Reporting of demographic variables in the Journal of Applied Behavior Analysis

Self-Control Training: A Scoping Review

We conducted a scoping review of the behavior analytic self-control training (SCT) literature. To identify included articles, we searched key terms in six databases for articles published between 1988 and 2021. We included empirical articles that used a behavioral approach to self-control training with human participants for whom increasing self-control choice was a clinically significant goal and measured self-control and impulsive choice as dependent variables. Twenty-five experiments from 24 articles with a total of 79 participants were included in the review. This review aims to summarize the characteristics of SCT procedures and outcomes, provide recommendations for future research directions, and offer practical suggestions to clinicians incorporating SCT into practice. We examined similarities across studies regarding the independent variables manipulated in SCT, dependent variables measured, metrics of successful interventions, and assessment of generalization and maintenance of self-control choice. Twenty-one experiments arranged concurrent self-control- and impulsive-choice options with positive reinforcement, and four experiments arranged self-control training with negative-reinforcement contingencies. Variations of SCT included progressively increasing delays, intervening activities, signaled delays, antecedent rules, and commitment responses. Providing an intervening activity during the delay was largely successful at increasing self-control choice. Maintenance and generalization of increased self-control choice were assessed in two and three experiments, respectively. Future research should focus on improving the generality of SCT procedures in clinical settings by increasing terminal delays, fading out intervening activities, including probabilistic outcomes, and combining appetitive and aversive outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40617-023-00885-y.

Mand Modality Preference Assessments among High- and Low-Tech Options for Individuals with Intellectual and Developmental Disabilities: A Systematic Review

The extant literature demonstrates that individuals with intellectual and developmental disabilities (IDD) exhibit preferences among communication modalities when multiple modalities are available and produce reinforcement on identical reinforcement schedules. High- and low-tech communication options, such as voice output devices and picture cards, are commonly recommended for individuals with limited vocal communication skills. In this study, we conducted a systematic literature review of research studies that implemented mand modality preference assessments (MMPAs) that included both a high- and low-tech communication option with individuals with IDD. We identified 27 studies meeting our inclusion criteria and summarized the participant demographics, MMPA design and procedural variations, and MMPA outcomes. The results suggested that high-tech communication options were generally more preferred over low-tech options. However, there was a high degree of variability in how the studies were conducted and conclusions were reached. We discuss some of the current research gaps and the implications for clinical practice.

Training individuals to implement discrete-trial teaching procedures using behavioral skills training: A scoping review with implications for practice and research

Behavioral skills training (BST) is an evidence-based approach for training individuals to implement discrete-trial teaching procedures. Despite the effectiveness of this approach, implementing BST can be time and resource intensive, which may interfere with a clinical organization's adoption of this training format. We conducted a scoping review of studies using BST components for training discrete-trial teaching procedures in peer-reviewed articles between 1977 and 2021. We identified 51 studies in 46 publications involving 354 participants. We coded descriptive data on (a) participant characteristics, (b) study characteristics, (c) training conditions (including instructions, modeling, rehearsal, and feedback), and (d) training outcomes. The results indicated that studies have primarily attempted to improve the efficacy and efficiency of BST by modifying or omitting common training components. We provide best-practice considerations for using BST to teach discrete-trial teaching procedures and offer a research agenda to guide future investigation in this area.

Caregiver involvement in applied behavior-analytic research: A scoping review and discussion

We conducted a scoping review to characterize the role of caregiver involvement in behavior-analytic research. We reviewed eight behavioral-learning journals from 2011-2022 for works that included children or caregivers as participants and characterized caregiver involvement as passive (implications for caregivers, input, social validity) and active (implementation, caregiver behavior, training, caregiver-collected data). The review identified 228 studies, and almost all (96.1%; n = 219) involved caregivers in some capacity; 94.3% (n = 215) had passive involvement (26.8% had only passive involvement; n = 61), 69.3% (n = 158) had active involvement (1.8% had only active involvement; n = 4), and 3.9% (n = 9) had neither passive nor active involvement. Involvement generally increased over publication years. The most common types of involvement were implications for caregivers, implementation, and input; caregiver-collected data were rare. We propose considerations when engaging caregivers in research and suggest new avenues of inquiry related to caregivers' treatment objectives and social validity, treatment implementers, and caregiver-collected data.

Reflections and Critical Directions for Toilet Training in Applied Behavior Analysis

Achieving toileting independence is a critical skill that yields several benefits of pressing social, developmental, and health-related importance. The seminal behavioral approach to toilet training established the conceptualization of continence and framework for toileting research thereafter. Contemporary researchers continue to evaluate toilet training procedures that produce efficacious outcomes for young children that closely align with current applied behavior analysis (ABA) ethics and standards of practice. Despite the overall success of behavior-analytic toileting approaches, there are critical directions still worthy of consideration and investigation. In this paper, we acknowledge the seminal roots and many of the contemporary contributions. We also critically reflect on current practices while proposing necessary areas to advance behavior-analytic toilet training research.

A Contextual Behavioral Framework for Enhancing Cultural Responsiveness in Behavioral Service Delivery for Latino Families

In recent years, the field of behavior analysis has shifted its attention to issues of diversity, social justice, and cultural responsiveness. With various cultural groups in the United States, behavior analytic practitioners increasingly find themselves serving clients of diverse cultural backgrounds. One of the populations that continue to face underrepresentation is Latinos. In the current article, a cultural understanding of the Latino culture is provided to support cultural responsiveness in behavioral service delivery. This article explores the Latino identity of individuals receiving behavioral services, systemic barriers faced by Latinos, the use of acceptance and commitment training for Latino families and clients, and Latino cultural values and their role in behavioral service delivery. Most important, a shift in perspective to account for the barriers perceived by practitioners within the context of Latino cultural values is offered through a contextual behavioral framework, the literature, and the authors' personal and professional experiences as Latino behavior analysts. Recommendations in the areas of assessment, treatment design, service delivery, and collaboration when working with Latinos are also discussed.

Integrating Diversity, Equity, and Inclusion Readings within Coursework: Suggestions for Instructors Teaching Behavior Analysis

Behavior analysis graduate programs must train their students to be culturally responsive so that they are prepared to effectively serve a diverse clientele. One important strategy for helping students gain a culturally responsive repertoire is embedding diversity, equity, and inclusion materials into behavior analysis graduate course sequences. However, little guidance exists for selecting content related to diversity, equity, and inclusion within behavior analysis to include in behavior analytic coursework. This article provides suggested readings for diversity, equity, and inclusion within behavior analysis that can be embedded into typical course structures in behavior analysis graduate programs. Each course requirement in the Association for Behavior Analysis International's Verified Course Sequence is given specific recommendations.

Palliative care nurses' experiences of stress, anxiety, and burnout: A thematic synthesis

OBJECTIVES

This systematic literature review aimed to critically appraise empirical evidence investigating palliative care (PC) nurses' experiences of stress, anxiety, and burnout.

METHODS

Six databases (PsycINFO, MEDLINE, Scopus, CINAHL, PubMed, and Web of Science) covering literature within psychology, medicine and healthcare, and social sciences were searched from inception until December 2020. Studies were eligible if they included qualitative literature reporting on experiences of nurses working in a PC setting of stress, anxiety, or burnout, and were published in English. Eighteen studies satisfied the review's inclusion criteria and were considered relevant to the review aims. Critical appraisal was undertaken using the Critical Appraisal Skills Programme Qualitative Checklist.

RESULTS

Thematic synthesis identified three main themes: When work becomes personal, The burden on mind and body, and Finding meaning and connection. The findings suggested that stress, anxiety, and burnout are deeply personal feelings experienced by nurses both on an emotional and physical level. Additionally, PC nurses' experiences can differ in meaning and strength depending on their relationships with patients, patients' families, and colleagues.

SIGNIFICANCE OF THE RESULTS

The synthesis highlighted that PC nurses' experiences are complex, encompassing clinical and organizational challenges, and the personal impact their work has on them. Having a greater understanding of the factors that contribute to PC nurses' experiences may help in PC nurses' core training and continuing professional education, as well as the provision of effective supervision and staff support.

A Descriptive Review of Telehealth for Individuals With Autism Spectrum Disorder

Since the early 2000s, telehealth has been used to provide behavior analytic intervention to individuals with autism spectrum disorder (ASD). Evaluating evidence supporting telehealth remains valuable, especially as there has been increased accessibility since the COVID-19 pandemic. Although there is empirical support for telehealth as an effective service-delivery option, important variables (e.g., costs, implementer training) remain unknown. Despite potential roles in telehealth service-delivery models, a careful review of participant prerequisite skills, implementer characteristics (e.g., experience, education), technology variables (e.g., HIPAA compliance), and skill(s) targeted (i.e., mastered or untrained skills) have not been considered. Therefore, we aimed to extend prior telehealth literature reviews by evaluating current research across variables important for telehealth service-delivery involving individuals with ASD. We found thorough descriptions of participants and implementers, implementer training, and social validity evaluations. Limitations of telehealth literature include exclusion of teen and adult participants, limited description of prerequisite skills and evaluations of direct telehealth interventions. Future research areas were identified.

A Preliminary Evaluation of the Effects of a Contingency Management + Deposit Contract Intervention on Problematic Smartphone Use With College Students

Problematic smartphone use (PSU) is smartphone usage that is, in some way, damaging to the user. PSU represents a growing public health concern that could be addressed via behavioral intervention. We recruited six college students who reported negative side effects of smartphone use and sought to decrease their PSU. The effects of a contingency management (CM) + deposit contract intervention on PSU was evaluated. During the CM + deposit contract condition, participants deposited $40 and had the opportunity to earn back their entire deposit by meeting daily smartphone usage goals. To promote adherence to study protocols, participants also had the opportunity to earn a $20 cooperation bonus. For all participants, lower levels of PSU were observed during intervention relative to baseline. The CM + deposit contract intervention produced consistent decreases in PSU for four participants (mean reduction percentages above 40% were obtained) and had inconsistent effects on PSU for two participants (mean reduction percentages below 20%). Maintenance of intervention effects was limited for all participants. Although preliminary, results suggest that CM + deposit contract interventions could be a viable, low-cost approach to addressing PSU. Potential explanations for our findings and avenues for future research are discussed.

Toward an Understanding of Data Collection Integrity

Data collection is an integral part of the practice of behavior analysis because behavior analysts rely on data to inform their clinical decisions. Data collection integrity (DCI) is the degree to which data are collected as planned, and issues with DCI can lead to misinformed clinical decisions. The current study aims to add to the limited research on DCI by evaluating risk factors and interventions that target DCI. An online survey, conducted through Qualtrics^TM, was completed by a combined total of 232 Board-Certified Behavior Analysts (BCBAs) and Board-Certified Behavior Analysts-Doctoral (BCBA-Ds). Participants answered questions about their demographics, their data collectors, their concerns about data collection, the systems they use to collect data, the training they provide data collectors, and the strategies they use to address data-collection issues. Results indicated that many risk factors related to DCI issues might be prevalent in behavior analytic practice. Recommendations on how to address DCI issues are provided.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40617-022-00684-x.

Cultural responsiveness in applied behavior analysis: Research and practice

The new Ethics Code for Behavior Analysts requires that certificants engage in training related to culturally responsive service delivery (BACB, 2020). There is limited work in the area of culturally responsive evidence-based practice within our field. Therefore, it is incumbent on researchers and practitioners to identify best practices for working with diverse populations. Hence, the purpose of this paper is three-fold: a) to review research within and outside the field of ABA related to culturally responsive assessment and treatment and provide practice recommendations, b) to examine the extent to which current practices in behavior assessment and treatment align with aspects of culturally responsive practices, and c) to inspire research in the areas of behavior assessment and treatment to identify best practices with regard to culturally responsive behavior analytic practices. The content of this paper is grounded in the framework described by Beaulieu and Jimenez-Gomez (2022).

Culturally Sensitive Behavior Intervention Materials: a Tutorial for Practicing Behavior Analysts

Behavior analytic interventions for people with disabilities often rely on implementation by novice caregivers and staff. However, behavior intervention documents are ineffective at evoking the level of performance needed for behavior change, and intensive training is often needed (Dogan et al., 2017; Ward-Horner & Sturmey, 2012). The cost and time requirements of intensive training may not be viable options for some clients, leading to nonadherence or attrition (Raulston et al., 2019). In addition, others may feel that prescribed interventions are not appropriate or will not work (Moore & Symons, 2011). These barriers may reflect a cultural mismatch (Rathod et al., 2018). One potential way to increase efficacy of intervention materials is to improve the cultural sensitivity and comprehensibility of these documents. Although the body of research on cultural adaptation of behavioral interventions is becoming more robust, adaptation of behavior intervention documents as a means to create effective behavior change when cultural and linguistic diversity are factors, is an area of behavior analytic practice that is not well researched and there remains a need for cultural humility. Because diversity can include expansive differences between individuals, such as race/ethnicity, socioeconomic status, religion, gender and sexuality; understanding and adapting to each of these areas may be best done through separate reviews. It is the intent of this article to focus on ethnic diversity in the United States as a starting point and frame of reference for cultural adaptation. This tutorial includes tips learned from health communication research to give step-by-step guidance on creating comprehensible, culturally adapted intervention plans through the example of training for parents of autistic children.

A Scoping Review of the Healthcare and Hygiene Literature for Individuals with Intellectual and Developmental Disabilities

OBJECTIVES

Previous reviews highlight the similarities in teaching healthcare and hygiene routines to individuals with and without intellectual and developmental disabilities. Additionally, similar interventions are used when interfering behaviors occur. Although these routines are topographically distinct, there are enough similarities to suggest effective procedures for one routine may be used to inform another. This scooping review aims to identify effective teaching and intervention procedures for healthcare and hygiene routines specifically for individuals with intellectual and developmental disabilities. We also evaluated the extent to which functional analyses were conducted; a dimension not included in previous reviews.

METHODS

Eligible articles targeted compliance or tolerance within the context of a defined healthcare or hygiene routine as a dependent variable and used an experimental design with a demonstration of experimental control. Articles were identified through PsycINFO, PubMed, and Academic Search Premier databases. Additionally, a hand search of five related journals was conducted. Data were collected on dependent variables, functional analyses, baseline contingencies, teaching procedures, and additional experimental components.

RESULTS

A total of 52 articles met inclusion criteria. Most experiments produced positive outcomes. The findings show all experiments involved a treatment package with multiple components. The most common teaching procedures were graduated exposure and DRA. A lack of functional analyses and social validity was noted.

CONCLUSIONS

Component analyses are needed to identify the most effective and efficient procedures. Pyramidal training to teach medical professionals how to provide preventative pyramidal training should be explored.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s41252-022-00249-7.

Behavioral Assessment and Treatment via Telehealth for Children with Autism: From Local to Global Clinical Applications

Functional analyses (FA) and functional communication training (FCT) are the most commonly used behavioral assessment and treatment approaches via telehealth for children with autism spectrum disorder (ASD) who display challenging behavior. The FA + FCT telehealth model has been shown to maintain treatment effectiveness (i.e., child behavioral outcomes and parent acceptability), as well as demonstrate treatment efficiency (i.e., cost savings). However, the majority of these studies have been conducted in the United States. Therefore, the purpose of this study was to evaluate the outcomes obtained with the telehealth FA + FCT model that included global applications. Descriptive statistics were used to analyze the results of the 199 participants who enrolled in the telehealth project across all project sites. The results showed that behavioral outcomes and parent acceptability maintained at similar levels to previous studies across all sites. Additionally, very few differences were found across project sites in relation to drop-out rates, visit cancellations, and technology issues. These results demonstrate the effectiveness of the FA + FCT telehealth model for addressing the challenging behavior needs of children with ASD globally and highlight areas in need of additional evaluation (e.g., drop-outs, cancellations) to determine the conditions under which telehealth could be best used.

Initiatives to Address Diversity, Equity, and Inclusion Within a Higher Education ABA Department

Recent events have highlighted the need for behavior analysis to address issues of diversity, equity, and inclusion (DEI) in service provision and in higher education. There has been a call to action issued, noting the need for cultural humility and cultural responsiveness. An opportunity exists within training programs to ensure that students of behavior analysis are instructed in ways that promote cultural responsiveness and that equip them to serve diverse populations. Additionally, more needs to be done to engineer environments where students of behavior analysis are treated with respect and compassion, and to ensure that educational environments promote the comfort and success of all students. This article outlines the initiatives of an applied behavior analysis department to gather information about DEI on the local level, identify goals, implement change, and evaluate progress toward these goals.

"Why don't behavior analysts do something?"1 Behavior analysts' historical, present, and potential future actions on sexual and gender minority issues

For thousands of years, societies actively practiced the oppression, persecution, and dehumanization of sexual and gender minority (SGM) people (e.g., lesbian, gay, bisexual, transgender, and queer individuals). Rekers and Lovaas' (1974) study is part of that history within behavior analysis. Following requests for retraction, the Society for the Experimental Analysis of Behavior and LeBlanc (2020) issued a formal Expression of Concern about the work. Continued conversation and debate have followed. First, we contextualize debate around retraction of Rekers and Lovaas and the history of behavior analysts' work on SGM issues. Second, we propose 5 steps that leaders in behavior analysis can take with relative immediacy, and we describe 5 research areas that individual behavior analysts could pursue. We conclude that behavior analysts can contribute much toward the liberation of SGM individuals if we begin to bring our science to bear on pressing, socially significant issues facing SGM communities.

On the Importance of Listening and Intercultural Communication for Actions against Racism

In a period where racial inequities in the United States have garnered more attention and discussion as a result of social media (e.g., increased use of the #BlackLivesMatter hashtag; Anderson et al., 2020) and newer generations (Tatum, 2017b), it is important to ensure that communication between cultural groups is effective and produces systemic change. This article will review the failures of a "postracial" society, with emphasis on ineffective communication among Black, Indigenous People of Color and non-Black, Indigenous People of Color. The role of the listener during intercultural verbal exchanges will be examined, while highlighting the barriers and harmful results of ineffective communication. A behavioral conceptualization of effective listener behavior will be presented, which if implemented, may maintain and sustain social equity, inclusion, and justice. A call to action will be made to further investigate intercultural communication using behavior-analytic research methodologies and how such research might inform on how to functionally and precisely mediate reinforcement in the fight against racism.

Increasing Access and Quality of Behavior-Analytic Services for the Latinx Population

Latinxs are the largest minority group in the United States, making up approximately 18% of the total population. Although there is a critical need for the behavioral health care system, including behavior analysts, to provide services to support the needs of the Latinx community, access to quality behavioral and mental health services continues to be lacking for the Black, Indigenous, and people of color populations. This article highlights some of the cultural and language factors that should be considered by behavior-analytic providers who have a shared responsibility to make culturally and linguistically appropriate services available to this population. Additionally, recommendations for systemic action across service providers, professional organizations, behavior-analytic training programs, and researchers are suggested to address these barriers. Recommendations for bringing about this systemic change are suggested across three domains: (a) increasing diversity in the behavior-analytic workforce, (b) enhancing training in cultural- and language-related issues, and (c) conducting research on cultural and language adaptations to behavior-analytic evidence-based treatments.

A Look in the Mirror: How the Field of Behavior Analysis Can become Anti-Racist

Sparked by recent events, discussions of systemic racism and racial inequalities have been pushed to the foreground of our global society, leading to what is being called the largest modern-day civil rights movement (Buchanan et al., 2020). In the past, Black, Indigenous, and People of Color (BIPOC) activists and scholars, among others, have evaluated and critiqued systems and organizations within our society. Nonetheless, it was not until recently that this movement was truly noticed by a greater number of people, some of whom are now further assessing how BIPOC are viewed and treated within their organization and by society as a whole (Worland, 2020). This is not only due to the increase in video evidence (e.g., released body cam footage, social media postings), but also the previous administration's rhetoric and political agenda (Hubler & Bosman, 2021). Police departments, educational institutions, and large companies have, for decades, been under scrutiny for their systems and practices that promote racism, inequality, and inequity. The field of behavior analysis, with its Eurocentric roots and observed lack of diversity, equity, and inclusion, is not exempt from such evaluations. It is time that we take a look in the mirror and evaluate our own professional, research, educational, and clinical practices, and work towards creating a new, more inclusive, field of behavior analysis that promotes anti-racism and cultural humility.

Treatment Acceptability for Interventions Addressing Challenging Behavior Among Chinese Caregivers of Children with Autism Spectrum Disorder

The present study evaluated treatment acceptability for behavioral interventions addressing challenging behaviors with Chinese caregivers of children with autism spectrum disorder. Factors influencing treatment acceptability (i.e., severity of challenging behavior and Chinese child-rearing values) were investigated. Caregivers of children aged 2-12 years (N = 216) participated in this survey study. Results suggest that caregivers found positive strategies including noncontingent reinforcement and positive reinforcement the most acceptable; punishment-based strategies were rated as the least acceptable. Furthermore, positive punishment was perceived as more acceptable for severe challenging behavior. Caregivers who endorsed training were more likely to find positive strategies acceptable, whereas those who endorsed shaming were more likely to rate punishment-based strategies as more acceptable. Implications for future research and culturally competent behavioral treatments in Chinese context are provided.

Participant assent in behavior analytic research: Considerations for participants with autism and developmental disabilities

Obtaining assent from potential research participants is an important component of research for reasons related to ethics compliance, self-determination, and choice. However, unique issues arise when working with populations who cannot assent through traditional means, such as individuals with Autism Spectrum Disorder (ASD) and related developmental disabilities (DD). The purpose of this paper is to review and discuss assent practices within behavior-analytic research to identify strategies that can be used to obtain assent from potential participants with ASD and DDs. We began with a descriptive literature review of behavior-analytic articles that included the term "assent" to identify what practices behavior analysts have used to obtain assent from participants. In short, very few articles that clearly addressed assent procedures were identified. Thus, we propose a model for gaining assent when working with individuals with ASD and DDs.