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 #241
CE Offered: BACB
Advancing Relapse Mitigation and Clinical Impact: Translational Research and Practical Recommendations
Sunday, May 26, 2024
10:00 AM–11:50 AM
Convention Center, 100 Level, 112 AB
Area: DDA/AUT; Domain: Translational
Chair: Casey Irwin Helvey (Rutgers University (RUCARES))
Discussant: Kelly M. Schieltz (University of Iowa)
CE Instructor: Kelly M. Schieltz, Ph.D.

Research has demonstrated the effectiveness of behavioral treatments, such as Functional Communication Training (FCT) and FCT with delay-and-denial tolerance training, for reducing challenging behavior. Relapse refers to the recurrence of a previously decreased response when a treatment is challenged, such as treatment integrity omission errors (i.e., resurgence) or when treatment is transferred from clinics to community settings, such as the home or school (i.e., renewal). Although effective, relapse following FCT is highly prevalent, and there is relatively little research evaluating relapse following FCT with delay-and-denial tolerance training. Additionally, there have been mixed findings across basic and applied studies, and guidance for practice is limited. In this symposium, one presentation investigates renewal following differential reinforcement of alternative behavior in single- and multiple-context training across basic and applied arrangements. Two presentations will highlight investigations of relapse during delay-and-denial tolerance training—one empirical demonstration of relapse following programmed treatment integrity errors and context changes during FCT with delay-and-denial tolerance training, and one systematic review of the magnitude and prevalence of resurgence during distinct components of delay-and-denial tolerance training. The final presentation will identify everyday examples of relapse and provide strategies and tools to assist practitioners in preparing for relapse in applied settings.

Instruction Level: Intermediate
Keyword(s): delay-and-denial training, multiple-context training, relapse, research-to-practice
Target Audience:

The intended audience is behavior analysts who have or currently work with individuals that engage in challenging behavior, as well as researchers who specialize in relapse. The audience should have some knowledge on treatment relapse and its clinical implications. Additionally, familiarity with experimental models of different forms of relapse will be useful, but a general overview will be provided for pertinent presentations.

Learning Objectives: At the conclusion of the presentation, participants will be able to: (1) describe recent research on renewal in applications of multiple-context training, (2) describe recent research on resurgence and renewal in applications of delay-and-denial tolerance training, (3) describe the differences between various forms of relapse and identify common applied examples, and (4) describe strategies for mitigating relapse in practice.

The Effects of Multiple-Context Training on Operant Renewal of Behavior Decreased by Differential Reinforcement of Alternative Behavior (DRA)

(Applied Research)
PAIGE TALHELM (University of South Florida), Caeli Virginia Cormier (University of Florida), Iser Guillermo DeLeon (University of Florida), Carolyn Ritchey (University of Florida), Christopher A. Podlesnik (University of Florida)

Individuals with autism spectrum disorder (ASD) often receive behavioral treatment for severe problem behavior. Although treatment may be effective in reducing problem behavior, the possibility of renewal of problem behavior may be of a concern to clinicians and caregivers. Renewal is the reemergence of a previously reduced response following a change in treatment conditions (Pritchard et al., 2014). One potential solution to mitigate renewal may incorporate multiple implementers across different settings before implementing treatment in contexts in which the target behavior was initially reinforced (Kimball et al., 2023). Additionally, translational human laboratory studies are conducted under the assumption that outcomes will be relevant to clinical conditions. However, few studies have examined the extent to which laboratory preparations predict whether similar findings will be obtained with clinically relevant behaviors. During the present study, single- and multiple- context training was evaluated with human participants recruited via Amazon Mechanical Turk (MTurk) and individuals with ASD, who engaged in problem behavior. Across both studies, minimal renewal effects were observed following the implementation of DRA plus extinction for both single- and multiple-context participants.

An Evaluation of Delay and Denial Training: Durability Against Treatment Relapse
(Applied Research)
KENDALL MAE KASTNER (68102), Stephanie A. Hood (Marquette University ), Daniel R. Mitteer (Rutgers University (RUCARES))
Abstract: Delay and Denial Training is a prevalent prescribed intervention following the successful implementation of Functional Communication Training (FCT). Although there is strong empirical evidence in support of delay and denial training as an intervention to reach socially acceptable outcomes, there have yet to be systematic assessments of this intervention’s susceptibility to treatment relapse. The goal of this evaluation was to arrange treatment challenges that mimic the conditions that threaten treatment outcomes in the natural environment, specifically such as transferring treatment to a new environment or treatment integrity omission errors. Researchers replicated recent iterations of delay and denial training procedures (Hanley et al., 2014; Rose & Beaulieu, 2019), and included treatment challenges based on procedures by Saini et al., (2018), and Fisher et al., (2019). This research adds to the literature on delay and denial training and examines the durability against treatment relapse in the forms of renewal and resurgence. This presentation will describe implications for future research and clinical practice.

On the Prevalence and Magnitude of Resurgence During Functional Communication Training With Delay-and-Denial Tolerance Training

(Applied Research)
ARIELLE ROSE MARSHALL (Rutgers Graduate School of Applied Psychology), Daniel R. Mitteer (Rutgers University (RUCARES)), Brian D. Greer (Rutgers Robert Wood Johnson Medical School)

Resurgence is the recurrence of target behavior (e.g., severe destructive behavior) during a worsening of reinforcement conditions (e.g., increases in response effort or decreases in reinforcement rate for appropriate behavior). Previous studies have examined the prevalence and magnitude of resurgence of severe destructive behavior during functional communication training with discriminative stimuli (i.e., multiple schedules). We conducted a systematic review of the literature to analyze the magnitude and prevalence of treatment relapse during functional communication training with delay-and-denial tolerance training, including during shaping of the complex communication response, introduction of tolerance responses, and increases in delays. Similar to previous studies with discriminative stimuli, resurgence occurred in nearly all participants (87%) and in about one-third of transitions. Resurgence was less likely to occur during response-effort manipulations (i.e., complexity training, tolerance-response training) and was most likely to occur during increases in delays that ended following the passage of time rather than a response criterion. These results highlight the importance of further evaluation of resurgence across different applications of functional communication training.

Understanding and Managing Relapse: Recommendations for Practitioners
(Service Delivery)
JENNIFER NEELY (Trumpet Behavioral Health), Ashley Marie Fuhrman (Trumpet Behavioral Health), Ryan Kimball (University of Saint Joseph (West Hartford, CT)), Clare Liddon (University of Dayton), Amber Valentino (ALV Consulting, LLC)
Abstract: Behavior analysts have identified and demonstrated effective assessment and treatment procedures for severe behavior, yet the relapse of severe behavior following effective treatment is highly prevalent (Briggs et al., 2018; Falligant et al., 2022; Haney et al., 2022; Muething et al., 2021). The purpose of the current paper is to provide (a) a consumable framework on relapse for practitioners and (b) recommendations for practitioners on managing and mitigating relapse. We outline the types of relapse, provide everyday examples of each, review safety precautions, highlight recommendations regarding best practices for data collection and data review, and discuss recommendations for responding to relapse based on current best practices. A decision tree is used to help guide practitioners on which type of relapse they are responding to based on the current variables at play and what approach to take in managing relapse to decrease the severity of the relapse in the moment as well as decrease the likelihood that the relapse will be reinforced, thereby mitigating relapse in the future. We provide definitions of relapse with examples of each, the recommended components for a relapse reaction plan, a relapse awareness checklist for practitioners to reference, and a sample relapse reaction plan to assist practitioners understand and manage for relapse for the individuals they serve.



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