Alison D. Cox’s research while affiliated with Brock University and other places

This review evaluated single-case experimental design research that examined challenging behavior interventions utilizing punishment elements. Thirty articles published between 2013 and 2022 met study inclusion criteria. Study quality was also assessed. Through multiple levels of analysis (e.g., descriptive statistics, non-parametric statistics), we examined (a) participant and study trends, (b) differential outcomes related to temporal reinforcement approaches (antecedent, consequent, or combined reinforcement) applied alongside punishment element(s), (c) differential outcomes related to the punishment type (negative, positive) applied alongside reinforcement, and (d) effect sizes associated with study rigor across peer-reviewed and gray literature. Our results may tentatively suggest that, for certain situations, concurrently applying punishment with antecedent reinforcement approaches may coincide with significantly larger effect sizes compared to combined temporal reinforcement approaches, while positive punishment applied concurrently with reinforcement may coincide with larger but non-significant intervention effects. Most featured articles met rigor criteria, but larger effects were seen in peer-reviewed literature.

Visual inspection of single‐subject data is the primary method for behavior analysts to interpret the effect of an independent variable on a dependent variable; however, there is no consensus on the most suitable method for teaching graph construction for single‐subject designs. We systematically replicated and extended Tyner and Fienup (2015) using a repeated‐measures between‐subjects design to compare the effects of instructor‐led, video‐model, and no‐instruction control tutorials on the graphing performance of 81 master's students with some reported Microsoft Excel experience. Our mixed‐design analysis revealed a statistically significant main effect of pretest, tutorial, and posttest submissions for each tutorial group and a nonsignificant main effect of tutorial group. Tutorial group significantly interacted with submissions, suggesting that both instructor‐led and video‐model tutorials may be superior to providing graduate students with a written list of graphing conventions (i.e., control condition). Finally, training influenced performance on an untrained graph type (multielement) for all tutorial groups.

It is considered best practice to conduct a functional analysis and visually inspect data collected to determine the function of problem behavior, which then informs the intervention approaches applied. Visual inspection has been described as a "subjective" process that may be affected by factors unrelated to the data. Structured decision-making guidelines have been established to address some of these shortcomings. The current paper is a follow-up to earlier work describing positive outcomes related to the viability of a decision support system based on structured criteria from Roane et al. Here, we demonstrate important improvements in a computer script's interpretation of functional analysis data, including improvement in agreement between the updated computer script version and experienced human raters (89%) compared to our original agreement outcomes (81%). This paper further supports the use of decision support systems for functional analysis interpretation.

Applied behavioral pharmacology explores how drugs may influence problem behavior in persons with intellectual and developmental disability (IDD). A comprehensive review was conducted featuring single-case experimental designs in the domain of applied behavioral pharmacology to evaluate and report on study quality. Studies included in the review featured participants with a diagnosis of IDD, with problem behavior as the intervention target, and who were receiving psychotropic medications to address problem behavior. Fifty-five articles met criteria and were scored using a 20-item literature-informed Quality Indicator Checklist. Total checklist scores ranged between 32 and 81% which suggest room for improvement regarding the methodological rigor of research in this domain. Barriers and possible solutions to improving study quality are discussed.

Background Research on training direct support professionals to address challenging behaviour exhibited by adults with intellectual disabilities is essential in generating effective training approaches for this sector. This systematic review's objective was to evaluate the effects of training types and whether specific training delivery components influenced outcomes. Methods Following PRISMA (2020) guidelines, 16 single‐case design studies were included that directly evaluated behaviour change of service providers training for adults with intellectual disabilities in community settings. Study quality was assessed using Horner et al. ( Exceptional Children , 2005, 71 (2), 165–180) criteria. The database searched included Academic Search Complete, CINAHL, Embase, ERIC, Psych Info, and Web of Science. Results Descriptive analysis of effect size outcomes suggested that all training types were associated with improved outcomes. Further, in situ training was associated with improved service provider performance. Interestingly, feedback was associated with poorer service provider performance. Conclusions We provide possible explanations for this surprising outcome and propose future research.

Previous research evaluating behavior skills training and performance feedback has largely examined factors influencing interventionist performance outcomes. However, to our knowledge, researchers have yet to compile existing literature to specifically explore characteristics associated with improved learner outcomes in the context of interventionist training research. In our meta-analysis, we conducted a regression analysis to examine the relationships between improved interventionist performance, interventionist training approach (behavioral skills training versus performance feedback in isolation), behavior domain (skill acquisition, behavior reduction, or both used in combination), and interventionist type on outcomes for learners. Results suggested that while interventionist performance was significantly correlated with improved learner outcomes, the training approach used was not. Behavior domain was found to reliably predict learner outcomes. Namely, training interventionists on protocols featuring both skill acquisition and behavior reduction were associated with better outcomes for learners than either skill acquisition or behavior reduction in isolation. Finally, interventionist type reliably predicted learner outcomes. That is, behavior therapists were positively correlated with larger learner effect sizes compared to other interventionist type, while post-secondary students as interventionists were correlated with the poorest learner outcomes. We end the paper by discussing potential clinical implications and make recommendations for future research.

Rationale: As acquired brain injury rates continue to increase, the ongoing need for efficient and effective treatment within neurobehavioral rehabilitation settings is clear. Some evidence suggests certain treatment components may be very important to incorporate into service delivery models (e.g., multidisciplinary). However, program evaluation literature and the uptake of complementary intervention strategies, like applied behavior analysis (ABA), in existing neurobehavioral settings remains largely unexplored. Primary objective: The purpose of this project was to: (1) develop and implement a simple, systematic program evaluation informed by best-practices (i.e., research) to assess service delivery models of several neurobehavioral rehabilitation settings, and (2) survey the current use of ABA by participating neurobehavioral agencies. Methodology: The program evaluation tool was applied to the charts of randomly selected past and current clients (referred to as participants). A secondary research assistant independently reviewed 29% of the charts to conduct interobserver agreement, which s. was 80% (range, 53%-100%). Results: Average program evaluation total percentage score was 33% (range, 4% - 63%), and program evaluation items describing ABA-uptake suggested the incorporation of ABA was low. Discussion: We discuss service model areas of strengths and areas for improvement as specified by tool outcomes, as well as in relation to quality improvement implications.

Despite a heavy clinical reliance on psychotropic medication to address challenging behavior in individuals with intellectual and developmental disabilities, monitoring the impact of these medications on behavioral outcomes occurs relatively infrequently or not at all. The skillset of Board Certified Behavior Analysts (BCBAs), including systematic, individualized data collection, suggests they may be well suited to address this challenge. Unfortunately, behavior analytic training programs often place little emphasis on formally training BCBAs on how psychotropic medication can affect behavioral programming. This study presents preliminary findings on the efficacy and acceptability of a brief modified behavioral skills training package to teach BCBAs to consider relevant psychotropic medication properties as they generate a comprehensive behavioral assessment strategy to monitor possible behavioral effects. In a concurrent multiple-probe design across 7 participants, we measured percent correct responding according to a literature-informed scoring rubric. All participants showed improvement with mean percentage change scores of 53%. We provide possible explanations for our results, discuss the implications of the outcomes for the field, and call on training programs and researchers to place a greater emphasis on formal training of BCBAs on considering psychotropic medication properties to devise comprehensive behavioral assessment strategies to monitor the behavioral effects of medication.

Group-based experimental designs are an outgrowth of the logic of null-hypothesis significance testing and thus, statistical tests are often considered inappropriate for single-case experimental designs. Behavior analysts have recently been more supportive of efforts to include appropriate statistical analysis techniques to evaluate single-case experimental design data. One way that behavior analysts can incorporate statistical analyses into their practices with single-case experimental designs is to use Monte Carlo analyses. These analyses compare experimentally obtained behavioral data to simulated samples of behavioral data to determine the likelihood that the experimentally obtained results occurred due to chance (i.e., a p value). Monte Carlo analyses are more in line with behavior analytic principles than traditional null-hypothesis significance testing. We present an open-source Monte Carlo tool, created in shiny, for behavior analysts who want to use Monte Carlo analyses in addition as part of their data analysis.

Visual inspection is the primary method of interpreting functional analysis (FA) outcomes, even though it has occasionally been criticized for producing low levels of interobserver agreement. Researchers have addressed this issue by creating structured visual-inspection criteria to guide visual inspection of FA outcomes (e.g., Hagopian et al., 1997, https://doi.org/10.1901/jaba.1997.30-313; Roane et al., 2013, https://doi.org/10.1002/jaba.13). The purpose of the current study was to systematically replicate and extend Study 1 of Roane et al. (2013, https://doi.org/10.1002/jaba.13). We did this by evaluating the reliability and accuracy of 15 novice participants’ visual inspection of 84 FA graphs with and without the modified visual-inspection criteria developed by Roane et al. Accuracy was markedly higher when participants used the modified visual-inspection criteria relative to when they used traditional visual-inspection strategies, while we observed more modest increases in reliability coefficients. Results are discussed in the context of practical and clinical implications of the modified visual-inspection criteria and suggestions for future research.