|Problem Behavior and Fragile X Syndrome: Does Diagnosis Matter?|
|Monday, May 28, 2018|
|9:00 AM–9:50 AM |
|Manchester Grand Hyatt, Harbor Ballroom AB|
|Area: DDA; Domain: Applied Research|
|Chair: Scott S. Hall (Stanford University)|
|CE Instructor: Scott S. Hall, Ph.D.|
Gene-environment interactions are being increasingly recognized as important in the assessment and treatment of problem behavior. A notable example of this phenomenon is fragile X syndrome (FXS), a well-known single-gene cause of intellectual disability. In this symposium, we will examine how the diagnosis of FXS might be important to consider in the assessment and treatment of problem behavior. The first speaker (Tobias Britton) will describe the topographies of problem behavior commonly shown by individuals with FXS, and report on the results from a descriptive assessment of problem behavior conducted on 47 boys with FXS. The second speaker (Katerina Monlux) will describe how condition-specific in-home functional analyses can be conducted for children with FXS using a parent-coaching model. Finally, the third speaker (Arlette Bujanda-Rodriguez) will describe how function-based treatments can be administered via telehealth to decrease problem behaviors in FXS. In all three presentations, the speakers will discuss how phenotypic features common to individuals with FXS (e.g., social anxiety, aversion to transitions) need to be considered in the assessment and treatment of problem behavior in this population.
|Instruction Level: Intermediate|
|Keyword(s): fragileX syndrome, function-based treatment, problem behavior, telehealth|
|Target Audience: |
Practitioners, scientists, and educators.
|Learning Objectives: At the conclusion of the presentation, participants will be able to: (1) identify key gene environment interactions associated with problem behaviors in children with fragile x syndrome (FXS); (2) consider why diagnosis is important in the assessment and treatment of problem behavior; (3) identify how condition specific functional analyses can be conducted in home using a parent coaching model, with subsequent treatment delivered via telehealth to reduce problem behaviors in FXS.|
Descriptive Assessment of Problem Behaviors Exhibited by Boys With Fragile X Syndrome
|TOBIAS BRITTON (Stanford University), Kat Monlux (Stanford University), Scott S. Hall (Stanford University)|
Fragile X syndrome (FXS) is a rare genetic disorder that could inform potential interactions between genes and environment. In this study, we examined the topographies and potential sources of reinforcement for aggression and self-injurious behaviors reported by caregivers of boys with FXS. Data were collected on 47 boys with FXS aged 8 to 18 years using The Functional Analysis Screening Tool (FAST), a commonly used descriptive assessment to identify potential functions of problem behavior (Iwata, DeLeon, & Roscoe, 2013). Results showed that the most common form of aggressive behavior was hitting others (58.3% of cases) and the most common form of self-injurious behavior was self-biting (56.3% of cases). For both aggression and self-injury, multiple sources of social reinforcement were more likely to be identified than single sources of social reinforcement. Automatic sensory reinforcement or pain attenuation were rarely endorsed for either behavior. Taken together, these data suggest that multiple sources of social reinforcement maintain aggression and self-injury in FXS
|In-Home Functional Analyses With Boys Diagnosed With Fragile X Syndrome|
|KAT MONLUX (Stanford University), Scott S. Hall (Stanford University)|
|Abstract: Fragile X syndrome (FXS) is a rare genetic single-gene disorder associated with an increased risk for problem behaviors such as self-injurious or aggressive behaviors. Surprisingly few studies, however, have directly examined the functions of problem behaviors in this syndrome. In this study, 15 boys with FXS, aged 3 to 10 years, who were reported to exhibit problem behavior on at least a daily basis, were identified via a national screening survey. For each case, a BCBA travelled to the child’s home and coached the parents to implement the FA conditions, including escape from social interaction and transition escape, over a two-day period. The results showed that that problem behavior was maintained by social functions in the majority of cases, including escape from transitions, escape from demands and access to tangible items. Factors such as environmental control, building rapport with the families and the feasibility of conducting in-home FAs with children with FXS are discussed.|
Telehealth Function-Based Treatment of Problem Behaviors for Boys With Fragile X Syndrome
|ARLETTE BUJANDA (Stanford University), Joy Pollard (Stanford University)|
Many individuals with fragile X syndrome (FXS), a rare genetic disorder associated with Autism Spectrum Disorder (ASD), commonly show severe problem behaviors such as self-injury and aggression that can be extremely distressing to families and can severely impact the child's quality of life. In this study, we evaluated whether targeted function-based behavioral treatments for problem behaviors conducted via telehealth, could reduce problem behaviors in this disorder. Following a functional analysis, 8 caregivers of boys with FXS initially received daily coaching via telemhealth to implement function-based treatments. The frequency of telehealth sessions was subsequently faded over a 12-week period, depending on progress. Results showed that significant reductions in problem behavior occurred over the 12 week period in almost all cases. These data suggest that telehealth behavioral treatment is an effective model for reducing problem behavior in children with FXS.