Association for Behavior Analysis International

A number of clinics exist worldwide that employee functional analysis-based treatments for severe problem behavior. This presentation will describe the organization and outcome data from a pediatric outpatient clinic at Upstate Medical University. Unique to this clinic is the fact that all services are provided within the constraints of psychotherapy current procedural terminology (CPT) codes. One facet of this method of billing is that all psychotherapy CPT codes are time-limited (e.g., 60 min) which could impact a number of client-related factors such as response to treatment and cancellation rates. We will discuss clinical procedures that have been developed to address these issues while maintaining the technical requirements of the functional analysis process. Case examples will be provided to illustrate the utility of the model. We will also provide outcome data on the types of problems addressed, diagnostic profiles of clients, cancellation rates, and percent reduction in problem behavior (presently over 90% reduction relative to baseline levels of problem behavior). These outcomes will be discussed in terms of factors to consider for clinic development, program evaluation, and client retention.

Noncontingent reinforcement (NCR) is a commonly used treatment for severe problem behavior displayed by individuals with intellectual and developmental disabilities. The purpose of the current study was to expand on the existing literature on NCR by reporting outcomes achieved with 28 applications of NCR as the primary treatment across consecutive cases with severe problem behavior using a collective case series to minimize selection bias. Participants ranged in age from 5 to 33 years and had intellectual and developmental disabilities. 14 application were for behavior maintained by automatic reinforcement, 13 for behavior maintained by social reinforcement (i.e., attention, escape, tangible), and one for behavior with unknown function (i.e., inconclusive FA). Results suggest that the effectiveness of NCR may in part be determined by behavioral function. NCR resulted in a 90% or better reduction in problem behavior for only 7 of 15 cases in which problem behavior was maintained by automatic reinforcement. In these cases, additional treatment components were added to bolster effects. In contrast, when NCR in isolation was applied to socially maintained behavior, the result was a 90% or better reduction for 12 of 13 cases. Results suggest that NCR is an effective treatment for socially maintained problem behavior.

The behavior analytic literature indicates multiple effective interventions to address pediatric feeding disorders (Milnes & Piazza, 2013; Sharp, Jaquess, Morton, & Herzinger, 2010). While the breadth of published interventions affirms that clinicians are developing effective treatments to progress children diagnosed with feeding disorders toward age-typical eating, these published studies provide information on only a small percentage of the children being treated. Furthermore, while there are a few published reviews summarizing which interventions clinicians are using to successfully treat feeding disorders (Volkert & Vaz, 2010), these reviews do not provide information about the totality of successful interventions used in their clinics. Success could be indicated by decreases in enteral feedings and disruptive mealtime behavior or increases in oral intake and integrity when transitioning to caregivers feeding (i.e., rather than a trained therapist). Thus, to contribute to our understanding of successful interventions for pediatric feeding disorders, we preliminarily evaluated outcomes for 46 children from a well-established Midwestern pediatric feeding disorders clinic, which included evaluation of the interventions we used to treat each child. These data may assist in bridging the gap between science and practice in determining which interventions are successful and used most often by clinicians to treat pediatric feeding disorders.