|The Application of Large-Scale Analysis to Examine Treatment Outcomes for Common Behavior Disorders|
|Saturday, September 3, 2022|
|2:00 PM–3:50 PM |
|Meeting Level 2; Ecocem Room|
|Area: DDA/AUT; Domain: Applied Research|
|Chair: Carrie S. W. Borrero (Kennedy Krieger Institute)|
|Discussant: Cynthia M. Anderson (May Institute)|
|CE Instructor: Cynthia M. Anderson, Ph.D.|
As data analytic techniques have advanced within social sciences, behavior analysts have begun examining larger data sets, large-scale research designs, and quantitative methods to assess variables that drive programmatic outcomes. These speakers will illustrate the application of such processes across a range of clinical problems and research questions. Both Scheithauer et al. and Lomas Mevers et al. employ randomized clinical trials (RCTs) to evaluate interventions for childhood behavior problems. Scheithauer et al. conducted an RCT of a function-based treatment for decreasing elopement across a sample of children with autism spectrum disorder (ASD) assigned to either the treatment condition or a control condition. Lomas Mevers et al. employed a similar methodology to examine a behavioral intervention for encopresis among 20 individuals with ASD. Using an alternative evaluative method, Cengher et al. conducted a controlled case series analysis across 29 individuals with ASD and related disorders who displayed challenging behavior maintained by escape from social attention. In the final talk, Borrero will describe two years of programmatic outcomes from an inpatient unit specializing in the treatment of pediatric feeding disorders. To summarize these findings within the larger framework of behavior analytic practice and research, Dr. Cynthia Anderson will provide a discussion.
|Instruction Level: Basic|
|Keyword(s): experimental design, large-scale, treatment evaluation|
|Target Audience: |
|Learning Objectives: At the conclusion of the presentation, participants will be able to: (1) identify the basic methodology of a randomized clinical trial; (2) understand the relation between single-case data and a controlled case series analyses; (3) develop an understanding of how clinical outcomes can be expressed beyond the level of the individual.|
|A Randomized Clinical Trial of a Manualized Function-Based Elopement Treatment: Secondary Interim Analyses|
|MINDY CHRISTINE SCHEITHAUER (Marcus Autism Center), Nathan Call (Marcus Autism Center), Joanna Lomas Mevers (Marcus Autism Center), Colin S. Muething (Marcus Autism Center), Sarah Slocum (Marcus Autism Center and Emory School of Medicine), Lawrence Scahill (Emory University School of Medicine), Chelsea Rock (Marcus Autism Center)|
|Abstract: Elopement is an incredibly common and dangerous concern among children with autism spectrum disorder (ASD). There are several demonstrations of function-based treatments successfully reducing elopement, with the majority of this evidence coming from studies with small sample sizes and variability in the specific procedures used. The goal of this study is to build on this past research by conducting a large-scale randomized clinical trial of a function-based elopement treatment. Participants included children (age 4 to 12) diagnosed with ASD. Following a latency-based functional analysis, the manual included several decision trees for selecting appropriate function-based treatment components. Treatment was implemented using a primarily parent-led intervention, with the therapist providing parent training and coaching through treatment implementation. An interim analysis (N > 20) was conducted evaluating secondary outcomes, including 7-days of caregiver-collected home-data on elopement attempts and a novel indirect measure of elopement completed at baseline and endpoint. Greater improvements were noted in the treatment group for several outcomes, but some improvement also occurred in the active control group (which focused on education related to ASD). Results are discussed in relation to the manualized intervention, validated measures for elopement, and the importance of including active control groups.|
Randomized Clinical 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/Emory University ), 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 University 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 clinical 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.
A Consecutive Controlled Case Series Investigating the Assessment and Treatment of Escape From Attention
|MIRELA CENGHER (UMBC), Michelle D. Chin (The Kennedy Krieger Institute), Patricia F. Kurtz (Kennedy Krieger Institute)|
The purpose of this controlled consecutive case series analysis was to evaluate outcomes of functional analysis and treatment procedures for problem behavior maintained by escape from attention. Twenty nine individuals who had received inpatient or outpatient services for severe problem behavior and whose functional analyses included an escape-from-attention test condition participated. An escape-from-attention function was identified for 24 of the 29 participants. Aggression, followed by self-injurious behavior, were the most prevalent forms of problem behavior demonstrated by participants with an escape-from-attention function. We analyzed the initial multielement functional analyses that did not include an escape-from-attention condition in participants for whom this function was subsequently identified, in order to establish predictive markers for escape from attention. The following predictive markers were identified: high rates of problem behavior in the escape from demands condition and low rates of problem behavior in the attention condition. Finally, function-based treatments were implemented for 13 participants with an escape-from-attention function; 84% of cases demonstrated a reduction of problem behavior of 80% or more relative to baseline. The most effective interventions included extinction and reinforcement-based procedures. Implications for research and clinical practice are discussed.
An Intensive Hospital-Based Program for the Assessment and Treatment of Food Refusal and Selectivity: General Overview and Outcomes
|CARRIE S. W. BORRERO (Kennedy Krieger Institute)|
Severe food refusal, food selectivity, and liquid dependence can be a relatively common concern for parents with young children, particularly those diagnosed with Autism Spectrum Disorder (ASD). It has been reported that as high as 90% of children with ASD have some form of food refusal or selectivity (Kodak & Piazza, 2008). Food refusal and selectivity are associated with a child experiencing severe difficulties consuming adequate nutrition by mouth and can often be a significant source for stress in the home. Intensive hospital-based programs have been successful in offering an interdisciplinary approach to the assessment and treatment of food refusal and selectivity. After consultation with the family, individual goals are set for admission, such as: increasing food consumption, reducing inappropriate mealtime behavior, increasing variety of foods (i.e., introducing new foods), and caregiver training. An overview of an intensive interdisciplinary approach to assessment and treatment will be discussed along with outcome data.