Utility of the multiple-stimulus without replacement procedure and stability of preferences of older adults with dementia

A Survey of Why and How Clinicians Change Reinforcers during Teaching Sessions

Preference assessments are used to make data-based decisions about which stimuli to use as reinforcers but they can be challenging to conduct frequently enough to avoid problems related to momentary shifts in preference and reinforcer efficacy. It remains unclear whether, why, and how clinicians change reinforcers on a momentary basis. Therefore, this study aimed to determine common reasons for, and methods of, changing reinforcers in practice. Most respondents indicated that they often change reinforcers during a session, do so when the client mands for or attends to different stimuli or refuses the current stimulus, and identify the new reinforcer based on recent client behaviors (e.g., mands) or by providing an informal choice between stimuli. Responses did not vary meaningfully based on respondent credentials, client characteristics, or service goals. Implications for clinical practice as well as future research on methods of momentary preference assessment and reinforcer identification are discussed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40617-023-00847-4.

A multiple-stimulus-without-replacement assessment for sexual partners: Test-retest stability

The stability of stimulus preference assessment results is an important consideration when using the identified stimuli in treatments and/or additional experiments. Prior research has demonstrated that the preference hierarchies identified by the multiple stimulus without replacement (MSWO) preference assessment are generally stable over time. This stability has been demonstrated with tangible and edible items, yet the extent to which that stability can be expected for other types of stimuli remains unknown. The current study tested the 2-month stability of the MSWO preference assessment in the context of college students' preferred sexual partners. Adequate stability was shown in most cases, suggesting generality of the stability of preference across tasks, populations, and stimuli.

Comparing the results of one-session, two-session, and three-session MSWO preference assessments

The multiple-stimulus-without-replacement (MSWO) preference assessment is commonly used in behavior-analytic research and practice. As originally published, the MSWO included 5 sessions in an effort to confirm stimulus preferences. Subsequent researchers have evaluated the validity of MSWO outcomes when the assessment is abbreviated. Generally, valid outcomes have been noted for 3-session MSWOs (that is, the outcomes match those of the 5-session version), while validity outcomes for 1- or 2-session MSWOs have varied across studies. The current study utilized data from 157 MSWO preference assessments conducted in previously published research with 49 total participants and analyzed the extent to which 1-session or 2-session variations of those assessments would have yielded similar outcomes as a 3-session assessment. Results indicate that the hierarchies produced by both abbreviated formats were strongly correlated with those produced by a 3-session assessment. However, neither 1- nor 2-session MSWOs reliably identified the same highest-preferred stimuli as a 3-session MSWO.

Priorities and Preferences of People Living with Dementia or Cognitive Impairment - A Systematic Review

BACKGROUND

Knowledge about the priorities and preferences of people living with dementia (PwD) might help to individualize treatment, care, and support, which could improve patient-related outcomes. This study aimed to summarize preferences of PwD or people with mild cognitive impairment (MCI), considering all relevant aspects of health care and everyday life.

METHODS

We conducted a systematic literature review and included studies about patient preferences published in English between January 1, 1990 and October 28, 2019. The inclusion criteria were that preferences were elicited directly by PwD or patients with MCI. We used the International Consortium for Health Outcomes Management value set for dementia to categorize the preferences into the following topics: a) clinical status, b) symptoms, functioning, and quality of life, and c) sustainability of care.

RESULTS

Of 578 initially identified studies, 45 met the inclusion criteria. Patients preferred to be informed about the diagnosis as early as possible, especially for anticipatory care planning. They ranked caregiver quality of life as their highest priority. They preferred not to be a burden to others more than their caregivers' mood, their own functional status, or their own distressing behaviors. Furthermore, PwD are eager to participate in medical decisions, especially in those about creating an everyday life routine. PwD preferred their own quality of life, self-efficacy, and emotional well-being. Institutionalized PwD preferred individualized and person-centered care. According to the sustainability of care, PwD preferred to maintain close bonds with their family at the end of their life and wanted to be treated with empathy.

CONCLUSION

This systematic review provides essential insights into cognitively impaired patients' preferences, which are rarely considered in treatment, care, and support services. Further studies should evaluate whether considering preferences in treatment and care or daily living can improve patient-reported outcomes.

An Assessment Method for Identifying Acceptable and Effective Ways to Present Demands to an Adult With Dementia

Simple instructions are often recommended for presenting demands to people with dementia; however, simple instructions may be perceived as authoritative and may not be appropriate for all individuals. We conducted a demand assessment with a woman with dementia who engaged in problem behaviors in response to direct instructions. We measured latency to compliance and verbal behavior when demands were presented as questions, rules, simple instructions, or demands embedded in social chatter. In contrast to the other conditions, simple instructions resulted in the most undesirable behavior and were least likely to evoke compliance. We conducted an intervention in which demands were phrased as requests for assistance.

The Use of Stimulus Preference Assessments for Persons with Neurocognitive Disorder: A Literature Review

Objectives: Stimulus preference assessments are a systematic, observation-based approach for identifying preferences among individuals with impaired communication skills. The purpose of this paper is to provide a review of the existing empirical literature that has utilized these methods with persons who have neurocognitive disorder (NCD).Methods: Studies were identified by searching online databases using a variety of search terms. Articles were included in the review if they were peer-reviewed, in English, were empirical in nature, and conducted a stimulus preference assessment with older adults diagnosed with NCD.Results: Eleven articles met the search criteria. Results revealed that data from stimulus preference assessments could increase activity engagement, increase requests for preferred items, identify reinforcers, and reduce behavioral and psychological symptoms.Conclusions: A small body of empirical literature suggests that data derived from stimulus preference assessments can be used to improve the lives of persons with NCD and their caregivers. Additional research is needed, however, to determine how effectively these procedures can be implemented into everyday practice in long-term care facilities.Clinical Implications: Stimulus preference assessments may provide a clinically useful means for efficiently identifying preferences in persons with severe NCD who cannot verbalize their needs.

Preference for leisure items over edible items in individuals with dementia: A replication

We replicated previous research in which adults with dementia tended to show a preference for leisure items over edible items when presented in the same array. Additionally, we conducted engagement analyses with the highest, middle, and lowest preference leisure items to determine whether relative preference corresponded to engagement in the natural environment. The most highly preferred stimulus for 6 out of 7 participants was a leisure item, and for each of those six the top 3 preferred stimuli were leisure stimuli. For 4 participants, the most preferred stimulus also produced the longest duration of engagement. We discuss the issues we encountered when conducting preference assessments with adults with intact vocal verbal repertoires, and suggest potential explanations for the displacement of edibles by leisure stimuli in older adults with dementia.

Behavior-Analytic Approaches to Working with People with Intellectual and Developmental Disabilities who Develop Dementia: a Review of the Literature

Behavior analysis has made contributions in the development of evidence-based interventions for people with intellectual and developmental disabilities (IDD), and there is a growing evidence base for behavior-analytic interventions for older adults with dementia. As there is an increased number of adults with IDD living to old age, and an increased prevalence of comorbid dementia in people with IDD, a review of the behavior-analytic contributions with this population is warranted. We searched Web of Science and PsycInfo and manually reviewed the last 20 years of five behavioral journals. Six behavior-analytic studies with people with IDD and dementia were identified, and all but one were published outside of core behavior-analytic journals. These articles were analyzed in terms of Baer, Wolf, and Risley's (Journal of Applied Behavior Analysis, 1, 91-97, 1968) seven dimensions of applied behavior analysis (ABA). The possible explanations and implications of these findings are discussed with consideration of the unique features of a comorbid diagnosis of IDD and dementia that may make it appropriate for increased focus in behavior-analytic research and practice.