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| The Use of Caregivers as Therapists in the Assessment of Problem Behavior |
| Tuesday, May 27, 2008 |
| 10:30 AM–11:50 AM |
| Boulevard B |
| Area: CBM/DDA; Domain: Applied Research |
| Chair: Nathan Call (The Marcus Institute) |
| Abstract: There is evidence that there may be advantages to having caregivers act as therapists during the assessment and treatment of problem behaviors such as aggression or food refusal (e.g., Ringdahl & Sellers, 2000). For example, antecedents, consequences, or both, may be qualitatively different when presented by caregivers than by a novel therapist. Similarly, caregivers may themselves become discriminative stimuli that signal the availability of social reinforcement. However, it remains unclear which types of assessments benefit from the inclusion of caregivers, or the degree to which assessments conducted by caregivers agree with more traditional assessments conducted by novel therapists. The papers presented in this symposium will present and evaluate a variety of functional assessment methodologies that incorporate the inclusion of caregivers as therapists. Two papers evaluated assessments that used caregivers as therapists while manipulating only antecedent variables and then compared these antecedent based assessments to ones that also manipulated consequences for problem behavior. The third paper evaluated naturalistic observations of participants and their caregivers to identify the consequences maintaining food refusal in the natural environment. The fourth paper will present two case studies of atypical problem behaviors assessed within a clinic that uses caregivers as therapists as standard operating procedure. |
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| Using Parent-conducted Descriptive Assessments to Treat Pediatric Feeding Disorders. |
| HEATHER KADEY (Munroe-Meyer Institute), Cathleen C. Piazza (Munroe-Meyer Institute), Kirsten Murphy (Munroe-Meyer Institute) |
| Abstract: Past research has demonstrated that functional analyses methods can be used to identify the environmental variables (e.g., access to caregiver attention, escape from eating and access to preferred items) that maintain inappropriate mealtime behavior in children with pediatric feeding disorders. What is less clear is the extent to which these consequences are provided following inappropriate mealtime behavior in the natural environment. The purpose of the current study was to (a) use descriptive assessment procedures to examine and measure the delivery of common sources of reinforcement (e.g., attention, escape) following food refusal behavior within a naturalistic feeding context and (b) use the data collected during the initial descriptive assessment to develop effective treatments to reduce food refusal behavior and increase food consumption. Caregivers served as the therapists for all participants, and we evaluated individual treatment components using a multiple baseline design across caregivers. Results indicated that escape extinction was a necessary treatment component for all participants, and attention extinction plus escape extinction was necessary to decrease problem behavior to clinically acceptable levels and increase food acceptance for only some participants. Results will be discussed in terms of the extent to which descriptive assessments predict treatment outcomes for children with feeding disorders. |
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| Procedural Integrity of Brief Functional Analyses with and without Consequences when Parents Serve as Therapists. |
| AMANDA ZANGRILLO (The Marcus Institute), Nathan Call (The Marcus Institute), Karen Rader (Louisiana State University), Michael E. Kelley (University of Southern Maine) |
| Abstract: A potential drawback of using care providers as therapists during functional analyses is that they may not always implement assessment procedures with high integrity, potentially resulting in inaccurate identification of the reinforcers maintaining problem behavior. We attempted to evaluate the usefulness of a simplified brief functional analysis (BFA) methodology that manipulated only the antecedent variable in each test condition in an effort to increase procedural integrity by care providers. Results of the simplified BFA were contrasted with those of a standard BFA. Data were examined for concordance of the two BFA outcomes as well as differences in procedural integrity. Interobserver agreement data were collected for greater than 20% of sessions and always exceeded 80% agreement for all dependent variables. Results of the two assessment methodologies matched with respect to the reinforcers maintaining problem behavior, though care providers were able to maintain higher integrity with the simplified BFA. Second, we compared the concordance of the two BFA methodologies to an extended functional analysis. Finally, function-based treatment procedures based on BFA results produced decreases in problem behavior, suggesting that the simplified BFA accurately identified the variables maintaining problem behavior. |
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| Comparison of Functional Assessment Methods: Structured Descriptive Assessment with Caregivers vs. Experimental Functional Analysis with Professionals. |
| STEPHANIE A. CONTRUCCI KUHN (Kennedy Krieger Institute), Michael A. Lind (Kennedy Krieger Institute/Johns Hopkins University School of Medicine), David E. Kuhn (Kennedy Krieger Institute) |
| Abstract: Few studies comparing structured descriptive assessment (SDA) with experimental functional analysis have been conducted. Results from the studies that have been conducted have generally found high levels of agreement when comparing the results from structured descriptive assessments and experimental functional analyses (Freeman et al., 2000, Anderson & Long, 2002). However, the number of participants in these studies was limited to 3-4 participants. In the current study, data from SDA with caregivers was retrospectively compared to data collected during experimental functional analyses with professionally trained staff. Data were obtained for over 20 individuals receiving inpatient treatment for severe behavior disorders. Data were analyzed in terms of identification of function, agreement with identification of function, number of sessions conducted, & delivery of consequences. Overall agreement was lower than that reported in previous studies. Implications of these findings are discussed. |
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| Applying Brief Experimental Analysis to Typically Developing Children with Severe Behavior Disorders. |
| BRENDA J. ENGEBRETSON (University of Iowa), David P. Wacker (University of Iowa), Melanie H. Bachmeyer (University of Iowa), Linda J. Cooper-Brown (University of Iowa), Matthew O'brien (University of Iowa), Michael A. Lind (University of Iowa) |
| Abstract: Since 1990, clinicians from the Behavioral Pediatrics Clinic at the University of Iowa Children’s Hospital have been using brief experimental analysis to evaluate a variety of challenging behaviors exhibited by young children who are typically developing. The child’s careprovider routinely serves as the therapist with coaching from clinic staff to evaluate the child’s behavior. An updated summary of the clinic will be discussed by reviewing outcomes from 2004 to 2007. Historically, the most common referral to clinic has been for disruptive behaviors (e.g., aggression, noncompliance), and the most common assessment procedure has been the brief functional analysis. The brief functional analysis is appealing for the assessment of disruptive behaviors because of its efficiency in identifying the response-reinforcer relationships within an outpatient evaluation. However, some behaviors, such as selective mutism and obsessions, are not as amenable to the procedure. In these instances, alternative assessments have been utilized in addition to or independently of the brief functional analysis (e.g., concurrent-choice analysis, fading analysis). Two case studies demonstrating this extension of clinic evaluations for two children who are typically developing and referred for selective mutism and obsessive-compulsive behaviors will be presented. |
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