Assessment and treatment of problem behavior maintained by escape from attention

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

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

Secondary and within-session analyses to improve the feasibility and precision of assessments of sociability

Previous research has improved the feasibility and precision of assessments of sociability, but further progress is warranted. The purpose of this study was to evaluate secondary measures and within-session analyses to further improve the feasibility and precision of assessments of sociability. We reanalyzed previously published assessment results to evaluate whether initial and conditional (i.e., on therapist movement) approach and avoidance may approximate established continuous measures. Results indicated that both measures were strongly correlated with the percentage of session on the social side and may provide a more feasible approximation for use in clinical practice. We also conducted within-session analyses of these assessment results to evaluate whether they may improve precision or clarity. Correlational and matching-based analyses of the within-session data suggest that clear conclusions may be drawn from the results of a single session and facilitate a richer understanding of sociability. Implications for clinical practice and future research are discussed.

Behavioral Assessment and Treatment of Aerophagia

Aerophagia is characterized by excessive air swallowing and can have serious negative effects on one’s health. We present the assessment and treatment of a 16-year-old girl, Khloe, with developmental disabilities and aerophagia. The initial assessment indicated that aerophagia occurred primarily to access attention in a divided attention context; however, our function-based treatment did not result in a clinically significant reduction in problem behavior. We then conducted a second assessment that indicated that Khloe’s aerophagia indeed occurred primarily in a divided attention context, but that it persisted independent of social consequences. We concluded that the divided attention context served as a motivating variable for aerophagia. Our second treatment consisted of differential reinforcement of other behavior, noncontingent access to competing stimuli, and graduated exposure to contextual variables (i.e., people and divided attention) that occasioned aerophagia. The treatment was successful in reducing rates of aerophagia. We discuss implications for assessment and treatment, as well as recommendations for clinicians and students.