Behavioral fluency and mathematics intervention research: A review of the last 20 years

Behavioral fluency refers to the relationship between the achievement of performance standards, or frequency ranges of behavior, and critical learning outcomes. Over the past 20 years, Precision Teaching and related research have contributed a number of studies examining behavioral fluency. The subsequent review investigates the empirical evidence from mathematics intervention research. Several studies suggest numerical markers that best support behavioral fluency. Results indicate that fluency interventions set to performance standards increased behavioral fluency and associated critical learning outcomes; however, more research is warranted to operationalize and standardize each outcome to the principles of behavior and numerical markers that constitute behavioral fluency.     

Normative Sample of the PEAK Relational Training System: Generalization Module with Comparison to Individuals with Autism

With the rising number of individuals diagnosed with autism and other developmental disabilities comes an increased need for effective assessment and treatment options. Previous research has indicated that applied behavior analytic techniques are among the most empirically supported and utilized treatments for this population; however, curriculum and assessment tools rooted in utilizing these techniques have very little empirical support for their reliability and validity. The current studies sought to assess the performance of both a normative sample and a sample with autism on one such assessment tool: The PEAK Generalization Module. Altogether, 183 typically developing children participated in study 1 and 84 children with a diagnosis of autism participated in study 2. The results indicated that the normative sample demonstrated a strong positive correlation between the PEAK Generalization Assessment and age, whereas the sample with autism demonstrated no significant relationship between the two. Further analysis indicates that the PEAK Generalization Assessment may be an appropriate tool for assessing individuals with autism across a wide range of ages, and provides a preliminary benchmark against which to measure both current functioning and progress in individuals with developmental disabilities.     

Dissemination and Implementation of Cognitive Behavioral Therapy for Depression in the Kaiser Permanente Health Care System: Evaluation of Initial Training and Clinical Outcomes

Notwithstanding its empirical status and strong recommendation in clinical practice guidelines, cognitive behavioral therapy (CBT) continues to be delivered infrequently and with low fidelity on the clinical front lines. Recently, organized efforts and policies within the public sector to disseminate and implement CBT and other evidence-based psychotherapies have yielded encouraging results and provided optimism for bridging the research-to-practice-gap. Following from these efforts, the current article examines the initial impact and experience of the implementation of an individualized approach to CBT training and treatment within the Kaiser Permanente health care system. Initial training outcomes, including changes in general and specific competencies, were assessed using divergent assessment methods within the initial cohort of therapists undergoing training. Initial patient outcomes, including changes in depression and anxiety, were assessed among patients receiving treatment from therapists in training. Results revealed training in and implementation of CBT-D was associated with overall large improvements in therapist competencies and in clinically significant improvements in both depression and anxiety among patients. Findings from the initial phase of dissemination and implementation within a large private system provide support for, and extend recent findings related to, the feasibility and effectiveness of training in and implementation of CBT-D in a real-world context.     

Treating the core features of autism: are we there yet?

A wide variety of nonestablished treatments have been proposed as "cures" for the core features of autism and are used frequently despite having largely escaped scientific scrutiny. In contrast, a growing body of empirical evidence supports the use of a few forms of theory-based and empirically validated treatment for some aspects of the core features of autism. These include behavioral/psychoeducational interventions and specific forms of medication treatment, which can produce significant improvements in communication, social interaction, and problem behaviors that both maintain over time and generalize across settings. While there is no doubt that treatment and educational services for persons with autism have improved over the past 6 decades, it also appears that significant issues remain with respect to (1) the routine application of validated treatments for the majority of cases with autism, (2) the resistance to even validated forms of treatment for a substantial minority of cases with autism, and (3) the extent to which validated treatments effectively treat the specific core features of autism that are most disabling for persons with autism and their families.     

A comparison of a modified sequential oral sensory approach to an applied behavior‐analytic approach in the treatment of food selectivity in children with autism spectrum disorder

Treatments of pediatric feeding disorders based on applied behavior analysis (ABA) have the most empirical support in the research literature (Volkert & Piazza, 2012); however, professionals often recommend, and caregivers often use, treatments that have limited empirical support. In the current investigation, we compared a modified sequential oral sensory approach (M‐SOS; Benson, Parke, Gannon, & Muñoz, 2013) to an ABA approach for the treatment of the food selectivity of 6 children with autism. We randomly assigned 3 children to ABA and 3 children to M‐SOS and compared the effects of treatment in a multiple baseline design across novel, healthy target foods. We used a multielement design to assess treatment generalization. Consumption of target foods increased for children who received ABA, but not for children who received M‐SOS. We subsequently implemented ABA with the children for whom M‐SOS was not effective and observed a potential treatment generalization effect during ABA when M‐SOS preceded ABA.     

AUTISM TREATMENTS IN PRINT: MEDIA'S COVERAGE OF SCIENTIFICALLY SUPPORTED AND ALTERNATIVE TREATMENTS

Professionals, celebrities, and media frequently suggest to parents the possible treatment options for their children with autism. Some treatment recommendations advocate for scientifically supported treatments whereas others suggest novel, untested interventions, or potentially ineffective or harmful treatments. The current study examined the print media's coverage of applied behavior analysis (ABA) and non‐scientifically supported autism treatments. Over the last 10 years, print media have increasingly published articles referring to autism treatments with little scientific support and a decreased coverage of ABA. Print media's positive statements about non‐scientifically supported treatments also increased over the last decade, whereas positive statements about ABA decreased. ABA received two times as many positive comments as negative; however, non‐scientifically supported treatments as a group received four times as many positive comments as negative. These results could contribute to parents' decisions to implement treatments for their children with autism. To contribute to future positive perception of ABA, we provided suggestions for the dissemination of information to increase positive reporting of ABA in print media. Copyright © 2013 John Wiley & Sons, Ltd.     

Perceptions and use of empirically-supported psychotherapies among eating disorder professionals

Despite growing support for the dissemination of empirically-supported treatments (ESTs), treatment providers have been slow to take up using ESTs. This study explored eating disorders (EDs) professionals' views of empirical support for psychotherapies for EDs and the role of empirical evidence in ED treatment selection. We distributed a web-based survey to members of two international organizations of ED practitioners and researchers; 402 members (32.7%) were eligible and participated. Most providers reported they used ESTs in treating EDs, but these ESTs were often folded into eclectic approaches rather than used in forms that had been evaluated in research trials. Use of ESTs and perceptions of empirical support for psychotherapies differed between participants who were and were not recently involved in research. We conclude that perceptions of available research evidence may be important to target in efforts to increase the uptake of ESTs in clinical practice and to help close the research-practice gap.     

Assessing and teaching job‐related social skills to adults with autism spectrum disorder

Few studies have evaluated interventions to improve the job‐related social skills of adults with autism spectrum disorder. In this study, we examined the efficacy of a treatment package for teaching several social skills that are critical to job success, such as responding appropriately to feedback and asking for a task model from the supervisor. Three adults, aged 19 to 27 years, participated. Initial training of each skill consisted of verbal explanations, modeling, and role‐play with feedback, along with stimulus prompts to promote generalization to a different setting. The trainer introduced additional intervention components as needed. We also evaluated generalization across different social skills and evocative situations. Results indicated that the treatment package was generally effective in improving the targeted social skills, and that stimulus prompts may be necessary for generalization to a job setting. However, generalized responding across social skills rarely emerged. These findings have important implications for preparing individuals with autism to function successfully on the job.     

Sleep disorders, epilepsy, and autism

The purpose of this review article is to describe the clinical data linking autism with sleep and epilepsy and to discuss the impact of treating sleep disorders in children with autism either with or without coexisting epileptic seizures. Studies are presented to support the view that sleep is abnormal in individuals with autistic spectrum disorders. Epilepsy and sleep have reciprocal relationships, with sleep facilitating seizures and seizures adversely affecting sleep architecture. The hypothesis put forth is that identifying and treating sleep disorders, which are potentially caused by or contributed to by autism, may impact favorably on seizure control and on daytime behavior. The article concludes with some practical suggestions for the evaluation and treatment of sleep disorders in this population of children with autism.     

THE COSTS OF EATING: A BEHAVIORAL ECONOMIC ANALYSIS OF FOOD REFUSAL

Behavioral economic concepts were applied to the analysis and treatment of pediatric feeding disorders in a clinical setting. In Experiment 1, children who chronically refused food were presented with varying amounts of food on a spoon (empty, dipped, quarter, half, and level). Each child exhibited a different but orderly demand function of response (acceptance, expulsion, and mouth clean) by cost (increasing spoon volume) for a constant pay-off of toys and social interaction. In Experiment 2, physical guidance or nonremoval of the spoon for food refusal was initiated at the smallest spoon volume with low levels of acceptance, and was subsequently introduced at the largest spoon volume with moderate levels of acceptance. Treatment was effective in increasing acceptance, and these effects generalized hierarchically across untargeted spoon volumes. The results of both studies provide preliminary support that increasing spoon volume can be equated conceptually with increasing response effort, and that the change from differential reinforcement to physical guidance or nonremoval of the spoon appears to have altered the elasticity of each child's demand function.     

LICENSURE FOR BEHAVIOR ANALYSTS: THE PATH TO RESPONSIBLE AND COOPERATIVE ACTION

The increase in the prevalence of autism spectrum disorders in the last decade has contributed to growth in the field of applied behavior analysis (ABA). This growth has been spurred by consumer demand for access to this evidence‐based treatment for those with an autism spectrum disorder. Presently, there are at least 34 states that have laws or regulations in place that mandate insurance coverage for autism spectrum disorders. There are also 14 states that have passed licensure or a similar regulatory mechanism for identifying competent providers of ABA. The following paper documents the process of insuring consumer advocacy and protection in the states of Missouri and Wisconsin through the passage of legislation that established licensure for practitioners of ABA. The evolution of this process in both of these states will be detailed as well as a number of lessons learned that should prove to be helpful as additional states move toward licensure for practitioners of ABA. Copyright © 2014 John Wiley & Sons, Ltd.     

Using the picture exchange communication system (PECS) with children with autism: assessment of PECS acquisition,speech, social-communicative behavior,and problem behavior

The picture exchange communication system (PECS) is an augmentative communication system frequently used with children with autism (Bondy & Frost, 1994; Siegel, 2000; Yamall, 2000). Despite its common clinical use, no well-controlled empirical investigations have been conducted to test the effectiveness of PECS. Using a multiple baseline design, the present study examined the acquisition of PECS with 3 children with autism. In addition, the study examined the effects of PECS training on the emergence of speech in play and academic settings. Ancillary measures of social-communicative behaviors and problem behaviors were recorded. Results indicated that all 3 children met the learning criterion for PECS and showed concomitant increases in verbal speech. Ancillary gains were associated with increases in social-communicative behaviors and decreases in problem behaviors. The results are discussed in terms of the provision of empirical support for PECS as well as the concomitant positive side effects of its use.     

A zero-bounded model of operant demand

Contemporary approaches for evaluating the demand for reinforcers use either the Exponential or the Exponentiated model of operant demand, both derived from the framework of Hursh and Silberberg (2008). This report summarizes the strengths and complications of this framework and proposes a novel implementation. This novel implementation incorporates earlier strengths and resolves existing shortcomings that are due to the use of a logarithmic scale for consumption. The Inverse Hyperbolic Sine (IHS) transformation is reviewed and evaluated as a replacement for the logarithmic scale in models of operant demand. Modeling consumption in the “log₁₀-like” IHS scale reflects relative changes in consumption (as with a log scale) and accommodates a true zero bound (i.e., zero consumption values). The presence of a zero bound obviates the need for a separate span parameter (i.e., k) and the span of the model may be more simply defined by maximum demand at zero price (i.e., Q₀). Further, this reformulated model serves to decouple the exponential rate constant (i.e., α) from variations in span, thus normalizing the rate constant to the span of consumption in IHS units and permitting comparisons when spans vary. This model, called the Zero-bounded Exponential (ZBE), is evaluated using simulated and real-world data. The direct reinstatement ZBE model showed strong correspondence with empirical indicators of demand and with a normalization of α (ZBEn) across empirical data that varied in reinforcing efficacy (dose, time to onset of peak effects). Future directions in demand curve analysis are discussed with recommendations for additional replication and exploration of scales beyond the logarithm when accommodating zero consumption data.     

Putting the power of behavior analysis in the hands of nonbehavioral professionals: Toward a blueprint for dissemination†

Behavior analysts have much to offer nonbehavioral professionals who work with the communities that we serve. Successful dissemination of behavior-analytic technologies to these professionals could potentially improve their practice. Although the literature contains some exemplary examples of successful dissemination, our discipline would benefit from a blueprint for conducting this important work. In this article, I share our experiences disseminating behavioral technologies to educators, law enforcement officers, and health care providers who engage with neurodiverse individuals. These experiences form the basis of a recommended blueprint for dissemination, which awaits empirical support. After describing this tentative blueprint, I provide suggestions for future research on how best to disseminate our technologies to nonbehavioral professionals, the ideal content of those dissemination activities, and the conditions under which professionals may be more likely to embed our technologies into their best practices.     

Trauma-Focused CBT in the Context of Parental Chronic Medical Conditions: A Case Report

Parental chronic medical conditions (CMCs) are relatively common and have been shown to impact children’s psychosocial functioning. Previous research suggests that, for some youth, parental CMCs may be conceptualized as a form of traumatic stress. Trauma-focused cognitive behavioral therapy (TF-CBT) is a multicomponent, evidence-based intervention that is designed to reduce symptoms of posttraumatic stress, depression, and anxiety, as well as behavioral problems, among children and adolescents. Despite its robust empirical support, however, no known studies have utilized this treatment approach to address the mental health needs of youth affected by parental CMCs. The purpose of this article is to describe the application of TF-CBT to treat an adolescent male whose mother was diagnosed with a CMC, which had resulted in continuous family stressors since his birth. Results suggest that TF-CBT offers a promising approach for treating symptoms of posttraumatic stress, anxiety, and depression among children of parents with CMCs, and clinical trials to investigate its effectiveness among this population may be warranted.     

Internet-based self-help treatment for panic disorder: a randomized controlled trial comparing mandatory versus optional complementary psychological support

Panic disorder (PD) is one of the most common psychiatric disorders. Web-based self-help treatments for PD have had promising results. These online treatments seem to have larger effect sizes (ESs) when professional support is added. However, the amount of support or how it should be administered is not yet clear. The aim of this trial was to study two ways of administering psychological support provided by phone as a part of Internet-based self-help treatment for PD based on cognitive behavioral therapy. Seventy-seven participants diagnosed with PD were randomly assigned to one of three experimental conditions: a waiting list control group; a treatment group with non-scheduled psychological support; or a treatment group with scheduled psychological support. PD symptoms of participants who received treatment improved significantly compared to the control group (mean ES d = 1.18, p < .05). In addition, there were statistically and clinically significant differences between treatment groups (Mean difference = ?3.20, p = .005, 95% CI [?5.62, ?.79]). The scheduled group showed a larger ES, a lower dropout rate, and better adherence to treatment than the non-scheduled group. Scheduled support seems to be indicated for patients who seek Web-based treatment for PD, and their symptoms of panic, anxiety, and depression improve at post-treatment and six-month follow-up. In contrast, when support depends on patient demand, they receive less support and so, the therapeutic effect is poorer.     

Videoconference to supervise early intensive behavioral intervention: A preliminary evaluation of acceptability

At present, early intensive behavioral intervention (EIBI) for children with autism spectrum disorders is the intervention that has the strongest empirical support. EIBI requires frequent supervision by qualified professionals. Norway, like many other countries, has a shortage of qualified supervisors, particularly in rural regions. This study used a reversal design to investigate how supervisors and supervisees perceive the quality of EIBI supervision and the local team's preparedness when supervision was provided either on-site or via videoconference. Calculations were made on how much time could be saved on travel when part of the supervision was provided via videoconference. There were no significant differences in the supervisors' and supervisees' ratings of on-site and videoconference supervision. Moreover, the supervisors found the local EIBI teams to be better prepared when supervision was provided via videoconference, and the videoconference supervision meetings were shorter. The study discusses the implications of these findings for the accessibility of EIBI and case capacity and proposes some areas for further research.     

A Meta-Analysis of Behavioral Interventions for Adolescents and Adults with Autism Spectrum Disorders

Evaluation of evidence-based treatments is important for adolescents and adults with autism spectrum disorders (ASD) given the increasing number of interventions available and the prevalence of ASD. In this study, we sought to evaluate the effectiveness of behavioral interventions for this population by conducting a meta-analysis of published single-case research studies. A new metric for calculating effect size in single-case research, nonoverlap of all pairs, was utilized. In addition, the certainty of evidence, a system to evaluate research methodology, was applied to the reviewed articles. Forty-three articles were identified in the study. Results suggested that the behavioral interventions in the areas of academic skills, adaptive skills, problem behavior, phobic avoidance, social skills, and vocational skills have medium-to-strong effect sizes. Medium-to-high confidence in findings was noted for 81 % of the studies in the meta-analysis; however, three-fourths of the reviewed studies did not include treatment integrity, which may affect the ability to draw conclusions about the effectiveness of the interventions. Overall, the evidence is promising for the use of behavioral interventions for this population; however, additional research and dissemination are needed to fill the gap between research and practice in order for practitioners to meet the increasing demand as individuals with ASD age.     

Using high-probability foods to increase the acceptance of low-probability foods

Studies have evaluated a range of interventions to treat food selectivity in children with autism and related developmental disabilities. The high-probability instructional sequence is one intervention with variable results in this area. We evaluated the effectiveness of a high-probability sequence using 3 presentations of a preferred food on increasing acceptance in a child with autism who refused a few specific foods. The high-probability sequence increased acceptance of 3 foods. We then systematically faded the intervention for 2 foods.     

A qualitative examination of the work–family interface: Parents of children with autism spectrum disorder

Within the work–family literature little is known about the work–family challenges and opportunities faced by families that have one or more children with autism spectrum disorder. However, it has been consistently demonstrated that parents of children with autism spectrum disorder are at a higher risk of experiencing a host of negative outcomes. Using a qualitative design, within grounded theory, the present study sheds light on the needs, experiences, and challenges that parents of children with autism spectrum disorder face and also offers insight into ways to expand the scope of work–family research in this area. The present research provides evidence of how the family domain can greatly impact experiences and decisions made in the work domain for families with special needs. The present research adds to the small but growing literature examining the interplay between home and work life for families with special needs and demonstrates that this is an important research domain in need of additional conceptual and empirical consideration.