Association for Behavior Analysis International

Individuals with intellectual and developmental disabilities who engage in challenging behavior are often precluded from meaningfully participating in daily life and community-based activities due to associated risks (e.g., substantial injury to self or others, extreme property destruction). In such cases, intensive supports involving combination interventions featuring decelerative properties may be employed to reduce challenging behavior. However, although it is important that there be a comprehensive understanding of both the efficacy and the effectiveness of intervention components to produce socially significant outcomes, effectiveness research has tended to lag. The purpose of this symposium is to feature two complementary talks that will contribute to effectiveness research by: (1) disseminating the findings of a quantitative systematic review exploring the status, quality, and rigor of combination interventions with decelerative properties; and (2) showcasing the results of a systematic program evaluation examining the use of a comprehensive behavioral treatment package involving decelerative strategies to target severe challenging behavior within an applied context. Discussant commentary may provide further insight for attendees regarding research on this topic, application of findings, and important next steps (e.g., future research).

Attendees will benefit from having previous training on effect sizes and related calculations within single-case experimental design research (e.g., Tau-U, standardized mean difference), quality rigor processes in the context of meta-analytic work (e.g., SCARF), non-parametric statistical tests (e.g., Kruskal-Wallis test), and applied research methodology conducive to conducting clinical research (e.g., consecutive case series, systematic program evaluation, social validity surveys).

Previous research suggests that decelerative strategies (i.e., punishment) may be an effective method for reducing challenging behaviors (Lerman & Vorndran, 2002; Lydon et al., 2015). In the current review, 30 articles featuring single-case experimental designs published between 2013 and October 2022 met the inclusion criteria. Primary study objectives included examining: (a) differential effect size outcomes related to temporal reinforcement approach applied (e.g., antecedent or consequence reinforcement approaches), (b) differential effect size outcomes related to the punishment method applied, and (c) patterns in effect size outcomes associated with study rigor across the published and gray literature. In conducting this review, we adhered to the preferred reporting items for systematic reviews and meta-analyses (PRISMA; see Paige et al., 2021) and applied the single-case analysis and review framework (SCARF; see Ledford et al., 2020) to assess rigor and quality outcomes. Descriptive results indicated positive punishment was more common, with higher effect sizes than negative punishment. However, the Kruskal-Wallis test showed no significant differences. Temporal reinforcement types had significant differences, especially between antecedent reinforcement and a combination of antecedent and consequence. Most literature met rigor criteria, with published studies displaying larger effect sizes. The discussion will address clinical implications and future research directions.

Individuals with intellectual and developmental disabilities who engage in severe challenging behavior may comprise 5%–10% of this clinical population. Unfortunately, challenging behavior literature tends to: (1) underrepresent adult participants in comparison to child participants; and (2) emphasize efficacy (Does the intervention work?) more often than effectiveness (Does the intervention work in real world settings?). We conducted a systematic program evaluation across three specialized treatment homes to examine the effectiveness of a comprehensive behavioral treatment package involving combination interventions with decelerative strategies. This was accomplished using a hybrid nonexperimental consecutive case series design featuring all adults (n = 8) who experienced the treatment package, regardless of their success. The results depicted a substantial decrease in challenging behavior (i.e., frequency of negative target behaviour episodes) from baseline to intervention for most participants and a commensurate increase in adaptive behavior (i.e., number of mastered skills targets) across sessions for all participants. Further, the treatment package was implemented with impressive integrity by frontline staff (M = 84%, range, 82%–90%) and was deemed instrumental for achieving a better quality of life by participants (100%) as well as by caregivers/case managers (100%). Project limitations, clinical considerations, and future directions are discussed.