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.

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49th Annual Convention; Denver, CO; 2023

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Symposium #338
CE Offered: BACB
Conceptual Extensions of Treatment-Refractory Behavior in Applied Behavior Analysis
Monday, May 29, 2023
10:00 AM–10:50 AM
Hyatt Regency, Centennial Ballroom D
Area: PCH/DEV; Domain: Theory
Chair: Nicholas Lowther (Judge Rotenberg Educational Center)
Discussant: Nathan Blenkush (Judge Rotenberg Educational Center)
CE Instructor: Nicholas Lowther, Ph.D.
Abstract:

In applied behavior analysis, great strides have been made in the treatment of problem behavior. However, behavior analytic interventions are not universally effective or efficient and in many cases are not curative. The term treatment-refractory is generally used across disciplines to describe conditions that do not respond to treatment or do not respond to a prescribed hierarchy of established treatments. We explore (1) established rationales for use of the term, definitions, and criteria adopted by other disciplines; (2) the rationale and conceptualization of treatment-refractory problem behavior in applied behavior analysis; (3) a working definition with inclusion/exclusion criteria; (4) idiosyncratic variables such as historical contingencies, physical attributes, medical conditions, and biological factors that impact the effectiveness of behavioral interventions; (5) regulatory restrictions that contribute to and in some cases exacerbate treatment-refractory problem behavior; and (6) limitations associated with the standard of care in applied behavior analysis. We assert that if applied behavior analysis is to continue to mature as a practice, it must acknowledge and examine the conditions under which treatment is not effective.

Instruction Level: Intermediate
Keyword(s): intractable, refractory, resistant, unmanageable
Target Audience:

Behavior analysts interested in the limitations associated with the standard of care in applied behavior analysis and regulatory restrictions that might contribute to and in some cases exacerbate problem behavior.

Learning Objectives: At the conclusion of the presentation, participants will be able to: (1) conceptualize and define treatment-refractory problem behavior; (2) list inclusion/exclusion criteria specifically for problem behavior; and (3) identify limitations associated with the standard of care in applied behavior analysis and regulatory restrictions in their region that might contribute to treatment-refractory problem behavior.
 

Toward a Conceptualization of Treatment-Refractory Problem Behavior

LYNDE KAYSER (Judge Rotenberg Education Center), Jessica Lindsay (Judge Rotenberg Educational Center), John O'Neill (Judge Rotenberg Educational Center), Nathan Blenkush (Judge Rotenberg Educational Center)
Abstract:

The term “treatment refractory” is generally used across disciplines to describe conditions that do not respond to treatment or do not respond to a prescribed hierarchy of established treatments. For example, the American Psychiatric Association has long recognized the existence of patients with treatment resistant schizophrenia. In fact, an international workgroup developed a detailed definition and criteria of treatment resistant schizophrenia. A similar approach might prove useful in moving applied behavior analysis toward a better understanding of the conditions under which problem behavior does not respond to treatment. In particular, non-socially mediated problem behaviors often present unique challenges in that often control cannot be exerted over (e.g., withhold or deliver) the automatic reinforcer and that disruption of the response–reinforcer contingency is not possible (Virues-Ortega, Clayton, Pérez-Bustamante, Gaerlan, & Fahmie (2022). We explore (1) established rationales for use of the term, definitions, and criteria adopted by other disciplines; (2) the rationale and conceptualization of treatment-refractory problem behavior in applied behavior analysis; and (3) a working definition with inclusion/exclusion criteria and supporting clinical data.

 

Idiosyncratic and Regulatory Variables Associated With Treatment-Refractory Problem Behavior

JESSICA LINDSAY (Judge Rotenberg Educational Center), Lynde Kayser (Judge Rotenberg Education Center), John O'Neill (Judge Rotenberg Educational Center), Nathan Blenkush (Judge Rotenberg Educational Center)
Abstract:

In recent years, great strides have been made in the treatment of problem behavior. However, behavior analytic interventions are not universally effective or efficient and in many cases are not curative. A number of complicating variables might impact the effectiveness and efficiency of function-based treatment for otherwise resolvable problem behaviors. We discuss (1) idiosyncratic variables such as momentary and historical contingencies, physical attributes (e.g., size, strength, hyper flexibility), and biological conditions (e.g., rare congenital disorders, brain injury, dementia) that impact the effectiveness of behavioral interventions; (2) regulatory restrictions (e.g., state guidelines on restraint and health related supports) that contribute to and in some cases exacerbate treatment-refractory problem behavior; and (3) limitations associated with the standard of care (e.g., Functional analysis & functional communication training) in applied behavior analysis. We assert that if applied behavior analysis is to continue to mature as a practice, it must acknowledge and examine the conditions under which treatment is not effective.

 

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