Current Perspectives on Interventions for Self-Injurious Behavior of Children with Autism Spectrum Disorder: A Systematic Review of the Literature

Our purpose in this systematic review was to identify, evaluate, and summarize the single-case research design studies examining behavioral interventions to address self-injurious behavior for young children with autism spectrum disorder. We identified 24 studies published between 2000 and 2016 that met the inclusion criteria. We reviewed and coded each study across five content areas using systematic procedures. These content areas consisted of the methodological quality of single-case research designs, children’s demographic information, conditions under which the intervention was implemented, characteristics of intervention, and outcomes. Our findings indicate that procedural integrity data were reported for only one study and social validity for two studies. The majority of studies were implemented by researchers or therapists in the school setting. For 24 of 30 children included in the studies reviewed, the authors taught a replacement behavior selected on the basis of an assessment conducted prior to intervention. All authors reported a decrease in the self-injurious behavior post-intervention. A limited number of authors examined generalization and maintenance of low rates of self-injurious behavior. Limitations of the present review and future directions and implications for research and practice are discussed.     

Happy Family Kitchen: Behavioral Outcomes of a Brief Community-Based Family Intervention in Hong Kong

Positive psychology interventions commonly involve behavioral exercises to improve psychosocial well-being. Intervention effect on behavior is unclear. The Happy Family Kitchen project, one of the community-based brief intervention projects under The FAMILY: A Jockey Club Initiative for a Harmonious Society, was conducted in Hong Kong to develop and evaluate the effectiveness of a positive psychology family intervention. We have previously reported positive intervention effects on family communication, family well-being, and subjective happiness. This paper aims to explore the effectiveness of the intervention on behavioral outcomes and their associations with psychosocial well-being. A total of 23 social service units organized and conducted intervention programs for 1419 individuals from 612 families in Hong Kong. Each intervention was developed with emphasis on one of five positive psychology themes: gratitude, flow, happiness, health, and savoring. Intervention outcomes were assessed at pre-intervention, immediate post-intervention, and 6 weeks and 12 weeks post-intervention. Results showed that family communication time and frequency of meal preparation with family members increased with sustainable small effects up to 12 weeks. Theme-specific behavior change was observed in the gratitude, flow, and happiness interventions, respectively. Family communication time, frequency of eating with family members, and theme-specific behaviors, including gratitude, flow, happiness behavior, health attitude, and health behavior, were positively associated with psychosocial well-being. Qualitative data provided additional evidence of effectiveness with in-depth insights into behavior change. The positive associations between target behaviors and well-being suggest that improvements in well-being as a function of the intervention may be associated with behavior change.     

Contributions of positive behavior support amid lingering questions over its relationship with behavior analysis: A review of Positive behavior supports for adults with disabilities in employment,community, and residential settings by Storey and Post

Positive Behavior Supports for Adults with Disabilities in Employment, Community, and Residential Settings by Keith Storey and Michal Post (2019) presents valuable information for support providers and clinicians working with adults in inclusive settings who display challenging behavior. Numerous examples of challenging behavior encountered in such settings are provided along with a multitude of interventions for addressing the behavior in ways that comport with the values of positive behavior support (PBS). This review highlights contributions of the Storey and Post book and considers the content in regard to the controversial relationship between PBS and applied behavior analysis (ABA). The authors specify ABA as the foundation of PBS, but questions linger about the exact PBS–ABA relationship that will likely affect the book's ultimate contribution. Concern over the relationship is illustrated in regard to qualifications of behavioral professionals whom the authors often refer to as being necessary to help support providers develop and implement PBS interventions.     

A friendship intervention for children with Attention-Deficit/Hyperactivity Disorder: preliminary findings

Children with Attention-Deficit/Hyperactivity Disorder (ADHD) are known to experience difficulty in peer relationships. Neither standard interventions for ADHD nor peer acceptance-oriented interventions fully remedy this problem. We propose that interventions targeting ADHD children's dyadic friendships may be more realistic strategies for improving peer relationships. Hence, a friendship intervention, implemented within the context of an intensive behavioral treatment program with 209 ADHD children, is described. A model is proposed in which the friend's antisocial behavior relates to parental compliance with the friendship intervention, and both the friend's antisocial behavior and parental compliance predict friendship quality and treatment response. Results indicate that children paired with peers lower on antisocial behavior and children whose parents had higher levels of compliance with the friendship intervention achieved higher quality friendships and were rated by teachers as more improved.     

Putting the client in control: The perception of control in the behavioral treatment of anxiety

Traditional explanations of anxiety reduction through behavioral interventions such as extinction, habituation, reciprocal inhibition, and counterconditioning do not adequately account for all instances and aspects of anxiety reduction and clinical methods employed in contemporary behavior therapy. This article examines the role of an additional process — the alterations of perceptions of control — believed to be operative in anxiety reduction. We discuss three targets for establishing control in behavioral treatments of anxiety: (1) control over one's physiological responding while in an anxiety-producing situation, (2) control over the anxiety-producing stimulus or situation itself, and (3) control over the conduct of exposure. These three types of control perceptions are differentially important for different types of anxiety disorders. Implications for the conduct of behavioral treatments and possibilities for increasing client perceptions of control in anxiety treatment programs are outlined. We also recommend that client perceptions of control should be systematically assessed in order to relate them to treatment successes and failures.     

Behavioral Assessment in the Schools:

This article discusses behavioral assessment as a way of obtaining and evaluating information used to individualize programming for special needs pupils. Behavioral assessment offers a range of techniques for gathering and for evaluating information. Strategies for obtaining information that are described are self-monitoring, direct observation, permanent product review, and retrospective ratings using behavior checklists. Strategies for evaluating information that are discussed are single-case research designs and social validation. These strategies assist in identifying pupil problems and selecting interventions, evaluating student progress, assessing treatment fidelity, determining causality, and revising individualized programs by providing a broad base for decision-making.     

Interventions to Address the Academic Impairment of Children and Adolescents with ADHD

There exists a strong link between ADHD and academic underachievement. Both the core behavioral symptoms of ADHD and associated executive functioning deficits likely contribute to academic impairment. Current evidence-based approaches to the treatment of ADHD (i.e., stimulant medication, clinical behavior therapy and classroom behavioral interventions) have demonstrated a robust impact on behavioral variables such as attention and disruptive behavior within classroom analogue settings; however, their efficacy in improving academic outcomes is much less clear. Although surprisingly few treatment outcome studies of ADHD have attempted to incorporate interventions that specifically target academic outcomes, the studies that are available suggest that these interventions may be beneficial. The state of the treatment literature for addressing academic impairment in children and adolescents with ADHD will be reviewed herein, as well as limitations of current research, and directions for future research.     

Evaluating the efficacy and generality of a skill-based approach for promoting universal behavioral readiness

Behavioral readiness can take the form of communication and self-control skills during challenging situations that are correlated with the development of problem behavior. A skill-based approach can teach behavioral readiness using procedures that involve synthesized reinforcement, probabilistic reinforcement, and contingency-based delays; however, this approach is commonly used to address severe behavior under specific situations. There is limited research evaluating a skill-based approach to teaching behavioral readiness and addressing emerging problem behavior. Also, it is unclear whether teaching effects under specific situations transfer across other, functionally distinct, situations. We evaluated the generality of a skill-based approach by teaching skills systematically across primary challenging situations involving the interruption of play, presentation of instructions, and removal of reinforcers. Teaching increased communication and self-control skills, and most skills transferred to secondary challenging situations (treatment extension probes) and caregiver-implemented sessions. We discuss challenging situations that required teaching, the generality of teaching, and procedural considerations.     

Function‐based replacement behavior interventions for students with challenging behavior

Using a concurrent multiple probe design, this study investigated the effects of function‐based replacement behavior interventions on the challenging behaviors of three students with or at risk of emotional and behavioral disorders who attended a rural elementary school. For all three students, interventions were effective at decreasing the occurrence of challenging and off‐task behavior. Effects were maintained for two participants. Maintenance and generalization effects in a replication setting in which replacement behaviors were loosely trained were also documented for two participants. Furthermore, teachers rated the interventions favorably. Implications for practice, study limitations, and areas for future research are discussed.     

Yoga in an Urban School for Children with Emotional and Behavioral Disorders: A Feasibility Study

Increasingly, school-aged children present with challenging emotional and behavioral problems and may be resistant to traditional special education approaches (Smith et al., Behav Disorders 36(3):185–194, 2011). These programs do not take into consideration the specific needs of students with emotional and behavioral disorder (EBD). We examined the feasibility and potential for positive effects of yoga sessions within a school setting for children with EBD at an urban elementary school. Thirty-seven children with EBD in an urban school completed a yoga intervention in small groups (7–10 students) twice per week for 3 ½ months. Teachers, parents, and students completed a systematic pre- and post-intervention assessment, and yoga instructors completed attendance and behavior checklists. Average attendance for the yoga sessions was 90 %. Eighty percent of responders described being very satisfied with the intervention. Teachers reported improved attention in class (p = 0.01) and adaptive skills (p = 0.03) and reduced depressive symptoms (p = 0.03), behavioral symptoms (p = 0.01), and internalizing symptoms (p = 0.04). No significant changes were found in the parent data and no discernable trend was found in student reports. These data suggest that yoga administered in small groups in an urban school setting is a feasible school intervention for children with emotional and behavioral disorders and may be effective in reducing symptoms.     

Effects of a brief behavioral treatment for PTSD-related sleep disturbances: a pilot study

OBJECTIVE: Sleep disturbances are a core feature of post-traumatic stress disorder (PTSD), and are often resistant to first-line pharmacological and psychological PTSD interventions. The goal of this pilot study was to explore the effects of a very brief intervention for PTSD-related nightmares and insomnia in victims of violent crimes with PTSD. METHODS: Seven adult victims of violent crimes with a current diagnosis of PTSD received a single, 90-min intervention session that used cognitive-behavioral techniques aimed at reducing post-traumatic nightmares and insomnia. Sleep diary measures, and measures of sleep quality, PTSD severity, anxiety, and depression were completed at baseline and 6 weeks post-intervention. RESULTS: Improvements in self-report and sleep diary measures of sleep quality and dream frequency were observed post-intervention. Clinically meaningful reductions in daytime PTSD symptom severity were also observed. CONCLUSIONS: A very brief behavioral intervention targeting post-traumatic nightmares and insomnia was associated with significant improvements in sleep and daytime PTSD symptom severity. Brief sleep-focused intervention may be helpful adjuncts to first-line PTSD treatments.     

Health Behavior Theories and Research: Implications for Suicidal Individuals’ Treatment Linkage and Adherence

Treatment linkage and adherence to psychotherapeutic interventions can be challenging with suicidal individuals. Health behavior theories, specifically the Health Belief Model, Stages of Change, and Theory of Planned Behavior, focus on individuals' beliefs, their readiness to change, their perceptions of illness severity and "threat," their perceptions of significant others' attitudes toward illness and treatment, and their behavioral intentions to change. These constructs have relevance both for understanding suicidal individuals' behaviors related to treatment utilization and for understanding cultural variations in these behaviors. Furthermore, these theories have implications for clinical practices aimed at facilitating improved treatment follow-through and adherence. After describing the theories and their constructs, clinical examples are provided to illustrate applications to practice with suicidal individuals.     

Religious versus Conventional Internet-based Cognitive Behavioral Therapy for Depression

The accessibility and efficacy of two Internet-supported interventions for depression: conventional cognitive behavioral therapy (C-CBT) and religious CBT (R-CBT) were investigated. Depressed participants (N = 79) were randomly assigned to either active treatment or wait-listed control group. Self-report measures of depression, anxiety, and life quality were collected before, immediately after, and 6 months after the intervention. Significant differences among the three conditions emerged at post-intervention with medium to large effect sizes (Cohen’s d between 0.45 and 1.89), but no differences between the R-CBT and C-CBT were found. However, the addition of religious components to CBT contributed to the initial treatment appeal for religious participants, thus increasing the treatment accessibility.     

A New Frontier: Integrating Behavioral and Digital Technology to Promote Health Behavior

Modifiable behavioral risk factors such as cigarette smoking, physical inactivity, and obesity contribute to over 40 % of premature deaths in the USA. Advances in digital and information technology are creating unprecedented opportunities for behavior analysts to assess and modify these risk factors. Technological advances include mobile devices, wearable sensors, biomarker detectors, and real-time access to therapeutic support via information technology. Integrating these advances with behavioral technology in the form of conceptually systematic principles and procedures could usher in a new generation of effective and scalable behavioral interventions targeting health behavior. In this selective review of the literature, we discuss how technological tools can assess and modify a range of antecedents and consequences of healthy and unhealthy behavior. We also describe practical, methodological, and conceptual advantages for behavior analysts that stem from the use of technology to assess and treat health behavior.     

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.

     

Non-pharmacologic Interventions for CFS: A Randomized Trial

Non-pharmacological behavioral treatments for CFS have been suggested as promising. These trials have tested protocols composed of behavioral, cognitive and cognitive–behavioral interventions but there have been few efforts to differentially evaluate their outcomes. The primary purpose of the current study was to evaluate the effectiveness of nurse delivered non-pharmacologic interventions. In the present study, 114 participants diagnosed with CFS were randomly assigned to four 6-month interventions. The interventions were: cognitive–behavior therapy, cognitive therapy, anaerobic activity, and a relaxation control group. The study found that these interventions led to increases in several areas of functioning, with more consistent changes occurring among those participants in the cognitive condition. For the 25 variables in this study, significant change occurred for 28%, 20%, 16%, and 12% of the variables for the cognitive, cognitive behavior therapy, anaerobic activity, and relaxation conditions, respectively. However, the majority of participants continued to be diagnosed with CFS following the treatment trial. Implications of these findings are discussed.     

Bidirectional Effects of Parenting Quality and Child Externalizing Behavior in Predominantly Single Parent, Under-Resourced African American Families

This study investigates the bidirectional perspective of parent–child effects by examining the extent to which parenting quality predicted child externalizing behavior and vice versa. Data was collected over four time points from primary caregivers and early school age children in low-income, primarily single parent homes (N = 249, mean age of children at Time 1 = 6.41 years). Parenting quality was operationalized as primary caregiver perceptions of positive parenting, effectiveness of parenting discipline, parenting efficacy and satisfaction. Child externalizing behavior data was captured via an assessment of the frequency of externalizing behavior as reported by caregivers. We hypothesized that parenting quality and child externalizing behavior would remain stable over time and that a bidirectional relationship would be present. Data was analyzed using structural equation modeling and results indicated that child externalizing behavior predicted subsequent parenting quality, and parenting quality predicted subsequent child externalizing. Specifically, our research team found that the influence of child externalizing behavior on parenting quality decreased with time, while the influence of parenting quality on child externalizing behavior increased with time. Overall results reveal the complex transactional influences of child externalizing behavior and parenting quality in our sample. Findings support the notion that parenting quality and child externalizing behavior are interactive processes which might best be handled by continual assessment and which may be potentially strong targets for interventions.     

Contextual Intervention for Caregiver Non-Adherence With Behavioral Intervention Plans

The extent to which parents and other caregivers implement behavioral interventions with integrity has an important impact on treatment effectiveness. This article considers popular interventions that train caregivers and improve treatment integrity in applied behavior analysis. After considering these interventions a contextual approach is described, whereby the function of caregiver non-adherence is considered. In particular, interventions aimed at manipulating setting factors are reviewed. The examples of respite and social support groups are provided as function-based interventions to improve caregiver adherence to behavioral recommendations. Implications for more contextual, coordinated, and comprehensive function-based behavioral services are provided.     

The role of teachers' commitment to implement in delivering evidence-based social-emotional learning programs

Although there are reasons to believe that teachers' commitment to learn and enact an evidence-based program (i.e., their commitment to implement) predicts their implementation fidelity, there is surprisingly little quantitative research testing this relationship. Using a national large-scale evaluation of three preschool social-emotional interventions, this study investigated how strongly teachers' commitment predicted implementation fidelity and whether commitment was a meaningful predictor of fidelity as compared to other individual factors (i.e., teacher stress at baseline) and contextual factors (i.e., collegial supports, classroom behavioral problems, and classroom quality at baseline). We surveyed 230 preschool teachers in their first year of implementing the interventions; data sources include surveys from teachers and 52 intervention coaches as well as classroom observational data. We found that teachers' baseline commitment consistently predicted implementation fidelity across time and that commitment predicted unique variation in fidelity after accounting for other individual and contextual factors. In addition, implementation fidelity had a moderate positive relationship with teachers' baseline classroom quality and a small negative association with baseline classroom behavior problems. Findings are discussed with respect to implementation science in education.