Mand Modality Preference Assessments among High- and Low-Tech Options for Individuals with Intellectual and Developmental Disabilities: A Systematic Review

The extant literature demonstrates that individuals with intellectual and developmental disabilities (IDD) exhibit preferences among communication modalities when multiple modalities are available and produce reinforcement on identical reinforcement schedules. High- and low-tech communication options, such as voice output devices and picture cards, are commonly recommended for individuals with limited vocal communication skills. In this study, we conducted a systematic literature review of research studies that implemented mand modality preference assessments (MMPAs) that included both a high- and low-tech communication option with individuals with IDD. We identified 27 studies meeting our inclusion criteria and summarized the participant demographics, MMPA design and procedural variations, and MMPA outcomes. The results suggested that high-tech communication options were generally more preferred over low-tech options. However, there was a high degree of variability in how the studies were conducted and conclusions were reached. We discuss some of the current research gaps and the implications for clinical practice.

Use of Augmentative and Alternative Communication by Individuals with Rett Syndrome Part 1: Page-Linking

Although the last decade has welcomed evidence that individuals with Rett syndrome (RTT) can communicate using alternative and augmentative communication (AAC), less is known about effective procedures for teaching various component skills required for expressive communication of individuals with complex communication needs. The purpose of the current study was to evaluate the effects of systematic individualized instruction procedures on the page-linking skills of individuals with RTT. A nonconcurrent multiple baseline design across participants was used to evaluate independent and accurate responding utilizing both a high-tech and low-tech AAC device for three participants. All sessions were conducted in the participants' homes by their parents with remote coaching from a researcher via telehealth. Results indicated that for all three participants, individualized procedures that included behavior chaining, differential reinforcement, and delayed prompting were effective for teaching page-linking in both a high-tech and a low-tech AAC device. Directions for future research and practice are discussed.

Teaching Requesting to Individuals with Rett Syndrome Using Alternative Augmentative Communication (AAC) Through Caregiver Coaching via Telehealth

Rett syndrome is a severe neurodevelopmental disorder that results in both motor and language skill regression with a wide range of severity in symptom presentation. Communication intervention may be particularly challenging for this population due to the decline in speech, motor skills, and motor planning difficulties that characterize the disorder (Townend et al., 2020), often resulting in the need for augmentative and alternative communication (AAC) technology. Very limited research has evaluated communication interventions for individuals with Rett syndrome and even fewer have targeted expressive communication, an important skill required for improved autonomy and quality of life (Sigafoos et al., 2009; Townend et al., 2020). The current study sought to systematically replicate the Simacek et al. (2017) mand training procedures to teach three girls with Rett Syndrome to use AAC to make requests through caregiver coaching by researchers via telehealth. Results suggest that mand training was successful in increasing AAC use for all three participants. Barriers to intervention for this population and implications of results for future research and clinical practice are discussed.

The Effect of Caregiver-Implemented Training on Augmentative Alternative Communication Use by Individuals with Rett Syndrome: Remote Coaching via Telehealth

Limited published literature exists demonstrating functional relations between idiosyncratic responses or augmentative alternative communication (AAC) and social reinforcement for individuals with Rett syndrome. In this study, six females with Rett syndrome ages 2-25 demonstrated requesting for preferred items using both idiosyncratic responses (e.g, looking, reaching) and AAC (e.g. single response microswitches). Researchers connected remotely via telehealth to coach caregivers to implement all sessions in home environments. Researchers individualized response prompt delays during AAC sessions (request/mand training) based on each participants' latency to respond during baseline. Implications for practice and directions for future research are discussed.

Use of Augmentative and Alternative Communication by Individuals with Rett Syndrome Part 2: High-Tech and Low-Tech Modalities

The vast majority of individuals with Rett syndrome do not utilize natural speech and therefore require alternative and augmentative communication (AAC). The purpose of the current study was to investigate the use of high- and low-tech AAC modalities by three individuals with Rett syndrome given similar instruction for using both modalities. For all participants, the number of sessions to criterion and cumulative number of trials with independent requests during simultaneous or alternating instruction in the use of a high- and low-tech AAC modality were investigated. Parents conducted all sessions with remote coaching from a research assistant via telecommunication. Each participant exhibited idiosyncratic response patterns in terms of use of their high- and low-tech AAC modalities during instruction but ultimately demonstrated the ability to use both modalities to make requests. Implications for future research and practice pertaining to AAC of individuals with complex communication needs are discussed. This paper is a companion to Girtler et al. (2023).

Delivering Interventions Via Telehealth: Functional Communication Training with a Child with Autism as a Case Example

In this article, we provide a case example of how telehealth can be used by care providers in their homes to access empirically validated procedures such as functional communication training. As shown in the case example, complex assessment and intervention procedures were implemented successfully by care providers in their homes while receiving real-time coaching by behavior analysts who were located in a hospital in a different city. This case example is representative of the results we obtained thus far; substantial improvements in challenging and adaptive behavior occurred. Given these results obtained to date with telehealth, in terms of both outcomes of interventions and rated acceptability of the procedures by care providers, further and more widespread application of telehealth is warranted.

Caregiver Training Via Telehealth on Behavioral Procedures: A Systematic Review

Telehealth has been utilized to provide behavioral services to families with children with autism spectrum disorder (ASD) and other disabilities. This systematic review provides an update on current research pertaining to the use of telehealth to provide behavior analytic-based services and train caregivers in implementing behavioral procedures. This review also describes information on reported training components and caregivers' procedural fidelity. Empirical studies were collected from five databases. Overall, the studies provide evidence of the utility of telehealth as a service delivery model for providing behavior analytic-based services and for training caregivers to implement behavioral assessments and procedures. The authors discuss potential considerations for developing training packages and training caregivers via telehealth. Future research should use experimental methods to determine effective components for training individuals via telehealth to use behavioral procedures with good fidelity as well as to detect other factors that may influence procedural fidelity.

Comparison of Reading Growth Among Students With Severe Reading Deficits Who Received Intervention to Typically Achieving Students and Students Receiving Special Education

This study compared the reading growth of students with and without learning disabilities, and students with and without reading deficits in response to tier 2 reading interventions within a response-to-intervention framework. Participants were 499 second- and third-grade students in six urban schools. Students who scored at or below the 10th percentile on the fall reading screening assessment were identified as having a severe reading deficit and received a tier 2 reading intervention that was targeted to their needs. Results showed a significant effect between groups on reading growth. Students with severe reading deficits receiving targeted tier 2 intervention grew at a rate that equaled the rate of growth of students without reading deficits and was significantly higher than students who were receiving special education services for reading. Implications for practice, suggestions for future research, and study limitations are discussed.

Agreement Between Structured Descriptive Assessments and Functional Analyses Conducted Over a Telehealth System

This study examined whether experimental functional analyses (FAs) conducted by parents at home with coaching via telehealth would produce differentiated results, and compared these results to the functions identified from structured descriptive assessments (SDAs) also conducted by parents at home via telehealth. Four boys between the ages of 4- and 8-years old with intellectual and developmental disabilities and their parents participated. All assessments were conducted in the children's homes with their parents serving as intervention agents and with coaching from remote behavior therapists using videoconferencing technology. Parent-implemented FAs produced differentiated results for all 4 children in the study. Overall, analyzing antecedent-behavior (A-B) and behavior-consequence (B-C) relations from the SDA videos identified only half of the functions identified by the FAs. For children whose SDA results were differentiated, analyzing A-B relations correctly identified 4 of 5 functions. Analyzing B-C relations correctly identified 5 of 6 functions identified by the experimental FA, but overidentified attention for all children. Implications for conducting functional analyses and interpreting structured descriptive assessment via telehealth are discussed.

Coaching parents to assess and treat self-injurious behaviour via telehealth

The application of telehealth technology to conduct functional analysis (FA) and functional communication training (FCT) is emerging for children with developmental disabilities and behaviour support needs. The current study was designed to extend FA + FCT for self-injurious behaviour by using telehealth in home with parents as interventionists receiving real-time remote coaching. Two families with school-aged boys with developmental disabilities associated with intellectual disability participated, one with cerebral palsy and the other with autism spectrum disorder. Results indicated that parent-implemented FA + FCT via telehealth was effective for reducing self-injurious behaviour and increasing mands (communication requests) for both children. Both families successfully implemented the FA + FCT protocol with 95% overall fidelity via telehealth-supported coaching. Results are discussed in terms of their relationship to previous research, limitations and future directions.

Comparison of progress monitoring data from general outcome measures and specific subskill mastery measures for reading

Interventionists often monitor the progress of students receiving supplemental interventions with general outcome measures (GOMs) such as curriculum-based measurement of reading (CBM-R). However, some researchers have suggested that interventionists should collect data more closely related to instructional targets, specific subskill mastery measures (SSMMs) because outcomes from GOMs such as CBM-R may not be sufficiently sensitive to gauge intervention effects. In turn, interventionists may prematurely terminate an effective intervention or continue to deliver an ineffective intervention if they do not monitor student progress with the appropriate measure. However, such recommendations are based upon expert opinion or studies with serious methodological shortcomings. We used multi-variate multilevel modeling to compare pre-intervention intercepts and intervention slopes between GOM and SSMM data collected concurrently in a sample of 96 first, 44 second, and 53 third grade students receiving tier 2 phonics interventions. Statistically significant differences were observed between slopes from SSMM consonant-vowel-consonant words and CBM-R data. Statistically significant differences in slopes were not observed for consonant blend, digraph or consonant-vowel-consonant-silent e (CVCe) SSMMs. Results suggest that using word lists to monitor student response to instruction for early struggling readers is beneficial but as students are exposed to more complex phonetic patterns, the distinction between SSMMs and CBM-R become less meaningful.

Communication Intervention for Young Children with Severe Neurodevelopmental Disabilities Via Telehealth

Young children with neurodevelopmental disorders such as autism spectrum disorders (ASD) and Rett syndrome often experience severe communication impairments. This study examined the efficacy of parent-implemented communication assessment and intervention with remote coaching via telehealth on the acquisition of early communication skills of three young children with ASD (2) and Rett syndrome (1). Efficacy of the intervention was evaluated using single-case experimental designs. First, functional assessment was used to identify idiosyncratic/potentially communicative responses and contexts for each child. Next, parents implemented functional communication training (FCT). All of the children acquired the targeted communication responses. The findings support the efficacy of telehealth as a service delivery model to coach parents on intervention strategies for their children's early communication skills.

Communication Intervention to Teach Requesting Through Aided AAC for Two Learners With Rett Syndrome

Evidence on effective communication interventions for persons with Rett syndrome is needed to drive the standard of care with this population. This study examined the effectiveness of an intervention package to teach multiple, aided communication requests for two persons with Rett syndrome (ages 27 and 7) through within participant, adapted multiple baseline designs across items/activities. Participants were taught graphic mode requests on speech generating devices, with access methods based on motor ability; one participant responded by pressing a touch screen, and one participant responded by fixed eye-gaze. Results are discussed in relation to the effectiveness of the intervention packages on increasing the accuracy of independent request selection responses emitted and the number of sessions required to reach an a priori performance criterion for both participants. Difficulties during initial prompting and during prompt fading with the eye-gaze response are considered. The findings suggest implications related to emerging evidence on the intervention methods to teach requesting skills to this population, and future research directions for communication intervention options for persons with severe communication impairment and limited motor repertoires.

Accuracy of student performance while reading leveled books rated at their instructional level by a reading inventory

Identifying a student's instructional level is necessary to ensure that students are appropriately challenged in reading. Informal reading inventories (IRIs) purport to assess the highest reading level at which a student can accurately decode and comprehend text. However, the use of IRIs in determining a student's instructional level has been questioned because of a lack of research. The current study examined the percentage of words read correctly with 64 second- and third-grade students while reading from texts at their instructional level as determined by an IRI. Students read for 1 min from three leveled texts that corresponded to their instructional level as measured by an IRI, and the percentage of words read correctly was recorded. The percentage read correctly correlated across the three books from r=.47 to r=.68 and instructional level categories correlated from tau=.59 to tau=.65. Percent agreement calculations showed that the categorical scores (frustration, instructional, and independent) for the three readings agreed approximately 67% to 70% of the time, which resulted in a kappa estimate of less than .50. Kappa coefficients of .70 are considered strong indicators of agreement. Moreover, more than half of the students with the lowest reading skills read at a frustration level when attempting to read books rated at their instructional level by an IRI. The current study questions how reliably and accurately IRIs identify students' instructional level for reading.

The Persistence-Strengthening Effects of DRA: An Illustration of Bidirectional Translational Research

We summarize a series of bidirectional research studies that demonstrate the persistence-strengthening effects of differential reinforcement of alternative behavior on problem behavior. We model a possible solution to this problem with rats followed by replication with a human clinical population. The importance of coordinated basic and applied research to stimulate new behavioral technologies is emphasized.

A Prospective Sequential Analysis of the Relation Between Physical Aggression and Peer Rejection Acts in a High-Risk Preschool Sample

Research Findings

In early childhood education, the social ecology of the child is considered critical for healthy behavioral development. There is, however, relatively little information based on directly observing what children do that describes the moment-by-moment (i.e., sequential) relation between physical aggression and peer rejection acts in early childhood contexts. Such information could be useful for policy and practice because it may inform specific intervention targets. In this descriptive study, a real-time direct observation protocol was used to measure the frequency of physically aggressive acts and peer rejection acts. The sequential association between directly observed physical aggression and peer rejection acts was examined for 5 high-risk preschool children (Child Behavior Checklist/Teacher Report Form clinical scores) at the beginning (Time 1 [T1]) and end (Time 2 [T2]) of their preschool year. Descriptive analyses showed that both aggression and peer rejection acts increased over the course of the preschool year. Sequential analyses showed that there was a significant (p < .05) increase in the likelihood of physical aggression followed by peer rejection acts from T1 to T2 as indexed by Yule's Q (a transformed odds ratio that controls for differences in the frequencies of children's target behavior). Similarly, there was a significant (p < .05) increase in the likelihood of peer rejection acts followed by physical aggression from T1 to T2.

Practice or Policy

Considering the long-term adversity that aggression and related early conduct problems can introduce into the education and social service system, additional studies using direct observation to study early social dynamics between peer rejection acts and physical aggression in at-risk children seem warranted to improve experts' ability to disrupt this developmental trajectory and improve peer relationships.

Differential reinforcement of alternative behavior increases resistance to extinction: clinical demonstration, animal modeling, and clinical test of one solution

Basic research with pigeons on behavioral momentum suggests that differential reinforcement of alternative behavior (DRA) can increase the resistance of target behavior to change. This finding suggests that clinical applications of DRA may inadvertently increase the persistence of target behavior even as it decreases its frequency. We conducted three coordinated experiments to test whether DRA has persistence-strengthening effects on clinically significant target behavior and then tested the effectiveness of a possible solution to this problem in both a nonhuman and clinical study. Experiment 1 compared resistance to extinction following baseline rates of reinforcement versus higher DRA rates of reinforcement in a clinical study. Resistance to extinction was substantially greater following DRA. Experiment 2 tested a rat model of a possible solution to this problem. Training an alternative response in a context without reinforcement of the target response circumvented the persistence-strengthening effects of DRA. Experiment 3 translated the rat model into a novel clinical application of DRA. Training an alternative response with DRA in a separate context resulted in lower resistance to extinction than employing DRA in the context correlated with reinforcement of target behavior. The value of coordinated bidirectional translational research is discussed.

Calculating contingencies in natural environments: issues in the application of sequential analysis

Analysis and interpretation of behavior-environment relations are increasingly being conducted with data that have been derived descriptively. This paper provides an overview of the logic that underlies a sequential analytic approach to the analysis of descriptive data. Several methods for quantifying sequential relations are reviewed along with their strengths and weaknesses. Data from descriptive analyses are used to illustrate key points. Issues germane to contingency analysis in natural environments are discussed briefly. It is concluded that the conceptual distinctions among contiguity, contingency, and dependency are critical if the logic of sequential analysis is to be extended successfully to a behavior-analytic account of reinforcement in natural environments.

Response persistence: the effects of stimulus control on negatively reinforced problem behavior in a concurrent operant

In the context of instructional demands, compliance and problem behavior can be considered concurrent operants. Of applied interest is increasing one response (i.e., compliance) while decreasing the other (i.e., problem behavior). Strategic arrangement of reinforcement can alter response allocation accordingly. Such schedules can also influence response persistence and generalization. A case study is used to illustrate the effects of stimulus-reinforcer relations in a concurrent-operants arrangement involving an adult with developmental disabilities and problem behavior. Results are discussed in the context of basic operant research findings in the areas of stimulus control and behavioral persistence.

Brief experimental analysis of early reading interventions

The purpose of this study was to investigate how brief experimental analyses (BEAs) could be used to identify effective interventions for Kindergartners (2 girls and 2 boys, 5 years and 7-10 months old) with low performance and/or growth slope in letter sound fluency (LSF). Interventions were tested within a multielement design with brief mini-reversals until an intervention yielding at least 20% improvement ona specific subskill measure or a curriculum-based measure of LSF was identified. BEA-identified interventions were implemented one-on-one for 5 to 9 weeks. A multiple-baseline design across participants showed large intervention effects (average adjusted d=2.4) on general outcome measures, supporting treatment validity of BEAs. Findings extend the BEA literature to younger participants, early reading interventions, and early reading measures.

Clinical observation of self-injurious behavior correlated with changes in scalp morphology in a child with congenital hydrocephalus

We report the case of a 12-year-old girl born with cerebral dysgenesis and congenital hydrocephalus first shunted shortly after birth. She had severe tissue-damaging self-injurious behavior, profound mental retardation, quadriparesis, as well as multiple cranial anomalies including turricephaly. After stage 1 cranial remodeling, a bone window was left pending second stage remodeling. Episodic changes in fluctuation of the scalp overlying the bone window were easily observed. During the course of a behavioral assessment for her self-injury, it was observed that the overall frequency of occurrence of self-injury increased significantly (P < .01) when the scalp was protruding and bulging compared with when the scalp was flush with the skull table. Periods of increased scalp protrusion were also associated with higher scores on a pain scale developed for children with communicative impairments associated with severe neurological impairment. After shunt replacement, there was remarkable improvement in functional status and decreased episodic self-injury.

Dynamic changes in reinforcer effectiveness: theoretical, methodological, and practical implications for applied research

Reinforcers lose their effectiveness when they are presented repeatedly. Traditionally, this loss of effectiveness has been labeled satiation. However, recent evidence suggests that habituation provides a more accurate and useful description. The characteristics of behavior undergoing satiation differ for different stimuli (e.g., food, water), and these characteristics have not been identified for the noningestive reinforcers often used by applied behavior analysts (e.g., praise, attention). As a result, the term satiation provides little guidance for either maintaining or reducing the effectiveness of reinforcers. In contrast, the characteristics of behavior undergoing habituation are well known and are relatively general across species and stimuli. These characteristics provide specific and novel guidance about how to maintain or reduce the effectiveness of a reinforcer. In addition, habituation may lead to a better understanding of several puzzling phenomena in the conditioning literature (e.g., extinction, behavioral contrast), and it may provide a more precise and accurate description of the dynamics of many different types of behavior.

The effects of presession attention on problem behavior maintained by different reinforcers

The effect of presession attention on the later occurrence of problem behavior was examined with elementary-school children with a range of disabilities. Results of analogue functional analyses suggested an escape function, an attention function, or both. Following the analogue functional analyses, the effects of two antecedent conditions (10-min ignore vs. 10-min attention) were compared on problem behavior in subsequent test conditions. For participants who displayed attention-maintained problem behavior, the test condition involved contingent attention for problem behavior. For participants who displayed escape-maintained problem behavior, the test condition involved contingent escape for problem behavior. Results indicated that participants who displayed attention-maintained problem behavior displayed less problem behavior following presession exposure to attention than when ignored. No such effect was found for presession attention on escape-maintained problem behavior. We discuss matching antecedent-based interventions to the results of functional analysis.

Sequential and matching analyses of self-injurious behavior a case of overmatching in the natural environment

In this study, we examined the relation between naturally occurring rates of self-injurious behavior and appropriate communicative behavior using prospective sequential and matching analyses of descriptive data. Results from both analyses suggested reliable covariation between both forms of behavior and staff attention. Findings are discussed in terms of the applicability of quantitative descriptive analyses to characterize behavior-environment relations in natural contexts.

The effects of differential and lag reinforcement schedules on varied verbal responding by individuals with autism

Variability has been shown to be a reinforceable dimension of behavior. One procedure that has been demonstrated to increase variability in basic research is the lag reinforcement schedule. On this type of schedule, a response is reinforced if it differs from a specified number of previous responses. Lag schedules are rarely used, however, for increasing response variability in applied settings. The purpose of the present study was to investigate the effects of a lag schedule of differential reinforcement on varied and appropriate verbal responding to social questions by 3 males with autism. A reversal design with a multiple baseline across subjects was used to evaluate the effects of the lag schedule. During baseline, differential reinforcement of appropriate responding (DRA) resulted in little or no varied responding. During the intervention, a Lag 1 requirement was added to the DRA (Lag 1/DRA) resulting in an increase in the percentage of trials with varied and appropriate verbal responding for 2 of the 3 participants. In addition, an increase in the cumulative number of novel verbal responses was also observed for the same 2 participants. These results are discussed in terms of reinforcement schedules that support variability, generalization, and potential stimulus control over varied responding.

Concurrent reinforcement schedules: behavior change and maintenance without extinction

We evaluated the effects of concurrent schedules of reinforcement on negatively reinforced problem behavior and task completion with 3 children with autism. Results indicated that problem behavior occurred at high levels and relatively few tasks were completed when problem behavior produced a break (from tasks) and task completion produced either no consequence or a break. By contrast, problem behavior was eliminated and tasks were completed when problem behavior produced a break and task completion produced a break with access to preferred activities. Treatment gains were maintained without the use of extinction when the response requirement was increased and the schedule of reinforcement was thinned.

The effects of magnitude and quality of reinforcement on choice responding during play activities

Three boys with autism participated in a study of the effects of magnitude and quality of reinforcement on choice responding. Two concurrent response alternatives were arranged: (a) to play in an area where a peer or sibling was located, or (b) to play in an area where there was no peer or sibling. During one condition, the magnitude (i.e., duration of access to toys) or quality (level of preference) of reinforcement provided for both responses was equal. During the other condition, the magnitude or quality of reinforcement was relatively greater for choosing the play area where the peer or sibling was located than the area where the peer or sibling was not located. Results showed that after repeated exposure to the unequal magnitude or quality condition, the participant increasingly allocated his responses to the play area where the peer or sibling was located. For 2 participants, this pattern of responding was maintained in the subsequent equal magnitude or quality condition. Overall, the analysis suggests that the dimensions of magnitude and quality of reinforcement can be arranged to influence choice responding in favor of playing near a peer or sibling rather than playing alone.

The effects of form training on foul-shooting performance in members of a women's college basketball team

The effects of instruction and feedback in proper form on foul-shooting performance was evaluated in 3 players of a women's NCAA Division II college basketball team. Players showed an increase in percentage of shots made and in correct form compared to baseline shooting without instruction or feedback. All players reached criterion within seven training sessions. The results suggest that training proper form is an effective strategy for improving foul-shooting performance.

Designing interventions that include delayed reinforcement: implications of recent laboratory research

The search for robust and durable interventions in everyday situations typically involves the use of delayed reinforcers, sometimes delivered well after a target behavior occurs. Integrating the findings from laboratory research on delayed reinforcement can contribute to the design and analysis of those applied interventions. As illustrations, we examine articles from the Journal of the Experimental Analysis of Behavior that analyzed delayed reinforcement with respect to response allocation (A. M. Williams & Lattal, 1999), stimulus chaining (B. A. Williams, 1999), and self-control (Jackson & Hackenberg, 1996). These studies help to clarify the conditions under which delayed reinforcement (a) exercises control of behavior, (b) entails conditioned reinforcement, and (c) displaces the effects of immediate reinforcement. The research has applied implications, including the development of positive social behavior and teaching people to make adaptive choices.

DESCRIPTORS

delayed reinforcement, response allocation, stimulus chains, self-control, integration of basic and applied research

Increasing accuracy and decreasing latency during clean intermittent self-catheterization procedures with young children

We examined the effects of simulation training on performance of clean intermittent self-catheterization procedures with 2 young girls. Simulation training was conducted, after which independent performance was assessed within a multiple baseline design. The training resulted in increased accuracy and decreased latency for both girls.

Use of a concurrent operants paradigm to evaluate positive reinforcers during treatment of food refusal

The authors evaluated the responsiveness of 4 preschool-aged children to positive reinforcers within a concurrent operants paradigm during mealtimes. The children were presented with two identical, concurrently available sets of food. Each set differed in quantity and quality of positive reinforcement paired with acceptance of each bite of food or in the number of bites of food required to obtain positive reinforcement. Experiment 1 evaluated 1 child's responsiveness to positive reinforcement while permitting escape from bite offers. Experiment 2 evaluated 2 children's responsiveness to positive reinforcement when escape extinction occurred. Results from these experiments suggested that the children were responsive to positive reinforcers and chose more often the bites paired with the greater quantity and/or quality of reinforcement. Experiment 3 evaluated 1 child's responsiveness to positive reinforcement both without and with escape extinction. Results suggested that positive reinforcement affected choice behavior and that escape extinction affected amount of food consumed.

Increasing compliance with medical procedures: application of the high-probability request procedure to a toddler

The effects of high-probability (high-p) requests on compliance with low-probability (low-p) responses have received increased attention from applied investigators. This study examined the effects of a high-p procedure on a toddler's compliance with medical procedures. Compliance to low-p requests occurred more frequently following compliance to high-p requests, suggesting that this procedure may be useful across different topographies of compliance.

Choice-making treatment of young children's severe behavior problems

The choice-making behavior of 5 young children with developmental disabilities who engaged in aberrant behavior was studied within a concurrent operants framework. Experimental analyses were conducted to identify reinforcers that maintained aberrant behavior, and functional communication training packages were implemented to teach the participants to gain reinforcement using mands. Next, a choice-making analysis, in which the participants chose one of two responses (either a mand or an alternative neutral response) to obtain different durations and qualities of reinforcement, was conducted. Finally, treatment packages involving choice making via manding were implemented to decrease inappropriate behavior and to increase mands. The results extended previous applications of choice making to severe behavior disorders and across behaviors maintained by positive and negative reinforcement.

Brief experimental analysis of stimulus prompts for accurate responding on academic tasks in an outpatient clinic

Brief multielement designs were used to examine the effects of specific instructional strategies on accuracy of academic performance during outpatient evaluations of 4 children with learning disorders. Instructional strategies that improved accuracy on academic tasks were identified for all participants. These results suggest that the application of experimental analysis methodologies to instructional variables may facilitate the identification of stimulus prompts that are associated with enhanced academic performance.

Separate and combined effects of methylphenidate and a behavioral intervention on disruptive behavior in children with mental retardation

We investigated the separate and combined effects of a behavioral intervention and methylphenidate (Ritalin) on disruptive behavior and task engagement in 3 children with severe to profound mental retardation. The behavioral intervention involved differential reinforcement of appropriate behavior and guided compliance. All 3 children demonstrated decreased disruptive behavior and improved task engagement in response to the response to the behavioral intervention. Two of the 3 children demonstrated similar improvement in response to methylphenidate. Although both interventions were highly effective for these 2 participants, the relative efficacy of the interventions varied between the 2 children. There was no evidence of an additive or synergistic effect of the two interventions, but the high efficacy of each intervention alone limited our ability to detect such effects.

Use of component analyses to identify active variables in treatment packages for children with feeding disorders

We evaluated the separate components in treatment packages for food refusal of 4 young children. First, treatment packages were implemented until food acceptance improved. Next, a component analysis was conducted within a multielement or reversal design to identify the active components that facilitated food acceptance. The results indicated that escape extinction was always identified as an active variable when assessed; however, other variables, including positive reinforcement and noncontingent play, were also identified as active variables for 2 of the children. The results suggest that the component analysis was useful for identifying variables that affected food acceptance.