Assessment Of Behavioral Problems Research Articles

Behavior-analytic assessment and treatment of problem behavior maintained by social escape with individuals with intellectual and developmental disabilities: A systematic review.

Behavior-analytic assessment and treatment of problem behavior maintained by social escape with individuals with intellectual and developmental disabilities: A systematic review.

Auditory mismatch negativity in pre-manifest and manifest Huntington’s disease

AimThe aim of this study was to investigate the characteristics of the electrophysiological brain response elicited in a passive acoustic oddball paradigm, i.e. mismatch negativity (MMN), in patients with Huntington’s disease (HD) in the premanifest (pHD) and manifest (mHD) phases. In this regard, we correlated the results of event-related potentials (ERP) with disease characteristics. MethodsThis was an observational cross-sectional MMN study. In addition to the MMN recording of the passive oddball task, all subjects with first-degree inheritance for HD underwent genetic testing for mutant HTT, the Huntington’s Disease Rating Scale, the Total Functional Capacity Scale, the Problem Behaviors Assessment short form, and the Mini-Mental State Examination. ResultsWe found that global field power (GFP) was reduced in the MMN time window in mHD patients compared to pHD and normal controls (NC). In the pHD group, MMN amplitude was only slightly and not significantly increased compared to mHD, while pHD patients showed increased theta coherence between trials compared to mHD. In the entire sample of HD gene carriers, the main MMN traits were not correlated with motor performance, cognitive impairment and functional disability. ConclusionThese results suggest an initial and subtle deterioration of pre-attentive mechanisms in the presymptomatic phase of HD, with an increasing phase shift in the MMN time frame. This result could indicate initial functional changes with a possible compensatory effect. SignificanceAn initial and slight decrease in MMN associated with increased phase coherence in the corresponding EEG frequencies could indicate an early functional involvement of pre-attentive resources that could precede the clinical expression of HD.

Assessment and treatment of problem behavior occasioned by variable‐sequence transitions for children with autism

AbstractTransitions from one daily activity to the next can occasion problem behavior (e.g., aggression). Inspired by clinical descriptions of children with autism, we compared the effects of fixed‐sequence and variable‐sequence transitions on problem behavior using a multiple baseline across participant design. In the fixed‐sequence condition, participants were exposed to the same sequence of activities. In the variable‐sequence condition, the sequence of activities was varied semi‐randomly. Results showed that transition‐related problem behavior was more likely to occur in the variable‐sequence condition. Advance notice of the upcoming transition, in the form of auditory and visual cues, was effective at reducing transition‐related problem behavior in the variable‐sequence condition for two participants. Results are discussed in light of the effect of uncertainty of outcomes, and suggestions for future cross‐disciplinary research are provided.

A Comparative Study to Assess behavioural Problems in Preschoolers of working and Non working mothers from a selected Urban Community in Kachery, Thrissur

Title of the study: A comparative study to assess behavioural problems in preschoolers of working and non working mothers from a selected urban community in Kachery, Thrissur. Introduction: A large number of children suffer from behavioural problems at ltheir development stage. Mothers should able to detect any behavioural changes at the earliest Objective: Assess the behavioural problems in preschoolers of working and non working mothers selected urban community in Kachery, Thrissur. Compare behavioural problems in preschoolers of working and non working mothers from selected urban community in Kachery, Thrissur. Associate selected behavioural problems in preschoolers of working and non working mothers of selected demographic variable. Material and Methodology: The study was conducted among preschoolers of 70 working and 70 non working mothers. The research design of the study was descriptive comparative design and sample was selected by non-probability purposive sampling. Tool: The tool consists of 2 sections: Section A deals with A-socio demographic and clinical data and Section B consist of likert scale to assess behavioural problems in preschoolers of working and non working mothers. Result: Socio-demographic and clinical data variables shows that 22(31.4%) children from age group 3 years, while 18(25.7%) and 7(10%) children are from 5 years and less than 6 years respectively. In non working mothers, 30(42.9%) children are from age group 3 years whereas 19(27.1%) children from age group 4 years while 11(15.1%) and 10(14.3%) are from age group 5 years and less than 6 years respectively. In working mothers, 33(47.1%) children are males whereas 37(52.9%) are females. In non working mothers, 37(52.9%) children are females while 33(47.1%) are males. In working mothers, 0(0.0 %) mothers are illiterate 4(5.7 %) mothers have primary education while 8(11.4%) mothers have secondary education, 38(54.3 %) mothers are graduated and 20(28.6 %) mothers have professional education. In non working mothers, 1(1.4 %) mothers are illiterate whereas 12(17.1 %) mothers have primary education while 30(42.49 %) mothers have secondary education and 4(5.7 %) mothers have professional education. Assessment of behavioural problems in preschoolers of working and non working mothers shows, mild behavioural problem seen in children of working mothers 64(91.429%) which is significantly more than the non working mothers 53(75.714%). Moderate behavioural problems are seen in preschoolers of working mothers 2(2.857%). None of the preschoolers of non working mothers have moderate behavioural problems. 4(5.714%) preschoolers of working mother have no behavioural problems whereas 17(24.286%) preschoolers of non working mothers have no behavioural problems. None of the preschoolers are affected with severe behavioural problems in both groups. In this study, there is significant association of education of mothers with selected behavioural problems. Discussion: Preschoolers of working mothers have more behavioural problems than those of non working mothers. Nurse can play amajor role in diminishing the behavioural problems by providing guidelines and counselling for the mothers. More interventional studies need to be conducted to reduce occurrence of the behavioural problems in preschoolers.

Predicting and Managing Risk during Functional Analysis of Problem Behavior

Maintaining participant safety during the assessment of problem behavior is of upmost importance. The performance-based, interview-informed synthesized contingency analysis (IISCA) is a functional analysis that incorporates an open-ended interview with caregivers. We introduced additional questions to the interview to identify participants who are prone to escalation. We found that the percentage of dangerous problem behavior and the probability of a burst were correlated with reports of quick escalation. The results suggest that questions regarding escalation speed may be helpful for predicting any safety concerns. Researchers should consider procedural modifications when safety concerns are anticipated to ensure individuals feel physically secure.

Mental health symptoms among those affected by Huntington's disease: A cross-sectional study.

Although cognitive and motor symptoms of Huntington's disease (HD) are associated with disease progression, the underlying causes of psychological symptoms are not as clearly understood. Recent evidence suggests that some mental health difficulties experienced by people with HD are shared by noncarriers within HD families. Accordingly, there is a need to evaluate potential systemic contributors to HD mental distress, to support meaningful interventions for psychological symptoms in people with HD and affected families. We used short-form Problem Behaviors Assessment mental health symptom data from the international Enroll-HD data set to characterize mental health symptoms across eight HD groups: Stages 1-5, premanifest and genotype-negative individuals, and family controls (n=8567) using chi-square analysis with post hoc comparisons. We identified that people with later-stage HD (Stages 2-5) had significantly higher apathy, obsessive-compulsiveness, and (from Stage 3) disorientation than the remaining groups at a medium effect size, and that these findings largely held across three measure administrations over time. These findings highlight the critical symptoms in manifest HD from Stage 2 onward, but also demonstrate that crucial symptoms such as depression, anxiety, and irritability are present across HD-affected groups (including noncarriers of the gene expansion). The outcomes highlight a need for specific clinical management of later-stage HD psychological symptoms, and for systemic support across affected families.

Assessment and treatment of problem behavior with multiple functions for individuals with disabilities: A systematic review of the literature and discussion.

Assessment and treatment of problem behavior with multiple functions for individuals with disabilities: A systematic review of the literature and discussion.

Excessive response to provocation rather than disinhibition mediates irritable behaviour in Huntington's disease.

Irritable and impulsive behaviour are common in Huntington's disease (HD: an autosomal dominant disorder causing degeneration in cortico-striatal networks). However, the cognitive mechanisms underlying these symptoms remain unclear, and previous research has not determined if common mechanisms underpin both symptoms. Here we used established and novel tasks to probe different aspects of irritable and impulsive behaviour to determine the neural mechanisms involved. We recruited a cohort of 53 gene positive HD participants and 26 controls from non-affected family members and local volunteers. We used established questionnaire measures of irritability in HD (Snaith Irritability Scale, Problem Behaviours Assessment) and impulsivity [Urgency, Premeditation Perseverance, Sensation-seeking, Positive urgency scale (UPPSP), Barratt Impulsivity Scale], in addition to cognitive tasks of provocation, motor inhibition, delay discounting and decision making under uncertainty. We used generalised linear models to determine differences between cases and controls, and associations with irritability in the HD group. We found differences between cases and controls on the negative urgency subscale of the UPPSP, which was associated with irritability in HD. The frustrative non-reward provocation task also showed differences between cases and controls, in addition to predicting irritability in HD. The stop signal reaction time task showed case-control differences but was not associated with irritability in HD. None of the other measures showed group differences or predicted irritability in HD after correcting for confounding variables. Irritability in HD is mediated by excessive response to provocation, rather than a failure of motor inhibition.

Frequency and Pathophysiology of Apathy in Huntington Disease: A Systematic Review and Meta-Analysis.

Apathy is a common behavioral symptom of Huntington disease (HD). This systematic review describes current evidence on the pathophysiology, assessment, and frequency of apathy in HD. This systematic review was conducted in accordance with PRISMA guidelines. Using a comprehensive search strategy, the investigators searched the MEDLINE, Embase, and PsycINFO databases. All studies that evaluated apathy in HD patients with a valid scale and reported apathy frequency or scores were included. Apathy scores were analyzed by mean or standardized mean differences in accordance with Cochrane guidelines. A total of 1,085 records were screened and 80 studies were ultimately included. The Problem Behaviors Assessment-Short was the most frequently used apathy assessment tool. Apathy frequency generally ranged from 10%-33% in premanifest HD to 24%-76% in manifest HD. A meta-analysis of 5,311 records of patients with premanifest HD showed significantly higher apathy scores, with a standardized mean difference of 0.41 (CI=0.29-0.52; p<0.001). A comparison of 1,247 patients showed significantly higher apathy scores in manifest than premanifest HD, with a mean difference of 1.87 (CI=1.48-2.26; p<0.001). There was evidence of involvement of various cortical and subcortical brain regions in HD patients with apathy. Apathy was more frequent among individuals with premanifest HD compared with those in a control group and among individuals with manifest HD compared with those with premanifest HD. Considering the complexity and unique pattern of development in neurodegenerative disease, further studies are required to explore the pathophysiology of apathy in HD.

Different depression: motivational anhedonia governs antidepressant efficacy in Huntington's disease.

Depression is more common in neurodegenerative diseases such as Huntington's disease than the general population. Antidepressant efficacy is well-established for depression within the general population: a recent meta-analysis showed serotonin norepinephrine reuptake inhibitors, tricyclic antidepressants and mirtazapine outperformed other antidepressants. Despite the severe morbidity, antidepressant choice in Huntington's disease is based on Class IV evidence. We used complementary approaches to determine treatment choice for depression in Huntington's disease: propensity score analyses of antidepressant treatment outcome using the ENROLL-HD data set, and a dissection of the cognitive mechanisms underlying depression in Huntington's disease using a cognitive battery based on the Research Domain Criteria for Depression. Study 1 included ENROLL-HD 5486 gene-positive adult patients started on an antidepressant medication for depression. Our outcome measures were depression (Hospital Anxiety and Depression Scale or Problem Behaviours Assessment 'Depressed Mood' item) at first follow-up (primary outcome) and all follow-ups (secondary outcome). The intervention was antidepressant class. We used Svyglm&Twang in R to perform propensity scoring, using known variables (disease progression, medical comorbidity, psychiatric morbidity, sedatives, number of antidepressants, demographics and antidepressant contraindications) to determine the probability of receiving different antidepressants (propensity score) and then included the propensity score in a model of treatment efficacy. Study 2 recruited 51 gene-positive adult patients and 26 controls from the South Wales Huntington's Disease Management Service. Participants completed a motor assessment, in addition to measures of depression and apathy, followed by tasks measuring consummatory anhedonia, motivational anhedonia, learning from reward and punishment and reaction to negative outcome. We used generalised linear models to determine the association between task performance and depression scores. Study 1 showed selective serotonin reuptake inhibitors outperformed serotonin norepinephrine reuptake inhibitors on the primary outcome (P = 0.048), whilst both selective serotonin reuptake inhibitors (P = 0.00069) and bupropion (P = 0.0045) were superior to serotonin norepinephrine reuptake inhibitors on the secondary outcome. Study 2 demonstrated an association between depression score and effort for reward that was not explained by apathy. No other mechanisms were associated with depression score. We found that selective serotonin reuptake inhibitors and bupropion outperform serotonin norepinephrine reuptake inhibitors at alleviating depression in Huntington's disease. Moreover, motivational anhedonia appears the most significant mechanism underlying depression in Huntington's disease. Bupropion is improves motivational anhedonia and has a synergistic effect with selective serotonin reuptake inhibitors. This work provides the first large-scale, objective evidence to determine treatment choice for depression in Huntington's disease, and provides a model for determining antidepressant efficacy in other neurodegenerative diseases.

Assessment of Behavioral Problems in Children Pre- and Post-Cochlear Implant: An Egyptian Study.

Objective The present study aimed to detect the behavioral problems pre- and post-cochlear implantation in comparison to normal hearing group to be able to manage these problems to get more benefit from using cochlear implants. Methods A case-control study included 53 children was done. They were divided into 2 groups, the control group included 28 healthy volunteers with normal hearing and the case group included 25 children with severe to profound hearing loss, fitted for cochlear implantation. The Arabic Child Behavior Checklist (CBCL) was used to detect different behavioral problems in both groups. Case group children were followed up and reassessed again by CBCL 3 months later after cochlear implantation. Results There were highly significant differences regarding total scores of internalizing and externalizing domains of empirically based CBCL between the control group and the case group after cochlear implants (p=0.001). There were non-significant differences in children within case group (pre- and post-cochlear implantation) regarding emotional and behavioral problems on both empirically based and Diagnostic and Statistical Manual of Mental Disorders-based CBCL. Conclusion For better results, it is necessary to include a specialist of psychosomatic medicine in the cochlear rehabilitation teamwork.

Prevalence of violence and associated factors among youth in Northwest Ethiopia: Community-based cross-sectional study.

Violence as a known serious public health problem affects people in all stages of life, from childhood to the elderly. In society, one of the most visible forms of violence is young people violence, whereas they, adolescents and young adults, are the main victims of such violence. There was limited information on the burden of violence and factors among this age group. Therefore, this study aimed to determine the prevalence of violence and its associated factors among youth in Northwest, Ethiopia. A community-based cross-sectional study design was conducted to estimate the magnitude of violence among youth in Northwest, Ethiopia. Data were taken from the mega project entitled assessment of common health problem and risky health behavior among youth. Youth violence was the dependent variable whereas the socio-demographic variables and substance use were the independent-variables. The bivariate logistic regression model was employed to identify associated factors. An adjusted odds ratio with a 95% confidence interval was used to determine factors associated with violence. From the total 1765 representatives of the youth population,1597 (90.5%) youth participated in the study. Overall, the prevalence of violence among youth aged 15-24 years for the last 12 months was 21.5%. In the multivariable logistic regression model, factors significantly associated with violence were being married and divorced (AOR = 1.77, 95%CI: 1.13, 2.79) and (AOR = 5.67, 95%CI: 2.93, 10.99), respectively, living with mother's only (AOR = 1.85,95%CI: 1.28, 2.66) and father's only (AOR = 2.45, 95% CI: 1.30, 4.63), and substance use (AOR = 2.38,95% CI: 1.56, 3.66). The prevalence of violence among youth was high compared to other studies. Special emphasis Should be given for youth violence in order to manage the victims as well as for preventing and controlling the identified factors through strengthening policies and strategies.

Sleep Quality and Related Clinical Manifestations in Huntington Disease.

(1) Background: Sleep patterns are frequently disrupted in neurodegenerative disorders such as Huntington disease (HD); however, they are still poorly understood, especially their association with clinic features. Our study aimed to explore potential correlations between sleep features and motor, cognitive, behavioural and functional changes in manifest HD subjects. (2) Methods: We enrolled 42 patients who were assessed by the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) questionnaires; clinical features were evaluated by the validated ENROLL-HD platform assay, including the Unified Huntington’s Disease Rating Scale (UHDRS) and the Problem Behaviours Assessment Short Form (PBA-s). (3) Results: We found a significant association between the patients’ perception of sleep abnormalities and scores of impaired independence, cognitive and motor performances. Specifically, sleep efficiency (PSQI—C4 subscores) and the use of sleep medications (PSQI—C6 subscores) seem to be more frequently associated with the severity of the disease progression. (4) Conclusion: sleep abnormalities represent an important part of the HD clinical profile and can impair patients’ quality of life by affecting their level of independence, cognition performance and mental well-being.

Assessment of behavioural problems in preschool and school going children with epilepsy.

IntroductionChildren with epilepsy are at greater risk of developing psychiatric and behavioural disorders such as attention deficit/hyperactivity disorder (ADHD), conduct disorder, autism spectrum disorder (ASD), as well as affective and aggressive disorders than normal children which may affect the well- being and quality of life of the child.Aim and ObjectivesThis study aims at identifying behavioural problems in children with epilepsy enabling early diagnosis and intervention. The objectives were to assess the presence and type of behavioural problems in children with epilepsy.MethodsA prospective cross-sectional study was conducted on children who were diagnosed as epilepsy in two age groups of 1.5–5 years and 6–18 years recruited by non-probability convenience sampling. Data regarding seizure semiology, clinical features and treatment were obtained. Children underwent IQ assessment, electroencephalogram and brain neuroimaging. Child Behaviour Check List (CBCL) was administered to parents or primary caregivers after obtaining informed consent. Results were analyzed for presence of behavioural problems using SPSS-23.ResultsIn the study, out of 50 study subjects, 72% were between 6–18 years. 60% children had generalised seizures, 58% children had epilepsy for <2 years and abnormal EEG was present in 80% children. 6% children had behavioural problems and 4% had borderline presentations. Co-relation of behavioural problems with age was statistically significant with p value 0.027. Behavioural problems identified were aggressiveness and anxiety.ConclusionChildhood epilepsy is associated with behavioural problems along with other co-morbidities warranting a search during follow-up visits.Take-home messageEarly identification and treatment of behavioural problems in children with epilepsy by periodic assessment during follow up visits, careful selection of combination of drugs and appropriate dose can improve the overall outcome in children taking antiepileptic drugs (AEDs) for epilepsy.

Clinical assessment of problem behavior in preschool children with autism spectrum disorders

Clinical assessment of problem behavior in preschool children with autism spectrum disorders

Establishing norms on the Japanese version of the Eyberg Child Behavior Inventory.

The Eyberg Child Behavior Inventory (ECBI) is one of the standardized parent rating scales used to identify disruptive behavior problems in children in Western countries. This study aimed to determine norms for the Japanese version of the ECBI, including clinical cutoff scores among the general population in Japan. This study established norms for the Japanese version of the ECBI using a sample of 1,992 parents of children aged 2-7, living in Japan. The research evaluates the validity and the reliability of the ECBI scores for the Intensity Scale and the Problem Scale. After validation, a clinical cutoff value of the ECBI scores was calculated, setting the cutoff to above the +1 standard deviation (SD) level based on the population distribution. The means of the Intensity and Problem Scale scores were 100.07 and 6.57, respectively. Cronbach's α for both the Intensity and the Problem scores was 0.91. At this point, we propose cutoff scores of 125 for the Intensity Scale and 14 for the Problem Scale. Our results suggest that the Japanese version of the ECBI is highly reliable and may be useful as a tool for assessing behavior problems in children.

Intellectual curiosity and action initiation are subtypes of apathy affected in Huntington’s disease gene expansion carriers

AbstractBackgroundApathy is a prevalent behavioral symptom in neurodegenerative diseases. In Huntington’s Disease, apathy can result in severe loss of function for the patient and substantial caregiver distress. The research‐based evidence of apathy is characterized by a lack of generalizability due to methodological differences. In this study we wished to characterize apathy in premanifest and motor‐manifest Huntington’s Disease gene expansion carriers and controls.Method82 Huntington’s Disease gene expansion carriers (premanifest and motor‐manifest) and 32 controls were included in the study (Mini‐Mental State Examination score ≥ 24 and Montreal Cognitive Assessment score ≥ 19). Apathy was quantified using the Lille Apathy Rating Scale and the Short Problem Behaviors Assessment for Huntington’s Disease. Analyses of association were performed between apathy on the Lille Apathy Rating Scale and motor function, cytosine‐adenine‐guanine repeat length, cytosine‐adenine‐guanine age product score, neuropsychiatric and cognitive screening tests.ResultCompared to premanifest and control participants, the motor‐manifest Huntington’s Disease gene expansion carriers scored significantly higher on the global score on the Lille Apathy Rating Scale and on two subscales (Intellectual Curiosity and Action Initiation – see table 1). Likewise, motor‐manifest HD gene expansion carriers scored significantly higher on the Short Problem Behaviors Assessment for Huntington’s Disease. Significant correlations were found between apathy on the Lille Apathy Rating Scale and the motor score, the neuropsychiatric measures and the cognitive screening tests. Apathy was present in 22 % of the Huntington’s Disease gene expansion carriers (including four premanifest participants) when examined with the Lille Apathy Rating Scale. The apathetic participants had significantly higher motor score and were significantly affected on the neuropsychiatric measures and the cognitive screening tests. When entered a multiple stepwise regression model, apathy was predicted by the motor score and the depression score. No other variables could significantly predict apathy on the Lille Apathy Rating Scale.ConclusionApathy is a frequent and early symptom of disease in Huntington’s Disease gene expansion carriers, and it has a specific expression that might be related to the underlying neuropathology. Apathy is related to disease progression, cognitive decline and neuropsychiatric symptoms.

Intellectual Curiosity and Action Initiation are Subtypes of Apathy Affected in Huntington Disease Gene Expansion Carriers.

Apathy is a prevalent behavioral syndrome of Huntington disease (HD) that can result in severe loss of function for the individual with HD and substantial caregiver distress. Research-based evidence of apathy is characterized by methodological differences, and there is a deficiency in the evidence concerning the subtypes of apathy. To characterize apathy in premanifest and motor-manifest HD gene expansion carriers and controls using the Short Problem Behaviors Assessment for Huntington's Disease (PBA-s) and the Lille Apathy Rating Scale (LARS). We included 82 HD gene expansion carriers (premanifest and motor manifest) and 32 controls (Mini-Mental State Examination score ≥24 and Montreal Cognitive Assessment score ≥19) in the study. We quantified apathy using the PBA-s and the LARS and performed correlation analyses between the global LARS score and motor function, cytosine-adenine-guanine repeat length, cytosine-adenine-guanine Age Product score, and neuropsychiatric and cognitive symptoms. The motor-manifest HD gene expansion carriers scored significantly higher than the controls on the global score and the Intellectual Curiosity and Action Initiation subscales of the LARS. Apathy was present in 28% of the HD gene expansion carriers (including 7 premanifest). The apathetic participants had a significantly higher motor score, significantly higher scores on the neuropsychiatric instruments, and significantly lower cognitive scores compared with the controls. Apathy is a frequent syndrome that is found in individuals with HD. Apathy has a specific expression, with symptoms such as reduced initiation, voluntary actions, and interests, that might be related to the underlying neuropathology. Apathy is related to disease progression, neuropsychiatric symptoms, and cognitive impairments.

Internalizing and Externalizing Behavioural Problems among Higher Secondary Students in Kerala

Adolescence is the period of life between the ages of 10-19 years (WHO). This is a stage identified as a period of “storm and stress” in one’s life. Adolescence has been included as an increase in the prevalence of both internalizing as well as externalizing problem behavior is generally demonstrated (Moffitt, 1993). The purpose of the present study was to find out the extent of various behavioural problems in adolescents. The study was a cross sectional descriptive in nature. 143 adolescents (76 males and 67 females) were randomly selected from the district of Thrissur, Kerala. The age range of the sample was 15-18 years. Youth Self Report (YSR/11-18) developed by Achenbach was used to assess behavior problems of adolescents. Student t test was used for statistical analysis of the data. The obtained result indicates that male and female adolescents come under the clinical range of internalizing behavior problems (nearly 75%) and externalizing behavior problems (below 50%). The mean scores, SD, and t value of all the scales were calculated. Significant differences among male and female adolescents were observed in withdrawal/ depression (t=2.199; p

Assessment and treatment of problem behavior maintained by escape from attention

AbstractThis study describes the assessment and treatment of problem behavior for two participants whose functional analysis results identified escape from attention as the function of problem behavior. Treatment involved functional communication training to teach an appropriate alternative behavior that produced escape from attention. Additionally, in both cases, we expanded treatments by using graduated exposure to attention to facilitate increases in social interaction while maintaining low levels of problem behavior. We discuss findings as they relate to (a) functional analysis procedures to identify escape from attention as a function for problem behavior, (b) treatment strategies to reduce problem behavior, and (c) treatment strategies aimed at decreasing escape from, and avoidance of, social interaction for individuals who demonstrate this problem behavior function.