|
| Development of Behavior Analytic Treatment Packages to Address Diverse Clinical Problems |
| Sunday, May 28, 2023 |
| 11:00 AM–12:50 PM |
| Hyatt Regency, Capitol Ballroom 1-3 |
| Area: CBM/AUT; Domain: Applied Research |
| Chair: Matthew L. Edelstein (Kennedy Krieger Institute) |
| Discussant: Robert LaRue (Rutgers University) |
| CE Instructor: Matthew L. Edelstein, Psy.D. |
| Abstract: Central to any evidence-based practice is the development of a series of procedures aimed at solving a specific problem. The effective “packaging” of behavior analytic technologies is essential to creating new contexts for our practice. In this symposium, we will provide preliminary evidence for innovative treatment packages to address problems of social significance. In the first presentation, Dr. Mellott will highlight a procedure to teach tolerance of aversive medical procedures for a small neurotypical child. In the second, Dr. Pogue will present data on functional assessment and treatment of selective mutism. In the third, Dr. Lenfestey will discuss a client-centered, function-based intervention of compulsive behavior. In the fourth, Dr. Strohmeier will present procedures for using behavior analytic techniques to change caregiver behavior. Collectively, these studies seek to broaden the reach of behavior analysis toward addressing diverse clinical problems. |
| Instruction Level: Intermediate |
| Keyword(s): caregiver behavior, diverse populations, functional assessment, systematic desensitization |
| Target Audience: Experience with functional assessment methodology, familiarity with different behavior problems associated with childhood, experience and interest in caregiver training |
| Learning Objectives: 1. Identify function-based interventions targeting novel clinical problems 2. Describe behavior analytic approaches to common socially significant interfering behaviors |
| |
| Evaluation of a Wait Training Procedure to Treat Challenging Behavior Evoked by Aversive Medical Procedures |
| JOSHUA MELLOTT (Kennedy Krieger Institute), Elizabeth Chan (Florida State University), Hannah Dugoni (Pacific University), Matthew L. Edelstein (Kennedy Krieger Institute) |
| Abstract: Behavior analytic approaches to treating anxiety include identifying the function of anxious behavior, teaching alternative replacement behaviors (e.g., a functional communication response), and conducting exposures to anxiety-provoking stimuli to increase habituation and decrease reactivity to such stimuli. The current study expanded upon a functional communication training and schedule thinning without programmed alternatives protocol as a framework for conducting exposures to aversive but necessary medical procedures. Following the patient’s ability to (a) utilize a functional communication response and (b) tolerate restricted access to preferred items for a terminal wait criteria (S∆ conditions), researchers implemented systematic desensitization by inserting increasingly anxiety-provoking stimuli within wait periods. Results suggested significant decreases in disruptive behavior in the presence of both S∆ conditions and anxiety-provoking stimuli, allowing the patient to access required medical treatment. Implications include procedures that may be implemented with patients who engage in disruptive behavior that prevents access to necessary medical treatment. |
| |
| Behavioral Assessment and Treatment of Selective Mutism |
| EMILY POGUE (Kennedy Krieger Institute, Johns Hopkins School of Medicine), Megan Krantz (Loma Linda University), Matthew L. Edelstein (Kennedy Krieger Institute) |
| Abstract: Selective mutism (SM) is a complex psychiatric disorder in which a child consistently fails to speak in specific situations despite demonstrating normal speech production in other situations. An ABA approach can offer individuals with SM a new understanding of the evocation and maintenance of this behavior, as well as individualized and effective treatment. Prior research has documented the heterogeneity of SM symptomology pointing to potential subtypes of the disorder. Via our training in direct assessment, systematic application of evidence-based treatments, and visual inspection of data, behavior analysts have much to contribute to this line of inquiry. This study used a multiple-baseline design across settings to evaluate the use of a behavioral intervention package consisting of differential reinforcement, contingency management, and exposure procedures in a 3.5-year-old girl with selective mutism. Treatment resulted in increased vocal responding across settings and verbal operants. Responding exhibited a highly variable, though increasing trend throughout baseline and treatment conditions. Oppositional behaviors and non-compliance were observed during treatment. Implications for subtypes of SM profiles and effective assessment and function-based treatment are discussed. |
| |
Treatment of Socially-Mediated Compulsive Behavior in a High Functioning Adolescent With Autism Spectrum Disorder |
| Amanda Taboas (Illinois State University), Charda Davis (William James College), Matthew L. Edelstein (Kennedy Krieger Institute) |
| Abstract: Compulsive and repetitive behaviors are common features of autism spectrum disorder (ASD) and obsessive compulsive disorder (OCD); however, assessing and treating compulsive behaviors in high functioning individuals presents a unique challenge for clinicians. While cognitive behavioral therapy (CBT) is the most commonly used method for treating of compulsive behaviors, its effectiveness may be limited in populations with ASD. The current study used a withdrawal design to evaluate a functional communication training and exposure with response prevention paradigm with a high functioning individual with comorbid ASD and OCD who engaged in socially mediated compulsive behaviors. Treatment resulted in high rates of functional communication and decreased rates of compulsive behaviors observed across settings. Follow-up data suggested maintenance of skills at 6-month follow up measured via direct observation and parent report. Implications for client-centered, function-based approach to address compulsive behavior are discussed. |
| |
| Shaping Parent Adherence to Function-Based Interventions |
| CRAIG STROHMEIER (Kennedy Krieger Institute; Johns Hopkins School of Medicine), Michelle D. Chin (The Kennedy Krieger Institute) |
| Abstract: Parent responses to child problem behavior may simultaneously abate the problem behavior episode and function as a reinforcer that maintains the problem behavior (e.g. attention delivered contingent on attention-maintained self-injurious behavior [SIB]). Parents may emit a similar response, independent of problem behavior, in order to avoid a behavior escalation; even when the response interferes with ongoing activities (e.g. interrupting work, a phone call, or an interaction with another family member). Strohmeier et al. (2020) referred to these escape and avoidance-maintained parent behaviors as Accommodation. Since accommodation is maintained by potent negative reinforcement contingencies (i.e. escape and avoidance of problem behavior), it may persist and interfere with adherence to function-based behavioral interventions, even after parents undergo behavioral skills training. This presentation will provide an overview of behavior therapy strategies, including Behavioral Activation, Exposure and Response Prevention, and Acceptance and Commitment Therapy, and describe their use to target the negative maintaining contingencies that support accommodation and nonadherence. The presentation will include preliminary data from a clinical trial investigating the use of behavior therapy strategies to reduce parent accommodation of problem behavior and increase adherence with behavior plans. |
|
| |