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.     

STIMULUS (INSTRUCTIONAL) FADING DURING EXTINCTION OF SELF-INJURIOUS ESCAPE BEHAVIOR

Three individuals with developmental disabilities were exposed to a series of assessment conditions to identify the source of reinforcement for their self-injurious behavior. In each case, self-injury occurred most often in instructional (demand) situations containing a brief time-out from the task contingent on self-injury, indicating that the behavior was an escape response (i.e., maintained by negative reinforcement). Treatment was implemented in a multiple baseline across subjects design and consisted of extinction (prevention of escape) plus instructional fading (initial elimination of instructions followed by their gradual reintroduction). Results showed that the combined treatment produced immediate and large reductions in self-injury that were maintained as the frequency of instructions was increased across sessions to match the original baseline rate of presentation. Results of a component analysis conducted with 1 subject suggested that stimulus fading accelerated the behavior-reducing effects of extinction.     

IMPROVED CURVEBALL HITTING THROUGH THE ENHANCEMENT OF VISUAL CUES

This study investigated the effectiveness of using visual cues to highlight the seams of baseballs to improve the hitting of curveballs. Five undergraduate varsity baseball team candidates served as subjects. Behavior change was assessed through an alternating treatments design involving unmarked balls and two treatment conditions that included baseballs with 1/4-in. and 1/8-in. orange stripes marking the seams of the baseballs. Results indicated that subjects hit a greater percentage of marked than unmarked balls. These results suggest that the addition of visual cues may be a significant and beneficial technique to enhance hitting performance. Further research is suggested regarding the training procedures, effect of feedback, rate of fading cues, generalization to live pitching, and generalization to other types of pitches.     

DIRECT AND COLLATERAL EFFECTS OF RESTRAINTS AND RESTRAINT FADING

Mechanical restraints are commonly used to reduce the risks associated with severe self-injurious behavior (SIB), but may result in movement restriction and adverse side effects (e.g., bone demineralization). Restraint fading may provide a method for decreasing SIB while increasing movement and reducing these side effects. In the current investigation, rigid arm sleeves and restraint fading (gradually reducing the rigidity of the sleeves) were used with 3 clients who engaged in hand-to-head SIB. Restraints and fading reduced the hand-to-head SIB of all clients. However, for 1 client, the addition of a water mist procedure further reduced SIB to near-zero levels. For a 2nd client, another form of SIB developed that was not prevented by the rigid sleeves. For a 3rd client, a topography of SIB that was not physically prevented by the rigid sleeves was also reduced when restraints and fading were introduced.     

Assessment to identify learner-specific prompt and prompt-fading procedures for children with autism spectrum disorder

Few studies have evaluated the use of assessment to identify the most efficient instructional practices for individuals with autism spectrum disorder. This is problematic as these individuals often have difficulty acquiring skills, and the procedures that may be efficient with one individual may not be for others. The experimenters conducted instructional assessments to identify the most efficient prompt type (model, partial physical, full physical) and prompt-fading procedure (progressive delay, most-to-least, least-to-most) for teaching auditory–visual conditional discriminations for individuals with autism spectrum disorder. Each assessment was conducted at least twice, and a final generality test combined the most and the least efficient prompt type and prompt-fading procedure for teaching novel auditory–visual conditional discriminations. The results demonstrated learner-specific outcomes for the prompt type assessment, whereas the least-to-most prompt fading procedure was most efficient for all participants.     

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.     

Evaluation of stimulus intensity fading on reduction of rapid eating in a child with autism

This study assessed the effects of a vibrating pager on reduction of rapid eating. The study also evaluated two strategies for fading the pager, by intensity and by frequency. The pager was successful in decreasing the pace of eating to an appropriate level and the pager prompt was successfully faded. Fading by frequency was ineffective in maintaining an appropriate pace of eating while intensity fading was successful.     

EFFECTS OF WITHIN-STIMULUS AND EXTRA-STIMULUS PROMPTING ON DISCRIMINATION LEARNING IN AUTISTIC CHILDREN1

Two different prompting procedures to teach visual and auditory discriminations to autistic children were compared. The first involved presenting an added cue as an extra-stimulus prompt. This required the child to respond to both prompt and training stimulus. The second involved the use of a within-stimulus prompt. This consisted of an exaggeration of the relevant component of the training stimulus and thus did not require that the child respond to multiple cues. The results indicated that (1) children usually failed to learn the discriminations without a prompt, (2) children always failed to learn when the extra-stimulus prompt was employed but usually did learn with the withinstimulus prompt, and (3) these findings were independent of which modality (auditory or visual) was required for the discrimination.