|Consecutive Controlled Case Series: Recent Examples in the Assessment and Treatment of Severe Problem Behavior
|Monday, May 29, 2023
|11:00 AM–12:50 PM
|Convention Center Mile High Ballroom 1C/D
|Area: DDA/AUT; Domain: Applied Research
|Chair: Michelle A. Frank-Crawford (Kennedy Krieger Institute)
|Discussant: Louis P. Hagopian (Kennedy Krieger Institute)
|CE Instructor: Michelle A. Frank-Crawford, Ph.D.
|Abstract: The consecutive controlled case series (CCCS) is a type of study that allows for the synthesis of outcomes from cases in which a single case experimental design was used to evaluate a common procedure or for individuals who share a common characteristic (Hagopian, 2020). Because all consecutively encountered cases that share the commonality are included, CCCS studies limit biases favoring inclusion of cases with predominantly positive outcomes. The CCCS study allows researchers to address issues related to the generality of clinical procedures or processes. This symposium will review recent examples of CCCS studies related to assessment and treatment of severe problem behavior. The first presenter will examine the prevalence of responding indicative an iatrogenic effect during functional analyses conducted for 116 individuals admitted to an inpatient hospital. The second presenter will describe the outcomes of competing stimulus assessments for 35 individuals admitted to an inpatient setting. The third presenter will discuss descriptive characteristics of extinction bursts for 108 individuals receiving treatment for problem behavior in an outpatient setting. The fourth presenter will report on outcomes of behavioral interventions designed to reduce pica for 13 individuals admitted to an inpatient hospital. Implications and comments will be provided by the discussant.
|Instruction Level: Basic
|Keyword(s): competing stimulus, extinction burst, iatrogenic effects, pica
|Target Audience: Basic
|Learning Objectives: 1. Understand what a consecutive controlled case series (CCCS) study is; 2. Understand the essential design elements and reporting methods of CCCS studies; 3. Understand the advantages of conducting a CCCS study.
|Assessment of Patterns of Learning During Functional Analysis Conditions: A Case Review of 116 Patients
|COURTNEY C HANLIN (Kennedy Krieger Institute), Nathalie Fernandez (Kenndey Krieger), Michelle A. Frank-Crawford (Kennedy Krieger Institute), Ryan Benson (Kennedy Krieger Institute), John Falligant (Kennedy Krieger Institute/Johns Hopkins University School of Medicine), Iser Guillermo DeLeon (University of Florida)
|Abstract: The functional analysis procedures described by Iwata et al. (1982/1994) have been widely used to determine the variables maintaining problem behavior, and the information gathered from these assessments has proven useful in guiding function-based treatments. However, one potential concern with the use of functional analysis is that repeated exposure to the contingencies during test conditions, particularly in the tangible condition, may generate false-positive results and induce a novel function. We recently conducted a consecutive controlled case series of 116 functional analysis applications that included socially mediated conditions and examined patterns of responding associated with "learning." The results suggest that learning rarely occurred in any of the test conditions, further supporting the use of functional analysis. Clinical implications for functional analysis practices will be discussed.
|Efficacy of Competing Stimulus Assessments: A Summary of 35 Consecutively Encountered Cases
|BRIANNA LAUREANO (Kennedy Krieger Institute, Johns Hopkins University School of Medicine), Nathalie Fernandez (Kenndey Krieger), Louis P. Hagopian (Kennedy Krieger Institute)
|Abstract: Competing stimulus assessments (CSAs) are designed to identify stimuli that reduce problem behavior through competition with its maintaining reinforcers. Recently, Haddock and Hagopian (2020) found that over 92% of CSAs described in published studies identified at least one high competition stimulus (i.e., a stimulus correlated with at least an 80% reduction in problem behavior). The current study describes the outcomes of CSAs in a retrospective consecutive controlled case series of 35 cases (individuals) admitted to an inpatient setting. Findings on the limited relation between stimulus engagement and reductions in problem behavior were replicated; however, the efficacy of CSAs was lower than the published literature (47% of CSAs were successful). The clinical implementation of CSAs are discussed and the discrepant findings across studies on the efficacy of CSAs are summarized.
|Descriptive Characteristics of Extinction Bursts: A Record Review
|ALEXANDRA HARDEE (Marcus Autism Center), Colin S. Muething (Marcus Autism Center), Tom Cariveau (University of North Carolina Wilmington), Summer Bottini (Marcus Autism Center ), Sarah Slocum (Marcus Autism Center and Emory School of Medicine), Catherine Williams (University of North Carolina Wilmington), Scott Gillespie (Emory School of Medicine), Mindy Christine Scheithauer (Marcus Autism Center)
|Abstract: Procedural extinction is sometimes associated with a temporary increase in responding known as an extinction burst. Extinction bursts present unique challenges in the context of treating challenging behavior. The present study updates the prevalence of extinction bursts using a clinical sample (n = 108) receiving treatment for problem behavior. The prevalence of extinction bursts in our sample (24%) was consistent with prior literature. As expected, the extinction-burst magnitude decreased across sessions after extinction was contacted during treatment, but this sample did not demonstrate decreased persistence or magnitude of extinction bursts across successive transitions from baseline to treatment. We also examined the prevalence and magnitude of extinction bursts based on the function and topography of challenging behavior and treatment components and found no consistent relation amongst these variables. These findings should lead clinicians to prepare for transient extinction bursts when implementing extinction-based treatment for decreasing challenging behavior and inspire future research on treatment and client factors that predict extinction bursts.
|Assessment and Treatment of Pica: A Consecutive Controlled Case Series
|JUSTIN TYLER HALL (Kennedy Krieger Institute), Michelle A. Frank-Crawford (Kennedy Krieger Institute), Margaret Cavanaugh (Kennedy Krieger Institute), Nathalie Fernandez (Kenndey Krieger), Jonathan Dean Schmidt (Kennedy Krieger Institute), Louis P. Hagopian (Kennedy Krieger Institute), Megan Ryan (Kennedy Krieger Institute)
|Abstract: Pica is a self-injurious behavior wherein the individual repeatedly consumes inedible objects. It has the potential to cause serious harm from choking, poisoning, and perforation of blockage of intestines. Research has indicated that behavioral interventions are well-established treatments for pica, particularly when arranged using reinforcement and response reduction procedures. However, research has largely focused on the overall efficacy of these interventions and has not attempted to identify the necessary intervention components or evaluate the generality of the findings. Thus, the current study evaluated and described treatment outcomes from 13 consecutively encountered cases in which a behavioral intervention was evaluated to reduce pica in an intensive inpatient setting (for a total of 15 applications). The generality of findings to other caregivers, settings, or discard apparatuses was assessed when available. Results both indicate that noncontingent reinforcement alone did not produce desired results, and replicate the findings of other studies that reinforcement in combination with response interruption and redirection procedures do produce clinically significant reductions in pica, and these treatment gains generalize across context changes.