Association for Behavior Analysis International

Tact training can be particularly challenging for individuals with attention-related difficulties, especially in home environments where distractions are prevalent. LaLonde et al. (2020) suggested that individuals with disabilities often struggled to acquire tacts due to difficulties attending to relevant stimuli. Partington et al. (1994) highlighted that verbal prompts could interfere with establishing stimulus control by nonverbal stimuli, potentially hindering tact acquisition. Modifying the stimulus modality might address this challenge. The present study investigated whether the modality of stimuli, tactile (the actual object) vs. visual (picture cards), impacts the acquisition and generalization of tacts. The participant in this study was a 5-year-old girl diagnosed with autism spectrum disorder (ASD) receiving home-based services. Trials were conducted in the home setting to compare acquisition and generalization across the two modalities, considering the unique challenges presented by the environment. The findings of this study aim to provide insights for ABA practitioners working with children with ASD who face tacting and generalization challenges. By examining the impact of stimulus modality on tact training, we hope to offer evidence-based recommendations for clinicians working in challenging environments.

A 20-year-old diagnosed with both autism and Tourette’s Syndrome engaged in persistent vocal and motor responses that interfered with learning, activities of daily living, vocational tasks, and social interaction. A common intervention for Tourette’s related responses, is differential reinforcement of incompatible responses such as engagement in deep breathing with arms crossed in front of the chest. However, DRI alone was not effective at reducing persistent vocal and motor responses for this participant and actually resulted in an increase from baseline. Additional tasks, that were not incompatible with target responses such as walking to a different location, walking on a treadmill, shooting a basketball, bouncing a basketball were identified informally through observation and teacher interview. These tasks were added to the intervention. Persistent vocal and motor responses decreased to near zero levels with this addition. Effects were further demonstrated using a brief reversal to baseline. Implications regarding the utility of informally identified competing tasks will be discussed.

Autistic individuals may experience difficulties with social-emotional reciprocity and nonverbal communication during social interactions. Although Applied Behavior Analysis (ABA)-based techniques have been shown to be effective in promoting specific, topographically defined social behaviors (e.g., greetings and farewells, turn-taking, etc.), it remains unclear to what extent these improvements lead to broader repertoire changes. The current study investigates the impact of commonly targeted ABA social skills training. Three autistic learners aged 7–9 participated in the current study. Each participant received an intervention package targeting turn-taking, greetings and farewells, and eye contact. Using a multiple-baseline design across participants, results indicated that ABA-based techniques were effective in increasing participants’ performance in contrived settings. However, differing degrees of generalization were observed in naturalistic settings as measured through direct observation and criterion-referenced indirect assessments. Implications for social skills training in ABA settings will be discussed. Authors: Kaitlin Preciado, Shaianne Kealoha, Aulani Latorre-Holt Keywords: Autism, Social Skill, Generalization

Engagement in elopement, the act of leaving a designated area without permission, is a serious safety concern, particularly for individuals with autism spectrum disorder (ASD). Anderson et al. (2012) found that 49% of children with ASD over the age of four had eloped at least once in their lifetime. This behavior can result in severe injuries or even death. This study aimed to examine the impact of Functional Communication Training (FCT) on reducing elopement in a male participant with ASD. A trial-based functional analysis revealed that the elopement was automatically maintained, rather than driven by socially mediated variables. The intervention involved teaching the participant to use functional communication as a replacement for elopement, with added parent collaboration to support generalization. The results showed that FCT significantly increased independent requests and reduced elopement. This study highlights the effectiveness of FCT in addressing elopement behaviors in individuals with ASD, emphasizing the importance of both therapy and family involvement in successful behavioral outcomes.

Posttraumatic stress disorder (PTSD) has significant physical, social, and mental health consequences for individuals and their families (American Psychological Association, 2013). Effects of PTSD include social isolation, disruption in psychological functioning, and chronic health issues, which can be especially true for individuals who also have caregiving responsibilities (Christie et al., 2019). Caregivers of children with a diagnosis of autism spectrum disorder (ASD) also report having increased difficulties accessing interpersonal and behavioral support for themselves and their children (Schieve et al., 2007). To date, there is limited research assessing the relationship between levels of posttraumatic stress in caregivers as it relates to their children’s engagement in complex behavior (i.e., aggression, self-injury) commonly associated with ASD. To bridge this gap, we investigated the association between caregivers’ PTSD symptoms and their children’s complex behavior. We administered the PTSD Checklist for DSM-V (PCL-5) and the Aberrant Behavior Checklist subscale for Irritability (ABC-I), examining the association between self-reported caregiver PTSD symptoms and their children's ABC-I scores. Preliminary results show a positive correlation between caregiver self-reported PTSD symptoms and their children’s engagement in challenging behaviors associated with ASD, indicating a need for further research in this area.

The purpose of this study is to evaluate the effectiveness of using match-to-sample, intraverbal prompts, and self-monitoring strategies to teach females with autism spectrum disorder (ASD) how to independently and properly manage self-care during their menstrual cycle. This research is an extended variation of Klett and Turan’s (2011) study on the generalized effects of social stories and task analysis in teaching menstrual care to young girls with autism. The current study aims to expand on these findings by incorporating additional instructional strategies, specifically match-to-sample for identifying menstrual products, intraverbal prompts for reinforcing verbal routines, and self-monitoring techniques for promoting independence in the menstrual care process. Participants will be taught how to independently select, use, and dispose of menstrual products, monitor hygiene steps, and track their behavior through self-reported checklists. The effectiveness of these strategies will be evaluated based on improvements in skill acquisition, accuracy of task completion, and overall independence during the menstrual cycle. Additionally, generalization of skills across settings and the caregiver satisfaction related to menstruation instruction will be assessed. Results are expected to contribute valuable insights into the development of more effective, individualized interventions for teaching menstrual care to females with autism spectrum disorder, thereby addressing a critical gap in the literature on autism and self-care.

Symptoms of autism spectrum disorder (ASD) are typically noticeable within the first 3 years of life. Instruments for early detection of ASD are critical, as these will promote better clinical outcomes. The Toddler Autism Symptom Inventory (TASI) is an instrument designed to assess behaviors consistent with autism symptoms in toddlers through parent report, showing adequate diagnostic predictive value among English-speakers. However, there is limited knowledge about its use among Spanish-speaking families. The purpose of this study was to examine the relationship between the Spanish version of the TASI and ADOS-2 scores in a Latino sample of autistic children. This study was part of a broader project examining the predictive value of autism screeners in Latino children. 16 Spanish-speaking child-parent dyads (nmale=12), with an average child’s age of 39 months (SD=10.78) participated. Results yielded a moderate positive correlation between the calibrated severity scores of the ADOS-2 and total scores of the Spanish TASI. Additionally, there was a strong positive correlation between the social affect domain from the ADOS-2 and the Criterion A section from the Spanish TASI. Preliminary data from this study suggests that the Spanish TASI may be a useful instrument in the identification of ASD among Latino children.

Background: Autism spectrum disorder (ASD) affects 1-3% of all children in most developed regions of the world. Due to national shortages in clinicians, patients may wait months to years for a diagnostic evaluation. For example, the median age of diagnosis in the US remains over 4 years, hindering early intervention. The American Academy of Pediatrics has stated that “…(biomarker) use could improve the reliability and validity of clinical diagnosis….” and enable early intervention. However, no US Food and Drug Administration-approved biochemical test for ASD is available to achieve these goals. We developed a biomarker test (named ClearStrand-ASD) that can rule out ASD in children after birth up to 36 months with high negative predictive values (NPV), where ASD is a concern. Methods: Foundational studies were conducted using deciduous teeth and hair samples from cohorts in the US, Sweden, the UK, and Japan. Here, we have undertaken a large state-wide study to validate the performance of ClearStrand-ASD against gold-standard clinical measures of ASD. In 490 children from two cohorts in California, ASD was assessed using DSM-5 criteria (168 cases and 322 controls). Hair was collected after birth to 36 months, and a single strand was analyzed using laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS) to generate time series data on essential and non-essential elemental profiles at 500-1000 time points. Analyses were done in a CLIA-certified laboratory. Data science methods focused on leveraging the full time series of data on all elements to train classification models with an emphasis on optimizing the negative predictive value (NPV) at a certain level of sensitivity. Results: Results are presented on models trained on 294 participants, which were then locked and tested in a blinded independent set of 196 participants. Separate models were developed for males and females. Based on an elevated prevalence of 7% (overall prevalence in the US is 2.8%), the test showed a sensitivity of 80% and an NPV above 95%. Conclusion: ClearStrand-ASD provides an objective biochemical test to aid clinicians in ruling out ASD in an efficient manner. The test may help reduce the time to confirm ASD diagnosis and initiation of earlier intervention, resulting in better outcomes for people on the autism spectrum.

Individuals diagnosed with intellectual and developmental disabilities (IDD) are at a higher risk of engaging in challenging behavior (Soke et al., 2016). Researchers have evaluated the relationship between physiological arousal and the occurrence of challenging behavior (Goodwin et al., 2019). More recently, behavior analysts have extended this work to evaluate the predictive validity of physiological responses on bouts of challenging behavior during functional analyses. McCabe and Greer (2023) demonstrated that heart rate was not a reliable predictor of challenging behavior, regardless of its topography or function. We replicated and extended McCabe and Greer by measuring electrodermal activity (EDA) during functional analyses. Participants were children diagnoses with an IDD who were referred for assessment of challenging behavior. Participants wore an Empatica® research-grade wearable biosensor while completing a functional analysis (Iwata et al. 1982/1994). Our preliminary results suggest that in some cases, physiological events (i.e., elevated galvanic skin response) were predictive of challenging behavior. Moreover, accelerometer data suggest that the physiological arousal was not attributable to a movement artifact.

De-escalation strategies, or procedures that result in short-term cessation of targeted behavior, are often needed for autistic youth with dangerous behavior to maintain safety. Most de-escalation recommendations are not individualized based on the presentation of behavior. This study evaluates a multielement assessment comparing five de-escalation strategies for autistic individuals who engaged in dangerous behavior, including self-injurious behavior and aggression, in an intensive out-patient setting. At the onset of an episode of dangerous behavior, therapists responded based on one of the de-escalation conditions and measured instances of targeted behaviors as well as latency to calm criteria. Conditions alternated between various strategies that included differential reinforcement of other behavior (DRO), differential reinforcement of alternative behavior (DRA), non-contingent access (NCA), and the use of coping skills. The Attention DRO and NCA Quiet Space conditions consistently resulted in the shortest latencies to calm criteria for the first participant, Ricky. The average inter-observer agreement (IOA) of this evaluation was 93.76%. Researchers are conducting ongoing analysis to determine the most effective de-escalation strategies for additional participants. Preliminary results of our study suggest that treatment teams should individualize de-escalation strategies based on the individual’s skills and the unique presentation of the dangerous behavior.

Children noncompliance with essential healthcare routines is a widely reported problem, especially for children with autism spectrum disorders (ASD). Study 1 was to evaluate collaboration of three who exhibit noncompliance with eye exam routines in an education program serving children with ASD in Turkey,Study 2 evaluated the effects of a shaping procedure to teach children with ASD to cooperate with haircuts. Probes in the simulated setting were conducted periodically to evaluate potential maintenance of compliance in the absence of treatment, as well as generalization of performance to novel therapists. Child compliance was also assessed during haircuts and eye examinations conducted by healthcare professionals in the actual relevant environments to determine the extent to which trained performance generalized. Results showed that mere exposure to the simulated environment increased compliance for all children. Treatment was necessary to increase compliance for six children. Successful generalization of compliance in the actual healthcare environments was observed for all children. The results extend the literature by assessing the extent to which treatment for compliance with healthcare routines that does not involve escape extinction can be effective and by assessing whether the effects of compliance training in an analogue setting will generalize to the actual healthcare setting.

Match stimuli assessments have become a more common treatment for treating automatically maintained behavior, focused on determining stimuli that compete with the reinforcement of a target behavior. However, there has been less focus on the collateral effects of this intervention on behaviors that fall within the same response class but are topographically different. The focus of this study was to identify matched stimuli to be used as a competing reinforcer. The subject was a 12-year-old male who presents with autism spectrum disorder. Spitplay fell within a response class that also included hand-biting, licking, and tapping, which all operated under the function of automatic reinforcement. Items selected were based on the sensory output they potentially produced that matched spitplay only. Sessions were conducted for the selected items along with a control (i.e., no matched stimuli), measuring frequency of spitplay and hand biting. Results displayed no direct impact on rates of spitplay, however, the intervention demonstrated success with decreasing hand biting. While this was not the target behavior stimuli were matched to, desired effects of the intervention transferred to this behavior. The study provides preliminary exploration on the effects of matched stimuli assessment on an entire response class of behaviors.

In this clinical case study, we used a concurrent operants reinforcer assessment to determine the function of property destruction demonstrated by a child on the autism spectrum. Caregivers reported that the child frequently engaged in paper ripping (i.e., destroying books, tax documents, and photo albums) when the mother’s attention was diverted. However, it was unclear if the mother’s diverted attention served as a discriminative stimulus signaling the availability of paper ripping and accessing automatic reinforcement (i.e., paper ripping was less likely to be blocked when the mother was not attending) or as an establishing operation for her attention. To elucidate the function, we conducted a concurrent operant reinforcer assessment in a simulated apartment using an ABAB reversal design. Alone condition procedures were implemented in one room, and attention condition procedures in another. In the reversal, we switched the contingencies in each room. We measured rate of paper ripping and time allocation to each room. Results suggest that paper ripping was maintained by automatic reinforcement and that the mother’s diverted attention functioned as a discriminative stimulus, signaling that paper ripping would be available. This study adds to the literature demonstrating the utility of concurrent operant assessments for identifying behavioral function.

Preference assessments are essential in applied behavior analysis, but not all highly preferred stimuli function as reinforcers. Identifying effective reinforcers is crucial for behavior change programs, requiring efficient and reliable means of identifying these stimuli. Previous research has compared two formats of a paired-stimulus preference assessment, a single- and double-presentation arrangement, and found that a single-presentation arrangement corresponds with the double-presentation arrangement but requires less time to conduct. Previous research, however, did not include a reinforcer assessment, so the utility of this assessment format is limited. The purpose of this study evaluated the effectiveness of the single-presentation paired-stimulus preference assessment in identifying preferred stimuli that function as reinforcers and compared it with the double-presentation format. The single-presentation format was embedded within the double-presentation assessment and followed by the concurrent operant reinforcer assessment. Results revealed strong correspondence between both formats, with high Spearman rank correlation coefficients (r? = 1.0, 0.97, 0.89) across participants. Reinforcer assessments confirmed that all highly preferred stimuli identified also functioned as reinforcers. These findings support the use of the single-presentation arrangement, but future research should investigate the social validity of this assessment in regard to clinician acceptability, usage, and implications for client programming.

Individuals with autism spectrum disorder (ASD) often receive pharmaceutical treatment; however, a concern with prescribing oral medications is that individuals may not correctly swallow pills (Polaha et al., 2008). One method of addressing this issue involves crushing pills; however, this method is often countertherapeutic because it can reduce medication efficacy or result in inaccurate dosing (Paparella, 2010). The purpose of this study was to assess the efficacy of a multiple-component intervention for increasing pill swallowing. Two individuals who attended a residential school for individuals with autism participated. Differential reinforcement of alternative behavior (DRA) alone was conducted first, and additional components were added if criterion performance was not achieved. Additional treatment components included stimulus fading, simultaneous presentation, and pill placement. One participant met the treatment termination criterion with the implementation of DRA alone, and the other participant required additional components, including stimulus fading and pill placement. The implications of the findings for increasing pill swallowing in individuals with ASD will be discussed.

The present study examined the utility of an evidence-based behavioral health multi-treatment package consisting of empirically-supported applied behavioral analytic (ABA) interventions for nonverbal children diagnosed with level 3 severe autism. Implemented in Greece and conducted for approximately 3.5 years (42 months) at home, at school whenever permissible, and in community-center-based settings, this longitudinal study tracked eight students as they received several ABA interventions, including generalized imitation training, echoic/vocal mand training, discrimination training, individualized photographic activity schedules, and various secondary supplemental interventions. This study showed that the multi-treatment package increased student prosocial and independent capabilities, reduced problem behaviors, and reduced overall autism symptomology ratings in this sample. This research contributes to the development of a model route of treatment in clinical and home settings for children diagnosed with severe autism. Further research should seek to replicate these findings in controlled, multicultural samples and determine the most potent interventions for improving educational success in children diagnosed with severe ASD.

One 5-year-old girl diagnosed with autism spectrum disorder with specific rigidities and ritualistic behavior occurring during mealtimes was treated utilizing the Balance Program framework (Ruppel, KW, et.al., 2021). Major delays included communication, socialization, and insistence on sameness. The client and treatment team had prior experience implementing the Balance Program to increase cooperation during clinic-based routines with a focus on ending preferred, child-led activities, transitioning to the workspace, and engaging in discrete trial teaching. At the start of treatment, the client’s skills included responding to her name, emitting a functional communication response (e.g., “my way”), emitting a tolerance response (high five), and cooperating with adult-led skill acquisition activities in the clinical setting. Generalization of skills from the classroom to other settings had not occurred and the client was unable to discriminate between conditions (“my way” versus “staff’s way”) or to generalize skills to unpracticed routines such as mealtimes. Of particular concern were rigid, repetitive, sensory-seeking behaviors that occurred at high rates and interfered with the client’s ability to consume a meal or snack with peers in a reasonable amount of time. Specifically, problem behaviors included rolling, smearing, picking, licking, and mouth-stuffing food items during mealtimes.

Generalization is a marker of successful behavior change, and Stokes and Baer (1977) provided a set of strategies that could promote generalization within teaching, such as Multiple Exemplar Training (MET). Most research has incorporated MET within teaching strategies but few studies have examined how MET influences generalization outcomes. The current research assessed MET’s effect on generalization outcomes by comparing three different stimuli sets, consisting of one, three, and five exemplars, on six generalization variables during tact training. One child diagnosed with autism, was taught to label three different sets of stimuli, each with different numbers of target examples (1, 3 or 5) and then generalization outcomes were assessed across variables such as settings, SD’s, stimuli, etc. Overall, the student learned all targets and demonstrated correct responding across all generalization probes. Results showed that the number of training examples did not differentially affect generalization outcomes, and that training time across all three sets was comparable. Although preliminary, our findings indicate that MET may not be required for generalization to be achieved for tact training for some individuals. Moreover, it may be advantageous to use less exemplars to increase teaching efficiency. However, additional replication with more participants are needed.

Behavior intervention plans are helpful in increasing safe engagement with medical procedures. Some of these plans are helpful for individuals diagnosed with autism spectrum disorder (ASD) who might display hyper- or hyposensitivity to environmental stimuli. Routine medical procedures may evoke challenging behaviors due to aversive reactions to sensory aspects of the medical procedure. For example, the electroencephalogram (EEG) procedure requires prolonged engagement with various tactile stimuli which may be aversive to individuals with autism spectrum disorder. In this evaluation, one patient with ASD displayed symptoms suggestive of a seizure disorder warranting referral for participation in an EEG. Alejandro’s severe challenging behaviors prohibited a safe completion of the procedure. A 30-step plan was then created in the hope that it would help him tolerate the steps that go into an EEG. The client then completed the EEG and found that he had no conditions that could start a seizure in the EEG.

Many individuals diagnosed with Autism Spectrum Disorder are not able to benefit from highly language-based anxiety reducing behavioral interventions. Shinrin-Yoku, translated into English from Japanese as "forest bathing," is the practice of deliberately interacting with nature for specified short periods. There are many studies in the medical literature detailing the positive results of shinrin-yoku in terms of reduction of pulse rate, increases in levels of natural killer cells and decreases in perceived anxiety (e.g., Bowler, Byung-Ali & Pullin, 2010). In the current study, the effects of shinrin-yoku on the pulse rate and self-reported anxiety levels of individuals diagnosed with Autism Spectrum Disorder were examined. Consistent benefits were demonstrated in terms of reduced pulse rate and self-reported reduced anxiety, with pulse rate reducing 6-8% on average. Future directions for how to possibly bring the effect indoors are explored. Shinrin-yoku may be an effective anxiety reducing procedure for individuals who do not respond to other more language-based interventions.

Functional analyses (FA) are commonly used to identify the function of challenging behavior, with both standard FA and trial-based functional analysis (TBFA) demonstrating the ability to reliably identify behavioral functions. However, there is limited research on conducting FA in home settings. To address this gap, we conducted a TBFA in the home setting using procedures similar to those described by Bloom et al. (2013). The participant was a 12-year-old boy diagnosed with autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (ADHD), referred for the assessment and treatment of severe challenging behavior. The results of the TBFA were compared to a traditional FA conducted in an intensive outpatient (IOP) hospital setting. Results demonstrated strong correspondence between the two approaches, suggesting that TBFA can effectively identify behavioral functions even in less controlled settings, such as the client’s home, where resources may be limited. These results highlight the potential for conducting FA in naturalistic settings while maintaining validity. The implications for in-home assessments and future research are discussed, focusing on the efficiency, effectiveness, and feasibility of conducting FA in these settings.

Individuals with autism spectrum disorder (ASD) often face challenges in establishing and maintaining meaningful friendships. They may struggle to discriminate the signs of unhealthy friendships, which can lead to involvement in manipulative or abusive relationships. This line of research seeks to help individuals make informed decisions when seeking meaningful and healthy friendships. We evaluated Behavioral Skills Training (BST) and Self-Questioning Training (SQT) to teach two adolescents with ASD to discriminate between healthy and unhealthy friendship traits and to provide a rationale for each video model. Following BST and SQT we observed an increase in identifying the correct traits and providing the correct rationales across the initial sets of exemplars for both participants. We assessed novel exemplars following the acquisition of the main teaching sets. Overall, we did not observe an increase in responding to the untaught sets, suggesting that our teaching arrangement was insufficient in promoting generalization, therefore we subsequently taught out all additional exemplars. Further refinements are needed to teach a generalized repertoire. Learning these skills may help protect individuals with ASD against the establishment of unhealthy friendships, bullying, and reduce the risk of harm for vulnerable populations.

Rural communities face unique challenges, such as limited access to resources and a shortage of community partners, which hinder the establishment of sustainable programs and services, particularly more specialized services, such as ABA (Bethune & Kiser, 2018). The growing demand for behavioral services, particularly in rural areas where resources are limited, exacerbates the difficulties in providing adequate support for this population (Traub et al., 2017). Yet, the availability of behavior analysts in rural schools remains limited. Considering this, low-intensity ABA services, which have shown promise in addressing a variety of skill deficits, are particularly relevant for rural settings (Bethune & Kiser, 2018). This study presents a model of how providers can successfully implement low-intensity ABA programming in a rural, public elementary school. Data will be presented on treatment outcomes of ABA programming designed to target functional communication, compliance with academic demands, and appropriate classroom behavior for a 6-year-old male with autism. In this model, 4 hours of one-on-one ABA services were provided per week. Results indicate that ABA programming effectively increased complexity and independence of mands, increased appropriate classroom behavior, and increased completion, accuracy, and efficiency of academic demands. Implications of offering low-intensity ABA services in a school setting will be discussed.

Children and adolescents with autism spectrum disorder (ASD) are at a greater risk of seeking emergency department (ED) services during behavioral crises, such as acute aggression, suicidal or homicidal ideation, self-injury, or other types of challenging behavior (e.g., pica, dangerous behaviors). Research demonstrates children and adolescents with ASD often return to the ED due to challenging behavior, suggesting that gaps in care exist (e.g., follow-up appointments, referrals). However, the current knowledge basis is largely based on data from other countries. Given the unique landscape of healthcare in the United States, it is prudent to elucidate characteristics of children and adolescents with ASD who are seeking emergency care due to challenging behavior, as well as systems-level factors that both contribute to our understanding of challenging behavior and ASD in ED settings. In this study, we focus on frequency and characteristics of children and adolescents with ASD presenting to the ED with challenging behavior over the course of a 6-year period in the Midwest region of the United States. Clinical implications for ED staff are discussed.