|Durability of Treatment Effects: Assessing Variables Contributing to Relapse in the Lab and Clinic
|Sunday, May 29, 2022
|3:00 PM–4:50 PM
|Meeting Level 1; Room 152
|Area: EAB; Domain: Translational
|Chair: Charlene Nicole Agnew (SUNY Upstate Medical University)
|Discussant: Andrew R. Craig (SUNY Upstate Medical University)
|CE Instructor: Daniel R. Mitteer, Ph.D.
|Abstract: Analyses of relapse in basic, translational, and clinical settings enables us to better understand factors that promote durability of treatment and those that contribute to reemergence of behavior. The focus of this symposium is to highlight research on relapse designed to 1) synthesize existing experimental and clinical data and 2) evaluate the impact of novel variables. First, we will explore the procedures and analyses used in laboratory investigations of resurgence over the past 5 decades. We will also review relapse during treatments of severe problem behavior during reinforcement thinning and context change in clinical settings. Then, we will examine variables in current investigations of relapse. These include 1) the use of cues during reinforcement thinning and their influence on resurgence and 2) antecedent and response variables that impact clinical cases of relapse resurgence. Attendees will deepen their understanding of relapse, the variables that affect it, and potential methods to prevent it. Dr. Andrew Craig will provide a discussion.
|Instruction Level: Intermediate
|Keyword(s): Alternative reinforcement, Reoccurrence, Resurgence, Treatment relapse
|Target Audience: The target audience for this talk should have some basic understanding of the paradigms used to study resurgence and familiarity with applications of these paradigms within basic and applied settings. Both practitioners and researchers are welcomed.
|Learning Objectives: At the conclusion of the presentation, participants will be able to: (1) identify variations of the study of relapse in the lab and clinic; (2) understand the value of studying relapse in both lab and clinical settings; (3) describe methods to analyze relapse in lab or clinical settings.
|A Systematic Review of Procedures and Analyses Used in Studies of Resurgence, 1970-2020
|CHRISTOPHER A. PODLESNIK (Auburn University), Carolyn Ritchey (Auburn University), Jodie Waits (Louisiana State University), Shawn Patrick Gilroy (Louisiana State University)
|Abstract: Despite basic research conducted on resurgence for over 50 years, there have been no published systematic reviews of the resurgence literature to provide organization to the range of procedures and analyses employed in this research. A systematic review of this area was performed consistent with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and representative works were classified across various dimensions, including participant characteristics, design, procedural features, criteria defining resurgence, and analytic strategies. The review included 120 articles and 200 experiments. Over three-fourths of all articles on resurgence were published in the last 10 years with 13 different nonhuman and human populations comprising the participants. Therefore, resurgence as a behavioral phenomenon is general across species and populations, but rats, pigeons, and university students make up the majority (88.5%) of participants. Overall, 149 experiments (74.5%) included nonhumans as participants. Of the 51 experiments (25.5% overall) including human participants, ten included individuals diagnosed with a disability. Only 12 experiments (6.0%) included a quantitative theoretical analysis of resurgence effects, indicating an area needing further development to organize and understand the behavioral processes involved in resurgence.
An Evaluation of Variables Across the Contingency on the Resurgence of Problem Behavior Following Functional Communication Therapy
|KARLA ZABALA-SNOW (University of Georgia), Joel Eric Ringdahl (University of Georgia), Kayla Crook (University of Mississippi), Kelly M. Schieltz (University of Iowa), Matthew O'Brien (The University of Iowa), Wendy K. Berg (The University of Iowa), Rose Morlino (University of Georgia), Courtney Mauzy (University of Georgia)
Resurgence, or the return of previously extinguished problem behavior when intervention is challenged, represents an important clinical problem for researchers and implementers to address. Understanding the conditions that bring about and mitigate resurgence can lead to improved long-term implementation of DRA-based intervention such as functional communication training (FCT). We evaluated response and consequence variables as part of a large research project related to response persistence in the context of FCT. Our research approach allowed for us to evaluate how these variables impacted resurgence of problem behavior for a subset of participants. For one subset of individuals, we evaluated the relation between communication modality included in FCT and subsequent resurgence. Results indicated that resurgence was greater during the disruption component associated with a low preferred FCT modality, relative to resurgence in a disruption component associated with a high preferred FCT modality. For another subset of individuals, we evaluated the relation between reinforcement history and subsequent resurgence. Results were more equivocal with this group. One individual displayed greater resurgence in the context associated with dense reinforcement, one individual displayed less resurgence in the context associated with dense reinforcement, and one individual displayed no resurgence. The results of the current study suggested that the level of resurgence observed might differ as a function of response-related variables, such as preference for communication modality. Results related to the impact of reinforcement history on resurgence were less consistent.
|On the Scope and Characteristics of Relapse When Treating Severe Destructive Behavior
|DANIEL R. MITTEER (Rutgers University - Children's Specialized Hospital Center for Autism Research, Education, and Services), Brian D. Greer (Rutgers Robert Wood Johnson Medical School), Kayla Randall (Georgia Southern University), Sarah D Haney (Kennedy Krieger Institute)
|Abstract: Prior studies on treatment relapse have typically examined the prevalence of resurgence or renewal of target behavior (e.g., destructive behavior) in isolation. In this study, we analyzed relapse during 25 consecutive treatments involving functional communication training with discriminative stimuli during worsening in reinforcement conditions for alternative behavior or following context changes. We also examined disruption of alternative behavior (i.e., functional communication requests, compliance). Resurgence and renewal of destructive behavior occurred in 76% and 69% of treatments, respectively, and in approximately a third of changes in reinforcement or context. Relapse of destructive behavior predicted alternative-response disruption and vice versa; the co-occurrence of these two events always exceeded the background probabilities of either event occurring in isolation. General reductions in treatment efficacy occurred across changes in reinforcement or context with no apparent decrease in likelihood with later transitions. We discuss implications of our findings with respect to future studies examining treatment durability.
Cues Associated With Alternative Reinforcement and their Effects on Resurgence
|Carlos Javier Flores Aguirre (Universidad de Guadalajara), L. Rebeca Mateos Morfin (Universidad de Guadalajara), CARLOS DANIEL EVERARDO RIVERA (Universidad de Guadalajara)
The mitigation of the resurgence effect has implications both theoretical and practical. In doing so, we add to the comprehension of variables that control resurgence as well as generate ideas that can potentially be applied to clinical situations. In the resurgence procedure, a target response (TR) is established during an initial phase, then extinguished in a second phase, while an alternative response (AR) is reinforced. Finally, during a test phase, both responses are extinguished. The TR usually resurges during the test. A cue associated with the extinction of the TR during alternative reinforcement can mitigate the resurgence effect. This study assessed the effects of varying the presentation of a cue during the alternative reinforcement phase on resurgence. Human participants were exposed to a resurgence procedure varying the presentation of the cue during alternative reinforcement in a continuous, contingent, or a random manner. Results indicated that resurgence can be reduced by presenting a cue associated with alternative reinforcement, although the continuous presentation seems to be the most effective to mitigate relapse.