Abstract
Programs that prevent the development of severe problem behavior in young children with autism spectrum disorder (ASD) are critically needed. We describe a program designed to do this, and we report on a preliminary evaluation of its effects with four 3- and 4-year-old children with ASD. Parents served as the primary implementers, with twice-weekly coaching from a Board Certified Behavior Analyst. Direct measures and Aberrant Behavior Checklist scores reflected decreases in emerging problem behavior. Direct measures also reflected increases in child communication, social, and cooperation skills, and parents rated the process as highly acceptable. A randomized controlled trial will be required to evaluate the extent to which the program prevents the development of problem behavior in young children with ASD.
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Notes
Studies calling synthesized reinforcers into question have not included comparative treatment phases (Fisher, Greer, Romani, Zangrillo, & Owen, 2016; Greer, Mitteer, Briggs, Fisher, & Sodawasser, 2019), permitting the conclusion that isolated and synthesized functional analyses may produce different results but precluding conclusions about the comparative treatment utility of those results.
Severe problem behavior is sometimes observed in children under 5. For example, Kurtz et al. (2003) reported on 30 children’s self-injury. The mean age was 2 years 9 months, and all produced tissue damage; 83% engaged in head banging (see also Kurtz, Chin, Huete, & Cataldo, 2012). Children who engaged in such behaviors were not eligible for the current study, given the preventive focus of the program.
Based on 1,036 parent ratings of children under the age of 6 with an ASD diagnosis (Aman & Singh, 2017).
All participants displayed some restricted/repetitive behavior or interests, consistent with the diagnostic criteria for ASD. The Stereotypic Behavior section of the ABC-2 focuses on motor stereotypy specifically. For our participants, vocal stereotypy and restricted interests were more common.
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Author Note
This manuscript was prepared in partial fulfillment of the doctoral program requirements of the Psychology Department at Western New England University. We thank Amy J. Henley, Rachel H. Thompson, and Jonathan W. Pinkston for their comments on earlier versions of this manuscript.
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During the peer review and publication process for this manuscript, Kelsey Ruppel and Gregory Hanley received salaries from FTF Behavioral Consulting, an organization that offers training on the Balance Program among other services. Neither were employed by FTF Behavioral Consulting before or during the conduct of the study. Robin Landa and Adithyan Rajaraman declare no conflict of interest.
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Research Highlights
• Parents served as the primary implementers of a skill-building package, resulting in child cooperation with multistep tasks following denial of a functional communication response.
• Rates of problem behavior decreased among all participants.
• Behavior analyst support occurred for 2 hr per week, making this package potentially useful where service availability is limited.
• Evaluation of the preventive effects of this package on the development of severe problem behavior in children with autism seems warranted.
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Ruppel, K.W., Hanley, G.P., Landa, R.K. et al. An Evaluation of “Balance”: a Home-Based, Parent-Implemented Program Addressing Emerging Problem Behavior. Behav Analysis Practice 14, 324–341 (2021). https://doi.org/10.1007/s40617-020-00490-3
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DOI: https://doi.org/10.1007/s40617-020-00490-3