Evaluation of a Telehealth ABA Program for Caregivers of Children with ASD.

Children with autism spectrum disorder (ASD) often experience skill deficits that can negatively affect long-term outcomes. Interventions based on applied behavior analysis (ABA) yield improvements in targeted skills. However, families often have difficulty accessing ABA services. The purpose of this study was to evaluate the efficacy of a caregiver coaching program delivered via telehealth. Thirty children with ASD and their caregivers (e.g., parents, grandparents) participated in all phases of the study. The program consisted of therapists providing coaching in English or Spanish to caregivers of children with ASD via synchronous video call telehealth visits, typically provided one to two times per week. Caregivers received coaching in interventions (e.g., functional communication training, discrete trial teaching, total task chaining, and naturalistic teaching) to address individualized goals. We collected data on caregiver treatment fidelity and child outcomes (i.e., Vineland-3, observation, and analysis of time series data). Caregivers implemented intervention procedures with 95% accuracy on average. The single-case effect sizes calculated based on the time series baseline and intervention data yielded medium, large, or very large improvements for 85% of goals addressed. Results indicated that the children improved on appropriate engagement (measured via observation), but there was no statistically significant improvement for the remaining pre-post measures. These results, along with the results of previous studies, provide preliminary support for the use of telehealth to provide ABA services. However, there is a need for additional research evaluating the efficacy of these types of programs.

Effectiveness of Remote Delayed Performance Feedback on Accurate Implementation of Caregiver Coaching.

The supervision of field experiences is an indispensable component of Board-Certified Behavior Analyst (BCBA®) training. During the supervised field experience, supervisors regularly provide performance feedback to trainees for the purpose of improving fidelity of implementation of various assessments and interventions. Emerging evidence supports the efficacy of using telehealth to train teachers and parents to implement interventions, but no study has evaluated the effectiveness of the remote delayed performance feedback among individuals completing BCBA® training. We used videoconference equipment and software to deliver remote delayed performance feedback to seven participants enrolled in a graduate program and completing supervised field experience. Remote delayed performance feedback was provided regarding participants' implementation of caregiver coaching. The results indicate that delayed performance feedback provided remotely increased the correct implementation of caregiver coaching. These preliminary results indicate the efficacy of remote supervision and delayed performance feedback.

Utilizing Telehealth to Coach Parents to Implement Trial-Based Functional Analysis and Treatment.

The trial-based functional analysis (TBFA) offers several advantages in natural settings, such as time efficiency and ecological validity. Previous studies have successfully trained or coached a variety of professionals and parents to conduct a TBFA utilizing in-person training procedures; however, no study has evaluated the effectiveness of telehealth coach or train others to implement a TBFA. Utilizing telehealth coaching, we coached three mothers of children with autism to conduct a TBFA in their home. The TBFA identified consequences maintaining challenging behavior for all three participants. Based on the results of the TBFA, we developed a functional communication training (FCT) intervention. Experimenters coached the mothers to implement the FCT intervention in their home. All interventions resulted in decreased challenging behavior and increased communication. The results suggest parents are capable of conducting a valid TBFA with telehealth coaching and support.

Parent-implemented brief functional analysis and treatment with coaching via telehealth.

We evaluated the use of parent-implemented brief functional analyses in the home with coaching delivered via telehealth. Parents of 7 children with autism conducted functional analyses of their child's challenging behavior. For 4 participants, the brief functional analysis provided information regarding the function of the child's challenging behavior. A full functional analysis indicated a social function for 1 participant. The brief functional analysis yielded false positive results and subsequent assessment indicated an automatic function for another participant. The final participant did not engage in sufficient rates of challenging behavior to provide information regarding the function of the child's challenging behavior. Treatment evaluations occurred with 4 participants; these evaluations provided support for the results of the functional analysis. Together with previous research, the results indicate that parent-implemented brief functional analyses, followed by additional assessment as needed, may be an effective method for assessing and treating challenging behavior via telehealth.

A Comparison of Demand Fading and a Dense Schedule of Reinforcement During Functional Communication Training.

Ample research indicates that functional communication training (FCT) is an effective intervention to reduce challenging behavior. The purpose of this study was to evaluate the effect of demand fading on escape-maintained challenging behavior, mands, and task completion for 2 children with autism spectrum disorder. The study utilized an embedded reversal and alternating-treatments design to evaluate the efficacy of the intervention and compare the efficacy of the demand fading and dense schedule conditions. During FCT, participants were taught 2 mand topographies, one of which was associated with demand fading. FCT with and without demand fading resulted in decreases in challenging behavior for both participants. FCT with demand fading resulted in higher task completion for both participants. The effect of demand fading on the rate of mands varied by participant. Results provide further support for the use of FCT. The importance of intervention fading in the treatment of challenging behavior is discussed.

Evaluating Preference and Performance in Accumulated versus Distributed Response-Reinforcer Arrangements.

To determine the effects of response-reinforcer arrangements on task performance and preference, participants completed tasks on accumulated and distributed response-reinforcer arrangements. Three males diagnosed with an autism spectrum disorder completed tasks before receiving 5-min or 30-seconds access to a preferred stimulus. To enhance discrimination between the two arrangements, color-coded token boards were used to represent each arrangement. Responding was evaluated within a multielement design to compare the response rate across conditions for each participant. A preference assessment was conducted after the comparison to determine whether a preference for one of the arrangements emerged. All participants produced a higher rate of responding in the accumulated schedule of reinforcement.

A Review of the Literature on the Functional Analysis of Inappropriate Mealtime Behavior.

A functional analysis is a well-established and widely used assessment in the treatment of challenging behavior. Given the fact that functional analysis results can inform treatment selection and procedures, a review of the current literature regarding functional analysis of inappropriate mealtime behavior (IMB) is warranted as it may guide researchers in conducting a functional analysis prior to treating IMB. This review summarizes the literature regarding functional analysis of IMB. Fourteen studies that implemented a functional analysis of IMB were identified and summarized based on procedural components of the functional analysis, results, and treatment selection. Results indicate functional analysis of IMB to be effective in the identification of variables maintaining IMB. Although functional analysis of IMB has been found to be helpful, several areas for further research and evaluation are identified.

Introduction to the Special Issue: Interventions to Reduce Challenging Behavior Among Individuals With Autism Spectrum Disorder.

The prevalence of autism spectrum disorder (ASD) is on the rise. In addition to the social communication skill deficits and restrictive repetitive behaviors and interests, many individuals with ASD engage in challenging behavior. Challenging behavior is associated with a multitude of negative outcomes. Challenging behavior may cause harm to the individual with ASD as well as limit opportunities for educational, vocational, and social participation and development. In addition, caregivers experience high stress and low quality of mental health. As a result, challenging behavior warrants intervention that is specifically tailored to the unique characteristics of individuals with ASD. The purpose of this Special Issue is to showcase recent research in the treatment of challenging behavior for individuals with ASD. This two-part Special Issue contains 12 studies that range from systematic and quality reviews of the intervention literature, to innovative treatment approaches, to studies that develop and evaluate treatments for restrictive and repetitive behaviors and interests.

Introduction to the Special Issue: Interventions to Reduce Challenging Behavior Among Individuals With Autism Spectrum Disorder.

The prevalence of autism spectrum disorder (ASD) is on the rise. In addition to the social communication skill deficits and restrictive repetitive behaviors and interests, many individuals with ASD engage in challenging behavior. Challenging behavior is associated with a multitude of negative outcomes. Challenging behavior may cause harm to the individual with ASD as well as limit opportunities for educational, vocational, and social participation and development. In addition, caregivers experience high stress and low quality of mental health. As a result, challenging behavior warrants intervention that is specifically tailored to the unique characteristics of individuals with ASD. The purpose of this Special Issue is to showcase recent research in the treatment of challenging behavior for individuals with ASD. This two-part Special Issue contains 12 studies that range from systematic and quality reviews of the intervention literature, to innovative treatment approaches, to studies that develop and evaluate treatments for restrictive and repetitive behaviors and interests.

Differential Reinforcement of Other Behaviors to Treat Challenging Behaviors Among Children With Autism: A Systematic and Quality Review.

This review summarizes the literature regarding differential reinforcement of other behaviors (DRO) to treat challenging behavior among children with autism spectrum disorder (ASD) and determines the quality of studies among the current literature according to the 2014 Council for Exceptional Children (CEC): Standards for Evidence-Based Practices in Special Education. Studies that focused on the use of DRO in the treatment of challenging behavior for individuals with ASD were included for systematic analysis. Forty-five studies were identified for inclusion in this review and were evaluated using the eight quality indicators described by the CEC. To the authors' knowledge, this is the only systematic review of the literature that evaluates DRO as an intervention for individuals diagnosed with ASD. Principle findings, practical recommendations, and areas of future research are discussed.

Using Shaping to Increase Foods Consumed by Children with Autism.

The current study used differential reinforcement and shaping to increase the variety of foods accepted by children with autism who demonstrated significant feeding inflexibility. Participants were introduced to four new food items via a hierarchical exposure, which involved systematically increasing the desired response with the food item. Level of food consumption was evaluated using a combined multiple baseline plus changing criterion design. Following intervention, all participants accepted all foods targeted, expanding upon the number of foods consumed.

Analysis of Behavioral Indicators as a Measure of Satiation.

Providing noncontingent access to a stimulus until an individual displays behavioral indicators of satiation has been used to determine when an abolishing operation is in effect, but there has been variation in its application in the literature. Four males diagnosed with autism spectrum disorder with tangibly maintained challenging behavior participated in this study. Individualized behavioral indicators were identified and verified to determine when each participant was finished playing with his/her preferred item. Three presession conditions were manipulated including restricted access to the tangible stimulus for 30 min, access to the tangible stimulus until the display of one behavioral indicator, and access to the tangible stimulus until the display of three behavioral indicators. Each presession condition was followed by a tangible condition of the functional analysis to measure challenging behavior. Results indicated that presession access to a tangible stimulus until the display of three behavioral indicators produced a greater abative effect on challenging behavior than one behavioral indicator.

A Review and Treatment Selection Model for Individuals with Developmental Disabilities Who Engage in Inappropriate Sexual Behavior.

Some individuals with developmental disabilities develop inappropriate sexual behaviors such as public masturbation, disrobing, and touching others in an unwanted sexual manner. Such acts are problematic given the taboo nature of the behaviors and the potential for significant negative consequences, such as restricted community access, injury, and legal ramifications. Therefore, it is necessary to equip caregivers and practitioners with effective treatment options. The purpose of this paper is to review studies that have evaluated behavioral treatments to reduce inappropriate sexual behavior in persons with developmental disabilities. The strengths and weaknesses of each treatment are reviewed, and a model for treatment selection is provided.

Effects associated with on- and off-label stimulant treatment of core autism and ADHD symptoms exhibited by children with autism spectrum disorder.

OBJECTIVE: Families of children with autism spectrum disorder are barraged by different treatment options. Some of these options have the support of empirical evidence while others do not. Stimulant treatments are typically utilized to treat symptoms of ADHD indicating an on-label use of such treatment. METHODS: This study examines the association of stimulant treatment with the on- (symptoms of ADHD) and off- (symptoms of ASD) label symptoms among children with ASD via a non-clinical, population-based sample. RESULTS: Results indicate no significant association of stimulant treatment with a reduction of on- or off-label symptoms among children with ASD. CONCLUSION: Stimulant medications utilized in the treatment of DSM core symptoms of autism spectrum disorder would be considered an off-label use because there is limited evidence to support that stimulants are effective in treating core symptoms of ASD, which is supported by the results of the current study.

An examination of within-session responding following access to reinforcing stimuli.

Previous research has shown tangibly maintained challenging behavior can be temporarily decreased by providing presession access to the relevant tangible. However, the duration of this beneficial effect is unknown. We measured the subsequent duration of behavior reduction effects following presession access during extended classroom observation sessions by analyzing within-session patterns of responding in three children with autism. An alternating treatments design was used to analyze within- and across-session responding following presession access and presession restriction conditions. The cumulative frequency of challenging behavior was higher following the presession restriction condition for all participants and lower following presession access. Within-session analysis revealed the same basic pattern of responding across participants. Specifically, the first half of the sessions contained very little, if any, challenging behavior; however, after 60 min, the rate of challenging behavior began to increase rapidly for two of the three participants. Results are discussed in terms of implications for practitioners, satiation, habituation, and behavioral contrast.

Evaluation of interventions to reduce multiply controlled vocal stereotypy.

This study examined four interventions targeted at decreasing multiply controlled vocal stereotypy for a 12-year-old boy diagnosed with autism spectrum disorder and a severe intellectual disability. These interventions included Noncontingent Music, Differential Reinforcement of Other Behaviors, Self-Recording, and Functional Communication Training (FCT). In addition to measuring vocal stereotypy during each condition, task engagement and challenging behavior were also monitored. Across conditions, vocal stereotypy did not vary significantly from baseline except in FCT, when it decreased significantly. Task engagement was higher in this condition as well. It is hypothesized that FCT provided an enriched environment by increasing social interaction and access to desired items as well as removal of less preferred activities. For these reasons, there was a decrease in the need for the participant to engage in vocal stereotypy and challenging behavior and increase in his ability to engage in a task.

A comparison of general and explicit delay cues to reinforcement for tangible-maintained challenging behaviour.

OBJECTIVES: This compares effects of explicit delay cue to reinforcement to general delay cue to reinforcement when attempting to decrease tangible-maintained challenging behaviours of children with autism spectrum disorder (ASD). METHODS: Two school-age children with ASD participated in this study. In order to evaluate the effects of a general cue versus an explicit cue on the participants' tangibly maintained challenging behaviours, a multiple baseline design across settings with an embedded alternating treatments design was used. RESULTS: Results suggested that both types of delay cue to reinforcement demonstrated effectiveness on decreasing tangible-maintained behaviours of the participant. For both participants, an explicit delay cue demonstrated slightly better effects on the participants' challenging behaviours then a general delay cue. CONCLUSIONS: This study adds an evidence to support that delayed reinforcement can be used as an effective strategy to reduce both escape and tangible-maintained challenging behaviours of children with ASD across multiple settings.

Voices from the past: comparing the rapid prompting method and facilitated communication.

OBJECTIVE: This article briefly reviews the history and damage caused by facilitated communication (FC) and highlights the parallels between FC and the Rapid Prompting Method (RPM). BACKGROUND: FC involves a therapist (or facilitator) supporting the hand of a person with autism while a message is typed on a letter board. FC is widely acknowledged to be a pseudoscientific, unsafe, and unethical treatment for people with autism. RPM is a more recent intervention for people with autism that involves the facilitator holding and moving the letter board while the individual with autism moves their own hand. Those who espouse the perceived benefits of FC and RPM make strikingly similar claims of hidden intelligence and extraordinary communication abilities in people with autism following treatment. CONCLUSION: Clients, proponents, and practitioners of RPM should demand scientific validation of RPM in order to ensure the safety of people with disabilities that are involved with RPM.

Reduction of automatically maintained self-injurious behavior utilizing noncontingent matched stimuli.

OBJECTIVE: Analyze the effects of noncontingent matched stimulation (NMS) on the self-injurious behavior (SIB) of an eight-year-old boy with autism. METHODS: First, a functional analysis was conducted to identify the reinforcers maintaining SIB. Next, an informal preference assessment was conducted to identify a potential object to provide safe matched stimulation. A multielement design was implemented to evaluate the effects of two conditions: (a) noncontingent access to attention and unmatched stimulation (DVD player) and (b) intervention consisting of access to NMS. RESULTS: Results suggested that NMS resulted in a marked decrease of SIB relative to baseline conditions with unmatched stimulation. CONCLUSIONS: Findings suggest that unconventional stimuli may provide stimulation similar to that produced by SIB.