2019年08月 | ARCHIVE-SELECT | 2019年10月



10th ABAI International Conference@Stockholm (DAY2)



Measuring the Effects of Psychotropic Medication on Behavioral Outcomes
Chair: Jennifer R. Zarcone (The May Institute)
This symposium will cover several aspects of measuring behavioral outcomes when individuals have been prescribed psychotropic medication. While the focus is on individuals with developmental disabilities, this information could be used with a wide range of individuals with a variety of diagnoses. The presentations will focus on methods for collecting data via several different analog (e.g., functional analysis) and assessment procedures that can inform decision making about whether the psychotropic medication is having the intended effect. The goal is to provide practitioners with assessments that they are able to implement in a variety of settings.

The Impact of Medication Changes on Functional Analysis Outcomes
(Applied Research)
LYNN G. BOWMAN (Kennedy Krieger Institute and Johns Hopkins University School of Medicine)
Abstract: Numerous studies have demonstrated drug specific effects on functional analysis (FA) outcomes (i.e., Crosland et al 2003; Zarcone et al 2004); however, few descriptive studies have examined how medication changes impact the clarity (i.e., differentiation) or results (i.e., masked functions) of subsequent FAs conducted with the same participant. The purpose of this study was to examine the extent to which psychotropic medication changes altered FA outcomes on an inpatient unit. A review of electronic medical charts was conducted between the years 1995-2014. Twelve cases had sufficient evidence (i.e., multiple FAs, detailed medication changes) for further review. Participants were aged 7 to 21 years and were diagnosed with IDD. Attending psychiatrists directed medication changes with the guidance of the senior behavior analyst, and therapists who collected data during the FAs remained blind to medication changes. To determine differentiation, criteria were established similar to Hagopian et al. (1997), and a quotient score was generated. In half of the cases, alterations to medication (dosage and/or type) led to different conclusions, while the other half did not. In 10 of the 12 cases quotient scores were improved following medication changes. Implications for practicing clinicians will be offered.

Polypharmacy and Problem Behavior: An Evaluation of Behavior When Medication Regimens are Altered
(Applied Research)
MARIA G. VALDOVINOS (Drake University)
Psychotropic medications are commonly prescribed in a polypharmacy fashion to adults with intellectual and developmental disabilities who engage in problem behavior to treat and reduce behavior; however, the impact these medications (and subsequent changes in medication) have on the behavior they are intended to treat are not well understood. A study was conducted to evaluate the extent to which changes in psychotropic medication regimens altered functional relations between problem behavior and the environment for adults with intellectual and developmental disabilities. This presentation will provide data for two of the participants whose behaviors (i.e., aggression, self-injurious behavior, stereotypy, and presence of adverse side effects) were monitored over several months (7 and 23 month) via direct observation and functional analyses. The results of this study revealed that changes in medication were associated with changes in assessment results. These findings suggest continued surveillance of behavior function when using psychotropic medication to address problem behavior (Funding: NICHD grant #: 1R15HD072497-01).

Behavioral Indicators to Measure the Impact of Psychotropic Medication
(Applied Research)
JENNIFER R. ZARCONE (The May Institute), Cara L. Phillips (The May Institute)
Abstract: This presentation will focus on two innovative analog assessments that we developed to evaluate the behavioral effects of medication for individuals with autism and other developmental disabilities. These analogs were developed to measure specific behavioral effects that go beyond measures of frequency of problem behavior. In the first case, we will describe a behavioral analog that we developed to measure the impact of two attention-deficit hyperactivity disorder (ADHD) medications on out of seat and problem behavior. The trial showed that the initial medication (atomoxetine) was more effective than methylphenidate on out of seat behavior but had no significant impact on problem behavior. In the second case, we measured the effects of two antipsychotic medications on reinforcement choice in a self-control analog. Results showed that neither medication affected the individual’s choice or ability to engage in self-control. These data indicate that we may be able to use analog conditions to determine how medications are affecting problem behavior and other related behavior within relevant contexts. These analogs assessments can be useful in clinical and educational settings.

Promoting Early Social Skills in Infants and Children At-Risk of Autism Spectrum Disorder and Fragile X Syndrome
Chair: Jacqueline Carrow (Caldwell University)
Discussant: Jacqueline Carrow (Caldwell University)
We have initiated, replicated, and extended a programmatic line of behavior-analytic research to facilitate and establish early social skills in infants at-risk of developing autism spectrum disorder (ASD). Infant social engagement responses including vocalizations, echoics, joint attention, and social referencing are considered critical developmental milestones that serve as fundamental prerequisites for early communication and social skills (Pelaez, 2009). Treatment based on the principles of Applied Behavior Analysis (ABA) has been consistently regarded as the most efficacious treatment for symptoms of ASD, and as such, has been similarly shown to be effective in teaching emerging social skills to infants at risk of ASD. Specifically, the first presenter will briefly identify the early behavioral indicators of at-risk infants, and overview the application of a brief ABA-based parent treatment model for promoting early infant vocalizations and emerging echoic response. The second presenter will examine the acquisition of joint attention and social referencing repertoires via an operant-learning paradigm arrangement among infants at-risk of ASD and Fragile X syndrome. The discussant will comment on these ongoing programs of research on early social skills in at-risk infant populations using ABA, and explore future directions and implications of this research.

Social Reinforcement Procedures to Establish Vocalizations and Echoics in Infants At-Risk of Autism Spectrum Disorder
(Applied Research)
HAYLEY NEIMY (Shabani Institute & Endicott College), Martha Pelaez (Florida International University), Jonathan J. Tarbox (University of Southern California), Mary Jane Weiss (Endicott College)
Infants who have not yet received any diagnoses often display markers, deficits, and behavioral indicators, that make them “at-risk” of a later ASD diagnosis. Among the hallmark diagnostic criteria of ASD are limitations and impairments in language and communication. Interventions to promote and encourage vocalizations in infants at risk of ASD as early as possible are of utmost priority. The present investigation compares the use of three different operant reinforcers to promote vocalizations, echoic approximations, and echoics with topographical correspondence in three infants at-risk of ASD. The results reliably confirmed findings from similar research (Bendixen & Pelaez, 2010; Pelaez, Virues, & Gewirtz, 2011a and 2011b) that contingent reinforcement procedures are more effective than non-contingent reinforcement procedures. Specifically, the vocal imitation condition reliably produced higher rates and accuracy of all three targeted responses: a) vocalizations, b) echoic approximations, and c) echoics with one-to-one correspondence. Implications of the present study highlight the important role of systematically and contingently arranging the social consequences delivered by the caregiver to promote the vocal behavior of an infant at-risk. Future research and application are discussed in the context of ASD prevention, optimal infant-caregiver environmental arrangements, misplaced contingencies, and the establishment of caregivers as social reinforcers.

Establishing Joint Attention Skills to Facilitate Social Referencing Repertoires in Toddlers via Operant Learning Procedures
(Applied Research)
KATERINA MONLUX (Stanford University; Oslo Metropolitan University ), Martha Pelaez (Florida International University), Jonathan J. Tarbox (University of Southern California)
Abstract: Deficits in social engagement are among the main developmental problems observed among children with autism spectrum disorders (ASD). In particular, joint attention and social referencing skills are critical for the development of more complex social interactions. The use of behavioral techniques and brief parent-infant engagement training has shown to be successful in promoting these social skills. We explore the hypothesis that by targeting joint attention and social referencing skills in the natural environment and by using caregivers as therapists we can potentially mitigate and prevent the development of later onset behavior language problems commonly associated with ASD. The current presentation reviews and extends previously published procedures for the training of joint attention and social referencing modeled after Pelaez and colleagues’ (2012) operant learning paradigm. Further, a model for expanding previous findings to the natural environment with a population at-risk of developing ASD and Fragile X syndrome is proposed where joint attending skills can be taught first to aid in the acquisition of social referencing. While very similar social behavior chains, joint attention and social referencing have functional differences, which will be explained.

Supporting Individuals With Autism Spectrum Disorder in Successful Transitions to Adulthood: Pathways, Pitfalls, and Progress
Chair: Eileen Hopkins (Eden II Programs)
PAIGE RAETZ (Southwest Autism Research and Resource Center)←大学院時代の同級生☆
RANDY I. HOROWITZ (Nassau Suffolk Services for Autism)
Despite the ongoing advances in effective intervention for children with autism spectrum disorder, outcomes in adulthood remain highly variable. This panel will discuss the literature on adult outcomes and the factors that appear to play a role. Presenters will share perspectives and experiences on how families, supporting organizations, and individuals with autism spectrum disorder can work together to plan early and effectively for the transition to adulthood. Gaps encountered in ABA-based educational settings with regard to planning and programming for adulthood will be shared, along with successful strategies to ensure essential skills are identified and developed. The panel will integrate information from available research on adult outcomes, and direct experience as service providers in areas including: identifying appropriate curricular targets, consideration of different approaches to build essential skills, assessment, progress monitoring, risk analysis, individual choice making, and approaches to service delivery fidelity and accountability. Panel presenters will share experiences and insights from three different service organizations across the United States of America, each of which utilizes different approaches, models, and funding sources, while maintaining a strong commitment to effective services grounded in applied behavior analysis.

Topics in Verbal Behavior
Chair: Rodrigo Dal Ben (Universidade Federal de São Carlos)

Looking Out the Window and Back Inside: A Behavioral Explanation of Early Speech Perception
Domain: Theory
RODRIGO DAL BEN (Universidade Federal de São Carlos), Débora Souza (Universidade Federal de São Carlos)
Abstract: Cognitive researchers have studied early speech perception extensively. Although their data reveal several contingencies involved in early verbal development, the theoretical explanations provided usually contain non-falsifiable constructs, such as cognitive agents. Falsifiable behavioral explanations, based on reflex and operant principles, may offer a more parsimonious alternative. However, explicit consequences for speech perception are usually absent in experimental designs employed by cognitivists and those conducted in natural environments. Automatic reinforcement/consequences are commonly invoked to fill this important gap. Although it may be a more parsimonious heuristic, the falsifiable line that distinguishes its use as a hypothetical construct from an oxymoron can be blurred. Here we analyze previous studies to show that conceptual and practical criteria should be followed for a proper use of automatic consequences as part of a behavioral explanation of verbal development. Conceptually, explicit descriptions of antecedents and of potentially testable relations between responses and assumed consequences should be provided. Practically, its use should promote empirical research on contingencies that establishes explicit consequences as automatic ones, which may require innovative research designs to put the behavior under the microscope. Adhering to these criteria may provide a more complete understanding of speech perception and verbal development.

Teaching Children With Autism Spectrum Disorder Intraverbal Responses About the Past
Domain: Applied Research
JEANNE STEPHANIE GONZALEZ (Johanna McDonald, LLC), Sarah Slocum (Marcus Autism Center and Emory School of Medicine)
Abstract: Research has demonstrated that responding to questions regarding past events is a developmental milestone typically reached by age three or four. Individuals with Autism Spectrum Disorder (ASD) might struggle with this skill in comparison to their neurotypical peers. This study describes a methodology for teaching subjects with ASD intraverbal responses about past events by systematically increasing delays between the presentation of target stimuli and the delivery of a question about the target stimuli. Probes of the terminal delay were conducted after each successive increase in delay. Results showed both subjects successfully responded to questions after a 30-min delay following some level of treatment. This study demonstrated an effective method for teaching intraverbal responses describing past events. More research is needed to replicate these results, study different methods for teaching this skill, and test theoretical mechanisms for remembering.

New Approaches to Communication and Social Speech for Children With Autism Spectrum Disorder
Chair: Marjorie H. Charlop (Claremont McKenna College)
Discussant: Ruth M. DeBar (Caldwell University)
Children with autism spectrum disorder (ASD) display characteristic communication deficits that interfere not only with verbal behavior but with social interactions as well. Researchers continue with their endeavors to find creative solutions and novel approaches. The present symposium includes four studies in which innovative interventions have been designed to help children on the spectrum advance in their social communication. In the first presentation, a new form of script prompting, a picture-script intervention, was created to teach minimal verbalizers to speak in full sentences. In the second presentation, children with limited verbal skills were taught to approach and initiate a verbal request for play to a peer using the Multiple Incidental Teaching Sessions (MITS) procedure. Presentation 3 discusses the use of heritage language for bilingual children with ASD during parent presented Natural Language Paradigm (NLP) sessions. Finally, the last study presents results from an assessment of social language during indoor versus outdoor social skills groups. Taken together, this symposium provides new interventions and adaptions to facilitate the children’s social communication. Exciting prospects can be drawn as we look forward to continued success in teaching communication to children with autism spectrum disorder.

Increasing Speech via Picture Script With Children With Autism Spectrum Disorder
Caitlyn Gumaer (Claremont Graduate University), Marjorie H. Charlop (Claremont McKenna College), Jenna Gilder (Claremont Graduate University), ALANNA DANTONA (Claremont Graduate University ), Benjamin R. Thomas (Claremont Graduate University), Brittany Nichole Bell (Claremont Graduate University)
Typically, communication interventions target nonverbal children and highly verbal children with autism spectrum disorder (ASD), but fewer focus on those in the middle who are considered “phrase speakers.” It may be possible to adjust the highly successful script programs that have been designed for verbal children for these phrase speakers (Charlop-Christy & Kelso, 2003). The present study used a multiple baseline design across participants to examine the effects of a picture-based script program with four school-aged, phrase speakers with ASD. Picture cards, similar to those used in PECS, were set up on a sentence strip, for the children to say. Each sentence contained verb pictures (to eat, to play), quantity pictures (numbers), size pictures (big, little), colors (red, orange, green), and nouns (candy, cars). Essentially, the child learned to say, “I want to play big blue cars” as opposed to “I want car.” The pictures were faded out until the child used only speech. Initial results indicate significant increases in mean length of utterances across all four participants. Results also indicate generalization to unfamiliar therapists in unfamiliar settings across three of the four participants. Findings from the current study may yield implications for communication interventions for phrase speakers with ASD.

Using Multiple Incidental Teaching Sessions to Increase Play Initiations for Children With Autism Spectrum Disorder
JENNA GILDER (Claremont Graduate University), Marjorie H. Charlop (Claremont McKenna College)
Children with autism spectrum disorder (ASD) may experience severe speech delays and language deficits (Schreibman, 1988) that as a result can restrict their already limited social skills (Diagnostic and Statistical Manual of Mental Disorders-5th edition). To address these concerns, the present study examined the use of Multiple Incidental Teaching Sessions (MITS) paired with an incremental time delay to teach appropriate verbal initiations for play to children with ASD. This study used a multiple baseline design across six participants with ASD. Each child was taught to ask their peer to play with them via MITS. In baseline, all six children did not consistently ask their peer to play. During intervention, all of the children learned quickly to independently ask their peers to play. Five of the six children generalized the skill to a new setting and to their sibling. Maintenance was also seen at 6-months. These finding provide support for the use of MITS in teaching social verbal initiations to children with ASD.

Assessing Bilingual Language Acquisition in Children With Autism Spectrum Disorder Using the Natural Language Paradigm
CAITLYN GUMAER (Claremont Graduate University), Nataly Lim (University of Texas at Austin), Alanna Dantona (Claremont Graduate University), Marjorie H. Charlop (Claremont McKenna College)
Little research has been done with bilingual children in their heritage language with autism spectrum disorder (ASD) as practitioners and parents fear that exposing a child with ASD to more than one language will cause further delays in language development and other core deficit areas (Kremer-Sadlik, 2005). Yet recent research has found that exposure to and the use of heritage languages can be advantageous (Lim & Charlop, 2018). However, research has yet to explore how exposure to both one’s heritage language and English can impact a child with ASD’s language abilities and verbal behavior. The present study used a multiple baseline design across four parent-child dyads to assess bilingual language acquisition using the Natural Language Paradigm (NLP; Laski, Charlop & Schreibman, 1987; Spector & Charlop, 2018). Following free-play baseline sessions, four mothers were taught to implement NLP in both their heritage language (i.e., Spanish, Korean) and English. To control for treatment effects, NLP was counter-balanced across the four parent-child dyads. Upon the implementation of NLP, regardless of language condition, each child’s appropriate verbalizations increased during NLP treatment sessions and in free-play probe sessions. Findings from the current study may yield implications for language interventions for bilingual children with ASD.

Treating Sleep Problems in Children With Autism: Complexity, Outcomes, and Collateral Effects

Chair: Laurie McLay (University of Canterbury)
Discussant: Stephanie Gerow (Baylor University)
Sleep problems are ubiquitous among children and adolescents with autism spectrum disorder (ASD). Without effective treatment these sleep problems are unlikely to resolve, resulting in adverse secondary effects on the daytime functioning and wellbeing of people with ASD and their families. Sleep problems in children with ASD are underpinned by a combination of biopsychosocial factors and treatments include both pharmacological and behavioral approaches. However, to date we know little about how parental attributions about sleep problems and child and family complexity variables affect treatment selection, perceptions of efficacy, and outcome. This symposium contains a series of data-based presentations evaluating these important issues, including: (a) the efficacy of individualized, assessment-informed behavioral interventions for sleep problems in children with ASD, (b) child and family complexity variables and their impact on treatment outcomes, (c) parental attributions about sleep problems in their child with ASD, and (d) the collateral child and family benefits of effective sleep treatment.

Assessment and Treatment of Sleep Problems in Young Children: Behavioral Intervention With and Without Pharmacological Intervention
SANDY JIN (California State University, Northridge), Frank Gutierres (California State University, Northridge), Sevan Ourfalian (California State University, Northridge)
Sleep problems are prevalent and persistent in young children, especially children diagnosed with Autism Spectrum Disorder (ASD). These problems negatively impact the health and development of young children and are often challenging to address for caregivers and clinicians. Pharmacological interventions, such as melatonin, are commonly recommended for pediatric sleep problems despite limited research on their efficacy and social acceptability. Function-based behavioral interventions show merit as a promising alternative but has yet to draw to focus of mainstream treatment providers. This present study evaluated the efficacy of personalized and assessment-based behavioral intervention on the sleep problems of children diagnosed with ASD. Nighttime infrared video and sleep diary were used to measure sleep interfering behaviors, sleep onset delay, night and early waking, the total amount of sleep, as well as other relevant variables in the participating children. Parents and caregivers were encouraged to assist with treatment development during the assessment process and served as interventionists at home following behavioral skills training. A multiple-baseline-across-subjects designed was used to evaluate the treatments. Parents also provided feedback on the acceptability of each treatment and on their satisfaction with the outcomes.

The Collateral Benefits of Treating Sleep Problems in Children With Autism
LAURIE MCLAY (University of Canterbury), Karyn G. France (University of Canterbury), Neville Morris Blampied (University of Canterbury), Jemma Vivian (University of Canterbury)
Sufficient quality of sleep is essential to an individual’s health, wellbeing, and development. Sleep problems affect a large number of children with Autism Spectrum Disorder (ASD) and are likely to persist if not effectively treated resulting in profound negative effects on the daytime functioning and well-being of children with ASD and their families. Behaviourally-based treatments, including extinction, adaptations to the sleep-wake schedule, reinforcement, and modifications to sleep hygiene practices have strong empirical support. Increasingly, these interventions are individualized based on the outcomes of Functional Behavioural Assessment (FBA). The present study evaluated the collateral effects of resolving sleep problems on children’s daytime behaviour and ASD symptomatology, and parental mental health, sleep, and relationship quality. Data is presented for 40 participants with ASD between 2-18 years of age who received a FBA-based, parent-implemented intervention. The Child Behavior Checklist, Gilliam Autism Rating Scale-3, Pittsburgh Sleep Quality Index, Depression, Anxiety, and Stress Scale, and Relationship Quality Index were administered during baseline and short-term follow-up to assess the collateral benefit of any improvement in sleep. Preliminary data indicates significant improvement in all measures of collateral behaviour change and well-being. This data and the implications thereof will be discussed.

Sleep Problems in Children and Adolescents With Autism: Type, Impact, Parental Attributions and Help-Seeking Behavior
AMARIE CARNETT (University of Texas at San Antonio), Laurie McLay (University of Canterbury), Sarah Grace Hansen (Georgia State University), Karyn France (University of Canterbury), Neville Morris Blampied (University of Canterbury)
Sleep problems of varying types and topographies are commonly reported among parents of children with autism spectrum disorder (ASD). Without effective treatment, sleep problems in children with ASD are likely to persist and can result in adverse long-term effects. Although the literature indicates higher rates of sleep problems in individuals with ASD, compared to typically developing children, little is known about the interaction between parental attributions about their child’s sleep problem and treatment selection; how parental beliefs align with research evidence; and the interaction between sleep problem type and child and family impacts. The purpose of this study was to examine the types of sleep problems reported by parents of children with ASD; parental attributions about the locus, stability and controllability of sleep problems; and the secondary impact of sleep problems on children and families. Data from 221 respondents collected via an online survey will be presented. Overall findings and implications will be discussed.

Case Complexity, Family Engagement, and Sleep Outcomes in Families Presenting for Behavioral Treatment of Sleep Problems in Their Child With Autism
Karyn France (University of Canterbury), LAURIE MCLAY (University of Canterbury), Neville Morris Blampied (University of Canterbury), Yvonne Chow (University of Canterbury), Philip Ng (University of Canterbury)
Case complexity in families of children with sleep problems and autism may be expected to present barriers to the effectiveness of treatment based on Functional Behaviour Assessment (FBA). This study investigated the extent to which this was the case in up to 40 families who completed, and 15 who did not complete, an intervention for their sleep problems. Families were rated on complexity using a scale developed from that presented by Kazdin (2006). The scale rated child comorbidity, parental mental diagnoses, child health, scope and severity of child dysfunction, socioeconomic disadvantage, parent and family functioning, risk, and barriers that emerged during treatment. The complexity scale was correlated with retention in the intervention programme and measures of sleep outcome including the Children’s Sleep Habits Questionnaire and the Sleep Problem Severity Score. The results indicated that, for families who completed the intervention programme, complexity in and of itself did not predict sleep-related outcomes. Complexity did however predict retention in the programme. Results are discussed in the light of best practice for assessment in FBA, the need for intervention to specifically target parental behaviours and support for families embarking on such an intervention





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