Evaluation of Empirical Pretreatment Assessments for Developing Treatments for Packing in Pediatric Feeding Disorders.

A significant problem among children with feeding disorders is packing (i.e., pocketing or holding accepted food in the mouth), which could hinder successful treatment. Previous research has identified effective treatments to reduce packing; however, an assessment model to guide treatment decisions is lacking. In the present study, we used a multielement design to identify conditions under which low levels of packing occurred for 4 children with feeding disorders. Results were used to empirically inform treatment selection to decrease packing for 3 children. Assessments indicated that packing was related to texture, food preference, or response effort and subsequently informed individualized treatments, which led to decreased levels of packing. Results suggest that this model may be useful in the design of treatment packages for children who engage in packing at clinically problematic levels.

Behavioral Interventions for Pediatric Food Refusal Maintain Effectiveness Despite Integrity Degradation: A Preliminary Demonstration.

Food refusal is commonly treated using behavioral treatment packages consisting of differential reinforcement of alternative behavior (DRA) and escape extinction. However, the effectiveness of such behavioral interventions is inextricably linked to the integrity with which the procedures are conducted. Although previous research has evaluated the effects of treatment integrity failures for behavioral interventions related to severe problem behavior and academic skill acquisition, the effects of these failures in the area of pediatric food refusal remain unknown. We conducted a parametric analysis to assess the effects of varying levels of errors on the treatment efficacy of contingent tangibles and attention, and escape extinction. Once stable responding was observed during an initial evaluation of treatment, participants were exposed to sessions of reduced-integrity treatment in descending order (i.e., 80%, 60%, 40%, and 20%) and subsequently exposed to full-integrity treatment (100% integrity). For one participant, integrity errors became detrimental to treatment when the level of integrity was decreased to 40%. For the other two participants, contingent tangibles and attention, and escape extinction remained effective despite being implemented with low integrity. Our preliminary demonstration suggests that behavioral interventions for pediatric food refusal remain effective despite considerable treatment integrity degradation.

A Comparison of Descriptive and Functional Analyses of Inappropriate Mealtime Behavior.

In recent years, rather than being used to assess the potential function of a response, descriptive assessment methods have been applied to evaluate potential consequences or contingencies for problem behavior (Borrero, Woods, Borrero, Masler, & Lesser in Journal of Applied Behavior Analysis, 43, 71-88. doi: 10.1901/jaba.2010.43-71, 2010) or to assist with designing baseline conditions to approximate caregiver behavior (Casey et al. in Behavior Modification, 33, 537-558. doi: 10.1177/0145445509341457, 2009). It has been shown that descriptive assessments of some forms of problem behavior (e.g., self-injury, aggression) are not good indicators of behavioral function and should not be used exclusively when conducting functional behavior assessments (Thompson & Iwata in Journal of Applied Behavior Analysis, 40, 333-338. doi: 10.1901/jaba.2007.56.06/epdf, 2007). However, the extent to which descriptive assessments of inappropriate mealtime behavior can predict behavioral function is not yet clear. We conducted descriptive assessments of inappropriate mealtime behavior and compared the results to functional analyses for ten children with severe food refusal. Results showed that, for 71 % of participants, the descriptive and functional analyses matched. These results suggest that the correspondence between descriptive and functional analyses, at least for inappropriate mealtime behavior, may be higher than that for other forms of problem behavior.

REDUCING AMBIGUITY IN THE FUNCTIONAL ASSESSMENT OF PROBLEM BEHAVIOR.

Severe problem behavior (e.g., self-injury and aggression) remains among the most serious challenges for the habilitation of persons with intellectual disabilities and is a significant obstacle to community integration. The current standard of behavior analytic treatment for problem behavior in this population consists of a functional assessment and treatment model. Within that model, the first step is to assess the behavior-environment relations that give rise to and maintain problem behavior, a functional behavioral assessment. Conventional methods of assessing behavioral function include indirect, descriptive, and experimental assessments of problem behavior. Clinical investigators have produced a rich literature demonstrating the relative effectiveness for each method, but in clinical practice, each can produce ambiguous or difficult-to-interpret outcomes that may impede treatment development. This paper outlines potential sources of variability in assessment outcomes and then reviews the evidence on strategies for avoiding ambiguous outcomes and/or clarifying initially ambiguous results. The end result for each assessment method is a set of best practice guidelines, given the available evidence, for conducting the initial assessment.

Concurrent reinforcement schedules for problem behavior and appropriate behavior: experimental applications of the matching law.

This study evaluated how children who exhibited functionally equivalent problem and appropriate behavior allocate responding to experimentally arranged reinforcer rates. Relative reinforcer rates were arranged on concurrent variable-interval schedules and effects on relative response rates were interpreted using the generalized matching equation. Results showed that relative rates of responding approximated relative rates of reinforcement. Finally, interventions for problem behavior were evaluated and differential reinforcement of alternative behavior and extinction procedures were implemented to increase appropriate behavior and decrease problem behavior. Practical considerations for the application of the generalized matching equation specific to severe problem behavior are discussed, including difficulties associated with defining a reinforced response, and obtaining steady state responding in clinical settings.

Descriptive analyses of pediatric food refusal and acceptance.

Functional analyses of inappropriate mealtime behavior typically include conditions to determine if the contingent delivery of attention, tangible items, or escape reinforce food refusal. In the current investigation, descriptive analyses were conducted for 25 children who had been admitted to a program for the assessment and treatment of food refusal to determine if the consequences commonly delivered during functional analyses were observed during parent-conducted meals. The conditional probabilities for the delivery of attention, tangible items, and escape following food refusal and acceptance were compared to the unconditional probabilities of each event. Results showed that attention and escape most frequently followed refusal and differed depending on the topography of refusal. Implications for further evaluations of food refusal using similar methods are discussed.

Descriptive analyses of pediatric food refusal: the structure of parental attention.

Mealtime observations were conducted and occurrences of appropriate and inappropriate mealtime behavior and various forms of parental attention (e.g., coaxing, reprimands) were recorded for 25 children admitted to an intensive feeding program and their parents. Using the data from the observations, lag sequential analyses were conducted to identify changes in the probability of child appropriate and inappropriate mealtime behavior before and after various forms of parental attention. A combination of univariate and repeated measures ANOVAs using frequency of child behavior were also conducted to corroborate conclusions drawn from the visual analysis of individual participant data. Results showed that parental attention was frequently followed by temporary decreases in inappropriate mealtime behavior and increases in bite acceptance. Moreover, various forms of parental attention resulted in statistically significant changes in child behavior, which supports the clinical utility of these data.

Descriptive and experimental analyses of potential precursors to problem behavior.

UNLABELLED: We conducted descriptive observations of severe problem behavior for 2 individuals with autism to identify precursors to problem behavior. Several comparative probability analyses were conducted in addition to lag-sequential analyses using the descriptive data. Results of the descriptive analyses showed that the probability of the potential precursor was greater given problem behavior compared to the unconditional probability of the potential precursor. Results of the lag-sequential analyses showed a marked increase in the probability of a potential precursor in the 1-s intervals immediately preceding an instance of problem behavior, and that the probability of problem behavior was highest in the 1-s intervals immediately following an instance of the precursor. We then conducted separate functional analyses of problem behavior and the precursor to identify respective operant functions. Results of the functional analyses showed that both problem behavior and the precursor served the same operant functions. These results replicate prior experimental analyses on the relation between problem behavior and precursors and extend prior research by illustrating a quantitative method to identify precursors to more severe problem behavior. DESCRIPTORS: descriptive assessment, functional analysis, lag-sequential analysis, precursors, problem behavior, response-class hierarchies

Experimental analysis and treatment of multiply controlled problem behavior: a systematic replication and extension.

We evaluated interventions designed to reduce multiply controlled problem behavior exhibited by a young boy with developmental disabilities, using a multiple baseline design. Each intervention was designed to address a specific social function of problem behavior. Results showed that the separate interventions were useful in reducing problem behavior, and terminal schedules were reached by way of schedule thinning (attention condition) and delays to reinforcement (tangible and escape conditions).

Descriptive analyses of caregiver reprimands.

We conducted descriptive observations of 5 individuals with developmental disabilities and severe problem behavior while they interacted with their caregivers in either simulated environments (an inpatient hospital facility) or in their homes. The focus of the study was on caregiver reprimands and child problem behavior. Thus, we compared the frequency of problem behavior that immediately preceded a caregiver reprimand to that immediately following a caregiver reprimand, and the results showed that the frequency of problem behavior decreased following a reprimand. It is possible that caregiver reprimands are negatively reinforced by the momentary attenuation of problem behavior, and the implications for long- and short-term effects on caregiver behavior are discussed.

A method for evaluating parameters of reinforcement during parent-child interactions.

We conducted functional analyses and identified reinforcers for problem behavior for three individuals with developmental disabilities. Based on results of the functional analysis, we evaluated the rate, probability, delay, and duration of reinforcement for problem and appropriate behavior during descriptive parent-child observations. Results showed that parameters of reinforcement, including rate, probability, delay, and duration may interact, and that evaluations of a single reinforcement parameter may be insufficient in describing response allocation. Hence, this study represents a movement toward a method for analyzing reinforcer dimensions, other than rate and probability, in a descriptive analysis.

On the role of attention in naturally occurring matching relations.

Prior researchers have evaluated the efficacy of using the matching law to describe naturally occurring behavior-environment interactions. However, spurious matching could be obtained if the response and environmental event were correlated, even if the event did not reinforce the response. To assess the likelihood of obtaining spurious matching when relating attention and problem behavior, we evaluated the problem behavior of 3 participants for whom attention did not serve as a reinforcer for problem behavior in a functional analysis. Both the simple and generalized matching equations were used to examine matching relations extracted from descriptive observations that were conducted in the participants' classrooms. The results of aggregated matching analyses showed that the proportional rate of responding approximately matched the proportional rate of contiguous adult attention. Matching analyses conducted for all participants showed correlations between attention and problem behavior. These results demonstrate that spurious matching can be obtained, and they highlight the role of functional analyses in the analysis of naturally occurring matching relations.