Behavior Modification

This study examined the feasibility and acceptability of a culturally adapted, asynchronous online caregiver training program for Arabic-speaking families of children with developmental disabilities. The program addressed behaviors commonly described in the literature as challenging behavior,¹ which may interfere with learning, participation, or social interactions. The training was culturally adapted using a structured checklist to enhance contextual and cultural relevance. Fourteen caregivers residing in Saudi Arabia participated. Pre- and post-training assessments showed statistically significant improvements in caregiver knowledge of behavioral strategies. Participants rated the training highly for clarity, cultural responsiveness, and perceived usefulness. Qualitative interviews underscored the program’s social validity and its relevance to caregivers’ lived experiences. These findings provide preliminary support for the potential of culturally grounded, online caregiver training programs to strengthen family capacity and expand access to evidence-based practices in underserved communities.

Time-out from positive reinforcement (TOPR) is an effective limit-setting strategy for decreasing disruptive behaviors in young children. However, most publicly available information on TOPR (e.g., social media and other internet outlets) is inaccurate, leading to misperceptions and ineffective implementation by caregivers. We evaluated a brief (2-minute) behavioral, psychoeducational video on the evidence-based use of TOPR to determine whether a low-dose, universal intervention would change caregivers’ attitudes, increase knowledge, and improve correct use of TOPR. The primary caregivers of 1,472 children 2 to 8 years old were randomly assigned to watch a video on TOPR (intervention) or a video on the stages of child play (control). Caregivers completed self-report measures assessing their knowledge of and attitudes toward TOPR, use of TOPR, and severity of their child’s behavior problems at baseline, immediate follow-up, and 1-month follow-up. Acceptability of the intervention was assessed at immediate and 1-month follow-up. Caregivers who watched a 2-minute video on TOPR showed significant improvements in their understanding of TOPR (F(1, 703) = 6.56, p = .011, Cohen’s d = .20) and the correct use of time-out (F(1, 703) = 4.36, p = .037, Cohen’s d = .16), but their attitudes toward time-out did not significantly change. Implications for the development and dissemination of universal, low-dose psychoeducation on TOPR are discussed.

Emergency physical restraints may still be widely used, with prevalence rates ranging from 11% to 78% across different service sectors (Fitton & Jones, 2020). At times, behavior analysts may recommend restraint when severe challenging behavior poses significant safety risks (e.g., intense aggression causing severe tissue damage; Foxx & Meindl, 2007; Vollmer et al., 2011). Most existing physical restraint literature featuring child and adolescent participants focuses on variables that behavior-analytic interventions do not manipulate (e.g., sex, diagnosis). Additionally, this literature most often features inpatient clinical populations with psychiatric conditions as opposed to those with intellectual and developmental disabilities. The current study applied a multi-level analysis informed by retrospective outpatient data (N = 12) from children and adolescents with intellectual and developmental disability who required emergency physical restraints. The study aimed to (a) examine and report on participant and restraint application characteristics and trends, and (b) determine if challenging behavior severity at intake predicted latency to restraint-application. According to the descriptive analysis, most participants were experiencing polypharmacy (i.e., prescribed at least three concurrent psychotropic medications), had been assigned moderate to high scores on challenging behavior severity, and primarily exhibited behavior maintained by access to tangibles or multiple reinforcers. Regarding restraint characteristics, the average restraint rate was 9.11 per 100 service hours, with most participants described as calm during restraint application. Typically, more than two staff members applied the restraints. Regression results indicated that challenging behavior severity scores significantly predicted latency to the first restraint application. Clinical implications related to these outcomes are discussed.

Concurrent-chains arrangements are commonly used to assess preference for interventions. Typically, these assessments are used to identify the most-preferred intervention, which may result in the rejection of other acceptable interventions. Modifications to the chained schedule might allow for the quantification of the degree of relative preference. The current study served as an initial demonstration of a modified concurrent-chains arrangement that included a progressive-ratio schedule as the second link of a three-link chain. Two participants preferred a single condition, requiring removal of the most-preferred alternative to yield a preference hierarchy. For two additional participants, preference hierarchies were identified through break points, although both participants exhibited small differences in relative preference across conditions. The findings of the current study suggest that alternative measures of relative preference might provide additional information for behavior analysts tasked with identifying individualized interventions.

Functional communication training (FCT) has emerged as the most often researched intervention to reduce challenging behavior exhibited by individuals with developmental disabilities. In recent years, there has been a shift toward evaluating FCT under conditions that approximate treatment challenges. In our research, we have noted that, during such challenges, variable responding sometimes emerges and this variability can include vocalizations. In the current study, we reported examples of this finding, as vocal behavior was not a dependent variable targeted by the larger study. The changes in vocal responding exhibited by three individuals receiving FCT that incorporated alternative and augmentative communication (AAC) strategies are discussed in the context of extinction-induced variability and the potential utility of AAC-based FCT interventions to bring about vocal responding.

Although function-based interventions (FBIs) are effective for individuals with intellectual and developmental disabilities, less is known about FBIs for students with extensive support needs (ESN) and school personnel involvement in FBI development and implementation. As such, we conducted a systematic literature review of 14 single-case research studies involving FBI implementation in K-12 U.S. school settings to address challenging behavior among 18 students with ESN. To identify relevant peer-reviewed articles, dissertations, and theses published between 2006 and March 2025, we searched 10 online databases, reference lists of 10 published reviews, and 19 peer-reviewed journals. Descriptive analyses revealed school personnel involvement varied widely, with school personnel often assuming FBI implementer roles and researchers primarily leading functional behavior assessments. Findings may be limited due to the small number of studies and eligible students with ESN included in the analyses and the limited descriptions of student and study characteristics.

Generalized anxiety disorder (GAD) is prevalent in the United States and while useful treatments exist, more treatment development work is needed. Acceptance and commitment therapy (ACT) for GAD has growing empirical support, but this literature has not yet been summarized for GAD alone. In this paper we provide a narrative review of the current literature on ACT for GAD. Our search yielded 21 studies of ACT for GAD with 15 included in this review (one case study, two open trials, one multiple baseline single subject design, three semi-experimental designs, and eight randomized clinical trials). Overall, ACT has preliminary support as an efficacious treatment for adults with GAD. Studies reported between group effect sizes in the medium to large range and 60% to 77% reduction in symptom severity, however there was significant variability in study design and methodological rigor. Limitations of the current literature are noted. Future directions for research to better inform clinical decision making on GAD are identified.

Individuals diagnosed with psychotic disorders have reduced life expectancy, primarily attributed to cardiovascular diseases exacerbated by lifestyle habits and antipsychotic side effects. Poor diet quality, marked by low fruit and vegetable consumption and high discretionary food intake are also at play. Limited information exists on factors influencing healthy dietary habits in this population. This systematic review aims to analyze qualitative and quantitative data, from the past 20 years, on obstacles and facilitators to healthy dietary habits among individuals with psychotic disorders. PsycINFO, PubMed and Google scholar searches with these inclusion criteria were conducted: (a) peer-reviewed articles, (b) participants are adults, (c) at least 30% or more of the sample had a psychotic disorder, and (d) focus on obstacles, facilitators or interventions related to healthy dietary habits. Among 21 identified articles, 14 addressed obstacles 11 discussed facilitators and 12 proposed interventions. This review identified seven key obstacles (cost and accessibility, taste of healthy food, emotional role of food, social environment, cognitive challenges, symptoms, and medication) and four facilitators (social support, health-related motivation, improved self-perception and interventions). Notably, some factors, such as social support and neighborhood environment, emerged as both obstacles and facilitators depending on the context. Access to effective interventions, including educational resources, such as cooking and planning skills, and more research on group therapy and peer-based programs are discussed.

Despite public health efforts and technological advancements, the global burden of lifestyle-related chronic diseases continues to grow. Lifestyle medicine, a discipline that leverages evidence-based behavioral interventions to prevent and manage chronic disease, presents a promising path to address this epidemic. Thus far, the lifestyle medicine field lacks comprehensive and validated tools to assess program effectiveness. This convergent mixed methods study fills a gap in research by examining the preliminary effectiveness of a promising lifestyle medicine program, the PAVING the Path to Wellness program. PAVING the Path to Wellness (PAVING program) is a group-based health promotion program centered on improving health behaviors, including physical activity, nutrition, sleep, substance use, stress management, and social connection. This pre-post evaluation aimed to assess (1) the preliminary effects of the PAVING program on the six lifestyle medicine health behaviors using the Lifestyle Medicine Health Behavior (LMHB) scale with 19 cohorts of PAVING groups (n = 126) and (2) the impacts of the PAVING program on determinants of health behaviors (attitudes, perceived norms, and self-efficacy, etc.) through semi-structured interviews. The program positively influenced determinants of behavior and significantly improved self-reported nutrition, physical activity, sleep, social connection, stress, and avoidance of risky substances. This mixed methods pilot study captures the impact of a group-based lifestyle medicine program and provides an evaluation blueprint for other lifestyle medicine and health promotion programs to more effectively translate from research to practice.

A reversal design (i.e., ABAB) was used to examine whether increasing steps correlate with higher levels of student interactions. Furthermore, does allowing educators to monitor their steps and set step goals enhance the potential for intervention adoption and lead to lasting teacher behavior change? Each pre-service inclusive early childhood special education teachers were in the final year of their preparation program, during their student teaching practicum. The study took place in two public k-5 elementary schools situated in a mid-size city (approximately 52K in population) in the Southern United States. In addition to visual analysis procedures, nonoverlap of all pairs was used to assess overlap, and Tau-U were used to calculate effect size. The research questions were: (1) Does goal setting and step counting increase the physical steps taken by educators during instruction?; 2) Is there a functional relation between steps taken and teacher-student interactions?; and (3) Are step increases a socially valid approach for increasing teacher-student engagement? Although the results point to minor (positive) effects on teacher steps, the data's variability prevents us from drawing conclusions about the relationship between independent and dependent variables. Nonetheless, when comparing baseline levels to MSI behaviors, we can observe meaningful shifts in a therapeutic direction in the MSI data.. Implications for research and practices are also presented.

Competing stimulus assessments (CSA) are effective tools for identifying stimuli that compete with automatically reinforced behavior. However, Jennett et al. suggests there are cases for which non-contingent access to competing stimuli are insufficient at decreasing target responding and additional treatment components may be necessary. The purpose of the current study was to examine procedural variations (i.e., rotating competing items and prompted engagement) when presenting competing stimuli on increasing functional engagement and decreasing stereotypy. Following a functional analysis, a CSA was conducted to identify competing stimuli for four individuals with autism. Items identified were then used with two procedural variations. Levels of stereotypy, functional engagement, and item contact were measured. Results showed that for two participants both treatments were effective, while for the other two participants prompting functional engagement was more effective. Prompting functional engagement is likely a productive strategy for enhancing engagement with competing stimuli for automatically reinforced problem behavior as it may result in functional engagement becoming reinforcing in and of itself.

In this study we tested the usability, feasibility, social validity, and effectiveness of Engaged Learners, a behavior support program designed to be integrated into small group reading interventions. Participants included eight Grade 3 to 5 students with co-occurring reading difficulties and inattention. A concurrent multiple-baseline design was utilized to test the effects of Engaged Learners on engagement outcomes. Visual analysis and effect sizes indicated an improvement in engagement for seven students. Interventionists and students viewed the Engaged Learners program to be effective and socially valid. Limitations included lower than expected levels of fidelity for one interventionist and high student absenteeism. More research is needed to identify the extent to which Engaged Learners can support reading outcomes. Educators seeking an effective behavior support program that requires minimal training and coaching may consider integrating Engaged Learners into their small group reading instruction.

The prevalence of autism spectrum disorder (ASD) is on the rise. In addition to the social communication skill deficits and restrictive repetitive behaviors and interests, many individuals with ASD engage in challenging behavior. Challenging behavior is associated with a multitude of negative outcomes. Challenging behavior may cause harm to the individual with ASD as well as limit opportunities for educational, vocational, and social participation and development. In addition, caregivers experience high stress and low quality of mental health. As a result, challenging behavior warrants intervention that is specifically tailored to the unique characteristics of individuals with ASD. The purpose of this Special Issue is to showcase recent research in the treatment of challenging behavior for individuals with ASD. This two-part Special Issue contains 12 studies that range from systematic and quality reviews of the intervention literature, to innovative treatment approaches, to studies that develop and evaluate treatments for restrictive and repetitive behaviors and interests.