Association for Behavior Analysis International

Meta-analyses of single case design research have demonstrated that interventions based in applied behavior analysis (ABA) have indicated clinically significant improvements in treating maladaptive behavior in individuals with acquired brain injury (ABI) (Heinicke & Carr, 2014).  Despite the demonstrated efficacy of these interventions and high need of clinical support in this population, only 0.1% of behavior analysts reported brain injury rehabilitation as their primary area of professional emphasis (BACB, 2024), and the total amount of published research is a correspondingly small portion of the behavior analytic knowledge base. Furthermore, there are unique challenges that exist for behavior analysts working with this population such as ensuring treatment fidelity, implementing data collection systems, and lack of resources for conducting functional assessments. This presentation will showcase further research on behavioral interventions in ABI and a variety of case studies discussing clinical implementation in both acute and post-acute ABI rehabilitation settings. Presenters will focus on how the philosophical assumptions of ABA can guide the pathway to patient success on an interdisciplinary team, and illustrate barriers and potential solutions to effective replication of behavior analytic literature.

Challenging behavior observed following acquired brain injuries (ABIs) can prevent productive engagement in therapies, create social barriers, interfere with medical treatments, and put the safety of both survivors and care providers at risk. This meta-analysis assessed the use of functional behavioral assessments (FBAs) in the treatment of challenging behavior following ABI and the extent to which function-based treatments contributed to relative differences in treatment effect sizes. Three databases were searched for studies focusing on brain injury and behavioral interventions. Studies meeting criteria for inclusion were categorized by their use of FBA procedures and function-based treatments. The results of each behavior reduction intervention were evaluated using two different measures of effect size. In the majority of cases, interventions produced large or medium treatment effects, indicating clinically significant improvements in behavior. The results of both visual analysis and statistical effect size measures indicated that treatments based on functional analysis outcomes produced the highest proportion of clinically significant improvements. These findings provide further support for the use of behavioral interventions in ABI rehabilitation and illustrate that the use of treatments developed with a functional understanding of behavior informed by an FBA contributes to clinically significant improvements in challenging behavior.

Individuals enter post-acute brain injury rehabilitation programs at various points in their recovery, and those involved (e.g. clients, families, and funders) frequently pose critical questions. These can include; whether/when a person can return home or move to a more independent setting, how much support is needed, and/or what resources are necessary for a successful transition? Neurobehavioral complications such as impaired awareness, verbal behavior deficits, and challenging behavior, combined with other factors such as funding, resources, and available discharge options, complicate answering these questions (Schaub, Peters, Peters, 2012). Conceptualizing and integrating treatment plan elements requires consideration of time and readiness. This presentation will focus on a model comprised of phases (i.e. level system) that organizes the goals of the interdisciplinary team, and focuses on shaping the behavior(s) through a variety of behavioral techniques, e.g. behavioral contract, differential reinforcement, token economy (Bauer, Shea, Keppler, 1989). Behavior analysts can utilize this model to target behaviors across treatment areas (e.g. adhering to mobility guidelines, completing activities of daily living, and utilizing coping strategies) in a concurrent manner. Authors will present tools demonstrating this framework, how behavior and progress is monitored, description of key behavior analytic underpinnings, and the challenges associated with implementation.