|Using Randomized Controlled Trials in Behavior Analytic Research|
|Monday, May 28, 2018|
|3:00 PM–4:50 PM |
|Manchester Grand Hyatt, Seaport Ballroom F|
|Area: AUT/DDA; Domain: Applied Research|
|Chair: Colin S. Muething (Marcus Autism Center, Emory School of Medicine)|
|Discussant: Cynthia M. Anderson (May Institute)|
|CE Instructor: Cynthia M. Anderson, Ph.D.|
Randomized controlled trials (RCTs) are widely considered the standard for demonstrating the efficacy of treatment. While the use of single case designs common in behavior analysis is vital, the use of other methodologies such as RCTs allow behavior analysts to combine procedures into a package and evaluate on a large scale (Smith, 2013). This symposium will present the results of four RCTs investigating behavioral interventions. Argumedes, Lanovaz, & Larivee conducted a RCT that compared the effectiveness of the Prevent-Teach-Reinforce model to a three-hour parent training session. Martin, Anderson, Smith, & Iovannone developed a comprehensive intervention in schools for subsequent validation using a RCT. Mruzek and colleagues conducted a RCT of an iOS-based app for toilet training. Finally, Lomas Mevers and colleagues conducted a RCT that evaluated a multidisciplinary treatment for encopresis. Together, these studies provide potential methods for RCTs for researchers to conduct RCTs in order to evaluate behavioral interventions. Additionally, challenges associated with conducting RCTs will be discussed.
|Instruction Level: Intermediate|
|Keyword(s): Controlled Trial, RCT|
|Target Audience: |
The target audience is behavior analysts and researchers interested in conducting or conducting randomized controlled trials of behavioral interventions.
Prevent-Teach-Reinforce: A Randomized Control Trial in Family Settings
|MALENA ARGUMEDES (University of Sherbrooke), Marc J. Lanovaz (Université de Montréal), Serge Larivée (Université de Montréal)|
Children with autism spectrum disorders (ASD) often engage in high levels of challenging behaviors, which can be difficult to reduce for parents in home settings. The purpose of our study was to examine the effects of adapting the Prevent-Teach-Reinforce model (PTR) model to support parents in reducing challenging behaviors in children with ASD. We conducted a randomized controlled trial to compare the effect of the PTR to a less intensive intervention (i.e., 3-hr training) on challenging and desirable behaviors. In total, 25 families participated in the study. Participants were 12 years old or younger, had a diagnosis of ASD and presented at least one serious and frequent challenging behavior at home. We conducted mixed between-within design analysis of variance (3 x 2 ANOVA), combining the repeated measures (three assessments) and the treatment groups (PTR-F vs. Training). The PTR and the 3-hr parental training both reduced challenging behaviors and increased desirable behaviors. Moreover, parents implemented the PTR model with high fidelity and rated it highly for social acceptability. Overall, our results indicate that the PTR model may serve as a relevant intensive intervention for families struggling with serious behavioral issues at home for children with ASD.
Randomized Controlled Trial of a Comprehensive School-Based Intervention for Autism Spectrum Disorder
|RYAN J. MARTIN (May Institute), Cynthia M. Anderson (May Institute), Tristram Smith (University of Rochester Medical Center), Rose Iovannone (University of South Florida; Florida Mental Health)|
Across social science and health fields, randomized controlled trails (RCTs) are generally considered the "gold standard" of demonstrating the efficacy of treatments by drawing comparisons between treatment and control groups. While single-case designs (SCDs) tend to be the preferred method in applied behavior analysis for documenting a functional relation between a response and environmental variables, randomized controlled trials (RCTs) may be more appropriate for demonstrating the scalability of a standardized treatment. This presentation will review the process of developing and validating Students with Autism Accessing General Education (SAAGE), a comprehensive, modular intervention for students with autism spectrum disorder using targeted focus groups, a feasibility study, and a subsequent randomized controlled trial in schools. Preliminary data from the RCT will be presented, and we will illustrate ways in which RCT and SCD methods were employed simultaneously to evaluate the initial effectiveness of the SAAGE model. Additionally, challenges associated with conducting RCTs in complex applied settings such as schools will be discussed.
A Randomized Controlled Trial of an iOS-Based App for Toilet Training Children With Autism Spectrum Disorder
|Daniel W. Mruzek (University of Rochester Medical Center), Stephen McAleavey (University of Rochester), Whitney Loring (Vanderbilt University Medical Center), Eric Butter (Nationwide Children's Hospital), Tristram Smith (University of Rochester Medical Center), Erin McDonnell (Massachusetts General Hospital), LYNNE LEVATO (University of Rochester Medical Center), Courtney A. Aponte (University of Rochester)|
Teaching children with autism spectrum disorder (ASD) toileting skills can be a burdensome and time-consuming task for all persons involved; therefore, we developed an iOS-based app with a transmitter/disposable sensor and corresponding manualized intervention. The app signaled the onset of urination, time-stamped accidents for analysis, reminded parents to reinforce intervals of continence, provided a visual outlet for parents to communicate reinforcement, and afforded opportunity for timely feedback from clinicians. We compared this intervention with an intervention that employs standard behavioral treatment in a pilot randomized controlled trial of 33 children with ASD aged 3–6 years with urinary incontinence. Parents in both groups received initial training and 4 booster consultations over three months. Results support the feasibility of parent-mediated toilet training studies (e.g., 84% retention rate, 92% fidelity of parent-implemented intervention). Parents employed the app and related technology with few difficulties or malfunctions. There were no statistically significant group differences for rate of urine accidents, toilet usage or satisfaction at close of intervention or 3-month follow-up; however, the alarm group trended toward greater rate of skill acquisition with significantly less day-to-day intervention. Further development of alarm and related technology and future comparative studies with a greater number of participants are warranted.
A Pilot Randomized Controlled Trial of a Multidisciplinary Treatment for Encopresis in Children With Austin Spectrum Disorders
|JOANNA LOMAS MEVERS (Marcus Autism Center), Nathan Call (Marcus Autism Center), Kristina Gerencser (Marcus Autism Center), Mindy Christine Scheithauer (Marcus Autism Center), Sarah Miller (Marcus Autism Center), Colin S. Muething (Marcus Autism Center), Shannon Kennedy Hewett (Marcus Autism Center), Courtney McCracken (Emory School of Medicine)|
A large percentage of individuals with Autism Spectrum Disorder (ASD) are delayed in achieving bowel continence or never achieve it at all. This problem has tremendous ramifications for these individuals and their families (can limit access to educational opportunities, and carries significant social stigma). Previous interventions for encopresis have either been unsuccessful or required implementation over very long periods. The current study is a small randomized controlled trial (RCT) evaluating an interdisciplinary approach to treatment. The study uses over-the-counter medications to elicit predictable bowel movements, which are then reinforced. Independence is increased by fading out medications and training caregivers to implement all procedures. This study demonstrated the efficacy of this approach with 20 individuals with ASD and encopresis within a RCT using a waitlist control. We found children that were randomized to the treatment group achieved significant increases in continence when compared to children randomized to the waitlist control group.