|Advances in Compassionate Applied Behavior Analysis
|Sunday, May 28, 2023
|8:00 AM–9:50 AM
|Convention Center Four Seasons Ballroom 4
|Area: AUT/DDA; Domain: Translational
|Chair: Tess Fruchtman (Queens College, City University of New York)
|Discussant: Cory Whelan (Vinfen)
|CE Instructor: Cory Whelan, Ph.D.
Compassionate applied behavior analysis (ABA) encompasses components of Trauma-informed Care and autistic-affirming socially valid assessment and treatment approaches. There is a large movement in the ABA field to promote and disseminate these practices to embrace a growing trend towards a more inclusive field. This symposium will focus on, not only how to practice compassionate ABA, but provides empirical evidence for doing so. A mixed methods survey was conducted in Study 1 to directly assess the perspectives of autistic individuals, and other stakeholders, regarding the educational decision-making process. The results from the respondents indicate the need for respecting autistic culture and selecting procedures that consider social and emotional needs. Study 2, introduces a novel, trauma-informed assessment of problem behavior that (a) reduces exposure to evocative situations that could potentially re-traumatize the individual and (b) ensures that the child maintains a level of control over their own environment. The authors validated the procedures among multiple participants by conducting function-based treatments informed by the results of the assessment to reduce problem behavior. The authors of Study 3 used the trauma-informed framework to incorporate the principles throughout the design of the entire assessment and treatment process of problem behavior. Following which, caregivers were presented with a series of questionnaires to determine the level of (a) stress experienced throughout and following the process and (b) acceptability of the comprehensive strategies employed. In Study 4, the implications of behavioral history in ABA are discussed. The authors propose how knowing an individual’s behavioral and medical history can assist in the development of compassionate treatment of problem behavior.
|Instruction Level: Intermediate
|Keyword(s): compassionate care, PFA/SBT, social validity, trauma-informed
Audience should be interested in learning about autistic-affirming practices, trauma-informed functional analysis and treatment of problem behavior, compassionate applied behavior analysis, and the implications of behavioral and medical history.
|Learning Objectives: (1) At the conclusion of the presentation, participants will be able to describe the trauma-informed framework of the performance-based IISCA and subsequent function-based treatment; (2) At the conclusion of this presentation, expanding on Ethics Code 2.09, participants will be able to identify new and emerging discrete strategies for involving clients and relevant stakeholders in selecting goals, designing assessments and interventions, and conducting progress monitoring; (3) At the conclusion of the presentation, participants will be able to describe how the PFA and SBT are aligned with commitments of trauma-informed care in the treatment of severe problem behavior; (4) Participants will be able to identify three possible benefits from a review of medical & behavioral history in developing effective, compassionate treatment.
|Centering Autistic Perspectives in Early Childhood Intervention
|KATE TYGIELSKI CHAZIN (Vanderbilt University Medical Center), Jennifer Ledford (Vanderbilt University), Jane Wilson-Moses (Vanderbilt University), Adithyan Rajaraman (Vanderbilt University Medical Center), Pablo Juárez (Vanderbilt University Medical Center)
|Abstract: It is critically important to incorporate autistic perspectives in educational decision-making for young autistic children, in order to improve practices so they are autistic-affirming and socially valid. However, few studies have directly assessed autistic perspectives on typical early childhood practices. We conducted a mixed methods survey assessing the social acceptability of goals, learning contexts, and procedures typically used in early childhood settings. We distributed the survey to autistic adults, as well as other stakeholders (i.e., parents, practitioners). We received responses from 660 individuals, 226 of whom identified as autistic. Respondents reported (a) high acceptability for goals promoting self-determination, and low social validity for goals that promote masking of autistic characteristics, (b) high acceptability for antecedent interventions, and low social validity for procedures that include some forms of extinction, and (c) that appropriate learning environments are highly context dependent, given individual needs. They also reported that the child is the most important stakeholder in educational-decision making. We make recommendations to practitioners in response to survey results, including (a) respecting autistic culture and characteristics in selecting goals, (b) considering social, emotional, and psychological needs in selecting procedures, and (c) individualizing goals, learning contexts, and procedures based on the child’s perspectives and unique needs.
|Towards a Trauma-Informed Functional Analysis
|TESS FRUCHTMAN (Queens College, City University of New York), Joshua Jessel (Queens College, City University of New York)
|Abstract: Many individuals diagnosed with intellectual and development disabilities who engage in problem behavior have most likely been exposed to traumatic events in their lifetime (Darnell et al., 2019; Kerns et al., 2018). The performance-based, interview-informed synthesized contingency analysis (IISCA; Iovino et al., 2022) is a brief model adapted from the original IISCA format described in Hanley et al. 2014. The novel components of the performance-based IISCA are the following: (1) determine the duration of reinforcement based on how calm the participant is, (2) measure count of problem behavior instead of rate, and (3) measure how engaged and calm the participant is throughout the analysis. These novel elements are aligned with a trauma-informed framework. Our participants included two autistic children who engaged in problem behavior. They both experienced the performance-based IISCA, the original IISCA, functional communication training, and delay- and denial-tolerance training. Each step of the assessment and treatment process served as validation for the previous step. Social validity measures were gathered from the mothers of the participants. The presenter will discuss the validation of the performance-based IISCA as a trauma-informed framework.
Trauma-Assumed Assessment and Treatment of Problem Behavior
|FLORIANA CANNIELLO (Neapolisanit Clinical and Research Center), LUIGI IOVINO (Neapolisanit Center), Roberta Simeoli (University of Naples, Italy; Neapolisanit Rehabilitation Center), Maria Gallucci (AIAS Onlus sez.Nola), Rosaria Benincasa (Neopolisanit Clinical and Research Center), MARIA ROSARIA RICCO (AIAS Onlus sez.Nola)
The new perspectives of applied behavior analysis (ABA) are leading behavior analysts to assume that patients exhibiting problem behavior have experienced multiple adverse events, many of which passed the criteria to be recognized as trauma. Within the conceptual framework of Trauma-Informed Care (TIC), we will illustrate how to incorporate this framework in ABA by promoting safety, trust, and governance. We will emphasize how the core TIC commitments could be applied to the assessment and treatment of problem behavior using the Practical Functional Assessment (PFA) and Skill-Based Treatment (SBT; Hanley et al., 2014). Our participants were two autistic 6-year-old twin girls who engaged in severe problem behavior. Our intervention prioritized client safety and compassionate practice to mitigate the risk of trauma while fostering the development of skills. The full treatment was generalized to the parents. The Parenting Stress Index was used to evaluate the magnitude of stress in the parent–child system. Social validity was assessed using a 7-point scale. Results showed the effectiveness of the PFA and SBT in reducing problem behavior and in increasing communication, toleration, and cooperation skills. The caregivers reported high levels of satisfaction and usability and lower stress levels after treatment.
|Can Behavioral and Medical History Help Achieve Compassionate Care and Trauma-Informed Applied Behavior Analysis?
|DAVID R DONNELLY (University of Rochester), Meghan L. McGee (University of Rochester )
|Abstract: In the field of Applied Behavior Analysis (ABA), a generation of behavior analysts have used Functional Analysis (FA) and Functional Behavior Assessment (FBA) to inform decisions regarding challenging behaviors exhibited by individuals with myriad diagnostic profiles, with profound positive impact. Recent advances in this area include the development of brief forms of assessment, expediting the onset of effective treatment. Within ABA, a small but growing area of interest and clinical focus has been on providing Compassionate Care (CC), providing treatment informed by empathy (EX: Taylor, LeBlanc & Nosik, 2019). At the same time, other clinical disciplines and governmental bodies have focused on training and system change that is informed by an awareness of the prevalence and effect of traumatic events on individuals exhibiting challenging behaviors. This approach is characterized as Trauma Informed Care (TIC). TIC has recently received attention as potentially important in clinical applications of ABA (Raharaman et al. 2021). This presentation will briefly discuss behavioral history in the development of ABA, and possible applications of behavioral and medical history on our understanding of the function of behavior. Awareness of the individual’s medical and behavioral history can assist behavior analysts in developing effective, compassionate treatment of challenging behaviors in collaboration with individuals with disabilities, caretakers, and other clinical disciplines involved in service provision.