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| Predicting and Quantifying the Effects of Behavioral Assessment and Treatment Methods |
| Sunday, May 29, 2022 |
| 11:00 AM–12:50 PM |
| Meeting Level 2; Room 258A |
| Area: AUT/DDA; Domain: Applied Research |
| Chair: Alec M Bernstein (Emory University School of Medicine; Marcus Autism Center) |
| Discussant: John Falligant (Kennedy Krieger Institute; Johns Hopkins University School of Medicine) |
| CE Instructor: Alec M Bernstein, Ph.D. |
| Abstract: Behavioral interventions often are individualized to the presenting issue. Such interventions, however, can be cost- and resource-intensive. The ability to predict treatment outcomes based on the presenting issue and pattern of responding could abbreviate intervention timelines. Identifying socially valid treatments that promote the durability of outcomes also can ensure services are efficient but effective. This symposium is the conglomeration of four thematically related presentations. In the first presentation, Dr. Bernstein describes the predictive validity and utility of the structured descriptive assessment through post-hoc analyses from an earlier randomized controlled trial on the assessment and treatment of challenging behavior. In the second presentation, Ms. Weber describes the use of precision medicine and behavioral markers for predicting outcomes of behavioral treatment for socially maintained destructive behavior. In the third presentation, Dr. MacNaul describes the utility of functional communication training without extinction followed by contingency-based progressive delays to increase a functional communication response and tolerance of reinforcer delays, respectively. In the fourth presentation, Ms. Fleck describes the manipulation to parameters of reinforcement within a concurrent-schedules arrangement to decrease challenging behavior during functional communication training without extinction. Dr. John Michael Falligant will conclude the symposium with a discussion on the importance and future direction of this research. |
| Instruction Level: Intermediate |
| Keyword(s): Descriptive Assessment, FCT, Nonextinction-Based Treatment, Predictive Validity |
| Target Audience: (1) Understand the principles of behavior and their application in identifying function and function-based interventions; (2) Understand the strengths and limitations to different functional behavioral assessment formats. |
| Learning Objectives: At the conclusion of the presentation, participants will be able to: (1) consider the potential utility of structured descriptive assessments to inform treatment for young children with autism and behavioral markers for predicting the success of functional communication training for socially maintained severe destructive behavior; (2) better understand nonextinction-based treatments and variations of these; (3) identify methods to mitigate the re-emergence of challenging behavior. |
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| The Predictive Validity and Utility of the Structured Descriptive Assessment |
| ALEC M BERNSTEIN (Emory University School of Medicine; Marcus Autism Center), Nathan Call (Marcus Autism Center), Matthew O'Brien (The University of Iowa), Loukia Tsami (Center for Autism and Developmental Disabilities, University of Houston – Clear Lake), Dorothea C. Lerman (University of Houston-Clear Lake), Kelly M. Schieltz (University of Iowa), Colin S. Muething (Marcus Autism Center), David P Wacker (The University of Iowa) |
| Abstract: Researchers often identify the validity of indirect and descriptive assessments by comparing their outcomes to those of a functional analysis (FA). Although reasonable considering the FA is the only experimental method to identify causal relations between behavior and environment, comparing treatment outcomes when treatment is informed by different functional behavioral assessment formats might suggest outcomes of greater social significance. After conducting a randomized controlled trial and finding that treatments informed by either a structured descriptive assessment (SDA) or an FA both resulted in at least an 88% reduction of challenging behavior from that during baseline, we further evaluated the validity of the SDA. We report on the concurrent validity of the SDA in addition to its positive and negative predictive values, sensitivity, and specificity. We discuss these outcomes relative to the utility of the SDA for young children commonly referred to early-intervention programs (e.g., those with autism, mild challenging behavior). |
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| Further Extension of Precision Medicine in the Treatment of Challenging Behavior |
| JESSIE KAYE WEBER (University of Nebraska Medicine), Tara A. Fahmie (University of Nebraska Medical Center), Seth Walker (Munroe-Meyer Institute), Amanda Zangrillo (University of Nebraska Medical Center, Munroe-Meyer Institute), Thomas Freetly (University of Nebraska Medicine) |
| Abstract: Precision medicine has been used to identify the casual pathway of disease and identify biomarkers to predict response to treatment. Behavior analysis has begun to follow suite and identify behavioral markers that may predict response to behavior treatment (Falligant & Hagopian, 2020). Past extensions of precision medicine to have led to the identification of subtypes of automatically maintained self-injury based on the level of differentiation (LOD) in a functional analysis (FA; Hagopian et al., 2017; Hagopian et al., 2015). These findings informed research evaluating the predictive validity of various behavioral markers (Hagopian et al., 2018). The current study aimed to expand the literature related to the identification of behavioral markers for socially maintained challenging behavior by evaluating the proportion of destructive behavior when the establishing operation was present (EOP) over the total amount of destructive behavior when the EO was absent (EOA) and EOP during FA test conditions. The current data set is comprised of individuals whose FA indicated a single function and data was available on EOA and EOP destructive behavior. Current data showed moderate to high levels of proportion of EOP responding and moderate to high levels of reduction in challenging behavior during functional communication training (FCT). This is an ongoing analysis. |
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Reducing Challenging Behavior Without Extinction and Promoting Delay Tolerance Through Contingency-Based Progressive Delays |
| HANNAH LYNN MACNAUL (University of Texas at San Antonio), Anh Nguyen (University of Texas at San Antonio), Madison Carr (University of Texas at San Antonio) |
| Abstract: Although extinction is a common component of functional communication training (FCT) procedures (Gerow et al., 2018), withholding reinforcement is not always possible or ethical with certain individuals or in particular contexts (MacNaul & Neely, 2018). Additionally, for individuals that engage in challenging behavior, delays to reinforcement are inevitable, even contingent on appropriate communication. The current study employed FCT without extinction through quality and magnitude parameter manipulations to decrease challenging behavior and teach a functional communication response (FCR) for two participants with autism. Then, contingency-based progressive delays (CBPD; Ghaemmaghami et al., 2016) were introduced to teach participants to tolerate increasing delays to reinforcement. A non-concurrent multiple baseline design was used to evaluate FCT without extinction and CPBDs, resulting in decreased challenging behavior and increased FCRs across both participants. Levels of both target responses maintained under increasing delay-to-reinforcement intervals, further supporting the utility of CBPDs to maintain appropriate behavior in the event of unpredictable or unavoidable delays to reinforcement. |
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| Concurrent Schedules of Differential Reinforcement of Alternative Behavior in the Treatment of Escape-Maintained Problem Behavior without Extinction |
| CHELSEA R. FLECK (New England Center for Children; Western New England University), Jason C. Bourret (New England Center for Children), Emma Jehle (Western New England University & New England Center for Children) |
| Abstract: Recent research on treatment of problem behavior has focused on interventions that do not require extinction. Positive reinforcement for compliance delivered on an FR 1 schedule has been shown to be an effective intervention for reducing escape-maintained problem behavior without extinction. Several studies have shown that problem behavior may re-emerge when the schedule of reinforcement for compliance is thinned. In the present study, we established and reinforced multiple alternative responses during treatment to decrease the likelihood of problem behavior during a treatment challenge with four participants with autism. First, we conducted a functional analysis to identify the maintaining variable for problem behavior (e.g., vocal protesting, self-injury, or aggression). Then, we reinforced two alternative responses with both the maintaining reinforcer and an arbitrary reinforcer while problem behavior continued to produce only the maintaining reinforcer. Finally, we withdrew reinforcement for one of the alternative responses to determine whether concurrently reinforcing an additional alternative response would avoid the re-emergence of problem behavior without extinction. The addition of a concurrently available alternative response was effective at avoiding the reemergence of problem behavior during a treatment challenge. Interobserver agreement was obtained for at least 33% of sessions and ranged from 81%-100% for all responses. |
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