Behavioral Treatment of Sleep Problems using Wake-Time Fading with Individuals with Autism: A Brief Report

Difficulties with sleep, such as delayed onset, night waking, and early waking, are pervasive among individuals with developmental disabilities and autism. Interventions that seek to improve sleep outcomes are particularly useful when these individuals have experienced extended hospitalizations where low activity levels and decreased exposure to light-dark cycles maintain or increase disturbance in sleep patterns. The current study examines the effects of wake-time phase advances on the sleep patterns of a 16-year-old male and 17-year-old female, both of whom presented with significant sleep disturbance, autism, developmental delays, and severe problem behavior in a hospital-based setting. For both individuals, clinically significant increases in appropriate sleep and decreases in latency to sleep were observed throughout the course of their admission as a result of wake-time phase advances. Together, these results replicate and extend limited research in this area by using behavioral interventions to decrease disrupted sleep in inpatient contexts.

Evaluation of accepted and rejected submissions in the Journal of Applied Behavior Analysis: Gender and experience

Researchers have examined factors of authors such as sex of author, gender identity, and seniority within the field of behavior analysis to determine if any biases towards a certain group existed. Most recently, Kranak et al. (2020) found that women and new authors are well-represented in the Journal of Applied Behavior Analysis (JABA). However, that analysis included only published manuscripts. Thus, the degree to which these subpopulations are proportionally represented is unknown, because that analysis was unable to determine how often these subpopulations are submitting manuscripts. Therefore, the purpose of the current investigation was to extend Kranak et al. and analyze all accepted and rejected manuscripts submitted to JABA from 2015 - 2019. Results indicated that women and men had nearly identical acceptance rates during this time period, whereas veteran authors' acceptance rate was nearly 2.5 times greater than that of new authors. Implications for publishing, reviewing, and research mentorship practices are discussed.

Interobserver agreement: A preliminary investigation into how much is enough?

Interobserver agreement (IOA) is important for research and practice, and supports the consistency of behavioral data (Kahng et al., 2011). Although general parameters for how much IOA is needed have been suggested (Bailey & Burch, 2018), it is unknown if the total number of sessions with IOA might impact the IOA coefficient. In this study, IOA was reanalyzed using functional analysis data at various cutoffs. Obtained IOA from these analyses was then compared to the original IOA. Overall, results suggested that, at least when using highly trained observers in a structured clinical setting, there were no significant differences in IOA across cutoffs. However, IOA was sensitive to overall rate of responding in the functional analysis. These data are encouraging, particularly for practitioners, because they provide preliminary support that the amount of sessions with IOA may not be as important as the consistency of the data.

Application of automated nonparametric statistical analysis in clinical contexts

Functional analyses (FAs) provide clinicians with results upon which they design behavioral treatments. Unfortunately, interrater reliability of visual analysis of FA results can be inconsistent. Accordingly, researchers have designed quantitative metrics and visual aids to supplement visual analysis. Recently, Hall et al. (2020) provided a proof of concept for using automated nonparametric statistical analysis (ANSA) to interpret FA data. Their results show promise for ANSA as a supplemental tool. However, they evaluated ANSA with only published FA datasets, which may not be representative of FAs commonly encountered in clinical care. Therefore, the purpose of this replication was to compare ANSA to another validated supplemental aid (i.e., the structured criteria method) and investigate its utility with unpublished clinical FA data. Our results were consistent with Hall et al.'s, indicating ANSA may augment clinical interpretation of FA data. Recommendations for clinical applications of ANSA and future directions for researchers are discussed.

Prevalence of renewal of problem behavior: Replication and extension to an inpatient setting

Individuals with intellectual and developmental disabilities who exhibit problem behavior often receive behavioral assessment and treatment in specialized inpatient and outpatient clinics. However, problem behavior sometimes reemerges as a function of changes in contexts and stimulus conditions, such as returning to the home environment. This reemergence is called renewal. Recently, Muething et al. (2020) found that renewal occurred in over half (67%) of cases from an outpatient clinic. Their sample was obtained exclusively from an outpatient setting and despite the applied relevance of renewal, its clinical prevalence in other populations is unknown. Accordingly, we replicated Muething et al.'s procedures and analyzed renewal in 37 inpatient treatment applications across 34 cases via consecutive-controlled case series. Renewal was present in 59% of cases; however, we found that renewal occurred in only 24% of context changes compared to 42% reported by Muething et al. Various factors related to the prevalence of renewal were evaluated.

Authorship trends in the Journal of Applied Behavior Analysis: An update

The Journal of Applied Behavior Analysis (JABA) is considered the flagship journal for the discipline of applied behavior analysis. Thus, popular research topics and other publication trends within JABA reflect the current cultural and scientific contingencies governing the field of behavior analysis. Researchers have previously quantified a number of authorship trends in JABA (and other behavior-analytic journals) across a number of variables, such as gender identity and sex of author, country of origin, or seniority within the field (Dunlap et al., 1998) to examine demographic and organizational factors associated with successful publication in JABA. These analyses ought to be conducted continuously to monitor trends and detect any potential biases (e.g., sexism). Accordingly, the purpose of the present investigation was to replicate previous research in this area (e.g., Dymond et al., 2000) and provide an update of current publication trends within JABA. Implications for future research and publishing practices are discussed.

Evaluating sources of baseline data using dual-criteria and conservative dual-criteria methods: A quantitative analysis

Scheithauer et al. (2020) recently demonstrated that differences in the source of baseline data extracted from a functional analysis (FA) may not affect subsequent clinical decision-making in comparison to a standard baseline. These outcomes warrant additional quantitative examination, as correspondence of visual analysis has sometimes been reported to be unreliable. In the current study, we quantified the occurrence of false positives within a dataset of FA and baseline data using the dual-criteria (DC) and conservative dual-criteria (CDC) methods. Results of this quantitative analysis suggest that false positives were more likely when using FA data (rather than original baseline data) as the initial treatment baseline. However, both sources of baseline data may have acceptably low levels of false positives for practical use. Overall, the findings provide preliminary quantitative support for the conclusion that determinations of effective treatment may be easily obtained using different sources of baseline data.

Context influences preference for and level of physical activity of adolescents with intellectual and developmental disabilities

The purpose of the current study was to replicate and extend Hustyi, Normand, Larson, and Morley (2012) by determining the effects of different contexts on physical activity displayed by adolescents with intellectual and developmental disabilities, and determining preference for various activities. Results indicated that an exergaming condition produced the highest levels of activity. Results of a preference assessment indicated that 2 out of 3 participants preferred the physical activity context to the sedentary. For the third participant, an intervention was included to increase activity. Although the intervention was successful, participant preference for the sedentary activity context remained unchanged.

Classification of injuries observed in functional classes of self-injurious behaviour

BACKGROUND

Limited research has examined how the functions of self-injurious behaviour (SIB) relate to the production of injuries and the location, type or severity of those injuries.

METHODS

Clinical and medical records were coded for 64 individuals hospitalised for SIB. When injuries were present, the physical properties of SIB and injuries were assessed across groups of individuals with automatically and socially maintained SIB.

RESULTS

Injuries were observed for 35 of the individuals who engaged in SIB. Individuals who engaged in a single form of SIB were more likely to have injuries (P < .05). Individuals with SIB maintained by automatic reinforcement had significantly more severe injuries to the head than those in the social group (q < .05, P = .0132, H = 12.54).

CONCLUSION

Although results are preliminary, the results provide evidence that the function of SIB may influence the severity and location of injuries produced.

Further investigation of a rapid restraint analysis

Research related to the use of mechanical restraint devices (e.g., arm splints) has been limited despite the frequency with which they are used in the clinical treatment of severe and dangerous self-injurious behavior (SIB). Wallace, Iwata, Zhou, and Goff () used a rapid restraint analysis (RRA) to evaluate the effects of different levels of arm-splint flexion on rates of hand-to-head SIB and adaptive behavior. The goal of the current study was 3-fold: (a) to extend previous research on RRA by reporting RRA results for 10 participants and investigating post-RRA outcomes, (b) to investigate whether the RRA might have the potential to eliminate the need for restraint fading altogether for some individuals, and (c) to investigate whether the RRA might help to identify a starting point for restraint fading for individuals for whom fading is necessary. Results suggested that the RRA helped to eliminate the need for restraint fading for 6 participants. With respect to the identification of a starting point for restraint fading, results were mixed. Overall, 8 of the 10 participants were discharged from the inpatient unit at a less restrictive level of flexion or at the same level of flexion identified by the RRA. Implications for adoption of the RRA are discussed.

Improving accuracy of portion-size estimations through a stimulus equivalence paradigm

The prevalence of obesity continues to increase in the United States (Gordon-Larsen, The, & Adair, 2010). Obesity can be attributed, in part, to overconsumption of energy-dense foods. Given that overeating plays a role in the development of obesity, interventions that teach individuals to identify and consume appropriate portion sizes are warranted. Specifically, interventions that teach individuals to estimate portion sizes correctly without the use of aids may be critical to the success of nutrition education programs. The current study evaluated the use of a stimulus equivalence paradigm to teach 9 undergraduate students to estimate portion size accurately. Results suggested that the stimulus equivalence paradigm was effective in teaching participants to make accurate portion size estimations without aids, and improved accuracy was observed in maintenance sessions that were conducted 1 week after training. Furthermore, 5 of 7 participants estimated the target portion size of novel foods during extension sessions. These data extend existing research on teaching accurate portion-size estimations and may be applicable to populations who seek treatment (e.g., overweight or obese children and adults) to teach healthier eating habits.

A comparison of reinforcement schedules to increase independent responding in individuals with intellectual disabilities

We compared the effects of varying reinforcement schedules on independent responding with 3 individuals with intellectual disabilities. Independent responding was always reinforced, and responding after a vocal response was either (a) always reinforced, (b) never reinforced, or (c) reinforced on a fixed-ratio 3 schedule. Results showed that for 2 of the 3 participants, independent responding was higher when responding after the vocal prompt was never reinforced. These data suggest that altering the reinforcement schedule to favor independent responding may lead to increased independent responding.

Behavior-analytic research on dementia in older adults

It is estimated that 1 in 10 adults aged 65 years and older have been diagnosed with dementia, which is associated with numerous behavioral excesses and deficits. Despite the publication of a special section of the Journal of Applied Behavior Analysis (JABA) on behavioral gerontology (Iwata, 1986), there continues to be a paucity of behavior-analytic research with this population. This review compares the research published before and after the behavioral gerontology special section and evaluates the most recently published aging articles in JABA.

Further examination of discriminated functional communication

One child with developmental disabilities was taught to mand for attention by saying "excuse me." Treatment effects were extended to multiple training contexts by teaching the participant to attend to naturally occurring discriminative stimuli through differential reinforcement of communication during periods of the experimenter's nonbusy activities (e.g., reading a magazine). Results are discussed in terms of future research on the generalization and maintenance of functional communication in the natural environment.

Some effects of noncontingent positive reinforcement on multiply controlled problem behavior and compliance in a demand context

Functional analysis suggested that the problem behavior of an 8-year-old girl with autism was maintained by escape from demands and access to edible items. Noncontingent delivery of an edible item was sufficient to increase compliance and reduce the rate of problem behavior without the use of escape extinction in a demand context. Leaner and richer schedules of noncontingent reinforcement were equally effective, and there were minimal differences between noncontingent reinforcement and differential reinforcement of compliance.