Virtual Training of Medical Students to Promote the Comfort and Cooperation of Patients with Neurodevelopmental Disabilities.

Patients with neurodevelopmental disabilities generally have less access to necessary medical care compared to those without disabilities. Barriers to adequate care include patient fear and uncooperative behavior during routine medical procedures and inadequate preparation of medical professionals to treat this population. Researchers have identified multiple behavior-analytic procedures for promoting comfort and cooperation during medical treatments. Efficient, cost-effective training programs are needed to widely disseminate behavior-analytic procedures to medical students and professionals. The purpose of this study was to assess the efficacy of a virtual training to prepare medical students to implement behavioral procedures that could be easily incorporated into typical wellness examinations. Seven medical students received behavioral skills training (BST) delivered remotely via the Internet. Results showed that the training successfully increased students' correct implementation of the procedures in roleplay with the experimenter and with patients with neurodevelopmental disabilities. Responding also maintained at high levels 2 weeks after the training. These findings suggest that virtual BST is an efficient, practical approach for training health care professionals to implement general behavior management strategies to increase the comfort and cooperation of patients with NDD.

A comparative effectiveness trial of functional behavioral assessment methods.

Clinicians report primarily using functional behavioral assessment (FBA) methods that do not include functional analyses. However, studies examining the correspondence between functional analyses and other types of FBAs have produced inconsistent results. In addition, although functional analyses are considered the gold standard, their contribution toward successful treatment compared with other FBA methods remains unclear. This comparative effectiveness study, conducted with 57 young children with autism spectrum disorder, evaluated the results of FBAs that did (n = 26) and did not (n = 31) include a functional analysis. Results of FBAs with and without functional analyses showed modest correspondence. All participants who completed functional communication training achieved successful outcomes regardless of the type of FBA conducted.

Putting the power of behavior analysis in the hands of nonbehavioral professionals: Toward a blueprint for dissemination†.

Behavior analysts have much to offer nonbehavioral professionals who work with the communities that we serve. Successful dissemination of behavior-analytic technologies to these professionals could potentially improve their practice. Although the literature contains some exemplary examples of successful dissemination, our discipline would benefit from a blueprint for conducting this important work. In this article, I share our experiences disseminating behavioral technologies to educators, law enforcement officers, and health care providers who engage with neurodiverse individuals. These experiences form the basis of a recommended blueprint for dissemination, which awaits empirical support. After describing this tentative blueprint, I provide suggestions for future research on how best to disseminate our technologies to nonbehavioral professionals, the ideal content of those dissemination activities, and the conditions under which professionals may be more likely to embed our technologies into their best practices.

When Science Cannot Guide us: A Call to Action for Applied Behavior Analysts.

Evidence presented in the ABAI Task Force Report on Contingent Electric Skin Shock (CESS) revealed serious ethical, clinical, and practical problems with the contemporary use of CESS. As a member of the task force, I ultimately concluded that our recommended position statement ("Position A") was a misguided attempt to uphold the field's commitment to client choice. Furthermore, information gathered by the task force supports an urgent call to find solutions to two additional troubling issues: a severe shortage of treatment services for severe problem behavior and the near-absence of research on treatment-resistant behavior. In this commentary, I discuss reasons Position A was not a tenable stance and why we must do better to help our most vulnerable clients.

Report of the ABAI Task Force on Contingent Electric Skin Shock.

As a task force appointed by the Executive Council of the Association for Behavior Analysis International (ABAI), we investigated the clinical use of contingent electric skin shock (CESS) in behavior analytic treatments for severe problem behavior. We studied how CESS is used in contemporary behavior analysis, reinforcement-based alternatives to CESS, and current ethical and professional guidelines for applied behavior analysts. We recommended that ABAI uphold clients' right to receive CESS when it is restricted to extreme cases and used under rigorous professional and legal oversight. Our recommendation was rejected by a vote of the full members of ABAI, who instead endorsed an alternative recommendation, developed by members of the Executive Council, that opposed the use of CESS under any condition. Here we present for the record our report and initial recommendations, the formal statement that was rejected by the members of ABAI, and the statement that was endorsed.

Fifteen Years and Counting: The Dissemination Impact of Behavior Analysis in Practice.

When Behavior Analysis in Practice (BAP) was founded 15 years ago, questions were raised about whether a practitioner-focused journal was really needed to complement our field's well-established applied research periodicals. Like research journals, BAP publishes primary research reports for which scholarly citations are one measure of impact. Unlike most research journals, it also was intended to achieve dissemination impact, which implies influence on people who may not conduct research or leave behind citations. Using altmetric data as an objective measure of dissemination impact, we present evidence that BAP is becoming a leader in this domain among applied behavior analysis journals, and thus appears to be accomplishing exactly what it was designed to. We recommend explicitly relying on dissemination impact data to help shape the journal's future development.

A comparison of synchronous and noncontingent stimulus delivery on task engagement.

Synchronous schedules of reinforcement are those in which the onset and offset of a reinforcer are synchronized with the onset and offset of a target behavior. The current study replicated and extended Diaz de Villegas et al. (2020) by comparing synchronous reinforcement to noncontingent stimulus delivery while evaluating on-task behavior of school-age children. A concurrent-chains preference assessment was then used to determine the preferred schedule. Results indicated that the synchronous schedule was more effective than the continuous, noncontingent delivery of the stimulus at increasing on-task behavior but that the children preferred noncontingent delivery. Additionally, the use of synchronous and noncontingent delivery did not alter the children's preference for the task.

A Decision-Making Tool for Evaluating and Selecting Prompting Strategies.

Literature has demonstrated the successful application of various prompts and prompt-fading procedures for teaching clients with intellectual and developmental disabilities. However, few practical resources exist to guide behavior analysts in the evaluation and selection of a prompting strategy for a given client and a targeted skill. In this article, we describe the development of a decision-making tool for selecting and evaluating prompting strategies, highlighting steps needed prior to evaluating clinical outcomes associated with the use of the tool. We used a multiple baseline across participants design to assess the ease with which graduate students could apply the decision-making tool with clients across a variety of skills. Results indicated that the participants learned to apply the decision-making tool with relatively limited involvement from a trainer. Social validity data collected from participants suggested that they found the tool helpful. Results contribute to the literature on the development of decision-making tools to guide behavior analysts in the selection of interventions to use with clients. Supplementary Information: The online version contains supplementary material available at 10.1007/s40617-022-00722-8.

Preparing Law Enforcement Officers to Engage Successfully with Individuals with Autism Spectrum Disorder: An Evaluation of a Performance-Based Approach.

Law enforcement officers (LEOs) may use physical force unnecessarily or escalate problem behavior when attempting to gain the compliance of individuals with autism spectrum disorder (ASD) (Copenhaver & Tewksbury in American Journal of Criminal Justice 44:309-333, 2019). Although specialized training may remedy this problem, the relatively small literature on such training programs indicates the need for further research (Railey et al. in Focus on Autism and Other Developmental Disabilities, 2020). This study used simulations with actors to evaluate the outcomes of performance-based instruction on strategies to promote compliance when LEOs respond to calls involving individuals with ASD. Results for three LEOs and 24 police cadets demonstrated the efficacy of behavioral skills training (BST) for teaching LEOs how to interact more effectively with individuals with ASD. Results also suggested that hands-on training should supplement commonly used forms of didactic instruction.

Remote Training of Dental Students and Professionals to Promote Cooperative Behavior in Patients with Intellectual and Developmental Disabilities.

Many individuals diagnosed with intellectual and developmental disabilities (IDD) are uncooperative during routine dental exams, leading to poor oral health in this population. Few studies have evaluated methodologies for preparing dental students and professionals to work effectively with patients diagnosed with IDD. In this study, experimenters used remote behavioral skills training (BST) to train dental students and professionals how to implement a practical intervention that included tell-show-do, contingent praise, and noncontingent reinforcement. Results suggested that group training conducted via videoconferencing was effective for teaching six of seven participants to implement the intervention in the absence of post-training feedback. This approach appears useful for quickly and efficiently training current and future dental professionals to implement behavior techniques to promote patient compliance.

Preliminary Results of an Interdisciplinary Behavioral Program to Improve Access to Preventative Dental Care for Adults With Intellectual and Developmental Disabilities.

Adults with intellectual and developmental disabilities (AIDD) experience significant oral health disparities, partially due to perceived behavioral issues. This article describes the preliminary outcomes of a developing interdisciplinary (dental, medical, behavioral) program involving a behavioral intervention for AIDD previously receiving preventative dental care with sedation, general anesthesia, or protective stabilization (SAS). After a baseline assessment, a board-certified behavior analyst implemented increasingly complex behavioral interventions during simulated dental visits. Prior to COVID-19 pandemic-related restrictions, there were 32 active participants; 15 (46.9%) successfully completed a focused, real dental exam with simple behavioral interventions and 17 (53.1%) remain in treatment. These preliminary results suggest that many AIDD previously receiving SAS may participate in a preventative dental exam with minimal behavioral supports, if given the opportunity.

Effects of environmental distractions on teachers' procedural integrity with three function-based treatments.

Past research has demonstrated the effectiveness of teacher-implemented, function-based treatments for problem behavior, but no studies have evaluated the impact of distractions on teachers' procedural integrity. In this proof-of-concept study, the experimenters employed a laboratory analog to examine the impact of distractions on levels of integrity when 5 teachers implemented 3 different treatments. Although integrity was similar across treatments when the setting was free of distractions, integrity declined for all teachers in the presence of student-driven distractions. In general, distractions had a greater impact on the integrity of differential negative reinforcement of alternative behavior (DNRA) compared to differential negative reinforcement of other behavior (DNRO) and noncontingent escape (NCE), particularly for the delivery of reinforcement. However, teachers tended to have lower levels of integrity when responding to problem behavior during DNRO. These findings support the potential viability of this approach for studying factors that impede procedural integrity in the classroom.

Teaching Adults with Neurodevelopmental Disabilities to Interact Successfully with Others in a Virtual Format.

As a result of the COVID-19 pandemic, individuals with neurodevelopmental disabilities (NDD) are engaging more with others in virtual group formats for social, educational, and professional reasons. This study extends prior research by evaluating the efficacy of common behavioral interventions, including behavioral skills training, provided via group video conferencing to teach skills that are important when interacting with others in a virtual format. Four adults with NDD were taught to use their cameras and microphones appropriately and to make encouraging statements to one another while discussing current events and social skills-based lessons via Zoom™. Two of the three skills increased and maintained for all participants even after the experimenter faded the contingencies for appropriate responding. The third skill maintained after the experimenter arranged for the response to produce natural consequences. Tests for generalization across group leads and activities yielded promising results. Findings suggest that adults with NDD benefit from group-based telehealth services to improve skills needed to interact successfully with others in a virtual format.

Behavioral Assessment and Treatment via Telehealth for Children with Autism: From Local to Global Clinical Applications.

Functional analyses (FA) and functional communication training (FCT) are the most commonly used behavioral assessment and treatment approaches via telehealth for children with autism spectrum disorder (ASD) who display challenging behavior. The FA + FCT telehealth model has been shown to maintain treatment effectiveness (i.e., child behavioral outcomes and parent acceptability), as well as demonstrate treatment efficiency (i.e., cost savings). However, the majority of these studies have been conducted in the United States. Therefore, the purpose of this study was to evaluate the outcomes obtained with the telehealth FA + FCT model that included global applications. Descriptive statistics were used to analyze the results of the 199 participants who enrolled in the telehealth project across all project sites. The results showed that behavioral outcomes and parent acceptability maintained at similar levels to previous studies across all sites. Additionally, very few differences were found across project sites in relation to drop-out rates, visit cancellations, and technology issues. These results demonstrate the effectiveness of the FA + FCT telehealth model for addressing the challenging behavior needs of children with ASD globally and highlight areas in need of additional evaluation (e.g., drop-outs, cancellations) to determine the conditions under which telehealth could be best used.

Towards the development of a curriculum to train behavior analysts to provide services via telehealth.

The COVID-19 pandemic has led to a dramatic increase in behavior analysts' use of telehealth services. Nonetheless, no research has evaluated the skills or training needed for therapists to provide these services effectively. The purpose of this study was to develop and evaluate a curriculum for providing high-quality, parent-training telehealth services. Four in-service Board Certified Behavior Analysts® (BCBAs®) who received brief behavioral skills training on this curriculum reached 100% fidelity within four sessions. The skills generalized to a novel family and maintained nearly 1 year after the training. All participants rated the training as highly acceptable and effective. The independent ratings of 4 in-service BCBAs, blinded to the study conditions, also supported the social validity of the outcomes. This curriculum may be considered an initial step towards development of competency for interventionists providing ABA services via telehealth. Further research is warranted as demand for telehealth services continues to grow.

Parent Ratings of Generalized and Indirect Effects of Functional Communication Training for Children with Autism Spectrum Disorder.

Functional communication training (FCT) is a behavioral treatment that has been shown to reduce problem behavior and increase appropriate communication in young children with autism spectrum disorder (ASD). In this study, we assessed the effects of FCT on targeted and nontargeted problem behaviors outside of the training context, as well as parent stress, for 30 young children with ASD and their parents. Indirect measures of generalization treatment effects were administered prior to and following FCT treatment delivered via telehealth. Children demonstrated significant improvement on both targeted (measured via observation) and nontargeted (measured via checklist) problem behaviors, both within and outside of the training context, and parent stress was significantly reduced following treatment. These results suggest that the impact of FCT may extend beyond the training context for both the children being treated and the parents delivering treatment, even when generalization is not specifically programmed for during treatment.

Discrete-trial training performance of behavior interventionists with autism spectrum disorder: A systematic replication and extension.

Further research is needed on strategies to improve employment outcomes for individuals with autism spectrum disorder (ASD). We replicated and extended prior research by examining the acquisition, maintenance, and generalization of discrete-trial training (DTT) performance of adults with ASD who were interested in careers as behavior technicians. Three participants received training on how to implement DTT with children and we assessed the maintenance and generalization of DTT performance in the absence of feedback. Results indicated that procedural integrity generalized across children and targets and maintained for 6 to 17 session days without feedback. Results have implications for the successful employment of individuals with ASD as behavior technicians and for future research on strategies to enhance their performance on the job.

Outcomes of a practical approach for improving conversation skills in adults with autism.

Many individuals with autism spectrum disorder (ASD) have deficits in conversation skills that can interfere with the development of personal and professional relationships. Further research is needed on efficient interventions for targeting conversation skills in adults with ASD and for evaluating the social validity of the outcomes. In this study, 2 practitioners implemented a 4-week training program for 5 adults with ASD that combined individualized computer-based instruction (CBI) and practice with peers to promote the acquisition, maintenance, and generalization of conversation skills. Training was associated with improvements in 12 of 13 skills across participants. These findings, along with peer ratings of the participants' conversation skills, suggest that this model is a promising, socially valid approach for improving conversation skills in adults with ASD.

Teaching adults with developmental disabilities to problem solve using electronic flowcharts in a simulated vocational setting.

Teaching job-related problem-solving skills may increase the likelihood that individuals with developmental disabilities obtain and maintain employment (Kaye et al., 2011; Peck & Kirkbride, 2001; Unger, 2002). In this study, we evaluated the use of electronic-based flowcharts on an iPod Touch as a form of self-instruction to increase problem solving skills with 2 men diagnosed with developmental disabilities. An instructor implemented behavioral skills training (BST) to teach the participants how to use an electronic flowchart to solve one problem and then evaluated the participants' use of electronic flowcharts to solve other types of problems, including those that required more than one solution. Results showed increases in problem solving skills across at least 2 problems that were not associated with BST and increases across all problem exemplars with verbal reminders and feedback. These findings have important implications for increasing independence on the job and decreasing intrusive and costly supports for those with disabilities.