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Donnelly LJ, Cervantes PE, Guo F, Stein CR, Okparaeke E, Kuriakose S, Filton B, Havens J, Horwitz SM. Changes in Attitudes and Knowledge after Trainings in a Clinical Care Pathway for Autism Spectrum Disorder. J Autism Dev Disord 2023; 53:606-614. [PMID: 33201422 DOI: 10.1007/s10803-020-04775-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 12/12/2022]
Abstract
Caring for individuals with autism spectrum disorder (ASD) can be complicated, especially when challenging behaviors are present. Providers may feel unprepared to work with these individuals because specialized training for medical and social service providers is limited. To increase access to specialized training, we modified an effective half-day ASD-Care Pathway training (Kuriakose et al. 2018) and disseminated it within five different settings. This short, focused training on strategies for preventing and reducing challenging behaviors of patients with ASD resulted in significant improvements in staff perceptions of challenging behaviors, increased comfort in working with the ASD population, and increased staff knowledge for evidence-informed practices. Implications, including the impact of sociodemographic characteristics on pre/post changes, and future directions are discussed.
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Affiliation(s)
- Lauren J Donnelly
- Child Study Center, Department of Child and Adolescent Psychiatry, NYU Langone, New York, NY, 10016, USA.
| | - Paige E Cervantes
- Child Study Center, Department of Child and Adolescent Psychiatry, NYU Langone, New York, NY, 10016, USA
| | - Fei Guo
- Child Study Center, Department of Child and Adolescent Psychiatry, NYU Langone, New York, NY, 10016, USA
- Division of Biostatistics, Department of Population Heath, NYU Langone, New York, NY, USA
| | - Cheryl R Stein
- Child Study Center, Department of Child and Adolescent Psychiatry, NYU Langone, New York, NY, 10016, USA
| | - Eugene Okparaeke
- Child Study Center, Department of Child and Adolescent Psychiatry, NYU Langone, New York, NY, 10016, USA
- Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY, USA
| | - Sarah Kuriakose
- Child Study Center, Department of Child and Adolescent Psychiatry, NYU Langone, New York, NY, 10016, USA
- New York State Office of Mental Health, Albany, NY, USA
| | - Beryl Filton
- Child Study Center, Department of Child and Adolescent Psychiatry, NYU Langone, New York, NY, 10016, USA
- Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY, USA
| | - Jennifer Havens
- Child Study Center, Department of Child and Adolescent Psychiatry, NYU Langone, New York, NY, 10016, USA
- Office of Behavioral Health, NYC Health and Hospitals, New York, NY, USA
| | - Sarah M Horwitz
- Child Study Center, Department of Child and Adolescent Psychiatry, NYU Langone, New York, NY, 10016, USA
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2
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Ryan J, Rosales R, Rowe E. A review of response interruption and redirection: 2007–2021. BEHAVIORAL INTERVENTIONS 2022. [DOI: 10.1002/bin.1886] [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]
Affiliation(s)
- Joseph Ryan
- Department of Psychology University of Massachusetts Lowell Lowell Massachusetts USA
| | - Rocío Rosales
- Department of Psychology University of Massachusetts Lowell Lowell Massachusetts USA
| | - Emily Rowe
- Department of Psychology University of Massachusetts Lowell Lowell Massachusetts USA
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3
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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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4
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Shepley C, Shepley SB, Allday RA, Tyner-Wilson M, Larrow D. Evaluation of a Brief Family-Centered Service Provision Model for Treating Children's Severe Behavior: A Retrospective Consecutive Case Series Analysis. Behav Anal Pract 2021; 14:86-96. [PMID: 33732579 PMCID: PMC7900314 DOI: 10.1007/s40617-020-00487-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This article serves as an initial program evaluation of a service provision model for providing applied behavior analysis services to families with severe behavior needs. A retrospective consecutive case series design was used to evaluate the effectiveness, feasibility, and cost of the model. We analyzed records for all families served through the model from summer 2017 to fall 2018. A total of 55 families received services, with 87% of children having autism and 63% having an intellectual disability. Within-participant single-case experimental designs were used to evaluate the clinic's assessment procedures, and caregiver interviews were used to evaluate the feasibility and effectiveness of developed and implemented treatments. Conclusive assessment results were obtained for approximately 69% of children. For families that received treatment, 92% reported improved child behavior. Intent-to-treat analyses that included families that withdrew from services prior to receiving treatment indicated that 61% of families experienced improved child behavior. Assessment and treatment outcomes for families that attended all appointments are commensurate with those of other similar clinics reported in the literature; however, the percentage of families that withdrew from services is substantially higher. For families adhering to the clinic's services, children's challenging behavior may be effectively assessed and treated through brief outpatient contacts utilizing services based on applied behavior analysis.
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Affiliation(s)
- Collin Shepley
- Department of Early Childhood, Special Education, and Rehabilitation Counseling, College of Education, University of Kentucky, 229 Taylor Education Building, Lexington, KY 40506 USA
| | - Sally B. Shepley
- Department of Early Childhood, Special Education, and Rehabilitation Counseling, College of Education, University of Kentucky, 229 Taylor Education Building, Lexington, KY 40506 USA
| | - R. Allan Allday
- Department of Early Childhood, Special Education, and Rehabilitation Counseling, College of Education, University of Kentucky, 229 Taylor Education Building, Lexington, KY 40506 USA
| | - Melanie Tyner-Wilson
- Developmental-Behavioral Pediatrics, College of Medicine, University of Kentucky, Lexington, KY USA
| | - Daniel Larrow
- Developmental-Behavioral Pediatrics, College of Medicine, University of Kentucky, Lexington, KY USA
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Davis TN, Machalicek W, Scalzo R, Kobylecky A, Campbell V, Pinkelman S, Chan JM, Sigafoos J. A Review and Treatment Selection Model for Individuals with Developmental Disabilities Who Engage in Inappropriate Sexual Behavior. Behav Anal Pract 2016; 9:389-402. [PMID: 27920970 PMCID: PMC5118249 DOI: 10.1007/s40617-015-0062-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Some individuals with developmental disabilities develop inappropriate sexual behaviors such as public masturbation, disrobing, and touching others in an unwanted sexual manner. Such acts are problematic given the taboo nature of the behaviors and the potential for significant negative consequences, such as restricted community access, injury, and legal ramifications. Therefore, it is necessary to equip caregivers and practitioners with effective treatment options. The purpose of this paper is to review studies that have evaluated behavioral treatments to reduce inappropriate sexual behavior in persons with developmental disabilities. The strengths and weaknesses of each treatment are reviewed, and a model for treatment selection is provided.
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Affiliation(s)
| | | | | | | | | | | | | | - Jeff Sigafoos
- Victoria University of Wellington, Wellington, New Zealand
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Fitzpatrick SE, Srivorakiat L, Wink LK, Pedapati EV, Erickson CA. Aggression in autism spectrum disorder: presentation and treatment options. Neuropsychiatr Dis Treat 2016; 12:1525-38. [PMID: 27382295 PMCID: PMC4922773 DOI: 10.2147/ndt.s84585] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by persistent difficulties in social communication and social interaction, coupled with restricted, repetitive patterns of behavior or interest. Research indicates that aggression rates may be higher in individuals with ASD compared to those with other developmental disabilities. Aggression is associated with negative outcomes for children with ASD and their caregivers, including decreased quality of life, increased stress levels, and reduced availability of educational and social support. Therapeutic strategies including functional behavioral assessment, reinforcement strategies, and functional communication training may have a significant impact in reducing the frequency and intensity of aggressive behavior in individuals with ASD. Pharmacologic treatments, particularly the use of second-generation antipsychotics, may also be of some benefit in reducing aggression in individuals with ASD. With the ever-increasing rate of ASD diagnosis, development of effective therapeutic and pharmacologic methods for preventing and treating aggression are essential to improving outcomes in this disorder.
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Affiliation(s)
- Sarah E Fitzpatrick
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Laura Srivorakiat
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Logan K Wink
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ernest V Pedapati
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Craig A Erickson
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Kurtz PF, Chin MD, Robinson AN, O'Connor JT, Hagopian LP. Functional analysis and treatment of problem behavior exhibited by children with fragile X syndrome. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 43-44:150-166. [PMID: 26183339 DOI: 10.1016/j.ridd.2015.06.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 06/16/2015] [Accepted: 06/25/2015] [Indexed: 06/04/2023]
Abstract
The efficacy of function-based interventions for the treatment of severe problem behavior exhibited by individuals with intellectual and developmental disabilities (IDD) is well established. However, few studies have reported on behavioral interventions in fragile X syndrome (FXS) specifically. The present study is a consecutive case-series analysis that reports on functional analysis and treatment of problem behavior of nine children with FXS. Assessment findings were consistent with previous research indicating that among individuals with FXS, problem behavior is more commonly maintained by escape from demands and access to tangible items, relative to the broader population of individuals with IDD. Functional analysis-based behavioral interventions resulted in a mean reduction in problem behavior of 95.2% across the nine participants. Additionally, generalization of treatment effects from controlled clinical settings to home, school, and community was demonstrated. The current findings suggest that function-based behavioral interventions shown to be effective with the broader population of individuals with IDD are also effective for individuals with FXS. Our results in combination with those of previous studies describing functional analysis outcomes provide additional evidence for a unique functional behavioral phenotype for severe problem behavior in individuals with FXS. Implications of study findings for early intervention and prevention of problem behavior in children with FXS are discussed.
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Affiliation(s)
- Patricia F Kurtz
- Kennedy Krieger Institute, Baltimore, MD, United States; Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | | | - Ashley N Robinson
- Kennedy Krieger Institute, Baltimore, MD, United States; Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Julia T O'Connor
- Kennedy Krieger Institute, Baltimore, MD, United States; Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Louis P Hagopian
- Kennedy Krieger Institute, Baltimore, MD, United States; Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Matson JL, Cervantes PE. Assessing aggression in persons with autism spectrum disorders: an overview. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:3269-3275. [PMID: 25178710 DOI: 10.1016/j.ridd.2014.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 08/04/2014] [Indexed: 06/03/2023]
Abstract
Aggression is a commonly co-occurring problem with autism spectrum disorders (ASD). Comorbid aggression can be every bit as debilitating as core symptoms of ASD itself. As a result, careful identification of aggression, the context in which it occurs, and factors that maintain the behavior all have important implications for treatment. As a result, researchers have begun to develop methods and measures to assess aggression among persons with ASD. The purpose of this paper was to review measures that have been used to assess aggression among persons with ASD. We located 25 different assessment methods for both children and adults. The current status and future directions of this area of research are discussed.
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Machalicek W, McDuffie A, Oakes A, Ma M, Thurman AJ, Rispoli MJ, Abbeduto L. Examining the operant function of challenging behavior in young males with fragile X syndrome: a summary of 12 cases. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:1694-1704. [PMID: 24679547 DOI: 10.1016/j.ridd.2014.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 02/28/2014] [Accepted: 03/06/2014] [Indexed: 06/03/2023]
Abstract
This study used experimental functional analyses to examine the operant function of challenging behaviors exhibited by 12 males (ages 27-51 months) with fragile X syndrome (FXS). Eight children met criteria for negatively reinforced challenging behavior in the form of escape from demands and/or escape from social interactions. Nine children met criteria for positively reinforced challenging behavior in the form of obtaining access to highly preferred items. Attention was identified as a maintaining consequence for three children. The functional analysis was inconclusive for one child. Results suggest that, for young males with FXS, challenging behaviors may more likely be tangibly and escape maintained than attention maintained. Our findings affirm past research suggesting a unique behavioral phenotype for this population.
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Affiliation(s)
| | - Andrea McDuffie
- University of California-Davis MIND Institute, United States
| | - Ashley Oakes
- University of California-Davis MIND Institute, United States
| | - Monica Ma
- University of California-Davis MIND Institute, United States
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Falcomata TS, Muething CS, Gainey S, Hoffman K, Fragale C. Further Evaluations of Functional Communication Training and Chained Schedules of Reinforcement to Treat Multiple Functions of Challenging Behavior. Behav Modif 2013; 37:723-46. [DOI: 10.1177/0145445513500785] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We evaluated functional communication training (FCT) combined with a chained schedule of reinforcement procedure for the treatment of challenging behavior exhibited by two individuals diagnosed with Asperger syndrome and autism. Following functional analyses that suggested that challenging behavior served multiple functions for both participants, we implemented FCT in which mands for a discriminative stimulus (SD; wristband) were reinforced with access to the SD and all three functional reinforcers. Next, we modified the procedure by incorporating delays to increase ease of implementation and promote toleration of delays to reinforcement. Last, we made additional modifications to the procedure by incorporating a chained schedule of reinforcement such that (a) mands for the wristband were reinforced with access to the wristband and (b) specific mands for respective functional reinforcers were reinforced in the presence of the wristband. The results showed that the procedure successfully treated challenging behavior with multiple functions. Future directions in the evaluation and development of treatments that simultaneously address multiple functions are discussed.
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Geiger KB, Carr JE, Leblanc LA. Function-based treatments for escape-maintained problem behavior: a treatment-selection model for practicing behavior analysts. Behav Anal Pract 2012; 3:22-32. [PMID: 22479669 DOI: 10.1007/bf03391755] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Escape from instructional activities is a common maintaining variable for problem behavior and a number of effective treatments have been developed for this function. Each of these treatments has characteristics that make them optimal for certain environments and clients, but less optimal for others. We summarize the most commonly researched function-based treatments for escape-maintained behavior, describe the contexts for which they are most appropriate, and provide a clinical model for selecting treatments based on client characteristics and the constraints of the therapeutic environment.
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12
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Abstract
Early intensive behavioral intervention is the only well-established treatment for young children with autism spectrum disorders (ASDs). Less intensive behavioral interventions are also effective for targeted concerns with older children and adolescents. This article describes the core features of behavioral treatments, summarizes the evidence base for effectiveness, and provides recommendations to facilitate family understanding of these interventions and identification of qualified providers. Recommendations are also provided for collaboration between pediatric providers and behavior analysts who are serving families of individuals with ASDs.
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On the use of fluency training in the behavioral treatment of autism: a commentary. THE BEHAVIOR ANALYST 2010; 33:223-9. [PMID: 22532717 DOI: 10.1007/bf03392221] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The substantial demand for behavior-analytic treatment of early childhood autism has been associated with rapid dissemination of treatment procedures to practitioners and caregivers. This level of demand could plausibly induce premature dissemination of treatments that do not yet have sufficient empirical support. We argue that this might have happened with the use of fluency training for learners with autism and identify four areas of research that are necessary to ensure that dissemination efforts are better matched to the available empirical support for this instructional strategy.
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Abstract
PURPOSE OF REVIEW To provide a critical evaluation of a broad range of peer-reviewed published studies of relevance to self-injurious behaviour in people with intellectual disability and autism spectrum disorders. RECENT FINDINGS The review covers the prevalence of self-injurious behaviour, the characteristics of those showing the behaviour, self-injury in autism spectrum disorders, biological influences on self-injurious behaviour, behavioural assessment and psychological and pharmacological interventions. SUMMARY The recent literature describes systematic evaluation of the efficacy of aripiprazole, and parent training combined with risperidone. Meta-analyses of behavioural interventions provide evidence of their efficacy and related research describes beneficial modification to behavioural assessment procedures. The prevalence literature provides data on individual characteristics that are associated with persistence and presence of self-injury and that might be considered as risk markers. Pain behaviour appears to be associated with self-injury, with implications for theories of the involvement of endorphins, and as a causal factor. In combination, these research findings demonstrate the multiple influences on self-injurious behaviour that must be taken into account in the assessment, formulation, intervention process.
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Current World Literature. Curr Opin Neurol 2010; 23:194-201. [DOI: 10.1097/wco.0b013e328338cade] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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