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Bio-Behavioral Approaches to the Assessment and Treatment of Autism

Bio-Behavioral Approaches to the Assessment and Treatment of Autism

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Bio-Behavioral Approaches to the Assessment and Treatment of Autism

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  1. Bio-Behavioral Approaches to the Assessment and Treatment of Autism WAYNE W. FISHER University of Nebraska Medical Center’s Munroe-Meyer Institute

  2. Center for Autism Spectrum Disorders: Assessment and Treatment Clinics Severe Behavior Program Early Intervention Program Autism Diagnostic Clinic Ph.D Program Virtual Care Program School Consultation Program

  3. Asking what contributes more to human behavior, nurture or nature is like asking what contributes more to the area of a rectangle, its width or length.Ebbinghaus, circa 1885

  4. Structural vs. Functional Diagnosis • Structural Approach • How often a particular set of symptoms or responses cluster or covary. • Functional Approach • Whether and which environmental variables influence the response.

  5. Functional Analysis • Identifies the environmental contexts in which aberrant behavior is likely and unlikely. • Identifies the consequences that reinforce and maintain the behavior. • Used to prescribe effective treatments.

  6. Direct Observation • "There are three principal means of acquiring knowledge. . . observation of nature, reflection, and experimentation. Observation collects facts; reflection combines them; experimentation verifies the result of that combination." • Denis Diderot (1713-1784)

  7. Common Functions of SIB • Social Positive Reinforcement (Attention, Tangible items) • Social Negative Reinforcement (Escape) • Automatic Reinforcement (e.g., Sensory Stimulation)

  8. Modifying Functional Analyses to Identify Idiosyncratic Social and Automatic Functions

  9. Previous Models • Iwata et al. (1982/1994) • Multielement Analog Assessment • Mace & Lalli (1991) • Linking Descriptive Assessments and Experimental Analyses

  10. Previous Models (cont.) • Wacker et al. (1991) • Brief Analog Assessments • Vollmer et al. (1993); Iwata et al. (1994) • Reversal and Pairwise Designs

  11. Previous Models (cont.) • Vollmer et al. (1995) • Model That Provided Decision Rules for Moving from Brief to Multielement, to Extended Alone, to Reversal Designs • Current Model • No Brief Assessment • DAs for Identifying Idiosyncratic Functions • Methods for Identifying Specific Automatic Functions

  12. Conduct Standard Functional Analysis If High Rates in Alone, Analyze Automatic Sources of SR+ or SR- If High Rates in Most Conditions, Conduct Extended Alone, Reversals or Pairwise Analyses If Social Function is Clear, Proceed to Treatment If Low or Variable Rates, Conduct Descriptive Assessment Generate and Test Hypotheses About Idiosyncratic Functions If Responding Decreases, Conduct Reversals or Pairwise Analyses If Responding Persists, Analyze Automatic Sources of SR+ or SR-

  13. Conduct Standard Functional Analysis If High Rates in Alone, Analyze Automatic Sources of SR+ or SR- If High Rates in Most Conditions, Conduct Extended Alone, Reversals or Pairwise Analyses If Social Function is Clear, Proceed to Treatment If Low or Variable Rates, Conduct Descriptive Assessment Generate and Test Hypotheses About Idiosyncratic Functions If Responding Decreases, Conduct Reversals or Pairwise Analyses If Responding Persists, Analyze Automatic Sources of SR+ or SR-

  14. 3 Attention 2 Per Minute Aggressive Responses Ignore 1 Tangible Demand Play 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 Sessions

  15. FCT + FCT + Baseline Baseline Extinction Extinction 8 Destructive Behavior 6 4 Response per Minute Kirk Communication 2 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Session

  16. Conduct Standard Functional Analysis If High Rates in Alone, Analyze Automatic Sources of SR+ or SR- If High Rates in Most Conditions, Conduct Extended Alone, Reversals or Pairwise Analyses If Social Function is Clear, Proceed to Treatment If Low or Variable Rates, Conduct Descriptive Assessment Generate and Test Hypotheses About Idiosyncratic Functions If Responding Decreases, Conduct Reversals or Pairwise Analyses If Responding Persists, Analyze Automatic Sources of SR+ or SR-

  17. Pica • Pica involves the repeated ingestion of inedible substances.

  18. Pica • Pica is the Latin word for magpie, a species of bird that eats almost anything.

  19. Conduct Standard Functional Analysis If High Rates in Alone, Analyze Automatic Sources of SR+ or SR- If High Rates in Most Conditions, Conduct Extended Alone, Reversals or Pair-wise Analyses If Social Function is Clear, Proceed to Treatment If Low or Variable Rates, Conduct Descriptive Assessment Generate and Test Hypotheses About Idiosyncratic Functions If Responding Decreases, Conduct Reversals or Pair-wise Analyses If Responding Persists, Analyze Automatic Sources of SR+ or SR-

  20. 25.5 20 16 Demand 12 DESTRUCTIVE RESPONSES PER MINUTE 8 Tangible 4 Attention Play 0 1 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61 65 69 SESSIONS Functional Analysis

  21. 20 Attention vs. Play Tangible vs. Play Demand vs. Play 16 Attention Demand 12 DESTRUCTIVE RESPONSES PER MINUTE 8 Tangible 4 Play 0 72 74 76 78 80 82 84 86 88 90 94 98 92 96 SESSIONS Functional Analysis (Pairwise)

  22. Conduct Standard Functional Analysis If High Rates in Alone, Analyze Automatic Sources of SR+ or SR- If High Rates in Most Conditions, Conduct Extended Alone, Reversals or Pairwise Analyses If Social Function is Clear, Proceed to Treatment If Low or Variable Rates, Conduct Descriptive Assessment Generate and Test Hypotheses About Idiosyncratic Functions If Responding Decreases, Conduct Reversals or Pairwise Analyses If Responding Persists, Analyze Automatic Sources of SR+ or SR-

  23. Social Attention 1 0.5 DESTRUCTIVE RESPONSES PER MINUTE Demand Alone Toy Play Tangible 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 SESSIONS Functional Analysis

  24. Descriptive Assessment Methods • Staff and Parent Interviews • Collect ABC Data • Sulzer-Azaroff & Mayer, 1977 • Selected Naturalist Observations • Probe Sessions • Hypothesis Development

  25. Case Example: Idiosyncratic Social Function • Hypothesis I: Respondent Behavior Elicited by Transitions or Changes in Routine • Hypothesis II: Escape from or Avoidance of Transitions or Changes in Routine • Hypothesis III: Escape from Nonpreferred Tasks

  26. 100% 90% M Sarah H 80% 70% H 60% Engagement M Chosen PERCENTAGE OF TRIALS CONSUMED 50% 40% 30% 20% L L 10% 0% Schoolwork Dust Pick Up Trash Make Bed Fold Clothes Set Table Wash Windows Vacuum TASKS

  27. 2 Transition From Moderate Preference Task Transition From High Preference Task Transition From Low Preference Task Sarah High to Low Moderate to Low DESTRUCTIVE RESPONSES PER MINUTE 1 Low to Moderate High to Moderate Low to High Moderate to High 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 SESSIONS Task Transition Assessment

  28. BL DRA+EXT(ESC) 4 100 Sarah 90 80 Destructive Responses 3 70 60 2 50 40 30 VACUUM 1 20 Compliance 10 0 0 DESTRUCTIVE RESPONSES PER MINUTE PERCENT DURATION COMPLIANCE 4 100 90 80 3 70 60 2 50 40 30 WINDOWS 1 20 10 0 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 Treatment Evaluation SESSIONS (Transitions to Low Preference)

  29. Summary of 40 Cases • Clear Function Identified During Standard Functional Analysis Social SR+ N = 16 (55.2%) Automatic SR+ N = 2 (6.9%) Total N = 18 (62.1%)

  30. Summary of 40 Cases (cont.) • Function Clarified Through Additional Analyses Idiosyncratic Social SR+ N = 7 (24.1%) Pervasive Automatic SR+ N = 4 (13.8%) Total N = 11 (37.9%)

  31. Studying Bio-Behavioral Relations Using ABA Methods • Pica with cigarettes • Is there a cross-species preference for choice (i.e., loosely referred to as freedom) • Sleep, SIB, and Cyclical Behavior in Individuals with Developmental Disabilities (Piazza, Fisher, et al.) • Drug-Environment-Behavior Interactions (Fisher, Piazza, et al.) • Forced Normalization

  32. Pica • Pica involves the repeated ingestion of inedible substances.

  33. Pica • Pica is the Latin word for magpie, a species of bird that eats almost anything.

  34. Similarities and Differences Between Human and Nonhuman Species • "Drinking without being thirsty and making love at any time, Madame, are the only things that distinguish us from other animals.” Beaumarchis:

  35. Pica (cont’d.) • Pica is often assumed to be maintained by automatic reinforcement.

  36. Pica (cont’d.) • Danford and Huber (1982) reported that 25.8% of persons with mental retardation residing in an institution engaged in pica.

  37. Pica (cont’d.) • Medical risks: • intestinal blockages • parasites • surgery to remove objects • lead and other poisoning • death

  38. Pica (cont’d.) • The risk of death associated with pica may be higher than that for other forms of self-injurious behavior (Foxx & Livesay, 1984; McLoughlin, 1988). • Death rates associated with pica in institutions are similar to those associated with heart disease.

  39. 3 2 Alone BUTT PICA PER MINUTE 1 Social Attention Toy Play 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 SESSIONS

  40. 3 Herbal 2 BUTT PICA PER MINUTE Tobacco 1 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 SESSIONS

  41. 100 90 80 70 60 PERCENTAGE OF TRIALS CONSUMED 50 40 30 20 10 0 Herbal Butts Tobacco Tobacco Butts Herbs Paper STIMULI

  42. BL NCF NCF v. NCF + Interrupt NCF + Interrupt 3.0 2.0 NCF BUTT PICA PER MINUTE 1.0 NCF + Interrupt 0.0 11 16 21 29 34 37 42 47 52 55 60 65 1 6 SESSIONS

  43. Does Choice Function as a Reinforcement Across Species • Basic research has shown that pigeons prefer having multiple response options to having just one response option, even when the amount of reinforcement (food) and the size of the response apparatus are held constant (Catania & Sagvolden, 1980).

  44. Similarities and Differences Between Human and Nonhuman Species • "If you pick up a starving dog and make him prosperous, he will not bite you. This is the principal difference between a dog and a man.” • Mark Twain

  45. Similarities and Differences Between Human and Nonhuman Species • "Man is rated the highest animal, at least among all animals who returned the questionnaire.”  • Robert Brault

  46. Experiment 1: Does Choice Function as Reinforcement? • The goal of this study was to determine whether individuals with disabilities preferred a choice to a no-choice condition when each produced the same terminal reinforcer(s).