Association for Behavior Analysis International

Early intensive behavioral interventions are considered the intervention of choice for treating individuals diagnosed with autism spectrum disorder. However, in many instances constraints prevent individuals from receiving intensive behavioral treatments and low-intensity interventions are provided instead. In this symposium, the authors will present outcome of low-intensity behavioral interventions across different sites using a variety of assessment tools, including the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP), the Vineland Adaptive Behavior Scale, Childhood Autism Rating Scale (CARS), IQ scores, and other related measures. The reliability of the VB-MAPP is discussed and it is evaluated as an outcome measure.

Practitioners and policy-makers who provide ABA interventions or prescribe interventions for autism.

We evaluated outcome of early behavioral intervention for children with Autism Spectrum Disorders (ASD) as it was provided through public service providers in Norway. One group of children received low intensity intervention (11.1 weekly hours), a second group higher intensity intervention (18.1 weekly hours), and a third group received eclectic special education. We compared outcomes on adaptive behavior, ASD severity and intellectual functioning across the groups after one year. Although, both the lower and higher intensity behavioral intervention groups received less hours than what is recommended in the literature, both groups did significantly better than the eclectic comparison group. Furthermore, the higher intensity behavioral group did better than the lower intensity behavioral group. Confirming a dose-response relationship between intensity and gains made. Nevertheless, gains in both behavioral groups were more modest than what is reported for intervention that is more intensive. We discuss the pros and cons of the publicly funded behavioral intervention model.

Despite the demonstrated effectiveness of ABA therapy for individuals with autism, relatively little research has focused on the characteristics and behaviors that distinguish exemplary client-therapist interactions. This symposium summarizes research to identify and train qualities and corresponding behaviors of effective ABA practitioners: (1) A survey of BCBAs ranked therapist characteristics and qualities, resulting in the development of the Exemplary Behavior Analyst Checklist (EBAC) of 35 essential traits. In a follow-up survey, BCBAs rated the extent to which exemplary practitioners demonstrated each trait, and ranked their Top 10 qualities in order of perceived importance. (2) Characteristics of ABA therapists within the concept of Behavioral Artistry (BA) (a repertoire of interpersonal behaviors including care, attentiveness, and creativity) were investigated. Parents surveyed significantly preferred BA traits. ABA students were determined to have lower levels of BA compared to other helping professions, and autism therapists with lower levels of BA qualities were observed to deliver ABA less effectively. (3) Therapist social interactions were conditioned using an operant discrimination training (ODT) procedure. Sequential analysis of social interactions and positive social responses suggest that client/therapist positive responding to each other’s social initiations increased following ODT. Implications for training and supervising effective ABA practitioners are addressed.

The target audience for this symposium is behavior analysts currently engaged in delivering therapeutic services and supervising other behavior analysts/staff, as well as researchers and clinical administrators.

The behavioral effects of reinforcement, punishment, and extinction are the cornerstones of behavior analysis. Yet, critiques of behavior analysis often point to problems with these basic effects even to the extent of stating that “reinforcement doesn’t work” or that the effects are due to other embedded variables (such as intrusion of natural behavior). In reality, the effects are complex and highly dependent on procedural variables. For example, reinforcement can strengthen behavior even at the level of a single reinforcer, yet after several sessions of acquisition, reinforcement no longer strengthens but instead maintains behavior. Effects also depend on levels of analysis, as seen when immediate effects of reinforcement, punishment, and extinction are very different from long-term effects. Stimuli routinely associated with reinforcement, punishment, and extinction can acquire discriminative properties for ongoing behavior with both excitatory and inhibiting effects. The presentations will outline various effects of reinforcement, punishment, and extinction in both laboratory and clinic, using examples from research to illustrate the problems with interpretation and terminology. The overall purpose is to alert behavior analysts that discourse about behavior becomes complex and unproductive when basic terms refer to different effects.

In 2016, the Victorian Government undertook a comprehensive review of its Program for Students with Disabilities (PSD). The review found that, while the PSD delivers substantial funding to support students with disabilities, there are significant weaknesses in its design, implementation and accountability. Specifically, the review found that (a) Victoria lacks a clear inclusive education policy and framework, (b) inclusion of all students requires a sustained investment in the education workforce’s training and professional learning opportunities, (c) there is a lack of accountability and transparency for funding and outcomes for all students with disabilities, and (d) a more effective approach to identify and support students with disabilities is required (www.education.vic.gov.au). As a result of these findings, The Victorian Department of Education and Training is now delivering an inclusive education agenda to give schools extra resources, support and guidance, with a focus on developing the knowledge and skills of school staff, and giving schools clearer guidance and specialist support to better respond to the needs of students with disabilities. In this symposium, we will present the findings from several current projects designed to directly address the issues highlighted by the Victorian Government in the 2016 review.

The Government of Victoria has recently launched an inclusive education reform agenda, which has included a considerable boost to funding. As part of this reform agenda, over 300 Victorian government schools have or soon will adopt the School Wide Positive Behaviour Support (SWPBS) framework to promote student engagement and well-being. SWPBS uses a tiered response-to-intervention framework which invests in prevention (Tier I), identifies and provides targeted, individualised, and small group interventions for students not responding to prevention (Tier II), and utilises function-based, individualised, and intensive interventions for students requiring further support (Tier III). Within the Victorian Department of Education, processes and resources are being established to ensure implementation is sustained at the state-level. In light of this, we conducted a systematic literature review to identify the factors that impede or enhance the successful and sustained implementation of SWPBS. Appropriate resourcing and the presence of an effective SWPBS support team were noted to be the most critical factors enabling the implementation of SWPBS, at both the school and state/district level. In this presentation, we will discuss the strengths and limitations of this body of literature, and propose several best practice recommendations for sustained implementation of SWBPS in Victorian schools.

Many applied behavioral interventions are concerned with affecting the choices (i.e., response allocation) of clients. For example, when a behavior analyst treats severe problem behavior, the goal is often conceptualized as decreasing problem behavior choices (e.g., aggression) while increasing choices to engage in appropriate alternatives (e.g., communication). Likewise, an interventionist working with adults on health-related goals may be interested in promoting more time engaged in physical activity. The first presentation in this symposium will present data from a series of human-operant studies demonstrating the effects of variables (e.g., differential reinforcement parameters) on response allocation and will discuss the implications of these basic findings for arrangements in applied settings. The second presentation will provide a systematic review of the choice-based intervention literature from the last 15 years and show clinical data to demonstrate the effects of concurrent-operant arrangements for treating challenging behavior. The third presentation will present a study investigating contingency management and noncontingent reinforcement on adults' allocation of time to physical activity. Together, these talks will show the benefits of bidirectional translational research on the use of concurrent-operant arrangements to help understand and refine choice-based interventions for socially significant problems.

The target audience for this symposium is behavior analysts who are researchers or practitioners and are interested in using concurrent-operant choice interventions in applied settings.

In the first paper, Arntzen and Bevolden Rustad present an experiment which aimed to study the correspondence between the results on the matching-to-sample test and the sorting test. Twenty-one participants were taught 12 conditional discriminations and tested for the emergence of three 5-member classes. The degree of correspondence in responding on the two types of test formats supports the notion about the usefulness of sorting tests. In second paper, Dunvoll, Arntzen, Elvsåshagen, Hatlestad-Hall, and Malt argue that unrelated stimuli pairs produce a more negative wave line the EEG than the related approximately 400 ms after stimuli presentation (N400 ERP). Five adults with high functioning autism were trained in six conditional discriminations, testing only a third of the trials in a matching to sample (MTS) format. The results show a small negativity in the unrelated stimuli pairs in the frontal and central midline compared to related stimuli pairs. Finally, Aggio, Rezende, Sbrocco, and de Rose argue that the N400 is observed after presentation of two abstract stimuli from different equivalence classes. The authors ask if this effect would be replicated with arbitrary equivalent stimuli in elderly participants. The main findings show that participants had reduced amplitude and longer latency of N400.

students and researchers

One of the problems often described in individuals with autism spectrum disorder is the lack of ability to generalize skills from one setting to another. One way to measure generalization is through equivalence class formation, training directly trained relations, and testing for emergent relations. Also, N400, a measure with electroencephalography (EEG) where related and unrelated stimulus pairs are tested can be used. Unrelated stimuli pairs produce a more negative wave line the EEG than the related approximately 400 ms after stimuli presentation. In the current experiment, five adults with high functioning autism participated. They were all trained in six conditional discriminations, testing only a third of the trials in a matching to sample (MTS) format. The rest of the possible emergent relations were tested in a priming procedure including EEG measurements. At the end, a full MTS test was conducted. The results show a small negativity (insignificant) in the unrelated stimuli pairs in the frontal and central midline compared to related stimuli pairs. On the other hand, when looking closer at the individual data there are differences between the participants. This might indicate that ASD should be considered a heterogeneous group with respect to the EEG measures.

Studies have shown that students tend to favour student active learning such as flipped classroom and peer instruction compared to traditional lectures. Interteaching is a procedure, based on behaviour principles, where the emphasize is on student active learning. In interteaching, students work on study guides, discussing the course material in pairs, and make notes on what they do not understand. The teacher then designs short lectures based on these notes. However, for interteaching to be evaluated as evidence based, studies must verify its efficacy. Sturmey, Dalfen and Fienup (2015) did a literature review in March 2014, identifying 18 articles on interteaching using Google Scholar and PsychINFO. The current study is a replication of Sturmey et al. conducted in December 2018. We limited the search to the period from March 2014 to date, using Google Scholar, PsychINFO, and ERIC. The review lead to identification of 12 articles on interteaching, published in 10 different journals in six different courses (e.g., psychology, physiology and nursing). The studies will be described and discussed.

This study investigated the relative effects of procedures used in equivalence research and a student active learning format (SALF) in establishing basic behavior principles. Equivalence procedures included matching-to-sample (MTS) training and test and SALF included elements from peer instruction and flipped classroom. All participants, college students, experienced both SALF and MTS. Some experienced MTS in an early phase (MTS–SALF group) and others experienced MTS at the end of the course (SALF–MTS group). A multiple choice test was presented three times (pre-test, post 1 and post 2). The MTS component included a generalization test. The results showed that MTS was equally effective as SALF and no effect of order was obtained. However, participants experiencing MTS in a late phase fulfilled the experiment and they were more positive to the MTS training in a social validity questionnaire than participants who experienced MTS in an early phase. Finally, participants who formed equivalence classes performed better on a generalization test than participants who did not form classes. Despite some limitations, the present results adds to previous findings demonstrating the effect of MTS in higher education and extends these by comparing the outcome of MTS to student active learning format.

Functional communication training (FCT) is a widely used and effective function-based treatment for socially-maintained problem behavior. Further, parents can be effective behavior change agents and providing rural caregivers with increased access to behavioral expertise via telehealth is a promising approach. However, challenges do occasionally arise, including lack of high-speed internet in rural areas, providing behavioral coaching internationally, and problem-solving when typically effective procedures prove ineffective. Further, less is known about the utility of FCT for individuals who have no formal communication system but who do not engage in severe destructive behavior, including individuals with Rett syndrome and related neurodevelopmental disorders. Kristín Guðmundsdóttir will kick off the symposium with the presentation "Caregiver training via telecommunication with rural Icelandic families of children with autism: Experimental findings and social validity," followed by Loukia Tsami who will present "An Application of Delivering Functional Communication Training via Telehealth Internationally." Kelly Schieltz will then present "Single-Case Analysis to Determine Reasons for Failure of Behavioral Treatment via Telehealth" and then Rebecca Kolb will then present on "The effects of functional communication training coached via telehealth for individuals with Rett syndrome." David Wacker will discuss the presentations in terms of methodological, clinical, and conceptual implications of behavioral consultation delivered via telehealth technology.

Parents can be effective behavior change agents and providing rural caregivers with increased access to behavioral expertise via telehealth is a promising approach. This presentation will describe results from two experimental studies of the effects of using telecommunication in training of rural Icelandic caregivers of children with autism. Furthermore, results from evaluation of the social validity of the training will be described. Participants included five caregivers and their preschool children with autism and one child‘s teacher. The intervention, included teaching the caregivers basic naturalistic teaching strategies to increase the frequency of their child’s socio-communicative skills. According to the results experimental control was demonstrated with all families. Measurable progress was displayed for all caregivers and children across all skill areas. Preliminary analysis of the social validity data indicates the caregivers believed the telecommunication training was feasible and viable. Challenges encountered during the studies regarding technical aspects, measurement and training procedures will be discussed. The results extend and confirm previous research on the effectiveness of teaching naturalistic strategies to caregivers via telecommunication. They also indicate that training via telecommunication is a promising alternative for families that have limited access to evidence-based behavioral expertise. However, further development and experimental study is important.

Functional communication training (FCT) based on functional analysis (FA) results is highly effective for treating socially maintained problem behavior of individuals with intellectual disabilities (ID) and ASD. Less is known about the utility of FCT for promoting a formal system of communicative behavior for individuals with Rett syndrome or other related neurodevelopmental disorders. We will describe the assessment and intervention procedures we have used with more than 15 participants with Rett syndrome who used idiosyncratic forms of communication as their primary means to communicate with family members. In addition, we will present illustrative case examples of various formal communication modes (e.g., microswitches operated with hands, eye pointing at picture cards, and eye-gaze activated speech-generating computer system). Challenges, limitations, and future directions will be discussed.

Parents and caregivers play an important role in the success and maintenance of gains achieved with behavioral procedures. Therefore, parents should be actively included and engaged in their child's intervention process. In addition, parents can also be the main agent of change and be trained how to implement behavioral interventions to promote socially relevant changes in their child's behavior. This symposium will explore two clinical applications for behavior change in which parents were the implementers. First, Abigail Kennedy will present a study that evaluated the effects of a parent-implemented deferred time-out procedure (i.e., a hands-free method in which the child learns to independently sit in contingent observation time-out) on the reduction of challenging behavior in four children with typical development. Next, Maegan Pisman will discuss the results of a study that implemented behavioral skills training (BST) with two mother-son dyads to train the parent how to implement behavioral strategies to improve child-parent interaction and to teach mands and tacts to their child who had a diagnosis of autism spectrum disorder (ASD). Finally, Marie-Hélène Konrad will reflect on the importance of considering families' cultural background while designing and implementing parent training procedures in clinical settings.

Clinicians, practitioners, and master students

Time-out is one of the most widely disseminated and commonly used behavioral interventions for managing problem behavior in early childhood. Although time-out has been shown to be an effective method for reducing children’s problem behavior, time-out resistance is nonetheless prevalent, and has the potential to increase caregivers' use of more intrusive and effortful implementation methods and negatively affect parental adherence. Deferred time-out (DTO) is a hands-free method for training children to sit in contingent observation time-out, and may provide an alternative to put-backs, back-up rooms, and other more restrictive methods that have been used to enforce the time-out location. The purpose of the present study was to evaluate the effect of DTO implemented by trained caregivers on time-out resistance. Participants were four children and their caregivers. DTO reduced the latency to comply with the time-out instruction and the duration of time-out trials for three of four participants. Additionally, overall improvements in initial command compliance were observed for all participants, and caregivers generally found DTO to be an acceptable approach for children’s problem behavior. This research contributes to time-out and parent training literature by increasing our understanding regarding DTO as a method for improving compliance with parents' instructions with contingent observation time-out.

Best practice in the treatment of problem behavior is for the clinician to begin the process with a functional behavior assessment (FBA) to identify possible variables that are contributing to and maintaining the problem behavior. In this symposium, we will present recent research regarding the use of FBA in the treatment of problem behavior. Stefania Dögg Johannesdottir will discuss an analysis of the agreement between mothers and their children on responses to FBA interviews. Bethany Contreras will present the results of systematic literature review that compared the outcomes for descriptive assessments and experimental functional analyses. Anna-Lind Petursdottir will end the symposium by presenting data from an application of function-based behavior support plans to improving challenging and appropriate behavior of six children in a typical pre-school setting. Each presentation will include a discussion of the implications of the data and considerations for enhancing the success of FBA in the treatment of problem behavior.

Clinicians who use functional behavior assessments.

Functional behavioral assessment (FBA) interviews are convenient tools for discussing and identifying influencing factors of behavior problems. Findings from FBAs serve as an important foundation for effective interventions to reduce challenging behaviors of children with severe emotional and behavioral difficulties. Including these children as informants in the process can have important benefits for the FBA and intervention process. The present study compared information gathered from children with persistent behavior problems and their mothers. Participants were six patients at the Child and Adolescent Psychiatric Department of the National University Hospital of Iceland, (4 male and 2 female) with severe emotional and behavioral problems, aged 7 to 13 years, and their mothers. Results showed high agreement between the children and their mothers regarding the definition of target behavior, antecedents and consequences of problem behavior, medium agreement on function of the problem behavior and low agreement on setting events. Participants found the interview to be useful for better understanding the cause and function of the problem behavior. Findings indicate the importance of exploring different views of children and parents of behavior problems and their influencing factors.

Effective early intervention is crucial to reduce persistent behavior problems of preschoolers and improve their engagment and well-being. This study evaluated the effects of function-based behavior support plans (BSPs) on the long-lasting problem behavior and lack of engagement of five children in preschool activities. Participants were five boys, aged three to six years, in public preschools in the capital region of Iceland. One participant had been diagnosed with speech impediment and one was diagnosed with autism spectrum disorder and ADHD. Single-subject multiple baseline designs across participants showed that function-based BSPs reduced the frequency of disruptive behavior (on average by 95,3%) and increased active participation (on average by 175%). Improvements in behavior and engagement were maintained when token systems were faded. Teacher ratings of participants behavior on the Pre-School Behavior Checklist improved significantly. Also, participants´ self-assessment of their well-being showed that they were feeling much better in different activities in preschool. Semi-structured interviews conducted with teachers and parents revealed high social validity of the procedures. Findings support the effectiveness of function-based behavior support to reduce persistent behavior problems of preschoolers and improve their school adjustment and well-being.