Association for Behavior Analysis International

The Association for Behavior Analysis International® (ABAI) is a nonprofit membership organization with the mission to contribute to the well-being of society by developing, enhancing, and supporting the growth and vitality of the science of behavior analysis through research, education, and practice.


45th Annual Convention; Chicago, IL; 2019

Event Details

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Symposium #103
CE Offered: BACB
Removing Barriers to Managing Diabetes With Cognitive Impairment
Saturday, May 25, 2019
3:00 PM–4:50 PM
Swissôtel, Event Center Second Floor, Vevey 3/4
Area: CBM; Domain: Theory
Chair: Elise Pearl (Eastern Michigan University)
Discussant: Rebecca A Sharp (Bangor University)
CE Instructor: Rebecca A Sharp, Ph.D.

Cognitive impairment and type 2 diabetes often co-occur: individuals with neurodevelopmental disorders are 1.5 to 2.7 times more likely to have diabetes than the general population, and there is a 1.5- to 2-fold increased risk that older adults with diabetes will develop a major neurocognitive disorder, such as vascular dementia. Adults with cognitive impairment and diabetes tend to receive substandard diabetes care, putting them at increased risk of complications and hospitalization. Consequently, approximately 33% and 9-17% of individuals with type 2 diabetes and cognitive impairment experience episodes of hyper or hypoglycemia, respectively. Problematic glycemic control associated with poorly managed type 2 diabetes can function as an antecedent, contributing to increased frequencies of behavioral problems when neurodevelopmental or neurocognitive disorders are also present. This symposium will present a behavior analytic approach to diabetes management, including a structured task analysis, and discuss barriers and facilitators to diabetes management, particularly the role of specific cognitive deficits, family care partner behavior, and the structure of food environments.

Instruction Level: Basic
Keyword(s): care partners, cognitive impairment, diabetes management, task analysis
Target Audience:

Behavior analysts working with children or adults, particularly those with impaired cognition and comorbid medical concerns.

Learning Objectives: At the conclusion of this presentation, participants will be able to 1. identify tasks required to manage diabetes and how these may be affected by impaired cognition; 2. contextualize difficulty structuring supportive food environments and consider intervention strategies; 3. conceptualize facilitators and barriers to care partner management of comorbid diabetes and cognitive impairment.
Task Analysis of Type 2 Diabetes Management
LINDSEY BUNIO (Eastern Michigan University), Kayla Rinna (Eastern Michigan), Claudia Drossel (Eastern Michigan University)
Abstract: Behavior analysts can prevent adverse events and contribute to the quality of service delivery for adults with type 2 diabetes and impaired cognition by enhancing adherence to treatment regimens. When a client has diabetes, a behavior analysis includes assessment of and intervention on the chain of behaviors required to effectively manage blood sugar levels, including systematic monitoring and medication administration. This presentation introduces the development and the implementation of a task analysis that clarifies areas of skill breakdown and suggests interventions at each relevant step. This task analysis can be modified based on the type of medication (e.g., insulin vs. oral tablets), and it can assess potential breakdowns within the complex sequence related to various elements, such as specific devices and tracking methods. Behavior analysts will be able to distinguish specific components of the process that the client may self-manage from those components that may require additional support or assistance for completion. Also discussed will be steps to train family care partners to provide the additional support.

Integrating Neuropsychological Test Data With Behavioral Analytic Conceptualization

REBECCA CAMPBELL (Wayne State University), John Woodard (Wayne State University)

Managing type 2 diabetes entails significant patient involvement to perform many daily self-care tasks, such as monitoring blood glucose, taking medications, and maintaining a diabetic diet. Chronic and poorly managed type 2 diabetes -- with frequent episodes of hyper- and hypoglycemia -- often is accompanied by functional decline, including changes in sensory acuity due to diabetic retinopathy and executive functioning, i.e., initiating complex actions, organizing, and planning. Decreased motor skills and difficulties learning, attending, or remembering may also occur. These types of changes further diminish individuals’ ability to direct and engage effectively in their diabetes care. Available neuropsychological testing data can supplement a task analysis and provide further useful information about the types of difficulties that may interfere with tasks necessary to self-management of diabetes. Common neuropsychological changes in type 2 diabetes will be discussed, along with the specific instruments used to measure these changes, and their potential impact on behavioral intervention strategies. When possible, neuropsychological testing should be integrated with behavioral analytic case conceptualizations, to facilitate intervention planning.


Food Environments and Glycemic Control: Education and Behavior Analytic Intervention

Kate Krautbauer (Eastern Michigan University), ELISE PEARL (Eastern Michigan University), Claudia Drossel (Eastern Michigan University)

Eating well is critical to health for all people, and this may be particularly true for individuals with type 2 diabetes. Given the relevance of behavioral economics and discounting to everyday food choices and obesity as a general public health problem, impaired cognition -- accompanied by decreased influence of larger later outcomes over behavior -- presents unique challenges when arranging or structuring a food environment to support adherence to diabetes management. Extremes of blood sugar - both high (hyperglycemia) and low (hypoglycemia) - have been associated with accelerated functional decline and behavioral disturbances. Hyperglycemia has been linked to the development of physical impairment and increased risk for delirium or psychosis. Hypoglycemia has been associated with increased difficulty tracking contingencies over time, impairment in immediate and delayed stimulus control, decrements in motor control and gait, and break down of behavioral chains. The impact of glycemic control on the functional status and behavior of those with comorbid diabetes and cognitive impairment will be reviewed. Contingency management interventions designed to increase the likelihood of glycemic control by targeting the food environment will be suggested.

Care Partners’ Role in Managing Diabetes and Cognitive Impairment
Jennifer Battles (Eastern Michigan University), Claudia Drossel (Eastern Michigan University), KAYLA RINNA (Eastern Michigan University)
Abstract: Effectively managing diabetes in the presence of cognitive limitations poses a significant challenge for healthcare providers, advocates, and families. Many adults with diabetes and impaired cognition have informal care partners -- family members or friends -- who assist with or complete instrumental activities of daily living, such as cooking or medication administration. Data from public health surveys indicate that long-term demands of informal caregiving for spouses or family members with cognitive impairment correlate with care partner health problems and functional decline. For this reason, there have been national initiatives to support care partners by providing education and skills. Despite these initiatives, many informal care partners do not receive proper training to assist individuals with cognitive impairment with diabetes management. Thus, care partners may misattribute behavioral changes associated with poor glycemic control to the neurodevelopmental or neurodegenerative disorder. Notably, evidence suggests that healthcare providers may make similar attributional errors. The current paper will review the facilitators and barriers to diabetes management within families and health systems, introduce functional analytic case diagrams to illustrate the reciprocal relationship between blood glucose control and external social/family factors, and suggest points of intervention for behavior analysts. Future research directions will also be discussed.



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