychiatric disorders.

METHODS/PROCEDURES

Here, we present 46 retrospective analyses of clinical cases that were followed by a psychiatrist. Propranolol was prescribed as an add-on to the patients' existing medications. The doses ranged from 120 to 960 mg per day (mean = 462 mg).

FINDINGS/RESULTS

Thirty-nine (85%) of 46 patients were found to be much improved or very much improved on the physician-rated Clinical Global Impression Improvement scale. There were few side effects noted, with only 2 subjects unable to tolerate the propranolol.

IMPLICATIONS/CONCLUSIONS

It appears that high-dose propranolol can be given safely with minimal adverse cardiovascular problems, provided that close clinical monitoring is maintained. A more rigorous clinical trial is needed to elucidate and verify its clinical utility, clinical practice parameters, and the effects of propranolol as a monotherapy versus as an add-on to the patient's existing medication regimen.

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.

Motivating Operations and Negative Reinforcement

The motivating operations concept has improved the precision of our approach to analyzing behavior; it serves as a framework for classifying events that alter the reinforcing and punishing effectiveness of other events. Nevertheless, some aspects of the concept are seriously flawed, thereby limiting its utility. We contend in this article that the emphasis it places on the onset of some stimuli (putative motivating operations) making their offset a reinforcer in the absence of a learning history (i.e., in the case of unconditioned motivating operations), or because of such a history (i.e., in the case of reflexive conditioned motivating operations), is of no value in predicting or controlling behavior. It is unfortunate that this pseudo-analysis has been widely accepted, which has drawn attention away from actual motivating operations that are relevant to negative reinforcement, and led to conceptually flawed explanations of challenging human behaviors that are escape-maintained. When used appropriately, the motivating operations concept can help to clarify the conditions under which a stimulus change (in particular, stimulus termination) will function as a negative reinforcer. From both a theoretical and a practical perspective, rethinking the application of the motivating operations concept to negative reinforcement is advantageous. Herein, we explore the implications of doing so with the aim of encouraging relevant research and improving the practice of applied behavior analysis.

The Effects of Vocal Stereotypy on Secondary Target Acquisition

Instructive feedback (IF) is a strategy for increasing the efficiency of targeted instruction. Previous research has demonstrated the success of IF with learners with autism spectrum disorder (ASD), but limited research exists regarding the efficacy of the intervention with individuals with ASD who engage in vocal stereotypy. The effects of 2 forms of IF were examined with a learner with ASD who engaged in vocal stereotypy. In Study 1, no intervention for vocal stereotypy was implemented. In Study 2, response interruption and redirection (RIRD) was implemented contingent on vocal stereotypy. IF before the praise statement resulted in faster acquisition of secondary targets, but only when RIRD was implemented. These results extend the IF literature by providing evidence that individuals who engage in vocal stereotypy may require concurrent intervention to increase the opportunity for indiscriminable contingencies to be established and the acquisition of secondary targets via IF.

An Investigation of Functional Communication Training and Schedule Thinning Using a Multiple Schedule on Elopement to Access Stereotypy

Individuals diagnosed with autism spectrum disorder (ASD) who engage in stereotypy may also emit a prior, temporally contiguous, high-risk response to access stereotypic behaviors. For example, the participant in this study who was diagnosed with ASD engaged in a chained response that included elopement, often in unsafe locations, to access light switch flipping. Previous research indicates that functional communication training (FCT) with delay fading is a viable approach to reduce chained problem behavior. In this study, we extended previous research by (a) evaluating the generalized effect of FCT and schedule thinning using multiple schedule technology for an automatically maintained chained response, and (b) evaluating whether intervention effects maintained in the participant's optimal context. Results for the participant suggested that FCT with schedule thinning mitigated high-risk chained responding across settings and discrimination training using a multiple schedule assessment effectively signaled available and unavailable times for the participant to emit the chained response which matched the participant's natural schedule parameters.