Objectives: The goal of this study was to develop and evaluate a tool to measure the complexity and intensity of psychotropic medication interventions, behavioral interventions, and issues related to ...crisis management for challenging behavior using a standardized rating form.
Method: The Treatment Intensity Rating Form (TIRF) is a 10-item scale with three categories: pharmacological interventions, behavior supports, and protective equipment. In a retrospective review, we examined the final treatment recommendations for 74 individuals with self-injurious behavior (SIB) based on psychiatric and behavioral notes and reports. We also compared whether TIRF scores differed across individuals for whom SIB was maintained by social reinforcement (e.g. to access attention or toys/activities, or escape from tasks) vs. those for whom SIB was maintained by automatic reinforcement (e.g. occurs independent of social variables, and is presumed to be maintained by sensory reinforcement).
Results: The TIRF was demonstrated to have strong inter-rater reliability (98%) and appears to have good face validity. As hypothesized, individuals with SIB maintained by automatic reinforcement had significantly more medication trials (p=0.0005) and required more protective equipment than individuals with SIB maintained by social reinforcement (p=0.0002). Antidepressant medication was used more often with individuals with automatically reinforced SIB, although antipsychotics and anticonvulsants were also commonly used across both groups.
Conclusion: Findings provide initial support for the TIRF's reliability and face validity as a measure of the level of complexity of medical and behavioral treatment plans - although additional research is needed to fully evaluate its psychometric properties.
Individuals with autism spectrum disorder (ASD) characteristically demonstrate interest in a restricted range of activities and often fail to respond to alternative environmental stimuli. These ...characteristics act as a barrier to learning important life skills. Strategies that motivate learners with ASD to engage in alternative activities warrant development and exploration. One such strategy is embedding interests into the learning environment to establish motivation and promote participation. While a number of studies in this area exist, the literature has yet to be synthesized. This dissertation contains two reviews and a single-case research evaluation to determine the evidence of embedding interests for individuals with ASD. The first study is a systematic review of quality and evidence for 20 single-case and group-based research studies. Studies were gated by quality to synthesize the evidence overall and within categories of dependent variables. This review shows limited or insufficient support for use of this intervention according to one rubric and mixed but sufficient support according to an alternative rubric. The majority of research support targets social/communication skills. The quality review identifies priorities for continued research. The second review is a meta-analysis of 18 single-case research studies on embedding interests of individuals with ASD. The literature suggests that embedding interest for learners with ASD can either be highly beneficial or highly distractible. Effects from moderator categories ranged from neutral to high, with several moderating variables identified. Threats to the internal validity of this meta-analysis are evaluated. Practitioners should take caution when using this intervention with students that display self-stimulatory or ritualistic behaviors when their interests are present. The third study is an original single-case research evaluation of the use of interests as receptive identification targets for children with ASD in the context of an intervention with added components. Overall outcomes demonstrate added effects of the embedded interest condition that correspond to increases in various indicators of engagement for two participants, while a third participant’s data is inconclusive. The outcomes of this study have implications for sequencing educational objectives and adding intervention components to promote skill acquisition in early language learning programs for children with ASD.
This review provides a summary and appraisal commentary on the treatment review by Falcomata, T. S., Wacker, D. P., Ringdahl, J. E., Vinquist, K., & Dutt, A. (2013). An evaluation of generalization ...of mands during functional communication training. Journal of Applied Behavior Analysis, 46, 444-454.
Source of funding and disclosure of interests. No source of funding was indicated, nor were any interests declared.
PDF
