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| Research Gaps and Ethical Considerations in Literature on Obsessive-Compulsive Behavior in Autism |
| Monday, May 27, 2024 |
| 9:00 AM–9:50 AM |
| Convention Center, 100 Level, 113 A |
| Area: AUT/CBM; Domain: Translational |
| Chair: Nicole M. Neil (University of Western Ontario) |
| Discussant: Mitch Fryling (California State University, Los Angeles) |
| CE Instructor: Mitch Fryling, Ph.D. |
| Abstract: Obsessive-compulsive behavior is a term used to describe the topographical overlap between Higher-order Restricted Repetitive Behaviors commonly observed in autistic individuals and compulsions characteristic of Obsessive-Compulsive Disorder. Due to the complex variables maintaining these behaviors (e.g., positive and/or negative automatic reinforcement and other operant functions), specific individualized treatments, such as adapted Cognitive Behavioral Therapy (CBT) and Functional Behavior-based CBT, have been developed to address these behaviors in autistic individuals. The research supporting these treatments is slowly growing; however, there are still significant gaps that need to be addressed. In our symposium, we examine the current body of literature and identify prominent gaps, such as limited extended follow-up studies, a lack of function-based treatment, and minimal incorporation of client voice in treatment. Further, we discuss the potential ethical implications that can arise from these gaps. Finally, we provide practical recommendations for researchers and clinicians providing adapted and Functional Behavior-based CBT to autistic individuals with obsessive-compulsive behaviors. |
| Instruction Level: Intermediate |
| Keyword(s): autism, behavioral intervention, ethics, obsessive-compulsive behavior |
| Target Audience: Working knowledge of basic behavior principles (e.g., functional assessments, function-based treatment) and the BACB Ethics Code for Behavior Analysts. |
| Learning Objectives: At the conclusion of the presentation, participants will be able to: (1) state three research gaps in the current body of obsessive-compulsive behavior literature; (2) explain why these research gaps pose ethical concerns and which BACB Ethics Code for Behavior Analysts standards these concerns fall under; (3) describe three strategies for remedying these ethical concerns; (4) identify one quantitative and one qualitative result from our follow-up study; and (5) list three trends identified in the scoping review of OCB treatments for autistic preschoolers. |
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Factors Affecting Long-Term Outcomes of Functional Behavior-Based Cognitive Behavioral Therapy (CBT) in Treating Obsessive-Compulsive Behaviors in Autistic Children |
| (Applied Research) |
| Courtney Denise Bishop (Brock University ), Emily Guertin (Brock University), Brianna M. Anderson (Brock University), TRICIA CORINNE VAUSE (Brock University), Jan Frijters (Brock University), Nicole M. Neil (University of Western Ontario), Maurice Feldman (Dept. of Applied Disability Studies, Brock University) |
| Abstract: Functional Behavior-based Cognitive Behavioral Therapy (CBT) is an empirically supported, manualized intervention for treating obsessive-compulsive behaviors (OCBs) in school-age autistic children. By using a combination of traditional CBT (e.g., psychoeducation, exposure, and response prevention) and applied behavior analysis (e.g., functional behavior assessment, basic behavioral principles), this treatment has proven to be efficacious; however, few follow-up studies have been conducted. Our study uses a mixed methods approach to evaluate the long-term effects of Functional Behavior-based CBT in reducing obsessive-compulsive behaviors in autistic children. Our quantitative results (Repetitive Behavior Scale–Revised Sameness, Compulsive, and Ritualistic Composite scores) revealed a significant reduction in parent OCB ratings from baseline to treatment (-1.81, SE = 0.16, t[3812] = -11.01, p < .0001), and a small and nonsignificant increase between treatment and follow-up (0.26, SE = 0.25, t[3812] = 1.06, p = .29) conducted 6.31 years later. We corroborate these findings with matched comparison parent and child semi-structured interviews, which provided insight into factors that may have contributed to successful or unsuccessful outcomes. We discuss considerations for improving the long-term effects of Functional Behavior-based CBT for reducing obsessive-compulsive behaviors and the benefits of using a mixed methods approach to evaluating treatment outcomes. |
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| Behavioral Interventions for Reducing Obsessive Compulsive Behaviors in Autistic Preschoolers |
| (Theory) |
| BRIANNA M. ANDERSON (Brock University), Tricia Corinne Vause (Brock University), Nicole M. Neil (University of Western Ontario), Sarah Davis (Brock University) |
| Abstract: The number of studies evaluating the effectiveness of applied behavior analytic interventions for reducing obsessive-compulsive behaviors in children 2 to 6 years of age with autism and related developmental disabilities has increased since 2010. However, research in this area is still limited, and the evidence has significant gaps. Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) protocol for scoping reviews, we systematically searched major databases using a combination of key search terms, resulting in 366 findings. Of these articles, 12 met our inclusion criteria, revealing the following limitations: (a) the absence of functional behavior assessments informing treatment; (b) minimal coverage of child consent or assent processes; (c) few functionally equivalent replacement behaviors taught; (d) and an overall lack of generalization and maintenance data reported. These findings raise several notable ethical concerns for both researchers and clinicians alike. In our presentation, we provide an overview of the current body of literature, identify areas of limited empirical support, and describe the ethical concerns these areas pose. Finally, we provide clinical recommendations for researchers and practitioners using applied behavior analytic interventions to reduce obsessive-compulsive behaviors in preschool-age children with autism and related developmental disabilities. |
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