Association for Behavior Analysis International

The Association for Behavior Analysis International® (ABAI) is a nonprofit membership organization with the mission to contribute to the well-being of society by developing, enhancing, and supporting the growth and vitality of the science of behavior analysis through research, education, and practice.


50th Annual Convention; Philadelphia, PA; 2024

Event Details

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Symposium #441
CE Offered: BACB
Applications of Consecutive Controlled Case Series Methodology in the Assessment and Treatment of Challenging Behavior
Monday, May 27, 2024
10:00 AM–11:50 AM
Convention Center, 100 Level, 103 A
Area: DDA; Domain: Applied Research
Chair: Patricia F. Kurtz (Kennedy Krieger Institute)
Discussant: Wayne W. Fisher (Rutgers Robert Wood Johnson Medical School)
CE Instructor: Craig Strohmeier, Ph.D.

Research on severe challenging behavior in persons with neurodevelopmental disabilities has seen in an increase in publication of consecutive controlled case series (CCCS). CCCS studies have unique value in that they report outcomes of all cases using single-case experimental design, regardless of outcome, to permit evaluation of the efficacy and generality of common procedures or for individuals with common characteristics. Accordingly, four new CCCS studies will be shared in this symposium. The first presentation describes CCCS methods, and reports findings from a systematic review of CCCS studies in the published literature over the past 30 years. The second paper reports outcomes of a functional analysis screener tool for 15 individuals with severe challenging behavior. The third presentation summarizes differences in functional analysis and treatment outcomes for 34 outpatients, comparing topography and treatment outcome with single vs. multiple functions for severe challenging behavior. The fourth presentation reports treatment outcomes from a comparison of terminal probe vs dense-to-lean schedule thinning procedures. Finally, our discussant will provide comments and implications for research and practice.

Instruction Level: Intermediate
Keyword(s): Challenging behavior, Controlled case-series, Developmental disabilities
Target Audience:

Students and professionals with knowledge of/experience with functional analysis and treatment of challenging behavior

Learning Objectives: At the conclusion of the presentation, participants will be able to (1) describe a controlled consecutive case series (CCCS) (2) provide examples of CCCS studies of assessment procedures (3) describe outcomes of CCCS studies of treatments for challenging behavior

In Pursuit of Generality: A Systematic Review on the Consecutive Controlled Case Series

JASMEEN KAUR (University of Nebraska Medical Center - MMI), Isaac Joseph Melanson (University of Nebraska Medical Center's Munroe-Meyer Institute), Tara A. Fahmie (University of Nebraska Medical Center), Michael Kranak (Oakland University), Daniel R. Mitteer (Rutgers University Center for Autism Research, Education, and Services (RUTCARES))

Generality of behavior change can be observed when it demonstrates durability across time, environments, and behaviors. Consecutive controlled case series (CCCS) studies facilitate questions concerning the generality and efficacy of procedures by describing the outcomes of all individuals who experienced a specific procedure, regardless of the outcome. We systematically reviewed published literature on the consecutive controlled case series between 1993–2023 identified via SCOPUS, PubMed, PsychInfo, and an ancestral and descendant search. The results of this search identified 44 consecutive controlled case series studies that employed a single-case experimental design with each case, the first of four defining elements of a CCCS (Hagopian, 2020). We also coded the following variables: presence of additional design, data analytic, and reporting elements across studies; methodological variants; application domains; and participant characteristics. In this talk, trends in CCCS research across time will be summarized, and we will propose directions for future research using consecutive controlled case series.


On the Utility of a Functional Analysis Screener With Individuals With Challenging Behavior

NATHALIE FERNANDEZ (Kennedy Krieger Institute), Louis P. Hagopian (Kennedy Krieger Institute), Michelle A. Frank-Crawford (Kennedy Krieger Institute), Jasmeen Kaur (University of Nebraska Medical Center - MMI), Ryan Benson (Kennedy Krieger Institute), Patricia F. Kurtz (Kennedy Krieger Institute)

Previous research has sought to enhance the efficiency of functional analysis methodology. Slanzi et al. (2022) assessed whether a hypothesis of behavior function could be generated based on responding during a 15 min no-interaction screener. The authors found correspondence between the hypothesis generated from the screening tool and the behavioral function determined in a brief functional analysis in 77% of cases. The purpose of this study was to (a) extend this technology to populations with long histories of engaging in challenging behavior requiring inpatient admission, (b) determine whether mands emitted during the screener could help inform hypotheses of behavioral function, (c) assesses multiple topographies of challenging behavior simultaneously, and (d) assess the correspondence between hypotheses drawn from the screener and the behavioral functions identified through a multielement functional analysis. We will report on data from 15 consecutively encountered cases. Further, we will discuss the utility, sensitivity, and specificity of this functional analysis screener for individuals with challenging behavior and implications for clinical practice.


Comparative Analysis of Severe Challenging Behavior With Single Versus Multiple Functions: A Consecutive Case Series

SARA R. JEGLUM (Blank Children's Hospital), Louis P. Hagopian (Kennedy Krieger Institute), Michelle D. Chin (Kennedy Krieger Institute), John Falligant (Kennedy Krieger Institute), Patricia F. Kurtz (Kennedy Krieger Institute)

Characterizing severe challenging behavior exhibited by individuals with intellectual and developmental disabilities remains a crucial area of research. The functional analysis (FA; Iwata et al., 1982/1994) is widely considered the gold standard for identifying underlying reinforcement contingencies of severe challenging behavior. Since the inception of the FA, numerous studies report descriptive information regarding response topography and function. However, few studies have examined the prevalence of specific topographies relative to number and type of functional classes, and the impact of single versus multiple functions in the treatment of severe challenging behavior. This study is the first to employ a retrospective consecutive-controlled case series design to evaluate differences in FA and treatment applications across single and multiple functions of severe challenging behavior. Results indicated that severe challenging behavior is commonly under the control of multiple variables. A single topography of severe challenging behavior with multiple functions was more treatment resistant relative to other combinations (i.e., single function/single topography; single function/multiple topographies; multiple functions/multiple topographies). Additional findings and implications for treatment are discussed.


Application of a Terminal Schedule Probe Method to Inform Schedule Thinning With Multiple Schedules

CRAIG STROHMEIER (Kennedy Krieger Institute), Mirela Cengher (University of Maryland, Baltimore County), Michelle D. Chin (Kennedy Krieger Institute), John Falligant (Kennedy Krieger Institute)

Thinning multiple schedules during the treatment of problem behavior involves decreasing the duration of the discriminative-stimulus component (FR1 for alternative behavior and extinction for problem behavior) and increasing the duration of the delta-stimulus component (extinction for both alternative and problem behavior). Typically, clinicians and researchers use an arbitrary dense-to-lean approach to gradually introduce longer delta-stimulus durations. In the current investigation we describe a terminal schedule probe method to empirically derive delta-stimulus starting points, and strategies to progress to a feasible terminal schedule while maintaining clinically significant decreases in problem behavior. We analyzed schedule thinning outcomes from two groups using a retrospective consecutive controlled case series design. One group included applications of terminal probe thinning (n = 24), and the other involved dense-to-lean thinning (n = 18). Within and between participant comparisons of results suggest that the terminal probe thinning method produced effective treatments with less resurgence of problem behavior, and leaner, more practical, multiple schedules. We will discuss the clinical implications of the findings and suggest future directions for applied research.




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