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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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2
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King H, Martone L, Laureano B, Falligant JM. A systematic review of enhanced resurgence paradigms. J Exp Anal Behav 2024; 121:266-278. [PMID: 38287780 DOI: 10.1002/jeab.902] [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: 08/27/2023] [Accepted: 01/10/2024] [Indexed: 01/31/2024]
Abstract
Following successful treatment in which problem behavior is reduced, it may reemerge as a function of changes in contextual stimuli or the worsening of reinforcement conditions for an alternative response. Although understudied, preliminary research suggests that simultaneous changes in contextual stimuli and reinforcement conditions may represent particularly exigent treatment challenges that create the condition for additive or superadditive relapse. The purpose of the present review was to systematically examine the relapse literature involving simultaneous changes in contextual stimuli and reinforcement conditions in relapse tests and experimental preparations arranged to evaluate their effect on response recovery. We identified 16 empirical articles spanning 27 experiments. Although all experiments included at least one condition that experienced a change in contextual stimuli and worsening of alternative reinforcement conditions, only two experiments included the comparison conditions needed to precisely evaluate additive and superadditive relapse. Our findings establish the preclinical generality of relapse effects associated with simultaneous changes to reinforcement conditions and contextual stimuli across a range of subjects, schedule arrangements, response topographies, reinforcers, and types of contextual changes. We make several recommendations for future research based on our findings from this nascent and clinically relevant subdomain of the relapse literature.
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Affiliation(s)
- Hunter King
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lauren Martone
- Department of Educational Psychology, University of Utah, Salt Lake City, UT, USA
| | - Brianna Laureano
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John Michael Falligant
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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3
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Falligant JM, Kranak MP, Piersma DE, Benson R, Schmidt JD, Frank-Crawford MA. Further evidence of renewal in automatically maintained behavior. J Appl Behav Anal 2024; 57:490-501. [PMID: 38239100 PMCID: PMC10984774 DOI: 10.1002/jaba.1055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 01/03/2024] [Indexed: 02/08/2024]
Abstract
Renewal is a relapse phenomenon that refers to the recurrence of a previously reduced behavior following a change in stimulus conditions. Muething et al. (2022) examined the phenomenology of renewal among individuals with automatically maintained challenging behavior treated at an outpatient clinic. We replicated their findings by retrospectively examining renewal across various topographies of automatically maintained behavior treated at an inpatient hospital, and we extended their work by also examining differences across subtypes of automatically maintained self-injurious behavior. The prevalence of renewal was comparable to that observed by Muething et al., supporting the notion that automatically maintained challenging behavior is susceptible to relapse phenomena. Furthermore, renewal was twice as likely to occur for individuals with Subtype 2 versus Subtype 1 self-injurious behavior, providing additional evidence of behavioral differentiation between subtypes. Our findings suggest that even after apparent stability in treatment, practitioners should remain vigilant for the recurrence of automatically maintained behavior during generalization.
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Affiliation(s)
- John Michael Falligant
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Science, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Michael P. Kranak
- Department of Human Development and Child Studies, Oakland University, Rochester, MI, USA
- Center for Autism, Oakland University, Rochester, MI, USA
| | - Drew E. Piersma
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Ryan Benson
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Jonathan D. Schmidt
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Science, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Michelle A. Frank-Crawford
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Science, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
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4
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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: 12] [Impact Index Per Article: 12.0] [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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5
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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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6
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Contreras BP, Tate SA, Morris SL, Kahng S. A systematic review of the correspondence between descriptive assessment and functional analysis. J Appl Behav Anal 2023; 56:146-165. [PMID: 36409837 DOI: 10.1002/jaba.958] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 11/03/2022] [Indexed: 11/22/2022]
Abstract
Clinicians report that they often rely on descriptive assessments when developing behavior-reduction plans despite literature suggesting that functional analysis is the most rigorous assessment method. Further, research comparing the outcomes of descriptive assessments and functional analyses is mixed, with some studies showing low correspondence and others showing high correspondence. Such persistent use of descriptive assessments suggests that they may yield useful information despite inconsistent correspondence with functional analyses. A more fine-grained analysis of the relation between descriptive assessments and functional analyses may elucidate variables affecting their utility. We conducted a review of 48 studies that included descriptive assessments and functional analyses and evaluated several measures of correspondence between each pair of assessments. Results indicated that descriptive assessments had exact correspondence with functional analyses in 50% of comparisons. Results also suggested that descriptive assessments were more likely to accurately identify and predict the absence of a function relative to the presence of a function and that structured descriptive assessments were more likely to accurately predict functions.
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Affiliation(s)
| | | | | | - SungWoo Kahng
- Department of Applied Psychology, Rutgers University
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7
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ABA and ABC Renewal during Ongoing Omission Training. PSYCHOLOGICAL RECORD 2022. [DOI: 10.1007/s40732-022-00524-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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8
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Keevy M, Bai JY, Ritchey CM, Podlesnik CA. Examining combinations of stimulus and contingency changes with children diagnosed with autism spectrum disorder and pigeons. LEARNING AND MOTIVATION 2022. [DOI: 10.1016/j.lmot.2022.101806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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9
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Berdeaux KL, Lerman DC, Williams SD. Effects of environmental distractions on teachers' procedural integrity with three function-based treatments. J Appl Behav Anal 2022; 55:832-850. [PMID: 35377494 DOI: 10.1002/jaba.918] [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: 04/06/2021] [Accepted: 02/23/2022] [Indexed: 11/08/2022]
Abstract
Past research has demonstrated the effectiveness of teacher-implemented, function-based treatments for problem behavior, but no studies have evaluated the impact of distractions on teachers' procedural integrity. In this proof-of-concept study, the experimenters employed a laboratory analog to examine the impact of distractions on levels of integrity when 5 teachers implemented 3 different treatments. Although integrity was similar across treatments when the setting was free of distractions, integrity declined for all teachers in the presence of student-driven distractions. In general, distractions had a greater impact on the integrity of differential negative reinforcement of alternative behavior (DNRA) compared to differential negative reinforcement of other behavior (DNRO) and noncontingent escape (NCE), particularly for the delivery of reinforcement. However, teachers tended to have lower levels of integrity when responding to problem behavior during DNRO. These findings support the potential viability of this approach for studying factors that impede procedural integrity in the classroom.
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Affiliation(s)
- Kally L Berdeaux
- Department of Clinical, Health, and Applied Sciences, University of Houston, Clear Lake
| | - Dorothea C Lerman
- Department of Clinical, Health, and Applied Sciences, University of Houston, Clear Lake
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10
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Finch KR, Kestner KM, Amanieh H. ABA and ABC Renewal during an Ongoing Fixed-Time Schedule. PSYCHOLOGICAL RECORD 2022. [DOI: 10.1007/s40732-022-00513-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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11
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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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12
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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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13
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Ritchey CM, Kuroda T, Podlesnik CA. Evaluating effects of context changes on resurgence in humans. Behav Processes 2021; 194:104563. [PMID: 34871750 DOI: 10.1016/j.beproc.2021.104563] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/23/2021] [Accepted: 12/01/2021] [Indexed: 12/29/2022]
Abstract
Laboratory models of relapse provide methods for evaluating challenges to behavioral treatments with differential reinforcement of an alternative response (DRA). Resurgence occurs with the worsening of conditions of reinforcement for appropriate behavior and renewal occurs when transitioning out of a treatment context. Across five experiments, participants recruited via online crowdsourcing pressed onscreen buttons to earn points exchangeable for money and contexts sometimes changed through changes in the background image. Returning to the training context (ABA, Experiment 1) and transitioning to a novel context (ABC, Experiment 2) produced greater resurgence when removing alternative reinforcement in comparison with remaining in the treatment context (ABB). In contrast, we observed little difference in resurgence among AAA, ABB, and AAC context manipulations (Experiment 3) and ABA, ABC, and AAC context manipulations (Experiment 4). In Experiment 5, we evaluated relative contributions of the presence versus absence of context changes (ABA vs. ABB) in combination with or without the removal of alternative reinforcement. Both changing context and removing alternative reinforcement increased responding in isolation and the combination produced greater-than-additive effects. Overall, the present findings demonstrate a consistent effect of removing alternative reinforcement on relapse that, under certain conditions, can be enhanced by context change.
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14
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Muething C, Call N, Ritchey CM, Pavlov A, Bernstein AM, Podlesnik CA. Prevalence of relapse of automatically maintained behavior resulting from context changes. J Appl Behav Anal 2021; 55:138-153. [PMID: 34734646 DOI: 10.1002/jaba.887] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 11/07/2022]
Abstract
Increases in behavior due to context changes are common and are known as instances of renewal. Clinically relevant examples from the literature highlighting renewal often include socially mediated problem behaviors. This report retrospectively analyzed data during context changes for individuals who engaged in problem behavior maintained by automatic reinforcement, to evaluate the prevalence of relapse. Problem behavior reemerged during changes both in the person implementing treatment (e.g., introducing a caregiver; 36%) and in the setting (e.g., introducing treatment in the home; 26%). Most prevalence studies report greatest relapse immediately following context changes but the highest level of relapse was observed after 5 sessions following person changes and no systematic pattern with setting changes. These patterns of relapse likely reflect differences in the function of settings and people relative to automatically reinforced behavior in the present study. Implications of relapse for treatments of problem behavior maintained by automatic reinforcement are discussed.
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Affiliation(s)
- Colin Muething
- Marcus Autism Center, Emory University School of Medicine
| | - Nathan Call
- Marcus Autism Center, Emory University School of Medicine
| | | | - Alexis Pavlov
- Marcus Autism Center, Emory University School of Medicine
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15
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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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16
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Falligant JM, Kranak MP, McNulty MK, Schmidt JD, Hausman NL, Rooker GW. Prevalence of renewal of problem behavior: Replication and extension to an inpatient setting. J Appl Behav Anal 2020; 54:367-373. [PMID: 32578889 DOI: 10.1002/jaba.740] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/13/2020] [Accepted: 05/13/2020] [Indexed: 11/09/2022]
Abstract
Individuals with intellectual and developmental disabilities who exhibit problem behavior often receive behavioral assessment and treatment in specialized inpatient and outpatient clinics. However, problem behavior sometimes reemerges as a function of changes in contexts and stimulus conditions, such as returning to the home environment. This reemergence is called renewal. Recently, Muething et al. (2020) found that renewal occurred in over half (67%) of cases from an outpatient clinic. Their sample was obtained exclusively from an outpatient setting and despite the applied relevance of renewal, its clinical prevalence in other populations is unknown. Accordingly, we replicated Muething et al.'s procedures and analyzed renewal in 37 inpatient treatment applications across 34 cases via consecutive-controlled case series. Renewal was present in 59% of cases; however, we found that renewal occurred in only 24% of context changes compared to 42% reported by Muething et al. Various factors related to the prevalence of renewal were evaluated.
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Affiliation(s)
| | - Michael P Kranak
- Kennedy Krieger Institute.,Johns Hopkins University School of Medicine
| | | | | | - Nicole L Hausman
- Kennedy Krieger Institute.,Johns Hopkins University School of Medicine
| | - Griffin W Rooker
- Kennedy Krieger Institute.,Johns Hopkins University School of Medicine
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