|Increasing the Feasibility of Treatment for Problem Behavior and Evaluating Treatment Outcomes|
|Sunday, May 26, 2019|
|4:00 PM–5:50 PM |
|Hyatt Regency West, Ballroom Level, Regency Ballroom C|
|Area: AUT/DDA; Domain: Applied Research|
|Chair: Jennifer N. Fritz (University of Houston-Clear Lake)|
|Discussant: Brian D. Greer (University of Nebraska Medical Center's Munroe-Meyer Institute)|
|CE Instructor: Brian D. Greer, Ph.D.|
During function-based treatment of severe problem behavior, caregivers may be unable to ignore or implement extinction consistently and may find it difficult to reinforce appropriate behavior immediately or on dense schedules of reinforcement. Interventions that address these issues are critical for maintaining treatment effects in home and community settings when caregivers are responsible for implementing the intervention. A growing body of research on treatment of problem behavior without extinction addresses the former issue, and various approaches to reinforcement schedule thinning after teaching an appropriate, alternative response addresses the latter. Furthermore, caregivers’ experience of problem behavior extends beyond simply dealing with the rate or duration of responding, and research that explores the other aspects of caregivers’ experiences following treatment of problem behavior is needed. This symposium will include studies on treatment without extinction, reinforcement schedule thinning with delay tolerance following FCT, and an evaluation of treatment outcomes beyond the traditional overall percentage reduction in rate or duration of problem behavior. Collectively, these studies will address the feasibility and outcomes of function-based behavioral interventions for severe problem behavior.
|Instruction Level: Intermediate|
|Keyword(s): concurrent reinforcement, delay tolerance, FCT, treatment outcome|
|Target Audience: |
|Competing Stimuli in Treatment of Problem Behavior Maintained by Social-Negative Reinforcement|
|KYLE DAWSON (University of Houston-Clear Lake; Marquette University), Jennifer N. Fritz (University of Houston-Clear Lake), Desiree Dawson (University of Houston-Clear Lake; Marquette University ), Leah Smith (University of Houston-Clear Lake), Kelsey Leadingham (University of Houston-Clear Lake)|
|Abstract: Treatment of escape-maintained problem behavior has largely focused on providing the functional reinforcer (a brief break) contingent on appropriate alternative behavior, for the absence of the target behavior, or noncontingently. Recent research suggests the use of arbitrary reinforcement can also be effective in decreasing problem behavior maintained by escape from demands. The current study examined the use of a competing stimulus without the use of extinction on problem behavior maintained by social-negative reinforcement in the form of escape from demands and on compliance with demands. The competing stimulus was provided noncontingently and continuously, while problem behavior still resulted in the functional reinforcer (i.e., break from demands). Results suggested the use of a competing stimulus was effective in decreasing problem behavior maintained by escape from demands and did not impede compliance with demands. For two participants, reductions in problem behavior maintained by the competing stimulus was removed. Therefore, this can be an effective, quick treatment with lasting effects for some individuals.|
Using Results From a Modified Assessment to Teach Functional Communication and Delay Tolerance Responses to Children With Severe Problem Behavior
|JESSI REIDY (Marquette University), Mary Halbur (Marquette University), Tiffany Kodak (Marquette University), Samantha Klasek (University of Wisconsin-Milwaukee), Alyssa P. Scott (Marquette University), Xi'an Maya Williams (Marquette University), Courtney Lyn Meyerhofer (Marquette University)|
Implementing a function-based intervention that is feasible to implement in the natural environment is a crucial component in behavior analytic interventions for problem behavior. The purpose of the present evaluation was to teach a child and adolescent with autism spectrum disorder to engage in functional communication responses (FCR) and delay-tolerance responses to escape multiple non-preferred tasks and/or gain access to preferred tangible and edible items. Following acquisition of the targeted FCRs, participants were taught a delay-tolerance response. Thereafter, we introduced delay-tolerance steps (i.e., walking part way to the garage before taking a break, working for a short period prior to obtaining a tangible) to successively reach the terminal delay goals identified by family members (e.g., walking to the bus stop, waiting 10 min for a requested tangible item). The intervention was efficacious in teaching both participants to engage in multiple FCRs and delay-tolerance responses. Additionally, the rate of problem behavior decreased during the delay tolerance steps that included completion of activities and the wait periods, and terminal delay goals were achieved for multiple skills.
A Summary and Evaluation of Using Tolerance Training With Children With Severe Problem Behavior
|ANLARA MCKENZIE (Kennedy Krieger Institute), Nicole Lynn Hausman (Kennedy Krieger Institute), Molly K Bednar (Kennedy Krieger Institute), Meagan K. Gregory (Kennedy Krieger Institute)|
Functional communication training (FCT) is a common intervention employed with children with Autism Spectrum Disorder who will engage in problem behavior to gain access to desired reinforcement. A common problem with FCT in the natural environment is the caregiver’s inability to reinforce appropriate communication immediately or on an FR1 schedule. Tolerance training as described by Hanley, Jin, Vanselow, and Hanratty (2014) is a method to increase a client’s acceptance of delays to or denials of reinforcement during periods caregivers are unable to respond to communication or when the desired reinforcer is not available. However, few studies have employed these procedures with clients that engage in severe topographies of problem behavior (e.g., problem behavior that causes injury to themselves or others). We replicated and extended previous literature by conducting variations of tolerance training with children and adolescents admitted to an inpatient hospital for assessment and treatment of severe problem behavior using a reversal design. Results indicated that tolerance training is generally an effective method in reducing problem behavior related to delayed or denied reinforcement with these clients. Possible mechanisms for these results (e.g., differing methods per individual client) are discussed.
Beyond Percent Reduction: A Consecutive Case Review Evaluating Outcomes From a Severe Behavior Day Treatment Model
|NADRATU NUHU (Marcus Autism Center; Emory University School of Medicine), Joanna Lomas Mevers (Marcus Autism Center; Emory University School of Medicine), Jamison Keenum (Marcus Autism Center; Children’s Healthcare of Atlanta), Colin S. Muething (Marcus Autism Center; Emory University School of Medicine), Mindy Christine Scheithauer (Marcus Autism Center; Emory University School of Medicine), Nathan Call (Marcus Autism Center; Emory University School of Medicine)|
Behavior analysts typically use percent reduction of problem behavior as a primary outcome measure when evaluating intervention effectiveness for the treatment of problem behavior (Scheithauer, Muething, Silva, Gerencser, Krantz, & Call, 2018). However, families of individuals who engage in severe problem behavior are likely to experience a number of outcomes beyond what is captured by percent reduction. To date, few researchers have systematically evaluated the broader impact of behavior interventions, beyond the observed reduction of problem behavior, on the lives of patients and their families. The purpose of the current study was to conduct a consecutive case series analysis of patients that were seen in a severe behavior day treatment program over five years. The current study examined the use of indirect assessments, combined with data from treatment evaluations, to assess the global impact of problem behavior interventions on families’. Indirect measures include Behavior Problem Index and Parental Stress Index. The current study includes data from two time points during the admission: pre-treatment and post-treatment. Overall, investigators found discrepancies between outcome measures. Indirect measures on other domains of functioning may provide valuable information regarding the global impact of interventions used to treat severe problem behavior.