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| When Nothing Works: On the Concept of Treatment Refractory Problem Behaviors in Applied Behavior Analysis |
| Saturday, May 28, 2022 |
| 12:00 PM–12:50 PM |
| Meeting Level 1; Room 153C |
| Domain: Service Delivery |
| Chair: Elizabeth A. Sanabria-Fitter (CCSN: The Center of Child with Special Needs) |
| CE Instructor: Elizabeth Fitter, M.A. |
| Abstract: The term “treatment refractory” is generally used across disciplines to describe conditions that do not respond to treatment or do not respond to a prescribed hierarchy of established treatments. For example, in psychiatry conditions such as depression, bipolar disorder, and schizophrenia are often labeled treatment refractory. In behavior analysis, the identification of behavior function(s) leads to a specific set of treatment interventions that are likely to be effective in reducing the frequency of the assessed problem behavior. Yet, for some individuals, problem behaviors persist despite precise implementation of well-established treatment packages. Here, we explore the concept of treatment refractory problem behaviors. First, characteristics, criteria, and implications of treatment refractory conditions outside of behavior analysis are reviewed. Second, factors contributing to the development of treatment refractory behaviors are discussed. Finally, specific individual cases of treatment refractory problem behaviors are reviewed and discussed. The conceptual of treatment refractory problem behaviors is important for treatment selection, consumer education, and research. |
| Instruction Level: Intermediate |
| Keyword(s): aggression, problem behaviors, self-injury, treatment refractory |
| Target Audience: The participants should have knowledge or the range of interventions and experience with treatment refractory cases. |
| Learning Objectives: At the conclusion of the presentation, participants will be able to: 1. List criteria used by other disciplines to classify a problem behaviors treatment refractory. 2. List contributing factors to the development of treatment refractory problem behaviors. 3. Identify long-term solutions to mitigate harm associated with treatment refractory behaviors. |
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Definitions of "Treatment Refractory" from Other Disciplines |
| LYNDE KAYSER (The Judge Rotenberg Educational Center) |
| Abstract: The term “treatment refractory” is generally used across disciplines to describe conditions that do not respond to treatment or do not respond to a prescribed hierarchy of established treatments. For example, in psychiatry conditions such as depression, bipolar disorder, and schizophrenia are often labeled treatment refractory. In other medical specialties, treatment refractory conditions are routinely described and defined (e.g. neurology defines treatment refractory and even super-refractory status epilepticus). Here we review the terminology and criteria that have been utilized by other disciplines. In some cases, refractory simply implies that no treatment has caused a therapeutic effect. However, in other cases, treatment refractory implies a certain set of treatment procedures have been implemented and failed. In all cases, treatment refractory does not preclude the possibility that some intervention will be efficacious. |
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| Factors Contributing to the Development of Treatment Refractory Problem Behaviors |
| JESSICA LINDSAY (The Judge Rotenberg Educational Center) |
| Abstract: Behavior analytic interventions are not universally effective. Despite comprehensive research, consultation, medical rule outs, preference assessments, functional assessment, implementation of evidence based procedures, some behavior problems do not improve. The clinical picture become more complicated with the topographies result in ongoing severe injury to the individual or others, including blindness, hearing loss, broken bones, brain injury, infection, etc. There are several factors that may contribute to the classification of a behavior problem as treatment refractory. For example, temporal factors associated with behavioral consequences, historical schedules of reinforcement, the physical size and strength of the patient, idiosyncratic medical conditions, and biological factors that affect learning (e.g. traumatic brain injuries). Taken together, such factors may prevent the implementation of procedures such as differential reinforcement, extinction, time-out, etc. |
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| Case Examples of Treatment Refractory Problem Behaviors |
| JOSEPH TACOSIK (Judge Rotenberg Education Center) |
| Abstract: Behavioral procedures are often effective in addressing severe problem behaviors. However, in some cases, behavioral procedures are partially effective or ineffective in reducing the frequency of a given problem behavior. Here, individual cases meeting the aforementioned criteria are discussed. Individual case studies describing problem behaviors refractory to standard behavioral interventions are presented. For each case, assessment results leading to specific functional hypothesis and the associated function based behavioral interventions are described. The specific factors and decision making that led to the treatment refractory conclusion and subsequent decision making are reviewed and discussed. The use of protective equipment, long-term safety procedures, non-behavior analytic interventions, and other measures are described and considered in the context of a risk benefit analysis. |
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