Self-injurious behavior (SIB) is maintained by automatic reinforcement in roughly 25% of cases. Automatically reinforced SIB typically has been considered a single functional category, and is less understood than socially reinforced SIB. Subtyping automatically reinforced SIB into functional categories has the potential to guide the development of more targeted interventions and increase our understanding of its biological underpinnings. The current study involved an analysis of 39 individuals with automatically reinforced SIB and a comparison group of 13 individuals with socially reinforced SIB. Automatically reinforced SIB was categorized into 3 subtypes based on patterns of responding in the functional analysis and the presence of self-restraint. These response features were selected as the basis for subtyping on the premise that they could reflect functional properties of SIB unique to each subtype. Analysis of treatment data revealed important differences across subtypes and provides preliminary support to warrant additional research on this proposed subtyping model.

Functional communication training (FCT) is an empirically supported treatment for problem behavior displayed by individuals with intellectual disabilities. Hagopian, Fisher, Sullivan, Acquisto, and LeBlanc (1998) analyzed 25 applications of FCT and showed that extinction was a necessary component of FCT, but sometimes punishment was needed to maintain low levels of problem behavior. The current consecutive case series summarized data from 58 applications of FCT in more recent cases. This analysis extended and updated Hagopian et al. by examining FCT when used in combination with alternative reinforcement (noncontingent and differential reinforcement) and multiple schedules during schedule thinning. Although it is difficult to make direct comparisons with the 1998 study, the results of the current case series analysis suggest that FCT can be enhanced when used in combination with alternative reinforcement and when multiple schedules are used during schedule thinning.

Hagopian, Rooker, and Zarcone (2015) evaluated a model for subtyping automatically reinforced self-injurious behavior (SIB) based on its sensitivity to changes in functional analysis conditions and the presence of self-restraint. The current study tested the generality of the model by applying it to all datasets of automatically reinforced SIB published from 1982 to 2015. We identified 49 datasets that included sufficient data to permit subtyping. Similar to the original study, Subtype-1 SIB was generally amenable to treatment using reinforcement alone, whereas Subtype-2 SIB was not. Conclusions could not be drawn about Subtype-3 SIB due to the small number of datasets. Nevertheless, the findings support the generality of the model and suggest that sensitivity of SIB to disruption by alternative reinforcement is an important dimension of automatically reinforced SIB. Findings also suggest that automatically reinforced SIB should no longer be considered a single category and that additional research is needed to better understand and treat Subtype-2 SIB.

Predictive biomarkers (PBioMs) are objective biological measures that predict response to medical treatments for diseases. The current study translates methods used in the field of precision medicine to identify PBioMs to identify parallel predictive behavioral markers (PBMs), defined as objective behavioral measures that predict response to treatment. We demonstrate the utility of this approach by examining the accuracy of two PBMs for automatically reinforced self-injurious behavior (ASIB). Results of the analysis indicated both functioned as good to excellent PBMs. We discuss the compatibility of this approach with applied behavior analysis, describe methods to identify additional PBMs, and posit that variables related to the mechanisms of problem behavior and putative mechanism of treatment action hold the most promise as potential PBMs. We discuss how this technology could guide individualized treatment selection, inform our understanding of problem behavior and mechanisms of treatment action, and help determine the conditional effectiveness of clinical procedures.

The functional analysis (FA) described by Iwata, Dorsey, Slifer, Bauman, and Richman (1982/1994) delineated not only a set a specific procedures, but also a model that involves the use of analogue conditions wherein antecedent and consequent variables are systematically manipulated. This consecutive case-series analysis describes FAs of 176 individuals with intellectual disabilities who had been admitted to an inpatient unit for severe problem behavior. Following an initial standardized FA, additional modifications were performed in pursuit of differentiation. Ultimately, a function was identified in 86.9% of the 176 cases and in 93.3% of the 161 cases for which the FA, if necessary, was modified up to 2 times. All modifications were documented and classified as involving changes to antecedents, consequences, or design (or some combination of these). Outcomes for each type of modification are reported. The results support the utility of ongoing hypothesis testing through individualized modifications to FA procedures, and provide information regarding how each type of modification affected results.

Competing stimulus assessments (CSAs) are designed to identify stimuli that, when made freely available, reduce problem behavior. Although CSAs have demonstrated utility, identifying competing stimuli can be difficult for some individuals. The current study describes outcomes from an augmented CSA (A-CSA) for 6 consecutively encountered cases with treatment-resistant subtypes of automatically maintained problem behavior. When test stimuli were made freely available, only between 0 and 1 effective competing stimuli were identified for each case. Prompting and response blocking were temporarily employed in succession to promote engagement with stimuli and disrupt problem behavior. When those procedures were withdrawn and stimuli made freely available, the number of effective competing stimuli increased in all 6 cases. Findings suggest that procedures designed to promote engagement and disrupt problem behavior may allow the A-CSA to be a platform not only for identifying competing stimuli, but also for actively establishing competing stimuli.

Individuals with intellectual and developmental disabilities who exhibit problem behavior often receive behavioral assessment and treatment in specialized inpatient and outpatient clinics. However, problem behavior sometimes reemerges as a function of changes in contexts and stimulus conditions, such as returning to the home environment. This reemergence is called renewal. Recently, Muething et al. (2020) found that renewal occurred in over half (67%) of cases from an outpatient clinic. Their sample was obtained exclusively from an outpatient setting and despite the applied relevance of renewal, its clinical prevalence in other populations is unknown. Accordingly, we replicated Muething et al.’s procedures and analyzed renewal in 37 inpatient treatment applications across 34 cases via consecutive‐controlled case series. Renewal was present in 59% of cases; however, we found that renewal occurred in only 24% of context changes compared to 42% reported by Muething et al. Various factors related to the prevalence of renewal were evaluated.

We evaluated the utility of an assessment for identifying tasks for the functional analysis demand condition with 4 individuals who had been diagnosed with autism. During the demand assessment, a therapist presented a variety of tasks, and observers measured problem behavior and compliance to identify demands associated with low levels of compliance or high levels of problem behavior (low-probability demands) and demands associated with high levels of compliance or low levels of problem behavior (high-probability demands). Results showed that clearer functional analysis outcomes were obtained for 3 of the 4 participants when low-probability rather than high-probability demands were used.