Association for Behavior Analysis International

Gastrointestinal (GI) complications are common in children with autism spectrum disorder (ASD) and are often accompanied by several aversive symptoms including, but not limited to, abdominal pain, constipation, and vomiting (Molloy & Manning-Courtney, 2003). In the current study, a 16 year-old male with ASD and enteral tube dependence had a history of excessive vomiting due to a GI lesion. He was admitted to an inpatient pediatric feeding disorders program to decrease spitting and drooling of saliva and it was hypothesized that an aversion to vomiting facilitated the patients avoidance of orally consuming food, drinks, and saliva into his stomach. The present study evaluated the effects of differential reinforcement of closing and clearing his mouth of saliva (i.e., swallowing) (DRA) and differential reinforcement of other behavior (DRO) to decrease spitting behavior. The treatment was gradually implemented throughout the day until no spitting or drooling was observed during all waking hours. Drink and food were successfully introduced using a similar DRA/DRO procedure. The volume of food and drink were increased to meet his daily caloric needs and all enteral tube feedings were discontinued. The present study supports the use of reinforcement-based behavioral interventions to treat maladaptive spitting/drooling behavior.

This poster will focus on highlighting prior research on Quality of Life (QoL) between 1990-2016 with an aim to identify predictors and patterns in QoL in individuals with Autism (ASD). Our aim is to be able to propose future directions in research in this field and derive suggestions to ameliorate QoL in individuals with ASD. The World Health Organization (1997) defines Quality of Life as the individuals perception of their position in life, in the context of culture and value systems in which they live, and in relation to their expectations, standards and concerns ranging from the persons physical health, psychological state, level of independence, social relationships, personal beliefs, and their relationships to salient features of their environment. Adolescence is a period in which it might be expected that a person with ASD would be likely to be able to evaluate aspects of their life experiences as well as integrate peer evaluations of social competence as a predictor of successful integration. As a result of their difficulties in the area of social interaction, adolescents with ASD may be expected to be particularly vulnerable to poor integration and social outcome, which may be expected to affect perceptions of QoL. These patterns are expected to continue into adulthood.

Despite ample research on evidence-based practices for children with autism spectrum disorder (ASD), there is limited empirical evidence of best practices for training therapists who implement manualized interventions. Passive training (self-directed reading) is a commonly used strategy, which often leads to an ability to report vs. perform intervention procedures. Therefore, additional active strategies (behavioral rehearsal) may be required to implement procedures accurately. We conducted a modified multiple baseline design across three pairs (n=6) of graduate student therapists recruited to implement a manualized intervention for youth with ASD. Therapists first completed 3 hours of passive learning (self-directed reading) followed by 3 hours of active learning (Behavioral Skills Training). Trained observers coded therapists' performance in each phase on two outcome measures: (1) fidelity, scored as percent correct on session checklists (IOA M= 95.76%, R= 86.67%-100%); and (2) quality, rated on a 5-point Likert scale (IRR M= .92 R= .84-.99). Five of the six therapists demonstrated an increase in fidelity after active training (M = 4.76% change, R= -1.57-8.77%), and four of the six therapists showed an improvement in session quality (M=0.30 change R= -0.20-1.28). Evaluation of training strategies that lead to increased fidelity and quality of evidence-based interventions for individuals with ASD is highly warranted.

Pain and discomfort associated with physical illness mediates the presentation of serious problem behaviors. Nonverbal children with autism often have pain that is ignored or under-treated (ref). Inability to report and describe pain results in improper treatment. Pain can also be a setting event for problem behavior. Self-injury may be a clue that there is pain and provide information on where the pain is located. Patterns of self-injury can be used to help determine if pain is present, where it is located and how it impacts the individual. The Non-Communicating Children Pain Checklist is a measurement tool used to identify pain behavior in nonverbal children with intellectual impairment. In the current study, the reliability and validity of the checklist was evaluated in a residential treatment facility by completing the checklist by two simultaneous observers following a 2 hour observation period. The pain scale data were compared to graphs of self-injurious behavior, medical exams, and direct observation of behavior at regularly scheduled intervals and when pain was hypothesized. Although the scale completion by some observers were consistent with pain identified by medical professionals, the interobserver agreement was very low.

Adults with developmental disabilities are significantly more likely to be in fair or poor general health status when compared to the general population (Sullivan et al., 2011). One of the main reasons is the lack of preventive health services within the developmental disabilities population (Yen et al., 2014). Many studies that have used behavioral treatment package to increase medical compliance involved children (Cuvo et al., 2010; Allen et al., 1992), but very few were with adults. The first purpose of the present study was to investigate the use of a behavioral treatment package that included choice-making, chaining and shaping with percentile schedules to increase physical health exam compliance in adults with developmental disabilities. The second purpose was to investigate whether or not carry-over effects were present across physical health exam components when training two physical health exam components simultaneously. Last, it evaluated whether generalization of physical health exam compliance occurred across time and settings. The physical health exam components included blood pressure, body temperature, ear, heart and lung, height, glucose, mouth/throat, and weight. The present study found that the behavioral treatment package was successful in increasing physical health exam compliance in adults with developmental disabilities.

There is increased use of off label psychotropic medications to treat behavior challenges for individuals with intellectual and developmental disabilities (Crystal, et al., 2009; Williamson, & Martin, 2012). Although the treatment efficacy is not promising (Crystal, et al., 2009; Deb, et al., 2007; Mandell, et al., 2008; Matson, & Neal, 2009; Tyrer, et al., 2000), the use of psychotropic medications is one of the common treatments for the population. Although On the other hand, other evidence based treatments such as behavioral interventions have been underutilized despite of previous studies demonstrating successful outcomes to reduce behavior challenges (Brosnan, & Healy, 2011; Hanly, et al., 2005; Matson, 2007; Matson, & Neal, 2009). This trend also changed the regulation for services in special education and behavioral health industries. In the current study, 128 adults were separated into two groups (with or without behavior reduction procedures prior to 2009) and the number of psychotropic medications prescribed for them before and after the removal of behavior reduction procedures was analyzed. It was found that there was a statistically significant increase in the number of psychotropic medications after the removal of behavior reduction procedures for the group with those procedures.

Previous research has demonstrated that manipulating the response effort associated with eating may increase appropriate feeding behaviors (e.g., acceptance, swallowing) and decrease inappropriate mealtime behavior. For example, Kerwin, Ahearn, Eicher, and Burd (1995) decreased the response effort associated with eating by decreasing the volume of food on the spoon. Wilkins, Piazza, Groff, and Vaz (2011) showed that decreasing the response effort associated with swallowing and increasing the response effort for expulsion by implementing a chin prompt to close the childs mouth during drink deposits decreased rates of expulsion in 4 children diagnosed with a feeding disorder. We extended the findings of Kerwin et al. (1995) and Wilkins et al. (2011) in the current study by using a bolus manipulation (i.e., 2 cc vs. 4 cc) and a chin prompt as antecedent interventions to treat the liquid expulsion of a 14-month-old girl. Use of the chin prompt effectively decreased expulsion for both bolus sizes relative to baseline, but the largest decrease in expulsion was with the smaller bolus size. We discuss the results in terms of changes in response effort associated with swallowing.

Background: Approximately 69-95% of children with Prader-Willi syndrome (PWS) engage in chronic skin picking (Morgan et al., 2010). Habit reversal training (HRT) is an effective treatment for skin picking in a variety of populations. There is limited information on the implementation of HRT for reducing skin picking in individuals with PWS. HRT involves self-monitoring and reinforcement of competing responses to decrease the target behavior. Competing responses sometimes become problematic and a more socially valid replacement behavior must be identified; there is little guidance on the procedures to do this. Methods: The current study focused on identifying an alternative competing response for a child with PWS and skin picking in an outpatient setting. HRT was previously successful and led to high rates of the competing response (crayon peeling); however, crayon peeling became socially inappropriate. A Competing Stimulus Assessment (CSA) was used to identify a more socially appropriate competing response. Functional assessment data indicated skin picking was maintained by automatic reinforcement. Results: A traditional CSA (Piazza et al., 1998) was ineffective in identifying a competing response and further modifications are needed. Future data collected will clarify the most appropriate method to identify new competing responses. Limitations and clinical considerations will be discussed.

Children with severe feeding problems engage in a variety of refusal behaviors to avoid or escape food and or liquids. This often results in parents engaging in a variety of unconventional methods and utensils in order to increase their childs food and/or liquid consumption such as syringes, bottles at inappropriate ages, dream feeds, walking around, etc. However, this may lead to long meal durations in which the child consumes food and/or liquid for the majority of waking hours which impedes caloric intake and nutritional needs. Furthermore, long meal durations with one aspect of eating such as drinking may leave less time for other aspects such as solids. The purpose of this study was to decrease the duration of milk consumption by comparing the effects of a escape extinction and positive reinforcement procedures between two different drinking utensils (straw bottle and open cut-out cup) in an intensive interdisciplinary home-based feeding program for a 15-month-old girl diagnosed with pediatric feeding disorder, failure to thrive (FTT), ventricular septal defect (VSD), gastroesophageal reflux disease (GERD). A multiple treatment reversal design was used to evaluate the treatment protocols. Results found that escape extinction and positive reinforcement paired with the open cut-out cup was the most successful procedure for increasing milk acceptance and decreasing the duration of milk consumption. Since duration of milk consumption decreased there was more time for solid intake. Furthermore, since all nutrition was obtained via solids and liquids multivitamins and iron supplements were no longer necessary. These data are discussed in relation to the importance of meal duration as a dependent variable and how it relates to overall health.

There is evidence to support that behavioral interventions result in significant improvements in feeding behavior in children with pediatric feeding disorders (Sharp et al., 2010; Williams et al., 2007). Despite increase in empirical evidence supporting the role of behavior analysis in treating severe feeding problems, evaluation of interdisciplinary program outcomes have been somewhat limited. The purpose of the current study was to evaluate the treatment outcomes of an interdisciplinary feeding program for 23 children diagnosed with pediatric feeding disorders. A retrospective chart analysis indicated these children were treated successfully overall with high levels of parent satisfaction. The program was found to be cost-effective when compared to the cost of outpatient therapy or long-term supplemental feeding.

With the growing number of adults suffering from aphasia every year, having effective treatment methods that improve quality of life and help regain communication abilities is highly important. Aphasia is an impairment of language that affects all language modalities (National Aphasia Association, 2011) and leads to loss of communication abilities and reduced life quality (Beeson & Bayles, 1997; Groher, 1989). Applied Behavior Analysis presents principles that are used for analyzing and modifying communicative behavior, which makes it an ideal foundation for aphasia rehabilitation (Goldfarb, 2006). Some of the behavioral treatment methods that have been used with aphasia are precision teaching, fluency training, and errorless learning. Precision teaching evaluates the effectiveness of teaching strategies (Chapman, 2005), fluency is a measure of speed and accuracy of responding (White, 1986), and errorless learning is a technique that focuses on decreasing the number of errors during skill acquisition (Fillingham, 2006). These behavioral techniques have shown to improve skills associated with aphasia, including the generalization of those skills (Ayers, 1975; Chapman, 2005; Sigurardttir, & Sighvatsson, 2006, 2012). This poster will provide an overview of the small body of research on the above mentioned behavioral techniques as effective treatments for aphasia, describe specific areas for further research, and provide guidelines for practice.