Association for Behavior Analysis International

One possible manifestation of a pediatric feeding disorder is when a child does not feed themselves by their appropriate, developmental age (e.g., typically by 24 months). Children who do not feed themselves, herein referred to as “self-feeding,” rely entirely on caregivers to feed them multiple times a day and therefore require substantial support to meet their nutritional and caloric needs. To date, evaluations targeting self-feeding involve primarily either pre-loaded spoons and cups or scooping with a spoon. The following clinical case study demonstrates an alternative to teaching a child to self-feed purees with a spoon to circumvent the amount of time it would take for the child to contact success with the demand by initially teaching the child to self-feed purees deposited from a puree pouch presented in an adaptive pouch holder. We used an ABCA design to evaluate a treatment package that included escape extinction, noncontingent reinforcement, graduated guidance, and differential negative reinforcement to increase self-feeding in a 3-year-old boy diagnosed with a pediatric feeding disorder, vision impairment, and global developmental delay. The results demonstrated an increase in independent self-feeding from an adaptive puree pouch holder following the introduction of treatment. Self-feeding maintained at a 12-month follow-up and generalized to the home setting. The case study provides a clinical example of incorporating adaptive feeding equipment into behavioral treatment programming to increase mealtime independence with purees.

Children with autism spectrum disorders are more susceptible to comorbidities than their neurotypical peers (Kennedy et al., 2024). This may include constipation, ear infections, dental issues, etc. Past research has relied on indirect measures (e.g., secondary verbal reports) to identify symptoms of pain and discomfort even though some pain and discomfort states produce direct observable symptoms. For example, gastrointestinal distress can be determined by stool typing (Lewis & Heaton, 1997). Still, it is not always ethical for another individual to be present when a child (particularly one who is toilet trained) is in the restroom. One potential way that clinicians can detect the presence of a pain or discomfort state indirectly is through observable events (i.e., public accompaniment) or behaviors (i.e., collateral response) that correspond with the private events of gastrointestinal discomfort. The current study utilized repeated measurement of known observable symptoms of pain and discomfort states (e.g., gastrointestinal distress) and behavioral indicators (e.g., stomach pressing) to identify the potential correspondence between the two.

Adults with autism are more likely to visit local emergency departments for a psychiatric disorder than those without autism (Vohra et al., 2016). This is largely due to extensive comorbidities and presentation of challenging behavior, but in many cases visits are deemed unnecessary (Vohra et al., 2016). In some cases, individuals may engage in hospital-seeking behavior which serves a behavioral function (Stevenson et al., 2019). This study builds on previous research which details the challenges faced due to a shortage of mental health clinicians trained to work with the population (Maddox et al., 2022) as well as the benefits of cross-disciplinary collaboration (Bowman et al., 2022). In addition to applied behavior analysis services, a community-based residential provider for adults with intellectual and developmental disabilities began providing psychiatry and therapy services. Data collected from 2014 through 2024 was used to identify the frequency of behavioral or psychiatric-related emergency room visits across a population of 200 service recipients. Data analysis demonstrated a significant reduction in visits following implementation of psychiatry and therapy services. However, there was a sustained further reduction of visits with regular cross-disciplinary collaboration including ABA services. Data analysis confirmed a 94.87% decrease overall when compared to baseline.

Behavioral treatments for severe problem behavior (SPB) are largely predicated on identifying effective reinforcers that increase appropriate behaviors and maintain low levels of SPB. Current clinical methods for identifying reinforcers vary widely and do not permit analysis of reinforcer dimensions critical to the efficacy and durability of behavioral treatment. This may severely limit practitioners’ ability to individualize behavioral interventions and ensure long-term treatment success. One approach is leveraging a theoretically based model of operant behavior to facilitate identification of reinforcers optimized for intended clinical application. Mathematical Principles of Reinforcement (MPR) is a general quantitative framework that offers one way to characterize the behavioral mechanisms underlying response strength and behavioral persistence to identify effective and durable reinforcers (Killeen, 1994). The current study uses MPR to analyze reinforcer assessment data obtained in clinical settings, with a critical first step being the evaluation of whether MPR can effectively model reinforcer assessment outcomes generated in these applied contexts. Specifically, we examine how MPR parameters vary across different stimuli and manipulanda, providing insights into the generalizability and applicability of this framework to clinical data.

Self-injurious behavior (SIB) is a significant concern, particularly in individuals with intellectual and developmental disabilities, due to its potential for severe physical and social consequences. The functional assessment of SIB can be especially complex when the behavior involves multiple response and functional classes, often requiring a series of individualized assessments to identify the maintaining variables. This project documents the clinical application of multiple modifications to the functional assessment process to identify the variables maintaining various topographies of SIB in a young girl with Down Syndrome. After conducting a standard functional analysis, we implemented several design modifications and follow-up assessments, including pairwise, reversal, trial-based, and single-behavior functional analyses. These assessments were prescriptive in developing a function-based treatment tailored to the participant’s needs. Results indicated that the participant's SIB was multiply maintained, highlighting the importance of individualized and comprehensive assessment strategies not only to understand the maintaining variables but also to inform the development of effective, function-based interventions.

Behavior analysts have been discussing ways to ensure that respect for autonomy, dignity, and compassion are present when working with adults with disabilities. A focus on dignity within human and legal rights, specifically for this population, could inform an essential need for understanding the social validity of procedures used by behavior analysts. A foundational part of behavior-analytic practice is identifying the preferences of the individuals we serve. A preference assessment is an essential tool used by behavior analysts to predict stimuli that may function as reinforcers. To understand the acceptability of these procedures by individuals whose preference is assessed, collecting social validity data of preference assessment procedures can inform practices that respect individuals’ choice and dignity. This study reviews and summarizes the literature on preference assessment and its social validity in adults with disabilities from 2013 to 2023 in the Journal of Applied Behavior Analysis. We reviewed 11 studies, of which only one reported social validity data. We discuss implications and future direction.