Competing stimulus assessments: A systematic review

Using Functional Communication and Competing Stimuli to Gradually Increase the Distance of Transitions in the Treatment of Tangibly Maintained Elopement

Behavioral interventions are highly efficacious in reducing elopement. However, few studies explicitly examine elopement during transitions, and they typically do not discuss distance traveled during the transition. We report on a successful treatment consisting of functional communication to "go see" stimuli during transitions along with blocking and competing stimuli during reinforcer delays for a young boy whose elopement occurred during transitions and was maintained by positive reinforcement in the form of access to tangibles. During generalization, the distance of the transitions was gradually increased while maintaining low levels of elopement.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40617-024-00957-7.

Evaluation of a latency-based competing stimulus assessment

A competing stimulus assessment is used to identify stimuli that are associated with a low level of challenging behavior and a high level of engagement. These stimuli are often used as a treatment component for challenging behavior that is maintained by automatic reinforcement. One limitation of implementing competing stimulus assessments is that they may be time consuming. The purpose of the current study was to evaluate the efficacy and efficiency of a latency-based competing stimulus assessment. During the asssessment, a therapist presented potential competing stimuli to the participants and contingent on the first occurrence of challenging behavior, the trial was terminated. The results of a brief treatment evaluation indicated that stimuli that were associated with the longest latency to challenging behavior were more effective in competing with challenging behavior relative to stimuli that were associated with shorter latencies. However, procedural modifications were necessary for one participant. The use of latency-based measures improved the efficiency of conducting a competing stimulus assessment.

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

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 Previous reviews of functional analysis outcomes have included large samples of published and unpublished data sets (i.e., clinical samples).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

Examining Procedural Variations of Delivering Competing Stimuli in the Treatment of Stereotypy

Competing stimulus assessments (CSA) are effective tools for identifying stimuli that compete with automatically reinforced behavior. However, Jennett et al. suggests there are cases for which non-contingent access to competing stimuli are insufficient at decreasing target responding and additional treatment components may be necessary. The purpose of the current study was to examine procedural variations (i.e., rotating competing items and prompted engagement) when presenting competing stimuli on increasing functional engagement and decreasing stereotypy. Following a functional analysis, a CSA was conducted to identify competing stimuli for four individuals with autism. Items identified were then used with two procedural variations. Levels of stereotypy, functional engagement, and item contact were measured. Results showed that for two participants both treatments were effective, while for the other two participants prompting functional engagement was more effective. Prompting functional engagement is likely a productive strategy for enhancing engagement with competing stimuli for automatically reinforced problem behavior as it may result in functional engagement becoming reinforcing in and of itself.

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

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

Stimulus Avoidance Assessment: A Systematic Literature Review

Board certified behavior analysts are ethically required to first address destructive behavior using reinforcement-based and other less intrusive procedures before considering the use of restrictive or punishment-based procedures (ethics standard 2.15; Behavior Analyst Certification Board, 2020). However, the inclusion of punishment in reinforcement-based treatments may be warranted in some cases of severe forms of destructive behavior that poses risk of harm to the client or others. In these cases, behavior analysts are required to base the selection of treatment components on empirical assessment results (ethics standard 2.14; Behavior Analyst Certification Board, 2020). One such preintervention assessment is the stimulus avoidance assessment (SAA), which allows clinicians to identify a procedure that is likely to function as a punisher. Since the inception of this assessment approach, no studies have conducted a systematic literature review of published SAA cases. These data may be pertinent to examine the efficacy, generality, and best practices for the SAA. The current review sought to address this gap by synthesizing findings from peer-reviewed published literature including (1) the phenomenology and epidemiology of the population partaking in the SAA; (2) procedural variations of the SAA across studies (e.g., number of series, session length); (3) important quality indicators of the SAA (i.e., procedural integrity, social validity); and (4) how the SAA informed final treatment efficacy. We discuss findings in the context of the clinical use of the SAA and suggest several avenues for future research.

Approaches for Treating Multiply Controlled Problem Behavior

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

Updated Recommendations for Reinforcement Schedule Thinning following Functional Communication Training

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

A replication and extension of the augmented competing stimulus assessment

Augmenting competing stimulus assessments by embedding tactics to increase stimulus engagement and disrupt challenging behavior can improve outcomes of treatments for automatically maintained self-injurious behavior, even for treatment-resistant subtypes. This study replicated and extended research on augmented competing stimulus assessments by reporting outcomes for 16 consecutively encountered cases with automatically maintained self-injurious behavior (19 total applications); six participants had treatment-responsive Subtype 1 and 10 had treatment-resistant Subtypes 2 or 3. Fewer high-competition stimuli were identified for individuals with treatment-resistant subtypes. When response-promotion and disruption tactics were applied and withdrawn, outcomes improved for six of eight applications. At least one high-competition stimulus was still effective when maintenance probes were conducted for a subset of participants. Ultimately, at least one high-competition stimulus was identified for each participant. Although augmenting tactics may not be necessary for all individuals, these findings provide additional support for their efficacy with treatment-resistant self-injurious behavior.

Efficacy of competing stimulus assessments: A summary of 35 consecutively encountered cases

Competing stimulus assessments (CSAs) are designed to identify stimuli that reduce challenging behavior through competition with its maintaining reinforcers. Recently, Haddock and Hagopian (2020) found that over 92% of CSAs described in published studies identified at least one high-competition stimulus (i.e., a stimulus correlated with at least an 80% reduction in challenging behavior). The current study describes the outcomes of CSAs in a retrospective consecutive controlled case series study of 35 cases (individuals) admitted to an inpatient setting. Findings on the limited relation between the level of stimulus engagement and reductions in challenging behavior were replicated; however, the efficacy of CSAs was lower (only 47% of CSAs were successful in identifying one or more high-competition stimuli). Discrepant findings across studies on the efficacy of CSAs are discussed in terms of differences in the sample participants and how outcomes are reported, which vary depending on the study's research questions.

Treatment of Self-Injury in Bainbridge-Ropers Syndrome: Replication and Extensions of Behavioral Assessments

Bainbridge-Ropers syndrome (BRPS) is a rare and understudied developmental disorder associated with medical (e.g., sleep disruption) and behavioral (e.g., self-injury) challenges. There are no published treatments for BRPS. We targeted self-injury in a child with BRPS using a functional analysis and differential reinforcement, with several extensions to common procedures. Results present the first example of behavioral reduction for self-injury in BRPS.

• ABA strategies can reduce self-injury in BRPS

• Evaluating multiply maintained self-injury following identification of an automatic function is important.

• Sleep deficits may complicate assessment.

A Competing Stimuli Intervention Package to Treat Automatically Reinforced Destructive Behavior

Behaviors maintained by automatic reinforcement are often more difficult to treat due to difficulty with identifying the relevant maintaining variable(s). One common intervention to treat automatically maintained behavior includes competing stimuli. Competing stimuli promote item engagement which may replace challenging behavior (i.e., response competition). Competing stimuli have shown to be a widely successful intervention across diverse topographies of challenging behavior; however, few studies have evaluated the use of competing stimuli on destructive behavior. The purpose of the current study was to treat automatically maintained destructive behavior with a competing stimuli intervention package for an adolescent with developmental disabilities. Results showed a decrease in destructive behavior when access to competing stimuli was a component of an intervention package in a clinic setting. Also, preliminary data are provided showing treatment effects when caregivers implemented the intervention. Due to the complexity of the final intervention package, recommendations for clinicians are provided which focus on improving feasibility, practicality, and sustainability of treatment components.

Animal Training, Environmental Enrichment, and Animal Welfare: A History of Behavior Analysis in Zoos

The modern zoo has been associated with two major behavioral welfare advances: (a) the use of training to increase voluntary husbandry care, and (b) the implementation of environmental enrichment to promote naturalistic behaviors. Both practices have their roots in behavior analysis, or the operant conditioning-centered, reward-based approach to behavioral psychology. Operant conditioning served as the foundation for the development of reinforcement-based training methods commonly used in zoos to make veterinary and husbandry procedures easier and safer for animals and their caregivers. Likewise, operant conditioning, with its focus on arranging environmental antecedents and consequences to change behavior, also provided a framework for successful environmental enrichment practices. In this paper, we outline the key individuals and events that shaped two of the cornerstones of the modern zoo: (1) the emergence of reward-based husbandry training practices, and (2) the engineering of environmental enrichment. In addition, we (3) suggest ways in which behavior analysis can continue to advance zoo welfare by (i) expanding the efficacy of environmental enrichment, (ii) using within-subject methodology, and (iii) improving animal-visitor interactions. Our goal is to provide a historical and contextual reference for future efforts to improve the well-being of zoo animals.

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

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

Initial outcomes of an augmented competing stimulus assessment

Competing stimulus assessments (CSAs) are designed to identify stimuli that, when made freely available, reduce problem behavior. Although CSAs have demonstrated utility, identifying competing stimuli can be difficult for some individuals. The current study describes outcomes from an augmented CSA (A-CSA) for 6 consecutively encountered cases with treatment-resistant subtypes of automatically maintained problem behavior. When test stimuli were made freely available, only between 0 and 1 effective competing stimuli were identified for each case. Prompting and response blocking were temporarily employed in succession to promote engagement with stimuli and disrupt problem behavior. When those procedures were withdrawn and stimuli made freely available, the number of effective competing stimuli increased in all 6 cases. Findings suggest that procedures designed to promote engagement and disrupt problem behavior may allow the A-CSA to be a platform not only for identifying competing stimuli, but also for actively establishing competing stimuli.