Association for Behavior Analysis International

Often the term effectiveness and efficacy as applied to describe behavioral interventions outcomes in the treatment of challenging behavior in individual with intellectual and developmental disabilities are used interchangeably. Given these terms are unique and are generally mutually exclusive - this is problematic when it comes to understanding and disseminating the status of the literature. The importance of maintaining this distinction was depicted well in a recent comprehensive systematic review on functional communication training. The current symposium features two different but complementary approaches to tackling this question of effectiveness. First, we will describe the outcomes of a comprehensive meta-analysis showcasing intervention research featuring treatment elements with decelerative properties. The second talk showcases applied research in action, specifically targeting combination intervention effectiveness through a retrospective consecutive controlled case series. Additionally, discussant commentary may provide further insight for attendees around consuming the research on this topic, as well as important next steps (i.e., future research).

Attendees will benefit from having previous training on single-case experimental design effect sizes and related calculations (e.g., Tau-U, standardized mean difference), quality rigor processes in the context of meta-analytic work, and applied research methodology conducive to conducting clinical research (e.g., consecutive controlled case series, program evaluation).

The current review explored single-case experimental design (SCED) research conducted to evaluate punishment procedures in the treatment of challenging behavior in individuals with intellectual and developmental disabilities. Featured articles were published between December 2013 and October 2022. Some primary research objectives included examining: (a) the relationship between select characteristics and the effectiveness of combination interventions that included punishment, (b) any differential affect across punishment method type applied, and (c) patterns in effect size outcomes coinciding with study rigor. After conducting several screening steps, the researchers uncovered 31 studies that met inclusion criteria. Relevant data was extracted and the articles were coded. Preliminary quality rigor outcomes showcase an average quality ranking of 3.3 (out of 4), with most employing reversal designs. None of the articles depicted punishment fading, while only one article showcased reinforcement fading. Maintenance was rarely collected, while generalization appeared absent. We will discuss the clinical implications informed by our outcomes, including how relatively limited research on punishment intervention fading may prevent practitioners from effectively and efficiently fading interventions that feature elements with decelerative properties.

High-risk problem behaviors can preclude the individuals who engage in them from meaningfully participating in everyday activities due to associated risks (e.g., substantial injury to self and others, extreme property destruction, outward physical aggression targeting others). Unfortunately, research featuring adult participants who engage in severe problem behavior is relatively scarce compared to research featuring child participants. In addition, problem behavior literature tends to emphasize efficacy (e.g., does the intervention work) more often than effectiveness (e.g., does it work in ‘real world’ settings, for whom and under which parameters). The current project is a systematic program evaluation conducted to evaluate the effectiveness of a comprehensive behavioral treatment package (i.e., including both reinforcement-based interventions and decelerative strategies) at reducing severe challenging behavior and generating adaptive skills. A retrospective consecutive controlled case series design is employed featuring all clients who participated in the treatment program, regardless of their ‘success’. Project results, thus far, depict primarily therapeutic outcomes. Upon completion, the results will: (1) add to an understudied area (i.e., adults with intellectual and developmental disabilities who engage in severe challenging behavior); (2) speak to behavioral program effectiveness; and (3) inform other works interested in program evaluations.