Managing disruptive or challenging behavior has been cited as one of the top concerns of early care and education providers. Equipping staff with feasible behavior management strategies is paramount in reducing the occurrence of challenging behaviors in the classroom and negating the need for more intrusive interventions. This article discusses several approaches for preventing severe episodes of challenging behavior altogether, describes intervention procedures that focus directly on functions of challenging behavior, and offers numerous in-the-moment strategies for destructive or dangerous behaviors that must be addresses immediately.

Background:Although intensive multidisciplinary interventions (IMIs) provide benefits for patients with pediatric feeding disorders (PFD), access to these programs is limited and challenges faced by the programs remain unclear. Objective:To better understand the barriers faced by existing day programs that provide IMI, disparities in patient care, and areas for improvement to better inform policy and improve access to treatment for PFD. Methods:Semi-structured interviews were conducted with a leader of outpatient programs providing IMI in the United States. Data regarding leader's perspectives on disparities in patient care, barriers faced by the intensive multidisciplinary feeding day programs, and future goals and directions for their programming were collected. Afterward, a qualitative content analysis was conducted to consolidate and categorize information related to patient care, access, and barriers faced by day programs and patients with PFD. Results:Barriers and challenges were identified at the patient, program, and systems levels. Patient-level barriers included familial resources or socioeconomic status, geographic distance from the program site, and difficulty with the time commitment, whereas program-level barriers included limited site personnel and capacity and long wait times. System-level barriers primarily center on insurance, with inconsistent coverage of services and limited payer knowledge about PFD and IMI. Conclusion:IMIs are effective in managing PFD; however, a variety of patient-level, program-level, and systems-level factors serve as barriers for patient access to care and program success. Further research, improved reimbursement, and consensus statements on effective treatments can help improve access to and coverage for care, allowing for the development and sustainability of more programs.

A single-case multiple baseline design across three families was used to evaluate the impact of a manualized Prevent Teach Reinforce for Families (PTR-F) process for addressing challenging behavior (CB) when delivered in a remote format (PTR-F: R). Results across three families showed that (a) a functional relation existed between parent implementation of the strategies and reductions in child's CB, (b) families achieved high levels of implementation fidelity for behavior intervention plans developed using the PTR-F: R process, and (c) families rated the PTR-F: R process and the intervention plans positively. The results replicated findings from previous research on the general efficacy of the PTR process while adapting the method for use in a remote format. Implications for practice and future research are discussed.

Intensive multidisciplinary intervention is increasingly recognized as the standard of care for children with complex feeding problems. Much, however, remains unknown about this treatment model. This current qualitative, prospective study sought to identify intensive multidisciplinary day hospital programs operating in the US, describe the treatment approach, and summarize current capacity.

Successful feeding intervention ultimately requires generalization and adoption of treatment into the home. Treatment models, however, differ regarding how and when caregivers are integrated into care delivery process. Some treatments involve a primary model of parent training with caregivers serving as co-therapist at the onset of intervention, while others involve a complimentary model where a therapist delivers the intervention and caregiver training occurs once the child’s behavior is stable. This review systematically evaluates the evidence-base regarding behavioral feeding intervention for children with autism spectrum disorder (ASD), with a specific focus on interventions involving parent training. Results provide further evidence regarding the potential benefits of behavioral intervention to improve feeding concerns in ASD, while also highlighting growing attention to documenting and/or evaluating parent training within the treatment literature. Important questions remain regarding factors guiding the use of a primary or complimentary model of parent training.

This qualitative phenomenological study utilized structured interviews with 23 preschool administrators to explore their beliefs about preschool inclusion and needed resources for providing high-quality preschool inclusion. Themes emerged regarding administrators’ beliefs about inclusion, including divergent understandings of inclusion as something that is either for all or for some children. Administrators placed a high value on families’ preferences regarding preschool inclusion and at times focused their descriptions of inclusion on logistical aspects of placements and funding. Administrators said they needed additional money and personnel resources to provide high-quality preschool inclusion. Study findings are discussed in the context of the paucity of research on administrator perspectives regarding inclusion and implications for supporting administrators who play a key role in implementing preschool inclusion.

Children diagnosed with pediatric feeding disorder (PFD) or avoidant/restrictive food intake disorder (ARFID) may present with comorbid oral-motor delays that often contribute to their failure to consume an adequate volume and/or variety of foods. Once the food enters the mouth, these children may exhibit additional problematic behavior such as expulsion and packing that further averts oral intake. Previous research has evaluated the impact of modified-bolus placement methods, including flipped spoon and NUK® brush, in comparison to upright spoon on expulsion and packing. Whether responses are due to performance or skill deficits, researchers hypothesize that modified-bolus placement may assist with reducing the response effort associated with swallowing. This retrospective consecutive controlled case series assessed the clinical application of an additional modified-bolus placement method, underspoon, to increase food consumption and decrease problematic behavior that interfere with mouth clean for children with PFD or ARFID.

Children with diagnosed disabilities, teachers and classroom staff, and families living in rural areas have difficulty accessing any and all behavioral services, including parent training, due to a lack of providers, distance to clinics, cost of transportation, low income and/or inadequate health insurance, and confidentiality concerns from living in small communities. In this study, Project ECHO (Extension for Community Healthcare Outcomes) was used to train early childhood professionals on how to implement Prevent–Teach–Reinforce for Young Children, which is a step-by-step manualized approach to the assessment and treatment of challenging behavior that reflects a commitment to evidence-based practice. Results of the pilot study, study limitations, and future directions are discussed.

Effective training programs for individuals with disabilities often involve the use of positive reinforcement. Social interactions have many benefits over other forms of reinforcement, but more research is needed to determine how to identify social interactions that serve as reinforcers. In the first experiment, we evaluated the use of two procedures to assess preference for social interactions: a video-presentation and a picture-presentation paired-choice preference assessment among five boys diagnosed with a developmental disability. In the second experiment, we conducted concurrent operant reinforcer assessments to validate the results of the preference assessments among three of the five participants in which at least one assessment indicated differentiated preferences. The video-presentation and picture-presentation preference assessments resulted in the identification of the same high-preferred social interactions for two of the three participants, and subsequent reinforcer assessments indicated these social interactions served as reinforcers. The results of the video- and picture-presentation preference assessments differed for the final participant. The results of a concurrent operant reinforcer assessment indicated the social interaction identified as highest preferred in the video-presentation assessment served as a relatively more effective reinforcer. Results of this study indicate that video- and picture-presentation preference assessment results in differentiate responding for some participants, but not others; however, reasons for these results remain unknown. Moreover, a video-presentation preference assessments may be more effective in identifying social reinforcers, but evidence should be considered; preliminary and future research is warranted.

Ample research indicates that functional communication training (FCT) is an effective intervention to reduce challenging behavior. The purpose of this study was to evaluate the effect of demand fading on escape-maintained challenging behavior, mands, and task completion for 2 children with autism spectrum disorder. The study utilized an embedded reversal and alternating-treatments design to evaluate the efficacy of the intervention and compare the efficacy of the demand fading and dense schedule conditions. During FCT, participants were taught 2 mand topographies, one of which was associated with demand fading. FCT with and without demand fading resulted in decreases in challenging behavior for both participants. FCT with demand fading resulted in higher task completion for both participants. The effect of demand fading on the rate of mands varied by participant. Results provide further support for the use of FCT. The importance of intervention fading in the treatment of challenging behavior is discussed.

A functional analysis is a well-established and widely used assessment in the treatment of challenging behavior. Given the fact that functional analysis results can inform treatment selection and procedures, a review of the current literature regarding functional analysis of inappropriate mealtime behavior (IMB) is warranted as it may guide researchers in conducting a functional analysis prior to treating IMB. This review summarizes the literature regarding functional analysis of IMB. Fourteen studies that implemented a functional analysis of IMB were identified and summarized based on procedural components of the functional analysis, results, and treatment selection. Results indicate functional analysis of IMB to be effective in the identification of variables maintaining IMB. Although functional analysis of IMB has been found to be helpful, several areas for further research and evaluation are identified.

Rapport between educators and students has been suggested as an important factor contributing to an effective educational setting. Rapport can be difficult to measure due to idiosyncratic characteristics; however, challenging behavior exhibited by an individual has been used to determine whether two individuals share a quality relationship. Although practitioners are frequently encouraged to established rapport to maximize educational benefit with students, there is no consensus regarding specific activities and duration associated with rapport-building other than the establishment of rapport requires some passage of time. Currently there is a lack of research comparing behaviors exhibited by an individual in the presence of an instructor with a prior relationship history and in the presence of an instructor with no history. This study compared the rate of correct responding and challenging behavior emitted by participants in the presence of an instructor in which they had previously worked and a second instructor with whom they had no previous interaction. Results indicate no marked differences in patterns of responding between the two therapists.

This meta-analysis systematically identified reading intervention research for students with reading difficulties and problem behaviors in grades K–12 to determine the (a) impact of these reading interventions on reading outcomes and (b) extent to which reading outcomes varied based on student characteristics (e.g., grade, disability), intervention characteristics (e.g., group size, additional behavioral supports), and quality indicator characteristics. Follow-up analyses investigated three of the four hypothesized mechanisms underlying the high co-occurrence rate between reading difficulties and problem behaviors: (a) reading difficulties lead to future problem behaviors, (b) problem behaviors lead to future reading difficulties, and (c) a bi-directional association exists between reading difficulties and problem behaviors. Eleven studies were identified. There was a statistically significant main effect of reading interventions on reading outcomes (g = 0.86, p < .01). We did not find evidence to support either of the three stated hypotheses. The primary limitation of this study was a lack of reading intervention research for students with reading difficulties and problem behaviors. Due to the limited sample of intervention research to investigate the first three hypotheses, future intervention research is needed to better understand the relationship between reading and behavior difficulties. Furthermore, future reading intervention research is needed to better understand how to best develop a program of instruction for this population of students.

A category of inappropriate behaviors in which individuals with intellectual disabilities engage that do not fit into the typical classifications of aggressive, disruptive, or self-injurious behavior exists. These behaviors include stereotypy, ritualistic behavior, and perseverative behavior related to unusual interests. Stereotypic behaviors are defined as repetitive, coordinated, seemingly purposeless, rhythmic behaviors that are most often maintained by automatic reinforcement (Chebli, Martin, & Lanovaz, 2016; Rapp & Vollmer, 2005; Singer, Mink, Gilbert, & Jankovic, 2016). Common topographies of stereotypy fall into the following categories: whole body (e.g., body rocking), head (e.g., head nodding), hand/finger (e.g., hand flapping), locomotion (e.g., jumping), object (e.g., object spinning), and sensory (e.g., covering ears; Lam & Aman, 2007). In addition to motor stereotypy, individuals with intellectual disabilities also engage in vocal stereotypy (e.g., repetitive sounds or words; Lanovaz & Sladeczek, 2012).

This review summarizes the literature regarding differential reinforcement of other behaviors (DRO) to treat challenging behavior among children with autism spectrum disorder (ASD) and determines the quality of studies among the current literature according to the 2014 Council for Exceptional Children (CEC): Standards for Evidence-Based Practices in Special Education. Studies that focused on the use of DRO in the treatment of challenging behavior for individuals with ASD were included for systematic analysis. Forty-five studies were identified for inclusion in this review and were evaluated using the eight quality indicators described by the CEC. To the authors' knowledge, this is the only systematic review of the literature that evaluates DRO as an intervention for individuals diagnosed with ASD. Principle findings, practical recommendations, and areas of future research are discussed.

Demand fading, a schedule thinning procedure for escape-maintained behaviors, typically includes an escape extinction component. The purpose of this study was to examine the effectiveness of demand fading with alternative reinforcement utilizing concurrent reinforcement schedules without extinction. During demand fading, aggression and requests emitted prior to meeting the task completion criterion were reinforced with short, low-quality breaks, but requests emitted following the task completion criterion were reinforced with long, high-quality breaks. Results suggest that concurrent schedules of reinforcement may be an effective alternative to extinction as a component of demand fading.

Treatment of inappropriate mealtime behavior (IMB) should involve a functional analysis to determine variables maintaining the target behaviors. The purpose of the present study was to evaluate the trial-based functional analysis of IMB and assess correspondence of the results with a traditional functional analysis. The participants were two boys, ages 3 and 5 years old, diagnosed with developmental disabilities. A trial-based functional analysis and traditional analogue functional analysis of IMB were conducted with each participant, with the order of functional analyses counterbalanced across participants. The trial-based functional analysis resulted in differentially higher levels of IMB in one or more test conditions, indicating a social function of IMB for both participants. In addition, the results of the trial-based and traditional functional analysis corresponded for both participants. The subsequent function-based intervention, developed based on the results of the trial-based functional analysis, was associated with a decrease in IMB and an increase in appropriate feeding behaviors for both participants. The results of this study provide initial support for the use of trial-based functional analysis to assess the function of IMB.

The current study used differential reinforcement and shaping to increase the variety of foods accepted by children with autism who demonstrated significant feeding inflexibility. Participants were introduced to four new food items via a hierarchical exposure, which involved systematically increasing the desired response with the food item. Level of food consumption was evaluated using a combined multiple baseline plus changing criterion design. Following intervention, all participants accepted all foods targeted, expanding upon the number of foods consumed.

Preferred forms of social interaction were identified using a paired-stimulus format in which two 3–5 s videos of the experimenter providing the social interaction to the participant were presented. Reinforcer efficacy of the high-, medium-, and low-preferred interactions was evaluated using a progressive-ratio schedule to determine the amount of work maintained by the stimuli. Results showed that higher preference stimuli produced larger break points than did lower preference stimuli.