Programming generalization and maintenance of treatment effects across time and across settings

Effects of three experimental and one control strategy were investigated in facilitating generalization and maintenance of treatment effects after two months in a token-economy classroom. At the conclusion of treatment, subjects were randomly assigned to one of three maintenance strategies or a control group and returned to their regular classrooms. The maintenance strategies were peer reprogramming, equating stimulus conditions between the experimental and regular classrooms, and teacher training in behavior management techniques. The maintenance strategies were implemented in the regular classroom for a two-month period and then terminated. Results indicated a powerful treatment effect produced by the token economy. Behavior maintenance effects following treatment were also obtained. The mean per cent appropriate behavior for the peer reprogramming and equating stimulus conditions strategies was significantly greater than the mean for the control subjects. The teacher training and control group means were not significantly different.     

Behavioral treatment of obsessive-compulsive neurosis

Three chronic and severe obsessive-compulsive neurotics were treated with behavioral intervention strategies and psychotropic medication. The effects of treatment were evaluated in three separate experiments with single case experimental designs. The results suggest that response prevention was effective in reducing ritualistic behavior while the effects of flooding and antidepressant medication added little to outcome. The results also suggest that strategies aimed only at reducing compulsive behavior per se are insufficient in eliminating other associated difficulties (e.g., depressive symptoms, interpersonal problems) and that a comprehensive approach to treatment is needed.     

Effects of response preference on resistance to change

Treatments based on differential reinforcement of alternative behavior, such as functional communication training, are widely used. Research regarding the maintenance of related treatment effects is limited. Nevin and Wacker (2013) provided a conceptual framework, rooted in behavioral momentum theory, for the study of treatment maintenance that addressed two components: (a) reemergence of problem behavior, and (b) continued expression of appropriate behavior. In the few studies on this topic, focus has been on variables impacting the reemergence of problem behavior, with fewer studies evaluating the persistence of appropriate behavior. Given the findings from applied research related to functional communication training, variables related to response topography, such as response preference, may impact this aspect of maintenance. In the current study, the impact of response preference on persistence was evaluated in the context of functional communication training for individuals who did not exhibit problem behavior (Experiment 1) and for individuals with a history of reinforcement for problem behavior (Experiment 2). High‐preferred mands were more persistent than low‐preferred mands. These findings suggest that response related variables, such as response preference, impact response persistence and further suggest that response related variables should be considered when developing interventions such as functional communication training.     

On the longevity of behavioral interventions for challenging behavior

The capacity for a treatment to maintain its effects over time may be the most critical component of behavioral interventions for challenging behavior as treatments that fail to persist are likely to be of little value to society. We reviewed the quality and quantity of different types of post-intervention data for the treatment of challenging behavior in studies published over the last 7 years. We found that for the majority of participants at least one measure of maintenance, fading, or follow-up was reported but with limited information regarding the quality of those measures. Reports of secondary variables related to post-intervention data (e.g., latency to measurement) were also uncommon. We discuss possible explanations for the paucity of post-intervention data, barriers to obtaining post-intervention data, strategies for obtaining these data, and implications for the external validity of behavioral interventions for challenging behavior. We provide recommendations for increasing the probability that post-intervention data are included in applied research on challenging behavior.     

Using goal setting, task clarification, and feedback to increase the use of the hands-free technique by hospital operating room staff

We evaluated the effects of a behavioral treatment on the safe passing of sharp instruments using the hands-free technique among hospital operating room personnel during surgical procedures. Treatment consisted of participative goal setting, task clarification, and feedback. The average percentage of sharp instruments passed safely increased from 32% to 64% and 31% to 70% between baseline and treatment phases in the inpatient and outpatient surgery units, respectively. Five-month follow-up data suggested maintenance of treatment effects. These findings suggest the utility of organizational behavior management strategies in reducing risky behavior in hospital settings.     

Generalization of social skills to peer interactions in a child with language delays

Researchers in this study have attempted to determine whether integrating generalization promoting strategies into intervention procedures would enhance the generalization and maintenance of social skills to peer interactions in a preschoold child with language delays. This intervention took place in the natural environment of the day care facility where the child was enrolled. A multiple baseline across behaviors design addressed social response behavior, approach behavior, and play organizers. The intervention utilized a prompting and social reinforcement procedure with minimal adaptations of the onging classroom activities to systematically improve the target child's peer interactions. Several generalization promoting strategies were also used. Improvements in all three types of behavior and generalization of treatment effects across persons, settings, and time were observed. These results lend support for the value of integrating several generalization promoting strategies pre-experimentally into the intervention instead of relying on post hoc evaluation of intervention. ©1997 John Wiley & Sons, Ltd.     

Fixed-time schedule effects in combination with response-dependent schedules

We evaluated the effects of fixed-interval (FI), fixed-time (FT), and conjoint (combined) FI FT reinforcement schedules on the responding of 3 adults who had been diagnosed with schizophrenia. Responding on vocational tasks decreased for 2 of 3 participants under FT alone relative to FI alone. Responding under FI FT resulted in response persistence for 2 of 3 participants. Results have implications for the maintenance of desirable behavior, as well as for situations in which FT treatment has been implemented for problem behavior and problem behavior is nevertheless reinforced by caregivers.     

Differential reinforcement to decrease stereotypy exhibited by an adult with autism spectrum disorder

Motor and vocal stereotypies are behaviors commonly exhibited by individuals with autism spectrum disorder (ASD). Stereotypy may impede and interfere with learning new skills and decrease work performance in employment settings. Previous research has evaluated effective interventions for stereotypy; however, they have typically focused on treating stereotypy exhibited by children in structured settings. We evaluated the practicality of implementing a simple differential reinforcement of other behavior procedure with an adult with ASD in multiple, naturalistic environments. Results showed rapid decreases in motor and vocal stereotypies upon implementation of the intervention and maintenance of low levels of behavior. These data highlighted the successful treatment of stereotypy exhibited by an adult with a long history of exhibiting these behaviors. Treatment effects were replicated across multiple, naturalistic environments.     

Program adherence and coping strategies as predictors of success in a smoking treatment program

Ninety-four participants in a 6-week behaviorally oriented smoking cessation program were administered weekly questionnaires assessing their use of the major program recommendations and other quitting strategies throughout treatment. An "affect-regulation" coping inventory was administered at the beginning and end of treatment as well. Adequate adherence was reported for most of the program recommendations. Although a composite measure of adherence did not predict quitting success, adherence and coping assessments were associated with maintenance of treatment gains. Short-term maintenance was associated with an extensive affect-regulation repertoire and use of "stimulus control" strategies during the program, and long-term maintenance was associated with consistent self-monitoring of smoking during treatment. These prospective findings highlight some behavioral characteristics that may be useful targets in future efforts to foster maintenance of smoking behavior change.     

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.     

A preliminary analysis of instructional control in the maintenance of appropriate behavior

This bridge study evaluated the effects of contingency-specifying instructions (CSIs) and incomplete instructions (IIs) in terms of establishing instructional control of appropriate behavior. Results suggested that instructional control and maintenance were achieved with CSIs but not with IIs. Results are discussed in terms of the potential use of instructional control in the maintenance of appropriate behavior for children with attention deficit hyperactivity disorder.     

Methodology, the matching law, and applied behavior analysis

THE PRACTICAL VALUE OF THE QUANTITATIVE ANALYSIS OF BEHAVIOR IS LIMITED BY TWO METHODOLOGICAL CHARACTERISTICS OF THIS AREA OF RESEARCH: the use of (a) steady-state strategies and (b) relative vs. absolute response rates. Applied behavior analysts are concerned with both transition-state and steady-state behavior, and applied interventions are typically evaluated by their effects on absolute response rates. Quantitative analyses of behavior will have greater practical value when methods are developed for their extension to traditional rate-of-response variables measured across time. Although steady-state and relative-rate-of-response strategies are appropriate to the experimental analysis of many behavioral phenomena, these methods are rarely used by applied behavior analysts and further separate the basic and applied areas.     

An evaluation of resurgence following functional communication training conducted in alternative antecedent contexts via telehealth

Treatments based on differential reinforcement may inadvertently increase the recurrence of problem behavior in the face of challenges because reinforcers for appropriate behavior occur in the same context as problem behavior. The current study evaluated one potential approach to mitigating these problems with differential reinforcement treatments based on behavioral momentum theory. Specifically, appropriate behavior was trained in contexts without a history of reinforcement prior to intervening with problem behavior. Participants were 4 children with autism spectrum disorder. Treatment used telehealth to implement functional communication training (FCT) in three alternative contexts with minimal or no history of reinforcement for problem behavior before initiating FCT in the treatment context. Evaluations of the effects of treatment and tests of resurgence were conducted intermittently during treatment to evaluate maintenance. When FCT treatment was initiated in alternative contexts, initial results were comparable to more typical implementations of FCT. Resurgence was reduced to similar levels during tests of resurgence for all participants when compared to more typical previously published implementations of FCT, but clinically significant reductions in resurgence occurred more quickly in the present study. These findings support training appropriate behavior in an alternative context to mitigate the resurgence of problem behavior during differential reinforcement treatments.     

Brief report: Contact desensitization in the treatment of dog phobias in persons who have mental retardation

In comparison with the research done on phobias in non-retarded individuals, there is a paucity of research in the treatment of phobias in persons with mental retardation. In this study, contact desensitization was evaluated as a treatment for two individuals who have mental retardation and an intense fear of dogs. Following base-line assessment using a behavioral avoidance test (BAT) measuring actual approach behavior, treatment was implemented in a multiple base-line across subjects design. Contact desensitization resulted in the elimination of avoidance behavior in both subjects during the BAT. Measures of generalization in an outdoor setting, and maintenance during a two-month follow-up, showed that the clients continued to be free of avoidance behavior. The implications for further application and research are discussed.     

Effects of the Acquisition of Prerequisite Behavior on the Learning of Nonvocal Verbal Behavior and Vocal Imitation in Children With Severe Retardation

The effects of acquisition and maintenance of prerequisite interactions, such as attending behavior, nonverbal imitative behavior, and disruptive behavior, on the learning of nonvocal verbal behavior and vocal imitation were evaluated. Four severely retarded children were selected on the basis of low level or absence of the target behaviors (nonvocal verbal behavior and vocal imitation) and failure to reach the acquisition criterion on prerequisite behavior. The results were evaluated visually and by time series analysis. Findings indicated that the acquisition of prerequisite interactions led to superior performance and fewer trials to reach criteria in this language intervention.

     

Effects of relationship maintenance on psychological distress and dyadic adjustment among couples coping with lung cancer

OBJECTIVE: Relationship maintenance strategies help to ensure the continuation of valued relationships by keeping them at a certain level of intimacy. This study evaluated how lung cancer patients' and spouses' efforts to maintain their relationships affected their psychological and marital adjustment over time. DESIGN: Psychosocial questionnaires were administered within 1 month of lung cancer treatment initiation (baseline) and 3 and 6 months later to 158 lung cancer patients and their spouses. MAIN OUTCOME MEASURES: Study outcomes were global severity index scores on the Brief Symptom Inventory, and total scores on the Dyadic Adjustment Scale. RESULTS: Multilevel modeling analyses using the Actor-Partner Interdependence Model showed that, regardless of gender or social role (i.e., patient or spouse), individuals who engaged in the strategies of positivity, networks, and shared tasks reported less distress at baseline than other participants. Over time, the effects of providing more assurances and experiencing a partner's increased reliance on social networks differed: patient distress was exacerbated, and spouse distress was alleviated. Couples where both partners engaged in more frequent maintenance behaviors reported greater dyadic adjustment at baseline and over time. CONCLUSION: For couples coping with lung cancer, the initial treatment period may be an important time that sets the tone for future spousal interactions. Engaging in relationship maintenance during this stressful time may help mold more resilient relationships and facilitate adjustment as the disease progresses.     

DISTRACTION: ITS UTILIZATION AND EFFICACY WITH CHILDREN UNDERGOING DENTAL TREATMENT

We investigated the utilization and efficacy of distraction in reducing the anxious and disruptive behavior of 4 children undergoing dental treatment. During the distraction procedure, the children were shown a poster and told a story about it during dental treatment. They earned a prize if they attended to the poster and story and could correctly answer questions about them following each intervention visit. The children's disruptive behavior was assessed via direct observation, and results were analyzed within a multiple baseline design. The children exhibited high levels of anxious and disruptive behavior across baseline visits, regardless of the length of time in treatment or number of visits. Anxious and disruptive behavior decreased upon introduction of the intervention for all children. This was accompanied by the children meeting the criterion for correct answers on the distraction quiz. However, 2 of the children demonstrated an increase in their anxious and disruptive behavior across intervention visits. Results are discussed in terms of the need to evaluate treatment strategies that promote maintenance as well as initial changes.     

A long-term case study of analysis,response suppression,and treatment maintenance involving life-threatening pica

Behavioral assessment and intervention strategies used to treat chronic, life-threatening pica in an institutionalized, 16-year-old male with profoundly retarded collateral self-injurious and aggressive conduct, are described and evaluated. Thirty-minute observation sessions, conducted under baited contitions, revealed that bait saliency and the absence of caregiver supervision were discriminative for high rates of pica. Oral delivery of response-contingent lemon juice suppressed pica to near zero rates, while a procedural package incorporating delivery of water mist contingent on response-antecedant wandering contributed to further reductions in pica. Considerable suppression was maintained for approximately 18 months, with administration by paraprofessional staff. Data spanning nearly four years indicated that pica suppression was primarily a function of the introduction, maintenance, and withdrawal of aversive contingencies, rather than of concurrent schedules of positive reinforcement. Positive and negative side effects, and ethical questions associated with the use of aversive stimuli in treating life-threatening behavior, are discussed.