Further evidence of renewal in automatically maintained behavior.

Renewal is a relapse phenomenon that refers to the recurrence of a previously reduced behavior following a change in stimulus conditions. Muething et al. (2022) examined the phenomenology of renewal among individuals with automatically maintained challenging behavior treated at an outpatient clinic. We replicated their findings by retrospectively examining renewal across various topographies of automatically maintained behavior treated at an inpatient hospital, and we extended their work by also examining differences across subtypes of automatically maintained self-injurious behavior. The prevalence of renewal was comparable to that observed by Muething et al., supporting the notion that automatically maintained challenging behavior is susceptible to relapse phenomena. Furthermore, renewal was twice as likely to occur for individuals with Subtype 2 versus Subtype 1 self-injurious behavior, providing additional evidence of behavioral differentiation between subtypes. Our findings suggest that even after apparent stability in treatment, practitioners should remain vigilant for the recurrence of automatically maintained behavior during generalization.

Repetitive Speech and Problem Behavior: Functional Analysis of Precurrent Contingencies.

When mands and problem behavior co-occur within an individual's repertoire, a functional analysis of precurrent contingencies helps to identify any relation between the two responses, as well as the function of problem behavior. Repetitive behaviors may function similarly to mands and also co-occur with problem behavior; particularly when repetitive behavior is blocked, or when caregivers refrain from participating in repetitive behavior episodes (e.g., the repetitive behavior involves a verbal or physical interaction with a caregiver). The current study presents assessment and treatment results for two participants diagnosed with autism, who demonstrated repetitive speech and problem behavior. Informal observations suggested that problem behavior occurred when an adult failed to emit a specific response to the participant's repetitive speech. Functional analysis results confirmed the informal observations and suggested that problem behavior functioned as a precurrent response to increase the probability of reinforcement for repetitive speech. We report treatment results and discuss the application of precurrent contingency analyses for problem behavior and repetitive behavior.

A replication and extension of the augmented competing stimulus assessment.

Augmenting competing stimulus assessments by embedding tactics to increase stimulus engagement and disrupt challenging behavior can improve outcomes of treatments for automatically maintained self-injurious behavior, even for treatment-resistant subtypes. This study replicated and extended research on augmented competing stimulus assessments by reporting outcomes for 16 consecutively encountered cases with automatically maintained self-injurious behavior (19 total applications); six participants had treatment-responsive Subtype 1 and 10 had treatment-resistant Subtypes 2 or 3. Fewer high-competition stimuli were identified for individuals with treatment-resistant subtypes. When response-promotion and disruption tactics were applied and withdrawn, outcomes improved for six of eight applications. At least one high-competition stimulus was still effective when maintenance probes were conducted for a subset of participants. Ultimately, at least one high-competition stimulus was identified for each participant. Although augmenting tactics may not be necessary for all individuals, these findings provide additional support for their efficacy with treatment-resistant self-injurious behavior.

Correction to: Assessment and Treatment of Challenging Behavior Maintained by a Nonvocal Mands Function.

[This corrects the article DOI: 10.1007/s40617-020-00486-z.].

Decreasing motor stereotypy with competing stimuli and tasks: Analysis of prompted engagement and response blocking.

Competing stimulus assessments (CSAs) are used to empirically identify stimuli associated with low levels of problem behavior. For some individuals with automatically maintained behavior, it can be difficult to identify effective competing stimuli. Recent research shows that prompting engagement and response blocking can be employed during the CSA to obtain significant reductions in problem behavior. The purpose of the present study was to replicate and extend prior research on the use of these tactics not only with competing stimuli, but also competing tasks, which require the active completion of a discrete response or response sequence. In addition, the current study validated the results of these pretreatment assessments in an extended treatment analysis, and examined the isolated and combined effects of prompting and response blocking within a component analysis. Future research directions and implications for clinical practice are discussed.

Prevalence of renewal of problem behavior: Replication and extension to an inpatient setting.

Individuals with intellectual and developmental disabilities who exhibit problem behavior often receive behavioral assessment and treatment in specialized inpatient and outpatient clinics. However, problem behavior sometimes reemerges as a function of changes in contexts and stimulus conditions, such as returning to the home environment. This reemergence is called renewal. Recently, Muething et al. (2020) found that renewal occurred in over half (67%) of cases from an outpatient clinic. Their sample was obtained exclusively from an outpatient setting and despite the applied relevance of renewal, its clinical prevalence in other populations is unknown. Accordingly, we replicated Muething et al.'s procedures and analyzed renewal in 37 inpatient treatment applications across 34 cases via consecutive-controlled case series. Renewal was present in 59% of cases; however, we found that renewal occurred in only 24% of context changes compared to 42% reported by Muething et al. Various factors related to the prevalence of renewal were evaluated.

A Clinical Demonstration of Correlational and Experimental Analyses of Precursor Behavior.

Individuals with intellectual and developmental disabilities are at an increased risk for engaging in severe problem behavior, which is often preceded by less intense precursor behaviors. These precursor behaviors may be a viable option as target behaviors for functional analyses in situations where evoking severe problem behavior is not ideal. We identified precursor behaviors through a correlational analysis and confirmed their membership in the same response class as more severe problem behavior through an experimental analysis.

Assessment and Treatment of Challenging Behavior Maintained by a Nonvocal Mands Function.

Standard functional analysis procedures may require modifications to assess idiosyncratic variables, such as adult compliance with mands. In the literature, the mands function is largely represented by individuals who vocally communicate idiosyncratic requests. Although effective treatment procedures have been published, schedule thinning has rarely been conducted. Using a reversal design, a mands functional analysis was completed with a 12-year-old nonvocal male. Results showed differentiated rates of challenging behavior. Treatment consisted of differential reinforcement via a chained schedule with signaled availability. During schedule thinning, low rates of challenging behavior were maintained.

Family Accommodation and Severe Problem Behavior: Considering Family-Based Interventions to Expand Function-Based Treatment.

Family involvement in routines that exacerbate and maintain child anxiety is referred to as family accommodation. Family involvement is also related to maintenance of severe problem behavior (SPB) demonstrated by children with intellectual and developmental disabilities (IDD). Family members may deliver attention, tangible items, or remove aversive task demands that produce temporary cessation, or avoidance of SPB, but long-term maintenance. This Clinical Perspectives article describes parallels between the treatment of family accommodation in child anxiety and the assessment and treatment process for SPB. Suggestions are described for borrowing the concept of family accommodation to help caregivers of children who demonstrate SPB begin to approach previously avoided contexts. A case vignette is provided to illustrate strategies for targeting family accommodation as an expansion of function-based treatments for SPB.

Correspondence between Fail-Safe k and Dual-Criteria Methods: Analysis of Data Series Stability.

Barnard-Brak, Richman, Little, and Yang (Behaviour Research and Therapy, 102, 8-15, 2018) developed a structured-criteria metric, fail-safe k, which quantifies the stability of data series within single-case experimental designs (SCEDs) using published baseline and treatment data. Fail-safe k suggests the optimal point in time to change phases (e.g., move from Phase B to Phase C, reverse back to Phase A). However, this tool has not been tested with clinical data obtained in the course of care. Thus, the purpose of the current study was to replicate the procedures described by Barnard-Brak et al. with clinical data. We also evaluated the correspondence between the fail-safe k metric with outcomes obtained via dual-criteria and conservative-dual criteria methods, which are empirically supported methods for evaluating data-series trends within SCEDs. Our results provide some degree of support for use of this approach as a research tool with clinical data, in particular when evaluating small or medium treatment effect sizes, but further research is needed before this can be used widely by practitioners.

An evaluation of the Aberrant Behavior Checklist for children under age 5.

Severe problem behaviors such as self-injury and aggression are frequently observed in young children under age 5 with intellectual and developmental disabilities (IDD). Although early identification of problem behavior is critical to effective intervention, there are few standardized measures available that identify severe problem behavior in this population. The Aberrant Behavior Checklist-Community (ABC-C; Aman & Singh, 1994) is a rating scale that measures the severity of a range of problem behaviors commonly observed in individuals with IDD. While it has been used with children under 5, investigations into the fit of the ABC-C for this population are sparse. The purpose of the present study was to report on ABC-C scores in a sample of 97 children under age 5 with problem behavior. Analyses included evaluating differences in scores between age groups, comparing sample norms to established norms for older children, and conducting a confirmatory factor analysis. Results indicated differences in mean scores based on age with younger children generally scoring higher on some subscales of the ABC-C. Furthermore, the original 5-factor structure of the ABC-C was not fully supported. In general, the ABC-C may over- or underestimate behavior problems in younger children; therefore more extensive investigation into the utility of the ABC-C for children under age 5 is warranted.

Graduated exposure and positive reinforcement to overcome setting and activity avoidance in an adolescent with autism.

Some students who have developmental disabilities avoid settings and activities that can improve their learning and quality of life. This two-phase study concerned an adolescent boy with autism who avoided the gross-motor exercise room, gymnasium, and music room at his school; he demonstrated distress, agitation, and problem behaviors when prompted to enter these areas. Using graduated exposure combined with positive reinforcement, he learned to enter these settings without resisting and eventually to participate in activities within the settings. This article discusses this intervention approach for reducing and eliminating avoidant behavior.