Manualized Assessment and Treatment Model of Challenging Behavior
Problem Behavior, Aggression, Self-Injury
About this trial
This is an interventional treatment trial for Problem Behavior
Eligibility Criteria
Inclusion Criteria: children from ages 3 to 17; challenging behavior that occurs at least 10 times a day, despite previous treatment; challenging behavior maintained by social positive or automatic reinforcement; stable protective supports for self-injurious behavior (e.g., helmet) with no anticipated changes during enrollment; on a stable psychoactive drug regimen for at least 10 half-lives per drug or drug free; stable educational plan and placement with no anticipated changes during the child's treatment. Exclusion Criteria: patients who do not meet the inclusion criteria; patients currently receiving 15 or more hours per week of treatment for their challenging behavior; DSM-5 diagnosis of Rett syndrome or other degenerative conditions (e.g., inborn error of metabolism); a comorbid health condition or major mental disorder that would interfere with study participation; occurrence of self-injury during study assessments that presents a risk of serious or permanent harm (e.g., detached retinas) based on our routine clinical-risk assessment (Betz, 2011); patients requiring changes to protective supports for self-injury or drug treatment, but we will invite these patients to participate when protective supports and drug regimen are stable.
Sites / Locations
- Children's Specialized Hospital-Rutgers University Center for Autism Research, Education, and Services
Arms of the Study
Arm 1
Arm 2
Experimental
Experimental
Functional Analysis Treatment for Harmful Challenging Behavior
Functional Analysis Treatment for Milder Challenging Behavior
If challenging behavior is found to be socially maintained, we will recommend functional communication training (FCT) to teach a functional communication response (FCR) (e.g., touching a card with a picture of the participant consuming the reinforcer), but we will also offer NCR as a potential treatment option to the caregivers. During FCT, reinforcement will be discontinued for challenging behavior and only the alternative communication response will be reinforced. If the parents choose NCR over FCT for socially maintained challenging behavior, we will deliver the functional and competing reinforcers on time-based schedules. If challenging behavior is found to be automatically maintained, we will recommend using NCR with competing items and response blocking for treatment. We will use multiple and chained schedules to thin the reinforcement schedules and increase the practicality of these treatments.
Caregivers of patients with mild challenging behavior will receive training using the Research Units in Behavioral Intervention (RUBI) protocol informed by the functional analysis conducted as a part of the initial assessment (Bearss et al., 2018). The RUBI protocol includes 11 core modules and 7 optional modules on training caregivers to apply behavior-analytic techniques to help manage challenging behaviors.