Contingency-based delay to reinforcement following functional communication training for autistic individuals: A multilevel meta-analysis

Functional communication training, an intervention for challenging behavior rooted in principles of applied behavior analysis, has copious empirical support dating back to the mid-1980s for autistic individuals. Recently, there has been a concerted effort to thin reinforcement delivery during functional communication training using contingency-based delays that, in turn, are designed to enhance practicality and feasibility while not compromising on efficacy. In this synthesis, we meta-analyzed the literature using log response ratio effect sizes to investigate (a) combined and across type effectiveness of contingency-based delays and (b) moderating variables that might impact intervention outcomes. Findings showed that contingency-based delays were effective for autistic individuals (log response ratio = −2.17; 95% CI = (−2.76, −1.58)) and most effective when the contingency incorporated positive reinforcement (log response ratio = −2.30; 95% CI = (−2.83, −1.78)). In addition, delay procedures that included differential reinforcement of alternative behavior were overall more effective (log response ratio = −2.13; 95% CI = (−2.72, −1.55)) than those that involved differential reinforcement of other behavior (log response ratio = −1.24; 95% CI = (−3.84, 1.37)). Noteworthy moderating variables found to impact contingency-based delay efficacy included the intervention dosage and the topography of behavior. We discuss these findings and highlight directions where additional empirical research is warranted to improve our understanding about contingency-based delays for autistic individuals. Lay abstract Functional communication training, an intervention for challenging behavior rooted in principles of applied behavior analysis, has copious empirical support dating back to the mid-1980s for autistic individuals. Recently, there has been a concerted effort to thin reinforcement delivery during functional communication training using contingency-based delays that, in turn, are designed to enhance practicality and feasibility while not compromising efficacy. In this synthesis, we meta-analyzed the literature base with the goal of investigating both combined and across type effectiveness of contingency-based delays. We also aimed to investigate moderating variables that might impact intervention outcomes. Findings showed that contingency-based delays were effective for individuals with an autism spectrum disorder diagnosis and most effective when the delay incorporated some form of positive reinforcement. In addition, differential reinforcement of alternative-based delays was overall more effective when compared to differential reinforcement of other behavior-based delays. Noteworthy moderating variables found to impact contingency-based delay efficacy included the intervention dosage and the topography of behavior. We discuss these findings and highlight directions where additional empirical research is warranted to improve our understanding about contingency-based delays for individuals diagnosed with autism spectrum disorder.

Behavioral Assessment and Treatment of Aerophagia

Aerophagia is characterized by excessive air swallowing and can have serious negative effects on one’s health. We present the assessment and treatment of a 16-year-old girl, Khloe, with developmental disabilities and aerophagia. The initial assessment indicated that aerophagia occurred primarily to access attention in a divided attention context; however, our function-based treatment did not result in a clinically significant reduction in problem behavior. We then conducted a second assessment that indicated that Khloe’s aerophagia indeed occurred primarily in a divided attention context, but that it persisted independent of social consequences. We concluded that the divided attention context served as a motivating variable for aerophagia. Our second treatment consisted of differential reinforcement of other behavior, noncontingent access to competing stimuli, and graduated exposure to contextual variables (i.e., people and divided attention) that occasioned aerophagia. The treatment was successful in reducing rates of aerophagia. We discuss implications for assessment and treatment, as well as recommendations for clinicians and students.

Teaching a Multi-Step Requesting Sequence to Two Adolescents with Autism Using an iPod-based Speech Generating Device

<p>Many children with autism fail to develop speech and are therefore candidates for the use of speech-generating devices (SGDs). However, existing studies are limited because they have tended to focus only on teaching an initial single-step requesting sequence. This thesis aimed to extend the existing literature by evaluating intervention procedures for teaching two adolescents with autism to perform multistep requesting sequences that required navigating across two screen pages (Intervention 1). Intervention 2 focused on teaching the adolescents to turn on and unlock the screen of the SGD prior to initiating the previously learnt multi-step requesting sequence. Both interventions made use of response prompting, prompt fading, and differential reinforcement procedures and were evaluated using the multiple-baseline across subjects design. Results showed that both interventions were effective in teaching these adolescents to use the iPod Touch(R) to make a sequence of requests. The results of the present study suggest that adolescents with autism can successfully learn to use an iPod Touch(R) to independently perform multi-step requesting sequences.</p>

Teaching a Multi-Step Requesting Sequence to Two Adolescents with Autism Using an iPod-based Speech Generating Device

<p>Many children with autism fail to develop speech and are therefore candidates for the use of speech-generating devices (SGDs). However, existing studies are limited because they have tended to focus only on teaching an initial single-step requesting sequence. This thesis aimed to extend the existing literature by evaluating intervention procedures for teaching two adolescents with autism to perform multistep requesting sequences that required navigating across two screen pages (Intervention 1). Intervention 2 focused on teaching the adolescents to turn on and unlock the screen of the SGD prior to initiating the previously learnt multi-step requesting sequence. Both interventions made use of response prompting, prompt fading, and differential reinforcement procedures and were evaluated using the multiple-baseline across subjects design. Results showed that both interventions were effective in teaching these adolescents to use the iPod Touch(R) to make a sequence of requests. The results of the present study suggest that adolescents with autism can successfully learn to use an iPod Touch(R) to independently perform multi-step requesting sequences.</p>

Assessing and Treating Anxiety in Individuals with Autism

Anxiety is a cluster of responses that can involve both operant and respondent behavior, which can be both public and/or private in nature, and occurs when an upcoming aversive stimulus is signaled. Despite the reported high comorbidity of autism and anxiety, there has been very limited research on how to directly assess and treat anxiety, especially with individuals who have limited communication skills. In Study 1, anxiety was assessed in five individuals with autism, ranging in age from 10 to 19 years old. Anxiety was assessed by measuring behavior during (1) a baseline (with no putative anxiety-provoking stimuli present), (2) signals for an upcoming aversive event, and (3) exposure to that aversive event. Anxiety presented in several different ways, as both conditioned activation and suppression, and both with and without problem behavior during the aversive event. In Study 2, individualized treatments involving differential reinforcement of alternative responses and stimulus fading were used to successfully reduce anxious responding in all four participants who displayed anxiety. These studies demonstrated a potentially useful means of assessing anxiety in individuals with autism which may not only help to measure anxious behavior and identify anxiety-provoking events, but may also lead to effective treatment.

Effectiveness of Differential Reinforcement of Other Behaviors in Reducing Non-suicidal Self-Injurious Behaviors in Adolescents

Objective: This study aimed to investigate the effectiveness of differential reinforcement of other behaviors in reducing non-suicidal self-injury behaviors in adolescents. Methods: A single-subject A-B-A-B design was used in this study. The statistical population included male adolescents with self-injurious behaviors, the families of whom were seeking treatment for these behaviors. In total, four adolescents were recruited from a psychology clinic in Tehran, Iran, using convenience sampling. Participants were observed at 6, 8, 10, and 12 sessions at baseline phases of A1 and A2, followed by 12 intervention sessions after each baseline phase. The intervention included differential reinforcement of other behaviors. If the participants showed no self-injury behavior within a specific time duration, a reward was provided. Non-suicidal self-injury behaviors included self-harm, hair pulling, severe itching, pinching, wound manipulation, and hand biting. The frequency of these behaviors was assessed during each session. Visual analysis of graphed data, percentage of non-overlapping data, and mean percentage improvement were used for data analysis. Results: The results showed a fairly reliable effect for the intervention on reducing the target behavior, as indicated by a frequency reduction from phase A1 to B1 and A2 to B2 and by a frequency elevation by the intervention withdrawal from B1 to A2. The average percentage reduction across participants was obtained at 56%. However, a low rate of self-injury remained consistent for the participants. Conclusion: The results provided further evidence on the effectiveness of differential reinforcement of other behaviors in reducing self-injury behaviors. Although the intervention could reduce self-injury substantially, it seemed that it could not eliminate the behavior.