Treatment Of Severe Problem Behavior Research Articles

Transition States in Single-Case Experimental Designs: A Retrospective Consecutive-Controlled Case Series Investigation.

Behavioral interventions to decrease problem behavior often involve the use of single-case experimental designs in which an individual's responding during a treatment condition is compared to responding during a control or baseline condition. It is possible that during the initial introduction of treatment, problem behavior continues to occur at baseline rates before behavior reduction is observed; this phenomenon is called a transition state. Evaluated the prevalence of transition states in the Journal of Applied Behavior Analysis and found that they occurred within 5.3% of the published literature. The current study replicated and extended Brogan et al. by evaluating the prevalence of transition states in unpublished clinical data of patients admitted to an inpatient hospital for the treatment of severe problem behavior. Using a retrospective consecutive-controlled case series, transition states were observed in 3% of cases for an average duration of 4.8 sessions. We discuss factors that may affect transitional behavior between phases and relevant implications for practice and research.

Evaluation of an Individualized Levels System to Increase Consumption for an Adolescent with Food Refusal

A levels system is an intervention that uses a combination of behavioral principles, such as differential reinforcement and response cost, in order to increase appropriate behaviors and simultaneously decrease problem behaviors. Within a levels system, an individual must meet a pre-determined behavioral criterion in order to gain access to various levels of reinforcement. For example, engaging in higher rates of inappropriate behavior will result in access to highly preferred items or activities, while higher rates of inappropriate behavior will access to lesser preferred activities. Although levels systems have been applied in group settings, as well as in the individual treatment of severe problem behavior, their use has not been explored in the treatment of food refusal. The current study implemented a levels system to target increasing the variety and volume of food consumed by a 12-year-old female diagnosed with fetal alcohol spectrum disorder (FASD) effects, mild intellectual disability, and attention-deficit/hyperactivity disorder (ADHD). At the end of her admission, the participant had increased her variety consumed at an age-appropriate volume significantly, as well as the volume of food consumed.

Measurement of nontargeted problem behavior during investigations of resurgence.

Resurgence occurs when a previously extinguished behavior reemerges once a more recently reinforced behavior is placed on extinction. Previous research has suggested that nontargeted responses within the same response class recur alongside target-response resurgence (e.g., da Silva, Maxwell, & Lattal, 2008; Lieving, Hagopian, Long, & O'Connor, 2004). The purpose of this two-experiment investigation was to examine target response resurgence while simultaneously measuring the occurrence of nontargeted responses. Three children diagnosed with autism spectrum disorder who displayed multiple topographies of problem behavior participated. In Experiment 1, a three-phase resurgence procedure was conducted and all three participants displayed target-response resurgence accompanied by the emergence of nontargeted forms of problem behavior. These findings were replicated in Experiment 2 using a 30-min assessment procedure. The implications of these findings as they pertain to the treatment of severe problem behavior and utility of a brief relapse assessment are discussed.

Rules and Statements of Reinforcer Loss in Differential Reinforcement of Other Behavior.

Providing a rule regarding consequences for behavior can increase the efficacy of differential reinforcement of other behavior (DRO) procedures in the treatment of severe problem behavior (Watts, Wilder, Gregory, Leon, and Ditzian, Journal of Applied Behavior Analysis, 46, 680-684, 2013). The purpose of the current study was to replicate and extend the literature on DRO procedures by evaluating the efficacy of rules and statements of reinforcer loss (SRL) in the treatment of severe problem behavior. Conditions included baseline, no rule DRO, rule DRO, and rule DRO with SRL. For 2 of 3 participants, neither the no rule DRO nor the rule DRO condition reduced problem behavior. The rule DRO with SRL condition produced a substantial decrease in problem behavior for all participants, suggesting that a consequent rule enhances the efficacy of DRO. The current study extends the literature on DRO procedures by providing data on nontargeted ("other") behavior. An increase in other behavior was observed for 2 participants.

Treatment of self‐injurious behavior using differential punishment of high rates of behavior (DPH)

The purpose of the current investigation was to explore the effectiveness of differential punishment of high rates of behavior (DPH) to treat the severe self‐injury of a 28‐year‐old man with autism in an adult day program setting. DPH procedures involve the use of an established criterion related to a rate of responding within some time interval at which a punisher is delivered. The implementation of DPH in this study resulted in a substantial long‐term reduction of severe self‐injurious behavior. These findings are significant in that they provide a model for the design and implementation of punishment procedures that can be adopted in applied settings where staff resources are limited. The results of this study have implications for the treatment of severe problem behavior among individuals with autism across settings and age groups.

Noncontingent reinforcement for the treatment of severe problem behavior: An analysis of 27 consecutive applications.

Noncontingent reinforcement (NCR) is a commonly used treatment for severe problem behavior displayed by individuals with intellectual and developmental disabilities. The current study sought to extend the literature by reporting outcomes achieved with 27 consecutive applications of NCR as the primary treatment for severe problem behavior. All applications of NCR were included regardless of treatment outcome to minimize selection bias favoring successful cases. Participants ranged in age from 5 to 33 years. We analyzed the results across behavioral function and with regard to the use of functional versus alternative reinforcers. NCR effectively treated problem behavior maintained by social reinforcement in 14 of 15 applications, using either the functional reinforcer or alternative reinforcers. When we implemented NCR to treat problem behavior maintained by automatic reinforcement, we often had to add other treatment components to produce clinically significant effects (five of nine applications). Results provide information on the effectiveness and limitations of NCR as treatment for severe problem behavior.

Functional analysis and treatment of problem behavior exhibited by children with fragile X syndrome

The efficacy of function-based interventions for the treatment of severe problem behavior exhibited by individuals with intellectual and developmental disabilities (IDD) is well established. However, few studies have reported on behavioral interventions in fragile X syndrome (FXS) specifically. The present study is a consecutive case-series analysis that reports on functional analysis and treatment of problem behavior of nine children with FXS. Assessment findings were consistent with previous research indicating that among individuals with FXS, problem behavior is more commonly maintained by escape from demands and access to tangible items, relative to the broader population of individuals with IDD. Functional analysis-based behavioral interventions resulted in a mean reduction in problem behavior of 95.2% across the nine participants. Additionally, generalization of treatment effects from controlled clinical settings to home, school, and community was demonstrated. The current findings suggest that function-based behavioral interventions shown to be effective with the broader population of individuals with IDD are also effective for individuals with FXS. Our results in combination with those of previous studies describing functional analysis outcomes provide additional evidence for a unique functional behavioral phenotype for severe problem behavior in individuals with FXS. Implications of study findings for early intervention and prevention of problem behavior in children with FXS are discussed.

AN INDIVIDUALIZED LEVELS SYSTEM TO INCREASE INDEPENDENT MEALTIME BEHAVIOR IN CHILDREN WITH FOOD REFUSAL

An individualized levels system was implemented to increase independent eating in two children with food refusal. Participants earned access to different status levels associated with varying availability of preferred items/activities outside of meals according to criteria based on low levels of prompting throughout the meal. A reversal design was implemented to evaluate the effects of the intervention on independent mealtime behavior. Results demonstrated that the levels system was effective in increasing independent eating and in decreasing prompted bites for both participants. Although the effectiveness of an individualized levels system has been previously demonstrated in the treatment of severe problem behavior, it has not been empirically evaluated in the context of increasing appropriate behavior or with children with food refusal. These findings provide support for such a treatment to promote mealtime independence during an intensive feeding program and at two months follow‐up. Copyright © 2013 John Wiley & Sons, Ltd.

Using Functional Analysis Methodology to Evaluate Effects of an Atypical Antipsychotic on Severe Problem Behavior

The atypical antipsychotic medication aripiprazole was evaluated using a randomized AB multiple baseline, double-blind, placebo-controlled design for the treatment of severe problem behavior with 4 children with intellectual and developmental disabilities. Functional analysis (FA) was conducted concurrent with the medication evaluation to determine whether severe problem behavior was differentially affected by the medication during assessment situations associated with specific reinforcement contingencies. Weekly rating scales were completed by parents or teachers. Descriptive and visual analysis indicated that aripiprazole had some apparent differential effects across behavioral function and behavioral topography for 3 out of 4 participants. This study provides a further demonstration of how FA can generate information relevant to understanding medication effects on the reinforcement contingencies maintaining severe problem behavior.

Alterations to functional analysis methodology to clarify the functions of low rate, high intensity problem behavior.

Current research provides few suggestions for modifications to functional analysis procedures to accommodate low rate, high intensity problem behavior. This study examined the results of the extended duration functional analysis procedures of Kahng, Abt, and Schonbachler (2001) with six children admitted to an inpatient hospital for the treatment of severe problem behavior. Results of initial functional analyses (Iwata, Dorsey, Slifer, Bauman, & Richman, 1982/1994) were inconclusive for all children because of low levels of responding. The altered functional analyses, which changed multiple variables including the duration of the functional analysis (i.e., 6 or 7 hrs), yielded clear behavioral functions for all six participants. These results add additional support for the utility of an altered analysis of low rate, high intensity problem behavior when standard functional analyses do not yield differentiated results.

The development and application of individualized levels systems for the treatment of severe problem behavior

Behavioral levels systems are commonly used in a variety of settings and are usually applied at the group level to promote socially desirable behavior and compliance with institutional rules. Despite their widespread use, however, there is surprisingly little empirical data supporting the effectiveness of these interventions. In addition, some researchers have suggested that such group-based interventions may not be consistent with laws mandating individualized educational programming. The current investigation examined the effectiveness of individualized levels systems for decreasing severe problem behaviors exhibited by 4 individuals with developmental disabilities. An individualized multilevel system was developed for each participant based on functional analysis and preference assessment results. These interventions were highly effective in decreasing problem behaviors for each participant. For 2 participants, a component analysis was conducted to identify the necessary components of the levels system. Generalization and care provider training were conducted for all participants. The results suggest that levels systems based on functional analysis and preference assessment results can be effectively generalized and implemented by care providers with good treatment integrity. This approach is presented as a potential alternative to the group-based levels systems that are described in the literature and commonly applied in the community.

Twenty Years of Applied Behavior Analysis in Treating the Most Severe Problem Behavior: Lessons Learned

This paper reviews some of the author's experiences during the past 20 years of treating severe problem behavior. Factors that represent barriers to success are identified and discussed, as are factors that contribute to the development of successful treatment programs. Barriers to success include the inherent reactive nature of human services and educational systems, expertise problems, systems problems, information gaps, programming problems, characteristics of problem behavior, and maintenance problems. Some new programmatic directions are suggested for overcoming the various treatment barriers. The paper concludes with strategies and factors to consider that will ensure long-term success in the treatment of severe problem behavior.