Behavior Analytic Interventions Research Articles

Acceptance of Telehealth Therapy to Replace In-Person Therapy for Autism Treatment During COVID-19 Pandemic: An Assessment of Patient Variables.

Importance: Children with autism achieve improved behavioral outcomes with applied behavior analytic (ABA) interventions. Typically, ABA is delivered in a participant's home or in a clinic setting. At the onset of COVID-19, treatment in these environments was not available due to health exposure concerns. A large social service organization in California rapidly pivoted to the delivery of ABA intervention through telehealth. Access disparity for telehealth has been a historical concern in health care delivery, particularly for disenfranchised populations within the autistic participant population. Objective: This study evaluated the demographic and behavioral variables associated with the acceptance or declination of telehealth by the pediatric participants' caregivers at the onset of the pandemic. Design, Setting, Participants: A non-experimental design was used, and archival data were compared for a random sample of 100 participants with autism who accepted telehealth interventions with 100 participants who declined it. Main Outcomes and Measures: Socioeconomic data, gender, age, ethnicity, language, and household size were compared. Clinical data were compared for treatment dosage, standardized Vineland Adaptive Behavior Scales scores, and Verbal Behavior Milestones Assessment and Placement Program scores. Results: None of the demographic variables were statistically significant in a participant's acceptance or declination of telehealth, but there were moderate differences in treatment dosage across the groups. Conclusions: It is concerning that a large portion of participants initially declined intervention via telehealth, resulting in these participants experiencing a gap in intervention during the pandemic. As intervention is imperative for pediatric autism participants, it is untenable that ∼40% of the population initially declined telehealth at the start of the pandemic.

Improving Juvenile Justice Settings by Decreasing Coercion: One Lab's Perspectives from Behind the Fence.

In this article, we outline an emerging role for applied behavior analysis in juvenile justice by summarizing recent publications from our lab and discussing our procedures through the lens of coercion proposed by Goltz (2020). In particular, we focus on individual and group interventions that target a range of behaviors emitted by adolescents in a residential treatment facility. In general, individual interventions involve teaching adolescents to (1) respond appropriately to staff, (2) tolerate nonpreferred environmental conditions, and (3) control problematic sexual arousal. Likewise, group interventions involve low-effort manipulations that decrease disruptive behavior and increase appropriate behavior in settings with numerous adolescents. Thereafter, we describe behavioral interventions for staff working in juvenile justice. These staff-focused interventions aim to increase staff-initiated, positive interactions with students in order to change subsequent student behavior. In addition, we review our recent endeavors to assess and conceptualize other service providers’ behavioral products (i.e., prescription practices) in a juvenile facility. Lastly, we discuss future directions of behavior-analytic intervention with juvenile-justice involved adolescents.

Behavior-Analytic Interventions for Oral Health Care: a Review of the Literature and Recommendations for Clinical Practice and Research

Behavior-Analytic Interventions for Oral Health Care: a Review of the Literature and Recommendations for Clinical Practice and Research

Adapting Direct Services for Telehealth: A Practical Tutorial.

Due to the pandemic brought on by the novel coronavirus (COVID-19), consumers of applied behavior-analytic interventions may be experiencing disrupted access to services. In response to the need for services, behavior analysts and therapists may find themselves treading unchartered waters as they use telehealth to provide direct intervention to consumers. Direct service provision via telehealth extends beyond the bounds of existing telehealth research, which primarily focuses on caregiver training and consultation. In the transition to telehealth, behavior analysts can consider how to adapt an existing evidence base of behavior-analytic strategies from a face-to-face format to intervention via a teleconferencing platform (i.e., Zoom). In this tutorial, we provide practice recommendations, task analyses, and a curated list of Zoom walk-throughs to help behavior analysts construct conceptually systematic learning opportunities in their direct telehealth services. Leveraging teleconferencing features to provide behavior-analytic intervention directly to consumers could spur future research to support these need-inspired practices and guide telehealth applications during and beyond the current pandemic.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40617-020-00529-5.

Barriers and Facilitators of Access to Psychological Services for Indigenous Populations: A Scoping Review and Thematic Analysis.

Background: The extent to which behavior-analytic interventions are offered to Indigenous populations across CANZUS in accessible and culturally appropriate ways is unknown. We conducted a scoping review with a thematic analysis of the extant literature to find: (1) what are the barriers and facilitators for providing effective and equitable delivery of psychological services (with a behavioral component) to Indigenous populations; and (2) what tools and practices exist for an effective and equitable service delivery.Methods: We systematically reviewed Medline, CINAHL, PubMed, PsycInfo, Web of science, Ovid and INNZ databases between 1990 and 2020. For the scoping review, we adhered to the JBI methodological approach (2015) and the PRISMA strategy for the identification, selection, and appraisal of the reviewed articles. A total of 1265 unique articles met the criteria for the screening by title; 238 by abstract; 57 were included for full text assessment; and 37 were included in the final analysis.Results: Three themes were revealed to account for the barriers and facilitators of culturally friendly practices: (1) connecting practices are about interactions shaping the relationship between service provider and service client; (2) innovative practices test new approaches and innovations that could facilitate access to psychological services and overcome barriers, and (3) reflective practices are about critically examining the processes and actions undertaken toward effective cultural adaptation of services.Conclusions: Our analysis suggests that the level of success in bringing together services and the recipients of treatment (connection), showing flexibility and persistence in finding solutions (innovation) and examining the role of our behaviors in reaching our goals (reflection) is determined by the providers' action in the aforementioned three dimensions of practice.

Effects of parent-child painting and creative crafting therapy on preschool children with autism spectrum disorder and their mothers: a prospective randomized controlled trial.

To study the effects of parent-child painting and creative crafting therapy on the core symptoms of preschool children with mild-to-moderate autism spectrum disorder (ASD) and the parenting stress and hope level of their mothers. A total of 56 preschool children with mild-to-moderate ASD and their mothers were divided into an experimental group and a control group using the block randomization method, with 28 pairs in each group. The subjects in the control group received an applied behavior analytic intervention and those in the experimental group received parent-child painting and creative crafting therapy in addition to the intervention in the control group. The intervention time was 20 weeks for both groups. Autism Behavior Checklist (ABC), Social Responsiveness Scale (SRS), Parenting Stress Index-Short Form (PSI-SF), and Herth Hope Index (HHI) were used to evaluate the core symptoms of children and the parenting stress and hope level of their mothers before and after 20 weeks of intervention. Forty-nine child-mother pairs completed the study (25 pairs in the intervention group and 24 pairs in the control group). The children in the experimental group had significantly lower scores of social interaction, language, social communication, and social motivation and total scores of ABC and SRS compared with those in the control group (P<0.05). The mothers in the experimental group had significantly lower scores of parental distress and parent-child dysfunctional interaction and total score of PSI-SF (P<0.05) and significantly higher total score of HHI and scores of each dimension compared with those in the control group (P<0.05). The combination of applied behavior analytic intervention with parent-child painting and creative crafting therapy can more effectively improve the core symptoms and social interaction of preschool children with mild-to-moderate ASD, reduce the parenting stress of mothers and improve their hope level.

Parent treatment integrity across multiple components of a behavioral intervention

AbstractChildren with autism spectrum disorder (ASD) often present with challenging behaviors such as aggression, tantrums, or noncompliance. Behavior analytic interventions are considered evidence‐based for decreasing challenging behaviors and may include a combination of strategies to teach replacement behaviors and prevent and respond to challenging behaviors. However, multi‐component interventions are often implemented in treatment settings by professionals and effects may not generalize to the home. Little research has explored the levels of treatment integrity with which multi‐component interventions are implemented by parents. This study evaluated the use of behavior skills training (BST) with ongoing coaching to train parents of two children with ASD to implement multi‐component behavioral interventions in the home to decrease challenging behaviors. Treatment integrity was monitored for each treatment component, and attempts were made to minimize barriers to treatment integrity. Results support the use of BST with ongoing coaching. Implications for practice and future research are discussed.

Delivering behavior analytic services in an inclusive job setting for a young adult with autism spectrum disorder: A case example

BACKGROUND: The rate of employment for adults diagnosed with Autism Spectrum Disorder (ASD) is low. This may be due in part to repetitive or disruptive behaviors associated with the ASD diagnosis and challenges to delivering services in the workplace. OBJECTIVE: This paper outlines a behavior analytic approach to providing job coaching supports in collaboration with employers in an inclusive setting. METHODS: A case example for a 26-year-old male (22 at the time of this project) diagnosed with ASD, employed as a data entry specialist, is highlighted. An A-B design was used to evaluate the impact of behavior analytic interventions on the rate of disruptive vocalizations. Behavior analysts and job coaches from a university-based team worked with employers to identify feasible and effective strategies. RESULTS: Rates of vocalizations decreased and maintained for 5 months following intervention fading. Social acceptability ratings from key office personnel reflected improved coworker relations and a high degree of acceptability for procedures used by the team. CONCLUSIONS: Employer collaboration was necessary for intervention design and decision making. Service providers should consider response effort for employers, the degree of normalization of strategies, how to limit disruption to productivity and the work setting, and methods for fading interventions or components of interventions.

IMPROVING LISTENER RESPONDING SKILL USING BEE-BOT® IN AUTISM SPECTRUM DISORDER: CASE STUDY

Children with autism spectrum disorder may have a variety of communication deficits. Their communication difficulties include language delay, limited vocabulary, inability to speak words, echolalia or repetitive use of phonemes, words, or phrases, absence of eye-contact during communication, and poor non-verbal communication skills. Moreover, some of them are nonverbal so they have to learn how to communicate by using alternative and augmentative communication techniques. Some children on the spectrum in order to improve their receptive and expressive communication skills need to work on a highly structured therapeutic environment and others need to work on a natural environment. Educational robotics can be a successful tool for children on the spectrum in order to improve communicational skills. The main goal of this study is to implement Bee-Bot® robotic toy as a supportive tool for a child with autism in order to improve his listener responding skill across actions. The results showed that during speech and Applied Behavior Analysis intervention, the child improved his receptive skill in a more funny and educational way. Researchers identified that by using Bee-Bot®, the participant communicated intensively and participated to the activity more enthusiastically than using the traditional method of teaching at the table. Nevertheless, researchers should implement generalization and maintenance procedures to ensure that the participant will be able to apply the learned behavior and skill outside of the learning environment and continue to practice the acquired skill over time.&#x0D; &#x0D; &lt;p&gt; &lt;/p&gt;&lt;p&gt;&lt;strong&gt; Article visualizations:&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;img src="/-counters-/edu_01/0781/a.php" alt="Hit counter" /&gt;&lt;/p&gt;

Behavior analytic interventions for children with autism: Policy and practice in the United Kingdom and China.

The prevalence of autism is increasing, and the development of these children and the lived experience of their families have become a global concern. Applied behavioral analytic intervention is proved to be effective in improving their cognitive abilities, language skills, and social and emotional skills, but the service delivery between developed and developing countries is different. A qualitative study was conducted to explore personal experiences with actual practice fidelity of behavior analytic services for children with autism in a Western developed country (United Kingdom) and an Eastern developing country (China). The study found: (1) a lack of support for autism and behavioral analytic services in both countries; (2) applied behavioral analytic intervention was not as widely endorsed by healthcare or educational systems in the United Kingdom; Chinese parents faced challenges around inclusive education and accessing high-quality services and there was a social stigma attached to autism; (3) a limited awareness and application of early intensive behavior intervention in both regions; and (4) intervention fidelity with regards to the practice of one particular aspect of behavioral analytic interventions was similar and increased with ongoing training. This study emphasizes the need to support children with autism, and to consider regional adaptations of evidence-based practice of behavior analytic interventions for the affected population.

Applied Behavior Analysis Intervention Can Improved Behaviors and Social Skills among Children with Autism

Background: Children with Autism Spectrum Disorders (ASD) are at particular risk of impairment in social interaction, repetitive and stereotyped behaviors, and a poor quality of life. We tested whether applied behavior analysis intervention could, compared to a control condition, reduce repetitive and stereotyped behaviors, and increase social skills and thus enhance the quality of life among children with ASD. Methods: Thirty children with ASD (mean age: 6.5 years) were randomly assigned either to applied behavior analysis intervention or to a control condition. All participants completed Gareth test on stereotypical behaviors, social communication, and interaction skills at the following time points: baseline, and six months later at completion of the intervention. Findings: Stereotypical behaviors, social communication, and interaction skills improved over time from baseline to intervention completion, but more so in the applied behavior analysis intervention than in the control group. Compared to the control group, the applied behavior analysis intervention group reported had more positive scores. Conclusion: The findings suggest that among children with ASD and compared to a control condition, applied behavior analysis intervention has the potential to improve symptoms of autism, thus contributing to their quality of life.

On the Uncanny Similarities Between Police Brutality and Client Mistreatment.

Direct-care staff are responsible for carrying out behavior-analytic services in a culture that perpetuates systemic racism and other problematic systems that can lead to the mistreatment of clients. Limited data exist on factors that influence the mistreatment of clients, so behavior analysts must look to better studied comparison contexts as a way to identify risk factors. Police brutality is one context where problematic systems are apparent. Therefore, examining variables known to affect police brutality offers one way to identify aspects of direct-care staff's implementation of behavior-analytic treatment that may harbor similar systems. The purpose of this article is to examine variables associated with police brutality as risk factors for the mistreatment of clients in direct-care settings. The primary risk factors discussed include racial bias, the warrior mentality, a lack of transparency and accountability, and ineffective intervention. This article concludes that the field of behavior analysis needs sensitive data collection methods and systematic evaluation of risk factors to better protect clients from mistreatment.

장애인 주간보호시설 종사자의 응용행동분석에 대한 인식과 요구*

The purpose of this study is to know the changed awareness since the social workers who directly provide services to have participated in the intervention with applied behavior analysis and about the requirements to be supported for adults with developmental disabilities with applied behavior analysis in the field. Semi-structured in-depth interviews were conducted with 6 workers in daycare centers located in Seoul and Gyeonggi-do. The results according to the research as follows: First, workers took a very positive direction that it needs to be applied for them because applied behavior analysis intervention for adults with intellectual disabilities and autism spectrum disorders got the distinct result, Second, professionals and financial supports were required for the field application. The results of this study demonstrated that applied behavior analysis intervention is the effective method for adults with developmental disabilities and proposed the demands to apply it concretely at daycare centers.

A Meta-Analysis of Single-Case Research on Applied Behavior Analytic Interventions for People With Down Syndrome.

This systematic review evaluates single-case research design studies investigating applied behavior analytic (ABA) interventions for people with Down syndrome (DS). One hundred twenty-five studies examining the efficacy of ABA interventions on increasing skills and/or decreasing challenging behaviors met inclusion criteria. The What Works Clearinghouse standards and Risk of Bias in N-of-1 Trials scale were used to analyze methodological characteristics, and Tau-U effect sizes were calculated. Results suggest the use of ABA-based interventions are promising for behavior change in people with DS. Thirty-six high-quality studies were identified and demonstrated a medium overall effect. A range of outcomes was targeted, primarily involving communication and challenging behavior. These outcomes will guide future research on ABA interventions and DS.

Behavior-analytic intervention for women with fibromyalgia and insomnia: a single subject design

This study evaluated the effects in the pain and sleep, and the clinic significance after an analytic-behavioral intervention to manage the condition of the physical and interpersonal environment related to pain. Four women with fibromyalgia and insomnia participated in a study with intervention withdrawal multiple baseline design and initial, intermediate, final, and follow-up assessments. Self-report instruments were used to assess pain intensity and disability, sleep quality, and insomnia severity, besides the actigraphy. Data showed that the intervention (20 sessions) was effective in reducing the sleep and pain problems in all participants by shifting two participants from clinical to non-clinical status in sleep indicators. The gains were maintained or increased in follow-up measures. However, the results should take into consideration the clinical condition and other variables that may have individually impacted the results.

The effects of transition to technician-delivered telehealth ABA treatment during the COVID-19 crisis: A preliminary analysis.

Telehealth delivery of applied behavior analysis treatment has focused on supervision or staff and parent training, rather than the direct delivery of treatment to clients. The novel coronavirus (COVID‐19) crisis had the potential to significantly disrupt access to direct treatment for individuals with autism. We report a sample of 17 cases that transitioned from in‐person to telehealth delivery of treatment when shelter‐in‐place orders were issued. Of these cases, 76% of participants transitioned to technician‐delivered telehealth services whereas the rest transitioned to a caregiver‐implemented telehealth model. Participants continued to access a similar dosage of treatment hours per week in spite of the treatment model transition (in‐person M = 12; telehealth M = 11) and maintained or improved correct independent responding across all targets from in‐person treatment (M = 75%) to telehealth treatment (M = 80%). These findings provide initial evidence that some clients with autism benefit from technician‐delivered telehealth services.

Increasing Praise Delivery Within Dorms of a Juvenile Justice Facility.

Researchers have shown that adolescents in residential treatment facilities benefit from behavior-analytic intervention. However, it remains unclear whether practitioners can apply behavioral interventions to increase staff members' appropriate interactions with residents within a juvenile justice facility. In Study 1, researchers compared direct measures of staff behavior in three target dorms (D1, D2, and D3) containing high levels of resident disruptive behavior to a dorm (D4) with consistently low levels of resident disruptive behavior. Results indicated that staff members in the target dorms engaged in significantly higher rates of reprimands and negative statements than in D4. In Study 2, researchers used didactic and video instruction to train staff members in D1, D2, and D3 to increase contingent and noncontingent praise delivery. Results indicated praise delivery by staff members increased slightly in each target dorm. In Study 3, researchers first evaluated the extent to which measures of staff members' and residents' behaviors improved following training within each dorm. Subsequently, researchers compared the post-training behavioral measures from D1, D2 and D3 to D4 to determine the extent to which staff behavior in the training dorms was distinguishable from D4. Results of Study 3 indicated that one or more staff behaviors improved in each training dorm. Nevertheless, residents' disruptive behavior was unchanged in each target dorm. In addition, staff members' behavior in each target dorm continued to be distinguishable from staff members' behavior in D4 on most behavioral measures.

Telehealth-enabled behavioral treatment for problem behaviors in boys with fragile X syndrome: a randomized controlled trial

BackgroundChildren with fragile X syndrome (FXS) are at increased risk for exhibiting problem behaviors such as aggression and self-injury. However, many children with FXS have limited access to behavioral treatments that have known efficacy due to the low availability of treatment providers and the wide geographical dispersion of families with FXS across the country. Telehealth may offer a cost-effective and practical solution to overcome these significant barriers. We examined the effect of administering an established behavior analytic intervention called functional communication training (FCT) via telehealth on levels of problem behaviors exhibited by boys with FXS. We also examined treatment acceptability, as well as the effect of the treatment on levels of parenting stress.MethodsBoys with FXS, aged 3 to 10 years, who displayed problem behaviors daily, were randomized to receive FCT via telehealth (n = 30) or treatment as usual (n = 27) over 12 weeks. Outcome measures included in-session observations of problem behavior, the Aberrant Behavior Checklist—Community (ABC-C), the Treatment Acceptability Rating Form—Revised (TARF-R), and the Parenting Stress Index, 4th edition (PSI-4).ResultsIntention-to-treat analyses indicated that scores on the irritability subscale of the ABC-C, our primary outcome measure, decreased significantly for boys who received FCT via telehealth compared to boys who received treatment as usual (p < .001, Cohen’s d = 0.65). In-session observations conducted for those who received treatment showed that levels of problem behavior decreased by 91% from baseline. Levels of parenting stress related to child behavioral problems were also lower following FCT treatment, and caregivers reported that the intervention was acceptable.ConclusionsThese findings support telehealth-enabled FCT as a framework for expanding access to behavioral treatments for problem behaviors in children with FXS. Expanded delivery of behavior analytic treatment via telehealth also has the potential to lower healthcare costs, improve child and family quality of life, and lead to advances in the treatment of problem behavior in the broader population of individuals with neurodevelopmental disorders.Trial registrationClinicalTrials.gov, NCT03510156. Registered 27 April 2018

A Feasibility Randomized Clinical Trial of a Structured Function-Based Intervention for Elopement in Children with Autism Spectrum Disorder.

Elopement is a common and dangerous concern in autism spectrum disorder (ASD). There is evidence that behavior analytic treatments can successfully treat elopement, but the research is limited due to small samples and treatment components varying across studies. The current study evaluated the feasibility of studying a manualized intervention for elopement, based on strategies from single-subject research, in a randomized clinical trial with 24 individuals with ASD. Results demonstrated that recruitment was feasible; the manual was acceptable to parents; and therapists followed the manual with high-integrity. Initial efficacy results measured by the Aberrant Behavior Checklist, Clinical Global Impression Scale, and a Home Elopement Safety Checklist suggested improvement in the treatment group that should be studied in future research.

Evaluating the Efficacy and Social Validity of a Culturally Adapted Training Program for Parents and Service Providers in India.

In regions such as India, where one-to-one behavior-analytic intervention is not easily accessible, parents and service providers may advocate for children with disabilities better if they have foundational training in behavioral approaches to problem behavior. The purpose of this study was to evaluate a culturally adapted training delivered in an underresourced region of India. Ten parents and professionals from Chennai completed the training, and the researchers evaluated its effects using a multiple-baseline design. Participants showed improvements in correct responses on a structured form designed to capture skills involved in function-based assessment and intervention, as well as the fidelity of implementation of extinction and functional communication training. Moreover, participants rated the acceptability of training highly on measures of social validity. Guidelines for the education of parents and service providers in underresourced areas outside of the United States are discussed.