|Think Outside the Clinic Box: Programming for Generalized Success When Reducing Severe Behavior
|Sunday, May 29, 2022
|8:00 AM–9:50 AM
|Meeting Level 2; Room 258C
|Area: AUT/DDA; Domain: Applied Research
|Chair: Laura Perry Senn (University of Alabama Huntsville)
|Discussant: Sarah Slocum (Emory School of Medicine; Children's Healthcare of Atlanta)
|CE Instructor: Sarah Slocum, Ph.D.
In their seminal article, Stokes and Baer (1977) called for purposeful generalization programming as part of behavior-analytic treatment. They asserted that generalization should be considered an active learning process in itself, rather than a passive phenomenon that occurs as a by-product of another behavior-change process. Despite this call, purposeful programming for generalization of treatment outcomes remains limited. Even more alarming, generalization programming within the treatment of severe challenging behavior is often overlooked. Given the significant and detrimental impact that severe challenging behavior can have on an individual, their family, and society, it is imperative that practitioners attempt to incorporate functional and relevant treatment components. The purpose of this symposium is to disseminate guidance on methodologies to promote generalization within the treatment of severe challenging behavior. Topics covered will include a review of recent generalization literature, the use of multiple schedules to promote generalization, and the use of parent-based interventions to further support generalization of their child’s treatment gains.
|Instruction Level: Intermediate
|Keyword(s): Generalization, Multiple schedule, Parent-based intervention, Severe behavior
Participants should have a basic understanding of generalization as well as its common methods ofprogramming and evaluation. Participants should have some familiarity with functional analysis and function-based treatment. Participants would also benefit from a basic understanding of functional communication training and signaled availability.
|Learning Objectives: 1. Describe the importance of actively evaluating generalization during treatment for severe problem behavior. 2. Identify potential strategies to incorporate during treatment to support the likelihood of generalization. 3. Identify potential means for evaluating the efficacy of treatment generalization.
|In Pursuit of Generalization: A Systematic Review of Treatment Outcomes for Severe Challenging Behavior
|LESLEY A. SHAWLER (Southern Illinois University, Carbondale), Brittany Tomasi (Endicott College; Kennedy Krieger Institute), Jessica L Becraft (Kennedy Krieger Institute; Johns Hopkins University School of Medicine)
|Abstract: Individuals with autism spectrum disorder and other neurodevelopmental disorders often do not generalize trained skills to novel contexts without direct teaching. As such, these individuals require direct programming for generalization to occur. Stokes and Osnes (1989) categorized three main areas of programming to promote the likelihood of generalization effects. These categories included: exploiting functional contingencies, incorporating functional mediators, and training diversely. However, despite these recommendations, programming and testing for generalization are often absent in the treatment of severe challenging behavior. The current systematic review examined the prevalence of generalization within the treatment of severe challenging behavior literature between 2011-2020. Specifically, we evaluated the frequency of studies that tested and programmed for generalization according to the categories set forth by Stokes and Osnes. We also investigated which generalization variables were most targeted, the overall efficacy of generalization, and the types of treatment most correlated with successful generalization outcomes. Overall, a majority of studies did not test for generalization, despite most studies including at least one area of generalization programming. Implications and strategies for improving treatment and generalization outcomes will be discussed.
An Evaluation of Discriminative Responding During a Multiple Schedule Arrangement
|COURTNEY MAUZY (University of Georgia), Jamison Keenum (Children's Healthcare of Atlanta; University of Georgia), Joanna Lomas Mevers (Marcus Autism Center), Kevin Ayres (University of Georgia), Colin Muething (Emory University; Children's Healthcare of Atlanta)
Using a consecutive controlled case series design (Hagopian, 2020), we evaluated rates of functional communication responses during a multiple schedule arrangement when schedule thinning criteria were based on rates of challenging behaviors. Multiple schedules are often used in conjunction with teaching a functional communication response. A common issue that arises once the communication response is established is that the individual continues to engage in the response during times in which the reinforcer is unavailable (Kuhn et al., 2010). To address this concern and to make treatment more practical, clinicians often use a multiple schedule arrangement to facilitate systematic schedule thinning. For this study, we reviewed the treatment data from 18 individuals diagnosed with autism spectrum disorder (ASD) enrolled in an intensive outpatient clinic. Rates of functional communication responses were evaluated during signaled available and unavailable reinforcement within a multiple schedule arrangement when schedule thinning criteria were based on rates of challenging behavior.
|Multiple Schedule Intervention for the Treatment of Severe Problem Behavior Following an Undifferentiated Functional Analysis
|LAURA PERRY SENN (University of Alabama Huntsville), Joy Clayborne (University of Maryland, Baltimore County), Matthew David Bowman (Kennedy Krieger Institute), Craig Strohmeier (Kennedy Krieger Institute; Johns Hopkins University School of Medicine)
|Abstract: While functional analysis (FA) is the preferred means of evaluating severe problem behavior in order to derive a function-based treatment, a small percentage of FA results remain undifferentiated even after assessment modifications. One potential reason for this outcome is failure to capture motivating operations for the target behavior during FA sessions. This may be even more challenging when the behavior occurs at a low rates and high intensity in the natural environment. Importantly, even infrequent severe behavior can pose a significant threat to the individual, others in their environment, or property. The present study was based on a hypothesis that low rate, high intensity, problem behavior was related to a mixed schedule of reinforcement for mands in the natural environment. Since problem behavior was not observed, parents were trained in implementation of a multiple schedule procedure to prevent problem behavior. A derived mixed schedule of reinforcement for functional communication responses served as a baseline. A multiple schedule was implemented during parent-conducted treatment sessions within the clinic. Following schedule thinning, baseline responding under a mixed schedule was replicated in the home via telehealth. This was followed by introduction of multiple schedule treatment and successful schedule thinning in the home.
CANCELED: Treating Severe Problem Behavior With Parent-Based Interventions
|EMILY SEALS MATHIS (Kennedy Krieger Institute; Johns Hopkins University School of Medicine), Matthew Ferrigno (Kennedy Krieger Institute; Johns Hopkins University School of Medicine), Craig Strohmeier (Kennedy Krieger Institute; Johns Hopkins University School of Medicine)
Parent-based interventions address a variety of challenging behaviors by focusing treatment on the parent’s behavior as the change agent for their child’s behavior. For example, Parent Child Interaction Therapy (PCIT) is an evidence-based intervention designed to reduce challenging behaviors in young children by improving parent-child interactions with healthy communication and effective and safe disciplinary techniques (Funderburk & Eyberg, 2011). Other parent focused interventions use a cognitive behavioral and psychoeducational approach to provide families with support in reducing accommodating behaviors (i.e., verbal reassurance, altering routines, honoring specific requests) that often perpetuate their child’s challenging behaviors associated with anxiety and obsessive-compulsive behaviors (Lebowitz et el., 2019). Similarly, parent responses to severe problem behavior (SPB; i.e., aggression, self-injury, disruptions, and property destruction) may also be considered a form of accommodation (Strohmeier et al., 2020) since the responses often exacerbate and maintain (i.e., reinforce) the SPB. Therefore, parent-based interventions aimed at reducing and replacing common responses that reinforce severe problem behavior (e.g., access to tangibles, attention, and escape from demands) may be effective at producing collateral changes in child SPB. This study examines the effects of parent-based interventions for two children who exhibit SPB.