Producing meaningful improvements in problem behavior of children with autism via synthesized analyses and treatments

Assignment Article Guide

Hanley, G., Jin, C., Vanselow, N., & Hanratty, L. (2014). Producing meaningful improvements in problem behavior of children with autism via synthesized analyses and treatments.  Journal of Applied Behavior Analysis,  47(1), 16-36.

Title of Article: Producing meaningful improvements in problem behavior of children with autism via synthesized analyses and treatments
Author(s): Gregory Hanley, Sandy Jin, Nicholas R. Vanselow, and Laura A. Hanratty.	Year: 2014
Journal: Journal of Applied Behavior Analysis

INTRODUCTION

a. What was the purpose of this study?

· The aim of the treatment is to restore balance in the relationships between persons with autism and their family members and teachers and without regrettable actions by either.

· A functional assessment model described by Hanley addressed the severe problem behavior of three children who had been diagnosed with autism.

· The purpose was to demonstrate the utility of the model in an outpatient clinic by implementing, generalizing, and socially validating the treatments designed from the results of the interview-informed analyses.

b. Why did this study need to be conducted? (This information comes from severity/impact of the problem, previous research into the problem, and what previous research lacked.)

· Children with autism that have restricted verbal repertoires may engage in maladaptive behavior (e.g., aggression). This behavior reduces the likelihood of integration into classroom settings. As a result, autistic children are isolated or marginalized from their peer group which reduces their contact with relevant stimuli. Previous studies have examined and proven the success of single a single aspect of the treatment process via comparative analysis.

· Autism has no biological determination

· 1 in 50 children have autism

· With Autism, there is a higher likelihood of problem behavior like meltdowns, aggression, and self‐injury.

· Problem behavior persist for many families with children on the spectrum.

· Research provides robust evidence that behavioral interventions work and have positive impact on reducing problem behaviors

· Research by Campbell suggests that larger reductions in problem behaviors were observed when the treatment was based on functional assessments.

· It is a process that identifies the variables that influence the problem behavior

· The assessment involves indirect interviews, descriptive assessment and functional analysis

· descriptive assessments include observations and measurements of the problem behavior and the context in which the behavior occurs.

· There is considerable variability in the manner in which functional assessments are conducted, the speed and success of the initial analysis in detecting a function of problem behavior, and the extent to which types of indirect and descriptive assessments are used in the functional assessment process.

· Functional analysis are observations in at least 2 contexts under different conditions (test conditions and control conditions)

· Research usually focuses on detection and evaluation of single variables on problem behavior

· However, very few studies evaluate the treatment from the start of the assessment to the end of treatment when the behaviors are reduced.

· In addition, there is a great variability in the way that functional assessments are conducted, in terms of the speed and the success in detecting the function of the behavior as well as the extent to which indirect and descriptive assessments are used.

METHOD

c. Who were the participants? (How many, ages, diagnoses, skill levels). How were they selected?

Gail	Dale	Bob
· 3 years old girl · Pervasive developmental disorder · Receiving speech language services at the time of her evaluation	· 11 years old boy · Autism · Attends specialized classrooms in public schools · Receives 1:1 paraprofessional support. · Attends regular classroom setting for 1 Hour each day with support	· 8 years old · Autism · Attends specialized classrooms in public schools · Receives 1:1 paraprofessional support. · Attends regular classroom setting for 1 hour each day with support

The three participating families learned of the university-based outpatient clinic through their local pediatrician’s office. The first three families who attended the clinic were;

Gail, 3 years old, PDD‐NOS

Dale, 8 years old, Autism

Bob, 11 years old, Autism

· All children could follow multistep vocal instructions (but usually did not do so), imitate, and speak in short sentences. Dale and Bob attended specialized classrooms in public schools and received one-on-one paraprofessional support. Both were included in regular classrooms with paraprofessional support for about 1 hour each day. Gail was receiving speech language services at the time of her evaluation. Services were provided without charge as part of the research and training mission of the university. All children engaged in episodes of problem behavior multiple times each day and had been receiving behavior-analytic services for at least 1 year prior to being served in our clinic.

d. Setting-where did the study take place?

· All functional analysis and treatment sessions were conducted in therapy rooms (4m by 3 m) with one-way observation panels and audio-video equipment located in the psychology department of a university.

e. What participant behavior(s) was being measured? (DVs)

Participants	Behaviors	Measurements
Gail	· Have difficulty when her mom asks her to clean up her toys or play independently while her mom is busy with other tasks. e.g.: "When her mother attempted to cook dinner or clean the house, Gail screamed, cried, and hit her mother or her sister."	· Trained observers collected data using software on small laptops. · Data were collected during continuous 10-s intervals and were summarized as numbers of responses per-minute or percentage of session. · Data were collected on the number of problem behaviors, functional communicative responses (FCRs), tolerance responses, and reinforcement duration. · Gail: Simple communication response was "toy, please" · Gail: Complex response required "excuse me" and wait for adult acknowledgment before engaging in a longer FCR. · "May I have toys, please?" · "Will you play with me?" or "May I have _____, please?" · Gail: Reinforcement duration was scored when she was allowed access to both toys and her mother's attention.
Dale	· Have difficulty to tolerate periods of times when adults did not honor his requests for items or activities. · Behaviors would occur when adults interrupted his ongoing activity with an instruction to do something else.	· Trained observers collected data using software on small laptops. · Data were collected during continuous 10-s intervals and were summarized as numbers of responses per-minute or percentage of session. · Data were collected on the number of problem behaviors, functional communicative responses (FCRs), tolerance responses, and reinforcement duration. · Dale's simple communication response: "My way, please" · Dale's complex communication response: "May I have my way, please?" · For Dale, reinforcement duration was scored when then analyst or parent removed demands, provided access to the preferred activity, and honored his request for reinforcers. ·
Bob	· Have trouble regulating his emotions when parents or teachers said "no" and where there was some loss of control in his environment. · He often have meltdown when parents took away his iPad or his games on ipad or other electronic device. · Meltdown also occurs when teacher corrects his math work or instructs him to transition to non-preferred academic tasks. · Bob can physically injure other people and meltdowns occur multiple times per day	· Trained observers collected data using software on small laptops. · Data were collected during continuous 10-s intervals and were summarized as numbers of responses per-minute or percentage of session. · Data were collected on the number of problem behaviors, functional communicative responses (FCRs), tolerance responses, and reinforcement duration. · Bob's simple communication response: "My way, please" · Bob's complex communication response: "May I have my way, please?" · For Bob, reinforcement duration was scored when then analyst or parent allowed Bob to play with the iPad or solve the math problems his way

f. What was the data collection system? How were the data summarized for graphing?

· Trained observers collected data using software on small laptop. Data were collected during continuous 10-s intervals and were summarized as numbers of responses per-minute or percentage of session. Data were collected on the number of problem behaviors, functional communicative responses (FCRs), tolerance responses, and reinforcement duration. The independent variable in this study was sessions (x-axis) and the dependent variable was number of problem behaviors (y-axis).

g. If reinforcers were used, did they conduct a preference assessment?

· A functional analysis, informed by the results of the interview and observation, was then conducted to test the apparent reinforcement contingencies.

· An open-ended functional assessment interview with the participants’ parents followed by, or concurrent with, a brief observation of the child was arranged to discover potential factors that may influence problem behavior.

h. What did the experimenters systematically do (IV) to influence the DV(s)? (Briefly summarize the teaching procedures in your own words).

· Functional analyses involved alternating between a test and a control condition (or for Gail and Bob, a series of test and control conditions).

· During each control condition, which was always conducted first, the putative reinforcers were available throughout the session.

· During each test condition, the putative reinforcers were removed every 30 s and were only returned contingent on problem behavior.

· The same materials were always available across each corresponding test and control condition, and reinforcers that were not part of the suspected controlling contingency were available non-contingently in both the test and control conditions.

· Therefore, the only difference between test and control conditions was the suspected reinforcement contingency.

i. What design was used? Did the authors demonstrate a functional relationship between the IV and DV?

· Single-subject designs demonstrated the influence of the separate treatment components that were progressively synthesized to produce socially valid outcomes for participating families.

· A multielement design was used to compare the test and control conditions of the functional analysis, and a reversal design was used to compare parent- and therapist- implemented analyses.

· Functional control was demonstrated by showing that levels of problem behavior and alternative responses closely corresponded, in the predicted direction, to four successive changes in reinforcement contingencies for those responses.

j. How often were IOA data collected? What was the mean and range? Any limitation with this?

· Interobserver agreement was assessed by having a second observer collect data on all target behaviors simultaneously but independently during at least 20% of each condition for all participants.

· Observers’ records were compared on an interval by interval basis, and agreement percentages were calculated by dividing the smaller number of responses or duration (in seconds) in each interval by the larger number. If both observers scored zero, the interval was scored as 100% agreement.

· Quotients were then averaged and converted to a percentage.

· Interobserver agreement averaged

· 99% (range, 80% to 100%) for Gail, 98% (range, 82% to 100%) for Dale, and 98% (range, 73% to 100%) for Bob.

· The limitation was that the researchers assumed that non-scored observations during IOA were taken as an agreement. Also, additional instances of problem behavior did not reset the interval.

k. How was the social validity of the goals, procedures, and outcomes of the study assessed? If missing in any area, describe how it could have been (or if they did not need to assess it, provide a rationale).

· To assess whether the functional assessment and treatment process was acceptable and resulted in socially meaningful outcomes for the participating families, parents were given a questionnaire at the end of the treatment.

· Parents were asked four questions about the extent to which they (a) found the assessment acceptable,(b) found the treatment procedures acceptable, (c) were satisfied with amount of improvement observed in problem behavior, and (d) were satisfied with the overall helpfulness of consultation.

· Also, research investigated comfort levels with presenting the situation reported to evoke problem behavior before and after the transfer of the treatment to their homes (e.g., comfort level in removing electronic devices, telling the child “no,” interrupting the child’s preferred activity, and telling them to do homework or other non-preferred activities).

l. How were procedures incorporated for facilitating (i.e., programming for) generalization? If missing, describe how they could have been (or if they did not need to program for this, provide a rationale)

· To evaluate the practicality and generality of the treatment, the intervention was extended outside the therapy rooms to more relevant situations.

· The manner in which treatment was extended differed slightly for each child according to their parents’ initial goals.

· In most cases, parents (or the teacher for Bob) were taught to implement the session contingencies in the session room first.

· The parents then were coached on implementation of the treatment in various areas of the outpatient clinic.

· The analyst then went to the child’s home and coached the parents to implement the treatment during tasks typical of the home environment (e.g., eating dinner, cleaning up toys, and completing homework) that had been described as being the most troublesome during the initial interview.

m. How were procedures incorporated for facilitating maintenance of behavior change? If missing, describe how they could have been (or if they did not need to program for this, provide a rationale).

· After an 8- to 14-week outpatient clinic consultation, no problem behavior was observed at the clinic and in the home.

· Furthermore, behavior that did not occur during baseline (e.g., functional communication, delay and denial tolerance, and compliance with instructions) occurred with regularity.

· A 1 month follow up could have been incorporated after generalization was established. Maintenance keeps skills stable across time, refers to the lasting change in a behavior after terminating treatment, fading to intermittent reinforcement schedule facilitates better maintenance of behavior can influence behaviors not accessible to external change agents. External change agents often miss important instances of behavior, but can still promote generalization & maintenance, small repertoire of self-management skills can control many behaviors, easily replicated, some people perform better under self-selected tasks and criteria.

n. Were data collected on the generalization? Maintenance? If either is missing, describe how these data could have been collected (or if they did not need to collect these data, provide a rationale).

· Treatment sessions required about 90% of the consultation time, with delay and denial training and treatment extension requiring the majority of the total treatment duration

· Gail received 2 sessions, Dale and Bob received 9 sessions for treatment extension.

· The researchers could have continued to collect data in the home when the parents implemented the procedures.

RESULTS AND DISCUSSION

o. Briefly summarize the findings.

· Gail: The result of functional assessment process indicated that the problem behavior was maintained by attention and tangible

· Dale: The result of the functional assessment process showed that his problem behaviors were maintained by access to "his way"

· Bob: Functional assessment indicated that the problem behavior was maintained by access.

Gail	Dale	Bob
· FCT resulted in immediate elimination of problem behavior and acquisition of FCR. · In denial-and delay tolerance training, problem behavior returned to near-zero levels · Problem behavior was at zero · Complex FCRs, tolerance responses and compliance persisted despite the fact that her requests were honored only about 50% of the time, the amount of reinforcement time was less than 50% · Control of the treatment was evident via the return of problem behavior in the denial baseline and social skills emerged when the reinforcement contingency was assigned to those responses.	· Result of variability in problem behavior due to a function of not being able to reinforce all his request during the reinforcement interval in the initial treatment phases. · Extended time during delay-tolerance training was due to greater amount of developmentally advanced behaviors that needed to be introduced, given his age and parental expectations. · Problem behavior was at zero and his complex FCRs, tolerance responses, and compliance persisted despite the facts that his requests were honored only about 40% and parents placed difficult demands during the delays.	· Some variability in problem behavior was observed while the complex FCR was being taught in the iPad context. · Zero levels of problem behaviors despite only having "his way" 20% of the time. · Consistently engaged in complex FCR and tolerance responses and complied with instructions to play with electronics or do math as requested by parents and teachers.

· All parents reported that the assessment procedures and treatment packages , improvements in problem behavior and overall consultation highly acceptable and helpful.

· Ratings between initial and final meeting improve in regards to comfort levels with presenting certain situations that evoked problem behavior

p. Were the findings in agreement with or in contrast to previous research?

· The importance of synthesizing contingencies, which has been implied in previous work (e.g., Bowman et al., 1997; Fisher, Adelinis, Thompson,Worsdell, & Zarcone, 1998). The finds in this study extended those found in previous research and showed that using open ended interview questions were superior to closed or Likert scale measures for synthesized functions and reinforcement.

q. What contribution(s) does this study make to this line of research?

· Replications of important variables from the extant assessment-based treatment literature, as well as some independent variables worthy of additional analysis, can be gleaned from the practice commitments evident in the treatment applied in this study.

· There is advantages to teaching children to request. Teaching specific delay cues provide more systematic inquiry as does the importance of gradually increasing the duration and developmental complexity of the expectations during delay tolerance training.

· Another advantage is empirical syntheses is that useful data regarding time and cost expenditures can be determined.

· The functional assessment process in the current study was sufficiently useful for discovering via interview and demonstrating via analysis on or more functions of the severe problem behavior.

· More research needs to be made on teaching children to tolerate delays and denials of function- based reinforcers and on strategies for extending treatment to homes and schools.

1

image1.tmp