Analysis of Demand Assessments in the Treatment of Severe Behavior

Background:  

Individuals diagnosed with autism spectrum disorders may engage in problem behavior to avoid or terminate aversive stimuli or demands to engage in non-preferred activities (Iwata, Dorsey, Slifer, Bauman & Richman, 1982/1994).  Identifying stimuli that are likely to evoke problem behavior and developing a hierarchy of aversiveness can be helpful in developing treatments for problem behaviors maintained by escape/avoidance.  However, methods for identifying and measuring aversiveness have generally relied upon information obtained from indirect sources, such as caregiver report (e.g., the Negative Reinforcement Rating Scale; Zarcone, Crosland, Fisher, Worsdell, & Herman, 1999). Recently, systematic assessments have been developed for this purpose (Call, Pabico, and Lomas, 2009; Roscoe et al., 2009). In the study by Call et al, the aversiveness of a demand was measured by the latency to the first instance of problem behavior following its presentation.  However, the study by Call et al. only presented data from two participants who each displayed different patterns of responding: either all demands evoked problem behavior, or only a few did so.  These results raise the question as to whether such patterns of responding are common during such assessments, and how these patterns may inform clinical practice.

Objectives:  

The purpose of the current investigation was to examine patterns of responding during demand assessments across a large number of participants.

Methods:  

Fifty-seven individuals referred to an intensive day-treatment program for the assessment and treatment of problem behavior participated.  For each participant, ten potentially aversive demands were selected based on information provided by caregivers. A demand assessment session consisted of the presentation of one of the caregiver nominated demands using a three-step-progressive prompting procedure (i.e., verbal, model, physical prompts) until the first occurrence of problem behavior or 10 min had elapsed. The order of sessions was randomly determined; however, each session was conducted once before being conducted again.  Each demand was evaluated a total of three times for each participant.

Results:  

Results show that the demand assessment was able to create a hierarchy of aversiveness for 73% of participants, but results for individual participants varied with respect to the amount of skew in that hierarchy. Demand aversiveness was defined as an average latency to the first occurrence of problem behavior less than 200 seconds. One to 3 demands were identified as aversive for 28% of participants; four to six demands were found to be aversive for 26% of participants; seven to nine demands were found to be aversive for 12% of participants; and all 10 demands were found to be aversive for 7% of participants.  

Conclusions:  

The distribution of participants was skewed heavily towards fewer demands being shown to be aversive.  This result suggests individuals with autism spectrum disorders may be more likely to find specific demands to be aversive, as opposed to demands in general.  Overall, the demand assessment described by Call et al. 2009 appears to be a useful procedure for clinicians to determine the relative aversiveness of demands.