Acceptance of Telehealth Therapy to Replace In-Person Therapy for Autism Treatment During COVID-19 Pandemic: An Assessment of Patient Variables.

Importance: Children with autism achieve improved behavioral outcomes with applied behavior analytic (ABA) interventions. Typically, ABA is delivered in a participant's home or in a clinic setting. At the onset of COVID-19, treatment in these environments was not available due to health exposure concerns. A large social service organization in California rapidly pivoted to the delivery of ABA intervention through telehealth. Access disparity for telehealth has been a historical concern in health care delivery, particularly for disenfranchised populations within the autistic participant population. Objective: This study evaluated the demographic and behavioral variables associated with the acceptance or declination of telehealth by the pediatric participants' caregivers at the onset of the pandemic. Design, Setting, Participants: A non-experimental design was used, and archival data were compared for a random sample of 100 participants with autism who accepted telehealth interventions with 100 participants who declined it. Main Outcomes and Measures: Socioeconomic data, gender, age, ethnicity, language, and household size were compared. Clinical data were compared for treatment dosage, standardized Vineland Adaptive Behavior Scales scores, and Verbal Behavior Milestones Assessment and Placement Program scores. Results: None of the demographic variables were statistically significant in a participant's acceptance or declination of telehealth, but there were moderate differences in treatment dosage across the groups. Conclusions: It is concerning that a large portion of participants initially declined intervention via telehealth, resulting in these participants experiencing a gap in intervention during the pandemic. As intervention is imperative for pediatric autism participants, it is untenable that ∼40% of the population initially declined telehealth at the start of the pandemic.

Evaluation of a Reinforcement Contingency to Increase University Students' Webcam Usage During Online Classroom Instructions.

During the COVID-19 pandemic, in-person classroom instruction was placed on hold and university courses transitioned to online instruction. This transition resulted in novel challenges for instructors, including reduced professor-student interactions due to limited student webcam usage. The purpose of this study was to assess the impact of a reinforcement contingency on students' use of webcams during synchronous online instruction. An alternating treatments design was used to assess the impact of a reinforcement contingency consisting of 0.5 points contingent on daily webcam usage. We also assessed the results based on how the contingency was communicated to the students (a verbal statement on the daily quiz plus a reminder on lecture slides versus a statement on the lecture slide only). The reinforcement contingency reliably increased webcam usage, but there was not a significant difference in results as a function of how the presence of the reinforcement contingency was communicated. These findings suggest that the behavior of using webcams can change with a simple reinforcement contingency.

Punishment-induced resurgence.

The phenomenon of extinction-induced resurgence is well established, but there is comparatively little experimental evidence for punishment-induced resurgence. Punishment-induced resurgence can by tested by contingent shocks following the alternative response. The purpose of Experiment 1 was to test whether low-intensity shocks, that do not decrease rate of reinforcement, result in resurgence. Four rats served as subjects. Rats were exposed to three sequential conditions: (a) variable-interval (VI) 30-s food delivery for a lever press (target response); (b) VI 30-s food delivery for a nose poke (alternative response) and extinction of the lever press; (c) VI 30-s reinforcement for a nose poke with superimposed VI 60-s shock delivery. In the final condition, shocks increased gradually from 0.1 to 0.5 mA. Experiment 2 evaluated whether an abrupt introduction of a high-intensity shock would result in resurgence. Three rats served as subjects and were exposed to three sequential conditions: (a) VI 30-s food delivery for a lever press; (b) VI 30-s food delivery for a nose poke and extinction of the lever press; (c) continued VI 30-s reinforcement for a nose poke with superimposed VI 60-s 0.6 mA shock delivery. Resurgence was observed in all subjects, including in situations in which rate of responding, but not rate of reinforcement, decreased. The present study provides additional evidence for punishment-induced resurgence, but future studies are warranted to determine the extent to which punishment can produce resurgence with or without decreases in rates of reinforcement.

Convergent and Discriminant Validity of the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP) and the Vineland Adaptive Behavior Scales (VABS).

Behavior analysts frequently use the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP) to assess the language and social skills of children with autism in everyday practice and in research. Despite the widespread use of the VB-MAPP, its psychometric characteristics have not been extensively investigated. To provide information about its convergent validity, we calculated correlations between scores earned by 235 children with autism on the VB-MAPP and the Vineland Adaptive Behavior Scale (VABS), a commonly used assessment with good reliability and validity. We obtained moderate or strong positive correlations between the VB-MAPP Milestones score and VABS Communication, Socialization, and Daily Living Skills subdomains. There was also a strong positive correlation between the VB-MAPP Milestones score and VABS overall raw score. These findings suggest that the VB-MAPP Milestones Assessment measures aspects of social and communicative behavior comparable to those indexed by these VABS subdomains which, like prior findings, supports the use of the Milestones Assessment. No significant relationship was observed between the VB-MAPP Barriers score and the VABS Internalizing, Externalizing, or overall Maladaptive Behavior scores. These findings, like prior findings, question the value of the VB-MAPP's Barriers Assessment as a measure of maladaptive behavior.

Caregiver Satisfaction with Delivery of Telehealth Autism Services.

Objective: The purpose of this study was to assess satisfaction with telehealth interventions for a large nonprofit organization that transitioned interventions for individuals with autism spectrum disorder (ASD) to telehealth during a pandemic. Services provided via telehealth included applied behavior analysis (ABA), speech and language, and occupational therapies. A secondary survey evaluated reasons for declining telehealth services. Methods: A survey was administered to 10,567 families who were receiving autism interventions. A total of 440 respondents answered all the questions on the survey, and their results were included in this study. A secondary survey was administered to 223 individuals who declined to have telehealth autism interventions. Results: There was not a clinically meaningful difference in satisfaction across service types. Although all ratings were in the high range, caregivers ranked speech therapists as more dependable than ABA therapists, and this difference was statistically significant. The findings suggested that the majority of caregivers were generally satisfied with services provided in a telehealth format. For those who declined services, the majority indicated a discomfort with the use of technology. Conclusions: The participants of telehealth autism interventions reported high general satisfaction and indicated an improvement in their quality of life. Results provide suggestive evidence that increased satisfaction of telehealth services may allow for further acceptability and access for participants. Future research should evaluate participant and clinician satisfaction with telehealth versus in-person interventions.

Resurgence increases with repetition.

Resurgence refers to a behavioral process in which a recent response is extinguished (or reinforcement conditions worsen) and a previously extinguished response recurs. In previous research, resurgence has been reliably produced when the resurgence procedure is repeated. Changes in the degree of increase of the resurging response across iterations of the procedure have been inconsistent, however, with some studies showing increases and some showing no changes or decreases in resurgence magnitude. The present study examined the nature of resurgence across repeated iterations of the conventional resurgence procedure by exposing four pigeons to the resurgence procedure six times in succession. In the first condition of the resurgence procedure, pecks on one key (e.g., the left) were reinforced under a variable-interval (VI) 30-s schedule. In the second condition pecks on that key were extinguished, and pecks on another key (e.g., the right) were reinforced under the same schedule. In the final condition there were no programmed consequences for either response. Resurgence was observed in 21 of 24 opportunities (87.5%). Iteration-over-iteration increases in resurgence were observed in 15 of 20 opportunities (75.0%), and this increase was found to be statistically significant. These findings demonstrate that, under certain conditions, resurgence generally increases in magnitude with repeated exposure to the procedures that generate it.

Motivating Operations and Discriminative Stimuli: Distinguishable but Interactive Variables.

The motivating operations concept has been of considerable interest and practical value to behavior analysts, including practitioners. Nonetheless, the concept has generated substantial controversy and has significant limitations. To address some of these limitations, we suggest that it would be wise to redefine motivating operations, to deemphasize the importance that has historically been placed on subtypes of conditioned motivating operations, to emphasize how motivating operations and discriminative stimuli interact, and to further examine the kinds of environmental changes that alter the reinforcing value of particular kinds of stimuli. These suggestions are detailed elsewhere and summarized in this article.

Moderate Effects of Low-Intensity Behavioral Intervention.

We compared clinical outcomes in a treatment group of 98 individuals who received between 8 and 15 weekly hours (M = 10.6; SD = 1.7) of applied behavior analysis (ABA) intervention with a comparison group of 73 individuals who received another provision, including some ABA, (between 1.4-8 weekly hours, M = 5.7; SD = 1.6). After 2 years, the treatment group made greater gains than the comparison group on language and social skills, and other areas assessed by the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP). We evaluated the outcome on adaptive skills for a smaller sample of participants using the Vineland Adaptive Behavior Scales II (VABS), but found no significant differences between the treatment (n = 17) and comparison groups (n = 11). Although the treatment group made important and clinically meaningful gains, the gains were moderate. These findings underline the importance of intervention intensity and provide further support for a dose-response relationship between ABA intervention hours and outcomes.

Motivating operations and stimulus control.

The motivating operations concept has generated substantial conceptual analysis and research interest. Following an analysis of how motivating operations affect behavior, one which emphasizes the interactive role of motivating operations and discriminative stimuli, we propose: a) redefining motivating operations as operations that modulate the reinforcing or punishing effectiveness of particular kinds of events and the control of behavior by discriminative stimuli historically relevant to those events, b) dropping the distinction between behavior-altering and function-altering effects of motivating operations, and c) reducing or eliminating emphasis on conditioned motivating operations. This reconceptualization of the motivating operations concept is intended to increase its value in predicting and gainfully changing behavior.

Inter-Rater Agreement for the Milestones and Barriers Assessments of the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP).

We determined inter-rater agreement for the VB-MAPP, an instrument sometimes used in planning educational goals and evaluating intervention effects for young people with autism. A pair of raters independently rated each of 32 children diagnosed with autism. Intraclass correlation coefficients for the total Milestones and Barrier scores were 0.876 and 0.629, respectively, indicating good and moderate reliability. There was variability in reliability in the different domains of the Milestones Assessment, with most indicating moderate reliability, and most of the individual Barriers Assessment domains indicating poor reliability. These are the first data relevant to the reliability of the VB-MAPP, they suggest that further evaluation of its reliability is merited and that a high reliability for individual domains should not be assumed.

Increasing food deprivation relative to baseline influences D-amphetamine dose-response gradients.

Several studies using non-pharmacological discriminative stimuli have found that stimulus control, as evident in generalization gradients, changes when motivation for (i.e., deprivation of) the relevant reinforcer is altered. Drug-discrimination studies, however, have not consistently revealed such an effect. A procedural detail that may account for the lack of a reliable effect in drug-discrimination studies is that motivation was characteristically reduced relative to the training condition in these studies. The present experiment examined how substantially increasing motivation affects D-amphetamine discrimination. Rats initially were trained to discriminate D-amphetamine (1.0 mg/kg) from vehicle (0 mg/kg) injections under 22-h food deprivation conditions. Dose-response gradients were then obtained under 22-h and 46-h deprivation levels. The ED50 was significantly higher with greater deprivation. This finding suggests that increasing motivation relative to the training condition may reduce stimulus control by drugs, while decreasing it may sharpen stimulus control.

Motivating operations affect stimulus control: a largely overlooked phenomenon in discrimination learning.

Several recent studies have explored what Michael (e.g., 1982) termed the value-altering effect and the behavior-altering effect of motivating operations. One aspect of the behavior-altering effect that has garnered no recent attention involves changes in stimulus control produced by motivating operations. To call attention to this aspect of the behavior-altering effect, we herein review 11 studies that are concerned with the influence of varying levels of food or water deprivation on stimulus generalization. These studies suggest that motivating operations influence stimulus control (a) by changing the evocative strength of not just an established discriminative stimulus, but also of stimuli that are physically similar to it; (b) by changing the range of stimuli that evoke the operant in question; and (c) by exerting these effects in a graded fashion. These findings are potentially of conceptual and applied significance, and it appears that further research examining how motivating operations alter stimulus control, including some studies suggested herein, is warranted.

Effects of altering motivation for food in rats trained with food reinforcement to discriminate between d-amphetamine and saline injections.

Previous studies have shown that altering motivation typically affects stimulus generalization in animals trained to discriminate exteroceptive stimuli, but few studies have evaluated the effects of manipulating motivation on drug stimuli. In the few published studies, motivation levels were manipulated by arranging different feeding conditions prior to stimulus generalization tests with rats trained to discriminate morphine from vehicle and in pigeons trained to discriminate phencyclidine or pentobarbital from vehicle. In the present study, rats maintained at 80% of free-feeding weights were trained to discriminate between injections of 1.0mg/kg d-amphetamine and saline in a two-lever food-reinforced operant procedure. Generalization tests were then conducted with a range of d-amphetamine doses (0, 0.03, 0.1, and 0.3, 1.0mg/kg) when the rats were not fed before experimental sessions (high motivation) and when they were pre-fed 1g of food (moderate motivation) or their daily ration of food (low motivation) 1h before test sessions. Changing the motivation level significantly affected response rate and latency to the first response in generalizations tests, but did not significantly affect mean percentage of drug-appropriate responding (a continuous measure) or percentage of animals that selected the drug-appropriate lever (a quantal measure). The present findings indicate that manipulating motivation for food minimally impacts d-amphetamine discrimination, however, the range of conditions used to examine the effects of motivating operations on stimulus control by d-amphetamine drugs and other drugs is limited and the topic may warrant further investigation.