Association for Behavior Analysis International

According to Benjasuwantep and colleagues (2013), approximately 20-50% of normally developing children and 70-89% of children with developmental disabilities were reported as having some level of feeding problems. For families, feeding challenges range from being a nuisance for parents to having serious medical complications for some individuals. Food selectivity is a common feeding concern that can be somewhat difficult for families to address on their own. Within the literature, several procedures have been shown to improve food selectivity. One of the most common procedures identified were escape extinction procedures (Tanner & Andreone, 2015). While proven effective, escape extinction procedures have been associated with challenging side effects such as response bursts, aggression, emotional responding, and general averseness for both caretaker and client (Bachmeyer, 2009). The purpose of this research study was to investigate the use of an alternative strategy to escape extinction as treatment for food selectivity. In this study, a 10-step graduated exposure hierarchy was used to increase food acceptance in a 13-year-old female diagnosed with autism. Results indicated an increase in number of foods consumed during sessions, as well as during snack breaks in instructional day.

The use and description of response blocking when implementing escape extinction procedures has been well-documented in literature for severe problem behavior. Response blocking is a relatively understudied technique related to treatment implementation for children with pediatric feeding disorders. We identified five studies evaluating treatment for food refusal and also mention the use of response blocking (Ormand, Masler, & Lesser, 2018). Wilkins, Piazza, Groff, Volkert, Kozisek, & Milnes, (2014) provided a procedural description of response blocking including the use of a secondary therapist to block inappropriate mealtime behavior. To evaluate the clinical frequency in which response blocking with a secondary therapist is used in the treatment of pediatric feeding disorders, we completed case reviews for 23 patients admitted to an intensive pediatric feeding disorders program. Of the patients reviewed, 40% required response blocking to decrease inappropriate mealtime behavior. The most prevalent treatment components included in protocols for patients requiring response blocking from a secondary therapist included nonremoval of the spoon, differential reinforcement, physical guidance, and alternative utensil presentation (i.e., nuk brush). Response blocking for these patients was required during sessions to increase compliance with acceptance of all food (67%), regular texture foods (44%), liquids (22%), and novel foods (11%).

Transition-age individuals with disabilities continue to lag behind same-age peers in postsecondary outcomes of education, employment, and independent living skills. The role of self-determination in postsecondary success has been thoroughly researched, acknowledged, and proven to be a predictor of postsecondary goal attainment (Test et al., 2009). Skills of self-determination include goal-setting and attainment, self-observation, evaluation, and reinforcement, and independence (Wehmeyer, 2007). Self-management strategies, such as self-evaluation, are a demonstrated evidence-based practive for students with developmental disabilities (Carr et al., 2014). This multiple baseline across participant dyads study examined the application of self-evaluation on overall work performance ratings for students with developmental disabilities in an authentic work environment. Scores of self-evaluation were compared to ratings by job coaches, and over time, student scores and job coach scores showed an emergence of convergence one prompting was used in conjunction with self-evaluation procedures and then faded. This study incorporated the use of a technology-based self-evaluation form. Social validity results demonstrate both students and job coaches involved in the study found self-evaluation to be beneficial to work performance and expressed enjoyment. Furthermore students felt more independent and in control of their work environments, and job coaches felt the students improved in independent living skills and taking ownership of their actions and work behaviors. Implications for practice suggest the incorporation of self-evaluation in the community work setting can positively benefit work performance and increase skills of self-awareness.

Individuals with dual diagnosis of mental illness and intellectual developmental disabilities experience a higher probability to being predisposed to health disparities such as obesity and other health related chronic conditions. The current study aimed at improving levels of physical activity in order to promote weight loss. This fitness program examined the effectiveness of a multi-component fitness program on adult females who are dually diagnosed. A component analysis was implemented, consisting of positive reinforcement through verbal praise, healthy edibles, healthy food outings, and cash reinforcers for each pound lost. Participants weight and percent of success in the fitness program, were measured before, during, and after the intervention. It was concluded that the combination of reinforcers and positive outcomes were the contributing factors to high performance in their exercise engagement. Findings from the fitness program showed the intervention was effective and exhibits potential for other dually diagnosed individuals.

Small-scale simulations consist of scale-models that include elements of stimuli from the natural environment in a training session. These small-scale simulations are used to create additional practice opportunities of a target behavior. In behavior-analytic research, there have been limited investigations using such simulations to teach skills (e.g., Page, Iwata, & Neef, 1976). The purpose of this investigation was to use small-scale simulations to teach daily living or occupational skills to individuals with developmental or intellectual disabilities. Following several sessions in which other training procedures (e.g., discrimination training, prompting) were efficacious but did not lead to mastery, the small-scale simulations were introduced as additional practice trials. One adolescent was taught an occupational skill using a 3D simulation, and one child was taught a daily living skill using 2D and 3D simulations. Practice trials with the small-scale simulation immediately preceded opportunities to perform the original target task. Upon introduction of practice with the simulation, correct responding during the simulation trials generalized to the original training sessions. Results of this investigation suggested that providing small-scale simulations can help teach daily living and occupational skills to individuals with ASD. Future clinical applications will be discussed.

There are several examples in the literature of successful toilet training for children who are typically developing and those with developmental disabilities. However, minimal research has been conducted on toilet training with children with medical complexities that impact their ability to orally intake fluids, such as those who use gastrointestinal tubes for caloric intake. One component of toilet training, which may not be feasible for those using gastrointestinal tubes, is the component of fluid loading. Fluid loading involves increasing individuals’ fluid intake across the day to increase opportunities for urination (Azrin and Foxx, 1971). For individuals who use gastrointestinal tubes, fluid loading may not be an option due to possible complications including: over-hydration, metabolic complications due to excessive fluid consumption, and electrolyte imbalance (Blumenstein, Shastri & Stein, 2014). A consecutive case series analysis was conducted, where medical records of participants attending an intensive day treatment program for enuresis between 2014 and 2018 were reviewed. Clinical data indicated seven participants were found to have gastrointestinal tubes in use at the time of their admission. Results indicated that four of the seven participants showed considerable improvements in continent voids, and maintained those improvements following one month post discharge.

The Advancement and Transition Services (ATS) at the University of Cincinnati (UC) addresses the needs of participants with intellectual and developmental disabilities (ID/DD) as they transition from high school through adulthood to enhance employment, healthy and independent living, and personal growth/life-long learning. ATS house three program: the Transition and Access Program (TAP; a four-year residential post-secondary certificate program for adults with ID/DD), IMPACT Innovation (a day service provider for adults more significantly impacted by Autism), and the Collaboration for Employment and Education Synergy (CEES; a 12-week high school/transition age youth workshop). Approximately 150 young adults and adults with ID/DD access these services on UC's campus each year. The purpose of phase one of this study is to determine the percentage of engagement and level of independence of ATS participants during vocational placements. Three data points were collected via direct observation using momentary time sampling. Data were also collected on the level of prompting provided during each interval. Interobserver agreement were collected on 30% of all data points. Phase two of this study will determine and implement appropriate interventions needed to increase independence and community engagement for ATS participants.

Research has demonstrated the effectiveness of a variety of procedures to increase urinary continence in children with developmental disabilities (for review see Kroeger & Sorensen-Burnworth, 2009). The majority of these procedures include scheduled sittings, reinforcement for continence, and urine alarms. For some children, traditional methods are ineffective and alternative procedures are used to facilitate the transfer of stimulus control. Hagopian and colleagues (1993) demonstrated the use of a water prompt to increase continent voids in a 9-year-old with intellectual disability, which allowed the child to contact reinforcement on the toilet. The current study sought to replicate these findings with a 5-year-old female diagnosed with autism who demonstrated an increase of both incontinent and continent urine voids following traditional toilet training (i.e., scheduled sit, urine alarm, reinforcement). Following the implementation of a water prompt (hands placed in water while on toilet), the participant’s incontinent voids decreased and continent voids increased. Following stable low levels of incontinent voids (3 or less across 3 days), the water prompt was removed, and the original treatment was put back into place. Initial results suggested that incontinent voids remained low and continent voids remained high.

Health and wellness routines such as blood pressure and lung checks at doctor visits, haircuts, and nail trimmings are filled with various stimuli which may be aversive and evoke problem behavior for children. Severe problem behavior that may occur may deter caregivers from following through with routines however these routines are not optional as they contribute to the overall well-being of the child and therefore are vital tasks to be able to tolerate and comply with. We used differential reinforcement of other behavior (DRO) with resetting time contingencies to teach tolerance of these skills to two children with severe problem behavior. We systematically increased the DRO requirement, such that we required the children to display tolerance for each health and wellness routine for longer periods prior to providing a break with access to preferred items such as toys or milk. We collected data on aggressions, self-injurious behavior, and avoidance movements to evaluate the effectiveness of the treatment. Our results showed an overall decrease in problematic behavior and frequency of resets as we systematically increased the length of exposure to each health and wellness routine.

Social inclusion is a strong indicator of successful quality of life outcomes (QOL) for persons with intellectual and developmental disabilities (IDD) (Cobigo, Ouellet-Kuntz, Lysaght & Martin, 2012). Barriers to social inclusion for persons with IDD have been identified in the literature, including functioning level, adaptive living skills, and staff involvement (Abbot & McConkey, 2006). Technology and applied behavior analysis have improved adaptive functioning, skill development, and subsequently QOL outcomes for persons with IDD (Owuor et al., 2018). This project aims to decrease social isolation for eight adults with IDD living in a supported-independent living program. Skills to reduce social isolation were identified and taught using technology (i.e., iPad) and specialized apps. Using behavioral skills training, task analysis, and shaping procedures, support workers were taught to assist skill development and technology. Two multiple-probe designs across participants were delivered concurrently. Data were taken on the total duration of the target skill and the duration of direct support provided. The percentage of direct support for the target skill decreased for two participants, from an average of 69% to 0% following the introduction of technology, while remaining participants continue to require 36%-77% direct support for the target skill during baseline. Data collection is ongoing.

Adults diagnosed with an intellectual disability have a higher rate of obesity in comparison to typical functioning adults in their same age group (Spanos, D., Melville, C. A., & Hankey, C. R. 2013). This study will evaluate the effectiveness and quality of positive reinforcement on the percentage of completed exercise sessions. Through pairing the completion of exercise activities with a preferred healthy food item, researchers expect the individuals will be more motivated to exercise, despite the increased effort required. Completed exercise sessions will be defined by collecting Partial Interval Recording data on if the individual completes 80% of a home workout DVD. The individuals will choose target days and time of activity completion and reinforcement will only be available for participation during those times. Researchers will use paired choice preference assessments to determine a preference hierarchy and deliver identified reinforcers in least-to most order to determine the quality of reinforcement required to motivate an individual to participate in a high effort and sometimes non-preferred activity. This study will discuss the implications for future research related to the effects of varying valued positive reinforcement on continuation of an exercise regiment, healthy eating choices, and weight loss. In addition, a system is developed using healthy options as reinforcement paired with increased exercise and how this can have long-term effects on the individual’s overall health and well-being.

Positive Behaviour Support Plans (PBSPs) are documents based on functional assessments that encompass all components of the bio-psycho-social model related to the individual with a developmental disability and promote positive improvements in the individual’s daily life (QAM, 2008). The purpose of this research was to devise recommendations for the content required in PBSPs and to create tools to facilitate the development and modification of PBSPs to incorporate best practices. This study involved the revision of an evaluation tool based on the review of current literature, legal regulations, and agency policies. The evaluation tool was used to evaluate the adequacy and comprehensiveness of 24 existing PBSPs in a community agency providing services to individuals with developmental disabilities. Overall, the PBSPs adherence average score on the evaluation tool was 70.76%. Furthermore, it was determined that 87.50% of the PBSPs were considered to have had good levels of adequacy, while 12.50% had underdeveloped levels of adequacy. Based on these findings a model PBSP and template with instructions were created to facilitate the development and revision of PBSPs to increase adherence to best practices and current regulations. Discussion of the findings and recommendations to increase PBSP adherence to best practices are also included.

Using a reversal design, the current study evaluated the effects of the high-probability request sequence (HPRS) on the compliance to low-probability requests for a high school student with a moderate intellectual disability. The participant was given three simple discrete prompts to complete tasks with which she had a history of complying (i.e., high-p requests) immediately before given a prompt to engage in requests which she had a history of not complying (e.g., low-p requests). In addition, reinforcement in the form of social praise and attention was provided contingent on compliance with each high-p and low-p request. This study also examined whether the effects observed during each phase of the study would be generalized if conditions were replicated by the classroom special education teacher. The results indicated that a functional relation exists between the implementation of the HPRS on both the increase of compliance with low-p requests and a decrease in the latency to respond to these requests. The findings also demonstrated that the participant engaged in similar levels of compliance when the intervention was implemented by either the investigator or the special education teacher. Limitations, recommendations for future research, and implications for practice are provided.

Showering is important beyond an individual’s physical appearance and odor and extends to an individual’s skin health. Avoiding bathing for an extended period of time may cause serious harm to an individual’s skin, resulting in issues such as skin breakdown that can develop into a serious concern impacting the individual’s skin, muscle, and bone. Self-Monitoring is an intervention that teaches an individual to observe their behavior systematically and record occurrences or non-occurrences of their behavior. The use of Self-Monitoring has been validated through many various applications including reducing overeating, to decrease smoking, and increase appropriate classroom behaviors. One strength of self-monitoring is that it has been shown to be effective in assisting an increase in desired behaviors. This study focused on utilizing a self-monitoring intervention combined with reinforcement to increase showering behaviors in an individual diagnosed with schizophrenia. This project evaluated the quantity as well as the quality of this individuals showering habits. This was done through creating a level-system for the client’s quality of shower and providing feedback to the client on the quality of that shower.

Some individuals with autism and intellectual disabilities engage in tics (e.g., vocal stereotypy, fidgeting, skin picking, and gestures) that might interfere with functioning in their daily lives. According to Long et al. (1999), habit reversal includes a number of components (i.e., awareness training, competing response training, reinforcement strategies, rehearsal, and positive practice) that ultimately lead to appropriate alternatives for tics. Some research has investigated modified, brief habit reversal for the treatment of tics and fidgeting (Miltenberger, Fuqua, & Woods, 1998). The purpose of the current study was to conduct a component analysis of a simplified habit reversal that would reduce maladaptive behavior exhibited by an individual with mild to moderate intellectual disability. The components evaluated in the study were (a) self-awareness training, (b) competing response training, and (c) social support. The results indicate that the individual components alone were not enough to decrease both skin-picking and self-restraint behaviors. All three components worked in tandem to reduce to the targeted behaviors.

In Ontario in 2004, more than half of interventions provided to adults with disabilities with challenging behaviors were found to be informal (i.e., lacked a Behavior Support Plan (BSP); Feldman et al., 2004). In response, legislation was implemented to foster accountability for service agencies (Ontario Regulation 299/10 QAM). The aim of this study was to explore and improve the quality of BSP within Ontario following these revised Quality Assurance Measures. A random sample of 30 BSP was reviewed using the BSP Quality Evaluation II Guide (Browning-Wright et al., 2013). Preliminary results revealed that the majority of the plans received a weak rating (80%). In 2017-2018, a Service Improvement Plan within a Ministry-funded behavioral agency was initiated. This plan included: a) dissemination of the assessment focusing on potential areas of strengths, areas for further improvement, and exemplars; b) revised BSP template; c) a structured Compliance Criteria Checklist; and d) additional training in BSP development for new consultants. This presentation will review the results of the follow-up evaluation including increased quality rating of the BSP, additional measures of effectiveness and improved consumer satisfaction. Additional areas to continue to improve behavioral supports will also be discussed.

The treatment of self-injurious behaviors (SIB) remains common and challenging for practitioners in behavior analysis, especially when those behaviors are not maintained by social reinforcement. Therefore, it is important to study strategies for addressing SIB maintained by automatic positive reinforcement. We conducted a functional analysis (Iwata et al, 1994) to determine the function of SIB in the form of hitting the face, forehead, hands, and body. We then used a combination of non-contingent access to a preferred item, DRO using an iPad every 30 seconds with a progressively increasing interval, and sensory extinction (Roscoe, Iwata, & Goh, 1998) by contingent presentation of gloves to reduce SIB. Results showed a significant reduction in frequency of SIB from baseline, and frequency of SIB remained low for 6 months. This treatment package was later applied to self-pinching that emerged about 2 months after baseline with success. This poster will present the treatment package for practitioners to implement, and we will discuss barriers to implementation along the way.

A systematic review was conducted to synthesize the literature on the use of graduated exposure to treat challenging behavior maintained by escape from aversive stimuli (e.g., aggression, disruption, elopement) with individuals diagnosed with developmental disabilities. This review identified 15 articles through the database search and ancillary searches. Results indicated that graduated exposure can be used to reduce the aversiveness of a wide variety of stimuli (e.g., animatronic toys, medical procedures, sanitary pads, pools) and may be conducted in naturalistic environments (e.g., medical facilities, schools, primary residential space). Additionally, based on What Works Clearinghouse Design Standards (2017), four studies Met Standards with or Met Standards without Reservations. Three of these four articles provided Strong Evidence for the efficacy of graduated exposure. Based on the results of the quality review, there needs to be higher quality research that examines graduated exposure as an intervention to decrease challenging behavior associated with aversive stimuli.

This paper summarizes peer reviewed published reviews that report literature reviews and meta analyses of research conducted on augmentative and alternative communication (AAC) interventions for individuals with developmental disabilities (DD). This paper also applies the A MeaSurement Tool to Assess systematic Reviews, revised (AMSTAR-2, Shea et al, 2017) to these reviews to assess their methodological strengths and needs. Overall, reviews in this field demonstrate a number of methodological weaknesses that detract from the strength of the research and inhibit practitioners from accessing high quality reporting of emerging evidence based practices in the field of AAC intervention for individuals with disabilities. Examined over time, published reviews have increased their methodological rigor from 2001 to mid-2018. Interventions with demonstrated positive effect sizes include Picture Exchange Communication System (PECS, Bondy and Frost, 1994), the use of speech generating devices (SGD), using systematic interventions based on principles of applied behavior analysis (ABA), and implementing intervention with naturalistic interventionists, communication partners, and in socially valid settings and contexts.

A systematic review was conducted to assess the types of school-based interventions commonly used for adolescents (10 to 21 years of age) to reduce challenging behavior. A total of 40 articles were identified through the database search and ancillary searches. Participant, implementer, and intervention characteristics were recorded during descriptive coding. This review found that antecedent-based interventions were most commonly used within the school setting. School personnel reported antecedent-based interventions to be acceptable and feasible within the school setting. Results of the descriptive coding found that around 70% of participants were ages 10 to 13 years old, with limited research being conducted with students older than 13; therefore, additional research is needed with this age group. Based on What Works Clearinghouse standards, 25 articles Meet Standards or Met Standards with Reservations and 22 articles provided moderate to strong evidence for the efficacy of these interventions within the school setting.

A systematic review was conducted to synthesize the literature on interventions implemented in the community setting (e.g., playground, restaurant, grocery store) to treat challenging behavior for individuals diagnosed with developmental disabilities. This review identified 18 articles through the database and ancillary search. The result indicated that for most participants the intervention was a function-based intervention, followed by an antecedent-based intervention. The most common assessment procedure to hypothesize the function of the challenging behavior was indirect assessment procedures (e.g., interview, checklists, scales). Additionally, the studies were evaluated on the quality of the experimental design based on the What Works Clearinghouse Design Standards (WWC, 2017). Four of the twenty studies Met Standards, five Met Standard with Reservations, and eleven studies Did Not Meet Standards. Evidence standards were applied to those studies that Met standards or Met standards with reservations. Of the 9 studies, seven received a rating of Strong Evidence. A number of implications and directions for future research were identified.

The behavior principle of extinction involves termination of reinforcement that is observed to maintain the problem behavior. Extinction is one of the most common procedures used to reduce various problem behaviors in children diagnosed with Developmental Disabilities and Autism Spectrum Disorders. The purpose of this current review is to examine the various applications and publications of escape extinction in behavior analysis. The examiners reviewed all the articles from the last 20 years across four major peer reviewed journals in applied behavior analysis: Journal of Applied Behavior Analysis (JABA), The Analysis of Verbal Behavior (AVB), Behavior Analysis in Practice (BAP), and Experimental Analysis of Behavior (EAB). The review is still in progress. The results so far suggest that there are more studies on escape extinction to treat food refusal and food selectivity in young children with and without disabilities. There are also some studies on escape extinction to reduce SIB, but often as a component within a treatment package. Escape extinction as a procedure itself and its application to increase compliance in children with diagnosed with Autism is scarce in the literature. The further review across other journals will help us further evaluate the scope of limitations of escape extinction in managing various problem behaviors in children diagnosed with Autism Spectrum Disorders.

Self advocacy is defined as the action of representing oneself. A skill that can be affected by individuals diagnosed with Autism Spectrum Disorder (ASD) due to lack of generalization, language and socialization skills. Self advocacy begins with simple mands and extends to more complex mands as individuals become older. Self Advocacy has also been linked to increase in assertiveness skills, decrease in being bullied by others and a better quality of life. Self advocacy skills for example; use of communication skills in negotiating and compromising and persuasion to obtain goals have been taught in individual therapy sessions and group sessions. The purpose of this review is to examine and compare the effects (rate of acquisiton) of teaching self advocacy skills in group verses individual therapy sessions.

Purpose of study was to determine the overall effect of embedded instruction on child outcomes and whether embedded instruction is an evidence-based practice for young children with disabilities. Database search resulted in 264 unique articles. Each article was screened using the inclusion criteria and the screening process resulted in 24 studies using a single subject experimental design. 24 studies were coded to determine whether they meet the design standards of What Works Clearinghouse for single subject experimental designs. Seven met standards, nine met standards with reservations, and eight did not met standards. Of the 16 studies that met standards with and without reservations, only three met all 21 quality indicators proposed by Horner et al. (2005). The remaining 13 studies met 16-20 quality indicators. Based on visual analysis, of these 16 studies, nine studies were classified as having strong evidence, three studies were classified as having moderate evidence, and four studies were classified as having no evidence. Quantitative analysis continued with the remaining 12 studies. Overall the mean of the treatment effect estimates was 83.8%, 92.4%, and 84.3% for PND, NAP, and Tau-U consecutively. Findings showed that embedded instruction is an evidence-based practice to teach young children with disabilities.

This systematic review evaluates single-case research design studies that investigate the application of applied behavior analytic interventions with individuals with Down syndrome. Articles published in English peer-reviewed journals that presented original empirical data on the effect of applied behavior analytic treatments on individuals with Down syndrome using single-subject research designs were selected for review. One-hundred-twenty-six studies examining the efficacy of applied behavior analytic interventions on increasing skill acquisition and/or decreasing challenging behaviors in individuals with Down syndrome met inclusion criteria. ?We used the What Works Clearinghouse (WWC) SCRD standards and Risk of Bias in N-of-1 Trials (RoBiNT) Scale to analyze study rigor, and calculated nonoverlap indices. We will report on the study quality, treatment procedures, and treatment outcomes across the studies. The outcomes of this systematic review demonstrate clinical applications for individuals with Down syndrome and will guide future research in the area of applied behaviour analytic interventions and individuals with Down syndrome.

Behavior analysts use instruments to identify an individual’s competencies and skill deficits in order to develop individualized goals and treatment plans. According to the assessment guidelines for evaluating individuals with disabilities in the Standards for Educational and Psychological Testing, assessments should have research to support the validity and reliability of the instrument (American Educational Research Association, the American Psychological Association, and the National Council on Measurement in Education 2014). Additionally, behavior analytic instruments should be aligned with the dimensions of applied behavior analysis set forth by Baer, Rolf, and Risley (1968) which set the foundation for the field. The purpose of this study is to present the results of a systematic literature review on instruments based within the applied behavior analytic framework. The authors will also present information regarding research on the instruments examined within the review that specifically address their reliability and validity. Instruments will also be measured against the dimensions of ABA.

As policies in most states are geared towards increasing inclusion rates, more students with disabilities are receiving their academic instruction in general education settings. However, children with developmental disabilities are more likely to engage in challenging behavior in educational settings than other children, which impedes their independent engagement in instructional activities and access to the general education curriculum. This study aims to (a) systematically review the literature on interventions targeting challenging behavior of students with developmental disabilities in inclusive school settings, (b) evaluate the quality of research in this area based on the What Works Clearinghouse (WWC) design standards, and (c) determine the magnitude of effects of interventions that meet quality standards. The search procedures included a keyword search in three databases, followed by a search of related review articles, and finally a reference search of the included articles. Twenty-six studies were included and evaluated based on the WWC design standards, and 16 studies met design criteria. An inter-rater agreement of 87% was obtained on half of the articles. Data were extracted from the studies (with 95% inter-rater agreement) and effect sizes were calculated. Moderating effects of variables such as participant characteristics and intervention components will be presented and discussed.