1
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Yassa RR, Mitteer DR, Greer BD, Angley SM, McCabe LH, Elwasli OM. Teaching trainees to implement functional communication training with multiple schedules: An evaluation of training effects and durability. J Appl Behav Anal 2024. [PMID: 39323390 DOI: 10.1002/jaba.2915] [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: 04/29/2024] [Accepted: 09/05/2024] [Indexed: 09/27/2024]
Abstract
We evaluated the effects of behavioral skills training on improving participant implementation of functional communication training with multiple schedules when working with a confederate. Behavioral skills training produced mastery-level responding for all six participants who required training, providing the first empirically supported training for this functional communication training approach. Next, we assessed durability during training challenges with (a) procedural changes to the original protocol, (b) a novel confederate with different discriminative stimuli and reinforcers, and (c) relapsed confederate destructive behavior. Training effects degraded at least once for all participants and in 62% of training challenges, although continuing to expose the participant to the challenging situations or providing postsession booster training resolved the degradation in most cases. We discuss these findings in relation to their clinical implications and directions for future research.
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Affiliation(s)
- Rana R Yassa
- Department of Applied Psychology, Rutgers University, New Brunswick, NJ, USA
| | - Daniel R Mitteer
- Severe Behavior Program, Children's Specialized Hospital-Rutgers University Center for Autism Research, Education, and Services (CSH-RUCARES), Somerset, NJ, USA
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Brian D Greer
- Severe Behavior Program, Children's Specialized Hospital-Rutgers University Center for Autism Research, Education, and Services (CSH-RUCARES), Somerset, NJ, USA
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Rutgers Brain Health Institute, Piscataway, NJ, USA
| | - Shannon M Angley
- Severe Behavior Program, Children's Specialized Hospital-Rutgers University Center for Autism Research, Education, and Services (CSH-RUCARES), Somerset, NJ, USA
| | - Liam H McCabe
- Severe Behavior Program, Children's Specialized Hospital-Rutgers University Center for Autism Research, Education, and Services (CSH-RUCARES), Somerset, NJ, USA
| | - Omar M Elwasli
- Severe Behavior Program, Children's Specialized Hospital-Rutgers University Center for Autism Research, Education, and Services (CSH-RUCARES), Somerset, NJ, USA
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2
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O'Brien MJ, Pauls AM, Cates AM, Larson PD, Zorn AN. Psychotropic Medication Use and Polypharmacy Among Children and Adolescents Initiating Intensive Behavioral Therapy for Severe Challenging Behavior. J Pediatr 2024; 271:114056. [PMID: 38615943 DOI: 10.1016/j.jpeds.2024.114056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/27/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE To evaluate the prevalence, trends, and factors associated with psychotropic medication use and polypharmacy among children and adolescents initiating intensive behavioral therapy for severe challenging behavior over a 10-year period. STUDY DESIGN In this retrospective observational study, we examined data from caregiver interviews and patient medical records on the number and types of psychotropic medications prescribed to patients initiating intensive behavioral therapy between January 1, 2013, and December 31, 2022. Trends in medication use and polypharmacy across the 10-year period were analyzed using regression analysis, while differences in demographics and clinical factors for patients with use and polypharmacy were analyzed using nonparametric statistical analysis with odds ratios presented for significant factors. RESULTS Data from all 302 pediatric patients initiating intensive behavioral therapy across the 10-year period were analyzed. Among all patients and all years, 83.8% were taking at least 1 psychotropic medication and 68.2% experienced polypharmacy. There were no changes in the prevalence of use, mean number of medications taken, or polypharmacy across the 10-year period. Patients diagnosed with attention-deficit/hyperactivity disorder or anxiety disorder, as well as those exhibiting self-injurious behavior had higher use of psychotropic medication and polypharmacy and were taking more medications overall. CONCLUSIONS Psychotropic medication use and polypharmacy were extremely high for children and adolescents with severe challenging behavior, but use and polypharmacy did not change over the 10-year period of data collection. Further research is needed to establish the generality of these findings to other regions of the US.
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Affiliation(s)
- Matthew J O'Brien
- The University of Iowa, Iowa City, IA; The University of Iowa Stead Family Department of Pediatrics, Iowa City, IA.
| | | | | | - Priya D Larson
- The University of Iowa, Iowa City, IA; The University of Iowa Department of Child and Adolescent Psychiatry, Iowa City, IA
| | - Alithea N Zorn
- The University of Iowa, Iowa City, IA; Center for Public Health Statistics, Iowa City, IA; College of Public Health, Iowa City, IA
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3
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Smith SW, Arroyo Antúnez BE, DeBartelo J, Sullivan WE, Roane HS, Craig AR. Synthesized alternative reinforcement and resurgence. J Exp Anal Behav 2024. [PMID: 39086124 DOI: 10.1002/jeab.4202] [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: 03/12/2024] [Accepted: 07/17/2024] [Indexed: 08/02/2024]
Abstract
In treatments based on differential reinforcement of alternative behavior, applied researchers and clinicians often provide multiple, qualitatively different reinforcers (i.e., synthesized reinforcement) rather than a single reinforcer (i.e., isolated reinforcement) contingent on alternative behavior. Some research shows that providing synthesized reinforcement for alternative responses within such treatments produces more rapid and complete suppression of target behavior; however, there is limited research evaluating the durability of these effects during treatment disruptions. Conceptual explanations of resurgence (e.g., resurgence as choice, context theory) suggest that treatments that include synthesized alternative reinforcement may lead to more resurgence of target behavior when alternative reinforcement is disrupted relative to treatments using isolated reinforcement. We evaluated this hypothesis within a three-phase resurgence evaluation. We exposed rats to isolated or synthesized reinforcement for alternative responding in the second phase, and we exposed rats to extinction in the third phase. Synthesized alternative reinforcement produced more rapid and complete suppression of target behavior than did isolated reinforcement in the second phase; however, exposure to extinction following synthesized reinforcement produced more resurgence. We discuss these results in terms of their implications for applied research and their support for current conceptual explanations for resurgence.
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Affiliation(s)
- Sean W Smith
- SUNY Upstate Medical University, Syracuse, NY, USA
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4
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Ayvaci AS, Cox AD, Dimopoulos A. A Quantitative Systematic Literature Review of Combination Punishment Literature: Progress Over the Last Decade. Behav Modif 2024:1454455241262414. [PMID: 39056439 DOI: 10.1177/01454455241262414] [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: 07/28/2024]
Abstract
This review evaluated single-case experimental design research that examined challenging behavior interventions utilizing punishment elements. Thirty articles published between 2013 and 2022 met study inclusion criteria. Study quality was also assessed. Through multiple levels of analysis (e.g., descriptive statistics, non-parametric statistics), we examined (a) participant and study trends, (b) differential outcomes related to temporal reinforcement approaches (antecedent, consequent, or combined reinforcement) applied alongside punishment element(s), (c) differential outcomes related to the punishment type (negative, positive) applied alongside reinforcement, and (d) effect sizes associated with study rigor across peer-reviewed and gray literature. Our results may tentatively suggest that, for certain situations, concurrently applying punishment with antecedent reinforcement approaches may coincide with significantly larger effect sizes compared to combined temporal reinforcement approaches, while positive punishment applied concurrently with reinforcement may coincide with larger but non-significant intervention effects. Most featured articles met rigor criteria, but larger effects were seen in peer-reviewed literature.
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5
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Strohmeier CW, Cengher M, Chin MD, Falligant JM. Application of a terminal schedule probe method to inform schedule thinning with multiple schedules. J Appl Behav Anal 2024; 57:676-694. [PMID: 38724468 DOI: 10.1002/jaba.1081] [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: 08/18/2023] [Accepted: 04/16/2024] [Indexed: 07/21/2024]
Abstract
Multiple schedules are effective at decreasing challenging behavior and maintaining alternative behavior at acceptable levels. Currently, no conclusive guidance is available for empirically deriving multiple-schedule components (continuous reinforcement for alternative behavior and extinction for challenging behavior [discriminative stimulus] and extinction for both alternative and challenging behavior [delta stimulus]) during the schedule-thinning process. In the current investigation, we describe a terminal schedule probe method to determine delta stimulus starting points and strategies for subsequent schedule-thinning progressions to reach caregiver-informed terminal schedules. We review schedule-thinning outcomes for a clinical cohort using a consecutive controlled case series approach and report results for two groups: One group included applications of terminal probe thinning (n = 24), and the other involved traditional dense-to-lean thinning (n = 18). Outcomes suggest that the terminal schedule probe method produced effective treatments with less resurgence of challenging behavior and leaner, more feasible, multiple schedules.
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Affiliation(s)
- Craig W Strohmeier
- 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
| | - Mirela Cengher
- Department of Psychology, University of Maryland Baltimore County, Baltimore, MD, USA
| | - Michelle D Chin
- Department of Behavioral Psychology, Kennedy Krieger Institute, 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
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6
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Weber JK, Brown KR, Retzlaff BJ, Hurd AM, Anderson HJ, Smallwood K. Retrospective consecutive controlled case series of outcomes for functional analyses of severe destructive behavior. J Appl Behav Anal 2024; 57:695-708. [PMID: 38619210 DOI: 10.1002/jaba.1077] [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: 11/16/2022] [Accepted: 04/01/2024] [Indexed: 04/16/2024]
Abstract
Functional analysis methods allow clinicians to determine the variable(s) that maintain destructive behavior. Previous reviews of functional analysis outcomes have included large samples of published and unpublished data sets (i.e., clinical samples). The purpose of this review was to conduct a large retrospective consecutive controlled case series of clinical functional analyses. We sought to identify the prevalence of differentiation, procedural modifications for undifferentiated and differentiated cases, and identified function(s) of destructive behavior. In addition, we extended the existing literature by determining whether functional analysis differentiation and function varied when single or multiple behavior topographies were consequated in the functional analysis. We discuss our findings considering previously published functional analysis reviews, provide avenues for future research, and offer suggestions for clinical practice.
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Affiliation(s)
- Jessie K Weber
- University of Nebraska Medical Center's Munroe-Meyer Institute, Omaha, NE, USA
| | | | | | - Alyssa M Hurd
- Psychology Department, Utah State University, Logan, UT, USA
| | - Heather J Anderson
- University of Nebraska Medical Center's Munroe-Meyer Institute, Omaha, NE, USA
| | - Kendra Smallwood
- University of Nebraska-Kearney, Communication Disorder Studies, Kearney, NE, USA
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7
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Weber J, Fahmie T, Walker S, Lambert J, Copeland B, Freetly T, Zangrillo A. Exploring factors that influence the efficacy of functional communication training. J Appl Behav Anal 2024; 57:709-724. [PMID: 38698667 DOI: 10.1002/jaba.1078] [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: 04/09/2023] [Accepted: 04/04/2024] [Indexed: 05/05/2024]
Abstract
Understanding factors that influence the efficacy of functional communication training has both practical and conceptual benefits. The current study extended research in this area by exploring data from 95 consecutive applications of functional communication training with extinction across two independent clinics. We selected candidate predictor variables based on conceptual analysis, conducted preliminary exploratory analyses, and then selectively applied quantitative methods that are used in precision medicine to examine their accuracy and predictive utility. Treatment outcomes were better when challenging behavior was maintained by a single function than they were when it was maintained by multiple functions; however, these differences were most apparent among cases with an escape function. We also analyzed within-session responding to explore the potential influence of unprogrammed establishing operations on decrements in treatment efficacy. Our within-session measure only distinguished responders from nonresponders when escape was one of the multiple functions. Additional research is needed to validate these findings with an independent sample and to address a number of clinical conceptual issues.
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Affiliation(s)
- Jessie Weber
- Severe Behavior Department, University of Nebraska Medical Center's Munroe Meyer Institute, Omaha, NE, USA
| | - Tara Fahmie
- Severe Behavior Department, University of Nebraska Medical Center's Munroe Meyer Institute, Omaha, NE, USA
| | - Seth Walker
- Severe Behavior Department, University of Nebraska Medical Center's Munroe Meyer Institute, Omaha, NE, USA
| | - Joseph Lambert
- Department of Special Education, Vanderbilt University, Nashville, TN, USA
| | - Bailey Copeland
- Department of Special Education, Vanderbilt University, Nashville, TN, USA
| | - Thomas Freetly
- Applied Behavioral Science Department, University of Kansas, Lawrence, KS, USA
| | - Amanda Zangrillo
- Severe Behavior Department, University of Nebraska Medical Center's Munroe Meyer Institute, Omaha, NE, USA
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8
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Slaton JD, Davis M, DePetris DA, Raftery KJ, Daniele S, Caruso CM. Long-term effectiveness and generality of practical functional assessment and skill-based treatment. J Appl Behav Anal 2024; 57:635-656. [PMID: 38804601 DOI: 10.1002/jaba.1090] [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: 09/13/2023] [Accepted: 05/03/2024] [Indexed: 05/29/2024]
Abstract
There are several considerations to address when conducting functional communication training for challenging behavior in a school setting, such as the need for schedule thinning and maintenance across staff and the need to establish a variety of appropriate classroom skills. There are several strategies for conducting schedule thinning following functional communication training and for transferring effects across people or settings. However, there are few examples of these processes in natural settings with relevant caregivers and with long-term maintenance of effects. We implemented a functional assessment and skill-based treatment process with six children with autism in a specialized school setting and extended treatment until challenging behavior was reduced to near-zero levels across multiple staff and settings. Follow-up data indicate that effects were still observed 1 year posttreatment and the use of crisis procedures (e.g., physical restraint) was eliminated for all participants.
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9
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Angley SM, Mitteer DR, Greer BD, Elwasli OM, Fisher WW. A demonstration of incorporating discriminative stimuli into an AAC device during functional communication training. Augment Altern Commun 2024:1-9. [PMID: 38588641 PMCID: PMC11459096 DOI: 10.1080/07434618.2024.2333380] [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: 09/05/2023] [Accepted: 03/12/2024] [Indexed: 04/10/2024] Open
Abstract
Functional communication training (FCT) is an effective intervention for teaching communication responses and reducing challenging behavior. One limitation of FCT is that frequent reinforcement may be impractical or impossible in many situations. Recently, Mitteer et al. published a tutorial in the journal AAC that provided video models on how to implement an empirically supported strategy for thinning reinforcement during FCT, known as FCT with discriminative stimuli, when teaching with an augmentative and alternative communication (AAC) device. However, no study has empirically evaluated the approach described in that tutorial. This paper details a case study using several single-case experimental designs to teach a non-vocal autistic adult who did not use speech to communicate requests only when reinforcement was signaled to be available by the color of the AAC icons. We demonstrated the efficacy of this approach with unique pairs of discriminative stimuli for tangible and edible items, thinning reinforcement for each stimulus class independently. We then rapidly transferred stimulus control to new icons and integrated both classes of stimuli into a single AAC grid. This first demonstration of embedding discriminative stimuli into an AAC device represents a promising advancement for individuals who do not use speech and may not readily respond to delay or denial cues.
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Affiliation(s)
- Shannon M Angley
- Severe Behavior Program, Children's Specialized Hospital-Rutgers University Center for Autism Research, Education, and Services (CSH-RUCARES), Somerset, NJ, USA
| | - Daniel R Mitteer
- Severe Behavior Program, Children's Specialized Hospital-Rutgers University Center for Autism Research, Education, and Services (CSH-RUCARES), Somerset, NJ, USA
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Brian D Greer
- Severe Behavior Program, Children's Specialized Hospital-Rutgers University Center for Autism Research, Education, and Services (CSH-RUCARES), Somerset, NJ, USA
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Rutgers Brain Health Institute, Piscataway, NJ, USA
| | - Omar M Elwasli
- Severe Behavior Program, Children's Specialized Hospital-Rutgers University Center for Autism Research, Education, and Services (CSH-RUCARES), Somerset, NJ, USA
| | - Wayne W Fisher
- Severe Behavior Program, Children's Specialized Hospital-Rutgers University Center for Autism Research, Education, and Services (CSH-RUCARES), Somerset, NJ, USA
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Rutgers Brain Health Institute, Piscataway, NJ, USA
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10
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Muething C, Ritchey CM, Call NA, Hardee AM, Mauzy CR, Argueta T, McMahon MXH, Podlesnik CA. A retrospective analysis of the relation between resurgence and renewal of behavior targeted for reduction. J Appl Behav Anal 2024; 57:455-462. [PMID: 38438320 DOI: 10.1002/jaba.1069] [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: 05/03/2023] [Accepted: 02/15/2024] [Indexed: 03/06/2024]
Abstract
Functional communication training (FCT) is an evidence-based treatment for behavior targeted for reduction that often combines extinction for target responses and arranges functionally equivalent reinforcement for alternative behavior. Long-term effectiveness of FCT can become compromised when transitioning from clinic to nonclinic contexts or thinning reinforcement schedules for appropriate behavior. Such increases in targeted behavior have been conceptualized as renewal and resurgence, respectively. The relation between resurgence and renewal has yet to be reported. Therefore, the present report retrospectively analyzed the relation between renewal and resurgence in data collected when implementing FCT with children diagnosed with developmental disabilities. We found no relation when evaluating all 34 individuals assessed for resurgence and renewal or a subset of individuals exhibiting both resurgence and renewal. These findings suggest that one form of relapse may not be predictive of another form of relapse.
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Affiliation(s)
- Colin Muething
- Marcus Autism Center, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Nathan A Call
- Marcus Autism Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Alexandra M Hardee
- Marcus Autism Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Courtney R Mauzy
- Marcus Autism Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Tracy Argueta
- Marcus Autism Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Meara X H McMahon
- Marcus Autism Center, Emory University School of Medicine, Atlanta, GA, USA
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11
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Kranak MP, Brown KR. Updated Recommendations for Reinforcement Schedule Thinning following Functional Communication Training. Behav Anal Pract 2024; 17:87-106. [PMID: 38405284 PMCID: PMC10891008 DOI: 10.1007/s40617-023-00863-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 02/27/2024] Open
Abstract
Schedule thinning is a necessary treatment procedure following the acquisition of a communication response during functional communication training. In this article, we update and extend the Hagopian et al. Behavior Analysis in Practice, 4, 4-16, (2011) review and recommendations on schedule-thinning procedures following functional communication training. Since their publication, substantial research has been published on the efficacy, efficiency, and social validity of schedule-thinning methods. We provide updated recommendations for schedule thinning based on contemporary literature that has been published since 2011, as well as discuss key areas for future research.
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Affiliation(s)
- Michael P. Kranak
- Oakland University, Rochester, MI USA
- Oakland University Center for Autism, Rochester, MI USA
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12
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Norris HM, Greer BD. Relative preference for distinct reinforcers maintaining destructive behavior. J Appl Behav Anal 2024; 57:358-371. [PMID: 38131231 PMCID: PMC10984786 DOI: 10.1002/jaba.1051] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023]
Abstract
The literature offers few recommendations for sequencing exposure to treatment conditions with individuals with multiply maintained destructive behavior. Identifying relative preference for the functional reinforcers maintaining destructive behavior may be one means of guiding that decision. The present study presents a preliminary attempt at developing a robust relative preference and reinforcer assessment for individuals with multiply maintained destructive behavior. Guided and free-choice trials were implemented in which participants chose between two multiple-schedule arrangements, each of which programmed signaled periods of isolated reinforcer availability and unavailability. Consistent participant choice and responding during free-choice trials was then used to thin the corresponding schedule of reinforcement. The results demonstrated a strong preference for one of the two functional reinforcers for all four participants, yet preferences differed across participants and were not well predicted by responding in prior analyses.
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Affiliation(s)
- Halle M. Norris
- 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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13
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Fisher WW. In Memoriam: Brian A. Iwata: A Mentor by Proxy. J Appl Behav Anal 2024; 57:21-24. [PMID: 37974455 DOI: 10.1002/jaba.1039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Wayne W Fisher
- 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
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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14
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Rahaman JA, Luczynski KC. Evaluating the efficacy and generality of a skill-based approach for promoting universal behavioral readiness. J Appl Behav Anal 2024; 57:131-152. [PMID: 38158227 DOI: 10.1002/jaba.1028] [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: 05/02/2022] [Accepted: 09/17/2023] [Indexed: 01/03/2024]
Abstract
Behavioral readiness can take the form of communication and self-control skills during challenging situations that are correlated with the development of problem behavior. A skill-based approach can teach behavioral readiness using procedures that involve synthesized reinforcement, probabilistic reinforcement, and contingency-based delays; however, this approach is commonly used to address severe behavior under specific situations. There is limited research evaluating a skill-based approach to teaching behavioral readiness and addressing emerging problem behavior. Also, it is unclear whether teaching effects under specific situations transfer across other, functionally distinct, situations. We evaluated the generality of a skill-based approach by teaching skills systematically across primary challenging situations involving the interruption of play, presentation of instructions, and removal of reinforcers. Teaching increased communication and self-control skills, and most skills transferred to secondary challenging situations (treatment extension probes) and caregiver-implemented sessions. We discuss challenging situations that required teaching, the generality of teaching, and procedural considerations.
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Affiliation(s)
- Javid A Rahaman
- Prosocial Interactions Program, University of Nebraska Medical Center's Munroe-Meyer Institute, Omaha, Nebraska, USA
| | - Kevin C Luczynski
- Prosocial Interactions Program, University of Nebraska Medical Center's Munroe-Meyer Institute, Omaha, Nebraska, USA
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15
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Call NA, Bernstein AM, O’Brien MJ, Schieltz KM, Tsami L, Lerman DC, Berg WK, Lindgren SD, Connelly MA, Wacker DP. A comparative effectiveness trial of functional behavioral assessment methods. J Appl Behav Anal 2024; 57:166-183. [PMID: 38049887 PMCID: PMC10843530 DOI: 10.1002/jaba.1045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 11/03/2023] [Indexed: 12/06/2023]
Abstract
Clinicians report primarily using functional behavioral assessment (FBA) methods that do not include functional analyses. However, studies examining the correspondence between functional analyses and other types of FBAs have produced inconsistent results. In addition, although functional analyses are considered the gold standard, their contribution toward successful treatment compared with other FBA methods remains unclear. This comparative effectiveness study, conducted with 57 young children with autism spectrum disorder, evaluated the results of FBAs that did (n = 26) and did not (n = 31) include a functional analysis. Results of FBAs with and without functional analyses showed modest correspondence. All participants who completed functional communication training achieved successful outcomes regardless of the type of FBA conducted.
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Affiliation(s)
- Nathan A. Call
- Marcus Autism Center, Atlanta, Georgia, USA
- Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Alec M. Bernstein
- Department of Pediatrics, Children’s Mercy Hospital, Kansas City, Missouri, USA
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Matthew J. O’Brien
- Stead Family Department of Pediatrics, University of Iowa College of Medicine, Iowa City, Iowa, USA
| | - Kelly M. Schieltz
- Stead Family Department of Pediatrics, University of Iowa College of Medicine, Iowa City, Iowa, USA
| | - Loukia Tsami
- Center for Autism and Developmental Disabilities, University of Houston-Clear Lake, Houston, Texas, USA
| | - Dorothea C. Lerman
- Center for Autism and Developmental Disabilities, University of Houston-Clear Lake, Houston, Texas, USA
| | - Wendy K. Berg
- Stead Family Department of Pediatrics, University of Iowa College of Medicine, Iowa City, Iowa, USA
| | - Scott D. Lindgren
- Stead Family Department of Pediatrics, University of Iowa College of Medicine, Iowa City, Iowa, USA
| | - Mark A. Connelly
- Department of Pediatrics, Children’s Mercy Hospital, Kansas City, Missouri, USA
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - David P. Wacker
- Stead Family Department of Pediatrics, University of Iowa College of Medicine, Iowa City, Iowa, USA
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16
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Smith SW, Greer BD. Translational evaluation of on/off alternative reinforcement cycling. J Exp Anal Behav 2023; 120:429-439. [PMID: 37680018 PMCID: PMC10840708 DOI: 10.1002/jeab.879] [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: 03/17/2023] [Accepted: 08/04/2023] [Indexed: 09/09/2023]
Abstract
Cycling between the availability and unavailability of reinforcement for alternative responding has successfully reduced resurgence in basic laboratory evaluations, but this approach represents a marked departure from current standards of care when treating problem behavior, warranting careful translation before its use clinically. Therefore, with extinction arranged for target responding across groups in Phase 2, we evaluated the effects of cycling between the availability and unavailability of differential reinforcement of alternative behavior (DRA) using a computer-based task with adult humans recruited through Amazon MTurk. Two control groups experienced constant DRA in Phase 2, with one group experiencing a dense DRA schedule and another group experiencing a lean DRA schedule. The cycling DRA group tended to show greater reductions in target responding and improved discrimination in Phase 2 and less target responding across Phases 2 and 3 than the lean DRA and dense DRA groups. These preliminary findings suggest that on/off DRA cycling procedures may produce more desirable treatment outcomes than constant DRA without producing negative side effects; however, further research is needed to confirm these possibilities.
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Affiliation(s)
- Sean W. Smith
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School
| | - Brian D. Greer
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School
- Children’s Specialized Hospital–Rutgers University Center for Autism Research, Education, and Services (CSH–RUCARES)
- Rutgers Brain Health Institute
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17
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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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18
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Blenkush N, O’Neill DA, O’Neill J. Contingent Electric Skin Shock: An Empirical or Ideological Issue? Perspect Behav Sci 2023; 46:329-337. [PMID: 37425982 PMCID: PMC10322794 DOI: 10.1007/s40614-023-00380-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 07/11/2023] Open
Abstract
Intractable self-injury, aggressive, and other destructive behaviors are real human conditions. Contingent electric skin shock (CESS) is a technology, based on behavior-analytic principles, used to ameliorate such behaviors. However, CESS has always been extraordinarily controversial. The Association for Behavior Analysis (ABAI), commissioned an independent Task Force to examine the issue. After a comprehensive review, the Task Force suggested the treatment should be available for use in select cases through a largely accurate report. Yet, ABAI adopted a position indicating CESS is never appropriate. On the issue of CESS, we are extremely concerned behavior analysis departed from the fundamental epistemology of positivism and is misleading nascent behavior analysts and consumers of behavioral technology. Destructive behaviors are extremely difficult to treat. In our commentary, we outline clarifications regarding aspects of the Task Force Report, proliferation of falsehoods by leaders in our field, and limitations to the standard of care in behavior analysis. We recommend using science to answer important questions instead of propagating false information at the expense of current and future clients with treatment refractory behaviors.
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Affiliation(s)
- Nathan Blenkush
- The Judge Rotenberg Educational Center, 250 Turnpike Street, Canton, MA 02021 USA
| | - Dawn A. O’Neill
- The Judge Rotenberg Educational Center, 250 Turnpike Street, Canton, MA 02021 USA
| | - John O’Neill
- The Judge Rotenberg Educational Center, 250 Turnpike Street, Canton, MA 02021 USA
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19
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Perone M, Lerman DC, Peterson SM, Williams DC. Report of the ABAI Task Force on Contingent Electric Skin Shock. Perspect Behav Sci 2023; 46:261-304. [PMID: 37425985 PMCID: PMC10323060 DOI: 10.1007/s40614-023-00379-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 07/11/2023] Open
Abstract
As a task force appointed by the Executive Council of the Association for Behavior Analysis International (ABAI), we investigated the clinical use of contingent electric skin shock (CESS) in behavior analytic treatments for severe problem behavior. We studied how CESS is used in contemporary behavior analysis, reinforcement-based alternatives to CESS, and current ethical and professional guidelines for applied behavior analysts. We recommended that ABAI uphold clients' right to receive CESS when it is restricted to extreme cases and used under rigorous professional and legal oversight. Our recommendation was rejected by a vote of the full members of ABAI, who instead endorsed an alternative recommendation, developed by members of the Executive Council, that opposed the use of CESS under any condition. Here we present for the record our report and initial recommendations, the formal statement that was rejected by the members of ABAI, and the statement that was endorsed.
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Affiliation(s)
- Michael Perone
- Department of Psychology, West Virginia University, 53 Campus Drive, Morgantown, WV 26506-6040 USA
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20
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Laureano B, Falligant JM. Modeling Behavioral Persistence with Resurgence as Choice in Context (RaC 2): A Tutorial. Behav Anal Pract 2023; 16:640-651. [PMID: 37187845 PMCID: PMC10170016 DOI: 10.1007/s40617-023-00796-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 05/17/2023] Open
Abstract
Resurgence as Choice in Context (RaC2) is a quantitative model for evaluating the reemergence of a previously extinguished response when alternative reinforcement is worsened. Rooted in the matching law, RaC2 proposes that allocation between target and alternative responding is based on changes in the relative value of each response option over time, accounting for periods with and without alternative reinforcement. Given that practitioners and applied researchers may have limited experience with constructing quantitative models, we provide a step-by-step task analysis for building RaC2 using Microsoft Excel 2013. We also provide a few basic learning activities to help readers better understand RaC2 itself, the variables that affect the model's predictions, and the clinical implications of those predictions. Supplementary Information The online version contains supplementary material available at 10.1007/s40617-023-00796-y.
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Affiliation(s)
- Brianna Laureano
- Neurobehavioral Unit, Kennedy Krieger Institute, 707 North Broadway, Baltimore, MD 21205 USA
- Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - John Michael Falligant
- Neurobehavioral Unit, Kennedy Krieger Institute, 707 North Broadway, Baltimore, MD 21205 USA
- Johns Hopkins University School of Medicine, Baltimore, MD USA
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21
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Fisher WW, Greer BD, Mitteer DR. Additional Comments on the Use of Contingent Electric Skin Shock. Perspect Behav Sci 2023; 46:339-348. [PMID: 37425986 PMCID: PMC10323055 DOI: 10.1007/s40614-023-00382-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 07/11/2023] Open
Abstract
Prior to the ABAI member vote to decide between two alternative position statements on contingent electric skin shock (CESS), the current authors helped draft a consensus statement supporting the abolition of CESS. In this commentary, we provide additional, supporting information for that consensus statement by (1) showing that the extant literature does not support the supposition that CESS is more efficacious than less-intrusive interventions; (2) providing data showing that implementing interventions that are less intrusive than CESS does not lead to overreliance on the use of physical or mechanical restraint to control destructive behavior; and (3) discussing the ethical and public relations issues that arise when behavior analysts use painful skin shock to reduce destructive behavior in persons with autism or intellectual disability.
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Affiliation(s)
- Wayne W. Fisher
- Children’s Specialized Hospital, Rutgers University Center for Autism Research, Education, and Services (CSH–RUCARES), 888 Easton Avenue, Somerset, NJ 08873 USA
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ USA
- Rutgers Brain Health Institute, Piscataway, NJ USA
| | - Brian D. Greer
- Children’s Specialized Hospital, Rutgers University Center for Autism Research, Education, and Services (CSH–RUCARES), 888 Easton Avenue, Somerset, NJ 08873 USA
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ USA
- Rutgers Brain Health Institute, Piscataway, NJ USA
| | - Daniel R. Mitteer
- Children’s Specialized Hospital, Rutgers University Center for Autism Research, Education, and Services (CSH–RUCARES), 888 Easton Avenue, Somerset, NJ 08873 USA
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ USA
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22
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Lerman DC. When Science Cannot Guide us: A Call to Action for Applied Behavior Analysts. Perspect Behav Sci 2023; 46:313-320. [PMID: 37425984 PMCID: PMC10322805 DOI: 10.1007/s40614-023-00377-y] [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] [Accepted: 05/09/2023] [Indexed: 07/11/2023] Open
Abstract
Evidence presented in the ABAI Task Force Report on Contingent Electric Skin Shock (CESS) revealed serious ethical, clinical, and practical problems with the contemporary use of CESS. As a member of the task force, I ultimately concluded that our recommended position statement ("Position A") was a misguided attempt to uphold the field's commitment to client choice. Furthermore, information gathered by the task force supports an urgent call to find solutions to two additional troubling issues: a severe shortage of treatment services for severe problem behavior and the near-absence of research on treatment-resistant behavior. In this commentary, I discuss reasons Position A was not a tenable stance and why we must do better to help our most vulnerable clients.
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23
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Sivaraman M, Fahmie T, Garcia A, Hamawe R, Tierman E. An Evaluation of Ethnicity-Matching for Caregiver Telehealth Training in India. Behav Anal Pract 2023; 16:573-586. [PMID: 37187850 PMCID: PMC10169975 DOI: 10.1007/s40617-022-00738-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 10/14/2022] Open
Abstract
Telehealth has become an increasingly viable service delivery option for function-based treatment of problem behavior (Lindgren et al., 2016). However, few applications have occurred with participants outside the United States and little research exists evaluating the role that culture plays in service delivery. In the current study, we compared functional analyses and functional communication training delivered via telehealth by ethnically matched and ethnically distinct trainers to six participants in India. We measured the effectiveness using a multiple baseline design while collecting supplemental measures of sessions to criterion, cancellations, treatment fidelity, and social validity. We directly assessed preference for the ethnically matched and ethnically distinct trainers using a concurrent chains arrangement. Sessions with both trainers were effective in reducing problem behavior and increasing functional verbal requests for participating children, and treatment fidelity was high across training modalities. There were no major differences in sessions-to-criterion or cancellations across trainers. However, all six caregivers demonstrated greater preference for sessions with the ethnically matched trainer.
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Affiliation(s)
- Maithri Sivaraman
- Department of Experimental, Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Tara Fahmie
- Munroe Meyer Institute, University of Nebraska Medical Center, Omaha, NE USA
| | | | - Rima Hamawe
- Family Model Behavior Therapy, Los Angeles, CA USA
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24
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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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25
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Kimball RT, Greer BD, Fuhrman AM, Lambert JM. Relapse and its mitigation: Toward behavioral inoculation. J Appl Behav Anal 2023; 56:282-301. [PMID: 36715533 PMCID: PMC10121865 DOI: 10.1002/jaba.971] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 12/03/2022] [Indexed: 01/31/2023]
Abstract
Relapse following the successful treatment of problem behavior can increase the likelihood of injury and the need for more intensive care. Current research offers some predictions of how treatment procedures may contribute to relapse, and conversely, how the risk of relapse can be mitigated. This review describes relapse-mitigation procedures with varying levels of support, the quantitative models that have influenced the research on relapse mitigation, different experimental methods for measuring relapse mitigation, and directions for future research. We propose that by viewing the implementation of relapse-mitigation procedures as a means of producing behavioral inoculation, clinicians are placed in the proactive and intentional role of exposing their client's behavior to an array of reinforcement and stimulus conditions during treatment with the goal of decreasing the detrimental impact of future treatment challenges.
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Affiliation(s)
- Ryan T. Kimball
- Department of Counseling and Applied Behavioral Studies, University of Saint Joseph
| | - Brian D. Greer
- Rutgers Brain Health Institute
- Severe Behavior Program, Children’s Specialized Hospital–Rutgers University Center for Autism Research, Education, and Services (CSH–RUCARES)
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School
| | - Ashley M. Fuhrman
- Severe Behavior Program, 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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26
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Kimball RT, Salvetti EL, Day LE, Karis R, Silveira J, Kranak MP. Operant ABA renewal during dense and lean schedules of differential reinforcement. J Exp Anal Behav 2023; 119:529-538. [PMID: 36945863 DOI: 10.1002/jeab.840] [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: 11/14/2022] [Accepted: 02/09/2023] [Indexed: 03/23/2023]
Abstract
Renewal is a type of relapse that occurs due to a change in context. Previous research has demonstrated that renewal of target responding may occur despite the availability of differential reinforcement for an alternative response (DRA). Nevertheless, the current literature on renewal presents mixed findings regarding the effects of dense and lean schedules of DRA on the magnitude of renewal. We used a translational approach with undergraduate college students and a task on a touchscreen tablet device to study the effects of dense and lean schedules of DRA during repeated renewal tests. All participants experienced two, three-phase ABA renewal arrangements. In the dense and lean renewal arrangements, we differentially reinforced alternative behavior in Context B and the renewal test in Context A on a VI 3-s or a VI 12-s schedule, respectively. Overall, we observed renewal in 31/36 (86%) renewal tests regardless of the density of reinforcement for the alternative response. Furthermore, the results showed that although renewal occurred in both arrangements, we found slightly higher magnitudes of renewal during DRA with lean schedules of reinforcement relative to dense schedules. We discuss the implications of these findings as they relate to the treatment of problem behavior.
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Affiliation(s)
| | - Emily L Salvetti
- University of Nebraska Medical Center's Munroe-Meyer Institute, Omaha, NE, USA
| | | | | | | | - Michael P Kranak
- Oakland University, Rochester, MI, USA
- Oakland University Center for Autism, Rochester, MI, USA
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27
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Kelley ME, Clark RJ, McGarry KM, Henry JE, Morgan AC, Gadaire DM, Sloman KN. Multiple Schedules Facilitate Rapid Noncontingent Reinforcement Schedule Thinning. Behav Anal Pract 2023; 16:185-193. [PMID: 37006419 PMCID: PMC10050655 DOI: 10.1007/s40617-022-00709-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 10/15/2022] Open
Abstract
We evaluated a noncontingent reinforcement treatment that included initial brief exposures to signaled alternation of availability and nonavailability of reinforcement, followed by rapid schedule thinning. Results confirmed findings from previous research (typically with differential reinforcement schedules) that establishing stimulus control across multiple treatment components facilitated schedule thinning. We discuss both the clinical utility of this procedure and the utility of stimulus control for making interventions more practical for clinicians.
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Affiliation(s)
| | - Ronald J. Clark
- The Scott Center for Autism Treatment at Florida Institute of Technology, Melbourne, FL USA
| | - Kacie M. McGarry
- The Scott Center for Autism Treatment at Florida Institute of Technology, Melbourne, FL USA
| | - Justine E. Henry
- The Scott Center for Autism Treatment at Florida Institute of Technology, Melbourne, FL USA
| | - Andrew C. Morgan
- The Scott Center for Autism Treatment at Florida Institute of Technology, Melbourne, FL USA
| | - Dana M. Gadaire
- The University of Scranton, Scranton, PA USA
- Geisinger Health System, Danville, USA
| | - Kimberly N. Sloman
- The Scott Center for Autism Treatment at Florida Institute of Technology, Melbourne, FL USA
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28
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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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29
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Greer BD, Shahan TA, Fisher WW, Mitteer DR, Fuhrman AM. Further evaluation of treatment duration on the resurgence of destructive behavior. J Appl Behav Anal 2023; 56:166-180. [PMID: 36203259 PMCID: PMC9868049 DOI: 10.1002/jaba.956] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 09/16/2022] [Indexed: 01/25/2023]
Abstract
Translation of promising procedures for mitigating treatment relapse has received considerable attention recently from researchers across the basic-applied continuum. One procedure that has demonstrated mixed support involves increasing the duration of treatment as a strategy for blunting resurgence. In a recent translational study, Greer et al. (2020) failed to detect a mitigation effect of increased treatment duration on the resurgence of destructive behavior. However, design limitations may have been responsible. The present study corrected these limitations by (a) employing a sequential design to decrease the possibility of multiple-treatment interference, (b) evaluating more treatment durations, (c) arranging treatments of fixed durations, and (d) conducting treatments of more extreme duration in a different clinical sample. Despite these improvements in experimental rigor and the testing of more extreme boundary conditions, the present study also failed to detect a mitigation effect of increased treatment duration. Likely explanations are discussed.
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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 PediatricsRutgers Robert Wood Johnson Medical School
| | | | - Wayne W. Fisher
- Rutgers Brain Health Institute
- Children's Specialized Hospital–Rutgers University Center for Autism Research, Education, and Services (CSH–RUCARES)
- Department of PediatricsRutgers Robert Wood Johnson Medical School
| | - Daniel R. Mitteer
- Children's Specialized Hospital–Rutgers University Center for Autism Research, Education, and Services (CSH–RUCARES)
- Department of PediatricsRutgers Robert Wood Johnson Medical School
| | - Ashley M. Fuhrman
- Children's Specialized Hospital–Rutgers University Center for Autism Research, Education, and Services (CSH–RUCARES)
- Department of PediatricsRutgers Robert Wood Johnson Medical School
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30
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Fisher WW, Greer BD, Shahan TA, Norris HM. Basic and applied research on extinction bursts. J Appl Behav Anal 2023; 56:4-28. [PMID: 36193974 PMCID: PMC9868065 DOI: 10.1002/jaba.954] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 09/15/2022] [Indexed: 01/26/2023]
Abstract
Discontinuation of the contingency between a response and its reinforcer sometimes produces a temporary increase in the response before its rate decreases, a phenomenon called the extinction burst. Prior clinical and basic studies on the prevalence of the extinction burst provide highly disparate estimates. Existing theories on the extinction burst fail to account for the dynamic nature of this phenomenon, and the basic behavioral processes that control response bursting remain poorly understood. In this paper, we first review the basic and applied literature on the extinction burst. We then describe a recent refinement of the concatenated matching law called the temporally weighted matching law that appears to resolve the above-mentioned issues regarding the extinction burst. We present illustrative translational data based conceptually on the model. Finally, we discuss specific recommendations derived from the temporally weighted matching law regarding procedures clinicians could implement to potentially mitigate or prevent extinction bursts.
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Affiliation(s)
- Wayne W. Fisher
- Rutgers Brain Health Institute
- Children's Specialized Hospital–Rutgers University Center for Autism Research, Education, and Services
- Department of PediatricsRutgers Robert Wood Johnson Medical School
| | - Brian D. Greer
- Rutgers Brain Health Institute
- Children's Specialized Hospital–Rutgers University Center for Autism Research, Education, and Services
- Department of PediatricsRutgers Robert Wood Johnson Medical School
| | | | - Halle M. Norris
- Children's Specialized Hospital–Rutgers University Center for Autism Research, Education, and Services
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31
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Examining Resurgence and Repetition with the Evolutionary Theory of Behavior Dynamics. Behav Processes 2022; 203:104776. [DOI: 10.1016/j.beproc.2022.104776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/16/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
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32
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Lambert JM, Copeland BA, Paranczak JL, Macdonald MJ, Torelli JN, Houchins-Juarez NJ. Description and evaluation of a function-informed and mechanisms-based framework for treating challenging behavior. J Appl Behav Anal 2022; 55:1193-1219. [PMID: 35762194 DOI: 10.1002/jaba.940] [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: 11/28/2021] [Accepted: 05/31/2022] [Indexed: 11/10/2022]
Abstract
Individualization and iterative design are essential components of the assessment and treatment of challenging behavior. Currently, there are few validated frameworks for engaging in iterative processes. Due to the nature of single-case design, empirically rigorous evaluations of decision-tree processes are particularly prohibitive. Notwithstanding, evaluations are needed. In this paper we first describe a function-informed and mechanisms-based (FIMB) framework for selecting treatment components employed by a university-based practicum experience designed to expose pre-service practitioners to a valid treatment process for challenging behavior. Then, we share a completed retrospective consecutive case series across a 6-year period in which we conducted a technique analysis to identify which procedures were most commonly selected in the practicum, and the impact of those choices on client outcomes. The results suggest that the model can be highly effective for some, but not all, cases. Implications are discussed.
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33
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Greer BD, Fisher WW, Fuhrman AM, Mitteer DR. Conducting Translational Research in the Context of Patient Care. Perspect Behav Sci 2022; 45:383-398. [PMID: 35719871 PMCID: PMC9163257 DOI: 10.1007/s40614-022-00333-2] [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] [Accepted: 03/17/2022] [Indexed: 10/18/2022] Open
Abstract
Although much has been written on the importance of translational research for bridging the continuum of basic science to clinical practice, few authors have described how such work can be carried out practically when working with patient populations in the context of ongoing clinical service delivery, where the priorities for patient care can sometimes conflict with the methods and goals of translational research. In this article, we explore some of the considerations for conducting this type of work while balancing clinical responsibilities that ensure high-quality patient care. We also discuss strategies we have found to jointly facilitate translational research and improve routine, clinical service delivery. A primary goal of this article is to encourage others working in applied settings to contribute to the increasingly important role that translational research plays in our science and practice by helping to better characterize and potentially lessen or remove barriers that may have impeded such investigations in the past.
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Affiliation(s)
- Brian D. Greer
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ USA
| | - Wayne W. Fisher
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ USA
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Houck EJ, Dracobly JD, Baak SA. A Practitioner’s Guide for Selecting Functional Communication Responses. Behav Anal Pract 2022; 16:65-75. [PMID: 37006421 PMCID: PMC10050301 DOI: 10.1007/s40617-022-00705-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 11/25/2022] Open
Abstract
Functional communication training (FCT) is an effective and widely used procedure to reduce problem behaviors. The purpose of FCT is to replace a problem behavior with a socially appropriate and communicative behavior - the functional communication response (FCR), which produces the same reinforcer as the problem behavior. Recent reviews of FCT have focused on providing overall recommendations for how the procedure should be implemented. A relatively small body of literature has been devoted to the selection of the FCR. The purpose of this article is to propose a set of considerations for practitioners in selecting FCRs.
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Affiliation(s)
- Elizabeth J. Houck
- Department of Behavior Analysis, University of North Texas, 1155 Union Circle #3311070, Denton, TX 76201 USA
| | - Joseph D. Dracobly
- Department of Behavior Analysis, University of North Texas, 1155 Union Circle #3311070, Denton, TX 76201 USA
| | - Sara A. Baak
- Department of Behavior Analysis, University of North Texas, 1155 Union Circle #3311070, Denton, TX 76201 USA
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35
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Modeling resurgence with an evolutionary theory of behavior dynamics. Behav Processes 2022; 197:104623. [PMID: 35318109 DOI: 10.1016/j.beproc.2022.104623] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 12/31/2022]
Abstract
McDowell's (2004) Evolutionary Theory of Behavior Dynamics (ETBD) is a computational theory that has reproduced a wide variety of behavioral phenomena observed in material reality. Here, we extended the generality of the ETBD by successfully replicating laboratory studies of resurgence with live animals using artificial organisms (AOs) animated by the theory. We ran AOs on concurrent random-interval random-interval (conc RI RI) schedules of reinforcement wherein one alternative (i.e., a target behavior) was reinforced while the other alternative (i.e., an alternative behavior) was not reinforced. Then, we placed the target behavior on extinction and reinforced the alternative response, producing a shift in allocation of responding from the target behavior to the alternative response. Finally, schedule thinning of the alternative response (i.e., downshifts) resulted in resurgence of target behavior. Our findings indicated that resurgence increased as a function of the relative downshift in reinforcement rate and magnitude, replicating findings from previous studies with live animals. These results further illustrate the utility of the ETBD for generating dynamic behavioral data and serve as a proof-of-concept for a novel computational approach for studying and understanding resurgence in future studies.
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36
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Translating Quantitative Theories of Behavior into Improved Clinical Treatments for Problem Behavior. Behav Processes 2022; 198:104639. [PMID: 35405305 PMCID: PMC10088503 DOI: 10.1016/j.beproc.2022.104639] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/28/2022] [Accepted: 04/04/2022] [Indexed: 12/15/2022]
Abstract
The most important advancement in the treatment of destructive behavior has been the development of the functional analysis, which is used to prescribe effective treatments like functional communication training. Although this approach can be highly effective, extinction bursts and forms of treatment relapse commonly occur when function-based treatments are implemented by caregivers in natural community settings. In recent years, researchers have increasingly applied quantitative theories of behavior like behavioral momentum theory (BMT) and the temporally weighted matching law (TWML) to understand, prevent, or mitigate extinction bursts and treatment relapse. In this paper, we describe BMT and TWML and selectively review the basic, translational, and applied research supporting and opposing each theory. Then, we describe how function-based treatments may be refined based on these theories to improve the effectiveness, generality, and durability of function-based treatments for individuals with autism spectrum and related disorders who display problem behavior.
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37
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Busch L, Saini V, Karim S, Jones R. Evaluation and Maintenance of Behavioral Interventions for 22q11.2 Deletion Syndrome. Dev Neurorehabil 2022; 25:170-177. [PMID: 34340650 DOI: 10.1080/17518423.2021.1960919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
22q11.2-deletion syndrome is a genetic disorder caused by a small deletion of chromosome 22. This deletion often results in developmental delays, learning disabilities, medical conditions, and comorbid psychiatric conditions. Patients with 22q11.2DS may present with a variety of behavioral phenotypes including obsessiveness and rigidity, poor social skills, and anxiety. In some cases, the phenotype can consist of destructive and inappropriate behavior including harming self and others. Behavioral difficulties are reported as one of the most challenging aspects of 22q11.2-deletion syndrome for families of patients, however, few studies have examined behavioral interventions as a possible therapeutic treatment for this population. Using principles derived from operant-behavioral psychology, we conducted functional assessments to determine the environmental correlates of destructive and inappropriate behaviors in two adult men with 22q11.2-deletion syndrome. Subsequently, behavioral interventions based on differential reinforcement were incorporated into each participant's natural environment to eliminate these behaviors. Significant reductions in destructive and inappropriate behavior were observed with both participants and therapeutic gains were maintained at follow-up. We discuss the role of behavioral interventions in combination with appropriate psychotropic medication when addressing challenging behaviors in this population.
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Affiliation(s)
- Louis Busch
- Centre for Addiction and Mental Health, Toronto, Canada
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38
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Falligant JM, Chin MD, Kurtz PF. Renewal and resurgence of severe problem behavior in an intensive outpatient setting: Prevalence, magnitude, and implications for practice. BEHAVIORAL INTERVENTIONS 2022. [DOI: 10.1002/bin.1878] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- John M. Falligant
- Department of Behavioral Psychology Kennedy Krieger Institute Baltimore Maryland USA
- Department of Psychiatry and Behavioral Sciences Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Michelle D. Chin
- Department of Behavioral Psychology Kennedy Krieger Institute Baltimore Maryland USA
| | - Patricia F. Kurtz
- Department of Behavioral Psychology Kennedy Krieger Institute Baltimore Maryland USA
- Department of Psychiatry and Behavioral Sciences Johns Hopkins University School of Medicine Baltimore Maryland USA
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39
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Haney SD, Greer BD, Mitteer DR, Randall KR. Relapse during the treatment of pediatric feeding disorders. J Appl Behav Anal 2022; 55:704-726. [PMID: 35318658 PMCID: PMC10091143 DOI: 10.1002/jaba.913] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/16/2021] [Accepted: 01/25/2022] [Indexed: 01/05/2023]
Abstract
Resurgence and renewal are treatment-relapse phenomena in which previously extinguished behavior returns after the conditions for an alternative response worsen or the context changes, respectively. Recently, researchers have evaluated the prevalence of resurgence and renewal when treating destructive behavior with functional communication training. However, resurgence of inappropriate mealtime behavior has yet to be evaluated; perhaps because treatments involve qualitatively different resurgence opportunities (e.g., increased bite-presentation rate). We evaluated the prevalence of resurgence and renewal of inappropriate mealtime behavior across 22 and 25 applications of extinction-based treatments, respectively. Resurgence occurred in 41% (9/22) of applications, most often following presentation-rate increases. Renewal occurred in 52% (13/25) of applications, most often following feeder changes from therapist to caregiver. We discuss these findings in terms of their ability to inform relapse-mitigation strategies for resurgence and renewal of inappropriate mealtime behavior.
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Affiliation(s)
| | - Brian D Greer
- Children's Specialized Hospital-Rutgers University Center for Autism Research, Education, and Services (CSH-RUCARES).,Rutgers Robert Wood Johnson Medical School
| | - Daniel R Mitteer
- Children's Specialized Hospital-Rutgers University Center for Autism Research, Education, and Services (CSH-RUCARES).,Rutgers Robert Wood Johnson Medical School
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40
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Mitteer DR, Greer BD, Randall KR, Haney SD. On the scope and characteristics of relapse when treating severe destructive behavior. J Appl Behav Anal 2022; 55:688-703. [PMID: 35290666 DOI: 10.1002/jaba.912] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 01/24/2022] [Accepted: 01/24/2022] [Indexed: 01/10/2023]
Abstract
Prior studies on treatment relapse have typically examined the prevalence of resurgence or renewal of target behavior (e.g., destructive behavior) in isolation. This study analyzed both types of relapse during 25 consecutive treatments involving functional communication training during worsening reinforcement conditions for alternative behavior (i.e., schedule thinning) or following context changes. We also examined disruption of alternative behavior (i.e., functional communication requests, compliance). Resurgence and renewal of destructive behavior occurred in 76% and 69% of treatments, respectively, and in approximately a third of changes in reinforcement or context. Relapse of destructive behavior predicted alternative-response disruption and vice versa; the co-occurrence of these two events always exceeded the background probabilities of either event occurring in isolation. General reductions in treatment efficacy occurred across changes in reinforcement or context, with no apparent decrease in likelihood in later transitions. We discuss implications of our findings with respect to future studies examining treatment durability.
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Affiliation(s)
- Daniel R Mitteer
- Children's Specialized Hospital-Rutgers University Center for Autism Research, Education, and Services (CSH-RUCARES).,Rutgers Robert Wood Johnson Medical School
| | - Brian D Greer
- Children's Specialized Hospital-Rutgers University Center for Autism Research, Education, and Services (CSH-RUCARES).,Rutgers Robert Wood Johnson Medical School
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41
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Bonner AC, Weinsztok SC, Fernandez N, Frank‐Crawford MA, DeLeon IG. Effects of reinforcer type on the durability of treatment for escape‐maintained behavior. BEHAVIORAL INTERVENTIONS 2022. [DOI: 10.1002/bin.1876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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42
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Torelli JN, Pickren SE. Using Chained or Tandem Schedules With Functional Communication Training: A Systematic Review. Behav Modif 2022; 47:185-218. [PMID: 35164521 DOI: 10.1177/01454455221077420] [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] [Indexed: 11/16/2022]
Abstract
Chained and tandem schedules are a common method for thinning schedules of reinforcement following functional communication training (FCT) in the treatment of problem behavior. We conducted a systematic literature review and meta-analysis of chained and tandem schedules following FCT to describe treatment characteristics and evaluate effects. We identified 38 articles and found reductions in problem behavior across four measures. Results of a random-effects multilevel meta-analysis of rigorous evaluations showed a significant effect of chained or tandem schedules + FCT on problem behavior relative to baseline. We observed resurgence in 77% of cases and 31% of schedule-thinning transitions. Results showed chained schedules resulted in greater reductions in problem behavior relative to tandem schedules. Exploratory moderator analyses suggested extinction, combined reinforcement, and delay and denial tolerance training procedures were associated with greater reductions in problem behavior relative to other treatment characteristics. Implications for practice and future research are discussed.
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43
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Smith SW, Greer BD. Phase duration and resurgence. J Exp Anal Behav 2022; 117:91-104. [PMID: 34762309 PMCID: PMC8908731 DOI: 10.1002/jeab.725] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/21/2021] [Accepted: 10/15/2021] [Indexed: 12/11/2022]
Abstract
Resurgence, the recurrence of responding due to a worsening of reinforcement conditions for current behavior, is a prevalent form of treatment relapse. Resurgence as Choice in Context predicts that increasing the duration of exposure to reinforcement for target responding during Phase 1 will increase resurgence magnitude, whereas increasing the duration of exposure to reinforcement for alternative responding and extinction for target responding during Phase 2 will decrease resurgence magnitude. We conducted an experiment evaluating these predictions with human participants recruited through Amazon's Mechanical Turk platform. We varied Phase 1 and Phase 2 durations across 4 experimental groups. Resurgence as Choice in Context successfully predicted the differences in resurgence magnitude across these groups, and fitting the quantitative model to the obtained data yielded an exceptional coefficient of determination. We discuss the implications of these results for using Resurgence as Choice in Context to inform experiments with human participants and the feasibility of using human-operant preparations to evaluate resurgence.
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Affiliation(s)
- Sean W. Smith
- Munroe-Meyer Institute, University of Nebraska Medical Center
- Severe Behavior Program, Children’s Specialized Hospital–Rutgers University Center for Autism Research, Education, and Services (CSH–RUCARES)
| | - Brian D. Greer
- Severe Behavior Program, 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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44
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Saini V, Andersen AS, Jessel J, Vance H. On the role of operant contingencies in the maintenance of inappropriate mealtime behavior: An epidemiological analysis. J Appl Behav Anal 2021; 55:513-528. [PMID: 34971457 DOI: 10.1002/jaba.901] [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: 06/21/2021] [Revised: 12/13/2021] [Accepted: 12/13/2021] [Indexed: 11/09/2022]
Abstract
Functional analysis is the primary assessment used to determine the function of inappropriate mealtime behavior in children with feeding disorders. Based on single-case experimental design studies and recent reviews, the prevalence of negative reinforcement alone in the maintenance of inappropriate mealtime behavior appears to be much greater than positive reinforcement alone. We conducted a retrospective consecutive-controlled case series to determine the generality of previous findings. Results of the epidemiological analysis support prior research in that negative reinforcement in the form of escape (44.8%), and multiple control (i.e., positive and negative reinforcement) in the forms of escape and attention (37.2%), are considerably more prevalent than positive reinforcement alone (2.5%). We discuss the relationship between functional analysis of inappropriate mealtime behavior and treatment utility. Further, we describe avenues of future research designed to advance the application of functional analysis in feeding disorders beyond inappropriate mealtime behavior.
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45
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Kranak MP, Falligant JM. Analysis of terminal schedule probes and schedule thinning effects following functional communication training. BEHAVIORAL INTERVENTIONS 2021. [DOI: 10.1002/bin.1842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Michael P. Kranak
- Department of Human Development and Child Studies Oakland University Rochester Michigan USA
- Oakland University Center for Autism Rochester Michigan USA
| | - John Michael Falligant
- Kennedy Krieger Institute Baltimore Maryland USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
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46
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Odell AJ, Greer BD, Fuhrman AM, Hardee AM. On the Efficacy of and Preference for Signaling Extinction in a Multiple Schedule. ACTA ACUST UNITED AC 2021; 26:43-61. [PMID: 34745411 DOI: 10.1037/bdb0000104] [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: 11/08/2022]
Abstract
Previous basic research has shown that signaling the extinction component of a compound schedule can be aversive and nonpreferred. However, such discriminative stimuli are common when thinning schedules of reinforcement in practice, and they provide several advantages to clinicians. A limitation of previous applied studies on different arrangements of discriminative stimuli is that researchers have used identical stimuli to signal the availability of reinforcement across conditions that do and do not signal extinction, often doubling exposure to the stimulus signaling the availability of reinforcement. The present experiments corrected this limitation by comparing multiple-schedule arrangements that do and do not signal extinction when unique stimuli signal each component across conditions. Results from three participants indicated that both multiple-schedule arrangements were similarly efficacious when teaching the successive discrimination. However, response patterns differed when testing under a concurrent-operants arrangement, suggesting different patterns of preference across various multiple-schedule arrangements.
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Affiliation(s)
- Alicia J Odell
- University of Nebraska Medical Center's Munroe-Meyer Institute
| | - Brian D Greer
- University of Nebraska Medical Center's Munroe-Meyer Institute
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47
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Mitteer DR, Greer BD, Randall KR, Kimball RT, Smith SW. Empirically Deriving Omission and Commission Errors for Relapse Tests: A Demonstration of Reverse Translation. BEHAVIOR ANALYSIS (WASHINGTON, D.C.) 2021; 21:351-363. [PMID: 35005218 DOI: 10.1037/bar0000218] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Most studies examine treatment relapse by programming contextual changes with perfect treatment integrity or with omission errors in the absence of a context change (i.e., all alternative responses placed on extinction). Recently, Mitteer et al. (2018) examined caregiver behavior in response to a confederate playing the role of a child with destructive behavior, providing the opportunity for researchers to empirically derive reinforcement schedules and test caregiver error patterns within future relapse tests with children. The present study represents a pilot demonstration of methods for reverse translating findings from caregivers to relapse preparations with children. We used a human-operant arrangement with three children with autism spectrum disorder in which they (a) emitted a target response (i.e., pad touch) for a preferred item in a home-like context, (b) emitted an alternative response (e.g., card touch) for the item in a clinic context while the target response was extinguished, and (c) experienced a relapse test in which the experimenter programmed the same low-rate omission and commission errors that caregivers made in the prior study within the home-like context. During the relapse test, target responding approximated or exceeded baseline ranges for all cases, and alternative behavior extinguished for two of the three cases. We discuss how researchers might incorporate similar translation processes in future relapse research.
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Affiliation(s)
| | - Brian D Greer
- Children's Specialized Hospital-Rutgers University Center for Autism Research, Education, and Services (CSH-RUCARES).,Rutgers Robert Wood Johnson Medical School
| | - Kayla R Randall
- University of Nebraska Medical Center's Munroe-Meyer Institute
| | | | - Sean W Smith
- University of Nebraska Medical Center's Munroe-Meyer Institute
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48
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Simmons CA, Salvatore GL, Zangrillo AN. Efficiency and preference for alternative activities during schedule thinning with functional communication training. J Appl Behav Anal 2021; 55:101-120. [PMID: 34694003 DOI: 10.1002/jaba.886] [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: 09/29/2020] [Revised: 09/27/2021] [Accepted: 09/30/2021] [Indexed: 11/07/2022]
Abstract
Functional communication training is an effective treatment for decreasing socially reinforced destructive behavior (Carr & Durand, 1985). Clinicians frequently use multiple schedules to thin the reinforcement schedule (Hanley et al., 2001). Individuals are often taught to wait for functional reinforcers without alternative programmed stimuli. However, concurrently available items and activities are often accessible in the natural environment. In this study, we taught 4 participants a functional communication response to access functional reinforcers. We implemented a multiple schedule during schedule thinning, comparing a control condition (nothing available during SΔ intervals) to separate conditions with items/activities (moderately preferred tangible items, attention, demands) noncontingently available during SΔ intervals. After reaching the terminal schedule in one condition, therapists assessed participant preference across SΔ conditions. For all participants, the terminal schedule was reached with alternative items and activities, and participant preference corresponded with the most efficient schedule thinning condition. Therapists also indicated preference for alternative items/activities.
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49
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Kranak MP, Falligant JM. Further investigation of resurgence following schedule thinning: Extension to an inpatient setting. BEHAVIORAL INTERVENTIONS 2021. [DOI: 10.1002/bin.1831] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Michael P. Kranak
- Department of Human Development and Child Studies Oakland University Rochester Michigan USA
- Oakland University Center for Autism Rochester Michigan USA
| | - John Michael Falligant
- Department of Behavioral Psychology Kennedy Krieger Institute Baltimore Maryland USA
- Department of Psychiatry and Behavioral Sciences Johns Hopkins University School of Medicine Baltimore Maryland USA
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50
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Nuhu NN, Pence ST. Schedule Thinning Following Functional Communication Training: Effects of Chained and Multiple Schedules. Behav Modif 2021; 46:1075-1108. [PMID: 34344228 DOI: 10.1177/01454455211036003] [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: 11/17/2022]
Abstract
Functional communication training (FCT) is used to reduce rates of problem behavior by teaching communicative responses that access functionally equivalent reinforcers. During FCT, the communicative response is typically placed on a dense schedule of reinforcement that is unlikely to be maintained in the natural environment. Experiment 1 evaluated the effects of two schedule-thinning procedures (chained schedules and multiple schedules) on problem behavior maintained by escape from demands for three participants following FCT. The chained and multiple-schedule procedures were effective in reducing rates of problem behavior. Compliance increased under both schedules, but the chained schedule resulted in higher levels of compliance with two participants. In Experiment 2, participants' preference for the chained or multiple-schedule procedure was evaluated using a modified concurrent-chain procedure. One participant preferred the chained schedule. One participant preferred the multiple schedule. One participant did not appear to discriminate between conditions.
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Affiliation(s)
- Nadrat N Nuhu
- Emory University School of Medicine, Atlanta, GA, USA.,Marcus Autism Center, Atlanta, GA, USA.,Children's Healthcare of Atlanta, GA, USA
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