BEH 5049 Unit 9 Slides

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 1 BEH 5049 Unit 9 Interdisciplinary Assessment and Treatment of Problem Behavior: Working With Other Health Professionals Iser G. DeLeon, Ph.D., BCBA-D 1 Outline A. Introductory Comments on Working With Non-Behavior Analysis Professionals on Problem Behavior B. Working With Medical Professionals C. Working With Speech, Hearing, and Language Professionals D. Working With Occupational Therapists E. Summary Comments on Collaborating on Problem Behavior 2 Outline A. Introductory Comments on Working With Non-Behavior Analysis Professionals on Problem Behavior B. Working With Medical Professionals C. Working With Speech, Hearing, and Language Professionals D. Working With Occupational Therapists E. Summary Comments on Collaborating on Problem Behavior 3 Section Outline A. Introductory Comments on Working With Non-Behavior Analysis Professionals on Problem Behavior 1. BA and Interdisciplinary Settings 2. Range of Interdisciplinary Efforts in ASD 3. BACB Ethics Code on Collaboration and its Practical Implications 4 Tasks q H-9: Collaborate with others who support and/or provide services to clients. q H-8: Make data-based decisions about the need for ongoing services. (BACB ® , 2017) 5 Objective q Interdisciplinary setting a. Define b. Identify examples and non- examples 6

Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 2 Interdisciplinary Settings q Professionals representing “multiple disciplines collaborate to improve outcomes of individuals” (Brodhead, 2015, p. 70). q Current focus = interdisciplinary collaborations most relevant to assessment and treatment of PBx 7 BA & Interdisciplinary Settings q Behavior analysts often work as part of an interdisciplinary team, sometimes converging upon the same behavior targets q Different team members may prescribe different intervention elements for a client q Ideally, all team members are aware of every intervention and how interventions may potentially interact 8 ASR ❑ Define an ”interdisciplinary setting”: 9 ASR ❑ Yuri is a BCBA ® who works in an interdisciplinary setting. When talking with an occupational therapist, Yuri is provided several OT interventions. It is important that Yuri review these interventions to determine how they may interact with his own proposed interventions. a. True b. False 10 ASR q Which of the following is an example of a behavior analyst working in an interdisciplinary setting? a. Allison meets with the team at the gymnasium where her client takes classes. She reviews with them the new intervention for self-injurious behavior and ensures they can implement the plan accurately b. Axel is working with children with severe eating disorders. He hosts a group meeting monthly with the parents of his clients to discuss challenges that they face and to provide general recommendations and support for the families ( ASR continues next slide ) 11 ASR (continued) a. Amanda works as a BCBA in a pediatric hospital setting. She meets with the OT to review assessment results for a client with significant eating difficulties. Together the OT and Amanda determine appropriate goals for the client to improve chewing and swallowing and increase the variety of foods accepted b. Austin is a BCBA who supervises six RBTs. He meets with them monthly as a group to review research articles and discuss client applications of the procedures in the research articles 12

Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 3 Benefits of Collaboration q Effective interdisciplinary planning promotes: § Frequent updates of progress across professionals § Joint problem-solving § Collective progress evaluation (LaFrance et al., 2019) 13 Benefits of Collaboration (continued) q “[Enhanced outcomes] can be achieved with a foundation of shared ethics and mission, combined with a respect for the unique expertise each discipline offers” (LaFrance et al., 2019, p. 710). 14 Primary Areas of Professional Emphasis (BACB, n.d.) 15 (Green et al., 2006, p. 76) Number of Concurrent Treatments for ASD 16 Common ASD Treatments: ABA Behavior analysis • 5 of top 25 (Green et al., 2006, p. 76) 17 Common ASD Treatments: Pharmacological and Dietary Pharmacotherapy Biological therapy Dietary interventions • 12 of top 25 • 35 other medications (clonidine, Prozac, etc.) listed in top 108 (Green et al., 2006, p. 76) 18

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 4 Common ASD Treatments: Speech and Language Speech & language • 3 of top 25 (Green et al., 2006, p. 76) 19 Common ASD Treatments: Occupational Therapy Occupational therapy • 2 of top 25 (Green et al., 2006, p. 76) 20 Common ASD Treatments q 21 of 25 most common treatments come from: § Applied behavior analysis § Medication; supplements; diet § Speech and language pathology § Occupational therapy (Green et al., 2006) 21 ASR ❑ Which of the following disciplines were identified as providing the most common ASD treatments? ❑ Occupational therapy ❑ Applied behavior analysis ❑ Speech and language pathology ❑ Chiropractic ❑ Medication, supplements, and diet 22 ASR ❑ Treatments for ASD are most commonly used: a. In isolation b. In combination with other treatments 23 Objective q Given a scenario, identify the best course of action for a behavior analyst to take when collaborating with other professionals 24

Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 5 BACB Ethics of Collaboration q What are BACB ethical obligations concerning interdisciplinary collaboration? q What are practical implications? § Putting ethics into practice 25 BACB Ethics Standard 2.10 q Collaborating with Colleagues § Prioritize the best interests of the client § Compromise when possible, but prioritize the client’s welfare (BACB, 2020) 26 BACB Ethics Standard 3.01 q Responsibility to Clients § Support client rights § Do no harm § Act in their best interest (BACB, 2020) 27 Practical Implications of Supporting Client’s Interests q Prioritizing the client’s best interest can mean: § Demonstrate respect for the knowledge and skills that others bring to a case § Gain an understanding of nonbehavioral interventions § Offer your expertise in systematically evaluating interventions (sometimes unproven) promoted by other professionals 28 ASR ❑ Which of the following statements are true regarding the BACB ethics code and interdisciplinary settings? ❑ ABA should always be placed first as a potential treatment ❑ We do not coerce people to use the treatment we select ❑ We have an obligation to support the client’s best interests ❑ One of our main priorities should be to disprove nonbehavioral approaches 29 Collaboration Example: Lerman at al. (2008) q “Appraisal could be extended to an experimental analysis when caregivers are not dissuaded from employing unproven therapies. A behavior analyst could offer his or her expertise in the measurement and analysis of behavior to help evaluate therapeutic outcomes” (p. 50). 30

Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 6 Unproven Therapy Example in Lerman et al. (2008) q Hyperbaric oxygen therapy (HBOT): Inhalation of concentrated oxygen inside pressurized chamber q Promotes dissolution of oxygen into the blood; enhancing reparation of damaged tissue q Relevance to ASD: “by reversing neurological abnormalities that might be associated with this disorder” thereby proving effects “beneficial for children with autism” (p. 51) “ HyperBaric Oxygen Therapy Chamber 2008.jpg ”, by James Heilman, MD , CC BY-SA 3.0 31 Evaluation Example in Lerman et al. (2008) q Evaluated task engagement and problem behavior during 10-minute instructional sessions at a therapy center: § Baseline: Before HBOT intervention § During HBOT: 60-minute HBOT sessions on the same day § Post-HBOT: After termination of HBOT intervention 32 Data From Lerman et al. (2008) (p. 55) 33 Lerman et al. (2008) Conclusions q HBOT provided little benefit, if any q Helped inform caregivers to make an informed decision regarding treatments q Demonstrates a model to evaluate interventions proposed by other disciplines 34 ASR q The Lerman et al. (2008) study evaluated the effectiveness of HBOT by measuring task _____ and problem behavior, across individuals with _____ start dates, through a _____ _____ design. 35 ASR ❑ The Lerman et al. (2008) study explicitly set out to disprove HBOT effectiveness because it could potentially be dangerous for individuals who receive it. a. True b. False 36

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 7 BACB Ethics Standard 2.12 q Considering Medical Needs § Assess and address medical needs first, if there is any reasonable likelihood the behavior is influenced by medical or biological variables (BACB, 2020) 37 BACB Ethics Standard 2.19 q Addressing Conditions Interfering with Service Delivery q When conditions interfere with service delivery: § Remove or minimize the interfering conditions § Modify the intervention § And/or obtain or recommend assistance from other professionals (BACB, 2020) 38 BACB Ethics Standard 3.06 q Consulting with Other Providers § Arrange for consultation and/or referrals in the best interests of their clients (BACB, 2020) 39 Practical Implications of Medical Considerations q Recognize the signs that may indicate the influence of medical or biological variables q Make appropriate referrals to other professionals when the best interest of the client involves methods in their domain q Make appropriate referrals to medical professions to rule out potential medical or biological causes of PBx 40 Example: Otitis Media q O’Reilly (1997) § Conducted standard functional analysis sessions for a 2-year-old girl under two conditions: • When diagnosed with otitis media • When not diagnosed with otitis media 41 O’Reilly (1997) Results (p. 167) 42

Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 8 O’Reilly (1997) Conclusions q Presence of otitis media impacted the likelihood of problem behavior q Behavior analysts are ethically obligated to address medical needs first q Resolving medical issues might eliminate the need for a complex behavioral intervention 43 ASR ❑ Vincent’s client has begun engaging in self-injurious behavior, which has not occurred in the past. Vincent suspects there may be a medical reason for the new behavior. What is the appropriate next step for Vincent? a. Make a referral to another behavior analyst b. Intervene immediately to decrease self-injury, regardless of the reason c. Make a referral to an appropriate medical professional d. Conduct a functional analysis on self-injury 44 ASR ❑ In the O’Reilly (1997) study, problem behavior occurred most often when _____ and the _____. a. Otitis media was present; radio was off b. Otitis media was absent; radio was on c. Otitis media was absent; radio was off d. Otitis media was present; radio was on 45 BACB Ethics Standard 2.17 q Collecting and Using Data § Use graphical data to make decisions about continuing, or modifying services q Can use data to help make decisions about treatment proposed by other professionals (BACB, 2020) 46 Practical Implications of Using Data q In your data stream, indicate changes to facilitate evaluation of nonbehavioral interventions q When presenting data on the influence of nonbehavioral interventions, format data in a manner that will resonate most clearly with other professionals 47 0 1 2 3 4 5 6 7 8 9 0 5 10 15 20 25 30 35 40 45 SELF-INJURIOUS BEHAVIOR (RPM) DAY OF OBSERVATION 9am 11am 1pm SIB Total 0.5mg Guan. (6am/pm) 1.0mg Guan. (6am/pm) 3 Drops CBD qd (AM) 1.0mg Guan. (6am/pm) 1.0mg Guan. (6am/pm) Loratadine 10mg qd 1.0mg Guan. (6am/pm) 1.0mg Guan. (6am/pm) Loratadine 10mg qd 0.5mg Guan. 6am 1.0mg Guan. 6pm Loratadine 10mg qd Medication Effects Evaluation Example 1 Courtesy of Iser G. DeLeon 48

Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 9 Medication Effects Evaluation Example 2 Courtesy of Iser G. DeLeon 49 ASR ❑ Graphical displays of data that are shared with nonbehavioral professionals should be no different than the graphs shared between behavior analysts. a. True b. False 50 ASR ❑ How can behavior analysts help evaluate the effects of nonbehavioral interventions? a. Use of experimental designs to track changes in behavior due to changes in intervention b. Assist nonbehavioral professionals in interpreting relevant literature c. Promote only interventions proven effective in behavior analytic journals d. Behavior analysts should not evaluate the effects of nonbehavioral interventions 51 ASR ❑ Ronald is Sun Lee’s client. He begins engaging in high-pitched screaming. Given the sudden emergence of the problem behavior and how disruptive it is in social environments, Ronald’s parents and school are concerned. Sun Lee participates in a meeting with all stakeholders. The school psychologist recommends that Ronald receive auditory integration training from an SLP as she has seen children’s inappropriate behaviors reduce after completing this treatment. 52 ASR (continued) q Given this scenario, what is the best course of action for the behavior analyst to take? a. Sun Lee should review with the team the importance of intervening based on the function of the behavior and recommend that an FBA and a medical exam be conducted before they initiate specific interventions b. Excuse herself from the meeting and resign from Ronald’s case as these are inappropriate interventions c. Explain that while the family may pursue the intervention, she cannot vouch for its efficacy d. Explain to the school psychologist that it is not her job to make recommendations; it is Sun Lee’s job to determine the best intervention and that she only agreed to the meeting as a courtesy to the family 53 Outline A. Introductory Comments on Working With Non-Behavior Analysis Professionals on Problem Behavior B. Working With Medical Professionals C. Working With Speech, Hearing, and Language Professionals D. Working With Occupational Therapists E. Summary Comments on Collaborating on Problem Behavior 54

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 10 Section Outline B. Working With Medical Professionals 1. PBx during routine health procedures 2. Biological influences/causes of PBx 3. Working with prescribing professionals on PBx: • Pharmacological treatment in ASD • Drug-function interactions • Simple model for using behavioral observations in drug evaluation 55 Task H-9 q Collaborate with others who support and/or provide services to clients. (BACB, 2017) 56 Objective q Intervention approaches used to minimize problem behavior during health exams a. Identify types b. Identify examples and non- examples 57 PBx During Routine Health Exams/Procedures (Iwata et al., 1994, p. 231) 58 PBx During Routine Dental Exams/Procedures (McConnell et al., 2020, p. 2239) 59 Prevalence of PBx During Routine Dental Exams/Procedures q Children with intellectual and developmental disabilities (IDD) are more likely to display “anxiety” at the dentist than typically developing peers (Stein et al., 2014) q Estimates suggest that as many as 22% of children with ASD engage in disruptive behavior when seen by pediatric dentists (McConnell et al., 2020) 60

Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 11 General Intervention Approaches q Caregiver-implemented interventions to prepare clients for exams q Intensive behavioral intervention outside of the exam context q Strategies implemented by health professionals to minimize PBx during exams 61 ASR ❑ List three general ways that interventions can be implemented to address problem behavior that occurs during medical procedures: 62 Example: Caregiver-Led Intervention q Schieber (2021) § Verbal instruction to parents on “mock dental exam” procedures § Behavioral skills training (BST) • For procedures not performed accurately on 100% of probe trials • Instruction, modeling, rehearsal, and feedback § Parent training required less than 45 minutes § Once trained, instructed caregiver to practice “at their leisure” 63 Example: Caregiver-Led Intervention Data Sheet q Caregiver data sheet (Schieber, 2021) 64 Example: Caregiver-Led Intervention Data Sheet: Mock Exam (Schieber, 2021) 65 ASR ❑ A caregiver-led intervention is one in which a parent or caregiver tells the therapist when and where to run simulated exposure trials. a. True b. False 66

Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 12 ASR ❑ Training caregivers to implement simulated medical procedures: a. Should never be done b. Takes a very long time and thus, should be done rarely c. Can be done relatively quickly d. Does not require any training 67 S1 S2 S3 Example: Caregiver-Led Intervention Filled columns indicate days of practice and whether practice was successful (green) or not (orange) (Schieber, 2021) 68 Example: Caregiver-Led Intervention Data (Schieber, 2021) 69 ASR ❑ Which of the following are drawbacks to caregiver-led interventions? ❑ Behavior analyst involvement is maximized ❑ Requires minimal caregiver time ❑ Requires more caregiver time ❑ Not as effective as intensive behavioral interventions 70 Intensive Behavioral Intervention q Longer, more complex interventions q Conducted by behavior therapist, technician, or teacher q Sessions conducted in analog settings q Generalization probes in real context 71 Intensive Behavioral Intervention Research Examples q Cuvo et al. (2010, 2012) § Intensive desensitization interventions in analog environments § Demonstrate generalization to real dental appointments § Multiple treatment components, including graduated exposure (stimulus fading) 72

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 13 Cuvo et al. (2010) Procedures: Graduated Exposure (p. 687) 73 q Video modelling q Stimulus fading q Distraction (preferred items) q Photo prompts q Differential reinforcement q Escape extinction Cuvo et al. (2010) Procedures: Treatment Package 74 (p. 687) Cuvo et al. (2010) Results 75 ASR q Intensive behavior intervention is most often conducted in a(n) ____ setting. 76 ASR ❑ Which of the following are likely the most appropriate interventions to include as part of an intensive behavioral intervention? ❑ Positive punishment ❑ Stimulus fading ❑ Shaping ❑ Prompting ❑ Sensory integration 77 Objective q Given a scenario, identify the role of medical professionals in the treatment of ASD 78

Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 14 Strategies Implemented by Health Professionals q Train the health professional to implement a behavioral strategy q Example: Allen and Wallace (2013) § Trained dentists to implement noncontingent escape during dental appointments § Assessed fidelity of implementation, effectiveness, and treatment acceptability 79 q Group design q Control group § Treatment as usual: “Tell-show-do” § Stopped treatment for safety reasons q Experimental group § Same as control group plus noncontingent brief breaks (8–10 seconds) § Delivered on a fixed-time 15-s schedule Allen and Wallace (2013): Procedures 80 (p. 732) Allen and Wallace (2013): Results 81 ASR ❑ If a behavior analyst provides training to a home healthcare aide and their data determine that teaching was effective, they do not need to collect data on the acceptability of procedures. a. True b. False 82 ASR ❑ Which of the following is an example of a caregiver- led intervention? a. A teacher implements a token system during recess b. A grandmother practices exposing her granddaughter to latex gloves that will be used during a surgery c. A surgeon sends a few articles on autism to a family after meeting them during a consultation d. An RBT ® implements a forward-chaining strategy to teach putting on deodorant during afternoon in-home sessions 83 ASR ❑ Evie is working with nurses to help conduct strep throat tests with young children. Evie teaches the nurses to increase the intrusiveness of the procedure gradually while providing breaks after each step. What is this an example of? a. Caregiver-led intervention b. Intensive behavioral intervention c. Healthcare provider implementing behavioral strategies d. Backward chaining 84

Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 15 ASR ❑ A behavior technician is implementing a program where a client is slowly exposed to dental procedures. The technician practices placing a small mirror and tube around the client’s mouth at least three times per session. a. Intensive behavioral intervention b. Caregiver-led intervention c. Intervention implemented by healthcare providers 85 ASR q Liza has a rare genetic disorder that requires yearly scans and medical checks. She has begun engaging in problem behavior that prevents doctors from conducting the tests. As part of her ABA sessions, Liza’s therapists begin wearing scrubs and masks and implementing a DRO for the absence of challenging behavior. They then introduce basic physical touches that replicate some of the checks the doctors will do. They work with Liza until she can participate without difficulty. This is an example of which intervention approach? a. Intensive behavioral intervention b. Caregiver-led intervention c. Health professional implemented strategy d. Collaborative strategy designed by an interdisciplinary team 86 ASR q The dentist cannot clean Jackie’s teeth due to her problem behaviors and refusal to keep her mouth open. Her BCBA teaches Jackie’s parents to integrate a dental mirror and scraper into Jackie's tooth-brushing routine. Initially, her parents show how they use the mirror and scraper on each other’s teeth. Stepwise, they have Jackie accept: Proximity of the tools, the tools in her mouth, the tools moving around and touching her teeth, and using the tools while she is reclined in a chair. This is an example of which intervention approach? a. Intensive behavioral intervention b. Caregiver-led intervention c. Health professional implemented strategy d. Collaborative strategy designed by an interdisciplinary team 87 ASR q Ella, a pediatrician, often treats children who struggle to remain still during blood pressure checks. She contacts a BCBA, and he teaches her how to use a high-p sequence based on behavioral momentum to increase the likelihood of success. Ella also learns how to use the Premack principle to increase behavioral success with her patients. While she still has difficulty occasionally, using those strategies has resulted in a much higher rate of success in taking her patients’ blood pressure. This is an example of which intervention approach? a. Intensive behavioral intervention b. Caregiver-led intervention c. Health professional implemented strategy d. Collaborative strategy designed by an interdisciplinary team 88 Objective q Identify strategies to increase cooperation with health visits identified by Kupzyk and Allen (2019) 89 Behavioral Interventions to Increase Cooperation q Kupzyk and Allen (2019) review of strategies to increase comfort/compliance in IDD identified these strategies: § Graduated exposure (81% of studies) § Contingent reinforcement (81% of studies) § GE plus contingent reinforcement (72% of studies) § Less common: • Modeling and prompting • Distraction/relaxation • Behavioral momentum (preceding low-p requests with high-p requests) • Managing noncompliance (response blocking, brief breaks, escape EXT) 90

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 16 Increasing Cooperation Through Graduated Exposure q Kupzyk and Allen (2019) recommendations: (p. 245) 91 ASR q What are the two most common procedures used when working to increase cooperation with medical exams? 92 ASR ❑ Which of the following are appropriate strategies to use when attempting to increase cooperation with medical procedures? ❑ In vivo modeling ❑ Facilitated communication ❑ Contingent exercise ❑ Using a hierarchy of steps ❑ Noncontingent access to preferred items 93 Graduated Exposure Example: Pill Swallowing q Beck et al. (2005) § Eight kids with ASD or ADHD § DRA for swallowing (toy from a prize bag) § Graduated exposure = systematically increased mock-pill size (p. 519) 94 Beck et al. (2005): Results (p. 521) 95 ASR ❑ In the case of pill swallowing, what was gradually adjusted? a. Pill position b. Pill shape c. Pill color d. Pill size 96

Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 17 Graduated Exposure Example: Blood Draws q Shabani and Fisher (2006) § 18-year-old male with ASD and diabetes; required needle sticks to draw blood for glucose monitoring § Graduated exposure (stimulus fading) plus DRO 97 Graduated Exposure Example: Blood Draws (continued) q Shabani and Fisher (2006) Steps § Step 1: • Arm positioned in a drawn outline • Lancet positioned 61 cm from index finger • Keeping arm in outline for 10 s à preferred edible reinforcer • Arm movement outside outline à terminate trial § Steps 2–7: Moving lancet closer § Step 8: Lancet 1 cm above finger for 10 trials, blood draw on 11 th trial § Step 9: Intermittent blood draws 98 Shabani and Fisher (2006) Results (p. 451) 99 ASR ❑ In the blood draw study, which two interventions were used? a. Differential reinforcement of alternative behavior; graduated guidance b. Graduated exposure; differential reinforcement of alternative behavior c. Differential reinforcement of other behavior; graduated exposure d. Graduated guidance; differential reinforcement of other behavior 100 ASR ❑ How was measurement conducted in the blood draw study? 101 Objective q Biological states a. Identify their relation to problem behavior b. Identify some that are MOs for problem behavior c. Identify methods for detecting d. Given a scenario, identify the effect that biological states have on behavior 102

Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 18 Motivating Operation (MO) Revisited q An antecedent environmental variable that increases or decreases the effectiveness of a consequence and thus evokes or abates a response. 103 Biological States as AOs Related to PBx q Biological states can decrease the effectiveness of some consequences (abolishing operations) § E.g., Some drugs’ effects alter the effectiveness of food as a reinforcer § E.g., Some drugs’ effects involve suppressing all behavior, including adaptive behavior, presumably diminishing the relative effectiveness of natural reinforcers to any behavior 104 Biological States as EOs Related to PBx q Biological states can increase the effectiveness of some consequences (establishing operations) § E.g., Many instances involve increasing the effectiveness of escape by “making the aversive stimulus more aversive” § E.g., Pain may enhance the value of escaping instructional activity 105 Implications of Biological States as MOs Related to PBx q The most direct route to assessing the problem behavior may be understanding the influence of the biological state q The most direct route to effective treatment is altering the biological state q Thus, it is important to rule out or confirm biological influences for PBx before implementing behavioral intervention 106 ASR ❑ The biological states of an organism will always function as an abolishing operation. a. True b. False 107 ASR ❑ Often, the best solution when it comes to managing problem behavior affected by biological states is: a. Ignore the biological state until it resolves itself b. Directly address the biological state, referring to medical professionals as necessary c. Discontinue services until the biological state is resolved d. Implement behavioral interventions as soon as possible 108

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 19 Examples of Biological States as MOs Related to PBx q Medical conditions/biological variables known to influence the probability of PBx in the BA literature (May & Kennedy, 2010): § Otitis media § Allergies § Sleep deprivation § Gastroesophageal reflux § Fatigue § Dysmenorrhea § Seizure disorders § Constipation § Drug-induced states 109 Example: Allergy Symptoms q Kennedy and Meyer (1996) § Functional analysis sessions,13-year-old boy § Attention, demand, “no attention” (ignore), and “recreation” (toy play control) sessions § Two naturally occurring conditions: • Active allergy symptoms (swollen, reddened, & irritated eyes; excess nasal mucous) • No active allergy symptoms 110 Example: Allergy Symptoms Results (Kennedy & Meyer, 1996, p. 135) 111 ASR ❑ List at least three examples of biological states that can affect an organism: 112 ASR ❑ In the Kennedy and Meyer study, how did allergies impact Rudolfo? a. They served as an AO for escape b. They served as an AO for attention c. They served as an EO for escape d. They did not have an impact 113 ASR q In the Kennedy and Meyer study, how was the impact of allergies assessed? 114

Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 20 Example: Sleep Deprivation q O’Reilly (1995) § Functional analysis sessions for a 31-year-old man § Escape and attention conditions under two, naturally occurring conditions: • Sleep deprived (< 5 hr sleep) • Not sleep deprived (> 5 hr sleep) 115 Sleep Deprivation: Results (O’Reilly, 1995, p. 226) 116 ASR ❑ In the O’Reilly (1995) study, sleep deprivation was assessed naturally, not intentionally altered by the researchers. a. True b. False 117 Detecting Biological MOs q Addressing biological state may be best treatment q Identifying biological factors: § Episodic in nature § Cyclical longitudinal patterns of PBx § Listen to caregiver reports § Collateral behaviors consistent with medical conditions/biological events q Refer to health professional as necessary 118 ASR q Identify two ways that biological MOs can be assessed: 119 ASR q Blaze is frequently constipated and reports cramping and other physical discomforts at least once weekly. When experiencing these symptoms, he often verbally refuses to eat or drink and throws food to the floor if someone presents it to him. When Blaze is not constipated, he eats and drinks without problem behavior. Given this scenario, what effect does Blaze’s constipation have on his problem behavior? a. EO for social interactions b. AO for sensory stimulation c. EO for escape d. AO for escape 120

Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 21 ASR q Regan generally loves to play outside with her therapist and will even request it as an activity. However, she has strenuous physical therapy sessions some days before her therapist’s arrival. Regan does not ask to play outside on those days, nor does she respond well in completing her homework with the therapist, which typically precedes the opportunity to play outside. What effect does the physical therapy session have on her requesting and homework behavior? a. AO for access to outside play b. EO for access to outside play c. AO for escape d. EO for social interaction 121 Objectives q Psychotropic medications a. Define b. Identify four concerns q Define prescriptive practices q Identify examples and non-examples of the assessment and approval of drug effects related to psychotropic medication 122 Prevalence of Psychotropic Medications in ASD Treatment (Spencer et al., 2013, p.836) 123 Concerns Regarding Psychotropic Medications q Assessment/approval of drug effects q Polypharmacy q Adverse side effects q Drug-function interactions 124 Approved Drugs and Assessment q Risperidone (Risperdal) and aripiprazole (Abilify) are approved by the U.S. FDA to treat “irritability” in children with ASD q “Irritability is not a disease or a behavior disorder” (Poling et al., 2017, p. 462) q Approvals commonly based on indirect assessments § Risperidone evaluated via Aberrant Behavior Checklist, Childhood Autism Rating Scale § Aripiprazole evaluated via Aberrant Behavior Checklist and Clinical Global Impression of Severity 125 ASR ❑ Which of the following is a concern regarding psychotropic medications? ❑ Approval of drug effects ❑ Size of pills to take ❑ Polypharmacy ❑ Positive side effects ❑ Drug-function interactions ❑ Adverse side effects 126

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 22 ASR q When medical professionals assess whether to prescribe medications, which method is typically conducted? a. Indirect assessments, such as ABC data b. Descriptive assessments, such as scatterplots c. Indirect assessments, such as the Aberrant Behavior Checklist d. Descriptive assessments, such as functional analyses 127 Drug Approval Example: McCracken et al. (2002) (p. 317) q “In this trial, risperidone was safe and effective for the short-term treatment of tantrums, aggression, and self- injurious behavior in children with autistic disorder” (p. 319). 128 (Aman & Singh, 1994) 129 (Aman & Singh, 1994) 130 Difficulties With Indirect Assessment q “Although the ABC is easy to use and is reported by its developer to be a reliable and valid behavior rating instrument … it is also a crude instrument that yields ordinal data and provides no detailed information about how a person with ASD is behaving. Moreover, it provides data that are based on raters’ subjective opinions and memories and provides no information about contextual variables that affect behavior” (Poling et al., 2017, p. 461). 131 ASR ❑ Drawbacks to relying on indirect assessments include: ❑ Direct observation of the behavior of interest ❑ Relying on memory for verbal descriptions ❑ Poor reliability of verbal descriptions ❑ No direct observation of the behavior of interest ❑ There are no drawbacks to indirect assessments 132

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 23 Objective q Polypharmacy a. Define b. Identify examples and non- examples related to psychotropic medication 133 Polypharmacy q Individual simultaneously prescribed multiple medications to treat either the same or different problems § Tendency to continue to use psychotropics and add more during lifetime; if effects of one wane, another may be added § May be more likely with more severe problem behavior 134 Prevalence of Polypharmacy (McCarty, 2021; Feroe et al., 2021) 135 ASR ❑ Polypharmacy is best defined as: a. Tendency for an individual to use less and less psychotropic medication over time b. Tendency to obtain medication from multiple pharmacies c. Tendency for an individual to continue to use psychotropics, adding more throughout their lives d. Tendency for an individual to take one medication at a time 136 Objective q Adverse side effects (ASEs) a. Define b. Identify examples and non- examples related to psychotropic medication 137 Adverse Side Effects (ASEs) q E.g., weight gain, nausea, drowsiness, insomnia, anxiety, tremors, tardive dyskinesia q More likely to experience ASEs if on multiple medications q May function as MOs § Consider effects of insomnia § Consider effects of increased anxiety 138

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 24 Common Adverse Side Effects (ASEs) (Shea et al., 2004, p. e639) 139 ASR ❑ List four examples of adverse side effects from drugs: 140 ASR ❑ For behavior analysts, it is important to recognize that adverse side effects may: a. Function as MOs b. Function as rules c. Function as negative punishment d. Typically reduce rates of behavior 141 Objective q Drug-function interactions a. Define b. Identify examples and non- examples related to psychotropic medication 142 Drug-Function Interactions q States in the person occasioned by psychotropic medication can interact with the functional relations that evoke and support problem behavior 143 Drug Effects and Stimulus Function q Drug-induced changes § Drugs’ effects may serve as motivational operations § Drugs may alter stimulus control—discriminative stimuli that evoke behavior or suppress behavior in the absence of a drug may lose these stimulus functions in its presence § Drugs’ side effects may function as behaviorally relevant stimuli (e.g., anxiety as a side effect) § Drugs may suppress all behavior 144

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 25 Drug Effects on Problem Behavior q May decrease PBx because all behavior is decreased q Could alter the reinforcing value and/or the aversiveness of stimuli, thereby varying the frequency of PBx supported or evoked by those stimuli q Can alter the functional relations that evoke and support PBx q Can alter the effects of behavioral interventions through all the above 145 ASR ❑ States in an organism that are caused by psychotropic medication and can interact with the functional relations that evoke problem behavior. This best defines: a. Function-environment interactions b. Drug-function interactions c. Environment-drug interactions d. Behavior-environment interactions 146 ASR ❑ Identify three ways that drugs can affect functional relations: 147 Example #1 of Drug-Function Interactions Peer Prompts: “Immediately prior to each session, the peer confederate was privately instructed to ‘‘pay attention to what Charlie is doing, and if you see him get out of his seat or if he says anything, you should say something to him about that.’’ (Northup et al., 1997, p. 124) 148 Northup et al. (1997) Conclusions q Medications such as MPH may act as motivating operations by altering the relative reinforcing effectiveness of stimuli § MPH may have decreased the relative reinforcing value of peer attention § MPH may improve student behavior by establishing a particular task as more reinforcing § MPH may reduce the aversiveness of some feature of a task demand 149 ASR ❑ In the Northup et al. (1997) study, the effects of Ritalin were measured by: a. Running ABC data collection both when the child had and had not taken Ritalin b. Running FA conditions only when the child took Ritalin c. Running FA conditions only when the child did not take Ritalin d. Running FA conditions both when the child did and did not take Ritalin 150

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 26 ASR ❑ The results of the Northup et al. (1997) indicated that: a. Ritalin had no impact on behavior b. Ritalin may have increased the value of peer attention c. Ritalin may have decreased the value of adult attention d. Ritalin may have decreased the value of peer attention 151 ASR q How were the results of the Northup et al. (1997) study identified? a. Contingent peer attention resulted in higher rates of behavior in the placebo condition compared to the Ritalin condition b. Contingent peer attention resulted in higher rates of behavior in the Ritalin condition compared to the placebo condition 152 ASR q Logan is taking a benzodiazepine as part of a treatment for his severe self-injurious behavior, which has successfully reduced his aggression. His BCBA observes that Logan is struggling to respond with an appropriate latency to questions he previously would answer quickly and accurately. His teachers report that he is often not completing classwork and appears drowsy and confused, especially in the first half of the day. This is an example of which concern related to the use of psychotropic medication? a. Assessment/approval of drug effects b. Polypharmacy c. Drug-function interactions d. Adverse side effects 153 ASR q Franny has taken Klonopin to help with insomnia for several years. She has recently begun getting up several times in the night to either use the bathroom or request a drink. Her caregiver reports this to the doctor, and she prescribes Lunesta as another sleep aid. This is an example of which concern related to the use of psychotropic medication? a. Assessment/approval of drug effects b. Polypharmacy c. Drug-function interactions d. Adverse side effects 154 ASR q Reese’s parents discuss with her pediatrician her recent increase in nail-biting. The pediatrician asks them about the current home and preschool environments and states that he believes she may suffer from anxiety as she recently started preschool. He prescribes a mild anti-anxiety medication and asks them to schedule a follow-up appointment in three months. This is an example of which concern related to the use of psychotropic medication? a. Assessment/approval of drug effects b. Polypharmacy c. Drug-function interactions d. Adverse side effects 155 Example #2 of Drug-Function Interactions q Valdovinos et al. (2016) § One way to detect a drug’s (risperidone) effects on functional relations is to examine drug effects on FA conditions § Procedure: • Eight participants • 28–49 years old • Diagnosed with moderate to profound IDD • Problem behavior • SIB, aggression, vocalizations, elopement, avoidance 156

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 27 Valdovinos et al. (2016): Procedures q FAs conducted upon enrollment and 2 weeks following medication changes: § Change in medication § Change in dosage § Change in time of administration q Escape, attention, tangible, ignore, and control; quasi-randomized; three repetitions q Indirect assessments with caregivers § QABF, ABC-C Irritability Subscale 157 Valdovinos et al. (2016) Results (Valdovinos et al., 2016, p.6) 158 ASR ❑ When assessing effects of medication on problem behavior, when would it be most relevant to conduct an FA? a. When new medication is added b. When new medication is removed c. When the dose is changed d. All of these 159 ASR ❑ Systematically measuring behavior in similar conditions after removing each of several medications would be considered a: a. Component analysis b. Comparative analysis c. Parametric analysis 160 ASR ❑ Systematically measuring behavior in similar conditions after changing the dosage of a current medication would be considered a: a. Component analysis b. Comparative analysis c. Parametric analysis 161 Valdovinos et al. (2016) Results (Valdovinos et al., 2016, p.6) Vocalizations Responses per Minute 162

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 28 Valdovinos et al. (2016) Results q Indirect assessments may not be the most accurate measure of the effects of psychotropic meds on problem behaviors of individuals with IDD (Valdovinos et al., 2016, p.9) 163 ASR ❑ What correlated with the increase in problem behavior in the last graph shared? a. Klonopin was increased b. Risperdal was discontinued c. Ativan was discontinued d. Zyprexa was decreased 164 ASR ❑ Agreement on effectiveness of medication between ABC-C and FA results was less than 50%. a. True b. False 165 Valdovinos et al. (2016): Conclusions q There is a need for direct observation of behavior to observe med effects q Systematic observations may show actual rate and/or magnitude changes in behavior (rather than judgments or clinical impressions) q New FAs may be necessary after medication change if treatment is no longer effective 166 Example #3: Crosland et al. (2003): Results (p. 274) 167 Crosland et al. (2003): Conclusions q Risperidone may affect behavior in the demand condition by decreasing the aversiveness of the tasks presented q Evidence in nonhuman literature that antipsychotics may affect escape/ avoidance 168

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 29 ASR ❑ Which method is best to use when evaluating the effects of medication? a. Indirect methods b. Observation c. Records reviews d. Any of these 169 ASR ❑ What was the drug-function interaction demonstrated in the Crosland et al. (2003) study? a. Risperidone decreased the aversiveness of task demand b. Risperidone functioned as an AO for edible reinforcement c. Risperidone increased the aversiveness of task demand d. Risperidone functioned as an AO for attention 170 Objective q Given a scenario, identify steps to take when evaluating drug effects 171 Simple Clinical Model for Evaluating Drug Effects q Parent interview: § Ask what symptoms/behavior this drug is expected to alter § Ask what behavioral changes would provide confidence that the drug was effective q Arrange observations of the targeted behaviors using simple single-case designs 172 Evaluating Drug Effects Example: Methods q Megan § 7-year-old girl § ASD and ADHD § Psychiatrist recommended Adderall, 10 mg b.i.d § Parent was unsure she wanted Megan on the drug § We offered to evaluate effects 173 Selecting Behaviors to Measure q Informal interview § Mother completed the ADHD Rating Scale § We asked her: “If the drug is effective, which of these behaviors would you expect to change?” § Highly scored behaviors were operationalized for direct observation (DuPaul et al., 1998) 174

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 30 Selecting Behaviors to Measure (continued) (DuPaul et al., 1998) 175 Operationalized Definitions q Elopement: Running from an area without the technician, flopping to the floor, or leaving her seat during instruction time q Compliance: Completing a task demand without a physical prompt q Aggression: Scratching, grabbing clothing, hair pulling, kicking 176 ASR ❑ Which of the following are steps in a simple drug evaluation? ❑ Ask parent about the behavioral changes that would provide evidence of effectiveness ❑ Ask parent about the symptoms/behavior expected to be affected ❑ Ask caregivers to rate the perceived level of drug effectiveness ❑ Arrange observations using single-case designs 177 ASR ❑ Yuri is a BCBA working with a 10-year-old child diagnosed with autism. The child’s mother wants to find out about the effectiveness of Risperdal, prescribed by her psychiatrist. Yuri first asks the mother about the symptoms and behaviors being targeted for reduction by the drug. She reports that her child engages in severe aggression and tantrums. What should Yuri do next? a. Arrange for observation using a single-case research design b. Ask caregivers about the symptoms expected to be altered c. Ask what behavioral changes would provide confidence that the drug was effective d. Ask caregivers to rate their perception of the change 178 Observation Methods q Three 1-hour observations were scheduled per day at 9 a.m. (1 hr), 11 a.m. (1 hr), and 1 p.m. (1.5 hr) q Megan and her behavior technician followed her typical programming from her BCBA ® q ABAB design with “No Adderall” and “Adderall Administration” phases § 6-day wash out period before “No Adderall” § 3 days of administration before “Adderall” 179 Courtesy of Iser G. DeLeon 180

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 31 ASR ❑ Why did researchers wait 6 days before measuring behavior in the “no Adderall” condition, and wait three days before recording data in the “Adderall” condition? ❑ To allow time for more observation and data collection ❑ To allow drug to reach therapeutic levels after 3 days ❑ To allow drug to wash out of the system after 6 days ❑ To allow trial period for evaluation of other drugs 181 ASR ❑ What allowed parents to make an informed decision about using or not using the drug? 182 Outline A. Introductory Comments on Working With Non-Behavior Analysis Professionals on Problem Behavior B. Working With Medical Professionals C. Working With Speech, Hearing, and Language Professionals D. Working With Occupational Therapists E. Summary Comments on Collaborating on Problem Behavior 183 Section Outline C.Working With Speech, Hearing, and Language Professionals 1. On the correspondence between language impairment and PBx and the role of speech professionals 2. Communication modalities in FCT 3. Social stories as intervention 184 Task H-9 q Collaborate with others who support and/or provide services to clients. (BACB, 2017) 185 Language Impairment and PBx q Many studies have examined the relationship between PBx and communication/language impairment q Most (not all) find a strong correlation: § The greater the degree of communication impairment § The higher the prevalence of problem behavior § Relationship is particularly strong for SIB 186

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 32 Data on the Relationship Between Language Impairment and PBx q Sample of 101 adults with IDD (Deb et al., 2002, p. 510) 187 Data on the Relationship Between Language Impairment and PBx q Sample of 320 adults with LD (Moss et al., 2000, p. 453) More demanding = PBx occurred at least once/day; prevented person from taking part in normal activities; required physical intervention by >1 caregiver; produced “major injury” to self/others 188 ASR ❑ What is the relationship between language impairment and problem behavior? a. There is no correlation b. The greater degree of language impairment, often the higher rate of problem behavior c. The lesser degree of language impairment, often the greater the problem behavior 189 Objective q Speech-language pathologist (SLP) a. Define b. Identify examples and non- examples of their role in treatment of ASD 190 Prevalence of Speech Therapy q When providing behavioral services for persons with communicative deficits, it is likely they are receiving speech and language services (Green et al., 2006, p. 76) 191 Working With Speech and Language Professionals q Speech-language pathologists § Professionals who evaluate, diagnose, and treat speech, language, communication, and swallowing disorders § What is their role in treatment of ASD? § How is their professional activity similar and different to behavior analysis? § Interaction in the treatment of PBx 192

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 33 Role of Speech and Language Professionals q In treating children with ASD, SLPs have: § “Extensive training in communication and development § A focus on reciprocity with communication partners § A strong understanding of the oral mechanism associated with speech § An understanding of pre-linguistic skills § Specialization in pre-literacy and literacy skills § A focus on social skills development from a pragmatic language perspective, and § Experience administering a variety of speech and language assessments.” (Cardon, 2017, p. 28) 193 Interaction Across Disciplines in Autism Treatment q “According to the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) (American Psychiatric Association, 2013), a diagnosis of ASD includes two domains: (a) deficits in social communication, and (b) the presence of restrictive, repetitive patterns of behaviors or interests. The very definition of ASD indicates that both the disciplines of SLP and BA are required to address the complex needs of individuals with this multifaceted disorder” (Cardon, 2017, p. 38). 194 ASR ❑ What is a speech-language pathologist (SLP)? 195 ASR ❑ Identify the relevant training and/or expertise an SLP brings to ASD treatment: ❑ An understanding of prelinguistic skills ❑ Specialization in diagnosing autism ❑ Training in communication and development ❑ Specialization in literacy skills ❑ Focus on reciprocity with communication partners ❑ Strong understanding of functional analysis of verbal behavior 196 Treatment Approaches: Scenario #1 (Cardon, 2017, p. 32) 197 Treatment Approaches: Scenario #2 (Cardon, 2017, p. 37) 198

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 34 ASR ❑ What is the likelihood of BCBAs and SLPs agreeing on an approach to treating a communication issue? a. There is always agreement on approaches b. There is often agreement on approaches c. The two professions rarely agree d. The two professions never agree 199 Objective q Identify the role of the SLP and BA in functional communication training (FCT) 200 Functional Communication Training q One clear area of intersection q The variable(s) maintaining problem behavior are determined by an FA q FCT = reinforcing an alternative, communicative response (FCR) by providing access to the consequence determined by the FA § Raising hand to gain attention (gesture) § Signing “break” to temporarily escape work (ASL) § Saying “iPad” to gain access to the iPad (vocal) 201 FCT Example (Greer et al., 2016) Result: When multiple schedules were used to thin the schedule of reinforcement for the FCR, destructive behavior remained less than 96% of baseline levels 202 ASR ❑ Why is FCT relevant in the discussion of interacting with SLPs? Because SLPs … a. Have competency in conducting a functional analysis b. Can help determine the best communication modality for the learner c. Can prescribe psychotropic medications if needed d. Focus on sensory integration strategies 203 Professional Strengths q ABAI has provided advice on Interprofessional Collaborative Practice Between Behavior Analysts and Speech-Language Pathologists (ABAI, n.d.) 204

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 35 Functional Communication Training: The Role of Behavior Analysts q Selection of targets q Functional behavior assessments q Skill acquisition – which can include communicative skills q Programming for generalization for targeted behavior to occur across environments and audiences (LaRue et al., 2009) 205 Functional Communication Training: The Role of SLPs q Determining communication modality q Mechanics of speech production q Target communicative responses that would be reinforced by the client’s audience (LaRue et al., 2009) 206 Functional Communication Training: What Does Collaboration Look Like? q What does collaboration look like? § BA: Identify the function of problem behavior § BA: Identify the adaptive behavior to replace problem behavior § SLP: Identify the communication modality best suited for the client to engage in the selected target (LaRue et al., 2009) 207 ASR ❑ Identify the roles of behavior analysts in FCT: ❑ Generalization of communication across settings/people ❑ Conducting functional behavior assessments ❑ Communication skills training ❑ Mechanics of speech production ❑ Selecting target behaviors ❑ Formally train the SLP in a verbal behavior approach 208 ASR ❑ Identify the roles of SLPs in FCT: ❑ Generalization of communication across settings/people ❑ Determining most effective communication modality ❑ Conducting functional behavior assessments ❑ Mechanics of speech production ❑ Selecting target behaviors 209 ASR ❑ A 10-year-old child is beginning FCT training. He can say a few words, knows a few signs and has significant motor delays affecting his tongue and face. Who would most likely have the relevant expertise to assess which communication modality to use? a. Behavior analyst b. Speech-language pathologist c. Either 210

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 36 FCT and Response Efficiency q Richman et al. (2001) § Individual with PDD § An FA indicated that subject’s aggression was maintained by access to toys § Conducted a mand analysis of novel FCRs used to appropriately gain access to toys • Handing over a card • Signing “please” § Evaluated the overall efficiency of both FCRs relative to aggression and relative to each other 211 Richman et al. (2001) Results (p. 75) 212 Arranging Functional Communication Training q Additional considerations in selecting communication mode § Preexisting skills § Ease of acquisition § Promotion of conventional vocal communication § Generalization q All of these are perhaps best considered in collaboration with a speech/language professional 213 ASR ❑ What was the purpose of the Richman et al. (2001) study? a. To demonstrate how to do a mand analysis b. To determine that aggression was maintained by access to toys c. To evaluate the efficiency of functional communicative responses relative to aggression and relative to each other d. All of these 214 ASR ❑ Explain how the evaluation in the Richman et al. (2001) study was conducted: 215 ASR ❑ Chad is a BCBA working with a 14-year- old male who engages in self-injury. The individual has some vocalization and can discriminate pictures on a visual schedule. The SLP is assessing the individual to determine which communication modality to use. What can Chad do to help the SLP in the decision making? 216

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 37 ASR (continued) a. Conduct a mand analysis using vocals and picture card b. Complete an FA to determine the function of the self-injurious behavior c. Evaluate effectiveness of the use of FCRs to decrease self-injury d. All of these 217 Objective q Define social stories 218 Social Stories q “A commonly used intervention for individuals diagnosed with autism spectrum disorder (ASD)” (p. 664) q “Are a systematic form of intervention in which a brief story is written that describes a target behavior (i.e., social or nonsocial behavior), the situation in which the behavior should be displayed, and the outcome of when the individual displays the behavior” (p. 664) q Not unique to SLPs (educators, occupational therapists, and behavior analysts also use them) (Leaf et al., 2020) 219 Social Stories—Criteria (Gray, 2004; Leaf et al., 2020, p. 665) 220 Social Stories Example Sam Dickinson via myboardmaker.com 221 ASR ❑ Describe what a social story is: 222

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 38 ASR ❑ Social stories are exclusively used by SLPs. a. True b. False 223 Social Stories & Behavior Analysis q Scattone et al. (2002) § BL = teacher instructed to respond to target behavior as usual § Intervention: • Teacher introduced the social story individually to each participant • Tested comprehension • Participant then read the story to the teacher each day 224 (Scattone et al., 2002, p. 542) 225 Scattone et al. (2002): Results (p. 539) 226 ASR ❑ What was measured to examine the effectiveness of social stories? a. Percent of intervals during which problem behavior occurred b. Students’ comprehension of the story c. Teacher’s response to the problem behavior d. Rate of problem behavior 227 Literature Review of Social Stories q Leaf et al. (2020): § Numerous methodological issues and limited effectiveness of the most social stories studies § Suggested that social stories should not be used or should be used with caution due to limited, or inconsistent, evidence in their efficacy 228

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 39 Addressing Suggestions to Use Social Stories q Be cautious q It is unlikely that you will benefit from refuting social stories outright q Use your role as a behavior analyst to evaluate its effectiveness § Identify the behaviors that the intervention are designed to change § Implement social stories in isolation § Measure & compare behavior before and during treatment 229 ASR ❑ During a team meeting, the BCBA was presenting client data on peer aggression. The SLP recommended using a social story to teach appropriate peer interactions. What should the behavior analyst do in this situation? ❑ Identify relevant behaviors to change ❑ Refute the suggestion, stating it is not a research-based intervention ❑ Include social stories as primary intervention ❑ Evaluate treatment alone and compare 230 ASR ❑ What is the clarity of research on social stories? a. Proven to be ineffective b. Demonstrated to be successful for most behavior c. Limited and inconsistent evidence of effectiveness 231 Outline A. Introductory Comments on Working With Non-Behavior Analysis Professionals on Problem Behavior B. Working With Medical Professionals C. Working With Speech, Hearing, and Language Professionals D. Working With Occupational Therapists E. Summary Comments on Collaborating on Problem Behavior 232 Section Outline D.Working With Occupational Therapists 1. The role of OTs in ASD 2. Why you might work with OTs in treating PBx 3. Evidence on OT-based intervention for PBx 233 Task H-9 q Collaborate with others who support and/or provide services to clients. (BACB, 2017) 234

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 40 Objective q Occupational therapist a. Define b. Identify examples and non- examples of their role in treatment of ASD 235 Occupational Therapy q Occupational therapy (OT) helps people work on cognitive, physical, social, and motor skills q The goal is to improve everyday (occupational) skills which allow people to become more independent and participate in a wide range of activities 236 Role of Occupational Therapists in ASD Treatment q “Occupational therapists evaluate sensory, motor, cognitive, social, and communication skills of children and adults with autism that are related to their participation in everyday life activities. Particular emphasis is placed on assessing sensory motor , emotional regulation, social relationship, and self-advocacy skills with the aim of facilitating full inclusion within the community [emphasis added]” (Crabtree & Demchick, 2018, para. 3). 237 Occupational Therapy Interventions q “Occupational therapy interventions include: § Independent living skills training and modifications § Motor development and motor planning skill development § Positive mental health strategies § Social emotional development and self-regulation strategies and programs § Behavioral approaches, in collaboration with team members to support participation § Sensory integration and sensory-based strategies ” (Crabtree & Demchick, 2018, para. 4) 238 ASR ❑ Occupational therapy (OT) interventions might include: ❑ Sensory integration and strategies ❑ Training independent living skills ❑ Assessing function of target behaviors ❑ Positive mental health strategies ❑ Motor skill development ❑ Training in communication skill development ❑ Self-regulation strategies 239 ASR ❑ What is the goal of occupational therapy? a. Vocational training and job placement b. Improve everyday skills to promote independence c. Assess problem behavior using sensory integration d. Determine most effective communication training 240

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 41 Objectives q Define sensory integration therapy (SIT) q Define sensory defensiveness 241 PBx and Occupational Therapy q Why behavior analysts might work with OTs on PBx § Certain theoretical concepts in OT lend themselves to an understanding of the causes of PBx § Sensory processing disorder (formerly sensory integration dysfunction) 242 Sensory Processing q Receiving, organizing, and interpreting of sensory stimuli using sensory systems § Visual: Sights § Vestibular: Movement § Auditory: Sounds § Oral: Tastes § Olfactory: Smells § Tactile: Touch § Proprioception: Awareness of position/movement in the body § Interoception: Internal sensations (hunger, thirst, bathroom needs, temperature) 243 Sensory Processing Difficulties q Sensory Processing Disorder (Kong & Moreno, 2018, p. 1208) 244 ASR ❑ What might be a reason for OT and ABA to overlap in practice? 245 ASR ❑ List at least two sensory systems: 246

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 42 Study on the Effects of Noise on Frequency of Problem Behavior (O’Reilly et al., 2000, p. 513) 247 Correlation in Indirect Assessments q Sensory Processing Disorder and PBx § Behavioral and emotional problems have been associated with sensory processing differences O’Donnell et al. (2012, p. 590) 248 ASR ❑ Isra is a BCBA working with a 16-year-old male who engages in self-injury. The OT working with the client suggests that the client has light sensitivity, and self- injury occurs when exposed to sunlight or florescent lighting. What is the best course of action for Isra to take? a. Arrange FA conditions under bright light and lower light conditions b. Refer the client to an OT who can provide an appropriate sensory diet c. Keep the individual inside when it is hot and sunny d. Arrange a behavior reduction program to reduce problem behavior across all settings 249 ASR 0 5 10 15 20 25 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Frequency per session Sessions Effects of Sunlight on Problem Behavior Outside sunny day Outside cloudy day Inside Inside 250 ASR (continued) ❑ Based on the graphed data, is there evidence that the sensory stimulation affects behavior? a. Yes b. No c. Unable to determine 251 Survey Data on OT Intervention Approaches (p. 171) q Case-Miller and Smith (1999) § Survey of 292 OTs regarding work with children with developmental disorders § Likert scale: 1 (never) 5 (always) 252

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 43 Sensory Integration Explanation of PBx Related to Sensory Input q “The theoretical underpinnings of SIT believe that problem behavior results from an inability to process complex sensory information effectively due to a lack of organization of the senses” (Lydon et al., 2017, p. 306). q “SIT views problem behavior as a lack of organization of the senses that results in the inability to process complex sensory information in an effective manner” (Devlin et al., 2011, p. 1317) q “SIT is designed to restore effective neurological processing by enhancing each of these systems” (Devlin et al., 2011, p. 1304). 253 ASR ❑ The Case-Miller and Smith (1999) survey showed that occupational therapists viewed behavior analysis favorably. a. True b. False 254 Interventions for PBx Based on Sensory Integration Theory q Sensory integration therapy q Sensory diets q Weighted vests 255 Case Study on Sensory Integration q Bright et al. (1981) § First study on SIT and SIB § Important to note: • “The rate of SIB remained essentially the same, with or without the presence of staff” (p. 170). • “During the sessions, foam sleeves that extended from the upper arm to the finger tips [ sic ] were applied to cushion the SIB, but not to prevent the behavior from occurring” (p. 171). 256 Bright et al. (1981) Procedure q “Concentrated heavily on slow, rhythmic vestibular and firm but light tactile stimulation in attempts to provide an organizational effect on the subcortical processing mechanisms of the CNS” (p. 170). q Auditory and visual stimuli, soft music, and dimmed lighting used to provide a consistent organized environment q SIT applied non-contingently, during daily 50- min sessions 257 Bright et al. (1981) Results q Dependent measures § Rate of SIB during treatment § Time out of physical restraint throughout day (Bright et al., 1981, p. 169) (Bright et al., 1981, p. 171) 258

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 44 ASR ❑ The BCBA is working with a student who will not sit in his seat for longer than 2 minutes. The OT wants him to wear a weighted vest. Explain what the BCBA can do in this scenario: 259 ASR ❑ The BCBA is working with an individual who bites his shirt causing holes in his clothing. The OT provided the individual with a chew device to replace shirt biting. What can the BCBA do to evaluate the effectiveness of the chew device? 260 ASR (continued) a. Provide the chew device contingent upon shirt biting b. Allow continuous access to the chew device and remove only if he bites his shirt c. Analyze data on shirt biting with and without the chew device d. Nothing; do not allow the chew device as it is not evidence-based treatment 261 Study Comparing Behavioral Intervention and Sensory-Integrative Therapy q Mason and Iwata (1990) § Comparison of behavioral intervention and “sensory-integrative therapy” on SIB § Three individuals, aged 3–18 years old • Diagnosed with intellectual disability • Functional analysis of SIB outcomes varied § Data collected during therapy sessions 262 Mason & Iwata (1990) Interventions Compared q SIT = Noncontingent access to multiple forms of stimulation, including: § Flashing lights suspend from ceiling § Rocking chair with vibrating pillow § Background music q Behavioral Intervention = varied; consistent with outcome of functional analysis 263 Mason & Iwata (1990) Results (Mason & Iwata, 1990, p. 366) 264

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 45 ASR ❑ In the study, was sensory integration alone effective for Sally? a. Yes, during treatment phase b. Yes, during the extinction phase c. No, SIT was only effective when continuous attention was also arranged d. No, not effective at all 265 Mason & Iwata (1990) Results (Mason & Iwata, 1990, p. 366) 266 Mason & Iwata (1990) Results (Mason & Iwata, 1990, p. 366) 267 ASR ❑ A BCBA just began services with Kayden. Kayden is a 12-year-old male with limited verbal skills who often lightly hits others while yelling. The existing OT has recommended brushing when Kayden begins yelling and hitting. Explain what the BCBA can do to evaluate the effectiveness of the OT intervention: 268 ASR ❑ Marlin often throws tantrums when presented with academic tasks. The existing therapy team has been arranging a break on a swing when problem behavior occurs. The BCBA evaluates the rate of tantrums during phases when Marlin receives the swing noncontingently, when Marlin requests the swing, and when Marlin is given the swing after a tantrum. The BCBA is collaborating to evaluate: 269 ASR (continued) a. Effects of an OT intervention b. Effects of an SLP intervention c. Effects of a medical intervention d. All of these 270

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 46 Research Comparing Sensory Diet and Function-Based Intervention q Devlin et al. (2011) § Comparison of function-based behavioral intervention and sensory diet for 6-hour sessions § Four children • Diagnosed with ASD • Functional analysis outcomes = varied; all showed an escape function; 3 showed tangible function § Alternating treatment design 271 Devlin et al. (2011) Procedures: Sensory Diet q “Based on techniques that would facilitate vestibular, proprioceptive and tactile input along with…joint compression and brushing” (p. 1310). § Wrapping participant in lycra blanket § Pressing a large ball on body § Tapping areas of the body with light bean bag § Chewing on a chewy tube q SIT activities provided for 15 min, six times per day or contingent on the emission of target behavior 272 Devlin et al. (2011) Procedures: Behavioral Intervention q Based on functional assessment § Reinforced compliance to tasks § Extinction § Differential reinforcement § Positive practice overcorrection § Functional communication training 273 Delvin et al. (2011) Results (Devlin et al., 2011, p. 1314) 274 Delvin et al. (2011) Results (Devlin et al., 2011, p. 1313) 275 Sensory Integration/PBx Summary q Mixed effects q Comparison studies suggest function-based behavioral intervention is usually more effective q Observed SIT effects may be attributable to competing stimulation especially if PBx is automatically reinforced. q Is within-session response rate the best way to find the effects of sensory integration? 276

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 47 ASR ❑ What was the general conclusion of the SIT research? 277 ASR ❑ Results of the studies comparing the effectiveness of SIT and ABA suggest that function-based interventions are: a. Usually less effective than SIT b. Equally as effective as SIT c. Typically more effective than SIT d. Always more effective than SIT 278 Outline A. Introductory Comments on Working With Non-Behavior Analysis Professionals on Problem Behavior B. Working With Medical Professionals C. Working With Speech, Hearing, and Language Professionals D. Working With Occupational Therapists E. Summary Comments on Collaborating on Problem Behavior 279 Collaborating With Health Professionals Summary q Prioritize the best interests of the client § Assume that all professional stakeholders are operating under best interests § Do not dismiss other approaches without due consideration § Consider whether others’ intervention impedes your own and discuss (e.g., two professionals promoting different modes of communication) 280 Relying on Evidence q Find, understand, and provide the available evidence § When alternatives are promoted, research the available evidence on efficacy and interactions § Share your research with collaborators when possible 281 Discussing Behavioral Interventions q Explain function-based approaches when collaborating § Use accessible language § Explain the rationale behind function- based model to team members § Discuss possibility of inadvertent reinforcement of PBx (e.g., contingent sensory diet) 282

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 48 Communicating Behavioral Concepts and Sharing Data q Avoid behavioral jargon and minimize behavioral-specific data displays § Understand audience control § Behavioral applications can be readily described in easy-to- understand conversational terms 283 ASR ❑ Provide a summary of how to collaborate with health professionals: 284 ASR ❑ During a team meeting an OT reported that using a wrap mat helps calm the child when they have a tantrum. Derrick, the BCBA, told the OT, “Discontinue the wrap mat immediately. The mat might stop the tantrum in the moment, but you are causing the tantrums to continue long-term.” What should the BCBA have done differently in this situation? a. Nothing, this was the best course of action b. He should have used less behavioral jargon c. He should have learned to implement the wrap mat and collected data d. He should have explained a rationale for a function- based approach, and supported collecting data to evaluate the effectiveness 285 Research on Use of Jargon q Jarmolowicz et al. (2008) § Technical: ‘‘All appropriate responses (defined as handing the therapist the picture card) are reinforced with the delivery of a small edible item on a FR1 schedule. SIB (defined as hand biting or head hitting) is on extinction.” § Conversational: ‘‘When the child hands you the card with a picture of a snack on it, give the child a little piece of the snack. If the child bites his hand or hits himself on the head, simply ignore it.’’ (p. 192) 286 Jarmolowicz et al. (2008) Results (p. 196) 287 Collaborating with Health Professionals Summary q Offer, and conduct, a well-controlled clinical evaluations when feasible § Outline your evaluation in advance § Make sure to include measures that all stakeholders consider important and relevant § Present data in the most accessible format 288

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 49 Collaborating with Health Professionals Summary q What behavior analysts can offer, at minimum, in collaboration: § Empirically based interventions § Behavior change systems needed before others’ interventions can be evaluated (e.g., pill swallowing) § Methods of direct observation and measurement § Single-case designs in which the client serves as their own control 289 ASR ❑ What were the results of the Jarmolowicz et al. (2008) study? a. FCT interventions were more successful than extinction b. More ABA jargon resulted in more accurate implementation c. Less ABA jargon resulted in more accurate implementation d. Implementation was more accurate with extinction than FCT 290 ASR ❑ Frantz, a BCBA, has a client who has diabetes and requires blood sugar checks three times a day. The client is refusing to allow the caregiver to prick her finger. Frantz is working with the caregiver on a plan to increase compliance with blood checks. What type of collaboration is described in this scenario? a. Using single-case design to evaluate a medical intervention b. Using an intervention to help tolerate a medical procedure c. Using single-case design to evaluate an OT intervention d. Using single-case design to evaluate an SLP intervention 291 ASR ❑ Maritza, a BCBA, is on a treatment team with other professionals. During a recent meeting, the parents mentioned they want to start a sensory diet. Maritza discusses a plan to track changes in behavior relevant to this intervention. What type of collaboration is Maritza doing in this scenario? a. Using single-case design to evaluate a medical intervention b. Using an intervention to help tolerate a medical procedure c. Using single-case design to evaluate an OT intervention d. Using single-case design to evaluate an SLP intervention 292 Benefits of Collaborative Efforts q “When mutual respect is realized, and when the common views and rationales of disciplines are familiar, real collaboration can occur. Such collaboration can involve multidisciplinary and transdisciplinary work, where professionals from different disciplines work together to identify goals, assess progress, and even cotreat. This may seem like a formidable challenge, but it is achievable” (LaFrance et al., 2019, p. 721). 293 ASR q Raj is making significant progress on his ABA goals but continues to struggle to be precise in his fine motor imitation skills. He is four years old, diagnosed with autism, and generally responding well to reinforcement-based interventions to strengthen new behaviors. He will always attempt to imitate fine motor movements, but despite application of differential reinforcement the accuracy is not improving. Another professional assesses Raj and gives the team a series of daily exercises and stretches to do with Raj just before running the fine motor programs. 294

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 50 ASR (continued) q This scenario best describes the role of which professional? a. Speech-language pathologist b. Medical professional c. Behavior analyst d. Occupational therapist 295 ASR q Alfonso is a 10-year-old with autism. He has always been a good eater, with no significant food selectivity or challenging mealtime behaviors. However, recently Alfonso has begun to refuse most foods and often cries and complains for several hours after eating. The family and team are concerned that Alfonso may have a severe allergy or digestive issue and seek testing. This would best fit the role of which professional in treatment? a. Speech-language pathologist b. Medical professional c. Behavior analyst d. Occupational therapist 296 ASR q Lupita is a 7-year-old diagnosed with autism. She begins to refuse foods that she typically would eat without difficulty. She will scream and yell until she is given the food she requests, which is often an unhealthy item. Her pediatrician conducts an exam and reports that there are no indications of allergies or other medical concerns. Treatment is focused on the use of antecedent manipulations and strong positive reinforcers to increase Lupita’s acceptance of the foods she would commonly eat before. This would best fit the role of which professional in treatment? a. Speech-language pathologist b. Medical professional c. Behavior analyst d. Occupational therapist 297 ASR q Ming is a 4-year-old diagnosed with autism. It is difficult for her to form the “M” sound, and she does not bring her lips into the pursed position required to pronounce it. To help, a professional recommends specific lip and cheek stretches and exercises and works with Ming twice per week for 45 minutes to improve her ability to form and pronounce the “M” sound. This would best fit the role of which professional in treatment? a. Speech-language pathologist b. Medical professional c. Behavior analyst d. Occupational therapist 298 Outline A. Introductory Comments on Working With Non-Behavior Analysis Professionals on Problem Behavior B. Working With Medical Professionals C. Working With Speech, Hearing, and Language Professionals D. Working With Occupational Therapists E. Summary Comments on Collaborating on Problem Behavior 299 References q Aman, M. G., & Singh, N. N. (1994). Aberrant Behavior Checklist – community. Supplementary manual . Slosson Educational Publications. q Association for Behavior Analysis International. (n.d.). Interprofessional collaborative practice between behavior analysts and speech- language pathologists . https:// www.abainternational.org/media/180194/ abai_interprofessional_collaboration_resource_ document.pdf 300

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 51 References (continued) q Allen, K. D., & Wallace, D. P. (2013), Effectiveness of using noncontingent escape for general behavior management in a pediatric dental clinic. Journal of Applied Behavior Analysis, 46 , 723–737. q Beck, M. H., Cataldo, M., Slifer, K. J., Pulbrook, V., & Guhman, J. K. (2005). Teaching children with attention deficit hyperactivity disorder (ADHD) and autistic disorder (AD) how to swallow pills. Clinical Pediatrics , 44 , 515–526. 301 References (continued) q Behavior Analyst Certification Board. (2017). BCBA task list (5th ed.). Author. q Behavior Analyst Certification Board. (2020). Ethics code for behavior analysts . Author. q Bright, T., Bittick, K., & Fleeman, B. (1981). Reduction of self-injurious behavior using sensory integrative techniques. The American Journal of Occupational Therapy: Official Publication of the American Occupational Therapy Association , 35 , 167–172. 302 References (continued) q Brodhead, M. T. (2015). Maintaining professional relationships in an interdisciplinary setting: Strategies for navigating nonbehavioral treatment recommendations for individuals with autism. Behavior Analysis in Practice, 8 (1), 70– 78. q Cardon, T. (2017). Speech-language pathologists and behavior analysts. Perspectives regarding theories and treatment of autism spectrum disorder. Perspectives of the ASHA Special Interest Groups, 2 , 27–46. 303 References (continued) q Case-Smith, J., & Miller, H. (1999). Occupational therapy with children with pervasive developmental disorders. The American Journal of Occupational Therapy , 53 , 506–513. 304 References (continued) q Crabtree, L., & Demchick, B. B. (2018). Occupational therapy’s role with autism . American Occupational Therapy Association. https://www.aota.org/- /media/Corporate/Files/AboutOT/Professionals/ WhatIsOT/CY/Fact- Sheets/Autism%20fact%20sheet.pdf 305 References (continued) q Crosland, K. A., Zarcone, J. R., Lindauer, S. E., Valdovinos, M. G., Zarcone, T. J., Hellings, J. A., & Schroeder, S. R. (2003). Use of functional analysis methodology in the evaluation of medication effects. Journal of Autism and Developmental Disorders , 33 , 271–279. q Cuvo, A. J., Godard, A., Huckfeldt, R., & DeMattei, R. (2010). Training children with autism spectrum disorders to be compliant with an oral assessment. Research in Autism Spectrum Disorders, 4 , 681–696. 306

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 52 References (continued) q Deb, S., Kwok, H., Bertelli, M., Salvador- Carulla, L., Bradley, E., Torr, J., Barnhill, J., & Guideline Development Group of the WPA Section on Psychiatry of Intellectual Disability (2009). International guide to prescribing psychotropic medication for the management of problem behaviours in adults with intellectual disabilities. World Psychiatry: Official Journal of the World Psychiatric Association (WPA) , 8 (3), 181–186. 307 References (continued) q Devlin, S., Healy, O., Leader, G., & Hughes, B. M. (2011). Comparison of behavioral intervention and sensory-integration therapy in the treatment of challenging behavior. Journal of Autism and Developmental Disorders, 41 , 1303–1320. 308 References (continued) q DuPaul, G. J., Anastopoulos, A. D., Power, T. J., Reid, R., Ikeda, M. J., & McGoey, K. E. (1998). Parent ratings of attention-deficit/hyperactivity disorder symptoms: Factor structure and normative data. Journal of Psychopathology and Behavioral Assessment, 20 , 83–102. 309 References (continued) q Feroe, A. G., Uppal, N., Gutiérrez-Sacristán, A., Mousavi, S., Greenspun, P., Surati, R., Kohane, I. S., & Avillach, P. (2021). Medication use in the management of comorbidities among individuals with autism spectrum disorder from a large nationwide insurance database. JAMA Pediatrics , e211329. Advance online publication. q Gray, C. A. (2004). Social stories 10.0: The new defining criteria and guidelines. Jensen Autism Journal, 15 , 2–21. 310 References (continued) q Green, V. A., Pituch, K. A., Itchon, J., Choi, A., O’Reilly, M., & Sigafoos, J. (2006). Internet survey of treatments used by parents of children with autism. Research in Developmental Disabilities, 27 , 70–84. q Greer, B. D., Fisher, W. W., Saini, V., Owen, T. M., & Jones, J. K. (2016). Functional communication training during reinforcement schedule thinning: An analysis of 25 applications. Journal of Applied Behavior Analysis , 49 (1), 105–121. 311 References (continued) q Iwata, B. A., Pace, G. M., Dorsey, M. F., Zarcone, J. R., Vollmer, T. R., Smith, R. G., Rodgers, T. A., Lerman, D. C., Shore, B. A., & Mazalesk, J. L. (1994). The functions of self- injurious behavior: An experimental- epidemiological analysis. Journal of Applied Behavior Analysis , 27 (2), 215–240. 312

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 53 References (continued) q Jarmolowicz, D. P., Kahng, S. W., Ingvarsson, E. T., Goysovich, R., Heggemeyer, R., & Gregory, M. K. (2008). Effects of conversational versus technical language on treatment preference and integrity. Intellectual and Developmental Disabilities , 46 (3), 190–199. q Kennedy, C. H., & Meyer, K. A. (1996). Sleep deprivation, allergy symptoms, and negatively reinforced problem behavior. Journal of Applied Behavior Analysis , 29 (1), 133–135. 313 References (continued) q Kong, M., & Moreno, M. A. (2018). Sensory processing in children. JAMA Pediatrics, 172 (12), 1208. q Kupzyk, S., & Allen, K. D. (2019). A review of strategies to increase comfort and compliance with medical/dental routines in persons with intellectual and developmental disabilities. Journal of Developmental and Physical Disabilities, 31 , 231–249. 314 References (continued) q LaFrance, D. L., Weiss, M. J., Kazemi, E., Gerenser, J., & Dobres, J. (2019). Multidisciplinary teaming: Enhancing collaboration through increased understanding. Behavior Analysis in Practice , 12 (3), 709–726. q LaRue, R., Weiss, M. J., & Cable, M. K. (2009). Functional communication training: The role of speech pathologists and behavior analysts in serving students with autism. The Journal of Speech and Language Pathology – Applied Behavior Analysis, 3 , 164–172. 315 References (continued) q Leaf, J. B., Cihon, J. H., Ferguson, J. L., Milne, C. M., Leaf, R., & McEachin, J. (2020). Recommendations for behavior analysts regarding the implementation of Social Stories for individuals diagnosed with autism spectrum disorder. Behavioral Interventions , 35 , 664–679. 316 References (continued) q Lerman, D. C., Sansbury, T., Hovanetz, A., Wolever, E., Garcia, A., O’Brien, E., & Adedipe, H. (2008). Using behavior analysis to examine the outcomes of unproven therapies: An evaluation of hyperbaric oxygen therapy for children with autism. Behavior Analysis in Practice , 1 , 50–58. q Lydon, H., Healy, O., & Grey, I. (2017). Comparison of behavioral intervention and sensory integration therapy on challenging behavior of children with autism. Behavioral Interventions, 32 , 297–310. 317 References (continued) q Mason, S. A., & Iwata, B. A. (1990). Artifactual effects of sensory - integrative therapy on self - injurious behavior. Journal of Applied Behavior Analysis , 23 , 361–370. q May, M. E., & Kennedy, C. H. (2010). Health and problem behavior among people with intellectual disabilities. Behavior Analysis in Practice , 3 , 4–12. 318

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 54 References (continued) q McCarty, N. (2021, July 1). Polypharmacy, shifting prescriptions common for autism comorbidities. https://www.spectrumnews.org/news/polypharm acy-shifting-prescriptions-common-for-autism- comorbidities/ q McConnell, K. L., Sassi, J. L., Carr, L., Szalwinski, J., Courtemanche, A., Njie - Jallow, F., & Cheney, W. R. (2020). Functional analysis and generalized treatment of disruptive behavior during dental exams. Journal of Applied Behavior Analysis, 53, 2233–2249. 319 References (continued) q McCracken, J. T., McGough, J., Shah, B., Cronin, P., Hong, D., Aman, M. G., Arnold, E., Lindsay, R., Nash, P., Holloway, J., McDougle, C. J., Posey, D., Swiezy, N., Kohn, A., Scahill, L., Martin, A., Koenig, K., Volkmar, F., Carroll, D., … McMahon, D. (2002). Risperidone in children with autism and serious behavioral problems. New England Journal of Medicine , 347 , 314–321. 320 References (continued) q Moss, S., Emerson, E., Kiernan, C., Turner, S., Hatton, C., & Alborz, A. (2000). Psychiatric symptoms in adults with learning disability and challenging behaviour. The British Journal of Psychiatry , 177 , 452–456. q Northup, J., Jones, K., Broussard, C., DiGiovanni, G., Herring, M., Fusilier, I., & Hanchey, A. (1997). A preliminary analysis of interactive effects between common classroom contingencies and methylphenidate. Journal of Applied Behavior Analysis , 30 , 121–125. 321 References (continued) q O’Donnell, S., Deitz, J., Kartin, D., Nalty, T., & Dawson, G. (2012). Sensory processing, problem behavior, adaptive behavior, and cognition in preschool children with autism spectrum disorders. American Journal of Occupational Therapy , 66 , 586–594. q O'Reilly, M. F. (1995). Functional analysis and treatment of escape - maintained aggression correlated with sleep deprivation. Journal of Applied Behavior Analysis , 28 (2), 225–226. 322 References (continued) q O'Reilly, M. F. (1997). Functional analysis of episodic self-injury correlated with recurrent otitis media. Journal of Applied Behavior Analysis , 30 , 165–167. q O'Reilly, M. F., Lacey, C., & Lancioni, G. E. (2000). Assessment of the influence of background noise on escape - maintained problem behavior and pain behavior in a child with Williams syndrome. Journal of Applied Behavior Analysis, 33, 511–514. 323 References (continued) q Poling, A., Ehrhardt, K., & Li, A. (2017). Psychotropic medications as treatments for people with autism spectrum disorders. In J. Matson (Ed.), Handbook of Treatments of Autism Spectrum Disorder. Springer q Richman, D. M., Wacker, D. P., Asmus, J. M., Casey, S. D., & Andelman, M. (1999). Further analysis of problem behavior in response class hierarchies. Journal of Applied Behavior Analysis , 32 (3), 269–283. 324

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 55 References (continued) q Scattone, D., Wilczynski, S. M., Edwards, R. P., & Rabian, B. (2002). Decreasing disruptive behaviors of children with autism using social stories. Journal of Autism and Developmental Disorders , 32 , 535–543. q Schieber, E. S. (2021). Increasing cooperation of children with developmental disabilities during dental exams [Unpublished doctoral dissertation]. University of Florida. 325 References (continued) q Shabani, D. B., & Fisher, W. W. (2006). Stimulus fading and differential reinforcement for the treatment of needle phobia in a youth with autism. Journal of Applied Behavior Analysis , 39 , 449–452. q Shea, S., Turgay, A., Carroll, A., Schulz, M., Orlik, H., Smith, I., & Dunbar, F. (2004). Risperidone in the treatment of disruptive behavioral symptoms in children with autistic and other pervasive developmental disorders. Pediatrics , 114 , e634-e641. 326 References (continued) q Spencer, D., Marshall, J., Post, B., Kulakodlu, M., Newschaffer, C., Dennen, T., Azocar, F., & Jain, A. (2013). Psychotropic medication use and polypharmacy in children with autism spectrum disorders. Pediatrics , 132 (5), 833– 840. 327 References (continued) q Stein, L. I., Lane, C. J., Williams, M. E., Dawson, M. E., Polido, J. C., & Cermak, S. A. (2014). Physiological and behavioral stress and anxiety in children with autism spectrum disorders during routine oral care. BioMed Research International , 2014 , 694876. 328 References (continued) q Valdovinos, M. G., Henninger-McMahon, M., Schieber, E., Beard, L., Conley, B., & Haas, A. (2016). Assessing the impact of psychotropic medication changes on challenging behavior of individuals with intellectual disabilities. International Journal of Developmental Disabilities , 62 , 200–211. 329

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