COVID-19 Vaccination Clinic for Individuals With Autism Spectrum Disorder and Related Disorders: Feasibility and Acceptability.

INTRODUCTION: Autistic individuals often have comorbid medical conditions, which can increase the likelihood of being severely affected by COVID-19. The best prevention for this is vaccination. However, some autistic individuals engage in behaviors that might create a barrier to successful vaccination. AIMS: We describe the development and acceptability of a clinic specializing in the administration of COVID-19 vaccines for individuals diagnosed with autism spectrum disorder (ASD) who exhibit challenging behavior. METHOD: The clinic utilized behavioral antecedent strategies and contingencies to increase compliance with the vaccine and decrease distress associated with the procedure. RESULTS: We achieved a 100% success rate with vaccine administration and caregivers reported high satisfaction with the clinic. CONCLUSIONS: The present vaccine clinic is adaptable to various settings and patients and was well-received overall by caregivers. Replication in different geographic regions may be beneficial when resources allow for this type of clinic.

A Feasibility Randomized Clinical Trial of a Structured Function-Based Intervention for Elopement in Children with Autism Spectrum Disorder.

Elopement is a common and dangerous concern in autism spectrum disorder (ASD). There is evidence that behavior analytic treatments can successfully treat elopement, but the research is limited due to small samples and treatment components varying across studies. The current study evaluated the feasibility of studying a manualized intervention for elopement, based on strategies from single-subject research, in a randomized clinical trial with 24 individuals with ASD. Results demonstrated that recruitment was feasible; the manual was acceptable to parents; and therapists followed the manual with high-integrity. Initial efficacy results measured by the Aberrant Behavior Checklist, Clinical Global Impression Scale, and a Home Elopement Safety Checklist suggested improvement in the treatment group that should be studied in future research.

A Pilot Randomized Clinical Trial of a Multidisciplinary Intervention for Encopresis in Children with Autism Spectrum Disorder.

Children with autism spectrum disorder (ASD) are often delayed in achieving bowel continence, resulting in negative outcomes. In this pilot trial, 20 children with ASD and encopresis were randomly assigned to multidisciplinary intervention for encopresis (MIE; n = 10) or a waitlist control group (n = 10). The MIE group was treated for constipation and received a 10-day behavioral intervention that utilized suppositories to produce predictable bowel movements that were reinforced. Caregivers were trained to implement the intervention. Results support the feasibility of clinical trials of MIE, with high enrolment, competition, attendance, and caregiver acceptability. Preliminary outcomes were positive, with six of 10 in the MIE group achieving continence by the end of treatment compared to 0 in the control group (p = 0.005).Registered at clinicaltrials.gov (https://clinicaltrials.gov); ID: NCT02383732.

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.

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

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.

Practice Recommendations for Addressing Problem Behaviors in Siblings with Autism Spectrum Disorder.

Children with autism spectrum disorder (ASD) display an increased prevalence of problem behavior, relative to the typically developing population. Given the heritability of ASD and its growing prevalence, clinicians who implement behavioral treatments are likely to encounter families with siblings with ASD who exhibit problem behavior. Thus, there is a need for guidance for treatment of problem behavior for these families. This paper presents strategies for conducting behavioral assessments, developing treatments for problem behaviors, caregiver training, and generalization strategies when there are multiple affected children in one family. A case study is presented to illustrate the key clinical decisions made to increase the likelihood of a successful treatment outcome for these families.

Correspondence between the results of functional analyses and brief functional analyses.

PURPOSE: This study sought to examine the correspondence between brief functional analyses and more thorough functional analyses as described in the model of functional assessment proposed by Vollmer et al.1 Methods: A panel of trained clinicians indicated the presence/absence of specific functions of problem behavior based on graphic results from brief functional analyses and functional analyses conducted with 19 participants. These conclusions were compared across assessments. RESULTS: The functions identified by the panel based on results of brief functional analyses had low correspondence with those of the more thorough functional analysis conducted with the same participants. CONCLUSIONS: Although brief-functional analyses appear regularly in clinical practice and the literature, findings from this study suggest that results may differ from those of more thorough functional analyses. Additional study is necessary to determine the cause of discrepant results between these two methodologies.

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).

The effects of variable-time versus contingent reinforcement delivery on problem behavior maintained by escape.

Results of previous research indicate that the delivery of positive reinforcement (e.g., food) for an appropriate, alternative target response (e.g., compliance) or delivery of food on a time-based schedule can decrease problem behavior reinforced by escape, even when problem behavior continues to produce negative reinforcement (e.g., Lalli et al., ; Lomas, Fisher, & Kelley, ). In this study, we compared the levels of both compliance and problem behavior when food and praise were delivered either contingent on compliance or on a time-based schedule. Results for 3 of the 4 participants showed that contingent delivery of preferred edible items and praise was more effective in both reducing problem behavior and increasing compliance compared to variable-time delivery of these same items. These findings are discussed in the context of motivating operations and competition between positive and negative reinforcement.

Increasing the Social Validity of Function-Based Treatments for Problem Behavior / Aumentando la Validez Social de los Tratamientos Funcionales para la Conducta Problemática

Functional assessment, and function-based treatments, are the gold standard for the treatment of problem behavior. Historically, these assessment and treatment evaluations have been conducted in austere clinical settings to increase internal validity. While prioritizing internal validity is critical in the initial stages of a treatment evaluation, if there is not an eventual shift to prioritizing the external or social validity of the treatment it may inevitably fail in the natural environment. The purpose of this case example is to outline a socially valid approach to the assessment and treatment of problem behavior that ensures individuals' and their families' lives benefit in meaningful ways. More specifically, this case-example will outline a method of prioritizing social validity to identify treatment goals, conduct functional analysis, evaluate and generalize treatment, and implement caregiver training.

La evaluación funcional y los tratamientos funcionales son el estándar de oro para el tratamiento de la conducta problemática. Históricamente, esas evaluaciones y tratamientos se han conducido en escenarios clínicos austeros para aumentar la validez interna. Si bien el priorizar la validez interna es crítico en las etapas iniciales de la evaluación de un tratamiento, si eventualmente no hay un cambio para priorizar la validez externa o social del tratamiento, éste puede fallar en un escenario natural. El propósito del ejemplo de caso que se presenta en este trabajo es mostrar una aproximación válida para la evaluación y tratamiento de conducta problemática que asegura que las vidas de los individuos y de sus familias se beneficien de forma significativa. Más específicamente, el ejemplo de caso que se presenta mostrará un método para identificar las metas del tratamiento priorizando la validez social, para conducir un análisis funcional, evaluar y generalizar el tratamiento y entrenar al cuidador.