Association for Behavior Analysis International

Acquired brain injury is the leading cause of death and disability worldwide. Challenging behaviors, such as resistance, refusal, and aggression can prevent successful community reintegration following an acquired brain injury. Differential reinforcement has been demonstrated to reduce challenging behaviors; however, applied behavior analysis remains under-utilized in brain injury rehabilitation. This project used a modified nonconcurrent multiple probe across groups design to evaluate an online training program for frontline workers on differential reinforcement. Participants were exposed to a didactic lecture followed by simulated client interactions, in which they were required to apply differential reinforcement. Preliminary pilot results indicate that participants’ scores on the post-test were higher than those on the pre-test. Further, participants reported the program increased their understanding of differential reinforcement and was easy to understand. This study supports that online learning is a viable training method for frontline workers and offers an accessible means for staff to access training in applied behaviour analysis that can be applied to their daily work with clients.

Primary complex motor stereotypies (pCMS) are repetitive, involuntary, rhythmic motor movements in individuals with a typical developmental history. pCMS has been differentiated from tics and other habitual behaviors both at the neurophysiological level and at the clinical level as pCMS is associated with an earlier onset (< 3 years of age), having fixed or consistent topography, occurring under highly stimulating evocative conditions, and lack of premonitory urge. We conducted a functional analysis of motor stereotypy, including both matched and unmatched stimuli, to identify the evocative contexts in which those behaviors were most likely to occur. Results suggested idiosyncratic responding across conditions; however, rates of stereotypy were differentiated across matched and unmatched conditions. Specifically, rates of stereotypy were observed to be highest within the matched stimulation conditions. Treatment involved a differential reinforcement of other behavior (DRO) paradigm within the context of these highly evocative contexts to decrease rates of stereotypy. Additional data on the participant’s subjective distress were collected in order to validate the acceptability and generality of the procedure.

Children with attention deficit/hyperactivity disorder (ADHD) are at higher risk of requiring psychiatric hospitalization. Stimulant medication is one effective intervention to address ADHD symptoms and psychopharmacological intervention is a common treatment component during psychiatric hospitalization. Monitoring the effects of stimulant medication is frequently done via indirect measures (e.g., rating scale) which may be challenging to implement during a child’s hospitalization. There are demonstrations in the behavior-analytic literature of utilizing objective, time series data along with single-case experimental methodology to assess medication effects. Such methodologies may have utility for child and adolescent psychiatry units. In the current case report, a reversal design was utilized to assess the effects of methylphenidate on the disruptive behavior, on-task behavior, and tic behavior of an adolescent male with multiple psychiatric diagnoses including ADHD during a psychiatric hospitalization. Observations occurred across six days when the patient was and was not on methylphenidate during an on-unit academic group activity. Results indicated that methylphenidate resulted in increased on-task behavior, decreased disruptive behavior, and did not increase tic behavior corresponding to previous research on this medication. Results also provide a demonstration of how behavior-analytic providers can be integrated into treatment on child and adolescent psychiatry units.

Children with externalizing behavior problems (EBPs) are at risk for chronic negative health, social-emotional, and behavioral outcomes. For other children such as those with and without intellectual disabilities and typically developing peers, services provided in an inclusive recreational summer camp setting have been shown to enhance social skills and competence which lead to positive peer relationships). We conducted a novel approach of combining two evidence-based programs to address the needs of rising second graders with EBPs by adapting them into a multimodal summer intervention program with children with and without externalizing behavioral disorders in an inclusive recreation setting. We discuss outcomes of the intervention, including the successful implementation and outcomes for participants, as well as issues surrounding implementation and pathways toward further development. Specifically, we address intervention outcomes on reducing problem behavior for children with EBPs, the impact on typically developing peers, and the and overall camp experience for all participants.

Ethical behavior analysts seek the least restrictive, most effective treatment for problem behavior (BACB, n.d.), however, in some cases, children with severe challenging behavior require aversive procedures including restraint and residential services apart from the general public. (Department of Health, 2007). In pursuance to curtail prohibitive contingencies and re-establish a quality of life, crisis management necessitates a multi-element behavior support plan (e.g. environmental considerations, explicit prevention, participant driven, minimize reactive strategies, and promote functional equivalent skills) in order to effectively reduce problem behavior (LaVigna, et al. 2022). In addition, long-term residential treatment due to refactory behavior results in prolonged stressors leading to ongoing challenging behavior (Griffith, et al. 2013). The purpose of this case study was to expand various positive intervention components i.e. non-contingent reinforcement during setting events, interdisciplinary approach and communication acquisition in order to reduce severe, treatment resistant challenging behavior. The results of this study showed a significant decrease in maladaptive behavior and increase with appropriate acquisition skills. This study demonstrated behavior support plans demand a higher ratio of proactive than reactive strategies to significantly increase treatment efficacy of high-risk behavior.

A levels system is a behavioral intervention with two or more levels that correspond to different standards of behavior and access to privileges. Universal levels systems are commonly implemented in a variety of settings, in which target behaviors and behavioral criteria for promotion and demotion are uniformly applied to all participants. Due to the legal ramifications and education inequities that arise when levels systems are universally applied across participants, an emerging literature base has evaluated the efficacy of individualized levels systems using highly controlled single-case design methodology; however, the status of this literature is currently unknown. Therefore, we conducted a systematic review and quality appraisal of the literature on individualized levels system, which included a total of eight studies. Several variables were extracted from each study to assess the myriad of ways in which levels systems have been individualized. These variables included experimental design, assessment procedures, treatment components, promotion and demotion criteria, and target behaviors. Findings are discussed in terms of the overall evidence-base for individualized levels systems, and practical issues are considered for future research on individualized levels systems.

An essential element of treatments targeting increasing appropriate behavior is the identification of stimuli that are potentially reinforcing; therefore, non-behavior analytic professionals who interact and provide intervention with various clients may need to identify preferred items. Previous research has taught non-behavior analytic professionals how to conduct multiple stimulus without replacement preference assessments using behavioral skills training (O’Handley et al., 2021). However, the literature suggests that paired stimulus preference assessments are among the most commonly implemented (Graff and Karsten, 2012) and lead to the most stable results across repeated administrations (MacNaul et al., 2021). This investigation assessed the effects of using behavioral skills training to teach the implementation of paired stimulus preference assessments for three social workers who worked at a residential facility for individuals who engage in severe challenging behavior. Results to date suggest that behavioral skills training can effectively increase the number of correct steps during paired stimulus preference assessment implementation. Maintenance follow-ups followed by social validity is in the process of being conducted.

Feeding disorders are prevalent in 25% to 45% of children (Silverman, 2010) and dysphagia (i.e., swallowing difficulties) is reported in 0.9% of children (CDC, 2012). To assess for dysphagia, a Modified Barium Swallow Study (MBSS) may be conducted during which an x-ray video is taken of the child eating. Children with feeding disorders often engage in inappropriate mealtime behavior (e.g., head turns, pushing away the spoon/cup), packing (i.e., holding bite/drink in the mouth), expelling (i.e., spitting out bite/drink), and negative vocalizations (e.g., crying) that may lead to unclear results during a MBSS. Applied behavior analytic interventions are the most efficacious treatments to reduce inappropriate mealtime behavior and increase consumption. However, research is limited in the application of behavior-analytic feeding interventions for preparing children for a swallow study. We review case studies utilizing behavior analytic interventions to prepare children with feeding disorders for a swallow study by increasing oral consumption and increasing the similarity between the treatment room and swallow-study setting. Across all cases, oral consumption increased resulting in participation in the swallow study such that clear MBSS results were obtained. These results will be discussed in terms of considerations for interdisciplinary collaboration for children with feeding disorders.

Functional analyses involve the systematic manipulation of antecedents and/or consequences (Iwata et al. 1994) and have long been considered the gold-standard for evaluating the functions of challenging behaviors. Piazza et al. (2003) adapted the standard functional analysis procedures to identify the function of inappropriate mealtime behavior among children with feeding difficulties. However, when replicated in a clinical setting, some limitations were identified. The purpose of this study was to modify functional analysis procedures to capture relevant establishing operations in a feeding context. Seven children who were recommended for intensive feeding therapy participated. All demonstrated high levels of inappropriate mealtime behavior during baseline assessments. A presentation assessment (Anderson et al., 2022) and a functional analysis were conducted for solids, liquids, or both across participants. Data for all participants showed elevated rates of inappropriate mealtime behavior in at least one test-condition compared to control indicating a socially-mediated function. These results were used to develop function-based treatments for participants. Future research should consider including additional components to assess motivating operations in functional analyses to further refine function-based treatments for feeding difficulties.