Foxx and Garito present a data-based case study on the reduction of a variety of significantly challenging behaviors in a 12-year-old boy with a previously established autism diagnosis. “Ned,” a Romanian orphan, was adopted at the age of 2 and subsequently diagnosed with autism (and ADHD) one year later. At the time of the investigation, Ned was reported to be taking Resperdal, Depakote, Clonadine, and Stratera although dosage levels were not reported. Over the years, Ned’s array of challenging behaviors had resulted in a number of different school placements, leading to a nine-month stay at “a renowned inpatient severe behavior treatment unit where a number of functional analyses were conducted” (p. 71). These analyses indicated that maintaining variables included access to tangibles, sensory reinforcement, and escape from demands. At discharge from his in-patient stay, Ned engaged in aggression, on average, six times per hour, disruption also six times per hour, and self-injury 32 times per hour.
The current investigation’s baseline (Phase I) consisted of the implementation of the program developed by the in-patient facility and was carried out in an elementary school classroom where Ned was the only student. After four months, Ned’s behavior had deteriorated to the point where he was removed from the classroom and home schooled for five months (Phase II). The intervention during Phase II consisted of a rich schedule of differential reinforcement, a token-earn program for compliance, a response-cost program for episodes of aggression or self-injury, and, if redirection was ineffective, physical restraint.
Phase III took place across a variety of settings including a classroom in Ned’s church, other areas of the church and grounds, and various locations in the community over a total of 21 months. Although he was in “a highly reinforcing and less demanding environment, Ned continued to display some of the targeted behaviors” (p. 75) and, as such, several new procedures were added to the program at this point. These included contingent exercise as a consequence for aggression, a less-intensive contingent exercise program for disruption during instruction, and overcorrection for specified dangerous and disruptive behaviors.
During Phase IV (three months), Ned was transitioned back to a classroom in his home school where all treatments, with the exception of the contingent exercise program for disruption, continued as in Phase III.
The results, in brief, documented that, during Phase III, all of Ned’s target behaviors had been reduced an average of 96 percent, and, in Phase IV, the same set of behaviors were reduced by greater than 95 percent with three at zero. In addition, during Phases III and IV, there were documented increases in Ned’s academic skill acquisition, social engagement, and the use of more complex language in the form of sentences to express his wishes. The authors attribute the overall success of the intervention to these factors among others: that aggression and disruption no longer resulted in escape from demands, functional communication training was emphasized, a dense schedule of positive reinforcement was delivered, and choice making and problem solving skills were emphasized.
Foxx, R.M., & Garito, J. (2007). The long-term successful treatment of the very severe behaviors of a preadolescent with autism. Behavioral Interventions, 22, 69-82.