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Falligant JM, Hagopian LP, Newland MC. Bouts, Pauses, and Units of Operant Performance: A Primer. Perspect Behav Sci 2024; 47:643-674. [PMID: 39309239 PMCID: PMC11411050 DOI: 10.1007/s40614-024-00419-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2024] [Indexed: 09/25/2024] Open
Abstract
Operant behavior typically occurs in bouts and pauses. The microstructural analysis of bouts and pauses reveals important and separable information about the physical characteristics of the operant and the motivation behind it. An analysis of interresponse times (IRTs) often reveals a mixture of two exponential distributions. One corresponds to short IRTs within ongoing response bouts, reflecting motor properties of the operant, and the other corresponds to longer intervals between bouts, reflecting the motivation behind the response. Partitioning responses into bout initiations and within-bout responses via this two-mode framework reveals the mechanisms underlying behavior maintenance and change. This approach is used in the fields of neurotoxicology, behavioral pharmacology, and behavioral neuroscience to disentangle the contribution of motivational and motoric variables to the pattern of operant behavior. In this article, we present a primer aimed at providing essential concepts related to the analysis of response bouts and temporal dynamics of operant performance.
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Affiliation(s)
- John Michael Falligant
- Kennedy Krieger Institute, Baltimore, MD USA
- Johns Hopkins University School of Medicine, Baltimore, MD USA
- Auburn University, Auburn, AL USA
| | - Louis P. Hagopian
- Kennedy Krieger Institute, Baltimore, MD USA
- Johns Hopkins University School of Medicine, Baltimore, MD USA
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2
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Shawler LA, Castaneda-Velazquez G, Lafo G. Toward Maximizing Assessment Efficiency: A Synthesized Trial-Based Functional Analysis and Competing Stimulus Assessment. Behav Sci (Basel) 2024; 14:372. [PMID: 38785863 PMCID: PMC11118102 DOI: 10.3390/bs14050372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/01/2024] [Accepted: 04/18/2024] [Indexed: 05/25/2024] Open
Abstract
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.
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Affiliation(s)
- Lesley A. Shawler
- School of Psychological and Behavioral Sciences, Southern Illinois University, Carbondale, IL 62901, USA; (G.C.-V.)
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3
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Fernandez N, Frank-Crawford MA, Hanlin C, Benson R, Falligant JM, DeLeon IG. Examining patterns suggestive of acquisition during functional analyses: A consecutive controlled series of 116 cases. J Appl Behav Anal 2024; 57:426-443. [PMID: 38438321 DOI: 10.1002/jaba.1068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 02/13/2024] [Indexed: 03/06/2024]
Abstract
The functional analysis approach described by Iwata et al. (1982/1994) has been used widely to determine the variables evoking and maintaining challenging behavior. However, one potential concern with conducting functional analyses is that repeated exposure to contingencies may induce a novel functional relation. To examine the likelihood of these potential iatrogenic effects, we evaluated social test conditions of the functional analysis for 116 participants and searched for patterns of responding indicative of acquisition. Patterns suggestive of acquisition occurred in 13.70% of tangible reinforcement conditions; however, the prevalence was only slightly lower in the attention condition (8.75%). Much lower prevalence was observed for the escape condition (2.13%). When grouped by quotient score, a pattern of acquisition was just as likely to be observed in the attention condition as in the tangible condition. Additionally, patterns indicative of acquisition were no more likely to be observed with participants who emitted automatically reinforced challenging behavior.
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Affiliation(s)
- Nathalie Fernandez
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Michelle A Frank-Crawford
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Courtney Hanlin
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Ryan Benson
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - John M Falligant
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Iser G DeLeon
- Department of Psychology, University of Florida, Gainesville, FL, USA
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4
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Falligant JM, Kranak MP, Piersma DE, Benson R, Schmidt JD, Frank-Crawford MA. Further evidence of renewal in automatically maintained behavior. J Appl Behav Anal 2024; 57:490-501. [PMID: 38239100 PMCID: PMC10984774 DOI: 10.1002/jaba.1055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 01/03/2024] [Indexed: 02/08/2024]
Abstract
Renewal is a relapse phenomenon that refers to the recurrence of a previously reduced behavior following a change in stimulus conditions. Muething et al. (2022) examined the phenomenology of renewal among individuals with automatically maintained challenging behavior treated at an outpatient clinic. We replicated their findings by retrospectively examining renewal across various topographies of automatically maintained behavior treated at an inpatient hospital, and we extended their work by also examining differences across subtypes of automatically maintained self-injurious behavior. The prevalence of renewal was comparable to that observed by Muething et al., supporting the notion that automatically maintained challenging behavior is susceptible to relapse phenomena. Furthermore, renewal was twice as likely to occur for individuals with Subtype 2 versus Subtype 1 self-injurious behavior, providing additional evidence of behavioral differentiation between subtypes. Our findings suggest that even after apparent stability in treatment, practitioners should remain vigilant for the recurrence of automatically maintained behavior during generalization.
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Affiliation(s)
- John Michael Falligant
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Science, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Michael P. Kranak
- Department of Human Development and Child Studies, Oakland University, Rochester, MI, USA
- Center for Autism, Oakland University, Rochester, MI, USA
| | - Drew E. Piersma
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Ryan Benson
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Jonathan D. Schmidt
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Science, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Michelle A. Frank-Crawford
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Science, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
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5
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Frankot MA, Young ME, Vonder Haar C. Understanding Individual Subject Differences through Large Behavioral Datasets: Analytical and Statistical Considerations. Perspect Behav Sci 2024; 47:225-250. [PMID: 38660505 PMCID: PMC11035513 DOI: 10.1007/s40614-023-00388-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 04/26/2024] Open
Abstract
A core feature of behavior analysis is the single-subject design, in which each subject serves as its own control. This approach is powerful for identifying manipulations that are causal to behavioral changes but often fails to account for individual differences, particularly when coupled with a small sample size. It is more common for other subfields of psychology to use larger-N approaches; however, these designs also often fail to account for the individual by focusing on aggregate-level data only. Moving forward, it is important to study individual differences to identify subgroups of the population that may respond differently to interventions and to improve the generalizability and reproducibility of behavioral science. We propose that large-N datasets should be used in behavior analysis to better understand individual subject variability. First, we describe how individual differences have been historically treated and then outline practical reasons to study individual subject variability. Then, we describe various methods for analyzing large-N datasets while accounting for the individual, including correlational analyses, machine learning, mixed-effects models, clustering, and simulation. We provide relevant examples of these techniques from published behavioral literature and from a publicly available dataset compiled from five different rat experiments, which illustrates both group-level effects and heterogeneity across individual subjects. We encourage other behavior analysts to make use of the substantial advancements in online data sharing to compile large-N datasets and use statistical approaches to explore individual differences.
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Affiliation(s)
- Michelle A. Frankot
- Injury and Recovery Laboratory, Department of Psychology, West Virginia University, Morgantown, WV USA
- Injury and Recovery Laboratory, Department of Neuroscience, Ohio State University, 460 West 12th Avenue, Columbus, OH 43210 USA
| | - Michael E. Young
- Department of Psychological Sciences, Kansas State University, Manhattan, KS USA
| | - Cole Vonder Haar
- Injury and Recovery Laboratory, Department of Psychology, West Virginia University, Morgantown, WV USA
- Injury and Recovery Laboratory, Department of Neuroscience, Ohio State University, 460 West 12th Avenue, Columbus, OH 43210 USA
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6
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Hagopian LP, Falligant JM. Application of the evolutionary theory of behavior dynamics to severe challenging behavior. J Appl Behav Anal 2023; 56:729-744. [PMID: 37614037 PMCID: PMC10591871 DOI: 10.1002/jaba.1018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 08/07/2023] [Indexed: 08/25/2023]
Abstract
The evolutionary theory of behavior dynamics (ETBD) is a genetic algorithm that applies the Darwinian principles of evolutionary biology to model how behavior changes dynamically via selection by contingencies of reinforcement. The ETBD is a complexity theory where low-level rules of selection, reproduction, and mutation operate iteratively to animate "artificial organisms" that generate emergent outcomes. Numerous studies have demonstrated the ETBD can accurately model behavior of live animals in the laboratory, and it has been applied recently to model automatically maintained self-injury. The purpose of the current series of studies was to further extend the application of the ETBD to model additional functional classes of challenging behavior and clinical procedures. Outcomes obtained with artificial organisms generally corresponded well with outcomes observed with clinical cases sourced from consecutive controlled case series studies. Conceptual and methodological considerations on the application of the ETBD to model challenging behavior are discussed.
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Affiliation(s)
- Louis P. Hagopian
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - John Michael Falligant
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
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7
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McCabe LH, Greer BD. Evaluations of heart rate during functional analyses of destructive behavior. J Appl Behav Anal 2023; 56:777-786. [PMID: 37608399 PMCID: PMC10696488 DOI: 10.1002/jaba.1019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023]
Abstract
Previous research has examined the predictive validity of heart rate on destructive behavior; however, such research has yet to improve clinical practice or enhance our understanding of the relation between physiology and destructive behavior. The purpose of this study was to examine the predictive validity of heart rate on varying topographies and functions of destructive behavior while controlling antecedent and consequent events through functional analysis. We first demonstrated the reliability of the Polar H10 heart rate monitor and assessed the feasibility of its use in simulated functional analysis sessions. However, across four consecutively enrolled patients, heart rate was not found to be a reliable predictor of destructive behavior, regardless of its topography or function. Instead, functional reinforcer presence and absence was sufficient to predict socially reinforced destructive behavior. This study may provide a framework for the future assessment of other biological measures in relation to destructive behavior occurrence and nonoccurrence.
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Affiliation(s)
- Liam H. McCabe
- Children’s Specialized Hospital–Rutgers University Center for Autism Research, Education, and Services (CSH–RUCARES), Somerset, NJ, USA
- Department of Applied Psychology, Rutgers University, Piscataway, NJ, USA
| | - Brian D. Greer
- Children’s Specialized Hospital–Rutgers University Center for Autism Research, Education, and Services (CSH–RUCARES), Somerset, NJ, USA
- Rutgers Brain Health Institute, Piscataway, NJ, USA
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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8
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Frank-Crawford MA, Hagopian LP, Schmidt JD, Kaur J, Hanlin C, Piersma DE. A replication and extension of the augmented competing stimulus assessment. J Appl Behav Anal 2023; 56:869-883. [PMID: 37464543 PMCID: PMC10592346 DOI: 10.1002/jaba.1009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/08/2023] [Indexed: 07/20/2023]
Abstract
Augmenting competing stimulus assessments by embedding tactics to increase stimulus engagement and disrupt challenging behavior can improve outcomes of treatments for automatically maintained self-injurious behavior, even for treatment-resistant subtypes. This study replicated and extended research on augmented competing stimulus assessments by reporting outcomes for 16 consecutively encountered cases with automatically maintained self-injurious behavior (19 total applications); six participants had treatment-responsive Subtype 1 and 10 had treatment-resistant Subtypes 2 or 3. Fewer high-competition stimuli were identified for individuals with treatment-resistant subtypes. When response-promotion and disruption tactics were applied and withdrawn, outcomes improved for six of eight applications. At least one high-competition stimulus was still effective when maintenance probes were conducted for a subset of participants. Ultimately, at least one high-competition stimulus was identified for each participant. Although augmenting tactics may not be necessary for all individuals, these findings provide additional support for their efficacy with treatment-resistant self-injurious behavior.
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Affiliation(s)
- Michelle A. Frank-Crawford
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, United States
- Department of Psychiatry and Behavioral Science, Johns Hopkins University, School of Medicine, Baltimore, MD, United States
| | - Louis P. Hagopian
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, United States
- Department of Psychiatry and Behavioral Science, Johns Hopkins University, School of Medicine, Baltimore, MD, United States
| | - Jonathan D. Schmidt
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, United States
- Department of Psychiatry and Behavioral Science, Johns Hopkins University, School of Medicine, Baltimore, MD, United States
| | - Jasmeen Kaur
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Courtney Hanlin
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Drew E. Piersma
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, United States
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9
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Hagopian LP, Falligant JM, Frank-Crawford MA, Yenokyan G, Piersma DE, Kaur J. Simplified methods for identifying subtypes of automatically maintained self-injury. J Appl Behav Anal 2023; 56:575-592. [PMID: 37249167 PMCID: PMC10330447 DOI: 10.1002/jaba.1005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 05/11/2023] [Indexed: 05/31/2023]
Abstract
Subtypes of automatically maintained self-injurious behavior (SIB) have been defined based on response patterns observed during the functional analysis, which are thought to reflect each subtype's distinct mechanisms. Current practice for identifying subtypes involves using structured criteria to identify whether SIB is automatically maintained, followed by the application of additional criteria to identify the subtype. We describe a series of studies directed at simplifying these methods to facilitate wider application of the subtyping model in research and practice. In Studies 1 and 2, we demonstrate the accuracy of modified criteria using the level of differentiation of SIB across the play and no-interaction conditions at distinguishing between two subtypes (i.e., Subtypes 1 and 2). We then demonstrate visual analysis (without structured criteria) can accurately identify SIB as automatically maintained in Study 3, which can be used in combination with level of differentiation to enable application of the subtyping model in practice.
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Affiliation(s)
- Louis P Hagopian
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John Michael Falligant
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michelle A Frank-Crawford
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gayane Yenokyan
- School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Drew E Piersma
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Jasmeen Kaur
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
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10
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Marini S, D'Agostino L, Ciamarra C, Gentile A. Deep brain stimulation for autism spectrum disorder. World J Psychiatry 2023; 13:174-181. [PMID: 37303931 PMCID: PMC10251363 DOI: 10.5498/wjp.v13.i5.174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/09/2023] [Accepted: 03/29/2023] [Indexed: 05/19/2023] Open
Abstract
Deep brain stimulation (DBS) is a medical treatment that aims to obtain therapeutic effects by applying chronic electrical impulses in specific brain structures and neurological circuits. Over the years, DBS has been studied for the treatment of many psychiatric disorders. Scientific research on the use of DBS in people with autism has focused this interest mainly on treatment-resistant obsessive-compulsive disorder, drug-resistant epilepsy, self-injurious behaviors (SIB), and aggressive behaviors toward the self. Autism spectrum disorder (ASD) includes a group of developmental disabilities characterized by patterns of delay and deviance in the development of social, communicative, and cognitive skills and the presence of repetitive and stereotyped behaviors as well as restricted interests. People with autism often have numerous medical and psychiatric comorbidities that worsen the quality of life of patients and their caregivers. Obsessive-compulsive symptoms can be found in up to 81.3% of people with autism. They are often severe, refractory to treatment, and particularly difficult to treat. SIB has a high prevalence in severely retarded individuals and is often associated with autism. Drug treatment of both autism and SIB presents a therapeutic challenge. To describe the current state of the art regarding the efficacy of DBS in people with ASD, a literature search was conducted for relevant studies using the PubMed database. Thirteen studies have been considered in this paper. Up to date, DBS has been used for the stimulation of the nucleus accumbens, globus pallidus internus, anterior limb of the internal capsule, ventral anterior limb of the internal capsule, basolateral amygdala, ventral capsule and ventral striatum, medial forebrain bundle, and posterior hypothalamus. In the total sample of 16 patients, 4 were adolescents, and 12 were adults. All patients had symptoms resistant to multiple drug therapy. Many patients taken into consideration by the studies showed clinical improvements as evidenced by the scores of the psychopathological scales used. In some cases, clinical improvements have varied over time, which may require further investigation. Among the new therapeutic perspectives, DBS could be a valid option. However, further, and more in-depth research is needed in this field.
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Affiliation(s)
- Stefano Marini
- Department of Mental Health, National Health Service, Termoli 86039, Italy
| | - Lucia D'Agostino
- Department of Mental Health, National Health Service, Termoli 86039, Italy
| | - Carla Ciamarra
- Department of Mental Health, National Health Service, Termoli 86039, Italy
| | - Alessandro Gentile
- Department of Mental Health, National Health Service, Termoli 86039, Italy
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11
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Laureano B, Fernandez N, Hagopian LP. Efficacy of competing stimulus assessments: A summary of 35 consecutively encountered cases. J Appl Behav Anal 2023; 56:428-441. [PMID: 36855029 PMCID: PMC10329484 DOI: 10.1002/jaba.979] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 02/12/2023] [Indexed: 03/02/2023]
Abstract
Competing stimulus assessments (CSAs) are designed to identify stimuli that reduce challenging behavior through competition with its maintaining reinforcers. Recently, Haddock and Hagopian (2020) found that over 92% of CSAs described in published studies identified at least one high-competition stimulus (i.e., a stimulus correlated with at least an 80% reduction in challenging behavior). The current study describes the outcomes of CSAs in a retrospective consecutive controlled case series study of 35 cases (individuals) admitted to an inpatient setting. Findings on the limited relation between the level of stimulus engagement and reductions in challenging behavior were replicated; however, the efficacy of CSAs was lower (only 47% of CSAs were successful in identifying one or more high-competition stimuli). Discrepant findings across studies on the efficacy of CSAs are discussed in terms of differences in the sample participants and how outcomes are reported, which vary depending on the study's research questions.
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Affiliation(s)
- Brianna Laureano
- Department of Behavioral Psychology, Kennedy Krieger Institute
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Nathalie Fernandez
- Department of Behavioral Psychology, Kennedy Krieger Institute
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Louis P. Hagopian
- Department of Behavioral Psychology, Kennedy Krieger Institute
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
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12
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Morris SL, Lucia SM. Applying the evolutionary theory of behavior dynamics to model the subtypes of automatically reinforced self-injurious behavior. J Appl Behav Anal 2023; 56:442-457. [PMID: 36922699 DOI: 10.1002/jaba.982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 02/19/2023] [Indexed: 03/18/2023]
Abstract
The delineation of the subtypes of automatically reinforced self-injurious behavior improved the utility of functional analysis results in predicting treatment efficacy. However, the mechanisms underlying subtype differences remain unclear and difficult to study in clinical populations. Morris and McDowell (2021) attempted to elucidate subtype differences by developing and evaluating models of the subtypes within the evolutionary theory of behavior dynamics. In the current study, we applied techniques from precision medicine to further evaluate the models developed by Morris and McDowell. This evaluation highlighted shortcomings of the existing models and suggested ways they could be improved. Thus, we conducted more extended modeling within the framework of precision medicine to identify models that were more quantitatively similar to available clinical data. Improved models that more closely approximate clinical data were identified. The implications of these models for research, practice, and further applications of the evolutionary theory of behavior dynamics are discussed.
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Affiliation(s)
- Samuel L Morris
- Department of Psychology, Louisiana State University, Baton Rouge, LA, United States
| | - Sarah M Lucia
- Department of Psychology, Southeastern Louisiana University, Hammond, LA, United States
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Melanson IJ, Fahmie TA. Functional analysis of problem behavior: A 40-year review. J Appl Behav Anal 2023; 56:262-281. [PMID: 36892835 DOI: 10.1002/jaba.983] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 02/19/2023] [Indexed: 03/10/2023]
Abstract
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.
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Affiliation(s)
- Isaac J Melanson
- University of Nebraska Medical Center's Munroe-Meyer Institute, Severe Behavior Department, Omaha, United States
| | - Tara A Fahmie
- University of Nebraska Medical Center's Munroe-Meyer Institute, Severe Behavior Department, Omaha, United States
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14
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Greer BD. Barriers to Accessing Effective Treatments for Destructive Behavior. POLICY INSIGHTS FROM THE BEHAVIORAL AND BRAIN SCIENCES 2023; 10:68-74. [PMID: 38840711 PMCID: PMC11150915 DOI: 10.1177/23727322221144653] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
The field of applied behavior analysis has developed and refined a comprehensive methodology for the assessment and successful treatment of destructive behavior: An individualized approach emphasizes (a) function of responding (or its cause) over its form; (b) objective and reliable measurement of behavior; (c) systematic procedures and their application; (d) rigorous, single-case experimental designs; and (e) determinations of successful intervention judged by improvements in the same individual's performance. Outcomes of this approach are often dramatic and reliably surpass those obtained by alternative means. However, significant barriers limit the accessibility of this proven therapy. Too few intensive behavioral intervention units, diagnosis- and age-dependent insurance authorization and reimbursement practices, long waitlists and slow approval processes, and the possibility of treatment relapse represent a few such barriers. This article describes these barriers and suggests some potential solutions.
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Affiliation(s)
- Brian D. Greer
- Rutgers Brain Health Institute
- Children’s Specialized Hospital–Rutgers
University Center for Autism Research, Education, and Services
(CSH–RUCARES)
- Department of Pediatrics, Rutgers Robert Wood Johnson
Medical School
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15
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Peters RJ, Richling SM, Rapp JT, Ethridge AN. Could Preference Indifference be a Social Behavioral Marker for Foster Youth? A Potential Alternative use for Preference Assessments. BEHAVIOR AND SOCIAL ISSUES 2023. [DOI: 10.1007/s42822-023-00122-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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16
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Samways B. Professionals' attitudes towards people with intellectual disabilities who self-harm: A literature review. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2022; 26:954-971. [PMID: 34338080 PMCID: PMC9608005 DOI: 10.1177/17446295211025959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND National Institute for Health and Care Excellence (NICE, 2013) Guidance on Self-Harm states that professionals supporting people who self-harm should demonstrate compassion, respect and dignity. This literature review examines the evidence for professionals' attitudes towards people with intellectual disabilities who self-harm. METHOD Four databases (PsychInfo, IBSS, CINAHL and Medline) were systematically searched to find relevant research since 2000. RESULTS Four studies met the criteria. Attitudes of professionals supporting people with intellectual disabilities are contrasted with those of professionals in settings focused on supporting people without intellectual disabilities. Professionals supporting people with intellectual disabilities tended to display attitudes and attributions reflective of biobehavioural and psychosocial theories of self-harm, with a greater emphasis on relationships. CONCLUSION Much more research is needed which examines the attitudes of professionals supporting people with intellectual disabilities who self-harm.
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Affiliation(s)
- Beverley Samways
- Beverley Samways, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK.
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MacNaul H, Wimberley J, Labay A, Neely L, Novotny M, Morgan B. Effects of an Adapted Telehealth Training Curriculum for Registered Behavior Technicians®. ADVANCES IN NEURODEVELOPMENTAL DISORDERS 2022; 7:1-12. [PMID: 36160310 PMCID: PMC9483257 DOI: 10.1007/s41252-022-00285-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
Objectives We evaluated a telehealth training curriculum to prepare Registered Behavior Technicians® (RBTs®) to conduct caregiver coaching on behavior analytic skills via telehealth. Methods A non-concurrent multiple baseline across therapists design was used to evaluate the training procedures delivered by Board Certified Behavior Analysts® (BCBAs®). All therapists (RBTs) worked with one family during the baseline and training phases and an additional session was conducted with a different family during the novelty probe condition to see if therapists were able to perform the newly acquired skills without BCBA support. Results Seven therapists who received behavioral skills training on the curriculum reached mastery criteria within three sessions. All RBTs were able to provide caregiver coaching via telehealth with high degrees of fidelity and were able to independently conduct a telehealth session with a new family without support from the BCBA. Conclusions Results of the current study provide support for the use of the telehealth training curriculum to prepare RBTs to conduct ABA services via telehealth.
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Affiliation(s)
- Hannah MacNaul
- Department of Educational Psychology, University of Texas at San Antonio, San Antonio, TX USA
| | | | | | - Leslie Neely
- Department of Educational Psychology, University of Texas at San Antonio, San Antonio, TX USA
| | - Marissa Novotny
- Department of Educational Psychology, University of Texas at San Antonio, San Antonio, TX USA
- Autism Treatment Center, San Antonio, TX USA
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18
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Fong A, Friedlander R, Richardson A, Allen K, Zhang Q. Characteristics of children with autism and unspecified intellectual developmental disorder (intellectual disability) presenting with severe self-injurious behaviours. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2022; 70:518-529. [PMID: 38699500 PMCID: PMC11062266 DOI: 10.1080/20473869.2022.2113321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 08/10/2022] [Indexed: 05/05/2024]
Abstract
Objective: This study aims to delineate the characteristics of severe self-injurious behaviors (SIB) in a cohort of children with autism and unspecified intellectual developmental disorder (UIDD) (intellectual disability) and examine potential risk factors for developing SIB. Methods: A retrospective chart review studied characteristics of severe SIB in 30 children with autism spectrum disorder (ASD) and UIDD referred to a tertiary care center. Characteristics examined include genetic syndromes, brain MRI abnormalities, verbal ability, adaptive functioning, SIB frequency and severity, age of onset, number of psychopharmacological agents, irritability, hyperactivity, stereotypy, psychiatric and physical comorbidities, among others. Descriptive and bivariate analysis were applied to explore potential relationships between factors. Results: Children with severe SIB exhibit this behaviour with high frequency, inflicting moderate to severe injury. Most children in the study sample are non-verbal and have ASD (93.3%; n = 28) with psychiatric (96.7%; n = 29) and physical (90%; n = 27) comorbidities. Overall SIB improvement using the Clinical Global Impression, Improvement Score (CGI-I) was 3.0 (minimally improved). A minority were much or very much improved following appropriate intervention. Conclusions: The severity of SIB is much higher in this sample than previously noted in the literature. Severe SIB is associated with ADHD, early onset mood disorders, tics, avoidant restrictive food intake disorder and Obsessive-Compulsive Disorder.
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Affiliation(s)
- Alison Fong
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | | | | | - Katie Allen
- British Columbia Children’s Hospital, Vancouver, Canada
| | - Qian Zhang
- British Columbia Children’s Hospital Research Institute Clinical Research Support Unit, Vancouver, Canada
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19
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McKeown CA, Vollmer TR, Cameron MJ, Kinsella L, Shaibani S. Pediatric Pain and Neurodevelopmental Disorders: Implications for Research and Practice in Behavior Analysis. Perspect Behav Sci 2022; 45:597-617. [DOI: 10.1007/s40614-022-00347-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 11/29/2022] Open
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20
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Slanzi CM, Vollmer TR, Iwata BA, Kronfli FR, Williams LP, Perez BC. Further evaluation of functional analysis screening methods in early autism intervention. J Appl Behav Anal 2022; 55:851-870. [PMID: 35607883 DOI: 10.1002/jaba.925] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 03/28/2022] [Accepted: 03/06/2022] [Indexed: 11/10/2022]
Abstract
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.
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21
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Morris SL, Vollmer TR. The matching law provides a quantitative description of social time allocation in children with autism. J Appl Behav Anal 2022; 55:934-957. [PMID: 35607852 DOI: 10.1002/jaba.934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 03/22/2022] [Indexed: 11/11/2022]
Abstract
Recent research has developed and evaluated assessments of sociability in which time allocation near or away from an adult who initiates social interactions is used to characterize the participant as social, indifferent, or avoidant of social interaction. Though these qualitative outcomes have been useful, no studies have evaluated methods of obtaining more quantitative measures of sociability. The matching law has been demonstrated to describe a wide range of human behavior and may also be useful in describing social time allocation. We adapted the matching law and assessment of sociability procedures with the aim of providing a more precise, quantitative measure of sociability. We fitted the matching equation to the social time allocation data of 8 children with autism spectrum disorder. The equation was effective in quantifying sociability, accounted for a large proportion of variance in participants' behavior, did so equally well for participants who were social and avoidant, and provided a more sensitive measure relative to those used in previous research. The implications of this methodology, its potential utility, and directions for future research are discussed.
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22
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Shawler LA, Clayborne JC, O’Connor JT. A Competing Stimuli Intervention Package to Treat Automatically Reinforced Destructive Behavior. Clin Case Stud 2022. [DOI: 10.1177/15346501221099218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Behaviors maintained by automatic reinforcement are often more difficult to treat due to difficulty with identifying the relevant maintaining variable(s). One common intervention to treat automatically maintained behavior includes competing stimuli. Competing stimuli promote item engagement which may replace challenging behavior (i.e., response competition). Competing stimuli have shown to be a widely successful intervention across diverse topographies of challenging behavior; however, few studies have evaluated the use of competing stimuli on destructive behavior. The purpose of the current study was to treat automatically maintained destructive behavior with a competing stimuli intervention package for an adolescent with developmental disabilities. Results showed a decrease in destructive behavior when access to competing stimuli was a component of an intervention package in a clinic setting. Also, preliminary data are provided showing treatment effects when caregivers implemented the intervention. Due to the complexity of the final intervention package, recommendations for clinicians are provided which focus on improving feasibility, practicality, and sustainability of treatment components.
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Affiliation(s)
- Lesley A. Shawler
- School of Psychological and Behavioral Sciences, Southern Illinois University, Carbondale, IL, USA
- Department of Behavioral Psychology, Kennedy Krieger Institute and Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joy C. Clayborne
- Department of Behavioral Psychology, Kennedy Krieger Institute and Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Psychology, University of Maryland, Baltimore, MD, USA
| | - Julia T. O’Connor
- Department of Behavioral Psychology, Kennedy Krieger Institute and Johns Hopkins University School of Medicine, Baltimore, MD, USA
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23
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Bottini S, Stremel JM, Scheithauer M, Morton HE. Extended alone and ignore assessments: A novel examination of factors that influence determination of an automatic function. BEHAVIORAL INTERVENTIONS 2022. [DOI: 10.1002/bin.1877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Summer Bottini
- Marcus Autism Center Emory School of Medicine Atlanta Georgia USA
- May Institute Randolph Massachusetts USA
| | - J. Meredith Stremel
- Marcus Autism Center Emory School of Medicine Atlanta Georgia USA
- Dayton Children's Hospital Dayton Ohio USA
| | | | - Hannah E. Morton
- May Institute Randolph Massachusetts USA
- Oregon Health & Science University Portland Oregon USA
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24
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Yan H, Siegel L, Breitbart S, Gorodetsky C, Fasano A, Rahim A, Loh A, Kulkarni AV, Ibrahim GM. An open-label prospective pilot trial of nucleus accumbens deep brain stimulation for children with autism spectrum disorder and severe, refractory self-injurious behavior: study protocol. Pilot Feasibility Stud 2022; 8:24. [PMID: 35109924 PMCID: PMC8808966 DOI: 10.1186/s40814-022-00988-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 01/20/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Children and youth with autism spectrum disorder (ASD) may manifest self-injurious behaviors (SIB) that may become severe and refractory with limited pharmacologic or behavioral treatment options. Here, we present the protocol of a prospective, mixed-methods study to assess the safety and efficacy of deep brain stimulation (DBS) of the nucleus accumbens (NAcc) for children and youth with ASD and severe, refractory SIB. METHODS This is a prospective, single-center, single-cohort, open-label, non-randomized pilot trial of 6 patients. Participants will be recruited through specialized behavioral clinics with persistent severe and refractory SIB following standard and intensive interventions. Following NAcc-DBS, participants will be enrolled in the study for 12 months. The primary objectives of the study are safety and feasibility, assessed by rate of recruitment and identification of factors impacting adherence to follow-up and study protocol. Potential treatment efficacy will be assessed by changes in the Children's Yale-Brown Obsessive-Compulsive Scale in ASD (CYBOCS-ASD), the Behavior Problems Index (BPI), the Inventory of Statements about Self-Injury (ISAS) and the Repetitive Behavior Scale-Revised (RBS-R) questionnaires. Additional clinical outcomes will be assessed, including measures of participant and caregiver quality of life, actigraph measurements, and positron emission tomography (PET) changes following DBS. DISCUSSION This study will be the first to evaluate the effect of DBS of the NAcc on a pediatric population in a controlled, prospective trial. Secondary outcomes will improve the understanding of behavioral, neuro-imaging, and electrophysiologic changes in children with ASD and SIB treated with DBS. This trial will provide an estimated effect size of NAcc-DBS for severe refractory SIB in children with ASD in preparation for future comparative trials. TRIAL REGISTRATION Registration on ClinicalTrials.gov was completed on 12 June 2019 with the Identifier: NCT03982888 .
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Affiliation(s)
- Han Yan
- Division of Neurosurgery, The Hospital for Sick Children, 555 University Avenue, Room 1503, Toronto, ON, M5G 1X8, Canada.,Institute of Health of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Lauren Siegel
- Neurosciences and Mental Health Program, The Hospital for Sick Children, 555 University Avenue, Room 1503, Toronto, ON, M5G 1X8, Canada
| | - Sara Breitbart
- Division of Neurosurgery, The Hospital for Sick Children, 555 University Avenue, Room 1503, Toronto, ON, M5G 1X8, Canada.,Neurosciences and Mental Health Program, The Hospital for Sick Children, 555 University Avenue, Room 1503, Toronto, ON, M5G 1X8, Canada
| | | | - Alfonso Fasano
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada.,Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada. Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Brain Institute, Toronto, Ontario, Canada.,CenteR for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada
| | - Aliya Rahim
- Neurosciences and Mental Health Program, The Hospital for Sick Children, 555 University Avenue, Room 1503, Toronto, ON, M5G 1X8, Canada.,Surrey Place, Toronto, Ontario, Canada
| | - Alvin Loh
- Surrey Place, Toronto, Ontario, Canada.,Division of Developmental Paediatrics, Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Abhaya V Kulkarni
- Division of Neurosurgery, The Hospital for Sick Children, 555 University Avenue, Room 1503, Toronto, ON, M5G 1X8, Canada.,Institute of Health of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - George M Ibrahim
- Division of Neurosurgery, The Hospital for Sick Children, 555 University Avenue, Room 1503, Toronto, ON, M5G 1X8, Canada. .,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada. .,Institute of Biomedical Engineering, University of Toronto, Toronto, Canada. .,Institute of Medical Science, University of Toronto, Toronto, Canada.
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25
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Rooker GW, Hagopian LP, Haddock JN, Arevalo AR, Bonner AC, Dillon CM. Analysis of unexpected disruptive effects of contingent food reinforcement on automatically maintained self-injury. J Appl Behav Anal 2022; 55:62-79. [PMID: 34449082 PMCID: PMC8758530 DOI: 10.1002/jaba.875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 07/07/2021] [Accepted: 07/10/2021] [Indexed: 02/03/2023]
Abstract
Research has identified treatment-responsive and treatment-resistant subtypes of automatically maintained self-injurious behavior (ASIB) based on patterns of responding in the functional analysis (FA) reflecting its sensitivity to disruption by alternative reinforcement, and the presence of self-restraint. Rooker et al. (2019) unexpectedly observed reductions in treatment-resistant self-injury while participants performed an operant task. The current study further examined this in nine participants with treatment-resistant ASIB in an example of discovery-based research. An operant task engendering high rates of responding (switch-pressing) to produce food, reduced self-injury across all participants, and eliminated self-injury for some participants under certain schedules. Although this finding must be replicated and evaluated over longer time periods, it provides some evidence that alternative reinforcement can disrupt self-injury in these treatment-resistant subtypes under some conditions. Reinforcer and response competition are discussed as possible mechanisms underlying these disruptive effects, as are the potential implications of these findings regarding treatment.
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Affiliation(s)
- Griffin W. Rooker
- Department of Behavioral Psychology Kennedy Krieger Institute Baltimore, MD
- Department of Psychiatry and Behavioral Sciences Johns Hopkins University School of Medicine Baltimore, MD
| | - Louis P. Hagopian
- Department of Behavioral Psychology Kennedy Krieger Institute Baltimore, MD
- Department of Psychiatry and Behavioral Sciences Johns Hopkins University School of Medicine Baltimore, MD
| | - Jennifer N. Haddock
- Department of Behavioral Psychology Kennedy Krieger Institute Baltimore, MD
- Department of Pediatrics Johns Hopkins University School of Medicine Baltimore, MD
| | | | | | - Christopher M. Dillon
- Department of Behavioral Psychology Kennedy Krieger Institute Baltimore, MD
- Department of Psychology University of Maryland Baltimore County
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26
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Virues‐Ortega J, Clayton K, Pérez‐Bustamante A, Gaerlan BFS, Fahmie TA. Functional analysis patterns of automatic reinforcement: A review and component analysis of treatment effects. J Appl Behav Anal 2022; 55:481-512. [DOI: 10.1002/jaba.900] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/03/2021] [Accepted: 12/03/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Javier Virues‐Ortega
- Universidad Autónoma de Madrid Madrid Spain
- The University of Auckland Auckland New Zealand
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27
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Wunderlich KL, Hemstreet R, Best L. A retrospective analysis of stereotypy: Applicability of the behavioral subtyping model. J Appl Behav Anal 2022; 55:529-546. [PMID: 34990020 DOI: 10.1002/jaba.902] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 11/12/2022]
Abstract
Recent research on automatically reinforced self-injurious behavior (ASIB) has identified specific patterns of responding in functional analyses that correlate with intervention efficacy (Hagopian et al., 2015; Hagopian et al., 2017). Whereas research by Hagopian et al. (2015, 2017) points to an important development in the assessment and treatment of ASIB, it is unclear if the applicability extends to automatically reinforced noninjurious behaviors, including stereotypy. Therefore, the current study replicated the methods of Hagopian et al. (2017), extending this research to published cases of stereotypy and related behavior. The behavioral subtype for each case was identified, and where applicable, the subtype was compared to intervention outcome data. The categorization of data sets as either Subtype 1 or Subtype 2 did not correspond with specific treatment outcomes. Unlike the results of Hagopian et al. (2015, 2017), reinforcement-based interventions were not more likely to be effective for Subtype 1 stereotypy than for Subtype 2 stereotypy.
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Affiliation(s)
| | | | - Lauren Best
- Department of Communication Sciences and Special Education, University of Georgia
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28
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Thompson TJ, Walker MW, LeBoeuf JB, Simeonsson RJ, Karakul E. Chronicity of Challenging Behaviors in Persons with Severe/Profound Intellectual Disabilities Who Received Active Treatment During a 20‐Year Period. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2021. [DOI: 10.1111/jppi.12395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | - Eda Karakul
- University of North Carolina Chapel Hill NC USA
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29
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Frank-Crawford MA, Borrero JC, Newcomb ET, Doan T, Fisher A, Rooker GW. Accumulated and distributed response-reinforcer arrangements during the treatment of escape-maintained problem behavior. J Appl Behav Anal 2021; 54:1566-1585. [PMID: 34341998 DOI: 10.1002/jaba.870] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 11/08/2022]
Abstract
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.
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Affiliation(s)
- Michelle A Frank-Crawford
- Department of Psychology, University of Maryland, Baltimore County.,Department of Behavioral Psychology, Kennedy Krieger Institute
| | - John C Borrero
- Department of Psychology, University of Maryland, Baltimore County
| | | | | | - Alyssa Fisher
- Department of Behavioral Psychology, Kennedy Krieger Institute
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30
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Goldfarb Y, Zafrani O, Hedley D, Yaari M, Gal E. Autistic adults' subjective experiences of hoarding and self-injurious behaviors. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:1457-1468. [PMID: 33631948 PMCID: PMC8264636 DOI: 10.1177/1362361321992640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
LAY ABSTRACT Hoarding and self-injurious behaviors are relatively common in autism, but knowledge about their expressions in adulthood is scarce. Through interviews collecting subjective experiences of autistic adults, these behaviors were explored, and categorized to their underlying purposes. Findings portray the occurrence of these behaviors in the lives of autistic adults, their self-regulatory purposes, and their relationship to other behaviors in the domain of Restrictive and Repetitive Behaviors and Interests.
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Affiliation(s)
| | | | | | - Maya Yaari
- La Trobe University, Australia
- GOSHEN—Community Child Health and Well-Being, Israel
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31
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Schmidt JD, Falligant JM, Goetzel A, Hardisty S, Hagopian LP. Decreasing motor stereotypy with competing stimuli and tasks: Analysis of prompted engagement and response blocking. BEHAVIORAL INTERVENTIONS 2021; 36:583-594. [PMID: 35370391 DOI: 10.1002/bin.1786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
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.
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Affiliation(s)
- Jonathan D Schmidt
- Kennedy Krieger Institute, Baltimore, Maryland, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John M Falligant
- Kennedy Krieger Institute, Baltimore, Maryland, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | - Louis P Hagopian
- Kennedy Krieger Institute, Baltimore, Maryland, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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32
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Morris SL, McDowell JJ. Modeling Subtypes of Automatically Reinforced Self-Injurious Behavior with the Evolutionary Theory of Behavior Dynamics. Perspect Behav Sci 2021; 44:581-603. [DOI: 10.1007/s40614-021-00297-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 10/21/2022] Open
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33
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Falligant JM, Hardesty SL, Pierce D, Kurtz PF. Assessment and treatment of tracheostomy tube manipulation: Effects of competing stimuli and protective equipment. J Appl Behav Anal 2021; 54:1625-1638. [PMID: 34021499 DOI: 10.1002/jaba.846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 11/10/2022]
Abstract
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.
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Affiliation(s)
- John M Falligant
- Kennedy Krieger Institute.,Johns Hopkins University School of Medicine
| | | | | | - Patricia F Kurtz
- Kennedy Krieger Institute.,Johns Hopkins University School of Medicine
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34
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Courtemanche AB, Black WR, Meyer JS. Hair Cortisol and Self-Injurious Behavior Among Children With Autism Spectrum Disorder. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2021; 126:158-166. [PMID: 33651886 DOI: 10.1352/1944-7558-126.2.158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 11/01/2020] [Indexed: 06/12/2023]
Abstract
Elevated salivary cortisol levels have been documented in individuals who engage in self-injurious behavior (SIB), indicating acute physiological stress. Less is known about the chronicity of stress and SIB. We analyzed the relationship between parent ratings of problem behavior and hair cortisol concentrations (an index of chronic adrenocortical activity) in 23 children with autism spectrum disorder (ASD). Parent ratings of problem behavior were not significantly correlated with hair cortisol concentrations. When children were categorized into groups based on the frequency and severity of SIB, participants with the greatest frequency and severity of SIB had higher hair cortisol concentrations compared to children without SIB. Frequent and severe SIB may be associated with altered hypothalamic-pituitary-adrenal (HPA) axis activity in children with ASD.
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The Safety and Effectiveness of High-Dose Propranolol as a Treatment for Challenging Behaviors in Individuals With Autism Spectrum Disorders. J Clin Psychopharmacol 2020; 40:122-129. [PMID: 32134849 DOI: 10.1097/jcp.0000000000001175] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
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.
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Quigley J, Dowdy A, Trucksess K, Finlay A. An Investigation of Functional Communication Training and Schedule Thinning Using a Multiple Schedule on Elopement to Access Stereotypy. J Autism Dev Disord 2020; 51:3224-3234. [PMID: 33196917 DOI: 10.1007/s10803-020-04788-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 10/23/2022]
Abstract
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.
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Affiliation(s)
- Jennifer Quigley
- The Chicago School of Professional Psychology, Chicago, IL, USA.
| | - Art Dowdy
- Temple University, Philadelphia, PA, USA
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Collateral Effects of Behavioral Treatment for Problem Behavior on Caregiver Stress. J Autism Dev Disord 2020; 51:2852-2865. [PMID: 33104925 DOI: 10.1007/s10803-020-04694-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
When individuals with autism and intellectual and developmental disabilities exhibit severe problem behavior, assessment and treatment are often warranted. Parents of such individuals are at high risk for developing parenting stress. In this study, 194 parents completed the Parenting Stress Index-Short Form at their child's time of admission to and discharge from inpatient or outpatient treatment for severe problem behavior. Parent stress was examined in relation to rate and function of child problem behavior as determined via functional analysis. Repeated measures analyses of variance were conducted, and differential effects were observed when child participants exhibited an attention, automatic, or mands function for problem behavior. These findings highlight the importance of considering function of problem behavior in relation to parenting stress.
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38
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Haddock JN, Hagopian LP. Competing stimulus assessments: A systematic review. J Appl Behav Anal 2020; 53:1982-2001. [PMID: 32720719 DOI: 10.1002/jaba.754] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 06/05/2020] [Accepted: 06/06/2020] [Indexed: 11/07/2022]
Abstract
The current review summarizes the literature on competing stimulus assessments (CSAs). CSAs are pretreatment assessments designed to systematically identify stimuli that reduce problem behavior (PB), ostensibly through reinforcer competition or substitution. We report on the participant characteristics, outcomes, and predictive validity of published CSAs that included (a) no-stimulus control trial(s), (b) test trials during which each stimulus was available singly and noncontingently, and (c) measurement of PB and stimulus engagement or contact. Results showed that CSAs have broad utility across a variety of topographies and functions of PB. In the majority of CSA applications for which extended analyses, or validations, were performed, stimuli shown to reduce PB during the CSA produced similar reductions during extended analysis. This was the case regardless of topography or function of PB, or whether the stimuli were assumed to be "matched" to the stimulation thought to be produced by PB. Implications for future research are discussed.
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Affiliation(s)
| | - Louis P Hagopian
- The Kennedy Krieger Institute.,Johns Hopkins School of Medicine.,University of Maryland, Baltimore County
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Schieltz KM, Wacker DP. Functional assessment and function-based treatment delivered via telehealth: A brief summary. J Appl Behav Anal 2020; 53:1242-1258. [PMID: 32643811 PMCID: PMC7361834 DOI: 10.1002/jaba.742] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/06/2020] [Accepted: 06/08/2020] [Indexed: 11/10/2022]
Abstract
As the world navigates the COVID-19 health crisis, behavior analysts are considering how best to support families while maintaining services and ensuring the health and safety of everyone involved. Telehealth is one service delivery option that provides families with access to care in their own communities and homes. In this article, we provide a brief summary of the telehealth literature in applied behavior analysis that provided coaching and training to families for individuals who displayed challenging behavior. These studies targeted functional assessment and function-based treatment for challenging behavior. We briefly summarize what is known relative to the assessment and treatment of challenging behavior via telehealth, place these results within a descriptive context of the decisions made by the research team at the University of Iowa, and discuss what we, as behavior analysts, should consider next to advance our understanding and practice of telehealth.
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40
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Hagopian LP, Frank-Crawford MA, Javed N, Fisher AB, Dillon CM, Zarcone JR, Rooker GW. Initial outcomes of an augmented competing stimulus assessment. J Appl Behav Anal 2020; 53:2172-2185. [PMID: 32588920 DOI: 10.1002/jaba.725] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 11/11/2022]
Abstract
Competing stimulus assessments (CSAs) are designed to identify stimuli that, when made freely available, reduce problem behavior. Although CSAs have demonstrated utility, identifying competing stimuli can be difficult for some individuals. The current study describes outcomes from an augmented CSA (A-CSA) for 6 consecutively encountered cases with treatment-resistant subtypes of automatically maintained problem behavior. When test stimuli were made freely available, only between 0 and 1 effective competing stimuli were identified for each case. Prompting and response blocking were temporarily employed in succession to promote engagement with stimuli and disrupt problem behavior. When those procedures were withdrawn and stimuli made freely available, the number of effective competing stimuli increased in all 6 cases. Findings suggest that procedures designed to promote engagement and disrupt problem behavior may allow the A-CSA to be a platform not only for identifying competing stimuli, but also for actively establishing competing stimuli.
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Affiliation(s)
- Louis P Hagopian
- Kennedy Krieger Institute and Johns Hopkins University School of Medicine
| | | | | | | | | | - Jennifer R Zarcone
- Kennedy Krieger Institute and Johns Hopkins University School of Medicine
| | - Griffin W Rooker
- Kennedy Krieger Institute and Johns Hopkins University School of Medicine
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41
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Conine DE, Vollmer TR, Barlow MA, Grauerholz-Fisher E, Dela Rosa CM, Petronelli AK. Assessment and treatment of response to name for children with autism spectrum disorder: Toward an efficient intervention model. J Appl Behav Anal 2020; 53:2024-2052. [PMID: 32578223 DOI: 10.1002/jaba.737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 11/09/2022]
Abstract
Response to name (RTN) is an early developmental milestone, deficits in which are associated with autism spectrum disorder (ASD). This study extends previous research by evaluating an assessment and treatment model for RTN with 13 children with ASD. For all participants, phase 1 was a naturalistic social baseline. The 9 children who did not meet mastery criteria in phase 1 underwent a series of treatment conditions in phase 2. In phase 3, treatment components were removed, and generalization was assessed. Results indicated that tangible reinforcement procedures can produce rapid increases in discriminated RTN, sometimes without prompts. The total number of trials to mastery were reduced in the current study relative to previous research. Results also provide preliminary evidence to suggest that the phase 1 baseline condition may produce distinct patterns of RTN that could be used to predict treatment effects and further reduce trials to mastery in future work.
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Rooker GW, Hagopian LP, Haddock JN, Mezhoudi N, Arevalo AR. Sensitivity to Changing Environmental Conditions across Individuals with Subtype 2 Automatically Reinforced and Socially Reinforced Self-injury. BEHAVIORAL DEVELOPMENT BULLETIN 2020; 24:89-99. [PMID: 32509138 DOI: 10.1037/bdb0000090] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Automatically reinforced Subtype 2 self-injurious behavior (ASIB) has been characterized as showing insensitivity to competing reinforcement contingencies in the contexts of both functional analyses and in treatment using reinforcement alone (Hagopian, Rooker, &Yenokyan, 2018). One question is whether this insensitivity is specific to Subtype 2 ASIB as response class in these contexts or whether it is represents a generalized response tendency of the individual that is evident across other response classes. To examine this question, we compared responding on a single-operant task under changing reinforcement schedules for three individuals with Subtype 2 ASIB, relative to a comparison group of three individuals with socially reinforced SIB (which is characterized by sensitivity to changes in reinforcement contingencies). As hypothesized, all individuals showed sensitivity to changes in contingencies. These results provide preliminary support that the insensitivity of Subtype 2 ASIB is a property specific to that response class in these contexts rather than a generalized response tendency of the individual.
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Affiliation(s)
| | | | | | - Nabil Mezhoudi
- The New England Center for Children.,Western New England University
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43
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Kubina RM, Ruiz S, Kostewicz DE. Quantifying Function with the Functional Analysis Celeration Chart. Behav Anal Pract 2020; 14:728-733. [PMID: 34631376 DOI: 10.1007/s40617-020-00426-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The present brief practice examined 6 randomly selected studies from the Journal of Applied Behavior Analysis that included functional analysis data replotted on the functional analysis celeration chart (FACC). The FACC showcases the practicality of a standard celeration chart- derived visual display. The research question asked, what level values occurred related to the original authors' determination of function? Results indicated all functions had a ×2 level multiplier or higher when placed on the FACC.
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Affiliation(s)
- Richard M Kubina
- The Pennsylvania State University, 209 CEDAR Building, University Park, PA 16802 USA
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Saini V, Ubdegrove K, Biran S, Duncan R. A Preliminary Evaluation of Interrater Reliability and Concurrent Validity of Open-Ended Indirect Assessment. Behav Anal Pract 2020; 13:114-125. [PMID: 32231972 DOI: 10.1007/s40617-019-00364-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Indirect assessments are a commonly used component of functional behavior assessment by behavior analysts in practice who work with individuals with severe behavior disorders. Although used frequently, closed-ended indirect assessments have repeatedly been shown to have low to moderate interrater reliability and poor concurrent validity with functional analysis. Recently, the use of open-ended interviews has become more commonly adopted in applied clinical practice, despite no studies evaluating the psychometric properties of such assessments. In the present study, we evaluated the interrater reliability and concurrent validity of an open-ended functional assessment interview. We compared the results of two open-ended indirect assessments conducted with a common caregiver and subsequently conducted functional analyses in an attempt to validate hypotheses generated from the interviews. Interrater agreement for the open-ended interviews was higher than previous research on closed-ended interviews (75%); however, concurrent validity with functional analysis was relatively poor (50%). We discuss these findings in the context of assessment and treatment for severe behavior disorders, as well as best practice methods during functional behavior assessment.
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Affiliation(s)
- Valdeep Saini
- 1Department of Applied Disability Studies, Brock University, 1812 Sir Isaac Brock Way, St. Catherines, ON Canada
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Hagopian LP. The consecutive controlled case series: Design, data-analytics, and reporting methods supporting the study of generality. J Appl Behav Anal 2020; 53:596-619. [PMID: 32125716 PMCID: PMC8805508 DOI: 10.1002/jaba.691] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 01/17/2020] [Accepted: 01/17/2020] [Indexed: 07/20/2023]
Abstract
Single-case experimental designs (SCEDs) have proven invaluable in research and practice because they are optimal for asking many experimental questions relevant to the analysis of behavior. The consecutive controlled case series (CCCS) is a type of study in which a SCED is employed in a series of consecutively encountered cases that undergo a common procedure or share a common characteristic. Additional design elements, data-analytic, and reporting methods enable researchers to ask experimental questions relevant to the study of generality of procedures and processes. The current paper discusses the CCCS methodologies, including the retrospective, prospective, and randomized CCCS. These methodologies can be applied to examine the generality of clinical procedures (including their general efficacy, the limits of their generality, and variables that may mediate generality); study the epidemiology and phenomenology of clinical problems; and compare the efficacy of 2 clinical procedures within a randomized controlled trial combining SCEDs with randomized group designs.
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Affiliation(s)
- Louis P Hagopian
- Kennedy Krieger Institute
- Johns Hopkins University School of Medicine
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46
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Associated Factors of Self-injury Among Adolescents with Autism Spectrum Disorder in a Community and Residential Treatment Setting. J Autism Dev Disord 2020; 50:2987-3004. [PMID: 32056114 DOI: 10.1007/s10803-020-04389-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Self-injurious behavior (SIB) occurs in up to 50% of individuals with autism. As one of the most serious conditions in individuals with developmental disabilities, SIB affects the individual and his or her family in multiple contexts. A systematic analysis of factors most commonly associated with SIB could inform the development of individualized intervention strategies. The current study examined factors related to SIB in an analysis of client records of 145 children with autism in a comprehensive care center. Predictor variables included age, gender, the Adaptive Behavior Composite, sensory processing, aggression, stereotypies, irritability, adaptive skills, and medical conditions. Age, irritability, and the Adaptive Behavior Composite were found to significantly predict SIB.
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47
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Moseley RL, Gregory NJ, Smith P, Allison C, Baron-Cohen S. Links between self-injury and suicidality in autism. Mol Autism 2020; 11:14. [PMID: 32039740 PMCID: PMC7008575 DOI: 10.1186/s13229-020-0319-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 01/30/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Autistic individuals without intellectual disability are at heightened risk of self-injury, and appear to engage in it for similar reasons as non-autistic people. A wide divergence of autistic perspectives on self-injury, including those who frame it as a helpful coping mechanism, motivate investigating the link between self-injury, suicide ideation, and attempts which has been reported in typically developing individuals. METHOD One hundred three autistic participants completed the Non-Suicidal Self-Injury Assessment Tool (NSSI-AT), the Suicide Behaviors Questionnaire (SBQ-R), and the Interpersonal Social Evaluation List (ISEL-12) across two online studies. Logistic regression was conducted to predict self-harming status via responses to questions on suicidality, and to predict whether certain self-injurious behaviors, including cutting, were especially associated with suicide ideation and attempts. Non-parametric correlation analysis examined relationships between suicide ideation/attempts and other variables that might characterize self-harmers especially at risk of suicidality. These included perceived access to social support, purposes or reasons for self-injury, the number of different self-injurious behaviors engaged in, the duration and lifetime incidence of self-injury, and the individual's feelings about their self-injury. RESULTS While self-injuring status was significantly predicted by responses to a question on suicide ideation and attempts, there was no relationship between suicide ideation/attempts and a participant's personal feelings about their self-injury. The method of cutting was also predicted by suicide ideation and attempts, though other methods common in autistic people were at borderline significance. Use of self-injury for the regulation of low-energy emotional states like depression, for self-punishment or deterrence from suicide, and for sensory stimulation, was associated with suicide ideation and attempts, as was the number of self-injurious behaviors engaged in. There was no significant relationship between suicide ideation/attempts and the duration and lifetime incidence of self-injury or social support. CONCLUSIONS These preliminary data suggest that while individuals might frame their self-injury as a positive or neutral thing, there remains a concerning relationship between self-injury and suicidality which exists regardless of individual feelings on self-injury. This is consistent with the theoretical perspective that self-injury can be a "gateway" through which individuals acquire capability for lethal suicidal behaviors. The data highlight that particular methods (cutting) and reasons for self-injury may be of significant concern, but this information, which might be of extreme value for clinicians, requires further investigation and validation.
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Affiliation(s)
- R. L. Moseley
- Department of Psychology, Bournemouth University, Poole, UK
| | - N. J. Gregory
- Department of Psychology, Bournemouth University, Poole, UK
| | - P. Smith
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - C. Allison
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - S. Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
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48
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Empirically derived consequences to treat rumination. BEHAVIORAL INTERVENTIONS 2019. [DOI: 10.1002/bin.1698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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49
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Rooker GW, Hagopian LP, Becraft JL, Javed N, Fisher AB, Finney KS. Injury characteristics across functional classes of self-injurious behavior. J Appl Behav Anal 2019; 53:1042-1057. [PMID: 31769039 DOI: 10.1002/jaba.664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 08/09/2019] [Indexed: 11/10/2022]
Abstract
Self-injurious behavior (SIB) is inherently problematic because it can lead to injuries, including those that are quite severe and may result in loss of function or permanent disfigurement. The current study replicated and extended Rooker et al. (2018) by classifying the physical characteristics of injuries across groups of individuals with automatically maintained SIB (ASIB Subtypes 2 and 3) and socially maintained SIB. Individuals with Subtype 2 ASIB had the most frequent and severe injuries. Further, an inverse relation was found between the level of differentiation in the functional analysis and the number of injuries across groups. Studying the response products of SIB (the injuries) documents the risks associated with SIB, justifies the need for research and the intensive intervention, and advances knowledge of SIB. Additional research is needed to replicate these findings, and determine the variables that produce different characteristics of injury secondary to SIB.
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Affiliation(s)
- Griffin W Rooker
- The Kennedy Krieger Institute and Johns Hopkins University School of Medicine
| | - Louis P Hagopian
- The Kennedy Krieger Institute and Johns Hopkins University School of Medicine and University of Maryland, Baltimore County
| | - Jessica L Becraft
- The Kennedy Krieger Institute and Johns Hopkins University School of Medicine
| | - Noor Javed
- The Kennedy Krieger Institute and University of Maryland, Baltimore County
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DeRosa NM, Novak MD, Morley AJ, Roane HS. Comparing response blocking and response interruption/redirection on levels of motor stereotypy: Effects of data analysis procedures. J Appl Behav Anal 2019; 52:1021-1033. [PMID: 31642524 DOI: 10.1002/jaba.644] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 08/16/2019] [Indexed: 11/07/2022]
Abstract
Autism spectrum disorder (ASD) is marked by deficits in social communication and the presence of restrictive and/or repetitive behaviors or interests. Motor stereotypy is a form of repetitive behavior that is common in ASD. Response Interruption and Redirection (RIRD) and response blocking (RB) are two interventions found to be efficacious in reducing motor stereotypy. However, the current literature presents with inconsistencies regarding the relative efficacy of these two procedures. Thus, we sought to replicate and extend previous literature by evaluating the efficacy of both interventions on reducing motor stereotypy among 3 individuals with ASD. We also sought to evaluate how variations in data analysis affected the interpretation of treatment outcomes. Results indicated that both interventions were equally efficacious at reducing stereotypy when analyzing data exclusive of treatment-implementation time. However, when analyzing total session time data, RB produced greater and more sustained reductions in stereotypy across all participants. These results emphasize the importance of data analysis decision-making in evaluating intervention outcomes.
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