The functions of self-injurious behavior: an experimental-epidemiological analysis

Consistent Visual Analysis of Multielement Data: A Preliminary Evaluation

Experimenters provided 33 graphical displays of hypothetical data depicted in a multielement experimental design to editorial board members of prominent, applied, behavior-analytic journals via an online survey. For each display, participants indicated (a) the presence or absence of experimental control and (b) the degree of experimental control (rated on a 1-100 scale). Each depiction varied systematically in (a) the number of data paths, (b) the number of data paths elevated above the control, (c) the mean difference between affected data paths and control conditions, and (d) the degree of variability within conditions. Correspondence among experts' ratings of experimental control was high across all presented graphical displays, supporting the reliability of visual analysis as an evaluative tool for these designs.

Problems with "problem behavior": A secondary systematic review of intervention research on transition-age autistic youth

LAY ABSTRACT

In a previous study, we looked at research done on strategies to support autistic people who were between 14 and 22 years old. For this study, we looked at all of the studies in our previous study that tried to decrease or stop autistic people from doing certain things-many researchers call these things "problem behavior." There were 48 studies that tried to reduce problem behavior, and most of them used strategies like prompting and reinforcement to try get autistic people to change their behavior. We found many things wrong with these studies. Most of them did not define the group of behaviors they were trying to stop autistic people from doing. None of the studies looked at whether any side effects happened when they tried the strategy they were studying. Also, most of the studies tried to stop autistic people from doing behaviors that probably were not harmful, like stereotypic behavior. Most of the studies did not say how they decided that the behaviors they tried to stop were a problem for the autistic people in the study, and most studies did not try to figure out why the autistic people in the study did the behaviors the researchers were trying to stop them from doing.

Predicting Problematic Behavior in Autism Spectrum Disorder Using Medical History and Environmental Data

Autism spectrum disorder (ASD), characterized by social, communication, and behavioral abnormalities, affects 1 in 36 children according to the CDC. Several co-occurring conditions are often associated with ASD, including sleep and immune disorders and gastrointestinal (GI) problems. ASD is also associated with sensory sensitivities. Some individuals with ASD exhibit episodes of challenging behaviors that can endanger themselves or others, including aggression and self-injurious behavior (SIB). In this work, we explored the use of artificial intelligence models to predict behavior episodes based on past data of co-occurring conditions and environmental factors for 80 individuals in a residential setting. We found that our models predict occurrences of behavior and non-behavior with accuracies as high as 90% for some individuals, and that environmental, as well as gastrointestinal, factors are notable predictors across the population examined. While more work is needed to examine the underlying connections between the factors and the behaviors, having reasonably accurate predictions for behaviors has the potential to improve the quality of life of some individuals with ASD.

Repetitive Speech and Problem Behavior: Functional Analysis of Precurrent Contingencies

When mands and problem behavior co-occur within an individual's repertoire, a functional analysis of precurrent contingencies helps to identify any relation between the two responses, as well as the function of problem behavior. Repetitive behaviors may function similarly to mands and also co-occur with problem behavior; particularly when repetitive behavior is blocked, or when caregivers refrain from participating in repetitive behavior episodes (e.g., the repetitive behavior involves a verbal or physical interaction with a caregiver). The current study presents assessment and treatment results for two participants diagnosed with autism, who demonstrated repetitive speech and problem behavior. Informal observations suggested that problem behavior occurred when an adult failed to emit a specific response to the participant's repetitive speech. Functional analysis results confirmed the informal observations and suggested that problem behavior functioned as a precurrent response to increase the probability of reinforcement for repetitive speech. We report treatment results and discuss the application of precurrent contingency analyses for problem behavior and repetitive behavior.

Contingent Electric Skin Shock: An Empirical or Ideological Issue?

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.

Barriers to Accessing Effective Treatments for Destructive Behavior

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.

Is language ability associated with behaviors of concern in autism? A systematic review

This review systematically synthesized evidence on the association between structural language ability and behaviors of concern (BoC) in autism. Four databases were searched for studies that included >10 autistic participants, measures of structural language (content and/or form of language) and BoC, and an analysis of their association. BoCs included self-injurious behavior (SIB), aggression, tantrums, and externalizing behavior. Methodological quality of studies were assessed using the Newcastle Ottawa Scale. Forty-five publications (n = 11,961) were included. Forty studies were cross-sectional and five were prospective cohort studies. Over 70% of the studies investigating expressive language and SIB (n = 10), aggression (n = 5), tantrums (n = 3), and externalizing behavior (n = 17) reported an inverse association, where lower expressive language ability was associated with increased BoC. Eleven out of sixteen studies of combined expressive and receptive language reported an inverse relationship with SIB or aggression. All outcomes were rated as moderate to very low certainty of evidence. This review highlights evidence showing an inverse association between expressive or combined language ability and SIB, and externalizing behavior in autism. However, further high-quality studies that use standardized, consistent measures of language and behavior and investigate longitudinal associations are needed. Early detection and support for reduced structural language difficulties have substantial potential to assist in reducing BoC.

Basic and applied research on extinction bursts

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.

Mapping the time course of overt emotion dysregulation, self-injurious behavior, and aggression in psychiatrically hospitalized autistic youth: A naturalistic study

Challenges with emotion dysregulation, self-injurious behavior (SIB), and aggression are common in autistic individuals. Prior research on the relationships between these behaviors is limited mainly to cross-sectional correlations of parent-report data. Understanding how emotion dysregulation, SIB, and aggression present and relate to one another in real-time could add to our understanding of the context and function of these behaviors. The present study examined the real-time occurrence and temporal relationships between these behaviors in 53 psychiatrically hospitalized autistic youth. Over 500 hours of behavioral observation occurred during everyday activities in the hospital. Start and stop times for instances of overt emotion dysregulation, SIB, and aggression were coded live using a custom mobile phone app. Results indicated large individual variability in the frequency and duration of these behaviors and their co-occurrence. Both SIB and aggression co-occurred with overt emotion dysregulation at above-chance levels, suggesting a role for emotional distress in the occurrence of these behaviors. However, there was substantial variability within and between individuals in co-occurrence, and SIB and aggression often (and for some individuals, almost always) occurred without overt emotion dysregulation. Relatedly, cross-recurrence quantitative analysis revealed that SIB and aggression preceded emotion dysregulation more often than emotion dysregulation preceded SIB and aggression. Future research, perhaps using ambulatory psychophysiological measures, is needed to understand whether emotion dysregulation may sometimes be present but not easily observed during SIB and aggression. LAY SUMMARY: This study provides insight into how overt emotion dysregulation (i.e., visible distress), aggression, and self-injury unfold in real-time for autistic individuals. Participants were 53 autistic youth staying in a psychiatric hospital. Research staff observed participants in everyday activities on the hospital unit and noted instances of aggression, self-injurious behavior, and emotion dysregulation. Results suggest that aggression and self-injury sometimes occur with visible signs of distress but also often occur without visible distress. In addition, observable distress was more common in the moments after these behaviors than in the moments before.

Management of self-injurious behaviour, reducing restrictive interventions and predictors of positive outcome in intellectual disability and/or autism

Perceptions of self-injurious behaviour as refractory to treatment, and of treatment outcomes as unpredictable, in children and adults with intellectual disabilities and/or autism may lead to treatment inertia or nihilism, restrictive practices and overuse of psychotropic medication in its management. Recent research suggests, however, that from infancy to young adulthood prospects for a positive outcome are fair, and markers predictive of treatment outcome have begun to be identified. In this clinical reflection we briefly describe this work, consider how it may contribute to case stratification, and outline current thinking on further functional differentiation of cases of SIB, promoting non-restrictive practices.

Updated Strategies for Making Regular Contact With the Scholarly Literature

The Ethics Code for Behavior Analysts (Behavior Analyst Certification Board, 2020a) states that behavior analysts must provide services based on the published scientific evidence (Code 2.01, "Providing Effective Treatment") and maintain competence by reading relevant scholarly literature (Code 1.06, "Maintaining Competence"). Carr and Briggs (2010) acknowledged several potential barriers that might prevent behavior analysts from pursuing this obligation and offered helpful recommendations for circumventing these barriers. Although the nature of these barriers has primarily stayed the same since the publication of Carr and Briggs, the profession and field have grown more complex over the past decade, and several additional barriers have emerged. Luckily, technological advances and resources recently made available offer additional solutions for behavior analysts to consider adopting. Therefore, the purpose of this article is to provide an update to the strategies described by Carr and Briggs for overcoming barriers related to searching the literature, accessing journal content, and contacting the contemporary literature. In addition, we conclude with how leaders might incorporate the proposed strategies into their organization at a systems-wide level.

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.

Conducting In-Home Functional Analyses of Aggression and Self-Injury Exhibited by Boys with Fragile X Syndrome

OBJECTIVE

Boys with fragile X syndrome (FXS) are at increased risk for exhibiting aggression and self-injury that can be extremely disruptive to families. Few studies, however, have examined the extent to which social-environmental factors can influence these behaviors, particularly in home settings.

METHODS

Caregivers of 32 boys with FXS, aged 3 to 10 years, were coached by a board-certified behavior analyst to implement a functional analysis (FA) with their child in their home over 2 days. The functions identified in the FAs were validated by behavioral interventions conducted through telehealth over 12 weeks.

RESULTS

Social functions for aggression and self-injury were identified in 29 (90.6%) cases, with the most common functions identified being escape from demands/transitions and/or tangible reinforcement. Subsequent function-based behavioral interventions (i.e., functional communication training) implemented for 22 cases by telehealth resulted in decreased rates of aggression and self-injury by 74% to 100%.

CONCLUSION

These data underscore the significant impact that social-environmental factors can have on the development and maintenance of aggression and self-injury in FXS. Conducting early home-based behavioral interventions designed to increase functional communication skills may therefore be an effective solution for the treatment of aggression and self-injury in FXS in the long term.

The roles of school in supporting LGBTQ+ youth: A systematic review and ecological framework for understanding risk for suicide-related thoughts and behaviors

The extant literature on suicide-related thoughts and behaviors (STB) has highlighted increased patterns of risk among specific minoritized populations, including lesbian, gay, bisexual, transgender, questioning, intersex, two spirit, and queer (LGBTQ+) youth. Compared to their heterosexual and cisgender peers, LGBTQ+ youth are at increased risk for having STB. Identity-specific stressors such as homonegativity and anti-queerness are among the unique factors posited to contribute to this risk and inhibit factors that protect against suicide. The school setting has been a focal point for suicide prevention and intervention and may also play a key role in linking students to care; however, schools also hold the potential to provide supports and experiences that may buffer against risk factors for STB in LGBTQ+ students. This systematic literature review presents findings from 44 studies examining school-related correlates of STB in LGBTQ+ students, informing an ecological approach to suicide prevention for school settings. Findings underscore the importance of school context for preventing STB in LGBTQ+ youth. Approaches that prioritize safety and acceptance of LGBTQ+ youth should span multiple layers of a student's ecology, including district and state level policies and school programs and interventions, such as Gender and Sexuality Alliances and universal bullying prevention programs. Beyond their role as a primary access point for behavioral health services, schools offer a unique opportunity to support suicide prevention by combating minority stressors through promoting positive social relationships and a safe community for LGBTQ+ students.

Translating Quantitative Theories of Behavior into Improved Clinical Treatments for Problem Behavior

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.

A Neurobehavioral Continuum of Care for Individuals with Intellectual and Developmental Disabilities with Severe Problem Behavior

The Neurobehavioral Programs at Kennedy Krieger Institute constitute a comprehensive continuum of care designed to serve individuals with intellectual and developmental disabilities with co-occurring problem behavior. This continuum includes inpatient, intensive outpatient, outpatient, consultation, and follow-up services. The mission of these programs is to fully integrate patient care, research, training, and advocacy to achieve the best possible outcomes with patients, and to benefit the broader community of individuals with severe behavioral dysfunction. The primary treatment approach utilized across all programs is applied behavior analysis, however the inpatient unit also provides fully integrated interdisciplinary care. Factors driving the development and expansion of these programs are described, as are the processes and systems by which the mission objectives are achieved.

On the role of operant contingencies in the maintenance of inappropriate mealtime behavior: An epidemiological analysis

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.

Machine Learning for Supplementing Behavioral Assessment

The Questions About Behavioral Function (QABF) has a high degree of convergent validity, but there is still a lack of agreement between the results of the assessment and the results of experimental function analysis. Machine learning (ML) may improve the validity of assessments by using data to build a mathematical model for more accurate predictions. We used published QABF and subsequent functional analyses to train ML models to identify the function of behavior. With ML models, predictions can be made from indirect assessment results based on learning from results of past experimental functional analyses. In Experiment 1, we compared the results of five algorithms to the QABF criteria using a leave-one-out cross-validation approach. All five outperformed the QABF assessment on multilabel accuracy (i.e., percentage of predictions with the presence or absence of each function indicated correctly), but false negatives remained an issue. In Experiment 2, we augmented the data with 1,000 artificial samples to train and test an artificial neural network. The artificial network outperformed other models on all measures of accuracy. The results indicated that ML could be used to inform conditions that should be present in a functional analysis. Therefore, this study represents a proof-of-concept for the application of machine learning to functional assessment.

Educational Interventions for Children and Youth with Autism: A 40-Year Perspective

Commemorating the 40 th anniversary of the Diagnostic and Statistical Manual (DSM) III, the purpose of this commentary is to describe school-based and school-relevant interventions and instructional approaches for children and youth with autism that have been developed and employed during that time period. The commentary begins with a brief description of foundational research that provides an historical context. Research themes shaped by science, ethics, social policy, and the changes in the DSM provide an organization for describing the evolution of intervention and instructional practices over the four previous decades. The commentary concludes with a discussion of school-contextual variables that influence implementation and the promise of the "iSciences" for closing the research to practice gap in the future.

On the generality of preference for contingent reinforcement

Reinforcers can be delivered dependent on or independent of responding. Both human and nonhuman animals have shown a preference for contexts involving contingent reinforcement, but the generality of this phenomenon to humans and its implications have not yet been described. We present an integrative summary of studies evaluating preference for contingent versus noncontingent reinforcement, including (a) study participants, reinforcer types, response topographies, and contexts; (b) outcomes; (c) potential variables influencing preference outcomes; and (d) suggestions regarding research to expand behavior analysts' ability to design preferred contexts.

An Exploration of Emergency Department Visits for Home Unintentional Injuries Among Children With Autism Spectrum Disorder for Evidence to Modify Injury Prevention Guidelines

OBJECTIVES

Current childhood injury prevention guidance is anchored by a child's age. For example, children are considered at high risk for falls at ages 4 years and less, and guidance for prevention focuses on these ages. However, these guidelines may not be adequate for children with autism spectrum disorders (ASD).

METHODS

This retrospective chart review examined injury characteristics for children with ASD receiving treatment in a pediatric emergency department between 2014 and 2016. Bivariate statistics determined injury demographic correlates. Chart narratives were also coded using traditional content analysis to determine the mechanism that caused the home injury.

RESULTS

The sample (27 cases) was mostly male (89%), Black (48%), with a mean age of 7.8 (SD, 4.9) years. The most common mechanism was a fall (44%), followed by self-injurious behavior (33%), and then burns (22%). All cases identified at least 1 mechanism contributing to the injury, in 2 cases, 2 items were mentioned. Of the 29 items identified, most involved a house feature that was not stairs (24%); some included stairs, furniture, or a combination of foreign object and grill (21%); and few identified food/beverage/liquid (11%).

CONCLUSIONS

Analyses suggest that unintentional home injury prevention for children with ASD may require prevention guidance extended through older ages.

A quantitative analysis of accuracy, reliability and bias in judgements of functional analyses

Functional analysis can be considered a diagnostic assessment that behavior analysts use to determine behavioral function. Such a diagnosis ultimately requires a yes or no decision (i.e., a variable maintains a behavior, or it does not) that is determined by both subjective (clinical judgement) and objective (data) variables. Accurate and reliable identification of function is essential for successful treatment, yet behavior analysts' interpretation of data relies on their ability to detect visual differences in graphed data. Some research indicates that behavior analysts have questionable reliability in their visual analysis. To further examine the reliability, accuracy, and bias in visual analysis of functional analysis graphs, we simulated functional analysis results and surveyed 121 BCBA-Ds experienced in visual analysis. We then examined reliability of responses and used a signal detection theory approach to analyze accuracy and bias. Findings suggest that reliability and accuracy of judgements are questionable, and exploration of decision aids is warranted.

Using Functional Communication Training to Reduce Self-Injurious Behavior for Individuals with Autism Spectrum Disorder

Children with autism spectrum disorders (ASD) have a high risk of developing self-injurious behavior (SIB), which is often a result of deficits in communication skills. The use of functional communication training (FCT) to address SIB maintained by negative reinforcement among children with ASD is supported by an emerging trend of behavioral research. The purpose of this study was to examine the effects of FCT on the SIB of children with ASD and to find out if the results would be maintained during periods of nonreinforcement. The results indicated significant reduction in SIB for all three participants and maintained for over two weeks following the withdrawal of the intervention. However, resurgence of SIB occurred when extinction was implemented for all participants.

Accumulated and distributed response-reinforcer arrangements during the treatment of escape-maintained problem behavior

Contingent positive reinforcement has proven more effective in treating escape-maintained problem behavior than contingent negative reinforcement, particularly when problem behavior continues to produce escape. However, this research has overwhelmingly used distributed-reinforcement arrangements, where tasks and reinforcer access are interspersed throughout the work period. An alternative to interspersal involves allowing the individual to accumulate and then receive a larger quantity of reinforcement once work requirements are completed; this is known as an accumulated-reinforcement arrangement. The current study examined the efficacy of, and preference for positive (food) and negative (break) reinforcement contingencies delivered in accumulated and distributed arrangements in the treatment of escape-maintained problem behavior. In Experiment 1, accumulated break was preferred for 4 of 5 participants and accumulated food was preferred for 3 of 5. In Experiment 2, accumulated break was similarly effective to distributed break for 3 of 5 participants and accumulated and distributed food were equally effective for 4 participants.

Assessment of children's and caregivers' preferences for treatments for escape-maintained problem behavior

This study assessed children's and caregivers' preferences for various arrangements of negative reinforcement, including differential negative reinforcement of an alternative behavior (DNRA), noncontingent escape (NCE), and escape extinction. In the first treatment comparison, the DNRA and NCE treatments similarly decreased problem behavior, but all 3 children preferred DNRA. By contrast, 3 of 4 caregivers preferred escape extinction, likely due to increased compliance in this condition. In a second treatment comparision with 1 child, a multiple schedule and then a chained schedule were introduced to increase the practically of the initial DNRA treatment. The child continued to prefer the treatment with contingent reinforcement in both comparisons, and his caregivers preferred the chained schedule. Results further support the selection of treatments that include contingent reinforcement, and the evaluation serves as a model for progressing through treatment options until child and caregiver preferences align.

Self-Injurious behavior in rhesus macaques: Issues and challenges

Some monkeys housed in research facilities develop abnormal behavior ranging from stereotypic to the more serious condition of self-injurious behavior (SIB). We initially sought to understand how and why monkeys engaged in SIB and more importantly why only a small percentage of laboratory monkeys, with seemingly similar housing and background, developed this disorder. Of particular importance was the recognition that different pathways might lead to SIB and that strong individual differences would affect the manifestation of this disorder and the response to treatment. We developed a comprehensive plan to identify effective treatment and prevention strategies. We started with characterizing the disorder in terms of prevalence and types of environments in which it was found. We then conducted observations on a cohort of SIB and control monkeys to identify conditions associated with SIB (e.g., disordered sleep) as well as clinical disease states and congenital defects that could be precipitating factors. We examined the environmental events that triggered episodes of SIB in monkeys with the disorder and evaluated three models that might explain the reinforcement contingencies associated with SIB, including tension reduction, self-stimulation, and social communication. Possible treatments for SIB such as environmental enrichment, social housing, and pharmacotherapy were tested by our group and others. To date, no single treatment has been found to abolish SIB, and each of these treatments is impacted by individual differences. To develop possible prevention strategies, we examined colony management and health records to find risk factors for SIB. These risk factors generalized to other facilities, and considerable effort was expended by all behavioral managers at these facilities to reduce early life stress exposure, to minimize the length of individual cage housing by emphasizing pair housing, and to reduce the possible stressfulness of various veterinary/medical procedures by implementing positive reinforcement training.

Evaluating the Efficacy and Social Validity of a Culturally Adapted Training Program for Parents and Service Providers in India

In regions such as India, where one-to-one behavior-analytic intervention is not easily accessible, parents and service providers may advocate for children with disabilities better if they have foundational training in behavioral approaches to problem behavior. The purpose of this study was to evaluate a culturally adapted training delivered in an underresourced region of India. Ten parents and professionals from Chennai completed the training, and the researchers evaluated its effects using a multiple-baseline design. Participants showed improvements in correct responses on a structured form designed to capture skills involved in function-based assessment and intervention, as well as the fidelity of implementation of extinction and functional communication training. Moreover, participants rated the acceptability of training highly on measures of social validity. Guidelines for the education of parents and service providers in underresourced areas outside of the United States are discussed.

Collateral Effects of Behavioral Treatment for Problem Behavior on Caregiver Stress

When individuals with autism and intellectual and developmental disabilities exhibit severe problem behavior, assessment and treatment are often warranted. Parents of such individuals are at high risk for developing parenting stress. In this study, 194 parents completed the Parenting Stress Index-Short Form at their child's time of admission to and discharge from inpatient or outpatient treatment for severe problem behavior. Parent stress was examined in relation to rate and function of child problem behavior as determined via functional analysis. Repeated measures analyses of variance were conducted, and differential effects were observed when child participants exhibited an attention, automatic, or mands function for problem behavior. These findings highlight the importance of considering function of problem behavior in relation to parenting stress.

Assessment and Treatment of Noise Hypersensitivity in a Teenager with Autism Spectrum Disorder: A Case Study

Noise hypersensitivity is a poorly understood symptom of Autism Spectrum Disorder (ASD). For some, problem behaviors co-occur with the aversive noise. Limited literature exists on treating noise hypersensitivity; however, noise hypersensitivity may be related to a specific phobia. This case study utilizes modified Cognitive Behavioral Therapy (CBT) to address anxiety, avoidance, and problem behaviors evoked by noise in a teen with ASD and mild Intellectual Disability (ID). Using multi-method assessment and individualized treatment, problem behaviors reduced, and independent coping strategies use occurred. Successful desensitization supports the efficacy of modified CBT as a treatment for noise-related anxiety and problem behaviors in individuals with ASD and ID. Outcomes are discussed considering intervention difficulties for noise hypersensitivity in a complex and diverse population.

Family Accommodation and Severe Problem Behavior: Considering Family-Based Interventions to Expand Function-Based Treatment

Family involvement in routines that exacerbate and maintain child anxiety is referred to as family accommodation. Family involvement is also related to maintenance of severe problem behavior (SPB) demonstrated by children with intellectual and developmental disabilities (IDD). Family members may deliver attention, tangible items, or remove aversive task demands that produce temporary cessation, or avoidance of SPB, but long-term maintenance. This Clinical Perspectives article describes parallels between the treatment of family accommodation in child anxiety and the assessment and treatment process for SPB. Suggestions are described for borrowing the concept of family accommodation to help caregivers of children who demonstrate SPB begin to approach previously avoided contexts. A case vignette is provided to illustrate strategies for targeting family accommodation as an expansion of function-based treatments for SPB.

Behavioral Approaches to Assessment and Early Intervention for Severe Problem Behavior in Intellectual and Developmental Disabilities

This article summarizes the literature on prevalence and establishment of severe problem behavior in individuals with intellectual and developmental disabilities, empirical support for applied behavior analysis, and evidence-based behavioral assessment and treatment procedures. Early intervention and prevention approaches and the role of the pediatrician with regard to surveillance, early intervention, and coordination of care are discussed.

Advances in Our Understanding of Behavioral Intervention: 1980 to 2020 for Individuals Diagnosed with Autism Spectrum Disorder

There are three branches of science of behavior analysis [i.e., experimental analysis of behavior, behavior analysis, and applied behavior analysis (ABA)]. ABA can be defined as a systematic approach to understanding behavior of social interest. For the past 40 plus years, researchers have evaluated ABA and ABA based procedures (e.g., behavioral intervention) as they relate to individuals diagnosed with autism spectrum disorder (ASD) and have implemented behavioral intervention in clinical settings for individuals diagnosed with ASD. In this paper, we discuss some of the pivotal contributions in the field of ABA in research and clinical practice. Additionally, we provide recommendations for the science and clinical practice of behavioral intervention in the next 40 years.

A Preliminary Evaluation of Interrater Reliability and Concurrent Validity of Open-Ended Indirect Assessment

Indirect assessments are a commonly used component of functional behavior assessment by behavior analysts in practice who work with individuals with severe behavior disorders. Although used frequently, closed-ended indirect assessments have repeatedly been shown to have low to moderate interrater reliability and poor concurrent validity with functional analysis. Recently, the use of open-ended interviews has become more commonly adopted in applied clinical practice, despite no studies evaluating the psychometric properties of such assessments. In the present study, we evaluated the interrater reliability and concurrent validity of an open-ended functional assessment interview. We compared the results of two open-ended indirect assessments conducted with a common caregiver and subsequently conducted functional analyses in an attempt to validate hypotheses generated from the interviews. Interrater agreement for the open-ended interviews was higher than previous research on closed-ended interviews (75%); however, concurrent validity with functional analysis was relatively poor (50%). We discuss these findings in the context of assessment and treatment for severe behavior disorders, as well as best practice methods during functional behavior assessment.

On the Standardization of the Functional Analysis

The functional analysis procedures described in the seminal Iwata et al. (1982/1994) study are prominent in the applied behavior analytic literature, having been replicated hundreds of times over the past 30 years (Beavers, Iwata, & Lerman, 2013; Hanley, McCord, Iwata, 2003). However, the extent to which particular components of this functional analysis model have become more or less prominent over time is not clear from these literature reviews. We therefore conducted a review of the functional analysis literature between the years of 1965 and 2016 to determine the trends in the usage of particular components over time and to determine if the published literature reflects a standardization of the manner in which functional analyses of problem behavior are conducted. Furthermore, we discuss whether or not this standardization of a functional analysis model is currently necessary.

The consecutive controlled case series: Design, data-analytics, and reporting methods supporting the study of generality

Single-case experimental designs (SCEDs) have proven invaluable in research and practice because they are optimal for asking many experimental questions relevant to the analysis of behavior. The consecutive controlled case series (CCCS) is a type of study in which a SCED is employed in a series of consecutively encountered cases that undergo a common procedure or share a common characteristic. Additional design elements, data-analytic, and reporting methods enable researchers to ask experimental questions relevant to the study of generality of procedures and processes. The current paper discusses the CCCS methodologies, including the retrospective, prospective, and randomized CCCS. These methodologies can be applied to examine the generality of clinical procedures (including their general efficacy, the limits of their generality, and variables that may mediate generality); study the epidemiology and phenomenology of clinical problems; and compare the efficacy of 2 clinical procedures within a randomized controlled trial combining SCEDs with randomized group designs.

Detecting and Classifying Self-injurious Behavior in Autism Spectrum Disorder Using Machine Learning Techniques

Traditional self-injurious behavior (SIB) management can place compliance demands on the caregiver and have low ecological validity and accuracy. To support an SIB monitoring system for autism spectrum disorder (ASD), we evaluated machine learning methods for detecting and distinguishing diverse SIB types. SIB episodes were captured with body-worn accelerometers from children with ASD and SIB. The highest detection accuracy was found with k-nearest neighbors and support vector machines (up to 99.1% for individuals and 94.6% for grouped participants), and classification efficiency was quite high (offline processing at ~ 0.1 ms/observation). Our results provide an initial step toward creating a continuous and objective smart SIB monitoring system, which could in turn facilitate the future care of a pervasive concern in ASD.

Interview-Informed Synthesized Contingency Analysis (IISCA): Novel Interpretations and Future Directions

The functional analysis (FA) methodology was developed to provide an empirical basis for understanding the reinforcers contributing to the maintenance of problem behavior. Previous research has demonstrated that multiple formats have been established to address some areas, such as practicality, efficiency, and safety. We reviewed the research on a new replication and extension of the standard FA format, the interview-informed synthesized contingency analysis (IISCA) and its subsequent treatment. We discuss the efficiency and effectiveness of the IISCA across various populations, settings, topographies of problem behaviors, and maintaining functions across 17 studies. Common treatment trends, novel developments, and other critical intervention components are also reviewed. We provide suggestions for future directions and guidelines for practitioners when considering the use of the IISCA.