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Bainbridge-Ropers syndrome (BRPS) is a rare and understudied developmental disorder associated with medical (e.g., sleep disruption) and behavioral (e.g., self-injury) challenges. There are no published treatments for BRPS. We targeted self-injury in a child with BRPS using a functional analysis and differential reinforcement, with several extensions to common procedures. Results present the first example of behavioral reduction for self-injury in BRPS. • ABA strategies can reduce self-injury in BRPS • Evaluating multiply maintained self-injury following identification of an automatic function is important. • Sleep deficits may complicate assessment.The online version contains supplementary material available at 10.1007/s40617-022-00749-x.

Early studies evaluating the relative preference for leisure compared with edible items suggested that, for most participants (>80%), edible items are more preferred than leisure items. Recent studies suggest more variability in the percentage of participants with this preference. The rationale for this variability could be sampling, setting, availability of items outside of the study, or the items included. As a systematic replication, we conducted preference assessments of leisure, edible, and leisure/edible items combined of 13 children with developmental disabilities. As an inclusion criterion, all participants had an electronic item as the top-preferred leisure item. An edible item ranked first in the combined assessment for 46.2% of participants. This replicates recent findings while accounting for access to edibles outside of the study. These outcomes are important to guide use of preference assessments across reinforcer classes in clinical and school settings.

Introduction: Autistic individuals often have comorbid medical conditions, which can increase the likelihood of being severely affected by COVID-19. The best prevention for this is vaccination. However, some autistic individuals engage in behaviors that might create a barrier to successful vaccination. Aims: We describe the development and acceptability of a clinic specializing in the administration of COVID-19 vaccines for individuals diagnosed with autism spectrum disorder (ASD) who exhibit challenging behavior. Method: The clinic utilized behavioral antecedent strategies and contingencies to increase compliance with the vaccine and decrease distress associated with the procedure. Results: We achieved a 100% success rate with vaccine administration and caregivers reported high satisfaction with the clinic. Conclusions: The present vaccine clinic is adaptable to various settings and patients and was well-received overall by caregivers. Replication in different geographic regions may be beneficial when resources allow for this type of clinic.

It is well-established that humans have a bias towards immediate, compared to delayed, rewards. Although this bias has been primarily studied using monetary or other consumable commodities, it has also been demonstrated with outcomes of caregiver-mediated behavioral interventions targeting challenging behavior, which is a prevalent concern among children with autism spectrum disorder. In particular, caregivers may discount improvements in their child’s challenging behavior following behavioral interventions when the onset of improvement is delayed (Call et al. Journal of Autism & Developmental Disorders, 45, 1013–1025, 2015). The present study includes a sample of college students reading hypothetical vignettes about children with challenging behavior to evaluate the impact of child characteristics and caregiver role (parent vs. teacher) on discounting and the relationship between discounting of treatment and monetary commodities. Results suggest a discounting pattern across all groups, with no significant differences in discounting based on characteristics of the child/caregiver and steeper discounting for monetary compared to treatment outcomes. The results have implications for future research on caregiver-mediated interventions.

Children with autism spectrum disorder (ASD) are often delayed in achieving bowel continence, resulting in negative outcomes. In this pilot trial, 20 children with ASD and encopresis were randomly assigned to multidisciplinary intervention for encopresis (MIE; n = 10) or a waitlist control group (n = 10). The MIE group was treated for constipation and received a 10-day behavioral intervention that utilized suppositories to produce predictable bowel movements that were reinforced. Caregivers were trained to implement the intervention. Results support the feasibility of clinical trials of MIE, with high enrolment, competition, attendance, and caregiver acceptability. Preliminary outcomes were positive, with six of 10 in the MIE group achieving continence by the end of treatment compared to 0 in the control group (p = 0.005). Registered at clinicaltrials.gov (https://clinicaltrials.gov); ID: NCT02383732.

Elopement is a common and dangerous concern in autism spectrum disorder (ASD). There is evidence that behavior analytic treatments can successfully treat elopement, but the research is limited due to small samples and treatment components varying across studies. The current study evaluated the feasibility of studying a manualized intervention for elopement, based on strategies from single-subject research, in a randomized clinical trial with 24 individuals with ASD. Results demonstrated that recruitment was feasible; the manual was acceptable to parents; and therapists followed the manual with high-integrity. Initial efficacy results measured by the Aberrant Behavior Checklist, Clinical Global Impression Scale, and a Home Elopement Safety Checklist suggested improvement in the treatment group that should be studied in future research.

Smith-Magenis syndrome (SMS) is a genetic disorder, commonly caused by a 17p11.2 deletion, affecting the Retinoic Acid Induced 1 gene. It affects approximately 1 in 25,000 individuals, with over 90% engaging in challenging behaviors. Function-based treatments, using the principles of applied behavior analysis, have consistently been shown to decrease challenging behaviors exhibited by individuals with developmental delays. However, additional research is needed to determine the effects of these interventions with specific diagnostic subsets, including SMS. The current study identified the function of challenging behavior for 2 children with SMS and found a function-based treatment, consisting of differential reinforcement and extinction, reduced challenging behavior for both.

Using multiple schedules of reinforcement following functional communication training (FCT) can produce discriminated mands while maintaining low rates of problem behavior (Fisher et al., 1998; Hanley et al., 2001). A review of this literature (Saini et al., 2016) noted the absence of a method for systematically determining the duration of reinforcement (SD) and extinction (SΔ) components in such multiple-schedule arrangements. The same review also suggested that introducing a momentary differential-reinforcement contingency could aid in producing discriminated mands by eliminating the possibility of adventitious reinforcement. The current investigation attempted to evaluate these two recommendations by altering the durations of SD and SΔ components of a multiple schedule based on participants’ response patterns during treatment. Specifically, we (a) yoked the duration of the initial SΔ component to the rate of mands during FCT and (b) introduced a delay to the SD following instances of problem behavior. All five participants exhibited discriminated mands. In addition, mands maintained for all five participants, and problem behavior remained low for four participants when the schedule of reinforcement was systematically thinned.

Objectives: Evaluations of treatments using applied behavior analysis (ABA) for challenging behavior have relied mostly on direct behavioral observation. While observation is crucial, qualitative information can also be beneficial. In this study, we describe methods for using qualitative information in ABA treatments for challenging behavior. Method: Three participants were undergoing treatment for challenging behavior. Information was collected through caregiver interviews at the start and end of the admission. Directed content analysis identified themes in the interviews and we compared treatment outcomes using qualitative and quantitative measures. Results: Three themes emerged: description, frequency, and impact of the behavior. Quantitative and qualitative measures both suggested successful interventions for two participants. For the third, direct observation suggested treatment was effective while caregiver report did not. Conclusion: Incorporation of qualitative information into outcomes allowed for a more comprehensive view of treatment success and guided assessment and treatment decisions. Treatments based on applied behavior analysis (ABA) are commonly studied for the treatment of challenging behavior, but these studies rely mostly on direct behavioral observation. While observation is crucial, qualitative information is also useful in ensuring meaningful results. In this study, we describe a method of collecting, analyzing, and using qualitative information collected from caregivers and compare qualitative to quantitative outcomes.

We taught three children with visual impairments to make tactile discriminations of the braille alphabet within a matching-to-sample format. That is, we presented participants with a braille character as a sample stimulus, and they selected the matching stimulus from a three-comparison array. In order to minimize participant errors, we initially arranged braille characters into training sets in which there was a maximum difference in the number of dots comprising the target and nontarget comparison stimuli. As participants mastered these discriminations, we increased the similarity between target and nontarget comparisons (i.e., an approximation of stimulus fading). All three participants’ accuracy systematically increased following the introduction of this identity-matching procedure.

When interpreting results of a functional analysis, a clinician may conclude an automatic function either because problem behavior is elevated in the alone/ignore condition relative to other conditions or because problem behavior is elevated and undifferentiated across multiple conditions. In the latter, it is difficult to determine if problem behavior is maintained by automatic reinforcement alone or is multiply maintained. The current study tested for multiply-maintained self-injurious behavior exhibited by two participants by implementing functional analysis contingencies while controlling for automatic reinforcement through sensory extinction. Results suggest that self-injury was maintained by automatic reinforcement alone for one participant and both automatic reinforcement and physical attention for another participant. These results were then used to create function-based treatments for self-injury that were successfully generalized across settings and caregivers.

Children with autism spectrum disorder (ASD) are often delayed in achieving bowel continence, resulting in negative outcomes. In this pilot trial, 20 children with ASD and encopresis were randomly assigned to multidisciplinary intervention for encopresis (MIE; n = 10) or a waitlist control group (n = 10). The MIE group was treated for constipation and received a 10-day behavioral intervention that utilized suppositories to produce predictable bowel movements that were reinforced. Caregivers were trained to implement the intervention. Results support the feasibility of clinical trials of MIE, with high enrolment, competition, attendance, and caregiver acceptability. Preliminary outcomes were positive, with six of 10 in the MIE group achieving continence by the end of treatment compared to 0 in the control group (p = 0.005).Registered at clinicaltrials.gov (https://clinicaltrials.gov); ID: NCT02383732.

Studies on preference assessments have shown that when both edible and leisure items are compared, edible items tend to displace leisure items in preference hierarchies. However, the mechanisms behind this process are currently unclear. One possibility is that displacement may be a product of the relatively brief periods of access to leisure items typically used in preference assessments. The purpose of the current investigation was to examine whether the duration of access to leisure items affects displacement. In this study, participants chose between preferred leisure items and the edible items that had previously been shown to displace those leisure items in a preference hierarchy. Duration of access to the leisure item was systematically increased across series to identify the magnitude at which leisure items became more preferred than edible items. Results indicate that as the duration of access to leisure items increases, displacement decreases.

It is common practice in research on the treatment of problem behavior to compare levels of targeted behaviors during treatment to levels when treatment is not in place. Some researchers use data collected as part of a multielement functional analysis as the initial baseline, whereas others collect new baseline data following completion of the functional analysis. We evaluated whether the source of baseline data influences the reliability and efficiency of decision-making. Results suggest that similar decisions are made in regard to treatment efficacy using the different sources of baseline data, but using data from a multielement functional analysis as baseline may save time. Interrater agreement was adequate, but lower for some graphs than has been observed in past studies. Several potential explanations for this discrepancy are discussed.

Self-injurious behavior or SIB is a common problem among persons with intellectual disabilities. SIB can cause severe tissue damage and physical injury, interfere with educational and social development, and serve as a stressor for caregivers. As such, a thorough understanding of SIB, including assessment and treatment, is crucial for clinicians who work with individuals with intellectual and developmental disabilities. This chapter provides a brief overview of how these behaviors are defined, how they are commonly expressed, and why they may emerge. An extensive review of evidence-based intervention then follows, including behavioral and pharmacological strategies. A description of recommendations for future treatment research will be provided.

Unlike potential tangible positive reinforcers, which are typically identified for inclusion in functional analyses empirically using preference assessments, demands are most often selected arbitrarily or based on caregiver report. The present study evaluated the use of a demand assessment with 12 participants who exhibited escape-maintained problem behavior. Participants were exposed to 10 demands, with aversiveness measured by average latency to the first instance of problem behavior. In subsequent functional analyses, results of a demand condition that included the demand with the shortest latency to problem behavior resulted in identification of an escape function for 11 of the participants. In contrast, a demand condition that included the demand with the longest latency resulted in identification of an escape function for only 5 participants. The implication of these findings is that for the remaining 7 participants, selection of the demand for the functional analysis without using the results of the demand assessment could have produced a false-negative finding.

Children with developmental disabilities (DD) are more likely than typically developing peers to have issues with enuresis. Past research has shown the success of behavioral treatments consisting of scheduled sits and reinforcement for continent voids. However, this research has included small sample sizes, while studies with larger numbers have lacked key information (i.e., baseline rates and follow-up data to evaluate maintenance and generalization). The current study conducted a consecutive case series analysis of 44 individuals with developmental disabilities who completed a 2-week program for enuresis. Results showed significant improvement in continent voids and follow-up data suggested positive results maintained when treatment was implemented by caregivers in a home environment.

When self-restraint and self-injurious behavior (SIB) co-occur, self-restraint might be maintained by negative reinforcement through the removal of SIB. The current study evaluated this possibility with an individual who exhibited hand-to-head SIB. Three functional analyses of SIB were conducted: (a) no consequences for self-restraint, (b) self-restraint blocked, and (c) hypothesized aversive effects of SIB blocked. The outcomes of the 3 analyses suggested that self-restraint was maintained by negative reinforcement.

Prior research on treatment integrity has focused either on the lack of measurement of the independent variable or on methods to increase overall levels of treatment integrity. Little research has focused on the effectiveness of common interventions when implemented with less than perfect integrity. The current investigation evaluated the effectiveness of using differential reinforcement of alternative behavior (DRA) and prompting to increase math completion for 36 early elementary students. Treatment was evaluated when both components were implemented, when only reinforcement was implemented, when only prompting was implemented, and when neither was implemented. In addition, preferences for either attention or escape and order-effects of conditions were evaluated. Results indicated treatment was effective at all levels of implementation compared to baseline. However, when preferences for escape and attention were evaluated, analysis revealed individuals who preferred escape responded best when both treatment components were implemented, whereas for individuals who preferred attention, all treatment conditions were equally effective. In addition, results evaluating order effects indicated that exposure to either prompting or reinforcement prior to baseline significantly increased math completion as well as exposure to reinforcement in the first condition.

Research has demonstrated that interventions for problem behaviors are more effective when treatment components are selected to match the consequences that maintain the individual’s behavior (i.e., its function). However, many methods for identifying the function of an individual’s problem behavior appear in the literature. The functional analysis (FA) methodology first introduced by Iwata et al. is the most comprehensive and well-studied. However, a variety of factors may prevent a clinician from conducting this type of FA. This chapter describes many of the functional assessment procedures that appear in the literature, including the advantages and disadvantages of each. In addition to various formats of FA, the relative strengths and weaknesses of indirect assessments and descriptive assessments are discussed, as well as the most appropriate applications for each.

Line tracking is a prerequisite skill for braille literacy that involves moving one's finger horizontally across a line of braille text and identifying when a line ends so the reader may reset his or her finger on the subsequent line. Current procedures for teaching line tracking are incomplete, because they focus on tracking lines with only small gaps between characters. The current study extended previous line-tracking instruction using stimulus fading to teach tracking across larger gaps. After instruction, all participants showed improvement in line tracking, and 2 of 3 participants met mastery criteria for tracking across extended spaces.

Scheithauer and Tiger (2012) created an efficient computerized program that taught 4 sighted college students to select text letters when presented with visual depictions of Braille alphabetic characters and resulted in the emergence of some braille reading. The current study extended these results to a larger sample (n = 81) and compared the efficacy and efficiency of the instructional program using 2 different response modalities. One variation of the program required a response in a multiple-choice format, and the other variation required a keyed response. Both instructional programs resulted in increased braille letter identification and braille reading. These skills were maintained at a follow-up session 7 to 14 days later. The mean time needed to complete the program was 22.8 min across participants. Implications of these results for future research, as well as practical implications for teaching the braille alphabet, are discussed.

School consultants who rely on direct observation typically conduct observational samples (e.g., 1 30-min observation per day) with the hopes that the sample is representative of performance during the remainder of the day, but the representativeness of these samples is unclear. In the current study, we recorded the problem behavior of 3 referred students for 4 consecutive school days between 9:30 a.m. and 2:30 p.m. using duration recording in consecutive 10-min sessions. We then culled 10-min, 20-min, 30-min, and 60-min observations from the complete record and compared these observations to the true daily mean to assess their accuracy (i.e., how well individual observations represented the daily occurrence of target behaviors). The results indicated that when behavior occurred with low variability, the majority of brief observations were representative of the overall levels; however, when behavior occurred with greater variability, even 60-min observations did not accurately capture the true levels of behavior.

The external validity of behavioral treatments for elopement (i.e. leaving supervision without permission) remains unclear because studies to date include only small samples ( n = 1–3). This study quantified the overall effectiveness of behavioral treatments for elopement by retrospectively examining treatment data from all patients seen for the treatment of elopement at an intensive day treatment clinic ( n = 11), irrespective of treatment success. Reductions in elopement from baseline to the final treatment for each participant demonstrate that behavioral intervention is a highly effective treatment for elopement, as determined by the large effect size (Cohen’s d = 1.18).

Problem behaviors, such as aggression, self-injury, and disruption, are common reasons for referrals for individuals with developmental and intellectual disabilities (Emerson et al. 2001; Murphy et al. 2009). Several studies using parental report indicate that children with problem behavior are also more likely to have sleep difficulties (e.g., Mazurek et al. 2013; Rzepecka et al. 2011), while others suggest that the two domains are not correlated (Dominick et al. 2007). There has also been support from a direct observation study suggesting that individuals who exhibit problem behavior have more sleep difficulties when compared to national norms (Piazza et al. 1996), but these findings are correlational in nature and do not provide information about a temporal relationship. Thus, it is unclear from current research whether sleep difficulties and problem behavior vary together (e.g., whether behavior is worse on days following low sleep) or whether they are temporally unrelated (Brylewski and Wiggs 1999).

Objective: There is a lack of empirically supported treatments for college students with ADHD and academic deficits. The current study evaluated self-monitoring, an intervention that may improve academics in children with ADHD, with a college sample diagnosed with ADHD. Method: Fifty-three participants were recruited, 41 of which completed the study and are included in the analyses. Participants were randomly assigned to a group that received study skills instruction, goal setting, and self-monitoring instruction (SM+ group; n = 22) or a group that received only study skills and goal setting (SM− group; n = 19). Results: Participants in the SM+ group demonstrated significant improvement in their ADHD symptoms, academic behavior, grade point averages (GPAs), and goal attainment. These improvements were not significant for the SM− group. Conclusion: These findings suggest that self-monitoring might be used to improve academic performance in college students with ADHD.

Parent engagement in behavioral interventions is critical for treatments to succeed. Parental decision-making regarding treatments can be impacted by systematic biases, such as the tendency to discount the value of delayed benefits, or “delay discounting”. This study examined the impact of delay discounting on parents’ perceptions of treatment for their children’s problem behavior. Seventeen caregivers of children with a developmental disability who displayed problem behaviors completed assessments in two conditions: a monetary reward paradigm and a paradigm related to treatment outcomes. Fifteen of 17 participants displayed patterns of choice-making suggesting discounting of delayed treatment outcomes. If corroborated in larger samples, our methods could afford clinicians a way to optimize their approach to caregivers to maximize the benefits of treatment.

When self-restraint and self-injurious behavior (SIB) co-occur, self-restraint might be maintained by negative reinforcement through the removal of SIB. The current study evaluated this possibility with an individual who exhibited hand-to-head SIB. Three functional analyses of SIB were conducted: (a) no consequences for self-restraint, (b) self-restraint blocked, and (c) hypothesized aversive effects of SIB blocked. The outcomes of the 3 analyses suggested that self-restraint was maintained by negative reinforcement.

Recent increases in attention deficit hyperactivity disorder (ADHD) diagnoses, and the escalation of stimulant prescriptions, has raised concern about diversion and abuse of stimulants, as well as the ethics of using these drugs as “cognitive enhancers.”Such concern appears misplaced in the face of substantial evidence that stimulant drugs do not improve the academic performance of ADHD-diagnosed students. Moreover, numerous studies have found little or no benefit of stimulants on neuropsychological tests of ADHD-diagnosed as well as normal, individuals. This paper examines the apparent paradox: why don't drugs that improve “attention,” produce better academic outcomes in ADHD-diagnosed students? We found that stimulant drugs significantly improved impairment of episodic memory in ADHD-diagnosed undergraduate students. Nevertheless, we also found consistent academic deficits between ADHD students and their non-ADHD counterparts, regardless of whether or not they used stimulant medications. We reviewed the current literature on the behavioral effects of stimulants, to try to find an explanation for these conflicting phenomena. Across a variety of behavioral tasks, stimulants have been shown to reduce emotional reactions to frustration, improve the ability to detect errors, and increase effortful behavior. However, all of these effects would presumably enhance academic performance. On the other hand, the drugs were also found to promote “risky behavior” and to increase susceptibility to environmental distraction. Such negative effects, including the use of drugs to promote wakefulness for last minute study, might explain the lack of academic benefit in the “real world,” despite their cognitive potential. Like many drugs, stimulants influence behavior in multiple ways, depending on the environmental contingencies. Depending on the circumstances, stimulants may, or may not, enhance cognition.

Instructors of the visually impaired need efficient braille-training methods. This study conducted a preliminary evaluation of a computer-based program intended to teach the relation between braille characters and English letters using a matching-to-sample format with 4 sighted college students. Each participant mastered matching visual depictions of the braille alphabet to their printed-word counterparts. Further, each participant increased the number of words they read in a braille passage following this training. These gains were maintained at variable levels on a maintenance probe conducted 2 to 4 weeks after training.