|Addressing Unique Referral Concerns: Assessment and Treatment of Idiosyncratic Target Behaviors in Outpatient Settings|
|Saturday, May 26, 2018|
|10:00 AM–10:50 AM |
|Manchester Grand Hyatt, Seaport Ballroom C|
|Area: PRA/AUT; Domain: Applied Research|
|Chair: Amanda Zangrillo (University of Nebraska Medical Center, Munroe-Meyer Institute)|
|CE Instructor: Amanda Zangrillo, Psy.D.|
The functional analysis provides a means for practitioners to identify the variables maintaining destructive behaviors and, in turn, develop function-based intervention. The current symposium outlines three studies which employed functional analysis to assess and inform function-based treatment of idiosyncratic presenting concerns. First, Simmons, Akers, and Fisher conducted a functional analysis of covert food stealing for a 6-year-old neurotypical individual. The results of the functional analysis informed the application of a function-based intervention and multiple schedule to signal availability and nonavailability of food items. Similarly, Stuesser and Roscoe provided a novel extension of assessment and treatment methods. Authors evaluated medical nonadherence and problem behavior in individuals with intellectual disabilities. Functional analysis results informed a differential reinforcement of alternative behaviors (DRA) treatment alone and in combination with stimulus fading to increase adherence and decrease problem behavior. Last, DeLisle and Thomason-Sassi extended the use of denial-and-delay tolerance training (Hanley, Jin, Vanselow, & Hanratty, 2014) for two individuals diagnosed with autism to automatically-maintained problem behavior. During this evaluation the authors taught the individuals to request permission to engage in the targeted behavior, and to refrain from behavior outside the permitted times. Finally, denial training, delay training, and fading therapist proximity were completed.
|Instruction Level: Intermediate|
|Keyword(s): denial-delay training, function-based treatment, functional analysis|
|Target Audience: |
|Learning Objectives: 1. Participants will be able to describe assessment and treatment pertaining to covert behaviors. 2. Participants will be able to operationally define and describe implementation of DRA and stimulus fading. 3. Participants will be able to describe delay-denial tolerance procedures.|
|Functional Analysis and Treatment of Covert Food Stealing in an Outpatient Setting|
|CHRISTINA SIMMONS (Rowan University), Jessica Akers (Baylor University), Wayne W. Fisher (Munroe-Meyer Institute, University of Nebraska Medical Center)|
|Abstract: Covert food stealing is a serious problem behavior that can pose a health risk to the individual and can be extremely disruptive for caregivers. Previous research on food stealing has been primarily conducted with individuals with Prader-Willi syndrome or intellectual disability in intensive residential settings and researchers have not demonstrated maintenance of treatment effects on food stealing in the natural environment. We conducted a functional analysis of food stealing and determined that food stealing was a covert behavior that was not maintained by
socially-mediated variables. A treatment package including discriminative stimuli to signal available and unavailable food items and contingent reprimands was effective in decreasing food stealing in a 6-year-old-child with typical development. The caregiver implemented the assessment and treatment in both clinic and home settings and rated procedures and outcomes as high in social validity. Treatment effects generalized to the home and maintained 8 weeks after in-clinic training sessions.|
Use of Denial-Delay Tolerance Training in the Treatment of Ritualistic and Stereotypic Behavior
|DEWEY DELISLE (The New England Center for Children; Western New England University), Jessica L. Thomason-Sassi (New England Center for Children; Western New England University)|
Denial-and-delay tolerance training (Hanley, Jin, Vanselow, & Hanratty, 2014) is a treatment protocol that has been used to teach children to mand for socially-mediated reinforcers. Subsequent treatment components include a teaching of tolerance response when requests are denied, and working until a reinforcer is available. In the current study, we extended this treatment for socially-mediated behavior to the treatment of automatically maintained behavior. We utilized an alone screen to determine the function of behavior for two individuals diagnosed with autism. Next, we taught the individuals to request permission to engage in their behavior targeted for decrease, and to refrain from behavior outside of those permitted times. Finally, denial training, delay training, and fading therapist proximity were completed. Results showed that participants engaged in low rates of inappropriate behavior, and were able to tolerate a denied mand by engaging in increasing amounts of work. Interobserver agreement was collected on 30% of sessions for both participants, and averaged at 96.7% (range, 93.3-100).
Increasing Medical Adherence for Individuals With Autism
|HAILEE STUESSER (The New England Center for Children; Western New England University ), Eileen M. Roscoe (The New England Center for Children; Western New England University)|
Medical procedures such as routine physicals and blood work are often associated with nonadherence and problem behavior in individuals with intellectual disabilities. Previous research has shown the utility of behavior analytic interventions for increasing medical adherence. However, these interventions often include a combination of components making it difficult to discern whether all components are necessary. The purpose of this study was to evaluate differential reinforcement of alternative behavior (DRA) without extinction alone and in combination with fading for increasing adherence and decreasing disruption during routine medical exams in four individuals with an autism spectrum disorder. An indirect assessment was conducted to identify routine medical exam steps. A functional analysis confirmed that problem behavior was maintained by escape from medical demands. We evaluated DRA alone and in combination with stimulus fading using multiple baseline across participants or reversal designs. DRA with fading was necessary for achieving clinically significant outcomes in three of the four participants. Interobserver agreement was assessed in 33% of sessions and averaged 91%.