Response competition and stimulus preference in the treatment of automatically reinforced behavior: a comparison

Evaluation of a latency-based competing stimulus assessment

A competing stimulus assessment is used to identify stimuli that are associated with a low level of challenging behavior and a high level of engagement. These stimuli are often used as a treatment component for challenging behavior that is maintained by automatic reinforcement. One limitation of implementing competing stimulus assessments is that they may be time consuming. The purpose of the current study was to evaluate the efficacy and efficiency of a latency-based competing stimulus assessment. During the asssessment, a therapist presented potential competing stimuli to the participants and contingent on the first occurrence of challenging behavior, the trial was terminated. The results of a brief treatment evaluation indicated that stimuli that were associated with the longest latency to challenging behavior were more effective in competing with challenging behavior relative to stimuli that were associated with shorter latencies. However, procedural modifications were necessary for one participant. The use of latency-based measures improved the efficiency of conducting a competing stimulus assessment.

Examining Procedural Variations of Delivering Competing Stimuli in the Treatment of Stereotypy

Competing stimulus assessments (CSA) are effective tools for identifying stimuli that compete with automatically reinforced behavior. However, Jennett et al. suggests there are cases for which non-contingent access to competing stimuli are insufficient at decreasing target responding and additional treatment components may be necessary. The purpose of the current study was to examine procedural variations (i.e., rotating competing items and prompted engagement) when presenting competing stimuli on increasing functional engagement and decreasing stereotypy. Following a functional analysis, a CSA was conducted to identify competing stimuli for four individuals with autism. Items identified were then used with two procedural variations. Levels of stereotypy, functional engagement, and item contact were measured. Results showed that for two participants both treatments were effective, while for the other two participants prompting functional engagement was more effective. Prompting functional engagement is likely a productive strategy for enhancing engagement with competing stimuli for automatically reinforced problem behavior as it may result in functional engagement becoming reinforcing in and of itself.

A replication and extension of the augmented competing stimulus assessment

Augmenting competing stimulus assessments by embedding tactics to increase stimulus engagement and disrupt challenging behavior can improve outcomes of treatments for automatically maintained self-injurious behavior, even for treatment-resistant subtypes. This study replicated and extended research on augmented competing stimulus assessments by reporting outcomes for 16 consecutively encountered cases with automatically maintained self-injurious behavior (19 total applications); six participants had treatment-responsive Subtype 1 and 10 had treatment-resistant Subtypes 2 or 3. Fewer high-competition stimuli were identified for individuals with treatment-resistant subtypes. When response-promotion and disruption tactics were applied and withdrawn, outcomes improved for six of eight applications. At least one high-competition stimulus was still effective when maintenance probes were conducted for a subset of participants. Ultimately, at least one high-competition stimulus was identified for each participant. Although augmenting tactics may not be necessary for all individuals, these findings provide additional support for their efficacy with treatment-resistant self-injurious behavior.

Efficacy of competing stimulus assessments: A summary of 35 consecutively encountered cases

Competing stimulus assessments (CSAs) are designed to identify stimuli that reduce challenging behavior through competition with its maintaining reinforcers. Recently, Haddock and Hagopian (2020) found that over 92% of CSAs described in published studies identified at least one high-competition stimulus (i.e., a stimulus correlated with at least an 80% reduction in challenging behavior). The current study describes the outcomes of CSAs in a retrospective consecutive controlled case series study of 35 cases (individuals) admitted to an inpatient setting. Findings on the limited relation between the level of stimulus engagement and reductions in challenging behavior were replicated; however, the efficacy of CSAs was lower (only 47% of CSAs were successful in identifying one or more high-competition stimuli). Discrepant findings across studies on the efficacy of CSAs are discussed in terms of differences in the sample participants and how outcomes are reported, which vary depending on the study's research questions.

Applied Behavior Analysis in Children and Youth with Autism Spectrum Disorders: A Scoping Review

This manuscript provides a comprehensive overview of the impact of applied behavior analysis (ABA) on children and youth with autism spectrum disorders (ASD). Seven online databases and identified systematic reviews were searched for published, peer-reviewed, English-language studies examining the impact of ABA on health outcomes. Measured outcomes were classified into eight categories: cognitive, language, social/communication, problem behavior, adaptive behavior, emotional, autism symptoms, and quality of life (QoL) outcomes. Improvements were observed across seven of the eight outcome measures. There were no included studies that measured subject QoL. Moreover, of 770 included study records, only 32 (4%) assessed ABA impact, had a comparison to a control or other intervention, and did not rely on mastery of specific skills to mark improvement. Results reinforce the need for large-scale prospective studies that compare ABA with other non-ABA interventions and include measurements of subject QoL to provide policy makers with valuable information on the impacts of ABA and other existing and emerging interventions.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40614-022-00338-x.

Parent-implemented brief functional analysis and treatment with coaching via telehealth

We evaluated the use of parent-implemented brief functional analyses in the home with coaching delivered via telehealth. Parents of 7 children with autism conducted functional analyses of their child's challenging behavior. For 4 participants, the brief functional analysis provided information regarding the function of the child's challenging behavior. A full functional analysis indicated a social function for 1 participant. The brief functional analysis yielded false positive results and subsequent assessment indicated an automatic function for another participant. The final participant did not engage in sufficient rates of challenging behavior to provide information regarding the function of the child's challenging behavior. Treatment evaluations occurred with 4 participants; these evaluations provided support for the results of the functional analysis. Together with previous research, the results indicate that parent-implemented brief functional analyses, followed by additional assessment as needed, may be an effective method for assessing and treating challenging behavior via telehealth.

Initial outcomes of an augmented competing stimulus assessment

Competing stimulus assessments (CSAs) are designed to identify stimuli that, when made freely available, reduce problem behavior. Although CSAs have demonstrated utility, identifying competing stimuli can be difficult for some individuals. The current study describes outcomes from an augmented CSA (A-CSA) for 6 consecutively encountered cases with treatment-resistant subtypes of automatically maintained problem behavior. When test stimuli were made freely available, only between 0 and 1 effective competing stimuli were identified for each case. Prompting and response blocking were temporarily employed in succession to promote engagement with stimuli and disrupt problem behavior. When those procedures were withdrawn and stimuli made freely available, the number of effective competing stimuli increased in all 6 cases. Findings suggest that procedures designed to promote engagement and disrupt problem behavior may allow the A-CSA to be a platform not only for identifying competing stimuli, but also for actively establishing competing stimuli.

A review of environmental enrichment as treatment for problem behavior maintained by automatic reinforcement

We reviewed studies that used environmental enrichment as treatment for problem behavior maintained by automatic reinforcement. A search of behavior analytic journals produced 71 publications with a total of 265 applications of environmental enrichment used alone or in conjunction with alternative behavior manipulations (e.g., prompting, reinforcement) and problem behavior manipulations (e.g., blocking, restraint). Environmental enrichment, as a sole intervention, was efficacious in 41% of the sample. Alternative behavior manipulations, problem behavior manipulations, and a combination of both improved the overall efficacy of environmental enrichment. We discuss factors that may influence the efficacy of environmental enrichment, current trends in research on this topic, and implications for both practitioners and researchers.

Behavioral treatment of automatically reinforced SIB: 1982 - 2015

Some individuals diagnosed with intellectual and developmental disabilities engage in automatically reinforced self-injurious behavior (SIB). For these individuals, identifying effective treatments may be difficult due to the nature of the reinforcement contingency. The purpose of this study was to review the literature on the treatment of automatically reinforced SIB to determine commonalities in procedures that produced effective and ineffective treatment outcomes, as well as historical trends in the treatment of this class of SIB. Results of this review indicated that there were many high-quality studies on this topic, but also a wide range in the quality of studies. As for effective treatments, noncontingent reinforcement (the most common treatment component) was found to be more effective when informed by a competing stimulus assessment rather than a preference assessment. Suggestions to improve the quality of the published record and areas in which additional research is needed are discussed.

Further Analysis of the Predictive Effects of a Free-Operant Competing Stimulus Assessment on Stereotypy

We conducted five experiments to evaluate the predictive validity of a free-operant competing stimulus assessment (FOCSA). In Experiment 1, we showed that each participant’s repetitive behavior persisted without social consequences. In Experiment 2, we used the FOCSA to identify high-preference, low-stereotypy (HP-LS) items for 11 participants and high-preference, high-stereotypy (HP-HS) items for nine participants. To validate the results of the FOCSAs (Experiment 3), we used a three-component multiple schedule to evaluate the immediate and subsequent effects of an HP-LS stimulus, an HP-HS stimulus, or both (in separate test sequences) on each participant’s stereotypy. Results of Experiment 3 showed that the FOCSA correctly predicted the immediate effect of the HP-LS stimulus for 10 of 11 participants; however, the FOCSA predictions were less accurate for the HP-HS stimulus. Results of Experiment 4 showed that a differential reinforcement of other behavior procedure in which participants earned access to the HP-LS for omitting vocal stereotypy increased all five participants’ latency to engaging in stereotypy; however, clinically significant omission durations were only achieved for one participant. Experiment 5 showed that differential reinforcement of alternative behavior in which participants earned access to the HP-LS stimulus contingent upon correct responses during discrete-trial training reduced targeted and nontargeted stereotypy and increased correct academic responding for all four participants. The potential utility of the FOCSA is discussed.

Using Conditional Percentages During Free-Operant Stimulus Preference Assessments to Predict the Effects of Preferred Items on Stereotypy: Preliminary Findings

To date, researchers have not identified an efficient methodology for selecting items that will compete with automatically reinforced behavior. In the present study, we identified high preference, high stereotypy (HP-HS), high preference, low stereotypy (HP-LS), low preference, high stereotypy (LP-HS), and low preference, low stereotypy (LP-LS) items based on response allocation to items and engagement in stereotypy during one to three, 30-min free-operant competing stimulus assessments (CSAs). The results showed that access to HP-LS items decreased stereotypy for all four participants; however, the results for other items were only predictive for one participant. Reanalysis of the CSA results revealed that the HP-LS item was typically identified by (a) the combined results of the first 10 min of the three 30-min assessments or (b) the results of one 30-min assessment. The clinical implications for the use of this method, as well as future directions for research, are briefly discussed.

Evaluating the Effects of Matched and Unmatched Stimuli on Nail Biting in Typically Developing Children

We evaluated the effects of matched and unmatched stimuli on nail biting for three typically developing children and adolescents. Antecedent-based assessments identified conditions when subjects were most likely to engage in nail biting. Treatment included the noncontingent delivery of four types of highly preferred stimuli: items hypothesized to match the oral, the tactile, or both the oral and tactile stimulation inherent to nail biting, as well as items that did not involve oral or tactile stimulation. Results suggested that all forms of alternative stimulation decreased nail biting.

Technology-based programs to promote walking fluency or improve foot-ground contact during walking: two case studies of adults with multiple disabilities

These two case studies assessed technology-based programs for promoting walking fluency and improving foot-ground contact during walking with a man and a woman with multiple disabilities, respectively. The man showed breaks during walking and the woman presented with toe walking. The technology used in the studies included a microprocessor with specific software, an MP3 with the recordings of preferred stimulus items, and optic sensors. Both studies were carried out according to an ABAB design. In Study I, the optic sensors were activated when the man crossed small marks distributed along the travel routes. At each sensor's activation, the man received a brief period of preferred stimulation. In Study II, the woman received preferred stimulation when the sensors at the toe and the heel of her shoes were activated in close time proximity. The man walked virtually without breaks and improved his mood (with an increase in indices of happiness) during the intervention phases of the study. The woman largely increased her percentages of steps with adequate foot-ground contact, which reached a mean of about 80 during the second intervention phase. The results were discussed in terms of rehabilitation implications and technology demands.