Brief assessment and treatment of multiple challenging behaviors

We conducted a brief assessment of multiple challenging behaviors in a 19‐year‐old man with developmental disabilities. The results of the brief assessment suggested that spitting and aggression were attention maintained, whereas property destruction was related to escape and tangibles. Spitting also appeared to have a sensory component. Based on the results of the brief assessment, three treatments were evaluated. For attention, treatment involved noncontingent attention and teaching an alternative attention‐gaining gesture. For the escape and tangible functions, opportunities to request tangibles were made contingent on task participation. The third treatment involved provision of leisure materials to provide an alternative source of sensory stimulation. All three treatments were associated with reduced challenging behavior and increased alternative behaviors. These findings suggest that a combination of brief assessment and treatment evaluation may be a useful component in the provision of behavioral support to individuals with developmental disabilities who present with multiple forms of challenging behaviors. Copyright © 2000 John Wiley & Sons, Ltd.     

PARENT EDUCATION INTERVENTION RESULTS IN DECREASED CHALLENGING BEHAVIOR AND IMPROVED TASK ENGAGEMENT FOR STUDENTS WITH DISABILITIES DURING ACADEMIC TASKS

Children with developmental disabilities and attention deficit hyperactivity disorder often engage in challenging behavior when presented with academic demands. Parents of school‐age children with such diagnoses are commonly asked to assist their child with academic tasks but may struggle to do so as a result of challenging behavior. This study evaluated the effects of a parent education intervention on the challenging behaviors and task engagement of three school‐age children with disabilities during academic activities. Parent education consisted of (i) weekly didactic instruction; (ii) modeling; (iii) role‐play; and (iv) in vivo coaching and performance feedback. Using a non‐concurrent multiple baseline across participants with embedded individual multi‐element design, this study demonstrates that a parent education intervention results in decreases in challenging behavior and increases in task engagement. These results suggest that parent education focused on addressing challenging behavior during one‐to‐one instruction may facilitate completion of academic tasks. Implications for practice and suggestions for future research are discussed. Copyright © 2013 John Wiley & Sons, Ltd.     

Reducing problem behaviors in a residential unit using structural analysis and staff management procedures: A preliminary study

A structural analysis of the problem behaviors of 32 adults with mental retardation living together in a residential facility showed that a disproportionate number of these behaviors were associated with a period of time scheduled for leisure activities. A staff management program was implemented during this time which included activity and staff scheduling, staff inservice training, and staff performance monitoring and feedback. The results showed an 83% decrease in problem behaviors when the program was implemented during the leisure period and no decrease in problem behaviors during adjacent time periods where the program was not utilized. Follow-up assessments indicated maintenance of these decreased levels of behavior at 3 and 6 months. It was concluded that this approach of combining a structural analysis with staff management procedures was effective in reducing a high level of problem behavior in a residential setting. The results are discussed with regard to pragmatic strategies for the pretreatment analysis of problem behaviors in residential settings, and the role of organizational behavior management techniques in habilitative programing for individuals with behavior disorders.     

Reducing Escape without Escape Extinction: A Systematic Review and Meta-Analysis of Escape-Based Interventions

Individuals with disabilities may engage in challenging behavior to escape aversive stimuli, like academic tasks or non-preferred foods. Interventions to reduce these behaviors often employ escape extinction; that is, the implementer withholds escape following challenging behavior. Escape extinction can increase risk of injury, restrict autonomy, and worsen the learner–implementer relationship. To mitigate collateral effects, interventions can use strategies without escape extinction (i.e., escape-based); that is, implementers can provide escape contingent on challenging behavior during intervention, in conjunction with other intervention components. However, no comprehensive syntheses of these interventions have been conducted. We identified 39 articles that included escape-based interventions, which contained 273 single-case designs. Escape-based interventions were associated with lower levels of challenging behavior and higher levels of adaptive behavior than baseline conditions. Most comparisons between escape-based and escape extinction interventions showed no functional relation, indicating that escape extinction may not add substantial benefit to intervention efficacy.

     

Evaluating Treatments for Functionally Equivalent Problem Behavior Maintained by Adult Compliance with Mands During Interactive Play

A primary goal of behavioral interventions is to reduce dangerous or inappropriate behavior and to generalize treatment effects across various settings. However, there is a lack of research evaluating generalization of treatment effects while individuals with functionally equivalent problem behavior interact with each other. For the current study, the severe problem behavior of two participants with developmental disabilities was targeted for assessment and treatment. Results of a functional analysis indicated that for both participants, problem behaviors occurred when destructive behavior produced reinforcement of participant mands . The use of a multiple schedule that alternated between differential reinforcement of other behaviors and differential reinforcement of alternative behavior (mands) was sufficient to produce a significant reduction in problem behavior for one participant; the addition of differential reinforcement of alternative behaviors via compliance was necessary for the second participant. Extended treatment sessions, which focused on interaction between the two participants, involved one therapist concurrently implementing each participant’s treatment while they were directed to play with one another (a situation that previously evoked problem behavior). Results show that each participant’s treatment produced low to zero rates of problem behavior even during extended interactions.     

The efficacy of noncontingent reinforcement as treatment for automatically reinforced stereotypy

Noncontingent reinforcement (NCR), in the form of continuous access to preferred leisure items, has recently been reported as a successful treatment for automatically reinforced aberrant behavior. However, previous research has shown that the outcome of such procedures can be compromised under certain circumstances, such as when the response effort required to access leisure items is increased. The purpose of the current study was to assess the efficacy of two variations of NCR as treatment for automatically reinforced stereotypy. In the first phase of the study, functional analyses revealed that the stereotypy of three individuals with developmental disabilities was maintained independent of social consequences. A sensory class assessment was then conducted to identify the specific sensory products that appeared to maintain the behaviors. Finally, we evaluated the effects of NCR (using stimuli identified in the previous assessments) under two conditions. In the first condition, the leisure item was made freely available, by placing it on the table in front of the participant. In the other condition, an experimenter prompted the participant to interact with the leisure item at the beginning of the session. The results indicated that NCR successfully competed with stereotypy only when participants were prompted to interact with the leisure item. These findings are discussed in the context of developing NCR interventions for automatically reinforced aberrant behavior. Copyright © 2002 John Wiley & Sons, Ltd.     

Increasing item engagement and decreasing automatically reinforced problem behavior within a modified competing stimulus assessment

A competing stimulus assessment (CSA) is commonly used to identify leisure items for use in treatments designed to decrease automatically reinforced problem behavior. However, this type of assessment may not yield useful information if participants do not readily engage with leisure items. The purpose of this study was to evaluate a modified CSA that included additional treatment components (i.e., prompting, prompting plus differential reinforcement of alternative behavior). The modified CSA identified the treatment components and leisure items that were most effective for increasing leisure-item engagement and decreasing problem behavior for each participant. Modified CSA outcomes maintained during an extended treatment analysis in a natural setting and when intervention components were faded.     

FUNCTIONAL COMMUNICATION TRAINING TO REDUCE CHALLENGING BEHAVIOR: MAINTENANCE AND APPLICATION IN NEW SETTINGS

We evaluated the initial effectiveness, maintenance, and transferability of the results of functional communication training as an intervention for the challenging behaviors exhibited by 3 students. Assessment indicated that escape from academic demands was involved in the maintenance of the challenging behaviors. Social attention was also implicated as controlling the behavior of 1 student. The intervention involved teaching alternative assistance-seeking and attention-getting phrases to the students in an effort to replace challenging behavior with these verbal equivalents. Multiple baseline data collected across the 3 students indicated that not only did the intervention substantially reduce challenging behavior but also that these results transferred across new tasks, environments, and teachers, and were generally maintained from 18 to 24 months following the introduction of functional communication training. These results are discussed in light of recent efforts to develop effective interventions for severe challenging behavior and to understand the processes underlying transfer and maintenance of intervention effects.     

Brief assessment and treatment of pica using differential reinforcement,response interruption and redirection,and competing stimuli

Pica is a life threating form of challenging behavior displayed by individuals with intellectual and developmental disabilities. In most cases, pica is maintained by automatic reinforcement. Common interventions for pica use some combination of response blocking, response interruption and redirection (RIRD), differential reinforcement of alternative behavior (DRA), and noncontingent reinforcement with competing stimuli. However, there is need for additional research regarding DRA procedures that emphasize skills acquisition by teaching alternative behaviors that modify the established behavioral chain of pica responses that occur in the presence of non-edible stimuli. There is also a need to examine the generality of recent advances in competing stimulus assessment (CSA) methodologies—namely, the augmented-CSA (A-CSA)—to pica. Thus, the purpose of the present investigation was to systematically replicate and extend previous research for the assessment and treatment of pica in an individual with IDD. First, we conducted a functional analysis to identify environmental variables associated with pica. Next, taught Patrick a differential response (i.e., discard pica items in trash receptacle) to earn reinforcers in conjunction with a RIRD procedure. Finally, we conducted an A-CSA for pica. Overall, low rates of pica were maintained over time with a combination of these procedures, and treatment was generalized across settings and people.     

A component analysis of "stereotypy as reinforcement" for alternative behavior

Results from several studies have suggested that the opportunity to engage in stereotypic behavior may function as reinforcement for alternative, more socially desirable behaviors. However, the procedural components of this intervention include several distinct operations whose effects have not been analyzed separately. While measuring the occurrence of stereotypy and an alternative behavior (manipulation of leisure materials), we exposed 3 participants to three or four components of a "stereotypy as reinforcement" contingency: (a) continuous access to materials, (b) prompts to manipulate materials, (c) restricted access to stereotypy (i.e., response blocking), and (d) access to stereotypy contingent on manipulating the materials. Continuous access to materials and prompting (a and b) produced negligible results. Restriction of stereotypy (c) produced a large increase in the alternative behavior of 2 participants, suggesting that response restriction per se may occasion alternative behavior. However, contingent access to stereotypy (d) was necessary to increase the 3rd participant's object manipulation; this finding provided some support for the use of stereotypy as reinforcement for alternative behavior. Finally, when transfer of the effects of intervention was assessed during periods in which active intervention components were withdrawn, the alternative behavior was maintained for 1 participant.     

Effects of outcome performance feedback on maintenance of client and staff behavior in a residential setting

This study examined effects of outcome performance feedback on maintenance of client and direct care staff behavior in a group home for four clients with severe/profound intellectual disability. Following baseline observations, 8 staff were instructed to prompt and praise interclient interactions and game activity during leisure sessions. Staff training comprised written instructions, in situ modeling and rehearsal, and performance feedback. This was followed by a 17-week maintenance period, during which staff received outcome performance feedback based on independent and self-recorded observations. Results showed that client gains were maintained, but did not stabilize. It was concluded that process feedback should have accompanied outcome feedback until staff behavior levels suitable for durable maintenance were obtained. In addition, successful use of performance feedback as a maintenance tool is highly dependent on which outcome behaviors are selected, and whether these are eventually naturally reinforced.     

Experiences of Support Staff with Expanding and Strengthening Social Networks of People with Mild Intellectual Disabilities

A supportive social network is crucial for facilitating social inclusion. The social networks of people with intellectual disabilities (ID) are often small and typically include very little contact with friends and acquaintances who do not have ID. Professionals can play an important role in strengthening and expanding the social networks of clients. In this study, experiences with interventions aimed at doing this were examined. Six group interviews were held with a total of 27 professionals. The results showed interventions to strengthen social networks (e.g. attention to the maintenance of contact with network members) and interventions to expand social networks (e.g. participation in leisure time activities and working with volunteers). However, a large number of impeding factors was mentioned, such as the limited size of the social networks, characteristics of the client, different perceptions and clients falling between the cracks when it comes to leisure time. The large number of impeding factors shows the strengthening and expansion of social networks to be complicated in actual practice. Recommendations are thus made to strengthen and expand the social networks of clients in an innovative manner which also takes these impeding factors into account. Copyright © 2013 John Wiley & Sons, Ltd.     

The assessed crisis service needs of clients in community-based programs serving persons with developmental disabilities

Crisis services for persons with developmental disabilities who display challenging behaviors is rapidly emerging as a critical need for individuals placed in the community. Many states continue to close their large state facilities for persons with developmental disabilities. Challenging behaviors impedes successful living in the community. A questionnaire providing information on the types of challenging behavior, the availability and perceived need for on-site and off-site crisis-respite support services, and the optimal method of accessing community-based crisis services, was sent to Minnesota residential facilities in the metropolitan and rural areas. The results revealed commonalities between these respondents as well as the differences. As the national trend of deinstitutionalization continues, the information derived from this study will be useful for the development of crisis services in other states. © 1998 John Wiley & Sons, Ltd.     

COVARIATION WITHIN FUNCTIONAL RESPONSE CLASSES: IMPLICATIONS FOR TREATMENT OF SEVERE PROBLEM BEHAVIOR

Two studies examined the effects of a reductive treatment versus instruction-based treatments on the generalized reduction of problem behaviors. Each study involved a detailed analysis of multiple problem behaviors performed by school-aged youth with severe intellectual disabilities. The analysis examined the contrasting effects of one of two different positive intervention procedures (teaching a positive alternative behavior or providing additional teacher assistance during instruction) versus blocking and/or verbally reprimanding a problem behavior. The focus of each analysis was on the covariation of multiple problem behaviors within functional response classes. Results of the investigation indicated that when only one member of the response class was blocked, a collateral increase was observed in one or more different problem behaviors from the same response class. Alternatively, when 1 participant was taught a functionally equivalent mand response, all problem behaviors in the response class were reduced. Problem behaviors also were reduced for the remaining participant by presenting antecedent teacher assistance. Implications of the research extend to analysis of covariation within response classes and to procedures that result in generalized reduction of problem behaviors within a response class.     

Behavioral intervention to reduce physical restraint of adolescents with developmental disabilities

Physical restraint procedures sometimes are approved for implementation in human service settings for children and adults who have developmental disabilities and seriously challenging behaviors. Although use of restraint may be clinically justified to manage behavior disorders and prevent injury to self and others, procedures should be evaluated to decrease, and possibly eliminate, such methods. This study addressed the effects of restraint‐reduction procedures with two adolescents who had developmental disabilities and displayed severe aggression. Clinically significant reductions in the frequency of physical restraint were achieved through a treatment package that included the behavior‐specific criterion for the application of restraint and antecedent control approaches. The implementation of strategic interventions to decrease physical restraint utilization is discussed. Copyright © 2000 John Wiley & Sons, Ltd.     

A follow up study of a behavioral program for young people with learning disabilities and challenging behavior

This paper describes a pilot follow-up study of a behavioral program for 20 young people with learning disabilities and challenging behavior. Eighteen participants made good overall improvement during the treatment period, and this was partially maintained at follow-up. Eight had continued to improve, eight had deteriorated slightly and four had deteriorated markedly. Adaptive skills were generally maintained. The reemergence of challenging behaviors explained the difference between the Good and Poor Outcome groups. Those participants in the Good Outcome group were younger on admission, scored lower on adaptive skills and higher on challenging behaviors. In addition they had remained on the treatment programme for 12–18 months and had been discharged from the Unit for longer. The overall level of independent living had increased from preadmission and the majority of participants were living in less restrictive placements. These results confirm and extend the findings of previous research. The paper concludes by highlighting the need for more detailed longitudinal follow-up studies in this area.     

The importance of leisure as a means of coping with work related stress: An exploratory study

Work stress researchers have long recognized the importance of coping in the work stress relationship and there is now a growing body of literature exploring the measurement and classification of coping strategies. While a range of coping activities have been explored one area that has received a less than complete treatment is the importance individuals give to leisure as a means of coping with work related stress. This research set out to explore the important reasons individual attach to leisure as a means of coping with work stress. The sample was made up of 695 principals and deputy principals from secondary schools throughout New Zealand. Analysis revealed that there were two reasons why leisure is important as a means of coping; one because of its active/challenging nature and the other because of its more passive/recuperative nature. The items that made up these two broad categories were then further explored in relation to a number of measures of well-being. This involved the use of sequential tree analysis and the sequential unfolding of the different reasons. The pattern to emerge suggested that 'being totally focused' was an important reason for engaging in active/challenging leisure whereas a more complex profile emerged for using passive/recuperative leisure activities. The significance of these findings is discussed in terms of intervention strategies and the role of leisure within work stress research.     

An analysis of the selective effects of NCR with punishment targeting problem behavior associated with positive affect

Among individuals with developmental disabilities and behavioral problems, self‐injury and aggression are often associated with negative affect such as crying. In the current report, we present data on two children who displayed problem behaviors (screaming and self‐injury) that were often associated with positive affect. In contrast to their other problem behaviors that were socially mediated, these behaviors were maintained independent of social consequences. One concern about treating problem behavior associated with positive affect is that the treatment may produce generalized reductions in positive affect. In both cases presented in the current study, the reductive effects of a treatment targeting these behaviors were highly selective, producing decreases in screaming and self‐injury, while minimally affecting affect. Copyright © 2001 John Wiley & Sons, Ltd.     

A Review of Interventions Designed to Increase Sharing Behaviors in Children with Social Delays or Deficits

Sharing materials is a complex social behavior that may lead to long-term development of friendships and concomitant increases in related prosocial behaviors. Given the complexities of sharing behaviors, children with social delays or deficits may not recognize when, how, and with whom to share. Because children with social delays or deficits, especially those with disabilities, may not engage in typical sharing behaviors, and because these behaviors are important, identifying interventions for sharing and related social behaviors are crucial. The purpose of this review was to identify sharing interventions, evaluate methodological rigor, and assess intervention effectiveness. Twenty single-case designs published in 11 articles were included. Some studies reported variable results and had considerable methodological limitations. Results of high-quality studies are promising and provide a foundation for future research on sharing behaviors.     

The Effect of Nonverbal Skills Training on Counselor Trainee Nonverbal Sensitivity and Responsiveness and on Session Impact and Working Alliance Ratings

Counselor trainees (N = 18) were randomly assigned to treatment (nonverbal sensitivity) or control (empathy training) conditions. Trainees saw a recruited client before (first 2 weeks) and after (last 2 weeks) a 15-week counseling methods class. Trainees rated their sensitivity to nonverbal behaviors, counseling self-efficacy, and the extent to which they focused on client nonverbal behavior. Clients filled out the Session Evaluation Questionnaire and Working Alliance Inventory at pre- and posttesting. Trained raters viewed videotapes of the counseling sessions and rated the extent that counselors focused on client nonverbal behavior. As hypothesized, trainees in the treatment condition, when compared with those in the control condition, increased their focus on client nonverbal behaviors. In addition, clients of treatment condition counselors showed significant differences in working alliance ratings. Trainees in both conditions increased their rating of nonverbal sensitivity and self-efficacy from pre- to posttesting. Implications are discussed.