|How Are We Doing? A Closer Look at Clinical Outcomes and Caregiver Behavior
|Sunday, May 24, 2020
|8:00 AM–9:50 AM
|Walter E. Washington Convention Center, Level 1, Room 103
|Area: DDA; Domain: Translational
|Chair: Jessica L Becraft (Kennedy Krieger Institute; Johns Hopkins University School of Medicine)
|Discussant: Linda A. LeBlanc (LeBlanc Behavioral Consulting LLC)
|CE Instructor: Jessica L Becraft, Ph.D.
Applied behavior analysis (ABA) has long been recognized as effective treatment for child problem behavior. Indeed, hundreds of studies demonstrate that ABA is highly effective in reducing aberrant behavior. Often such studies give little consideration to caregiver behavior, despite the fact that caregivers often (a) initiate the process that results in treatment and (b) are responsible for implementing treatment recommendations. In this symposium, we explore aspects of ABA related to clinical outcomes and caregiver behavior. In the first presentation, we will discuss the changing landscape of service delivery for child problem behavior and contingencies that necessitate an emphasis on caregivers. Second, we will present data on caregivers’ goals for treatment as a way to identify barriers to effective treatment outcomes. The third presentation will explore the validity of caregiver ratings for treatment effects. Finally, the fourth presentation will focus on caregiver treatment fidelity, treatment acceptability, and choice of treatment. Together, these presentations will highlight the role caregivers do (and should) play in behavioral treatment.
|Instruction Level: Intermediate
|Keyword(s): behavioral treatment, caregivers, problem behavior, treatment outcomes
practicing behavior analysts, behavior analysis researchers, parents of children receiving behavior analysis treatment
|Valuation of Behavioral Analysis: From Social to Societal Validity
|MICHAEL F. CATALDO (Kennedy Krieger Institute; Johns Hopkins University School of Medicine)
|Abstract: Over the past five decades, Behavioral Analysis has existed – and some might say flourished – in an environment that has been increasingly stable and supportive. Several factors, present and predicted, suggest that continued support for Behavior Analysis will increasingly be related to clinical outcomes for behavioral treatment and consumer choice. Aside from its heuristic value, such Societal Validity is directly related to the potential – if not anticipated – disruption of the stable support that we have benefitted from to date. This first presentation will explore the trends in meta-data, both within the field and at a macro level, that influence the future direction and opportunities for both research and practice in Behavior Analysis. Included will be discussion of the societal valuation processes, workforce projections, and economic factors that will affect stability and support.
|Parent Perception of Problem Behavior: A Thematic Analysis of Parent Descriptions of Problem Behavior
|NADRATU NUHU (Marcus Autism Center; Children's Healthcare of Atlanta; Emory University), Joanna Lomas Mevers (Marcus Autism Center; Children's Healthcare of Atlanta; Emory University), Alexis Constantin Pavlov (Marcus Autism Center; Children's Healthcare of Atlanta; Emory University), Nathan Call (Marcus Autism Center; Children's Healthcare of Atlanta; Emory University)
|Abstract: Children with developmental disorders are at increased risk of presenting with problem behaviors (Kanne & Mazurek, 2011; Jang, Dixon, Tarbox, & Granpeesheh, 2011; Emerson et al., 2001). To date, it has been well established that interventions employing applied behavior analysis (ABA) techniques are effective at reducing the rates of problem behaviors in these individuals (National Standards Report, 2009). Caregivers seeking ABA services for children that engage in problematic behaviors typically initiate the process by receiving an intake to assess the client’s presenting problems and caregiver’s associated concerns. Referrals for the assessment and treatment of severe problem behavior are typically based on caregiver report. While observations are crucial, qualitative information received from parents is vital in determining the level of services an individual may need (Scheithauer et al., 2018). The project focuses on coding caregiver descriptions of their child's problem behavior at the initial intake meeting for reoccurring themes that may provide insight about caregiver perceptions of their child’s problem behavior. Caregivers reported a number of concerns regarding the impact of their child’s problem behavior on the family (e.g., damage to property, emergence of mental health problems, and limited family involvement in the community).
|The Validity of Parent Evaluation of Treatment Effects
|JESSICA L BECRAFT (Kennedy Krieger Institute; Johns Hopkins University School of Medicine), Michael F. Cataldo (Kennedy Krieger Institute; Johns Hopkins University School of Medicine), Patricia F. Kurtz (Kennedy Krieger Institute; Johns Hopkins University School of Medicine), Usai Bah (Kennedy Krieger Institute)
|Abstract: Treatment effects in behavior analysis are typically evaluated by a behavior analyst or similarly trained individual. In the case of child problem behavior, however, parents’ evaluation of treatment effects are critical because parents initiate treatment services, are expected to implement treatment protocols, and, ultimately, determine when treatment is no longer required. We compared parent evaluation of treatment effects for severe problem behavior to that of trained observers in two studies. In the first study, parents collected data on their child’s behavior in baseline and treatment sessions. In the second study, parents viewed pre- and post-treatment videos of other children and scored the level of problem behavior in each clip. Results indicate good session-by-session correspondence with trained observers in both studies. In addition, the majority of parents had similar overall evaluations of treatment effectiveness as trained observers (i.e., percentage reduction in problem behavior). These studies suggest a valid use of parent data to evaluate treatment effects for severe problem behavior, which can be used to evaluate maintenance and generalization of treatment and to justify services to third party payers.
Caregiver Training and Choice in Reducing Problem Behavior for Children With Autism Spectrum Disorder
|ASHLEY ANNE STEVENS (The Mentor Network, REM Minnesota), Casey J. Clay (University of Missouri), Alison Jo Cooper (Thompson Center for Autism and Neurodevelopmental Disorders ), Savannah Tate (University of Florida), SungWoo Kahng (Rutgers University)
Caregivers have a large impact on the long-term effectiveness of any Applied Behavior Analysis (ABA) treatment plan designed for their child’s needs. There is a call-to-action to develop more effective training procedures and implement strategies to gain buy-in up front to maintain caregiver adherence. The purposes of this current study were to (1) further evaluate the effectiveness of nontechnical instructions on fidelity in a Behavioral Skills Training component analysis for caregivers with previous exposure to behavior analytic procedures, (2) evaluate whether caregiver choice is impacted by treatment effectiveness alone, or if graphic feedback is needed, and (3) evaluate the preference for and effects of providing choices to caregivers via social validity data. Three caregivers requesting Applied Behavior Analysis services for their child were involved in treatment planning and implementation of protocols in an alternating treatment with initial baseline and final best practice design. Results indicated (1) nontechnical protocols alone were not sufficient in training any of the caregivers to fidelity, despite previous exposure to behavior analytic procedures, (2) treatment effectiveness impacted 2/3 caregivers’ choices of implementation whereas graphic feedback was necessary for 1/3 caregivers, and (3) overall, the study processes were deemed socially valid for all caregivers.