Mindy Scheithauer

Assessment of self‐restraint using a functional analysis of self‐injury

When self-restraint and self-injurious behavior (SIB) co-occur, self-restraint might be maintained by negative reinforcement through the removal of SIB. The current study evaluated this possibility with an individual who exhibited hand-to-head SIB. Three functional analyses of SIB were conducted: (a) no consequences for self-restraint, (b) self-restraint blocked, and (c) hypothesized aversive effects of SIB blocked. The outcomes of the 3 analyses suggested that self-restraint was maintained by negative reinforcement.

The impact of stimulus preference, order-effects, and treatment component omission in evaluating treatment integrity

Prior research on treatment integrity has focused either on the lack of measurement of the independent variable or on methods to increase overall levels of treatment integrity. Little research has focused on the effectiveness of common interventions when implemented with less than perfect integrity. The current investigation evaluated the effectiveness of using differential reinforcement of alternative behavior (DRA) and prompting to increase math completion for 36 early elementary students. Treatment was evaluated when both components were implemented, when only reinforcement was implemented, when only prompting was implemented, and when neither was implemented. In addition, preferences for either attention or escape and order-effects of conditions were evaluated. Results indicated treatment was effective at all levels of implementation compared to baseline. However, when preferences for escape and attention were evaluated, analysis revealed individuals who preferred escape responded best when both treatment components were implemented, whereas for individuals who preferred attention, all treatment conditions were equally effective. In addition, results evaluating order effects indicated that exposure to either prompting or reinforcement prior to baseline significantly increased math completion as well as exposure to reinforcement in the first condition.

Functional Behavioral Assessments

Abstract Research has demonstrated that interventions for problem behaviors are more effective when treatment components are selected to match the consequences that maintain the individual’s behavior (i.e., its function). However, many methods for identifying the function of an individual’s problem behavior appear in the literature. The functional analysis (FA) methodology first introduced by Iwata et al. is the most comprehensive and well-studied. However, a variety of factors may prevent a clinician from conducting this type of FA. This chapter describes many of the functional assessment procedures that appear in the literature, including the advantages and disadvantages of each. In addition to various formats of FA, the relative strengths and weaknesses of indirect assessments and descriptive assessments are discussed, as well as the most appropriate applications for each.

A consecutive case review of token systems used to reduce socially maintained challenging behavior in individuals with intellectual and developmental delays

Objectives: The current paper describes the use of token systems in a behavioral day-treatment unit for severe challenging behavior using a consecutive case review spanning three years. Methods: Experimenters reviewed 96 patient case files, 24 of which implemented some token system as a component of the individual’s treatment package. Aspects of each token system (including schedules of token delivery and exchange; inclusion of token training and response cost; and types of backup reinforcers delivered), and participant characteristics were coded. Results: Token systems were most frequently employed during differential reinforcement for alternative behavior (DRA, most commonly for compliance) or differential reinforcement of other behavior (DRO). Tokens were most frequently used in an instructional context. Several commonalities were identified (e.g. restriction of backup reinforcers between token exchanges and initial dense schedules of reinforcement). Compared to past reviews, this sample had an over-representation of individuals with challenging behavior maintained by escape, multiply maintained challenging behavior, and individuals for which the function was not identified in a functional analysis. Treatment packages including token systems resulted in a reduction in challenging behavior for 91.67% of participants, with 70.83% exhibiting at least an 80% reduction. Conclusion: Our findings suggest that token systems may be a beneficial component of treatment plans used to address challenging behavior. Some common components should likely be included in all token systems and specific client variables may guide decisions related to idiosyncratic treatments.

The Impact of Delays on Parents’ Perceptions of Treatments for Problem Behavior

Parent engagement in behavioral interventions is critical for treatments to succeed. Parental decision-making regarding treatments can be impacted by systematic biases, such as the tendency to discount the value of delayed benefits, or “delay discounting”. This study examined the impact of delay discounting on parents’ perceptions of treatment for their children’s problem behavior. Seventeen caregivers of children with a developmental disability who displayed problem behaviors completed assessments in two conditions: a monetary reward paradigm and a paradigm related to treatment outcomes. Fifteen of 17 participants displayed patterns of choice-making suggesting discounting of delayed treatment outcomes. If corroborated in larger samples, our methods could afford clinicians a way to optimize their approach to caregivers to maximize the benefits of treatment.

Using caregiver report on the impact of challenging behavior exhibited by children with autism spectrum disorder to guide treatment development and outcomes

Objectives: Evaluations of treatments using applied behavior analysis (ABA) for challenging behavior have relied mostly on direct behavioral observation. While observation is crucial, qualitative information can also be beneficial. In this study, we describe methods for using qualitative information in ABA treatments for challenging behavior. Method: Three participants were undergoing treatment for challenging behavior. Information was collected through caregiver interviews at the start and end of the admission. Directed content analysis identified themes in the interviews and we compared treatment outcomes using qualitative and quantitative measures. Results: Three themes emerged: description, frequency, and impact of the behavior. Quantitative and qualitative measures both suggested successful interventions for two participants. For the third, direct observation suggested treatment was effective while caregiver report did not. Conclusion: Incorporation of qualitative information into outcomes allowed for a more comprehensive view of treatment success and guided assessment and treatment decisions. Treatments based on applied behavior analysis (ABA) are commonly studied for the treatment of challenging behavior, but these studies rely mostly on direct behavioral observation. While observation is crucial, qualitative information is also useful in ensuring meaningful results. In this study, we describe a method of collecting, analyzing, and using qualitative information collected from caregivers and compare qualitative to quantitative outcomes.

A consecutive case series analysis of a behavioral intervention for enuresis in children with developmental disabilities

ABSTRACT Children with developmental disabilities (DD) are more likely than typically developing peers to have issues with enuresis. Past research has shown the success of behavioral treatments consisting of scheduled sits and reinforcement for continent voids. However, this research has included small sample sizes, while studies with larger numbers have lacked key information (i.e., baseline rates and follow-up data to evaluate maintenance and generalization). The current study conducted a consecutive case series analysis of 44 individuals with developmental disabilities who completed a 2-week program for enuresis. Results showed significant improvement in continent voids and follow-up data suggested positive results maintained when treatment was implemented by caregivers in a home environment.

A multidisciplinary treatment for encopresis in children with developmental disabilities

Achieving continence of ones bowel movements is a key step in development and failure to do so leads to many negative consequences. Treatments for encopresis appearing in the literature have employed behavioral strategies; medications such as suppositories, laxatives, or enemas; and in some studies a combination of these approaches. To date, attempts to extend successful treatments for encopresis in typically developing children to those with developmental disabilities have been limited. The current study included three participants diagnosed with developmental disabilities who had a history of encopresis. None of the participants had a continent bowel movement under baseline conditions. Continent bowel movements increased during treatment that included the addition of suppositories to elicit continent bowel movements. Two participants began having independent continent bowel movements (i.e., without requiring suppositories) and medication was successfully faded out for the remaining participant. Treatment took between 13 and 21 days.

Clinical outcomes of behavioral treatments for elopement in individuals with autism spectrum disorder and other developmental disabilities

The external validity of behavioral treatments for elopement (i.e. leaving supervision without permission) remains unclear because studies to date include only small samples (n = 1–3). This study quantified the overall effectiveness of behavioral treatments for elopement by retrospectively examining treatment data from all patients seen for the treatment of elopement at an intensive day treatment clinic (n = 11), irrespective of treatment success. Reductions in elopement from baseline to the final treatment for each participant demonstrate that behavioral intervention is a highly effective treatment for elopement, as determined by the large effect size (Cohen’s d = 1.18).

Use of a latency‐based demand assessment to identify potential demands for functional analyses

Unlike potential tangible positive reinforcers, which are typically identified for inclusion in functional analyses empirically using preference assessments, demands are most often selected arbitrarily or based on caregiver report. The present study evaluated the use of a demand assessment with 12 participants who exhibited escape-maintained problem behavior. Participants were exposed to 10 demands, with aversiveness measured by average latency to the first instance of problem behavior. In subsequent functional analyses, results of a demand condition that included the demand with the shortest latency to problem behavior resulted in identification of an escape function for 11 of the participants. In contrast, a demand condition that included the demand with the longest latency resulted in identification of an escape function for only 5 participants. The implication of these findings is that for the remaining 7 participants, selection of the demand for the functional analysis without using the results of the demand assessment could have produced a false-negative finding.