Challenging Behavior In Individuals Research Articles

발달지체 및 장애 영유아의 도전적 행동 지원을 위한 기능평가에 대한 체계적 문헌 분석

The purpose of this paper is to systematically review and summarize the characteristics of peer-reviewed studies on functional assessments for supporting the challenging behaviors of young children with delays and disabilities. In addition to studies reported from 2000 to 2014 in a previously conducted review on functional assessment supporting challenging behaviors of individuals with developmental disabilities (Lee et al., 2015), we conducted systematic searches of electronic databases, authors, and citations to identify studies that meet the study inclusion criteria. A total of 28 studies were included in this review and were coded by the characteristics of the general study, child participants, and functional assessment. The results indicated the following discussion points: (1) the need for further investigation on various approaches for functional assessment in South Korea, (2) the inclusion of a broader range of children as participants in functional assessment studies, (3) the need for collecting and reporting data on a more detailed information about the functional assessment studies(e.g., duration of the functional assessment). Limitations of the current review and the implications for research and practice are included.

A functional communication training for developing verbal behavior and treatment of challenging behavior in individuals with autism spectrum disorders

Communication problems are one of the symptoms of autism spectrum disorders. Challenging behaviors may be a form of communication with the environment, and when other forms of communication are not available, they may be the only way to meet their needs. The purpose of this article is to demonstrate the potential use of functional communication training in reducing problem behaviors of individuals with ASD, as well as developing acceptable ways of communication. In a research process based on behavior analysis, the method of single-subject experiment with multiple-baseline design was used. The results of the study show that the research participants developed communication skills on the basic level, and the frequency of their challenging behaviors has significantly decreased.

Reducing Escape-Maintained Challenging Behavior in Children with Autism Spectrum Disorder through Visual Activity Schedule and Instructional Choice

Children with autism tend to engage in challenging behavior more than other children, which impacts their ability to engage appropriately with instructional tasks. Existing literature has established that visual activity schedules are effective for maximizing on-task behaviors and reducing challenging behavior in individuals with autism. However, in some cases challenging behavior may not be effectively reduced, especially when the visual activity schedule includes a less preferred task. This study aimed to address this need by (a) examining the effects of a treatment package consisting of a visual activity schedule and instructional choice on escape-maintained challenging behavior of children with autism during less preferred tasks and (b) comparing the effects of the treatment package with a visual activity schedule only treatment. Results suggest the treatment package effectively reduced challenging behavior during less preferred tasks and had more consistent effects than the visual schedule only treatment on the reduction of challenging behavior.

First Steps Toward Positive Behavior Support in the Netherlands: A Pilot Study Exploring the Effectiveness of a Training for Staff

AbstractDespite the effectiveness of positive behavior support (PBS) in reducing challenging behaviors, the availability of PBS for individuals with intellectual disabilities is limited in many countries including the Netherlands. Training care staff supporting individuals with intellectual disabilities in PBS may be a way to improve the provision of PBS. We aimed to explore the preliminary effectiveness of a PBS training for staff in reducing challenging behaviors of individuals with intellectual disabilities. Using a one group, double pretest–posttest design, 24 staff members involved in the care of 11 adult individuals with intellectual disabilities and challenging behaviors participated. We assessed changes in challenging behaviors and quality of life of the individuals, in staff self‐efficacy in dealing with challenging behaviors, and in the use of restraints, using staff rated questionnaires, structured interviews, and medical files. At posttest, we found significant reductions in challenging behaviors, improved quality of life, and increased staff self‐efficacy, but no changes in the use of restraints. In contrast, no significant changes on any of the measures appeared between the two pretests. These findings suggest that a staff training in PBS may be effective for reducing challenging behaviors in individuals with intellectual disabilities.

Emotional development, aggression regulation and challenging behavior in individuals with intellectual disbility

Analysis of the causes of challenging behavior in individuals with intellectual disability (ID). The relatedness and the impact of cognitive and emotional functioning on challenging behavior was investigated by correlation and regression analyses in 262 individuals with ID and mental disorders / challenging behavior. Despite the high correlation between ID and emotional development, cognitive-emotional developmental discrepancies were found in every second patient. The severity of challenging behavior was associated with a lower level of emotional development, especially in the area of "aggression regulation". The level of emotional development should be ascertained in the context of an assessment of challenging behavior in individuals with ID.

Is risperidone effective in reducing challenging behaviours in individuals with intellectual disabilities after 1year or longer use? A placebo-controlled, randomised, double-blind discontinuation study.

Many people with intellectual disabilities use risperidone long term for the management of challenging behaviours, despite its limited proof of effectiveness and its clear association with adverse events. Therefore, this study aimed to investigate the effectiveness of ongoing treatment with risperidone in reducing challenging behaviours versus controlled discontinuation on behaviour and health parameters. This was a placebo-controlled, double-blind, randomised discontinuation trial of risperidone. In the discontinuation group, risperidone was gradually replaced by a placebo over 14weeks, while the control group maintained their existing dosage. Eight weeks after discontinuation, behaviour (as measured by the 'Aberrant Behavior Checklist') and health parameters (dyskinesia, akathisia, parkinsonism, weight, waist circumference, sedation and laboratory outcomes) were compared in both groups. A total of 25 participants were included in the trial, of which 11 were randomised into the discontinuation group and 14 were randomised into the continued treatment group. In the discontinuation group, 82% completely withdrew from risperidone. There was no significant change in irritability, compared with the continuation group, although there was a Group*Time effects on stereotypical behaviour in favour of the continuation group. Significant Group*Time effects were also found for weight, waist, body mass index, prolactin levels and testosterone levels, with beneficial effects for the discontinuation group. Discontinuation of long-term risperidone for reducing challenging behaviours is possible, without an increase in irritability. Discontinuation of risperidone may have beneficial effects on weight, waist circumference, prolactin levels and testosterone levels. The study suffered from difficulties in achieving the required sample size, which affected study power and generalizability.

Assessments and Interventions to Address Challenging Behavior in Individuals with Intellectual Disability and Autism Spectrum Disorder in Japan: A Consolidated Review.

Intellectual disability and autism spectrum disorder are neurodevelopmental disorders that emerge during the developmental period. A significant barrier that impedes the social adaptation of individuals with these disorders is the exhibition of problem behaviors, such as self-injurious, stereotyped, and aggressive/destructive behaviors. In recent years, these problem behaviors have been collectively referred to as "challenging behavior," in accordance with the contention that they result from an interaction between the individual and his or her social environment. Evidence-based psychosocial interventions that adopt the functional approach to treating challenging behavior are increasing. However, in order to effectively implement such interventions in educational settings and welfare facilities, it is essential to develop staff training programs and usable psychometric assessments. Accordingly, a brief overview of research studies on challenging behavior that have been conducted in Japan, as well as the various support systems that are available to individuals who exhibit challenging behavior, are presented in this article. The discussion makes it apparent that, in order to improve treatment systems in Japan that are aimed at addressing challenging behavior, it is necessary to establish not only better staff training programs, but also reliable and valid assessments measuring challenging behavior that can be readily used by teachers and parents. On the basis of this discussion, it is proposed that technological advancements must be applied to psychosocial approaches in the study of problem behaviors, in order to develop assessment system using software applications and automatic measurement system of target behaviors using sensing technology.

Understanding and Addressing Aggressive and Related Challenging Behaviors in Individuals with Dementia

Understanding and Addressing Aggressive and Related Challenging Behaviors in Individuals with Dementia

Using In-Vivo Modeling and Feedback to Teach Classroom Staff to Implement a Complex Behavior Intervention Plan

Behavior intervention plans (BIPs), implemented with high treatment integrity, are effective in decreasing challenging behaviors in individuals with autism spectrum disorder (ASD). High treatment integrity requires staff training such as Behavioral Skills Training (BST). Modeling and feedback alone, however, have been shown to be briefer and as effective as BST. Due to limited resources educational settings may prefer briefer training models to train staff to implement BIPs. This study used only two of the BST components, in-vivo modeling and feedback, to train three classroom staff members to implement a complex BIP. All three staff acquired the skills rapidly.

Sleep patterns predictive of daytime challenging behavior in individuals with low-functioning autism.

We analyzed over 20,000 nights of sleep from 67 individuals with autism to investigate whether daytime behaviors can be predicted from prior sleep patterns. Better-than-chance accuracy was obtained for 81% of individuals, with measures of night-to-night variation in sleep timing and duration most relevant for accurate prediction. Our results highlight the importance of regular sleep patterns for better daytime functioning and represent a step toward the development of 'smart sleep technologies' to pre-empt behavior in individuals with autism.

Systematic Review of Differential Reinforcement of Alternative Behavior Without Extinction for Individuals With Autism

The purpose of this article is to review the literature on differential reinforcement of alternative behavior procedures without extinction for individuals with autism. Using predetermined inclusion criteria, a total of 10 studies were included and summarized in terms of the following: (a) participant characteristics (e.g., sex, age, and diagnosis), (b) treatment setting, (c) problem behavior, (d) function, (e) alternative behavior, (f) intervention, (g) outcomes, and (h) conclusiveness of evidence. Of the 10 studies, nine demonstrated positive effects and one mixed effects. Five studies successfully reduced problem behavior by manipulating different reinforcement parameters (magnitude, immediacy, and quality) and four manipulated the schedule of reinforcement. One study had mixed results with two of the three participants requiring extinction. The findings of this review suggest that variations of differential reinforcement of alternative behavior interventions without an extinction component may be considered promising practices for the treatment of challenging behavior in individuals with autism.

Adverse Side Effects of Psychotropic Medication and Challenging Behavior: Pilot Work Assessing Impact.

Psychotropic medications are often prescribed to reduce challenging behavior in individuals with intellectual and developmental disabilities (IDD). Functional analyses (FAs) have demonstrated utility in assessing medication impact on behavior; however, the impact of adverse side effects (ASE) on challenging behavior is under-assessed. The purpose of this study was to develop a methodology, similar to FAs, to explore potential medication ASE impact on challenging behavior in seven individuals with IDD. Results revealed response rate differences in designed ASE conditions for most participants. Outcomes support further development and use of this methodology to assess the presence and impact of ASEs.

Examination of behavioral flexibility and function of severe challenging behavior in individuals with autism and intellectual disability

Objectives: Behavioral flexibility may be an important aspect of the occurrence of challenging behavior in individuals with autism and intellectual disability (ID). The primary purpose of the current study was to examine the scores on the Behavioral Flexibility Rating Scale-Revised (BFRS-R) across two groups of individuals with autism: those with ID (AID) and those without ID (A). These scores were then compared to the outcome of each participant’s functional analysis. In addition, we evaluated the relationship between these scores and reported adaptive behavior (Vineland Adaptive Behavior Scale) within each group.Methods: The BFRS-R is a survey measure of the degree of an individual’s behavioral inflexibility. Specifically, the BFRS-R identifies those contexts in which challenging behavior is most likely to occur. In the current study, the BFRS-R, functional analysis of challenging behavior outcome, and Vineland II scores were correlated using a Mann–Whitney test for 110 individuals admitted to a specialized inpatient unit.Results: There was a significant difference (p < .05) between the BFRS-R scores of the A group and the AID group. The A group had slightly higher mean scores (18.3 compared to 15.3), and these individuals were more likely to have challenging behavior maintained by automatic reinforcement. Within this group, an automatic function was most likely if the BFRS-R score was above 16. Individuals in the AID group were more likely to have challenging behavior maintained by access to tangible items and activities. Consistent with previous research, higher scores on the BFRS-R were correlated with a higher Adaptive Behavior composite score on the Vineland for both groups.Conclusions: The BFRS may help inform the functional assessment process so that specific conditions can be evaluated. Also, we were surprised to find that high adaptive scores did not necessarily mean that the individuals with autism had more behavioral flexibility. In fact they had less.

A consecutive case review of token systems used to reduce socially maintained challenging behavior in individuals with intellectual and developmental delays

Objectives: The current paper describes the use of token systems in a behavioral day-treatment unit for severe challenging behavior using a consecutive case review spanning three years.Methods: Experimenters reviewed 96 patient case files, 24 of which implemented some token system as a component of the individual’s treatment package. Aspects of each token system (including schedules of token delivery and exchange; inclusion of token training and response cost; and types of backup reinforcers delivered), and participant characteristics were coded.Results: Token systems were most frequently employed during differential reinforcement for alternative behavior (DRA, most commonly for compliance) or differential reinforcement of other behavior (DRO). Tokens were most frequently used in an instructional context. Several commonalities were identified (e.g. restriction of backup reinforcers between token exchanges and initial dense schedules of reinforcement). Compared to past reviews, this sample had an over-representation of individuals with challenging behavior maintained by escape, multiply maintained challenging behavior, and individuals for which the function was not identified in a functional analysis. Treatment packages including token systems resulted in a reduction in challenging behavior for 91.67% of participants, with 70.83% exhibiting at least an 80% reduction.Conclusion: Our findings suggest that token systems may be a beneficial component of treatment plans used to address challenging behavior. Some common components should likely be included in all token systems and specific client variables may guide decisions related to idiosyncratic treatments.

Assessing the impact of psychotropic medication changes on challenging behavior of individuals with intellectual disabilities

Objective: The use of psychotropic medication to address challenging behavior in individuals diagnosed with intellectual disabilities is common practice; however, very few studies have examined how multiple medication use (or combination treatment) impacts the behaviors these medications are prescribed to treat.Method: The current study followed eight individuals over a two-year period as they experienced changes in their psychotropic medication regimens. During that time, data from functional analyses and indirect assessments of challenging behavior were collected.Results: The results suggest that changes in psychotropic medication regimens can produce changes in functional assessment outcomes, suggesting a need for continued behavioral assessment to better inform medication practices and behavioral treatment. Of the eight participants in the study, five participants’ behaviors varied in rate of responding in functional analysis (FAs) across all medication changes. Additionally, three participants’ FAs produced changes in outcomes; however, those changes were not consistent across all medication changes, that is, not every medication change yielded different outcomes from previous assessments.Conclusion: This study demonstrates how the outcome of an FA can be used to monitor the effects of psychotropic medication changes, specifically when medications are combined, on challenging behavior in individuals with intellectual and developmental disabilities.

Construct validity and internal consistency of the neuropsychiatric inventory - nursing home (NPI-NH) in German nursing homes.

The Neuropsychiatric Inventory (NPI) is one of the most popular and frequently used instruments for assessing so-called challenging behavior in individuals with dementia in research practice. However, no information is available regarding the factor structure of the German version of the Neuropsychiatric Inventory - Nursing Home (NPI-NH). The aim of this study was to evaluate the factor structure (an aspect of construct validity) and internal consistency of the NPI-NH for two different stages of dementia severity in a large German nursing home population. A total of 784 residents with dementia from 40 nursing homes in three studies was included in a secondary data analysis. Principal component analysis (PCA) using an orthogonal rotational procedure (with varimax rotation) was used to evaluate the factor structure of the NPI. Cronbach's α was used to assess the stability of the scale. The factors agitation & restless behavior, psychosis, and mood were identified (with factor loading > 0.4 explaining 50% of the variance). The factors showed a moderate internal consistency of 0.55 and 0.68 (Cronbach's α). The results show the acceptable factor structure of the NPI for a German population in nursing homes and confirm the results of studies from other countries. The three identified factors appear to be robust over the various stages of dementia severity. The results also support the hypothesis that the NPI-NH can be subdivided into multiple domains.

A review of research on direct-care staff data collection regarding the severity and function of challenging behavior in individuals with intellectual and developmental disabilities.

In working with individuals with intellectual and developmental disabilities (IDDs), it is direct care staff who are often required to collect data on individuals' behavior which is used as the basis for implementation of empirically based approaches for intervention and treatment. Due to limited resources, indirect and descriptive measures of challenging behaviors are employed to analyze the function of individuals' behaviors in place of the preferred method of multimodal assessment, which includes experimental functional analysis. To ensure the most effective services and support to individuals with IDDs, accurate and consistent data collection is critical. In this article, we highlight the importance of accurate data collection practices, conduct a comparison of data collection methods, and discuss limitations .… and barriers for staff. The article concludes with recommendations for best practices and future research.

Salivary cortisol levels and challenging behavior in children with autism spectrum disorder

A relationship between stress and challenging behavior in individuals with autism spectrum disorder (ASD) has been theorized but infrequently examined empirically. The current study sought to examine the relationship between a parent-reported measure of stress, a physiological measure of stress (diurnal salivary cortisol), and various topographies of challenging behavior among 61 children and adolescents diagnosed with ASD between the ages of three and 18 years. Significant differences in cortisol levels between those engaging in high and low rates of stereotyped behavior were observed such that higher levels of stereotypy appeared an overt manifestation of higher levels of stress. A comparison between a subset of participants with ASD and typically developing peers matched on age, gender, and pubertal status failed to yield any differences in diurnal cortisol levels or cortisol variability between the two groups. The results of the current study suggest that similar levels of stress may exist among children with autism and their typically developing peers, but that for a subset of individuals with ASD, stereotyped behavior may be an indicator of elevated cortisol levels.

RETRACTED: Functional variables of challenging behavior in individuals with intellectual disabilities.

This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the Editor in Chief, after review by an independent panel of experts, due to evidence of a compromised peer review process and the failure of one author to disclose significant conflicts of interest. An independent peer-review process is a cornerstone of scientific integrity that allows for research to be scrutinized before publication to ensure that conclusions are anchored in sound methodology and objective interpretation of the results. Equally important is that the readership of research is fully informed about any potential competing interests that may have influenced the research process. This article is being retracted because it did not include a declaration of a conflict of interest of one author in relation to diagnostic tools which the paper endorses. The same author was also the Editor in Chief of the journal at the time of publication and evidence indicates that the paper was accepted without any independent peer review by external reviewers. The article is therefore retracted in accordance with the ethical guidelines of Elsevier: https://www.elsevier.com/about/policies/publishing-ethics and the Committee on Publication Ethics (COPE) https://publicationethics.org/files/retraction-guidelines.pdf.

Challenging behavior: Behavioral phenotypes of some genetic syndromes

Challenging behavior in individuals with mental retardation (MR) is relatively frequent, and represents a significant obstacle to adaptive skills. The frequency of specific forms and manifestations of challenging behavior can depend on a variety of personal and environmental factors. There are several prominent theoretical models regarding the etiology of challenging behavior and psychopathology in persons with MR: behavioral, developmental, socio-cultural and biological.The biological model emphasizes the physiological, biochemical and genetic factors as the potential source of challenging behavior. The progress in the field of genetics and neuroscience has opened the opportunity to study and discover the neurobiological basis of phenotypic characteristics. Genetic syndromes associated with MR can be followed by a specific set of problems and disorders which constitutes their behavioral phenotype. The aim of this paper was to present challenging behaviors that manifest in the most frequently studied syndromes: Down syndrome, Fragile X syndrome, Williams syndrome, Prader-Willi syndrome and Angelman syndrome. The concept of behavioral phenotype implies a higher probability of manifesting specific developmental characteristics and specific behaviors in individuals with a certain genetic syndrome. Although the specific set of (possible) problems and disorders is distinctive for the described genetic syndromes, the connection between genetics and behavior should be viewed through probabilistic dimension. The probabilistic concept takes into consideration the possibility of intra-syndrome variability in the occurrence, intensity and time onset of behavioral characteristics, at which the higher variability the lower is the specificity of the genetic syndrome. Identifying the specific pattern of behavior can be most important for the process of early diagnosis and prognosis. In addition, having knowledge about behavioral phenotype can be a landmark in the creation of targeted treatment strategies for individuals with a specific genetic syndrome.