Peter Sturmey’s research while affiliated with Brock University and other places

Over the last decade, the amount of attention on autism has continued to increase among professionals and parents alike. Particular emphasis is placed on the care of young children with the disorder. The growing recognition that autism is a lifelong condition that can be best supported by interventions provided as early as possible has been a major catalyst for these developments. In this chapter, we discuss some of the advances that have occurred since the first edition of our volume was published. Among these subject areas are the continuing increase in the prevalence rates of autism in the general population, issues that have cropped up around the world since the COVID-19 pandemic, trends in the types of treatments that are being applied along with their impacts on parents, and the incorporation of technology. Issues in diagnosis and assessment have emerged as have new or modified treatments, some of which are wacky whereas others that are mainstream. These topics are hardly the only new issues covered in this expansive text, but they do provide some notions about how the field is expanding and maturing.

A Practical Guide to Functional Assessment and Treatment for Severe Problem Behavior discusses how to utilize functional assessment and function-based treatment for patients with severe problem behaviors. The book begins by defining problem behavior, contrasting functional and structural definitions, and clearly reviewing the term “severe”. The second section, Functional Assessment of Problem Behavior, reviews three different assessments in detail, providing sample questionnaires, methods for interviewing and brief bonus vignettes. The third section, Function-Based Treatments, outlines three main treatment options, including comprehensive and trauma-informed strategies and outline information on collecting, graphing, and analyzing treatment data. The final section, Promoting Sustainability and Compassionate Care will review strategies to implement these assessments and treatments in a culturally relevant and compassionate way.

Problem behavior includes aggression, destructive behavior, self-injury, pica, elopement among many other forms. Problem behavior is associated with poor quality of life for the individual and their caregivers, risks of injury, reduced learning opportunities, restrictive behavior management practices, and increased costs. Applied Behavior Analysis (ABA) had a 65-year or so history of research and practice in treating problem behavior and has continued to evolve over time. One consistent feature has been the use of pre-treatment assessments to determine the function of the problem behavior and to direct non-restrictive treatment. A wide range of assessment methods have now been developed to do this. Contemporary ABA is characterized by a range of new and not so new social concerns, including minimizing the use of punishment and extinction and reducing other negative experiences, broadening the range of measures of program effectiveness to address outcomes such as happiness and quality of life, diversity, equity, and inclusion, negative perceptions of ABA, and scaling up dissemination of evidence-based ABA in typical services.

There are now a very wide range of psychosocial treatments for individuals with intellectual disabilities. Major treatment groups include behavior analysis, behavior modification, sensory interventions, cognitive behavior therapy (CBT), counseling, mindfulness, and psychotherapy. Most outcome research has been behavior analytic research using small N experimental designs and is associated with large effect sizes in many applications. Over the last 30 years, there has been increasing application of CBT that is associated with modest outcomes and questionable quality of research, although the application of anger management is associated with more robust effect sizes than application to anxiety and depression. In addition, recent research on mindfulness is another relatively new promising approach. Research on sensory interventions has proven to be negative when well-conducted and otherwise weak and absent, suggesting that sensory treatments are not recommended. Finally, there continues to be little outcome research on counseling and psychotherapy with individuals.

The defining criteria for intellectual disabilities (ID) and psychopathology have undergone continuous development since the first attempts to define these concepts. Diagnostic systems include those from the American Psychiatric Association, the American Association on Intellectual and Developmental Disabilities, and the World Health Organization’s International Classification of Diseases 11th edition. Over time, these diagnostic categories have evolved from relatively simple and rigid to complex, multidimensional categories. The chapter sections “Overview” and “Shifting Definitions of Intellectual Disabilities” explore historical and contemporary definitions of ID and psychopathology. While the consideration of possible interactions between ID and psychopathology has an established history, researchers did not dedicate major efforts to understanding dual diagnosis until the 1980s. Current concepts and measurements of dual diagnosis, as well as diagnostic dilemmas, are explored in the “Definitions of Psychopathology” section of this chapter.

Restraint encompasses a variety of procedures that reduce movement. Their use raises numerous ethical questions for human services. Their use can safely be reduced through behavioral treatment of the problem behavior that occasions their use and organization-wide interventions using honest and valid measurement, goal setting, feedback, and staff training and support.

Objectives Dental behaviour support (DBS) describes all specific techniques practiced to support patients in their experience of professional oral healthcare. DBS is roughly synonymous with behaviour management, which is an outdated concept. There is no agreed terminology to specify the techniques used to support patients who receive dental care. This lack of specificity may lead to imprecision in describing, understanding, teaching, evaluating and implementing behaviour support techniques in dentistry. Therefore, this e‐Delphi study aimed to develop a list of agreed labels and descriptions of DBS techniques used in dentistry and sort them according to underlying principles of behaviour. Methods Following a registered protocol, a modified e‐Delphi study was applied over two rounds with a final consensus meeting. The threshold of consensus was set a priori at 75%. Agreed techniques were then categorized by four coders, according to behavioural learning theory, to sort techniques according to their mechanism of action. Results The panel ( n = 35) agreed on 42 DBS techniques from a total of 63 candidate labels and descriptions. Complete agreement was achieved regarding all labels and descriptions, while agreement was not achieved regarding distinctiveness for 17 techniques. In exploring underlying principles of learning, it became clear that multiple and differing principles may apply depending on the specific context and procedure in which the technique may be applied. Discussion Experts agreed on what each DBS technique is, what label to use, and their description, but were less likely to agree on what distinguishes one technique from another. All techniques were describable but not comprehensively categorizable according to principles of learning. While objective consistency was not attained, greater clarity and consistency now exists. The resulting list of agreed terminology marks a significant foundation for future efforts towards understanding DBS techniques in research, education and clinical care.

A component analysis is a process that includes the addition or subtraction of individual intervention components while continuing to measure behavior change. Component analysis single case research experimentation is used in many of the social science fields including Applied Behavior Analysis. Yet, this design is used less than other single case research designs such as the multiple baseline design. Therefore, the purpose of this study is to map the scientific literature base pertaining to the component analysis single case research design. The present comprehensive review examined the use of component analyses in the scientific and gray literature. The authors identified 177 studies that met inclusion and were evaluated. Results indicate that most studies using component analysis experimental designs are published in the Journal of Applied Behavior Analysis and focused on non-punishment-based procedures. Additionally, the review demonstrates that outside of the field of Applied Behavior Analysis, component analyses are not widely used as an experimental method. The authors recommend expanding the use of component analyses outside of behavior analysis and examining the quality of studies in future research.

Pyramidal training is an effective model for disseminating behavior analytic skills. However, pyramidal training in research is often conducted in controlled university settings. Further, research that has evaluated the effectiveness of pyramidal training in classroom settings (see Pence et al. 2014) often focuses on improving the use of one procedure (e.g., functional analysis) over a brief period. We conducted this study to evaluate the generalized effectiveness of behavioral skills training within a pyramidal model to improve teacher training skills across five procedures in the classroom setting over a nine-month period. We used behavioral skills training (BST) to train teachers (Tier 1) to implement BST to train teaching assistants (Tier 2) to implement Applied Behavior Analytic (ABA) procedures stimulus-stimulus pairing, multiple stimulus without replacement (MSWO) preference assessment, mand training, discrete trial teaching (DTT), and graphing data. Pyramidal training was effective in increasing teachers’ procedural integrity of BST, and the social validity of the model was apparent in that teacher assistants’ procedural integrity of target ABA procedures increased after Tier 2 training. Teachers required periodic feedback to maintain training skills, train novel procedures, and novel staff. Thus, pyramidal BST was effective to teach new skills, but required ongoing monitoring and feedback to ensure maintenance and generality of training skills.