Comparisons of standardized and interview-informed synthesized reinforcement contingencies relative to functional analysis

A scoping review of consecutive controlled case series studies

We conducted a scoping review on the consecutive controlled case series (CCCS) methodology (Hagopian, 2020). The CCCS is an approach to studying functional relations across a series of consecutive cases that share common features. We identified and reviewed 76 studies that used CCCS methodology. Most of these (a) were retrospective CCCS studies that incorporated most of the CCCS elements that were identified by Hagopian (2020), (b) involved child participants with autism spectrum disorder or an intellectual disability, and (c) evaluated the assessment and treatment of challenging behavior within specialized clinical settings. The sample sizes ranged from 3 to 269 participants, with a median of 20 participants. We discuss current trends, gaps in the literature, and implications for statements of the generality of behavioral procedures.

The Challenges Ahead: Concepts, Analytics, and Ethics of Value-Based Care in Applied Behavior Analysis

Value-based care has incrementally increased its footprint across healthcare over the past 2 decades. Several organizations in ABA have begun experimenting with various components of value-based care specific to the delivery of ABA services and it seems likely that this trend will continue into the future. For those new to value-based care, this article reviews the main conceptual components as well as common myths and misconceptions about value-based care. Though conceptually straightforward, practically pulling off value-based care in ABA will require significant advancements in data collection, analytics, sharing, and transparency that follow from broad field-wide collaboration. Further, many ethical questions will likely arise as ABA providers begin thinking about and assessing their clinical and business operations through a value-based care lens. Though value-based care will likely roll out slowly and incrementally over many years, ABA providers interested in participating or leading these conversations will likely benefit from focusing collaborative efforts around: normalizing data sharing and self-analysis; defining and developing quality and cost measures; identifying patient risk variables; addressing challenges at the intersection of public health ethics and clinical ethics; and addressing challenges at the intersection of AI ethics and clinical ethics. Most probably agree that optimizing patient outcomes is the goal of ABA services. However, doing it in an objective, measurable, and consistent manner that can be validated by third-parties will require overcoming significant challenges.

Protective procedures in functional analysis of self-injurious behavior: An updated scoping review

Despite the efficacy of functional analyses in identifying the function of challenging behavior, clinicians report not always using them, partly due to safety concerns. Understanding how researchers employ safeguards to mitigate risks, particularly with dangerous topographies like self-injurious behavior (SIB), is important to guide research and practice. However, the results of a scoping review of functional analyses of self-injurious behavior conducted by Weeden et al. (2010) revealed that only 19.83% of publications included protections. We extended the work of Weeden et al. to determine whether reporting has improved. We observed increases in all but two types of protections reviewed by Weeden et al. Additionally, we included new protections not reported by Weeden et al. In total, 69.52% of the studies included at least one protective procedure and 44.39% specified that the protections were used for safety. It appears that reporting has increased since Weeden et al. called for improved descriptions of participant protections.

Long-term effectiveness and generality of practical functional assessment and skill-based treatment

There are several considerations to address when conducting functional communication training for challenging behavior in a school setting, such as the need for schedule thinning and maintenance across staff and the need to establish a variety of appropriate classroom skills. There are several strategies for conducting schedule thinning following functional communication training and for transferring effects across people or settings. However, there are few examples of these processes in natural settings with relevant caregivers and with long-term maintenance of effects. We implemented a functional assessment and skill-based treatment process with six children with autism in a specialized school setting and extended treatment until challenging behavior was reduced to near-zero levels across multiple staff and settings. Follow-up data indicate that effects were still observed 1 year posttreatment and the use of crisis procedures (e.g., physical restraint) was eliminated for all participants.

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.

Conducting Translational Research in the Context of Patient Care

Although much has been written on the importance of translational research for bridging the continuum of basic science to clinical practice, few authors have described how such work can be carried out practically when working with patient populations in the context of ongoing clinical service delivery, where the priorities for patient care can sometimes conflict with the methods and goals of translational research. In this article, we explore some of the considerations for conducting this type of work while balancing clinical responsibilities that ensure high-quality patient care. We also discuss strategies we have found to jointly facilitate translational research and improve routine, clinical service delivery. A primary goal of this article is to encourage others working in applied settings to contribute to the increasingly important role that translational research plays in our science and practice by helping to better characterize and potentially lessen or remove barriers that may have impeded such investigations in the past.

Further evaluation of functional analysis screening methods in early autism intervention

A goal of some functional analysis (FA) variations is to reduce assessment time while still maintaining efficacy. This may be especially important when conducting FAs in early intervention programs, where time is a crucial commodity. To that end, we evaluated a model for using the results of the no-interaction condition as a screening for behavioral function and to guide selection of FA test conditions with 20 participants (22 assessments) aged 3 to 7 years old. We used the no-interaction condition to develop hypotheses for both automatic reinforcement and socially mediated reinforcement. The outcome of the no-interaction condition guided the selection of test conditions for the remainder of the FA. We also incorporated methods from prior FA studies (e.g., divided attention) to modify the test conditions. We obtained differentiated results in 91% of assessments, all within 70 min and, as such, extended evidence that an FA can be completed in little time without sacrificing efficacy.

On the Reliability and Treatment Utility of the Practical Functional Assessment Process

Saini et al. (2019) urged caution with respect to the use of practical functional assessment (PFA) procedures to inform behavioral treatment when they found that responses to an open-ended caregiver interview were only somewhat reliable and showed moderate to weak correspondence with analog functional analyses. Because the practitioner's goal in conducting any functional assessment process is to inform the successful treatment of problem behavior, we replicated and extended Saini et al. by (a) evaluating the reliability of hypotheses gleaned from two independent PFA processes for each of four children, (b) conducting treatment informed by a randomly assigned PFA, and (c) determining the extent to which potentially different levels of reliability impacted the treatment utility of the PFA process. Results indicated that the reliability of the PFA process varied depending on the stringency with which it was evaluated. However, treatments developed from randomly determined PFA processes produced efficacious outcomes on problem behavior and targeted social skills that transferred to the context designed from the other PFA process in all evaluations, suggesting that the PFA has strong treatment utility despite parts of the process having ambiguous levels of reliability. We discuss implications for practitioners tasked with treating severe problem behavior.

Further comparison of isolated and synthesized contingencies in functional analyses

Recent research on functional analyses (FAs) has examined the extent to which problem behavior is maintained by single (isolated) or combined (synthesized) reinforcement contingencies. Outcomes of these analyses might differ depending on the sources of information that are used to inform contingencies included in test conditions. The purpose of the current study was to compare the outcomes of isolated FAs and synthesized contingency analyses (SCAs) with 3 participants. Conditions in both analyses were informed by interviews and both unstructured and structured observations. Problem behavior for all 3 participants was maintained by 1 or 2 isolated reinforcers. Results suggested false-positive SCA results for 2 participants. For 1 participant, a second isolated reinforcer was identified following the SCA, indicating the induction of a novel function. Implications for the use of isolated and synthesized consequences are discussed, as well as the predictive validity of the assessments that are used to inform them.

Evaluating the Potential for Correspondence Between Brief Functional Analysis and Interview-Informed Synthesized Contingency Analysis Procedures

School Psychologists regularly conduct Functional Behavior Assessment (FBA), though, most FBA are completed using indirect procedures, which are inadequate for creating function-based interventions relative to experimental measures, such as functional analysis (FA). However, traditional FA may be considered arduous in the school setting. Alternative procedures like brief functional analysis (BFA) and interview informed synthesized contingency analysis (IISCA), may be as effective and more efficient than FA. Limited research exploring the correspondence of these procedures exists. The current study used an alternating treatment design across eight school aged children to compare control and test conditions for each measure. A within subjects approach was also used to compare the results of BFA and IISCA. Correspondence across the two measures was 54.17%. With average correspondence yielding just over half, the results indicate the two FA methods did not reliably identify the same function. Implications for practice are discussed.

An Evaluation of "Balance": a Home-Based, Parent-Implemented Program Addressing Emerging Problem Behavior

Programs that prevent the development of severe problem behavior in young children with autism spectrum disorder (ASD) are critically needed. We describe a program designed to do this, and we report on a preliminary evaluation of its effects with four 3- and 4-year-old children with ASD. Parents served as the primary implementers, with twice-weekly coaching from a Board Certified Behavior Analyst. Direct measures and Aberrant Behavior Checklist scores reflected decreases in emerging problem behavior. Direct measures also reflected increases in child communication, social, and cooperation skills, and parents rated the process as highly acceptable. A randomized controlled trial will be required to evaluate the extent to which the program prevents the development of problem behavior in young children with ASD.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40617-020-00490-3.

The consecutive controlled case series: Design, data-analytics, and reporting methods supporting the study of generality

Single-case experimental designs (SCEDs) have proven invaluable in research and practice because they are optimal for asking many experimental questions relevant to the analysis of behavior. The consecutive controlled case series (CCCS) is a type of study in which a SCED is employed in a series of consecutively encountered cases that undergo a common procedure or share a common characteristic. Additional design elements, data-analytic, and reporting methods enable researchers to ask experimental questions relevant to the study of generality of procedures and processes. The current paper discusses the CCCS methodologies, including the retrospective, prospective, and randomized CCCS. These methodologies can be applied to examine the generality of clinical procedures (including their general efficacy, the limits of their generality, and variables that may mediate generality); study the epidemiology and phenomenology of clinical problems; and compare the efficacy of 2 clinical procedures within a randomized controlled trial combining SCEDs with randomized group designs.

Treating destructive behavior reinforced by increased caregiver compliance with the participant's mands

Functional analyses sometimes do not identify momentary fluctuations in the function of destructive behavior (Bowman, Fisher, Thompson, & Piazza, 1997). In such cases, individuals may mand for the reinforcer that is currently most preferred and display destructive behavior if that mand goes unreinforced. In this study, we conducted a mand analysis to test whether destructive behavior functioned as a precurrent response that increased reinforcement for the participant's mands. We then evaluated a treatment that matched this function of destructive behavior by providing differential or time-based reinforcement of participant mands in accordance with multiple or chained schedules with reinforcement-schedule thinning. Decreases in destructive behavior averaged 97.4% across cases. We discuss these results relative to the importance of matching treatments for destructive behavior to operant functions for both traditional and idiosyncratic functions of destructive behavior.

Mitigating resurgence of destructive behavior using the discriminative stimuli of a multiple schedule

Results of several recent translational studies have suggested that correlating contextual or discriminative stimuli with the delivery and withholding of reinforcement for the functional communication response (FCR) may mitigate resurgence of destructive behavior, but few, if any, have isolated the effects of those stimuli. In the present study, we first trained the FCR, brought it under stimulus control of a multiple schedule, and thinned its reinforcement schedule in one stimulus context. Next, we conducted resurgence evaluations (i.e., baseline, functional communication training [FCT], extinction challenge) in two novel contexts to test the effects of the discriminative stimuli on resurgence. We programmed one context to include the (a) S^D during the FCT phase to signal the availability of reinforcement for the FCR and (b) S^Δ during a subsequent extinction challenge to signal the unavailability of reinforcement for the FCR. The other context did not include the S^D during the FCT phase, nor the S^Δ during the extinction challenge. We expected to see greater persistence of the FCR in the context that included the S^D during FCT and less persistence of the FCR and less resurgence of destructive behavior in the context that included the S^Δ during the extinction challenge. Obtained results confirmed this latter prediction, but we observed no reliable difference when the S^D was present or absent during the FCT phase. Our results have relevance for practitioners in that they provide further empirical support for the use of discriminative stimuli when treating destructive behavior.

Evaluation of an Omnibus Mand in the Treatment of Multiply Controlled Destructive Behavior

Functional communication training is a commonly used and effective treatment for socially reinforced destructive behavior. However, when a functional analysis suggests that destructive behavior is multiply controlled (e.g., by attention, tangibles, and escape), teaching and evaluating separate functional communication responses (FCRs) can be time-consuming or only partially effective when failing to address multiple establishing operations that may occur simultaneously. We evaluated the use of an omnibus FCR or mand that produced access to attention, tangibles, and escape within each functional-analysis test condition for two boys with autism spectrum disorder who displayed multiply controlled destructive behavior. The omnibus-FCR treatment produced low rates of destructive behavior and high percentages of independent FCRs within each condition for both children, suggesting that such a treatment option may reduce destructive behavior and teach communication skills quickly prior to introducing other treatment components, such as teaching individual FCRs to address each unique function of destructive behavior.