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| Recent Advancements in the Treatment of Severe Challenging Behavior |
| Saturday, May 25, 2024 |
| 3:00 PM–3:50 PM |
| Convention Center, 100 Level, 114 |
| Area: AUT/DDA; Domain: Applied Research |
| Chair: Matthew Louis Lucciola (Rutgers University) |
| CE Instructor: Matthew Louis Lucciola, M.A. |
| Abstract: Treatment strategies for severe challenging behavior have evolved in recent years, giving way to more advanced tools clinicians can use to meet treatment goals. The current symposium will explore three distinct studies related to the treatment of severe problem behavior. The first study discusses the results of an updated literature review regarding the use of reinforcement- and punishment-based interventions for self-injurious and aggressive behavior. Findings reveal the number of articles published related to punishment-based interventions decreased and remained low in recent years while the number of articles exploring reinforcement-based procedures continued to be higher than punishment-based interventions. The second study explores the use of multiple schedules to teach “flexibility” skills to decrease severe challenging behavior. Results indicate that signaling the availability of an alternative reinforcer for the emittance of a tolerance response without challenging behavior (the flexibility skill) effectively decreased challenging behavior when extinction was in place for a functional communication response for two autistic adults. Lastly, the third study will discuss the use of multiple schedules to transfer lean schedules of reinforcer availability across contexts during the treatment of problem behavior. Findings indicate the effectiveness of multiple schedules to sustain treatment effects as schedules of reinforcement are thinned. |
| Instruction Level: Intermediate |
| Keyword(s): aggression, differential reinforcement, multiple schedules, self-injurious behavior |
| Target Audience: Participants should have a basic understanding of the theory of reinforcement. |
| Learning Objectives: At the conclusion of this presentation, participants will be able to (1) identify current trends in the literature regarding publication of reinforcement-based and punishment-based interventions to treat problem behavior, (2) describe a method to use multiple schedules to teach flexibility skills and decrease problem behavior, and (3) discuss a procedure using multiple schedules to thin schedules of reinforcement in the treatment of problem behavior. |
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The Influence of Functional Analysis Methodology on Publication of Treatments for Self-Injury and Aggression in Individuals With Intellectual or Developmental Disabilities (IDD): An Extension of Pelios et al. (1999) |
| Kissel Joseph Goldman (Kennedy Krieger Institute), GARRET HACK (University of Florida), Maxime Korner (University of Florida), Iser Guillermo DeLeon (University of Florida) |
| Abstract: Pelios et al. (1999) examined the impact of functional-analysis methodology, specifically the publication of Iwata et al., (1982/1994), on the publication of reinforcement- and punishment-based treatment for self-injurious behavior (SIB) and aggression in individuals with intellectual or developmental disabilities. We extended the analysis conducted by Pelios et al. to include the years between 1998 and 2022 and analyzed individual participants in terms of demographics, topographies displayed, and assessment and treatment types used. We found that publication of reinforcement-based treatments for SIB and aggression has decreased from a peak in 1997 but remained elevated since Pelios et al. completed their review. The number of publications including punishment-based treatments has decreased more recently but remained low, averaging between one and two articles published yearly since 1968. Regarding individual datasets, we found that specific topographies of behavior were differentially associated with particular behavioral functions. Similarly, we also observed that treatment type was differentially associated with particular topographies, assessment types, and functions. We discuss these outcomes in terms of variables affecting publication, research on punishment-based treatments, and potential areas for further research. |
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Teaching Flexibility Skills to Treat Severe Problem Behavior in Adults With Autism Spectrum Disorder |
| JULIA IANNACCONE (Rutgers University), Matthew Louis Lucciola (Rutgers University), Christopher Manente (Rutgers Center for Adult Autism Services, Rutgers University), SungWoo Kahng (Rutgers University), Robert LaRue (Rutgers University) |
| Abstract: Multiple schedules of reinforcement have a history of effectiveness in treating severe challenging behavior demonstrated by individuals with autism spectrum disorder (ASD) and related disabilities (Saini et al., 2016). The literature demonstrating this efficacy, however, is limited within the adult population. The present study evaluated the utility of multiples schedules to teach “flexibility” skills to two autistic adults demonstrating severe challenging behavior. More specifically, functional analyses were conducted to determine the reinforcing variables maintaining the challenging behavior, then a multiple schedule treatment was evaluated. The multiple schedule was comprised of two signaled component schedules. One schedule involved continuous differential reinforcement of alternative behavior (DRA; e.g., appropriate mands for the functional reinforcer). The second schedule, called “Flexible Time”, involved extinction for the first alternative behavior (e.g., mands) as well as additional DRA for another behavior, a tolerance response, and the absence of problem behavior (differential reinforcement of other behavior; DRO). The present procedures successfully reduced challenging behavior for both participants and provide a model to clinicians to teach flexibility skills while decreasing severe challenging behavior. |
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Transfer of Schedule Thinning Effects Across Contexts During Treatment With Functional Communication Training |
| JASMINE SORRELL (Kennedy Krieger Institute & Johns Hopkins School of Medicine), Craig Strohmeier (Kennedy Krieger Institute) |
| Abstract: After reducing problem behavior and establishing an appropriate alternative behavior, schedule thinning is necessary to create feasible treatment plans for implementation in naturalistic environments. Multiple schedules are effective at creating lean schedules of reinforcement for alternative behavior while maintaining low rates of problem behavior. When problem behavior is multiply maintained, or requires treatment extension across multiple contexts, schedule thinning with multiple schedules may be required across several treatment contexts. Few studies to date describe the transfer of treatment effects with multiple schedules across treatment contexts. In the current investigation, we implemented a terminal probe procedure in one context to derive initial schedule thinning starting points and subsequent schedule thinning progressions. Once we achieved a lean, feasible schedule in one treatment context, we transferred the treatment effects across contexts at the terminal schedule value. Treatment effects were maintained across contexts with the lean schedule of reinforcement. Results across participants suggested that these procedures yielded an efficient schedule thinning process when treating problem behavior across contexts. In addition to a review of treatment outcomes, we review the terminal probe method process, further strategies for transferring lean schedules across contexts, and implications for clinical practice and future research. |
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