Producing meaningful improvements in problem behavior of children with autism via synthesized analyses and treatments

Progressive Functional Analysis and Function-Based Intervention Via Telehealth: A Replication and Extension

The purpose of this study was to evaluate a progressive functional analysis (FA) model and function-based intervention delivered by caregivers with coaching via telehealth. Children diagnosed with autism and at least one caregiver (e.g., parent) participated in the study. We conducted three assessments prior to and following intervention: a researcher-developed 10-min observation, the Parental Stress Index, and the externalizing section of the Vineland Adaptive Behavior Rating Scales, Third Edition (VABS-3). We included 47 participants in the present evaluation of the progressive FA model. We identified the function of challenging behavior for 36 participants. A function was not identified for nine participants who exhibited low or no challenging behavior during the assessment; the results were inconclusive for two participants. For the 17 participants who participated in the intervention evaluation phase, each of the participants achieved the mastery criterion, which was an 80% reduction in challenging behavior for most participants. Additionally, there was a statistically significant decrease in the VABS-3 externalizing behavior measure from pre- to post-assessment, although neither of the other pre-post measures resulted in statistically significant changes. This study replicates and extends previous research, supporting the use of progressive FA model and function-based interventions to improve challenging behavior.

On the prevalence and magnitude of resurgence during delay-and-denial tolerance teaching

Resurgence is the recurrence of target behavior (e.g., challenging behavior) during a worsening of reinforcement conditions (e.g., increases in response effort, decreases in alternative reinforcement). Previous studies have examined the prevalence and magnitude of resurgence during functional communication training implemented with discriminative stimuli. We conducted a systematic review of the literature to analyze the magnitude and prevalence of resurgence during delay-and-denial tolerance teaching. Similar to previous studies with discriminative stimuli, resurgence occurred for most participants and in about one third of transitions. When resurgence was present, challenging behavior increased to approximately 26% of baseline levels. Resurgence was less likely to occur during response-effort manipulations (i.e., complexity teaching, tolerance-response teaching) and was most likely to occur during increases in delays that ended following the passage of time rather than a response criterion. We discuss implications for treatment refinements and future treatment-relapse research.

A Quantitative Systematic Literature Review of Combination Punishment Literature: Progress Over the Last Decade

This review evaluated single-case experimental design research that examined challenging behavior interventions utilizing punishment elements. Thirty articles published between 2013 and 2022 met study inclusion criteria. Study quality was also assessed. Through multiple levels of analysis (e.g., descriptive statistics, non-parametric statistics), we examined (a) participant and study trends, (b) differential outcomes related to temporal reinforcement approaches (antecedent, consequent, or combined reinforcement) applied alongside punishment element(s), (c) differential outcomes related to the punishment type (negative, positive) applied alongside reinforcement, and (d) effect sizes associated with study rigor across peer-reviewed and gray literature. Our results may tentatively suggest that, for certain situations, concurrently applying punishment with antecedent reinforcement approaches may coincide with significantly larger effect sizes compared to combined temporal reinforcement approaches, while positive punishment applied concurrently with reinforcement may coincide with larger but non-significant intervention effects. Most featured articles met rigor criteria, but larger effects were seen in peer-reviewed literature.

The Challenges Ahead: Concepts, Analytics, and Ethics of Value-Based Care in Applied Behavior Analysis

Value-based care has incrementally increased its footprint across healthcare over the past 2 decades. Several organizations in ABA have begun experimenting with various components of value-based care specific to the delivery of ABA services and it seems likely that this trend will continue into the future. For those new to value-based care, this article reviews the main conceptual components as well as common myths and misconceptions about value-based care. Though conceptually straightforward, practically pulling off value-based care in ABA will require significant advancements in data collection, analytics, sharing, and transparency that follow from broad field-wide collaboration. Further, many ethical questions will likely arise as ABA providers begin thinking about and assessing their clinical and business operations through a value-based care lens. Though value-based care will likely roll out slowly and incrementally over many years, ABA providers interested in participating or leading these conversations will likely benefit from focusing collaborative efforts around: normalizing data sharing and self-analysis; defining and developing quality and cost measures; identifying patient risk variables; addressing challenges at the intersection of public health ethics and clinical ethics; and addressing challenges at the intersection of AI ethics and clinical ethics. Most probably agree that optimizing patient outcomes is the goal of ABA services. However, doing it in an objective, measurable, and consistent manner that can be validated by third-parties will require overcoming significant challenges.

Functional Communication Training in Schools: A Systematic Analysis of the Evidence for Ecological Validity

Ecological validity refers to the meaningfulness or practical significance of research outcomes in everyday settings or the extent to which an intervention can be implemented by typical people during naturally occurring opportunities. In education, ecological validity may contribute to the adoption of interventions by teachers working with students in school settings. Our purpose in this review was to examine the evidence for ecological validity of functional communication training (FCT) used to address challenging behavior in school-age individuals with disabilities. We reviewed 19 single-case experimental design (SCED) studies published between 1985 and 2023. First, we used the What Works Clearinghouse (WWC) Standards to evaluate the empirical evidence of each study. Second, we evaluated the extent to which behavioral assessment and FCT procedures were described in the 15 studies that met the WWC Standards. Third, we conducted a systematic analysis of the evidence for ecological validity of behavioral assessment and FCT. Results indicate that 95% of the SCED studies met the WWC Standards. The description of procedures was complete for 50% of the behavioral assessments and for 11% of the FCT. The overall evidence for ecological validity was moderate for 16.7% and low for 83.3% of the behavioral assessments. The evidence for ecological validity for all FCT procedures was low. Future research and implications related to ecological validity are discussed.

Distance-Based Collaborations for Assessing and Treating Challenging Behavior

An interview-informed synthesized contingency analysis (IISCA; Hanley et al. in J Appl Behav Anal 47:16-36, 2014) and related skill-based treatment process can result in socially valid outcomes for clients exhibiting severe challenging behavior when implemented by professionals and then transferred to parents (e.g., Santiago et al. in J Autism Dev Disord 46:797-811, 2016). However, many families do not have access to professionals trained to implement functional analyses or function-based treatments (Deochand & Fuqua Behav Anal Pract 9:243-252, 2016). Experimenters in the present study coached three parents of children with autism exhibiting severe challenging behavior through implementing an IISCA and resulting skill-based treatment process through distance-based collaborative consulting. All parents achieved differentiated functional analyses, taught their children to emit functional replacement skills, and reduced challenging behavior relative to baseline.

Addressing Prompt Dependency in the Treatment of Challenging Behavior Maintained by Access to Tangible Items

Prompt dependency is a common concern for individuals with developmental disabilities, particularly autism spectrum disorder. Previous research has shown that different interventions can be used to decrease prompt dependency. The purpose of the present study was to evaluate the efficacy of various treatments to decrease prompt dependency during functional communication training in the treatment of challenging behavior maintained by access to tangible items in a 16-year-old female diagnosed with autism spectrum disorder. Specifically, we compared the effects of differential reinforcement, vocal prompt fading, extended response intervals, and full physical prompts with a constant prompt delay to increase independent functional communication responses. The results of the study suggest that the prompt dependency treatment evaluation was efficacious in increasing independent functional communication responses and subsequently reducing challenging behavior to zero rates.

A Two Step Validation of the Performance-Based IISCA: A Trauma-Informed Functional Analysis Model

Functional analyses often involve extended exposure to evocative events and problem behavior, which potentially places the client at risk of retraumatization. The performance-based, interview-informed synthesized contingency analysis (IISCA) is a brief analysis that is conducted in a single session and applies a trauma-assumed framework in the development of the assessment procedures (e.g., measures of calm, reinforcing precursors to avoid escalation and physical management). We conducted 12 applications of the performance-based IISCA in the United States and Brazil and (1) compared the results to a subset of 7 applications who also experienced the original IISCA and (2) incorporated a function-based treatment informed by the performance-based IISCA in a further subset of 5 of those 12 applications. The results support the use of the performance-based IISCA in that this variation of the IISCA corresponded with the original IISCA and informed effective treatment of problem behavior.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40617-023-00792-2.

Using the Preschool Life Skills Program to Support Skill Development for Children with Trauma Histories

The Preschool Life Skills (PLS) program has a wealth of evidence demonstrating efficacy in remediating important social and learning-to-learn skill deficits in at-risk preschoolers. Those same skill deficits also are common in older children in foster or residential care, most of whom have experienced some sort of trauma or other adverse childhood events. This study sought to evaluate individualized PLS curricula for two boys with substantial trauma histories and demonstrate how the PLS program could be delivered within a trauma-informed framework. We delivered the program and evaluated skill acquisition in a one-to-one setting in a UK-based clinic, and asked caregivers to assess skills at home. Results showed that both boys acquired skills targeted in their individual curriculum, but maintenance was sometimes inconsistent. Social validity assessments suggested that both boys enjoyed the training but were less definitive about its overall benefits. Caregivers rated the program highly and reported skill improvements at home. We discuss the implications of these findings in terms of adapting the PLS program to children with trauma histories.

Synthesized alternative reinforcement and resurgence

In treatments based on differential reinforcement of alternative behavior, applied researchers and clinicians often provide multiple, qualitatively different reinforcers (i.e., synthesized reinforcement) rather than a single reinforcer (i.e., isolated reinforcement) contingent on alternative behavior. Some research shows that providing synthesized reinforcement for alternative responses within such treatments produces more rapid and complete suppression of target behavior; however, there is limited research evaluating the durability of these effects during treatment disruptions. Conceptual explanations of resurgence (e.g., resurgence as choice, context theory) suggest that treatments that include synthesized alternative reinforcement may lead to more resurgence of target behavior when alternative reinforcement is disrupted relative to treatments using isolated reinforcement. We evaluated this hypothesis within a three-phase resurgence evaluation. We exposed rats to isolated or synthesized reinforcement for alternative responding in the second phase, and we exposed rats to extinction in the third phase. Synthesized alternative reinforcement produced more rapid and complete suppression of target behavior than did isolated reinforcement in the second phase; however, exposure to extinction following synthesized reinforcement produced more resurgence. We discuss these results in terms of their implications for applied research and their support for current conceptual explanations for resurgence.

Are Function-Based Interventions for Students with Emotional/Behavioral Disorders Trauma Informed? A Systematic Review

Students with emotional/behavioral disorders (EBD) commonly engage in both externalizing and internalizing behaviors-a behavioral profile that has been connected to childhood trauma. Although the efficacy of function-based interventions for students with EBD has been documented, the extent to which these interventions align with principles of trauma-informed care (TIC) is unknown. We conducted a systematic review of function-based intervention studies for students with EBD to evaluate whether and how these interventions incorporated critical elements of TIC. We identified 56 articles that met the eligibility criteria and used an iterative process to identify intervention practices consistent with each of six pillars of TIC, then evaluated the extent to which interventions in the study sample incorporated these practices. Despite identifying 45 function-based intervention practices aligned with pillars of TIC, we found most of these practices were absent in most interventions. We identified teaching skills, building healthy relationships, and including family, culture, and community as three pillars of TIC that warrant more attention when developing function-based interventions for students with EBD. For pillars of TIC that lack a strong empirical foundation in behavior analysis, we point to related literatures and disciplines with potential to inform next steps in behavior analytic research and practice.

Protective procedures in functional analysis of self-injurious behavior: An updated scoping review

Despite the efficacy of functional analyses in identifying the function of challenging behavior, clinicians report not always using them, partly due to safety concerns. Understanding how researchers employ safeguards to mitigate risks, particularly with dangerous topographies like self-injurious behavior (SIB), is important to guide research and practice. However, the results of a scoping review of functional analyses of self-injurious behavior conducted by Weeden et al. (2010) revealed that only 19.83% of publications included protections. We extended the work of Weeden et al. to determine whether reporting has improved. We observed increases in all but two types of protections reviewed by Weeden et al. Additionally, we included new protections not reported by Weeden et al. In total, 69.52% of the studies included at least one protective procedure and 44.39% specified that the protections were used for safety. It appears that reporting has increased since Weeden et al. called for improved descriptions of participant protections.

Problems with "problem behavior": A secondary systematic review of intervention research on transition-age autistic youth

LAY ABSTRACT

In a previous study, we looked at research done on strategies to support autistic people who were between 14 and 22 years old. For this study, we looked at all of the studies in our previous study that tried to decrease or stop autistic people from doing certain things-many researchers call these things "problem behavior." There were 48 studies that tried to reduce problem behavior, and most of them used strategies like prompting and reinforcement to try get autistic people to change their behavior. We found many things wrong with these studies. Most of them did not define the group of behaviors they were trying to stop autistic people from doing. None of the studies looked at whether any side effects happened when they tried the strategy they were studying. Also, most of the studies tried to stop autistic people from doing behaviors that probably were not harmful, like stereotypic behavior. Most of the studies did not say how they decided that the behaviors they tried to stop were a problem for the autistic people in the study, and most studies did not try to figure out why the autistic people in the study did the behaviors the researchers were trying to stop them from doing.

A systematic review of social-validity assessments in the Journal of Applied Behavior Analysis: 2010-2020

We conducted a systematic review of studies published in the Journal of Applied Behavior Analysis between 2010 and 2020 to identify reports of social validity. A total of 160 studies (17.60%) published during this time included a measure of social validity. For each study, we extracted data on (a) the dimensions of social validity, (b) the methods used for collecting social-validity data, (c) the respondents, and (d) when social-validity data were collected. Most social-validity assessments measured the acceptability of intervention procedures and outcomes, with fewer evaluating goals. The most common method for collecting social validity data was Likert-type rating scales, followed by non-Likert-type questionnaires. In most studies, the direct recipients of the intervention provided feedback on social validity. Social-validity assessment data were often collected at the conclusion of the study. We provide examples of social-validity measurement methods, discuss their strengths and limitations, and provide recommendations for improving the future collection and reporting of social-validity data.

Retrospective consecutive controlled case series of outcomes for functional analyses of severe destructive behavior

Functional analysis methods allow clinicians to determine the variable(s) that maintain destructive behavior. Previous reviews of functional analysis outcomes have included large samples of published and unpublished data sets (i.e., clinical samples). The purpose of this review was to conduct a large retrospective consecutive controlled case series of clinical functional analyses. We sought to identify the prevalence of differentiation, procedural modifications for undifferentiated and differentiated cases, and identified function(s) of destructive behavior. In addition, we extended the existing literature by determining whether functional analysis differentiation and function varied when single or multiple behavior topographies were consequated in the functional analysis. We discuss our findings considering previously published functional analysis reviews, provide avenues for future research, and offer suggestions for clinical practice.

Exploring factors that influence the efficacy of functional communication training

Understanding factors that influence the efficacy of functional communication training has both practical and conceptual benefits. The current study extended research in this area by exploring data from 95 consecutive applications of functional communication training with extinction across two independent clinics. We selected candidate predictor variables based on conceptual analysis, conducted preliminary exploratory analyses, and then selectively applied quantitative methods that are used in precision medicine to examine their accuracy and predictive utility. Treatment outcomes were better when challenging behavior was maintained by a single function than they were when it was maintained by multiple functions; however, these differences were most apparent among cases with an escape function. We also analyzed within-session responding to explore the potential influence of unprogrammed establishing operations on decrements in treatment efficacy. Our within-session measure only distinguished responders from nonresponders when escape was one of the multiple functions. Additional research is needed to validate these findings with an independent sample and to address a number of clinical conceptual issues.

Long-term effectiveness and generality of practical functional assessment and skill-based treatment

There are several considerations to address when conducting functional communication training for challenging behavior in a school setting, such as the need for schedule thinning and maintenance across staff and the need to establish a variety of appropriate classroom skills. There are several strategies for conducting schedule thinning following functional communication training and for transferring effects across people or settings. However, there are few examples of these processes in natural settings with relevant caregivers and with long-term maintenance of effects. We implemented a functional assessment and skill-based treatment process with six children with autism in a specialized school setting and extended treatment until challenging behavior was reduced to near-zero levels across multiple staff and settings. Follow-up data indicate that effects were still observed 1 year posttreatment and the use of crisis procedures (e.g., physical restraint) was eliminated for all participants.

Generalized Linear Mixed Effects Modeling (GLMM) of Functional Analysis Graphical Construction Elements on Visual Analysis

Multielement designs are the quintessential design tactic to evaluate outcomes of a functional analysis in applied behavior analysis. Protecting the credibility of the data collection, graphing, and visual analysis processes from a functional analysis increases the likelihood that optimal intervention decisions are made for individuals. Time-series graphs and visual analysis are the most prevalent method used to interpret functional analysis data. The current project included two principal aims. First, we tested whether the graphical construction manipulation of the x-to-y axes ratio (i.e., data points per x- axis to y-axis ratio [DPPXYR]) influenced visual analyst's detection of a function on 32 multielement design graphs displaying functional analyses. Second, we investigated the alignment between board certified behavior analysts (BCBAs; N = 59) visual analysis with the modified visual inspection criteria (Roane et al., Journal of Applied Behavior Analysis, 46, 130-146, 2013). We found that the crossed GLMM that included random slopes, random intercepts, and did not include an interaction effect (AIC = 1406.1, BIC = 1478.2) performed optimally. Second, alignment between BCBAs decisions and the MVI appeared to be low across data sets. We also leveraged current best practices in Open Science for raw data and analysis transparency.

Exploratory Time-Series Analysis of Consecutive Case Series Data: A Quality Improvement and Adherence Study of a Behavior Analytic Service Provider

Program evaluation is an essential practice for providers of behavior analytic services, as it helps providers understand the extent to which they are achieving their intended mission to the community they serve. A proposed method for conducting such evaluations, is through the use of a consecutive case series design, for which cases are sequentially gathered following the onset of a specific occurrence. Given the sequential nature in which data are collected within a consecutive case series, analytic techniques that adopt a time-series framework may be particularly advantageous. Although such methods are commonly used for program evaluation in medicine and economics, their application within the field of applied behavior analysis is largely absent. To serve as a model for providers undertaking evaluation efforts, I conducted a program evaluation of an outpatient severe behavior clinic, in which I employed quasi-experimental methods using an interrupted time-series analysis.

Functional Analysis of Contextually Inappropriate Social Behavior in Children With Down Syndrome

BACKGROUND

Children with Down syndrome often engage in contextually inappropriate social behavior, which researchers suggest may function to escape from difficult activities to preferred social interactions. Caregivers may reinforce the behavior, perceiving it only as evidence of the child's social strength, when, in fact, the pattern may also prevent or slow the development of critical skills. Unlike overt forms of challenging behavior, contextually inappropriate social behavior had never been subjected to experimental analysis.

AIMS

The purpose of the current study was to identify and demonstrate functional control of contextually inappropriate social behavior to caregiver-informed contingencies.

METHOD AND PROCEDURES

We interviewed caregivers and subjected contextually inappropriate social behavior to functional analyses for nine young children with Down syndrome.

OUTCOMES AND RESULTS

We found sensitivity to the caregiver-informed contingencies for all nine participants with strong functional control and large effect sizes for most.

CONCLUSIONS AND IMPLICATIONS

Caregivers may not perceive contextually inappropriate social behavior as problematic, yet patterns of contextually inappropriate and other problem behaviors suggest decreased engagement and poor task persistence. Assessments that lead to intervention decisions may be more informative when they include questions about social topographies of behavior not typically considered as problematic. Once caregivers are aware of the pattern, they may be better prepared to intervene.

Toward Maximizing Assessment Efficiency: A Synthesized Trial-Based Functional Analysis and Competing Stimulus Assessment

Despite the success of the standard functional analysis (FA), some limitations to conducting an FA in practice include time, resources, ecological relevance, and safety, which have led to the development of procedural adaptations such as trial-based and synthesized FA formats. The purpose of this case study was to identify the function(s) of self-injurious behavior (SIB) for a 3-year-old female with developmental disabilities using a brief trial-based FA with ecologically relevant synthesized contingencies, based on caregiver input, to minimize opportunities for SIB. We identified that positive physical attention likely functioned, at least in part, as a reinforcer for SIB, in less than 42 min. Overall harm to the child as a result of the synthesized trial-based FA was minimal, and the caregiver viewed the modified conditions favorably. We then assessed the role of competing stimuli on SIB rates with the child's mother and identified two potential items that may compete with attention as a reinforcer for SIB. Our findings highlight the utility and importance of individualized assessment as the first step in the safe treatment of severely challenging behavior.

Approaches for Treating Multiply Controlled Problem Behavior

A portion of problem behavior is maintained by multiple reinforcement contingencies. Treating multiply controlled problem behavior may be more complex than treating problem behavior maintained by a single contingency. Several approaches for addressing multiply controlled problem behavior have been described in the literature. The purpose of this review is to provide practitioners with an overview of function-based approaches for addressing multiply controlled problem behavior. In particular, we present guidelines for functional analysis and treatment. We also describe strengths and limitations of published treatment approaches and discuss strategies for mitigating these limitations. Finally, we describe areas for future research.

Updated Recommendations for Reinforcement Schedule Thinning following Functional Communication Training

Schedule thinning is a necessary treatment procedure following the acquisition of a communication response during functional communication training. In this article, we update and extend the Hagopian et al. Behavior Analysis in Practice, 4, 4-16, (2011) review and recommendations on schedule-thinning procedures following functional communication training. Since their publication, substantial research has been published on the efficacy, efficiency, and social validity of schedule-thinning methods. We provide updated recommendations for schedule thinning based on contemporary literature that has been published since 2011, as well as discuss key areas for future research.

Pilot study of a real-time early agitation capture technology (REACT) for children with intellectual and developmental disabilities

Objective

Children and adolescents with intellectual and developmental disabilities (IDD), particularly those with autism spectrum disorder, are at increased risk of challenging behaviors such as self-injury, aggression, elopement, and property destruction. To mitigate these challenges, it is crucial to focus on early signs of distress that may lead to these behaviors. These early signs might not be visible to the human eye but could be detected by predictive machine learning (ML) models that utilizes real-time sensing. Current behavioral assessment practices lack such proactive predictive models. This study developed and pilot-tested real-time early agitation capture technology (REACT), a real-time multimodal ML model to detect early signs of distress, termed "agitations." Integrating multimodal sensing, ML, and human expertise could make behavioral assessments for people with IDD safer and more efficient.

Methods

We leveraged wearable technology to collect behavioral and physiological data from three children with IDD aged 6 to 9 years. The effectiveness of the REACT system was measured using F1 score, assessing its usefulness at the time of agitation to 20s prior.

Results

The REACT system was able to detect agitations with an average F1 score of 78.69% at the time of agitation and 68.20% 20s prior.

Conclusion

The findings support the use of the REACT model for real-time, proactive detection of agitations in children with IDD. This approach not only improves the accuracy of detecting distress signals that are imperceptible to the human eye but also increases the window for timely intervention before behavioral escalation, thereby enhancing safety, well-being, and inclusion for this vulnerable population. We believe that such technological support system will enhance user autonomy, self-advocacy, and self-determination.

Evaluating the efficacy and generality of a skill-based approach for promoting universal behavioral readiness

Behavioral readiness can take the form of communication and self-control skills during challenging situations that are correlated with the development of problem behavior. A skill-based approach can teach behavioral readiness using procedures that involve synthesized reinforcement, probabilistic reinforcement, and contingency-based delays; however, this approach is commonly used to address severe behavior under specific situations. There is limited research evaluating a skill-based approach to teaching behavioral readiness and addressing emerging problem behavior. Also, it is unclear whether teaching effects under specific situations transfer across other, functionally distinct, situations. We evaluated the generality of a skill-based approach by teaching skills systematically across primary challenging situations involving the interruption of play, presentation of instructions, and removal of reinforcers. Teaching increased communication and self-control skills, and most skills transferred to secondary challenging situations (treatment extension probes) and caregiver-implemented sessions. We discuss challenging situations that required teaching, the generality of teaching, and procedural considerations.

Multiple Isolated Functions of Problematic Behavior: A Case Study

Multiple isolated functions of problematic behavior are distinct from synthesized functions. Limited research has focused on the considerations of assessing and treating multiple isolated functions of problematic behavior. This case study utilized traditional functional analysis procedures to identify the functions of the targeted problematic behavior and a multiple baseline across functional contexts design to evaluate a function-based treatment. The nuances of assessing and treating multiple isolated functions are discussed.

The Science and Social Validity of Companion Animal Welfare: Functionally Defined Parameters in a Multidisciplinary Field

Social validity refers to the social significance and acceptability of intervention goals, procedures, and outcomes. Animal practitioners, who are often guided by the principles of ABA, lack the benefit of verbal participants (at least with respect to target animals) with which to assess a client's needs and preferences. The study of a learner's welfare is useful for determining areas where intervention is needed or how the learner feels about an intervention that is underway. Three tenets of animal welfare measurement include physiological function, naturalistic behavior, and affect, where affect refers to private events, including emotions, which are a function of the same variables and contingencies responsible for controlling public behavior. The development of new technologies allows us to look "under the skin" and account for subjective experiences that can now be observed objectively. We introduce the reader to tools available from the animal welfare sciences for the objective measurement of social validity from the learner's perspective.

Functional analysis of problem behavior: A 40-year review

Extensive reviews of functional analysis literature were conducted 10 (Beavers et al., 2013) and 20 (Hanley et al., 2003) years ago; we expanded this review to capture the vast and innovative functional analysis research that has occurred over the past decade. Our review produced 1,333 functional analysis outcomes from 326 studies on the functional analysis of problem behavior between June 2012 and May 2022. Some characteristics of functional analysis studies were similar across the current and previous two reviews (e.g., child participants, developmental disability diagnosis, use of line graphs depicting session means, differentiated response outcomes). Other characteristics deviated from the previous two reviews (e.g., increase in autistic representation, outpatient settings, use of supplementary assessments, the inclusion of tangible conditions, and multiple function outcomes; decrease in session durations). We update previously reported participant and methodological characteristics, summarize outcomes, comment on recent trends, and propose future directions in the functional analysis literature.

Prioritizing choice and assent in the assessment and treatment of food selectivity

Food selectivity affects up to 72% and 45% of individuals with and without disabilities, respectively, and there is a need for interventions that rely on positive, unrestrictive strategies. We evaluated an assessment and treatment package for food selectivity for young children with developmental disabilities that prioritized caregiver collaboration, client autonomy, and did not rely on restrictive procedures (e.g. escape extinction). The process involved: (a) collaborating with caregivers on the selection of foods and design of the children's functional analyses; (b) indirectly and directly measuring food preferences prior to treatment; (c) evaluating the sensitivity of mealtime problem behavior to environmental variables through an interview-informed synthesized contingency analysis (IISCA); and (c) incorporating the assessment results into a progressive treatment process consisting of choice-making opportunities and differential reinforcement of successive approximations to consumption. Children also had the ability to opt in and out of treatment sessions. The treatment was effective in increasing consumption of nonpreferred foods and successfully extended to caregivers. Practical implications and directions for future research are discussed.

Analysis of Whole Blood and Urine Trace Elements in Children with Autism Spectrum Disorders and Autistic Behaviors

The relationship between trace elements and neurological development is an emerging research focus. We performed a case-control study to explore (1) the differences of 13 trace elements chromium (Cr), manganese (Mn), cobalt (Co), zinc (Zn), arsenic (As), selenium (Se), molybdenum (Mo), cadmium (Cd), stannum (Sn), stibium (Sb), mercury (Hg), titanium (TI), and plumbum (Pb) concentration in whole blood and urine between autism spectrum disorder (ASD) children and their typical development peers, and (2) the association between the 13 trace elements and core behaviors of ASD. Thirty ASD subjects (cases) and 30 age-sex-matched healthy subjects from Baise City, Guangxi Zhuang Autonomous Region, China, were recruited. Element analysis was carried out by inductively coupled plasma-optical emission spectrometry. Autistic behaviors were assessed using Autism Behavior Checklist (ABC), Childhood Autism Rating Scale (CARS), and Children Neuropsychological and Behavior Scale (CNBS). The whole blood concentrations of Mo (p = 0.004), Cd (0.007), Sn (p = 0.003), and Pb (p = 0.037) were significantly higher in the ASD cases than in the controls. Moreover, Se (0.393), Hg (0.408), and Mn (- 0.373) concentrations were significantly correlated between whole blood and urine levels in ASD case subjects. There were significant correlations between whole blood Sb (0.406), Tl (0.365), Mo (- 0.4237), Mn (- 0.389), Zn (0.476), and Se (0.375) levels and core behaviors of ASD. Although the mechanism of trace element imbalance in ASD is unclear, these data demonstrate that core behaviors of ASD may be affected by certain trace elements. Further studies are recommended for exploring the mechanism of element imbalance and providing corresponding clinical treatment measures.

Assent in applied behaviour analysis and positive behaviour support: ethical considerations and practical recommendations

The term positive behaviour support (PBS) is used to describe the integration of the contemporary ideology of disability service provision with the clinical framework of applied behaviour analysis (ABA). Assent, the participation consent of those not legally able to consent, has gained recent popularity in the fields of ABA and PBS. The goal of assent-based ABA and PBS is a person-centered approach to assessment, intervention, and all other decision-making. In this model, the learner's assent withdrawal for participation is honored, whether it be a vocal 'no' or a non-vocal expression of verbal behaviour. There is currently a limited subset of studies that mention or utilize assent with learners in ABA or PBS. The lack of published research can make assent-based practices seem to be a choice of the practitioner. The authors of this manuscript seek to further define assent, illuminate the necessity of assent-based practices, and offer assent-based procedures in ABA- and PBS-based intervention.

A practitioner's guide to emphasizing choice-making opportunities in behavioral services provided to individuals with intellectual and developmental disabilities

Promoting choice is a defining value guiding Positive Behavior Support (PBS) models for serving individuals with intellectual and/or developmental disabilities (IDD). The ability to make independent choices is of paramount importance to self-advocacy and self-determination. Promoting choice is also an essential commitment of trauma-informed care (TIC) in the provision of services to vulnerable individuals, as trauma often involves experiences in which an individual has no control over aversive events that occur, and choice-making opportunities can empower traumatized individuals to regain control over the environments they routinely encounter. However, incorporating meaningful choice making into behavioral programming is often more difficult than it seems. We synthesize the relevant, contemporary literature to provide professionals with actionable suggestions for incorporating choice making into everyday behavioral services. After summarizing the importance of promoting choice into behavioral services based on the values that define both PBS and TIC frameworks, we (a) offer a behavior-analytic interpretation of the skill of making choices, (b) synthesize key literature on how to teach choice making skills, (c) provide recommendations for the situations within one's care in which choice-making opportunities may be most beneficial, and (d) discuss some of the barriers and potential solutions to incorporating choice-making opportunities for individuals with IDD.

Bridging the gap between laboratory and applied research on response-independent schedules

In 1948, Skinner described the behavior of pigeons under response-independent schedules as "superstitious," and proposed that the responses were reinforced by contiguous, adventitious food deliveries. Subsequently, response-independent schedules have been of interest to both basic and applied researchers, first to understand the mechanisms involved, and later, as "noncontingent reinforcement" (NCR) to reduce undesirable behavior. However, the potential superstitious effects produced by these schedules have been challenged, with some researchers arguing that antecedent variables play a significant role. This paper examines the evidence for adventitious reinforcement from both laboratory and applied research, the results of which suggest that antecedent, nonoperant functions may be important in fully understanding the effects of NCR. We propose an applied-basic research synthesis, in which attention to potential nonoperant functions could provide a more complete understanding of response-independent schedules. We conclude with a summary of the applied implications of the nonoperant functions of NCR schedules.

Feasibility and Acceptability of a Compressed Caregiver Training Program to Treat Child Behavior Problems

In an effort to address some of the criticisms of Behavioral Parent Training programs (BPT; high attrition, reliance on caregiver report measures), the current study examined the feasibility, acceptability, and outcome of an intensive behavior treatment program (120-minute sessions for 5 days/week over the course of 2 weeks). Using a changing criterion single case experimental design, 12 children ( M child age = 4.9 years) and their primary caregivers completed the 2-week function-based intervention procedure designed to increase children’s frustration tolerance via a wait training procedure based on the principles of applied behavior analysis. Using both direct observation and standardized measures, results indicated that the treatment was effective in reducing childhood behavior problems, both within and between appointments (Cohen’s ds = 3.2 and 1.37, respectively). Preliminary evidence suggests that a compressed treatment package designed to train caregivers in function-based intervention strategies is feasible and acceptable.

Parent Ratings of Generalized and Indirect Effects of Functional Communication Training for Children with Autism Spectrum Disorder

Functional communication training (FCT) is a behavioral treatment that has been shown to reduce problem behavior and increase appropriate communication in young children with autism spectrum disorder (ASD). In this study, we assessed the effects of FCT on targeted and nontargeted problem behaviors outside of the training context, as well as parent stress, for 30 young children with ASD and their parents. Indirect measures of generalization treatment effects were administered prior to and following FCT treatment delivered via telehealth. Children demonstrated significant improvement on both targeted (measured via observation) and nontargeted (measured via checklist) problem behaviors, both within and outside of the training context, and parent stress was significantly reduced following treatment. These results suggest that the impact of FCT may extend beyond the training context for both the children being treated and the parents delivering treatment, even when generalization is not specifically programmed for during treatment.

Effectiveness of a Brief Functional Analysis and Functional Communication Training Conducted Through Telehealth

This study evaluates the effectiveness of a brief functional analysis and functional communication training conducted via telehealth. Three interventionist-child dyads took part in the study including one speech and language pathologist and two school teaching assistants, each working with one child with autism spectrum disorder. Interventionists were trained using didactic training to implement a brief functional analysis as well as synchronous coaching from a BCBA® to implement functional communication training. A multiple baseline across participants design was utilised to evaluate if interventionists could implement functional communication training to decrease challenging behaviours that included aggression, elopement and disruption. Sessions concluded earlier than planned due to school closures mandated by the COVID-19 outbreak for two of the three participants; however, existing data provide evidence that telehealth is a valid model for enabling clinicians to work in collaboration with school personnel to effectively deliver assessment and intervention procedures remotely via telehealth.

Description and evaluation of a function-informed and mechanisms-based framework for treating challenging behavior

Individualization and iterative design are essential components of the assessment and treatment of challenging behavior. Currently, there are few validated frameworks for engaging in iterative processes. Due to the nature of single-case design, empirically rigorous evaluations of decision-tree processes are particularly prohibitive. Notwithstanding, evaluations are needed. In this paper we first describe a function-informed and mechanisms-based (FIMB) framework for selecting treatment components employed by a university-based practicum experience designed to expose pre-service practitioners to a valid treatment process for challenging behavior. Then, we share a completed retrospective consecutive case series across a 6-year period in which we conducted a technique analysis to identify which procedures were most commonly selected in the practicum, and the impact of those choices on client outcomes. The results suggest that the model can be highly effective for some, but not all, cases. Implications are discussed.

Evaluating Professional Behavior Analysts’ Literature Searches

The first section of the new Behavior Analyst Certification Board’s Ethics Code for Behavior Analysts (BACB, 2020) includes the expectation that behavior analysts will maintain competence by reading relevant literature. The purpose of the current study was to evaluate to what extent professional behavior analysts search for and access the behavior analytic literature. A survey invitation was sent through the Behavior Analyst Certification Board and social media outlets at the end of 2020; 180 professionals responded. Roughly 80% of participants searched for research at least once per month. The top three online resources used were academic web search (72.7%), a university library subscription (65.6%), and the BACB research resource (65.6%). Forty-five percent of all participants indicated satisfaction with the research resources available to them. A series of independent samples t-test and analysis of variance (ANOVA) were conducted to determine group differences. Participants with doctorates searched more frequently and reported higher satisfaction and confidence across all tested domains. Participants using a university library reported more frequent literature searches, a higher skill level in conducting searches, more confidence in their ability to conduct a meaningful literature search, more satisfaction with the research resources available to them, and were more likely to report that the identified research would inform their practice.

Further evaluation of functional analysis screening methods in early autism intervention

A goal of some functional analysis (FA) variations is to reduce assessment time while still maintaining efficacy. This may be especially important when conducting FAs in early intervention programs, where time is a crucial commodity. To that end, we evaluated a model for using the results of the no-interaction condition as a screening for behavioral function and to guide selection of FA test conditions with 20 participants (22 assessments) aged 3 to 7 years old. We used the no-interaction condition to develop hypotheses for both automatic reinforcement and socially mediated reinforcement. The outcome of the no-interaction condition guided the selection of test conditions for the remainder of the FA. We also incorporated methods from prior FA studies (e.g., divided attention) to modify the test conditions. We obtained differentiated results in 91% of assessments, all within 70 min and, as such, extended evidence that an FA can be completed in little time without sacrificing efficacy.

A Practitioner’s Guide for Selecting Functional Communication Responses

Functional communication training (FCT) is an effective and widely used procedure to reduce problem behaviors. The purpose of FCT is to replace a problem behavior with a socially appropriate and communicative behavior - the functional communication response (FCR), which produces the same reinforcer as the problem behavior. Recent reviews of FCT have focused on providing overall recommendations for how the procedure should be implemented. A relatively small body of literature has been devoted to the selection of the FCR. The purpose of this article is to propose a set of considerations for practitioners in selecting FCRs.

Cultural responsiveness in applied behavior analysis: Research and practice

The new Ethics Code for Behavior Analysts requires that certificants engage in training related to culturally responsive service delivery (BACB, 2020). There is limited work in the area of culturally responsive evidence-based practice within our field. Therefore, it is incumbent on researchers and practitioners to identify best practices for working with diverse populations. Hence, the purpose of this paper is three-fold: a) to review research within and outside the field of ABA related to culturally responsive assessment and treatment and provide practice recommendations, b) to examine the extent to which current practices in behavior assessment and treatment align with aspects of culturally responsive practices, and c) to inspire research in the areas of behavior assessment and treatment to identify best practices with regard to culturally responsive behavior analytic practices. The content of this paper is grounded in the framework described by Beaulieu and Jimenez-Gomez (2022).

They have a Voice; are we Listening?

The field of applied behavior analysis (ABA) has produced powerful changes and improvements to the lives of many. However, the field is not immune from criticism. One criticism from those outside the field is that the goal of ABA therapy is to make Autistic people appear "indistinguishable" from their peers. This paper examines "indistinguishability" and its implications by defining "indistinguishable" in behavior analytic terms, exploring how the term was used in two notable studies in the field (Lovaas, 1987, Journal of Consulting and Clinical Psychology, 55[1], 3-9; Rekers & Lovaas, 1974, Journal of Applied Behavior Analysis, 7[2], 173-190), and providing a review of the social validity and ethical implications of having "indistinguishability" as an explicit or implied goal. This is partially accomplished by incorporating concerns from the Autistic self-advocate community. We argue that the Autistic self-advocate community's concerns surrounding "indistinguishability" as a goal have a degree of legitimacy and need to be given due consideration. Suggestions for addressing these concerns in ABA degree programs and research are discussed, emphasizing the importance of considering stakeholder values, taking criticisms seriously, and making changes when necessary.

Using Chained or Tandem Schedules With Functional Communication Training: A Systematic Review

Chained and tandem schedules are a common method for thinning schedules of reinforcement following functional communication training (FCT) in the treatment of problem behavior. We conducted a systematic literature review and meta-analysis of chained and tandem schedules following FCT to describe treatment characteristics and evaluate effects. We identified 38 articles and found reductions in problem behavior across four measures. Results of a random-effects multilevel meta-analysis of rigorous evaluations showed a significant effect of chained or tandem schedules + FCT on problem behavior relative to baseline. We observed resurgence in 77% of cases and 31% of schedule-thinning transitions. Results showed chained schedules resulted in greater reductions in problem behavior relative to tandem schedules. Exploratory moderator analyses suggested extinction, combined reinforcement, and delay and denial tolerance training procedures were associated with greater reductions in problem behavior relative to other treatment characteristics. Implications for practice and future research are discussed.