Antecedent influences on behavior disorders

Development and Validation of an Assessment-Driven Behavioral Intervention for Primary Complex Motor Stereotypies in Young Children

Complex motor stereotypies are rhythmic, repetitive, fixed, and non-goal directed movements (e.g., bilateral flapping/waving movements of the hands/arms). Movements typically begin in early childhood and can occur in otherwise normally developing ("primary") or autistic ("secondary") children. Stereotypies persist, occur multiple times a day, have prolonged durations, can be socially stigmatizing, and may lead to bullying and isolation. Prior behavioral treatment studies have focused on older children (ages 6-12) and report modest reductions in stereotypy (i.e., between 14% and 33%). The current study involves the functional assessment and treatment of five children with Primary Complex Motor Stereotypy using a modified awareness training procedure, differential reinforcement of other behavior, and schedule thinning in a nonconcurrent multiple baseline design. Results suggest a 99% reduction of motor stereotypy from baseline across all participants.

The Evolution of the Conceptually Systematic Dimension and Its Current Functions in Applied Behavior Analysis

What does it mean to be conceptually systematic in contemporary applied behavior analysis (ABA) research and practice? To answer this question, the present study conducted a historical analysis of ABA scholars' interpretations of the conceptually systematic dimension of ABA over the last 55 years. The present article found the current characteristics of the conceptually systematic dimension are indeed sufficient to suggest ABA's conceptual independence from the experimental analysis of behavior or any other subdisciplines of behavior analysis. Based on this finding, this article addresses the challenges in contemporary ABA field such as ABA's own basic and applied continuum, translational research, and its relationship with other disciplines' research and practice.

Behavior-Analytic Approaches to the Management of Diabetes Mellitus: Current Status and Future Directions

Diabetes mellitus is the seventh leading cause of death in the United States, requiring a series of complex behavior changes that must be sustained for a lifetime (e.g., counting carbohydrates, self-monitoring blood glucose, adjusting insulin). Although complex, all of these tasks involve behavior, making them amenable targets for behavior analysts. In this article, the authors describe interventions that have focused on antecedent, consequent, multicomponent, and alternate procedures for the management of diabetes, highlighting ways in which technology has been used to overcome common barriers to the use of these intensive, evidence-based interventions. Additional variables relevant to poorly managed diabetes (e.g., delay discounting) are also discussed. Future research and practice should focus on harnessing continued advances in information technology while also considering underexplored behavioral technologies for the effective treatment of diabetes, with a focus on identifying sustainable, long-term solutions for maintaining proper diabetes management. Practical implementation of these interventions will depend on having qualified behavior analysts working in integrated primary care settings where the interventions are most likely to be used, which will require interdisciplinary training and collaboration.

Task as Reinforcer: a Reactive Alternative to Traditional Forms of Escape Extinction

Inappropriate behaviors, ranging from passive resistance to physical aggression, property destruction, or self-injurious behavior frequently function for escape from or avoidance of non-preferred activities. Proactive procedures have been shown to be only moderately effective without the use of escape extinction, but escape extinction can produce negative side effects, and efforts have been made to find alternatives. The current study tested the efficacy of a reactive procedure that may serve as an alternative to traditional forms of escape extinction. In a multiple baseline across behavioral excesses, non-preferred activities, and participants, a timeout from the opportunity to work effectively reduced behavioral excesses and increased compliance with non-preferred activities. With one participant, a multiple baseline was implemented across instructional targets, resulting in an increased rate of skill acquisition after "wait outs" were introduced to each program.

A Bibliographic Tribute to Jack Michael

"In the late 1950's, Jack Michael, a bright but irritating young psychology instructor, moved from the Universities of Kansas to Houston to Arizona State. Along the way he befriended two nontraditional students, protected them through their Ph.D. programs, and turned them loose on the world: Teodoro Ayllon…and Montrose Wolf…" (Risley, 2001, p. 267). So begins Risley's chapter on the origins of applied behavior analysis. For almost 50 years, Jack Michael provided a model for us to "talk like Skinner" and to analyze behavior as Skinner would. For this, he has been widely respected and revered. The purpose of this bibliography is to explain to new and familiar readers alike Jack's contributions to the field of behavior analysis in areas of his primary focus: (a) behavioral function taxonomy, (b) motivation, (c) reinforcement, (d) response topographies, (e) multiple control, (f) duplic and codic verbal behavior, and (g) teaching. Throughout, we weave his role in the field's history and his leadership in its expansion, as these have been additional areas of significant contributions. Above all, we wish to highlight Jack's work, in bibliographic and narrative form, in a way that expresses a heartfelt tribute on behalf of his students and others whom he influenced to learn about psychology as a natural science and to think and talk like Skinner.

Staff Reports of Setting Events Associated With Challenging Behavior

This study sought to identify the setting events reported by care staff as more and less likely to be associated with the challenging behaviors of people with intellectual disabilities. Sixty-five staff working with 22 individuals were interviewed using an inventory of putative setting events. Findings were collated to allow identification of those events reported to be associated with increased and decreased likelihood of challenging behavior. Some events were reported as strongly associated with the occurrence of challenging behavior, some as strongly associated with its absence, some as largely “inert,” and many as idiosyncratically associated with occurrence, absence, or inertness. Different categories of setting events contributed different relative amounts to reported variation in challenging behavior. The use of the inventory described here, or modified versions, may be a useful way of identifying relationships between setting events and challenging behaviors, which suggest ways in which routine service provision might be modified to help prevent challenging behavior.

Identifying Academic Demands That Occasion Problem Behaviors for Students With Behavioral Disorders

In two independent experiments, we (a) examined aspects of academic demands associated with the problem behaviors of two elementary students with behavioral disorders and (b) investigated the effects of academic interventions to decrease problem behaviors and increase task engagement. Preliminary functional behavior assessment data suggested each student participant’s problem behaviors functioned to escape/avoid academic demands, and experimental structural analyses performed in naturalistic settings confirmed relations between their problem behaviors and specific features of academic tasks. Antecedent-based interventions were developed for each student and separate single-case alternating treatment experiments indicated functional relations between the academic interventions and appropriate task engagement. Findings support the use of structural analyses to inform academic planning and improve the behaviors of students who exhibit escape-maintained problem behaviors associated with academic tasks.

Temper outbursts in Prader-Willi syndrome: causes, behavioural and emotional sequence and responses by carers

BACKGROUND

Temper outbursts are common in Prader-Willi syndrome but rarely described in detail. This study investigated the phenomenology of temper outbursts in terms of antecedents, sequence of behaviours and emotions and intervention strategies used.

METHOD

A semi-structured interview about temper outbursts was conducted with the main carers of seven children (9.5 to 16.7 years) and seven adults (24.7 to 47.10 years) with Prader-Willi syndrome (10 male, 4 female). Reliability and validity of the interview results was established.

RESULTS

Various setting events increased and reduced the likelihood of temper outbursts. The most common antecedent was a change to routine or expectation. There were marked similarities in the sequence of behaviours and emotions during temper outbursts, with anger rising quickly followed by expressions of remorse and distress at the end of an outburst.

DISCUSSION

The sequence of behaviours and emotions within outbursts was similar to that described in temper tantrums in typical development. Cognitive and emotional processes are likely to be important in the understanding of temper outbursts with implications for early intervention.

The motivating operation and negatively reinforced problem behavior: a systematic review

The concept of motivational operations exerts an increasing influence on the understanding and assessment of problem behavior in people with intellectual and developmental disability. In this systematic review of 59 methodologically robust studies of the influence of motivational operations in negative reinforcement paradigms in this population, we identify themes related to situational and biological variables that have implications for assessment, intervention, and further research. There is now good evidence that motivational operations of differing origins influence negatively reinforced problem behavior, and that these might be subject to manipulation to facilitate favorable outcomes. There is also good evidence that some biological variables warrant consideration in assessment procedures as they predispose the person's behavior to be influenced by specific motivational operations. The implications for assessment and intervention are made explicit with reference to variables that are open to manipulation or that require further research and conceptualization within causal models.

Jack Michael's Motivation

Among many of Jack Michael's contributions to the field of behavior analysis is his behavioral account of motivation. This paper focuses on the concept of motivating operation (MO) by outlining its development from Skinner's (1938) notion of drive. Conceptually, Michael's term helped us change our focus on how to study motivation by shifting its origins from the organism to the environment. Michael's account also served to stimulate applied research and to better understand behavioral function in clinical practice.

The establishing operation and teaching verbal behavior

Twenty years ago Michael (1993) refined and extended the concept of the conditioned establishing operation (CEO). With this paper he updated his previous treatment of the topic (Michael, 1982) by providing terminological refinements and conceptually clear descriptions of the reflexive and transitive CEOs. In the 20 years since the publication of that paper there has been an increase in the application of CEOs as independent variables in the teaching of verbal behavior in applied setting. The purpose of this paper is to provide a brief overview of clinical applications of the EO to the teaching of verbal behavior during the last 20 years.

The effect of varying teacher presentation rates on responding during discrete trial training for two children with autism

Recent research has emphasized the importance of manipulating antecedent variables to reduce interfering behaviors when teaching persons with autism. Few studies have focused on the effects of the rate of teacher-presented instructional demands as an independent variable. In this study, an alternating treatment design was used to evaluate the effects of varied rates of teacher-presented demands (1 s, 5 s, 10 s) on the occurrence of problem behavior, opportunities to respond, responses emitted, accuracy of responding, and magnitude and rate of reinforcement for two children with autism. Results indicated that fast presentation rate (1 s) resulted in lower rates of problem behavior, higher frequencies of instructional demands, higher frequencies of participant responding, and greater magnitudes and rates of reinforcement. Differential effects on accuracy of responding across conditions were not observed. Implications for manipulating the rate of teacher-presented instructional demands as an antecedent variable to reduce problem behavior are discussed.

A tutorial on the concept of the motivating operation and its importance to application

Motivating operations (MOs) exert a powerful influence over operant relations and hold significant implications for those working in applied settings. In this paper, we describe the concept of the MO and provide "real world" examples. Particular emphasis is given to the concept of the conditioned MO (CMO). Implications for intervention are discussed. It is hoped that this endeavour will encourage the utilization of the full conceptual system of the MO.

Some reflections on 25 years of the association for behavior analysis: Past, present, and future

This paper offers some reflections on the discipline and profession of behavior analysis, as well as on the Association for Behavior Analysis (ABA), on the occasion of the association's 25th anniversary. It is based on a panel session conducted at the 1999 convention that included six past presidents of ABA (Donald M. Baer, Judith E. Favell, Sigrid S. Glenn, Philip N. Hineline, Jack Michael, and Edward K. Morris) and its current Executive Director and Secretary-Treasurer (Maria E. Malott). Among the topics addressed were (a) the survival of behavior analysis in university and cultural contexts, (b) the training of behavior-analytic researchers and practitioners, (c) relations between basic and applied research, (d) convergences between behavior analysis and other disciplines, (e) the structure and function of ABA, and (f) the importance of students for the future of the association, the discipline, and the profession. Questions from the audience raised issues concerning the relevance of major behavior-analytic journals, advances in behavior analysis since the death of B. F. Skinner, and the availability of accessible, popular material on applied behavior analysis.

Health and problem behavior among people with intellectual disabilities

Good health significantly improves a person's quality of life. However, people with intellectual disabilities disproportionately have more health problems than the general population. Further complicating the matter is that people with more severe disabilities often cannot verbalize health complications they are experiencing, which leads to health problems being undiagnosed and untreated. It is plausible these conditions can interact with reinforcement contingencies to maintain problem behavior because of the increased incidence of health problems among people with intellectual disabilities. This paper reviews common health problems influencing problem behavior and reinforcement processes. A clear implication of this review is the need for comprehensive functional assessments of problem behavior involving behavior analysts and health professionals.

Function-based treatments for escape-maintained problem behavior: a treatment-selection model for practicing behavior analysts

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.

A systematic examination of different parameters of presession exposure to tangible stimuli that maintain problem behavior

We examined the effects of three different presession conditions on tangibly maintained problem behavior for 2 students with autism, using individual-participant multielement designs. First, an analogue functional analysis demonstrated that problem behavior was maintained by access to tangible items. Next, topographies of item rejection were identified. Finally, students were exposed to (a) brief access, (b) no access, and (c) satiation to the tangible items prior to tangible sessions. The results demonstrated high levels of problem behavior following the brief-access and no-access presession conditions and low levels of problem behavior following the satiation condition. The findings are discussed in the context of how satiation might best be defined for these sorts of evaluations.

Evidence for reciprocal interaction effects among adults with self-injury and their caregivers

Patterns of caregiver responses to client adaptive behavior were compared between adults with intellectual disabilities with and without self-injurious behavior. Participants with moderate to profound intellectual disability and self-injury (n=89) and age/IQ matched control participants (n=20) were selected from a large sample of adults living in a regional residential center. Approximately 45 minutes of direct observation data were collected for each participant during unstructured leisure time. Data were sequentially analyzed and Yule's Q scores derived and compared among groups. Results indicated that caregivers were more responsive to prosocial initiations and adaptive engagement among individuals with severe self-injurious behavior than to those with mild or no self-injurious behavior and that these responses were more likely to be in the form of a demand.

Influence of motivating operations and discriminative stimuli on challenging behavior maintained by positive reinforcement

We examined the effects of an establishing operation (EO) and abolishing operation (AO) on stimulus control of challenging behavior. Two participants with developmental disabilities and challenging behavior participated. In Phase I, a functional analysis was conducted to identify the consequences maintaining challenging behavior. In Phase II, a discrimination between SD and SΔ was trained. In Phase III, pre-session MOs (i.e., EO and AO conditions) were arranged to assess their effects on challenging behavior. Finally in Phase IV, in addition to manipulating pre-session MOs the challenging behavior was evaluated under extinction in both SD and SΔ conditions. Results indicated that in the context of extinction when pre-session EO and AO conditions were manipulated, responding not only became differentiated but was higher in both SD and SΔ conditions in the pre-session EO condition when compared to the pre-session AO condition.

Behaviors and corresponding functions addressed via functional assessment

One-hundred seventy-three studies that employed functional assessment were evaluated with respect to types of challenging behaviors studied and the functions identified that maintained those behaviors. For most studies, two to three behaviors were targeted. Of the 38 different challenging behaviors identified, self-injurious behavior (SIB) and aggression were by far the most studied. Other commonly studied behaviors were tantrums, stereotypies, property destruction, bizarre/inappropriate speech/vocalizations, and disruptive behaviors. The most commonly identified functions for both SIB and aggressions were attention and escape/demands. The implications of these and other data complied on target behaviors and maintaining variables are discussed.

Behavioral treatments in autism spectrum disorder: what do we know?

Although there are a large and growing number of scientifically questionable treatments available for children with autism spectrum disorder (ASD), intervention programs applying the scientific teaching principles of applied behavior analysis (ABA) have been identified as the treatment of choice. The following article provides a selective review of ABA intervention approaches, some of which are designed as comprehensive programs that aim to address all developmental areas of need, whereas others are skills based or directed toward a more circumscribed, specific set of goals. However, both types of approaches have been shown to be effective in improving communication, social skills, and management of problem behavior for children with ASD. Implications of these findings are discussed in relation to critical areas of research that have yet to be fully explored.

The association of promised consequences with child compliance to maternal directives

Noncompliance is a primary reason parents seek services for their young children. Research on socialization suggests that warning children about consequences is associated with greater compliance. In the current study, we test whether promised consequences (i.e., promises of parental responses to subsequent child behavior), compared with directives alone, were more strongly associated with compliance. We also tested whether some types of promised consequences were more strongly associated with compliance than others. Forty White mother-toddler (age 17-36 months) dyads were video recorded in a 30-min behavioral analogue situation. Interactions were coded using a derived coding scheme. Promised consequences were not found to be more strongly associated with compliance than were directives alone using sequential analyses; however, negative and immediate promised consequences were more strongly associated with compliance. Findings suggest that promising negative and immediate consequences for noncompliance may encourage compliance.

Progressing from initially ambiguous functional analyses: three case examples

Most often functional analyses are initiated using a standard set of test conditions, similar to those described by Iwata, Dorsey, Slifer, Bauman, and Richman [Iwata, B. A., Dorsey, M. F., Slifer, K. J., Bauman, K. E., & Richman, G. S. (1994). Toward a functional analysis of self-injury. Journal of Applied Behavior Analysis, 27, 197-209 (Reprinted from Analysis and Intervention in Developmental Disabilities, 2, 3-20, 1982)]. These test conditions involve the careful manipulation of motivating operations, discriminative stimuli, and reinforcement contingencies to determine the events related to the occurrence and maintenance of problem behavior. Some individuals display problem behavior that is occasioned and reinforced by idiosyncratic or otherwise unique combinations of environmental antecedents and consequences of behavior, which are unlikely to be detected using these standard assessment conditions. For these individuals, modifications to the standard test conditions or the inclusion of novel test conditions may result in clearer assessment outcomes. The current study provides three case examples of individuals whose functional analyses were initially undifferentiated; however, modifications to the standard conditions resulted in the identification of behavioral functions and the implementation of effective function-based treatments.

Antecedent interventions in the management of maladaptive behaviours in a child with brain injury

Typically behaviour management plans attempt to change behaviour by manipulating the environmental consequences of selected behaviour. However, identifying the antecedent events that precede behaviour has also been demonstrated to be an important component of effective behaviour change programmes. The present case presentation attempts to demonstrate how antecedent procedures could be used to effectively manage behaviour problems in individuals with brain injury. Visual inspection of changes in the frequency of physical aggression and self-injurious behaviour of a child with brain injury provides preliminary data supporting the use of an intervention package of antecedent and consequence-based procedures. Clinical implications, limitations and possibilities for future research of antecedent control procedures are discussed.

Incorporating "motivation" into the functional analysis of challenging behavior: on the interactive and integrative potential of the motivating operation

Sensitivity theory attempts to account for the variability often observed in challenging behavior by recourse to the "aberrant motivation" of people with intellectual and developmental disabilities. In this article, we suggest that a functional analysis based on environmental (challenging environments) and biological (challenging needs) motivating operations provides a more parsimonious and empirically grounded account of challenging behavior than that proposed by sensitivity theory. It is argued that the concept of the motivating operation provides a means of integrating diverse strands of research without the undue inference of mentalistic constructs. An integrated model of challenging behavior is proposed, one that remains compatible with the central tenets of functional analysis.

Two Approaches to Behavior Disorder After Traumatic Brain Injury

A 3-stage model of intervention is used to contrast the philosophy and treatment practices of 2 behavioral approaches to behavior disorder following traumatic brain injury. The first referred to here as the Operant Neurobehavioral Approach developed from neuropsychology and learning theory. The second referred to as the Relational Neurobehavioral Approach builds on the nonaversive behavioral techniques of the Operant Neurobehavioral Approach. It also incorporates principles of motivational interviewing, places more overt emphasis on the therapeutic relationship, and targets staff attributions for aggression in staff training. The strengths and weaknesses of both approaches are discussed. It is suggested that the Relational Neurobehavioral Approach is more likely to engage and/or reengage clients with traumatic brain injury who are resistant to behavior change. Research implications are discussed including the need to measure the fidelity of all intervention variables.

Twenty-month effectiveness of a non-aversive, long-term, low-cost programme for persons with persisting neurobehavioural disability

PRIMARY OBJECTIVE

To examine the effectiveness of a programme developed for persons with persisting neurobehavioural/ neuropsychiatric disorders.

RESEARCH DESIGN

Descriptive study of a programme that has a philosophy of normalization, respect, non-confrontation, positive engagement, support and functional and behavioural skill development.

METHODS AND PROCEDURES

Participants were the 40 clients admitted during the initial 20 months of operation. Prior to admission clients had recurrent placement failures secondary to behavioural disregulation and typically were housed at County or State Hospitals. An expanded version of the Overt Aggression Scale Modified for Neurorehabilitation was used to provide detailed descriptions of assaults.

MAIN OUTCOMES AND RESULTS

Over the 20-month period, 49 incidents of client-to-client aggression occurred representing a rate of 0.11 incidents per client month. Thirty-five of 40 clients remained at the end of 20 months, with only three discharges due to behaviour.

CONCLUSIONS

A long-term, stable living environment has been provided for individuals who had been intractable management problems elsewhere.

Motivating operations and terms to describe them: some further refinements

Over the past decade, behavior analysts have increasingly used the term establishing operation (EO) to refer to environmental events that influence the behavioral effects of operant consequences. Nonetheless, some elements of current terminology regarding EOs may interfere with applied behavior analysts' efforts to predict, control, describe, and understand behavior. The present paper (a) describes how the current conceptualization of the EO is in need of revision, (b) suggests alternative terms, including the generic term motivating operation (MO), and (c) provides examples of MOs and their behavioral effects using articles from the applied behavior analysis literature.

Motivating operations and terms to describe them: some further refinements

Over the past decade, behavior analysts have increasingly used the term establishing operation (EO) to refer to environmental events that influence the behavioral effects of operant consequences. Nonetheless, some elements of current terminology regarding EOs may interfere with applied behavior analysts' efforts to predict, control, describe, and understand behavior. The present paper (a) describes how the current conceptualization of the EO is in need of revision, (b) suggests alternative terms, including the generic term motivating operation (MO), and (c) provides examples of MOs and their behavioral effects using articles from the applied behavior analysis literature.

Staff reports of setting events associated with challenging behavior

This study identified the setting events reported by caregivers as more and less likely to be associated with challenging behaviors of people with intellectual disabilities. Sixty-five staff working with 22 individuals were interviewed using a setting event inventory. Some setting events (e.g., being in a crowded room) were reported as strongly associated with challenging behavior, some (e.g., one-to-one support) as strongly associated with its absence. Some (e.g., day of week) were reported to be largely "inert"; many were idiosyncratically associated with occurrence, absence, or inertness. Different categories of setting events contributed different amounts to reported variation in challenging behavior. The inventory described here, or modified versions, may help identify relationships between setting events and challenging behaviors. The relationships reported in this study suggest ways in which service provision might be modified to help prevent challenging behavior.

Functional analysis of problem behavior: a review

Functional analysis methodology focuses on the identification of variables that influence the occurrence of problem behavior and has become a hallmark of contemporary approaches to behavioral assessment. In light of the widespread use of pretreatment functional analyses in articles published in this and other journals, we reviewed the literature in an attempt to identify best practices and directions for future research. Studies included in the present review were those in which (a) a pretreatment assessment based on (b) direct observation and measurement of (c) problem behavior was conducted under (d) at least two conditions involving manipulation of an environmental variable in an attempt (e) to demonstrate a relation between the environmental event and behavior. Studies that met the criteria for inclusion were quantified and critically evaluated along a number of dimensions related to subject and setting characteristics, parametric and qualitative characteristics of the methodology, types of assessment conditions, experimental designs, topographies of problem behaviors, and the manner in which data were displayed and analyzed.

Antecedent control of sleep-awakening disruption

The sleep-awakening disruption of an adolescent with developmental disabilities was treated using an antecedent control intervention that identified his consistent time of wake-up, provided the presence of a preferred staff in his bedroom, and prompted social interaction from staff before challenging behaviors occurred. Positive findings were documented using a combined reversal and multiple baseline across settings design, with results maintained through a 9-month follow-up. A partial component analysis of the intervention plan suggested that the presence of preferred staff was the influential antecedent variable.