Behavior Modification : Interventions to Reduce Challenging Behavior Among Individuals with Autism Spectrum Disorder (mai 2018)

samedi 28 avril 2018

Le numéro de mai 2018 de la revue Behavior Modification est consacré aux interventions sur les comportements-défis chez les personnes avec TSA.

Interventions to Reduce Challenging Behavior Among Individuals with Autism Spectrum Disorder

1. Davis TN, Rispoli M. Introduction to the Special Issue : Interventions to Reduce Challenging Behavior Among Individuals With Autism Spectrum Disorder. Behav Modif ;2018 (May) ;42(3):307-313.

The prevalence of autism spectrum disorder (ASD) is on the rise. In addition to the social communication skill deficits and restrictive repetitive behaviors and interests, many individuals with ASD engage in challenging behavior. Challenging behavior is associated with a multitude of negative outcomes. Challenging behavior may cause harm to the individual with ASD as well as limit opportunities for educational, vocational, and social participation and development. In addition, caregivers experience high stress and low quality of mental health. As a result, challenging behavior warrants intervention that is specifically tailored to the unique characteristics of individuals with ASD. The purpose of this Special Issue is to showcase recent research in the treatment of challenging behavior for individuals with ASD. This two-part Special Issue contains 12 studies that range from systematic and quality reviews of the intervention literature, to innovative treatment approaches, to studies that develop and evaluate treatments for restrictive and repetitive behaviors and interests.

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2. Falcomata TS, Muething CS, Silbaugh BC, Adami S, Hoffman K, Shpall C, Ringdahl JE. Lag Schedules and Functional Communication Training : Persistence of Mands and Relapse of Problem Behavior. Behav Modif ;2018 (May) ;42(3):314-334.

We evaluated the effects of lag schedules of reinforcement and functional communication training (FCT) on mand variability and problem behavior in two children with autism spectrum disorder. Specifically, we implemented FCT with increasing lag schedules and compared its effects on problem behavior with baseline conditions. The results showed that both participants exhibited low rates of problem behavior during treatment relative to baseline during and following schedule thinning (up to a Lag 5 schedule arrangement). Variable and total mands remained high during schedule thinning. With one participant, variable manding persisted when the value of the lag schedule was reduced to zero. The current results are discussed in terms of implications for training multiple mand topographies during FCT for the potential prevention and/or mitigation of clinical relapse during challenges to treatment.

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3. Gerow S, Hagan-Burke S, Rispoli M, Gregori E, Mason R, Ninci J. A Systematic Review of Parent-Implemented Functional Communication Training for Children With ASD. Behav Modif ;2018 (May) ;42(3):335-363.

Supporting parents in reducing challenging behavior of children with autism spectrum disorder (ASD) requires the identification of effective, feasible, and sustainable interventions. Functional communication training (FCT) is one of the most well-established interventions in the behavioral literature and is used increasingly by parents. However, there is a need for additional evaluation of the literature related to parent-implemented FCT. In the present review, we identified 26 peer-reviewed studies on parent-implemented FCT. We conducted systematic descriptive and social validity analyses to summarize the extant literature. Across studies, parent-implemented FCT was effective in reducing child challenging behavior, and in some cases, intervention outcomes maintained and generalized to novel settings and implementers. However, few studies reported fidelity data on parent implementation of FCT, and data regarding sustained use of FCT by parents were limited. Results of the social validity analysis indicate that while FCT is often implemented by natural change agents in typical settings, parent training is often provided by professionals not typically accessible to parents. These findings suggest that future research is warranted in the areas of parent training and long-term sustainability of parent-implemented FCT.

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4. Kunnavatana SS, Wolfe K, Aguilar AN. Assessing Mand Topography Preference When Developing a Functional Communication Training Intervention. Behav Modif ;2018 (May) ;42(3):364-381.

Functional communication training (FCT) is a common function-based behavioral intervention used to decrease problem behavior by teaching an alternative communication response. Therapists often arbitrarily select the topography of the alternative response, which may influence long-term effectiveness of the intervention. Assessing individual mand topography preference may increase treatment effectiveness and promote self-determination in the development of interventions. This study sought to reduce arbitrary selection of FCT mand topography by determining preference during response training and acquisition for two adults with autism who had no functional communication skills. Both participants demonstrated a clear preference for one mand topography during choice probes, and the preferred topography was then reinforced during FCT to reduce problem behavior and increase independent communication. The implications of the results for future research on mand selection during FCT are discussed.

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5. Clay CJ, Clohisy AM, Ball AM, Haider AF, Schmitz BA, Kahng S. Further Evaluation of Presentation Format of Competing Stimuli for Treatment of Automatically Maintained Challenging Behavior. Behav Modif ;2018 (May) ;42(3):382-397.

Behavioral interventions have been effective in reducing automatically maintained skin picking for individuals with disabilities including autism spectrum disorder (ASD). A competing stimulus assessment (CSA) is typically utilized in behavioral intervention and assessment to identify potential stimuli which compete with the reinforcer for various forms of challenging behavior (CB). Treatment evaluations have validated the results of these assessments by demonstrating competing stimuli may reduce levels of CB. In Phase 1 of this study, we conducted a functional analysis (FA) to determine what variables were maintaining skin picking of an 11-year-old girl diagnosed with ASD. In Phase 2, we conducted a CSA to determine which stimulus competed the most with skin picking. In Phase 3, we utilized a multielement with reversal design to compare the effectiveness of three presentation formats : (a) single stimulus (single), (b) multiple stimuli (multiple), and (c) alternating stimuli (alternating) in reducing levels of automatically maintained CB. We found noncontingent access to a single item was the most effective intervention to decrease skin picking. This study adds to the literature on reducing CB in children with ASD by incorporating a CSA before the evaluation of different formats of delivering competing stimuli, across extended duration session times.

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6. MacNaul HL, Neely LC. Systematic Review of Differential Reinforcement of Alternative Behavior Without Extinction for Individuals With Autism. Behav Modif ;2018 (May) ;42(3):398-421.

The purpose of this article is to review the literature on differential reinforcement of alternative behavior procedures without extinction for individuals with autism. Using predetermined inclusion criteria, a total of 10 studies were included and summarized in terms of the following : (a) participant characteristics (e.g., sex, age, and diagnosis), (b) treatment setting, (c) problem behavior, (d) function, (e) alternative behavior, (f) intervention, (g) outcomes, and (h) conclusiveness of evidence. Of the 10 studies, nine demonstrated positive effects and one mixed effects. Five studies successfully reduced problem behavior by manipulating different reinforcement parameters (magnitude, immediacy, and quality) and four manipulated the schedule of reinforcement. One study had mixed results with two of the three participants requiring extinction. The findings of this review suggest that variations of differential reinforcement of alternative behavior interventions without an extinction component may be considered promising practices for the treatment of challenging behavior in individuals with autism.

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7. Randall KR, Lambert JM, Matthews MP, Houchins-Juarez NJ. Individualized Levels System and Systematic Stimulus Pairing to Reduce Multiply Controlled Aggression of a Child With Autism Spectrum Disorder. Behav Modif ;2018 (May) ;42(3):422-440.

Research has shown that physical aggression is common in individuals with autism spectrum disorder (ASD). Interventions for multiply controlled aggression may be complex and difficult to implement with fidelity. As a result, the probability of treatment efficacy for this class of behavior may suffer. We designed an individualized levels system to reduce the physical aggression of an 11-year-old female with ASD. We then employed a systematic stimulus pairing procedure to facilitate generalization. Results suggest individualized levels systems can suppress multiply controlled aggression and that systematic stimulus pairing is an effective way to transfer treatment effects from trained therapists to caregivers.

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8. Rispoli M, Brodhead M, Wolfe K, Gregori E. Trial-Based Functional Analysis Informs Treatment for Vocal Scripting. Behav Modif ;2018 (May) ;42(3):441-465.

Research on trial-based functional analysis has primarily focused on socially maintained challenging behaviors. However, procedural modifications may be necessary to clarify ambiguous assessment results. The purposes of this study were to evaluate the utility of iterative modifications to trial-based functional analysis on the identification of putative reinforcement and subsequent treatment for vocal scripting. For all participants, modifications to the trial-based functional analysis identified a primary function of automatic reinforcement. The structure of the trial-based format led to identification of social attention as an abolishing operation for vocal scripting. A noncontingent attention treatment was evaluated using withdrawal designs for each participant. This noncontingent attention treatment resulted in near zero levels of vocal scripting for all participants. Implications for research and practice are presented.

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