The safety of functional analyses of self-injurious behavior

Retrospective consecutive controlled case series of outcomes for functional analyses of severe destructive behavior

Functional analysis methods allow clinicians to determine the variable(s) that maintain destructive behavior. Previous reviews of functional analysis outcomes have included large samples of published and unpublished data sets (i.e., clinical samples). The purpose of this review was to conduct a large retrospective consecutive controlled case series of clinical functional analyses. We sought to identify the prevalence of differentiation, procedural modifications for undifferentiated and differentiated cases, and identified function(s) of destructive behavior. In addition, we extended the existing literature by determining whether functional analysis differentiation and function varied when single or multiple behavior topographies were consequated in the functional analysis. We discuss our findings considering previously published functional analysis reviews, provide avenues for future research, and offer suggestions for clinical practice.

Functional analysis of problem behavior: A 40-year review

Extensive reviews of functional analysis literature were conducted 10 (Beavers et al., 2013) and 20 (Hanley et al., 2003) years ago; we expanded this review to capture the vast and innovative functional analysis research that has occurred over the past decade. Our review produced 1,333 functional analysis outcomes from 326 studies on the functional analysis of problem behavior between June 2012 and May 2022. Some characteristics of functional analysis studies were similar across the current and previous two reviews (e.g., child participants, developmental disability diagnosis, use of line graphs depicting session means, differentiated response outcomes). Other characteristics deviated from the previous two reviews (e.g., increase in autistic representation, outpatient settings, use of supplementary assessments, the inclusion of tangible conditions, and multiple function outcomes; decrease in session durations). We update previously reported participant and methodological characteristics, summarize outcomes, comment on recent trends, and propose future directions in the functional analysis literature.

On the Occurrence of Dangerous Problem Behavior during Functional Analysis: An Evaluation of 30 Applications

Functional analyses are often conducted by behavior analysts to understand the environmental variables contributing to an individual's problem behavior to better inform treatment implementation. While functional analyses are integral for designing function-based interventions, they often arrange contingencies to evoke and reinforce dangerous problem behavior. In Study 1 we reviewed 22 functional analyses with open-contingency classes including non-dangerous topographies of problem behavior and we found that participants were more likely to exhibit the non-dangerous behavior in 82% of the applications. We then conducted a single-subject comparison of closed and open-contingency classes with four additional participants in Study 2. Our results suggest that the functional analyses with the open-contingency class reduced the likelihood of observing dangerous problem behavior.

Search and Selection Procedures of Literature Reviews in Behavior Analysis

Literature reviews allow professionals to identify effective interventions and assess developments in research and practice. As in other forms of scientific inquiry, the transparency of literature searches enhances the credibility of findings, particularly in regards to intervention research. The current review evaluated the characteristics of search methods employed in literature reviews appearing in publications concerning behavior analysis (n = 28) from 1997 to 2017. Specific aims included determining the frequency of narrative, systematic, and meta-analytic reviews over time; examining the publication of reviews in specific journals; and evaluating author reports of literature search and selection procedures. Narrative reviews (51.30%; n = 630) represented the majority of the total sample (n = 1,228), followed by systematic (31.51%; n = 387) and meta-analytic (17.18%; n = 211) reviews. In contrast to trends in related fields (e.g., special education), narrative reviews continued to represent a large portion of published reviews each year. The evaluated reviews exhibited multiple strengths; nonetheless, issues involving the reporting and execution of searches may limit the validity and replicability of literature reviews. A discussion of implications for research follows an overview of findings.

Classification of injuries observed in functional classes of self-injurious behaviour

BACKGROUND

Limited research has examined how the functions of self-injurious behaviour (SIB) relate to the production of injuries and the location, type or severity of those injuries.

METHODS

Clinical and medical records were coded for 64 individuals hospitalised for SIB. When injuries were present, the physical properties of SIB and injuries were assessed across groups of individuals with automatically and socially maintained SIB.

RESULTS

Injuries were observed for 35 of the individuals who engaged in SIB. Individuals who engaged in a single form of SIB were more likely to have injuries (P < .05). Individuals with SIB maintained by automatic reinforcement had significantly more severe injuries to the head than those in the social group (q < .05, P = .0132, H = 12.54).

CONCLUSION

Although results are preliminary, the results provide evidence that the function of SIB may influence the severity and location of injuries produced.

Retrospective analysis of changes in response topographies of escape-maintained aggressive behavior during functional analyses

We observed changes in the rates of response topographies during the demand condition of functional analyses for participants who demonstrated problem behavior maintained by escape. Over the course of the functional analysis for each participant, the number of topographies decreased from the first to the last session. Additionally, after the first session of the demand condition the rate of responding for one topography increased or remained at high levels while the rates of all other topographies decreased. The implications of these results when conducting functional analysis are discussed.

The Fuzzy Concept of Applied Behavior Analysis Research

A seven-dimension framework, introduced by Baer, Wolf, and Risley in an iconic 1968 article, has become the de facto gold standard for identifying "good" work in applied behavior analysis. We examine the framework's historical context and show how its overarching attention to social relevance first arose and then subsequently fueled the growth of applied behavior analysis. Ironically, however, in contemporary use, the framework serves as a bottleneck that prevents many socially important problems from receiving adequate attention in applied behavior analysis research. The core problem lies in viewing the framework as a conjoint set in which "good" research must reflect all seven dimensions at equally high levels of integrity. We advocate a bigger-tent version of applied behavior analysis research in which, to use Baer and colleagues' own words, "The label applied is determined not by the procedures used but by the interest society shows in the problem being studied." Because the Baer-Wolf-Risley article expressly endorses the conjoint-set perspective and devalues work that falls outside the seven-dimension framework, pitching the big tent may require moving beyond that article as a primary frame of reference for defining what ABA should be.

Self-injurious behaviour in people with intellectual disability and autism spectrum disorder

PURPOSE OF REVIEW

This review summarises the recent trends in research in the field of self-injurious behaviour in people with intellectual disability and autism spectrum disorder.

RECENT FINDINGS

New data on incidence, persistence and severity add to studies of prevalence to indicate the large scale of the clinical need. A number of person characteristics have been repeatedly identified in prevalence and cohort studies that: can be considered as risk markers (e.g. stereotyped behaviour, autism spectrum disorder) and indicate possible causal mechanisms (e.g. sleep disorder, anxiety). Studies have started to integrate traditional operant learning paradigms with known person characteristics and reviews and meta-analyses of applied behaviour analytic procedures can now inform practice.

SUMMARY

Despite these positive developments interventions and appropriate support falls far short of the required need. Expansions in applied research are warranted to develop and evaluate innovative service delivery models that can translate knowledge of risk markers and operant learning paradigms into widespread, low cost routine clinical practice. Alongside this, further pure research is needed to elucidate the direction of causality of implicated risk factors, in order to understand and intervene more effectively in self-injury.

Comparisons of synthesized and individual reinforcement contingencies during functional analysis

Researchers typically modify individual functional analysis (FA) conditions after results are inconclusive (Hanley, Iwata, & McCord, 2003). Hanley, Jin, Vanselow, and Hanratty (2014) introduced a marked departure from this practice, using an interview-informed synthesized contingency analysis (IISCA). In the test condition, they delivered multiple contingencies simultaneously (e.g., attention and escape) after each occurrence of problem behavior; in the control condition, they delivered those same reinforcers noncontingently and continuously. In the current investigation, we compared the results of the IISCA with a more traditional FA in which we evaluated each putative reinforcer individually. Four of 5 participants displayed destructive behavior that was sensitive to the individual contingencies evaluated in the traditional FA. By contrast, none of the participants showed a response pattern consistent with the assumption of the IISCA. We discuss the implications of these findings on the development of accurate and efficient functional analyses.