Non-concurrent Multiple Baseline Design Research Articles

Development and Validation of an Assessment-Driven Behavioral Intervention for Primary Complex Motor Stereotypies in Young Children.

Complex motor stereotypies are rhythmic, repetitive, fixed, and non-goal directed movements (e.g., bilateral flapping/waving movements of the hands/arms). Movements typically begin in early childhood and can occur in otherwise normally developing ("primary") or autistic ("secondary") children. Stereotypies persist, occur multiple times a day, have prolonged durations, can be socially stigmatizing, and may lead to bullying and isolation. Prior behavioral treatment studies have focused on older children (ages 6-12) and report modest reductions in stereotypy (i.e., between 14% and 33%). The current study involves the functional assessment and treatment of five children with Primary Complex Motor Stereotypy using a modified awareness training procedure, differential reinforcement of other behavior, and schedule thinning in a nonconcurrent multiple baseline design. Results suggest a 99% reduction of motor stereotypy from baseline across all participants.

Parent-Child Interaction Therapy as Applied to Turkish Families: Effectiveness for Children with Behavior Problems and Their Caregivers

This study assessed the impact of Parent-Child Interaction Therapy (PCIT) on caregiver and child outcomes in Türkiye using a non-concurrent multiple baseline design (N = 3). Improvements in child disruptive behavior frequency were observed, with a large effect across participants (Tau-U = −0.74) and perceived problematic child behaviors (Tau-U = −0.87). School refusal, anxiety symptoms, and child emotion regulation improved with reliable change indices indicating clinically significant improvements (>1.96). Clinically significant decreases (RCI >1.96) in parenting stress and parent emotion regulation difficulties were also observed. Parents demonstrated improvements in parenting skills, as outlined by the PCIT protocol. This study highlights PCIT’s efficacy within a novel cultural context.

Technology for helping people with neuromotor, intellectual, and speech disabilities engage in leisure and communication activities: a proof-of-concept study.

We extended the assessment of our recently developed technology to help people with neuromotor, intellectual, and speech disabilities access (listen to) music, communicate with distant partners, and answer questions. The technology included a tablet (1) fitted with an Internet connection, a SIM card, WhatsApp Messenger, and MacroDroid application, and (2) interfaced with different pairs of response sensors. Six participants were included in the study, which was carried out according to a nonconcurrent multiple baseline design across participants. During the baseline phase (5-8 sessions carried out over 1-2 weeks), participants were unable to access music, make video calls, or answer questions using a regular tablet. During the intervention phase (50-102 sessions carried out with the technology over 2-4 months), however, they activated means of 4.7-7.6 songs and 0.4-3.6 video calls per session. Moreover, they answered correctly a mean of 69-96% of the questions presented to them. These results suggest that our technology solution is a viable and potentially valuable resource for people with extensive disabilities.

Enhancing Parental Understanding of Emotions in Children with Developmental Language Disorder: An Online Parent-Led Intervention Program.

Many children with developmental language disorder (DLD) have emotion recognition and regulation difficulties, but there are currently no known interventions enhancing emotional awareness in this population. This study explores the impact of parents' perspectives regarding children with DLD emotional understanding through a parent-led online emotion recognition (ER) intervention. Ten parents of children with DLD aged 6-11 participated in the study. A nonconcurrent multiple baseline design was employed, allowing for a rigorous analysis of changes in parental beliefs over time. Weekly data were collected through the Parents' Beliefs About Children's Emotions Questionnaire. Interviews were also conducted to gain deeper insights into parents' perceptions regarding the ER skills of their children. Results indicated that parents' beliefs about the need for guiding and supporting their child's ER skills increased over the intervention. Interviews also supported this, and three main themes were generated. The intervention program increased parents' awareness of (a) the importance of ER for children with DLD, (b) emotion-focused communication and engagement with their child, and (c) the integration of emotions into daily life. This study is the first known study that explores parents' beliefs about children with DLD ER skills, highlighting the importance of supporting parents through accessible interventions.

Teaching basic personal finance to justice‐involved youth

AbstractJustice‐involved youth (JIY) display skills deficits in a variety of domains, but particularly in life skills such as health habits, obtaining a job, and maintaining finances. These skills are particularly important for JIY, who often come from historically disenfranchised communities. This population encounters many challenges as they transition from juvenile correctional facilities to their respective communities. To have the greatest impact, these skills should likely be taught prior to the transition. Thus, the purpose of this study was to teach basic personal finance skills to adolescent males in a juvenile residential treatment facility, using an information packet with rehearsal and feedback. The intervention was specifically chosen to be minimally invasive due to the challenges presented by the COVID‐19 pandemic relating to providing services to JIY. Data were analyzed visually using nonconcurrent multiple baseline designs. The results of the study showed the intervention was moderately effective at teaching basic financial skills relating to budgeting, banking, and credit to four participants.

Enabling People With Intellectual and Sensory Disabilities to Trigger a Tablet's Delivery of Task Instructions by Walking to the Tablet: Proof-of-Concept Study.

People with intellectual and sensory or sensory-motor disabilities tend to have problems performing multistep tasks. To alleviate their problems, technological solutions have been developed that provide task-step instructions. Instructions are generally delivered at people's request (eg, as they touch an area of a computer or tablet screen) or automatically, at preset intervals. This study carried out a preliminary assessment of a new tablet-based technology system that presented task-step instructions when participants with intellectual and sensory disabilities walked close to the tablet (ie, did not require participants to perform fine motor responses on the tablet screen). The system entailed a tablet and a wireless camera and was programmed to present instructions when participants approached the tablet, that is, when the camera positioned in front of the tablet detected them. Two instructions were available for each task step. One instruction concerned the object(s) that the participants were to collect, and the other instruction concerned the "where" and "how" the object(s) collected would need to be used. For 3 of the six participants, the two instructions were presented in succession, with the second instruction presented once the required object(s) had been collected. For the other 3 participants, the two instructions were presented simultaneously. Instructions consisted of pictorial representations combined with brief verbal phrases. The impact of the system was assessed for each of the 2 groups of participants using a nonconcurrent multiple baseline design across individuals. All participants were successful in using the system. Their mean frequency of correct task steps was close to or above 11.5 for tasks including 12 steps. Their level of correct performance tended to be much lower during the baseline phase when they were to receive the task-step instructions from a regular tablet through scrolling responses. The findings, which need to be interpreted with caution given the preliminary nature of the study, suggest that the new tablet-based technology system might be useful for helping people with intellectual and sensory disabilities perform multistep tasks.

A novel independence intervention to treat child anxiety: A nonconcurrent multiple baseline evaluation

Rates of child and adolescent anxiety have increased markedly over the past decade (Haidt & Twenge, 2023). Exposure-based cognitive-behavioral therapy is the gold standard in the treatment of anxious children (Hofmann et al. (2012)). However, many clinicians refrain from using exposure due to concerns about its safety, effectiveness, and ethics (Deacon et al., 2013; Whiteside et al., 2016). We propose a novel treatment approach for child anxiety composed of independence activities (IAs), which are child-directed, fun, unstructured, developmentally challenging tasks performed without parents’ help. These tasks are purposely topographically unrelated to the stimuli that cause anxiety, in direct contrast to exposure therapy. Despite this dissimilarity, IAs target putative mechanisms involved in the development and maintenance of child anxiety (e.g., parental accommodation and overinvolvement, child avoidance, unhelpful thinking styles). Using a nonconcurrent multiple baseline design, this five-session treatment provided preliminary evidence of high treatment acceptability from children and parents. Medium to large improvements were reported in child anxiety and avoidance, parent and child (behavioral and cognitive) mechanisms involved in the maintenance of child anxiety, and untargeted secondary outcomes such as child happiness. Results may suggest a new treatment paradigm, which is desperately needed, given unabated increases in child and adolescent anxiety despite vast resources being directed toward the problem.

People with Neuro-motor Impairment, Lack of Speech, and General Passivity Can Engage in Basic Forms of Activity and Communication with Technology Support

Abstract Objectives People with neuro-motor impairment, lack of speech and general passivity live in a marginalized and isolating condition. This study used a technology-aided program to help three of these people achieve basic activity (i.e., accessing music videos and listening to stories and/or answering questions) and communication (i.e., video calling or sending messages to preferred partners). Methods The study was carried out according to a non-concurrent multiple baseline design across participants. During the intervention, the participants were provided with the technology system that entailed a tablet and two touch or two optic sensors. Within each session, the tablet presented the participants with choice periods (i.e., periods in which they could choose between music videos and communication with distant partners) interspersed with stories plus questions or questions periods. Results During the baseline (without the technology system), the participants were not able to make choices (failing to access music videos or communication events) or to answer questions. During the intervention sessions, all participants used the technology successfully to access music videos and communication events and to answer questions independently. Conclusions The results suggest that simple technology can be adapted to help people like the participants of this study achieve basic forms of functional activity and communication.

Effects of Serial Multiple Exemplar Training on Bidirectional Naming in Children with Autism

This study examined the effect of a serial multiple exemplar training (S-MET) procedure on bidirectional naming (BiN) in four preschool children diagnosed with autism spectrum disorder (ASD). A non-concurrent multiple baseline design was used to evaluate the effects of training listener and speaker behavior for one stimulus at a time until BiN occurred. When BiN occurred, probes were conducted to measure whether generalization occurred across settings and people. Three out of four participants’ responding met the mastery criterion for BiN, while the fourth participant improved her performance. The results of this study suggest that S-MET may be a promising intervention and contribute to our knowledge about learning histories required for BiN.

Uma Comparação do Ensino de Relações de Tato-Intraverbal e de Ouvinte para Crianças Diagnosticadas com Transtorno do Espectro do Autismo

Abstract Studies using teaching techniques derived from Applied Behavior Analysis (ABA) principles have shown promising results, based on empirical evidence, in teaching speaker and listener behavior to individuals diagnosed with Autism Spectrum Disorder (ASD). Our objective was to compare the effects of two teaching procedures on the acquisition of intraverbal-tact and listener relations involving spatial relations concerning body parts in six boys with autism. In “intraverbal-tact-to-listener”, questions in the presence of non-verbal stimulus were taught and then tested for emergence of listener responding. In “listener-to-intraverbal-tact”, listener responses were initially taught and the emergence of intraverbal-tact responses were tested. An alternate treatment design with an embedded nonconcurrent multiple baseline design across participants was used. The results suggest that the intraverbal-tact-to-listener protocol was more effective. Such data concerning to body parts spatial relations replicate findings for other repertoires.

Professional Development Effects on Early Intervention Providers’ Implementation of Home Visiting Practices

A non-concurrent multiple baseline design across four early intervention providers was used to examine functional relations between job-embedded professional development (PD), including practice-based coaching (PBC), and providers’ fidelity of implementation of home visiting practices for embedded intervention. Four providers with one to two caregivers and their toddler with disabilities or developmental delays participated. The primary dependent measure was the number of essential home visiting practices providers implemented with fidelity. Results from visual analyses showed a functional relation between job-embedded PD and the number of essential home visiting practices implemented with fidelity for three of four providers. Provider and caregiver social validity data indicated PD and home visiting practices and embedded intervention were appropriate, feasible, and useful. Results provide promising evidence for job-embedded PD, including PBC, to support providers’ fidelity of implementation of home visiting practices for embedded intervention. Implications for future research and practice are discussed.

CICO-Secondary: A Single-Case Experimental Study in High School

Check-in/check-out (CICO) is an evidence-based multicomponent intervention widely implemented in elementary and middle schools. The purpose of this study was to evaluate whether an adapted CICO intervention, with CICO components designed to be more developmentally appropriate for adolescents and contextually relevant for high schools, could be implemented with procedural fidelity and improve outcomes for students with and at risk for disabilities. The study included three ninth-grade students (two with Individualized Education Programs) in one U.S. public high school. We used a non-concurrent multiple baseline design conducted over two academic years during the COVID-19 pandemic to experimentally evaluate the effects of CICO-Secondary on student academic engagement. Results demonstrated that students participated with adequate procedural fidelity and that there was a functional relation between implementation of CICO-Secondary and improved student academic engagement. Students and school personnel also perceived CICO-Secondary to be socially valid. Implications for both future research and practice are discussed.

Integrated Behavior Therapy for Exclusively Anxious Selective Mutism: A Nonconcurrent Multiple-Baseline Design across Five Participants.

Selective mutism (SM) is a rare childhood anxiety disorder which may be markedly detrimental to a child's academic and social functioning if left untreated. Cognitive-behavioral treatments for social anxiety disorders have been found to be effective for SM, yet a paucity of published studies have explored manualized treatment approaches carried out by novice clinicians. The purpose of the present study was to examine the adherence, effectiveness, and acceptability of a condensed, 16-session version of Integrated Behavior Therapy for Selective Mutism (IBTSM; Bergman, 2013), the first manualized treatment for SM. A nonconcurrent multiple-baseline single-case design was used across five children diagnosed with SM, exclusively anxious subtype. IBTSM was implemented with excellent adherence (M = 98%) over an average of 19 weeks (range = 16-22 weeks). Visual analyses of weekly caregiver ratings of social anxiety and speaking behaviors did not demonstrate a replicated intervention effect; however, Tau-U effect sizes and Reliable Change Index (RCI) calculations demonstrated significant individual improvements in social anxiety and speaking behaviors over time on several measures. Three children (60%) no longer met diagnostic criteria for SM following treatment. All caregivers rated IBTSM as acceptable, with specific endorsements of acceptability in the areas of time required and treatment quality.

Teaching Receptive Vocabulary to Minimally Verbal Preschoolers With Autism Spectrum Disorder: A Single-Case Multiple Baseline Design.

The purpose of this multiple probe design was (a) to investigate whether the use of the match-to-sample (MtS) procedure would result in independent identification of objects and (b) to examine whether the participants could generalize to matching objects and nonidentical pictures. Using a nonconcurrent multiple baseline design, three minimally verbal preschoolers with autism spectrum disorder and receptive language impairment were taught to identify common objects using a MtS procedure and physical prompts. Participants were taught to match identical objects to identical pictures. Maintenance checks were completed following mastery of vocabulary for a total of 22 words. Generalization probes were conducted with the objects and nonidentical pictures. Intervention was completed by a speech-language pathologist during typical speech-language pathology sessions. Results illustrated that all of the participants learned to match and generalize the pictures. All were able to independently identify the objects at 1-month follow-up. MtS and prompting appear to be effective procedures for teaching receptive vocabulary and can be easily implemented by education professionals. Learner profiles varied for the participants in this study and are an important aspect when teaching students with autism spectrum disorder and co-occurring receptive language impairment.

Using video modeling to teach the picture exchange communication system

The picture exchange communication system (PECS) is an evidence-based communication intervention designed to improve communication skills in people with limited to no functional speech. Because of this, professionals frequently look for opportunities to receive training in how to implement PECS. Though most training methodologies have included robust, and time intensive, training methodologies, one recent study used video modeling (VM) with voice-over instructions and text descriptions to train three future professionals in the implementation of PECS. Thus, to find even more efficient and effective training methodologies, this study aimed to train future professionals in the first three phases of PECS using VM alone and, if necessary, verbal feedback. A nonconcurrent multiple baseline design across three participants was used in the study. The results indicated all three participants demonstrated an immediate change in skills following VM alone, with only one participant requiring brief feedback in Phase 1. This was further evidenced by large effect sizes. Thus, results indicate that training future professionals using VM was both more efficient and equally effective when compared to previous training methodologies.

Using Simple Interactive Technology to Help People with Intellectual and Visual Disabilities Exercise Functional Physical Responses: A Case Series Study

The study assessed a new interactive technology system for helping six people with intellectual and visual disabilities exercise relevant physical responses embedded within a fairly straightforward activity (i.e., placing objects in containers). Activity responses consisted of the participants taking objects from the floor or a low shelf and placing those objects in a container high up in front of them (thus bending their body and legs and stretching their arms and hands). The technology involved a portable computer, a webcam, and three mini speakers whose basic functions included monitoring the participants’ responses, delivering preferred stimulation contingent on the responses and verbal encouragements/prompts for lack of responses, and assisting in data recording. The study was conducted following a non-concurrent multiple baseline design across participants. During baseline (i.e., when the system was used only for data recording), the participants’ mean frequency of responses per session varied between zero and nearly 12. During intervention (i.e., when the system was fully working), the participants’ mean frequency of responses per session increased to between about 34 and 59. Mean session duration varied between nearly 10 and over 14 min. The new system may be a valuable tool for supporting relevant physical activity engagement in people with intellectual and multiple disabilities.

A Digital Music-Based Mindfulness Intervention for Black Americans With Elevated Race-Based Anxiety: A Multiple-Baseline Pilot Study.

Race-based anxiety is a substantial health issue for the Black community. Although mindfulness interventions have demonstrated efficacy for alleviating anxiety, three central barriers prevent Black Americans from accessing existing mindfulness treatments: high costs, excessive time commitments, and limited cultural relevance. There is a need for novel mindfulness interventions for the Black community that can overcome these barriers. The goal of this web-based study was to examine the preliminary efficacy, feasibility, and acceptability of a novel digital music-based mindfulness intervention for middle-to-low-income Black Americans with elevated race-based anxiety. This study used a nonconcurrent multiple-baseline design (n=5). The intervention featured contributions from Lama Rod Owens (a world-renowned meditation teacher and LA Times best-selling author) and Terry Edmonds (the former chief speechwriter for President Bill Clinton). We examined the effect of the intervention on state anxiety and assessed its feasibility and acceptability using quantitative and qualitative measures. Results revealed that administration of the intervention led to significant decreases in state anxiety (Tau-U range -0.75 to -0.38; P values<.001). Virtually all feasibility and acceptability metrics were high (ie, the average likelihood of recommending the intervention was 98 out of 100). This study offers preliminary evidence that a digital music-based mindfulness intervention can decrease race-based anxiety in Black Americans. Future research is needed to replicate these results, test whether the intervention can elicit lasting changes in anxiety, assess mechanisms of change, and explore the efficacy of the intervention in real-world contexts.

Motivating children with feeding disorders to self‐feed: An evaluation of using differential reinforcement and manipulation of establishing operations to increase self‐feeding

AbstractSelf‐feeding is a behavioral cusp vital to independence, growth, and development. Previous studies demonstrate that interventions like escape extinction in the form of physical guidance are effective at increasing self‐feeding in children with feeding disorders. However, these interventions may not be effective for all children. In the present study, we evaluated the effects of a treatment package that involved increasing the quality of feeder attention and access to tangibles to decrease the comparative value of escape from the self‐feeding demand for two children with feeding disorders using a nonconcurrent multiple baseline design. Despite demonstrating the skills to self‐feed preferred foods and consume target foods, neither child self‐fed target foods independently. Following differential reinforcement with the manipulation of establishing operations, both children demonstrated improvement in self‐feeding bites of target foods. In addition, caregivers were trained to implement the protocol with high procedural integrity.

Effect of Unified Protocol on neuroticism, emotion regulation skills, and symptom severity—A case series

BackgroundThere has been a shift from single disease protocols to interventions that address shared vulnerabilities across disorders with high comorbidity. Unified Protocol (UP) is an emotion-focused transdiagnostic intervention that addresses neuroticism, a shared mechanism identified in emotional disorders by enhancing emotion regulation skills. In this study, we attempted to understand the effect of the (UP) on symptom severity, emotion regulation, and neuroticism. MethodsA non-concurrent multiple baseline design was adopted. Six clients with a primary diagnosis of an anxiety disorder were randomly assigned to a 2, 3, or 4-week baseline period, following medication stabilization for 4 weeks. Following the baseline period, UP was delivered over 15–18 sessions. Neuroticism and emotion regulation were assessed at baseline, post, and follow-up. Anxiety severity was measured weekly by both an independent rater and on self-report. ResultsOf the 6 clients randomized, 3 completed the intervention. Visual analysis was used to examine changes in symptom severity and Reliable Change Index (RCI) was used to examine changes in scores on neuroticism and emotion regulation across time points for the 3 completers. Reliable change was observed in 1 out of 3 clients for neuroticism and in 2 out of 3 clients for emotion regulation skills. Change in slope, and level of symptom severity was observed across participants. ConclusionsUP is a parsimonious approach to addressing co-morbidities. Our findings support the role of emotion regulation skills in the management of anxiety. A larger sample is required to establish these findings more robustly and support generalization of findings.

Trauma-focused treatment for traumatic stress symptoms in unaccompanied refugee minors: a multiple baseline case series.

Unaccompanied refugee minors (URMs) are at increased risk of developing mental health problems, such as symptoms of posttraumatic stress disorder (PTSD) and depression. In addition, URMs face several barriers to mental health care. Few studies have evaluated trauma-focused interventions for URMs that target these issues. The current study evaluated a multimodal trauma-focused treatment approach for URMs. It aimed to provide an initial indication of the effectiveness of this treatment approach and to provide a qualitative evaluation assessing treatment satisfaction of the participating URMs. A mixed-methods study was conducted among ten URMs, combining quantitative data with qualitative data through triangulation. Quantitative data were collected using a non-concurrent multiple baseline design in which repeated, weekly assessments were carried out during a randomized baseline period, during treatment, and during a 4-week follow-up period. Questionnaires assessing PTSD (Children's Revised Impact of Event Scale) and symptoms of depression (The Patient Health Questionnaire-9, modified for adolescents) were used. In addition, treatment satisfaction was measured post-treatment using a semi-structured interview. During the qualitative evaluation, all but one URM noted they found the trauma-focused treatment approach useful and felt the treatment had positively impacted their wellbeing. However, the results of the quantitative evaluation did not show clinically reliable symptom reductions at posttest or follow-up. Implications for clinical practice and research are discussed. The current study presents our search in developing a treatment approach for URMs. It adds to the current knowledge about methodological considerations in evaluating treatments for URMs, the potential effects of trauma-focused treatments on URMs, and the implementation of treatments for URMs.Clinical trial registration: The study was registered in the Netherlands Trial Register (NL8519), 10 April 2020.