Case Studies in Applied Behavior Analysis for Individuals with Disabilities [2 ed.] 0398094004, 9780398094003

Table of contents :
Dedications
Preface
Contents
Overview of Applied Behavior Analysis for Individuals with Disabilities
SECTION ONE — Case Studies with Complete Analysis
Case Study One — Kathleen
Case Study Two — Merve
Case Study Three — Horatio
Case Study Four — Audrey
Case Study Five — Levin
Case Study Six — Doug
SECTION TWO — Case Studies with Partial Analysis
Case Study Seven: Asanka
Case Study Eight: Billy Joe
Case Study Nine: Celia
Case Study Ten: Rolph
Case Study Eleven: Wyclef
Case Study Twelve: Cameron
SECTION THREE — Case Studies Without Analysis
Case Study Thirteen: Patti
Case Study Fourteen: Exene
Case Study Fifteen: Leron
Case Study Sixteen: Angeline
Case Study Seventeen: Ian
Case Study Eighteen: Jelme
Appendix: Resources Regarding Applied Behavior Analysis and People with Disabilities
Name Index
Subject Index
About the Authors

Citation preview

Case Studies in Applied Behavior Analysis for Individuals with Disabilities

Second Edition

Case Studies in Applied Behavior Analysis for Individuals with Disabilities By

KEITH STOREY, Ph.D., BCBA-D Touro University Vallejo, California

and

LINDA HAYMES, Ph.D., BCBA-D Touro University Vallejo, California

Published and Distributed Throughout the World by CHARLES C THOMAS • PUBLISHER, LTD. 2600 South First Street Springfield, Illinois 62704 This book is protected by copyright. No part of it may be reproduced in any manner without written permission from the publisher. All rights reserved. © 2023 by CHARLES C THOMAS • PUBLISHER, LTD. ISBN 978-0-398-09400-3 (paper) ISBN 978-0-398-09401-0 (ebook) First Edition, 2017 Second Edition, 2023 Library of Congress Catalog Card Number: 2022050770 (print) 2022050771 (ebook) With THOMAS BOOKS careful attention is given to all details of manufacturing and design. It is the Publisher’s desire to present books that are satisfactory as to their physical qualities and artistic possibilities and appropriate for their particular use. THOMAS BOOKS will be true to those laws of quality that assure a good name and good will. Printed in the United States of America CM-C-1 Library of Congress Cataloging-in-Publication Data Names: Storey, Keith, 1956- author. | Haymes, Linda, author. Title: Case studies in applied behavior analysis for individuals with disabilities / by Keith Storey, PH.D, BCBA-D, Touro University, Vallejo, California and Linda Haymes, PH.D., BCBA-D, Touro University, Vallejo, California. Description: Second edition. | Springfield : Charles C Thomas, Publisher, Ltd., 2023 | Includes bibliographical references and index. Identifiers: LCCN 2022050770 (print) | 2022050771 (ebook) | ISBN 9780398094003 (paperback) | ISBN 9780398094010 (e-book) Subjects: LCSH: Students with disabilities -- United States -- Case studies. | People with disabilities--United States--Case studies. | Behavioral assessment--United States--Case studies. Classification: LCC LC4031 .S845 2023 (print) | LCC LC4031 (ebook) | DDC 371.9--dc23/eng/20221129 LC record available at https://lccn.loc.gov/2022050770 LC ebook record available at https://lccn.loc.gov/2022050771

For my brother Bruce. From baseball and football in the back yard to basketball in the driveway to ping pong downstairs and to APBA and Avalon Hill games upstairs we always had a great time (except of course when I lost!). Thanks for being my big brother! K. S.

To my parents, Carol and Carl Haymes. You have instilled a love of learning in all your children and empowered us to do what we love. You are the best! L. H.

Preface

T

his book is intended to give support providers the knowledge and skills for providing Applied Behavior Analysis services in schools, homes, employment, and community settings and thereby improve the quality of life for the individuals that they support. The rubber meets the road, not only in how to support an individual with a disability, but also in how to implement services and systems change so that positive quality of life outcomes occur. This book responds to a critical need for highly qualified personnel who will become exemplary professionals because of their advanced knowledge, skills, and experiences in working with children, students, and adults with disabilities, including autism spectrum disorders (ASD). Since Board Certification for behavior analysts was introduced in 1999 there has been an expansion of training programs in applied behavior analysis to meet the demands from consumers (e.g., school districts, health insurers, and families). The Behavior Analyst Certification Board (BACB) is a private non-profit organization without governmental powers to regulate behavior analytic practice. However, it does wield the power to suspend or revoke certification from those certified if they violate the strict ethical guidelines of practice. While the BACB certification means that candidates have satisfied entry-level requirements in applied behavior analysis, it does not necessarily mean that they have the skills to develop and implement interventions which often are very complex and must involve a variety of funders and providers and be able to analyze the situation broadly (quality of life, person centered planning, or systems change for example). Most health insurance companies also recognize the BCBA credential as one conferring the capability and the right to practice independently in many states. The demand for expertise in Applied Behavior Analysis continues to grow and this demand has been spurred on by: (1) increased recognition of board certification and even licensure in many states, (2) recognition by health insurers and state legislation, (3) the need for behavior specialists in home, school, and other settings and (3) the increase in individuals with ASD who need ABA services. The BACB is endorsed by the Association of Professional Behavior Analysts, the Association vii

viii | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

for Behavior Analysis International, Division 25 (Behavior Analysis) of the American Psychological Association, and the European Association for Behavior Analysis. The Behavior Analyst Certification Board has a Behavior Analyst Task List 5th edition which outlines the content areas across two major sections that are required for basic competency as a behavior analyst. An advantage of this book is that universities, agencies, school districts, and organizations can easily use it in courses or trainings that address Applied Behavior Analysis as it covers methodology that is seldom covered in detail in most texts in Applied Behavior Analysis. Readers will find the information to be practical and easily implemented in applied settings. We see four main groups who would primarily be interested in this book: 1. College instructors teaching courses in Applied Behavior Analysis, School Psychology, Special Education, or related areas. College instructors are likely to choose our book based upon: a. The consistent format throughout the book. b. The “practicality” and “readability” of the book for students in college. c. The comprehensive analysis and coverage of developing supports for individuals with disabilities. d. The direct applicability to applied settings. e. The ability to use the case studies as assignments and/or exams. 2. Individuals taking courses or studying for their BCBA exam. 3. Individuals working in the disability field. 4. Individuals studying to work in the disability field. K. S. L. H.

Contents Page Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Overview of Applied Behavior Analysis for Individuals with Disabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Components of Applied Behavior Analysis . . . . . . . . . . . . . . . . . . . . 5 Seven Basic Principles of Applied Behavior Analysis . . . . . . . . . . . . . 9 Applied Behavior Analysis and People with Disabilities . . . . . . . . . 10 Self-Determination, Self-Advocacy, and Person-Centered Planning . 12 Quality of Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Executive Skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Consultation Skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Multiculturalism and Diversity Applications in Applied Behavior Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Overview of Case Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Fifth Edition Task List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Matrix of Case Studies by Age and Disability . . . . . . . . . . . . . . . . . 35 Terminology in Text . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 SECTION ONE — Case Studies with Complete Analysis Case Study One — Kathleen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Case Study Two — Merve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Case Study Three — Horatio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Case Study Four — Audrey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 Case Study Five — Levin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 Case Study Six — Doug . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227 SECTION TWO — Case Studies with Partial Analysis Case Study Seven: Asanka . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257 ix

x | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

Case Study Eight: Billy Joe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269 Case Study Nine: Celia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281 Case Study Ten: Rolph . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297 Case Study Eleven: Wyclef . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307 Case Study Twelve: Cameron . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317 SECTION THREE — Case Studies Without Analysis Case Study Thirteen: Patti . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case Study Fourteen: Exene . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case Study Fifteen: Leron . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case Study Sixteen: Angeline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case Study Seventeen: Ian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case Study Eighteen: Jelme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

329 331 333 335 337 339

Appendix: Resources Regarding Applied Behavior Analysis and People with Disabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341 Name Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347 Subject Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 359 About the Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361

Case Studies in Applied Behavior Analysis for Individuals with Disabilities

Overview of Applied Behavior Analysis for Individuals with Disabilities

T

he foundation of Applied Behavior Analysis (ABA) is based upon the work of B. F. Skinner (1953, 1971). Skinner advocated that the focus of education and interventions should be on the behavior of individuals rather than on internal states (O’Donohue & Ferguson, 2001). Behavior may be defined as observable actions that a person does. Sitting in a seat, completing a math problem correctly, raising one’s hand to answer a question, cursing, and running out of the room are all observable behaviors (verbal behaviors are classified as behaviors as well). These are all behaviors that can be changed (for better or worse). Being motivated, trying hard, and being unruly are not observable behaviors and thus cannot be directly changed. John Watson is often credited as being the first behavioral psychologist. In his 1913 manifesto he wrote that, “Psychology as the behaviorist views it is a purely objective experimental branch of natural science. Its theoretical goal is the prediction and control of behavior.” For Applied Behavior Analysis the key words are “prediction” and “control.” Good support providers1 are effective at predicting what will work in their intervention situation (such as in a classroom using active responding strategies, reinforcing classroom rules, and using cooperative learning strategies) and then controlling the environment around that individual so that these behaviors occur. Sometimes support providers have concerns with the concept of control and view control as being a bad thing. However, not positively controlling the support situation only leads to anarchy and poor outcomes. For instance, by doing things such as having set routines, classroom rules, and praising students for completing assignments the teacher is 1. By support providers we mean to include parents, teachers, behavior specialists, school psychologists, job coaches, supported living staff and others who are providing services to individuals with disabilities. 3

4 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

“controlling” student behavior. Having a teacher controlling a classroom environment in this way is good teaching and is not deceitful or wrong. In other words, the focus is on the cause-and-effect relationship between the environment and the behavior of the student (Nye, 1992). This cause and effect is not a one-way process as there is the issue of counter control where the behavior of the student also influences the environment (e.g., the behavior of the teacher). As they read this, many support providers may be thinking “I do this every day.” Good support providers use these types of strategies all the time. In this text, we are presenting a coherent and systematic approach to understanding the purpose of Applied Behavior Analysis and how support providers can implement these strategies to arrive at the desirable results for carefully targeting the behaviors that need changing, as opposed to a “hit or miss” strategy that many support providers use. In applied behavior analysis, it is assumed that the behavior of an individual is lawful. This means that an individual does things for a reason such as being previously reinforced for a behavior (such as putting dishes in the dishwasher) or being punished for a behavior (such as making a socially inappropriate remark to a peer). In other words, each individual has a history of behavior being reinforced or punished and this history influences their current behavior. For example, if a student consistently receives reinforcement for turning in homework (praise from teachers, positive feedback on the homework, good grades, and/or positive notes home to parents) then the student is likely to continue to turn in homework consistently. A student whose behavior does not receive this reinforcement for turning in homework is less likely to turn in homework assignments consistently. The three basic assumptions of applied behavior analysis are: 1. All behavior is learned or is a physiological response (such as sneezing due to allergies). 2. Behavior can be changed by altering antecedents and/or consequences. 3. Factors in the environment (the home, classroom, school, etc.) can be changed to increase and maintain specific behaviors or to decrease specific behaviors. Behavior analysts agree that people feel and think, but they do not consider these events (feeling and thinking) as causes of behavior. It is the observable behaviors of the individual that are relevant for analysis and an intervention to change those behaviors. For instance, a child

Overview of Applied Behavior Analysis for Individuals with Disabilities | 5

with autism spectrum disorder (ASD) may engage in certain “challenging” behaviors (such as screaming, throwing kitchen utensils, hitting siblings, or refusing to brush their teeth). To analyze these behaviors as “feelings” of the child is not helpful as it is an inference as to the causes and the support provider cannot directly change the feelings of a child. Applied behavior analysis focuses on the behavior of people. Behavior is not considered to be an expression of inner causes like personality, cognition, and attitude. Poor performance on coursework, not attending school, engaging in self-stimulatory behavior, or not keeping a job are analyzed as problems of behavior rather than examples of a person having a “poor attitude,” being “unreasonable” or having a “disability label” such as Down Syndrome. Interventions for these and other challenging behaviors are directed at changing environmental events (teacher behaviors, parent behaviors, a job coach teaching specific work tasks) to improve behavior (e.g., to increase desirable behavior). For example, engaging in peer tutoring for coursework and using a self-management strategy to increase specific job performance skill such as task completion could change the person’s undesirable behaviors for the better and by doing so could change the “poor attitude” or “unemployability” of the person. But this is accomplished only by changing specific behaviors of the person. So the focus is not only on the behaviors of an individual but also on understanding why that individual engages in certain behaviors (e.g., the function of the behavior). Kazdin (2008) succinctly summarizes this issue: Even today, even at our most scientifically precise, we can’t always or even often locate the exact source of a behavior problem....We know how to change behavior for the better, regardless of its exact cause, and our best bet is to just go ahead and change it. Instead of treating the child as if there’s something wrong inside her that needs to be fixed, let’s treat the behavior as the something wrong, and address it directly. In practice, that means locating the problem in the relationship between the child and the situation around him, in how he interacts with other people and things, (which might well include flaws in the therapy or how it’s delivered) (p. 169).

COMPONENTS OF APPLIED BEHAVIOR ANALYSIS There are three factors that influence behavior: antecedents (what

6 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

occurs before a behavior), consequences (what occurs after a behavior), and motivation. Antecedents become effective at producing desirable behavior only when they are a signal for a predictable consequence. For instance, if a child knows that she gets points each time that she completes each part of her bedtime routine (putting on pajamas, brushing teeth, washing face, etc.) and that points can be traded in for backup reinforcers (backup reinforcers are things or activities that are delivered at a later time such as an extra story at bedtime, popcorn and a video, or playing a favorite table game) then she may be more likely to be complete her bedtime routine independently and timely. In fact, the presence of the point board evokes instances of completing the bedtime routine (a response class of behaviors). Consequences affect behavior by strengthening the behavior (increasing its probability of occurrence) or by weakening the behavior (decreasing its probability of occurrence). In the example above, the completion of bedtime routine was strengthened through positive reinforcement (the token economy). The behaviors of refusing to put on pajamas or dawdling could be weakened (decreased) through consequences with the use of punishment (such as a response cost system where the child is fined points for not completing tasks in a timely manner). Motivation has a major role in the effectiveness of the consequences. A motivating operation (MO) is a variable that can either strengthen or weaken the value of a consequence for a behavior (Laraway et al., 2014) and has been used as a more generic term. Motivation operations effect behavior through two mechanisms; value-altering effect or behavior-altering effect. Let’s look at an example of value-altering effects. An example of value-altering effects is an adolescent loves tacos, and will complete after school chores and homework to get tacos. If the adolescent comes home from school starving given that she missed lunch, that increases the value of the tacos as reinforcers. In this case the food deprivation increases the effectiveness of a reinforcer this called an establishing operation (EO) (Laraway et al., 2003). An MO that decreases the effectiveness of the reinforcer is an abolishing operation (AO) (Shillingsburg et al., 2014). In the case of an AO, the same adolescent had a party at school at the end of the day and ate cake, she comes home stuffed, with no interest in tacos. Now the value of tacos as a reinforcer has decreased due to her satiation. The cake ingestion altered the value of tacos as reinforcers having a reinforcerabolishing effect. These examples provide a glimpse into the

Overview of Applied Behavior Analysis for Individuals with Disabilities | 7

value-altering effect of MOs, the behavior-altering effect of MOs may not be as clear in these examples. The behavior-altering effect can increase (EO) or decrease (AO) the frequency of behavior because of an evocative or abative effect (Poling et al., 2017). If the adolescent is under a more extreme deprivation state, missing lunch and breakfast, she may engage in a greater frequency of all chores, doing them quicker, including doing chores that she previously had not done and that had not been reinforced in the past. This would be a demonstration of a behavior-altering evocative effect (Cooper et al., 2020). A behavioraltering abative effect would be seen if the adolescent was completely satiated from food and decreased the current frequency of behaviors, more than just chores and homework, that had been reinforced by food. In applied behavior analysis there is an emphasis on objective description with a focus on observable events. There is also a focus on absolute unit-based measurement, e.g., behaviors that have clear, limited extensions in space and time and have easy to determine onsets and offsets (Baer, 1986). Applied behavior analysis relies upon experimental analysis to determine if interventions are effective or not. This analysis often involves the use of single case research designs (also known as single subject designs) that involve one or a small number of participants (these may be individual students or all of the students in the classroom, for example) and the design involves data that are taken frequently over an extended time period which allows for detailed analysis of variables that might be effecting the behavior (Gast & Ledyard, 2014; Kazdin, 2020). In single case designs the replication of the effect of the intervention is very important. In other words, the experimenter demonstrates repeatedly that it is the intervention that leads to the change in the student behavior and not something else. That means that the independent variable (intervention) has a functional relationship with the dependent variable (target behavior). For example, it is the teacher increasing her rate of praise for students turning in homework rather than something that parents may be doing at home that is increasing the rate of students turning in their homework. Applied behavior analysis stresses the understanding of functional relations between the individual and their environment (school, home, community, worksite). The behavior of an individual is not random. There is some variance in behavior as people are not always consistent in what they do, and people can have “good days” and “bad days” due to a variety of reasons. But there are lawful relationships between what

8 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

is happening in the environment (in school, home, and the community) and the behavior of the individual. For example, factors such as food intake (what a student has eaten in the morning or their not having had any breakfast) or sleep patterns (whether the student had a good night’s sleep) can influence student behavior and learning in the classroom. By understanding the relationship between distal events (sleep), the environment, immediate events (putting a demand on student) and the person it becomes possible to establish effective learning environments and support situations. Distal events are setting events that may not be directly observable. The teacher cannot observe the distal event of the lack of sleep, but that information can be communicated to the teacher by the family or student. In this example the distal event has a functional relationship to behavior exhibited in school. If a parent understands that the child has had a poor night’s sleep the night before then it is possible to adjust schedules, demands, and reinforcers in the morning (Durand, 1998). Then at school, the student can have an adjusted schedule with fewer demands and class changes on sleepless days versus typical days thus setting up the student for success given these distal events (Horner et al., 1997). It is important to emphasize that the behavior of an individual is always changing. As a person learns skills, antecedents, consequences, and motivation change, the behavior of that individual changes. Factors such as falling into a poor peer group, doing drugs, learning positive social skills, learning reading skills are all things that are likely to change student behavior (some for the better, some not so). The more that support providers understand these changes the better off they will be in developing instruction and other supports for individuals that they work with. Applied Behavior Analysis is the science in which the principles of the analysis of behavior are applied systematically to improve socially significant behavior and in which experimentation is used to identify the variables responsible for change in behavior (Alberto et al., 2021; Miltenberger, 2016). Applied Behavior Analysis is a well developed discipline, with a large body of scientific knowledge. In more than 60 years of research it has established standards for evidence-based practice, recognized experience and educational requirements for practice, and identified sources of requisite education in universities. Most recently, Behavior Analysts, as a profession, are recognized and regulated by The Behavior Analyst Certification Board. BCBA and BCaBA (Board Certified Assistant Behavior Analysts) credentialing programs are accredited by the National Council for Certifying Agencies in Washington, DC.

Overview of Applied Behavior Analysis for Individuals with Disabilities | 9

NCCA is the accreditation body of the Institute for Credentialing Excellence. The BACB is endorsed by the Association of Professional Behavior Analysts, the Association for Behavior Analysis International, Division 25 (Behavior Analysis) of the American Psychological Association, and the European Association for Behavior Analysis.

SEVEN BASIC PRINCIPLES OF APPLIED BEHAVIOR ANALYSIS There is often a misunderstanding of applied behavior analysis. It is not just a curriculum or teaching method (discrete trials) designed for people with autism spectrum disorders (Durand, 2014; Fisher et al., 2021; Koegel, & LaZebnik, 2014). Some practitioners fail to provide a comprehensive and effective program for individuals with disabilities because they only implement a curriculum or discrete trial teaching and do not understand the basic principles of applied behavior analysis. The seven basic principles of applied behavior analysis, were clarified by Baer et al. (1968, 1987 ). Applying behavior analysis to real life, “socially significant” behaviors (such as academics, social skills, communication, and adaptive living skills) are the first principle of ABA. The second principle of ABA is behavioral — behaviors addressed are observable and measurable. Reliable measurement requires that behaviors be defined objectively. Vague terms such as frustrated, depressed, or low self-esteem cannot be observed and measured. Instead, behaviors such as aggression, initiating conversations, ordering food, and reading number of correct words per minute are defined in observable and quantifiable terms, so their frequency, duration or other measurable properties can be directly recorded (Kearney, 2015; Miltenberger, 2016). Defining the behavior and effectively measuring them is significant to effect change in individuals to enhance their skills and lives and create best outcomes. The third component is the analytic application of procedures. ABA interventions require an analysis, which is a demonstration of the events that are responsible for the occurrence, or nonoccurrence, of behavior. An essential component of programs based upon ABA methodologies are the use of single case experimental design to evaluate the effectiveness of individualized interventions (Barlow et al., 2009; Ledford & Gast, 2018). These designs are commonly referred to as single case experimental design that includes reversals, multiple baselines, parallel treatments, and changing criterions.

10 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

The fourth principle refers to the technological aspect of ABA. That means the practioner must clearly communicate the steps and procedures used with clients so others can replicate. It is typically meant for research purposes but clearly this is an important aspect of interventions so that we can have consistency in implementation. ABA procedures are conceptually systematic (fifth principle) in that they are founded on the basic principles, rather than just a tool pulled randomly out of a toolbox. Behavior change interventions are derived from these principles of behavior (Dillenburger & Keenan, 2009). Granpeesheh et al. (2009) reviewed the treatment research on comprehensive early intervention programs for young children with autism. In the review, they highlighted the basic behavioral principles of learning and motivation that has been demonstrated to be effective to improve behavior and develop skills these are principles such as reinforcement, extinction, stimulus control and generalization. A sixth principle is the effectiveness of the ABA procedures. The procedures used should increase desirable behaviors or decrease inappropriate behaviors. There is a strong empirical basis for the effectiveness of ABA for people with disabilities such as increased academic skills (Browder et al., 2012; Coyne et al., 2011; Spooner et al., 2019), language development (Fitzer & Sturmey, 2009), development of friendships with peers (Carter et al., 2009), and acquisition of job skills (Defulio et al., 2009; Matthews et al., 2019; Wehman et al., 2009). At the heart of the effectiveness of ABA is the three-term contingency in which much of the research is based. The three terms include an antecedent (what precipitates the behavior or skill), the response (target skill or behavior) and the consequence that follows that target response. The analyst manipulates the antecedent or consequence to elicit positive behavior change. Finally, the interventions should have generality (seventh principle). The behavior change should generalize across times, settings, behaviors, and people (Whalen, 2009). Behavior change should also maintain over time (Horner et al., 1988).

Applied Behavior Analysis and People with Disabilities In addition, to understanding the principles of ABA it is also imperative to understand how ABA methods can be used to support individuals with disabilities. The field of applied behavior analysis has

Overview of Applied Behavior Analysis for Individuals with Disabilities | 11

substantial evidence supporting the efficacy of functional behavioral assessments and positive behavioral supports for the reduction of interfering behaviors and development of positive alternative behaviors. In addition, direct instruction (DI) has been shown to be an extremely effective evidence-based practice for education and academic acquisition (Coyne et al., 2011; Kamps et al., 2003; Kitchen & Kraus, 2018). ABA has an extensive research basis for successfully educating students with disabilities and is considered scientifically based research (Granpeesheh et al., 2014; Odom et al., 2005; Odom et al., 2013; Sturmey & Didden, 2014; Tincani & Bondy, 2014). Through challenging behavior reductions, increased skills, development of alternative behavior across academic, social and behavioral opportunities have been created for students with disabilities to access colleges and careers (Freedman, 2010; Koegle et al., 2013; Wehman et al., 2009). The National Autism Center published their National Standards Project (2009, 2015), which provides a summary of treatments for individuals with ASD. They reviewed the latest research in ASD treatment and through a lengthy and scientific procedure they categorized treatments (with reliability) as “established, emerging, unestablished or ineffective/harmful.” All the established treatment for people with ASD was based upon Applied Behavior Analysis. In addition, The National Autism Center (2009) published Evidenced—Based-Practice and Autism in the schools. This is a guide providing appropriate interventions to students with autism spectrum disorders. All evidence-based school interventions were based upon Applied Behavior Analysis. Applied Behavior Analysis has an established record of research demonstrating positive outcomes for people with disabilities (Brown et al., 2016; Taubman et al., 2011). ABA has proven to be successful in establishing inclusive classroom environments (Robinson et al., 2019), for acquisition for daily living skills (Shipley-Benamou et al., 2002; Goodson et al., 2007), acquisition of academics (Kagohara et al., 2012; Riesen et al., 2003), vocational activities (Edrisinha et al., 2011), and reducing severe behaviors such as self-injury (Neidert et al., 2005). For example, ABA has been effective in reducing serious and pervasive challenging behavior by students with disabilities (Chandler & Dahlquist, 2015; Scott et al., 2012). The development of Positive Behavior Supports has made it possible for people with varying disabilities to have success in their schools, communities, and worksites, leading to access to colleges and careers (Bambara et al., 2015; Brown et al., 2014; Crone et al., 2015; Dunlap et al., 2005; McIntosh & Av Gay, 2007; Newton et al., 2012; Simonsen, & Myers, 2015).

12 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

Self-Determination, Self-Advocacy, and Person-Centered Planning Self-Determination, Self-Advocacy, and Person-Centered Planning have become important components of any intervention program for people with disabilities (Agran & Hughes, 2014; Balint-Langel & Riden, in press; Corrigan, 2015; O’Brien, 2014; Peterson, et al., 2021; Wehmeyer & Webb, 2012). Self-determination can be defined as the person with a disability deciding upon the lifestyle that they want and then having control over the implementation of interventions to support that lifestyle. While the concept is simple, the implementation of the concept can be complex (Burke et al., 2019; Shogren, 2013; Wehmeyer, 1999; Wehmeyer et al., 2007). Self-determination is the capacity to choose and act on the basis of those lifestyle choices (Wehmeyer et al., 2002). Self-determination involves not only choice but also control over major issues such as where and with whom to live, what job or career to have, and leisure preferences. In other words, people with self-determination know how to choose, know what they want, and know how to get it (Martin & Sale, 2012). Self-advocacy is a critical component to self-determination and may be defined as advocating or speaking up for one’s self (Dybwad & Bersani, 1996; Heumann, 2020; Holzberg, et al., 2019; Tufail & Lyon, 2007). Self-advocacy is essential to becoming self determined as a person cannot self-advocate if they do not have self-determination skills. In other words, you have to know what you want in order to then know how to get it. Person-centered planning encourages a positive view of the future based on strengths and preferences (Miner & Bates, 1997; Ratti et al., 2016). The major purpose of person-centered planning is to clearly describe goals based on an individual’s strengths, talents, and preferences. The process of person-centered planning consists of four components: 1) a personal profile that promotes a positive view of the individual, 2) a positive vision of the future lifestyle, 3) action steps leading to the attainment of the desirable future lifestyle, and 4) any necessary changes to the current support system (i.e., school or adult services).

Overview of Applied Behavior Analysis for Individuals with Disabilities | 13

Quality of Life Quality of life is one of the most important driving forces in human services (Brown & Faragher, 2014; Fabian, 1990; Fava & Magnani, 1988; Gómez et al., 2021; Landesman, 1986; Schalock et al., 2007; Strain et al., 1991; Sylvester, 1989; Warren, 2013). Several global definitions for quality of life have been proposed, but no operational definition or appropriate measures have been agreed upon. (Schalock et al., 1989) have suggested that for persons with disabilities, quality of life combines environmental control, community involvement, and perception of personal change. For the general public, Campbell (1981) discussed twelve “life domains” as being components of quality of life (education, marriage, family life, friendship, self, health, standard of living, the country, neighborhood, housing, residence, and work). Felce (1997) has suggested six categories of Quality of Life (Physical well-being, Material well-being, Social well-being, Productive well-being, Emotional well-being, Civic well-being). It is important to realize that it is probable that appropriate quality of life measures will change over a person’s lifespan (Friedman, 2019; Stark & Goldsbury, 1990). What is clear from the literature is that quality of life is focused upon lifestyle outcomes for people and that though objective measures are important (i.e., economic indicators), quality of life often must be measured subjectively from an individual perspective (Cheng, 1988; Csikszentmihalyi & LeFevre, 1989; Robertson, 2010; Schwartz & Kelly, 2021). Research has often found a poor correlation between objective indicators and subjective measures of life satisfaction (Hughes et al., 1995; Milbraith, 1982). Therefore, it appears to be necessary to utilize both objective indicators and subjective measures in assessing quality of life (Andrews & Whitney, 1979; Perry & Felce, 2005), but to interpret results with caution, especially if the correlation between measures is poor. For example, in teaching appropriate social interaction skills, objective measures such as the number of positive interactions between a high school student with a disability and nondisabled peers may be important. However, subjective measures such as the quality of the interactions and personal satisfaction with the number of interactions are perhaps as, if not more, important. The student with disabilities may prefer to interact with only one or two peers and be more concerned with the quality of those interactions rather than the frequency. Increasing the frequency of the interactions may actually decrease the quality of life experience for that student.

14 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

In the case studies we combine the Felce (1997) and Schwartz and Kelley (2021) categories into these six: Physical well-being, Material well-being, Interpersonal wellbeing, Productive well-being, Emotional well-being, and Rights and Inclusion.

Executive Skills Executive functioning (EF) is a theoretical construct representing a varying list of cognitive processes that control or manage other cognitive processes involved in behavioral control. These cognitive processes are required for goal-directed behavior (Najdowski, 2017; Will et al., 2021). Behavioral control involves stopping and thinking before acting, monitoring the time needed to complete an assignment, or possibly using strategies and seeking support when independence is not possible. There is varying agreement about the subsets of EF skills. Mostly they are higher brain functions that lead to the formation of goal-directed action including; shifting attention, inhibiting impulses (response inhibition), initiating activity, sustained attention, emotional regulation, working memory, planning and organizing, self-monitoring (meta-cognition), flexibility, and time management. Executive dysfunction, a deficit in executive function skills is commonly associated with ADHD, ASD, TBI, Schizophrenia, Oppositional Defiant Disorder, Conduct disorder and bipolar disorder. For example, in an examination of executive function skills in aggressive teenagers, it was found that teens with disruptive behavior disorders (DBD) with ADHD performed worse on executive function tests than teens with DBD without ADHD (Hummer et al., 2011). The students with DBD still demonstrate some executive function deficits just not as extensive. Thus, executive functioning interventions need to be individualized and based upon the displayed behavior or executive functioning deficits. Interestingly, as a group, children with ADHD displayed more problems on neuropsychological measures of EF than non-clinical children; at the individual level, there appeared to be heterogeneity in EF impairment (Lambek et al., 2011). Executive function skills are most often associated with the prefrontal cortex but also involve a network of connections to other areas of the brain such as the thalamus. Despite the research showing location of the deficit there is no medical treatment for executive dysfunction. Each case study includes associated executive dysfunctions and treatment suggestions based upon evidenced-based practices.

Overview of Applied Behavior Analysis for Individuals with Disabilities | 15

Consultation Skills In this book we address the need for collaboration and consultation skill development. It is important that behavioral intervention plans are developed and implemented to fidelity. If a great behavior plan is placed in a drawer and never looked at or implemented, who benefits from that great plan? Great plans are only as great as their implementation. Therefore, it is often critical to focus on consultation skills so that information is received from multiple players (parents, the person with a disability, teachers, employers, etc.) And that intervention plans are developed with input from others and given approval by relevant people. For example, a behavior specialist may develop an intervention based upon a functional assessment for an adult with an intellectual disability in a supported employment position that is logical and based upon empirical research only to be told by the employer “that is not the way that we do things here.” Consulting with the employer ahead of time about possible interventions would have saved a lot of time and effort for the behavior specialist. School consultation is a process for providing psychological and educational services in which a specialist (consultant) works cooperatively with a staff member (consultee) to improve the learning and adjustment of a student (client) or group of students. During face-to-face interactions, the consultant helps the consultee through systematic problem solving, social influence, and professional support. In turn, the consultee helps the client(s) through selecting and implementing effective school-based interventions. In all cases, school consultation serves a remedial function and has the potential to serve a preventive function (Erchul & Martens, 2010). In addition, consultation requires setting up systems so that the client can implement the services creating a spectrum of competent employees. This book tries to demonstrate some of these systems that can be used or created for consultation across environments. Similar to the ABA treatments used within this book the consultation practices are based on solid conceptual ground and, where possible, relevant evidence-based findings (Daniels & Lattal, 2017). School consultation involves a combination of social influence and professional support within a problem-solving context. School and work-based consultation of behavioral interventions is well documented with empirical support outlined in each case where relevant (Bergan & Kratochwill, 1990; Kaye et al., 2020; Sugai & Tindal, 1993).

16 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

Multiculturalism and Diversity Applications in Applied Behavior Analysis Recently, there has been discussions, debate and publications related to diversity, cultural awareness, humility, and cultural competence in behavior analysis (Conners & Capell, 2021). ABA seems to have been “late to the game” and we have had to rely on the research in this area from nursing, social work, and counseling. Fong and colleagues (2016, 2017) provide guidance to increase cultural awareness of self and clients. They make many recommendations including the need for increasing training opportunities with culture and diversity relevant educational materials and increase the number of ethnically and racially diverse behavior analysts. In the most recent version of the Ethics Code for Behavior Analysts (BACB, 2020) included enhanced and added statements related to diversity and multiculturalism as seen in standards 1.07 and 4.07. 1.07 Cultural Responsiveness and Diversity Behavior analysts actively engage in professional development activities to acquire knowledge and skills related to cultural responsiveness and diversity. They evaluate their own biases and the ability to address the needs of individuals with diverse needs/backgrounds (e.g., age, disability, ethnicity, gender expression/identity, immigration status, marital/relationship status, national origin, race, religion, sexual orientation, socioeconomic status). Behavior analysts also evaluate biases of their supervisees and trainees, as well as their supervisees’ and trainees’ ability to address the needs of individuals with diverse needs/backgrounds (BACB, 2020, p.9). 4.07 Incorporating and Addressing Diversity During supervision and training, behavior analysts actively incorporate, and address topics related to diversity (e.g., age, disability, ethnicity, gender expression/identity, immigration status, marital/ relationship status, national origin, race, religion, sexual orientation, socioeconomic status) (BACB, 2020, p. 15)

In the first edition of this book, we addressed cultural issues with a separate section in each case study. In this edition, we have embedded cultural issues, reflections, and considerations into the assessment, treatment planning and implementation. This has been done as a model of how assessments and treatments should be driven with

Overview of Applied Behavior Analysis for Individuals with Disabilities | 17

consideration of cultural factors, cultural preferences, linguistic considerations, and norms (Broadhead et al., 2014; Fong et al., 2016; Rispoli et al., 2011) with inclusion of family, caregivers, and community. Rispoli et al. (2011) compared functional analysis data for a client that had a Spanish speaking family. There was an increase in aggressive behavior during the demand and attention conditions when in English compared to those conditions in Spanish. Similarly, one of the authors of this book is Spanish speaking and had more success in the classroom providing instruction in Spanish to an autistic student from Puerto Rico and more destruction when instruction was in English. Not only does culture and language influence assessments, but an impact is also seen in the selection of target behaviors (Fong et al., 2016; Fong & Tonaka, 2013). For example, one family wanted their child to sit for many hours in chair without making vocalizations so they could attend religious services. Even though the behavior analyst and the family designated increasing verbalizations as a priority they needed to also target quiet sitting in church (establishing stimulus control) to meet the families cultural needs. Rather than the behavior analysts making assumptions about the target behaviors, this should be a team effort involving the individual, caregivers, community members, and professionals using culturally sensitive practices. In this book, we address culturally appropriate language acquisition programs and recognize the functional relationship between a client’s behavior and culture.

REFERENCES Agran, M., & Hughes, C. (2014). Promoting self-determination and self-directed learning. In M. Agran, F. Brown, C. Hughes, C. Quirk, & D. Ryndak, (Eds.). Equity and full participation for individuals with severe disabilities: A vision for the future (pp. 75-97). Baltimore, MD: Paul Brookes. Alberto, P. A. Troutman, A. C., & Axe, J. B. (2021). Applied behavior analysis for teachers (10th ed.). Hoboken, NJ: Pearson. Andrews, F. M., & Whitney, S. B. (1979). Social indicators of well-being: Americans’ perceptions of life quality. New York, NY: Plenum Press. Balint-Langel, K., & Riden, B. S. (in press). Using the self-advocacy strategy to support middle school students with EBD. Beyond Behavior. Behavior Analysts Certification Board (2020). Ethics code for behavior analysts. Littleton, CO: Author. Baer, D. M. (1986). In application, frequency is not the only estimate of the probability ofbehavioral units. In T. Thompson & M. D. Zieler (Eds.), Analysis and integration of behavioral units (pp. 117-136). Hillsdale, NJ: Law-

18 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

rence Erlbaum Associates. Baer, D. M., Wolf, M. M., & Risley, T. R. (1968). Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 1(1), 91-97. Baer, D. M., Wolf, M. M., & Risley, T. R. (1987). Some still-current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 20(4), 313-327. Bambara, L., M., Janney, R., & Snell, M. E. (2015). Behavioral support (3rd ed.). Baltimore, MD: Paul H. Brookes. Barlow, D. H., Nock, M. K., & Hersen, M. (2009). Single-case experimental designs: Strategies for studying behavior change (3rd edition). New York: Allyn & Bacon. Bergan, J. R., & Kratochwill, T. R. (1990). Behavioral consultation and therapy. New York: Plenum. Brodhead, M. T., Durán, L., & Bloom, S. E. (2014). Cultural and linguistic diversity in recent verbal behavior research on individuals with disabilities: A review and implications for research and practice. The Analysis of Verbal Behavior, 30(1), 75-86. Browder, D. M., Trela, K., Courtade, G. R., Jimenez, B. A., Knight, V., & Flowers, C. (2012). Teaching mathematics and science standards to students with moderate and severe developmental disabilities. Journal of Special Education, 46(1), 26-35. Brown, F., Anderson, J., & De Pry, R. L. (2014). Individual positive behavior supports: A standards-based guide to practices in school and community settings. Baltimore: Paul H. Brookes Publishing. Brown, R. I., & Faragher, R. M. (2014). Quality of life and intellectual disability: Knowledge application to other social and educational challenges. Hauppauge, New York: Nova Science Publisher’s, Inc. Burke, K. M., Shogren, K. A., Raley, S. K., Wehmeyer, M. L., Antosh, A. A., & LaPlante, T. (2019). Implementing evidence-based practices to promote self-determination: Lessons learned from a state-wide implementation of the Self-Determined Learning Model of Instruction. Education and Training in Autism and Developmental Disabilities, 54(1), 18-29. Campbell, A. (1981). The sense of well-being in America. New York: McGraw-Hill. Carnine, D. (1992). Expanding the notion of teachers’ rights: Access to tools that work. Journal of Applied Behavior Analysis, 25(1), 13-19. Carnine, D., & Granzin, A. (2001). Setting learning expectations for students with disabilities. School Psychology Review, 30(4), 466-672. Carter, E. W., Cushing, L. S., & Kennedy, C. H. (2009). Peer support strategies for improving all students’ social lives and learning. Baltimore, MD: Paul Brookes. Chandler, L. K., & Dahlquist, C. M. (2015). Functional assessment: Strategies to prevent and remediate challenging behavior in school settings (4th ed.). Boston, MA: Pearson. Cheng, S. (1988). Subjective quality of life in the planning and evaluation of programs. Evaluation and Program Planning, 11(2), 123-134. Conners, B. M., & Capell, S. T. (Eds.). (2020). Multiculturalism and diversity in Applied Behavior Analysis: Bridging theory and application. Routledge.

Overview of Applied Behavior Analysis for Individuals with Disabilities | 19

Cooper, J. O., Heron, T. E., & Heward, W. L. (2020). Applied behavior analysis (3rd ed.). Hoboken, NJ: Pearson. Corrigan, P. W. (2015). Person-centered care for mental illness: The evolution of adherence and self-determination. Washington, DC: American Psychological Association. Coyne, M. D., Kame’enui, E. J., & Carnine, D. W. (2011). Effective teaching strategies that accommodate diverse learners (4th ed.). Upper Saddle River, NJ: Pearson. Crone, D. A., Hawken, L. S., & Horner, R. H. (2015). Building positive behavior support systems in schools: Functional behavioral assessment (Second edition). New York, NY: The Guilford Press. Csikszentmihalyi, M., & LeFevre, J. (1989). Optimal experience in work and leisure. Journal of Personality and Social Psychology, 56(5), 815-822. Daniels, A.C. & Lattal, A.D. (2017). Life’s a pic/nic . . . when you understand behavior. New York, NY: Sloan Publishing. Defulio, A., Iata, C. Needham, M., & Silverman, K. (2009). Modification of perseverative responding that increased earnings but impeded skill acquisition in a job-skills training program. Journal of Applied Behavior Analysis, 42(3), 627-640. Dillenburger, K., & Keenan, M. (2009). None of the As in ABA stand for autism: Dispelling the myths. Journal of Intellectual and Developmental Disabilities, 34(2), 193-195. Dunlap, G., Harrower, J., & Fox, L. (2005). Understanding the environmental determinants of problem behaviors. In L. Bambara & L. Kern (Eds.), Individualized supports for students with problem behaviors. (pp. 25-46). New York: Guilford Press. Dunlap, G., Iovannone, R., Kincaid, D., Wilson, K., Christiansen, K., Strain, P. & English, C. (2010). Prevent–teach–reinforce: The school-based model of individualized positive behavior support. Baltimore, MD: Paul Brookes. Durand, V. M. (1998). Sleep better!: A guide to improving sleep for children with special needs. Baltimore, MD: Paul H. Brookes. Durand, V. M. (2014). Autism spectrum disorder: A clinical guide for general practitioners. Washington, DC: American Psychological Association. Dybwad, G., & Bersani, H. (1996). New voices: Self-advocacy by people with disabilities. Cambridge, MA: Brookline Books. Edrisinha, C., O’Reilly, M. F., Choi, H., Sigafoos, J., & Lancioni, G. E. (2011). “Say Cheese”: Teaching photography skills to adults with developmental disabilities. Research in Developmental Disabilities, 32(2), 636-642. Erchul, W. P., & Martens, B. K. (2010). School consultation: Conceptual and empirical bases of practice (2nd ed.). New York: Kluwer Academic/Plenum. Fabian, E. S. (1990). Quality of life: A review of theory and practice implications for individuals with long-term mental illness. Rehabilitation Psychology, 35(3), 161-170. Fava, G.A., & Magnani, B. (1988). Quality of life: A review of contemporary confusion. Medical Sciences Research, 16(20), 1051-1054. Felce, D. (1997). Defining and applying the concept of quality of life. Journal of Intellectual Disability Research, 41(2), 126-135. Fisher, W. W., Piazza, C. C., & Roane, H. S. (2021). Handbook of applied behav-

20 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

ior analysis (2nd ed.). New York, NY: Guilford Press. Fitzer, A., & Sturmey, P. A. (2009). Language and autism: Applied behavior analysis, evidence, and practice. Austin, TX: Pro-Ed. Fong, E. H., Catagnus, R., Brodhead, M., Quigley, S., & Field, S. (2016). Developing the cultural awareness skills of behavior analysts. Behavior Analysis in Practice, 9(1), 84–94. Fong, E. H., Ficklin, S., & Lee, H. Y. (2017). Increasing cultural understanding and diversity in applied behavior analysis. Behavior Analysis: Research and Practice, 17(2), 103-113. Fong, E. H., & Tanaka, S. (2013). Multicultural alliance of behavior analysis standards for cultural competence in behavior analysis. International Journal of Behavioral and Consultation Therapy, 8(2), 17–19. Freedman, S. (2010). Developing college skills in students with Autism and Asperger’s Syndrome. Philadelphia, PA: Jessica Kingsley Publishers. Friedman, C. (2019). Quality-of-life outcomes of older adults with severe disabilities. Research and Practice for Persons with Severe Disabilities, 44(4), 237-250. Gómez, L. E., Schalock, R. L., & Verdugo, M. A. (2021). A new paradigm in the field of intellectual and developmental disabilities: Characteristics and evaluation, Psicothema, 33(1), 28-35. Goodson, J., Sigafoos, J., O’Reilly, M., Cannella, H., & Lancioni, G. E. (2007). Evaluation of a video-based error correction procedure for teaching a domestic skill to individuals with developmental disabilities. Research in Developmental Disabilities, 28(5), 458-467. Granpeesheh, D., Tarbox, J., & Dixon, D. R. (2009). Applied behavior analytic interventions for children with autism: A description and review of treatment research. Annals of Clinical Psychiatry, 21(3), 162-173. Granpeesheh, D., Tarbox, J., & Najdowski, A. (2014). Evidence-based treatment for children with autism. Boston, MA: Elsevier. Heumann, J. (2020). Being heumann: An unrepentant memoir of a disability rights activist. Boston, MA: Beacon. Holzberg, D. G., Test, D. W., & Rusher, D. E. (2019). Self-advocacy instruction to teach high school seniors with mild disabilities to access accommodations in college. Remedial and Special Education, 40(3), 166-176. Horner, R. H, Day, M. H., Day, J. (1997). Using neutralizing routines to reduce problem behaviors. Journal of Applied Behavior Analysis, 30(4), 601-614. Horner, R. H., Dunlap, G., & Koegel, R. L. (1988). Generalization and maintenance: Lifestyle changes in applied settings. Baltimore, MD: Paul Brookes. Hughes, C., Hwang, B., Kim, J. H., Eisenman, L. T., & Killian, D. J. (1995). Quality of life in applied research: A review and analysis of empirical measures. American Journal on Mental Retardation, 99(6), 623-641. Hummer, T., Kronenberger, W., Wang, Y., Dunn, D., Mosier, K., Kalnin, A., & Mathews, V. (2011). Executive functioning characteristics associated with ADHD comorbidity in adolescents with disruptive behavior disorders. Journal of Abnormal Child Psychology, 39(1), 11-19. Kagohara, D. M., Sigafoos, J., Achmadi, D., O’Reilly, M., & Lancioni, G. (2012). Teaching children with autism spectrum disorders to check the

Overview of Applied Behavior Analysis for Individuals with Disabilities | 21

spelling of words. Research in Autism Spectrum Disorders, 6(1), 304-310. Kamps, D.M., Wills, H.P., Greenwood, C.R., & Thorne, S. (2003). Curriculum influences on growth in early reading fluency for students with academic and behavior risks: A descriptive study. Journal of Emotional and Behavioral Disorders, 11(4), 211-224. Kazdin, A. E. (2008). The Kazdin method for parenting the defiant child. Boston, MA: Houghton Mifflin. Kazdin, A. E. (2020). Single-case research designs: Methods for clinical and applied Settings (3rd ed.). New York: Oxford University Press. Kaye, A. J., Pejic, V., Jordan, M., Dennery, K., & DeMaso, D. R. (2020). Evaluation of an urban school-based social, emotional, and behavioral health professional development and consultation model. Children and Schools, 42(2), 79-87. Kearney, A. J. (2015). Understanding applied behavior analysis: An introduction to ABA parents, teachers, and other professionals (2nd ed.). Philadelphia, PA: Jessica Kingsley Publishers. Kitchen, T., & Kraus, W. (2018). Teaching reading skills using discrete trial training. Journal of Evidence-Based Practices for Schools, 17(2), 174-194. Koegel, L. K., Asbaugh, K., Koegel, R. L., Detar, W.J., & Regester, A. (2013). Increasing socialization in adults with Asperger’s Syndrome. Psychology in the Schools, 50(9), 899-909. Koegel, L. K., & LaZebnik, C. (2014). Overcoming autism: Finding the answers, strategies, and hope that can transform a child’s life. New York: Penguin Books. Lambek, R., Tannock, R., Dalsgaard, S., Trillingsgaard, A., Damm, D., & Thomsen, P. H. (2011). Executive dysfunction in school-age children with ADHD. Journal of Attention Disorders, 15(8), 646-655. Landesman, S. (1986). Quality of life and personal life satisfaction: Definition and measurement issues. Mental Retardation, 24(3), 141-143. Laraway, S., Snycerski, S., Michael, J., & Poling, A. (2003). Motivating operations and terms to describe them: Some further refinements. Journal of Applied Behavior Analysis, 36(3), 407-414. Laraway, S., Snycerski, S., Olson, R., Becker, B., & Poling, A. (2014). The motivating operations concept: Current status and critical response. The Psychological Record, 64(3), 601-623. Ledford, J. R., & Gast, D. L. (Eds.). (2018). Single case research methodology: Applications in special education and behavioral sciences (3rd ed.). Routledge. Martin, J. E., & Sale, R. P. (2012). Self-determination. In P. Wehman & J. Kregel (Eds.), Functional curriculum for elementary and secondary students with special needs (3rd ed.), (pp. 105-136). Austin, TX: Pro Ed Matthews, K. M., Newcomb, E. T., Morgan, C. A., Chen, T., & Vanderburg, N. (2019). Effects of emulation training on activities of daily living and job-related skills. Behavior Analysis: Research and Practice, 19(4), 379-388. McIntosh, K., & Av-Gay, H. (2007). Implications of current research on the use of functional behavior assessment and behavior support planning in school systems. International Journal of Behavior Consultation and Therapy, 3(1), 38-52. Milbraith, L. W. (1982). A conceptualization and research strategy for the study of ecological aspects of the quality of life. Social Indicators Research,

22 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

10(2), 133-157. Miltenberger, R. G. (2016). Behavior modification: Principles and procedures (6th ed.). Boston, MA: Cengage Learning. Miner, C. A., & Bates, P. E. (1997). The effects of person centered planning activities on the IEP/transition planning process. Education and Training in Mental Retardation and Developmental Disabilities, 32(2), 105-112. Morgan, D. (2010). Schedules of reinforcement at 50: A retrospective appreciation. Psychological Record, 60(1), 151-172. Munk, D. D., & Karsh, K. G. (1999). Antecedent curriculum and instructional variables as class wide interventions for preventing or reducing problem behaviors. In A. C. Repp & R. H. Horner (Eds.), Functional analysis of problem behaviors: From effective assessment to effective support (pp. 259-276). Belmont, CA: Wadsworth. Najowski, A. (2017). Flexible and focused: Teaching executive function skills to individuals with autism and attention disorders. Academic Press. National Autism Center. (2009, 2015). National standards report. National Autism Center, Randolph: MA National Autism Center. (2009). Evidence-based practice & autism in the schools. National Autism Center, Randolph: MA. Neidert, P. L., Iwata, B. A., & Dozier, C. L. (2005). Treatment of multiply controlled problem behavior with procedural variations of differential reinforcement. Exceptionality, 13(1), 45-53. Newton, J. S., Horner, R. H., Algozzine, B., Todd, A. W. & Algozzine, K. (2012). A randomized wait-list controlled analysis of the implementation integrity of team-initiated problem solving processes. Journal of School Psychology, 50(4), 421-441. O’Brien, J. (2014). Person-centered planning and the quest for systems change. In M. Agran, F. Brown, C. Hughes, C. Quirk, & D. Ryndak, (Eds.). Equity and full participation for individuals with severe disabilities: A vision for the future (pp. 57-74). Baltimore, MD: Paul Brookes. Odom, S. L., Brantlinger, E., Gersten, R., Horner, R. H., Thompson, B., & Harris, K. R. (2005). Research in special education: Scientific methods and evidence-based practices. Exceptional Children, 71(2), 137-148. Odom, S. L., Cox, A. W., & Brock, M. E. (2013). Implementation science, professional development, and autism spectrum disorders. Exceptional Children, 79(2), 233-251. Nye, R. D. (1992). The legacy of B. F. Skinner: Concepts and perspectives, controversies And misunderstandings. Wadsworth: Belmont, CA. O’Donohue, W., & Ferguson, K. E. (2001). The psychology of B. F. Skinner. Sage Publications: Thousand Oaks, CA. O’Neill, R. E., Albin, R. W., Storey, K., Horner, R. H., & Sprague, J. R. (2015). Functional assessment and program development for problem behavior: A practical handbook (3rd edition). Stamford, CT: Cengage Publishing Company. Perry, J., & Felce, D. (2005). Correlation between subject and objective measures of outcomes in staffed community housing. Journal of Intellectual Disability Research, 49(4), 278-287. Peterson, S. M., Aljadeff-Abergel, E., Eldridge, R. R., VanderWeele, N. J., &

Overview of Applied Behavior Analysis for Individuals with Disabilities | 23

Acker, N. S. (2021). Conceptualizing self-determination from a behavioral perspective: The role of choice, self-control, and self-management. Journal of Behavioral Education, 30(2), 299-318. Poling, A., Lotfizadeh, A., & Edwards, T. L. (2017). Predicting reinforcement: Utility of the motivating operations concept. The Behavior Analyst, 40(1), 49–56. Ratti, V., Hassiotis, A., Crabtree, J., Deb, S., Gallagher, P., & Unwin, G. (2016). The effectiveness of person-centered planning for people with intellectual disabilities: A systematic review. Research in Developmental Disabilities, 57(1), 63–84. Riesen, T., McDonnell, J., Johnson, J. W., Polychronis, S., & Jameson, M. (2003). A comparison of constant time delay and simultaneous prompting within embedded instruction in general education classes with students with moderate to severe disabilities. Journal of Behavioral Education, 12(4), 241-259. Rispoli, M., O’Reilly, M., Lang, R., Sigafoos, J., Mulloy, A., Aguilar, J., & Singer, G. (2011). Effects of language of implementation on functional analysis outcomes. Journal of Behavioral Education, 20(4), 224-232. Robertson, S. M. (2010). Neurodiversity, quality of life, and autistic adults: shifting research and professional focuses onto real-life challenges. Disability Studies Quarterly, 30(1). Robinson, J., Gershwin, T., & London, D. (2019). Maintaining safety and facilitating inclusion: Using applied behavior analysis to address self-injurious behaviors within general education classrooms. Beyond Behavior, 28(3), 154-167. Sallows, G. O., & Graupner, T. D. (2005). Intensive behavioral treatment for children with autism: Four-year outcome and predictors. American Journal on Mental Retardation, 110(6), 417–438. Schalock, R. L., Gardner, J. F., & Bradley, V. J. (2007). Quality of life for people with intellectual and other developmental disabilities: Applications across individuals, organizations, communities, and systems. Washington, DC: American Association on Intellectual and Developmental Disabilities. Schalock, R. L., Keith, K. D., Hoffman, K., & Karan, O. C. (1989). Quality of life: Its measurement and use. Mental Retardation, 27(1), 25-31. Schwartz, I. S., & Kelly, E. M. (2021). Quality of life for people with disabilities: Why applied behavior analysts should consider this a primary dependent variable. Research and Practice for Persons with Severe Disabilities, 46(3), 159-172. Scott, T. M., Anderson, C. M., & Alter, P. (2012). Managing classroom behavior using positive behavior supports. Boston, MA: Pearson. Shillingsburg, M. A., Bowen, C. N., Valentino, A. L., & Pierce, L. E. (2014). Mands for information using “who?” and “which?” in the presence of establishing and abolishing operations. Journal of Applied Behavior Analysis, 47(1), 136-150. Shipley-Benamou, R., Lutzker, J. R., & Taubman, M. (2002). Teaching daily living skills to children with autism through instructional video modeling. Journal of Positive Behavior Interventions, 4(3), 166-177. Shogren, K. A. (2013). Self-determination and transition planning. Baltimore,

24 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

MD: Paul H. Brookes Publishing Co. Simonsen, B., & Myers, D. (2015). Classwide positive behavior interventions and supports. New York: Guilford Press. Skinner, B. F. (1953). Science and human behavior. New York: MacMillan. Skinner, B. F. (1971). Beyond freedom and dignity. New York: Knopf. Spooner, F., Root, J. R., Saunders, A. F., & Browder, D. M. (2019). An updated evidence-based practice review on teaching mathematics to students with moderate and severe developmental disabilities. Remedial and Special Education, 40(3), 150-165. Stark, J. A., & Goldsbury, T. (1990). Quality of life from childhood to adulthood. In R. L. Schalock (Ed.), Quality of life: Perspectives and issues (pp. 7183). Washington, DC: American Association on Mental Retardation. Storey, K. (2007). Review of research on self-management interventions in supported employment settings for workers with disabilities. Career Development for Exceptional Individuals, 30(1), 27-34. Strain, P. S., Storey, K., & Smith, D. J. (1991). Quality of life outcomes for young children with disabilities: Legislative and service delivery implications. Early Education and Development, 2(1), 40-53. Sturmey, P., & Didden, R. (2014). Evidence-based practice and intellectual disabilities. Hoboken, NJ: Wiley-Blackwell. Sugai, G. M., & Tindal, G. A. (1993). Effective school consultation. Pacific Grove, CA: Brooks/Cole. Sylvester, C. (1989). Quality assurance and quality of life: Accounting for the good and healthy life. Therapeutic Recreation Journal, 23(2), 7-22. Taubman, M., Leaf, R., & McEachin, J. (2011). Crafting connections: Contemporary Applied behavior analysis for enriching the social lives of persons with autism spectrum disorder. New York, NY: DRL Books, Inc. Tincani, M., & Bondy, A. (2014). Autism spectrum disorders in adolescents and adults: Evidence-based and promising interventions. New York: The Guilford Press. Tufail, J., & Lyon, K. (2007). Introducing advocacy: The first book of speaking up: A plain text guide to advocacy. Philadelphia, PA: Jessica Kingsley. Warren, N. (2013). Reframing disability and quality of life: A global perspective. New York: Springer. Watson, J. B. (1913). Psychology as the behaviorist views it. Psychological Review, 20(2), 158-177. Wehman, P., Smith, M. D., & Schall, C. (2009). Autism and the transition to adulthood: Success beyond the classroom. Baltimore: Paul H. Brookes. Wehmeyer, M. (1999). A functional model of self-determination: Describing development and implementing instruction. Focus on Autism and Other Developmental Disabilities, 14(1), 53-62. Wehmeyer, M. L., Agran, M., Hughes, C., Martin, J. E., Mithaug, D. E., & Palmer, S. B. (2007). Promoting self-determination in students with developmental disabilities. New York: Guilford. Wehmeyer, M. L., Lance, G. D., & Bashinski, S. (2002). Promoting access to the general curriculum for students with mental retardation: A multi-level model. Education and Training in Mental Retardation and Developmental Disabilities, 37(3), 223-234.

Overview of Applied Behavior Analysis for Individuals with Disabilities | 25

Wehmeyer, M. L., & Webb, K. W. (2012). Handbook of adolescent transition education for youth with disabilities. New York: Routledge. Whalen, C. (2009). Real life, real progress for children with Autism Spectrum Disorders: Strategies for successful generalization in natural environments. Baltimore, Maryland: Paul H. Brookes Publishing Will, E. A., Schworer, E. K., & Esbensen, A. J. (2021). The role of distinct executive functions on adaptive behavior in children and adolescents with Down syndrome. Child Neuropsychology, 27(8),1054-1072.

Overview of Case Studies

I

t is important for service providers, consultants, teachers, as well as behavior analysts to have a working knowledge of application of applied behavior analysis to real life cases across a spectrum of disabilities and age groups. This book is designed to meet that need. This book provides detailed case studies that can be used by individuals in the field, students practicing for certification and university programs applied behavior analysts. This book provides case studies for real life examples and practice for individuals working with people with disabilities. The examples cover items on the 5th edition Task List from the BACB as well other areas of executive function skills, Person Centered Planning, the use of technology, and quality of life. The areas covered are detailed within the sections and cover a broad range of topics necessary for consultation and implementation for support of the individuals with disabilities. In the case studies we use the 5th Edition of the Behavior Analyst Task List by the Behavior Analyst Certification Board which outlines nine content areas across two major sections (Foundations and Applications) that are required for competency as a Board Certified Behavior Analyst. We use one area from Foundations, Measurement, Data Display, and Interpretation. We use the five content areas from the Applications section, Ethics, Behavior Assessment, Behavior-Change Procedures, Selecting and Implementing Interventions, and Personnel Supervision and Management, for covering the interventions in the case studies. These areas of the Behavior Analyst Task List provide guidelines for analysis within the case studies and cover a broad range of topics necessary for consideration of appropriate interventions. In the case studies, we list all the Applications section components of fifth edition task list per section and strikethrough the ones that do not directly apply to that case study. Then in the content area we provide the narrative of the case study related to that content area. We have not relisted each of the content areas in the narrative so that the narrative 27

28 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

is easier to read and follow. For example, in Case Study One, for the Behavior Assessment section, we have struck through the component, F-8, and that area is not discussed in the analysis. Areas F-1 to F-7 and F-9 are not struck through and these areas are analyzed in the narrative for the Behavior Assessment section of the case study. While it is important to initially consider many potentially relevant components of an intervention and to have a comprehensive intervention, it is also important not to make the plan too complex so that it is difficult to actually implement the intervention with fidelity. In the case studies with complete analysis (the first six case studies) we have tried to strike a balance with providing enough information about the interventions without going into too much detail. Those readers wanting more information on interventions discussed in the case studies are directed to the references in at the end of each complete case study. The first six case studies provide readers with a complete analysis, which will allow readers to see how to analyze and develop a comprehensive Behavior Support Plan (BSP) with detailed answers and supporting data systems. The second six case studies have the areas from Task list and items outlined that we deem to be most relevant for analysis with data provided but not with the analysis completed. This will guide the readers in their analysis and allow them to complete the analysis themselves for skill building. The final six case studies have the case study but no analysis or guidelines. This will allow readers to further develop their skills by coming up with their own guidelines for analysis and then their own analysis.

Fifth Edition Task List Section 1: Foundations A. Philosophical Underpinnings A-1 A-2

A-3 A-4

Identify the goals of behavior analysis as a science (i.e., description, prediction, control). Explain the philosophical assumptions underlying the science of behavior analysis (e.g., selectionism, determinism, empiricism, parsimony, pragmatism). Describe and explain behavior from the perspective of radical behaviorism. Distinguish among behaviorism, the experimental analysis of

Overview of Case Studies | 29

A-5

behavior, applied behavior analysis, and professional practice guided by the science of behavior analysis. Describe and define the dimensions of applied behavior analysis (Baer, Wolf, & Risley, 1968).

B.

Concepts and Principles

B-1

Define and provide examples of behavior, response, and response class. Define and provide examples of stimulus and stimulus class. Define and provide examples of respondent and operant conditioning. Define and provide examples of positive and negative reinforcement contingencies. Define and provide examples of schedules of reinforcement. Define and provide examples of positive and negative punishment contingencies. Define and provide examples of automatic and socially mediated contingencies. Define and provide examples of unconditioned, conditioned, and generalized reinforcers and punishers. Define and provide examples of operant extinction. Define and provide examples of stimulus control. Define and provide examples of discrimination, generalization, and maintenance. Define and provide examples of motivating operations. Define and provide examples of rule-governed and contingency-shaped behavior. Define and provide examples of the verbal operants. Define and provide examples of derived stimulus relations.

B-2 B-3 B-4 B-5 B-6 B-7 B-8 B-9 B-10 B-11 B-12 B-13 B-14 B-15

C. Measurement, Data Display, and Interpretation C-1 C-2 C-3 C-4 C-5

Establish operational definitions of behavior. Distinguish among direct, indirect, and product measures of behavior. Measure occurrence (e.g., frequency, rate, percentage). Measure temporal dimensions of behavior (e.g., duration, latency, interresponse time). Measure form and strength of behavior (e.g., topography, magnitude).

30 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

C-6 Measure trials to criterion. C-7 Design and implement sampling procedures (i.e., interval recording, time sampling). C-8 Evaluate the validity and reliability of measurement procedures. C-9 Select a measurement system to obtain representative data given the dimensions of behavior and the logistics of observing and recording. C-10 Graph data to communicate relevant quantitative relations (e.g., equal-interval graphs, bar graphs, cumulative records). C-11 Interpret graphed data. D. Experimental Design D-1 D-2 D-3

D-4 D-5 D-6

Distinguish between dependent and independent variables. Distinguish between internal and external validity. Identify the defining features of single-subject experimental designs (e.g., individuals serve as their own controls, repeated measures, prediction, verification, replication). Describe the advantages of single-subject experimental designs compared to group designs. Use single-subject experimental designs (e.g., reversal, multiple baseline, multielement, changing criterion). Describe rationales for conducting comparative, component, and parametric analyses.

Section 2: Applications E. Ethics Behave in accordance with The Ethics Code for Behavior Analysts. E-1 Responsible conduct of behavior analysts. E-2 Behavior analysts’ responsibility to clients. E-3 Assessing behavior. E-4 Behavior analysts and the behavior-change program. E-5 Behavior analysts as supervisors. E-6 Behavior analysts’ ethical responsibility to the profession of behavior analysis. E-7 Behavior analysts’ ethical responsibility to colleagues E-8 Public statements. E-9 Behavior analysts and research. E-10 Behavior analysts’ ethical responsibility to the BACB.

Overview of Case Studies | 31

F. Behavior Assessment F-1 F-2 F-3 F-4 F-5 F-6 F-7 F-8 F-9

Review records and available data (e.g., educational, medical, historical) at the outset of the case. Determine the need for behavior-analytic services. Identify and prioritize socially significant behavior-change goals. Conduct assessments of relevant skill strengths and deficits. Conduct preference assessments. Describe the common functions of problem behavior. Conduct a descriptive assessment of problem behavior. Conduct a functional analysis of problem behavior. Interpret functional assessment data.

G. Behavior-Change Procedures G-1 Use positive and negative reinforcement procedures to strengthen behavior. G-2 Use interventions based on motivating operations and discriminative stimuli. G-3 Establish and use conditioned reinforcers. G-4 Use stimulus and response prompts and fading (e.g., errorless, most-to-least, least-to-most, prompt delay, stimulus fading). G-5 Use modeling and imitation training. G-6 Use instructions and rules. G-7 Use shaping. G-8 Use chaining. G-9 Use discrete-trial, free-operant, and naturalistic teaching arrangements. G-10 Teach simple and conditional discriminations. G-11 Use Skinner’s analysis to teach verbal behavior. G-12 Use equivalence-based instruction. G-13 Use the high-probability instructional sequence. G-14 Use reinforcement procedures to weaken behavior (e.g., DRA, FCT, DRO, DRL, NCR). G-15 Use extinction. G-16 Use positive and negative punishment (e.g., time-out, response cost, overcorrection). G-17 Use token economies. G-18 Use group contingencies.

32 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

G-19 Use contingency contracting. G-20 Use self-management strategies. G-21 Use procedures to promote stimulus and response generalization. G-22 Use procedures to promote maintenance. H. Selecting and Implementing Interventions H-1 State intervention goals in observable and measurable terms. H-2 Identify potential interventions based on assessment results and the best available scientific evidence. H-3 Recommend intervention goals and strategies based on such factors as client preferences, supporting environments, risks, constraints, and social validity. H-4 When a target behavior is to be decreased, select an acceptable alternative behavior to be established or increased. H-5 Plan for possible unwanted effects when using reinforcement, extinction, and punishment procedures. H-6 Monitor client progress and treatment integrity. H-7 Make data-based decisions about the effectiveness of the intervention and the need for treatment revision. H-8 Make data-based decisions about the need for ongoing services. H-9 Collaborate with others who support and/or provide services to clients. I. Personnel Supervision and Management I-1

I-2 I-3 I-4 I-5 I-6

State the reasons for using behavior-analytic supervision and the potential risks of ineffective supervision (e.g., poor client outcomes, poor supervisee performance). Establish clear performance expectations for the supervisor and supervisee. Select supervision goals based on an assessment of the supervisee’s skills. Train personnel to competently perform assessment and intervention procedures. Use performance monitoring, feedback, and reinforcement systems. Use a functional assessment approach (e.g., performance diagnostics) to identify variables affecting personnel performance.

Overview of Case Studies | 33

I-7 Use function-based strategies to improve personnel performance. I-8 Evaluate the effects of supervision (e.g., on client outcomes, on supervisee repertoires). The BACB often updates the task list with input from a committee of subject matter experts from various areas of behavior analysis. The 5th edition task list is in effect until January of 2025 when the 6th edition Test Content Outline (TCO) will be implemented. Rather than a stable task list that is in effect for three to five years this is being replaced by TCOs. The BCBA and BCaBA examinations and their respective TCOs will be updated and implemented independent of changes to certification requirements. This will enable examination content to be revised more frequently in response to changes in the profession. That being said, the content outlined in the case studies in this book are based upon the 5th edition list they will remain relevant across the additions of TCO updates. These cases provide assessments and interventions with core concepts and principles. Some of the areas of change involve title changes, elimination of duplications, and integration of diversity, equity and inclusion. The 13 tasks that have been added to the 6th edition TOC are below. B.20 Identify the role of multiple control in verbal behavior. B.22 Identify ways behavioral momentum can be used to understand response persistence. B.23 Identify ways the matching law can be used to interpret response allocation. B.24 Identify and distinguish between imitation and observational learning. C.12 Select a measurement procedure to obtain representative procedural integrity data that accounts for relevant dimensions (e.g., accuracy, dosage) and environmental constraints. D.3 Identify threats to internal validity (e.g., history, maturation). D.6 Critique and interpret data from single-case experimental designs. E.2 Identify the risks to oneself, others, and the profession as a result of engaging in unethical behavior. E.8 Identify and apply interpersonal and other skills (e.g., accepting feedback, listening actively, seeking input, collaborating) to establish and maintain professional relationships. F.2 Identify and integrate relevant cultural variables in the assess-

34 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

ment process. G.18 Evaluate emotional and elicited effects of behavior-change procedures. H.5 Plan for and attempt to mitigate possible relapse of the target behavior. I.3 Identify and implement methods that promote equity in supervision practices.

Additional Areas for Analysis Executive Functioning Shifting Attention Inhibiting Impulses Initiating Activity Emotional Control Planning and Organizing Self-Monitoring Time Management The Use of Technology in Interventions for Behavior Change Legal Issues Quality of Life Physical Well-Being Material Well-Being Interpersonal Well-Being Productive Well-Being Emotional Well-Being Rights and Inclusion Foundational and Lifestyle Strategies Person-Centered Planning Physical, Medical, Psychological, or Mental Health Issues Supports Teachers/Service Providers The Neurodiverse Person Family Members Employers/Community Members Technological Supports Instructional Supports Discussion Questions Empirical Research to Support that the Intervention is an Evidence-Based Practice. The book includes 18 case studies of individuals with disabilities

Overview of Case Studies | 35

Matrix of Case Studies by Age and Disability Provided in the Book Autism Spectrum Disorder— extensive support needs In-Home/ Clinic

Complete Analysis Kathleen

Elementary School Younger

Complete Analysis Merve

High School Older Transition

Mental Health/ED

Specific Learning Disability

Partial Analysis Asanka Partial Analysis Billy Joe Without Analysis Leron

Without Analysis Angeline

Without Analysis Exene Partial Analysis Celia

Complete Analysis Horatio Partial Analysis Rolph Partial Analysis Wyclef

Without Analysis Jelme

Traumatic Brain Injury

Without Analysis Patti

Complete Analysis Audrey

College

Adult

Intellectual Disability

Autism Spectrum Disorder— minimal support needs

Complete Analysis Levin

Without Analysis Ian

Partial Analysis Cameron

Complete Analysis Doug

across age groups. Above is a chart that shows the cases across disabilities and age group that are covered with this book.

TERMINOLOGY IN TEXT In this book we use the terms “desirable” and “challenging” in describing the behavior of the student or adult receiving services. A variety of terms have been used in the professional literature such as difficult, acting out, disruptive, good/bad, appropriate/inappropriate, at-risk, target behavior, and undesirable behavior. Basically, these terms have been used to describe student (or adult) behavior that is seen as being either desirable or undesirable from the viewpoint of the

36 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

support providers such as teachers, parents, employers as well the general public. We use “Person-First” language throughout the book. The language and words used to describe people has tremendous power. When language is used positively (student with a learning disability, person who is liberated by using a wheelchair) it can enhance the value that people are given. When language is used negatively (cripple, retard, handicapped, low functioning) it can result in the devaluing of people and the lowering of expectations of what is possible for that person to achieve. What is written and said can promote positive attitudes about the ability of people or it can marginalize and demean them (Mackelprang & Salsgiver, 2009; Mairs, 1986; Russell, 1994; Shapiro et al., 1990; Vivanti, 2020; Ziegler, 2020). It is important to use terms that are clear, accurate, and unbiased. Most recently, there has been a movement in the autism community to use identify-first language rather than person-first language. Autistic self-advocates and their allies have pushed for this paradigm shift based upon at least two factors. One factor is autism is an inherent part of the individual’s identity (Autistic Hoya, 2011) and can’t be separated from the individual. Second, some advocates argue that the use of person-first language can perpetuate stigmatizing views that the autism is less than desirable (Vivanti, 2020). In this book we have been judicious in our use of person-first and identity-first language in relation to autism based upon the context and experiences of these case studies.

REFERENCES Autistic Hoya (August, 2011). The significance of semantics: Person-first language: Why it matters. https://www.autistichoya.com/2011/08/significance-of-semantics-person-first.html Mackelprang, R. W., & Salsgiver, R. (2009). Disability: A diversity model approach in human service practice (2nd ed.). Chicago, IL: Lyceum Books. Mairs, N. (1986). On being a cripple. In Plaintest: Essays (p. 9-20). Tucson, AZ: University of Arizona Press. Russell, M. (1994). Malcom teaches us, too. In B. Shaw (Ed.), The ragged edge: The disability experience from the pages of the first fifteen years of the Disability Rag (pp. 11-14). Louisville, KY: The Advocado Press. Shapiro, A., Marglois, H., & Anderson, P. M. (1990). The vocabulary of disability: Critical reading and handicapism. The High School Journal, 73(2), 86-91. Vivanti, G. (2020). Ask the editor: What is the most appropriate way to talk about individuals with a diagnosis of autism? Journal of Autism and Develop-

Overview of Case Studies | 37

mental Disorders, 5(2), 691-693. Ziegler, Meg. E. (2020). Disabling language: Why legal terminology should comport with a social model of disability. Boston College Law Review, 61(3), 1183-1221.

SECTION ONE

Case Studies with Complete Analysis

Case Study One — Kathleen Case Study Covers: • Autism Spectrum Disorders (ASD) • Early Intensive Behavioral Intervention (EIBI)

K

athleen is a 2 year 9-month-old girl with ASD with extensive support needs, who receives intensive behavioral intervention services. She has a home and clinic program covered by her insurance provider and overseen by a behavioral health service provider. The agency provides the services in both home and clinic settings. Typical of EIBI services for young children with ASD, she has a 30 hour a week program which is divided into 20 hours in-clinic, 10 hours of in-home, with a variety of one-on-one support providers.

There are two major issues involved in the analysis and development of services and support for Kathleen. Kathleen is verbal but rarely uses language to initiate contact with others. In the clinic and her home program, she has mastered many of the early learner measures for expressive and receptive skills (Sallows & Graupner, 2005). She is continuing to work on conversational skills, back-and-forth exchanges, game playing, and role-play in pretend play. She does have some skills in all those areas as demonstrated with the adult therapists in the clinic but is not yet at criterion levels. At the clinic and home, she works with registered behavior technicians (RBT) that are supervised by a BCBA. At the clinic, during play sessions with typical peers, she engages in isolated play with puzzles and trains but does not engage with her peers in parallel or cooperative play. She will respond to adult initiations with single word responses or up to 3-word responses. One important issue is getting Kathleen to generalize the demonstrated skills from the clinic to the home program and from technicians to family members and to same age peers (generalization across settings and across people). This is especially important for generalization of speech and language skills in social context and play. Kathleen can 41

42 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

become extremely focused on an activity at home and at the clinic. She can be resistant to transitions requiring movement from one activity to another activity. This resistance can range from whining to crying and laying on the floor. Kathleen’s family are from South Korea, both parents speak English with her and her siblings but speak Korean to each other. Kathleen has an older sister, Hanna that is in elementary school, and younger brother, Tobi who is just a year old. The grandparents that live with them only speak Korean. Translation of the materials and service reports has not been necessary for the parents. Kathleen is hard working and diligent in the clinic and her home program. She is motivated by positive reinforcement and powerful reinforcers are playing with her mom, siblings, and therapists, salty foods, and watching movies for young children, especially princess themed movies. When new skills are introduced to Kathleen, she needs to have the trials set up with errorless learning so that she is less likely to make errors, which can lead to frustration and challenging behaviors. Trial and error learning does not work for Kathleen. When she gets an item incorrect, she often immediately hits her head with her fist with a short quick whack. The hits have not caused physical injury to her head and are not severe enough to cause concern for her behavioral pediatrician, but it does cause alarm and frightens her family and peers. Her team has struggled to eliminate the head hitting. The family has asked the BCBA to assist in increasing verbal skills across environments and people, social initiations and peer engagement at the clinic, generalization of all skills learned across multiple environments, head hitting at the clinic and home program, and flexibility with transitions across environments and activities.

CASE STUDY EVALUATION Based upon the case study provided above and accompanying data sheets, analyze the issues that arise in providing behavioral services and supports for Kathleen at the clinic and home. Below are the areas to assess based upon the Behavior Analyst Certification Board Task List 5th edition. Competencies addressed are Foundations, C: Measurement, Data Display, and Interpretation, D: Experimental Design, and Applications, E: Ethics, F: Behavior Assessment, G: Behavior-Change Procedures, H: Selecting and Implementing Interventions, and I: Personnel Supervision and Management. These examples are provided as

Case Study One — Kathleen | 43

a guide to successfully resolving client case issues and developing competencies as behavior analysts. Behavior Assessment F-1 F-2 F-3 F-4 F-5 F-6 F-7 F-8 F-9

Review records and available data at the outset of the case. Determine the need for behavior-analytic services Identify and prioritize socially significant behaviorchange goals. Conduct assessments of relevant skill strengths and deficits. Conduct preference assessments. Describe the common functions of problem behavior. Conduct a descriptive assessment of problem behavior. Conduct a functional analysis of problem behavior. Interpret functional assessment data.

Measurement, Data Display, and Interpretation C-1 C-2

Establish operational definitions of behavior. Distinguish among direct, indirect, and product measures of behavior. C-3 Measure occurrence (e.g., frequency, rate, percentage). C-4 Measure temporal dimensions of behavior (e.g., duration, latency, interresponse time). C-5 Measure form and strength of behavior (e.g., topography, magnitude). C-6 Measure trials to criterion. C-7 Design and implement sampling procedures (i.e., interval recording, time sampling). C-8 Evaluate the validity and reliability of measurement procedures. C-9 Select a measurement system to obtain representative data given the dimensions of behavior and the logistics of observing and recording. C-10 Graph data to communicate relevant quantitative relations (e.g., equal-interval graphs, bar graphs, cumulative records). C-11 Interpret graphed data.

44 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

Prior to the start of the behavioral assessment and planning of goals and interventions, a review of records was conducted. Given that Kathleen was young and new to the ABA system, there was limited documentation to review. The review included the original diagnosis and testing done by an autism center at a local university-based teaching hospital. The record review confirmed the diagnosis of autism, without accompanying intellectual impairment, and requiring substantial support. This diagnosis was based upon the use of Autism Diagnostic Observation Schedule (ADOS-2) and accompanying assessments. The inflexibility, difficulty with transitions between activities, was noted in the report as well as limited initiation of social interactions and reduced or abnormal responses to social overtures from others. During the preliminary assessment of the behaviors at the clinic and home, the behaviorist initially collected data during observations (descriptive assessment) to develop the initial definitions of the behaviors. Once that was completed along with the records reviewed, interviews were conducted, and this constituted the preliminary assessment. An interview was done with the family, behavioral pediatrician that provided the diagnosis, lead therapist from home program, and director of the clinic, the results of which are summarized in the functional analysis interview (FAI) from O’Neill et al. (2015) in Figure 1.1. The interviews were conducted using an interview form (FAI) to guide the questions, but they were presented verbally and in writing while seated together with each person on the team. Medical and biological variables were ruled out for the challenging behaviors. It was determined that there was a need for behavior analytic services and an assessment based upon these interviews. A data collection system was developed for recording frequency counts with antecedents and consequences for the occurrence and non-occurrence of the challenging behaviors, head hitting, and tantrums as seen in Table 1.1. This ABC chart was used to track the variety of tasks and transitions that occurred in the clinic for two days. Clinical staff did not record only the occurrence of challenging behaviors but also the non-occurrence to see under what conditions was the challenging behavior less likely to occur (low probability times). Based upon an analysis of the data in the ABC chart the team was able to draw a few hypotheses for the challenging behaviors. It was clear that the head hitting occurred during new or difficult tasks when prompts were not provided as an antecedent strategy (not errorless learning). A sequence emerged of new/hard task presented, an error occurred, a head hit followed, and a prompt was provided consequently. When

Case Study One — Kathleen | 45 Figure 1.1. Functional Assessment Interview Form (FAI) — Kathleen.

46 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 1.1.– Continued

Case Study One — Kathleen | 47

48 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 1.1.– Continued

Case Study One — Kathleen | 49

50 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 1.1.– Continued

Case Study One — Kathleen | 51

head hitting occurred it ranged from one to three hits per occurrence. Tantrums were harder to predict as they appeared to occur when moving from preferred to less preferred as well as from one task to another task. However, tantrums were less likely to occur if a warning was provided for the transition. In addition to her head hitting and tantrums the team was concerned about Kathleen’s lack of social engagement. Data were collected on the number of Kathleen’s initiations, exchanges, and responses with peers in the integrated play group and the duration of those interactions (Table 1.2). This was a system of continuous measurement with momentary time sampling (every minute) once per day during indoor

52 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Table 1.1. Frequency Data with ABC Chart — Kathleen.

Case Study One — Kathleen | 53 Table 1.2a. Integrated Play Group Social Data — Kathleen.

and outdoor play groups with peers. It is important that the definition of the behavior includes both examples of the occurrence of what the behavior is and non-examples of what the behavior is not (Storey & Post, 2017). These examples of occurrence and non examples help to ensure that all people collecting data are consistent in measuring behaviors as there are often “gray areas” in deciding if a behavior is an occurrence or not. The behavior of head hitting is defined as using a balled-up fist (punch) or open hand (slap) that contacts the side of the head or any part of the head. A separate episode of hitting is recorded if there has been more than 5 seconds between contact hits. A single instance of head hitting can consist of a single isolated hit or multiple hits presented in rapid succession if they are within the 5-second time frame. An example of occurrence is Kathleen uses an open hand to slap the side of her face three times in quick succession (under 5-seconds). A non example is Kathleen uses a

54 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Table 1.2b. Integrated Play Group Social Data — Kathleen.

curled hand to scratch her eyebrow three times (under 5-seconds). Tantrum is defined as the occurrence of any of the following for any period of time; whining, crying, and/or laying on the ground when doing so is not part of an activity. Crying is any vocalization (sounds or words) accompanied by facial contraction with or without tears. An example of occurrence Kathleen is told to stop the video and she drops to the floor and cries for one minute. In an example of nonoccurrence Kathleen is asked to look at the clouds, she lays on the ground to look up. Social engagement with peers is verbal and non-verbal and is defined as having an exchange either non-verbal or verbal, or a verbal engagement of an initiation or response directed to the person as seen by eye contact, body positioning, or use of a name. An example of social engagement is Kathleen is doing a puzzle within 3 feet of a classmate. The classmate states, “This piece goes there by you” and hands the

Case Study One — Kathleen | 55

piece to Kathleen. Kathleen takes the piece from the classmate and puts it in the identified location. A non example of social engagement is Kathleen is completing a puzzle with a peer within 3 feet of each other. The peer states, “Do you know where this piece goes?” Kathleen continues to look down at the puzzle, does not reach for the piece and does not give a verbal response. Kathleen was observed at the clinic across the entire day on multiple occasions to assess both her skills and deficits. To track her social skills, continuous data were collected for two 15-minute samples during clinic integrated playgroup. These were described previously. Kathleen had limited social contact with peers during her home program so the data on this skill were only recorded in the clinic. Data were taken on the skill development of social skills as demonstrated with her home therapists. Data were collected at the clinic and home on head hitting and the behavior occurred in both environments and across a variety of therapists. Therefore, the ABC frequency counts were used in the home and clinic program. The ABC sample is provided in Table 1.1. The functional assessment consisted of a variety of measures and observations across different environments. A variety of measures were used so the team could get a complete analysis of behaviors, skills, and deficits for Kathleen. Environmental variables can include weather, sleep, diet, people, places, time, or stimuli. For Kathleen the data were clear for head hitting. This behavior occurred only during the home and clinic 1:1 sessions. Head hitting did not occur during play, in the community or at home at times other when she was having a home program session such as when engaged with her siblings or at mealtimes. There were not specific stimuli that precipitated the undesirable behavior (such as flash cards), instead it was difficult or new tasks where Kathleen engaged in an incorrect response and either received feedback that she was incorrect or did not receive feedback that she was correct. The team wanted to be certain on the identification of the triggers for the undesirable behavior as well as the function. Therefore, they manipulated the antecedents across a few clinic and home sessions using analogue assessment procedures (Kennedy et al., 2000). They presented easy tasks defined as task in which she scored 70% or greater, mastered tasks (90-100%), new tasks or new stimuli, and difficult tasks defined as tasks where she has scored below 40% correct. Consistent reinforcement was provided for working on the tasks across the conditions. The results of this antecedent manipulation, seen in Figure 1.2, confirmed that Kathleen was more likely to hit her head when the tasks were new, involved new stimuli or were difficult. This

56 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 1.2. Antecedent Assessment Form — Kathleen.

Case Study One — Kathleen | 57

was seen in the clinic and at the home program. Given an easy task at the clinic and at home with a mastered task Kathleen was appropriate 100% of the intervals. At the clinic given a task with new stimuli she was appropriate 69% of the intervals with head hits scored in 31% of the intervals. In the clinic when presented with a difficult task Kathleen was scored as inappropriate, engaging in head hitting during 37.5% of the intervals. Kathleen engaged in appropriate social behaviors of initiation of conversations and responses to conversations under a restricted number of environmental conditions. She engaged in initiations with her therapists when they presented cues (e.g., taking out a game, taking out a preferred item) and when seated with her therapist at the work desk with toys present (SD). Therefore, she was responding to a restricted range of cues and SDs for initiation of conversation and play. She also had a limited number of initiation statements that were taught in the clinic, but these were not generalized to various phrases, people, and conditions. Based upon the peer play interaction data taken at the clinic, Kathleen was prompted to engage with her peers, and she responded to the prompt appropriately 70% of the time. The other 30% of the time she failed to respond appropriately to the prompt (stating “No” to the adult when given the prompt). She failed to respond to peers’ initiations and even during an exchange where she was prompted and appropriate on the 3rd exchange, she did not respond. Only on one occasion she initiated appropriately to a peer during the playgroup. These data show that Kathleen is not responding to the prompts from adults for initiation or responses and needs to have the program changed as the verbal prompts are not working at playgroup. Independent initiations and responses to peers will need to be established under the play conditions. Based upon ABC data and antecedent partial interval data, the behavior of head hitting occurs at the clinic and home program. The clinic is where she is introduced to new tasks and the home is often for generalization. The data taken at the clinic and home program show that the behavior only occurs after an incorrect response to work during sessions, especially with new or difficult tasks. Therefore, Kathleen needs to develop compensatory skills such as self-talk and calming when working on new or difficult tasks especially when getting items incorrect. Selecting and Implementing Interventions H-1 State intervention goals in observable and measurable

58 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

H-2 H-3

H-4

H-5 H-6 H-7 H-8 H-9

terms. Identify potential interventions based on assessment results and the best available scientific evidence. Recommend intervention goals and strategies based on such factors as client preferences, supporting environments, risks, constraints, and social validity. When a target behavior is to be decreased, select an acceptable alternative behavior to be established or increased. Plan for possible unwanted effects when using reinforcement, extinction, and punishment procedures. Monitor client progress and treatment integrity. Make data-based decisions about the effectiveness of the intervention and the need for treatment revision. Make data-based decisions about the need for ongoing services. Collaborate with others who support and/or provide services to clients.

Based upon the assessment results, Kathleen’s current repertoire and preferences, a treatment package was created to increase alternative and compensatory behaviors and decrease undesirable behaviors. One goal of the treatment package was for Kathleen to decrease head hits to zero occurrences per session and increase use of self-calming and self-talk when faced with new or difficult tasks. These goals and intervention package were agreed upon based upon the assessment and collaboration between the BCBA and the family. The plan was developed with consideration for the families’ cultural values and practices, with awareness of the different family members that would need to implement the behavior plan at the home program. Rather than an emphasis on tangible reinforcers and praise the important components for home involved a manipulation of the establishing operations and prevention strategies. This was a best-fit intervention based upon the families expressed parenting style from their Korean culture (Kim et al., 2016). To address head hits during home program sessions the treatment focused on prevention and development of alternative skills. The head hits occurred when Kathleen made an error on a new or difficult task, therefore, as much as possible new items and skills needed to be presented in an errorless fashion rather than trial and error or No-no prompting (Donaghey et al., 2010). No-no prompting is a standard

Case Study One — Kathleen | 59

prompting procedure used for children with autism and other disabilities (Leaf et al., 2010). With this prompting strategy, an instruction (SD) is presented to the learner and the learner has an opportunity to respond. If the learner provides a correct response the teacher provides reinforcement or positive feedback. If the learner makes an incorrect response or no response, the instructor provides corrective feedback (‘No” or “Try again”) and presents the SD again for a second opportunity. After two consecutive errors the instructor provides an instructional prompt. Errorless prompting can be presented in a variety of formats and six different techniques for errorless instruction have been researched and cited in the literature (Mueller et al., 2007). Errorless instruction is not truly errorless rather it involves procedures that greatly reduce the likelihood of errors. Errorless techniques include time delay (Doyle et al.,1990; Knight et al., 2003; Liber et al., 2008), stimulus shaping (Schilmoeller et al., 1979), stimulus fading (Redhair et al., 2013; Smeets et al., 1984), response prevention (Morgan et al., 2013), superimposition with stimulus fading and superimposition with stimulus shaping (Cipani & Madigan, 1986; Sprinkle & Miguel, 2013). The errorless prompt used during an instruction is matched to the skill being taught (e.g., For “Ask Why questions” a gradual verbal time delay would be appropriate). Also, the learner’s learning style is considered for the use of errorless procedures (non-verbal learner that attend to visual would use visual prompts). Kathleen is a verbal child who responds to both visual and verbal prompts therefore, she will benefit from a combination of those prompts used errorlessly based upon her skill level. When a new item is introduced in a language-based skill (Where, What, I see, I don’t know) a progressive time delay is effective (Walker, 2008). For the mathematical task, “Give me (number) of item,” a visual antecedent prompt would be an effective strategy. This can be especially useful when the learner has difficulty with one-to-one correspondence. Rather than pointing and counting the objects if they are verbal use visual supports to have them name the items. Often learners become rote counters and count to a specified number regardless of the number of items. By having the learner point and name each item it pairs the objects with one response. This technique can be used with gradual fading out the naming and fading in the counting. Kathleen is working on “give me (7-10).” To introduce the task her team would first have her count out the number with stickers on strips rather than counting she would name the characters. Given a strip of seven stickers with fruits she

60 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

might point and state, “apple, orange, banana, grapes, kiwi, lemon, mango.” A second feature of the treatment package for decreasing head hitting is to use a changing criterion treatment design (Ganz & Sigafoos, 2005; Rapp et al., 2017). Kathleen has most new tasks and difficult tasks presented in an errorless fashion. However, in order for her to develop a tolerance for errors and correction feedback she needs to learn to calm herself and engage in self-talk while gradually exposing her to potential error inducing problems. The first step in this process is teaching Kathleen to use calming techniques such as deep breathing through her nose and out her mouth, squeezing her thighs, using a visual signal for calming and mindfulness strategies (Myles & Southwick, 1999; Singh et al., 2011). This can be taught under typical instructional conditions and prompted when presented with new tasks. Simultaneous with self-calming Kathleen needs to talk herself through difficult tasks. When presented with a new or difficult task Kathleen will be given rote phrases (e.g., “I can do this,” “Couple of tries”) and reinforcement for using the phrase while approaching more difficult work (Arntzen et al., 2009; Koegel et al., 2014; Salend et al., 1989). The changing criterion is the gradual increase in presentation of hard and new tasks in proportion to easy-mastered tasks. This can start with a 5:1 (easy: hard) ratio and gradually change to a 1:5 ratio (easy: hard). The new skills of self-calming, self-talk and the acceptance of difficult work will need to be reinforced initially on a thick schedule of reinforcement and then be gradually faded to maintain the skill in the natural environment. The thick schedule of reinforcement would be implemented at the clinic to establish the skills in her repertoire given that is where new skills are often introduced. Additionally, the clinic staff are more skilled with implementing reinforcement strategies. The skill will be addressed at home for generalization by her supervising BCBA. Based upon the preference assessment Kathleen prefers salty foods, princess themed movies and playing with family and therapists. The team will need to run frequent preference assessments to make sure that Kathleen receives highly preferred reinforcers for development of the alternative skills, that will motivate her to use these new skills. Based upon the data collected and interview results. Kathleen has the most difficulty on days in which she lacks sleep. Therefore, rather than working on new or difficult tasks her team should enforce an alternative schedule reserved for days of difficult sleep (less than 5 hours). This will prevent her from reacting to the difficult tasks and new items

Case Study One — Kathleen | 61

even with errorless learning in place (Horner et al., 1997). Horner et al. (1997) demonstrated that neutralizing routines could be used to decrease the occurrence of problem behaviors when the neutralizing routine was implemented given an establishing operation (EO) for the problem behavior. In Kathleen’s case the EO is the lack of sleep. To address her difficulty in socializing with peers in clinic play groups, including initiations and responses, Kathleen can use a script for initiations and responses based upon objects of obsession (CharlopChristy & Haymes, 1996, 1998). The scripts will need to have pictures as a guide with accompanying texts given that Kathleen does not read printed text (Ganz & Flores, 2010; Garcia-Albea et al., 2014) but she does have familiarity with books and pictures. Kathleen is very interested in movies, especially princess movies, which are also popular with her playmates. The topics for initiations can be tested for social validity by observation of playmates topics of conversation and surveying the peers for topics of conversation through play with toys. In addition to scripted conversations, she also should use objects that are appealing to playmates to initiate contact and engagement in play (Gaylord-Ross et al., 1984). This can be princess items (jewelry) that can be worn in the clinic. These are all preferred items for Kathleen and can be used for initiations. These are also items that are acceptable with her families’ cultural values. The behaviors to increase include initiation of conversations with peers, response to peer’s initiations, engagement in verbal exchanges with peers and physical exchange of toys with peers. The behavior to decrease is sitting faraway from peers during free play (e.g., more than 6 feet away), avoidance of peers, and failure to respond to peers’ initiations. The behaviors can be increased through access to preferred items as tools for engagement. The items would need to be removed for failure to engage with peers. This would be a response cost, which has been demonstrated to be an effective treatment for people with ASD for social skill acquisition and decreasing undesirable behaviors (Falcomata et al., 2004; Lopata et al., 2010). Behavior-Change Procedures G-1 Use positive and negative reinforcement procedures to strengthen behavior. G-2 Use interventions based on motivating operations and discriminative stimuli. G-3 Establish and use conditioned reinforcers.

62 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

G-4 Use stimulus and response prompts and fading (e.g., errorless, most-to-least, least-to-most, prompt delay, stimulus fading). G-5 Use modeling and imitation training. G-6 Use instructions and rules. G-7 Use shaping. G-8 Use chaining. G-9 Use discrete-trial, free-operant, and naturalistic teaching arrangements. G-10 Teach simple and conditional discriminations. G-11 Use Skinner’s analysis to teach verbal behavior. G-12 Use equivalence-based instruction. G-13 Use the high-probability instructional sequence. G-14 Use reinforcement procedures to weaken behavior (e.g., DRA, FCT, DRO, DRL, NCR). G-15 Use extinction. G-16 Use positive and negative punishment (e.g., time-out, response cost, overcorrection). G-17 Use token economies. G-18 Use group contingencies. G-19 Use contingency contracting. G-20 Use self-management strategies. G-21 Use procedures to promote stimulus and response generalization. G-22 Use procedures to promote maintenance. For both the use of self-calming and social initiations and responses it is important to consider generalization and behavioral cusps. Behavioral cusps are behavioral responses that have consequences for the person beyond the change itself (Bosch, & Fuqua, 2001; Rosales-Ruiz, & Baer, 1997). Social initiation could be considered a behavioral cusp in that Kathleen will have a) access to new reinforcers and contingencies, b) social validity to the response, c) has generativeness, and social initiations d) competes with the undesirable behavior. A general case analysis form was used to plan for generalization and behavioral cusps (see Figure 1.3) (Horner & Albin, 1988; Horner et al., 1984). Figure 1.3 provides a sample of the development and considerations for generalization planning for teaching of self-calming skills and acceptance of difficult problems with numerous response options. There are also examples on the form for teaching initiations and responses to peer’s social contact both verbal and non-verbal for the expansion and ap-

Case Study One — Kathleen | 63 Figure 1.3. General Case Analysis form — Kathleen

64 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

propriate use of social skills under various stimulus conditions. Kathleen engages in self-injury when she is given new or difficult tasks unless she is provided with tasks in an errorless fashion. Not all therapists or family members will be consistent in implementing errorless procedures. Kathleen will need to learn the alternative skill of selfcalming to reduce her undesirable reaction to new and difficult problems as an option when errorless procedures are not available. In addition, an important pivotal skill to develop is choice-making and asking for access to choices. When Kathleen is given difficult tasks, she can ask for another task or an easier problem. This will need to be prompted and planned using incidental teaching and time delay. The therapists will present Kathleen with a new task or new problem and before she could respond they will provide an immediate verbal prompt “Can I do something else?” Kathleen’s response will be reinforced by access to another easier task. This zero-second time delay prompt will be used to establish the new response of asking for another task. Once this is established (three responses with 100% accuracy), the delay will be gradually faded (two-seconds, four- seconds, etc.). The use of prompts (visual and verbal) will be faded gradually in a systematic manner through the progressive time delay described here. It is important that a plan for fading is made prior to use of the prompts so that they can be quickly faded and prevent prompt dependency, which is common among individuals with ASD. Kathleen does not choose difficult or new tasks when given the option. She is more likely to choose difficult tasks if she has had a choice of selecting easier tasks first using behavioral momentum following a high-probability request sequence (easy, easy, hard), completing a difficult task following easier task. The availability of making choices on the materials used and the items has been shown to reduce undesirable escape-based behaviors (Lough et al., 2012; Rispoli et al., 2013). Shaping is to be used when you want a particular replacement behavior either increased or developed in the individual’s repertoire. This procedure involves the reinforcement of successive approximations. For Kathleen, shaping is used for self-calming and self-talk to facilitate her acceptance of new or difficult work. It can also be used for development of peer exchanges. The alternative skill of asking for a different task or items within a task can be presented in a structured discrete trial format for initial acquisition of the alternative skill. Kathleen is presented with a new/ difficult task followed by a prompt to ask for another task using a

Case Study One — Kathleen | 65

progressive time delay. This can be presented in mass trials (repeated trials or blocks of trials) and then eventually interspersed within sessions. Free operant conditions exist for the development of conversational exchanges and exchanges of objects with peers. These are not dependent upon the presentation of an SD either verbally or manually. Shaping can still be used for the development of conversational exchanges and exchange of items as a replacement for isolated behavior and isolated play. Given a natural opportunity in the preschool environment a visual cue can be presented to prompt the skill. This would not be taught using discrete trials given the need for natural teaching and generalization issues. There are many types of self-management strategies including selfinstruction, self-monitoring, self-evaluation, self-reinforcement and selfgraphing. Most of these can be used alone or in combination with other procedures. For a young child of Kathleen’s age, self-instruction (e.g., “I can do this.”) and self-reinforcement (“Yes, I did it!) are appropriate. It is important to match the self-management strategy with the individual or group of individuals that would result in the most success and independence (other clients at the clinic might benefit from this instruction). This match can be based upon, age, skills relevant to selfmanagement, verbal or visual learning styles, and motivation. Most importantly, the choice and implementation need to lead to independence and increased access to a quality life. Personnel Supervision and Management I-1

I-2 I-3 I-4 I-5 I-6

State the reasons for using behavior-analytic supervision and the potential risks of ineffective supervision (e.g., poor client outcomes, poor supervisee performance). Establish clear performance expectations for the supervisor and supervisee. Select supervision goals based on an assessment of the supervisee’s skills. Train personnel to competently perform assessment and intervention procedures. Use performance monitoring, feedback, and reinforcement systems. Use a functional assessment approach (e.g., performance diagnostics) to identify variables affecting personnel performance.

66 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

I-7 I-8

Use function-based strategies to improve personnel performance. Evaluate the effects of supervision (e.g., on client outcomes, on supervisee repertoires).

Whether the behavioral services are provided by the BCBA in home or in the clinic, an RBT, or clinic supervisor it is important to document the services provided and not just for billing purposes. This is done to track implementation, training, and support. Documentation for risk-management purposes, can be particularly important as a tool to protect clients and to protect practitioners in the event of an ethics complaint or lawsuit. For the best delivery of services, it is important to note what has worked, what is to be continued, and what has not worked. In addition to documentation of notes it is important that data are collected, analyzed, and graphed and most importantly that the data and analysis drive the decisions for the individual case for goals, changes to plan and other factors. The data need to be analyzed and used for data-driven decision making. First for case documentation a simple form can be used for ongoing notes. Case notes for Kathleen from one day is in Figure 1.4. This form can be kept in the client file, which should be kept in a locked cabinet. This can also be kept on a computer, cloud-based data server as long as it is password protected. Finally, it can be emailed with an encryption service, to the necessary party with a notice of confidentiality and following regulations set forth in the privacy rules in the Health Insurance Portability Accountability Act (HIPAA). The form will need to be dated and signed for each consultation visit, video or phone appointment, the location of services noted (home, clinic, online or phone). Next, there needs to be an area to note observations from the case written in observable and measurable terms, not mentalistic terms. This section can refer the data collected during the observation with a note for the location of the data and results (table or graph). Intervention notes should follow this; what has been implemented, what changes may need to be seen. This section can refer to treatment integrity data collected during the observation. Finally, follow-up actions need to be noted with a due date and check mark once follow-up is completed. Follow up can be the need to make a call to the behavioral pediatrician (with written consent of course), sharing of data, creating a visual cue card, scheduling a home visit, etc. Most important is their needs to be a note of any actions that need to happen following observation, visit, or phone call and documentation once that follow-up is completed.

Case Study One — Kathleen | 67 Figure 1.4. Case Notes — Kathleen.

68 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

The therapists and family members will need training on Kathleen’s behavioral plan. The supervision and training will need training done in four parts: a) didactic content knowledge, b) demonstration, c) behavioral rehearsal, d) demonstration with performance feedback (Wood et al., 2007). Training for Kathleen’s team, for example on time delay, would start with a simple step-by-step visual task analysis and verbal explanation (didactic). This is followed by the BCBA modeling the use of time delay for her replacement skill and the team has a chance to practice (behavioral rehearsal). During the training session the team members are given feedback in the form of coaching where they are shaped to competency (as seen in the integrity data). There is a need for training where the therapist and family members can ask questions and receive immediate feedback with modeling. There has been research to support the use of modeling, role play and feedback as well as video demonstration for training (Rispoli et al., 2011). There is also evidence that video self–evaluation is an effective tool for the development of staff skills (Sarokoff & Sturmey, 2004; Sarokoff & Sturmey, 2008; Singer et al., 1986). Sarokoff and Sturmey (2004; 2008) demonstrated the effectiveness of a training package consisting of instructions, feedback, rehearsal, and modeling. There are online and DVD tools available for training individuals to work with people with ASD using ABA, DTT and incidental teaching (Eldevik et al., 2013). Importantly, these four components of training described here are behavior skills training (BST) which has been found to be effective for family members and caregivers (Sun, 2020), teachers (Kirkpatrick et al., 2019), and paraeducators (Andzik et al., 2021). Sarakoff and Sturmey (2004) demonstrated that BST was effective in increasing three teachers’ implementation of DTT following training with the BST package. Day-Watkins et al. (2018) used a BST package to teach three adults to implement video modeling as a tool to teach social skills to adults with ASD. The model component of the package included video models with voice over instructions to teach the skills. Then the adult trainees had repeated roleplay trials, and feedback following their performance. All the participants were successful in implementation of the video modeling of the social skill and generalized to three other social skills. Interestingly, Ward-Horner and Sturmey (2012) conducted a component analysis of BST with teachers and found that feedback, and to a lesser extent, modeling are the necessary components of BST. Thus, BST is an effective intervention for training of the families, caregivers and RBTs even if all components cannot be implemented at least the necessary components of feedback and modeling are needed for successful behavior change.

Case Study One — Kathleen | 69 Figure 1.5. Staff Competency Training.

70 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

Behavior skills training is based upon building competency. A competency tool should be used to monitor the therapists progress, skill by skill, based upon data collected during observations. Following didactic training, modeling and rehearsal the therapist should be observed demonstrating the particular skill that was trained and is necessary for case implementation. Based upon the data collected, a training plan should be developed for areas of concern. A sample competency-based tool is available in Figure 1.5 for tracking use of reinforcement in an ABA program. Procedural integrity can be monitored using a similar tool as seen in Figure 1.5 Using a data driven rating system observation data can be collected on use of specific skills including reinforcement, incidental teaching, prompts, prompt fading, planning for generalization, discrete trial teaching, collection of data, use of functional communication training. If a learner has a positive behavior intervention plan (PBI) a data system specific to the plan can be developed similar to the competency-based observation system. Ethics E-1 E-2 E-3 E-4 E-5 E-6 E-7

Introduction. Responsibility as a Professional. Responsibility in Practice. Responsibility to Clients and Stakeholders. Responsibility to Supervisees and Trainees. Responsibility in Public Statements. Responsibility in Research.

Effective January 1, 2022, the Behavior Analysis Certification Board (BACB) has a new ethics code for behavior analysts in place (Behavior Analyst Certification Board [BACB] 2020). The ABA organization needs to be aware of and comply with all components of this new ethics code. The organization has responsibilities to the supervisors, RBTs, clients and to other stakeholders (Code Element 3.01 Responsibility to Clients and 3.02 Identifying Stakeholders). The organization needs to have an organizational compliance monitoring system as seen in the checklist provided in Britton et al. (2021). In this case of Kathleen, the BCBA would be a supervisor for the RBTs at the clinic and home. Often the RBTs and other therapists are training to become BCBAs and gain their hours through direct work with clients. The organization has a responsibility to make sure the trainee receives appropriate supervision with systems in place to

Case Study One — Kathleen | 71

ensure consistency of supervision across supervisors and trainees (Code Element 4.0 Responsibility to Supervisees and Trainees). The organization has the responsibility to determine that the supervisor has the competence to provide supervision in the specific areas (e.g., incidental teaching, functional communication training, discrete trial training). The organization can assist in the endeavor of assessment of skills by establishing periodic competency checks to ensure that supervisors can demonstrate the skills in the areas in which they are tasked to supervise. Additionally, the BCBA should also assess the degree to which they have the prerequisite skills to supervise competently as seen in Code Element 4.02 (BACB, 2020). Supervision competence includes the ability to utilize behavior skills training (BST) effectively to build the knowledge and application of behavioral principles with clients. In the case of Kathleen as well as most clients the team needs to provide services with cultural awareness and humility. According to Conners and Capell (2021) cultural humility is defined as: Focuses on individuals and organizations to examine culture and recognize continual learning as practitioners for other cultures and that we do not know everything and need to learn from the client. It is the ability to maintain an interpersonal stance where the practioner is “other-oriented” and is learning about the cultural identity that is most important to the client. Cultural humility often encompasses self-reflection and personal critique and is an ongoing, lifelong process. (Conners & Capell, 2021, p.2)

Culturally aware service delivery includes understanding how our own cultural values and learning histories can impact our relationship with our clients (Fong et al., 2016). The behaviors targeted for intervention, the assessment methods and the interventions used are all influenced by the identified culture of the client and family. Code Element 1.07, Cultural Responsiveness and Diversity, encompasses evaluating your own bias and ability to provide services to individuals with diverse backgrounds and needs. Given this case involves supervision Code Element 4.07, Incorporating and Addressing Diversity, needs to be considered. This element addresses topics related to diversity in supervision and training.

72 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

The Use of Technology in Interventions for Behavior Change The use of technology has been addressed in the training of the staff via BST with video modeling and voice over modeling systems as an option. Video modeling and computer assisted instruction can be useful in the development of the social skills. There are many commercially available social skill programs, videos can be found online and the team can create individualized videos for her social skill targets.

Executive Function Skills Shifting Attention As mentioned earlier in Kathleen’s profile she has difficulty transitioning from one activity to another. This is an executive dysfunction that is commonly seen in people with ASD. They may be highly focused and have attention to task once they are engaged but they have difficulty moving from one task to another or from one strategy to another (Ozonoff et al.,1991; Ozonoff & McEvoy, 1994; Prior & Hoffmann, 1990). Visual schedules have an empirical history of success for improving transitions for young children with ASD (Lequia et al., 2015). Siegel and Lien (2015) demonstrated that preschool children with ASD with more challenging needs transitioned more quickly and independently when they used high-context photographs. The high context photographs had more relevant contextual cues for the preschool students. Spriggs et al. (2015) used activity schedules embedded with video models via an iPad to aid transitions within and between novel activities. Kathleen would benefit from the use of visual activities either using low or high technology formats.

Collaboration with Others There are many players involved with Kathleen’s case between the home program and clinic. This case requires collaboration, consultation skills, an ability to use non-technical language, and cultural humility so that all collaborators are included and have input into the programming. This is especially important given the family speaks

Case Study One — Kathleen | 73

Korean at home and have extended family living with them. Those family members may not implement the programs but they will certainly need to be on board for the development of her communication skills and replacement skills. Next, to work collaboratively, the team meets regularly (between home and the clinic staff and family). In that collaboration they develop a communication system of goals and locations for implementation. This helps the team see where the goals are implemented, new items are introduced, and generalization is targeted documenting acquisition stage versus generalization stages.

Legal Issues Kathleen is entitled to services covered by health insurance mandated by her state. The nature of that treatment and the extent of the mandate varies by state for example California covers the services into adulthood, Vermont up to age 21, West Virginia through age 18, and Utah until age 10. Given Kathleen’s age she is legally entitled to comprehensive programming. According to The Council of Autism Service Providers (CASP) “Comprehensive ABA refers to treatment of the multiple affected developmental domains, such as cognitive, communicative, social, emotional, and adaptive functioning. Maladaptive behaviors, such as noncompliance, tantrums, and stereotypy are also typically the focus of treatment.” (CASP, 2020, p. #15). These programs are typically provided to autistics under the age of 6. These programs range from 30-40 hours per week. Once Kathleen is school age she will be legally entitled to services and supports provided by her school district and she would have an Individualized Education Program (IEP).

Quality of Life Interpersonal Well-Being Kathleen currently has a poor quality of life in her interpersonal relationships with her peers. This needs to be a focus of her program at the clinic and home. The goal would be to include Kathleen in typical preschool aged activities with children in her neighborhood and through the church. This is a critical age in the development of peer relations with same age peers. The eventual goal of services would be

74 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

placement in a general education kindergarten once Kathleen turns 5. Emotional Well-Being Mental health and self-esteem are important areas to focus on in this category. Kathleen is currently at risk for developing problems in these two areas but developing positive social skills, interpersonal relationships, and social networks for her should alleviate these concerns. Rights and Inclusion Autistic individuals, more than ever, have been pushing for acceptance, inclusion and self-determination. Autistic advocacy groups have grown in recent years. It would be best if Kathleen’s family familiarized themselves with these groups, connect with the community and school district special education services and advisory groups so they have the knowledge to push for full inclusion in the school and community.

FOUNDATIONAL AND LIFESTYLE STRATEGIES Person-Centered Planning It would be best to get Kathleen’s input as to preference for items to use for initiations of conversations and interactions with peers as well as preferences for peers and activities for social opportunities.

Supports The Neurodiverse Person Kathleen is very young and is not able to advocate for herself and recognize her skills and needs at this point. She currently is able to participate in making choices in her peers, work, and reinforcers. Family Members The family will need to be closely involved in all aspects of Kathleen’s program at home and from the clinic. Her siblings are an important ally in practicing social skills and conversation skills. Kathleen

Case Study One — Kathleen | 75

would benefit from joining age typical community activities such as dance, gymnastic, art classes that are offered at community recreation centers or other places providing services to young children. She should join and participate in groups and activities that have been offered to her siblings. Employers/Community Members If Kathleen does a class or sports teams in her community then the children and/or adults in those settings might need information regarding autism spectrum disorders as well as specific recommendations on how to support Kathleen. Instructional Supports Instructional supports related to errorless learning and social interaction skills have been previously addressed.

Discussion Questions 1. 2. 3.

4.

At what point do you move clients with ASD from home and clinic-based programs to preschool or community programs? Should there be a criterion or demonstrated level of skills before the transition is made from home and clinic-based programs to school? Which type of school program; integrated community preschool or a class designed to specifically service students with ASD, would be most likely to provide an effective environment for Kathleen? Would Kathleen be best served in a preschool classroom that is specific to students with ASD?

EMPIRICAL RESEARCH TO SUPPORT THAT THE INTERVENTION IS AN EVIDENCE-BASED PRACTICE Functional Analysis Carr, E. (1988). Functional equivalence as a mechanism of response generalization. In R. Homer, R. Koegel, & G. Dunlap (Eds.), Generalization and

76 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

maintenance: Life-style changes in applied settings (pp. 194-219). Baltimore: Paul H. Brookes.

Antecedent Stimulus Control CKern, L., Vorndran, C. M., Hilt, A., Ringdahl, J. E., Adelman, B. E., & Koegel, R. L., Shirotova, L., & Koegel, L. (2009). Antecedent stimulus control: Using orienting cues to facilitate first-word acquisition for nonresponders with autism. The Behavior Analyst, 32(2), 281-284

Behavior Skills Training Dogan, R. K., King, M. L., Fischetti, A. T., Lake, C. M., Mathews, T. L., & Warzak, W. J. (2017). Parent implemented behavioral skills training of social skills. Journal of Applied Behavior Analysis, 50(4), 805–818. Fetherston, A., & Sturmey, P. (2014). The effects of behavioral skills training on instructor and learner behavior across responses and skill sets. Research in Developmental Disabilities, 35(2), 541–562. Homlitas, C., Rosales, R., & Candel, L. (2014). A further evaluation of behavioral skills training for implementation of the picture exchange communication system. Journal of Applied Behavior Analysis, 47(1), 198–203. Sawyer, M. R., Andzik, N. R., Kranak, M. P., Willke, C. P., Curiel, E. S., Hensley, L. E., & Neef, N. A. (2017). Improving pre-service teachers’ performance skills through behavioral skills training. Behavior Analysis in Practice, 10(3), 296-300.

Choice Kern, L., Vorndran, C. M., Hilt, A., Ringdahl, J. E., Adelman, B. E., & Dunlap, G. (1998). Choice as an intervention to improve behavior: A review of the literature. Journal of Behavioral Education, 8(2), 151-169. Lough, C. L., Rice, M. S., & Lough, L. G. (2012). Choice as a strategy to enhance engagement in a colouring task in children with Autism Spectrum Disorders. Occupational Therapy International, 19(4), 204-211. Rispoli, M., Lang, R., Neely, L., Camargo, S., Hutchins, N., Davenport, K., & Goodwyn, F. (2013). A Comparison of within- and across-activity choices for reducing challenging behavior in children with autism spectrum disorders. Journal of Behavioral Education, 22(1), 66-83.

Curricular Revisions Dunlap, G., Kern-Dunlap, L., Clarke, S., & Robbins, F. R. (1991). Functional assessment, curricular revision, and severe behavior problems. Journal of Applied Behavior Analysis, 24(2), 387-397. Kern, L., Childs, K., Dunlap, G., Clarke, S., & Falk, G. D. (1994). Using assessment based curricular intervention to improve the classroom behavior of a

Case Study One — Kathleen | 77

student with emotional and behavioral challenges. Journal of Applied Behavior Analysis, 27(1), 7-19. Moore, D., Anderson, A., & Kumar, K. (2005). Instructional adaptation in the management of escape-maintained behavior in a classroom. Journal of Positive Behavior Interventions, 7(4), 216-223.

Errorless Learning Donaghey, C. L., McMillan, T. M., & O’Neill, B. (2010). Errorless learning is superior to trial and error when learning a practical skill in rehabilitation: a randomized controlled trial. Clinical Rehabilitation, 24(3), 195-201. Mueller, M. M., Palkovic, C. M., & Maynard, C. S. (2007). Errorless learning: Review and practical application for teaching children with pervasive developmental disorders. Psychology in the Schools, 44(7), 691-700. Schilmoeller, G. L., Schilmoeller, K. J., Etzel, B. C., & LeBlanc, J. M. (1979). Conditional discrimination after errorless and trial-and-error training. Journal of the Experimental Analysis of Behavior, 31(3), 405-420. Smeets, P. M., Lancioni, G. E., & Hoogeveen, F. R. (1984). Using stimulus shaping and fading to establish stimulus control in normal and retarded children. Journal of Mental Deficiency Research, 28(3), 207-218.

Functional Analysis Iwata, B., Dorsey, M., Slifer, K., Bauman, K., & Richman, G. (1982). Toward a functional analysis of self-injury. Analysis and Intervention in Developmental Disabilities, 2(1), 3-20. Sugai, G., Horner, R. H., & Sprague, J. R. (1999). Functional-assessmentbased behavior support planning: Research to practice to research. Behavioral Disorders, 24(3), 253-257. Umbreit, J. (1995). Functional assessment and intervention in a regular classroom setting for the disruptive behavior of a student with attention deficit hyperactivity disorder. Behavioral Disorders, 20(4), 267-278.

Generalization of Responses Falcomata, T. & Wacker, D. (2013) On the use of strategies for programming generalization during Functional Communication Training: A review of the literature. Journal of Developmental and Physical Disabilities, 25(1), 5-15. Horner, R. H., & Albin, R. W. (1988). Research on general-case procedures for learners with severe disabilities. Education and Treatment of Children, 11(4), 375-88.

Positive Reinforcement Horner, R. H., Carr, E. G., Strain, P. S., Todd, A. W., & Reed, H. K. (2002). Problem behavior interventions for young children with autism: A

78 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

research synthesis. Journal of Autism and Developmental Disorders, 32(5), 423-446.

Premack Principle Premack, D. (1959). Toward empirical behavioral laws: I. Positive reinforcement Psychological Review, 66, 219-233.

Self-Management Koegel, L., Park, M., & Koegel, R. (2014). Using self-management to improve the reciprocal social conversation of children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 44(5), 1055-1063. Salend, S. J. Ellis, L. L., & Reynolds, C. J. (1989). Using self-instruction to teach vocational skills to individuals who are severely retarded. Education and Training in Mental Retardation, 24(3), 248-254. Singh, N. N., Lancioni, G. E., Manikam, R., Winton, A. W., Singh, A. A., Singh, J., & Singh, A. A. (2011). A mindfulness-based strategy for selfmanagement of aggressive behavior in adolescents with autism. Research in Autism Spectrum Disorders, 5(3), 1153-1158.

Social Initiations and Pivotal Responses Koegel, L., Koegel, R. L., & Brookman, L. I. (2005). Child-initiated interactions that are pivotal in intervention for children with autism. In E. D. Hibbs, P. S. Jensen (Eds.), Psychosocial treatments for child and adolescent disorders: Empirically based strategies for clinical practice (2nd ed.) (pp. 633-657). Washington, DC: American Psychological Association. Koegel, R. L., & Frea, W. D. (1993). Treatment of social behavior in autism through the modification of pivotal social skills. Journal of Applied Behavior Analysis, 26(3), 369-77.

Staff Training Rispoli, M., Neely, L., Lang, R., Ganz, J. (2011). Training paraprofessionals to implement interventions for people autism spectrum disorders: A systematic review. Developmental Neurorehabilitation, 14(6), 378-388. Sarokoff, R. A., & Sturmey, P. (2008). The effects of instructions, rehearsal, modeling, and feedback on acquisition and generalization of staff use of discrete trial teaching and student correct responses. Research in Autism Spectrum Disorders, 2(1), 125-136. Wood, A., Luiselli, J., & Harchik, A. (2007). Training instructional skills with paraprofessional service providers at a community-based habilitation setting. Behavior Modification, 31(6), 847-855.

Case Study One — Kathleen | 79

Time Delay Doyle, P., Gast, D. L., & Wolery, M. (1990). Use of constant time delay in small group instruction: a study of observational and incidental learning. Journal of Special Education, 23(4), 369-385. Knight, M. G., Ross, D. E., Taylor, R. L., & Ramasamy, R. (2003). Constant time delay and interspersal of known items to teach sight words to students with mental retardation and learning disabilities. Education and Training in Developmental Disabilities, 38(2), 179-191. Liber, D. B., Frea, W. D., & Symon, J. (2008). Using time-delay to improve social play skills with peers for children with autism. Journal of Autism and Developemental Disorders, 38(2), 312-323.

Transitions and Picture Schedules Siegel, E. B., & Lien, S. E. (2015). Using photographs of contrasting contextual complexity to support classroom transitions for children with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 30(2), 100-114. Spriggs, A. Knight, V., & Sherrow, L. (2015). Talking picture schedules: Embedding video models into visual activity schedules to increase independence for students with ASD. Journal of Autism and Developmental Disorders, 45(12), 3846-3861.

GENERAL REFERENCES Andzik, N. R., Schaefer, J. M., & Christensen, V. L. (2021). The effects of teacher-delivered behavior skills training on paraeducators’ use of a communication intervention for a student with autism who uses AAC. Augmentative and Alternative Communication, 37(1),1-13. Arntzen, E., Halstadtro, L., & Halstadtro, M. (2009). The “Silent Dog” method: Analyzing the impact of self-generated rules when teaching different computer chains to boys with autism. Analysis of Verbal Behavior, 25(1), 51-66. Behavior Analyst Certification Board. (2020). Ethics code for behavior analysts. Littleton, CO: Author. Bosch, S., & Fuqua, R. (2001). Behavioral cusps: A model for selecting target behaviors. Journal of Applied Behavior Analysis, 34(1), 123-125. Britton, L. N., Crye, A. A., & Haymes, L. K. (2021). Cultivating the ethical repertoires of behavior analysts: Prevention of common violations. Behavior Analysis in Practice, 14(2), 534-548. Charlop-Christy, M. H., & Haymes, L. K. (1996). Using obsessions as reinforcers with and without mild reductive procedures to decrease inappropriate behaviors of children with autism. Journal of Autism and Developemental Disorders, 26(5), 527-546.

80 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

Charlop-Christy, M. H., & Haymes, L. K. (1998). Using objects of obsession as token reinforcers for children with autism. Journal of Autism and Developemental Disorders, 28(3), 189-198. Cipani, E., & Madigan, K. (1986). Errorless learning: Research and application for “difficult to teach” children. Canadian Journal for Exceptional Children, 3(2), 39-43. Conners, B. M., & Capell, S. T. (Eds.). (2020). Multiculturalism and diversity in applied behavior analysis: Bridging theory and application. New York, NY: Routledge. Council of Autism Service Providers (2020). Applied behavior analysis Treatment of Autism Spectrum Disorder: Practice guidelines for healthcare funders and managers (2nd ed.). https://casproviders.org/wp-content/uploads/2020/03/ ABA-ASD-Practice-Guidelines.pdf Day-Watkins, J., Pallathra, A. A., Connell, J. E., & Brodkin, E. S. (2018). Behavior skills training with voice-over video modeling. Journal of Organizational Behavior Management, 38(2/3), 258-273. Donaghey, C. L., McMillan, T. M., & O’Neill, B. (2010). Errorless learning is superior to trial and error when learning a practical skill in rehabilitation: a randomized controlled trial. Clinical Rehabilitation, 24(3), 195-201. Doyle, P. M., Gast, D. L., Wolery, M., Ault, M. J., & Farmer, J. A. (1990). Use of constant time delay in small group instruction: A study of observational and incidental learning. The Journal of Special Education, 23(4), 369-385. Eldevik, Si., Ondire, I., Hughes, J., Grindle, C., Randell, T., & Remington, B. (2013). Effects of computer simulation training on in vivo discrete trial teaching. Journal of Autism and Developemental Disorders, 43(3), 569-578. Falcomata, T. S., Roane, H. S., Hovanetz, A. N., Kettering, T. L., & Keeney, K. M. (2004). An evaluation of response cost in the treatment of inappropriate vocalizations maintained by automatic reinforcement. Journal of Applied Behavior Analysis, 37(1), 83-87. Felce, D. (1997). Defining and applying the concept of quality of life. Journal of Intellectual Disability Research, 41(3), 126-135. Fong, E. H., Catagnus, R. M., Brodhead, M. T., Quigley, S., & Field, S. (2016). Developing the cultural awareness skills of behavior analysts. Behavior Analysis in Practice, 9(1), 84-94. Ganz, J. B., & Flores, M. M. (2010). Supporting the play of preschoolers with autism spectrum disorders: Implementation of visual scripts. Young Exceptional Children, 13(2), 58-70. Ganz, J. B., & Sigafoos, J. (2005). Self-monitoring: Are young adults with MR and autism able to utilize cognitive strategies independently?. Education and Training in Developmental Disabilities, 40 (1), 24-33. Garcia-Albea, E., Reeve, S. A., Brothers, K. J., & Reeve, K. F. (2014). Using audio script fading and multiple-exemplar training to increase vocal interactions in children with autism. Journal of Applied Behavior Analysis, 47(2), 325-343. Gaylord-Ross, R.J., Haring, T. G., Breen, C. G., & Pitts-Conway, V. (1984). The training and generalization of social interaction skills wtih autistic youth. Journal of Applied Behavior Analysis, 17(2), 229-247.

Case Study One — Kathleen | 81

Horner, R. H., & Albin, R. W. (1988). Research on general-case procedures for learners with severe disabilities. Education and Treatment of Children, 11(4), 375-388. Horner, R. H., Bellamy, G. T., & Colvin, G. (1984). Responding in the presence of nontrained stimuli: Implications of generalization error patterns. Journal of the Association for Persons with Severe Handicaps, 9(4), 287-295. Horner, R. H., Day, H. M., & Day, J. R. (1997). Using neutralizing routines to reduce problem behaviors. Journal of Applied Behavior Analysis, 30(4), 601-614. Kennedy, C. H., Meyer, K. A., Knowles, T., & Shukla, S. (2000). Analyzing the multiple functions of stereotypical behavior for students with autism: Implications for assessment and treatment. Journal of Applied Behavior Analysis, 33(4), 559-571. Kim, E., Hong, S., & Rockett, C. M. (2016) Korean American parents’ perceptions of effective parenting strategies in the United States. Journal of Cultural Diversity, 23(1), 12-20. Kirkpatrick, M., Akers, J., & Rivera, G. (2019). Use of behavioral skills training with teachers: A systematic review. Journal of Behavioral Education, 28(3), 344-361. Knight, M. G., Ross, D. E., & Taylor, R. L. (2003). Constant time delay and interspersal of known items to teach sight words to students with mental retardation and learning disabilities. Education and Training in Developmental Disabilities, 38(2) 179-191. Koegel, L. K., Park, M. N., & Koegel, R. L. (2014). Using self-management to improve the reciprocal social conversation of children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 44(5), 1055-1063. Leaf, J. B., Sheldon, J. B., & Sherman, J. A. (2010). Comparison of simultaneous prompting and no-no prompting in two-choice discrimination learning with children with autism. Journal of Applied Behavior Analysis, 43(2), 215-228. Lequia, J., Wilkerson, K. L., Kim, S., & Lyons, G. L. (2015). Improving transition behaviors in students with autism spectrum disorders: A comprehensive evaluation of interventions in educational settings. Journal of Positive Behavior Interventions, 17(3), 146-158. Liber, D. B., Frea, W. D., & Symon, J. B. (2008). Using time-delay to improve social play skills with peers for children with autism. Journal of Autism and Developmental Disorders, 38(2), 312-323. Lopata, C., Thomeer, M. L., Volker, M. A., Toomey, J. A., Nida, R. E., Lee, G. K., Smerbeck, A. M., & Rodgers, J.D. (2010). RCT of a manualized social treatment for high-functioning autism spectrum disorders. Journal of Autism and Developmental Disorders, 40(11), 1297-1310. Lough, C. L., Rice, M. S., & Lough, L. G. (2012). Choice as a strategy to enhance engagement in a coloring task in children with autism spectrum disorders. Occupational Therapy International, 19(4), 204-211. Morgan, J., Caporino, N. E., De Nadai, A. S., Truax, T, Lewin, A., Jung, Leah, Park, J. M., Khan, Y. A., Murphy, T. K., & Storch, E. A. (2013). Preliminary predictors of within session adherence to exposure and

82 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

response prevention in pediatric obsessive-compulsive disorder. Child and Youth Care Forum, 42(3), 181-191. Mueller, M. M., Palkovic, C. M., & Maynard, C. S. (2007). Errorless learning: Review and practical application for teaching children with pervasive developmental disorders. Psychology in the Schools, 44(7), 691-700. Myles, B., & Southwick, J. (1999). Asperger Syndrome and difficult moments: Practical Solutions for Tantrums, Rage, and Meltdowns. Shawnee Mission, KS: Autism Asperger Publishing Co. O’Neill, R. E., Albin, R. H., Storey, K., Horner, R. H., & Sprague, J.R., (2015). Functional assessment and program development for problem behavior: A practical handbook (third edition). Stamford, CT: Cengage Ozonoff, S., Pennington, B. F, & Rogers, S. J. (1991). Executive function deficits in high-functioning autistic individuals: Relationship to theory of mind. Journal of Child Psychology, Psychiatry, and Allied Disciplines, 32(7), 1081-1105. Ozonoff, S., & McEvoy, R. E. (1994). A longitudinal study of executive function and theory of mind development in autism. Development and Psychopathology, 6(3), 415-431. Prior, M., & Hoffmann, W (1990). Brief report: Neuropsychological testing of autistic children through an exploration with frontal lobe tests. Journal of Autism and Developmental Disorders, 20(4), 581-590. Rapp, J. T., Cook, J. L., McHugh, C., & Mann, K. R. (2017). Decreasing stereotypy using NCR and DRO with functionally matched stimulation: Effects on targeted and non-targeted stereotypy. Behavior Modification, 41(1), 45-83. Redhair, E. I., McCoy, K. M., Zucker, S. H., Mathur, S. R., & Caterino, L. (2013). Identification of printed nonsense words for an individual with autism: A comparison of constant time delay and stimulus fading. Education and Training in Autism and Developmental Disabilities, 48(3), 351-362. Rispoli, M., Neely, L., Lang, R., & Ganz, J. (2011). Training paraprofessionals to implement interventions for people autism spectrum disorders: A systematic review. Developemental Neurorehabilitation, 14(6), 378-388. Rosales-Ruiz, J., & Baer, D. M. (1997). Behavioral cusps: A developmental and pragmatic concept for behavior analysis. Journal of Applied Behavior Analysis, 30(3), 533-544. Salend, S. J., Ellis, L. L., & Reynolds, C. J. (1989). Using self-instruction to teach vocational skills to individuals who are severely retarded. Education and Training in Mental Retardation, 24(3) 248-254. Sallows, G. O., & Graupner, T. D. (2005). Intensive behavioral treatment for children with autism: four-year outcome and predictors. American Journal on Mental Retardation, 110(6), 417-438. Sarokoff, R. A., & Sturmey, P. (2004). The effects of behavioral skills training on staff implementation of discrete-trial teaching. Journal of Applied Behavior Analysis, 37(4), 535-538. Sarokoff, R. A., & Sturmey, P. (2008). The effects of instructions, rehearsal, modeling, and feedback on acquisition and generalization of staff use of discrete trial teaching and student correct responses. Research in Autism Spectrum Disorders, 2(1), 125-136.

Case Study One — Kathleen | 83

Schilmoeller, G. L., Schilmoeller, K. J., Etzel, B. C., & Leblanc, J. M. (1979). Conditional discrimination after errorless and trial-and-error training 1. Journal of the Experimental Analysis of Behavior, 31(3), 405-420. Singer, G. H. S., Sowers, J., & Irvin, L. K. (1986). Computer-assisted video instruction for training paraprofessionals in rural special education. Journal of Special Education Technology, 8(1), 27-34. Smeets, P. M., Lancioni, G. E., & Hoogeveen, F. R. (1984). Using stimulus shaping and fading to establish stimulus control in normal and retarded children. Journal of Mental Deficiency Research, 28(3), 207-218. Sprinkle, E. C., & Miguel, C.F. (2013). Establishing derived textual activity schedules in children with autism. Behavioral Interventions, 28(3), 185-202. Storey, K., & Post, M. (2017) Positive behavior supports in classrooms and schools: Effective and practical strategies for teachers and other service providers (2nd ed.) Springfield, IL: Charles C. Thomas Publisher, Inc. Sun, X. (2020). Behavior skills training for family caregivers of people with intellectual or developmental disabilities: A systematic review of literature. International Journal of Developmental Disabilities, 68(3) 247-273. Walker, G. (2008). Constant and progressive time delay procedures for teaching children with autism: A literature review. Journal of Autism and Developemental Disorders, 38(2), 261-275. Ward-Horner, J. & Sturmey, P. (2012). Component analysis of behavoir skills trianing in functional analysis. Behavioral Interventions, 27(2), 75-92. Wood, A. L., Luiselli, J. K., & Harchik, A. E. (2007). Training instructional skills with paraprofessional service providers at a community-based habilitation setting. Behavior Modification, 31(6), 847-855.

Case Study Two — Merve Case Study Covers: • Autism Spectrum Disorders • Elementary School Setting

M

erve is a 6-year-old first grader diagnosed with autism spectrum disorders (ASD). She is of Turkish descent. Merve is fully included in her class and receives supports from an inclusion specialist. Merve generally does well academically. Socially, she prefers to be by herself but does participate in group work. At lunch and recess, she prefers to be by herself though she will join groups if asked (especially four square which she enjoys). Occasionally, her peers ask her to join them but mostly they all just gather around the four square game. Typically, 6-year-olds do not require direct invitations to enter play with peers. Her classmates enjoy her company and have positive responses to her playing and conversations. Merve was in kindergarten with her peers in her class, so she knows them and they know her. The teacher, Ms. Denecke, has had many students with disabilities in her class through the years and she is very much in favor of inclusion. A variety of supports are available to Ms. Denecke and her students such as the inclusion specialist, a Speech Language Pathologist, a Behavior Specialist, and others if necessary. Unfortunately, Merve has started having some challenging behavior four months into the school year. At times she tells the teacher “No” and turns away and refuses to participate in the activity. This challenging behavior occurs most frequently during reading times. At recess she has started becoming aggressive towards her peers (pushing and pinching them). This is especially of concern as she has never been aggressive before. The behavior specialist, Ms. Ziegler, is brought in to help with the situation. Ms. Ziegler conducts a functional behavioral assessment 85

86 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

(FBA) interview form (O’Neill et al., 2105) with the teacher and inclusion specialist and conducts observations during different class times and at recess. Using information from the FBA interview (see Figure 2.1) and The Functional Assessment Observation Form (FAOF) (O’Neill et al., 2015) (see Figure 2.2), Ms. Ziegler determines that the refusals in the classroom are occurring during reading activities. The aggression at recess is occurring during four square, which is puzzling as this is her favorite activity. Refinement of the FA observation during recess revealed that the aggression is occurring when Merve was not participating in the four square game but wanted to participate. During Ms. Ziegler’s observations in the classroom, she recognized Merve has some executive function deficits that should be addressed in her Individualized Education Program (IEP) and in the behavior plan. As seen in the play situation and in the classroom, Merve has difficulties initiating activities with a tendency toward prompt dependence. Transitions can be difficult whether Merve is asked to move from one activity (e.g., art) to another (math) or even within an activity moving from task to task.

CASE STUDY EVALUATION Based upon the case study provided above, the following sections analyze the issues that arise in providing behavioral services and supports for Merve. This analysis is based upon the Behavior Analyst Certification Board Task List 5th Edition. Competencies addressed are Foundations, C: Measurement, Data Display, and Interpretation and Applications, E: Ethics (Ethics Code for Behavior Analysts), F: Behavior Assessment, G: Behavior-Change Procedures, H: Selecting and Implementing Interventions, and I: Personnel Supervision and Management. These examples are provided as a guide to successfully resolving client case issues and developing competencies as behavior analysts. Behavior Assessment F-1 F-2 F-3

Review records and available data at the outset of the case. Determine the need for behavior-analytic services. Identify and prioritize socially significant behaviorchange goals.

Case Study Two — Merve | 87

F-4 F-5 F-6 F-7 F-8 F-9

Conduct assessments of relevant skill strengths and deficits. Conduct preference assessments. Describe the common functions of problem behavior. Conduct a descriptive assessment of problem behavior. Conduct a functional analysis of problem behavior. Interpret functional assessment data.

Ms. Ziegler began by conducting a records review focusing on information regarding literacy from the Psychoeducational Evaluation assessments and the Individual Education Program (IEP). This information helped to confirm that Merve struggles with reading. Biological/medical factors were ruled out from the Psychoeducational Evaluation. Additionally, the parents were informally interviewed for the assessment, and they were able to confirm that there were no medication or dietary changes for Merve. The behaviors in Merve’s case were related to specific activities and not medical or biological factors and thus behavior-analytic services are appropriate for Merve. It was determined that the socially significant behavior-change goals were to decrease her challenging behaviors, to increase her reading skills, to increase her social skills, and to have her transition appropriately. A preliminary assessment included an interview using the FAI (Figure 2.1) and direct observation data collection using the FAOF (Figure 2.2) from O’Neil et al (2015). The FAOF) form was used to analyze the function of the behavior throughout the day from the teacher’s perspective. Based upon the interview it was decided that it would be important to observe Merve during the high probability times (when the challenging behaviors are most likely to occur) which are recess and reading. It was also important to assess in low probability times (when the challenging behaviors are least likely to occur) because what happens during the low probability times that makes the challenging behaviors less likely to occur and this information is just as important as the factors that cause the challenging behaviors to occur. To conduct a more thorough functional assessment Ms. Ziegler understood that the interview data would not by itself be sufficient for determining the function of the behavior. Instead, she decided to use multiple systems of data collection, observation, and interviews with multiple parties. All of these data were collated to look for patterns in environmental factors, antecedents, establishing operations, responses and consequences. In this case, the frequency data taken during recess (high probability of aggression) that also included an ABC chart for

88 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 2.1. Functional Assessment Interview Form (FAI) — Merv.

Case Study Two — Merve | 89

90 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 2.1. — Continued.

Case Study Two — Merve | 91

92 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 2.1. — Continued.

Case Study Two — Merve | 93

94 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 2.1. — Continued.

analyzing antecedents the behavior and its consequences (Figure 2.3). The scatterplot was used for both behaviors to determine the high probability times and low times for both behaviors as well as frequency of episodes (Figure 2.4). From the various assessments, it is clear that refusals were sustained during reading activities and spelling bookwork. It is also clear that refusals occurred during small reading groups, sustained silent reading and spelling books all activities that require individualized reading. The challenging behavior did not occur while the teacher was reading to the class or during math (with manipulatives and no reading).

Figure 2.2. Functional Assessment Observation Form — Merv.

Case Study Two — Merve | 95

96 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 2.3. ABC Chart — Merve.

Therefore, this provides more information about the context and type of demand (individual reading as the issue) and that the challenging behavior at this time was escape maintained. From the frequency data it was learned that the challenging behavior occurred when Merve was not asked to join students when they were playing four square. She did not have challenging behaviors when she was invited to join prior to recess. It is also clear from the data collected that she has limited social skills and limited interest socially. Therefore, a skill deficit can contribute to her behavior in that she does not initiate play with peers (e.g., asking to join or starting a four square game). Her social skills were analyzed using a peer interaction data system (See Figure 2.5). The results of that observation and data collection supported that Merve could engage in appropriate play with peers

Figure 2.4. Scatterplot Data — Merve.

Case Study Two — Merve | 97

98 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 2.5. Peer Interaction Data — Merve.

when invited. She only engaged in responses to peers, all were appropriate, but she had no initiations across the time they were engaged in play. The assessment involved observations and manipulations within the natural environment, which is referred to as a descriptive analysis, commonly used within school settings (McComas et al., 2009). Based upon the description given and the data provided the function during recess is to obtain access to engagement in a preferred activity (four square) and during reading the function is to avoid a difficult academic task (e.g., reading and spelling). The final question of describing the context for behavior for aggression is; peers are engaged in her preferred game, Merve is not engaged in the game or with peers. In class the context is individualized reading activities/demands. Measurement, Data Display, and Interpretation C-1 C-2 C-3

Establish operational definitions of behavior. Distinguish among direct, indirect, and product measures of behavior. Measure occurrence (e.g., frequency, rate, percentage).

Case Study Two — Merve | 99

C-4

Measure temporal dimensions of behavior (e.g., duration, latency, interresponse time). C-5 Measure form and strength of behavior (e.g., topography, magnitude). C-6 Measure trials to criterion. C-7 Design and implement sampling procedures (i.e., interval recording, time sampling). C-8 Evaluate the validity and reliability of measurement procedures. C-9 Select a measurement system to obtain representative data given the dimensions of behavior and the logistics of observing and recording. C-10 Graph data to communicate relevant quantitative relations (e.g., equal-interval graphs, bar graphs, cumulative records). C-11 Interpret graphed data. The challenging behaviors were identified and preliminary operational definitions were provided by the teacher interview form: “1) In class at times she refuses to work, states ‘No’ and will put her head down. 2) At recess she is aggressive at times hitting or pushing her peers.” The definitions of the challenging behaviors are based upon the Functional Assessment Interview, but the definition can then be refined based upon observation prior to formal data collection. It is important that the definition of the behavior includes both occurrences of what the behavior is and nonoccurrences of what the behavior is not (Storey & Post, 2017). These examples and nonexamples help to ensure that all people collecting data are consistent in measuring behaviors as there are often “gray areas” in deciding if a behavior is an (occurrence) or not. For example, is threatening to hit someone, but not hitting them, an act of aggression or not? These operational definitions of aggression and refusal were established for data collection with Merve (see Table 2.1). Merve was observed across two days during both recess/snack time and lunch recess (see the FAOF in Figure 2.2). During recess, when Merve was not playing four square she engaged in aggression 1-3 times and when she was engaged in her preferred game with peers she had zero incidents of aggression. She was most successful when she was invited to play prior to going to recess. A scatter plot was useful for determining number of episodes of the

100 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

behaviors per day and the duration of refusal (Figure 2.4). Frequency data collection of episodes of aggression and refusal were sufficient for the case of Merve (however, refusals can take many forms and can have potentially different functions). By using duration data, it is possible to determine if her refusals are a quick “No I won’t” but then she does accomplish the assignment or are they extended refusals to do the work. As can be seen in the scatterplot, the duration data were helpful to see that Merve can have refusals that last up to 15 minutes. In fact, it seemed from the scatterplot and direct observations that the challenging behavior lasted the entire time the assignment was given. The scatter plot was also selected because it would give the high probability and low probability times for the challenging behaviors. The information from the interviews concerning the challenging behaviors was supported by the scatter plot data and frequency data collected. The assessment was based upon the initial case information shared by the teachers and staff. The scatter plot was individualized to match her behaviors of concern and her schedule at school. Additional data collection systems were created to provide more fine detailed information about her challenging behaviors. It was possible to observe peer interactions and take data on initiations and responses with frequency data and rate the interactions as positive/appropriate or negative/inappropriate. This was done with a time sampling method of partial-interval recording. In this case the observer recorded whether there was an initiation (+/0) or response (+/0) any time during the interval. This provides a more detailed analysis of Merve’s interaction skills as compared to her peers. The data collection system and data on Merve are provided in Figure 2.5. Another system that was created for providing more details about refusal is also a time sampling method of wholeinterval recording. The positive behavior of on-task was recorded for the interval (10 seconds) if Merve engaged in on-task behavior throughout the complete interval time period. Merve’s behavior needed to meet the definition of on-task for the entire interval to be recorded. This provides information whether Merve has a pattern of starting work and then refusing once she starts and struggles or if she refuses from the beginning of assignments. These data can then be used in planning the interventions and strategies. Figure 2.6 presents the example of whole interval data collection of Merve’s on-task behavior. She was on-task in 12 of the 64 intervals (19% of the intervals).

Case Study Two — Merve | 101 Figure 2.6. Whole Interval Data Collection — Merve.

Selecting and Implementing Interventions H-1 State intervention goals in observable and measurable terms. H-2 Identify potential interventions based on assessment results and the best available scientific evidence. H-3 Recommend intervention goals and strategies based on such factors as client preferences, supporting environments, risks, constraints, and social validity. H-4 When a target behavior is to be decreased, select an

102 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

H-5 H-6 H-7 H-8 H-9

acceptable alternative behavior to be established or increased. Plan for possible unwanted effects when using reinforcement, extinction, and punishment procedures. Monitor client progress and treatment integrity. Make data-based decisions about the effectiveness of the intervention and the need for treatment revision. Make data-based decisions about the need for ongoing services. Collaborate with others who support and/or provide services to clients.

Based upon the assessment results of avoidance of reading tasks for the refusal behavior and gain for the aggression toward peers, the interventions chosen address those functions. The interventions take into consideration prevention of the behaviors as they decrease the need for Merve to engage in avoidance of reading or gain peer engagement in her preferred activity. A variety of preventative measures can be implemented that involve antecedent manipulation so that the challenging behavior is less likely to occur. Antecedent manipulations include but are not limited to noncontingent reinforcement, behavioral momentum, high-probability response sequences and functional communication training (Mueller et al., 2001; Pritchard et al., 2014; Roantree & Kennedy, 2006). A pragmatic and easy to implement strategy is a reduction in the amount of work required and the provision of work with a clear beginning and end (Bennett et al., 2011). Rather than asking Merve to read her book during SSR time, Merve can be provided with one paragraph from her book (make a copy of the page and circle the paragraph so the expectations is visually clear). During spelling, circle the problems to be completed again reducing the number of responses. To guide her responses and reduce the demand, prompts should be provided in the spelling book following the components of Pivotal Response Training (PRT). In this case, visual prompts will reduce the likelihood of challenging avoidance behaviors (Koegel & Koegel, 2006). Another technique that can be used to make reading more interesting and less difficult is the implementation of a multisensory reading approach such as Orton-Gillingham (Coleman & Vaughn, 2000; Giess et al., 2012; Ritchey & Goeke, 2006). While the teacher provides reading in instruction to the whole class the teacher can implement a multisensory approach for all students in first grade as it benefits all the

Case Study Two — Merve | 103

students. The inclusion specialist can also assist with implementation during reading instruction as a push-in technique. Use of white boards, smart boards, response cards, magnetic letters and letter/word tiles adds a multisensory component to reading instruction and facilitates acquisition (Conderman et al., 2012; Duchaine et al., 2011). For aggression based upon the function of gaining access to a preferred activity, peer-mediated antecedent procedures are also focused on decreasing the likelihood and need for gaining. The peers can be used as behavior change-agents (Harjusola-Webb et al., 2012; Schmidt & Stichter, 2012) and invite Merve to play four square at recess and lunch. Rather than inviting Merve just for four square she can be a part of their peer network using Circle of Friends or similar peer-based intervention where friendships are established through friends in-common or common interest (Barrett & Randall, 2004; Calabrese et al., 2008; Haring & Breen, 1992; Kalyva & Avramidis, 2005). Behavior-Change Procedures G-1 Use positive and negative reinforcement procedures to strengthen behavior. G-2 Use interventions based on motivating operations and discriminative stimuli. G-3 Establish and use conditioned reinforcers. G-4 Use stimulus and response prompts and fading (e.g., errorless, most-to-least, least-to-most, prompt delay, stimulus fading). G-5 Use modeling and imitation training. G-6 Use instructions and rules. G-7 Use shaping. G-8 Use chaining. G-9 Use discrete-trial, free-operant, and naturalistic teaching arrangements. G-10 Teach simple and conditional discriminations. G-11 Use Skinner’s analysis to teach verbal behavior. G-12 Use equivalence-based instruction. G-13 Use the high-probability instructional sequence. G-14 Use reinforcement procedures to weaken behavior (e.g., DRA, FCT, DRO, DRL, NCR). G-15 Use extinction. G-16 Use positive and negative punishment (e.g., time-out, response cost, overcorrection).

104 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

G-17 G-18 G-19 G-20 G-21

Use token economies. Use group contingencies. Use contingency contracting. Use self-management strategies. Use procedures to promote stimulus and response generalization. G-22 Use procedures to promote maintenance. Merve demonstrates an issue of compliance with reading instruction but she also needs to increase her reading skills as described above. In addition to increasing her reading skills, her compliance with teacher instructions related to reading needs to be increased. By using a high-probability sequence, Merve is more likely to respond to the low probability request (reading). High probability sequences have been shown to be effective for academic avoidance (Mace & Belfiore, 1990; Zarcone et al., 1994). Merve can read single words such as CVC words (words that follow the pattern of consonant-vowel-consonant) from lists. Ms. Denecke decides to compile a list of mastered words that Merve has a history of successful independent reading. This list is then used two ways: 1) the teacher provides Merve with mastered words on flash cards, thus having success and gaining reinforcements, followed by an unknown word in a sequence of known, known, unknown, known and 2) using a familiar text/paragraph, the teacher reads a few sentences to get started, followed by having Merve read a few known words within the passage after success and reinforcement for reading the familiar mastered words Merve is then asked to read an unknown word. Again, this follows a pattern of mastered, mastered, unknown word using behavioral momentum. The Premack Principle (Premack, 1959) states that a high probability behavior can serve as a reinforcer for a low probability behavior provided contingently upon the occurrence of the low probability behavior. In this case study, reading is the low probability behavior. If Merve reads her passage or completes her spelling assignments (reduced amount) she can gain access to her preferred activity of having a peer/teacher read to her, which is her high probability behavior (Horan & Johnson, 1971; Welsh et al., 1992). A preference assessment is conducted by Ms. Ziegler within the school environment to determine Merve’s preferences and reinforcers. The interview of parents and teachers determins some activity preferences and food reinforcers for Merve. Based upon naturalistic observation, interviews, and paired stimulus trials a list of preferences was

Case Study Two — Merve | 105

compiled. Merve loved having others read to her and did not have a preference for peers versus adults, thus this preference was used in the development of the treatment plan for decreasing avoidance of reading. Merve was able to read CVC words and other words when presented as a list or in a simple passage (single paragraph) thus, her mastered reading skills were then used in a high probability sequence. Merve also responds to models and therefore did well with pre-teaching of reading words and an “I do-You do” format. In this type of instruction, the adult reads the sentence followed by Merve’s reading of the sentence. The current providers (teacher, inclusion specialist) implemented these antecedent strategies within the classroom environment and not in a pullout manner. Merve has success in her current classroom when she is provided with opportunities to respond to the class reading expectations within the current natural environment (Jennings et al., 2012). Merve has access to a speech therapist and inclusion specialist whom can do push-in services supporting her reading and communication with her peers and teachers in her current classroom. These interventions are implemented with the support of the many service providers in her environment. The interventions are not that unusual for students within the first grade in fact many first-grade teachers use multisensory approaches and response cards (white boards) for reading instruction. Thus, the interventions have social validity (Kazdin, 1977). For the aggression based upon gain, Merve already has an expressed preference for four square and has the skills to play the game with her classmates. Using a peer-based intervention, such as Circle of Friends, provides Merve with an intervention that has social validity and can be supported across environments and is not dependent upon adults for prompting and reinforcement (Haring & Breen, 1992). Often peers that have expressed interest in the student, Merve, would be invited to Circle of Friends as well as peers that interest Merve, thus addressing her preferences for peers and the activity. There are many options for alternatives for the challenging behaviors based upon their function. The typography of response does depend upon the person’s repertoire and demonstrated skills as well as behavioral cusps to gain access to reinforcers, environments, new skills and generativeness of responses. A behavioral cusp is a behavior change that provides the individual with access to new contingencies, new reinforcers, and impacts the people in the environment (Bosch & Fuqua, 2001; Rosales-Ruiz & Baer, 1997). If Merve is taught to initiate play with others rather than simply use a phrase to request four square

106 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

she will gain access to new friends and social opportunities. Generativeness of responses is the acquisition of a variety of responses and related behaviors rather than one single response. In many cases of work refusal, the student is taught to ask for a break, however, in Merve’s case she is not seeking a break from work but is avoiding a difficult task. In her case, an alternative response might be asking for help so that the task is not as difficult. Asking for help can have multiple typographies. Merve is verbal and she should be expected to verbalize for her response. But when developing an alternative response it is important to consider ease of response. The alternative needs to be easier than the challenging behavior, must be reinforced more often than the challenging behavior, to compete. Therefore, a visual prompt for help should be available and paired with her verbal so that it is quick and easy. Whether Merve uses the verbal or visual request for help the behavior needs to be immediately reinforced. For aggression during play, Merve needs another way to gain access to play in a preferred activity with less effort than aggression and the response must receive reinforcement immediately with a greater magnitude. Setting up the circle of friends and having friends ask Merve to play is good for prevention of difficulties but again, it is important to promote the development of positive skills and behavioral cusps. If Merve can be taught to positively initiate with peers by asking them to play four square she will gain access to reinforcers of friends and a preferred activity (you cannot play four square alone). Given that Merve is verbal she can invite friends to play four square by following a visual script. Reading is not her strength but she does have good visual skills. Using a script such as a comic strip picture Merve can initiate asking peers to join a game of four square. Both of these alternative methods of gaining access to play in preferred activity and avoiding a difficult task use functional communication training (FCT) where an alternative method of communication is established to replace the challenging behaviors Durand & Carr, 1992; Durand & Kishi, 1987; Northup et al., 1997). Both of the positive alternative skills developed (initiating social requests and asking for help) are skills that will allow Merve to gain access to new reinforcers within the natural environment, access to new environments, compete with the inappropriate behaviors and impact her friends and teachers at school. These positive skills represent behavioral cusps (Rosales-Ruiz & Baer, 1997; Smith et al., 2006). Merve will need to be taught a response class of a) initiating with peers

Case Study Two — Merve | 107

(for the gain function) and b) asking for help (for the avoid function). The Skillstreaming program (McGinnis, 2011) would be an appropriate intervention program to use. To program for response generalization Merve will need to be taught to ask for help and gain access to preferred activities with multiple phrases (with multiple visual prompts) that result in reinforcement. The specific typography of these phrases will need to be tested for social acceptability. Surveying students or observation of language samples within the classroom can determine social acceptability. Social acceptability of the phrases will more likely lead to maintenance of the response within the natural environment. To program for stimulus generalization, Merve will need to have access to her visual prompt and taught to use the phrases under different conditions. When FCT is implemented in the natural environment it minimizes issues of generalization (Falcomata & Wacker, 2013). For example, Merve avoids reading, which is a difficult task. During sustained silently reading times Merve can ask for help. That is one stimulus that can elicit the alternative response. However, it is more important for Merve to ask for help when met with other challenges of other reading activities. Therefore, when Merve is given the spelling work at her seat she will need to be prompted to ask for help. If the teacher provides a work sheet for independent work again, she will need to be prompted to ask for help. General case analysis can help plan for what skills Merve needs (see Figure 2.7) Similarly, with four square this is not the only game she will want to play and gain access to at school and with peers. A variety of stimuli need to be presented to Merve where she has access to an alternative response and reinforcement. To establish the replacement behaviors that serve the same function as the challenging behaviors, it is possible to use positive reinforcement (Luczynski & Hanley, 2014; Payne & Dozier, 2013). During the initial stages of learning it is best if positive reinforcement is used to establish an association between the behavior and the response. Following this initial stage of learning and demonstrated acquisition the newly established replacement behavior can gain access to reinforcement on a variable ratio schedule of reinforcement, this creates a high steady rate of responding. During the initial stage of acquisition asking for help would gain immediate and continuous reinforcement (help and praise). With a variable schedule asking for help would be praised on average every two responses. This schedule would eventually be thinned using a variable ratio of reinforcement. These positive behaviors are established through a combination of

108 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 2.7. General Case Analysis Form — Merv.

reinforcement as described above, prompting and modeling. Merve attends to visual models and patterns and according to interviews imitates others’ actions. Therefore, it will be important that peers and adults provide natural opportunities with modeling using observational learning. Merve will be asked to attend to the peer and the peer engages in the response. Merve is asked to imitate the peer following the observation. This can be done in the natural environment while working in small groups in the classroom and at lunch prior to recess. The prompts provided would be visual given Merve’s strength in this modality. Data tracking will provide guidelines for fading the visual prompts. In her case, a time delay method for fading prompts might be appropriate. With this procedure a brief delay is provided between

Case Study Two — Merve | 109

the stimulus and the prompt (Coleman et al., 2012; Knight et al., 2003). Doyle, Gast, and Wolery (1990) used a constant time delay method of prompt fading during group instruction. Therefore, they took advantage of observational learning and incidental teaching combined with time delay, all of which are suggested for Merve. Incidental teaching (also known as naturalistic approaches or milieu teaching) involves systematic protocols used in the natural environment (Kaiser et al.,1993). These are planned, prearranged opportunities for Merve to use her replacement skills (McGee & Daly, 2007; McGee et al., 1986). In order to establish the replacement skills for use in the natural environment of classrooms, recess, lunchtime and play with peers the skill needs to be reinforced and prompted within the context of use. On the daily schedule set times for prompting and implementation should be established with all adults and with the Circle of Friends. To establish a new response in Merve’s repertoire it will need to be systematically targeted at least 15 times per day. Personnel Supervision and Management I-1 I-2 I-3 I-4 I-5 I-6

I-7 I-8

State the reasons for using behavior-analytic supervision and the potential risks of ineffective supervision (e.g., poor client outcomes, poor supervisee performance). Establish clear performance expectations for the supervisor and supervisee. Select supervision goals based on an assessment of the supervisee’s skills. Train personnel to competently perform assessment and intervention procedures. Use performance monitoring, feedback, and reinforcement systems. Use a functional assessment approach (e.g., performance diagnostics) to identify variables affecting personnel performance. Use function-based strategies to improve personnel performance. Evaluate the effects of supervision (e.g., on client outcomes, on supervisee repertoires).

In order to monitor the behavior plan, successful implementation data will need to be taken on treatment fidelity and behavior change. Ongoing data collection will be necessary to determine if the

110 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

replacement behaviors occur with monitoring of prompts and spontaneity of replacement skills within natural context. Ms. Ziegler will need to be the point person for data collection and will need to make sure that staff have the skills to collect and understand data. She will also need to make sure that the functions of behavior are clear so that staff understand why Merve is engaging in the challenging behaviors. A scatterplot format would be useful for ongoing monitoring to determine if the replacement skills occur in lieu of the aggression at recess and in lieu of shutting down during reading. The service providers, teachers, and support staff can conduct ongoing probes to determine the fidelity of behavior plan implementation rather than a daily data system. The data collected on the challenging behaviors and replacement behaviors will need to be graphed on a regular scheduled basis to determine the effectiveness of the behavior intervention plan. These data can be shared at team meetings or at progress report dates. The progress data related to the plan will also need to be compared with the treatment fidelity. If Merve’s behaviors do not improve or the replacement behaviors are not observed in natural contexts, given implementation of the plan at 90% or better, an IEP would need to take place to make necessary changes to the behavior plan. If there is a failure to implement the behavior plan as developed by the team again an IEP would be requested to make revisions to the plan by the team. At that time or prior to the IEP the behaviorist would need to determine what parts of the plan are not being implemented and what are the factors that contribute to the failure. A failure to implement can be due to many factors such as a cultural mismatch or competency of implementers. Rather than changing the plan the team may decide the implementers need training and support. There are no aides in the class to supervise and Ms. Ziegler is not Ms. Denecke’s supervisor nor is Ms. Denecke Ms. Ziegler’s supervisor. Finally, the replacement behaviors will need to be maintained in the natural environment with natural supports. The data collection system will determine if natural supports such as peers can maintain the replacement skills of asking to join games and initiate interactions. Ethics E-1 E-2 E-3

Introduction. Responsibility as a Professional. Responsibility in Practice.

Case Study Two — Merve | 111

E-4 E-5 E-6 E-7

Responsibility to Clients and Stakeholders. Responsibility to Supervisees and Trainees. Responsibility in Public Statements. Responsibility in Research.

Ms. Denecke and Ms. Ziegler have already made their professional determination that the inclusion of students with disabilities in general education environments is a good thing. It was also their ethical responsibility to collect data for determining if the interventions are effective or not. Now that Merve is their student, they are ethically responsible to her, to other students in the class, and to others in the school to provide a good education to Merve and to support her so that she and other students are successful.

The Use of Technology in Interventions for Behavior Change Ms. Ziegler recommends that assistive technology be used for Merve in the development of her executive function skills. The technology is discussed in detail in the executive function section of her support plan. Executive Function Skills Initiating Activities Merve has difficulty with initiating work activities and social activities and displays prompt dependence. To move Merve to independence, technology was used as a bridge. Merve uses an iPad device with applications (App) for schedules, such as First/Then (created for iPad/ iPhone) which is a simple App that can be used with photographs from the program, photographs imported and auditory steps if needed. A picture schedule helped Merve to become familiar with the routines and locations for the commencement of activities. This was also used as a guide to initiating activities. Other Apps such as Pictello were also used in creating photographic stories created that show steps to initiate and complete an activity. The use of schedules and stories is supported by research for students with autism (Knight et al., 2015; Pierce et al., 2013; Sprinkle & Miguel, 2013). To address initiating activities, Merve

112 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

also benefited from the use of self-talk as a self-management skill (Holland & Low, 2010; Winsler et al., 2007). This was taught while in the classroom working on assignments as push in from her speech therapist. Shifting Attention Merve has difficulty with transitions from location to location and task to task. Shifting attention can was addressed through the use of visual schedules. Technology was used as described above for the executive function skill of shifting attention. Low technology options were also used for transitions from material to material within task and “modifications on the fly.” This was the use of a white board in class that was used to communicate visual schedules and changes. To develop the compensatory skill of shifting attention and transitioning games with transitions were used as a teaching tool for Merve as well as for other students in the class.

Collaboration with Others It will be important for the teacher and behavior specialist to collaborate with the school administration and recess and lunch supervisors regarding Merve’s aggression. Merve’s parents should be provided information on a regular basis (daily through email or some other documented form of communication) regarding her behavior so that they can provide reinforcement at home for positive behaviors on Merve’s part.

Legal Issues The school needs to ensure that there is adequate supervision of Merve during recess and lunch times so that appropriate generic antecedent and consequence strategies are implemented (e.g., what would happen when any student is aggressive during those times). Any acts of aggression need to be documented according to school policy. The teacher or behavior specialist should provide recess and lunch supervisors with written guidelines regarding Merve’s aggression.

Case Study Two — Merve | 113

Quality of Life Physical Well-Being Merve is a healthy young child, and this area is positive for her as her family eats healthy meals and gets regular exercise. For Merve this is often going to the playground or riding her bike with her family. Material Well-Being This area is not a concern for Merve as her parents both work and bring in an adequate income for meeting the needs of the family. Interpersonal Well-Being Merve currently has a poor quality of life in her interpersonal relationships with her peers. This needs to be focused upon so that she builds positive social relationships and networks with her peers. This is especially important at her young age so that she develops positive social interaction skills. Merve currently has few play dates with friends outside of school and is dependent upon her family members for social interactions. This is an important area for collaboration between school staff and her family. Productive Well-Being Education is a subcategory in this area and reading is a key skill for Merve to have and it is extremely important that she not fall behind, especially at this early stage. Emotional Well-Being Mental health and self-esteem are important areas to focus on in this category. Merve is currently at risk for developing problems in these two areas but developing positive social skills, interpersonal relationships, and social networks for her should minimize or even alleviate these concerns. Rights and Inclusion Merve is currently fully included at school and is receiving an appropriate education under the Individuals with Disability Education Act.

114 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

FOUNDATIONAL AND LIFESTYLE STRATEGIES O’Neill et al (2015) recommend that in analyzing foundational and lifestyle strategies it is important to consider communication, mobility, activity patterns, social relationships, control/choice, and predictability. The social relationship issues has been addressed. Communication, mobility, and predictability are not of concern with Merve. Activity patterns are important to consider in relation to her aggression. Merve needs to have activities that foster positive social interactions with her peers. At school this relates to her playing four square. It is also important for her to consider joining other games as well that her peers are playing. If Merve has not previously played these games with her peers she may not know if she would enjoy them or not. Thus, she needs to try playing them in order to be able to make an informed decision. This may involve teaching her game rules and skills so that she has competence in playing the games. Merve may want to consider joining sports teams or clubs that are available at the school as this would help foster her positive social relationships. Control and choice also are important considerations for Merve. Since she often prefers to be by herself it is important that she have the choice and control of when she participates in activities with her peers and recess and lunch. For her reading is not a choice if she gets to read or not but giving her control over some aspects of the reading (such as which passages to read out loud) may be helpful in alleviating some of the challenging behaviors (Dunlap et al., 1994; Kern et al., 1998).

Person-Centered Planning In regard to Merve’s aggression, it may be helpful to do personcentered planning with Merve so that she has input into the activity patterns and choices to make during recess and lunch times.

Physical, Medical, Psychological, or Mental Health Issues The physical and medical components are not of concern for Merve. As previously discussed, Psychological and Mental Health issues may arise if her aggression continues and her social interaction problems are not addressed and remediated.

Case Study Two — Merve | 115

Supports Teachers/Service Providers Merve’s teacher may need help from a reading specialist in adapting the reading curriculum. Merve may also need instruction from a reading specialist. The supervisors at recess and lunch times will need supports on how to appropriately intervene with Merve. The Neurodiverse Person The interventions to help Merve have been addressed in previous section of this case study. Family Members Merve’s parents will need close communication and information regarding her performance at school. They may possibly need support in getting books to read to Merve at home and having her read to them. This could involve structured family time, trips to the library for story times or for getting books, providing information on recommended books for Merve to read. In-home ABA services could be an appropriate support to the family in establishing these routines and activities. Merve would likely benefit from joining clubs or sports teams in her community as this would provide additional opportunities for her to develop her skills and positive social relationships. Information regarding these opportunities could be provided to her parents. Employers/Community Members If Merve does join clubs or sports teams in her communities then the children and/or adults in those settings might need information regarding autism spectrum disorders as well as specific recommendations on how to support Merve. Instructional Supports Instructional supports related to reading and social interaction skills have been previously addressed in this case study.

116 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

Discussion Questions 1. Should students with aggressive behaviors be placed in a special education classroom with other students with behavior disorders so that there are teachers and staff who are specifically trained to provide educational and behavioral supports to these types of students? 2. Are the measurement of frequency and duration appropriate for this case? Why or why not? 3. When in the assessment process should you define the challenging behavior? 4. How are reading or other academic skills tied to the function of challenging behaviors?

EMPIRICAL RESEARCH TO SUPPORT THAT THE INTERVENTION IS AN EVIDENCE-BASED PRACTICE Alternative Behaviors to Replace Challenging Behaviors Durand, V. M., & Carr, E. G. (1992). An analysis of maintenance following functional communication training. Journal of Applied Behavior Analysis, 25(4), 777-794. Durand, V. M., & Kishi, G. (1987). Reducing severe behavior problems among persons with dual sensory impairments: An evaluation of a technical assistance model. Journal of The Association for Persons with Severe Handicaps, 12(1), 2-10. Northup, J., Wacker, D., Sasso, G., Steege, M., Cigrand, K., Cook, J., & DeRaad, A. (1991). A brief functional analysis of aggressive and alternative behavior in an outclinic setting. Journal of Applied Behavior Analysis, 24(3), 509-522.

Antecedent Manipulations for Interventions Mueller, M. M., Wilczynski, S. M., & Moore, J. W. (2001). Antecedent manipulations in a tangible condition: Effects of stimulus preference on aggression. Journal of Applied Behavior Analysis, 34(2), 237-240.

Behavioral Momentum Common, E. A., Bross, L. A., Oakes, W. P., Cantwell, E. D., Lane, K. L., & Germer, K. (2019). Systematic review of high probability requests in k-12 settings: Examining the evidence base. Behavioral Disorders, 45(1), 3-21.

Case Study Two — Merve | 117

Zarcone, J. R., Iwata, B. A., Mazaleski, J. L., & Smith, R. G. (1994). Momentum and extinction effects on self-injurious escape behavior and noncompliance. Journal of Applied Behavior Analysis, 27(4), 649-658.

Circle of Friends Kalyva, E., & Avramidis, E. (2005). Improving communication between children with autism and their peers through the ‘Circle of Friends’: A smallscale intervention study. Journal of Applied Research in Intellectual Disabilities, 18(3), 253-261. Haring, T. G., & Breen, C. G. (1992). A peer-mediated social network intervention to enhance the social integration of persons with moderate and severe disabilities. Journal of Applied Behavior Analysis, 25(2), 319-333.

Curricular Revisions Dunlap, G., Kern-Dunlap, L., Clarke, S., & Robbins, F. R. (1991). Functional assessment, curricular revision, and severe behavior problems. Journal of Applied Behavior Analysis, 24(2), 387-397. Kern, L., Childs, K., Dunlap, G., Clarke, S., & Falk, G. D. (1994). Using assessment based curricular intervention to improve the classroom behavior of a student with emotional and behavioral challenges. Journal of Applied Behavior Analysis, 27(1), 7-19.

Descriptive Analysis McComas, J., Vollmer, T., & Kennedy, C. (2009). Descriptive analysis: Quantification and examination of behavior-environment interactions. Journal of Applied Behavior Analysis, 42(2), 411-412. Roantree, C. F., & Kennedy, C. H. (2006). A paradoxical effect of pre-session attention on stereotypy: Antecedent attention as an establishing, not an abolishing, operation. Journal of Applied Behavior Analysis, 39(3), 381-384.

Scatter Plot Touchette, P. E., MacDonald, R. F., & Langer, S. N. (1985). A scatter plot for identifying stimulus control of problem behavior. Journal of Applied Behavior Analysis, 18(4), 343-351.

Photographic Schedules Knight, V., Sartini, E., & Spriggs, A. (2015). Evaluating visual activity schedules as evidence-based practice for individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders, 45(1), 157-178. Pierce, J. M., Spriggs, A. D., Gast, D. L., & Luscre, D. (2013). Effects of visual activity schedules on independent classroom transitions for students with

118 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

autism. International Journal of Disability, Development and Education, 60(3), 253-269. Sprinkle, E. C., & Miguel, C. F. (2013). Establishing derived textual activity schedules in children with autism. Behavioral Interventions, 28(3), 185-202.

Positive Reinforcement Luczynski, K. C., & Hanley, G. P. (2014). How should periods without social interaction be scheduled? Children’s preference for practical schedules of positive reinforcement. Journal of Applied Behavior Analysis, 47(3), 500-522. Payne, S. W., & Dozier, C. L. (2013). Positive reinforcement as treatment for problem behavior maintained by negative reinforcement. Journal of Applied Behavior Analysis, 46(3), 699-703. Prykanowski, D. A., Conroy, M. A., & Reichow, B. (2021). Schedule thinning during functional communication training in the home for young children with autism. Journal of Positive Behavior Interventions, 23(4), 257-271.

Premack Principle Horan, J. J., & Johnson, R. G. (1971). Coverant conditioning through a selfmanagement application of the Premack principle: Its effect on weight reduction. Journal of Behavior Therapy and Experimental Psychiatry, 2(4), 243-249. Welsh, D. H., Bernstein, D. J., & Luthans, F. (1992). Application of the Premack principle of reinforcement to the quality performance of service employees. Journal of Organizational Behavior Management, 13(1), 9-32.

Reading Intervention Coleman, M., & Vaughn, S. (2000). Reading interventions for students with emotional/behavioral disorders. Behavioral Disorders, 25(2), 93–104. Giess, S. A., Rivers, K. O., Kennedy, K., & Lombardino, L. J. (2012). Effects of multisensory phonics-based training on the word recognition and spelling skills of adolescents with reading disabilities. International Journal of Special Education, 27(1), 60-73. Hwee, N. K., & Houghton, S. (2011). The effectiveness of Orton-Gillinghambased instruction with Singaporean children with specific reading disability (dyslexia). British Journal of Special Education, 38(3), 143-149. Steinle, P. K., Stevens, E., & Vaughn, S. (2022). Fluency interventions for struggling readers in grades 6 to 12: A Research Synthesis. Journal of Learning Disabilities, 55(1), 3-21.

Response Cards Duchaine, E. L., Green, K. B., & Jolivette, K. (2011). Using response cards as a class-wide intervention to decrease challenging behavior. Beyond Behavior, 20(1), 3-10.

Case Study Two — Merve | 119

Marsh, R. J., Cumming, T. M., Randolph, J. J., & Michaels, S. (in press). Updated meta-analysis of the research on response cards. Journal of Behavioral Education.

Self-Talk and Self-Management Lee, S., Wang, T., & Ren, X. (2020). Inner speech in the learning context and the prediction of students’ learning strategy and academic performance. Educational Psychology, 40(5), 535-549. Winsler, A., Abar, B., Feder, M. A., Schunn, C., & Rubio, D. A. (2007). Private speech and executive functioning among high-functioning children with Autistic Spectrum Disorders. Journal of Autism and Developmental Disorders, 37(9), 1617-1635.

Role of Choice Deel, N. M., Brodhead, M. T., Akers, J. S., White, A. N., & Miranda, D. R. (2021). Teaching choice-making within activity schedules to children with autism. Behavioral Interventions, 36(4), 731-744. Dunlap, G., dePerczel, M., Clarke, S., Wilson, D., Wright, S., White, R., & Gomez, A. (1994). Choice making to promote adaptive behavior for students with emotional and behavioral challenges. Journal of Applied Behavior Analysis, 27(3), 505-518.

Social Initiations and Pivotal Responses Koegel, R. L., Bradshaw, J. L., Ashbaugh, K., & Koegel, L. K. (2014). Improving question-asking initiations in young children with Autism using pivotal response treatment. Journal of Autism and Developmental Disorders, 44(4), 816-827. Koegel, R. L., & Frea, W. D. (1993). Treatment of social behavior in autism through the modification of pivotal social skills. Journal of Applied Behavior Analysis, 26(3), 369-377. Mohammadzaheri, F., Koegel, L. K., Bakhshi, E., Khosrowabadi, R., & Soleymani, Z. (in press). The effect of teaching initiations on the communication of children with autism spectrum disorder: A randomized clinical trial. Journal of Autism and Developmental Disorders.

Time Delay Chazin, K. T., & Ledford, J/ R. (2021). Constant time delay and system of least prompts: efficiency and child preference. Journal of Behavioral Education, 30(4), 684-707. Doyle, P., Gast, D. L., & Wolery, M. (1990). Use of constant time delay in small group instruction: A study of observational and incidental learning. Journal of Special Education, 23(4), 369-385.

120 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

GENERAL REFERENCES Barrett, W., & Randall, L. (2004). Investigating the circle of friends approach: adaptations and implications for practice. Educational Psychology in Practice, 20(4), 353-368. Bennett, K., Reichow, B., & Wolery, M. (2011). Effects of structured teaching on the behavior of young children with disabilities. Focus on Autism and Other Developmental Disabilities, 26(3), 143-152. Bosch, S., & Fuqua, R. (2001). Behavioral cusps: A model for selecting target behaviors. Journal of Applied Behavior Analysis, 34(1), 123-125. Calabrese, R., Patterson, J., Liu, F., Goodvin, S., Hummel, C., & Nance, E. (2008). An appreciative inquiry into the Circle of Friends program: The benefits of social inclusion of students with disabilities. International Journal of Whole Schooling, 4(2), 20-49. Coleman, M.B., Hurley, K. J., & Cihak, D. F. (2012). Comparing teacher-directed and computer-assisted constant time delay for teaching functional sight words to students with moderate intellectual disability. Education and Training in Autism and Developmental Disabilities, 47(3), 280-292. Conderman, G., Bresnahan, V., & Hedin, L. (2012). Promoting active involvement in classrooms. Education Digest: Essential Readings Condensed for Quick Review, 77(6), 33-39. Harjusola-Webb, S., Parke Hubbell, S., & Bedesem, P. (2012). increasing prosocial behaviors of young children with disabilities in inclusive classrooms using a combination of peer-mediated intervention and social narratives. Beyond Behavior, 21(2), 29-36. Holland, L., & Low, J. (2010). Do children with autism use inner speech and visuospatial resources for the service of executive control? Evidence from suppression in dual tasks. British Journal of Developmental Psychology, 28(2), 369-391. Jennings, D., Hanline, M. F., & Woods, J. (2012). Using routines-based interventions in early childhood special education. Dimensions of Early Childhood, 40(2), 13-23. Kaiser, A. P., Ostrosky, M. M., & Alpertrady or n, C. L. (1993). Training teachers to use environmental arrangement and milieu teaching with non-vocal preschool children. Journal of the Association for Persons with Severe Handicaps, 18(3), 188-199. Kazdin, A. E. (1977). Assessing the clinical or applied importance of behavior change through social validation. Behavior Modification, 1(4), 427-452. Kern, L., Vorndran, C. M., Hilt, A., Ringdahl, J. E., Adelman, B. E., & Dunlap, G. (1998). Choice as an intervention to improve behavior: A review of the literature. Journal of Behavioral Education, 8(2), 151-169. Knight, M. G., Ross, D. E., Taylor, R. L., & Ramasamy, R. (2003). Constant time delay and interspersal of known items to teach sight words to students with mental retardation and learning disabilities. Education and Training in Developmental Disabilities, 38(2), 179-191. Knight, V, Sartini, E, & Spriggs, A. (2015). Evaluating visual activity schedules as evidence-based practice for individuals with autism spectrum dis-

Case Study Two — Merve | 121

orders. Journal of Autism and Developmental Disorders, 45(1), 157-178. Koegel, R. L., & Koegel, L. K. (2006). Pivotal response treatments for autism: Communication, social, and academic development. Baltimore, MD: Brookes Publishing Company. Mace, F. C., & Belfiore, P. (1990). Behavioral momentum in the treatment of escape-motivated stereotypy. Journal of Applied Behavior Analysis, 23(4), 507-514. McGinnis, E. (2012). Skillstreaming the elementary school child: A guide for teaching prosocial skills (3rd ed.). Champaign, IL, US: Research Press. O’Neill, R. E., Albin, R. W., Storey, K., Horner, R. H., & Sprague, J. R. (2015). Functional assessment and program development for problem behavior: A practical handbook (3rd edition). Stamford, CT: Cengage Publishing Company. Pierce, J. M., Spriggs, A. D., Gast, D. L., & Luscre, D. (2013). Effects of visual activity schedules on independent classroom transitions for students with autism. International Journal of Disability, Development and Education, 60(3), 253-269. Premack, D. (1959). Toward empirical behavioral laws: I. Positive reinforcement. Psychological Review, 66(4), 219-233. Pritchard, D., Hoerger, M., & Mace, F. C. (2014). Treatment relapse and behavioral momentum theory. Journal of Applied Behavior Analysis, 47(4), 814-833. Ritchey, K. D., & Goeke, J. L. (2006). Orton-Gillingham and Orton-Gillingham-Based reading instruction: A review of the literature. Journal of Special Education, 40(3), 171-183. Rosales-Ruiz, J., & Baer, D. M. (1997). Behavioral cusps: A developmental and pragmatic concept for behavior analysis. Journal of Aplied Behavior Analysis, 30(3), 533-544. Schmidt, C., & Stichter, J. P. (2012). The use of peer-mediated interventions to promote the generalization of social competence for adolescents with high-functioning autism and asperger’s syndrome. Exceptionality, 20(2), 94-113. Smith, G.J., McDougall, D., & Edelen-Smith, P. (2006). Behavioral cusps: A person-centered concept for establishing pivotal individual, family, and community behaviors and repertoires. Focus on Autism and Other Developmental Disabilities, 21(4), 223-229. Sprinkle, E. C., & Miguel, C. F. (2013). Establishing derived textual activity schedules in children with autism. Behavioral Interventions, 28(3), 185-202. Storey, K., & Post, M. (2017). Positive behavior supports in classrooms and schools: Effective and practical strategies for teachers and other service providers (2nd ed.). Springfield, IL: Charles C. Thomas Publisher, Inc. Winsler, A., Abar, B., Feder, M. A., Schunn, C., & Rubio, D. A. (2007). Private speech and executive functioning among high-functioning children with Autistic Spectrum Disorders. Journal of Autism and Developmental Disorders, 37(9), 1617-1635.

Case Study Three — Horatio Case Study Covers: • Learning Disability • High School

H

oratio is a 16-year-old high school student. He lives with his parents and his younger brother. Horatio is of mixed descent of Puerto Rican and European backgrounds. Horatio and his family members are bilingual in both speech and in reading. His teachers view him as having a “split personality” as he is sometimes actively engaged, funny, and a group leader. However, at other times he is sullen and defiant and will sometimes make rude (talking out) remarks to teachers when asked to perform academic tasks. He plays on the soccer and basketball teams at school and is a good athlete. Horatio is popular among his peers and is seen by them as a leader. On the weekends he volunteers at the boating club where he helps with maintenance on different sailing boats, and he gets to work as a volunteer crew member on boat trips on the bay. Horatio’s tentative career goal is to become a ship captain or other role in marine transportation after attending a maritime college program. Horatio’s academic performance is very mixed with his doing well in cooperative learning groups but poor in individual work such as on tests. His teachers formed a Student Study Team (SST) regarding Horatio. The lead teacher, Ms. Heumann, collects information regarding his academic performance and in the committee discussion it becomes clear that Horatio’s sullen and defiant behaviors occur any time that he is asked to read and present information during the class period or if he is asked to read something out loud. It is not clear if Horatio’s being bilingual impacts his reading skills. The SST recommends that Horatio be assessed by a reading disability expert, Ms. Emig, who conducts an assessment using the Peabody Individual Achievement Test-Revised (Markwardt, 1989), the 123

124 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

Comprehensive Test of Phonological Processing (Wagner et al., 2013), and the Kaufman Test of Educational Achievement (Kaufman & Kaufman, 2004). Some of these tests may have bias in culturally and linguistically diverse (CLD) populations the results have not been conclusive (Scheiber, 2016). Therefore, Ms. Emig chooses a variety of methods of assessment including curriculum-based measures (Vanderwood et al., 2014). These assessments indicate that Horatio’s overall reading ability is at the second-grade level. Horatio can identify letters and has some word recognition for up to two syllable words but his three or more-syllable word recognition and decoding skills are poor. Horatio has difficulty reading passages and sometimes struggles to answer literal or inferential comprehension questions about the passages. His written expression and spelling were also at a second-grade level. Also, his word recognition fluency and decoding fluency were at a third-grade level (his receptive skills precede expressive skills). Horatio has difficulty decoding words (especially multi-syllable words), which deceased his fluency in terms of reading speed, accuracy of decoding, and proper inflection. However, his listening comprehension, oral expression, and phonological awareness were all very good and are at or close to his grade level.

CASE STUDY EVALUATION Based upon the case study provided above, the following sections analyze the issues that arise in providing behavioral services and supports for Horatio. This analysis is based upon the Behavior Analyst Certification Board Task List 5th edition. Competencies addressed are Foundations, C: Measurement, Data Display, and Interpretation and Applications, E: Ethics (The Ethics Code for Behavior Analysts), F: Behavior Assessment, G: Behavior-Change Procedures, H: Selecting and Implementing Interventions, and I: Personnel Supervision and Management. These examples are provided as a guide to successfully resolving client case issues and developing competencies as behavior analysts. Behavior Assessment F-1 F-2

Review records and available data at the outset of the case. Determine the need for behavior-analytic services.

Case Study Three — Horatio | 125

F-3 F-4 F-5 F-6 F-7 F-8 F-9

Identify and prioritize socially significant behaviorchange goals. Conduct assessments of relevant skill strengths and deficits. Conduct preference assessments. Describe the common functions of problem behavior. Conduct a descriptive assessment of problem behavior. Conduct a functional analysis of problem behavior. Interpret functional assessment data.

The School Psychologist, Ms. Lee met with several different teachers of Horatio’s academic classes to assess the situation and provide recommendations. She interviews the teachers using the Functional Assessment Interview form (FAI) from O’Neill et al. (2015). See Figure 3.1 Ms. Lee also reviewed Horatio’s academic records. This collection of data provide the basic relevant information for the analysis, decision-making regarding an intervention, and confirm there is a need for behavior-analytic services. The challenging behaviors were identified, and a preliminary definition provided by the interview form: 1) “sullen behaviors involve Horatio becoming withdrawn and refusing to do academic work or to interact with others (peers or teacher)”; 2) “defiant behaviors involve Horatio refusing to follow classroom rules or directions from the teacher”; 3) talking out remarks are “remarks that are rude and disrupt instruction.” Ms. Lee observes Horatio in different academic classes using the FAST (Iwata & DeLeon, 2005), see Figure 3.2. Results from the FAST indicate that the function of Horatio’s behavior is escape. Since Ms. Lee is aware from her review of Horatio’s records that he does well in some classes but not in others, she is careful to conduct direct observational assessments when challenging behaviors are least likely to occur as well as when they are most likely to occur. This information concerning when the challenging behaviors are least likely to occur can often provide valuable information regarding environmental events or establishing operations that are keeping the challenging behaviors from occurring. The School Psychologist, Ms. Lee found that from her observation of Horatio and from the functional assessment interviews with teachers that the function of the challenging behaviors appears to be escape from reading tasks. This hypothesis is logical and supported by her use of functional assessment procedures and well as empirical evidence in

126 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 3.1. Functional Assessment Interview (FAI) — Horatio.

Case Study Three — Horatio | 127

128 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 3.1. — Continued.

Case Study Three — Horatio | 129

130 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 3.1. — Continued.

Case Study Three — Horatio | 131

132 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 3.1. — Continued.

the literature (Carter & Horner, 2009; Chard et al., 2008; Filter & Horner, 2009; McIntosh et al., 2006). For example, McIntosh et al. (2008) found that students with challenging behaviors whose identified function was to escape academic tasks had lower levels and growth rates in reading skills than students with other identified functions. In addition, they found that these lower skill levels were durable across multiple years and became more discrepant over time. Ms. Lee and the team decided that the function of the behaviors was clear from the functional assessment and that a functional analysis was not necessary.

Case Study Three — Horatio | 133 Figure 3.2. Functional Analysis Screening Tool — Horatio.

134 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

Measurement, Data Display, and Interpretation C-1 C-2

Establish operational definitions of behavior. Distinguish among direct, indirect, and product measures of behavior. C-3 Measure occurrence (e.g., frequency, rate, percentage). C-4 Measure temporal dimensions of behavior (e.g., duration, latency, interresponse time). C-5 Measure form and strength of behavior (e.g., topography, magnitude). C-6 Measure trials to criterion C-7 Design and implement sampling procedures (i.e., interval recording, time sampling). C-8 Evaluate the validity and reliability of measurement procedures. C-9 Select a measurement system to obtain representative data given the dimensions of behavior and the logistics of observing and recording. C-10 Graph data to communicate relevant quantitative relations (e.g., equal-interval graphs, bar graphs, cumulative records). C-11 Interpret graphed data. The definition of the behaviors was determined prior to self-observation and the Functional Assessment Interview (O’Neill et al., 2015), but the definitions were refined based upon observation prior to formal data collection. Operational definitions are provided in Table 3.1. Ms. Lee and the teachers take frequency data on Horatio’s sullen, defiant behavior, and talking out. These data are displayed in Table 3.2 and the data show that the challenging behaviors occur during English, Social Studies, and Chemistry (mean occurrences of 3.1 incidents per class period with a range of 0-6 per period) but not during Mathematics and Physical Education (zero incidents observed). The use of Curriculum-Based Measurement procedures allowed for ongoing assessment of Horatio’s skills and provided information regarding the effectiveness of the intervention procedures. CurriculumBased Measurement procedures are focused on ongoing monitoring of student progress and making instructional decisions based upon these formative assessments (Overton, 2015). These assessments took place during instructional sessions and thus allowed the instructor to modify the instruction in a timely manner. For example, Ms. Emig had

Case Study Three — Horatio | 135 Table 3.1. Operational Definitions of Behavior — Horatio.

Horatio read aloud (during a 1:1 instructional pull-out session with her) from a basal reader for one minute and the number of words read correctly per minute then constituted the decision-making metric for the teachers (Shinn et al., 1990). This information (see Table 3.3) allows for his teachers to continue to assess and monitor improvement (or

136 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Table 3.2. Frequency Count Data Collection — Horatio.

lack of) in Horatio’s decoding, fluency, and comprehension reading skills. For these reading skills, incidental instruction included cooperative learning, question answering, mapping, scaffolding, and question generation, but Horatio, like many students with learning disabilities, sometimes requires more explicit structured instruction. For Horatio, these were “themed instruction” (Williams, 1998), before reading (such as review of vocabulary), during reading (such as directing attention to difficult dimensions of the text), and after reading (asking Horatio to summarize the story) strategies (Lerner & Johns, 2015) and activating background knowledge (Ogle, 1986). Ms. Lee then followed the recommendation of Fuchs et al. (2015) in that curriculum-based measures be used to develop instructional programs in four ways: (a) to judge the appropriateness of the goal, (b) to assess the adequacy of student progress and the need to modify an existing program, (c) to contrast the efficacy of different treatments, and (d) to determine potentially effective strategies for modifying and enhancing instructional programs. One reason for the success of curriculum-based measures with Horatio is that it provided his teachers with

Case Study Three — Horatio | 137 Table 3.3. Number of Words Read Correctly Per Minute — Horatio.

specific and detailed data regarding his reading fluency needs and skills and that this increased knowledge was then used to guide decisions regarding the specific reading intervention to enhance Horatio’s oral reading fluency development (Grima-Farrell, 2014). A benefit of using curriculum-based measures is that CBM reading in English was as reliable and valid for bilingual students as for English-only students, and that CBM is sensitive to the reading progress of bilingual students (Baker & Good, 1995). Selecting and Implementing Interventions H-1 State intervention goals in observable and measurable terms. H-2 Identify potential interventions based on assessment results and the best available scientific evidence. H-3 Recommend intervention goals and strategies based on such factors as client preferences, supporting environments, risks, constraints, and social validity. H-4 When a target behavior is to be decreased, select an acceptable alternative behavior to be established or increased. H-5 Plan for possible unwanted effects when using reinforcement, extinction, and punishment procedures.

138 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

H-6 Monitor client progress and treatment integrity. H-7 Make data-based decisions about the effectiveness of the intervention and the need for treatment revision. H-8 Make data-based decisions about the need for ongoing services. H-9 Collaborate with others who support and/or provide services to clients. It will be important to focus on increasing Horatio’s reading skills as his challenging behaviors are tied to his academic difficulties related to reading. These positive academic skills may be viewed as replacement behaviors for his challenging escape behaviors from academic reading tasks. Since reading is his most difficult academic task it clearly makes sense to focus interventions on improving his reading skills (Algozzine et al., 2012; Chard et al., 2008; Lin et al., 2013). In order to increase Horatio’s reading fluency (the ability to read connected text rapidly, effortlessly, and automatically) it will be important to build Horatio’s sight vocabulary, his automaticity (knowing how to perform a task at a competent level without requiring conscious effort), and recognizing syllables (Compton et al., 2004; Jennings et al., 2014). Interventions such as repeated reading, read-along, paired reading, echo reading, and reading aloud to other audiences are found to be beneficial for Horatio (Lerner & Johns, 2015; MacDonald, 2010; Nelson et al., 2004; Olson, 2011). In order to address reading comprehension Horatio will need to be taught skills during non-reading times (such as use of text features, observing how text is organized), during reading (use of context clues, identifying the main ideas as he reads), and after reading (summarizing important points, drawing inferences) (Berkeley & Barber, 2014). Horatio is then taught reading comprehension skills with an intervention involving modeling, guided practice, independent practice, and corrective feedback (Edmonds et al., 2009;). Since Horatio is technologically savvy, he finds the use of different technology supports for reading such as the use of visual tools such as automatic scaffolding and layer concept maps (Yang, 2015) and the use of wikis (Lenz, 2014; Li & Chu, 2018) to be helpful. The use of a high-probability sequence for affecting reading fluency within academic assignments could be an effective intervention for Horatio. This procedure is to alter text difficulty by dividing longer paragraphs into shorter paragraphs, breaking long complex sentences into shorter simple sentences, and replacing multisyllabic terms with simpler synonyms (Vostal & Lee, 2011). Reduced text difficulty has

Case Study Three — Horatio | 139

been shown to increase response rate and establish momentum-like effects on reading behaviors. The high-probability sequence in reading has been based on increasing response rate and in increasing reinforcer delivery. Supplementing classroom instruction with well-targeted supplemental phonological awareness interventions such as the Phonological Awareness Training for Reading supplemental intervention (Lane et al., 2001), Corrective Reading Decoding (Strong et al., 2004), or multisensory approaches (Oakland et al., 1998; Simpson et al., 1992) are likely to benefit Horatio. Scaffolded instruction using the SRA FLEX Literacy is also found to be beneficial for Horatio. This approach uses a gradual-release model involving explicit modeling, guided practice, independent practice, assessment, and maintenance (Martella & Marchand-Martella, 2015). Related to this strategy is the use of semantic organizers (such as word webs or hierarchical maps) for reinforcing vocabulary development (Berkeley & Barber, 2014). Preciado et al. (2009) used a combination of 20 minutes of skill-level reading mastery, (b) 20 minutes of vocabulary instruction and review/ preview of the next day’s reading lesson, (c) 10 minutes to define the instructions for the next day’s independent practice task, and (d) 10 minutes to teach and review appropriate social skills (e.g., how to request assistance from a teacher and/or peer, and how to ask for a break from a task) in order implement effective literacy, instructional intervention, and positive behavior support to build a comprehensive intervention plan. This combination of approaches is also effective in assisting Horatio. The use of morphemic analysis (Berkeley & Barber, 2014) was found to be helpful for Horatio in understanding affixes and prefixes and to thus increase his understanding of new words that fit these patterns. Horatio will also need a replacement skill as he will be faced with challenging and difficult work in the future and will need to be able to calm himself and ask for an “out” or “pass” from the academic demand. The use of progressive delay training (PDT) to promote self-controlled choices for Horatio (i.e., selecting a larger, later reward over immediate escape from the difficult task) would potentially be an effective method for his having an alternative way of handling a difficult academic situation (Staubitz et al., 2020). This strategy could be combined with a self-monitoring procedure where Horatio observes and records his behavior during difficult academic demands to provide feedback on his successful use of the skill (Clemons et al., 2016).

140 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

Behavior-Change Procedures G-1 Use positive and negative reinforcement procedures to strengthen behavior. G-2 Use interventions based on motivating operations and discriminative stimuli. G-3 Establish and use conditioned reinforcers. G-4 Use stimulus and response prompts and fading (e.g., errorless, most-to-least, least-to-most, prompt delay, stimulus fading). G-5 Use modeling and imitation training. G-6 Use instructions and rules. G-7 Use shaping. G-8 Use chaining. G-9 Use discrete-trial, free-operant, and naturalistic teaching arrangements. G-10 Teach simple and conditional discriminations. G-11 Use Skinner’s analysis to teach verbal behavior. G-12 Use equivalence-based instruction. G-13 Use the high-probability instructional sequence. G-14 Use reinforcement procedures to weaken behavior (e.g., DRA, FCT, DRO, DRL, NCR). G-15 Use extinction. G-16 Use positive and negative punishment (e.g., time-out, response cost, overcorrection). G-17 Use token economies. G-18 Use group contingencies. G-19 Use contingency contracting. G-20 Use self-management strategies. G-21 Use procedures to promote stimulus and response generalization. G-22 Use procedures to promote maintenance. A reinforcement system for Horatio was tied into reading at home, progress in sight word vocabulary, increase in reading fluency, etc. In this system teachers posted on their class website information on Horatio’s performance (visible only to Horatio and his parents) which allowed the parents to deliver reinforcers (preferred foods and activities) for behaviors at home. The use of high interest reading materials such as sports and boating also was preferred by Horatio. It was also beneficial to use a reinforcement system for Horatio reading aloud in class (on material he had received instruction on [pre-teaching] and had

Case Study Three — Horatio | 141

mastered). Ms. Lee and the teachers consulted with Horatio about a reinforcement system for reading aloud in class (again, information to be shared with the parents for back up reinforcers at home) and to ensure that his reading ability has reached a level where he will not look incompetent or be embarrassed by his reading out loud in class. Personnel Supervision and Management I-1 I-2 I-3 I-4 I-5 I-6

I-7 I-8

State the reasons for using behavior-analytic supervision and the potential risks of ineffective supervision (e.g., poor client outcomes, poor supervisee performance). Establish clear performance expectations for the supervisor and supervisee. Select supervision goals based on an assessment of the supervisee’s skills. Train personnel to competently perform assessment and intervention procedures. Use performance monitoring, feedback, and reinforcement systems. Use a functional assessment approach (e.g., performance diagnostics) to identify variables affecting personnel performance. Use function-based strategies to improve personnel performance. Evaluate the effects of supervision (e.g., on client outcomes, on supervisee repertoires).

Reinforcement for behavior and feedback to Horatio, his parents, and his teachers would likely increase the effectiveness of the interventions. Feedback on the immediacy of the effects would be valuable information for each of the parties to have and it is likely that positive changes in Horatio’s reading ability would be reinforcing for all concerned. Since Horatio has many different teachers throughout his day it will be important that there is a point person/case manager to coordinate information and feedback regarding Horatio’s academic needs and outcomes (or lack of) from the interventions. Ms. Lee takes on the case manager responsibility for Horatio since it is easier for her to coordinate services and stay in touch with the Horatio’s teachers. Ms. Lee is responsible for overseeing that the reading and behavioral interventions are implemented correctly and with fidelity. Mr. Lee will also be responsible for working with the teachers who will be collecting data

142 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

and to oversee the data analysis and that it is shared among team members. Since she is not the direct supervisors of the teachers, she will need to work with the school principal of there are direct supervision issues that need to be addressed. The use of frequency counts of challenging behaviors, curriculumbased measurement, reading scores, and academic participation and performance in classes would provide valuable information regarding the success of the interventions. As there will be some change in instructional procedures for Horatio it will be important that his teachers have “buy in” regarding the plans. They also need to have the necessary skills for implementing the interventions. In-service training from or one to one mentoring of the teachers from Ms. Emig may be necessary for securing the support of others and also ensuring that they have the necessary skills. Ethics E-1 E-2 E-3 E-4 E-5 E-6 E-7

Introduction. Responsibility as a Professional. Responsibility in Practice. Responsibility to Clients and Stakeholders. Responsibility to Supervisees and Trainees. Responsibility in Public Statements. Responsibility in Research.

Ms. Lee maintains and expands her professional competence by attending conferences and reading literature from professional journals. She is careful to pay close attention to technology and literacy instruction since technology is such an area of rapid innovation. It will also be an important intervention for Ms. Lee and other professionals to help inform Horatio about his rights and responsibilities as a student and individual with a disability. He will need to develop the capacity to make informed decisions so that he can have the ability to select and express his choices and have the ability to engage in a rational process of decision making (Cooper et al., 2020). In order for Horatio to be more independent and self-directed, Ms. Lee and several other teachers briefly describe possible interventions to Horatio and provide a brief trial intervention for each possible intervention so that he can make an informed choice about preferences that he may have for interventions (Agran & Wehmeyer, 2010; Agran et al., 2008).

Case Study Three — Horatio | 143

Contingency Contracts Self-Monitoring (Meta-Cognition) Horatio needs to develop self-awareness as to when he is confronted with a text that is difficult and beyond his current skill level. This also touches on problem solving. Horatio will experience texts that are more difficult and he will need to know what resources are available for those situations. To prepare Horatio for generalized problem solving for reading while in school he should have access to texts at various levels with tools for completing the assignment. For example, given a text that includes unknown words, and a 6th grade reading level Horatio can choose to have the text read to him from the computer or device using the computers accessibility features.

Collaboration with Others It will be necessary for the teachers to collaborate with each other and then with Horatio and his parents. This communication with his parents could include phone calls, emails, texts, teacher/parent meetings, and/or regular progress reports (Storey & Post, 2017).

Legal Issues The SST may want to consider 504 accommodations for Horatio or that he receives services under the Individuals with Disabilities Education Act (Giuliani, 2012; Siegel, 2020). It is Horatio’s legal right to these services if he qualifies for them so he and his family as well as the educational staff should not hesitate to advocate for appropriate services if he will benefit from them (Colker & Waterstone, 2011).

Quality of Life Physical Well-Being Horatio is currently in excellent physical condition due to his sports teams and his boating activities. His overall health is good as is his nu-

144 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

trition. This is not an area of concern for him. Material Well-Being Currently Horatio’s material well-being is fine. His family lives in a nice neighborhood and his material possessions are typical for someone his age. He currently does not have a job but would like to so that he has income of his own and it not as dependent upon his parents for material possessions or community activities. Interpersonal Well-Being Horatio’s interpersonal relationships are strong. His family life is good and his parents are supportive of him. He has many friends and has an active social life. His community involvement is also good due to his volunteering with the sailboats which involves him with positive adult role models. Productive Well-Being Horatio’s productive well-being is also good. He has choice and control in his life that is appropriate for someone his age and he engages in constructive activities through his hobbies. Emotional Well-Being This is an area of concern for Horatio. He has difficulties and support needs regarding his mental health, stress, and self-esteem. These are mainly directly related to his academic issues. Successful interventions for his academic issues are likely to alleviate these concerns and thus appropriate academic interventions are of critical concern for his longterm quality of life in this area. Rights and Inclusion It is important that Horatio start to learn about his legal rights as an individual with a documented disability and as he gets older and starts the transition process to adult life, he will need to have information and skills for this quality of life area. Self-advocacy will be an important skill for Horatio to have so that he can self-advocate for his rights and not be dependent upon others in this area.

Case Study Three — Horatio | 145

FOUNDATIONAL AND LIFESTYLE STRATEGIES Person-Centered Planning Since Horatio is approaching his transition from high school to college and/or career it may be beneficial to have an informal PCP meeting (O’Brien & Mount, 2006; 2015). An informal PCP meeting would be appropriate at this point in time and it should include family, friends, and school staff (Falvey et al., 1997; Taylor, 1997). It could also be combined with PCP meetings concerning his friends who are also facing the transition to adult life as well to make it a fun and festive occasion for everyone.

Supports Teachers/Service Providers Each of Horatio’s teachers will need information on appropriate reading interventions that they can implement in their classrooms. One teacher (probably Ms. Emig) should be designated for providing this information and for collecting assessment information regarding the effectiveness of the interventions. The Neurodiverse Person Horatio will benefit from receiving information regarding his reading interventions so that he can understand both why and how the interventions are being implemented. Providing information to Horatio about his learning disability would also be appropriate (Levine, 2004). Horatio would benefit from access to web site support (e.g., https:// learningally.org) and online support groups found on social media. Family Members Horatio’s parents are worried about his academic performance and want to support him. However, they are not experts in reading, literacy, or learning disabilities so it will be important that Horatio’s parents receive information regarding support strategies for Horatio that are written in a non-technical language and provide specific strategies with examples of how they can assist him with reading at home. Website

146 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

such as LD Online (http://www.ldonline.org/parents) would be a helpful site for resources for the parents. Technological Supports A variety of instructional strategies using technology may be helpful for Horatio. For example. Horatio could video himself reading out loud so that he can self-evaluate his strengths and weaknesses with both visual and auditory stimuli (Laverick, 2014). Vocabulary words and main story ideas can be presented through a variety of electronic methods such as PowerPoint, podcasts, or apps using Horatio’s computer, smart phone, or other electronic devices (Toonder & Sawyer, 2021). There are a variety of apps and software programs available such as Lexia: Strategies for Older Students (Lexia SOS) or Strategic Reader that Horatio might find useful (Hall et al., 2015; Kennedy & Deshler, 2010; Kennedy et al., 2014; Regan et al., 2014) and free access to textbooks through organizations such as Bookshare.org. Instructional Supports As noted above, Horatio’s teachers will need to change their instruction regarding how Horatio is being taught reading skills. These changes would of course help Horatio but there are likely other students in his courses who could benefit from this differentiated instruction as well

DISCUSSION QUESTIONS 1.

2. 3.

Would focusing on support strategies such as self-management, anger control, or stress reduction be sufficient for changing Horatio’s challenging behaviors and thus alleviate the need for changing the instructional environment? Is academic instruction by itself enough to reduce Horatio’s challenging behaviors? Since Horatio has many skills and meaningful activities outside of school times how important is his ability to read since he seems to generally be doing well with his current reading skill level?

Case Study Three — Horatio | 147

EMPIRICAL RESEARCH TO SUPPORT THAT THE INTERVENTION IS AN EVIDENCE-BASED PRACTICE Supports Functional Assessment, Positive Behavior Supports and Academic Interventions Bunch-Crump, K. R., & Lo, Y. Y. (2017). An investigation of multitiered behavioral interventions on disruptive behavior and academic engagement of elementary students. Journal of Positive Behavior Interventions, 19(4), 216-227. Carter, D. R. & Horner, R. H. (2009). Adding functional behavioral assessment to First Step to Success: A case study. Journal of Positive Behavior Interventions, 11(1), 22-34. Filter, K. J., & Horner, R. H. (2009). Function-based academic interventions for problem behavior. Education and Treatment of Children, 32(1), 1-20. Iwata, B., DeLeon, I., & Roscoe, E. (2013). Reliability and validity of the Functional Analysis Screening Tool. Journal of Applied Behavior Analysis. 46(1). 271-284. Larson, K. E., Pas, E. T., Bottiani, J. H., Kush, J. M., & Bradshaw, C. P. (2021). A multidimensional and multilevel examination of student engagement and secondary school teachers’ use of classroom management practices. Journal of Positive Behavior Interventions. 23(3), 149-162.

Reading and Literacy Instruction Chen, C. M., & Huang, S. H. (2014). Web-based reading annotation system with an attention-based self-regulated learning mechanism for promoting reading performance. British Journal of Educational Technology, 45(5), 959-980. Compton, D. L., Appleton, A. C., & Hosp, M. K. (2004). Exploring the relationship between text-leveling systems and reading accuracy and fluency in second-grade students who are average and poor decoders. Learning Disabilities Research and Practice, 19(3), 176-184. Grima-Farrell, C. (2014). Curriculum-based measurement of oral reading fluency (CBM- R): An objective orientated evaluation study. Support for Learning, 29(4), 370-393. Hall, T. E., Cohen, N., Vue, G., & Ganley, P. (2015). Addressing Learning Disabilities with UDL and technology: Strategic Reader. Learning Disability Quarterly, 38(2), 72-83. Li, X., & Chu, S. K. (2018). Using design-based research methodology to develop a pedagogy for teaching and learning of Chinese writing with wiki among Chinese upper primary school students. Computers and Education, 126(1), 359-375.

148 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

Jenkins, J. R., Fuchs, L. S., van den Broek, P., Espin, C., & Deno, S. L. (2003). Accuracy and fluency in list and context reading of skilled and RD groups: Absolute and relative performance levels. Learning Disabilities Research and Practice, 18(4), 237-245. Kennedy, M. J., Thomas, C. N., Meyer, J. P., Alves, K. D., & Lloyd, J. W. (2014). Using evidence-based multimedia to improve vocabulary performance of adolescents with LD: A UDL approach. Learning Disability Quarterly, 37(2), 71-86. Lane, K. L., O’Shaughnessy, T. E., Lambros, K. M., Gresham, F. M., & BeebeFrankenberger, M. E. (2001). The efficacy of phonological awareness training with first-grade students who have behavior problems and reading difficulties. Journal of Emotional and Behavioral Disorders, 9(4), 219-231. MacDonald, P. (2010). Paired reading: A structured approach to raising attainment in literacy. Support for Learning, 25(1), 15-23. Nelson, J., Alber, S., & Gordy, A. (2004). Effects of systematic error correction and repeated readings on the reading accuracy and proficiency of second graders with disabilities. Education and Treatment of Children, 27(3), 186-198. Oakland, T., Black, J. L., Stanford, G., Nussbaum, N. L., & Balise, R. R. (1998). An evaluation of the Dyslexia Training Program: A multisensory method for promoting reading in students with reading disabilities. Journal of Learning Disabilities, 31(2), 140-147. Olson, P. (2011). Weaker readers as experts: Preferential instruction and the fluency improvement of lower performing student tutors. Reading Improvement, 48(4), 157-167. Preciado, J., Horner, R. H., & Baker, S. (2009). Using a function-based approach to decrease problem behavior and increase academic engagement for Latino English Language Learners. Journal of Special Education, 42(4), 227-240. Regan, K., Berkeley, S., Hughes, M., Kirby, S. (2014). Effects of computer-assisted instruction for struggling elementary readers with disabilities. Journal of Special Education, 48(2), 106-119. Simpson, S. B., Swanson, J. M., & Kunkel, K. (1992). The impact of an intensive multisensory reading program on a population of learning-disabled delinquents. Annals of Dyslexia, 42(1), 54-66. Steinle, P. K., Stevens, E., & Vaughn, S. (2022). Fluency interventions for struggling readers in grades 6 to 12: A research synthesis. Journal of Learning Disabilities, 55(1), 3-21. Washburn, J. (2022). Reviewing evidence on the relations between oral reading fluency and reading comprehension for adolescents. Journal of Learning Disabilities, 55(1), 22-42. Yang, Y. F. (2015). Automatic scaffolding and measurement of concept mapping for EFL students to write summaries. Journal of Educational Technology and Society 18(4), 273-286.

Case Study Three — Horatio | 149

Self-Control Clemons, L. L., Mason, B. A., Garrison-Kane, L., & Wills, H. P. (2016). Selfmonitoring for high-school students with disabilities: A cross-categorical investigation of I-Connect. Journal of Positive Behavior Interventions, 18(3), 145-155. Staubitz, J. L., Lloyd, B. P., & Reed, D. D. (2020). Effects of self-control training for elementary students with emotional and behavioral disorders. Journal of Applied Behavior Analysis, 53(2), 857-874.

Self-Determination Agran, M., Wehmeyer, M., Palmer, S., & Cavin, M. (2008). Promoting student active classroom participation skills through instruction to promote selfregulated learning and self-determination. Career Development for Exceptional Individuals, 31(2), 106-114. Raley, S. K., Shogren, K. A., Rifenbark, G. G., Lane, K. L., & Pace, J. R. (2021). The impact of the self-determined learning model of instruction on student self-determination in inclusive, secondary classrooms. Remedial and Special Education, 42(6), 363-373.

GENERAL REFERENCES Agran, M., & Wehmeyer, M. (2010). Promoting self-regulated learning. In A. Mourad & J. de la Fuente Arias (Eds.), International perspectives on applying self-regulated learning in different settings (pp. 205-224). New York: Peter Lang Publishing. Algozzine, R., Putnam, R., & Horner, R. (2012). Support for teaching students with learning disabilities academic skills and social behaviors within a response-to-intervention model: Why it doesn’t matter what comes first. Insights on Learning Disabilities: From Prevailing Theories to Validated Practices, 9(1), 7-36. Baker, S. K., & Good, R. (1995). Curriculum-based measurement of English reading with bilingual Hispanic students: A validation study with secondgradestudents. School Psychology Review, 24(4), 561-578. Benner, G. J., Nelson, J. R., Ralston, N. C., & Mooney, P. (2010). A metaanalysis of the effects of reading instruction on the reading skills of students with or at risk of behavioral disorders. Behavioral Disorders, 35(2), 86-102. Berkeley, S., & Barber, A.T. (2014). Maximizing effectiveness of reading comprehension instruction in diverse classroom. Baltimore, MD: Paul Brookes Publishing Company. Carter, D. R., & Horner, R. H. (2009). Adding functional behavioral assessment to First Step to Success: A case study. Journal of Positive Behavior Interventions, 11(1), 22-34.

150 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

Chard, D., Harn, B., Sugai, G., Horner, R., Simmons, D. C., & Kame’enui, E. (2008). Core features of multi-tiered systems of reading and behavioral support. In C. Greenwood, T. Kratochwill, & M. Clements (Eds.), Schoolwide Prevention Models: Lessons Learned in Elementary Schools (pp. 31-60). New York, NY: Guilford Press. Colker, R., & Waterstone, J. K. (2011). Special education advocacy. New Providence, NJ: LexisNexis. Cooper, J. O., Heron, E. T., & Heward, W. L. (2020). Applied behavior analysis (3rd ed.). Hobson, NJ: Pearson. Edmonds, M. S., Vaughn, S., Wexler, J., Reutebuch, C., Cable, A., Tackett, K. K., & Schnakenberg, J. W. (2009). A synthesis of reading interventions and effects on reading comprehension outcomes for older struggling students. Review of Educational Research, 79(1), 262-300. Falvey, M., Forest, M., Pearpoint, J., & Rosenberg, R. (1997). All my life’s a circle: Using the Tools: Circles, MAPS and PATH. Toronto, ON, Canada: Inclusion Press. Fuchs, D., Fuchs, L. S., Benowitz, S., & Berringer, K. (1987). Norm-referenced tests: Are they valid for use with handicapped students? Exceptional Children, 54(3), 263-271. Fuchs, L. S., Fuchs, D., Seethaler, P. M., & Craddock, C. (2020). Improving language comprehension to enhance word-problem solving. Reading and Writing Quarterly, 36(2), 142-156 Giuliani, G. A. (2012). The comprehensive guide to special education law: Over 400 frequently asked questions and answers every educator needs to know about the legal rights of exceptional children and their parents. Philadelphia, PA: Jessica Kingsley Publishers. Iwata, B., & DeLeon, I. (2005). The Functional Analysis Screening Tool. Gainesville, FL: The Florida Center on Self-Injury, University of Florida. Jennings, J. H., Caldwell, J. S., Lerner, J. W. (2014). Reading problems: Assessment and teaching strategies (7th ed.). Boston, MA: Pearson. Kaufman, A. S., & Kaufman, N. L. (2004). Kaufman test of educational achievement (2nd ed.). Circle Pine, MN: AGS Publishing. Kennedy, M. J., & Deschler, D. D. (2010). Literacy instruction, technology, and students with learning disabilities: Research we have, research we need. Learning Disability Quarterly, 33(4), 289-298. Laverick, D. M. (2014). Supporting striving readers through technology-based instruction. Reading Improvement, 51(1), 11-19. Lenz, C. (2014). Can we talk? A model for active reading comprehension using technology. Journal of Adolescent and Adult Literacy, 58(2), 109-109. Lerner, J.W., & Johns, B. H. (2015). Learning disabilities and related disabilities: Strategies for success (13th ed.). Stamford, CT: Cengage. Levine, M. (2004). Ready or not, here life comes. New York: Simon & Schuster. Lin, Y., Morgan, P. L., Hillemeier, M., Cook, M., Maczuga, S., & Farkas, G. (2013). Reading, mathematics, and behavioral difficulties interrelate: Evidence from a cross-lagged panel design and population-based sample of US upper elementary students. Behavioral Disorders, 38(4), 212-227. Markwardt, F. C. (1989). Peabody individual achievement test-revised. Circle Pine, MN: AGS Publishing.

Case Study Three — Horatio | 151

Martella, R. C., & Marchand-Martella, N. E. (2015). Improving classroom behavior through effective instruction: An illustrative program example using SRA FLEX Literacy. Education and Treatment of Children, 38(2), 241-271. McIntosh, K., Chard, D., Boland, J., & Horner, R. H. (2006). Demonstration of combined efforts in school-wide academic and behavioral systems and incidence of reading and behavior challenges in early elementary grades. Journal of Positive Behavior Interventions, 8(3), 146-154. McIntosh, K., Horner, R. H., Chard, D. J., Dickey, C. R., & Braun, D. H. (2008). Reading skills and function of problem behavior in typical school settings. Journal of Special Education, 42(3), 131-147. O’Brien, J., & Mount, B. (2006). Make a difference: A guidebook for person-centered direct support. Toronto, ON, Canada: Inclusion Press. O’Brien, J., & Mount, B. (2015). Pathfinders: People with developmental disabilities & their allies building communities that work better for everybody. Toronto, ON, Canada: Inclusion Press. Ogle, D. M. (1986). K-W-L: A teaching model that develops active reading of expository text. Reading Teacher, 39(6), 564-570. O’Neill, R. E., Albin, R. W., Storey, K., Horner, R. H., & Sprague, J. R. (2015). Functional assessment and program development for problem behavior: A practical handbook (3rd edition). Stamford, CT: Cengage Publishing Company. Overton, T. (2015). Assessing learners with special needs: An applied approach (8th edition). Boston, MA: Pearson. Roberts, E. L, Ju, S., & Zhang, D. (2016). Review of practices that promote self-advocacy for students with disabilities. Journal of Disability Policy Studies, 26(4), 209-220. Scheiber, C. (2016). Do the Kaufman tests of cognitive ability and academic achievement display construct bias across a representative sample of Black, Hispanic, and Caucasian school-age children in grades 1 through 12?. Psychological assessment, 28(8), 942-952. Shinn, M. R., Knutson, N., & Nolet, V. (1990). Best practices in curriculumbased measurement. In A. Thomas & J. Grimes (Eds.), Best Practices in School Psychology (2nd Ed.), (pp. 287-308). Washington, DC: National Association of School Psychologists. Siegel, L. M. (2020). The complete IEP guide: How to advocate for your special ed child (10th ed.). Berkeley, CA: Nolo. Spear-Swerling, L. (2022). Structured literacy interventions: Teaching students with reading difficulties, grades K-6. New York, NY: Guilford Press. Storey, K., & Post, M. (2017). Positive behavior supports in classrooms and schools: Effective and practical strategies for teachers and other service providers (2nd ed.). Springfield, IL: Charles C. Thomas, Publisher, Ltd. Taylor, G. (1997). Community building in schools: Developing a circle of friends. Educational and Child Psychology, 14(3), 45–50. Toonder, S., & Sawyer, L. B. (2021). The impact of adaptive computer assisted instruction on reading comprehension: Identifying the main idea. Journal of Computer Assisted Learning, 37(5), 1336-1347. Vanderwood, M., Tung, C., & Hickey, R. (2014). Use of CBA/CBM with

152 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

culturally and linguistically diverse populations. In S. Little & A. AkinLittle (Eds.) Academic Assessment and Intervention (pp.179-196). New York: Routledge. Wagner, R., Torgesen, J., Rashotte, C., & Pearson, N. (2013). Comprehensive test of phonological processing (2nd Ed.). Pro-Ed. Austin, TX.

Case Study Four — Audrey Case Study Covers: • Intellectual Disability • Transition setting

A

udrey is a twenty-year-old student with an intellectual disability. She currently attends her school district’s transition program for students age 18-22. Audrey and her family want her to have a job in the community once she moves from the transition program into the adult service system. Audrey and her family have two cats and two dogs (an English Springer Spaniel and a Vizsla). Audrey is very involved in their care, and she takes the dogs for a walk every evening. Through these walks she has gotten to know many people in her neighborhood. On Saturday mornings, she goes with a group of her neighbors to the local dog park. This has given Audrey’s neighbors a chance to get to know her and they now see her as a fellow dog lover and as part of her community. Audrey’s older sister, Melissa, is in graduate school studying to be a veterinarian and Audrey has decided that she too wants to work in that field. With her executive functioning skills, Audrey is strong in initiating activities such as dog walking and in planning and organizing as she often helps to plan outings to the dog park through social media. Audrey struggles with executive functioning areas of emotional control and inhibiting impulses. The transition program is based out of an office in the downtown area. At the transition program Audrey is involved in doing tasks such as counting money, pretending to order food at a fast-food restaurant, and learning to stuff envelopes. At Audrey’s last IEP/ITP meeting (it was a self-directed IEP) she brought up her career goal of working in the veterinary field. This caused much consternation with the school staff and with the local adult service provider who was also attending the meeting. The school staff pointed out that Audrey’s ITP goals were focused on “prevocational” skills, which were getting her ready to work 153

154 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

in the community but that she had not yet met those goals. The school staff also pointed out that Audrey has never worked before and has several serious challenging behaviors, which make it difficult to do community instruction, let alone, get her ready to work in the community. These behaviors include biting her hand (showing bite marks and a couple of times drawing blood), screaming, and slamming her body into the wall. The school staff and Ms. Boyton (from the local adult day training program) made it quite clear that it was their professional opinion that someone with these challenging behaviors was not ready to work in the community and that such an expectation was very unrealistic. Ms. Boyton, pointed out that her program was very proud of their “state of the art” sheltered workshop which does subcontract work and prepares people to work in the community. She advised that Audrey might be better suited to their “behavioral adult day training program” which would provide specific behavioral services to get Audrey’s challenging behavior under control and then at that point she would be able to move into the sheltered workshop program and from there into a real job in the community. After much wrangling it was decided that there would be an independent assessment from a new supported employment program that also provides applied behavior analysis (ABA) services, which has started up in the community. The supported employment program brought in their assessor and job developer, Mr. Hastings, and also their BCBA Behavior Specialist, Ms. Grosche. They visited Audrey at the transition program and in her home. In addition, they visited the adult program that Ms. Boyton oversees. After visiting with Audrey and her family at their house and also visiting the adult program where Audrey attends Mr. Hastings develops job shadowing experiences for Audrey at three veterinary offices, the city’s animal shelter, and the local SPCA. Each of these are half day job shadowing situations where Audrey and Mr. Hastings observe different technicians at the sites as they do their different job duties. These experiences give both Audrey and Mr. Hastings the opportunity to analyze the types of job skills that Audrey might need and also what type of work environment would be most appropriate for Audrey. Following these job shadowing experiences, Mr. Hastings arranges a two week internship at the SPCA where Audrey works alongside one of the senior technicians who regularly supervises interns and volunteers. During this internship Mr. Hastings and Ms. Grosche both are there part of the time to observe Audrey but Audrey also has the opportunity to work directly with the technician on her own as well. This

Case Study Four — Audrey | 155

provides information on her skills, skills that she needs to learn, supports that will help her succeed, as well as her ability to fit in to the work situation During her visits at the day program and the internship location Ms. Grosche collects data on Audrey’s challenging behaviors using the FAOF Form (O’Neill et al., 2015).

CASE STUDY EVALUATION Based upon the case study provided above, the following sections analyze the issues that arise in providing behavioral services and supports for Audrey. This analysis is based upon the Behavior Analyst Certification Board Task List 5th edition. Competencies addressed are Foundations, C: Measurement, Data Display, and Interpretation and Applications, E: Ethics (The Ethics Code for Behavior Analysts), F: Behavior Assessment, G: Behavior-Change Procedures, H: Selecting and Implementing Interventions, and I: Personnel Supervision and Management. These examples are provided as a guide to successfully resolving client case issues and developing competencies as behavior analysts. Behavior Assessment F-1 F-2 F-3 F-4 F-5 F-6 F-7 F-8 F-9

Review records and available data at the outset of the case. Determine the need for behavior-analytic services. Identify and prioritize socially significant behaviorchange goals. Conduct assessments of relevant skill strengths and deficits. Conduct preference assessments. Describe the common functions of problem behavior. Conduct a descriptive assessment of problem behavior. Conduct a functional analysis of problem behavior. Interpret functional assessment data.

After reviewing the IEP, ITP, and other records the team determined that behavior analytic services were appropriate for supporting Audrey. A preliminary assessment was then conducted which included the interview Ms. Grosche conducted with Audrey and her parents using the

156 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

Functional Assessment Interview Form (FAI) from O’Neill et al (2015). Ms. Grosche conducted a separate interview with the school staff. Audrey’s family members, employers, and co-workers are not familiar with professional jargon and technical language so it will be important for professionals to describe situations and terms in language that is understandable to these important people in Audrey’s life. After completing the FAOF (O’Neill et al., 2015) it would be easy to use frequency counts for data collection on the hand biting, screaming, and slamming behaviors. These data could be collected using a continuous observation schedule. The challenging behaviors were identified, and a preliminary definition provided by the interview form: 1) “biting her hand,” 2) “screaming,” and 3) “slamming her body into the wall.” The data collected using the FAOF form indicated that in the school transition setting that the function of her challenging behaviors is escape from tasks. The results from the FAOF (Figure 4.1) and FAI (Figure 4.2) indicate that the function of Audrey’s “hand biting” and “body slamming” is to avoid tasks that she does not like (escape behaviors). The function of the “screaming” is to get attention. Using frequency counts for measuring Audrey’s challenging behaviors would provide useful information and be an easy method for the job coach or others to use. The FAOF form shows that biting the hand occurred six times (incidents 1, 2, 5, 6, 11, and 12) during math, pre-vocational (AKA pre-voc), and academics instructional times from 9:00- 12:00. Screaming occurred three times (incidents 3, 7, and 13) at the job site. Body slamming occurred six times (incidents 1, 4, 6, 8, 9, and 10) during math, pre-vocational, and academics instructional times from 9:00- 12:00. Incidents 1 and 6 involved the occurrences of hand biting and body slamming which occurred simultaneously. Under the Predictors section of the FAOF, all of the incidents of hand biting and body slamming occurred during non-preferred tasks while all of the incidents of screaming occurred when Audrey was alone or receiving no attention. Under the Perceived Functions section of the FAOF, the function of all of the incidents of hand biting and body slamming were scored as escape/avoid an activity and all of the incidents of screaming were hypothesized to get/obtain attention. In the Actual Consequence section of the FAOF, for the hand biting and body slamming occurrences staff physically stopped the behaviors. For all of the occurrences of screaming staff told Audrey to be quiet. The frequency data could best be presented in a line graph using an A-B design.

Figure 4.1. Functional Assessment Observation Form — Audrey.

Case Study Four — Audrey | 157

158 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 4.2. Functional Assessment Interview Form (FAI) — Audrey.

Case Study Four — Audrey | 159

160 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 4.2. — Continued.

Case Study Four — Audrey | 161

162 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 4.2. — Continued.

Case Study Four — Audrey | 163

164 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 4.2. — Continued.

Measurement, Data Display, and Interpretation C-1 C-2 C-3 C-4 C-5 C-6

Establish operational definitions of behavior. Distinguish among direct, indirect, and product measures of behavior. Measure occurrence (e.g., frequency, rate, percentage). Measure temporal dimensions of behavior (e.g., duration, latency, interresponse time). Measure form and strength of behavior (e.g., topography, magnitude). Measure trials to criterion.

Case Study Four — Audrey | 165

C-7

Design and implement sampling procedures (i.e., interval recording, time sampling). C-8 Evaluate the validity and reliability of measurement procedures. C-9 Select a measurement system to obtain representative data given the dimensions of behavior and the logistics of observing and recording. C-10 Graph data to communicate relevant quantitative relations (e.g., equal-interval graphs, bar graphs, cumulative records). C-11 Interpret graphed data.

The definition of the behaviors was determined prior to self-observation and data collection based upon the Functional Assessment Interview (FAI), but the definitions were refined based upon observation prior to formal data collection (see Table 4.1). Mr. Hastings uses the Work Performance Summary Form (Dymond, et al., 2014) to record and summarized Audrey’s performance and progress (see Figure 4.3). This documentation and analysis provides an understanding of Audrey’s performance within the specific job types and work sites that she is interested in and contributes to the decisionmaking process for a long-term job placement for Audrey. The use of a line graph with the frequency of Audrey’s challenging behaviors on the on the vertical axis and days along the horizontal axis would provide relevant information on the success of the placement and behavior change strategies for Audrey and would be easily understandable for Audrey and her family and for employers and co-workers. It could also be as important or even more important to track Audrey’s initiations towards co-workers. This could also be a line graph analyzing components such the frequency and type of interaction (initiating, continuing, terminating), where the interaction occurred, with whom the interaction occurred, the topic of the conversation, was it the appropriate social occasion, the right time, the task in which the person was engaged, and was it with an appropriate person (Storey, et al., 1997). Selecting and Implementing Interventions H-1 State intervention goals in observable and measurable terms. H-2 Identify potential interventions based on assessment

166 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Table 4.1. Operatiopnal Definitions of Behavior — Audrey.

The definition for hand biting: Hand-biting is inserting the hand past the plane of the lips and closing her teeth on the hand (Devlin et al., 2009). Occurrences: Hand in mouth with teeth touching hand and mouth closed, hand in mouth with teeth touching hand and mouth open. Non-Occurrences: Hand pressed up against mouth with mouth closed, arm in mouth with teeth touching arm. The definition for screaming: Screaming is a vocalization above normal conversational level (Galiatsatos & Graff, 2003; Graff et al., 1999). Occurrences: Yelling a word or phrase, making a non-word sound above a normal conversational level. Non-Occurrences: Saying a word or phrase at a normal conversational level, making a non-word sound at a normal conversational level. The definition for slamming her body into the wall: Body slams are when Audrey throws her body against a wall with her head, shoulder, hip, or leg making contact with the wall. Occurrences: Head making contact to the wall at the same time as her shoulder, her shoulder making contact with the wall with one or more feet off the ground, running head first into the wall. Non-Occurrences: Brushing against the wall while walking, leaning against the wall while standing, tripping over an item and falling against the wall

results and the best available scientific evidence. H-3 Recommend intervention goals and strategies based on such factors as client preferences, supporting environments, risks, constraints, and social validity. H-4 When a target behavior is to be decreased, select an acceptable alternative behavior to be established or increased. H-5 Plan for possible unwanted effects when using reinforce-

Case Study Four — Audrey | 167 Figure 4.3. Work Performance Summary Form — Audrey.

168 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 4.3. — Continued.

Case Study Four — Audrey | 169

170 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 4.3. Continued.

Case Study Four — Audrey | 171

H-6 H-7 H-8 H-9

ment, extinction, and punishment procedures. Monitor client progress and treatment integrity. Make data-based decisions about the effectiveness of the intervention and the need for treatment revision. Make data-based decisions about the need for ongoing services. Collaborate with others who support and/or provide services to clients.

Once Audrey is in the job sites, her hand biting rarely occurs and her body slamming does not occur at all. Her screaming, however, does continue though at reduced levels. A behavioral goal for reduction that is acceptable in the workplace is “Audrey will have zero incidents of screaming while at work for three consecutive workdays.” It will be extremely important that job skills be established and maintained for Audrey. The development of these skills could occur through job shadowing, internships, and summer work at different veterinary offices and local organizations such as the Society for the Prevention to Cruelty to Animals or the city animal shelters. It will be important that Audrey have the opportunity to work at different jobs and different tasks that make up the components of those jobs. Since Audrey may not have the skills to perform successfully at a whole job such as a veterinary technician, it may important to look at job carving positions where Audrey performs certain tasks such as cleaning cages and prepping examination rooms. This would allow the analysis of specific tasks that could be assigned to Audrey rather than expecting her to perform all of the complete job tasks for that position. Once a specific task has been identified the use of a task analysis can assist in the development of independent skills. A task analysis is a strategy that takes a complex task and breaks it down into smaller, teachable steps (Cooper et al., 2020). A sample task analysis for cleaning the kennel at a job site is provided in Figure 4.4. The sequential steps in this task analysis can be taught using either forward or backward chaining depending upon Audrey’s assessment results. Data would be taken on the training steps using this sample sheet. The skill would be taught using either least-tomost prompts or most-to-least depending upon the results of Audrey’s single opportunity assessment of the task, which can give an estimate of her skills (Scott, et al., 2013; Taber, et al., 2003). Audrey has had limited career exploration and/or job shadowing experiences. She has no experience working in community jobs and has little work experiences to draw upon for assessment or preferences.

172 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 4.4. Task Analysis for Cleaning Dog Kennel — Audrey.

Case Study Four — Audrey | 173

She has been taught skills in isolated contexts with no instruction on specific community jobs. She needs more job experience involving career exploration and job shadowing as well as job placement opportunities. A list activities and skills needed for each job that Audrey is interested in will guide the team on skill development goals that are specific to certain jobs. In addition, Audrey should be assessed by the state Department of Rehabilitation for becoming a client there. It is important that this occur after she has engaged in job shadowing, situational assessments, and had work opportunities so that she meets their criterion of “is able to benefit” from Department of Rehabilitation Services. The district needs to work with an adult service agency to make for a smooth transition from school to adult services for Audrey. This is known as “point of transition services” which is focused on making sure that Audrey has a job before she leaves the school system that she will keep so that there is continuity of services and the adult service agency only has to take over providing services (Certo et al., 1997; 2003). The adult service agency needs to be willing and able to start providing services (to take over the job coaching and other support needs) before Audrey exits the school system. As Audrey learns skills on her job site and her challenging behaviors are reduced or eliminated it will be possible to fade out behavior analysis and job coaching services. Increasing natural supports and self-management strategies in the workplace is likely to benefit Audrey and to maintain her skills. Supports from professionals include having the job coach checking in with Audrey and her employer on a regular schedule such as twice a month and then training Audrey on new skills regarding equipment or technology changes as needed (e.g., followalong services). While it would be possible to work on reducing Audrey’s challenging behaviors in the school setting as a precursor to her working in employment settings, a more efficient strategy is focused on curriculum modification and environmental rearrangement (O’Neill et al., 2015). Since the school tasks that Audrey is being taught are non-functional and are not tied to the criterion of ultimate functioning, it makes little sense to continue with them (Storey, 2022). Making these changes to the environment and curriculum (functional skills and a meaningful environment) may by themselves reduce or eliminate Audrey’s challenging behaviors. Teaching Audrey functional skills that relate to or are taught directly in the criterion environment (e.g., training and/or employment sites) may serve as replacement behaviors or they may

174 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

serve as skills that make her more competent in that setting and thus her deviant behaviors may be more likely to be tolerated by others in that setting. Gold (1980) stressed the importance of teaching skills that increase an individual’s competence and decreases their deviance1. Deviance equals aspects of an individual, which cause negative attention. Competence equals attributes and skills which not everyone else has, and which are appreciated and needed by someone else (Gold, 1980). It is important to note that the more competence an individual such as Audrey has, the more deviance from her that will be tolerated by others. The value placed on people is greatly influenced by how their deviance balanced against their competence in the eyes of others. Competence for Audrey then depends on whether the employer and co-workers value Audrey’s skills in their workplace. For example, Audrey may come to work groomed and dressed and not engage in any challenging behaviors. This may eliminate deviance but not lead to competence as the employer will be looking for Audrey to have skills in performing specific work tasks and getting along with others. Thus, Audrey’s instructional programs needs to have a balance between an intervention which is focused on reducing deviance and an intervention that is focused on teaching skills and thus results in establishing competencies for Audrey. As Gold (1980) emphasized, if there was only an intervention that reduced Audrey’s challenging behaviors the support providers might believe that they have done their job, but the employer would only see this as Audrey’s getting to “zero.” In this situation, any challenging behavior by Audrey would put her into the deviance category and likely result in her being fired. If Audrey is viewed by the employer and co-workers as having competence then they are more likely to tolerate or accept her deviant behaviors as long as her competence outweighs her deviance. Since the function of Audrey’s challenging behavior of screaming is to obtain attention an alternative behavior that serves the same function would be teaching Audrey appropriate ways of obtaining attention. Directly teaching Audrey social initiation skills towards co-workers and supervisors would be a logical replacement behavior so that Audrey is not dependent upon others to initiate interactions (Mautz et al., 2001; Park et al., 1991). It is recommended that teaching social initiation and interactions skills should use a combination of strategies 2. We use the term “deviance/deviant” in the historical context in which Gold framed the issue and in the context of skilled or behaviors which are judged by others to be undesirable and we in no way intend the use of the term to reinforce negative stereotypes of individuals with disabilities. Interested readers are referred to Johnson (2003) and Shapiro (1993) for insightful discussions of this larger issue.

Case Study Four — Audrey | 175

with modeling, role playing, and feedback being the most critical components to include (Storey, 2002). It will be important that social skills instruction consider the contextual variables of the environment as they relate to social initiations so that Audrey’s initiations do not interrupt on-task behaviors or work task completion by others (Chadsey et al., 1997; Chadsey-Rusch, 1992). Audrey’s hand biting and body slamming function as an escape from tasks in the school setting. Audrey needs an alternative behavior to communicate her desire for escape from tasks that are non-functional, non-preferred, and/or difficult. In addition to the environmental and antecedent interventions, she will need to communicate her desire to not participate in tasks or activities that are challenging or difficult. Functional commination training is a systematic method of teaching an alternative communication to replace the challenging behaviors; the replacement has to serve the same function as the challenging behavior (Carr & Durand, 1985; Durand, & Moskowitz, 2015). In Audrey’s case a short phrase such as “I need a break,” can serve the same function as hand biting or body slamming. The replacement behavior must be easier to engage in than the challenging behavior. Horner and Day (1991) demonstrated that the when the communicative alternative required less effort than the challenging behavior it occurred to the exclusion of the challenging behavior. The alternative communication must be efficient, it must be acceptable to the environment, to the learner, and must be recognized by multiple communicative partners (Tiger et al., 2008). Given this occurs in the school site the school personal will need to arrange opportunities and prompt the use of the replacement skill. The school staff will need to provide natural opportunities to use the communicative alternative response to ensure mastery and generalization of this skill. In addition, to maximize learning and the adoption of the alternative skill school staff may need to contrive opportunities to prompt and reinforce the communicative alternative. Behavior-Change Procedures G-1 Use positive and negative reinforcement procedures to strengthen behavior. G-2 Use interventions based on motivating operations and discriminative stimuli. G-3 Establish and use conditioned reinforcers. G-4 Use stimulus and response prompts and fading (e.g.,

176 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

G-5 G-6 G-7 G-8 G-9 G-10 G-11 G-12 G-13 G-14 G-15 G-16 G-17 G-18 G-19 G-20 G-21 G-22

errorless, most-to-least, least-to-most, prompt delay, stimulus fading). Use modeling and imitation training. Use instructions and rules. Use shaping. Use chaining. Use discrete-trial, free-operant, and naturalistic teaching arrangements. Teach simple and conditional discriminations. Use Skinner’s analysis to teach verbal behavior. Use equivalence-based instruction. Use the high-probability instructional sequence. Use reinforcement procedures to weaken behavior (e.g., DRA, FCT, DRO, DRL, NCR). Use extinction. Use positive and negative punishment (e.g., time-out, response cost, overcorrection). Use token economies. Use group contingencies. Use contingency contracting. Use self-management strategies. Use procedures to promote stimulus and response generalization. Use procedures to promote maintenance.

Since Audrey engages in screaming when she has not received attention, one component of an antecedent intervention would be to encourage co-workers to initiate interactions with Audrey (Storey & Garff, 1997). Also it would be very relevant to also teach Audrey how to initiate interactions with co-workers so that she is not dependent upon their initiations (Storey & Garff, 1997). For example, Storey et al. (1997) taught four adults with disabilities to interact appropriately with co-workers and supervisors using conversational script instruction (teaching initiation, sustaining, and terminating conversational skills) and question asking instruction (role playing question-asking conversational exchanges and expansion training appropriate to the conversational context). In both of these studies, conversational topics were socially validated by having co-workers and supervisors complete a questionnaire to determine topics of conversation that the preferred to have with their co-workers. As part of this instruction, it would be important to teach Audrey when it is appropriate to initiate to co-workers

Case Study Four — Audrey | 177

and what topics it is appropriate to talk about (slow work times when it is okay to interact socially versus work times when it is busy and only okay to initiate about relevant work topics). Effectiveness of the reduction in challenging behaviors could best be evaluated using an A-B design with a graph of the frequency of the biting, body slamming, and screaming behaviors. It will be important to teach Audrey appropriate discriminative stimuli for determining if it is an appropriate time or not to initiate a social interaction with a co-worker or employer. The use of video-modeling would be an appropriate intervention as it would assist in her understanding positive and negative exemplars and in evaluating subtle discriminative stimuli in the social context. The use of video peer modeling (VPM) would probably be most appropriate in this context. Video peer modeling could use co-workers and/or employers as the model in the tape. Specific target behaviors would be presented to Audrey as a form of observational learning so that she will imitate and generalize the particular skill or behavior to the context of the setting. Video modeling would allow Audrey to watch the video repeatedly in order to maximize the likelihood for skill acquisition and success (LeBlanc et al., 2003; Sigafoos et al., 2007). Social skills often do not generalize or maintain it will be important to incorporate specific intervention strategies for Audrey. In her work settings it will be important to assess for generalization across times, people (different co-workers), behaviors (different ways to initiating), and settings (work sites, lunchroom) and then intervention with a general case intervention (Albin & Horner, 1988). Social skills could be maintained by the use of self-administered consequences as in self-management strategies (Christian & Poling, 1997; Koegel et al.,1992) combined with a variable ratio reinforcement schedule, which could be thinned (but not eliminated over time). It would be possible to use a token economy in a variety of ways to support Audrey. This could easily be tied to her self-management system for maintenance of behavior where the self-monitoring component could be combined with a point system and backup reinforcers, which could be self-delivered at work (a special food item purchased at lunch) and/or at home (praise from parents and a special activity with her dogs and/or family). The use of incidental teaching strategies (also known as naturalistic teaching, non-intensive teaching, or minimal intervention) would likely be an effective intervention for Audrey. At her job site, Audrey’s job coach could use the “Wait-Ask-Say-Show-Do” steps incidental teaching

178 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

procedures. These five steps would be: 1. Wait for an opportunity where Audrey could self-initiate and interact with a co-worker. 2. Ask the generic question, “What do you need to do?” 3. Say what is expected (this would be a good time to “say good morning to Hugh and ask him how his weekend was.”). 4. Prompt to start the initiation. 5. Prompt Audrey to complete the interaction if necessary (Farmer-Dougan, 1994; McGee & Daly, 2007). Personnel Supervision and Management I-1 I-2 I-3 I-4 I-5 I-6

I-7 I-8

State the reasons for using behavior-analytic supervision and the potential risks of ineffective supervision (e.g., poor client outcomes, poor supervisee performance). Establish clear performance expectations for the supervisor and supervisee. Select supervision goals based on an assessment of the supervisee’s skills. Train personnel to competently perform assessment and intervention procedures. Use performance monitoring, feedback, and reinforcement systems. Use a functional assessment approach (e.g., performance diagnostics) to identify variables affecting personnel performance. Use function-based strategies to improve personnel performance. Evaluate the effects of supervision (e.g., on client outcomes, on supervisee repertoires).

If Audrey has a job coach at her employment site that individual will need training and support related to Audrey’s challenging behaviors as well as for assisting Audrey in learning her job tasks. Providing information, training, and evaluation to the job coaches and other services providers will be important for the maintenance of appropriate and high quality services for Audrey (Targett, 2007). Buckley et al. (1990) recommend that supports should relate to three variables, a) the individual (i.e., Audrey), b) the job performance of the individual, and

Case Study Four — Audrey | 179

c) the support organization. Buckley et al. (1990) suggest three major categories of support: a) direct strategies focused on supporting the individual (general case analysis, antecedent cue regulation, self-monitoring, self-delivery of consequences, rate, pacing, social skills instruction, positive behavior supports, and mobility instruction, b) indirect strategies focused on supporting others in the work setting (advocacy training, co-worker orientation and supports, supervisor communication training, and ongoing employer supports, and c) external strategies focused on supporting others outside of the work setting (parent/ advocate training, parent/advocate counseling, and agenda setting for service coordination). Albin (1992) suggests that supervision in supported employment settings be based upon quality improvement strategies and should involve troubleshooting of performance problems and performance engineering of solutions. Hardesty et al. (2014), Lebbon et al. (2012), and Wirth and Sigurdsson (2008) suggest looking broadly at staff supervision and support and recommend considering factors such as equipment, goal/objectives, skill level, supervision, process disconnect, feedback, reinforcement, and discipline/punishment. If Audrey is successful due to her receiving supported employment services should those services be phased out or terminated? It may be possible to move from job coach supports to natural supports or a combination of in order to build in continued assessment and maintenance of behavior for Audrey (Parent et al.,1994; Storey & Certo, 1996). Ethics E-1 Introduction. E-2 Responsibility as a Professional. E-3 Responsibility in Practice. E-4 Responsibility to Clients and Stakeholders. E-5 Responsibility to Supervisees and Trainees. E-6 Responsibility in Public Statements. E-7 Responsibility in Research. Those working with Audrey must make the professional and ethical decision whether or not Audrey should have a supported employment position in the community or if she should be placed in a segregated day program such as a sheltered workshop. They will also need to make a decision if they should base their intervention on the

180 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

preference of Audrey and her family that she have a supported employment position or if they as professionals, have a better understanding of the research and what is best for Audrey. Cooper et al. (2020) recommend evaluating a cost-benefit ratio of the cost of an intervention versus the benefits to the individual and society. In Audrey’s case, will the benefit to her and society be greater if she is earning an income and being a tax-paying citizen than if she is in a sheltered workshop where she is not earning a meaningful income and not paying taxes (Cimera et al., 2018)?

Executive Functioning Skills Shifting Attention If Audrey likes a task she is able to focus on it for extended time periods. If Audrey does not like a task, she has a very short attention span and after a short time on that task is likely to start engaging in challenging behaviors. The use of an auditory prompting procedure would be an appropriate self-management method for helping to keep her on-task (Montgomery et al., 2011). Inhibiting Impulses Audrey lacks the ability to control her impulses and to stop her challenging behaviors when she wants to avoid tasks or to get attention. This would require the use of an antecedent procedure such as teaching her to count to five when she wants to avoid a task or having a visual reminder such as a checklist (which has words or pictures for “stop,” “clasp hands together,” take a deep breath” before engaging in the avoidance behavior. Intervention components of self-instruction should include verbal pre-testing, contingent reinforcement, multiple exemplars, reminders to use self-instructional statements in performance, and self-reinforcement (Hughes & Agran, 1994). Emotional Control Audrey has difficulty managing her emotional responses appropriately. The use of an auditory prompting procedure could also be an appropriate self-management method for self-evaluation regarding her emotional control in certain situations. It could also be combined with

Case Study Four — Audrey | 181

a self-reinforcement system. Sometimes it is important to fade a support system while other times it is important to keep the system in place. If the auditory prompting procedure is successful, the support team may want to keep the system in place for Audrey. Self-Monitoring (Meta-Cognition) Currently Audrey does not have the ability to self-evaluate her behaviors and she does not have a formal self-monitoring system in place. Auditory prompting procedures could also be used for self-monitoring and self-evaluating her behaviors including her inhibiting impulses and emotional control behaviors (Post et al., 2009). Collaboration with Others In order for Audrey to gain experience in employment settings it will be important that collaboration occur between her family, the school district, and the supported employment program so that there is a seamless transition from the school program to the adult supported employment program (Certo et al., 2003). Simonsen et al. (2014) have outlined various roles for stakeholders in the seamless transition process. In this context Audrey will need to identify tasks that she performs well that might point to future job searches, identify areas of interest that will inform planning, and express her preferences about the type of job that she desires. Audrey’s family members will need to participate in meetings, share Audrey’s strengths, interests, and support needs, help Audrey negotiate with the transition partners, advocate for Audrey’s goals, and provide feedback to the transition partners. The school district staff will need to convene partners for collaborative planning. The Department of Rehabilitation staff will need to open a case for Audrey so that she is eligible for services prior to her school exit and potentially authorize payment for services for Audrey while she is still in school. The supported employment staff will need to participate in the transition planning, enter into contractual agreement with the school system and Department of Rehabilitation in order to provide services, and serve as a vendor to provide job coaching and other services after Audrey’s exit from the school system. A counselor from the Department of Rehabilitation could support Audrey in developing a resume and practice interviewing for jobs.

182 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

Legal Issues It will be important that all legal requirements of the IEP/ITP process be followed. The stated purpose of IDEA is “to ensure that all children with disabilities have available to them a free appropriate education that emphasized special education and related services designed to meet their unique needs and prepare them for further education, employment, and independent living” and thus the ITP process is a critical component of the education of students with disabilities. The transition process must be based on the needs, interests, preferences and strengths of the student and address a) instruction, b) related services, c) community experiences, d) employment and adult living experiences, and e) acquisition of daily living and functional vocational evaluation (Kaufman et al., 2014). The Department of Rehabilitation also has legal obligations to pay for services such as job development, job coaching, assistive devices, and other accommodations for individuals with a disability who are able to benefit from having a job (Simonsen et al., 2014). Services from the Department of Rehabilitation are usually time limited so Audrey must receive services in a timely manner. Also, adult service providers for individuals with intellectual/developmental disabilities have state legal requirements that they must meet and these would have to be considered for Audrey.

Quality of Life Physical Well-Being Audrey is in good physical health as she gets regular exercise walking her dogs. Her physical mobility is not a concern and having her dogs with her increases her personal safety in the community as does her often being in groups with other dog owners. Material Well-Being Audrey’s wealth, income, and security are likely to be tied to her having a supported employment position rather than working in a day program (Cimera, 2011, 2012). Her income may also influence her housing quality as well as a higher income will allow her to live in a nice apartment or house in a good neighborhood. If Audrey is placed into a segregated day program, it is likely that she will be stuck there

Case Study Four — Audrey | 183

for many years earning little money and not learning skills that are marketable in supported employment settings (Bellamy et al., 1986; Murphy & Rogan, 1995). Interpersonal Well-Being Audrey currently has good interpersonal relationships with her family as well as friends and social life with people in her neighborhood. Having a supported employment job will also open up more possibilities for interpersonal relationships to develop with individuals without an intellectual disability. If Audrey were to be placed in a day program, her interpersonal relationships at that site would only be with other people with intellectual disabilities. The supported employment position would be more likely to lead to community involvement and supportive social networks than the segregated day program. Productive Well-Being Currently Audrey has little choice and control over her employment options through the school district and the adult day program. Having her lead a self-directed IEP/ITP, do job shadowing, and internships will help develop her meaningful choices and control. In the day program, Audrey would have little opportunity for constructive activities while her having a supported employment position would provide those constructive activities (Storey, 2000). It will also be important to consider what Audrey’s home life will be like as she grows older. She and her family are planning on Audrey living at home for the next few years. However, she and her family may want to explore a supported living situation for Audrey. There would be different options for them to consider such as her living by herself, with a roommate with an intellectual disability, or a roommate without a disability (Lakin & Stancliffe, 2007). Audrey’s choice of living situation may not remain static as she grows older, gains more skills, and may want to try different situations and locations. Emotional Well-Being Audrey’s emotional well-being is likely to be tied to her social networks. Friend and co-workers without a disability are likely to provide adequate reciprocity and social networks that benefit Audrey’s emotional well-being needs (Kennedy et al., 1989; Newton et al, 1994; Newton et al., 1996). Analysis by Bele and Kvalsund (2015) indicates

184 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

that being placed in segregated placements during upper secondary school have a negative effect on being in having an adequate and supporting social network at age 24. Forrester-Jones et al. (2004) found that having a supported employment position increased the social networks of individuals with intellectual disabilities. Thus, it is important that Audrey develop these networks in inclusive settings and before she exits the school system and that she has a supported employment position before she graduates from school that she will continue in. Rights and Inclusion As an adult Audrey may want to become involved in civil roles and responsibilities in her community. This could be in relation to her involvement with dogs and other animals such as city policies on dog parks, serving on boards such as at the SPCA or in other areas that may interest Audrey. Having a supported employment position may open up opportunities for Audrey to be civically involved in her community.

FOUNDATIONAL AND LIFESTYLE STRATEGIES Person-Centered Planning Person-centered planning will be a key component for developing an appropriate and successful intervention for Audrey, especially since the school district and adult service provider have a very different vision for Audrey than what she, her family, and the supported employment agency have. In preparation for person-centered planning, it is important that the team consider cultural and familial issues. Does person-directed advocacy match to the family’s cultural heritage? Other considerations are the cultures impact on housing some families expect their children to live at home with extended family and others would expect community housing with peers. These need to be considered and presented in the person-centered plan. Supporting Audrey in having a self-directed IEP/ITP could help ensure that her school objectives and outcomes are what she desires (Martin & Williams-Diehm, 2013). Woods et al. (2010) recommend that students be taught content knowledge about the transition process and then develop a script that provides information for the student to lead a discussion regarding their academic and functional performance, interests, post-school and

Case Study Four — Audrey | 185

transition goals, and connecting with adult support services.

Physical, Medical, Psychological, or Mental Health Issues Physical and medical components are not of concern for Audrey. Psychological and Mental Health issues may arise if her self-injury continues. If Audrey goes into a segregated setting, such as a day program, this segregation may cause Audrey to lack an adequate social support network (which often involves co-workers who are capable of providing such support) and then the stress and difficulty that she is going through may be substantially increased and lead to psychological or mental health issues (Goleman, 2006; Kaufmann & Meyer, 2013). Friends, co-workers, and family members are more likely to be stable in Audrey’s life than other people with intellectual disabilities or professionals paid to provide support and be more likely to provide reciprocity and social networks (Dileo, 2007; Newton et al., 1996). With employment in an integrated setting, Audrey is more likely to have co-workers, friends, and significant others to meet her psychological and mental health needs. When considering mental health needs, again culture needs to be considered as to whether community and coworkers can support mental health versus professionals or only family members. In Audrey’s case, her family system recognizes and uses community and co-workers in the support of mental health.

Supports Teachers/Service Providers Audrey’s school staff do not believe that Audrey is capable of working in a supported employment setting, in large part due to her challenging behaviors. This concern could be due to lack of awareness of supported employment programs in general or specific examples of individuals similar to Audrey being successful in supported employment situations. These negative attitudes have limited Audrey’s being taught functional skills that would help her develop abilities to be successful in supported employment settings and have instead focused instruction on “pre-vocational” skills that have no meaningful impact on her having marketable job skills such as putting pegs in a peg board,

186 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

stuffing envelopes, or assembling pens. Polloway et al. (1996) and Taylor (1988) have provided analysis of why segregated settings fail to provide adequate outcomes for people with intellectual disabilities. The general goal of all instruction should be focused on enhancing Audrey’s capacity to functional successfully in the community. To that end, the curriculum should consist of skills that enable her to function in employment, residential, community living, and recreational/leisure domains. Thus, any skill taught needs to be referenced to one (or more) of these domains and meet the test of being personally meaningful and valuable to specific individuals (Storey, 2022). School staff could become more aware by visiting supported employment sites, talking with teachers who provide transition services in integrated sites, watching videos of supported employment situations, and reading relevant professional literature in this area (Carter et al., 2012; Migliore et al., 2007; Schall et al., 2020; Simonsen & Neubert, 2013; Test et al., 2009; Wehman et al., 2020). The Neurodiverse Person Martin and Marshall (1995) have conceptualized that individuals who are self-determined establish goals from an awareness of their needs and interests, then develop plans, implement the plans, self-evaluate progress, and make needed adjustments to attain their goals. It is important that Audrey have self-determination in her life as individuals who are self-determined have higher employment rates and postschool success than those who are not self-determined (Goldberg et al., 2003; Wehmeyer & Schwartz, 1997). As part of this self-determination Audrey must have meaningful choices (Agran et al., 2010). These meaningful choices may be derived from her self-directed IEP. Bambara et al (1998) recommend that four components of support need to be put in place to help facilitate self-determination. These are a) know the person, b) build an option rich lifestyle, c) teach self-determination skills, and d) create supportive social contexts. Audrey will need instruction and supports for running her self-directed IEP. The Self-Directed IEP curriculum developed by Martin et al. (1996) would be appropriate for Audrey. This curriculum teaches students how to become actively involved and take a leadership role at their own IEP meeting. It involves a multi-media package consisting of a video depicting a student modeling the 11-steps of the Self-Directed IEP process, a teacher manual with scripted lessons, and a 27-page student workbook.

Case Study Four — Audrey | 187

In addition, Audrey could benefit from learning leadership skills related to self-advocacy. The People First organization provides advocacy training for people with intellectual disabilities and Audrey could benefit from being connected with this organization (http://www.peoplefirst.org). Another method would be to connect Audrey with a mentorship program for youth (Carter et al., 2011). This would not necessarily have to be a program specifically designed for youth with disabilities but could be a generic program such as those offered by school districts, community college’s, or private organizations such as boys/girls clubs, YMCA’s, or cultural organizations. Family Members Audrey’s family members are in support of her having a real job in the community. They also respect and value her right to self-determine her own process and future which research indicates is often the case for parents (Carter et al., 2013). However, Audrey’s family members are not familiar with the process or of the different players (the adult service agency, DR) in the process or what their roles are. This is an important issue as Kraemer et al. (2003) found that parent knowledge of and involvement in the transition process was significantly correlated with student quality of life outcomes. Employers Potential employers of Audrey are likely to have valid concerns and questions not only about Audrey as a possible employee but also about her disability and especially about her work history and her ability to perform specific job tasks and to fit into the work culture of that workplace. Targett and Griffin (2013) have found that employers generally have three main concerns which they classify as “will this work?”, “what will others think?”, and “will I lose or spend too much money?”. Targett and Griffin (2013) recommend that the employment specialist (such as the job developer or job coach) introduce Audrey to the employer, ask for the next step of what is wanted by Audrey (such as job shadowing or employment), conduct a workplace and job analysis, and then create the job for Audrey. Community Members Members of Audrey’s community may need assistance in supporting

188 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

Audrey in the dog walking groups. This could involve making sure that Audrey is invited and supported in group events and that she receives transportation to events and happenings if her family is not able to provide transportation. Natural support strategies would be an effective system for assisting Audrey. The overarching purpose behind developing natural supports is to develop an individualized system of supports for a person that is effective without being overly intrusive. A common way of viewing natural supports is to consider drawing support from people other than staff members paid to support an individual (Storey & Certo, 1996). For Audrey, these individuals might support relationships by providing transportation, assisting with communication, providing advocacy, serving as a mentor, or introducing Audrey to new people. Technological Supports Though Audrey is well connected with community members in her neighborhood she is dependent upon her family members for assisting her in using social media to connect with others around dog walking groups. This could involve using a smart phone to text the other dog walkers and walking groups. Contacts can be accessed with photos of the people and nicknames rather than the last names. There are dog walker apps, which Audrey may find useful. Audrey and her family members could also sign up for list serves related to dog walking as well as those specific to Vizsla’s or English Spring Spaniels which often provide information on dog walking and dog related events. Instructional Supports Storey (2022) advocates that the curriculum should consist of skills that enable a person to function in employment, residential, community living, and recreational/leisure domains and suggest that any skill taught needs to be referenced to one (or more) of these domains and meet the test of being personally meaningful and valuable to specific individuals. Instruction for Audrey needs to change to being focused on the criterion of ultimate functioning. Brown et al. (1976) have defined this as “the ever changing, expanding, localized, and personalized cluster of factors that each person must possess in order to function as productively and independently as possible in socially, vocationally, and domestically integrated adult community environments” (p. 8). For

Case Study Four — Audrey | 189

example, Brown et al. (1976) argue that the artificial instructional materials used with Audrey are not appropriate because artificial materials and settings seldom provide students with the information needed to solve practical problems in natural settings. Brown et al., advocate a “zero-degree inference strategy” in which no inferences are made that teaching to criterion for one task will result in generalization to other tasks, settings, peoples, or times. Finally, Brown et al., provide six questions that should be asked prior to the initiation of instruction. These are: 1. Why should we engage in this activity? 2. Is this activity necessary to prepare students to ultimately function in complex heterogeneous community settings? 3. Could students function successfully as adults if they did not acquire the skill? 4. Is there a different activity that will allow students to approximate realization of the criterion of ultimate functioning more quickly and more efficiently? 5. Will this activity impede, restrict, or reduce the probability that students will ultimately function successfully in integrated community settings? 6. Are the skills, materials, tasks, and criteria of concern similar to those encountered in adult life?

Discussion Questions 1. If school staff and family members disagree on student objectives and what is possible for the student, how should the process go forward? 2. How much job experience does a person have to have in order to be appropriate for a supported employment position? 3. Should challenging behaviors be eliminated before job development or a job placement is made? 4. Who is able to make a better judgement about Audrey’s abilities? Credentialed and well-trained school staff or Audrey and her family? 5. Is there anything wrong with Audrey being placed in a day program with other individuals with intellectual disabilities? 6. Is a skill functional if that skill is not necessary for the

190 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

individual to function effectively in community settings (in one of the four domains of employment, residential, community living, and recreational/leisure)? 7. How do segregated or integrated programs affect social networks? 8. Are some individuals too severely disabled to work in a real job?

EMPIRICAL RESEARCH TO SUPPORT THAT THE INTERVENTION IS AN EVIDENCE-BASED PRACTICE Functional Communication Training Carr, E. G., & Durand, V. M. (1985). Reducing behavior problems through functional communication training. Journal of Applied Behavior Analysis, 18(2), 111–126. Durand, V. M., & Carr, E. G. (1991). Functional communication training to reduce challenging behavior: maintenance and application in new settings. Journal of Applied Behavior Analysis, 24(2), 251–264. Gregori, E., Rispoli, M., Neely, L., Lory, C., Kim, S. Y., & David, M. (2021). Training direct service personnel in functional communication training with adults with disabilities. Journal of Developmental and Physical Disabilities, 33(4), 669-692.

Incidental Teaching Farmer-Dougan, V. (1994). Increasing requests by adults with developmental disabilities using incidental teaching by peers. Journal of Applied Behavior Analysis, 27(3), 533-544. McGee, G. G., & Daly, T. (2007). Incidental teaching of age-appropriate social phrases to children with autism. Research and Practice for Persons with Severe Disabilities, 32(2), 112-123. Rosenberg, N. E., Artman-Meeker, K., Kelly, E., & Yang, X. (2020). The effects of a bug-in-ear coaching package on implementation of incidental teaching by paraprofessionals in a K-12 school. Journal of Behavioral Education, 29(2), 409-432.

Self-Determination Agran, M., Storey, K., & Krupp, M. (2010). Choosing and choice making are not the same: Asking “what do you want for lunch?” is not self-determination. Journal of Vocational Rehabilitation, 33(2), 77-88. Carter, E. W., Lane, K. L., Cooney, M., Weir, K., Moss, C. K., & Machalicek, W. (2013). Self-determination among transition-age youth with autism or

Case Study Four — Audrey | 191

intellectual disability: Parent perspectives. Research and Practice for Persons with Severe Disabilities, 38(3), 129-138. Carter, E. W., Swedeen, B., Walter, M. J., Moss, C. K., & Hsin, C. (2011). Perspectives of young adults with disabilities on leadership. Career Development for Exceptional Individuals, 34(1), 57-67. Kraemer, B. R., McIntyre, L. L & Blacher, J. (2003). Quality of life for young adults with mental retardation during transition. Mental Retardation, 41(4), 250-262. Morán, M. L., Hagiwara, M., Raley, S. K., Alsaeed, A, H., Shogren, K. A., Qian, X., Gómez, L. E., & Alcedo, M. A. (2021). Self-determination of students with autism spectrum disorder: A systematic review. Journal of Developmental and Physical Disabilities, 33(6), 887-908. Shogren, K. Gotto, G. S., Wehmeyer, M. Shaw, L. Seo, H. Palmer, S. Snyder, M. J., & Barton, K. (2016). The impact of the Self-Determined Career Development Model on self-determination outcomes. Journal of Vocational Rehabilitation, 45(3), 337-350. Wehmeyer, M. L., & Schwartz, M. (1997). Self-determination and positive adult outcomes: A follow-up study of youth with mental retardation or learning disabilities. Exceptional Children, 63(2), 245-255.

Self-Management Christian, L., & Poling, A. (1997). Using self-management procedures to improve the productivity of adults with developmental disabilities in a competitive employment setting. Journal of Applied Behavior Analysis, 30(1), 169-172. Koegel, L. K., Koegel, R. L., Hurley, C., & Frea, W. D. (1992). Improving social skills and disruptive behavior in children with autism through selfmanagement. Journal of Applied Behavior Analysis, 25(2), 341-353. Montgomery, J., Storey, K., Post, M., & Lemly, J. (2011). The use of auditory prompting systems for increasing independent performance of students with autism in employment training. International Journal of Rehabilitation Research, 34(4), 330–335. Munsell, E. G., & Coster, W. J. (2021). Scoping review of interventions supporting self-management of life tasks for youth with high functioning ASD. Exceptionality, 29(2), 81-94.

Social Networks Bele, I. V., & Kvalsund, R. (2015). On your own within a network? Vulnerable youths’ social networks in transition from school to adult life. Scandinavian Journal of Disability Research, 17(3), 195-220. Kennedy. C. H., Horner, R. H., & Newton, J. S. (1989). Social contacts of adults with severe disabilities living in the community: A descriptive analysis of relationship patterns. Journal of the Association for Persons with Severe Handicaps, 14(3), 190-196. Newton, J. S., Olson, D., Horner, R. H., & Ard, W. R. (1996). Social skills and

192 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

the stability of social relationships between individuals with intellectual disabilities and other community members. Research in Developmental Disabilities, 17(1), 15-26. Spruit, S., & Carter, E. W. (2021). Friendships through inclusive postsecondary education programs: perspectives of current and former students with intellectual and developmental disabilities. Intellectual and Developmental Disabilities, 59(6), 487-501.

Social Skills Instruction Chadsey, J. G., Linneman, D. Rusch, F. R., & Cimera, R. E. (1997). The impact of social integration interventions and job coaches in work settings. Education and Training in Mental Retardation and Developmental Disabilities, 32(4), 281-292. Gorenstein, M., Giserman-Kiss, I., Feldman, E., Isenstein, E. L., Donnelly, L., Wang, A. T., & Foss-Feig, J. H. (2020). A Job-Based Social Skills Program (JOBSS) for adults with autism spectrum disorder: A pilot randomized controlled trial. Journal of Autism and Developmental Disorders, 50(12), 4527-4534. Mautz, D., Storey, K., & Certo, N. J. (2001). Increasing integrated workplace social interactions: The effects of job modification, natural supports, adaptive communication instruction, and job coach training. Journal of the Association for Persons with Severe Handicaps, 26(4), 257-269. Park, H. S., Simon, M., Tappe, P., Wozniak, T., Johnson B., & Gaylord-Ross, R. (1991). Effects of a coworker advocacy program and social skills training on the social interaction of employees with mild disabilities. Journal of Vocational Rehabilitation, 1(4), 73-90. Storey, K., & Garff, J. T. (1997). The cumulative effect of natural support strategies and social skills instruction on the integration of a worker in supported employment. Journal of Vocational Rehabilitation, 9(2), 143-152. Storey, K., Lengyel, L., & Pruszynski, B. (1997). Assessing the effectiveness and measuring the complexity of two conversational instructional procedures in supported employment contexts. Journal of Vocational Rehabilitation, 8(1), 21-33. Walsh, E., Holloway, J., & Lydon, H. (2018). An evaluation of a social skills intervention for adults with autism spectrum disorder and intellectual disabilities preparing for employment in Ireland: A pilot study. Journal of Autism and Developmental Disorders, 48(5), 1727-1741.

Staff Supervision Hardesty, S., Hagopian, L. P., McIvor, M. M., Wagner, L. L., Sigurdsson, S., & Bowman, L. G. (2014). Effects of specified performance criterion and performance feedback on staff behavior: A component analysis. Behavior Modification, 38(5), 760-773. Lebbon, A., Sigurdsson, S., & Austin, J. (2012). Behavioral safety in the food services industry: Challenges and outcomes. Journal of Organizational Behavior Management, 32(1), 44-57.

Case Study Four — Audrey | 193

Supported Employment Baer, H., Welker, K., & Cox, C. (2021). Work performance and support needs analysis ofstudents with intellectual disabilities. Journal of Vocational Rehabilitation, 55(3), 335-344. Carter, E. W., Austin, D., & Trainor, A. (2012). Predictors of postschool employment outcomes for young adults with severe disabilities. Journal of Disability Policy Studies, 23(1), 1–14. Cimera, R. E. (2011). Supported versus sheltered employment: Cumulative costs, hours worked, and wages earned. Journal of Vocational Rehabilitation, 35(2), 85-92. Cimera, R. E. (2012). The economics of supported employment: What new data tell us. Journal of Vocational Rehabilitation, 37(2), 109-117. Forrester-Jones, R., Jones, S., Heason, S., & Di’Terlizzi, M. (2004). Supported employment: A route to social networks. Journal of Applied Research in Intellectual Disabilities, 17(3), 199-208. Migliore, A., Mank, D., Grossi, T., & Rogan, P. (2007). Integrated employment or sheltered workshops: Preferences of adults with intellectual disabilities, their families, and staff. Journal of Vocational Rehabilitation, 26(1), 5–19. Simonsen, M., & Neubert, D. (2013). Transitioning youth with intellectual and other developmental disabilities: Predicting community employment outcomes. Career Development and Transition for Exceptional Individuals, 36(3), 188-198.

Task Analysis Kearney, K. B., Dukes, C., Brady, M. P., Pistorio, K. H., Duffy, M. L., & Bucholz, J. L., (2019). Using an instructional package to teach cardiopulmonary resuscitation with automated external defibrillator to college students with intellectual disability. Journal of Special Education, 53(3), 142-152. Scott, R., Collins, B., Knight, V., & Kleinert, H. (2013). Teaching adults with moderate intellectual disability ATM use via the “iPod”. Education and Training In Autism And Developmental Disabilities, 48(2), 190-199. Taber, T. A., Alberto, P. A., Seltzer, A., & Hughes, M. (2003). Obtaining assistance when lost in the community using cell phones. Research and Practice for Persons with Severe Disabilities, 28(3), 105-116.

Video Modeling LeBlanc, L. A., Coates, A. M., Daneshvar, S., Charlop-Christy, M. H., Morris, C., & Lancaster, B. M. (2003). Using video modeling and reinforcement to teach perspective-taking skills to children with autism. Journal of Applied Behavior Analysis, 36(2), 253-257. Wertalik, J. L, & Kubina, R. M. (2018). Comparison of Tagteach and video modeling to teach daily living skills to adolescents with autism. Journal of Behavioral Education, 27(2), 279-300.

194 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

GENERAL REFERENCES Albin, J. M. (1992). Quality improvement in employment and other human services: Managing quality through change. Baltimore, MD: Paul Brookes. Albin, R. W., & Horner, R. H. (1988). Generalization with precision. In R. H. Horner, G. Dunlap, & R. L. Koegel (Eds), Generaliztion and maintenance: Life-style changes in applied settings (pp. 99-120). Baltimore, MD: Paul Brookes. Bambara, L. M., Cole, C. L., & Koger, F. (1998). Translating self-determination concepts into supports for adults with severe disabilities. Journal of the Association for Persons with Severe Handicaps, 23(1), 27-37. Bellamy, G. T., Rhodes, L. E., Bourbeau, P. E., & Mank, D. M. (1986). Mental retardation services in sheltered workshops and day activity programs: Consumer benefits and policy alternatives. In F. R. Rusch (Ed.), Competitive Employment Issues and Strategies (pp. 257-271). Baltimore, MD: Paul Brookes. Brown, L., Nietupski, J., & Hamre-Nietupski, S. (1976). Criterion of ultimate functioning. In M. A. Thomas (Ed.), Hey, don’t forget about me! (pp. 2-15). Reston, VA: Council for Exceptional Children. Buckley, J., Mank, D., & Sandow, D. (1990). Developing and implementing support strategies. In F. R. Rusch (ed.), Supported employment: Models, methods, and issues (pp. 131-144). Sycamore, IL: Sycamore Publishing Company. Certo, N. J., Mautz, D., Pumpian, I., Sax, C., Smalley, K., Wade, H. A., Noyes, D., Luecking, R., Weschler, J., & Batterman, N. (2003). A review and discussion of a model for seamless transition to adulthood. Education and Training in Mental Retardation and Developmental Disabilities, 38(1), 3-17. Certo, N. J., Pumpian, I., Fisher, D., Storey, K., & Smalley, K. (1997). Focusing on the point of transition: A service integration model. Education and Treatment of Children, 20(1), 68-84. Chadsey-Rusch, J. (1992). Toward defining and measuring social skills in employment settings. American Journal on Mental Retardation, 96(4), 405-418. Cimera, R. E., Thoma, C. A., Whittenburg, H, N., & Ruhl, A. N. (2018). Is getting a postsecondary education a good investment for supported employees with intellectual disability and taxpayers? Is postsecondary education a good investment? Inclusion. 6(2), 97-109. Cooper, J. O., Heron, T. E., & Heward, W. L. (2020). Applied behavior analysis (3rd ed.). Hoboken, NJ: Pearson. Devlin, S., Leader, G., & Healy, O. (2009). Comparison of behavioral intervention and sensory-integration therapy in the treatment of self-injurious behavior. Research in Autism Spectrum Disorders, 3(1), 223–231. Dileo, D. (2007). Raymond’s room: Ending the segregation of people with disabilities. St. Augustine, FL: Training Resources Network. Durand, V. M., & Moskowitz, L. (2015). Functional Communication Training: Thirty years of treating challenging behavior. Topics in Early Childhood Special Education, 35(2), 116-126.

Case Study Four — Audrey | 195

Dymond, S. T., Renzaglia, A., & Hutchins, M. P. (2014). Career development: An experiential model for developing basic work skills and employment preferences. In K. Storey & D. Hunter, (Eds.), The road ahead: Transition to adult life for persons with disabilities (3rd ed.) (pp. 107-136). Washington, DC: IOS Press. Galiatsatos, T., & Graff, R. (2003). Combining descriptive and functional analyses to assess and treat screaming. Behavioral Interventions, 18(2), 123-138. Gold, M. W. (1980). Did I say that? Articles and commentary on the try another way system. Champaign, IL: Research Press. Goldberg, R., Higgins, E., Raskind, M., & Herman, K. (2003). Predictors of success in individuals with learning disabilities: A qualitative analysis of a 20-year longitudinal study. Learning Disabilities Research Practice, 18(4), 222-236. Goleman, D. (2006). Social intelligence: The new science of human relationships. New York. Bantam. Graff, R. B., Lineman, G. T., Libby, M. E., & Ahearn, W. H. (1999). Functional analysis and treatment of screaming in a young girl with severe disabilities. Behavioral Interventions, 14(4), 233-239. Horner, R. H., & Day, H. (1991). The effects of response efficiency on functionally equivalent competing behaviors. Journal of Applied Behavior Analysis, 24(4), 719-732. Hughes, C., & Agran, M. (1994). Teaching persons with severe disabilities to use self-instruction in community settings: An analysis of applications. Journal of the Association for Persons with Severe Handicaps, 18(4), 261-274. Johnson, M. (2003). Make them go away: Clint Eastwood, Christopher Reeve & the case against disability rights. Louisville, KY: Advocado Press. Kaufmann, S., & Meyer, V. (2013). Friendships: Cultural variations, developmental issues and impact on health. Hauppauge, NY: Nova Science Publishers. Kaufman, R. B., Westland, C. A., Rosas, C. E., & Winterman, K. G. (2014). The transition process. In K. G. Winterman & C. E. Rosas (Eds.), The IEP checklist: Your guide to creating meaningful and compliant IEPs (pp. 137-158). Baltimore, MD: Paul Brookes. Lakin, K. C., & Stancliffe, R. J. (2007). Residential supports for persons with intellectual and developmental disabilities. Mental Retardation and Developmental Disabilities Research Reviews, 13(2), 151-159. Martin, J. E., & Marshall, L. H. (1995). ChoiceMaker: A comprehensive selfdetermination transition program. Intervention in School and Clinic, 30(3), 147-156. Martin, J. E., Marshall, L. H., Maxson, L. M., & Jerman, P. L. (1996). The selfdirected IEP. Lonmont, CO: Sopris West. Martin, J. E., & Williams-Diehm, K. (2013). Student engagement and leadership of the transition planning process. Career Development and Transition for Exceptional Individuals, 36(1), 43-50. Murphy, S. T., & Rogan, P. M. (1995). Closing the shop: Conversion from sheltered to integrated work. Baltimore, MD: Paul Brookes. Newton, J. S., Horner, R. H., Ard, W. R., LeBaron, N., & Sappington, G. (1994). A conceptual model for improving the social life of individuals

196 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

with mental retardation. Mental Retardation, 32(6), 393-402. O’Neill, R. E., Albin, R. W., Storey, K., Horner, R. H., & Sprague, J. R. (2015). Functional assessment and program development for problem behavior: A practical handbook (3rd edition). Stamford, CT: Cengage Publishing Company. Parent, W., Unger, D., Gibson, K., & Clements, C. (1994). The role of the job coach: Orchestrating community and workplace supports. American Rehabilitation, 3(3), 17-26. Polloway, E. A., Smith, J. D., Patton, J. R., & Smith, T. E. C. (1996). Historic changes in mental retardation and developmental disabilities. Education and Training in Mental Retardation and Developmental Disabilities, 31(1), 3-12. Post, M., Montgomery, J., & Storey, K. (2009). A decision tree for the use of auditory prompting strategies. Journal of Vocational Rehabilitation, 31(1), 51-54. Schall, C., Sima, A. P., Avellone, L., Wehman, P., McDonough, J., & Brown, A. (2020). The effect of business internships model and employment on enhancing the independence of young adults with significant impact from autism. Intellectual and Developmental Disabilities, 58(4), 301-313. Shapiro, J. P. (1993). No pity: People with disabilities forging a new civil rights movement. New York: Times Books. Sigafoos, J., O’Reilly, M., & de la Cruz, B. (2007). How to use video modeling and video prompting. Austin, TX: Pro-Ed. Simonsen, M., Stuart, C., Luecking, R., & Certo, N. J. (2014). Collaboration among school and post-school agencies for seamless transition. In K. Storey & D. Hunter, (Eds.), The road ahead: Transition to adult life for persons with disabilities (3rd ed.) (pp. 137-154). Washington, DC: IOS Press. Storey, K. (2000). Why employment in integrated settings for people with disabilities. International Journal of Rehabilitation Research, 23(2), 103-110. Storey, K. (2002). Strategies for increasing interactions in supported employment settings: An updated review. Journal of Vocational Rehabilitation, 17(4), 231-237 Storey, K., & Certo, N. J. (1996). Natural supports for increasing integration in the workplace for people with disabilities: A review of the literature and guidelines for implementation. Rehabilitation Counseling Bulletin, 40(1), 62-76. Storey, K. (2022). Systematic instruction of functional skills for students and adults with disabilities (3rd ed.). Springfield, IL: Charles C. Thomas Publisher, Inc. Targett, P. S. (2007). Staff selection, training, and development for community rehabilitation programs. In P. Wehman, K. J. Inge, W. G. Revell, & V. A. Brooke (Eds.) Real work for real pay: Inclusive employment for people with disabilities (pp. 75-103). Baltimore, MD: Paul Brookes. Targett, P., & Griffin, C. (2013). Developing jobs for young people with disabilities. In P. Wehman (Ed.) Life beyond the classroom: Transition strategies for young people with disabilities (pp. 339-362). Baltimore, MD: Paul Brookes. Taylor, S. J. (1988). Caught in the continuum: A critical analysis of the principle of the least restrictive environment. Journal of the Association for Persons with Severe Handicaps, 13(1), 41-53.

Case Study Four — Audrey | 197

Test, D. W., Fowler, C. H., Richter, S. M., White, J., Mazzotti, V., Walker, A. R., & Kortering, L. (2009). Evidence-based practices in secondary transition. Career Development for Exceptional Individuals, 32(2), 115-128. Tiger, J. H., Hanley, G. P., & Bruzek, J. (2008). Functional communication training: A review and practical guide. Behavior Analysis in Practice, 1(1), 16-23. Wehman, P. (2020). Essentials of transition planning (2nd ed.). Baltimore, MD: Paul Brookes. Wehman, P., Schall, C., McDonough, J., Sima, A., Brooke, A., Ham, W., Whittenburg, H., Brooke, V., Avellone, L., & Riehle, E. (2020). Competitive employment for transition-aged youth with significant impact from autism: A multi-site randomized clinical trial. Journal of Autism and Developmental Disorders, 50(6), 1882-1897. Wirth, O., & Sigurdsson, S. (2008). When workplace safety depends on behavior change: Topics for behavioral safety research. Journal of Safety Research, 39(6), 589-598. Woods, L. L., Sylvester, L., & Martin, J. E. (2010). Student-directed transition planning: Increasing student knowledge and self-efficacy in the transition planning process. Career Development for Exceptional Individuals, 33(2), 106-114.

Case Study Five — Levin Case Study Covers: • Autism Spectrum Disorder Minimal Support Needs • College Setting

L

evin is autistic, 18 years old, and recently entered college as a freshman at a large university. This university was selected by Levin and his family due to the opportunities and supports for students with disabilities that are not always available at smaller colleges. Academically, he has always done well in school and by most accounts he is “gifted.” He was in Gifted and Talented Education (GATE) through elementary school and in high school he enrolled in community college courses even as a high school freshman. He intends to finish college earlier than four years due to the college credits he has accumulated. He chose this university for the nuclear engineering program, which is his major. Academically, Levin and his family know he can do the work, but he has difficulty with organization given the number of courses he is required to take, studying in the library, and now living in a dorm situation, which requires socialization and eating meals with others. His handwriting and note taking have always been an issue in high school and this is exacerbated by the demands of large lectures and seminar classes. Levin is living in a dorm and was placed in a single room, in part due to his diagnosis and needs. He needs time alone and recognizes that he does not always have patience for others. Levin had social skills instruction in high school from a school psychologist and participated in a community social skills group lead by a BCBA from the ages of 13 through 18. Those groups helped him to be able to engage in conversations, listen to others, wait his turn, and engage in small talk. However, he still often engages in monologues about his favorite topics 199

200 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

(nuclear fission, thermal hydraulics, and Monte Carlo Simulations). Whereas, these are possibly interesting to nuclear engineers, most of his peers do not find these interesting and have nothing to say on those topics. Levin loves baseball, in particular the Mets from New York. He will often talk about baseball statistics both present day and historical. Again, his peers have limited knowledge and interest in these details. Regardless, Levin will engage others at the campus coffee house, in the dorm cafeteria, and campus outdoor study areas in “conversations” on these topics. Most disturbing, however is that Levin is engaging in behaviors that are legally considered as stalking. He has followed women that live in his dorm to class and engaged in monologues or attempts at conversation. Then when class is over he has waited for them outside of their classrooms. Often, he will leave notes on their dorm room doors. He learned the schedules of three of these women from his dorm and has been seen hiding behind trees and doors waiting for them. He has posted sexual comments about these women online using social media. In addition, to following them he has approached one woman on many occasions and has asked her inappropriate questions (such as her shoe size and bra size), which frightened her. She reported Levin to the residential assistant (RA) in her dorm. The other women have also reported Levin to the RA and also campus security. From Levin’s perspective he is only trying to get a date. Once he was confronted by campus security he realized that he was not going to get a date with any of these women, that he was engaging in potential criminal behavior, and that he needed help. He shared with his parents what had been happening and they (with Levin) contacted the disability support services (DSS) at his college to see what could be done so that Levin does not get in trouble with the criminal system and get kicked out of the university. The DSS has coaches available that can work on organizational skills and time management as well as mentoring, social skill instruction and feedback for social behavior and Levin was assigned a personal coach, Fripp, who is also a graduate student in the psychology department.

CASE STUDY EVALUATION Based upon the case study provided above, the following sections analyze the issues that arise in providing behavioral services and supports for Levin. This analysis is based upon the Behavior Analyst Certification Board Task List 5th edition. Competencies addressed are

Case Study Five — Levin | 201

Foundations, C: Measurement, Data Display, and Interpretation and Applications, E: Ethics, F: Behavior Assessment, G: Behavior-Change Procedures, H: Selecting and Implementing Interventions, and I: Personnel Supervision and Management. These examples are provided as a guide to successfully resolving client case issues and developing competencies as behavior analysts. Behavior Assessment F-1 F-2 F-3 F-4 F-5 F-6 F-7 F-8 F-9

Review records and available data at the outset of the case. Determine the need for behavior-analytic services Identify and prioritize socially significant behaviorchange goals. Conduct assessments of relevant skill strengths and deficits. Conduct preference assessments. Describe the common functions of problem behavior. Conduct a descriptive assessment of problem behavior. Conduct a functional analysis of problem behavior. Interpret functional assessment data.

A review of records shows that Levin had social skill instruction in high school but that none of the groups or sessions focused on dating and relationships. He did demonstrate issues with organizational and time management in high school but he had supports in place provided by the school district and he used some technology (Riviere, 1996). In high school, he did not demonstrate behaviors that would be considered stalking. He had a few friends in high school that he met through mutual interest in computer coding and from the engineering robotics team but none of these individuals attend the same university as Levin. The challenging behaviors were identified, and a preliminary definition provided by the interview form. Stalking is defined as a continuum of behavior that can range from harassment to threatening behavior to assault and homicide (Snow, 1998). It is often a fine line between acceptable and unacceptable behavior (e.g., waiting for someone after class may be interpreted differently by the receiver depending upon their own intentions and their assessment of the context). The definitions used needed to be in non-legal terms and observable and measurable to Levin and his coach, Fripp.

202 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

The definition of the behaviors was determined prior to self-observation and data collection based upon the open-ended interview, based upon Hanley (2012) but the definition was refined based upon self-observation. Measurement, Data Display, and Interpretation C-1 C-2

Establish operational definitions of behavior. Distinguish among direct, indirect, and product measures of behavior. C-3 Measure occurrence (e.g., frequency, rate, percentage). C-4 Measure temporal dimensions of behavior (e.g., duration, latency, interresponse time). C-5 Measure form and strength of behavior (e.g., topography, magnitude). C-6 Measure trials to criterion. C-7 Design and implement sampling procedures (i.e., interval recording, time sampling). C-8 Evaluate the validity and reliability of measurement procedures. C-9 Select a measurement system to obtain representative data given the dimensions of behavior and the logistics of observing and recording. C-10 Graph data to communicate relevant quantitative relations (e.g., equal-interval graphs, bar graphs, cumulative records). C-11 Interpret graphed data. The director of DSS interviewed Levin at the center. She was able to use an open-ended interview process (Hanley, 2012) and this interview can be found in Figure 5.1. Levin demonstrates self-awareness and appears to be accurate in his self-reports. He agreed to take some frequency data on the challenging behaviors within an ABC chart. He worked with Fripp to assist with feedback on the definitions for him. This provides more social validity to the definitions and help Levin in being able to discriminate between the challenging and desirable behaviors. The challenging behaviors were identified, and definitions were refined based upon the interviews and Levin’s frequency counts and categories of stalking actions, stalking thoughts and odd behavior. The definition of stalking was refined specifically for Levin as behaviors that made others fearful, pursing a relationship or friendship

Case Study Five — Levin | 203 Figure 5.1. Open-Ended Questionnaire — Levin

204 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 5.2. Antecedent Behavior Consequence Chart (ABE) — Levin

after being told directly that the person had no interest and repeated pursuits of the person in vivo or online when either he was told to stop, or the person pursued implied no interest. Legally a stalking crime includes the following elements: 1) harassment involving repetitive, annoying and disturbing behavior directed towards a person that has no positive or legitimate reason other than to harm the person, 2) a credible threat toward a person that causes the person to become

Case Study Five — Levin | 205

fearful of their safety or causes emotional distress, and 3) a course of conduct involving a series of acts over time towards a person that causes emotional stress and/or concern with safety (Proctor, 2003). Examples of occurrence are following people, gathering personal data on the person without their knowledge, engaging in conversations or posting about sexual or physical characteristics of known people, leaving notes for people where they live if you do not know them, touching people without first confirming that touch is desired or appropriate. Non-examples are walking to class and wave hello to someone you recognize and keep on walking, going to a party that he is invited to and talking to someone about baseball, college sports teams, or other non-sexual or personal topics. The definition for thinking about stalking was developed as: Repeated thoughts or creating plans to engage in the behaviors defined as stalking from the list above. Examples of occurrence are plans to gain someone’s schedule, plans to meet someone at their dorm room, thoughts about posting love messages online. Non-examples are thoughts about creating a study group. Odd behaviors were defined as physical or verbal behaviors that made others uncomfortable when it is inappropriate in the social context to make them feel uncomfortable. Examples of occurrence are sitting too close (closer than three feet, arm’s length for acquaintances), putting his face too close to someone who was not expecting that to happen, going to a party or someone’s dorm room when you were not invited. Non-examples are meeting a study partner at their dorm room for a prearranged study meeting, meeting someone at the cafeteria and joining him or her for the meal after you have asked permission to join him or her. Levin and Fripp were able to work together to define the challenging behaviors. Using the ABC chart, they were able to determine a few triggers for the stalking behaviors and Levin’s thoughts about stalking these women, including seeing couples together at parties, in the cafeteria, and walking to class. Seeing these couples served as a reminder that he wanted a girlfriend too. Additionally, Levin and Fripp decoded that he could only engage in what are socially desirable behaviors from the woman’s perspective. The consequence for the stalking behavior was either outright rejection (e.g., “I told you to not meet me or walk with me”) subtle surprise

206 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

and rejection (“What are you doing here at this class you don’t have class with me?” stated in a perturbed manner) or neutral (“oh it’s you again.”). According to the data that Levin took, the consequences were equally divided between these three reactions. Environmental variables were analyzed using data from the ABC chart and it seemed that Levin was more likely to engage in the challenging behaviors on a Monday, following a weekend. The online posts were most likely late at night after studying. The odd behaviors were more likely to occur when Levin was with a group of people such as in the cafeteria, occasionally with an individual person and often due to misreading the situation. Based upon these data, it was clear to Levin and his coach, Fripp, that weekends were difficult for him to be alone in his room and only see people in the cafeteria. Occasionally, there would be an on-campus party or event he attended but generally he attended alone or with one other male student, Bruford, from his nuclear engineering classes (who was also often inept in social situations). Levin was friends with Bruford from class and they had similar interest in nuclear fission, thermal hydraulics, and Monte Carlo Simulations as well as baseball statistics. In assessing Levin’s strengths, skills, and deficits as part of this process, it was determined that Levin had some positive social skills that he learned through previous groups and activities, and he understood most of the social rules when interacting with other males. He had difficulty with monologues and topics of conversation on his restricted area of interests with males but only engaged in the stalking behavior, stalking thoughts and odd behaviors with females. It was clear that Levin needed skills for the establishment and development of dating and romantic relationships. No preference assessment was required. Levin was clear about the preferred topics of conversation and what was a preferred activity and/or topics of conversation when talking with women. Selecting and Implementing Interventions H-1 State intervention goals in observable and measurable terms. H-2 Identify potential interventions based on assessment results and the best available scientific evidence. H-3 Recommend intervention goals and strategies based on such factors as client preferences, supporting environments, risks, constraints, and social validity.

Case Study Five — Levin | 207

H-4 When a target behavior is to be decreased, select an acceptable alternative behavior to be established or increased. H-5 Plan for possible unwanted effects when using reinforcement, extinction, and punishment procedures. H-6 Monitor client progress and treatment integrity. H-7 Make data-based decisions about the effectiveness of the intervention and the need for treatment revision. H-8 Make data-based decisions about the need for ongoing services. H-9 Collaborate with others who support and/or provide services to clients. Levin is a cis-gender white male and thus his interventions and goals were developed with that in mind guided by his preferences, supporting environment of a college campus and social validity. Levin, Fripp and Adrian, a female friend from the school dorm, created a list of the skills necessary to develop and maintain a romantic relationship. Adrian volunteered to assist Levin in giving him the perspective from the woman’s point of view. This list included: recognizing private versus general public topics of conversation, body language of interest versus non-interest from the opposite gender, simultaneous body, facial and situational cues for engagement and discontinuation of conversations, perception of others’ feelings, recognizing both wanted and unwanted behaviors, acceptance of rejection, development of vocabulary associated with relationships and intimacy, distinguishing friendships from intimate relationships, consent, discerning appropriate targets for relationships, rules for approaching others with romantic intentions (Post et al., 2014). Fripp and the DSS staff researched empirical studies on stalking behavior by individuals with ASD and found that there have been few empirical studies related to stalking and applied behavior analysis. Westrup and Fremouw (1998) recommend using the technology of functional assessment for stalking but there have been no published studies of a functional analysis of stalking. However, Spitzberg and Cupach (2007) conducted a meta-analysis of 175 studies on stalking. Part of this meta-analysis was an analysis of motives. In addition, Meloy and Gothard (1995) looked at demographic and clinical comparisons between obsessional followers and offenders with “mental disorders.” Both of these articles found that those with “mental disorders” demonstrated social incompetence and engaged in obsessional behaviors as seen in people with Asperger’s syndrome. The function of the behavior often was seeking attention or a relationship with the person with a

208 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

concomitant lack of social competence (Post et al., 2014). Whereas, there are only a few published studies related to stalking behaviors in the behavior analytic literature there are many articles related to social competence and the developmental of appropriate social skills (Haring & Breen, 1992; Koegel et al., 2013). As seen above, the list of skills for Levin to learn was extensive. The development of the skills was not expected to be completed over night. However, Levin and Fripp were able to develop a few measurable goals to track his progress to reach his long-term goal to 1) develop a romantic relationship and 2) refrain from engaging in stalking behaviors. Sample short-term goals developed included: 1) Levin will maintain an appropriate social distance (outside of arms reach) when engaged in conversation with females given social cues and other situations for acquaintance or friendship, 2) Levin will engage in conversations that are appropriate to the persons’ relationship to him (acquaintance, friend, romantic) and maintain a topic of conversation that is of interest by the conversant as determined by direct questioning, (e.g., “Do you have any interest in baseball statistics, in particular the Mets?”) as well as open questions (“what sort of things are you interested in?”). Levin’s interventions consisted of a package of procedures that he developed with Fripp and Adrian during coaching sessions. The first step in the process was learning about what behaviors are considered stalking. To get started they used a curriculum developed by Buron (2007) which uses a five-point scale to assess appropriate social behaviors including dating behaviors. The five-point scale includes: 1) very informal social behavior, 2) reasonable behavior, 3) odd behavior, 4) scary behavior and 5) physically hurtful behavior or threatening behavior In addition to using the Buron (2007) book as a guide, they role played the various scenarios from parties to one-on-one conversations to develop the skills listed above. During these role play sessions they used video feedback (Myles & Simpson, 2001). The video feedback (VFB) involved the use of video recording of a session and then Levin watching himself on the video and evaluates his own behaviors while receiving coaching and support (Deitchman et al., 2010). This is procedures that is often used in conjunction with self-management (Winsler et al., 2007) and Levin used the self-management procedures for invivo behavioral control. Using specific observable steps, Levin used a list of steps to help him initiate a friendship based upon common interests, make chit chat at a party and steps for a romantic relationship. Embedded in this list of observable steps were also rules for behavior for specific contexts (Mruzek et al., 2007). In addition to the rules and steps, to develop alternative appropriate behaviors, Levin used a visual on his phone as a reminder of the five-point scale of what is stalking to

Case Study Five — Levin | 209

acceptable behavior. Figure 5.3 includes a visual from an iPhone application developed with that scale. Levin has a preference for rules and is a strict rule follower. Given those qualities it was decided that following the research on rule-governed behavior, Levin would benefit from positive rules for behavior across contexts (Watts et al., 2013). These rules would be updated and changed as his relationship changed with those in his life. For example, if someone was an acquaintance he could say hello, ask how you are and make chit chat given a rule for acquaintances. The rule for friendship was to establish if there is a common interest (e.g., baseball

Figure 5.3. Visual of Five is Against the Law — Levin

210 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 5.4. Self-Management with Rules for Friendship or Potential Romantic — Levin

statistics, Monte Carlo Simulations). If a common interest is established than the conversation can be on those topics of interest and they can make plans to do something around that common interest typical of friendships. Rules paired with self-management had approval from both Fripp and Adrian and they assisted in the development of the specific rules adding to the social validity to treatment package

Case Study Five — Levin | 211

(Barbaro & Dissanayake, 2007). A sample of the rules and self-management for friendship is in Figure 5.4. The final component of the intervention package was to address the triggers for stalking such as weekend’s alone and late nights of studying. Given common interests and shared social difficulty, his friend Bruford was more than happy to assist with some prevention strategies. They worked to find activities that interested them both such as going to see the university sports teams play on Friday nights or a Saturday day together. If there were a group of students from their department going they helped arrange a meeting place to sit together. In response to the trigger of being alone on weekends and late nights of studying, Levin was taught by Fripp and Adrian to use selftalk with calming and some distress tolerance. Self-talk was used as a self-management strategy but also as a component of cognitive behavior therapy (Myles, 2003). Distress tolerance is a component of Dialectical Behavior Therapy (DBT) where clients learn the skills of acceptance and awareness of situations that cause distress and practice coping skills to be used when exposed to situations that cause distress. A counselor within the DSS helped Levin with learning and using this skill and was supported by Fripp as well, given that this is part of his training to become a psychologist. When exposed to a trigger Levin was taught to use his self-calming measures (breathing, yoga, self-hugs, deep squeezes), distraction techniques (splashing the face with cold water, intense short exercise), plus to engage in self-talk following the calming. The self-talk was composed of positive statements on how he is handling the trigger (“I am alone, I am okay, I have friends”) as well as statements for future and hope (“I am not always alone, I will have a girlfriend at some point”). Levin received support through the DSS at his college. His coach collaborated with the director of DSS and given Levin’s permission his family was included in the development of treatments and interventions so that the behavior would be more likely to be maintained across environments from school to community, and visits with his family. Levin and his coach shared the goals and contracts with his family. In addition, Levin brought in his friends Bruford and Adrian to help maintain support at school Behavior-Change Procedures G-1 Use positive and negative reinforcement procedures to strengthen behavior. G-2 Use interventions based on motivating operations and discriminative stimuli. G-3 Establish and use conditioned reinforcers.

212 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

G-4 Use stimulus and response prompts and fading (e.g., errorless, most-to-least, least-to-most, prompt delay, stimulus fading). G-5 Use modeling and imitation training. G-6 Use instructions and rules. G-7 Use shaping. G-8 Use chaining. G-9 Use discrete-trial, free-operant, and naturalistic teaching arrangements. G-10 Teach simple and conditional discriminations. G-11 Use Skinner’s analysis to teach verbal behavior. G-12 Use equivalence-based instruction. G-13 Use the high-probability instructional sequence. G-14 Use reinforcement procedures to weaken behavior (e.g., DRA, FCT, DRO, DRL, NCR). G-15 Use extinction. G-16 Use positive and negative punishment (e.g., time-out, response cost, overcorrection). G-17 Use token economies. G-18 Use group contingencies. G-19 Use contingency contracting. G-20 Use self-management strategies. G-21 Use procedures to promote stimulus and response generalization. G-22 Use procedures to promote maintenance. Levin and his team of support through DSS were aware that Levin needed to demonstrate the acquired skills not just at school but also in the community and in future employment situations. Thus, to support the generalization of the skills across contexts, Levin and his team developed a general case plan that addressed the skills with variations on responses, contexts and exceptions for parties, clubs, social events, as well as department professional events, and interviews. The general case plan sample is found in Figure 5.5. To increase the likelihood of long-term effectiveness they took advantage of Levin’s preference for rules and followed rule-governed behavior (RGB) strategies. According to Skinner (1984), rules function as a contingency specifying stimulus similar to SD. RGB promotes control by long-term consequences (e.g., making friends or romantic relations). Hayes et al. (1998) hypothesized that moral behavior can be developed via verbal regulation. Given that Levin is highly verbal, he developed rules based upon contexts that

Case Study Five — Levin | 213 Figure 5.5. General Case Analysis Form — Levin

were available with the support of technology such as voice recorders in his phone, Apps, and notes within his smart phone (Ehlhardt et al., 2008). Behavioral cusps are behaviors that extend beyond the immediate change itself because it exposes the person to new environments, reinforcers, contingencies, and responses (Cooper et al., 2020). The behaviors selected as replacements for the stalking-type behaviors were

214 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

all behavioral cusps and many were within Levin’s behavioral repertoire but were not demonstrated under the appropriate contexts and conditions. As described above, the rules served as SDs for engagement in appropriate replacement behaviors for the challenging behaviors that could be interpreted as stalking. Rather than manipulation of antecedents, Levin was aware of the antecedents and triggers and arranged prevention strategies and coping skills to use when faced with those triggers. Through the use of role play, Levin received discrimination training to evaluate his behaviors to determine where they stood on the scale of 1-5 with 1) very informal social behavior, 2) reasonable behavior, 3) odd behavior, 4) scary behavior and 5) physically hurtful behavior or threatening behavior (see Figure 5.3 for the checklist of this scale). Levin and Fripp developed bi-weekly contracts that were based upon the demonstration of a new skill and the absence of the challenging behaviors. Reinforcers for following the behavioral contracts included tickets to sporting events and movie passes. Levin’s family was also involved in the behavior contracts where they supported the demonstration of new skills and meeting of goals with special activities. Reinforcement did not need to immediately follow demonstration of the behavior given that Levin responds well to delayed reinforcement. Personnel Supervision and Management I-1

I-2 I-3 I-4 I-5 I-6

I-7

State the reasons for using behavior-analytic supervision and the potential risks of ineffective supervision (e.g., poor client outcomes, poor supervisee performance). Establish clear performance expectations for the supervisor and supervisee. Select supervision goals based on an assessment of the supervisee’s skills. Train personnel to competently perform assessment and intervention procedures. Use performance monitoring, feedback, and reinforcement systems. Use a functional assessment approach (e.g., performance diagnostics) to identify variables affecting personnel performance. Use function-based strategies to improve personnel performance.

Case Study Five — Levin | 215

I-8

Evaluate the effects of supervision (e.g., on client outcomes, on supervisee repertoires).

Personnel supervision and management are not relevant in this case. Ethics E-1 Introduction. E-2 Responsibility as a Professional. E-3 Responsibility in Practice. E-4 Responsibility to Clients and Stakeholders. E-5 Responsibility to Supervisees and Trainees. E-6 Responsibility in Public Statements. E-7 Responsibility in Research. Levin’s behavior involves potential legal issues that are addressed below. Fripp, Levin’s coach from the DDS Center on campus has ethical obligations to Levin as his client, to the profession as a graduate student, to the stakeholders such as Levin’s family and to the women on the campus. Code element 2.04 Disclosing confidential information is something that Fripp will need to be aware of in this process given Levin has brought in friends from his classes and the dorm into the treatment implementation. Fripp has an obligation to report behavior that could cause physical or mental harm and if the behavior leads to legal action he may need to disclose information about the situation if court ordered. Levin and Fripp already have involved client (Levin) and stakeholders (family and friends) as seen under Code element 2.09. They have participated in selecting the interventions and goals. The team needs to continual evaluate the behavior-change interventions for effectiveness with data monitoring (self-monitor) with check-ins for accuracy. This is captured in Code element 2.18.

The Use of Technology in Interventions for Behavior Change As noted earlier in the description of Levin, he has difficulty with handwriting. Given universities often have large lectures with demand for note taking, he benefited from the use of technology to support note

216 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

taking through the use of a Smart pen. He used the smart pen for writing, scribbles and diagrams that provides links from notes to recorded lectures. Levin also has difficulty with organization; getting assignments in on time, noting when assignments are due, scheduling the time to complete the assignment in steps, and tracking four to five courses at a time on a schedule. The DSS can provide some support for Levin but mostly he uses technology to support himself in the development of organization systems. Using a smart phone Levin photographs diagrams, notes and assignments posted in classrooms. Most assignments are posted within a learning management system in his university (e.g., Blackboard, Canvas). These assignments and deadlines can be imported into a digital calendar. There are Apps created that are meant for college students organized by semesters and courses with due dates, short-term and long-term assignments as well as categorized items for anytime or someday. These Apps can integrate with calendars from Google to iCalendar. Levin is fluent in use of the technology and his coach helps him set-up assignment deadlines for pieces of the assignment. In addition, digital voice recorders, alarms with designated activities, reminders, and digital checklists are used as reminders and guides.

Executive Function Skills Planning and Organizing Levin created systems on his desk in his dorm with the support of his family. He has low technology systems such as a corkboard where assignments are listed on a calendar with due dates. When items are completed, Levin checks the items as submitted and it moves to the completed section of the tracking application. Self-Monitoring (Meta-cognition) This is a skill that Levin is working on with Fripp during coaching sessions. Levin uses this skill to talk himself through situations that are triggers for stalking behaviors. Again, this is also supported with the scale of 1-5 of acceptable behavior to stalking on the phone. Time Management This is incorporated within Levin’s systems for planning assignments

Case Study Five — Levin | 217

and deadlines. However, recognizing the amount of time that has elapsed and planning how long to spend on assignments can be a deficit for some with executive function issues. Levin decided to use planning a time to complete assignments (e.g., 45 minutes to study biology), setting a timer and then moving on to the next assignments once the time elapses as a self-management strategy.

Collaboration with Others It is important that Levin is honest with his coach and family and gets their support in the development of these skills. Even more important is the availability of peers for support and feedback. Levin has recruited his friends Bruford and Adrian. They may also bring in their friends to help him develop a network of friends that are aware of his areas of interest and topics, his social deficits, and goals. Stokes et al. (2007) examined the nature and predictors of social and romantic functioning in autistic adolescents and adults and found that individuals with ASD pursued a romantic interest longer than typical when there was no response or a negative reaction from the other person. Parents reported that it was difficult for their autistic child to know when it was appropriate to stop contact. Importantly, a significant predictor of successful romantic interaction in the Stokes et al. (2007) study was the extent to which social skills were learned from neurotypical peers. A neurodiversity model assumes that individuals’ strengths and difficulties are contextual and tend to be the result of the interaction between an ableist society and individual differences or impairments (Milton 2014; Robertson 2009). There would be no attempt to change who Levin is or reject his interest and strengths. But it is important that he engage in safe behaviors and remain within the law. This indicates how important it is to involve neurotypical peers and other autistics in Levin’s intervention for social validity, modeling, feedback, and friendship.

Legal Issues Levin has access to DSS at his university and has arranged reasonable accommodations and support at his school under the Americans with Disabilities Act (ADA). The ADA requires colleges to provide accommodations for students with disabilities to have equal access to educational opportunities (Duffy & Gugerty, 2005). This is his legal right.

218 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

However, college students are no longer protected under IDEA, instead they have rights under ADA and 504. These laws prevent discrimination against “otherwise qualified” individuals based on disability. Universities can accept or reject applicants who do not meet standards, however, under 504 the students can receive accommodations and modifications, but individual must request these (not parents) and there are no requirements to provide an FBA. If a student violates the student conduct code (e.g., stalking), the college is not required to provide an FBA, any behavior intervention or support services. A student whose disability prevents them from complying with the conduct code is not considered to be an “otherwise qualified” student and is subject to the same disciplinary procedures as nondisabled students, up to and including expulsion. (Autistic Self Advocacy Network, 2013, p.22). What this means is that Levin must manage own behavior and comply with code of conduct. Levin benefited from knowing what specifically are stalking behaviors under the state laws. This assisted him in making sure that he is not engaging in any criminal behavior and face potential expulsion from the university.

Quality of Life Physical Well-Being Levin is currently physically healthy and is typical of most college freshman in his physical activity. Whereas he loves to watch sporting events he does not participate in teams. Physically, he can be awkward, so this is not the best activity for making friendships. However, he participates in casual Ultimate Frisbee games with other students in the nuclear engineering program. Mostly he gets exercise walking the large campus. He has free access to a gym and facilities if he chooses to engage in more physical activities. Material Well-Being Graduating from college is tied to wealth, housing, and transportation. College graduates have a significantly better life outcome and opportunity then those that have not attended college. It will be important for Levin to continue to receive support so that he can successfully graduate. For neurodiverse people, maintaining employment in a rigid, deficit model, society can be difficult. Mastering the social communicative demands of the workplace and challenging the negative view of autism,

Case Study Five — Levin | 219

will assist with access to employment. Interpersonal Well-Being This will continue to be an issue for Levin in an ableist society, thus the need for supports, feedback, coaching and interventions (Robertson, 2009). If Levin chooses to be friends with only neurodiverse people that is an option. However, the goal here is to keep Levin’s behavior within the law and bring him happiness through reaching his goal of attaining a girlfriend. The interventions reviewed above will support Levin to develop social relationships with a diversity of friends and romantic relationships. Additionally, Levin needs to choose social activities that match his interests, which may be on the college campus but also could be in the community. Importantly, he needs to determine activities of interest, have a mentor prepare him for those activities, possibly have friend or mentors attend events and practice the skills needed in those preferred activities. Productive Well-Being Levin’s participation in the development of his interventions and selfmanagement skills will help him to remain productive. A degree in nuclear engineering will likely provide Levin with opportunities to be productive and a contributing member of society. Emotional Well-Being Autistics often have a co-occurrence of anxiety, depression, or obsessive-compulsive disorder (OCD). Levin, his family, and support network should help monitor symptoms of these potential disorders and get support from a psychiatrist, psychologist or therapist if they see signs. Rights and Inclusion As a student at a large university Levin has many opportunities for civic involvement through clubs and political organizations. There also needs to be consideration of rights to respect for dignity, respect for differences, and opportunities for full participation in the community and society. This is changing as society becomes more aware of neurodiversity but these rights and inclusion in society needs to be forged by autistic advocacy.

220 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

FOUNDATIONAL AND LIFESTYLE STRATEGIES O’Neill et al. (2015) recommend that in analyzing foundational and lifestyle strategies it is important to consider communication, mobility, activity patterns, social relationships, control/choice, and predictability. The social relationships issue has previously been addressed. Communication, mobility, and predictability are not of concern with Levin.

Person-Centered Planning Levin has participated in the development of his interventions and sought help when he was confronted with the problem. He has selfawareness, self-determinations skills and the desire and impetus to plan for his future. A formal person-centered planning process is not necessary for his success.

Supports The Neurodiverse Person Levin knows his rights as an American with a disability. His diagnosis is not new to him, and he has identified himself as an autistic person. He has been able to share information with the college faculty on universal design (an area that interests Levin). The benefits of attending a large university are the availability of others on the autism spectrum. The university has a support group facilitated by an advisor (graduate student). Family Members Levin’s family will need to remain in close contact with him to support him through college. Employers/Community Members Legally, Levin does not need to disclose his disability to anyone in the community, on the university campus, or with employers should he seek student employment. However, Levin sees the advantage of self-disclosure and usually makes this disclosure (such as seeking supports with the

Case Study Five — Levin | 221

DSS office). As autism has increased in diagnosis, people in society are much more aware of autism spectrum disorder. When Levin engages in what many people would describe as “odd” behaviors he finds people are more understanding. However, the community at large needs to continue to increase acceptance of neurodivergence’s and the benefits to employers and the community.

Discussion Questions 1. Should Levin self-disclose his diagnosis of autism spectrum disorder to his dorm-mates and peers in class? What would be the benefit or drawbacks of self-disclosure? 2. Should Levin face consequences with the criminal justice system for his behavior at this point? If his stalking behavior continues, should he face criminal charges? 3. Do Levin’s behaviors qualify as stalking given the intent was to gain a romantic relationship, but he lacked the competencies required?

EMPIRICAL RESEARCH TO SUPPORT THAT THE INTERVENTION IS AN EVIDENCE-BASED PRACTICE College and ASD Koegel, L. K., Ashbaugh, K., Koegel, R. L., Detar, W. J., & Regester, A. (2013). Increasing socialization in adults with Asperger’s Syndrome. Psychology in the Schools, 50(9), 899-909. Roberts, N., & Birmingham, E. (2017). Mentoring university students with ASD: A mentee-centered approach. Journal of Autism and Developmental Disorders, 47(4), 1038-1050. Shattuck, P. T., Narendorf, S. C., Cooper, B., Sterzing, P. R., Wagner, M., & Taylor, J. L. (2012). Postsecondary education and employment among youth with an autism spectrum disorder. Pediatrics, 129(6), 1042-1049. Vincent, J., Potts, M., Fletcher, D., Hodges, S., Howells, J., Mitchell, A., . . . Ledger, T. (2017). “I think autism Is like running on Windows while everyone else is a Mac”: Using a participatory action research approach with students on the autistic spectrum to rearticulate autism and the lived experience of university. Educational Action Research, 25(2), 300-315. White, S. W., Elias, R., Salinas, C. E., Capriola, N., Conner, C. M., Asselin, S. B.,Miyazaki, Y., Mazefsky, C. A., Howlin, P., & Getzel, E. E. (2016). Students with autism spectrum disorder in college: Results from a preliminary mixed methods needs analysis. Research in Developmental Disabilities, 56, 29-40.

222 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

Rule-Governed Behavior Arntzen, E., Halstadtro, L., & Halstadtro, M. (2009). The “Silent Dog” method: Analyzing the impact of self-generated rules when teaching different computer chains to boys with autism. Analysis of Verbal Behavior, 25(1), 51-66. Browder, D., Demchak, M. A., Heller, M., & King, D. (1989). An in vivo evaluation of the use of data-based rules to guide instructional decisions. Journal of the Association for Persons with Severe Handicaps, 14(3), 234-40. Jameel, L. l., Vyas, K., Bellesi, G., Cassell, D., & Channon, S. (2015). Great expectations: The role of rules in guiding pro-social behavior in groups with high versus low autistic traits. Journal of Autism and Developmental Disorders, 45(8), 2311-2322. Tarbox, J., Zuckerman, C. K., Bishop, M. R., Olive, M. L., & O’Hora, D. P. (2011). Rule-governed behavior: Teaching a preliminary repertoire of rulefollowing to children with autism. The Analysis of Verbal Behavior, 27(1), 125-139.

Self-Calming Bemmouna, D., Coutelle, R., Weibel, S., & Weiner, L. (2021). Feasibility, acceptability and preliminary efficacy of Dialectical Behavior Therapy for autistic adults without intellectual disability: A mixed methods study. Journal of Autism and Developmental Disorders, 52(10), 4337-4354. Ritschel, L. A., Guy, L., & Maddox, B. B. (2022). A pilot study of dialectical behaviour therapy skills training for autistic adults. Behavioural and Cognitive Psychotherapy, 50(2), 187-202. Sturges, J., & Sturges, L. (1998). In vivo systematic desensitization in a singlesession treatment of an 11-Year old girl’s elevator phobia. Child and Family Behavior Therapy, 20(4), 55-62.

Self-Management Ganz, J. B., Heath, A. K., Davis, J. L., & Vannest, K. J. (2013). Effects of a selfmonitoring device on socially relevant behaviors in adolescents with Asperger Disorder: A pilot study. Assistive Technology, 25(3), 149-157. Koegel, L., Park, M., & Koegel, R. (2014). Using self-management to improve the reciprocal social conversation of children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 44(5), 1055-1063.

Technology Supports for Memory and Organization Powell, L. E., Glang, A., Ettel, D., Todis, B., Sohlberg, M., & Albin, R. (2012). Systematic instruction for individuals with acquired brain injury: Results of a randomized controlled trial. Neuropsychological Rehabilitation, 22(1), 85–112.

Case Study Five — Levin | 223

Video Feedback Deitchman, C., Reeve, S. A., Reeve, K. F., & Progar, P. R. (2010). Incorporating video feedback into self-management training to promote generalization of social initiations by children with autism. Education and Treatment of Children, 33(3), 475-488. Detar, W. J. (2013, January 1). Targeting question-asking initiations through video feedback to improve social conversation in college students with Autism Spectrum Disorders. Dissertation UC Santa Barbara, ProQuest LLC. Sibley, M. H., Pelham, W. J., Mazur, A., Gnagy, E. M., Ross, J. M., & Kuriyan, A. B. (2012). The effect of video feedback on the social behavior of an adolescent with ADHD. Journal of Attention Disorders, 16(7), 579-588.

GENERAL REFERENCES Autistic Self Advocacy Network. (2013). Navigating college: A handbook on selfadvocacy. Written for autistic students from autistic adults. https://autisticadvocacy.org/ Barbaro, J., & Dissanayake, C. (2007). A comparative study of the use and understanding of self-presentational display rules in children with high functioning autism and asperger’s disorder. Journal of Autism and Developmental Disorders, 37(7), 1235-1246. Buron, K. (2007). A 5 is against the law! Social boundries: Straight up! Shawnee Mission, KS: Autism Asperger Publishing Co. Cooper, J. O., Heron, T. E., & Heward, W. L. (2020). Applied behavior analysis (3rd ed.). Hoboken, NJ: Pearson. Deitchman, C., Reeve, S. A., Reeve, K. F., & Progar, P. R. (2010). Incorporating vdeo feedback into self-management training to promote generalization of social initiations by children with autism. Education and Treatment of Children, 33(3), 475-488. Duffy, J.T. , & Gugerty, J. (2005) The role of disability support services. In E.E. Getzel, & P. Wehman, (Eds.), Going to college (89-115). Baltimore: MD.: Paul H. Brookes Publishing Co. Ehlhardt, L. A., Sohlberg, M. M., Kennedy, M., Coelho, C., Ylvisaker, M., Turkstra, L., & Yorkston, K. (2008). Evidence-based practice guidelines for instructing individuals with neurogenic memory impairments: What have we learned in the past 20 years?. Neuropsychological Rehabilitation, 18(3), 300-342. Hanley, G. P. (2012). Functional assessment of problem behavior: Dispelling myths, overcoming implementation obstacles, and developing new lore. Behavior Analysis in Practice, 5(1), 54-72. Haring, T. G., & Breen, C. G. (1992). A peer-mediated social network intervention to enhance the social integration of persons with moderate and severe disabilities. Journal of Applied Behavior Analysis, 25(2), 319-333.

224 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

Hayes, S. C., Gifford, E. V., & Hayes, G. J. (1998). Moral behavior and the development of verbal regulation. The Behavior Analyst, 21(2), 253-279. Koegel, L. K., Ashbaugh, K., Koegel, R. L., Detar, W. J., & Regester, A. (2013). Increasing socialization in adults with Asperger’s syndrome. Psychology in the Schools, 50(9), 899-909. Meloy, J.R. & Gothard, S. (1995). Demographic and clinical comparisons of obsesisonal followers and offenders with mental disorders. American Journal of Psychiatry, 152(2), 258-263. Milton, D. E. (2014). Autistic expertise: A critical reflection on the production of knowledge in autism studies. Autism, 1(4) 1–9. Mruzek, D. W., Cohen, C., & Smith, T. (2007). Contingency contracting with students with autism spectrum disorders in a public school setting. Journal of Developmental and Physical Disabilities, 19(2), 103-114. Myles, B. S. (2003). Behavioral forms of stress management for individuals with Asperger syndrome. Child and Adolescent Psychiatric Clinics of North America, 12(1), 123-141. Myles, B. S., & Simpson, R. L. (2001). Understanding the hidden curriculum: An essential social skill for children and youth with Asperger syndrome. Intervention in School and Clinic, 36(5), 279–286. Post, M., Haymes, L. K., Storey, K., Loughrey, T., & Campbell, C. (2014). Understanding stalking behaviors by individuals with autism spectrum disorders and recommended prevention strategies for school settings. Journal of Autism and Developmental Disorders, 44(11), 2698-2706. Proctor, M. (2003). How to stop a stalker. Amherst, NY: Prometheus Books. Riviere, A. (1996). Assistive technology: Meeting the needs of adults with learning disabilities. Academy for Educational Development, Washington D. C. National Adult, Literacy Learning Disabilities Center, Washington D. C. Robertson, S. M.( 2009). Neurodiversity, quality of life, and autistic adults: Shifting research and professional focuses onto real-life challenges. Disability Studies Quarterly 30(1). Skinner, B. F. (1984). An operant analysis of problem solving. Behavioral and Brain Sciences, 7(4), 583-613. Snow, R. L. (1998). Stopping stalking: A cop’s guide to making the system work for you. New York: Plenum. Spitzberg, B. H., & Cupach, W. R. (2007). The state of the art of stalking: Taking stock of the emerging literature. Aggression and Violent Behavior, 12(1), 64-86. Stokes, M., Newton, N., & Kaur, A. (2007). Stalking, and social and romantic functioning among adolescents and adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 37(10), 1969-1986. Watts, A. C., Wilder, D. A., Gregory, M. K., Leon, Y., & Ditzian, K. (2013). The effect of rules on differential reinforcement of other behavior. Journal of Applied Behavior Analysis, 46(3), 680-684. Westrup, D., & Fremouw, W. J. (1998). Stalking behavior: A literature review and suggested functional analytic assessment technology. Aggression and Violent Behavior, 3(3), 255-274. Winsler, A., Abar, B., Feder, M. A., Schunn, C., & Rubio, D. A. (2007). Private speech and executive functioning among high-functioning children with

Case Study Five — Levin | 225

autistic spectrum disorders. Journal of Autism and Developmental Disorders, 37(9), 1617-1635.

Case Study Six — Doug Case Study Covers: • Traumatic Brain Injury • Adult Setting

D

oug is a twenty-six-year-old man who graduated from college with a degree in accounting. He had worked at an accounting firm for several years when he sustained a head injury when he was hit by a car while riding his bike. Fortunately, he was wearing a helmet but he still sustained a Traumatic Brain Injury (TBI), which put him in the hospital for several months. Following his hospitalization, he received rehabilitative services and he was out of work for several more months. Doug lives in an apartment with his wife Linda and he has a large and close-knit extended family that lives in the same town. Therefore, he receives a lot of support for residential and community living from Linda and his family. Doug also receives services from the Department of Rehabilitation to assist him with returning to work. Doug’s employer and co-workers at his job site are glad to see Doug back as he is competent at his work and very personable and is well liked by all. Doug has been worried about returning to work. He walks slower due to his TBI and also his processing skills are sometimes a bit slower as well. Doug experiences some cognitive impairment in that he can only handle small amounts of new information at a time. This has increased his anxiety level. At work, Doug sometimes gets multiple work requests from his supervisor or co-workers within a short time frame. These are legitimate requests but Doug has started having “mini meltdowns” when they occur. These meltdowns involve Doug becoming highly anxious where he starts hyperventilating, sweating, pacing, and swearing to himself. He then “shuts down” and is unable to work at all for several hours. 227

228 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

Needless to say, Doug’s supervisor and co-workers are very concerned as they want him to succeed in coming back to work. Doug had previously provided information to his supervisor that he has a counselor from Department of Rehabilitation and given permission for his supervisor to contact that person. He has also given permission for his supervisor to contact his wife as well so that she can help support him.

CASE STUDY EVALUATION Based upon the case study provided above and accompanying data sheBased upon the case study provided above, the following sections analyze the issues that arise in providing behavioral services and supports for Doug. This analysis is based upon the Behavior Analyst Certification Board Task List 5th edition. Competencies addressed are Foundations, C: Measurement, Data Display, and Interpretation and Applications, E: Ethics (The Ethics Code for Behavior Analysts), F: Behavior Assessment, G: Behavior-Change Procedures, H: Selecting and Implementing Interventions, and I: Personnel Supervision and Management. These examples are provided as a guide to successfully resolving client case issues and developing competencies as behavior analysts. Behavior Assessment F-1 F-2 F-3 F-4 F-5 F-6 F-7 F-8 F-9

Review records and available data at the outset of the case. Determine the need for behavior-analytic services. Identify and prioritize socially significant behaviorchange goals. Conduct assessments of relevant skill strengths and deficits. Conduct preference assessments. Describe the common functions of problem behavior. Conduct a descriptive assessment of problem behavior. Conduct a functional analysis of problem behavior. Interpret functional assessment data.

A counselor from the state Department of Rehabilitation, Ms. Moont, met with Doug and Linda to assess the situation and provide recommendations. Ms. Moont reviewed Doug’s records and

Case Study Seven — Doug | 229

recommended a preliminary assessment that included the interview and direct observation data collection using the Functional Assessment Interview Form (FAI) from O’Neill et al. (2015). Ms. Moont conducted the interview with Doug and his wife Linda was present as well. Based upon the interview it was decided to have Doug collect data upon his own behavior, as it was not appropriate to have data collectors observing Doug in his work environment. Doug decided to use the FAOF data collection form following each incident of the challenging behaviors and Doug shrunk the FAOF form on a copier so that it fit in his day planner so that he could unobtrusively collect data. His collection of data then provides the relevant information for analysis and data decision regarding an intervention. The FAOF form provides a frequency count which would provide accurate and relevant information regarding Doug’s “shut-downs” and “meltdowns.” It would also be an easy data collection procedure for Doug to use and for him to share the data with others. It would be appropriate to begin by conducting a records review of Doug’s medical reports, vocational rehabilitation records, and any documentation/information that the employer could provide. Because of privacy requirements, it would be necessary to obtain Doug’s written permission for service providers to see these sources. Doug received a closed head injury to the left side of his head. His medical diagnosis suggested that it would be likely that Doug would have cognitive deficits such as impaired attention, reduced processing speed, distractibility, and deficits in executive functions. Understanding these factors will help in assessing how Doug responds to antecedents in his environment (Rahman et al., 2010). A preliminary assessment included the interview Ms. Moont conducted with Doug and his wife Linda using the Functional Assessment Interview Form (FAI) from O’Neill et al. (2015). Not all of the questions were relevant to Doug’s situation but it did serve as an initial assessment guide (Figure 6.1). This assisted in providing a more comprehensive assessment and a discussion of issues that could be relevant but that Doug and Linda had not considered such as Doug’s sleep patterns. Measurement, Data Display, and Interpretation C-1 C-2

Establish operational definitions of behavior. Distinguish among direct, indirect, and product measures of behavior.

230 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 6.1. Functional Assessment Interview (FAI) — Doug.

Case Study Seven — Doug | 231

232 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 6.1. Continued.

Case Study Seven — Doug | 233

234 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 6.1. Continued.

Case Study Seven — Doug | 235

236 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 6.1. Continued.

C-3 C-4 C-5 C-6 C-7 C-8

Measure occurrence (e.g., frequency, rate, percentage). Measure temporal dimensions of behavior (e.g., duration, latency, interresponse time). Measure form and strength of behavior (e.g., topography, magnitude). Measure trials to criterion. Design and implement sampling procedures (i.e., interval recording, time sampling). Evaluate the validity and reliability of measurement

Case Study Seven — Doug | 237

procedures. C-9 Select a measurement system to obtain representative data given the dimensions of behavior and the logistics of observing and recording. C-10 Graph data to communicate relevant quantitative relations (e.g., equal-interval graphs, bar graphs, cumulative records). C-11 Interpret graphed data. The FAOF form was selected as it provided information on the antecedents and consequences that may be controlling Doug’s behavior (Figure 6.2). An ABC data collection system would also provide this information, but it was decided that it would be difficult for Doug and others to easily analyze the information. Frequency data collection would provide some information regarding antecedents and consequences. Thus, the FAOF was helpful in development of appropriate interventions, but once the interventions are in place frequency would provide relevant information in determining program effectiveness. Doug was able to self-record information on the FAOF form each time that an incident occurred so it was not necessary to schedule specific observation and recording periods. The challenging behaviors were identified, and a preliminary definition provided by the interview form: 1) “meltdowns involve Doug becoming highly anxious with hyperventilating, sweating, pacing, and swearing to himself”; 2) “shut-downs involve Doug not working or interacting with others when he should be.” The results from the FAOF (Figure 6.2) and FAI (Figure 6.1) indicate that the function of Doug’s “meltdowns” and “shutdowns” is to avoid work task requests when he is “overloaded” (escape behaviors). The FAOF form (Figure 6.2) shows that melt downs occurred twelve times (incidents 1 through 12) most frequently during afternoon times. Shutdowns also occurred twelve times (incidents 1 through 12) and occurred immediately following meltdowns. Each incident occurred when given more than one work request and the function of each incident was escape from the work request. The actual consequence of each incident was the removal of the work request. Thus, Doug’s challenging behaviors are negatively reinforced. The definition of the behaviors was determined prior to self-observation and data collection based upon the Functional Assessment interview, but the definition was refined based upon observation prior to formal data collection. The operational definitions are provided in

Figure 6.2. Functional Assessment Observation Form — Doug.

238 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

Case Study Seven — Doug | 239

Table 6.1. After talking with Doug and visiting him at his work site, Ms. Moont defined the environmental variables that are influencing Doug’s challenging behaviors as: “When Doug is presented with more than one work request within a 15-minute time frame, he will often have a ‘meltdown.’ ‘Meltdowns also are likely to occur when Doug has three or more work assignments to complete at one time.’” The results from the FAOF and FAI indicate that the function of Doug’s “meltdowns” and “shutdowns” is to avoid work tasks. These behaviors occur most frequently when Doug has had a poor night’s sleep, is stressed from his workload, and when work demands are unpredictable to him. The FAOF sheet can also be used by Doug to continue to analyze the changes in his behavior and to track the factors influencing any areas that continue to need an intervention. Selecting and Implementing Interventions H-1 State intervention goals in observable and measurable terms. H-2 Identify potential interventions based on assessment results and the best available scientific evidence. H-3 Recommend intervention goals and strategies based on such factors as client preferences, supporting environments, risks, constraints, and social validity. H-4 When a target behavior is to be decreased, select an

Table 6.1. Operational Definitions of Behavior — Doug.

240 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

H-5 H-6 H-7 H-8 H-9

acceptable alternative behavior to be established or increased. Plan for possible unwanted effects when using reinforcement, extinction, and punishment procedures. Monitor client progress and treatment integrity. Make data-based decisions about the effectiveness of the intervention and the need for treatment revision. Make data-based decisions about the need for ongoing services. Collaborate with others who support and/or provide services to clients.

It will be important to establish and increase “calming” or “coping” behaviors for Doug when he is presented with work requests (HayesSkelton et al., 2013). These will serve as replacement behaviors for his “meltdowns” and “shutdowns” and thus decrease his engaging in these challenging behaviors. Because Doug is in a work situation where the presence of a direct service provider such as a job coach would be inappropriate, self-management strategies would be a logical intervention as they would help him to control both antecedents and consequences in his work environment (Kendrick et al., 2012; Knight et al., 2002; Watson & Tharp, 2014). Behavior-Change Procedures G-1 Use positive and negative reinforcement procedures to strengthen behavior. G-2 Use interventions based on motivating operations and discriminative stimuli. G-3 Establish and use conditioned reinforcers. G-4 Use stimulus and response prompts and fading (e.g., errorless, most-to-least, least-to-most, prompt delay, stimulus fading). G-5 Use modeling and imitation training. G-6 Use instructions and rules. G-7 Use shaping. G-8 Use chaining. G-9 Use discrete-trial, free-operant, and naturalistic teaching arrangements. G-10 Teach simple and conditional discriminations.

Case Study Seven — Doug | 241

G-11 G-12 G-13 G-14 G-15 G-16 G-17 G-18 G-19 G-20 G-21 G-22

Use Skinner’s analysis to teach verbal behavior. Use equivalence-based instruction. Use the high-probability instructional sequence. Use reinforcement procedures to weaken behavior (e.g., DRA, FCT, DRO, DRL, NCR). Use extinction. Use positive and negative punishment (e.g., time-out, response cost, overcorrection). Use token economies. Use group contingencies. Use contingency contracting. Use self-management strategies. Use procedures to promote stimulus and response generalization. Use procedures to promote maintenance.

Ms. Moont met with Doug and his supervisor to develop appropriate strategies to support Doug. After discussing the situation and going over the data that Doug had collected using the FAOF form it became clear that antecedent strategies would be key, and they would potentially stop the challenging behaviors from occurring (Schaub et al., 2012). First, they decided that work requests from co-workers for Doug should initially go through his supervisor (but that this intervention would be phased out once the other interventions have reached fluency). This would allow Doug to screen the number of requests so that not too many would be coming in at one time (e.g., not more than one in a 15-minute time period). Second, Doug wanted some sort of signal to co-workers and his supervisor that he was feeling stressed at that point in time, but that this intervention would be phased out once the other interventions had reached fluency levels. Ms. Moont also worked with Doug on recognizing the stimuli that represent his being stressed so that he can intervene early on in the escalation process. Ms. Moont did role-play with Doug around stressful situations and how to recognize when he was becoming stressed. Because Doug was well known for his wacky sense of humor, Doug decided that he would put up a large yellow sign on his desk that read “Doug is stressed, so approach with caution!” This would provide others with an antecedent cue that they may not want to approach Doug at that time either for work request or for chitchat (Kennedy, 1994; O’Reilly & Cuvo, 1989; Therrien et al., 2005). These

242 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

signs also served as a self-management strategy for Doug and provided self-feedback regarding his ability to handle work requests. Third, Doug also decided upon a red sign with the words “Doug is more than stressed, do not approach. Stay away!” to use when he had reached the beginning of a “meltdown” stage. This would keep others away when Doug was at the start of his “meltdown” stage and allow him an opportunity to calm himself down. Finally, as an antecedent strategy Doug decided upon several selfcalming strategies. First, he worked on recognizing triggers to his “meltdown” behaviors such as sweating or swearing to himself. Then he learned deep breathing and muscle tense and relaxation techniques (Hsieh et al., 2012). He also used a compensatory skill (or calming strategy) where he would do deep breathing and visualization of his walking in the redwoods at his and Linda’s favorite hike (Guercio et al., 2001). The team also decided upon several consequence strategies. First, they decided upon a self-recruited feedback strategy (Mank & Horner, 1987). With this strategy, every time that Doug started to get stressed but then handled it well with one of the antecedent strategies, he would either stop by his supervisor’s office or if he was not available, he would tweet or text him that he had handled a stressful situation well. This would allow opportunities for Doug to get reinforcement and feedback for his skillful behavior, from his supervisor and also to give the supervisor information on how Doug was doing handling these situations. Second, Doug decided that he would also text Linda when he handled a situation well so that she could reinforce his use of compensatory behaviors, at home as well. Third, Doug decided to use a cumulative graph of both well-handled situations and poorly handled situations so that he would get visual feedback on a daily basis on his performance (Maki et al., 2008). He could also then share these data with Linda and/or his supervisor if he desired. Fourth, Doug asked for a “quiet room” as an accommodation so that when he reached the stage of having a “meltdown” or a “shutdown” he could remove himself to that room to have time to recover in a private area (Steward & Alderman, 2010). After some deliberation, his supervisor agreed as long as the room was also available to other co-workers so that they could meditate, relax, or calm down themselves. Doug readily agreed to this suggestion as it would benefit everyone at the work site. Fifth, and finally, Doug decided upon a delayed self-reinforcement

Case Study Seven — Doug | 243

system (Dixon et al., 2003). Every time that he handles a stressful situation well, he pays himself a dollar that he then uses for back-up reinforcers such as buying CD’s and books or going out for dinner with Linda. Doug and others used social validation regarding acceptability of procedures and acceptability of the focus of the intervention (social significance of goals). Acceptability of the procedures involves a judgment of whether the intervention is socially acceptable. In this case study, both Doug and his employer indicated that the proposed interventions were acceptable to them. Social significance of the goals involves having the behavior analyst consult others about skills that need to be taught. This occurred through consultation with Doug, his employer, and co-workers. Doug will need to be able to generalize skills across people, times, and behaviors (generalization across settings is not an issue for Doug since all occurrences are at his work site and he is able to generalize skills from other settings to his work site). Two general case intervention strategies that would be most relevant for Doug are programming common stimuli and the use of multiple exemplars. Program common stimuli involves selecting a salient stimulus from the situation to which generalization is desired, and include that stimulus in the training program (Horner et al., 1986). For Doug this could involve role-playing with Linda or his supervisor where they model verbal requests (the salient stimulus) that co-workers often make to Doug. Multiple exemplars involves providing several examples of the stimulus class to which generalization is desired. This could involve roleplaying where Doug is doing work tasks and Linda and his supervisor provide different situations where Doug can practice using his antecedent strategies (self-calming). These role-playing scenarios should include when Doug is presented with more than one work request within a 15-minute time frame and when Doug has three or more work assignments to complete at one time. Since it will be important to quickly reduce Doug’s challenging behaviors so that he is not fired there needs to be frequent positive reinforcement for Doug and others so that the behavior change is immediately strengthened and maintained. Doug may want to start with a fixed ratio schedule of reinforcement as this schedule often produces high rates of response. He may want to initially start with an FR1 schedule (where each time he completes an assigned task or handles a difficult situation well he provides self-reinforcement) and then

244 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

gradually thin it to a FR2 and then to an FR3 as long as his desirable behavior is maintaining. Personnel Supervision and Management I-1 I-2 I-3 I-4 I-5 I-6

I-7 I-8

State the reasons for using behavior-analytic supervision and the potential risks of ineffective supervision (e.g., poor client outcomes, poor supervisee performance). Establish clear performance expectations for the supervisor and supervisee. Select supervision goals based on an assessment of the supervisee’s skills. Train personnel to competently perform assessment and intervention procedures. Use performance monitoring, feedback, and reinforcement systems. Use a functional assessment approach (e.g., performance diagnostics) to identify variables affecting personnel performance. Use function-based strategies to improve personnel performance. Evaluate the effects of supervision (e.g., on client outcomes, on supervisee repertoires).

It will be especially important that Doug’s wife Linda and Doug’s boss continue to experience reinforcement for implementing the behavior change strategies, monitoring the implementation, and for continuing their use. Thus, both Linda and Doug’s boss will need both feedback on Doug’s behavior and to put in place a reinforcement system for their behavior. This feedback could be provided by a cumulative graph or an A-B design line graph displaying Doug’s challenging behaviors at his work site. For Doug’s boss, this could be a brief weekly meeting where Doug shows him that week’s graphed data and if the results are positive they could praise each other (perhaps in a joking manner which would fit into Doug’s work style) and the boss might use a self-delivered reinforcer afterwards such as a special food item or activity. Doug could then share the information with Linda and then provide her with a reinforcer from items or activities that Doug knows that Linda likes or Linda could select one from a list of mutually agreed upon activities which both find reinforcing. Linda may want to

Case Study Seven — Doug | 245

gain access to breaks from her caretaker role as reinforcement for Doug’s progress. Ethics E-1 E-2 E-3 E-4 E-5 E-6 E-7

Introduction. Responsibility as a Professional. Responsibility in Practice. Responsibility to Clients and Stakeholders. Responsibility to Supervisees and Trainees. Responsibility in Public Statements. Responsibility in Research.

It is very important that Ms. Moont provide information to Doug so that he can make informed choice about the supports that he wants to receive. Information for Doug’s wife and family as well as his employer and co-workers are also important but Ms. Moont must make sure that she has Doug’s consent before sharing information with them. Ms. Moont’s recommendations must “fit” and be compatible with Doug’s work and home environments.

The Use of Technology in Interventions for Behavior Change Doug is technologically savvy and he is able to use his smart phone and computer to help meet his support needs so this is not an issue for him. For example, his smart phone can prompt him to take breaks to breathe and do his relaxation techniques. He also has access to commonly used technology such as an activity/sleep monitor, specifically the Jawbone. Or he may use a Fitbit or applications on the smart phone for monitoring activity and sleep.

Executive Function Skills Shifting Attention Doug has difficulty moving from one task to another and shifting attention from one task to another task. To address issues with shifting, Doug has a schedule and calendar on his smart phone. His meetings

246 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

with various people may change daily but those changes are anchored with set items on his schedule. The schedule also has a list of tasks to be completed within the time period of the day. Alerts on his smart phone give him warnings about events coming minutes before he needs to make a change in activity. He has lunch and scheduled breaks to walk and engage in self-calming, relaxing activities and these are the anchor events. In addition, these scheduled walks and breaks serve as opportunities to develop compensatory self-calming skills. Inhibiting Impulses Doug lacks the ability to control his impulses and to stop his challenging behaviors when he is stressed (Kocka & Gagnon, 2014). Doug has visual reminders on his smart phone that provide cues to stop, breathe, count and respond. These are available for now as his wallpaper but eventually these can be placed in an application to be retrieved and used as a reminder. Emotional Control Doug has difficulty modulating and managing his emotional responses appropriately (Pollens et al., 1988). Doug has already arranged to have a quiet calm place he can use when he needs to calm himself down and regain emotional control. His wife is available by phone if he needs to be reminded to use a calm space and reinforcement for use of his self-monitoring. Self-Monitoring (Meta-Cognition) Doug has the ability to self-evaluate his behaviors, which is a strength for him.

Collaboration with Others It is important that Doug be up front and open with his employer regarding his support needs. Cooperation with his supervisor and coworkers will be a critical factor in the success of any interventions in his work site. It will also be very important that Doug cooperate with his wife Linda and other family members so that they can be supportive,

Case Study Seven — Doug | 247

especially in the areas of Doug’s sleep patterns, exercise, and social reinforcers.

Legal Issues Doug is able to ask for reasonable accommodations at his work site under the Americans with Disabilities Act. This is his legal right.

Quality of Life Physical Well-Being The analysis of Doug’s sleeping patterns using his Jawbone device allowed him to see that his sleeping well at night was highly correlated with his exercising regularly and engaging in relaxation procedures (Epstein et al., 2012). It was clear that when he had a poor night’s sleep that he was more stressed at work and thus hindered his ability to handle situations well and led to more “meltdowns.” Doug decided that he would try to ride his bike to work once or twice a week and to ride every day on weekends. He also started a lunch walking group where he and co-workers would go out every day and walk briskly for 20-30 minutes after eating lunch. He and Linda also decided that they would take a walk or bike ride every night after dinner during the week. Material Well-Being Doug’s working is closely tried to his wealth, housing quality, and transportation. Without his job and income his Quality of Life in housing and security would be compromised and his material well-being would decline. Interpersonal Well-Being Doug’s interpersonal relationships are strong. Through his Employee Assistance Program (EAP) at work, Doug decided to join a support group for individuals with TBI. This allowed him to develop social supports from others who were dealing with similar issues and to share difficulties and successes with others who would understand his situa-

248 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

tion from a personal perspective. Productive Well-Being Doug’s working provides personal development in terms of competence and independence. Work is obviously a constructive activity for him to engage in. Keeping his job has allowed him to maintain his Quality of Life in these areas. Doug’s involvement in the assessment of and development of the interventions has given him choice and control over his life. Emotional Well-Being Doug’s happiness, contentment, mental health, and self-esteem are all positively influenced by his continuing in his current job. All jobs have some stress and it is the level of stress and the person’s ability to handle that stress that determines its influence on the person’s quality of life. Doug’s stress level at work was too high for him and negatively affected his quality of life. Putting his interventions into place did not eliminate his stress at work, but made it manageable so that it did not diminish his quality of life. Rights and Inclusion Through his support group, Doug decided to serve as a mentor for a high school student with TBI. This allows him to give back to his community and to serve as a positive role model for that student. Doug also met several times with his city council representative regarding establishing clear bike routes on streets in the city and this led to the establishment of additional bike routes, which will minimize accidents such as the one that Doug was involved in.

FOUNDATIONAL AND LIFESTYLE STRATEGIES Person-Centered Planning It was clear to Doug from the beginning that it was very important that he be in charge of the planning process, in analyzing the situation at his work site, and in developing the interventions (DeHope & Finegan, 1999). This allowed him to play an active role in controlling his life and

Case Study Seven — Doug | 249

decreasing the possibility of passivity on his part. It was not necessary to have a formal PCP meeting (O’Brien & Mount, 2006) but Doug and Linda were able to control the general PCP process to their satisfaction.

Physical, Medical, Psychological, or Mental Health Issues Supports Service Providers Doug receives supports from his family, co-workers, and his employer. The only support that he receives from a professional is from the Department of Rehabilitation, Ms. Moont. It will be important for Doug to keep open lines of communication with Ms. Moont and his employer for any issues regarding supports for Doug that may arise in the future. The Neurodiverse Person Doug (and his wife Linda) need information regarding how his TBI may influence his physical well-being and other aspects of his life. This will help them in making informed decisions regarding these issues as they arise. Doug needs information about his legal rights under the Americans with Disabilities Act and other laws. Organizations and resources such as The Association of People Supporting Employment First, the Job Accommodation Network, the National Rehabilitation Information Center, and the local Center for Independent Living would all be appropriate resources. Family Members Doug’s extended family members need information and education about TBI. Support groups for family members, especially his wife Linda could be very beneficial for them in understanding Doug’s TBI and in developing appropriate supports for Doug as well as for themselves. Information about support group availability should be made available to family members so that they can decide if they would like to join one or not.

250 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

Employers/Community Members Legally, Doug does not necessarily have to disclose information about his TBI to his employer but has chosen to make this disclosure. This has allowed Doug to work collaboratively with his employer in developing appropriate supports to help him be a productive employee. Instructional Supports This is not an issue for Doug in his situation as he knows how to perform his job tasks to the standard that the employer has set. Cultural and Linguistic Issues Doug may choose to add “disability” or “neurodiversity” to his selfidentification and self-description. Doug and others should not view his having a disability as a negative but should instead view it as a positive development in many respects. Doug is now part of the neurodiverse culture, which has asserted that “disability” is primarily a socially constructed role and one that requires self-identification (Longmore, 1995). Thus, Doug is now a member of a group that represents selfidentity and empowerment in political, work, social, and community situations and can lead to both individual and collective empowerment and self-determination (Longmore, 2003). For example, Doug’s involvement in the development of bike lanes in his city demonstrates political empowerment. Doug will have to understand and navigate the negative stereotypes and stigmatization that often go hand in hand with having a disability (Darling, 2013). Having a neurodiverse cultural identity can assist Doug in this navigation.

Discussion Questions 1. If someone has anxiety issues, should they work in a job that may produce those anxieties? 2. Since Doug has a “hidden disability” (e.g., one that is not physically apparent to others) should he disclose his disability to his employer and/or co-workers? Or will disclosing lead to negative attitudes of pity, patronization, etc. 3. Since Doug has a legal and identified disability and thus legal rights related to having a disability should he ask for

Case Study Seven — Doug | 251

specific accommodations before returning to work? 4. Would medication be an effective intervention for helping Doug with his anxiety, “melt-downs,” and stress?

EMPIRICAL RESEARCH TO SUPPORT THAT THE INTERVENTION IS AN EVIDENCE-BASED PRACTICE Antecedent Control Kennedy, C. H. (1994). Manipulating antecedent conditions to alter the stimulus control of problem behavior. Journal of Applied Behavior Analysis, 27(1), 161–170. O’Reilly, M. F., & Cuvo, A. J. (1989). Teaching self-treatment of cold symptoms to a anoxic brain injured adult. Behavioral Residential Treatment, 4(4), 359-375. Therrien, K., Wilder, D. A., Rodriguez, M., & Wine, B. (2005). Preintervention analysis and improvement of customer greeting in a restaurant. Journal of Applied Behavior Analysis, 38(3), 411–415.

Feedback Fleming, J., Tsi Hui Goh, A., Lannin, N. A., Ownsworth, T., & Schmidt, J. (2020). An exploratory study of verbal feedback on occupational performance for improving self-awareness in people with traumatic brain injury. Australian Occupational Therapy Journal, 67(2), 142-152. Levy, T., Crotty, M., Laver, K., Lannin, N., & Killington, M. (2020). Does the addition of concurrent visual feedback increase adherence to a home exercise program in people with stroke: a single-case series? BMC Research Notes, 13(1), 1-6. Maki, A. L., Rudrud, E. H., Schulze, K. A., & Rapp, J. T. (2008). Increasing therapeutic exercise participation by individuals with acquired brain injury using self-recording and reinforcement. Behavioral Interventions, 23(2), 75-86. Mank, D. M., & Horner, R. H. (1987). Self-recruited feedback: A cost-effective procedure for maintaining behavior. Research in Developmental Disabilities, 8(1), 91-112. Sansonetti, D., Fleming, J., Patterson, F., & Lannin, N. A. (In press). Conceptualization of self-awareness in adults with acquired brain injury: A qualitative systematic review. Neuropsychological Rehabilitation.

Self-Reinforcement Dixon, M. R., Horner, M. J., & Guercio, J. (2003). Self-control and the preference for delayed reinforcement an example in brain injury. Journal of Applied Behavior Analysis, 36(3), 371–374.

252 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

Stress Reduction and Relaxation Techniques Cole, M. A., Muir, J. J., Gans, J. J., Shin, L. M., D’Esposito, M., Harel, B. T., & Schembri, A. (2005). Simultaneous treatment of neurocognitive and psychiatric symptoms in veterans with post-traumatic stress disorder and history of mild traumatic brain injury: A pilot study of mindfulness-based stress reduction. Military Medicine. 180(9), 956-963. Guercio, J. M., Ferguson, K. E., & McMorrow, M. J. (2001). Increasing functional communication through relaxation training and neuromuscular feedback. Brain Injury, 15(12), 1073-1082. Hsieh, M., Ponsford, J., Wong, D., Schonberger, M., McKay, A., & Haines, K. (2012). A cognitive behavior therapy (CBT) program for anxiety following moderate – severe traumatic brain injury: Two case studies. Brain Injury, 26(2), 126-138. Steward, I., & Alderman, N. (2010). Active versus passive management of postacquired brain injury challenging behaviour: A case study analysis of multiple operant procedures in the treatment of challenging behaviour maintained by negative reinforcement. Brain Injury, 24(13/14), 1616-1627.

GENERAL REFERENCES Agran, M., & Wehmeyer, M. (2008). Person-centered planning. In F. R. Rusch (Ed), Beyond high school (pp. 56-77). Upper Saddle River, NJ: Pearson. Darling, R. B. (2013). Disability and identity: Negotiating self in a changing society. Boulder, CO: Lynne Rienner Publishers. DeHope, E., & Finegan, J. (1999). The self-determination model: An approach to develop awareness for survivors of traumatic brain injury. Neurorehabilitation, 13(1), 3-12. Epstein, D. R., Babcock-Parziale, J. L., Haynes, P. L., & Herb, C. A. (2012). Insomnia treatment acceptability and preferences of male Iraq and Afghanistan combat veterans and their healthcare providers. Journal of Rehabilitation Research and Development, 49(6), 867-878. Fisher, A., Bellon, M., Lawn, S., & Lennon, S. (2021). Family perspectives on the acceptability and usefulness of the FAB Positive Behaviour Support program: A pilot study. Brain Injury, 35(5), 609-619. Guercio, J., Davis, P., Faw, G., McMorrow, M., Ori, L., Berkowitz, B., & Nigra, M. (2002). Increasing functional rehabilitation in acquired brain injury treatment: Effective application of behavioral principles. Brain Injury, 16(10), 849-860. Hayes-Skelton, S. A., Roemer, L., Orsillo, S. M., & Borkovec, T. D. (2013). A contemporary view of applied relaxation for generalized anxiety disorder. Cognitive Behaviour Therapy, 42(4), 292-302. Hindhede, A. L., & Poulsen, I. (in press). The value of social networks to individuals with a severe traumatic brain injury: A mixed methods approach. Disability and Rehabilitation. Horner, R. H., McDonnell, J. J., & Bellamy, G. T. (1986). Teaching generalized

Case Study Seven — Doug | 253

skills: General case instruction in simulation and community settings. In R. H. Horner, L. H. Meyer, & H. D. Fredericks (Eds.), Education of learners with severe handicaps: Exemplary service strategies (pp. 289-314). Baltimore, MD: Paul H. Brookes Publishing Company. Kendrick, D., Silverberg, N. D., Barlow, S., Miller, W. C., & Moffat, J. (2012). Acquired brain injury self-management program: A pilot study. Brain Injury, 26(10), 1243-1249. Knight, C., Rutterford, N. A., Alderman, N., & Swan, L. J. (2002). Is accurate self-monitoring necessary for people with acquired neurological problems to benefit from the use of differential reinforcement methods? Brain Injury, 16(1), 75-87. Kocka, A., & Gagnon, J. (2014). Definition of impulsivity and related terms following Traumatic Brain Injury: A review of the different concepts and measures used to assess impulsivity, disinhibition and other related concepts. Behavioral Sciences, 4(4), 352-370. Longmore, P. (1995). The second phase: From disability rights to disability culture. Disability Rag, 16(5), 3-11. Longmore, P. (2003). Why I burned my book and other essays on disability. Philadelphia: Temple University. Nalder, E., Hartman, L., Hunt, A., & King, G. (2019). Traumatic brain injury resiliency model: A conceptual model to guide rehabilitation research and practice. Disability and Rehabilitation, 41(22), 2708-2717. O’Brien, J., & Mount, B. (2006). Make a difference: A guidebook for person-centered direct support. Toronto, ON, Canada: Inclusion Press. Pollens, R. D., McBratnie, B. P., & Burton, P. L. (1988). Beyond cognition: Executive functions in closed head injury. Cognitive Rehabilitation, 6(5), 26-32. Rahman, B., Oliver, C., & Alderman, N. (2010). Descriptive analysis of challenging behaviours shown by adults with acquired brain injury. Neuropsychological Rehabilitation, 20(2), 212-238. Schaub, C., Peters, C., & Peters, S. (2012). Behavioral strategies for assessing and promoting community readiness in brain injury rehabilitation. Neurorehabilitation, 31(1), 41-49. Watson, D. L., & Tharp, R. G. (2014). Self-directed behavior: Self-modification for personal adjustment (10th ed.). Belmont, CA: Wadsworth/Thomson Learning.

SECTION TWO

Case Studies with Partial Analysis

Case Study Seven — Asanka Case Study Covers: • Intellectual Disability • In-Home

A

sanka is an eight-year-old male who has a diagnosis of intellectual disability. He lives with his parents and his older sister who is ten. Asanka’s parents are from South Asia and from their cultural perspective they see his having a disability as shameful and is a result of their behavior in previous lives (a violation of Dharma). As a result of Asanka’s disability, they also see him as a “baby” who needs care. Thus, many activities of daily living are performed for Asanka by his parents and sister. This includes dressing him, bathing him, brushing his teeth, and even feeding him given Asanka does not know how to use utensils. He is not toilet trained and wears a diaper. Asanka has “learned helplessness” and is very passive. He does attend his local public school where he is in a “moderate/severe” special day class (SDC). At school he is also very passive requiring mostly hand-over-hand instruction. At lunch time, he will sometimes nibble a bit on finger foods but if staff don’t directly feed him then he does not eat. In addition to the prompt dependency, Asanka has some challenging behaviors. He engages in a lot of repetitive behaviors such as twirling his hair, rubbing his hands on his stomach and legs, and scratching himself. The scratching results in scars and sometimes bleeding on his face or scalp. He will also sometimes throw things when people are working with him including utensils. Asanka’s family rarely take him out into the community as they don’t want others to notice him and negatively judge their parenting. When he does go out Asanka’s repetitive behaviors increase in frequency and intensity which makes it even more aversive for his parents. At home Asanka prefers to sit with his shirt off and to watch 257

258 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

videos on his electronic device, though he doesn’t really watch anything in particular and will generally randomly scroll through things. He has no other independent play skills. Recently Asanka’s father was at his daughter’s soccer game and struck up a conversation with another father there that he often talks with, and this father is also from South Asia. During this conversation, it came up that the other father has a young son with autism spectrum disorders who received in-home ABA services. The father was describing the great progress that his son has made and the positive impact that the service has had on their family as a whole. Asanka’s father was quite impressed by these services and told his wife and daughter about the conversation. They decided to investigate in-home ABA services further and it turned out that their health insurance plan does cover the in-home ABA services for children with intellectual disabilities so they requested as assessment. A BCBA, Ms. Hemmings, from a local ABA agency came out to meet with the family and explained how inhome ABA services work. She also observed Asanka and thought that he would be a good candidate for in-home services. Ms. Hemmings came out a second time to develop some goals for the family and to collect some baseline data before the registered behavior technician (RBT) starts in-home services.

Figure 7.1. Summary of Partial Interval Recording — Asanka.

Case Study Seven — Asanka | 259

CASE STUDY EVALUATION Based upon the case study provided above, the following sections analyze the issues that arise in providing behavioral services and supports for Asanka. This analysis is based upon the Behavior Analyst Certification Board Task List 5th edition. Competencies addressed are Foundations, C: Measurement, Data Display, and Interpretation, Applications, E: Ethics, F: Behavior Assessment, G: Behavior-Change Procedures, H: Selecting and Implementing Intervention, and I: Personnel Supervision and Management. This is a partial case study thus we have the areas from the Task list and items outlined that are deemed to be most relevant for analysis with data provided but not with the analysis completed. The accompanying data should be used to fully develop the assessment, function, interventions, trainings and follow up. Behavior Assessment F-1 F-2 F-3 F-4 F-5 F-6 F-7 F-8 F-9

Review records and available data at the outset of the case. Determine the need for behavior-analytic services Identify and prioritize socially significant behaviorchange goals. Conduct assessments of relevant skill strengths and deficits. Conduct preference assessments. Describe the common functions of problem behavior. Conduct a descriptive assessment of problem behavior. Conduct a functional analysis of problem behavior. Interpret functional assessment data.

After the initial in-home interview with the parents, Ms. Hemmings collected direct observation data “Helping Behavior by Family Member,” “Repetitive Behavior,” and “Independent Initiations” by Asanka. Ms. Hemmings used a 15-second partial interval data collection system for data collection in 10-minute time increments during different family activities. Ms. Hemmings directed the family to interact with Asanka at home as they usually did. She also went with the family on a community outing to a grocery store that they prefer to shop at and again she asked the family to behave as they usually did in the store and she stayed as far away from them as possible while still able to hear and observe them in the store. The data in Figure 7.1 rep-

260 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 7.2. Functional Analysis Tool — Asanka.

Case Study Seven — Asanka | 261 Figure 7.3. Paired Stimulus Preference Assessment — Asanka.

resent percentage of intervals from these observations An indirect measurement system was also initially used to assess the behavior. Ms. Hemmings met with Asanka’s parents and togther they completed the Functional Analysis Screening Tool (FAST) (Iwata et al., 2013). The FAST (see Figure 7.2) results from this assessment indicate that the main function of Asanka’s challenging behavior is automatic and is to obtain internal stimulation (three Yes responses). The second possible function was escape from social tasks/activities (two Yes responses). The third possible function was to obtain attention/preferred items (one Yes response). In order to help determine what items Asanka prefers, Ms. Hemmings used a paired stimulus preference assessment with four different items that the parents indicated that Asanka will sometimes play with.

262 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

These results are presented in Figure 7.3 and indicate that Asanka’s main preference is electronic devices with finger food items being his second preference Ms. Hemmings also conducted a brief functional analysis of the throwing, scratching, and repititve behaviors using the Practical Functional Analysis method as described by Hanley (2010; 2012). The data from the partial interval recording of the alternating conditions appears in Figure 7.4. The analysis of the data in Figure 7.4 shows that in the attention given as a consequence condition, scratching occurred in 52% of the intervals, repitive behavior in 28% of the intervals, and throwing in 05% of the intervals. During the escape given as a consequence, scratching occurred in 35% of the intervals, repitive behavior in 45% of the intervals, and throwing in 01% of the intervals. Measurement, Data Display, and Interpretation C-1 C-2

Establish operational definitions of behavior. Distinguish among direct, indirect, and product measures of behavior. C-3 Measure occurrence (e.g., frequency, rate, percentage). C-4 Measure temporal dimensions of behavior (e.g., duration, latency, interresponse time). C-5 Measure form and strength of behavior (e.g., topography, magnitude). C-6 Measure trials to criterion. C-7 Design and implement sampling procedures (i.e., interval recording, time sampling). C-8 Evaluate the validity and reliability of measurement procedures. C-9 Select a measurement system to obtain representative data given the dimensions of behavior and the logistics of observing and recording. C-10 Graph data to communicate relevant quantitative relations (e.g., equal-interval graphs, bar graphs, cumulative records). C-11 Interpret graphed data. Selecting and Implementing Interventions H-1 State intervention goals in observable and measurable terms. H-2 Identify potential interventions based on assessment

Case Study Seven — Asanka | 263 Figure 7.4. Functional Analysis Data — Asanka.

264 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

H-3

H-4

H-5 H-6 H-7 H-8 H-9

results and the best available scientific evidence. Recommend intervention goals and strategies based on such factors as client preferences, supporting environments, risks, constraints, and social validity. When a target behavior is to be decreased, select an acceptable alternative behavior to be established or increased. Plan for possible unwanted effects when using reinforcement, extinction, and punishment procedures. Monitor client progress and treatment integrity. Make data-based decisions about the effectiveness of the intervention and the need for treatment revision. Make data-based decisions about the need for ongoing services. Collaborate with others who support and/or provide services to clients.

Behavior-Change Procedures G-1 Use positive and negative reinforcement procedures to strengthen behavior. G-2 Use interventions based on motivating operations and discriminative stimuli. G-3 Establish and use conditioned reinforcers. G-4 Use stimulus and response prompts and fading (e.g., errorless, most-to-least, least-to-most, prompt delay, stimulus fading). G-5 Use modeling and imitation training. G-6 Use instructions and rules. G-7 Use shaping. G-8 Use chaining. G-9 Use discrete-trial, free-operant, and naturalistic teaching arrangements. G-10 Teach simple and conditional discriminations. G-11 Use Skinner’s analysis to teach verbal behavior. G-12 Use equivalence-based instruction. G-13 Use the high-probability instructional sequence. G-14 Use reinforcement procedures to weaken behavior (e.g., DRA, FCT, DRO, DRL, NCR). G-15 Use extinction. G-16 Use positive and negative punishment (e.g., time-out,

Case Study Seven — Asanka | 265

G-17 G-18 G-19 G-20 G-21 G-22

response cost, overcorrection). Use token economies. Use group contingencies. Use contingency contracting. Use self-management strategies. Use procedures to promote stimulus and response generalization. Use procedures to promote maintenance

Personnel Supervision and Management I-1

I-2 I-3 I-4 I-5 I-6

I-7 I-8

State the reasons for using behavior-analytic supervision and the potential risks of ineffective supervision (e.g., poor client outcomes, poor supervisee performance). Establish clear performance expectations for the supervisor and supervisee. Select supervision goals based on an assessment of the supervisee’s skills. Train personnel to competently perform assessment and intervention procedures. Use performance monitoring, feedback, and reinforcement systems. Use a functional assessment approach (e.g., performance diagnostics) to identify variables affecting personnel performance. Use function-based strategies to improve personnel performance. Evaluate the effects of supervision (e.g., on client outcomes, on supervisee repertoires).

Ethics E-1 E-2 E-3 E-4 E-5 E-6 E-7

Introduction. Responsibility as a Professional. Responsibility in Practice. Responsibility to Clients and Stakeholders. Responsibility to Supervisees and Trainees. Responsibility in Public Statements. Responsibility in Research.

266 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

Additional Areas for Analysis Executive Functioning Emotional Control

The Use of Technology in Interventions for Behavior Change Legal Issues Cultural Issues Implications for Targets Assessment Interventions Supports

Quality of Life Physical Well-Being Material Well-Being Interpersonal Well-Being Productive Well-Being Emotional Well-Being Rights and Inclusion

Case Study Seven — Asanka | 267

FOUNDATIONAL AND LIFESTYLE STRATEGIES Person-Centered Planning Physical, Medical, Psychological, or Mental Health Issues Supports Teachers/Service Providers The Neurodiverse Person Family Members Employers/Community Members Technological Supports Instructional Supports Empirical Research to Support that the Intervention is an EvidenceBased Practice

Case Study Eight — Billy Joe Case Study Covers: • Mental Health Disability • Elementary School Setting

B

illy Joe is a second-grade student in a general education classroom in a public elementary school within a small rural district. This district has just one elementary school. Given the district is small everyone knows Billy Joe, his foster family, and his siblings. Billy Joe has been in and out of the foster care system. Prior to placement with his current foster care family he was hospitalized in a mental health facility due to severe aggressive behaviors. These current foster parents immediately enrolled him in the local public school with their other (biological) children. Billy Joe did not demonstrate any of the behaviors that led to his hospitalization or were concerns from previous documentation when he was placed in the public school. He was determined to please the adults and often sought their attention. His speech was at times difficult to understand with annunciation and articulation problems. After five months with this foster care family he was returned to his biological mother, thus leaving the school district. Within two months, he returned to that foster care family and the elementary school second grade classroom. Upon return, Billy Joe was extremely aggressive toward his peers. His aggressions consisted of hitting, kicking, spitting, and pushing peers. He grabs their materials, pushes them off the play structure or swings so that he can use them, and overall is determined to get whatever they had from materials to snack. His aggression occurs at the highest levels in the lunchroom and in at recess. At home the family experienced similar behaviors or grabbing items from the other children during meals and playtime. The foster family parents were hesitant to report the behavior issues given they were fearful of losing Billy 269

270 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

Joe once again. The parents and children were willing to put up with Billy Joe’s behaviors because they love him and want him to be a part of their family. Thus, his behaviors are frequently reinforced with access to the items he grabs. The family and the school staff all enjoy Billy Joe given his energetic and positive attitude. He smiles more than anyone when he is not having an aggressive episode. The episodes never last very long and more often he is being goofy making everyone laugh with his pantomimes, faces, and jokes. Billy Joe is a good soccer player and everyone in the family likes to play soccer, so this is something that they all enjoy doing together.

CASE STUDY EVALUATION Based upon the case study provided above, the following sections analyze the issues that arise in providing behavioral services and supports for Billy Joe. This analysis is based upon the Behavior Analyst Certification Board Task List 5th edition. Competencies addressed are Foundations, C: Measurement, Data Display, and Interpretation, Applications, E: Ethics, F: Behavior Assessment, G: Behavior-Change Procedures, H: Selecting and Implementing Intervention, and I: Personnel Supervision and Management. This is a partial case study thus we have the areas from the task list and items outlined that are deemed to be most relevant for analysis with data provided but not with the analysis completed. The accompanying data should be used to fully develop the assessment, function, interventions, trainings and follow up. First an indirect measurement system was used to assess the behavior. The team had the classroom teacher and parents complete the Functional Analysis Screening Tool (FAST) (Iwata et al., 2013). The FAST was used as an initial screening tool. The results (seen in Figure 8.1) guide the direct observations to verify likely behavioral functions of the behavior. An ABC chart was then used in the classroom only. At home they kept rough notes of what happened with a frequency count for aggression. The ABC (Figure 8.2) chart was used as part of a descriptive assessment of the challenging behaviors. There was no manipulation of environmental variables, just an observation of the behavior in the natural environment. The antecedents are the events that occurred directly before the challenging behaviors. The behaviors are the challenging behaviors observed followed by the consequences, which are environmental changes that occur following the challenging

Case Study Eight — Billy Joe | 271

behavior. Anyone should be cautious of an analysis based purely on a descriptive assessment. The descriptive assessment was used to generate a hypothesis since the indirect measure was inconclusive as to whether the challenging behavior was for access attention or tangibles (an “obtain” function). Finally, the team decided to complete a functional analysis to test a few hypotheses. They used a trial based functional analysis with 10 trials each testing attention, demand, tangible, and a control condition. Trials were 2-minutes long and if the challenging behavior never occurred in the trial they moved to the next trial, different condition. The challenging behaviors were typically discrete actions and did not occur for a long duration thus the trials were easy to implement and record occurrence or nonoccurrence. The data were collected on the occurrence of the challenging behavior per trial. In the attention phase if the challenging behavior occurred Billy Joe was told, “Don’t do that.” During demand phase a task was presented and three-step prompting system was used, if a challenging behavior occurred the BCBA moved away and removed the task. During the tangible condition, a high preference item was presented for 30-seconds and removed. If the challenging behavior occurred, the item was returned to Billy Joe. The control condition involved noncontingent presentation of an item that was not highly preferred, and no demands were placed on Billy Joe. Thus, the trial-based functional analysis involved antecedent manipulation with condition specific consequences contingent upon the challenging behavior. The data appear in Figure 8.3 for trial-by-trial the order of trial presentation was attention, demand, tangible followed by control. Determine the results of the trial-based functional analysis for primary and secondary functions. Use the following data and categories in the case development. Measurement, Data Display, and Interpretation C-1 C-2 C-3 C-4 C-5 C-6 C-7

Establish operational definitions of behavior. Distinguish among direct, indirect, and product measures of behavior. Measure occurrence (e.g., frequency, rate, percentage). Measure temporal dimensions of behavior (e.g., duration, latency, interresponse time). Measure form and strength of behavior (e.g., topography, magnitude). Measure trials to criterion. Design and implement sampling procedures (i.e., inter-

272 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

val recording, time sampling). C-8 Evaluate the validity and reliability of measurement procedures. C-9 Select a measurement system to obtain representative data given the dimensions of behavior and the logistics of observing and recording. C-10 Graph data to communicate relevant quantitative relations (e.g., equal-interval graphs, bar graphs, cumulative records). C-11 Interpret graphed data. Behavior Assessment F-1 F-2 F-3 F-4 F-5 F-6 F-7 F-8 F-9

Review records and available data at the outset of the case. Determine the need for behavior-analytic services Identify and prioritize socially significant behaviorchange goals. Conduct assessments of relevant skill strengths and deficits. Conduct preference assessments. Describe the common functions of problem behavior. Conduct a descriptive assessment of problem behavior. Conduct a functional analysis of problem behavior. Interpret functional assessment data.

Behavior-Change Procedures G-1 Use positive and negative reinforcement procedures to strengthen behavior. G-2 Use interventions based on motivating operations and discriminative stimuli. G-3 Establish and use conditioned reinforcers. G-4 Use stimulus and response prompts and fading (e.g., errorless, most-to-least, least-to-most, prompt delay, stimulus fading). G-5 Use modeling and imitation training. G-6 Use instructions and rules. G-7 Use shaping. G-8 Use chaining. G-9 Use discrete-trial, free-operant, and naturalistic teaching

Case Study Eight — Billy Joe | 273 Figure 8.1. Functional Analysis Screening Tool — Billy Joe.

274 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

G-10 G-11 G-12 G-13 G-14 G-15 G-16 G-17 G-18 G-19 G-20 G-21 G-22

arrangements. Teach simple and conditional discriminations. Use Skinner’s analysis to teach verbal behavior. Use equivalence-based instruction. Use the high-probability instructional sequence. Use reinforcement procedures to weaken behavior (e.g., DRA, FCT, DRO, DRL, NCR). Use extinction. Use positive and negative punishment (e.g., time-out, response cost, overcorrection). Use token economies. Use group contingencies. Use contingency contracting. Use self-management strategies. Use procedures to promote stimulus and response generalization. Use procedures to promote maintenance.

Selecting and Implementing Interventions H-1 State intervention goals in observable and measurable terms. H-2 Identify potential interventions based on assessment results and the best available scientific evidence. H-3 Recommend intervention goals and strategies based on such factors as client preferences, supporting environments, risks, constraints, and social validity. H-4 When a target behavior is to be decreased, select an acceptable alternative behavior to be established or increased. H-5 Plan for possible unwanted effects when using reinforcement, extinction, and punishment procedures. H-6 Monitor client progress and treatment integrity. H-7 Make data-based decisions about the effectiveness of the intervention and the need for treatment revision. H-8 Make data-based decisions about the need for ongoing services. H-9 Collaborate with others who support and/or provide services to clients.

Case Study Eight — Billy Joe | 275 Figure 8.2. Antecedent Behavior Consequence Chart — Billy Joe.

276 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 8.3. Trial Data for Trial-Based Functional Analysis — Billy Joe.

Personnel Supervision and Management I-1

I-2 I-3 I-4 I-5 I-6

State the reasons for using behavior-analytic supervision and the potential risks of ineffective supervision (e.g., poor client outcomes, poor supervisee performance). Establish clear performance expectations for the supervisor and supervisee. Select supervision goals based on an assessment of the supervisee’s skills. Train personnel to competently perform assessment and intervention procedures. Use performance monitoring, feedback, and reinforcement systems. Use a functional assessment approach (e.g.,

Case Study Eight — Billy Joe | 277

I-7 I-8

performance diagnostics) to identify variables affecting personnel performance. Use function-based strategies to improve personnel performance. Evaluate the effects of supervision (e.g., on client outcomes, on supervisee repertoires). Personnel supervision and management are not relevant in this case.

Ethics E-1 E-2 E-3 E-4 E-5 E-6 E-7

Introduction. Responsibility as a Professional. Responsibility in Practice. Responsibility to Clients and Stakeholders. Responsibility to Supervisees and Trainees. Responsibility in Public Statements. Responsibility in Research.

Executive Function Skills Inhibiting Impulses Emotional Control Self-Monitoring Time Management

Collaboration with Others Legal Issues Cultural Issues Implications for Targets Assessment

278 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

Interventions Supports

Quality of Life Physical Well-Being Material Well-Being Interpersonal Well-Being Productive Well-Being Emotional Well-Being Rights and Inclusion

FOUNDATIONAL AND LIFESTYLE STRATEGIES Person-Centered Planning Physical, Medical, Psychological, or Mental Health Issues Supports Teachers/Service Providers The Neurodiverse Person Family Members Technological Supports Instructional Supports

Case Study Eight — Billy Joe | 279

GENERAL REFERENCES Iwata, B. A., DeLeon, I. G., & Roscoe, E. M. (2013). Reliability and validity of the functional analysis screening tool. Journal of Applied Behavior Analysis, 46(1), 271-284.

Case Study Nine — Celia Case Study Covers: • Intellectual Disability • High School Setting

C

elia is a high school student who is diagnosed as having an Intellectual Disability (ID). She lives at home with her parents, grandfather, and two young siblings. Her family is very supportive of her and encourages her to do things in the community. Celia is athletic and enjoys playing basketball with her two siblings and kicking the soccer ball around in the backyard. She especially likes to swim and has just joined a swim team at the local swim club. Celia has a speech impediment which sometimes makes her hard to understand and she sometimes must repeat herself. She prefers not to interact with others when she can help it. Celia is fully included into general education classes and does well in academic tasks that are concrete such as spelling, math, and science. She does less well in academic subjects that are more abstract such as history and literature. She receives academic support from a resource specialist, Ms. Cruz, and is generally pulled out one period a day (during the physical education class so that she is not missing academic content instruction and her swimming team meets the physical education requirements of the school) to get help with homework assignments and additional academic instruction on topics being covered in classes (pre-teaching). Celia finds group work in her classes to be difficult from a social standpoint. During group work or other social times, she becomes anxious and starts engaging in behavior such as rocking, twirling hair, drumming fingers on objects, and rolling her shoulders. During group work occasionally, she will engage in pica, eating non-edible items from the floor (mostly pieces of paper). Though she generally enjoys doing the academic work required for group participation, she does 281

282 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

not enjoy the discussions or other social aspects of the group work and generally is very quiet during group times. Her peers perceive her as a bit “odd” but not necessarily a bad person to have in their group as she does complete academic tasks that are assigned to her (as long as she has buy-in on what she is to do). Celia does not like to be individually presented with tasks and told what to do (in a 1:1 situation). In these situations, she will often make inappropriate remarks such as “I won’t do it,” “Try and make me,” and “I don’t go to school to do things like this” to the staff person presenting the task and demand. Finally, Celia will occasionally engage in pica when walking in the halls. This is often done when others are present such as passing time. Her pica occurs approximately once per week and mostly consists of ingesting paper pieces but can also include wrappers with wax or foil.

CASE STUDY EVALUATION Based upon the case study provided above, the following sections analyze the issues that arise in providing behavioral services and supports for Celia. This analysis is based upon the Behavior Analyst Certification Board Task List 5th edition. Competencies addressed are Foundations, C: Measurement, Data Display, and Interpretation, Applications, E: Ethics, F: Behavior Assessment, G: Behavior-Change Procedures, H: Selecting and Implementing Intervention, and I: Personnel Supervision and Management.This is a partial case study thus we have the areas from the task list and items outlined that are deemed to be most relevant for analysis with data provided but not with the analysis completed. The accompanying data should be used to fully develop the assessment, function, interventions, trainings and follow up. Measurement, Data Display, and Interpretation C-1 C-2 C-3 C-4 C-5

Establish operational definitions of behavior. Distinguish among direct, indirect, and product measures of behavior. Measure occurrence (e.g., frequency, rate, percentage). Measure temporal dimensions of behavior (e.g., duration, latency, interresponse time). Measure form and strength of behavior (e.g., topography, magnitude).

Case Study Nine — Celia | 283

C-6 C-7

Measure trials to criterion. Design and implement sampling procedures (i.e., interval recording, time sampling). C-8 Evaluate the validity and reliability of measurement procedures. C-9 Select a measurement system to obtain representative data given the dimensions of behavior and the logistics of observing and recording. C-10 Graph data to communicate relevant quantitative relations (e.g., equal-interval graphs, bar graphs, cumulative records). C-11 Interpret graphed data.

Behavior Assessment F-1

Review records and available data at the outset of the case. F-2 Determine the need for behavior-analytic services F-3 I dentify and prioritize socially significant behavior-change goals. F-4 Conduct assessments of relevant skill strengths and deficits. F-5 Conduct preference assessments. F-6 Describe the common functions of problem behavior. F-7 Conduct a descriptive assessment of problem behavior. F-8 Conduct a functional analysis of problem behavior. F-9 Interpret functional assessment data. In the process of determining the function of Celia’s behaviors the BCBA, Mr. Palmieri, completed interviews with Ms. Cruz the resource teacher and a few different paraprofessionals that support the high school students in general education. All were familiar with Celia and were consistent in their responses to the open-ended questionnaire. The FAI is in Figure 9.1. Based upon the interview information the body rocking, hair twirling, drumming fingers and shoulder rolls appear to be a response class in that despite different typographies the behaviors appear to occur together as a cluster or separately and have the same function or impact upon the environment (Cooper et al., 2020). Pica appears to occur under two different conditions, group work with social component and passing time in the hallway, but still be maintained by the same contingencies.

284 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 9.1. Functional Assessment Form — Celia.

Case Study Nine — Celia | 285

.

286 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 9.1. Continued.

Case Study Nine — Celia | 287

288 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 9.1. Continued.

Case Study Nine — Celia | 289

290 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 9.1. Continued.

Given the potential serious nature of pica the team decided to conduct a brief functional analysis of the pica using the Practical Functional Analysis method as described by Hanley (2010; 2012). The most common function of pica has been found to be in part maintained by automatic reinforcement (Ing et al., 2011; Rapp et al., 2001). However, based upon the interview results the team set up one test condition and one control condition and automatic reinforcement was not evaluated given that was not supported by the open-ended questions from the FAI. The behaviors occurred during tasks in groups but mostly when there was a social component of the group work. Thus, the conditions tested were a high interaction task versus a low interaction task. The

Case Study Nine — Celia | 291

conditions were alternated for a total of three conditions each. For all conditions Celia was placed at a table with three other students and the BCBA, Mr. Palmieri, sat in the room but away from where instruction was occurring to take data. The low social interaction task was a science task that involved the step-by-step construction of a battery pack to a light bulb. The instruction was provided on a video and each student had their own materials. The high social task was a science task that required problem solving and discussion with one experiment completed by all students together. Each session lasted approximately five minutes. Small pieces of paper were placed on the ground prior to Celia entering the room for both conditions. The data from the partial interval recording of the two alternating conditions appears in Figure 9.2. As can be seen following the analysis of the data in Figure 9.2, the high interaction conditions resulted in behaviors occurring in 32% of the intervals with the rocking, twirling, etc. occurring 18% of the time and pica occurring 13% of the time. The low interaction condition resulted in the behaviors occurring 5% of the time with rocking, twirling, etc. occurring 5% of the time, accounting for the only behaviors displayed in the low social condition. Pica was not observed to occur in the low social condition. This can best be displayed in line graphs using percentage of intervals or frequency of occurrence per condition for comparison. Behavior-Change Procedures G-1 Use positive and negative reinforcement procedures to strengthen behavior. G-2 Use interventions based on motivating operations and discriminative stimuli. G-3 Establish and use conditioned reinforcers. G-4 Use stimulus and response prompts and fading (e.g., errorless, most-to-least, least-to-most, prompt delay, stimulus fading). G-5 Use modeling and imitation training. G-6 Use instructions and rules. G-7 Use shaping. G-8 Use chaining. G-9 Use discrete-trial, free-operant, and naturalistic teaching arrangements. G-10 Teach simple and conditional discriminations. G-11 Use Skinner’s analysis to teach verbal behavior.

292 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 9.2a. Functional Analysis Data — Celia.

Case Study Nine — Celia | 293 Figure 9.2b. Functional Analysis Data — Celia.

G-12 Use equivalence-based instruction. G-13 Use the high-probability instructional sequence. G-14 Use reinforcement procedures to weaken behavior (e.g., DRA, FCT, DRO, DRL, NCR). G-15 Use extinction. G-16 Use positive and negative punishment (e.g., time-out, response cost, overcorrection). G-17 Use token economies. G-18 Use group contingencies. G-19 Use contingency contracting. G-20 Use self-management strategies. G-21 Use procedures to promote stimulus and response generalization. G-22 Use procedures to promote maintenance. Selecting and Implementing Interventions H-1 State intervention goals in observable and measurable terms. H-2 Identify potential interventions based on assessment results and the best available scientific evidence. H-3 Recommend intervention goals and strategies based on such factors as client preferences, supporting environments, risks, constraints, and social validity. H-4 When a target behavior is to be decreased, select an acceptable alternative behavior to be established or

294 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

H-5 H-6 H-7 H-8 H-9

increased. Plan for possible unwanted effects when using reinforcement, extinction, and punishment procedures. Monitor client progress and treatment integrity. Make data-based decisions about the effectiveness of the intervention and the need for treatment revision. Make data-based decisions about the need for ongoing services. Collaborate with others who support and/or provide services to clients.

Personnel Supervision and Management I-1

I-2 I-3 I-4 I-5 I-6

I-7 I-8

State the reasons for using behavior-analytic supervision and the potential risks of ineffective supervision (e.g., poor client outcomes, poor supervisee performance). Establish clear performance expectations for the supervisor and supervisee. Select supervision goals based on an assessment of the supervisee’s skills. Train personnel to competently perform assessment and intervention procedures. Use performance monitoring, feedback, and reinforcement systems. Use a functional assessment approach (e.g., performance diagnostics) to identify variables affecting personnel performance. Use function-based strategies to improve personnel performance. Evaluate the effects of supervision (e.g., on client outcomes, on supervisee repertoires).

Ethics E-1 E-2 E-3 E-4 E-5 E-6 E-7

Introduction. Responsibility as a Professional. Responsibility in Practice. Responsibility to Clients and Stakeholders. Responsibility to Supervisees and Trainees. Responsibility in Public Statements. Responsibility in Research.

Case Study Nine — Celia | 295

Executive Function Skills Emotional Control Self-Monitoring

Collaboration with Others Legal Issues Cultural Issues Implications for Targets Assessment Interventions Supports

Quality of Life Physical well-being Material well-being Interpersonal well-being Productive well-being Emotional well-being Rights and Inclusion

FOUNDATIONAL AND LIFESTYLE STRATEGIES Person-Centered Planning

296 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

Physical, Medical, Psychological, or Mental Health Issues Supports Teachers/Service Providers The Neurodiverse Person Family Members Technological Supports Instructional Supports

GENERAL REFERENCES Hanley, G.P. (2010). Prevention and treatment of severe problem behavior. In E. Mayville & J. Mulick (Eds.), Behavioral foundations of autism intervention (pp. 233-256). New York: Sloman Publishing. Hanley, G. P. (2012). Functional assessment of problem behavior: Dispelling myths, overcoming implementation obstacles, and developing new lore. Behavior Analysis in Practice, 5(1), 54-72. Ing, A. D., Roane, H. S., & Veenstra, R. A. (2011). Functional analysis and treatment of coprophagia. Journal of Applied Behavior Analysis, 44(1), 151-155. Rapp, J. T., Dozier, C. L., & Carr, J. E. (2001). Functional assessment and treatment of pica: A single-case experiment. Behavioral Interventions, 16(2), 111-125.

Case Study Ten — Rolph Case Study Covers: • Traumatic Brain Injury • Transition Setting

R

olph is a twenty-year-old man who had a Traumatic Brain Injury two years ago when he slipped on an icy step on the front steps of his house and fell, striking the back of his head on the cement steps. He was in the hospital for two weeks and then spent several months in a rehabilitation facility before returning home. Before the accident, Rolph was a senior in high school and did well academically, was very outgoing, had many friends, and was a star athlete with the football and basketball teams. He had sports scholarship opportunities from several universities. Now, two years later he has not graduated from high school and refuses to return to high school or take classes at the local adult school for a General Educational Development high school equivalency credential (GED). Rolph lives at home with his mother and his three younger sisters, his older brother is in college and was the first one in his family to attend college. He does not have a job and rarely socializes with any of his old friends, as they have moved on to college or work. Rolph spends most of his time in his room playing video games. He stays up very late and sleeps into the early afternoon, and he rarely leaves the apartment. Rolph eats a lot of junk food and his weight has been increasing. His doctor has prescribed different medications for different aspects of his behavior and health but Rolph was not consistent in taking them and now has pretty much stopped taking any medication. Rolph’s father passed away shortly after the last of the five children was born and Rolph’s mother is divorced from her second husband and that marriage did not last very long. She is often overwhelmed with working, paying the bills, keeping house, and raising her three daughters. Since his injury, Rolph has a number of cognitive issues such as 297

298 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

reduced processing speed, distractibility, and issues with executive functioning including abstract reasoning, planning, problem-solving, emotional regulation, and multi-tasking. He also has some memory loss such as remembering people’s names, which is a factor in his not wanting to socialize with former friends from high school. Other memory deficits include difficulty remembering all parts of a task sequence (such as forgetting to shave parts of his face in the morning) and blocking on words when he is speaking. From the perspective of his family and friends it seems as though he has had a personality change since his injury. He appears to be depressed, is moody, often listless, is very short-tempered, and has no drive or ambition. He becomes anxious when in social situations, even with his family, as he has trouble following conversations and making appropriate responses in a timely manner. These changes to Rolph have placed additional strain on his family and his mother admits to others that she is near her “breaking point” with all of her various responsibilities. Rolph’s sisters used to admire him and enjoy being around him but now they tend to avoid him whenever possible. His mother has talked with a counselor multiple times through the Employee Assistance Program (EAP) that is part of her benefits package through her work.

CASE STUDY EVALUATION Based upon the case study provided above, the following sections analyze the issues that arise in providing behavioral services and supports for Rolph. This analysis is based upon the Behavior Analyst Certification Board Task List 5th edition. Competencies addressed are Foundations, C: Measurement, Data Display, and Interpretation, Applications, E: Ethics, F: Behavior Assessment, G: Behavior-Change Procedures, H: Selecting and Implementing Intervention, and I: Personnel Supervision and Management. This is a partial case study thus we have the areas from the task list and items outlined that are deemed to be most relevant for analysis with data provided but not with the analysis completed. The accompanying data should be used to fully develop the assessment, function, interventions, goals and follow up. Measurement, Data Display, and Interpretation C-1

Establish operational definitions of behavior.

Case Study Ten — Rolph | 299

C-2

Distinguish among direct, indirect, and product measures of behavior. C-3 Measure occurrence (e.g., frequency, rate, percentage). C-4 Measure temporal dimensions of behavior (e.g., duration, latency, interresponse time). C-5 Measure form and strength of behavior (e.g., topography, magnitude). C-6 Measure trials to criterion. C-7 Design and implement sampling procedures (i.e., interval recording, time sampling) C-8 Evaluate the validity and reliability of measurement procedures. C-9 Select a measurement system to obtain representative data given the dimensions of behavior and the logistics of observing and recording. C-10 Graph data to communicate relevant quantitative relations (e.g., equal-interval graphs, bar graphs, cumulative records). C-11 Interpret graphed data. The counselor from the EAP assigns a BCBA-D, Dr. Cuvo, to the case and Dr. Cuvo suggests that his mother collect some data on Rolph so that she can provide specific data and feedback to Rolph rather than nagging him. And with his consent (mainly to get his mother off of his back) she collects data for a week on the number of times that Rolph leaves the apartment, the number of rude comments that he makes to family members, the number of fruits or vegetables that he eats, and the number of times that he exercises. The frequency count data appears in Figure 10.1. Rolph is interviewed by his mother and Dr. Cuvo using an open-ended interview process to obtain his input and viewpoint on his situation (Hanley, 2012). Behavior Assessment F-1 F-2 F-3 F-4

Review records and available data at the outset of the case. Determine the need for behavior-analytic services Identify and prioritize socially significant behaviorchange goals. Conduct assessments of relevant skill strengths and deficits.

300 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 10.1. Data Collection Behaviors of Concern — Rolph.

F-5 F-6 F-7 F-8 F-9

Conduct preference assessments. Describe the common functions of problem behavior. Conduct a descriptive assessment of problem behavior. Conduct a functional analysis of problem behavior. Interpret functional assessment data.

In order to determine the function of Rolph’s behaviors the BCBA completed an open-ended interview with Rolph (see Figure 10.2). From this interview, Dr. Cuvo concluded that the function of Rolph’s challenging behaviors is escape from difficult situations though his eating of junk food is to obtain internal stimulation. Selecting and Implementing Interventions H-1 State intervention goals in observable and measurable terms. H-2 Identify potential interventions based on assessment results and the best available scientific evidence.

Case Study Ten — Rolph | 301 Figure 10.2. Open Ended Questionnaire — Rolph.

302 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

H-3 Recommend intervention goals and strategies based on such factors as client preferences, supporting environments, risks, constraints, and social validity. H-4 When a target behavior is to be decreased, select an acceptable alternative behavior to be established or increased. H-5 Plan for possible unwanted effects when using reinforcement, extinction, and punishment procedures. H-6 Monitor client progress and treatment integrity. H-7 Make data-based decisions about the effectiveness of the intervention and the need for treatment revision. H-8 Make data-based decisions about the need for ongoing services. H-9 Collaborate with others who support and/or provide services to clients. Behavior-Change Procedures G-1 Use positive and negative reinforcement procedures to strengthen behavior. G-2 Use interventions based on motivating operations and discriminative stimuli. G-3 Establish and use conditioned reinforcers. G-4 Use stimulus and response prompts and fading (e.g., errorless, most-to-least, least-to-most, prompt delay, stimulus fading). G-5 Use modeling and imitation training. G-6 Use instructions and rules. G-7 Use shaping. G-8 Use chaining. G-9 Use discrete-trial, free-operant, and naturalistic teaching arrangements. G-10 Teach simple and conditional discriminations. G-11 Use Skinner’s analysis to teach verbal behavior. G-12 Use equivalence-based instruction. G-13 Use the high-probability instructional sequence. G-14 Use reinforcement procedures to weaken behavior (e.g., DRA, FCT, DRO, DRL, NCR). G-15 Use extinction. G-16 Use positive and negative punishment (e.g., time-out, response cost, overcorrection).

Case Study Ten — Rolph | 303

G-17 G-18 G-19 G-20 G-21

Use token economies. Use group contingencies. Use contingency contracting. Use self-management strategies. Use procedures to promote stimulus and response generalization. G-22 Use procedures to promote maintenance Personnel Supervision and Management I-1

I-2 I-3 I-4 I-5 I-6

I-7 I-8

State the reasons for using behavior-analytic supervision and the potential risks of ineffective supervision (e.g., poor client outcomes, poor supervisee performance). Establish clear performance expectations for the supervisor and supervisee. Select supervision goals based on an assessment of the supervisee’s skills. Train personnel to competently perform assessment and intervention procedures. Use performance monitoring, feedback, and reinforcement systems. Use a functional assessment approach (e.g., performance diagnostics) to identify variables affecting personnel performance. Use function-based strategies to improve personnel performance. Evaluate the effects of supervision (e.g., on client outcomes, on supervisee repertoires). Personnel supervision and management are not relevant in this case.

Ethics E-1 Introduction. E-2 Responsibility as a Professional. E-3 Responsibility in Practice. E-4 Responsibility to Clients and Stakeholders. E-5 Responsibility to Supervisees and Trainees. E-6 Responsibility in Public Statements. E-7 Responsibility in Research.

304 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

Additional Areas for Analysis Executive Functioning Inhibiting Impulses Initiating Activity Emotional Control Planning and Organizing Self-Monitoring Time Management

The Use of Technology in Interventions for Behavior Change Legal Issues Cultural Issues Implications for Targets Assessment Interventions Supports

FOUNDATIONAL AND LIFESTYLE STRATEGIES Person-Centered Planning

Case Study Ten — Rolph | 305

Physical, Medical, Psychological, or Mental Health Issues Supports Teachers/Service Providers The Neurodiverse Person Family Members Employers/Community Members Technological Supports Instructional Supports

EMPIRICAL RESEARCH TO SUPPORT THAT THE INTERVENTION IS AN EVIDENCE-BASED PRACTICE

Case Study Eleven — Wyclef Case Study Covers: • Learning Disability • College Setting

W

yclef is an 18-year-old student at his local community college where he is in his second semester as a part time student. He is getting an AA degree in Automotive Services. He is currently taking classes in Automotive Services as well as for his general requirements. In this area, he wants to focus on electric and hybrid vehicle repair and he is very clear that his career goal is to work at local automotive dealer that focuses on “green” cars. Wyclef also works at a laundry five mornings a week so that he can support himself and attend school. He lives in an apartment with two other guys who are also 18. In his free time, he enjoys riding his bike, kick boxing, and hiking in local nature areas. Wyclef is very likeable, has a lot of friends, and has a close-knit family. Importantly, he is a second generation American with his family from Haiti. Despite these positive attributes, Wyclef often struggles academically and on a personal level. Though he radiates self-confidence and competence, inside he is insecure and anxious, mainly due to his academic struggles. In high school, his grades were mediocre to poor and he barely managed to graduate. He was pretty successful in hiding his poor performance from his peers in high school. By the time he started high school Wyclef’s parents were concerned about his academic performance, but they were not aware of services and supports that might be available to Wyclef through the Individuals with Disabilities Education Act (IDEA). They did not want teachers or administration to view them as “rocking the boat” or being “troublemakers” so they did not express their concerns. Since Wyclef was passing his classes, his teachers let him slide by and did not refer him to a student study team. 307

308 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

At the community college though, the situation has become much more difficult for Wyclef. His academic struggles are much greater as there is more reading required and the instructors are not necessarily able to provide assistance and feedback before assignments are due. Wyclef managed to barely pass the two courses he took his first semester (“Topics in Automotive Services” and “Automotive Fundamentals”) only because he knows quite a bit about cars and has spent a lot of time working on the family cars with his father, older sister, and younger brother. In classes, Wyclef has difficulty following the lectures, PowerPoints and taking notes at the same time, completing the readings, keeping up with assignments and being organized. Written expression is especially difficult for Wyclef. His written assignments in class have many grammatical and punctuation errors as well as poor paragraph organization. It appears likely that Wyclef will fail all three of his courses this semester. He is taking general education required courses this semester. He is very frustrated with himself and the instruction and his competent exterior is starting to crack. He has started to snap at his friends when they ask about school and he is becoming surely with classmates, a complainer in class and he has started making derogatory remarks to the instructors about their teaching ability. Two of the instructors have pointed out the student code of conduct to Wyclef and warned him about his behavior. This has made Wyclef even more upset and anxious, and he has no idea as to what he should do, and he is uncomfortable sharing the situation with his friends and family as they may then view him as a failure and unworthy of their affection and support.

CASE STUDY EVALUATION Based upon the case study provided above, the following sections analyze the issues that arise in providing behavioral services and supports for Wyclef. This analysis is based upon the Behavior Analyst Certification Board Task List 5th edition. Competencies addressed are Foundations, C: Measurement, Data Display, and Interpretation, Applications, E: Ethics, F: Behavior Assessment, G: Behavior-Change Procedures, H: Selecting and Implementing Intervention, and I: Personnel Supervision and Management. This is a partial case study thus we have the areas from the task list and items outlined that are deemed to be most relevant for analysis with data provided but not with the analysis completed. The accompanying

Case Study Eleven — Wyclef | 309 Figure 11.1. Self-Tally of Behaviors of Concern — Wyclef.

data should be used to fully develop the assessment, function, interventions, goals and follow up. Behavior Assessment F-1 F-2 F-3 F-4 F-5 F-6 F-7 F-8 F-9

Review records and available data at the outset of the case. Determine the need for behavior-analytic services Identify and prioritize socially significant behaviorchange goals. Conduct assessments of relevant skill strengths and deficits. Conduct preference assessments. Describe the common functions of problem behavior. Conduct a descriptive assessment of problem behavior. Conduct a functional analysis of problem behavior. Interpret functional assessment data.

Measurement, Data Display, and Interpretation C-1 C-2

Establish operational definitions of behavior. Distinguish among direct, indirect, and product measures of behavior.

310 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Figure 11.2. Self-Recorded ABC Data Across Three Days — Wyclef.

Case Study Eleven — Wyclef | 311

C-3 C-4

Measure occurrence (e.g., frequency, rate, percentage). Measure temporal dimensions of behavior (e.g., duration, latency, interresponse time). C-5 Measure form and strength of behavior (e.g., topography, magnitude). C-6 Measure trials to criterion. C-7 Design and implement sampling procedures (i.e., interval recording, time sampling). C-8 Evaluate the validity and reliability of measurement procedures. C-9 Select a measurement system to obtain representative data given the dimensions of behavior and the logistics of observing and recording. C-10 Graph data to communicate relevant quantitative relations (e.g., equal-interval graphs, bar graphs, cumulative records). C-11 Interpret graphed data. The first step in figuring out the behavior involves self-monitoring, taking data on the frequency of the behaviors of concern and determining definitions of the behaviors. Wyclef kept a frequency chart initially, making tally marks each time he was aware he engaged in behavior either through his own awareness, teacher, staff, or classmate feedback from verbal responses to facial responses. Additionally, he noted the typography of the behavior to start getting it defined (minimizing the writing though). Selecting and Implementing Interventions H-1 State intervention goals in observable and measurable terms. H-2 Identify potential interventions based on assessment results and the best available scientific evidence. H-3 Recommend intervention goals and strategies based on such factors as client preferences, supporting environments, risks, constraints, and social validity. H-4 When a target behavior is to be decreased, select an acceptable alternative behavior to be established or increased. H-5 Plan for possible unwanted effects when using reinforcement, extinction, and punishment procedures.

312 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

H-6 Monitor client progress and treatment integrity. H-7 Make data-based decisions about the effectiveness of the intervention and the need for treatment revision. H-8 Make data-based decisions about the need for ongoing services. H-9 Collaborate with others who support and/or provide services to clients. Behavior-Change Procedures G-1 Use positive and negative reinforcement procedures to strengthen behavior. G-2 Use interventions based on motivating operations and discriminative stimuli. G-3 Establish and use conditioned reinforcers. G-4 Use stimulus and response prompts and fading (e.g., errorless, most-to-least, least-to-most, prompt delay, stimulus fading). G-5 Use modeling and imitation training. G-6 Use instructions and rules. G-7 Use shaping. G-8 Use chaining. G-9 Use discrete-trial, free-operant, and naturalistic teaching arrangements. G-10 Teach simple and conditional discriminations. G-11 Use Skinner’s analysis to teach verbal behavior. G-12 Use equivalence-based instruction. G-13 Use the high-probability instructional sequence. G-14 Use reinforcement procedures to weaken behavior (e.g., DRA, FCT, DRO, DRL, NCR). G-15 Use extinction. G-16 Use positive and negative punishment (e.g., time-out, response cost, overcorrection). G-17 Use token economies. G-18 Use group contingencies. G-19 Use contingency contracting. G-20 Use self-management strategies. G-21 Use procedures to promote stimulus and response generalization. G-22 Use procedures to promote maintenance.

Case Study Eleven — Wyclef | 313

Personnel Supervision and Management I-1

I-2 I-3 I-4 I-5 I-6

I-7 I-8

State the reasons for using behavior-analytic supervision and the potential risks of ineffective supervision (e.g., poor client outcomes, poor supervisee performance). Establish clear performance expectations for the supervisor and supervisee. Select supervision goals based on an assessment of the supervisee’s skills. Train personnel to competently perform assessment and intervention procedures. Use performance monitoring, feedback, and reinforcement systems. Use a functional assessment approach (e.g., performance diagnostics) to identify variables affecting personnel performance. Use function-based strategies to improve personnel performance. Evaluate the effects of supervision (e.g., on client outcomes, on supervisee repertoires).

Ethics E-1 E-2 E-3 E-4 E-5 E-6 E-7

Introduction. Responsibility as a Professional. Responsibility in Practice. Responsibility to Clients and Stakeholders. Responsibility to Supervisees and Trainees. Responsibility in Public Statements. Responsibility in Research.

Additional Areas for Analysis Executive Functioning Emotional Control Planning and Organizing Self-Monitoring

314 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

Time Management

The Use of Technology in Interventions for Behavior Change Legal Issues

Cultural issues Implications for Targets Assessment Interventions Supports

Quality of Life Physical Well-Being Material Well-Being Interpersonal Well-Being Productive Well-Being Emotional Well-Being Rights and Inclusion

FOUNDATIONAL AND LIFESTYLE STRATEGIES Person-Centered Planning

Case Study Eleven — Wyclef | 315

Physical, Medical, Psychological, or Mental Health Issues Supports Teachers/Service Providers The Neurodiverse Person Family Members Employers/Community Members Technological Supports Instructional Supports

EMPIRICAL RESEARCH TO SUPPORT THAT THE INTERVENTION IS AN EVIDENCE-BASED PRACTICE

Case Study Twelve — Cameron Case Study Covers: • Autism Spectrum Disorder Minimal Support Needs • Adult Employment Setting

C

ameron is a 25-year-old African American adult who was diagnosed with autism spectrum disorder (ASD) when he was in college. Cameron always did well academically in school and graduated from a prestigious university with a dual degree in economics and mathematics. After graduation he joined a mid-sized financial firm that specializes in mutual funds. Cameron’s position is in developing mathematical programs to analyze economic data and provide guidance on companies to or not to invest in. He is good at this work and in this area is looked upon as a valuable employee. Socially, Cameron does poorly at work, and his supervisor and peers are unhappy with his performance in this area. Cameron is arrogant and rude towards others. He will make disparaging remarks about the quality of their work, their intelligence, their vocabulary and grammar (he enjoys correcting others), and their educational background. Co-workers avoid him if possible but there is a lot of collaborative work that is required. The firm prefers that meetings be in person so that people are more engaged and that there is more discussion around issues. The information that Cameron presents in these meetings is impressive, but his social influence and interaction skills are limited. Cameron eats lunch by himself and does not interact with co-workers outside of work. In fact, he doesn’t really have any friends and reports that he is lonely. He spends most of his non-work time in his apartment reading and going to mathematical forums and discussion boards. Cameron’s supervisor, Ms. Kelley, decides to sit Cameron down and 317

318 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

have a frank discussion with him about his interactions with co-workers and his “soft skills.” She tells him that this is a formal meeting, and that documentation is being collected for his Human Resources (HR) file. He is warned that if his negative verbal statements and tone with coworkers does not change that he will be terminated. She encourages Cameron to meet with someone from HR which he agrees to do. He meets with Mr. Choyce from HR and from their discussion of the situation, Mr. Choyce and Cameron contact the firm’s Employee Assistance Program (EAP) which puts Cameron in touch with a BCBA, Ms. Idar.

CASE STUDY EVALUATION Based upon the case study provided above, the following sections analyze the issues that arise in providing behavioral services and supports for Cameron. This analysis is based upon the Behavior Analyst Certification Board Task List 5th edition. Competencies addressed are Foundations, C: Measurement, Data Display, and Interpretation, Applications, E: Ethics, F: Behavior Assessment, G: Behavior-Change Procedures, H: Selecting and Implementing Intervention, and I: Personnel Supervision and Management. This is a partial case study thus we have the areas from the task list and items outlined that are deemed to be most relevant for analysis with data provided but not with the analysis completed. The accompanying data should be used to fully develop the assessment, function, interventions, trainings and follow up. Behavior Assessment F-1 F-2 F-3 F-4 F-5 F-6 F-7 F-8

Review records and available data at the outset of the case. Determine the need for behavior-analytic services Identify and prioritize socially significant behaviorchange goals. Conduct assessments of relevant skill strengths and deficits. Conduct preference assessments. Describe the common functions of problem behavior. Conduct a descriptive assessment of problem behavior. Conduct a functional analysis of problem behavior.

Case Study Twelve — Cameron | 319 Figure 12.1. Open Ended Questionnaire — Cameron.

320 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

F-9

Interpret functional assessment data.

Ms. Idar meets with Cameron and Mr. Choyce to collect anecdotal information on the situation. They review the documents that HR are able to legally share with them. From this information they decide upon a process that Ms. Idar believes will be helpful to everyone. With Cameron’s consent and Mr. Choyce’s agreement, she says that she will provide regular written feedback to them about what is implemented and outcome data. Next, she conducts an informal assessment with Cameron (see Figure 12.1) including a structured interview with openended questions and a preference assessment. Measurement, Data Display, and Interpretation C-1 C-2

Establish operational definitions of behavior. Distinguish among direct, indirect, and product measures of behavior. C-3 Measure occurrence (e.g., frequency, rate, percentage). C-4 Measure temporal dimensions of behavior (e.g., duration, latency, interresponse time). C-5 Measure form and strength of behavior (e.g., topography, magnitude). C-6 Measure trials to criterion. C-7 Design and implement sampling procedures (i.e., interval recording, time sampling). C-8 Evaluate the validity and reliability of measurement procedures. C-9 Select a measurement system to obtain representative data given the dimensions of behavior and the logistics of observing and recording. C-10 Graph data to communicate relevant quantitative relations (e.g., equal-interval graphs, bar graphs, cumulative records). C-11 Interpret graphed data. From this interview it is clear that Cameron does not understand the viewpoint of others (“Theory of Mind”) and is misinterpreting their reaction to his behaviors. Ms. Idar develops an operational definition of Cameron’s inappropriate remarks to others (see Table 12.1). She goes over this with Cameron and is careful to explain Theory of Mind and its importance and that it is “smart” to understand the perspective of others. She is also careful to discuss with him that his behavior is not

Case Study Twelve — Cameron | 321 Table 12.1. Operational Definition of Inappropriate Remarks to Others — Cameron.

“bad” or “wrong” per se but that others may interpret as being that way and that their complaints to HR may result in his being fired from his position. Ms. Idar then meets again with Cameron and Mr. Choyce where the three of them role-play different social situations that are related to the complaints about Cameron’s behavior. Ms. Idar uses video-modeling in these role-plays so that it is possible to review them with Cameron so that he understands the exemplars of the behavior and can then collect data. Ms. Idar does this so that it is then possible for Cameron to self-record accurate data on his behavior. Once Cameron is consistent in recognizing behaviors via these exemplars, he records his own data. Cameron’s self-recording of antecedents, behavior and consequences is in Table 12.2. Ms. Idar also conducts an informal reinforcement assessment with Cameron so that she is clear about what contingencies are likely to be effective, especially for self-delivered consequences (see Table 12.3). Selecting and Implementing Interventions H-1 State intervention goals in observable and measurable terms. H-2 Identify potential interventions based on assessment results and the best available scientific evidence. H-3 Recommend intervention goals and strategies based on such factors as client preferences, supporting environ-

322 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Table 12.2. Self-Recorded ABC Chart — Cameron.

Case Study Twelve — Cameron | 323 Table 12.3. Reinforcer Assessment — Cameron.

H-4

H-5 H-6 H-7 H-8 H-9

ments, risks, constraints, and social validity. When a target behavior is to be decreased, select an acceptable alternative behavior to be established or increased. Plan for possible unwanted effects when using reinforcement, extinction, and punishment procedures. Monitor client progress and treatment integrity. Make data-based decisions about the effectiveness of the intervention and the need for treatment revision. Make data-based decisions about the need for ongoing services. Collaborate with others who support and/or provide services to clients.

Behavior-Change Procedures G-1 Use positive and negative reinforcement procedures to strengthen behavior. G-2 Use interventions based on motivating operations and discriminative stimuli. G-3 Establish and use conditioned reinforcers. G-4 Use stimulus and response prompts and fading (e.g., errorless, most-to-least, least-to-most, prompt delay, stimulus fading). G-5 Use modeling and imitation training.

324 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

G-6 G-7 G-8 G-9 G-10 G-11 G-12 G-13 G-14 G-15 G-16 G-17 G-18 G-19 G-20 G-21 G-22

Use instructions and rules. Use shaping. Use chaining. Use discrete-trial, free-operant, and naturalistic teaching arrangements. Teach simple and conditional discriminations. Use Skinner’s analysis to teach verbal behavior. Use equivalence-based instruction. Use the high-probability instructional sequence. Use reinforcement procedures to weaken behavior (e.g., DRA, FCT, DRO, DRL, NCR). Use extinction. Use positive and negative punishment (e.g., time-out, response cost, overcorrection). Use token economies. Use group contingencies. Use contingency contracting. Use self-management strategies. Use procedures to promote stimulus and response generalization. Use procedures to promote maintenance.

Personnel Supervision and Management I-1

I-2 I-3 I-4 I-5 I-6

I-7 I-8

State the reasons for using behavior-analytic supervision and the potential risks of ineffective supervision (e.g., poor client outcomes, poor supervisee performance). Establish clear performance expectations for the supervisor and supervisee. Select supervision goals based on an assessment of the supervisee’s skills. Train personnel to competently perform assessment and intervention procedures. Use performance monitoring, feedback, and reinforcement systems. Use a functional assessment approach (e.g., performance diagnostics) to identify variables affecting personnel performance. Use function-based strategies to improve personnel performance. Evaluate the effects of supervision (e.g., on client out-

Case Study Twelve — Cameron | 325

comes, on supervisee repertoires). Ethics E-1 E-2 E-3 E-4 E-5 E-6 E-7

Introduction. Responsibility as a Professional. Responsibility in Practice. Responsibility to Clients and Stakeholders. Responsibility to Supervisees and Trainees. Responsibility in Public Statements. Responsibility in Research.

Additional Areas for Analysis Executive Functioning Emotional Control Self-Monitoring

The Use of Technology in Interventions for Behavior Change Legal Issues Cultural issues Implications for Targets Assessment Interventions Supports

326 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

Quality of Life Physical Well-Being Material Well-Being Interpersonal Well-Being Productive Well-Being Emotional Well-Being Rights and Inclusion

FOUNDATIONAL AND LIFESTYLE STRATEGIES Person-Centered Planning Physical, Medical, Psychological, or Mental Health Issues Supports Teachers/Service Providers The Neurodiverse Person Family Members Employers/Community Members Technological Supports Instructional Supports

EMPIRICAL RESEARCH TO SUPPORT THAT THE INTERVENTION IS AN EVIDENCE-BASED PRACTICE

SECTION THREE

Case Studies Without Analysis

Case Study Thirteen — Patti Case Study Covers: • Autism Spectrum Disorders • Early Intensive Behavioral Intervention (EIBI)

P

atti is age two and a half years old and lives with her parents and her older brother Lenny. She receives early intensive behavioral intervention services for fifteen hours per week between her home and a clinic. She has a diagnosis of autism spectrum disorder (ASD) from the local children’s hospital pediatric autism clinic where she receives some of her services. Her home and clinic program are overseen by a BCBA with extensive experience in autism, especially those with behavioral challenges. Patti has minimal support needs in speech and language, self-care, and pre-academic areas. She is highly verbal and has been conversational in her use of exchanges and question asking since she was 18 months old. She has extensive needs in the area of social communication, peer play, gross and fine motor skills and behavioral flexibility. Socially, she has difficulty playing games with others, turn taking and is considered a sore loser. The family would like to get her into a local cooperative preschool but feel that first they need to establish more positive skills and address the challenging behaviors. She will blame others when she falls (e.g., “he pushed me!”) and when she writes on the furniture (“he told me to”) and lacks perspective taking as seen in games and role-plays. She has creative ideas for role-plays (e.g., fire fighters, home life, and horses) typical of dramatic play seen in preschools, however, she will be rigid and inflexible in her role and actions (e.g., only play the captain of fire team, the mom in the family, or the cowgirl). In her play, she won’t use objects to stand in for real life items (frisbee for steering wheel). This can escalate quickly to a tantrum when family or peers 329

330 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

suggest other uses for objects or other roles. The inflexible behavior is seen in other areas as well. When the family drives to consistent locations (e.g., grocery store, clinic, aunties) she will insist on going the same route and will tantrum if they need to take a different route. This is especially problematic when there are accidents or traffic. The tantrums can last up to an hour and involves screaming, crying, and kicking (people and the car window). Just once it escalated to the point of her hitting her head on the car window. One other inflexible behavior is seen in her choice of clothing. She will only wear purple t-shirts without tags and made a of a soft cotton. The family has three of these shirts and can rotate them, but she will wear them dirty if none are clean and refuses all other shirts. If the shirts are not available, she will again have tantrums that can last from 15-minutes to an hour. The family is concerned about these social issues and challenging behaviors and are inconsistent in how they handle them (sometimes reprimanding her, sometimes ignoring the behavior, and sometimes giving in quickly to avoid the challenging behaviors).

Case Study Fourteen — Exene Case Study Covers: • Learning Disability • Elementary School Setting

E

xene is a student who attends an urban elementary school in large school district with issues of poverty, crime, and low-test scores. Despite the environment and lack of availability of funds this school is developing a reputation for academic excellence due to increased test scores, increased attendance, and grants for after-school programming. Exene has been diagnosed as having a learning disability and is a fourth-grade student in a general education class. She has always performed below grade level in class and has struggled as a reader. In addition, Exene has poor and often illegible handwriting, difficulties with spelling and writing complete sentences as well as difficulty with math fact memorization. These deficits have become more pronounced in fourth grade, as the texts and academic demands for reading have changed from learning to read to reading to learn. She has support in reading and math from the free after-school program. The free program consists of high school students from the district who get paid to tutor the elementary school students with oversight from an adult with a teaching credential. The reading tutors and after-school teacher notice Exene’s enthusiasm and motivation to learn to read. They all report that she enjoys the one-on-one time for reading instruction and is motivated to earn stickers. They report that she is bright and has a good knowledge of facts and information. Exene has recently started refusing to attend school and once at school it’s the after-school program she avoids. Often, she will pretend to have stomachaches so that she can stay home or leave school early. In class, she puts her head down and claims she cannot participate in reading or math due to these stomachaches. She will go to the office 331

332 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

during lunch (before reading circles) at least twice per week to call home due to some illness. In response to her avoidance of school, her family requested a meeting with the teacher and student study team. Her family has had to rely upon neighbors and extended family to help pick up Exene from school when she calls home. Her school avoidance is causing problems for her mother at her work. The teacher requested an assessment from the school district to further analyze her academic problems with reading, spelling, and math. The school psychologist was brought in to do the testing for academic and emotional issues due to the school avoidance. The school psychologist is fluent in English and Spanish so she can communicate with Exene’s family, who have limited English skills. The testing showed that Exene meets the criteria for dyslexia and dysgraphia. She showed typical warning signs for dyslexia; chronic ear infections, confusion of left and right, difficulty learning to tie her shoes, slow choppy reading, difficulty with spelling, difficulty memorizing her address and phone number. Her testing results included Phonological Awareness Composite Scores (PACS), rapid naming, oral reading (a list of 20 words out of context) and nonsense words reading list. Reading words in isolation is the hardest type of reading for someone with dyslexia, as there is no context such as a story line or pictures to help them guess the word. Instead, they will often say a word that starts with the same letter or two and has a similar length and shape. Exene demonstrated these types of word replacements. During these tests, Exene started to bite her shirt, put her head down and complain of headaches. Dysgraphia, an inability to write coherently, was demonstrated by her unfinished words, inconsistent spacing between words and letters, slow copying from a distance and close-by, poor spatial planning on her paper and an unusual grip on her pencil. Despite her difficulty with writing and reading, Exene stated that she wants to be a children’s book author someday.

Case Study Fifteen — Leron Case Study Covers: • Mental Health Disability • High School Setting

L

eron is a student who attends an urban high school in a poor neighborhood with high levels of crime in the area and issues of gang involvement within the school. Leron has an Individualized Education Program (IEP) due to learning difficulties and a mental health diagnosis. Leron is fully included in general education classes with pull out for resource support. Leron has had a history of behavior difficulties in school and has been suspended a few times over the years. A functional behavior assessment (FBA) was not conducted despite having an IEP, documented mental health issues, and prior suspensions due to fighting and threats of violence. Recently, Leron brought a bullet to school and showed it to peers in his freshman classes. This created a stir at school and Leron was suspended. At that point a behavior support specialist was brought in to conduct a formal functional assessment and develop a behavior intervention plan to be implemented at his current school and program. Upon inquiry, the behavior specialist determined that Leron had a history of disruptive behaviors and frequent office referrals. Furthermore, supported by direct observation data using the Functional Assessment Observation Form (O’Neill et al., 2015), the behavior specialists determined that Leron calls out random phrases unrelated to instruction in class, disrupts instruction with loud vocalizations, sings, and dances out of his seat during instruction. The teachers report that Leron is just seeking attention from his classmates, and this is verified through the direct observations that the behavior specialist conducted. A thorough file review and data 333

334 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

collection including a curriculum–based assessment, shows that Leron has difficulty reading (decoding and fluency issues). His disruptive behaviors, that appear to be attention seeking from peers only are demonstrated during classes that require extensive reading (History and English class) and he does not engage in them in math or electives. Outside of class time, during passing period, lunch and P.E. he engages in threats (showing the bullet and verbal). Thus, they may have different functions. Recently, Leron’s mother has been diagnosed with terminal cancer. She is at home. Since her diagnosis, his disruptive behaviors and actions leading to suspensions (e.g., the bullet) have increased. The frequency of his behaviors in the classroom remains the same — they are disruptive and annoying but not suspension-worthy. His team is concerned that his behaviors outside of the classroom have escalated and is concerned about the function as either attention seeking or attempts to gain suspensions to have more time with his mother, given her illness.

Case Study Sixteen — Angeline Case Study Covers: • Autism Spectrum Disorders • Transition Setting

A

ngeline is a 19-year-old student in her district’s 18-22 transition program. She is receiving services under the autism spectrum disorder (ASD) category, but she has also had a diagnosis of Intellectual Disability (ID). Angeline’s parents are divorced, and she lives with her father and her 17-year-old brother, who is a junior in high school. Angeline spent most of her academic career in special day classes that served only students with disabilities, and she rarely interacted with peers without disabilities. Angeline’s academic skills are fair at best, and she received little vocational instruction during her K-12 schooling. Now that she is in the transition program, the focus is on her obtaining job experience (she has not previously worked) and then having a job that she will keep after she leaves the transition program and is supported by an adult service agency. Angeline has a limited range of interests (anime, Star Wars, Italian cooking, and the singer Adele) though her knowledge of these interests is very detailed. An important consideration for Angeline is that she is a transgender female. Her father and sibling have supported her in this transition, though fumbling through, sometimes accidentally mis-gendering her. But they support her in her identification and medical decisions. Her mother, though not involved in her life, does not understand, or recognize her as female, intentionally using her dead-name and the wrong pronoun. Angeline’s behavior is consistent at home, she will do the bare minimum, do a very poor job as quickly as possible, or refuse to do the task at all. If she refuses and is pressed to do the task she will start saying “no way” over and over and she will start destroying the materials or 335

336 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

throwing them at the wall if destruction is not possible. Then, if the request continues, as a final escalation she will start throwing things at the person making the request. In her transition program, Angeline has had two opportunities for job shadowing, job tryouts, and situational assessments in an office and a retail store. Neither of these worked well at all, and the staff had to abort each situation after a short time period when Angeline quickly started having challenging behaviors. The school transition staff are frustrated with Angeline, as these are long standing places where they rotate students through for initial assessment purposes. It is very rare for students to have behavioral issues in these sites. The employers are not pleased, and the school staff were embarrassed by Angeline’s challenging behaviors. Angeline stands out in the small community given she has ASD, and intellectual disability, and is transgender. Her lack of inclusive opportunities early on has negatively impacted her challenging behaviors and skills. The school transition staff are not sure if Angeline is capable of holding a real job, and that maybe an adult day program would be a better placement for her so that she can work on controlling her challenging behaviors. In addition, many of her friends that she knows from school are at the adult day program, so she would be around people similar to herself, and the school transition staff believe that the peers and staff at the adult day program would likely be more understanding and accepting of her challenging behaviors.

Case Study Seventeen — Ian Case Study Covers: • Traumatic Brain Injury • College

I

an is a 23-year-old college student. Two years ago, he had a traumatic brain injury (TBI) when he received a gunshot wound at an off-campus party that involved violence between non-student party crashers. Ian was an innocent bystander as he and his girlfriend Trudi happened to be walking past the house where the party was when the violence occurred. Ian received a penetrating wound from a severe blow to the head with shrapnel. Ian was in intensive care and then in a rehabilitation facility for people with TBI. He was out of college for two years but eventually recovered enough to return to college. Ian has a variety of issues from his traumatic brain injury including a lack of motor coordination (he walks now with an awkward gait where he swings his arms and legs out from his body in a jerking motion), has difficulty balancing, blurred vision, and fatigue. In school he now has problems with sustained attention in classes and when reading, auditory processing speed, and executive functioning. Finally, he also has been depressed since his injury. At school almost all of his friends graduated while he was in the rehabilitation facility. He lived in a dorm for a brief time on his return, but the noise and people were distracting to him. He was older than most of the people in the dorm and could not relate to them and they found him rather strange to be around (mainly due to his disability but also in part due to his age). He then moved to a small studio apartment (he lives by himself, but his cooking and cleaning skills are minimal) not too far from campus so that he can walk or take the campus shuttle that serves the university town to classes. He is still in touch with Trudi but she had graduated and moved to a different city and they are no longer romantically involved. 337

338 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

Ian finds himself socially isolated at school and his academic performance is less than stellar. He was an outstanding student before his injury, studying music theory and music production. Ian’s parents are supportive of him and his desire to return to college and finish his degree so that he can get a job in the music industry. However, they live in a city four hours away from where Ian goes to school so it is difficult for them to provide any direct supports. Ian is currently eligible for services from the state Department of Rehabilitation and from the Disabled Student Services Program at his university. However, he does not always complete the necessary forms and attend scheduled meetings and thus he is not currently receiving any services from the state Department of Rehabilitation or Disabled Student Services and Programs. This failure is in part due to his trouble focusing on things and his executive functioning issues such as poor self-management. Ian is finding himself more depressed and emotionally upset and is thinking that maybe college is not going to work out for him after all and that maybe he needs to lower his career goals as well.

Case Study Eighteen — Jelme Case Study Covers: • Emotional & Behavioral Disorders • Adult Setting

J

elme is twenty-four years old and has struggled throughout his life. He did poorly in school with low grades and was often in trouble. In high school he spent a lot of time in detention, and he was suspended quite a few times for behaviors such as threatening others, defacing school property, and leaving school grounds without permission. At different points in time, Jelme has been in foster care and in and out of many different homes with his foster parents often unable to handle the situation due to his anger and rage issues. When he was seventeen, he was placed in an involuntary psychiatric hold after threatening his mother with a knife. His mother called the police in this instance after numerous episodes of “rage” when he would threaten his parents if they did not give him money. When he turned eighteen, he aged-out of foster care, dropped out of high school, and stopped having contact with his parents. Since that time, Jelme has lived with different friends or acquaintances, but the living situations tend to be short term. Jelme can be difficult to get along with, is usually short of money and often he doesn’t pay his share of the rent or utilities. Jelme can sometimes be fun to be with, as he likes to go out and have a good time and will spend his money freely, buying food and drinks for whomever is with him. Jelme can be very funny with his droll sense of humor when he is “on” and he will have his companions in stitches. Jelme is often lonely and out of sorts. He would like to have a steady girlfriend but his relationships rarely last very long at all. He doesn’t have any real friends to hang out with and often spends his time alone drinking and watching sports on television. Jelme wants friendships 339

340 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

and relationships but has problems connecting with others, trusting them and reacts angrily over minor misunderstandings. He can push away people who like him or try to help him. Jelme reacts and accuses others for not liking him because he is Asian in a community with few Asian people. Others see being around him as “walking on eggshells,” as it is never very clear how he will respond to situations, including some those others view as trivial, such as asking him how his day is going. In other words, Jelme has a pervasive pattern of instability in his interpersonal relations, his moods, and his impulsivity, which often leads to rage and intense anger. Jelme has also had a difficult time keeping a job, and the jobs that he has had have been “dead-end” and low paying. The length of his job has often been a week or two to a few months as he doesn’t like the entry-level work and always being told what to do by a boss. His rages and threats to others at work, not surprisingly, get him quickly fired. He has had employers that have liked him and tried to give him guidance, but he always ends up yelling at them and/or threatening them, resulting in job loss. Jelme’s moods swing from depression to anger at others. There is rarely a middle ground. He has come to realize that he has serious problems and is starting to think that he should seek help but is clueless as to where he should turn.

Appendix Resources Regarding Applied Behavior Analysis And People With Disabilities

I

t is important to join professional organizations, read professional journals, and visit web sites. Here is a list of suggestions. Joining an organization will help you in your professional development and assist you in staying current in the field. Journals Advances in Mental Health and Intellectual Disabilities American Journal on Intellectual and Developmental Disabilities Assessment for Effective Intervention Augmentative and Alternative Communication Autism: The International Journal of Research and Practice Autism Research and Treatment Autism Research Review International Behavior Analysis in Practice Behavior Analysis: Research and Practice Behavior and Social Issues Behavior Modification Behavior Therapy Behavioral Disorders Behavioral Interventions Beyond Behavior British Journal of Learning Disabilities British Journal of Special Education Career Development and Transition for Exceptional Individuals 341

342 | Case Studies in Applied Behavior Analysis for Students and Adults with Disabilities

Child and Family Behavior Therapy Clinical Psychology: Science and Practice Communication Disorders Quarterly Developmental Neurorehabilitation Education and Training in Autism and Developmental Disabilities Education and Treatment of Children European Journal of Behavior Analysis European Journal of Disability Research European Journal of Special Needs Education Exceptional Children Exceptionality Focus on Autism and Other Developmental Disabilities Intellectual and Developmental Disabilities International Journal of Disability, Development and Education International Journal of Positive Behavioural Support Intervention in School and Clinic Journal of Applied Behavior Analysis Journal of Autism and Developmental Disorders Journal of Behavioral Education Journal of Clinical Child and Adolescent Psychology Journal of Disability Policy Studies Journal of Early Intervention Journal of Emotional and Behavioral Disorders Journal of Mental Health Research in Intellectual Disabilities Journal of the Experimental Analysis of Behavior Journal of International Special Needs Education Journal of Learning Disabilities Journal of Positive Behavior Interventions Journal of Rehabilitation Journal of Research in Special Education Needs Journal of School Psychology Journal of Special Education Journal of Special Education Technology Journal of Vocational Rehabilitation Learning Disabilities Research and Practice Multiple Voices for Ethnically Diverse Exceptional Learners Physical Disabilities: Education and Related Services Preventing School Failure Research and Practice for Persons with Severe Disabilities Research in Autism Spectrum Disorders Research in Developmental Disabilities

Appendix | 343

Review Journal of Autism and Developmental Disorders Rural Special Education Quarterly Scandinavian Journal of Disability Research School Psychology Review Teacher Education and Special Education Teaching Exceptional Children The Behavior Analyst The Analysis of Verbal Behavior Therapeutic Recreation Journal Professional Organizations American Association on Intellectual and Developmental Disabilities 8403 Colesville Road, Suite 900 Silver Spring, MD. 20910 202-387-1968 www.aaidd.org Association for Behavior Analysis International 550 West Centre Avenue, Suite 1 Portage, MI 49024 269/492-9310 www.abainternational.org [email protected] Association for Science in Autism Treatment PO Box 1447 Hoboken, NJ 07030 http://www.asatonline.org The Association of Positive Behavior Support P.O Box 328 Bloomsburg, PA 17815 570/389-4081 www.apbs.org Membership: [email protected] Association of Professional Behavior Analysts 6977 Navajo Rd. #176 San Diego, CA 92119 http://www.apbahome.net Autism Society of America

344 | Case Studies in Applied Behavior Analysis for Students and Adults with Disabilities

6110 Executive Boulevard Suite 305 Rockville, Maryland 20852 http://www.autism-society.org B. F. Skinner Foundation One Mifflin Place, Suite 400 Cambridge, MA 02138 USA www.bfskinner.org [email protected] Cambridge Center for Behavioral Studies 410 Newtown Road Littleton, MA. 01460 www.behavior.org Council for Exceptional Children 3100 Clarendon Blvd. Suite 600 Arlington, VA 22201-5332 888-232-7733 www.cec.sped.org International Dyslexia Association 40 York Road, 4th Floor Baltimore, MD 21204 (410) 296-0232 https://dyslexiaida.org/ National Alliance for the Mentally Ill 4301 Wilson Blvd. Suite 300 Arlington, VA 22203 Main 703-524-7600 Member services 888-999-6264 www.nami.org National Center for Learning Disabilities 1220 L Street, NW Ste. 100 Box #168 Washington, DC 20005 301-966-2234 www.ncld.org Parent Advocacy Coalition for Education Rights 8161 Normandale Blvd.

Appendix | 345

Minneapolis, MN 55437 952/838-9000 www.pacer.org [email protected] TASH 1101 15th Street NW, Suite 206 Washington, D.C. 20005 202-817-3264 www.tash.org The National Institute for Direct Instruction P.O. Box 11248 Eugene, OR 97440 [email protected] Relevant Websites Behavior Homepage www.state.ky.us/agencies/behave/homepage.html Intervention Central www.interventioncentral.org Positive Behavioral Supports and Interventions www.pbis.org Research and Training Center on Family Support and Children’s Mental Health www.rtc.pdx.edu Functional behavioral assessment http://cecp.air.org/fba/ The Challenging Behaviour Foundation http://www.challengingbehaviour.org.uk/ Podcasts ABA Inside Track https://www.abainsidetrack.com/ Behavior Analysis in Practice (BAPCast)

346 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

https://www.abainternational.org/journals/bap/bapcast.aspx Behavior Babe https://www.behaviorbabe.com/ Behavioral Observations https://behavioralobservations.com/

NAME INDEX A Abar, Beau, 119, 121, 224 Acker, Nicholas, 23 Achmadi, Donna, 20 Adelman, Barry, 76, 120 Agran, Martin, 12, 17, 24, 142, 149, 180, 186, 190, 195, 252 Aguilar, Jeanne, 23 Ahearn, William, 195 Akers, Jessica, 81, 119 Alber, Sheila, 148 Alberto, Paul, 8, 17, 193 Albin, Joyce, 194 Albin, Richard, 22, 62, 77, 81, 82, 121, 151, 177, 179, 194, 196, 222 Alcedo, M. Ángeles, 191 Alderman, Nick, 242, 252, 253 Algozzine, Bob, 22, 138, 149 Algozzine, Kate, 22 Aljadeff-Abergel, Elian, 23 Alber, Sheila, 148 Alpert, Cathy, 120, Alsaeed, Abdulaziz, 191 Alter, Peter, 23 Alves, Kat, 148 Andzik, Natalie, 68, 76, 79 Anderson, Angelika, 77 Anderson, Cynthia, 23 Anderson, Jacky, 18 Anderson, Philip, 36 Andrews, Frank, 13, 17 Antosh, Anthony, 18 Appleton, Amanda, 147 Ard, William, 191, 196 Arntzen, Eric, 60, 79, 222 Artman-Meeker, Kathleen, 190 Ashbaugh, Kristen, 21, 119, 221, 224 Asselin, Susan, 221 Ault, Melinda, 80 Austin, Diane, 193 Austin, John, 192 Autistic Self Advocacy Network, 218, 223

Avellone, Lauren, 196, 197 Av-Gay, Hadas, 12, 21 Avramidis, Elias, 103, 117 Axe, Judah, 17 B Babcock-Parziale, Judith, 252 Baer, Donald, 7, 9, 17, 18, 62, 82, 105, 106, 121 Baer, Hailee, 193 Bakhshi, Enayatollah, 119 Baker, Scott, 137, 148, 149 Balint-Langel, Kinga, 12, 17 Balise, Raymond, 148 Bambara, Linda, 11, 18, 186, 194 Barbaro, Josephine, 211, 223 Barber, Ana, 138, 139, 149 Barlow, David, 9, 18, Barlow, Susan, 253 Barrett, Whitney, 103, 120 Barringe, Kenneth, 150 Bashinski, Susan, 24 Bates, Paul, 12, 22 Batterman, Nancy, 194 Bauman, Kenneth, 77 Becker, Bernd, 21 Bedesem, Pena, 120 Beebe-Frankenberger, Margaret, 148 Bele, Irene, 183, 191 Belfiore, Phillip, 104, 121 Bellamy, G. Thomas, 81, 194, 252 Bellesi, Karishma, 222 Bellon, Michelle, 252 Bemmouna, Doha, 222 Benner, Gregory, 149 Bennett, Katherine, 102, 120 Benowitz, Suanne, 150 Bergan, John, 15, 18 Berkeley, Sheri, 138, 139, 148, 149 Berkowitz, Brooke, 252 Bernstein, Daniel, 118 Bersani, Hank, 12, 19

347

348 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Birmingham, Elina, 221 Bishop, Michele, 222 Blacher, Jan, 191 Black, Jeffrey, 148 Bloom, Sarah, 18 Boland, Joseph, 151 Bondy, Andy, 11, 24 Borkovec, Thomas, 252 Bosch, Sebastian, 62, 79, 105, 120 Bottiani, Jessika, 147 Bourbeau, Phil, 194 Bowen, Crystal, 23 Bowman, Lynn, 192 Bradley, Valerie, 23 Bradshaw, Catherine, 147 Bradshaw, Jessica, 119 Brady, Michael, 193 Brantlinger, Ellen, 22 Braun, Drew, 151 Breen, Catherine, 80, 103, 105, 117, 208, 223 Bresnahan, Val, 120 Britton, Lisa, 70, 79 Brodhead, Matthew, 18, 20, 80, 119 Brock, Matthew, 22 Brodkin, Edward, 79, 80 Brooke, Alisa, 197 Brooke, Valerie, 197 Brookman, Lauren, 78 Bross, Leslie, 116 Brothers, Kevin, 80 Browder, Diane, 10, 18, 24, 222 Brown, Alecia, 196 Brown, Fredda, 11, 18 Brown, Lou, 188, 189, 194 Brown, Roy, 13, 18 Bruzek, Jennifer, 197 Bucholz, Jessica, 193 Buckley, Jay, 178, 194 Bunch-Crump, Kimberly, 147 Burke, Kathryn, 12, 18 Buron, Kari, 208, 223 Burton, Kelli, 191 Burton, Patricia, 253 C Cable, Amory, 150 Calabrese, Raymond, 103, 120 Caldwell, Joanne, 150 Camargo, Siglia, 76 Campbell, Alisa, 13, 18 Campbell, Camille, 224 Candel, Lindsay, 76 Cannella, Helen, 20 Cantwell, Emily, 116 Capell, Shawn, 16, 18, 71, 80

Caporino, Nicole, 81 Capriola, Nicole, 221 Carnine, Douglas, 18, 19 Carr, Edward, 75, 77, 106, 116, 175, 190 Carr, James, 296 Carter, Deborah, 132, 147, 149 Carter, Erik, 10, 18, 186, 187, 190, 191, 192, 193 Cassell, Diana, 222 Catagnus, Robyn, 20, 80 Caterinao, Linda, 82 Cavin, Michael, 149 Certo, Nicholas, 173, 179, 181, 188, 192, 194, 196 Chadsey, Janis, 175, 192 Chadsey-Rusch, Janis, 175, 194 Chandler, Lynette, 11, 18 Channon, Shelley, 222 Chard, David, 132, 178, 150, 151 Charlop-Christy, Marjorie, 61, 79, 80, 193 Chazin, Kate, 119 Chen, Chih-Ming, 147 Chen, Ting, 21 Cheng, Sheung-Tak, 13, 18 Childs, Karen, 117 Choi, Ha Young, 19 Christensen, Victoria, 79 Christian, LeeAnn, 177, 191 Christiansen, Kathy, 19 Chu, Samuel, 138, 147 Cigrand, Karla, 116 Cihak, David, 120 Cimera, Robert, 180, 182, 192, 193, 194 Cipani, Ennio, 59, 80 Clarke, Shelley, 76, 117, 119 Clements, Carlyle, 196 Clemons, Lachelle, 139, 149 Coates, Andrea, 193 Coelho, Carl, 223 Cohen, Celina, 224 Cohen, Nicole, 147 Cole, Christine, 194 Cole, Michael, 251 Coleman, Maggie, 102, 118 Coleman, Mari, 109, 120 Colker, Ruth, 143, 150 Collins, Belva, 193 Colvin, Geoffrey, 81 Common, Eric, 116 Compton, Donald, 138, 147 Conderman, Greg, 103, 120 Connell, James, 79, 80 Conner, Caitlin, 221 Conners, Brian, 16, 18, 71, 80 Conroy, Maureen, 118 Cook, Jennifer, 82

Name Index | 349 Cook, Joni, 116 Cook, Michael, 150 Cooney, Molly, 190 Cooper, Benjamin, 221 Cooper, John, 7, 19, 142, 150, 180, 194, 213, 223 Corrigan, Patrick, 12, 19 Coster, Wendy, 191 Coutelle, Romain, 222 Courtade, Ginevra, 18 Cox, Ann, 22 Cox, Carol, 193 Coyne, Michael, 10, 11, 19 Crabtree, J., 23 Craddock, Caitlin, 150 Crone, Deanne, 12, 19 Crotty, Maria, 251 Crye, Amy, 79 Csikszentmihalyi, Mihaly, 13, 19 Cumming, Therese, 119 Cupach, William, 207, 224 Curiel, Emily, 76 Cushing, Lisa, 18 Cuvo, Anthony, 241, 251 D Dahlquist, Carol, 11, 18 Dalsgaard, Soeren, 21 Daly, Teresa, 109, 190 Damm, Dorte, 21 Daneshvar, Sabrina, 193 Daniels, Aubrey, 15, 19 Darling, Rosalyn, 250, 252 Davenport, Katy, 76 David, Marie, 190 Davis, John, 222 Davis, Paula, 252 Day, Julie, 20, 81 Day, H. Michael, 20, 81, 175, 195 Day-Watkins, Jessica, 68, 80 Daly, Teresa, 109, 178, 190 Deb, S., 23 Deel, Nicole, 119 DeFulio, Anthony, 10, 19 DeHope, Eli, 248, 252 Deitchman, Carole, 208, 223 de la Cruz, Chaturi, 196 DeLeon, Iser, 125, 147, 150, 260, 273, 279 DeMaso, David, 21 Demchak, Mary, 222 De Nadai, Alessandro, 81 Dennery, Kristine, 21 Deno, Stanley, 148 dePerczel, Maria, 119 De Pry, Randall, 18

DeRaad, Agnes, 116 Deshler, Donald, 146, 150 D’Esposito, Mark, 251 Detar, Whitney, 21, 221, 223, 224 Devlin, Sarah, 166, 194 Dickey, Celeste, 151 Didden, Robert, 11, 24 Dileo, Dale, 185, 194 Dillenburger, Karola, 10, 19 Dissanayake, Cheryl, 211, 223 Di’Terlizzi, Michele, 193 Ditzian, Kyle, 224 Dixon, Dennis, 20 Dixon, Mark, 243, 251 Dogan, Rebecca, 76 Donaghey, C. L., 58, 77, 80 Donnelly, Lauren, 192 Dorsey, Michael, 77 Doyle, Patricia, 59, 79, 80, 109, 119 Dozier, Claudia, 22, 107, 118, 296 Duchaine, Ellen, 103, 118, Duffy, J. Trey, 217, 223 Duffy, Mary, 193 Dukes, Charles, 193 Dunlap, Glen, 12, 19, 20, 76, 114, 117, 119, 120 Dunn, David, 20 Duran, Lillian, 18 Durand, V. Mark, 8, 9, 19, 106, 116, 175, 190, 195 Dybwad, Gunnar, 12, 19 Dymond, Stacy, 165, 194 E Edelen-Smith, Patricia, 121 Edmonds, Meaghan, 138, 150 Edrisinha, Chaturi, 11, 19 Edwards, Timothy, 23 Ehlhardt, Laurie, 213, 223 Eldevik, Sigmund, 68, 80 Eldridge, Rebecca, 23 Elia, Rebecca, 221 Ellis, Lorrie, 78, 82 Eisenman, Laura, 20 English, Carie, 19 Epstein, Dana, 247, 252 Erchul, William, 15, 19 Esbensen, Anna, 25 Espin, Christine, 148 Ettel, Deborah, 222 Etzel, Barbara, 77, 82 F Fabian, Ellen, 13, 19

350 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Falcomata, Terry, 61, 77, 80, 107 Falk, George, 76, 117 Falvey, Mary, 145, 150 Faragher, Rhonda, 13, 18 Farkas, George, 150 Farmer, Jacqueline, 80 Farmer-Dougan, Valeri, 190 Fava, Giovanni, 13, 19, Faw, Jerry, 252 Feder, Michael, 119, 121, 224 Felce, David, 13, 14, 19, 22, 80 Feldman, Elyana, 192 Ferguson, Kyle, 3, 22, 252 Fetherston, Anne, 76 Fickin, Seana, 20 Field, Sean, 20, 80 Filter, Kevin, 132, 147 Finegan, Joanne, 248, 252 Fischetti, Anthony, 76 Fisher, Alinka, 252 Fisher, Doug, 194 Fisher, Wayne, 9, 19 Fitzer, Adrienne, 10, 19 Fleming, Jennifer, 251 Fletcher, Daniel, 221 Flores, Margaret, 61, 80 Flowers, Claudia, 18 Fong, Elizabeth, 16, 17, 20, 80 Forest, Marsha, 150 Forrester-Jones, Rachel, 184, 193 Foss-Feig, Jennifer, 192 Fowler, Catherine, 197 Fox, Lise, 19 Frea, William, 78, 79, 81, 119, 191 Freedman, Sarita, 10, 20 Fremouwa, William, 207, 224 Friedman, Carli, 13, 20 Fuchs, Douglas, 150 Fuchs, Lynn, 148, 150 Fuqua, Richard, 62, 79, 105, 120 G Gagnon, Jean, 246 Galiatsato, G. Tracey, 166, 195 Gallagher, P., 23 Ganley, Patricia, 147 Gans, Jennifer, 251 Ganz, Jennifer, 60, 61, 78, 80, 82, 222 Garcia-Albea, Elana, 61, 80 Gardner, James, 23 Garff, Jennifer, 176, 192 Garrison-Kane, Linda, 149 Gast, David, 7, 9, 21, 79, 80, 109, 117, 119, 121 Gaylord-Ross, Robert, 61, 80, 192

Germer, Kathryn, 116 Gershwin, Tracy, 23 Gersten, Russell, 22 Getzel, Elizabeth, 221 Gibson, Karen, 196 Giess, Sally, 102, 118 Gifford, Elizabeth, 224 Giserman-Kiss, Ivy, 192 Giuliani, George, 143, 150 Glang, Ann, 222 Gnagy, Elizabeth, 223 Goeke, Jennifer, 102, 121 Goh, Amelia, 251 Gold, Marc, 174, 195 Goldberg, Roberta, 186, 195 Goldsbury, Tammi, 13, 24 Goleman, Daniel, 185, 195 Gomez, Arcadia, 119 Gomez, Laura, 13, 20, 191 Good, Roland, 137, 149 Goodson, John, 11, 20 Goodwyn, Fara, 76 Goodvin, Sherry, 120 Gordy, Alicia, 148 Gorenstein, Michelle, 192 Gothard, Shayna, 207, 224 Gotto, George, 191 Graff, Richard, 166, 195 Granpeesheh, Doreen, 10, 11, 20 Granzin, Alex, 18 Graupner, Tamlynn, 23, 41, 82 Green, Katherine, 118 Greenwood, Charles, 21 Gregori, Emily, 190 Gregory, Meagan, 224 Gresham, Frank, 148, Griffin, Cary, 187, 196 Grima-Farrell, Christine, 137, 147 Grindle, Corinna, 80 Grossi, Teresa, 193 Guercio, John, 242, 251, 252 Gugerty, John, 217, 223 Guy, Lisa, 222 H Hagiwara, Mayumi, 191 Hagopian, Louis, 192 Haines, Kerrie, 252 Hall, Tracey, 146, 147 Halstadtro, Lill-Beathe, 79, 222 Halstadtro, Monica, 79, 222 Ham, Whitney, 197 Hamre-Nietupski, Susan, 194 Hanley, Gregory, 107, 118, 197, 202, 223, 290, 296, 299

Name Index | 351 Hanline, Mary, 120 Harchik, Alan, 78, 83 Hardesty, Samantha, 179, 192 Harel, Brian, 251 Haring, Thomas, 80, 103, 105, 117, 208, 223 Harn, Beth, 150 Harjusola-Webb, Sanna, 103, 120 Harris, Karen, 22 Harrower, Joshua, 19 Hartman, Laura, 253 Hassiotis, A., 23 Hawken, Leanne, 19 Hayes, Gregory, 224 Hayes, Steven, 224 Hayes-Skelton, Sarah, 240 Haymes, Linda, 61, 79, 80, 224 Haynes, Patricia, 252 Healy, Olive, 194 Heason, Sophie, 193 Heath, Amy, 222 Hedin, Laura, 120 Heller, Meredith, 222 Hensley, Lauren, 76 Herb, Christine, 252 Herman, Kenneth, 195 Hersen, Michael, 18 Heron, Timothy, 19, 150, 194. 223 Heumann, Judith, 12, 20, Heward, William, 19, 150, 194, 223 Hickey, R., 151 Higgins, Eleanor, 195 Hillemeier, Marianne, 150 Hilt, Alexandra, 76, 120 Hindhede, Anette, 252 Hodges, Simon, 221 Hoerger, Marguerite, 121 Hoffman, Karen, 23 Hoffmann, Wendy, 72, 82 Holland, Lucy, 112, 120 Holloway, Jennifer, 192 Holzberg, Debra, 12, 20 Homlitas, Christa, 76 Hong, Seunghye, 81 Hoogeveen, Frans, 77, 83 Horan, John, 104, 118 Horner, Molly, 251 Horner, Robert, 8, 10, 19, 20, 22, 61, 62, 77, 81, 82, 121, 132, 147, 148, 149, 150, 151, 175, 177, 191, 194, 195, 196, 242, 243, 251, 252 Hosp, Michelle, 147 Houghton, Stephen, 118 Hovanetz, Alyson, 80 Howells, Jenny, 221 Howlin, Patricia, 221 Hsieh, Ming-Yun, 242, 252

Hsin, Ching-Ting, 191 Huang, Sheng, 147 Hughes, Carolyn, 12, 13, 17, 20, 24, 180, 195 Hughes, J. Carl, 80 Hughes, Melissa, 148, 193 Hummel, Crystal, 120 Hummer, Tom, 14, 20 Hunt, Anne, 253 Hurley, Kevin, 120, 191 Hutchins, Meg, 195 Hutchins, Nancy, 76 Hwee, Noel, 118 Hwang, Bogseon, 20 I Iata, Carina, 19 Ing, Anna, 290, 296 Iovannone, Rose, 19 Isenstein, Emily, 192 Irvin, Larry, 83 Iwata, Brian, 22, 77, 117, 125, 147, 150, 260, 261, 270, 273, 279 J Jameel, Leila, 222 Jameson, J. Matt, 23 Janney, Rachel, 18 Jenkins, Joseph, 148 Jennings, Danielle, 105, 120 Jennings, Joyce, 138, 150 Jerman, Patty, 195 Jimenez, Bree, 18 Johns, Beverley, 136, 138, 150 Johnson, Beverley, 192 Johnson, Jesse, 23 Johnson, Mary, 174, 195 Johnson, R. Gilmore, 104, 118 Jolivette, Kristine, 118 Jones, Samantha,193 Jordan, Molly, 21 Ju, Song, 151 Jung, Leah, 81 K Kagohara, Debora, 11, 20 Kaiser, Ann, 109, 120 Kalnin, Andrew, 20 Kalyva, Efrosini, 103, 117 Kame’enui, Edward, 19, 150 Kamps, Debra, 11, 21 Karan, Orv, 23 Karsh, Kathryn, 22 Kaufman, Alan, 124, 150

352 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Kaufman, Nadine, 124, 150 Kaufman, Roberta, 182, 195 Kaufmann, Sarah, 185, 195 Kaur, Archana, 224 Kaye, Amy, 15, 21 Kazdin, Alan, 5, 7, 21, 105, 120 Kearney, Albert, 9 Kearney, Kelly, 193 Keenan, Mickey, 10, 19 Keeney, Kris, 80 Keith, Kenneth, 23 Kelly, Elizabeth, 13, 14, 23, 190 Kendrick, Denise, 240, 253 Kennedy, Craig, 18, 55, 81, 102, 117, 183, 191, 241, 251 Kennedy, Kelly, 118 Kennedy, Michael, 146, 148, 150, 223 Kern, Lee, 76, 117, 120 Kern Dunlap, Lee, 76, 114, 117 Kettering, Tracy, 80 Khosrowabadi, Reza, 119 Killian, Daniel, 20 Killington, Maggie, 251 Kim, Eunjung, 58, 81 Kim, Jin-Ho, 20 Kim, So, 190 Kim, Sunyoung, 81 Kincaid, Donald, 19 King, Diane, 222 King, Gillian, 253 King, Melissa, 76 Kirby, Suzanne, 148 Kirkpatrick, Marie, 68, 81 Kishi, Gloria, 106, 116 Kitchen, Thomas, 11, 21 Kleinert, Harold, 193 Knight, Caroline, 240, 253 Knight, Melissa, 59, 79, 81, 109, 120 Knight, Victoria, 18, 79, 111, 117, 121, 193 Knowles, Tanya, 81 Knutson, Nancy, 151 Kocka, Andrea, 246, 253 Koegel, Lynn, 9, 11, 21, 60, 76, 78, 81, 102, 119, 121, 177, 191, 208, 221, 222, 224 Koegel, Robert, 20, 21, 76, 78, 81, 102, 119, 121, 191, 221, 222, 224 Koger, Freya, 194 Kortering, Larry, 197 Kraemer, Bonnie, 187, 191 Kranak, Michael, 76 Kratochwill, Thomas, 15, 18 Kraus, William, 11, 21 Kronenberger, William, 20 Krupp, Michael, 190 Kubina, Richard, 193 Kumar, Koshila, 77 Kunkel, Ken, 148

Kuriyan, Aparajita, 223 Kush, Joseph, 147 Kvalsund, Rune, 183, 191 L Lake, Candice, 76 Lakin, Charlie, 183, 195 Lambek, Rikke, 14, 21 Lambros, Katina, 148 Lancaster, Blake, 193 Lance, G. Denise, 24 Lancioni, Giulio, 19, 20, 77, 83 Landesman, Sharon, 13, 21 Lane, Kathleen, 116, 139, 148, 149, 190 Lang, Russell, 23, 76, 78, 82 Langer, Susan, 117 Lannin, Natasha, 251 LaPlante, Terri, 18 Laraw, Sean, 6, 21 Larson, Kristine, 147 Lattal, Alice, 15, 19 Laver, Kate, 251 Laverick, DeAnna, 146, 150 Lawn, Sharon, 252 LaZebnik, Claire, 9, 21 Leader, Geraldine, 194 Leaf, Justin, 81 Leaf, Ron, 24 LeBaron, Nancy, 196 Lebbon, Angela, 179, 192 LeBlanc, Judith, 77, 82 LeBlanc, Linda, 177, 193 Ledford, Jennifer, 9, 21, 119 Ledger, Thomas, 221 Ledyard, Jennifer, 7 Lee, David, 138 Lee, Gloria, 81 Lee, Helen, 20 Lee, Shuangshuang, 119 LeFevre, Judith, 13, 19 Lengyel, Linda, 192 Lennon, Sheila, 252 Lenz, Claire, 150 Leon, Yaerys, 224 Lequia, Jenna, 72, 81 Lerner, Janet, 136, 138, 150 Levine, Mel, 145, 150 Levy, Tamina, 251 Lewin, Adam, 81 Li, Xuanxi, 138, 147 Libby, Myrna, 195 Liber, Daniella, 59, 79, 81 Lien, Susan, 72, 79 Lin, Yu-Chu, 138, 150 Lineman, Gregg, 195 Linneman, Dan, 192

Name Index | 353 Liu, Fuchang, 120 Lloyd, Blair, 149 Lloyd, John, 148 Lomardino, Linda, 118 London, Dina, 23 Longmore, Paul, 250, 253 Lopata, Christopher, 61, 81 Lory, Catharine, 190 Lotfizadeh, Amin, 23 Lough, Christine, 64, 76, 81 Lough, Larry, 76, 81 Loughry, Tamara, 224 Low, Jason, 112, 120 Lo, Ya-yu, 147 Luecking, Richard, 194, 196 Luczynski, Kevin, 107, 118 Luiselli, James, 78, 83 Luscre, Deanna, 117, 121 Luthans, Fred, 118 Lutzger, John, 23 Lydon, Helena, 192 Lyon, Kate, 12, 24 Lyons, Gregory, 81 M MacDonald, Pam, 138, 148 MacDonald, Rebecca, 117 Mace, F. Charles, 104, 121 Machalicek, Wendy, 190 Mackelprang, Romel, 36 Maczuga, Steve, 150 Maddox, Brenna, 222 Madigan, Kathleen, 59, 80 Magnani, B., 13, 19 Mairs, Nancy, 36 Maki, Amber, 242, 251 Mallon, Brett, 221 Manikam, Ramasamy, 78 Mank, David, 177, 193, 194, 242, 251 Mann, Kathryn, 82 Marchand-Martella, Nancy, 139, 151 Markwardt, Frederick, 123, 150 Marsh, Robbie, 119 Marshall, Laura, 186, 195 Martella, Ronald, 139, 151 Martens, Brian, 15, 19 Martin, James, 12, 21, 24, 184, 186, 195, 197 Mason, Benjamin, 149 Mathur, Sarup, 82 Mathews, Therese, 76 Mathews, Vincent, 10, 20 Matthews, Katherine, 21 Mautz, Denise, 174, 192, 194 Maxson, Laurie, 195 Maynard, Cynthia, 77, 82 Mazaleski, Jodi, 117

Mazefsky, Carla, 221 Mazur, Amy, 223 Mazzotti, Valerie, 197 McBratnie, Barb, 253 McComas, Jennifer, 98, 117 McCoy, Kathleen, 82 McDonnell, John, 23, 252 McDonough, Jennifer, 196, 197 McDougall, Dennis, 121 McEachin, John, 24 McEvoy, Robin, 72, 82 McGee, Gail, 109, 190 McGinnis, Ellen, 107, 121 McHugh, Catherine, 82 McIntosh, Kent, 12, 21, 132, 151 McIntyre, Laura, 191 McIvor, Melissa, 192 McKay, Adam, 252 McMillan, Thomas, 77, 80 McMorrow, Martin, 252 Meloy, John, 207, 224 Meyer, Kim, 81 Meyer, J. Patrick, 148 Meyer, Viktor, 185, 195 Michael, Jack, 21 Michaels, Stephen, 119 Migliore, Alberto, 186, 193 Miguel, Caio, 59, 83, 111, 118, 121 Milbraith, Lester, 13, 21 Miller, William, 253 Milton, Damian, 217, 224 Miner, Craig, 12, 22 Miltenberger, Raymond, 8, 9, 22 Miranda, David, 119 Mitchell, Alex, 221 Mithaug, Dennis, 24 Miyazaki, Yasuo, 221 Moffat, Jacqui, 253 Mohammadzaher, Fereshteh, 119 Montgomery, Joyce, 180, 191, 196 Mooney, Paul, 149 Moore, Dennis, 77 Moore, James, 116 Moran, M Lucía, 191 Morgan, Christopher, 21 Morgan, David, 22 Morgan, Jessica, 59, 81 Morgan, Paul, 150 Morris, Caroline, 193 Mosier, Kristine, 20 Moskowitz, Lauren, 175, 194 Moss, Colleen, 190, 191 Mount, Beth, 145, 151, 248, 253 Mruzek, Daniel, 208, 224 Mueller, Michael, 59, 77, 82, 102, 116 Muir, James, 251 Mulloy, Austin, 23

354 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Munk, Dennis, 22 Munsell, Elizabeth, 191 Murphy, Stephen, 196 Myers, Diane, 12, 24 Myles, Brenda, 60, 82, 208, 211, 224

O’Shaughnessy, Tam, 148 Ostrosky, Michaelene, 120 Overton, Terry, 134, 151 Ownsworth, Tamara, 251 Ozonoff, Sally, 72, 82

N

P

Najdowski, Nadel, 14, 20 Najowski, Adel, 22 Nalder, Emily, 253 Nance, Erica, 120 Narendorf, Sarah, 221 Needham, Mick, 19 Neef, Nancy, 76 Neely, Leslie, 76, 78, 82, 190 Neidert, Pamela, 11, 22 Nelson, Janet, 138, 148 Nelson, J. Ron, 149 Neubert, Debra, 186, 193 Newcomb, Eli, 21 Newton, J. Stephen, 11, 22, 183, 185, 191, 196 Newton, Naomi, 224 Nida, Robert, 81 Nietupski, John, 194 Nigra, Megan, 252 Nock, Matthew, 18 Nolet, Victor, 151 Northup, John, 106, 116 Noyes, David, 194 Nussbaum, Nancy, 148 Nye, Robert, 4, 22

Pace, Jesse, 149 Palkovic, Christine, 77, 82 Pallathra, Ashley, 79, 80 Palmer, Susan, 24, 149, 191 Parent, Wendy, 179, 196 Park, Hyun-Sook, 174, 192 Park, Mi, 78, 81, 222 Parke Hubbel, Sophia, 120 Pas, Elise, 147 Patterson, Freyr, 251 Patterson, Jean 120 Patton, James, 196 Payne, Steven, 107, 118 Pearpoint, Jack, 150 Pearson, Nils, 152 Pejic, Vania, 21 Pelham, William, 223 Pennington, Bruce, 82 Perry, Jonathan, 13, 22 Peters, Christina, 253 Peters, Schott, 253 Peterson, Stephanie, 12, 23 Piazza, Cathleen, 19, Pierce, Janelle, 111, 117, 121 Pierce, Laura, 23 Pistorio, Kalynn, 193 Pitts-Conway, Valerie, 80 Poling, Alan, 7, 21, 23, 177, 191 Pollens, Robin, 246, 253 Polloway, Edward, 196 Polychronis, Shamby, 23 Ponsford, Jennie, 252 Post, Michal, 53, 83, 99, 121, 143, 151, 181, 191, 196, 207, 208, 224 Potts, Magan, 221 Poulsen, Ingrid, 252 Powell, Laurie, 222 Preciado, Jorge, 139, 148 Premack, David, 78, 104, 121 Prior, Margaret, 72, 82 Pritchard, Duncan, 102, 121 Proctor, Mike, 205, 224 Progar, Patrick, 223 Pruszynski, Barbara, 192 Prykanowski, Debra, 118 Pumpian, Ian, 194 Putnam, Robert, 149

O Oakes, Wendy, 116 Oakland, Thomas, 139, 148 O’Brien, John, 12, 22, 145, 151, 248, 253 Odom, Samuel, 11, 22 O’Donohue, William, 3, 22 Ogle, Donna, 136, 151 O’Hora, Denis, 222 Olive, Melissa, 222 Oliver, Chris, 253 Olson, Deborah, 191 Olson, Peter, 138, 148 Olson, Ryan, 21 Ondire, Iwona, 80 O’Neill, Brian, 80 O’Neill, Robert, 22, 44, 77, 82, 86, 87, 114, 121, 125, 134, 151, 155, 156, 173, 196, 220, 229 O’Reilly, Mark, 19, 20, 23, 196, 241, 251 Ori, Lindsay, 252 Orsillo, Susan, 252

Name Index | 355 Q Qian, Xueqin, 191 Quigley, Shawn, 20, 80 R Rahman, Barzan, 229, 253 Raley, Sheida, 18, 149, 191 Ralston, Nicole, 149 Ramasamy, Rangasamy, 79, 120 Randall, Leisa, 103, 120 Randell, Tom, 80 Randolph, Justus, 119 Rapp, John, 60, 82, 251, 290, 296 Rashotte, Carol, 152 Raskind, Marshall, 195 Ratti, V., 12, 23 Redhair, Emily, 59, 82 Reed, Derek, 149 Reed, Holly, 77 Reeve, Kenneth, 80, 223 Reeve, Sharon, 80, 223 Regan, Kelley, 146, 148 Regester, April, 21, 221, 224 Reichow, Brian, 118, 120 Remington, Bob, 80 Ren, Xuezhu, 119 Renzaglia, Adelle, 195 Reutebuch, Colleen, 150 Reynolds, Catharine, 78, 82 Rhodes, Larry, 194 Rice, Martin, 76, 81 Richman, Gina, 77 Richter, Sharon, 197 Riden, Benjamin, 12, 17 Riehle, Erin, 197 Riesen, Tim, 11, 23 Rifenbark, Graham, 149 Ringdahl, Joel, 76, 120 Risley, Todd, 18 Rispoli, Mandy, 17, 23, 64, 68, 76, 78, 82, 190 Ritchey, Kristen, 102, 121 Ritschel, Lorie, 222 Rivera, Gabby, 81 Rivers, Kenyatta, 118 Riviere, Adrienne, 201, 224 Roane, Henry, 19, 80, 296 Roantree, Christina, 102, 117 Robbins, Frank, 117 Roberts, Eric, 151 Roberts, Nicole, 221 Robertson, Scott, 13, 23, 217, 219, 224 Robinson, Jason, 11, 23 Robinson, Jeffrey, 11, 23 Rockett, Camille, 81

Rodgers, Jonathan, 81 Rodriguez, Manuel, 251 Roemer, Lizabeth, 252 Rogan, Patricia, 193, 196 Rogers, Sally, 82 Root, Jenny, 24 Rosales-Ruiz, Jesus, 62, 82 105, 106, 121 Rosas, Clarissa, 195 Rosales, Rocio, 76 Roscoe, Eileen, 147, 260, 273, 279 Rosenberg, Nancy, 190 Rosenberg, Richard, 150 Ross, Denise, 79, 81, 120 Ross, J. Megan, 223 Rubio, David, 119, 121, 224 Rudrud, Eric, 251 Ruhl, Ashley, 194 Rusch, Frank, 192 Rusher, Dana, 20 Russell, Marta, 36 Rutterford, Neil, 253 S Sale, Paul, 12, 21 Salend, Spencer, 60, 78, 82 Salinas, Carlos, 221 Sallows, Glen, 23, 41, 82 Salsgiver, Richard, 36 Sandow, Dennis, 194 Sansonetti, Danielle, 251 Sappington, Gary, 196 Sarokoff, Randi, 68, 78, 82 Sartini, Emily, 117, 121 Sasso, Gary, 116 Saunders, Alicia, 24 Sawyer, L. Brook, 146, 151 Sawyer, Mary, 76 Sax, Caren, 194 Schaefer, John, 79 Schall, Carol, 24, 186, 196, 197 Schalock, Robert, 13, 20, 23 Schaub, Chris, 241, 253 Scheiber, Caroline, 124, 151 Schembri, Adrian, 252 Schilmoeller, Gary, 59, 77, 82 Schilmoeller, Kathryn, 77, 82 Schmidt, Carla, 103, 121 Schmidt, Julia, 251 Schnakenberg, Jennifer, 150 Schönberger, Michael, 252 Schulze, Kim, 251 Schunn, Christian, 119, 121, 224 Schwartz, Ilene, 13, 14, 23 Schwartz, Michelle, 186, 191 Schworer, Emily, 25

356 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Scott, Renee, 171, 193 Scott, Terrance, 11, 23 Seltzer, Melissa, 193 Seethaler, Pamlea, 150 Seo, Hyojeong, 191 Shapiro, Arthur, 36 Shapiro, Joseph, 174, 196 Shattuck, Paul, 221 Shaw, Leslie, 191 Sheldon, Jan, 81 Sherman, James, 81 Sherrow, Lauren, 79 Shillingsburg M. Alice, 6, 23 Shin, Lisa, 251 Shinn, Mark, 135, 151 Shipley-Benamou, Robin, 11, 23 Shirotova, Larisa, 76 Shogren, Karrie, 12, 18, 24, 149, 191 Shukla, Smita, 81 Sibley, Margaret, 223 Siegel, Elin, 72, 79 Siegel, Lawrence, 143, 151 Sigafoos, Jeff, 19, 20, 23, 60, 80, 177, 196 Sigurdsson, Sigurdur, 179, 192, 197 Silverberg, Noah, 253 Silverman, Kenneth, 19 Sima, Adam, 196, 197 Simmons, Deborah, 150 Simon, Marlene, 192 Simonsen, Brandi, 12, 24 Simonsen, Monica, 181, 182, 186, 193, 196 Simpson, Richard, 139, 208, 224 Simpson, Stephen, 148 Singer, George, 23, 83 Singh, Ashvind, 78 Singh, Nirbhay, 60, 78 Skinner, B. F., 3, 24, 212, 224 Slifer, Keith, 77 Smalley, Kim, 194 Smeets, Paul, 59, 77, 83 Smerbeck, Audrey, 80 Smith, Deborah, 24 Smith, Garnett, 106, 121 Smith, J. David, 196 Smith, Marcia, 24 Smith, Richard, 117 Smith, Tom, 196 Smith, Tristram, 224 Snell, Martha, 18 Snow, Robert, 201, 224 Snycerski, Susan, 21 Snyder, Megan, 191 Soleymani, Zahra, 119 Sohlberg, McKay, 222, 223 Southwick, Jack, 60, 82 Sowers, Joanne, 83

Spear-Swerling, Louise, 151 Spitzberg, Brian, 207, 224 Spooner, Fred, 10, 24 Sprague, Jeffrey, 22, 77, 82, 121, 151, 196 Spriggs, Amy, 72, 79, 117, 121 Sprinkle, Evelyn, 59, 83, 111, 118, 121 Spruit, Stephanie, 192 Stancliffe, Roger, 183, 195 Stanford, George, 148 Stark, Jack, 13, 24 Staubitz, Johanna, 139, 149 Steege, Mark, 116 Steinle, Paul, 118, 148 Sterzing, Paul, 221 Stevens, Elizabeth, 118, 148 Stewart, Inga, 242, 252 Stichter, Janine, 103, 121 Stokes, Marc, 217, 224 Storch, Eric, 81 Storey, Keith, 22, 24, 53, 82, 83, 99, 121, 143, 151, 173, 175, 176, 179, 183, 186, 188, 190, 191, 192, 194, 196, 224 Strain, Phillip, 13, 19, 24, 77 Strong, Amanda, 139, Stuart, Christy, 196 Sturges, James, 222 Sturges, Lois, 222 Sturmey, Peter, 10, 11, 19, 24, 68, 76, 78, 82, 83 Sugai, George, 15, 24, 77, 150 Sun, Xiaohui, 68, 83 Swan, Louise, 253 Swanson, James, 148 Swedeen, Beth, 191 Sylvester, Charles, 13, 24 Sylvester, Lorraine, 197 Symon, Jennifer, 79, 81 T Taber, Teresa, 171, 193 Tackett, Kathryn, 150 Tanaka, Sakurako, 20 Tannock, Rosemary, 21 Tappe, Phyllis, 192 Tarbox, Jonathan, 20, 222 Targett, Pamela, 178, 187, 196 Taubman, Mitchell, 11, 23, 24 Taylor, Gill, 145, 151 Taylor, Julie, 221 Taylor, Ronald, 79, 81, 120 Taylor, Steven, 197 Test, David, 20, 186, 197 Tharp, Roland, 240, 253 Therrien, Kelly, 241, 251

Name Index | 357 Thoma, Coleen, 194 Thomas, Cathy, 148 Thomeer, Marcus, 81 Thompson, Bruce, 22 Thomsen, Per Hove, 21 Thorne, Stephanie, 21 Tiger, Jeffrey, 175, 197 Tincani, Matt, 11, 24 Tindal, Gerald, 15, 24 Todd, Anne, 22, 77 Todis, Bonnie, 222 Toomey, Jennifer, 81 Toonder, Scott, 146, 151 Torgesen, Joseph, 152 Touchette, Paul, 117 Trainor, Audrey, 193 Trela, Katherine, 18 Trillingsgaard, Anegen, 21 Troutman, Anne, 17 Truax, Tatyana, 81 Tufail, John, 12, 24 Tung, Catherine, 151 Turkstra, Lyn, 223 U Umbreit, John, 77 Unger, Darlene, 196 Unwin, G., 23 V Valentino, Amber, 23 van den Broek, Paul, 148 Vanderburg, Nicholas, 21 VanderWeele, Nathan, 23, 124 Vanderwood, Michael, 151 Vannest, Kimberley, 222 Vaughn, Sharon, 102, 118, 148, 150 Veenstra, Rebecca, 196 Verdugo, Miguel, 20 Vincent, Jonathan, 221 Vivanti, Giacomo, 36 Volker, Martin, 81 Vollmer, Timothy, 117 Vorndran, Christine, 76, 120 Vostal, Broos, 138 Vue, Ge, 147 W Wacker, David, 77, 107, 116 Wade, Holly, 194 Wagner, Leaora, 192 Wagner, Mary, 221 Wagner, Richard, 124, 152

Walker, Allison, 197 Walker, Gabriela, 59, 83 Welker, Kristen, 193 Walsh, Edith, 192 Walter, Martha, 191 Wang, A Ting, 192 Wang, Tengfei, 119 Wang, Yang, 20 Ward‐Horner, John, 68, 83 Warren, Narelle, 13, 24 Warzak, William, 76 Washburn, Jocelyn, 148 Waterstone, Julie, 143, 150 Watson, David, 240, 253 Watson, John, 3, 24 Watts, Amanda, 209, 224 Webb, Kristine,12, 25 Wehman, Paul, 10, 11, 24, 186, 196, 197 Wehmeyer, Michael, 12, 18, 24, 142, 149, 186, 191, 252 Weibel, Sébastien, 222 Weiner, Luisa, 222 Weir, Katherine, 25, 190 Welsh, Dianne, 104, 118 Wertalik, Jennifer, 193 Weschler, Jerry, 194 Westland, Carón, 195 Westrup, Darrah, 207, 224 Wexler, Jade, 150 Whalen, Christina, 10, 25 White, Allison, 119 White, James, 197 White, Ronnie, 119 White, Susan, 221 Whitney, Stephen, 13, 17 Whittenburg, Holly, 194, 197 Wilczynski, Susan, 116 Wilder, David, 224, 251 Wilkerson, Kimber, 81 Will, Elizabeth, 14, 25 Williams-Diehm, Kendra, 184, 195 Willke, Carolyn, 76 Wills, Howard, 21. 149 Wilson, Diane, 119 Wilson, Kelly, 19 Wine, Brian, 251 Winsler, Adam, 112, 119, 121, 208, 224 Winterman, Kathleen, 195 Winton, Alan, 78 Wirth, Oliver, 179, 197 Wolery, Mark, 79, 80, 109, 119, 120 Wolf, Montrose, 18 Wong, Diana, 252 Wood, Amanda, 68, 78, 83 Woods, Juliann, 120 Woods, Lee, 184, 197

358 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities Wozniak, Thom, 192 Wright, Suzanne, 119 Y Yang, Xueyan, 190 Yang, Yu-Fen, 138, 148 Ylvisaker, Mark, 223 Yorkston, Kathryn, 223

Z Zarcone, Jennifer, 104, 117 Zhang, Dalun, 151 Ziegler, Meg, 36, 37 Zucker, Stanley, 82 Zuckerman, Carrie, 222

SUBJECT INDEX A ABC Assessment/Analysis, 44, 52, 55, 58, 87, 96, 202, 205, 206, 237, 270, 310, 322 Academic Skills, 9, 10, 11, 98, 104, 116 Antecedent, 4, 5, 6, 8, 10, 44, 55, 56, 58, 59, 76, 87, 94, 102, 103, 105, 112, 116, 175, 176, 179, 180, 214, 229, 237, 240, 241, 242, 243, 251, 270, 272, 321 Applied Behavior Analysis, vii, viii, 3, 4, 5, 7, 8, 9, 10, 11, 16, 27, 44, 68, 70, 70, 73, 115, 154, 207, 258

337, 338 Extinction, 10, 29, 31, 32, 58, 62, 102, 103, 137, 140, 171, 176, 207, 212, 240, 241, 264, 265, 274, 293, 294, 302, 312, 312, 323, 324 F

Classroom Rules, 3, 125 Control, 3, 4, 10, 12, 13, 14, 17, 28, 29, 30, 33, 34, 76, 114, 139, 144, 146, 149, 153, 154, 180, 181, 183, 208, 212, 220, 237, 240, 246, 248, 251, 267, 271, 277, 290, 295, 304, 313, 325, 336 Consequences, 4, 6, 8, 10, 44, 62, 87, 94, 112, 156, 177, 179, 205, 206, 212, 221, 237, 238, 240, 242, 262, 270, 271, 321 Cooperative Learning, 123, 136

Feedback, 4, 32, 33, 55, 59, 60, 65, 68, 109, 138, 139, 141, 175, 178, 179, 181, 200, 202, 208, 214, 217, 219, 223, 242, 244, 251, 265, 276, 294, 299, 303, 307, 311, 313, 320, 324 Feelings, 5, 207 Frequency Data Collection, 52, 87, 96, 100, 134, 156, 202, 237 Functional Assessment/Analysis, 15, 17, 31, 32, 43, 45, 55, 65, 75, 77, 86, 87, 88, 95, 99, 109, 125, 125, 132, 133, 134, 141, 147, 155, 156, 157, 158, 165, 178, 201, 207, 214, 228, 229, 230, 237, 238, 244, 259, 260, 261, 262, 263, 265, 270, 271, 272, 273, 274, 276, 283, 284, 290, 292, 293, 294, 300, 303, 309, 313, 318, 320, 324, 333

D

G

Data Collection, 44, 60, 66, 70, 87, 96, 99, 100, 101, 109, 110, 134, 136, 156, 165, 202, 229, 237, 259, 300 Discriminative Stimuli, 55, 57, 61, 103, 107, 140, 146, 175, 177, 211, 240, 241, 243, 264, 272, 291, 302, 312, 323 Duration Data Collection, 9, 29, 43, 51, 99, 100, 116, 134, 164, 202, 236, 262, 271, 282, 299, 311, 320

Generalization, 10, 29, 32, 41, 42, 57, 60, 62, 65, 70, 73, 77, 104, 107, 140, 175, 176, 177, 189, 212, 241, 243, 265, 274, 293, 303, 312, 324

C

E Executive Function Skills, 14, 27, 34, 72, 86, 111,112, 153, 180, 216, 217, 225, 229, 245, 266, 277, 295, 298, 304, 313, 325,

I Interval Recording, 30, 43, 57, 57, 99, 100, 101, 134, 165, 202, 236, 237, 258, 259, 261, 262, 272, 283, 291, 299, 311, 320 M Maintenance, 29, 32, 62, 104, 107, 123, 139, 140, 176, 177, 178, 179, 212, 241, 265,

359

360 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities 274, 293, 303, 312, 324 Measurement, 7, 9, 13, 14, 27, 29, 30, 33, 41, 42, 43, 51, 55, 86, 98, 99, 102, 116, 124, 134, 136, 137, 142, 155, 164, 165, 201, 202, 211, 228, 229, 236, 237, 259, 261, 262, 270, 271, 272, 282, 283, 298, 299, 308, 309, 311, 318, 320 Mental Health, 34, 74, 113, 114, 144, 185, 248, 249, 267, 269, 278, 296, 305, 315, 326, 333 O Observable Behaviors, 3, 4, 7, 8, 9, 32, 57, 66, 101, 137, 165, 201, 206, 208, 239, 264, 274, 293, 300, 311, 321 Operational Definitions of Behavior, 13, 29, 43, 98, 99, 134, 135, 164, 202, 229, 237, 239, 262, 271, 282, 298, 309, 320, 321 P Percent Data Collection, 43, 98, 134, 164, 202, 236, 261, 262, 271, 282, 291, 299, 311, 320 Person-Centered Planning, vii, 12, 27, 34, 74, 114, 145, 184, 220, 248, 267, 279, 295, 304, 314, 326 Punishment, 6, 29, 31, 32, 58, 62, 102, 103, 137, 140, 171, 176, 179, 207, 212, 240, 241, 264, 265, 274, 293, 294, 302, 312, 323, 324 Q Quality of Life, vii, 13, 27, 34, 73, 113, 144, 182, 187, 218, 247, 248, 266, 278, 295, 314, 326

R Reading Skills/Literacy, 8, 9, 85, 86, 87, 139, 140, 141, 142, 143, 145, 146, 147, 186, 206, 308, 331, 332, 334 Reinforcement, 4, 6, 7, 8, 10, 29, 31, 32, 42, 55, 58, 59, 60, 61, 62, 64, 65, 70, 74, 102, 103, 104, 105, 106, 107, 108, 109, 112, 137, 139, 140, 141, 166, 174, 175, 176, 177, 178, 179, 180, 181, 207, 211, 212, 213, 214, 237, 240, 241, 242, 243, 244, 245, 246, 247, 264, 265, 266, 270, 272, 274, 276, 290, 291, 293, 294, 302, 303, 311, 312, 313, 321, 323, 324, 324 Relaxation Training, 242, 245, 246, 247, 251 Replacement Behaviors, 64, 65, 68, 73, 106, 107, 109, 110, 116, 138, 139, 173, 174, 175, 213, 214, 240 Response Cost, 6, 29, 31, 61, 62, 103, 140, 176, 212, 241, 265, 274, 293, 302, 312, 324 S Self-Advocacy, 12, 36, 144, 187 Self-Determination, 12, 74, 149, 186, 187, 190, 220, 250 Self-Management, 5, 32, 62, 65, 78, 104, 112, 119, 140, 146, 173, 176, 177, 181, 208, 210, 211, 212, 217, 222, 240, 241, 242, 265, 274, 293, 303, 312, 324, 338 Social Networks, 74, 113, 183, 184, 185, 191 Social Skills, 8, 9, 55, 61, 64, 68, 72, 74, 87, 96, 113, 139, 175, 177, 179, 192, 199, 200, 201, 206, 208 T Token Economy, 6, 31, 62, 104, 140, 176, 177, 212, 241, 265, 274, 293, 303, 312, 324

ABOUT THE AUTHORS Keith Storey, Ph.D., BCBA-D, is a Professor Emeritus at Touro University California in Vallejo, California. Keith has over forty years’ experience working with individuals with disabilities, including six years as a classroom teacher. His professional and research interests include transition from school to adult life, functional analysis and positive behavioral supports, supported employment, inclusion, and curriculum development. Keith is the recipient of the 1988 Alice H. Hayden Award from The Association for Persons with Severe Handicaps; the 1996 Hau-Cheng Wang Fellowship from Chapman University, which is presented for exceptional merit in scholarship; and the 2001 Robert Gaylord-Ross Memorial Scholar Award from the California Association for Persons with Severe Disabilities. He is a member of the Illinois State University College of Education Alumni Hall of Fame. He has published over 100 journal articles on a wide variety of topics. In addition to this book, Keith has published the books Systematic Instruction of Functional Skills for Students and Adults with Disabilities, Case Studies for Positive Behavior Supports in Classrooms and Schools; Case Studies for Inclusion in Education: Strategies and Guidelines for Educating Students with Disabilities in the General Education Environment; Positive Behavior Supports for Adults with Disabilities in Employment, Community, and Residential Settings: Practical Strategies that Work; Case Studies in Transition and Employment for Students and Adults with Disabilities; Positive Behavior Supports in Classrooms and Schools: Effective and Practical Strategies for Teachers and Other Service Providers; Case Studies in Applied Behavior Analysis for Students and Adults with Disabilities; The Road Ahead: Transition to Adult Life for Persons with Disabilities; Walking Isn’t Everything: An Account of the Life of Jean Denecke; and Functional Assessment and Program Development for Problem Behavior: A Practical Handbook. He served on the editorial boards of Journal of Vocational Rehabilitation, Education and Training in Autism and Developmental Disabilities, Journal of Positive of Behavior Interventions, Research and Practice for Persons with Severe Disabilities, Career Development and Transition for Exceptional Individuals, Education and Treatment of Children, Vocational Evaluation and Career Assessment Professional Journal, and Exceptionality. Keith’s Amazon author page is at www.amazon.com/ author/keithstorey and his Goodreads author page is at https://www.goodreads.com/ author/show/105547. Keith’s Academic page is at https://tu-ca.academia.edu/ KeithStorey and his ResearchGate page is https://www.researchgate.net/profile/ Keith_Storey. His Facebook page is https://www.facebook.com/Keith.Storey.books, his YouTube channel is at https://www.youtube.com/channel/UCTfL7zEI4D3mPJDbpQF5olw, and Instagram page is keith.storey.books. Linda Haymes, Ph.D., BCBA-D is an Associate Professor of Special Education in the Graduate School of Education at Touro University California. She has over 30 years’ experience in special education as a teacher, researcher, and clinician. Her professional and research interests include functional analysis and treatment of unusual behaviors, flexibility in ASD, over-selective attention and technology. She is a 361

362 | Case Studies in Applied Behavior Analysis for Individuals with Disabilities

board certified behavior analyst doctoral level and licensed psychologist in California. She has maintained a practice focusing on supporting students with disabilities and their families. She received her Ph.D. in Psychology from Claremont Graduate University and her Master’s from University of Kansas in Early Childhood Education and Applied Behavior Analysis. Dr. Haymes has published close to 20 research articles in a variety of journals including The Journal of Autism and Developmental Disabilities, Journal of Early Intervention, Behavioral Interventions, Education and Training in Autism and Developmental Disabilities, Behavior Analysis in Practice, Developmental Neurorehabilitation and Research and Practice for Persons with Severe Disabilities. She is frequently invited as a presenter at national and international conferences totally over 50 presentations. Dr. Haymes has been the recipient of grants from The UniversitySchool Partnerships for the Renewal of Educator Preparation (US PREP), intramural research grants from Touro University California and development grants from Morris Stultaft Foundation, Rosie O’Donell Foundation/For All Kids, and San Francisco Foundation for establishing programs for students with ASD. Linda’s author page at Amazon can be found at amazon.com/author/lindahaymes. Linda’s ResearchGate page can be found at https://www.researchgate.net/profile/LindaHaymes and her Google Scholar Profile is https://scholar.google.com/ citations?user=k2aFN_gAAAAJ&hl=en. Dr. Haymes has been a middle school special education teacher and preschool teacher, the clinical director of an ASD clinic, a practicing clinical psychologist, and an educational and behavioral consultant. Dr. Haymes is also the parent of a neurodiverse child.