|Considerations for Enhancing Treatment Efficacy: Overcoming Barriers in the Implementation of Extinction and Treatment-Resistant Behavior
|Monday, May 25, 2020
|3:00 PM–4:50 PM
|Area: DDA/AUT; Domain: Applied Research
|Chair: Sarah Elizabeth Martinez Rowe (University of Nebraska Medical Center's Munroe-Meyer Institute)
|Discussant: Joanna Lomas Mevers (Marcus Autism Center)
Differential reinforcement of alternative behavior (i.e., DRA) combines the reinforcement of prosocial behaviors and extinction of destructive behaviors. While highly effective, DRA alone may be insufficient for producing clinically significant reductions in destructive behavior (i.e., behavior is treatment resistant, extinction cannot be implemented). Thus, clinicians must address these barriers by incorporating additional treatment components to enhance efficacy. This symposium will consist of four presentations followed by comments from Dr. Joanna Lomas Mevers. First, Kimberly Ford will present on a comparison of the efficiency and preference for interventions with and without physical guidance for treating escape-maintained problem behavior. Next, Katherine Brown will present on the development and validation of a reinforcer dimension sensitivity assessment to inform DRA without extinction procedures. Third, Andrew Sodawasser will present data from a clinical review of clients who displayed treatment resistant problem behavior and participated in a stimulus avoidance assessment. Last, Alexandra Hardee will discuss the utility of the stimulus avoidance assessment and implications for future practice.
Comparison of Instructional Methods With and Without Physical Guidance When Teaching Chained Tasks
|KIMBERLY FORD (Rowan University), Christina Simmons (Rowan University)
Physical guidance is a common intervention component; however, in some situations, physical guidance may be contraindicated (e.g., client of larger stature, hands-off school policy, caregiver physical limitations, history of physical abuse). In this study, we evaluated the effectiveness of a multiple opportunity probe (MOP) as an alternative to physical guidance (PG) to teach chained tasks to 4 school-aged participants (range, 5-18) with autism spectrum disorder who engaged in escape-maintained destructive behavior. An adapted-alternating design was used to teach three equally matched arbitrary tasks to evaluate the effectiveness of the MOP as an alternative instructional method. Data were collected on the percentage of steps completed independently, rate of destructive behavior, and the social validity (i.e., participant and therapist preference of the two instructional methods). All participants mastered tasks more efficiently with the MOP and displayed lower rates of problem behavior with the MOP. The majority of participants demonstrated preference for the MOP. Factors influencing participant preference will be discussed. Social validity of incorporating participant and therapist instructional preferences will also be discussed. This study provides evidence of an effective alternative when physical guidance is contraindicated that may provide a safer and socially valid way to teach chained tasks.
|Development and Validation of a Systematic Approach to Identifying Reinforcer
|KATHERINE BROWN (Utah State University), Amanda Zangrillo (University of Nebraska Medical Center, Munroe-Meyer Institute), Brian D. Greer (Rutgers Robert Wood Johnson Medical School)
|Abstract: Differential reinforcement of alternative behavior (DRA), which often arranges extinction (EXT) for destructive behavior, is an effective treatment for destructive behavior. However, the use of EXT has several limitations resulting in practitioners implementing DRA without EXT. During these treatments, practitioners often manipulate reinforcer dimensions to favor appropriate behavior. The pre-identification of reinforcer dimensions to which an individual’s behavior is sensitive may be important to inform efficacious DRA without EXT treatments. In Study 1, we extended previous research by developing a systematic methodology to assess identify individual sensitivity to parametric values of reinforcer dimensions. In Study 2, we conducted a validation analysis during which we implemented two DRA without EXT procedures to assess if participants allocated responding towards the response that produced the optimal reinforcer relative to the response that produced the suboptimal reinforcer identified in Study 1.
|A Consecutive-Case Review of the Clinical Use of the Stimulus Avoidance Assessment
|ANDREW SODAWASSER (University of Nebraska Medical Center), Katherine Brown (Utah State University), Alexandra Hardee (University of Nebraska Medical Center's Munroe-Meyer Institute), Billie Retzlaff (University of Nebraska Medical Center's Munroe-Meyer Institute)
|Abstract: Behavior analysts may conduct a stimulus avoidance assessment (Fisher et al., 1994) to identify a behavior reduction procedure when reinforcement-based procedures alone are ineffective in producing clinically significant reductions in destructive behavior or when an individual's destructive behavior causes significant injury and warrants the quickest possible reduction. Although stimulus avoidance assessments are used clinically, there is a scarcity of published data regarding the use of this assessment. The purpose of this review was to examine the clinical use of stimulus avoidance assessment in a university-based severe behavior program. We examined the prevalence of the assessment over a ten-year period and considered demographic information for individuals for whom a stimulus avoidance assessment was conducted including (a) the individual’s age, gender, diagnoses, and use of medication, (b) the topography and function of the individual’s destructive behavior, and (c) the length of time in treatment prior to conducting the stimulus avoidance assessment. We compared the obtained demographic information to a randomly selected sample of individuals who received services in the same program without experiencing a stimulus avoidance assessment. Overall, 12% of clients over the ten-year period experienced a stimulus avoidance assessment, and no major demographic differences existed between the stimulus avoidance group and the comparison group.
|Clinical Concerns Regarding the Utility of the Stimulus Avoidance Assessment
|ALEXANDRA HARDEE (University of Nebraska Medical Center's Munroe-Meyer Institute), Katherine Brown (Utah State University), Andrew Sodawasser (University of Nebraska Medical Center), Billie Retzlaff (University of Nebraska Medical Center's Munroe-Meyer Institute)
|Abstract: The stimulus avoidance assessment is the only empirical method to identify stimuli that may serve as punishers for destructive behavior. However, only a small number of studies have reported on the stimulus avoidance assessment, and therefore the clinical utility remains unknown. To evaluate the clinical utility of the assessment, we reviewed all clinical cases from a university-based severe behavior program that included a stimulus avoidance assessment in the last ten years. We examined 254 patient records, and included in our analysis 30 cases for which a stimulus avoidance assessment was conducted. Findings indicated that although over half (66.7%) of the cases for which a stimulus avoidance assessment was conducted included a punisher in the final treatment recommendations, the punisher was the procedure with the highest avoidance index from the assessment in only 13.3% of cases. Additionally, for a subset of cases, the patient experienced more than one series of the stimulus avoidance assessment, allowing us to examine the reliability of the assessment within the same participant. In the majority of the cases, the reliability of outcomes across series was low (exact agreement averaged 21.3%). We discuss concerns regarding the clinical utility of the stimulus avoidance assessment raised by these findings.