Association for Behavior Analysis International

Many experts consider Applied Behavior Analysis (ABA) to be the gold-standard treatment for children with autism spectrum disorder (ASD). Treatment intensity (sometimes referred to as dosage) typically comprises both the number of hours of direct ABA treatment per week and the total duration of treatment. Recommendations regarding the specific intensity of treatment should be based on the?medical necessity?of the treatment for each individual patient (BACB 2019), and it is the professional behavior analyst that determines the treatment intensity or dosage that is medically necessary. However, there is currently no standard method for making medical necessity determinations for ABA services and there is no data available on how behavior analysts individualize dosage for children who present with varied skills, needs, ages, and family contexts (Pellecchia et al., 2019). Indeed, researchers can only speculate as to the reasoning that each clinician uses in making treatment intensity recommendations, given that there is a high degree of variability reported in the number of treatment hours patients receive in clinical practice—an important limitation in large-scale outcomes research (Linstead et al., 2017). Medical necessity determinations are part of the careful construction and individualization of behavior analytic treatment and are an essential element of ABA practice that is not well understood. In this symposium, we will discuss considerations for determining medical necessity and calibrating recommendations based on the best available information, and the potential for greater standardization.

Behavior analysts within their first 5 years of practice, practitioners, supervisors, and senior leaders.

Most published outcome research on Applied Behavior Analysis (ABA) treatment seems to suggest that high intensity yields the best outcomes for patients with autism spectrum disorder (ASD). Yet little is known about what impacts the medical necessity determinations made by behavior analysts to inform treatment intensity recommendations. We conducted a cross-sectional survey of behavior analysts with experience developing and overseeing behavior analytic programming for individuals with ASD (N = 559). We asked participants to report how 36 patient, familial, and logistical factors impact their recommendations using a 7-point Likert Scale (Significantly Decrease, Moderately Decrease, Somewhat Decrease, No Impact, Somewhat Increase, Moderately Increase, Significantly Increase). Results indicated variation in the factors that impact recommendations as well as the direction of impact. A majority agreed on the direction of impact among 9 of 10 factors related to patient diagnosis and skills (e.g., Level 3 DSM-5 Classification), 4 of 10 factors related to patient medical history (e.g., presence of seizure disorder), 3 of 5 additional patient-specific factors (e.g., age at treatment onset), and 3 of 11 familial and logistical factors (e.g., limited family availability). Implications will be discussed specifically as they relate to clinical practice when working with managed care organizations.

Academics, practitioners, animal trainers, dog owners, zookeepers, animal researchers

The development of the functional analysis represents a landmark event in the history of our field with the method developed by Iwata and colleagues being the most widely used, researched, and cited form of functional analysis to date. While there is an abundant literature concerning the utility of the functional analysis, many procedural modifications are documented in the literature to address barriers, concerns, and criticisms. In this symposium authors provide examples of modifications to the multi-element functional analysis to address patient-specific concerns related to safety risk and feasibility of implementation. DeBrine and colleagues evaluated the degree to which the number of collected observation in trial-based precursor analysis impacted accuracy of precursor response identification and validity of functional analysis results. Morris et al., explored opening the contingency class to include appropriate behavior, such as mands, within the functional analysis. The author will discuss relevant impact on validity and safety of this modification during implementation. Last, Ramos et al. assessed the implementation of functional analysis with caregiver implementers. Specifically, they conducted behavioral skills training and an in-depth error analysis to evaluate feasibility and practicality for the use of caregivers as implementors in the use synthesized functional analysis in assessment.

Practitioners interested in or participating in treating severer destructive behavior.

Successful collaborative efforts in treatment among behavior analysts, parents, and others serving as behavior change agents helps to ensure ethical and effective treatment delivery. This symposium evaluates procedures to use when transferring technology to non-professional caregivers and parents. Study one used a telehealth-based, behavioral parent-training program known as the Online and Applied System for Intervention Skills (OASIS) to teach parents of children diagnosed with autism to correctly implement behavioral procedures: reinforcement, prompting, extinction, etc. Following training, most parents scored 80% or above on skill and knowledge-based tests. Study two utilized a behavior skills training (instructions, modeling, rehearsal with feedback) to improve treatment fidelity to a feeding procedure for parents whose child diagnosed with autism presented with severe food selectivity. Results indicate parents’ feeding treatment fidelity met 80% or above criteria and generalized to the home environment. Study three examined parents' attitudes toward scientific or behavior-analytic language relating to aspects of practice. Thirteen parents of children with autism rated items with scientific terms relating to functional analyses, translational research, and experimentation as most uncomfortable. Replacing behavior-analytic terms with layman synonyms reduced discomfort. Together these studies provide insight into conditions that contribute to treatment adherence among parents and other behavior change agents.

Advanced - this symposium is appropriate for current BCBA's that are interested in empirically driven methods to disseminate research.

Effective communication with a client or a client’s family or guardians about services is a key factor in creating treatment success. However, behavior-analytic terminology or jargon may be viewed as unpleasant, confusing, or intimidating to non-experts which may be a barrier to effective communication. The purpose of this study was to examine parents' attitudes toward scientific language related to behavior analysis. To examine this, we surveyed 13 parents of children with autism enrolled in applied behavior analysis services and asked them to rate their level of comfort in response to seven sets of matched statements about practice or behavior analysis procedures that contain scientific terminology (e.g., experimental functional analysis), semi-scientific terminology (e.g., functional analysis), and layman terminology (e.g., assessment about your child’s behavior). Results showed consistently lower comfort ratings for statements with science terminology or behavioral jargon, and that comfort ratings were higher when these terms were replaced with layman synonyms. Results suggest that clinician-caregiver communication needs to be more adaptive for parents who may not comprehend behavior analysis terminology to ensure the execution of effective services.

This symposium includes two talks that provide considerations and guidance for administering the performance diagnostic checklist – human services (PDC-HS; Carr et al., 2013), interpreting the data, and selecting indicated interventions. The PDC-HS is a performance analysis tool designed to assess the environmental variables impacting employee performance problems in human service settings. Numerous researchers have used the results of the PDC-HS to successfully address a variety of performance problems, including problems related to implementing behavior analytic procedures, and adhering to safety measures, as well as workplace cleaning expectations (e.g., Bowe & Sellers, 2018; Ditzian et al., 2015; Wilder et al., 2018; Hess et al., 2019). Although the assessment is valid, limitations related to the objectivity and clarity of its administration, data interpretation, and intervention selection guidelines have been raised (Wilder et al., 2019; 2020). In response, Jimenez will discuss considerations and recommendations for administering the PDC-HS assessment, and Vance will share refinements developed for data interpretation and intervention selection that researchers and practitioners may consider adopting.

Intermediate

As the field of applied behavior analysis has grown exponentially in the last decade there have been greater accusations of past and present abuse and trauma caused by the interventions, strategies, and practitioners of ABA. How best can we address these concerns with a sense of curiosity rather than a defensive posture? Are these just the acts of some inexperienced newbies or evil eugenic founders of science? In this presentation, you will learn some of the histories of abuse and maltreatment of underrepresented groups (specifically BIPOC and disabled individuals). You will gain an understanding of how these learning histories of groups with a shared cultural identity or multiple shared identities lead to mistrust, non-compliance, and lack of consent to evidence-based strategies. Additionally, you will learn how cultural humility, awareness, and culturally relevant practices can improve the acceptance, consent, assent, and ultimately social significance of instructional objectives and outcomes for clients.

BCBA, BCaBA, Teachers, Psychologists, School Administrators or Consultants

Advancing research and clinical practice in applied behavior analysis requires critical evaluation and integration of the scientific literature. Synthesizing research across published and unpublished studies enables behavior analysts to make evidence-based decisions in clinical practice, evaluate potential sources of bias in the literature, and identify critical gaps in our understanding of behavioral science. Two common research synthesis approaches include systematic reviews and quantitative meta-analyses. These types of studies are distinct from other literature reviews due to their adherence to strict guidelines for conducting comprehensive literature searches, article screening, data extraction, data analysis, and reporting of results. This presentation will discuss the strengths and limitations of systematic reviews and meta-analyses in behavior analysis, with an emphasis on methodological recommendations and practical tools. Specific topics will include choosing a research question and defining the scope of the review, pre-registration, and adhering to international guidelines for conducting literature searches, study selection, data extraction, evaluating study quality and publication bias. An overview of common quantitative analyses used in meta-analyses and effective ways to present results will also be discussed. Finally, the presenter will share his experiences with software and database management tools for increasing efficiency and transparency at each phase of the review. Examples from published systematic-reviews and meta-analyses from the presenter’s research on behavioral economics of substance use and psychiatric disorders team will be discussed to illustrate the promise and pitfalls of these studies. The overall goal of this presentation is to provide attendees with methodological techniques for conducting reviews which can be translated to their respective specialty areas in applied behavior analysis.

Behavior analysts and basic researchers with at basic, intermediate, and advanced experience levels. No prior experience with systematic reviews or quantitative analyses is required, but familiarity will be helpful for some of the advanced topics.

This symposium will cover the need for advocacy and policy change related to adults with autism spectrum disorders. The talks will focus on specific interventions that target high risk aggressive behavior and the manner in which these issues can be addressed through the use of a comprehensive treatment package that is steeped in applied behavior analysis. The indications for organizations and the population of adults will be evaluated within its broader context. The symposium will also discuss the application of a specific curriculum for use with the adult population with ASD and other intellectual disabilities. The Assessment of Adult Core Competencies Curriculum for Clients with Severe Aggression (ACCEA), as well as The Skills Based Treatment model (SBT) will be detailed as they are employed in active treatment settings to enhance autonomy for those that serve adult populations.

Participants will be able to identify proactive approaches to problem behavior. Participants will be able to select effective Organizational Behavior Management techniques. Participants will be familiar with the Skills Based Training (SBT) approach.

This presentation will cover the need for advocacy and organizational change related to adults with autism spectrum disorders (ASD) and problem behavior. The talk will focus on specific interventions that target high risk aggressive behavior and the manner in which these issues can be addressed through the use of a comprehensive treatment package that targets some of the crucial outcome areas that are important for adults with autism or other Intellectual Disabilities. Specific clinical applications of the Assessment of Adult Core Competencies Curriculum (ACCEA) will be detailed along with the socially valid outcomes that were observed for each case. The indications for organizations and the population of adults with ASD will be evaluated within a broader context. The application of the ACCEA curriculum will also be detailed as it applies to specific outcome areas that are crucial for community inclusion for adults with ASD that display problem behavior.

Building autonomy or safely addressing behavioral challenges in congregate care requires continuity between clinical interventions and the day-to-day behaviors of direct support professionals. The Universal Protocol can fill this gap, teaching interactions that are safe, dignifying, and relationship-based. This talk will describe the Universal Protocol and the role it plays as both a cultural foundation for an organization and the first step to an integrated skill-based teaching model for adults with (and without) behavioral challenges. Additionally, the talk will highlight the introduction of Universal Protocol to Upstate Cerebral Palsy over the past few years and its impact on various outcome measures such as restraint reduction and staff satisfaction.

This talk will discuss the conceptualization of synthesized reinforcement contexts for adults with limited sense of agency and expressing choice who also display significant aggressive behavior. Further, this talk will underscore the importance of teaching an omnibus mand through Skills-based Treatment (SBT) to those with limited communication repertoires in order to promote autonomy and self-advocacy in congregate care and educational settings.

Escape extinction is widely used in intensive multidisciplinary feeding programs to treat various topographies of food refusal, presumed to be reinforced by escape or avoidance of the mealtime context (Saini et al., 2019; Sharp et al., 2010). In this symposium, presenters will discuss a range of additives to escape extinction for treating problematic behavior exhibited by children diagnosed with pediatric feeding disorder. Presenters will begin with an overview of the existing literature on the effects of treatment with and without escape extinction on inappropriate mealtime behavior and present on a clinical dataset in which response covariation was an observed side effect. Presenters will transition to discussing how noncontingent reinforcement may mitigate negative side effects associated with escape extinction and the use of a modified bolus placement to assist with reducing expels and packing.

Researchers and clinicians interested in learning more about considerations for the use of escape extinction in the treatment of pediatric feeding disorders or avoidant/restrictive food intake disorder.

Inappropriate mealtime behavior (IMB) is a type of feeding challenge within the broader class of food refusal behavior. Although there have been some single-case studies examining the extent to which behavioural interventions can aide in reducing IMB, the relative efficacy and generality of these studies is unclear. The purpose of this systematic review was to critically analyze the efficacy of interventions for the treatment of IMB through a meta-analysis of single-subject experimental designs. We identified 38 studies involving 307 cases in which IMB was treated with a behavioral intervention. Results indicated that combined escape extinction and non-escape extinction interventions had greater effect sizes than escape extinction alone or non-escape extinction alone. Escape extinction alone had greater effects sizes compared to non-escape extinction alone. However, escape extinction alone resulted in a higher percentage of negative side effects compared to non-escape extinction alone and combined interventions. We discuss the implications of these findings and provide recommendations for future research.

Escape extinction is a well-established treatment for increasing acceptance and decreasing inappropriate mealtime behavior of children with feeding disorders. Sevin et al. (2002) found that when extinction was in place, both desired (acceptance) and undesired (expel, packing) behavior increased during the initial three sessions. In the current study, we assessed response covariation of both desired and undesired behavior during extinction-based treatment of inappropriate mealtime behavior. We analyzed the data of 60 children with food refusal, liquid refusal, or both, resulting in 90 data sets. We observed an extinction burst in 7% of data sets. During these initial sessions, we also observed an increase in or emergence of other undesired behavior (expel, packing; 81%, 47%, respectively), as well as an increase in desired behavior (acceptance, consumption; 44%, 70%, respectively). We analyzed the efficiency and stability of treatment effects and will discuss these findings to provide an all-encompassing review of child behavior during extinction.

Adding noncontingent reinforcement to escape extinction might result in lower levels of inappropriate mealtime behavior, negative vocalizations, or both for children with feeding disorders. Unfortunately, making firm conclusions about the role of noncontingent reinforcement is difficult because of the minimal number of systematic evaluations and the procedural variations across studies. We also do not know whether the removal of noncontingent reinforcement results in undesirable side effects and how children with feeding disorders respond to treatment components that may be necessary, like schedule thinning. Therefore, we first conducted a concise review of the feeding literature and found that only five studies directly evaluated noncontingent reinforcement with and without escape extinction. However, 8 out of 10 randomly selected studies from 2017-2022 incorporated some type of noncontingent reinforcement arrangement (e.g., attention, tangibles). Finally, we compared escape extinction alone and escape extinction with noncontingent reinforcement on the acceptance, inappropriate mealtime behavior, and negative vocalizations across two sets of foods with a 3-year-old male enrolled in a day-treatment feeding program. So far, results indicate that both treatments produced clinically meaningful outcomes, but we observed fewer bouts of negative vocalizations during escape extinction plus noncontingent reinforcement. Additional findings and implications will be discussed.

Placement of bites on the tongue has been evaluated as an initial treatment for pediatric feeding disorder (Ibañez, 2021; Wilkins et al., 2014), specifically for decreasing packing and expulsion. When evaluating modified bolus placement, previous studies have typically compared flipped and upright baby or maroon spoons and Nuk presentation. However, Bloomfield et al. (2021) included a comparison between a Nuk and flipped E-Z spoon for both initial bolus placement and redistribution of packed food for one of their participants with severe oral-motor skills deficits, which introduced a potential new tool to the field. The purpose of the current study is to extend Ibañez et al. (2021) and Bloomfield et al. (2021) by evaluating the effectiveness of the E-Z spoon as a tool for modified bolus placement in the initial treatment of children with pediatric feeding disorder.

Establishing conditioned reinforcers is often a critical step in service delivery for individuals with autism spectrum disorder (ASD) and/or intellectual and developmental disabilities (IDDs). Therefore, identifying effective procedures for establishing conditioned reinforcers is critical. In this review, we systematically searched the literature for published and unpublished single-case design studies that evaluated stimulus-stimulus (S-S) pairing, response-stimulus (R-S) pairing, and/or operant discrimination training (ODT) for establishing conditioned reinforcers for individuals with ASD and/or IDDs. We searched two electronic databases for studies that included pre- and post-pairing measurements of responding that resulted in access to the stimulus targeted for conditioning. Thirty-one studies, including twelve theses and dissertations, met inclusion criteria. Eight studies evaluated S-S pairing, 20 evaluated R-S pairing, and nine evaluated ODT. Combined, S-S pairing, R-S pairing and ODT were effective at establishing conditioned reinforcers only about half the time. However, analyses of the effectiveness of each procedure indicate that R-S pairing is the most effective of the three procedures.

We recently surveyed certified clinicians about their commonly used practices when training and implementing token economies with individuals with autism and other neurodevelopmental disorders. Overwhelmingly, clinicians reported selecting stimuli to be used as tokens based on the learner’s existing interests (e.g., characters, animals, etc.). Additionally, clinicians reported that learners are allowed to manipulate tokens during both token production and exchange. Tokens based on a learner’s interest (i.e., interest-based tokens) have been demonstrated to produce greater increases in the levels of on-task behavior compared to novel tokens (Carnett et al., 2014) Interest-based tokens have also been shown to increase correct responding, relative to pre-existing tokens, within the context of skill acquisition (Charlop-Christy & Haymes, 1998). However, several limitations in both Carnett et al. (2014) and Charlop-Christy and Haymes (1998) limit the conclusions that can be drawn to inform clinical practice. The present study evaluated that how novel and interest-based tokens affect skill acquisition with three children diagnosed with autism spectrum disorder. Results suggest that the type of stimuli used as a token does not have a significant effect on skill acquisition but can produce longer handling times which can result in fewer learning opportunities across time. Suggestions for clinical practice and future research will be discussed.

We examined the effects of token production delays on the rate of skill acquisition during discrete trial instruction (DTI) for three children with an intellectual or developmental disability (IDD). We used a multielement design to compare the rate of skill acquisition in a DTI with accumulated reinforcers context across three conditions: a) immediate reinforcement; B) 5-s token-production delay; and c) 10-s s token-production delay. All participants acquired the skills more quickly in the immediate reinforcement condition. Delays of both 5 s and 10 s decreased the efficiency and efficacy of skill acquisition for all participants.

Basic research has shown that nonhuman animals generally display a preference for variable ratio (VR) rather than fixed ratio (FR) schedules of reinforcement, particularly when low individual ratios are included (Field et al., 1996). Minimal applied research has investigated preference for these schedules among children with autism spectrum disorder (ASD) despite a clinical phenotype that suggests a general preference for sameness (which may theoretically extend to a preference for fixed schedules). In a preliminary investigation of second-order schedule effects within a token economy, Argueta et al., (2019) found a similar preference for VR rather than FR schedules for their participant with ASD. This study extends Argueta et al. by evaluating preference for FR and VR exchange schedules across an escalating range of exchange ratios within a token economy. We used a concurrent chains assessment to evaluate preference for FR or VR exchange-production schedules of reinforcement at equal ratios of 5 and 10. Preliminary results did not indicate a strong preference for either schedule at a ratio of 5, however an increase to a ratio of 10 resulted in an emergence of preference.

This symposium will feature four presentations on the use of technology in behavior analytic research and practice. The first two presentations will focus on the use of virtual reality, specifically as it relates to learning and teacher acceptability and interventions for delay discounting. The final two presentations will focus on video game play, specifically as it relates to assessments of audience effects and reactions and stimulus control of response variability. A discussion of these presentations will follow.

The current symposium is an intermediate level discussion of the use of technology in applied behavior analysis. Participants should have familiarity with behavior analysis, common research designs in behavior-analytic research and practice, have a passing familiarity with gamification in research, and be interested in how technology can be added to evaluations of behavioral processes.

Episodic future thinking (EFT) has been shown to be an effective way to reduce delay discounting, which is correlated to a number of maladaptive behaviors related to impulsive choice. EFT uses a narrative interview method that maps well onto factors related to immersion in virtual reality. Virtual reality has been used in psychological and neurocognitive interventions due to those immersive properties, however has yet to be used as a method of EFT delivery. Therefore, we ask if virtual reality will be an effective method of delivery of EFT, and if this reduction will have a relationship with individual levels of immersion in virtual reality reported. Using a pre-post measure of discounting, preliminary research suggests that individuals who experience EFT in a virtual reality setting see a reduction in delay discounting, however more research must be done to further understand the relationship between changes in discounting and reported levels of immersion.

Creativity can be a useful skill in today’s classrooms and workplaces. Behavioral variability, something different from the norm, may be an aspect of creativity. Much behavior analytic research on behavioral variability involves response sequences, a response form that could limit applicability of findings to the everyday environment. To address this, we replicated Page and Neuringer (1985, Experiment 6) by investigating stimulus control of variability in a video game. Participants played a 2D online video game made in Bloxels. Patterns of alternating colors served as the discriminative stimuli for the vary and repeat components. Three parameters of variability were measured (e.g., left jumps, right jumps, and double jumps). The results of the study indicate that participants were able to learn the discrimination of when to repeat and vary their responses depending on which colored platform they encountered. We will discuss practical implications of rapid stimulus control of non-sequence variability.

In collaboration with educators in the Eastern Cape townships of South Africa since 2004, PEER International (Partnerships for Educational Excellence and Research) has shared the Morningside Model of Generative Instruction. Professional development an