The consecutive controlled case series: Design,data-analytics,and reporting methods supporting the study of generality

Single-case experimental designs (SCEDs) have proven invaluable in research and practice because they are optimal for asking many experimental questions relevant to the analysis of behavior. The consecutive controlled case series (CCCS) is a type of study in which a SCED is employed in a series of consecutively encountered cases that undergo a common procedure or share a common characteristic. Additional design elements, data-analytic, and reporting methods enable researchers to ask experimental questions relevant to the study of generality of procedures and processes. The current paper discusses the CCCS methodologies, including the retrospective, prospective, and randomized CCCS. These methodologies can be applied to examine the generality of clinical procedures (including their general efficacy, the limits of their generality, and variables that may mediate generality); study the epidemiology and phenomenology of clinical problems; and compare the efficacy of 2 clinical procedures within a randomized controlled trial combining SCEDs with randomized group designs.     

False-positive tangible outcomes of functional analyses

Functional analysis (FA) methodology is the most precise method for identifying variables that maintain problem behavior. Occasionally, however, results of an FA may be influenced by idiosyncratic sensitivity to aspects of the assessment conditions. For example, data from several studies suggest that inclusion of a tangible condition during an FA may be prone to a false-positive outcome, although the extent to which tangible reinforcement routinely produces such outcomes is unknown. We examined susceptibility to tangible reinforcement by determining whether a new response was acquired more readily when exposed to a tangible contingency relative to others commonly used in an FA (Study 1), and whether problem behavior known not to have a social function nevertheless emerged when exposed to tangible reinforcement (Study 2). Results indicated that inclusion of items in the tangible condition should be done with care and that selection should be based on those items typically found in the individual's environment.     

Evaluating the boundaries of analytic efficiency and control: A consecutive controlled case series of 26 functional analyses

We conducted this study to determine if the efficiency of the functional analysis could be improved without detrimental effects on control. In Experiment 1, we reanalyzed functional analyses conducted for the problem behavior of 18 children. We analyzed rates of problem behavior during the first 5 min and first 3 min of the original 10-min sessions and evaluated if changes in the level of control over problem behavior by the programmed contingency were evident from the analyses of shorter session duration. In Experiment 2, we conducted 8 consecutive functional analyses with 3-min sessions to further evaluate the utility of brief session durations. We found that control over problem behavior was demonstrated when conducting functional analyses with sessions as brief as 3 min.     

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

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

Toward accurate inferences of response class membership

In their review of synthesis within the functional analysis (FA) literature, Slaton and Hanley (2018) reported that most synthesized contingency analyses have included multiple topographies of problem behavior in the reinforcement contingency class. This leaves the question of whether one, some, or all forms of problem behavior are sensitive to the synthesized reinforcement contingencies in published analyses. To address this ambiguity, all topographies of problem behavior that were reported by caregivers to co-occur with the most concerning problem behavior were analyzed for 10 participants. We implemented extinction across one or more forms of problem behavior to determine whether all forms reported to co-occur were sensitive to the same synthesized reinforcement contingency. For nine of 10 participants, the most concerning topographies were sensitive to the same synthesized reinforcement contingencies as the less concerning topographies (results were inconclusive for one). Implications for inferring response class membership from single analyses are discussed.     

Interview‐informed functional analyses: A comparison of synthesized and isolated components

Hanley, Jin, Vanselow, and Hanratty (2014) described a functional analysis (FA) format that relied on a synthesis of multiple contingencies described by caregivers during open‐ended interviews. These interview‐informed synthesized contingency analyses (IISCA) provided effective baselines from which to develop socially validated treatments, but the synthesis precluded a precise understanding of individual contingencies influencing problem behavior. We conducted IISCAs and standard FAs (Iwata, Dorsey, Slifer, Bauman, & Richman, 1982/1994) for nine children with autism to evaluate the likelihood of differentiation given a number of synthesized versus isolated variables. The IISCA was differentiated for all. The standard FA was differentiated for four; this number increased to six when we included precursors in the standard FA. We then compared treatments based on sets of differentiated analyses for four children. Treatment based on the IISCA was effective for all four; treatments based on the standard FA were effective for two. The role of synthesis in analysis is discussed.     

A comparison of parental attention and preferred items during tummy time: A consecutive controlled case series evaluation

Tummy time is an activity for infants to practice their early motor skills. Although most pediatricians recommend tummy time, parents may avoid the procedures due to indices of infant discomfort during this period. This consecutive controlled case series evaluation compared the effects of preferred items selected from a preference assessment with those of parental attention on head evaluation and negative vocalizations during tummy time. In addition, we directly evaluated parental choice by inviting parents to select which tummy time treatment they wanted to implement. We found that both preferred items and parental attention effectively increased head elevation and decreased negative vocalizations during tummy time; however, parents tended to prefer the treatment that included the preferred item.