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DavidP.Wacker CenterforDisabilitiesandDevelopment,TheUniversityofIowa,IowaCity,Iowa,USA LaciWatkins DepartmentofSpecialEducation,TheUniversityofTexasatAustin,Austin,Texas,USA

DavidA.Wilder SchoolofBehaviorAnalysis,FloridaInstituteofTechnology,Melbourne,Florida,USA

AlyssaN.Wilson SchoolofSocialWork,StLouisUniversity,StLouis,Missouri,USA

DouglasW.Woods DepartmentofPsychology,TexasA&MUniversity,CollegeStation,Texas,USA

AmandaN.Zangrillo CenterforAutismSpectrumDisorders,Munroe-MeyerInstitute,TheUniversityof NebraskaMedicalCenter,Omaha,Nebraska,USA

PREFACE

Theoriginofthistextarosefromcountlessconversationswithotherprofessionalswhogenerallyreported,“Iknowaboutappliedbehavioranalysis. I’veseenitdonebefore.”Undoubtedly,manyofthoseprofessionalshad seenaversionofappliedbehavioranalysis(or“ABA”asitisoftenreferred to)conductedwiththeirchild,student,orpatient;however,itbecameclear thatothersheldarelativelyrestrictednotionofABA.Withoutdoubt,one ofthemostnotableutilizationsofABAhasbeenwithinthecontextof theinterventionsrelatingtoskilldeficitsandbehaviorsofexcessdisplayed byindividualswithdevelopmentaldisabilities,specificallyautism.Although numerousproceduresandapproacheshavebeenpresentedaspotentialtreatmentsforthebehavioralsymptomsofautism,thosebasedontheprinciples ofABAhavereceivedthemostempiricalsupport.Asaresult,inrecentyears, theterm“appliedbehavioranalysis”appearstobeusedquiteoftenasa synonymforaveryspecificrangeofinterventionsforautism.

ManyreaderswouldnotethatABAisbutasubfieldofthebroaderarea ofbehavioranalysisthatalsoincludes:(a)behaviorism,whichfocuseson theworldview,theory,orphilosophyofbehavioranalysis,and(b)the experimentalanalysisofbehavior(EAB),whichfocusesonidentifying andanalyzingthebasicprinciples,mechanisms,andprocessesthatexplain behavior.ABAisdistinctfromEABinthatitisconsideredaclinicaldisciplineinwhichthegeneralprinciplesoflearningandbehaviorareappliedfor thepurposeofaddressingsociallyrelevantproblemsandissues.Thus,behavioranalystswhoworkinABAconductresearchthatassistsindevelopingand evaluatingevidence-basedpracticesdirectedtowardtheremedyofproblems associatedwithsociallysignificantbehavior.Appliedbehavioranalyststhen usetheresultsoftheappliedresearchtocreateandimplementeffective evidence-basedproceduresinmorenaturalsettingssuchasschools,homes, andthecommunity.Suchworkoftenfocusesonbehavioralproblemsthat occurinparticularsettings,areassociatedwithparticularpopulations(e.g., individualswithautismorotherdevelopmentaldisabilities),andthosethat arepresentwithinlargersocialcontexts(e.g.,organizationalbehavior management).

InlightoftheefficacyofABA-basedproceduresinaddressingbehaviors associatedwithautism,itisimportanttonotethattheprinciplesunderlying thistherapeuticapproachhavebeenshowntobesimilarlyeffectivewhen

appliedtootherpopulations,settings,andbehaviors.Thecurrenttextprovidesareviewofsuchclinicalapplicationstowardthepurposeofexpanding thereader’sknowledgerelatedtothebreadthofABA-basedapplications. Simplyput,thegoalistoillustratetheuseofABAbeyondtherealmof autism.

ThecontentofthisbookwasidentifiedfromaninformalsurveyofABA practitionersandresearchersontheirknowledgeofcurrentareasofclinical practice.Ingeneral,anattemptwasmadetolimittheproposedcontentto clinicalapplicationswhichhavebeendividedintofourbroadareas:child applications,adultapplications,broad-basedhealthapplications,andapplicationsintheareaoforganizationalbehaviormanagement.Undoubtedly,as thefieldcontinuestoexpanditsbreadth,therearesomeareasinwhichABA methodsareappliedtonovelareasofstudythatmayhavebeenomittedfrom inclusion.

Theeditorshavedrawnuponarangeofsubject-matterexpertswhohave clinicalandresearchexperienceintheapplicationofABAacrossmultiple applicationstoserveascontributorstothisvolume.Agreatdealofthought wasexpendedindeterminingwhomweshouldcontactformaterialona givenchapter.Inmanycases,thedecisionwasdifficultasthereareanumber ofsubject-matterexpertswhowouldhavebeenappropriate.Inthemajority ofcases,ourinitialapproachtoapotentialcontributorwasmetwithan enthusiasticacceptance.Consequently,theresultingtextincludescontributionsfromindividualswhohaveservedaseditors,associateeditors,oreditorialboardmembersforprominentcontent-areajournalssuchasthe Journal ofAppliedBehaviorAnalysis,the JournaloftheExperimentalAnalysisofBehavior, the JournalofOrganizationalBehaviorManagement,andthe BehaviorAnalyst. Thisbookisbestsuitedasaprimarytextbookforcourseworkinbehavior analysis,psychology,oreducation.Also,whilepractitionersandstudentsare theultimatetargetsofthiswork,otherprofessionalsshouldfindthecontent andlanguagetobemanageable.ThehopeisthatthisvolumewillbeinformativeindemonstratingtherangeofapplicationofABAtovariousproblemsofsocialsignificance.Wehopethereaderfindsthisbookasenjoyableas itwastoedit.

CHAPTER1

DefiningFeaturesofApplied BehaviorAnalysis

INTRODUCTION

Individualswhoworkinappliedbehavioranalysis(ABA)implementclinical interventionsaswellasconductresearchtoassistinthedevelopmentofpracticesforaddressingproblemsthatoccurwithsociallysignificantbehavior. Appliedbehavioranalystsoftenconductappliedresearchandusetheresults tocreateandimplementeffective,evidence-basedproceduresinmorenatural settingssuchasthehome,schools,andthecommunity.ABA-basedresearch oftenfocusesonbehavioralissuesthatoccurinspecificsettings,areassociated withparticularpopulationsincludingchildren(e.g.,obesity,autismorother developmentaldisabilities,traumaticbraininjury,feedingdisorders)andadults (e.g.,caregivertraining,sportsperformance,gambling),aswellasthosewithin othersocialcontextssuchasvariousworkplaceenvironments(e.g.,performancemanagement,workplacesafety,systemsanalysis).

AlthoughABAhasanextensivehistoryofeffectivenessinapplication andresearchacrossadiversenumberofareasoffocus,settings,andpopulations,perceptionsexistinthemedia,variousdisciplines,andthepublicin generalthatABAissynonymouswithproceduresforaddressingissues relatedtoautismspectrumdisorderandotherdevelopmentaldisabilities (e.g.,discrete-trialtrainingandotherprocedurestopromoteskillacquisition;functionalbehavioralassessmentandtreatmentofchallengingbehavior).Infact,theuseofABA-basedmethodsandprocedurestoaddressissues relatingtoautismisjustoneofthemanyexamplesoftheeffectiveapplicationoftheABAapproachtoaddressingsociallysignificantbehavior.Said anotherway,althoughABAhasbeendemonstratedtobeaneffective approachtoaddressingissueswithautism(e.g., Howard,Stanislaw,Green, Sparkman,&Cohen,2014;MacDonald,Parry-Cruwys,Dupere,&Ahearn, 2014;Matson,Tureck,Turygin,Beighley,&Rieske,2012),thisaspectof ABArepresentsonlyone,relativelynarrowapplication.

ThischapterprovidesanoverviewofthefeaturesofABAwithinthe frameworkprovidedby Baer,Wolf,andRisley(1968) andhowthosefeaturescharacterizeworkconductedinvariousareasoffocus,settings,and populations.Eachofthedimensionsisdescribedanddemonstratedusing examplesfromvariouschild,adult,andorganizationalABA-basedresearch.

DIMENSIONSOFABA

Baeretal.(1968) providedwhattheycontendedweredefiningdimensions ofABA.AsdescribedbyBaeretal.,therearesevendimensionsofABA thatmustbepresenttoensurethateffectivepracticesaredevelopedand implemented.AccordingtoBaeretal.,ABAis(a)applied,(b)behavioral, (c)analytic,(d)technological,(e)conceptuallysystematic,(f)effective,and (g)generalizable.Theremainderofthischapterwillreviewthedimensions describedbyBaeretal.usingappliedstudiesacrossvariouspopulations andareasoffocusasoutlinedinthistexttoillustratehowthey characterizeABA.

Applied

Theterm applied indicatesthataparticulartargetbehaviorofinterestisof socialsignificance.Further,itistheemphasisonsocialsignificancethatdistinguishesABAfromlaboratoryanalysis.Specifically,appliedbehavioranalystsselectbehaviorsthataresociallymeaningfulandarecurrentlyof importancetotheindividual(s)whosebehaviorisbeingaddressed.Atvarioustimes,appliedbehavioranalystshaveopportunitiestoaddressnumerous behaviorsdemonstratedbyindividuals,anditisconsideredvitalthatthey prioritizethosebehaviorsintermsofimportance.Illustrationsofthe applied dimensionofABAarewide-rangingandcanbeobservedinstudiesacross numerouspopulations,settings,andareas.

Myriadchild-focusedstudieshavebeenconductedwithinABAthat exemplifythefocusonsocialsignificance.Theseinclude(butarenotlimited to)studiesevaluatingtreatmentsforfeedingdisorders(e.g., Kadey,Piazza, Rivas,&Zeleny,2013;Kadey,Roane,Diaz,&Merrow,2013; LaRue etal.,2011;Volkert,Vaz,Piazza,Frese,&Barnett,2011),interventions forchildhoodobesity(e.g., Fogel,Miltenberger,Graves,&Koehler, 2010;VanCamp&Hayes,2012),andissuesrelatingtoattentiondeficit hyperactivitydisorder(ADHD;e.g., Northup,Fusilier,Swanson,Roane, &Borrero,1997;Ridgway,Northup,Pellegrin,LaRue,&Hightsoe,2003).

TheABA-basedapproachtotheassessmentandtreatmentofpediatric feedingdisordershasincludedawidevarietyofbehaviorsofsignificantsocial

importanceincludingfoodrefusal(Borrero,Woods,Borrero,Masler,& Lesser,2010),self-feeding(Vaz,Volkert,&Piazza,2011),andswallowing (e.g., Kadey,Piazza,etal.,2013).Forexample, Kadey,Piazza,etal.(2013) addressedthefoodconsumptionofa5-year-oldgirlwhoreliedonagastrostomytubeforhercaloricneeds.Theauthorsconductedatextureassessmentinwhichtheyevaluatedvarioustextures,acrossfoods,todetermine theonewhichthegirlcouldsuccessfullyswallow.Throughtheirsystematic processofidentifyingatexturewithwhichshecouldbesuccessfulwithindividualfoods,theauthorswereabletoincreasethegirl’sconsumptionof thosefoods.

ChildobesityisanothersociallysignificantareainwhichseveralABAbasedstudieshavebeenconducted. Fogeletal.(2010) evaluatedtheeffects ofvideogame-basedexercise(i.e.,exergaming)relativetotraditionalphysicaleducation(PE)withfourphysicallyinactiveandoverweightfifthgrade students.Theauthors’purposewastoevaluatewhetherthephysicalactivity ofthechildrenwouldincreasethroughexposureto10exergames(e.g.,Play Station;NintendoWiiBoxing,SportsBaseball,SportsTennis;iTechFitness XrBoard).Throughtheuseoftheexergamingapproach,theauthorswere abletosubstantiallyincreasethephysicalactivityofallfourchildrenabove thelevelsobservedduringtraditionalPE.

Athirdsociallysignificant,child-focusedareaofstudydealswithvariablesrelatingtoADHD. Northupetal.(1997) evaluatedtheeffectsofstimulantmedicationonfivechildrenwithADHDdiagnoses.Specifically,the authorsevaluatedthechildren’spreferencefordifferentreinforcers(quiet time,aloneplay,andsocialplay)acrossthepresenceandabsenceofstimulant medications.AlthoughtheresultsofNorthupetal.wereidiosyncraticacross children,theauthorsshowedthatstimulantmedicationcanalterchildren’s motivationfortypesofreinforcement.

Studiesconductedintheareasofpediatricfeedingdisorderssuchas Kadey,Piazza,etal.(2013),childhoodobesitysuchas Fogeletal.(2010), andADHDsuchas LaRueetal.(2011) illustratetheemphasisofchildfocusedABAonsocialsignificance.Eachofthedependentvariables,ortargetbehaviors,intheabovestudieswasmeaningfulandofpracticalimportancetothechildreninthestudiesandtopotentialfutureconsumersofthe studies.

Similarly,alargenumberofadult-focusedstudieswithhighsocialsignificancehavebeenconductedwithinABA.Theseinclude(butarenotlimited to)studiesevaluatingassessment,treatment,andtrainingpracticesinpathologicalgambling(e.g., Guercio,Johnson,&Dixon,2012;Nastally,Dixon, &Jackson,2010)aswellasteacherandcaregivertraining(e.g., Lerman,

Tetreault,Hovanetz,Strobel,&Garro,2008;Lerman,Vorndran,Addison, &Kuhn,2004).

Forexample,thedimensionofsocialsignificanceisdemonstratedin adult-focused,ABA-basedstudiespertainingtotheassessment,treatment, anddeterminationofthevariablesthatcontributetopathologicalgambling. Guercioetal.(2012) studiedatreatmentintendedtodecreaseurgestogambleandactualgamblingbehaviorofthreeadultswithacquiredbraininjury whowerealsoindicatedaspathologicalgamblers.Theauthorsimplemented atreatmentprogramthatconsistedofone-on-onetherapythatentailedprovidinginstructiontotheadultsaboutmotivatingoperations(MOs),antecedents,andconsequencesrelatingtogambling.Throughtheapplication ofthetreatmentprogram,theauthorsdemonstratedareductioninurges togamble(basedondatacollectedviaself-reports)andgamblingbehavior ineachoftheadults.

Anotheradult-focusedareaofstudythatillustratesthedimensionof socialsignificanceinABAiscareprovidertraining. Lermanetal.(2008) evaluatedatrainingprogramintendedtoteachskillstoteachersofchildren withautismrelatingtotheimplementationofpreferenceassessmentand teachingprocedures.Thetrainingprogramconsistedofavarietyofteaching methodsincludinglectures,discussion,androle-playprocedures.The resultsshowedthatthetrainingprogramresultedintheacquisitionofthe targetskillsbyeachoftheteachers,andfollow-upassessmentsuggestedthat thoseskillsmaintainedovertimefollowingtraining.Similartothechildbasedstudiesdescribedabove,eachofthedependentvariablesevaluated inadult-basedstudieswasmeaningfulandofobviouspracticalimportance.

Manystudieshavealsobeenconductedintheareaoforganizational behaviormanagement(OBM)pertainingtosafety(e.g., Ludwig&Geller, 1997)illustratingtheappliednatureofABA.Forexample, Ludwigand Geller(1997) conductedastudyinwhichtheyevaluatedanintervention aimedatincreasingsafedrivingbehaviorofpizzadeliverydrivers.Specifically, theauthorsimplementedtwointerventionswithtwogroupsofdrivers, respectively.Oneinterventionconsistedofgoalsettinginwhichthedrivers participatedinthesettingofthegoals.Thesecondinterventionconsistedof goalsettingbutthedriversdidnotparticipateinthesettingofgoals.The resultsshowedthatbothinterventionswereeffectiveatincreasingcomplete stopsatintersections.Further,theresultsalsoshowedthatnontargetedsafe drivingbehaviors(i.e.,turnsignaluse,safetybeltuse)alsoincreasedduring oneoftheinterventions.Theinterventions,whichwereantecedent-based innature,utilizedby LudwigandGeller(1997) demonstratedtheeffective

useofanABA-basedapproachtoproducepositive,sociallysignificant changeswithmeaningfulandpracticaltargetbehaviors.

Behavioral

Theterm behavioral indicatesthatABAconcernsitselfwiththestudyof directlyobservablebehavior.Specifically,appliedbehavioranalystsemphasizethedirectobservationandmanipulationofovertbehavior.Indirect measuresofbehaviorsuchasself-report,interviews,orchecklists,although oftenused,arede-emphasizedinABAresearchinfavorofdirectmethodsof measurementandmanipulation.Inaddition,appliedbehavioranalystsdo notattributebehaviorascharacteristicsof,orbasedupon,nonbehavioral constructsorinnerqualities(e.g.,personalitytraits).Rather,ABAemphasizesthemanipulationofenvironmentalvariablesandtheobservationof relationsbetweenbehaviorsofinterestandthosevariablesforthepurpose ofdemonstratingfunctionalrelations(i.e.,functionsofbehavior).The behavioraldimensionofABAisvitalbecauseoftheimportanceofprecise measurementsofbehaviorsofinterestthat,inturn,allowforvalidevaluationsanddemonstrationsoffunctionalrelationsbetweeninterventionsof interestandtargetbehaviorsofimportance(seeSection“Analytic”).Further,itallowsforasystematicanalysisoftheextenttowhichappliedbehavioranalystsareaddressingtheintendedtargetbehaviorsandnot approximationsornontargetbehaviors(i.e.,reliabilityofmeasurement).

The behavioral dimensionofABAcanbeillustratedinnumerouschildbasedstudiesincludingthosefocusingonchallengingbehavior(e.g., Athens &Vollmer,2010;Lustigetal.,2014)andacademicskills(e.g., Martens, Werder,Hier,&Koenig,2013).Forexample, AthensandVollmer (2010) conductedastudyinwhichtheyevaluatedatreatmentofchallenging behaviorexhibitedbychildrenwithautismandADHD.Theauthors focusedexclusivelyonthedirectobservationofthetargetbehaviors(i.e., aggression,disruption,compliance,communicativebehaviors).Todoso, theauthorsestablishedaspecific,operationaldefinitionofaggressionfor theparticipant(Henry)thatconsistedof“forcefullyhittingandkicking othersresultinginbruisinghisvictims”(p.573).Thisdefinitionallowed forthedirectobservationandmeasurementofthepresenceandabsence ofthebehavior.Thisapproachcanbecontrastedwithanonbehavioral approachthatmightconsistofanecdotalreports,orimpressionsprovided bycareprovidersregardingthebehaviorofthechild.

Martensetal.(2013) focusedonaccuracyandfluencyexhibitedbychildrenduringoralreading.Theauthorsspecificallydefinedeachofthesetarget

behaviorstoallowfordirectobservationandmeasurement.Specifically,they establishedanoperationaldefinitionofaccuracythatconsistedofthecorrect readingofaparticularword,andtheyestablishedanoperationaldefinitionof fluencythatconsistedofthenumberofwordscorrectlyreadperminute. Establishingthesespecific,observableoperationaldefinitionsallowedthe authorstoevaluatevariables(i.e.,aninterventionconsistingofwordtraining) impactingtheiroccurrence,orlackthereof,inasystematicway.Withoutan emphasisonabehavioralapproach,establishmentofreliabilityofmeasurementwouldnotbepossiblewhichwouldhaveprecludedtheauthorsfrom drawingconclusionsaboutrelationsbetweentheirindependentanddependentvariables(i.e.,conclusionsabouttheeffectivenessoftheirinterventions wouldnotbeappropriateintheabsenceofdemonstrationofreliabilityof measurementmadepossiblebythebehavioralapproach).

The behavioral dimensionofABAisalsoillustratedinnumerousadultbasedstudiesincludingthosefocusingonproblembehaviorsingerontologicalpopulations(e.g., Baker,LeBlanc,Raetz,&Hilton,2011)andacquired braininjury(e.g., Lancionietal.,2012).Forexample, Bakeretal.(2011) intervenedwithanindividualwithAlzheimer’s-typeseveredementia whowasengaginginhoardingbehaviors.Theauthorsestablishedadefinitionofhoardingthatallowedforthedirectobservationandmeasurementof thebehavior(i.e.,puttingitemsinhershirtorpants).Thiswasopposedtoa nonbehavioralapproachthatmighthavereliedonthefeelingsofthestaff thatworkedwithher.Thus,byrelyingondirectlyobservablebehaviors, theauthorsminimizedpotentialbiasandaccuracyissuesthatwouldlikely impactnonbehavioralapproaches(e.g.,staffimpressions).Subsequently, theauthorswereabletosystematicallyevaluatetheeffectivenessoftwo interventionsanddemonstratetheireffectiveness.Inanotheradult-focused study,Lancionietal.focusedontextmessagingskillswithindividualswith acquiredbraininjuries.Tosystematicallyevaluatetheeffectivenessoftheir intervention,theauthorsestablishedoperationaldefinitionsthatallowedfor thedirectobservationandmeasurementoftargetskillsrelatedtotextmessagingincludingnumberofmessagessent,lengthofmessages,thetime neededtosendandreceivemessages,andnumberofmessagesreceived andwhethertheindividualread/listenedtothemessage.Whereasthis approachallowedforasystematic,empiricalevaluationoftheeffectsof theintervention,anonbehavioralapproachwouldnothaveallowedfora preciseandaccuratereflectionofpositive(orlackthereof)effects.

Manystudiesthatillustratethe behavioral approachofABAhavealsobeen conductedintheareaofOBMpertainingtoperformancemanagement

(e.g., Fienup,Luiselli,Joy,Smyth,&Stein,2013;Goomas,Smith,& Ludwig,2011).Forexample, Fienupetal.(2013) evaluatedanintervention intendedtoimprovetheperformanceofstaffatahumanservicesorganization.Specifically,theauthorsintervenedwiththepurposeofdecreasingstaff tardinessforsupervisionmeetings.Theauthorsmeasuredlatencyfromthe scheduledbeginningtimeformeetingsuntiltheactualtimeinwhichmeetingsbegan.Thisbehavioralandobservablemeasurementsystemminimized potentialinaccurateinferencesaboutthepositiveeffectsoftheintervention theyemployed. Goomasetal.(2011) focusedontheperformanceof employeesataretaildistributioncenter.Theauthorsdirectlymeasured theamountoftimeittookemployeestocompletespecifictasks.Byestablishingdirectmeasuresofbehavior,theseauthorswereabletodirectlyevaluatepotentialrelationsbetweentheirinterventionanditseffectsonthose targetedbehaviors.

Analytic

Theterm analytic indicatesthatABAemphasizesbelievabledemonstrations ofrelationsbetweenbehaviorsofinterestandenvironmentalvariables, interventions,andtreatmentsunderstudy.Systematic analyses ofbehavior arevitalforthedemonstrationofexperimentalcontrolwithregardtothe effectsofindependentvariables(e.g.,interventionsandtreatments)on dependentvariables(e.g.,sociallyrelevantbehaviorsofinterest).AnemphasisisplacedontheanalyticnatureofABAbecauseitisvitalthatapplied behavioranalystsbasetheirpracticalrecommendationson“believabledemonstrations”(Baeretal.,1968,p.93)thattheirinterventionswereresponsibleforpositivechangesinbehaviorsofinterest.Thus,itisimportantthat theinferencesaboutcausalrelationsbetweenrecommendedinterventions andpositiveoutcomesshouldbebasedonsystematic,empiricalmethods anddemonstrationsofexperimentalcontrol.

Experimentalcontrolisachievedwhenanappliedbehavioranalystdemonstratesafunctional,orcausal,relationbetweenenvironmentalvariablesof interestandbehaviorsofinterest.InABA,varioussingle-subjectexperimentaldesignsareutilizedtodemonstratefunctionalrelationsincluding(butnot limitedto)thereversal,multielement(andalternatingtreatmentsdesign), changingcriterion,andmultiple-baselineexperimentaldesigns.Thesebasic designssharethreecommonelements:(a)prediction—anticipatedfuture levelsofbehavior,(b)verification—demonstrationthatthepreviously predictedlevelsofbehaviorwouldcontinueintheabsenceofatreatment, and(c)replication—repeatingpreviouschangesinbehaviorviathe

reintroductionandsubsequentremovalofthetreatmentacrosstime,settings,and/orindividuals.

The analysis dimensionofABAisillustratedinthechild-basedliteratureas reflectedbyemphasison,anduseof,varioussingle-subjectexperimental designstodemonstratefunctionalrelationsbetweentheindependentvariables (e.g.,environmentalvariables,interventions,treatments)andsociallyrelevant behaviorsofinterest.Forexample,inthestudydescribedabove, Kadey,Piazza, etal.(2013) employedareversaldesigntosystematicallydemonstratethe relationbetweenswallowingbehavior(i.e.,mouthcleans)demonstratedby a5-year-oldgirlwithfeedingproblemsandspecifictexturelevels.Usingthe reversaldesign,theauthorsfirstimplementedasmoothtexturelevelproduced byaspecifictypeoffoodprocesser(i.e.,aMagicBullet®)anddocumentedthe percentageofbitetrialsinwhichthechildswallowedasreflectedbymouth cleans.Theauthorsconductedrepeatedsessionsinthisinitialcondition,and thechilddemonstratedhighandrelativelystablelevelsofswallowingbehavior. Theresultsofthefirstconditionprovidedpreliminaryevidenceofarelation betweenthechild’sswallowingbehaviorandthetexturelevelofthefood. However,withoutadditionalexperimentalmanipulations,itwouldhavebeen inappropriatetoinfercausalitybetweenfoodtextureandswallowing.Therefore,theauthorsendedtheconditionandimplementedasecondconditionin whichpureedfoodwaspresentedthatwasofadifferenttexturethanthefood presentedinthepreviouscondition.Theauthorsimplementedrepeatedsessionsinthesecondconditionuntiltheyobservedlowandstablelevelsofswallowing.Theresultsofthesecondconditionprovidedadditionalevidencethat theleveloftextureusedinthefirstconditionwasresponsibleforthehighlevels ofswallowingobserved.However,thepotentialeffectsofextraneousvariables onswallowingcouldnotberuledout(e.g.,avariableoutsideoftheevaluation mayhavecoincidedwiththeonsetofthesecondconditionandcouldhave influencedtheresults).Theauthorsreimplementedtheinitialconditionand swallowingbehaviorincreasedbacktolevelsobservedduringtheinitialcondition.Theseresultsprovidedadditionalevidencethatthehighlevelswallowingresultedfromthetexturelevelratherthanextraneousvariables.Theauthors subsequentlyconductedanadditionalreversal(i.e.,anadditionalpureeconditionandadditionalMagicBullet® condition)andproducedsimilarresults. Thus,theco-occurrenceofpositivechangesinthetargetbehavior(i.e.,swallowing)wasdemonstratedtooccuronlyinthepresenceofthefoodtexture producedbytheMagicBulletblender.Therefore,causalitybetweenpositive effectsobservedwiththeswallowingbehaviorandthetreatmentcouldbereasonablyinferred.

Normand(2008) providedanexampleoftheuseofamultiple-baseline (combinedwithanABABdesign),single-subjectexperimentaldesignto demonstratethefunctionalrelationbetweenaninterventionpackageand physicalactivitydemonstratedbyadults.Normandfirstintroducedbaseline conditionstoeachoffouradultparticipantsandmeasuredthetotalnumber ofstepstakenbyeachparticipant.Thetreatmentpackage(consistingofgoal setting,self-monitoring,andfeedback)wasintroducedwithoneoftheparticipantsafterstablelevelsofstepstakenwereobserved;whilebaselinecontinuedtobeimplementedwiththeotherthreeparticipants.Positiveeffects (i.e.,increasedlevelsofstepstaken)wereobservedwiththefirstparticipant whileconcurrently,levelsofstepstakencontinuedatconsistentlevelswith theadditionalfourparticipants.Thisresultprovidedpreliminaryevidence thatthetreatmentpackagewaseffectiveatincreasingstepstaken;however, extraneousvariablescouldnotberuledoutwithoutreplicationofthose effectsacrossparticipants.Therefore,Normandintroducedtheintervention withthesecondparticipantwhilebaselineconditionscontinuedwiththe otherthreeparticipants.Similarpatternsofbehaviorwereobservedwith thesecondparticipantasthoseobservedwiththefirstparticipantwithan increaseinstepstaken.Theseresultsrepresentedareplicationofthepositive effectsobservedwiththefirstparticipant.Coupledwiththecontinuedconsistentlevelsofstepstakenwiththeothertwoparticipantsduringbaseline conditions,evidenceaccruedsuggestingafunctionalrelationbetweenthe treatmentpackageandanincreaseinstepstaken.Normandwentontoreplicatethepositiveeffectswiththeadditionaltwoparticipants,demonstrating threereplicationsoftheinitialpositiveeffects.Throughthisprocess,the authorwasabletoruleout,toareasonabledegree,thepossibleeffectsof extraneousvariablesontheobservedpositiveeffects.Saidanotherway, throughthedemonstrationoffunctionalrelations,Normandcouldbeconfidentthatitwasthetreatmentpackagethatproducedthepositiveresultsand notsomeotherextraexperimentalvariable(s).

Empiricalmethodsthatemphasizethedemonstrationoffunctional relationsarealsoemphasizedintheareaofOBM.Forexample, Pampino, MacDonald,Mullin,andWilder(2004) usedamultiple-baseline,singlesubjectdesigntoevaluatetheeffectsofaninterventionpackageconsisting oftaskclarification,goalsetting,positivereinforcement,andfeedbackon completionofmaintenancetasksbyworkersinaframingandartstore. Theauthorsfirstcollectedbaselinedatapriortotheimplementationof theinterventionpackageacrosstwosetsofduties.Afterstablelevelsofcompletionofdutieswereobservedacrossbothsetsofduties,theauthors

implementedtheinterventionwithonesetofdutieswhilecontinuingto collectbaselinedatawiththesecondsetofduties.Percentagesofcompletion ofthedutiesintheinterventionconditionimmediatelyincreasedwhenthe interventionwasimplemented,whilelevelsofcompletionofthesecondset ofduties(i.e.,inbaselineconditions)remainedlow.Next,theauthors implementedtheinterventionwiththesecondsetofdutiesandanimmediateincreaseincompletionofthosedutieswasobserved;thus,thepositive effectsobservedwiththefirstsetofdutieswerereplicatedwiththesecond setofduties.Thesystematicmethodsusedbytheauthorsallowedthemto infercausalitybetweentheirinterventionandtheobservedpositiveeffects.

Technological

Inadditiontofocusingon analysis andemphasizingfunctionalrelations throughtheuseofappropriateexperimentaldesignsandtheuseof behavioral methods(e.g.,precisemeasurementsoftargetbehaviors),ABAemphasizes thoroughandaccuratedescriptionsofprocedureswithinthecontextof researchandtheapplicationofbehavioralinterventions.Descriptionsof procedures,operationaldefinitions,andproceduralintegritydataaredocumentedtoallowotherappliedbehavioranalyststoreplicatestudiesandevaluationsinappliedsettingsandresearch.Areviewofpracticallyanystudy publishedinapeer-reviewedABAjournal(suchasthe JournalofApplied BehaviorAnalysis)willprovideademonstrationofthetechnologicalaspect ofABA.

ConceptuallySystematic

ThepracticesutilizedinABAareappliedinnature.However,thereisaclear emphasisinABAthatthesepracticesbe conceptuallysystematic.Thus,basic behavioralprinciplesempiricallyvalidatedovermanyyearsbyscientists andappliedbehavioranalystswhoconductbasicandappliedresearchon thebehavioraltheoriesofexperimentalanalysisofbehaviorunderliethe practicesofABA.Forexample,interventioncomponentsthatarebased onconceptuallysystematicbehavioralprinciplesinclude(butarenotlimited to)reinforcement,extinction,punishment,stimuluscontrol,discrimination,MOs,andschedulesofreinforcement. Baeretal.(1968) assertedthat byemphasizingbehavioralprinciplesalongwithprecisedescriptionsofprocedures,ABAwouldadvanceataratesuperiortoanalternativeapproach thatcouldbedescribedasa“collectionoftricks”(p.96).

Theemphasisonconceptualsystemscanbeillustratedinthechild-based behavioralliteraturepertainingtofunctionalcommunicationtraining(FCT;

Carr&Durand,1985).FCTinvolves(a)evaluatingandidentifyingthereinforcermaintainingchallengingbehaviorviaafunctionalassessment(e.g.,functionalanalysis; Carr&Durand,1985;Iwata,Dorsey,Slifer,Bauman,& Richman,1982/1994);(b)traininganewappropriatecommunicativebehavior(e.g.,cardexchange,microswitch,signlanguage)anddeliveringthesame reinforcercontingentontheresponse;(c)placingchallengingbehavioron extinction(i.e.,reinforcementiswithheldfollowingoccurrencesofchallengingbehavior; Fisheretal.,1993;Hagopian,Fisher,Sullivan,Acquisto,& LeBlanc,1998);and(d)insomecases,applyingpunishmentcontingenton challengingbehavior(Hagopianetal.,1998;Wackeretal.,1990).Thus, theeffectivenessofFCTisbasedonthebehavioralmechanismsincludingreinforcement(positiveand/ornegative)and,inmanycases,extinctionandpunishment,aswellastrainingproceduressuchastheuseofatime-delayprompt.

TheapproachofconceptualizingFCTusingbehavioralmechanismsand aconceptualsystemisdistinctfromapotentialapproachtothetreatment thatmightfocusonotheraspectsofthetreatment.Forexample,aclinician focusingonFCTwithoutconsideringtheunderlyingconceptualsystem mayfavorconceptualizingthetreatmentasonethatfocusesontheutilizationoftechnology(e.g.,iPadtechnology,voice-outputdevice)forcommunicationandmistakenlyassumethattheeffectivenessofthetreatmentis basedontheprovisionoftechnology-basedcommunicativetechniques. Suchanapproachwouldbeproblematicforseveralreasons.First,without consideringtheantecedentsandreinforcementcontingenciesassociated withchallengingbehavior,whilefocusingsolelyontrainingcommunicationusingtechnology-basedmodalities,itislikelythetreatmentwillfail toeffectivelytreatthechallengingbehaviorbecausethecontingenciescontrollingthebehaviorwillnothavebeenaddressed.Thus,toaddressthecontingenciescontrollingthebehavior,theeffectiveappliedbehavioranalyst considersthebehavioralmechanismsresponsibleforthechallengingbehavioraswellasthetarget-appropriatecommunicativebehaviors(technologybasedorotherwise).Inaddition,as Baeretal.(1968) asserted,withoutusing aconceptualsystemwhenimplementingthetreatment,itisunlikelytheclinicianwillgeneralizeandapplythetreatmenteffectivelyinothersituations.

Guercioetal.(2012) providedanexampleoftheapplicationofatreatmentbasedonabehavioralconceptualsystemforadultpathologicalgamblersinindividualswithacquiredbraininjury.Asdescribedpreviously, theauthorsimplementedaprogramthatconsistedofone-on-onetreatment therapysessionsinwhichtheyfocusedonteachingtheparticipantsaboutthe MOs,antecedents,andreinforcersassociatedwithgamblingbehaviors.

Thus,thetreatmentwasexplicitlybasedonbehavioralmechanismsconceptualizedascontrollinggamblingbehavior.Analternativeconceptualization ofthetreatmentmightminimizeoromitthebehavioralcomponentsofthe approachandinsteadfocusontheformatfortherapy(e.g.,one-on-onesessions,client-centereddiscussions).SimilartoFCT,however,thefocusand relianceonbehavioralmechanismsisvitaltotheeffectivenessofthetreatmentaswellastheeffectivegeneralizationandapplicationoftheprocedures byfutureclinicians.

Theuseofabehavioralconceptualsystemisalsoemphasizedinthearea ofOBM.Forexample, CunninghamandAustin(2007) utilizedaninterventionpackageconsistingofgoalsetting,taskclarification(viamodeling),and feedback(descriptionofperformance,praise)viaweeklymeetingsto improvetheperformanceofhospitaloperatingroomemployeespertaining tohands-freeoperatingtechniques.Theauthorsconceptualizedthebehavioralmechanismofthefeedbackcomponentoftheinterventionpackageas positivereinforcementofthetargetbehavior.Analternativeconceptualizationthatwouldnotincorporateanunderlyingbehavioralmechanismmight focusnotonthemechanismofreinforcement,butrathertheimplementationofweeklymeetingstodiscusstheperformanceofstaff.However,future attemptedapplicationsoftheinterventionthatemphasizeelementsofthe interventionthatwerenotresponsiblefortheobservedpositivebehavior (ratherthanthebehavioralmechanismresponsible;i.e.,positivereinforcement)wouldbemuchlesslikelytobeeffective.Itshouldalsobenotedthat althoughnotexplicitlystatedinthestudy,thegoalsettingandmodeling componentscouldbeconceptualizedasantecedent-basedandintendedto increasediscriminationandoccasionthedesiredbehaviors.

Effective

Effectiveness isadimensionthatemphasizesthepracticalqualityofABApractices.Thatis,the effectiveness dimensionofABAfocusesonwhethertheindividualwhosebehaviorwaschangedandthefamilyandcareprovidersofthe individualviewthebehaviorchangetobepracticalandsignificant.Applied behavioranalystsdeterminethe effectiveness oftheirproceduresbyevaluating theirdata,oftenthroughvisualinspectionusingvalidsingle-subjectexperimentaldesigns(asopposedtotheuseofstatisticalprocedurestodetermineif behaviorchangeissignificant).Additionally,ABAemphasizesjudgmentsof sociallyacceptablelevelsofimprovementoftargetbehaviors.

Anexamplefromthechild-basedABAliteraturepertainstotheassessmentandtreatmentofpica.Pica(i.e.,theinsertionofinedibleobjectsinto

theoralcavityortheingestionofinedibleobjects; Piazzaetal.,1998; Roane,Kelly,&Fisher,2003)canbealife-threateningbehaviordisplayed bychildrenwithautismandotherdevelopmentaldisabilities. Falcomata, Roane,andPabico(2007) conductedastudythatinvolvedtheassessment andtreatmentofpicaina12-year-oldboywithautism.Duringthestudy, theauthorsevaluatedseveraltreatmentapproachesbycomparingtheir effectstoeachotheraswellasbaselineconditions.Thetreatmentsincluded enrichedenvironment(i.e.,continuousaccesstohighlypreferredstimuli) andenrichedenvironmentplusatimeoutprocedure(i.e.,visualscreentimeout).Theresultsshowedthatbothtreatmentswereeffectiveatdecreasing picaincomparisontobaselineconditions.However,althoughtheenriched environmenttreatmentdecreasedpicarelativetobaseline(inwhichamean rateof6.7occurrencesperminutewereobserved),picastilloccurredata meanof1.8occurrencesperminute.Thus,althoughitcouldbearguedthat thetreatmentproducedanimprovement,thedangerousnatureofthe behaviordictatedthatthiswasnotapractical,or effective,levelofimprovement.Anacceptablelevelofpracticalimprovement(i.e.,ademonstrationof effectiveness)withadangerousbehaviorsuchaspicaiszeroornearzero occurrences.Theresultsofthestudyalsoshowed,however,thatthesecond treatmentconsistingofenrichedenvironmentplustimeoutproducednear zerolevelsofpica.Thus,thiswasconsideredapracticaloutcome,andthe treatmentcouldbedeemedeffective.

Astudyconductedby NormandandOsborne(2010) providesanexampleofthedemonstrationofeffectivenesswithinanadult-focusedapplication ofABAtohealthierfoodchoicesdemonstratedbycollegestudents.The authorsfirstimplementedabaselineconditioninwhichtheyassessedcollege students’foodchoicesviareceiptsandfoodchecklistsandtrackedtheirdaily calorieintake.Next,theauthorsimplementedaninterventionthatinvolved providingfeedbacktothestudentsbyshowingthemgraphsdepictingdaily calorieandfatintake.Additionally,theauthorsprovidedinformationtothe studentsonrecommendeddailyconsumptionforfoodgroupsaswellas recommendedlevelsofsugarandfatintake.Decreasesincalorieandfat intakeweredemonstratedwiththreeofthefourparticipants.Witheach oftheparticipantsforwhomcleareffectsoftheinterventionweredemonstrated,theirintakelevelsduringtheinterventionconditionoccurredator belowUnitedStatesDairyAssociation(USDA)recommendeddailyguidelines.Thecleardemonstrationofanexperimentaleffectwithinthemultiplebaseline,single-subjectexperimentaldesigninNormandandOsbornedid not,inandofitself,confirmthe effectiveness oftheintervention.However,

theUSDArecommendeddailyguidelinesprovidedabenchmarkwith whichtoevaluateeffectiveness;thefavorablecomparisontothatbenchmark providedclearevidenceoftheeffectivenessoftheintervention.

Lebbon,Sigurdsson,andAustin(2012) providedanexampleofthedemonstrationofeffectivenessinOBM-basedABAresearch.Theauthorsevaluatedaninterventionpackageconsistingoftraining,peerobservations, peer-directedfeedback,andgraphicfeedback.Toevaluatetheintervention package,theauthorscollecteddataonseveraldependentvariablesincluding OccupationalSafetyHealthAdministrationrecordableincidents,lostworkdays,andpeerobservations.Theresultssuggestedthattheintervention packagedecreasedthetotalnumberofincidentsandlostdayswhencomparedtopreinterventionconditions.Theauthorsprovidedacosteffectivenessanalysisbycomparingtheaveragedirectcostofindividual work-relateddisablinginjuriesandotherinjuriestothetotalcostofthe interventiongiventhereductionininjuriesduringthecourseofthestudy. Theresultssuggestedthattheinterventionwasclearlycost-effective,providingevidenceofthe effectiveness oftheintervention.

Generality

ThelastdimensionofABAplacesanemphasisontheextenttowhichgains are generalizable toothersettings,caregivers,orbehaviors. Generalization is importantbecauseitisnotbeneficialtoimproveaclient’sbehavioronly insettings(e.g.,clinics)outsideofthenaturalenvironment,particularlyif theclientonlyspendsafewhoursofhis/herweekoutsidethenaturalenvironment.Thebehavioralinterventionisonlybeneficialifitimproves behavioracrossdifferentsettingsandwhenitisimplementedbydifferent individuals(e.g.,multiplecaregivers).

SilberandMartens(2010) providedanexampleoftheapplicationof child-focusedABAinwhichthedimensionofgeneralitywasevident. Theauthorsevaluatedamultipleexemplarapproachtoaprogramforgeneralizedoralreadingfluencydemonstratedbychildreninthefirstandsecond grades.Specifically,theauthorscomparedthreeconditionsincludingacontrol,areadinginterventionthatconsistedofteachingkeywordsandsentencestructures,andatypicalreadinginterventionconsistingofpreview andrepeatedreadings.Followingtheimplementationofeachcondition, theauthorsconductedprobeswithnontrainedreadingpassagestoevaluate theextenttowhichthechildren’slearnedskillsgeneralized.Theresults showedthatbothreadinginterventionsweremoreeffectiveatpromoting generalizationofreadingskillsasevidencedbysignificantlyhigherscores

duringthegeneralizationprobeswithuntrainedreadings.Byshowingthe spreadofthepositiveeffectsoftheinterventionstountrainedreadingpassages,theauthorsdemonstratedthegeneralityoftheinterventions.

Stokes,Luiselli,Reed,andFleming(2010) providedanexampleofthe emphasisongeneralizationintheABA-basedsportsmanagementliterature. Duringthestudy,theauthorsevaluatedtheutilityofdescriptivefeedback alone;descriptivefeedbackincombinationwithvideo-basedfeedback; andacombinationofdescriptivefeedback,video-basedfeedback,andan audio-basedfeedbackprocedure(i.e.,teachingwithacousticalguidance, TAG)toimprovelinepass-blockingskillsinhighschoolfootballplayers. Afterdemonstratingtheeffectivenessoftheinterventionpackageconsisting ofdescriptivefeedback,video-basedfeedback,andTAGwithimprovementsinblocking,theauthorsassessedimprovementsduringgamesituations(withfourofthefiveparticipants)intheabsenceofthe intervention.Theresultsshowedthatallfourplayersdemonstratedhigh levelsofcorrectblockingtechniquesduringgamesituationssuggestingthat generalizationhadoccurredwiththeintervention.

The generality dimensionofABAisalsoillustratedinnumerousOBMbasedABAstudies.Forexample,asdescribedearlier, LudwigandGeller (1997) evaluatedtwoapproachestoimprovingintersectionstoppingby pizzadeliverydriversaswellasgeneralizationtonontargetedsafedriving behaviors(i.e.,turnsignalusage,safetybeltusage).Bothinterventionswere showntoimproveintersectionstopping.However,significantincreasesin nontargetedturnsignalandsafetybeltusageweredemonstratedwiththe driverswhoparticipatedinthegoal-settingprocess.Thus,theresultssuggestedahighlevelof generality oftheintervention.

SUMMARY

FeaturesofABAincludesevendimensionsdescribedby Baeretal.(1968) includingapplied,behavioral,analytic, technological,conceptuallysystematic, effective,andgeneralizable.Applied behavioranalysts,throughbothapplied workandresearch,haveconductedpracticecharacterizedbythesedimensions andfeaturesacrosspopulationsandspecificareasoffocusformorethanahalfcentury.Inaddition,assessmentandinterventionpracticesbasedontheprinciplesofABAhavebeenimplementedsuccessfullyineducational,clinical, sports,andbusinesssettingstoaddressawiderangeofbehavioralissues.

Thischapterhighlightedthewidebreadthanddiversityofapplicationof proceduresandmethodologiesbasedonthedisciplineofABA.Despitethe

impressionthatABAissynonymouswithspecificassessmentandtreatment approachestoautismanddevelopmentaldisabilities(e.g., Bowman&Baker, 2014),thewiderangeofstudiesdescribedinthischapterintermsofpopulations,areasoffocus,andsettingsillustratestheactualnatureoftheimpact anddisciplineofABA.

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CHAPTER2

AppliedBehaviorAnalytic AssessmentandTreatment ofAutismSpectrumDisorder

Omaha,Nebraska,USA

Typetheword“autism”intoanyInternetsearchengineandtheabundanceof returnedresultsisoverwhelming.Theprevalenceofautismspectrumdisorder (ASD)hassteadilyincreased,nearlytriplingoverthelastdecade(i.e.,increasing from1in150childrentoapproximately1in50children; Blumbergetal.,2013; CentersforDiseaseControlandPrevention[CDC],2014).Giventhisincrease, itisnotsurprisingthatcaregivers,clinicians,andthegeneralpublicaregenerating considerablediscussionaboutASD.EugenBleulerprovidedaninitialdescriptionofthesymptomsofASDintheearly1900s(Klinger,Dawson,&Renner, 2003).Overthepastcentury,researchhascontributedsignificantlytotheavailabilityofinformationregardingdiagnosis,assessment,andtreatmentofASD. Unfortunately,notallresearchiscreatedequal,andconsumersarefacedwith thedauntingtaskofdifferentiatingempiricalresearchandevidence-basedpracticefromthatwhichisinvalidorpseudoscientific(NationalAutismCenter, 2009).Inthischapter,weprovide(a)areviewofthediagnosticcriteriaandhallmarksofASDandrecentchangestothediagnosticcriteria;(b)adiscussionofthe impactofthedisorderintermsofprevalencerates,etiology,andprognosis;(c)an overviewofbehavioranalytic,evidence-basedapproachestoassessmentand treatment;and(d)futuredirectionsandconsiderationsforpractitioners.

Alittlelearningisadang’rousthing;Drinkdeeportastenot

THEIMPACTOFASDONAFFECTEDCHILDREN ANDTHEIRFAMILIES

Theimpactofautismonaffectedchildrenandtheirfamiliesisdifficultto overstate.Intheabsenceofeffectiveintervention,long-termoutcomes forchildrendiagnosedwithASDhavegenerallybeenpoor.Forexample,

inonelong-termfollow-upstudyofadultsaffectedbyautism,only4%lived independently,only13%workedindependently(primarilyinlowpaying occupations),andonly26%hadoneormorefriends(Howlin,2005; Howlin,Goode,Hutton,&Rutter,2004).MorerecentstudiesonadolescentandadultoutcomesforpersonswithASDhaveproducedsomewhat moreoptimisticresults;however,manyofthesestudieshavefocusedon outcomesforasmallsampleofrelativelyhigh-functioningindividuals (see Levy&Perry,2011 forareview).Finally,parentsandsiblingsofindividualsaffectedbyASDareatincreasedriskfordevelopingstress-related mentaldisorders(Dumas,Wolf,Fisman,&Culligan,1991;Feldman etal.,2007;Lofholm,2008).

DEFININGFEATURESANDDIAGNOSIS

ASDisaneurodevelopmentaldisorderthatistypicallyidentifiedinearly childhood,withsymptomsoftenpresentingatorbefore18months (Blumbergetal.,2013).EugenBleulerinitiallyconceptualizedautismas aformofchildhoodschizophrenia;however,ASDdiffersfromschizophreniaonallofthefactorsthatdefineasyndrome,includingsymptoms,ageof onset,etiology,familyhistory,andresponsetotreatment.BasedonthepresentationoftheuniquesymptomsassociatedwithASD,LeoKannerand HansAspergerlaterconceptualizedautismandAsperger’ssyndrome, respectively,asseparatedisordersintheearly1940s(Klingeretal.,2003), andin2013thediagnosticlabelwaschangedtoASD.Althoughthespecific namingconventionshavechangedovertheyears,thehallmarksofASD establishedinthe DiagnosticandStatisticalManualofMentalDisorders 5th ed.(DSM-5; AmericanPsychiatricAssociation[APA],2013a)havegenerallyremainedconsistentandaredeeplyrootedinimpairmentsinsocialcommunicationbehaviors(e.g.,socialinteraction,verbalandnonverbal communication)andrestrictedandrepetitiveinterestsandbehaviorsina varietyofcontexts,andacrossmanydomains(APA,2013a).

CliniciansusetheDSM-5asaguidetodetermineifthesymptomsdisplayedbyanindividualmeetthediagnosticcriteriaforASDdiagnosis.The DSM-5outlinesfivekeydiagnosticcriteriathatarerequiredfordiagnosing ASD:(a)anindividualmustdisplaypersistentimpairmentsordeficitsin socialcommunicationandsocialinteraction;(b)anindividualmustdisplay restricted,repetitivepatternsofbehavior,interests,oractivities;(c)the symptomsmustbepresentinearlychildhood;(d)symptomsproduceclinicallysignificantimpairmentsincurrentfunctioninginavarietyofcontexts

21 AppliedbehavioranalyticassessmentandTreatmentofASD

(e.g.,home,work,andschool);and(e)thesymptomscannotbebetter explainedbyintellectualdisabilityorglobaldevelopmentaldelay.Eachcategoryisevaluatedseparately,andeachcriterionspecifiedinthefiveareas listedabovemustbemettoprovideanindividualwithadiagnosisof ASD(APA,2013a).Whatfollowsisadiscussionoftheobservableandmeasureablesymptomsthataredescribedinthefirsttwoareasofthediagnostic criteria.

SocialCommunicationandSocialInteraction

Thecategoryofsocialcommunicationandsocialinteractionisdividedinto threedistinctsubdivisions.Thefirstsubcategoryincludesskillsrelatedto social-emotionalreciprocity.Anindividualexperiencingmarkeddelays ordeficitsinthissubcategorymay(a)rarelyinitiateconversationwithothers, (b)failtolookatoracknowledgeotherswhenhisorhernameiscalledor whenothersentertheroom,and(c)intrudeonwhatistypicallycalled anotherindividual’s“personalspace.”

Thesecondsubcategorydescribesdeficitsorimpairmentsinsocialinteractionsinvolvingnonverbalcommunicativebehaviors(e.g.,deficitsincoordinateduseofverbalandnonverbalcommunication,eyecontact).Thethird subcategoryincludesdeficitsorimpairmentsindeveloping,maintaining, andunderstandingrelationships(e.g.,adjustingbehaviortofitsocialcontexts,absenceofinterestinpeers).Anindividualmustpresentwithimpairmentsordeficitsin all threesubcategoriesinordertomeetthecriteriafora diagnosisofASD.

Restricted,RepetitivePatternsofBehavior,Interests, orActivities

Thecategoryofrestricted,repetitivepatternsofbehavior,interests,oractivitiesisalsodividedintofourdistinctsubdivisions.Thefirstsubcategory includesstereotypedorrepetitive(a)motormovements(e.g.,handflapping, toewalking,spinningincircles),(b)useofobjects(e.g.,repeatedlydropping objectsandwatchingthemfall,liningupobjects),and/or(c)speech(e.g., pedanticoroverlyformalspeech,idiosyncraticwordsorphrases,echolalia). Behaviorsthatareincludedinthissubcategorymayvarydependingonthe cognitivelevelandvocalabilitiesoftheindividual.Thesecondareaincludes insistenceonsameness,inflexibleadherencetoroutines,and/orritualized patternsofverbalornonverbalbehavior(e.g.,rigidlyfollowingrules,insistingonwearingthesameshirteachday).Thethirdareaincludeshighly restricted,fixatedintereststhatareabnormalinintensityorfocus(e.g.,only

talkingaboutonetopic,significantlyrestrictedfoodpreferences,preoccupationwithalimitedrangeoftoysoractivities).Thelastareaincludes hyper-orhyporeactivitytosensoryinputorunusualinterestinsensory aspectsoftheenvironment(e.g.,extremeresponsestospecificsounds,textures,changesintheenvironment,indifferencetoexposuretopainortemperatures).Anindividualmustdisplaymarkedimpairmentin atleasttwoofthe four subcategoriesnotedabovetomeetthediagnosticcriteriaforrestricted, repetitivepatternsofbehavior,interests,oractivities.

ThedefiningfeaturesofASD(previouslydiscussed)existalongacontinuumandmaymanifestdifferentlyineachindividual.Specificcharacteristics maydevelopovertime(i.e.,asthechildmaturesandsocialinteractions becomemorecomplex),changeformortopography,and/orincreaseor decreaseinintensityorlevelofimpairmentofdailyfunctioning(i.e.,followingexposuretoenvironmentalconsequencesorearlyinterventionservices; APA,2013a).IndividualsdiagnosedwithASDmayalsopresentwithavariety offeaturesthatarenotincludedashallmarksofthedisorder,butareassociated features.Theseassociatedfeaturesincludedisturbancesinfeedingandsleeping (see Kodak&Piazza,2008),delayedtoilettraining(Kodak&Grow,2011), geneticandmedicalconditions(e.g.,intellectualdisability,seizuredisorders, fragile-Xsyndrome; Klingeretal.,2003;Kodak&Grow,2011),severeselfinjury,and/orotherrelatedbehaviorproblems(e.g.,aggression,pica,elopement,tantrums,etc.; Jones,Lerman,&Laechago,2014).

MODIFICATIONSTOTHEDSM

In2013,theAPApublishedtheDSM-5,whichincludedanumberofrevisionstothediagnosticcriteriainthe DSM-IV-TextRevision(TR;2000) thathavebeensomewhatcontroversial.TheDSM-5collapsedseveralof theDSM-IV-TRdiagnoses(e.g.,autisticdisorder,Aspergersyndrome)into asingledisorder(i.e.,ASD).Inaddition,Rettsyndromewasconsidereda pervasivedevelopmentaldisorderinDSM-IV-TR,butwithDSM-5,a childwithRettsyndromewouldreceiveadiagnosisofASDonlyifthe newdiagnosticcriteriaaremet,inwhichcasethediagnosisofRettsyndromewouldbeconsidereda“specifier”(e.g.,ASDassociatedwiththe geneticconditioncalledRettsyndrome; APA,2013b).Thesechangeshave beencontroversialduetoconcernsthatthenewdiagnosticcriteriamaybe lesssensitivethanthepriorversion,whichwouldresultinfewerchildren beingdiagnosedwithanASDandreceivingassociatedtreatments(APA, 2013b).Forexample,arecentmeta-analysisofstudiescomparingthe

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