David P. Wacker - US grants

The purpose of this project is to investigate the relationship between specific genetic mutations associated with fragile X and the child's response to behavioral treatment.

DESCRIPTION: The investigators propose to evaluate two versions of choice-making procedures (concurrent operants), one during assessment and one during treatment, as a continuation project. To date, they have shown that a treatment package involving functional analysis and functional communication training (FCT) has been successful in suppressing aberrant behavior, inducing prosocial behavior, and promoting stimulus generalization. In this proposed project, they will evaluate key elements of both the assessment and the treatment aspects of their model with 20 children over a 4-year period. During assessment, they will conduct a concurrent operants assessment to test the relative influence of negative and positive reinforcement on prosocial behaviors (e.g., social interaction, time allocation with parent). These results will be compared with the results of the functional analysis of aberrant behavior to evaluate the correspondence between the two assessment methodologies. During treatment, they will evaluate whether standard FCT treatment is enhanced when children are provided with choices. They will compare their current FCT treatment with a FCT plus choices treatment within a reversal design to determine whether the FCT plus choices treatment reduces the need for parents to implement extinction and mild punishment procedures. During post-treatment, the investigators will conduct a component analysis to evaluate whether the positive and/or negative reinforcement variables identified via the concurrent operants assessment influence the maintenance of treatment effects. The application addresses the issue of interaction between positive and negative reinforcement. This interaction will be evaluated in two ways. First, during assessment, they will study if positive reinforcers maintain adaptive behavior even when negative reinforcement is shown to maintain aberrant behavior. One clinical implication of this finding would be the need for positive reinforcers to be incorporated more directly into long-term maintenance. Second, they will study if distinct types of treatment components, such as choices, are relatively more effective for different functional categories of aberrant behavior (i.e., behavior maintained by positive or negative reinforcement).

[unreadable] DESCRIPTION (provided by applicant): We propose to analyze the long-term maintenance (up to 2 years) of both reductions in destructive behavior and increases in adaptive behavior achieved via functional communication training (FCT) as a continuation of our currently funded project (HD29402-11). To date, we have shown that a treatment package of functional analysis and FCT is often successfully used by parents to reduce destructive behavior and to increase adaptive behavior in young children who have both developmental disabilities and behavioral disorders. In this proposed project, we will specifically study why these positive results occurred by analyzing the operant mechanisms that control adaptive and destructive responding at different points in time. We propose to study the effects of reinforcement and extinction on distinct topographies of both adaptive and destructive behavior over a 2-year period and to evaluate whether changes or interactions occur in these mechanisms over the long-term course of treatment. A four-phase analysis will be conducted to specifically analyze the role of these two mechanisms prior to treatment (Phase 1), during initial treatment (Phase 2), at posttreatment (Phase 3), and during long-term maintenance (Phase 4). Our objectives are to determine (a) the degree of overlap of functional reinforcers across response classes of destructive and adaptive behavior (Objective 1), (b) if changes in functional reinforcers occur within and across topographies over time (Objective 2), and (c) the response strength or persistence of both adaptive and destructive behavior over time (Objective 3) when faced with distinct environmental challenges: changes in establishing operations, discriminative stimuli, or competing reinforcers. These results will increase our understanding of why FCT is often an effective long-term treatment and may identify the conditions under which maintenance is disrupted in natural settings such as homes. [unreadable] [unreadable]

DESCRIPTION (provided by applicant): This study is designed to improve access to appropriate behavioral services for young children (ages 1 to 6 years) with autism spectrum disorders. The major research goal is to evaluate the effectiveness and efficiency of conducting behavioral treatment for autism through a telehealth network to reach underserved areas of a rural state. Our prior research has demonstrated that parents can be successfully trained to conduct functional behavior analysis (FA) and functional communication training (FCT) to reduce the disruptive behavior of young children with autism and other developmental disabilities. The current proposal evaluates a service delivery model in which telehealth is used by behavioral specialists to "coach" staff and parents at regional health centers across a rural state to assess and treat the disruptive behaviors displayed by young children with autism. The specific aims of this study focus on testing whether functional analysis and functional communication training, conducted through telehealth coaching, is effective in reducing disruptive behavior and increasing positive social behaviors in young children with autism spectrum disorders. Providing greater local access to behavioral procedures with expert consultation from a remote site should increase families'opportunities to obtain behavioral services in a cost-effective and timely manner, which is an urgent public health need in rural states that face a scarcity of trained behavioral specialists. The current project thus represents an investment in the statewide infrastructure needed to more effectively serve children with autism and their families. PUBLIC HEALTH RELEVANCE: Autism is a neurodevelopmental disorder that results in marked difficulties in social interaction, communication, and repetitive behavior. With a prevalence as high as 1 in 150 children (Centers for Disease Control and Prevention, 2007), autism spectrum disorders represent a serious public health challenge. The proposed research will study the effectiveness of delivering behavioral treatment for autism through telehealth methodology, which has the potential to overcome barriers that limit access to care in rural and other underserved areas. The results of the proposed study should provide an evidence base on which to expand behavioral treatment options for families of children with autism spectrum disorders.

? DESCRIPTION (provided by applicant): Managing challenging behavior in autism spectrum disorders (ASD) can profoundly improve quality of life for children and families. However, many families lack access to research-based treatment, such as applied behavior analysis (ABA). This study is a randomized trial comparing outcomes of treatment for ASD using either a standard Functional Analysis Plus Functional Communication Training (FA+FCT) package or a pragmatic version that offers a briefer, less time-intensive model of FA+FCT. Both types of FA+FCT are provided via telehealth in family homes to maximize generalizability to real-life settings. Providing ABA through telehealth makes an effective treatment accessible across geographic barriers so that no child is excluded based on where they live. The study also examines key family factors that influence successful outcomes. Objectives: The main objective of this study is to determine the most efficient way for families to reduce problem behavior in their children with autism. The study has 3 primary aims: (1) To assess outcomes for ABA telehealth by assigning children to either a Pragmatic FA+FCT group or to a group receiving Standard FA+FCT. Outcomes will be compared based on the percent reduction in problem behavior, communication increases, time to achieve outcomes, treatment fidelity, family acceptance of treatment, and generalization and maintenance of treatment gains. (2) The study will assess the relation of family factors to treatment efficacy and acceptability by assessing parent stress, mood, and social support in relation to outcomes. (3) Cost effectiveness will be assessed in relation to the treatment methods used and the efficiency of ABA telehealth. Methods: The study will include 102 children who are 18-83 months of age, have a confirmed ASD diagnosis, and have serious behavior problems requiring treatment. Thirty-six children will receive intervention in each of three states: Iowa, Georgia, and Texas. Study design is a randomized trial using an intent-to-treat analysis. Half of the sample will be randomized to Pragmatic FA+FCT and half to Standard FA+FCT. Treatment will be provided via telehealth using FCT, which is a function-based ABA technique in which parents are trained to be therapists under the direction of behavior consultants. Study procedures typically are completed within 6 months, and follow-up assessments occur 6 months after treatment completion. Data analyses include comparisons between assessment groups, single-case designs examining responses in individual children, cost analyses, and regression analyses of the effects of family factors on outcomes. Impact: Our prior research shows that problem behavior can be reduced by over 90% in most children with ASD after 4-6 months of telehealth treatment. If Pragmatic FA+FCT can reduce problem behavior at rates comparable to Standard FA+FCT, then treatment can be started sooner and families can achieve successful outcomes at lower cost. Although pragmatic FA+FCT provides less behavioral information, it may be more resistant to treatment relapse because it does not involve reinforcing high rates of problem behavior.