Functional analysis of problem behavior: a review

How Does Sleep Deprivation Functionally Impact the Challenging Behavior of People With Intellectual Disabilities? A Systematic Review

Sleep deprivation is a common health condition among people with intellectual disabilities. Studies have linked sleep problems with challenging behaviors. However, it is unclear if there is a consistent effect on challenging behavior and what reinforcement mechanism(s) might be involved. A systematic review of PsychINFO, PubMed, and Scopus identified seven studies meeting the inclusion criteria that had been published over the past 50 years. Data were extracted regarding participant characteristics, specific aim, sleep deprivation, functional behavioral assessments, results, and key findings. Studies consistently reported increased rates of challenging behavior following bouts of sleep deprivation. Five of the seven studies demonstrated negative reinforcement as the mechanism associated with increased challenging behavior. Results were unclear or lacking for other reinforcer mechanisms. Current evidence shows that sleep deprivation can increase negatively reinforced challenging behavior, but automatic and positive reinforcement mechanisms may be unaffected. Theoretical and practice implications are discussed.

Recognizing employees' contribution to effectiveness and values: A randomized waitlist-controlled trial of operant-based leadership training

To develop and sustain a healthy and efficient work environment, managers need to provide their employees with relevant and useful performance feedback. However, research on leadership training in functional behaviors, such as performance feedback, has yet to demonstrate consistent long-term effectiveness. Therefore, the purpose of this study was to evaluate the long-term influence of operant-based leadership training on managers' performance feedback behaviors. Municipality employees (n = 439) responded to a questionnaire four times over a period of 18 months. The employees' managers were randomized into an experimental and a control group. The managers in the experimental group received managerial behavioral training, while the waitlist control group managers did not. Multilevel growth curve modeling was used for data analysis. The results showed that employees in the experimental group reported a significantly greater improvement in their managers' performance feedback behaviors compared to employees in the control group (β = 0.30, p = 0.04). Furthermore, the improvement in the experimental group managers' leadership behaviors had a linear trajectory throughout the 18-month study period, with no significant deceleration in their learning curve (Δχ2(2) = 2.2, p = 0.34). In conclusion, operant-based leadership training can help managers develop their performance feedback behaviors and the effect of such training is persistent over time. The findings imply that leadership training research and practice should strive to integrate operant learning theory and practice in order to improve the long-term effectiveness of leadership training interventions. Positive utility reactions, achieved by shaping leadership behaviors to optimize their fit with the managers' work context, may be critical for ensuring the enduring effects of leadership training.

Cortisol as a Biomarker for Stress During the Assessment and Treatment of Destructive Behavior

Behavior-analytic treatments successfully reduce individuals' destructive behavior (e.g., self-injurious behavior, aggression, property destruction, disruption); however, there is limited research evaluating these treatments' effects on individuals' physiological stress responses, even though stress can have significant negative impacts on quality of life. Research from other fields has demonstrated that salivary cortisol concentration is a valid biomarker for stress, so researchers could potentially use this biomarker to assess the stress of individuals with limited communication repertoires who also engage in destructive behavior. The purpose of this research was to assess changes in salivary cortisol concentrations as a biomarker for stress with two participants to evaluate whether conditions that evoke destructive behavior induce stress relative to conditions that do not evoke destructive behavior. For one participant, salivary cortisol concentrations tended to increase following exposures to stimuli that evoked destructive behavior compared to conditions that did not evoke destructive behavior. The other participant had elevated salivary cortisol concentrations across all conditions. Salivary cortisol may be a useful biomarker for evaluating physiological stress as an outcome measure during research on the assessment and treatment of destructive behavior.

A method for conducting culturally responsive functional analyses with bilingual children and evaluating language effects

Functional analysis has been shown to effectively identify the function of challenging behavior and inform the design of function-based treatment that emphasizes reinforcement-based procedures. However, there is minimal research on culturally responsive approaches to functional analysis with bilingual clients with a developmental disability who speak English and Spanish. This study evaluated a method of individualizing assessment conditions using culturally relevant variables, analyzing the data to evaluate the influence of language on functional analysis outcomes and considering the influence of language proficiency and preference on functional analysis results. The data for the influence of language on functional analysis were analyzed separately, which highlighted areas for further exploration and consideration with caregivers that likely would have been missed if the functional analysis had been conducted solely in one language. The influence of language during behavioral assessment and considerations of these variables in clinical practice for bilingual communities are discussed.

Adapting a Functional Assessment of Cigarette Smoking for People with Intellectual and Developmental Disabilities

There is a concerning lack of published smoking cessation research on people with intellectual and developmental disabilities (IDD). A Functional Assessment for Smoking Treatment Recommendations (FASTR) was recently developed to help personalize patients' tobacco treatment. Adapting this tool to effectively identify putative environmental variables that maintain smoking for people with IDD is predicted to improve current treatments. The purpose of this study was to pilot the FASTR with people with IDD to understand modifications necessary to implement it in this population. During 1-hour interviews participants (n = 8) described the extent they agreed with each FASTR statement using a Likert scale, corresponding to one of five potential functions of smoking (i.e., Automatic Positive, Automatic Negative, Social Positive, Social Negative, and Antecedent). Participants gave input on potential modifications to make the assessment more inclusive for people with IDD. A quantitative approach was used to pilot the FASTR and participant narratives were used to understand difficulties and potential modifications. For each participant a function was endorsed if the average response to questions corresponding to that function was greater than 3 (neutral) or over 50% "yes" responses. The two most frequently endorsed functions were Automatic Negative (87.5% participants) and Social Negative (75% of participants). Participants recommended making the focus of each statement larger and in bold so respondents can understand the most important part of the statement. The FASTR was modified based on their feedback and will be distributed to a larger sample of people with IDD for further validation.

Functional Analysis and Treatment of Hoarding in a Child with Autism Spectrum Disorder

Excessive collecting is frequently reported in children with autism spectrum disorder, but few studies have used behavior analytic interventions based on functional analysis to treat it. In the current study, functional analysis results informed the creation of a multicomponent treatment package involving parent training for a 12-year-old girl with autism spectrum disorder who engaged in interfering hoarding that was significantly limiting quality of life for both her and her family. Based on the results of the functional analysis, which suggested automatic and potential attention functions, we evaluated differential reinforcement, rules, and acceptability criteria across the two hoarding topographies. Using a multiple baseline across behaviors design, results showed that the multicomponent treatment package successfully reduced hoarding. Social validity measures indicated a reduction in symptom severity, improvements in family quality of life, and high consumer satisfaction. In addition, outcomes were maintained over 2 months. This study shows the utility of functional analysis-based treatments for hoarding in children with autism spectrum disorder.

Toward improved understanding and treatment of self-injurious behaviors in autistic individuals with profound intellectual disability

Self-injurious behaviors (SIB) commonly occur in autism spectrum disorder (ASD) and span diverse topographies of self-inflicted behaviors ranging from head banging to hitting oneself against hard objects. Despite the high rates of SIB in autistic individuals, relatively little research has focused on psychological factors associated with the development and maintenance of SIB in individuals with autism and moderate-profound intellectual disability (ID). This commentary synthesizes existing literature on SIB and highlights the need for more research focused on psychological correlates and mechanisms in autistic individuals with moderate-profound ID. We highlight the key role of difficulties in emotion regulation (ER) and co-occurring internalizing symptoms in the manifestation of self-harm behaviors in clinical samples and autism. Furthermore, this commentary proposes a framework for understanding the interplay between poor ER and internalizing symptoms in the development and maintenance of SIB in autistic individuals with moderate-profound ID. Specifically, we explore the emergence of SIB in the context of precipitating cues that trigger strong emotions, ER processes and strategy deployment, and co-occurring internalizing symptoms. Future directions and implications for longitudinal research, measurement development, and clinical treatments are discussed.

Exploring the Heterogeneity of Self-Injurious Behaviors in Autistic Youth: Patterns, Predictors, and Implications for Intervention

Self-injurious behaviors (SIB) encompass a heterogeneous set of self-inflicted aggressive behaviors that are highly prevalent in autistic youth. Existing research on SIB in autism spectrum disorder (ASD) has been limited by significant methodological and conceptual inconsistencies. Thus, the current study leveraged item-level data capturing the severity of unique SIB topographies to further understanding of factors associated with distinct SIB in a sample of 582 autistic youth (Mage = 12.12, SDage = 3.68; range: 3-19 years; 13% females). Results suggest variation in severity endorsements for specific SIB topographies amongst autistic youth, such that 30%-50% of caregivers endorsed slight to very serious concern regarding the SIB topographies of bites nails/skin/fingers, scratches self, hits head/face/neck, bangs head against things, and picks skin. Generalized additive models demonstrated distinct patterns of associations between each SIB topography and dysregulation, sensory hypersensitivity, age, sex, IQ, and language level. Findings underscore the importance of exploring SIB as a multifaceted construct to capture unique correlates of distinct SIB that vary in severity and functional impact, which is critical for the development of effective interventions. This study represents an important step towards more individualized characterization of SIB and support for diverse presentations of these behaviors in autistic youth.

Progressive Functional Analysis and Function-Based Intervention Via Telehealth: A Replication and Extension

The purpose of this study was to evaluate a progressive functional analysis (FA) model and function-based intervention delivered by caregivers with coaching via telehealth. Children diagnosed with autism and at least one caregiver (e.g., parent) participated in the study. We conducted three assessments prior to and following intervention: a researcher-developed 10-min observation, the Parental Stress Index, and the externalizing section of the Vineland Adaptive Behavior Rating Scales, Third Edition (VABS-3). We included 47 participants in the present evaluation of the progressive FA model. We identified the function of challenging behavior for 36 participants. A function was not identified for nine participants who exhibited low or no challenging behavior during the assessment; the results were inconclusive for two participants. For the 17 participants who participated in the intervention evaluation phase, each of the participants achieved the mastery criterion, which was an 80% reduction in challenging behavior for most participants. Additionally, there was a statistically significant decrease in the VABS-3 externalizing behavior measure from pre- to post-assessment, although neither of the other pre-post measures resulted in statistically significant changes. This study replicates and extends previous research, supporting the use of progressive FA model and function-based interventions to improve challenging behavior.

An Interdisciplinary Multimodal Integrative Healthcare Program for Chronic Spinal Pain and Comorbid Mental Disorders

OBJECTIVE

Previous studies evaluating interdisciplinary multimodal interventions for chronic spinal pain often excluded patients with comorbid mental disorders. This study aims to assess the effectiveness of an outpatient secondary care interdisciplinary multimodal integrative healthcare program for individuals experiencing co-occurring chronic spinal pain and mental disorders.

METHODS

Participants were 944 patients with chronic spinal pain and comorbid mental disorders. Primary outcomes were health-related quality of life, assessed using the Research and Development-36 (RAND-36), and pain-related disability, assessed using the Quebec Back Pain Disability Scale (QBPDS). Secondary outcomes included pain intensity, pain catastrophizing, kinesiophobia, fatigue, lumbar mobility, and isometric strength. Data were collected during the healthcare program at four time points: pretreatment (T0), midway through 20-week treatment (T1), end of 20-week treatment (T2), and at completion of 12-month relapse prevention program (T3). Multilevel regression analyses were conducted to examine the effects of the healthcare program on primary outcomes over time.

RESULTS

The 20-week treatment period yielded significant improvements in both mental ( B = 0.44, t (943) = 19.42, p < .001) and physical component summary scores ( B = 0.45, t (943) = 18.24, p < .001) of the RAND-36, as well as in QBPDS total score ( B = -0.77, t (943) = -26.16 p < .001). Pretreatment scores indicated the presence of problematic fatigue, kinesiophobia, and clinical levels of pain catastrophizing, all of which resolved by the end of the 12-month relapse prevention program.

CONCLUSIONS

An interdisciplinary multimodal integrative healthcare program seems effective for patients with chronic spinal pain and comorbid mental disorders.

Problems with "problem behavior": A secondary systematic review of intervention research on transition-age autistic youth

LAY ABSTRACT

In a previous study, we looked at research done on strategies to support autistic people who were between 14 and 22 years old. For this study, we looked at all of the studies in our previous study that tried to decrease or stop autistic people from doing certain things-many researchers call these things "problem behavior." There were 48 studies that tried to reduce problem behavior, and most of them used strategies like prompting and reinforcement to try get autistic people to change their behavior. We found many things wrong with these studies. Most of them did not define the group of behaviors they were trying to stop autistic people from doing. None of the studies looked at whether any side effects happened when they tried the strategy they were studying. Also, most of the studies tried to stop autistic people from doing behaviors that probably were not harmful, like stereotypic behavior. Most of the studies did not say how they decided that the behaviors they tried to stop were a problem for the autistic people in the study, and most studies did not try to figure out why the autistic people in the study did the behaviors the researchers were trying to stop them from doing.

Prevention and Intervention Strategies for the Sexual Abuse and Commercial Sexual Exploitation of Children Who Run Away from Foster Care: A Scoping Review

Literature on human trafficking suggests the vulnerability to commercial sexual exploitation of children (CSEC) and child sexual abuse (CSA) changes by the prevalence of certain risk factors (e.g., runaway), trafficker-used lures (e.g., isolation), and the environmental conditions present at the time of victimization (e.g., foster care). Often, youth in foster care are at high risk for CSEC and CSA victimization associated with runaway instances. This scoping review aims to identify prevention and intervention strategies for CSEC/CSA of youth who run away from foster care. PRISMA scoping review guidelines were followed to review the literature across two search parameters (CSEC; CSA). An electronic review was conducted between August 2022 and January 2023 across four databases: PubMed, SAGE Journals Online, ScienceDirect, and Web of Science. The CSEC and CSA search parameters comprised three domains (sexual exploitation, foster care, and runaway; sexual abuse, foster care, and runaway, respectively). Literature published between 2012 and 2022 was included regardless of the methodological approach. Literature not concerning youth who run from foster care was excluded. Database searches yielded 206 publications for CSEC and 351 for CSA, reduced to 185 and 212, respectively, after removing duplicates. Seventy-one articles were identified, of which, 64 articles (28 CSEC, 36 CSA) were categorized as prevention strategies and seven (five CSEC, two CSA) as interventions. The intersection and dual victimization of CSEC and CSA of youth who run away from foster care are discussed. This paper also discusses applied behavior analysis principles for developing function-based interventions.

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.

Generalized Linear Mixed Effects Modeling (GLMM) of Functional Analysis Graphical Construction Elements on Visual Analysis

Multielement designs are the quintessential design tactic to evaluate outcomes of a functional analysis in applied behavior analysis. Protecting the credibility of the data collection, graphing, and visual analysis processes from a functional analysis increases the likelihood that optimal intervention decisions are made for individuals. Time-series graphs and visual analysis are the most prevalent method used to interpret functional analysis data. The current project included two principal aims. First, we tested whether the graphical construction manipulation of the x-to-y axes ratio (i.e., data points per x- axis to y-axis ratio [DPPXYR]) influenced visual analyst's detection of a function on 32 multielement design graphs displaying functional analyses. Second, we investigated the alignment between board certified behavior analysts (BCBAs; N = 59) visual analysis with the modified visual inspection criteria (Roane et al., Journal of Applied Behavior Analysis, 46, 130-146, 2013). We found that the crossed GLMM that included random slopes, random intercepts, and did not include an interaction effect (AIC = 1406.1, BIC = 1478.2) performed optimally. Second, alignment between BCBAs decisions and the MVI appeared to be low across data sets. We also leveraged current best practices in Open Science for raw data and analysis transparency.

A Non-parametric Analysis of Gender Differences With the Impacts of Applied Behavior Analysis on Autistic Individuals

Introduction Considering the scarcity of research that directly investigates the differences between genders in their response to applied behavior analysis (ABA) therapy for individuals diagnosed with autism spectrum disorder (ASD), the objective of this study is twofold. First, it aims to reinforce the male-to-female ratio reported in existing scientific literature, thereby contributing to a broader understanding of gender distribution in ABA therapy for ASD. Second, it seeks to identify gender-based differences in aggregate target behaviors at various time intervals using three distinct datasets. The goal is to determine if gender influences the effectiveness of ABA therapy for ASD, which could inform future therapeutic strategies. Ultimately, this study strives to enhance our understanding of gender disparities in ABA therapy response among ASD individuals and hopes to improve therapeutic outcomes for all, regardless of gender. Materials and methods Three to five behavioral technicians per child collected daily general target mastery data for 263 individuals with autism. This data was gathered using a large N design through retrospective chart reviews within the "Catalyst" tracking software (DataFinch Technologies, Atlanta, USA). Three separate datasets were collected from June 7, 2023 to January 7, 2024. Behavior analysts employed a mixed model of discrete trial training, mass trials, and naturalistic environment treatment over seven months. General target mastery data was assembled for 259 children and four adults, with seven data instances missing. Descriptive statistics encompassed central tendency and dispersion measures, including the data distribution's mean, standard deviation, median, and range. Non-parametric inferential analysis was performed with the Mann-Whitney U test. Results Mann-Whitney U computations resulted in non-significant gender differences on all gender comparisons for the three datasets covering the seven-month timeframe. Dataset #1: Time 1-(U=727.5, p=0.846, ή2=0.0002, Time 2-(U=736, p=0.910, ή2=0.00005), Time 3-(U=687.5, p=0.569, ή2=0.001) Dataset #2: Time 1-(U=781, p=0.383, ή2=0.003), Time 2-(U=819.5, p=0.585, ή2=0.001), Time 3-(U=825, p=0.618, ή2=0.001) Dataset #3: Time 1-(U=395, p=0.198, ή2=0.007), Time 2-(U=373.5, p=0.365, ή2 =0.003), Time 3-(U=363, p=0.471, ή2=0.002), Time 4-(U=366.5, p=0.436, ή2 =0.003), Time 5-(U=371, p=0.391, ή2=0.003), Time 6-(U=394, p=0.208, ή2=0.007), Time 7-(U=373, p=0.373, ή2=0.003), Time 8-(U=371.5, p=0.387, ή2=0.003), Time 9-(U=464.5, p=0.512, ή2=0.002), Time 10-(U=356.5, p=0.546, ή2=0.002), Time 11-(U=357.5, p=0.535, ή2=0.002), Time 12-(U=350.5, p=0.346, ή2=0.004) Conclusions This study suggests no significant gender differences in response to ABA therapy among individuals with autism, indicating its potential effectiveness for both genders. However, these findings should be interpreted cautiously due to statistical uncertainties reflected in the broad confidence intervals as they hint at possible substantial gender differences. Further research, including an extension study, must confirm these results and understand potential gender nuances in ABA therapy response. This could help tailor more effective, personalized therapeutic strategies for individuals with autism.

Functional Analysis of Contextually Inappropriate Social Behavior in Children With Down Syndrome

BACKGROUND

Children with Down syndrome often engage in contextually inappropriate social behavior, which researchers suggest may function to escape from difficult activities to preferred social interactions. Caregivers may reinforce the behavior, perceiving it only as evidence of the child's social strength, when, in fact, the pattern may also prevent or slow the development of critical skills. Unlike overt forms of challenging behavior, contextually inappropriate social behavior had never been subjected to experimental analysis.

AIMS

The purpose of the current study was to identify and demonstrate functional control of contextually inappropriate social behavior to caregiver-informed contingencies.

METHOD AND PROCEDURES

We interviewed caregivers and subjected contextually inappropriate social behavior to functional analyses for nine young children with Down syndrome.

OUTCOMES AND RESULTS

We found sensitivity to the caregiver-informed contingencies for all nine participants with strong functional control and large effect sizes for most.

CONCLUSIONS AND IMPLICATIONS

Caregivers may not perceive contextually inappropriate social behavior as problematic, yet patterns of contextually inappropriate and other problem behaviors suggest decreased engagement and poor task persistence. Assessments that lead to intervention decisions may be more informative when they include questions about social topographies of behavior not typically considered as problematic. Once caregivers are aware of the pattern, they may be better prepared to intervene.

Comparative Effects of Applied Behavior Analysis on Male and Female Individuals With Autism Spectrum Disorder

Introduction Current evidence-based treatments for autism spectrum disorder (ASD) are based on applied behavior analysis (ABA). However, research on gender differences in ABA therapy response is limited. This study seeks to (1) confirm the 4:1 male-to-female ratio reported in the literature and (2) identify any possible gender differences in target behaviors over seven timepoints measured every two weeks. Materials and methods  For three months, from March 19, 2023, to June 11, 2023, a team of 3-5 behavioral technicians per individual collected daily data on general target mastery for 100 individuals with ASD treated with ABA. Data was collected at seven timepoints every two weeks. Descriptive demographics were computed. Two independent sample t-tests were performed to determine significant or nonsignificant gender differences with the seven timepoint variables.  Results Nonstatistically significant gender differences (p > .05) were found on all seven cumulative target behavior timepoints measured at two-week intervals. For targets mastered Time 1, baseline between males and females, there was no significant difference in the means for males (M = 1.0571, SD = 1.9196) and females (M = 2.0455, SD = 3.9457) (t(90) = -1.591, p = 0.115, confidence interval (CI) = -2.2223, 0.2456, d = -0.389). For targets mastered Time 2, two weeks between males and females, there was no significant difference in the means for males (M = 3.7132; SD = 4.5065) and females (M = 4.0682, SD = 5.1508) (t(88) = -0.310, p = 0.757, CI = -2.6305, 1.92056, d = -0.076). For targets mastered Time 3, four weeks between males and females, there was no significant difference in the means for males (M = 7.0956; SD = 8.7781) and females (M = 8.6136; SD = 11.2799) (t(88) = -0.656, p = 0.514, CI = -6.1173, 3.0811, d = -0.161). For targets mastered Time 4, six weeks between males and females, there was no significant difference in the means for males (M = 13.1728, SD = 16.2003) and females (M = 13.0682, SD = 16.9272) (t(88) = 0.026, p = 0.979, CI = -7.8779, 8.0871, d = 0.006). For targets mastered Time 5, eight weeks between males and females, there was no significant difference in the means for males (M = 17.2096; SD = 18.8546) and females (M = 17.4286, SD = 22.1683) (t(87) = -0.045, p = 0.965, CI = -9.9773, 9.5393, d = -0.011). For targets mastered Time 6, 10 weeks between males and females, there was no significant difference in the means for males (M = 21.0074, SD = 21.3329) and females (M = 20.6818, SD = 26.1231) (t(88) = 0.059, p = 0.953, CI = -10.6752, 11.3262, d = 0.014). For targets mastered Time 7, 12 weeks between males and females, there was no significant difference in the means for males (M = 26.1196, SD = 24.2235) and females (M = 29.6364, SD = 33.7406) (t(89) = -0.536, p = 0.593, CI = -16.5431, 9.5094, d = -0.131). Conclusions The study indicates that ABA treatments may be equally beneficial for both genders with ASD, showing no significant gender differences. However, the broad CIs in this study imply a level of statistical uncertainty, indicating potential gender differences, suggesting the results may not be uniform across genders. These findings challenge assumptions on gender-specific treatment responses, implying that ABA treatments shouldn't be recommended based on gender. Instead, individual needs should guide treatment recommendations. Future research could consider other response moderators like age, ASD severity, or coexisting mental health conditions.

Toward Maximizing Assessment Efficiency: A Synthesized Trial-Based Functional Analysis and Competing Stimulus Assessment

Despite the success of the standard functional analysis (FA), some limitations to conducting an FA in practice include time, resources, ecological relevance, and safety, which have led to the development of procedural adaptations such as trial-based and synthesized FA formats. The purpose of this case study was to identify the function(s) of self-injurious behavior (SIB) for a 3-year-old female with developmental disabilities using a brief trial-based FA with ecologically relevant synthesized contingencies, based on caregiver input, to minimize opportunities for SIB. We identified that positive physical attention likely functioned, at least in part, as a reinforcer for SIB, in less than 42 min. Overall harm to the child as a result of the synthesized trial-based FA was minimal, and the caregiver viewed the modified conditions favorably. We then assessed the role of competing stimuli on SIB rates with the child's mother and identified two potential items that may compete with attention as a reinforcer for SIB. Our findings highlight the utility and importance of individualized assessment as the first step in the safe treatment of severely challenging behavior.

Stimulus Avoidance Assessment: A Systematic Literature Review

Board certified behavior analysts are ethically required to first address destructive behavior using reinforcement-based and other less intrusive procedures before considering the use of restrictive or punishment-based procedures (ethics standard 2.15; Behavior Analyst Certification Board, 2020). However, the inclusion of punishment in reinforcement-based treatments may be warranted in some cases of severe forms of destructive behavior that poses risk of harm to the client or others. In these cases, behavior analysts are required to base the selection of treatment components on empirical assessment results (ethics standard 2.14; Behavior Analyst Certification Board, 2020). One such preintervention assessment is the stimulus avoidance assessment (SAA), which allows clinicians to identify a procedure that is likely to function as a punisher. Since the inception of this assessment approach, no studies have conducted a systematic literature review of published SAA cases. These data may be pertinent to examine the efficacy, generality, and best practices for the SAA. The current review sought to address this gap by synthesizing findings from peer-reviewed published literature including (1) the phenomenology and epidemiology of the population partaking in the SAA; (2) procedural variations of the SAA across studies (e.g., number of series, session length); (3) important quality indicators of the SAA (i.e., procedural integrity, social validity); and (4) how the SAA informed final treatment efficacy. We discuss findings in the context of the clinical use of the SAA and suggest several avenues for future research.

Consistent Visual Analysis of Multielement Data: A Preliminary Evaluation

Experimenters provided 33 graphical displays of hypothetical data depicted in a multielement experimental design to editorial board members of prominent, applied, behavior-analytic journals via an online survey. For each display, participants indicated (a) the presence or absence of experimental control and (b) the degree of experimental control (rated on a 1-100 scale). Each depiction varied systematically in (a) the number of data paths, (b) the number of data paths elevated above the control, (c) the mean difference between affected data paths and control conditions, and (d) the degree of variability within conditions. Correspondence among experts' ratings of experimental control was high across all presented graphical displays, supporting the reliability of visual analysis as an evaluative tool for these designs.

Approaches for Treating Multiply Controlled Problem Behavior

A portion of problem behavior is maintained by multiple reinforcement contingencies. Treating multiply controlled problem behavior may be more complex than treating problem behavior maintained by a single contingency. Several approaches for addressing multiply controlled problem behavior have been described in the literature. The purpose of this review is to provide practitioners with an overview of function-based approaches for addressing multiply controlled problem behavior. In particular, we present guidelines for functional analysis and treatment. We also describe strengths and limitations of published treatment approaches and discuss strategies for mitigating these limitations. Finally, we describe areas for future research.

A Meta-Analysis of Treatment for Self-Injurious Behavior in Children and Adolescents With Intellectual and Developmental Disabilities

Self-injurious behavior (SIB) among children and youth with developmental disabilities has not diminished in prevalence despite the availability of effective interventions, and the impact on quality of life for people and their families is devastating. The current meta-analysis reviews SIB intervention research between 2011 and 2021 using single-case experimental designs with children and youth up to 21 years old and provides a quantitative synthesis of data from high-quality studies including moderator analyses to determine effects of participant and study characteristics on intervention outcomes. Encouraging findings include a high level of effectiveness across studies in the decrease of SIB (Tau-U = -0.90) and increase of positive behavior (Tau-U = 0.73), as well as an increase in studies (relative to prior reviews) reporting intervention fidelity, generalization, maintenance, and social validity. However, our findings shed limited light on potential moderating variables in the development of interventions for children and youth who exhibit SIB. Of the potential moderators of intervention effects, only implementer (researcher/therapist vs. parent/caregiver) and setting (clinic vs. home) were significantly associated with improved outcomes. We discuss the need for more robust involvement of natural communities of implementers in SIB intervention research to better equip them to effectively and sustainably meet the needs of people they care for. We also discuss the importance of creating systems enabling broad access for children with SIB to effective interventions in service of reducing burden for people, families, and society over time.

A peek into the room where it happens: Quantifying ABA's influence on public policy discussions

To maximize its influence, applied behavior analysis must both create solutions and shape public policy to implement those solutions at scale. From the perspective of data-driven decision making, it is illogical to talk about seeking public policy influence without consulting evidence showing when influence has been achieved. One relevant form of evidence is the attention that behavioral solutions receive in published discussions about policy issues, and here I show how much of this attention has been earned by articles published in Journal of Applied Behavior Analysis. I also propose using the same kind of data to support finer grained analyses focusing on specific behavior problems, specific types of interventions, and the research programs of individual investigators. Although this is far from a complete account of the influence of applied behavior analysis on policy, it is better to have data than none if the goal is to transform the quest for influence on policy from a matter of speculation and casual discussion into an evidence-based practice.

Examining the Effects of Discrete Trials, Mass Trials, and Naturalistic Environment Training on Autistic Individuals Using Repeated Measures

INTRODUCTION

Behavioral interventions based on applied behavior analysis (ABA) form current evidence-based practices in treating autism spectrum disorder (ASD). Research is scarce relative to the broad effects of intensive repetitive, discrete trial training, and mass trials combined with a naturalistic environment as measured by overall general target behaviors. The primary objective of this study was to evaluate the effectiveness of a mixed behavioral model consisting of discrete trial training and mass trial interventions in the naturalistic environment, using a repeated measures design with a retrospective snapshot cohort of 93 individuals with autism.

METHODS

A repeated measures analysis tracked 89 autistic children with four adult autistic individuals over seven time points during a three-month snapshot period from March 19, 2023, to June 11, 2023. This study determined the effectiveness of applied behavior analysis (ABA) interventions combining discrete trial training, mass trials, and naturalistic environment training on mastered broad target behaviors in autistic individuals using a mixed (between and within) ANOVA statistical design.

RESULTS

Mixed (between and within) ANOVA indicated overall statistical significance, F (6,674)=45.447, p<0.001, partial eta squared=0.365 across time. These results indicated a large effect size. Multiple comparisons showed statistical significance (p<0.001) on all 21 multiple comparisons between timepoints. There was also a significant interaction effect with time × age category, F (24,474)=2.961, p<0.001, partial eta squared=0.130. These results also indicated a large effect size.

CONCLUSIONS

Autistic individuals who received applied behavior analysis combining discrete trial training, mass trials, and naturalistic environment training intervention demonstrated statistically significant improvement in target behaviors over the three-month snapshot period, the most prominent being in the 13-16 years age category.

Impact of Applied Behavior Analysis on Autistic Children Target Behaviors: A Replication Using Repeated Measures

INTRODUCTION

Applied behavior analysis (ABA) is a primary evidence-based practice in treating autism spectrum disorder (ASD). Ongoing research is needed to report the results of ABA relative to attaining target behaviors. This study aims to replicate the results of previous research to determine the effectiveness of ABA of target behaviors in autistic children with a new timepoint sample of data.  Materials & methods: A repeated measures analysis tracked 98 autistic children, which included four adult participants, over three timepoints during a one-month snapshot period from 6/7/23 to 7/7/23. This study used a retrospective chart review to gather data on target behaviors to determine the effectiveness of ABA treatments across age categories. A mixed (between x within) analysis of variance (ANOVA) and subsequent post hoc and interaction contrasts were used to determine statistical significance.

RESULTS

Mixed (between x within) ANOVA indicated statistical significance (sphericity assumed), F(2,160) = 32.893, and p < 0.05, across time. Using bootstrapped paired t-tests, multiple comparisons indicated p < 0.001 on all three multiple comparisons, with Bonferroni corrected α = 0.017. There was also a non-significant interaction effect (sphericity assumed) with (time) x (age category), F(8,160) = 0.333, p = 0.952, likely due to sizeable within-group variation resulting in a lowered statistical power.  Conclusions: This replication found that autistic children receiving the ABA intervention demonstrated statistically significant improvement in target behaviors over the one-month snapshot period.

A comparative effectiveness trial of functional behavioral assessment methods

Clinicians report primarily using functional behavioral assessment (FBA) methods that do not include functional analyses. However, studies examining the correspondence between functional analyses and other types of FBAs have produced inconsistent results. In addition, although functional analyses are considered the gold standard, their contribution toward successful treatment compared with other FBA methods remains unclear. This comparative effectiveness study, conducted with 57 young children with autism spectrum disorder, evaluated the results of FBAs that did (n = 26) and did not (n = 31) include a functional analysis. Results of FBAs with and without functional analyses showed modest correspondence. All participants who completed functional communication training achieved successful outcomes regardless of the type of FBA conducted.

Individualized behavior-based safety-leadership training: A randomized controlled trial

INTRODUCTION

Construction site managers play a critical role in occupational safety in the construction industry. This study aimed to develop and test a method for training construction site managers in positive feedback and active listening by incorporating the behavioral training components of behavior analysis, goal setting, practice with behavior feedback, homework, and maintenance planning into individualized behavior-based safety-leadership training (IBST), and to assess the effect of IBST on construction site managers' safety-leadership behaviors and performance.

METHOD

In a naturalistic randomized controlled trial, construction site managers were randomly assigned to an experimental group (n = 16) or a control group (n = 19). The experimental-group managers received IBST, while the control-group managers received no training. Paired sample t-tests on pre- to post-training (i.e., six weeks after the final training session) were performed separately for the experimental- and control-group managers.

RESULTS

The safety-leadership behaviors of the experimental-group managers improved in terms of favorable feedback (d = 0.99, p <.01), safety-specific feedback (d = 0.89, p =.02), behavior-specific feedback (d = 0.66, p =.02), antecedent listening (d = 0.68, p =.02), and consequential listening (d = 0.78, p =.01). In addition, safety-leadership performance improved in terms of transformational leadership (d = 0.78, p =.01) and contingent-reward leadership (d = 0.64, p =.02). No significant change was found for the control-group managers.

CONCLUSIONS

The results indicate that behavior analysis, goal setting, practice with behavior feedback, homework, and maintenance planning are effective behavioral training components of safety-leadership training. Positive feedback and active listening were also found to be important behavioral requisites for transformational and contingent-reward leadership.

PRACTICAL APPLICATIONS

IBST can be used to develop occupational safety in the construction industry by improving construction site managers' safety-leadership behaviors and performance.

Functional analysis: what have we learned in 85 years?

Purpose

Even though the term "functional analysis" (FA) is prevalent in the current behavioral literature, the concept and process have roots in the early days of basic research in behavior analysis. Furthermore, the methodology developed in the field of FA has been one of the most significant advances in research on challenging behaviors over the past four decades. The current article reviews the history of the term "functional analysis" and research related to experimental FA. The aim is to summarize what the field of behavior analysis has learned about this powerful methodology.

Views

FA is considered a gold standard of functional assessment. However, several arguments about limitations relating to methodological issues in FA and its ecological validity have been put forward. Some of these shortcomings include constraints on the time available for assessment, the risk posed by severe problem behavior, and the inability to exert tight control over environmental conditions.

Conclusions

The literature on the subject clearly shows that refinements have been aimed not only at improving some of the methodological characteristics of FA but also at adapting the strategy for real-world application. Practical functional assessment (known as interview-informed synthesized contingency analysis [IISCA]) is a contemporary approach to assessing and treating problem behavior. Recent research on IISCA offers empirical support for the practical functional assessment and skill-based treatment model, confirming that it can obtain sustainable and socially meaningful reductions in problem behavior. Nevertheless, more research is needed to address procedural variations in, and the utility and social validity of, IISCA.

Latent Class Analysis on Types of Challenging Behavior in Persons with Developmental Disabilities: Focusing on Factors Affecting the Types of Challenging Behavior

This study sought to analyze the latent classes of challenging behaviors among persons with developmental disabilities and examine the effects of related variables. To this end, the Korea Employment Agency for Persons with Disabilities collected data from the Survey on the Work and Life of Persons with Developmental Disabilities from 3000 households that included at least one family member with a developmental disability aged ≥15 years, surveying the persons themselves as well as their caregivers. As a result of the analysis, four latent classes were derived based on the types of challenging behavior and named as follows: overall challenging behavior, aggressive behavior, socially inappropriate behavior, and no challenging behavior. The main disability, disability grade, presence of multiple disabilities, disability status, activities of daily living, reading skills, writing skills, and situational awareness were significant factors affecting each latent class in the type of challenging behavior. Significant factors differed among the groups. This study identified the types of challenging behaviors and their influencing factors in a large sample of individuals with developmental disabilities and analyzed the correlation between their challenging behaviors and activities of daily living.

Multiple Isolated Functions of Problematic Behavior: A Case Study

Multiple isolated functions of problematic behavior are distinct from synthesized functions. Limited research has focused on the considerations of assessing and treating multiple isolated functions of problematic behavior. This case study utilized traditional functional analysis procedures to identify the functions of the targeted problematic behavior and a multiple baseline across functional contexts design to evaluate a function-based treatment. The nuances of assessing and treating multiple isolated functions are discussed.

Conceptualising migraine attacks from a biopsychosocial model using qualitative and functional behavioural analysis

OBJECTIVE

The aim of this study was to explore patients' experiences and management of pain in connection with a migraine attack in episodic migraine.

DESIGN, SETTING AND SUBJECTS

This qualitative study used a semi-structured interview format based on functional behavioural analysis as commonly used in cognitive behavioural therapy. We interviewed eight participants and analysed their responses using systematic text condensation.

RESULTS

Participants' descriptions of their experiences and management of pain from episodic migraine were sorted into three description First physical sensations, Automatic reactions and Acts according to the interpretation.

CONCLUSION

From a biopsychosocial perspective, a migraine attack is much more complex than just an experience of pain. The purely biological pain prompts a number of automatic reactions leading to strategies for pain management.

An interdisciplinary multimodal integrative healthcare program for depressive and anxiety disorders

Objective

Although multimodal interventions are recommended in patients with severe depressive and/or anxiety disorders, available evidence is scarce. Therefore, the current study evaluates the effectiveness of an outpatient secondary care interdisciplinary multimodal integrative healthcare program, delivered within a transdiagnostic framework, for patients with (comorbid) depressive and/or anxiety disorders.

Methods

Participants were 3,900 patients diagnosed with a depressive and/or anxiety disorder. The primary outcome was Health-Related Quality of Life (HRQoL) measured with the Research and Development-36 (RAND-36). Secondary outcomes included: (1) current psychological and physical symptoms measured with the Brief Symptom Inventory (BSI) and (2) symptoms of depression, anxiety, and stress measured with the Depression Anxiety Stress Scale (DASS). The healthcare program consisted of two active treatment phases: main 20-week program and a subsequent continuation-phase intervention (i.e., 12-month relapse prevention program). Mixed linear models were used to examine the effects of the healthcare program on primary/secondary outcomes over four time points: before start 20-week program (T0), halfway 20-week program (T1), end of 20-week program (T2) and end of 12-month relapse prevention program (T3).

Results

Results showed significant improvements from T0 to T2 for the primary variable (i.e., RAND-36) and secondary variables (i.e., BSI/DASS). During the 12-month relapse prevention program, further significant improvements were mainly observed for secondary variables (i.e., BSI/DASS) and to a lesser extent for the primary variable (i.e., RAND-36). At the end of the relapse prevention program (i.e., T3), 63% of patients achieved remission of depressive symptoms (i.e., DASS depression score ≤ 9) and 67% of patients achieved remission of anxiety symptoms (i.e., DASS anxiety score ≤ 7).

Conclusion

An interdisciplinary multimodal integrative healthcare program, delivered within a transdiagnostic framework, seems effective for patients suffering from depressive and/or anxiety disorders with regard to HRQoL and symptoms of psychopathology. As reimbursement and funding for interdisciplinary multimodal interventions in this patient group has been under pressure in recent years, this study could add important evidence by reporting on routinely collected outcome data from a large patient group. Future studies should further investigate the long-term stability of treatment outcomes after interdisciplinary multimodal interventions for patients suffering from depressive and/or anxiety disorders.

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.

Using Direct and Indirect Functional Assessments to Guide the Selection of Individualized Academic Interventions

When teachers work with students exhibiting academic failure, they may look to factors outside of instruction such as a student's home life or perceived disability as explanations. Placing the locus of control outside of the instructional context becomes a convenient way to escape culpability for unsatisfactory outcomes. A more functional approach to addressing academic deficits allows educators to determine environmental factors responsible for the lack of progress and then create interventions designed to address these functions of academic failure. Although experimental analyses serve as the gold standard for evaluating functional relations between behavior and environment, educators may not always have the ability to systematically test all behavior-environment relations. Indirect assessments provide one means to develop hypotheses about environment-behavior relations that can then be validated with experimental analyses. In this study, researchers developed an indirect tool (Academic Diagnostic Checklist - Beta; ADC-B) based on the function of academic performance deficits (Daly et al. in School Psychology Review 26:554, 1997) and validated the use of the ADC-B by comparing interventions that were suggested (indicated) and those non-suggested (contraindicated) by the ADC-B. Researchers used the ADC-B with four participants and found that for three of the four participants, the suggested intervention was the most efficacious at improving accuracy with the target skills. One limitation is that we did not evaluate the full technical adequacy of the ADC-B, which should be a focus of future research.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10864-023-09511-x.

The Mealtime Behavior Problems of Children with Developmental Disabilities and the Teacher’s Stress in Inclusive Preschools

With an increasing number of children with developmental disabilities entering inclusive preschools, preschool teachers face more behavioral problems in class. Preschool teachers typically attempt to address mealtime behavior problems of children with and without developmental disabilities simultaneously in class. This study used qualitative research to identify the stress triggers of preschool teachers addressing the mealtime behavior problems of children with developmental disabilities. Five preschool teachers attended semi-structured interviews. The results indicated that most children with developmental disabilities had problems with eating only preferred foods, using eating utensils appropriately during mealtime, becoming distracted from eating, and becoming frustrated with the classroom routine. Although solving these problems triggered stress in the preschool teachers, their stress was mainly in response to the children’s parents, other children’s imitation of inappropriate mealtime behaviors, and classroom schedule time management. Most of the preschool teachers stated that they had insufficient support. Preschool teachers require specialized information and strategies for improving the mealtime behaviors of children with developmental disabilities.

Accuracy of paper-and-pencil systematic observation versus computer-aided systems

Computer-aided behavior observation is gradually supplanting paper-and-pencil approaches to behavior observation, but there is a dearth of evidence on the relative accuracy of paper-and-pencil versus computer-aided behavior observation formats in the literature. The current study evaluated the accuracy resulting from paper-and-pencil observation and from two computer-aided behavior observation methods: The Observer XT® desktop software and the Big Eye Observer® smartphone application. Twelve postgraduate students without behavior observation experience underwent a behavior observation training protocol. As part of a multi-element design, participants recorded 60 real clinical sessions randomly assigned to one of the three observation methods. All three methods produced high levels of accuracy (paper-and-pencil, .88 ± .01; The Observer XT, .84 ± .01; Big Eye Observer, .84 ± .01). A mixed linear model analysis indicated that paper-and-pencil observation produced marginally superior accuracy values, whereas the accuracy produced by The Observer XT and Big Eye Observer did not differ. The analysis suggests that accuracy of recording was mediated by the number of recordable events in the observation videos. The implications of these findings for research and practice are discussed.

Exploring Subtypes of Repetitive Behavior in Children with Autism Through Functional Analysis and Wearable Technology: a Pilot Biobehavioral Assessment

Objectives

Prior research has established assessment methodologies, such as functional analysis to identify specific contexts in which restricted and repetitive behavior (RRB) occurs, and measures of heart rate variability (HRV) to index the level of autonomic arousal in individuals with autism spectrum disorder (ASD). Yet, a gap remains in integrating multiple assessment methodologies to examine the complex underlying mechanisms of RRB. This study piloted a multi-disciplinary approach to assess both the functional behavioral and neurophysiological factors that may underlie occurrences of RRB. The study (a) evaluated the effect of a modified functional analysis protocol on delineating functional subtypes of RRB and (b) explored the effect of using a wearable technology within a functional analysis on identifying the relationship between RRB and HRV.

Method

A single-case alternating treatment design was used to randomly alternate noncontingent low-stimulation and high-stimulation conditions in a modified functional analysis protocol. Simultaneous measurement of RRB and HRV was obtained through direct behavioral observations and a wristband that collects blood volume pulse, respectively. Visual analysis of time series data was used to determine the functional subtypes of RRB, and nonparametric correlational analyses were conducted to determine the association between HRV and RRB.

Results

Findings from a sample of six participants suggest preliminary effectiveness of the assessment protocol in identifying subtypes of RRB and a significant correlation between HRV and RRB.

Conclusions

This study demonstrates the potential effect and usability of a wearable technology-aided biobehavioral approach to assess RRB and HRV in individuals with ASD.

Applied behavior analysis and the zoo: Forthman and Ogden (1992) thirty years later

The field of applied behavior analysis has been directly involved in both research and applications of behavioral principles to improve the lives of captive zoo animals. Thirty years ago, Forthman and Ogden (1992) wrote one of the first papers documenting some of these efforts. Since that time, considerable work has been done using behavioral principles and procedures to guide zoo welfare efforts. The current paper reexamines and updates Forthman and Ogden's original points, with attention to the 5 categories they detailed: (a) promotion of species-typical behavior, (b) reintroduction and repatriation of endangered species, (c) animal handling, (d) pest control, and (e) animal performances. In addition, we outline 3 current and future directions for behavior analytic endeavors: (a) experimental analyses of behavior and the zoo, (b) applied behavior analysis and the zoo, and (c) single-case designs and the zoo. The goal is to provide a framework that can guide future behavioral research in zoos, as well as create applications based on these empirical evaluations.

Bridging the gap between laboratory and applied research on response-independent schedules

In 1948, Skinner described the behavior of pigeons under response-independent schedules as "superstitious," and proposed that the responses were reinforced by contiguous, adventitious food deliveries. Subsequently, response-independent schedules have been of interest to both basic and applied researchers, first to understand the mechanisms involved, and later, as "noncontingent reinforcement" (NCR) to reduce undesirable behavior. However, the potential superstitious effects produced by these schedules have been challenged, with some researchers arguing that antecedent variables play a significant role. This paper examines the evidence for adventitious reinforcement from both laboratory and applied research, the results of which suggest that antecedent, nonoperant functions may be important in fully understanding the effects of NCR. We propose an applied-basic research synthesis, in which attention to potential nonoperant functions could provide a more complete understanding of response-independent schedules. We conclude with a summary of the applied implications of the nonoperant functions of NCR schedules.

An interdisciplinary multimodal integrative healthcare program for somatic symptom disorder, with predominant (spinal) pain

OBJECTIVE

Although multimodal interventions are generally recommended in patients with long-term somatic symptom disorders (SSD), available evidence is limited. The current study evaluates the effectiveness of an outpatient secondary care interdisciplinary multimodal integrative healthcare program for patients with SSD and predominant (spinal) pain.

METHOD

The healthcare program consisted of two active treatment phases: main 20-week program and a 12-month relapse prevention program. Participants were 4453 patients diagnosed with SSD. The primary outcome was health-related quality of life (HRQoL) assessed using the RAND-36 (i.e., mental/physical component summary) and secondary outcomes included physical and psychological symptoms assessed using the Brief Symptom Inventory (BSI) and RAND-36 subscales. Mixed linear models were used to examine the effects of the multimodal healthcare program on primary/secondary outcomes over four time points: before start 20-week program (T0), halfway 20-week program (T1), end of 20-week program (T2) and end of relapse prevention program (T3).

RESULTS

Significant improvements were found from T0 to T2 for all primary variables (i.e., mental/physical component summary) and secondary variables (i.e., BSI/RAND-36 subscales), which were maintained until the end of the relapse prevention program (T3).

CONCLUSION

An interdisciplinary multimodal integrative treatment for SSD is effective for improving HRQoL and reducing physical and psychological symptoms.

The Effect of Napping on the Function of Problem Behavior for One Child With an Acquired Brain Injury

Many children experience sleep disruption in the form of difficulties falling asleep, staying asleep, or getting back to sleep. Children with acquired brain injuries (ABI) sometimes experience an exacerbation of these symptoms. Thus, researchers and practitioners alike need to identify creative assessment and treatment approaches to meet this population’s needs. The purpose of the current case study was to highlight one method for (a) determining a nap schedule and (b) evaluating the effect of fatigue on behavioral function for one child diagnosed with an ABI. We conducted a scatterplot analysis to identify periods in which problem behaviors occurred more or less often. These data informed when the child took naps. Afterward, the child participated in a functional analysis of problem behavior before a nap and again after a nap. Results showed both negative and positive reinforcement maintained problem behaviors before naps, while only positive reinforcement maintained problem behaviors after naps. Functional communication training (FCT) programs implemented to address escape, tangible, and attention functions before naps reduced problem behavior and increased communication. These data suggested that (a) motivating operations for problem behavior can differ depending on fatigue and (b) FCT is an effective intervention for problem behavior affected by fatigue. The current study provides an example of an assessment and treatment approach when biologic factors, like sleep, may influence problem behavior.

Teachers' Familiarity, Confidence, Training, and Use of Problem Behavior Interventions for Learners with Autism Spectrum Disorder in School Settings

Our main purpose in this study was to investigate the levels of and the relationship between familiarity, confidence, training, and use of problem behavior interventions by special education teachers working with learners with autism spectrum disorder (ASD) in school settings. A total of 80 special education teachers in South Carolina and Virginia completed an online survey. Results indicate a positive correlation between teachers' familiarity, confidence, training, and use of problem behavior interventions. Across all intervention categories, providing choices, prompting, modeling, and direct instruction received the highest rankings for familiarity, confidence, and use. In addition, our results reveal that familiarity and confidence in implementing these interventions differs across groups of special education teachers based on years of experience. The most frequently reported factors that limit the use of problem behavior interventions in school settings were competing responsibilities, the need to involve multiple people, the amount of time required, and the difficulty using interventions during typical routines. Implications for research and practice are discussed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10882-022-09885-2.

The ABC of academic procrastination: Functional analysis of a detrimental habit

Academic procrastination - habitually delaying work with academic tasks to the extent that the delays become detrimental to performance, wellbeing, and health - represents a substantial personal, systemic, and societal problem. Still, efforts to prevent and reduce it are surprisingly scarce and often offered as treatment regimens rather than preventive efforts. Based on the principles of functional analysis and a broad examination of factors that are important for academic procrastinatory behaviors, this paper aims to describe a strategy for analyzing individual controlling conditions for procrastination and give parallel advice on how to change those controlling conditions. Both are ideographic, allowing for individual and dynamic analyses of factors responsible for instigating and maintaining procrastination, as well as tailor-made remedies that address controlling conditions in preventive and curative efforts to reduce procrastination. Although functional analysis integrates well with important research findings in the procrastination field, this approach suggests new criteria for identifying procrastinatory behaviors and an alternative model for analyzing their control conditions. We conclude that a functional approach may supplement procrastination research and efforts to prevent and alleviate this detrimental habit.

The Spanish Version of the Video Game Functional Assessment-Revised

It is estimated that 16.8 million in Spain (41% female) are involved in gaming, and approximately 8.3% of Spanish gamers are problematic gamers (i.e., endorsing five or more of the nine criteria for Internet Gaming Disorder [IGD]). Given the high prevalence of IGD in Spain, this study evaluated construct validity and concurrent validity of the Spanish Version of the Video Game Functional Assessment-Revised (SP-VGFA-R), by examining the correlational coefficients with the nine-item Internet Gaming Disorder Scale-Short-Form (IGDS9-SF). A total of 434 adults 18 years of age or older participated in the study (15.1% female). Results showed that the SP-VGFA-R was positively and significantly associated with the IGDS9-SF (bivariate coefficients ranging from 0.411 to 0.610). Four distinct factors in the SP-VGFA-R were identified in confirmatory factor analysis, including (a) social attention, (b) tangible/intangible rewards, (c) escape/avoidance of demands or pain, and (d) sensory stimulation. Other findings showed that IGDS9-SF scores increased as (a) the escape/avoidance of demands or pain function increased and (b) two or more function scores increased. The SP-VGFA-R can be used in combination with the IGDS9-SF to assess Spanish gamers with IGD internationally, and to develop evidence-based behavioral interventions.

Impact of a Training Package to Improve the Effectiveness of Descriptive Assessment Data

Identifying the maintaining contingencies of problem behavior can lead to effective treatment that reduces the occurrence of problem behavior and increases the potential for the occurrence of alternative behaviors. Many studies use descriptive assessments, but results vary in effectiveness and validity. Comparative research further supports the superior utility of analog functional analyses over descriptive assessments, but clinicians continue to report the consistent use of descriptive assessments in practice. Direct training on the recording of descriptive assessments as well as the process for interpreting the results are limited. The absence of research-based guidance leaves clinicians to interpret the results as they see fit rather than following best practice guidelines for this critical activity. This study examined the potential impact of direct training on several components of descriptive assessment: the recording of narrative antecedent-behavior-consequence data, interpretation of the data, and the selection of a function-based treatment. Implications for training and practice are reviewed.