Functional analysis and generalized treatment of disruptive behavior during dental exams.

Patient disruption during dental visits can impede treatment and may result in invasive approaches to care. The current study evaluated the efficacy of graduated exposure with and without extinction to decrease disruption during dental treatment for 4 young men with autism spectrum disorder (ASD). Modified functional analyses confirmed that disruption was maintained by escape from dental demands for all four young men. Initial treatment consisted of graduated exposure, whereby exam steps were initially removed and then gradually reintroduced as disruption remained low; throughout this phase, disruption resulted in a break from the exam. During the subsequent treatment phase, graduated exposure procedures continued and extinction for disruption was added. Graduated exposure alone did not result in sufficient treatment effects; however, the addition of extinction resulted in greater reductions in disruption and increases in exam completion for all 4 young men, and treatment effects generalized to a dental clinic setting.

Effects of decreasing intersession interval duration on graduated exposure treatment during simulated routine dental care.

Reports suggest that individuals with developmental disabilities often engage in behavior during dental visits that precludes regular dental care. Graduated exposure therapies are an effective treatment for avoidant behavior in people with developmental delays, and some studies show that the duration of the intersession interval (ISI) can impact the effectiveness of graduated exposure treatments for typically developing individuals. The current study examined the effects of decreasing ISI on outcomes of a graduated exposure treatment during simulated routine dental care for 3 individuals diagnosed with autism. Treatment consisted of graduated exposure and extinction for disruptive behavior. Initially, sessions were conducted once per week. In subsequent conditions, treatment sessions were conducted 3-5 times per week. A nonconcurrent multiple baseline across subjects design was used to demonstrate experimental control. Results suggest that decreasing ISI durations can produce improved treatment outcomes.

Therapist and setting influences on functional analysis outcomes.

Functional analyses (FAs) of problem behavior typically are conducted in controlled settings to minimize potential sources of confounding. Several studies have reported that results of FAs conducted in controlled settings occasionally differ from those conducted under more naturalistic conditions, although little is known about factors that may contribute to the different outcomes. We examined correspondence between FAs conducted by staff in a clinic and those conducted either by caregivers as therapists or in the home setting. If results of the 2 analyses were dissimilar, we conducted further analyses to identify variables responsible for the different outcomes. Results showed that, in most cases, correspondence of function was observed across familiar and unfamiliar stimuli. Results are discussed in terms of implications for research and clinical practice for the evaluation of problem behavior.

Does supplementary reinforcement of stereotypy facilitate extinction?

Results of several studies suggest that delivery of supplemental (social) reinforcement for stereotypy might facilitate its subsequent extinction. We examined this possibility with 9 subjects who engaged in stereotypy by including methodological refinements to ensure that (a) subjects' stereotypy was maintained in the absence of social consequences, (b) supplementary reinforcers were highly preferred and were shown to be reinforcers for some behavior, and (c) subjects were exposed to lengthy reinforcement and extinction conditions. In spite of these modifications, only 4 subjects' stereotypy increased when supplementary reinforcement was delivered contingent on stereotypy, and no subject's stereotypy decreased below initial baseline levels when social reinforcement was subsequently withheld. Decreases in stereotypy occurred with the implementation of noncontingent reinforcement. Thus, delivery of supplementary reinforcers either did not increase stereotypy or did not facilitate extinction of stereotypy maintained by automatic reinforcement. We discuss the practical and conceptual bases of these results with respect to our current understanding of function-based interventions.

Latency of response during the functional analysis of elopement.

Elopement is a dangerous behavior sometimes exhibited by individuals with intellectual disabilities. We conducted trial-based functional analyses in which latency was the index of elopement for 2 students. Two unobtrusive safety monitors were placed outside the building to eliminate potential confounding caused by having to retrieve a student. Results of both students' assessments indicated that elopement served multiple functions. Results are discussed in terms of the study's methodological and applied implications.

Response latency as an index of response strength during functional analyses of problem behavior.

Dependent variables in research on problem behavior typically are based on measures of response repetition, but these measures may be problematic when behavior poses high risk or when its occurrence terminates a session. We examined response latency as the index of behavior during assessment. In Experiment 1, we compared response rate and latency to the first response under acquisition and maintenance conditions. In Experiment 2, we compared data from existing functional analyses when graphed as rate versus latency. In Experiment 3, we compared results from pairs of independent functional analyses. Sessions in the first analysis were terminated following the first occurrence of behavior, whereas sessions in the second analysis lasted for 10 min. Results of all three studies showed an inverse relation between rate and latency, indicating that latency might be a useful measure of responding when repeated occurrences of behavior are undesirable or impractical to arrange.