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Science Can Guide Us: Assent, Countercontrol, and Treatment Refractory Behavior |
Sunday, May 26, 2024 |
3:00 PM–4:50 PM |
Convention Center, 100 Level, 114 |
Area: DDA; Domain: Translational |
Chair: Nicholas Lowther (Judge Rotenberg Educational Center) |
Discussant: Nathan Blenkush (Judge Rotenberg Educational Center) |
CE Instructor: Nathan Blenkush, Ph.D. |
Abstract: Applied behavior analysis has directed little empirical attention to the interrelated concepts of assent, countercontrol, and treatment refractory behavior. Despite recent conceptual discussions of assent (Morris, Detrick, & Peterson, 2021), countercontrol (Spencer, King, Martone, & Houlihan, 2022), and treatment refractory behavior (Blenkush, O’Neill, & O’Neill, 2023) the field has yet to develop standardized measures for any of these concepts. To that end, we developed and tested the validity of (1) the Behavioral Assent to Treatment Scale; (2) a treatment protocol for countercontrol in residential settings; (3) an operational definition of treatment refractory behavior to include associated variables; and (4) the Refractory Behavior Index assessment tool. Across presentations, we will discuss conceptual overlap between assent, countercontrol, and treatment refractory behavior with an emphasis on empirical evaluation and clinical case analysis. We conclude that science can, and should, guide us in our attempts at tackling complex treatment issues such as assent, countercontrol, and treatment refractory behavior. |
Instruction Level: Intermediate |
Target Audience: Behavior analysts interested in the limitations associated with the standard of care in applied behavior analysis |
Learning Objectives: At the conclusion of the presentation, participants will be able to: (1) conceptualize and define assent, countercontrol, and treatment-refractory problem behavior; (2) list associated variables for consideration; (3) identify limitations associated with the standard of care in applied behavior analysis and regulatory restrictions in their region that might contribute to assent, countercontrol, and treatment-refractory problem behavior; and (4) understand how to utilize the Behavioral Assent to Treatment Scale (BATS) and Refractory Behavior Index (RBI) in their own practice |
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Behavioral Assent to Treatment Scale (BATS): A Proposed Tool
to Assess and Optimize Assent |
(Applied Research) |
HALLE APELGREN (Judge Rotenberg Center ), John O'Neill (Judge Rotenberg Educational Center) |
Abstract: Behavior analysts are obligated to consider “obtaining assent
from clients when applicable” as dictated by the ethics code -
section 2.11 (Behavior Analyst Certification Board, 2020). Assent
is broadly thought of as client agreement or approval of treatment
procedures. In behavior analysis, there is limited research
describing assent procedures or studying the implications for
treatment outcomes (Morris, Detrick, & Peterson, 2021). To
address this gap, an assessment tool, the Behavioral Assent to
Treatment Scale (BATS), will be proposed that weighs factors
such as safety, risk/benefit analysis, behavioral dimensions,
socially significant goals, essential/nonessential treatment
progress, and legal/ethical obligations. Next, we will examine the
treatment of countercontrol as a special example of the necessary
risk/benefit analysis associated with client assent in applied
behavior analysis. Considerations of countercontrol and assent
share some common features as the former can be an indirect
byproduct of a learning history which was inattentive to the latter.
Here we will review the cases of individuals enrolled in a
residential treatment facility and examine vital components of
treatment. Pre- and post-treatment measures of assent (with interobserver agreement) will be provided as preliminary construct
validation for the BATS. |
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Countercontrol in Residential Treatment Settings |
(Applied Research) |
JOSEPH TACOSIK (Judge Rotenberg Education Center), John O'Neill (Judge Rotenberg Educational Center) |
Abstract: B. F. Skinner described countercontrol as a response to socially
mediated aversive consequences in personal, group,
governmental, religious, therapeutic, economic, and educational
environments that are primarily reinforced through negative
reinforcement (i.e., removal or weakening of aversive stimuli)
and may be strengthened through positive reinforcement (e.g.,
peer approval or other attention). Residential treatment settings
are inherently restrictive, potentially aversive to consumers, and
thus may evoke countercontrol by clients, especially when
assent/consent is withheld or provided by someone other than the
individual receiving treatment (e.g., a guardian). We provide
insights specific to challenges presented by countercontrol in
residential treatment settings to include the following: (1) the
potential for false-positive functional hypothesis results; (2) the
limited control of setting events; (3) the idiosyncratic nature of
conditioned aversive stimuli; (4) the various competing
contingencies of reinforcement; (5) associated delayed
consequences that complicate treatment; and (6) the general
insensitivity of rule-governed behavior in relation to the effects of
countercontrol. We will provide clinical case examples (with
inter-observer agreement) of countercontrol challenges and
propose a standard set of considerations for residential treatment
facilities. |
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The Refractory Behavior Index (RBI): Identification of Treatment
Refractory Behaviors |
(Theory) |
LYNDE KAYSER (Judge Rotenberg Education Center), Jessica Lindsay (Judge Rotenberg Educational Center ), John O'Neill (Judge Rotenberg Educational Center), Nathan Blenkush (Judge Rotenberg Educational Center) |
Abstract: Across disciplines, the term treatment refractory refers to
inadequate reductions in symptomology following appropriate
treatment. In behavior analysis, treatment refractory behavior
problems consist of the sustainment or worsening of maladaptive
behavior topographies despite appropriate behavior analytic
service delivery. To objectively evaluate and identify refractory
behavioral presentations, we propose the utilization of the
Refractory Behavior Index (RBI). The RBI employs a five-point
scale to quantify variables that are indicative of the development
of treatment refractory behavior problems. Variables are
categorized across three primary domains: (1) Assessment and
Intervention; (2) Quality of Treatment; and (3) Course of
Behavior Problem. Based on a review of an individual’s treatment
history and behavioral presentation, ratings across each domain
enable an assessment of responsiveness to treatment across time
and interventions. We will review the proposed definition of
treatment refractory behavior in behavior analysis, discuss factors
contributing to the development of behavioral resistance to
treatment (including assent & countercontrol), evaluate these
factors within the context of the RBI, and discuss the potential of
the RBI to identify refractory behavior problems. |
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Quantifying Treatment Resistance: A Review of Case Examples |
(Applied Research) |
JESSICA LINDSAY (Judge Rotenberg Educational Center ), Lynde Kayser (Judge Rotenberg Education Center), John O'Neill (Judge Rotenberg Educational Center), Nathan Blenkush (Judge Rotenberg Educational Center) |
Abstract: The purpose of this presentation is to review clinical cases, based
on practical experience, that exemplify the spectrum of treatment
refractory behavior. Clinical cases will be scored using the
Refractory Behavior Index (RBI) to quantify resistance to
treatment (with inter-observer agreement). It is hypothesized that
individuals whose behaviors score low on the index are more
likely to demonstrate behavioral progress following behavior
analytic treatment; whereas individuals receiving high scores may
exhibit challenging behaviors (including assent withdrawal &
countercontrol) which persist or worsen despite behavior analytic
treatment. Historical information pertaining to each clinical case
will be reviewed and considered in relation to the development of
treatment refractory behavior. Through widescale use, the RBI
may help practitioners identify relevant risk factors, and indicate
areas in need of further assessment and/or intervention. The
advancement of behavior analysis relies on the ability to
objectively describe and measure behavioral presentations. We
will discuss how the RBI might highlight the need for and
promote the develop |
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