Challenging behavior tends to increase in levels during adolescence for individuals with developmental disabilities (DD). If not addressed, this can lead to negative post-school outcomes for adolescents with DD. The purposes of this meta-analysis were to examine the effects of behavioral intervention in reducing challenging behaviors of adolescents with DD and to identify variables that could potentially moderate these effects. This meta-analysis included thirty single-case design studies that met standards for methodological rigor and experimental control. Overall, behavioral interventions were found to yield moderate effects for adolescents with DD (overall Tau-U = 0.68, SD = 0.04, [0.62, 0.73]) across settings and types of challenging behaviors. With regards to participant and setting characteristics, verbal ability and classroom setting were found to moderate the effects of the intervention outcomes with statistical significance. No other variables produced similar findings. Furthermore, statistically significant differences were found between interventions that included or did not include planned reinforcement as an intervention component. Several implications for research and practice are discussed.
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Andzik, N. R., Cannella-Malone, H. I., & Sigafoos, J. (2016). Practitioner-implemented functional communication training: A review of the literature. Research and Practice for Persons with Severe Disabilities, 41(2), 79–89. https://doi.org/10.1177/1540796916633874
*Banda, D. R., & Kubina, R. M. (2006). The effects of a high-probability request sequencing technique in enhancing transition behaviors. Education and Treatment of Children, 29(3), 507–516. https://www.jstor.org/stable/42899898
*Banda, D. R., & Kubina, R. M., Jr. (2009). Increasing academic compliance with mathematics tasks using the high-preference strategy with a student with autism. Preventing School Failure: Alternative Education for Children and Youth, 54(2), 81–85. https://doi.org/10.1080/10459880903217564
*Banda, D. R., McAfee, J. K., & Hart, S. L. (2012). Decreasing self-injurious behavior and fading self-restraint in a student with autism and tourette syndrome. Behavioral Interventions, 27, 164–174. https://doi.org/10.1002/bin.1344
Biggs, E. E., & Carter, E. W. (2016). Quality of life for transition-age youth with autism or intellectual disability. Journal of Autism and Developmental Disorders, 46(1), 190–204. https://doi.org/10.1007/s10803-015-2563-x
*Bilias-Lolis, E., Chafoulas, S. M., Kehle, T. J., & Bray, M. A. (2012). Exploring the utility of self-modeling in decreasing disruptive behavior in students with intellectual disability. Psychology in the Schools, 49(1), 82–92. https://doi.org/10.1002/pits.20616
Billstedt, E., Carina Gillberg, I., & Gillberg, C. (2007). Autism in adults: Symptom patterns and early childhood predictors. Use of the DISCO in a community sample followed from childhood. Journal of Child Psychology and Psychiatry and Allied Disciplines, 48(11), 1102–1110. https://doi.org/10.1111/j.1469-7610.2007.01774.x
*Brown, K. E., & Mirenda, P. (2006). Contingency mapping: Use of a novel visual support strategy as an adjunct to functional equivalence training. Journal of Positive Behavior Interventions, 8(3), 155–164. https://doi.org/10.1177/10983007060080030401
*Butler, L. R., & Luiselli, J. K. (2007). Escape-maintained problem behavior in a child with autism. Journal of Positive Behavior Interventions, 9(4), 195–202. https://doi.org/10.1177/10983007070090040201
Brosnan, J., & Healy, O. (2011). A review of behavioral interventions for the treatment of aggression in individuals with developmental disabilities. Research in Developmental Disabilities, 32(2), 437–446. https://doi.org/10.1016/j.ridd.2010.12.023
Bruni, T. P., Drevon, D., Hixson, M., Wyse, R., Corcoran, S., & Fursa, S. (2017). The effect of functional behavior assessment on school-based interventions: A meta-analysis of single-case research. Psychology in the Schools, 54(4), 351–369. https://doi.org/10.1002/pits.22007
Carter, E. W., Austin, D., & Trainor, A. A. (2012). Predictors of postschool employment outcomes for young adults with severe disabilities. Journal of Disability Policy Studies, 23(1), 50–63. https://doi.org/10.1177/1044207311414680
Chezan, L. C., Wolfe, K., & Drasgow, E. (2018). A meta-analysis of functional communication training effects on problem behavior and alternative communicative responses. Focus on Autism and Other Developmental Disabilities, 33(4), 195–205. https://doi.org/10.1177/1088357617741294
*Chung, Y. C., & Cannella-Malone, H. I. (2010). The effects of presession manipulations on automatically maintained challenging behavior and task responding. Behavior Modification, 34(6), 479–502. https://doi.org/10.1177/0145445510378380
*Clarke, S., Worcester, J., Dunlap, G., Murray, M., & Bradley-Klug, K. (2002). Using multiple measures to evaluate positive behavior support: A case example. Journal of Positive Behavior Interventions, 4(3), 131–145. https://doi.org/10.1177/10983007020040030201
Cook, B. G., Buysse, V., Klingner, J., Landrum, T. J., McWilliam, R. A., Tankersley, M., & Test, D. W. (2015). CEC’s standards for classifying the evidence base of practices in special education. Remedial and Special Education, 36(4), 220–234. https://doi.org/10.1177/0741932514557271
Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied behavior analysis (2nd ed.). Pearson.
Council for Exceptional Children. (2014). Council for Exceptional Children standards for evidence-based practices in special education. Arlington, VA: Author.
*Courtemanche, A., Sheldon, J., Sherman, J., Schroeder, S., Bell, A., & House, R. (2014). Assessing the effects of a staff training package on the implementation fidelity of an intervention for self-injurious behavior. Journal of Developmental and Physical Disabilities, 26(4), 371–389. https://doi.org/10.1007/s10882-014-9372-6
David, M., Rispoli, R., Gregori, E., Lory, C., Kim, S. Y., & Wang, D. (2021). A quality review of school-based challenging behavior interventions for adolescents with developmental disabilities. Review Journal of Autism and Developmental Disorders, 8(2), 145–169. https://doi.org/10.1007/s40489-020-00207-w
de Bruin, C. L., Deppeler, J. M., Moore, D. W., & Diamond, N. T. (2013). Public school-based interventions for adolescents and young adults with an autism spectrum disorder: A meta-analysis. Review of Educational Research, 83(4), 521–550. https://doi.org/10.3102/0034654313498621
*Dibley, S., & Lim, L. (1999). Providing choice making opportunities within and between daily school routines. Journal of Behavioral Education, 9(2), 117–132. https://doi.org/10.1023/A:1022888917128
Didden, R., Korzilius, H., van Oorsouw, W., & Sturmey, P. (2006). Behavioral treatment of challenging beahviors in individuals with mild mental retardation: A meta-analysis of single-subject research. American Journal on Mental Retardation, 111(4), 290–298. https://doi.org/10.1352/0895-8017(2006)111[290:BTOchallengingbehaviorI]2.0.CO;2
*Dozier, C. L., Vollmer, T. R., Borrero, J. C., Borrero, C. S., Rapp, J. T., Bourret, J., & Gutierrez, A. (2007). Assessment of preference for behavioral treatment versus baseline conditions. Behavioral Interventions, 22, 245–261. https://doi.org/10.1002/bin.241
Drevon, D., Fursa, S. R., & Malcolm, A. L. (2017). Intercoder reliability and validity of webplotdigitizer in extracting graphed data. Behavior Modification, 41(2), 323–339. https://doi.org/10.1177/0145445516673998
Dunn, O. J. (1964). Multiple comparisons using rank sums. Technometrics, 6(3), 241–252.
*Durand, V. M. (1999). Functional communication training using assistive devices: Recruiting natural communities of reinforcement. Journal of Applied Behavior Analysis, 32(3), 247–267. https://doi.org/10.1901/jaba.1999.32-247
Emerson, E., Kiernan, C., Alborz, A., Reeves, D., Mason, H., Swarbrick, R., Hatton, C. (2001). The prevalence of challenging behaviors: A total population study. Research in Developmental Disabilities, 22(1), 77–93. S0891-4222(00)00061-5 [pii].
Fergusson, D. M., & Horwood, L. J. (1995). Early disruptive behavior, IQ, and later school achievement and delinquent behavior. Journal of Abnormal Child Psychology, 23(2), 183–199. https://doi.org/10.1007/BF01447088
Gage, N. A., Cook, B. G., & Reichow, B. (2017). Publication bias in special education meta-analyses. Exceptional Children, 83(4), 428–445. https://doi.org/10.1177/0014402917691016
Gerow, S., Davis, T., Radhakrishnan, S., Gregori, E., & Rivera, G. (2018). Functional communication training: The strength of evidence across disabilities. Exceptional Children, 85(1), 86–103. https://doi.org/10.1177/0014402918793399
*Gibney, C., Phillips, K. J., Arnold-Saritepe, A., & Taylor, S. A. (2020). An evaluation of the effects of response interruption redirection and matched stimulation on vocal stereotypy. Behavioral Interventions, 35(1), 114–130. https://doi.org/10.1002/bin.1700
Gregori, E., Rispoli, M., Gerow, S., & Lory, C. (2018). Treatment of self-injurious behavior in adults with intellectual and developmental disabilities: A systematic review. Journal of Developmental and Physical Disabilities, 30(1), 111–139. https://doi.org/10.1007/s10882-017-9568-7
Gregori, E., Wendt, O., Gerow, S., Peltier, C., Genc-Tosun, D., Lory, C., & Gold, Z. S. (2019). Functional communication training for adults with autism spectrum disorder: A systematic review and quality appraisal. Journal of Behavioral Education. https://doi.org/10.1007/s10864-019-09339-4
Gresham, F. M., Watson, T. S., & Skinner, C. M. (2001). Functional behavior assessment: Principles, procedures, and future directions. School Psychology Review, 30(2), 156–172.
*Hammond, J. L., Iwata, B. A., Fritz, J. N., & Dempsey, C. M. (2011). Evaluation of fixed momentary DRO schedules under signaled and unsignaled arrangements. Journal of Applied Behavior Analysis, 44(1), 69–81. https://doi.org/10.1901/jaba.2011.44-69
Heyvaert, M., Maes, B., Van den Noortgate, W., Kuppens, S., & Onghena, P. (2012). A multilevel meta-analysis of single-case and small-n research on interventions for reducing challenging behavior in persons with intellectual disabilities. Research in Developmental Disabilities, 33(2), 766–780. https://doi.org/10.1016/j.ridd.2011.10.010
*Hirasawa, N., Fujiwara, Y., & Yamane, M. (2009). Physical arrangements and staff implementation of function-based interventions in school and community settings. The Japanese Journal of Special Education, 46(6), 435–446. https://doi.org/10.6033/tokkyou.46.435
Iwata, B. A., Dorsey, M. F., Slifer, K. J., Bauman, K. E., & Richman, G. S. (1982). Toward a functional analysis of self-injury. Analysis and Intervention in Developmental Disabilities, 2(1), 3–20. https://doi.org/10.1016/0270-4684(82)90003-9
*Kim, M. S., Blair, K. S. C., & Lim, K. (2014). Using tablet assisted Social StoriesTM to improve classroom behavior for adolescents with intellectual disabilities. Research in Developmental Disabilities, 35(9), 2241–2251. https://doi.org/10.1016/j.ridd.2014.05.011
Kratochwill, T. R., Hitchcock, J., Horner, R. H., Levin, J. R., Odom, S. L., Rindskopf, D. M., & Shadish, W. R. (2010). Single-case designs technical documentation, version 1.0. What Works Clearinghouse. https://ies.ed.gov/ncee/wwc/Docs/ReferenceResources/wwc_scd.pdf
Kruskal, W. H., & Wallis, W. A. (1952). Use of ranks in one-criterion variance analysis. Journal of the American Statistical Association, 47(260), 583–621. https://doi.org/10.1080/01621459.1952.10483441
Kuhn, T. M., Ebert, J. S., Gracey, K. A., Chapman, G. L., & Epstein, R. A. (2015). Evidence-based interventions for adolescents with disruptive behaviors in school-based settings. Child and Adolescent Psychiatric Clinics of North America, 24(2), 305–317. https://doi.org/10.1016/j.chc.2014.11.005
Lanovaz, M. J., & Sladeczek, I. E. (2012). Vocal stereotypy in individuals with autism spectrum disorders: A review of behavioral interventions. Behavior Modification, 36(2), 146–164. https://doi.org/10.1177/0145445511427192
Lloyd, B. P., Torelli, J. N., & Pollack, M. S. (2020). Practitioner perspectives on hypothesis testing strategies in the context of functional behavior assessment. Journal of Behavioral Education, 30, 417–443. https://doi.org/10.1007/s10864-020-09384-4
Levy, A., & Perry, A. (2011). Outcomes in adolescents and adults with autism: A review of the literature. Research in Autism Spectrum Disorders, 5(4), 1271–1282. https://doi.org/10.1016/j.rasd.2011.01.023
*Machalicek, W., Shogren, K., Lang, R., Rispoli, M., O’Reilly, M. F., Franco, J. H., & Sigafoos, J. (2009). Increasing play and decreasing the challenging behavior of children with autism during recess with activity schedules and task correspondence training. Research in Autism Spectrum Disorders, 3(2), 547–555. https://doi.org/10.1016/j.rasd.2008.11.003
Manente, C. J., Maraventano, J. C., LaRue, R. H., Delmolino, L., & Sloan, D. (2010). Effective behav- ioral intervention for adults on the autism spectrum: Best practices in functional assessment and treatment development. Behavior Analyst Today, 11(1), 36–48. https://doi.org/10.1037/h0100687
Matson, J. L., Mahan, S., Hess, J. A., Fodstad, J. C., & Neal, D. (2010). Progression of challenging behaviors in children and adolescents with Autism Spectrum Disorders as measured by the Autism Spectrum Disorders-Problem Behaviors for Children (ASD-PBC). Research in Autism Spectrum Disorders, 4(3), 400–404. https://doi.org/10.1016/j.rasd.2009.10.010
McIntyre, L. L., Gresham, F. M., DiGennaro Reed, F. D., & Reed, D. D. (2007). Treatment integrity of school-based interventions with children in the journal of applied behavior analysis 1991-2005. Journal of Applied Behavior Analysis, 40(4), 659–672. https://doi.org/10.1901/jaba.2007.659
*Muething, C. S., Falcomata, T. S., Ferguson, R., Swinnea, S., & Shpall, C. (2018). An evaluation of delay to reinforcement and mand variability during functional communication training. Journal of Applied Behavior Analysis, 51(2), 263–275. https://doi.org/10.1002/jaba.441
Murphy, G. H., Beadle-Brown, J., Wing, L., Gould, J., Shah, A., & Holmes, N. (2005). Chronicity of challenging behaviours in people with severe intellectual disabilities and/or autism: A total population sample. Journal of Autism and Developmental Disorders, 35(4), 405–418. https://doi.org/10.1007/s10803-005-5030-2
National Center for Education Statistics. (2019). Table 204.30 Children 3 to 21 years old served under Individuals with Disabilities Education Act (IDEA), Part B, by type of disability: Selected years, 1976–77 through 2017–18. United States Department of Education, National Center for Education Statistics (Ed.). Digest of Education Statistics (2018 Ed.). https://nces.ed.gov/programs/digest/d18/tables/dt18_204.30.asp
*O’Reilly, M., Sigafoos, J., Lancioni, G., Edrisinha, C., & Andrews, A. (2005). An examination of the effects of a classroom activity schedule on levels of self-injury and engagement for a child with severe autism. Journal of Autism and Developmental Disorders, 35(3), 305–311. https://doi.org/10.1007/s10803-005-3294-1
Parker, R. I., Hagan-Burke, S., & Vannest, K. (2007). Percentage of All Non-Overlapping Data (PAND): An alternative to PND. Journal of Special Education, 40(4), 194–204. https://doi.org/10.1177/00224669070400040101
Parker, R. I., & Vannest, K. (2009). An improved effect size for single-case research: Nonoverlap of all pairs. Behavior Therapy, 40(4), 357–367. https://doi.org/10.1016/j.beth.2008.10.006
Parker, R. I., Vannest, K. J., Davis, J. L., & Sauber, S. B. (2011). Combining nonoverlap and trend for single-case research: Tau-U. Behavior Therapy, 42(2), 284–299. https://doi.org/10.1016/j.beth.2010.08.006
*Pipkin, C. S. P., Vollmer, T. R., & Sloman, K. N. (2010). Effects of implementation fidelity failures during differential reinforcement of alternative behavior: A translational model. Journal of Applied Behavior Analysis, 43(1), 47–70. https://doi.org/10.1901/jaba.2010.43-47
Radley, K. C., & Dart, E. H. (2016). Antecedent strategies to promote children’s and adolescents’ compliance with adult requests: A review of the literature. Clinical Child and Family Psychology Review, 19(1), 39–54. https://doi.org/10.1007/s10567-015-0197-3
Richman, D. M., Barnard-Brak, L., Grubb, L., Bosch, A., & Abby, L. (2015). Meta-analysis of noncontingent reinforcement effects on problem behavior. Journal of Applied Behavior Analysis, 48(1), 131–152. https://doi.org/10.1002/jaba.189
Rivera, G., Gerow, S., & Kirkpatrick, M. (2019). A review of school-based interventions to reduce challenging behavior for adolescents with ASD. Journal of Developmental and Physical Disabilities, 31(1), 1–21. https://doi.org/10.1007/s10882-018-9626-9
*Rogalski, J. P., Roscoe, E. M., Fredericks, D. W., & Mezhoudi, N. (2020). Negative reinforcer magnitude manipulations for treating escape-maintained problem behavior. Journal of Applied Behavior Analysis, 53(3), 1514–1530. https://doi.org/10.1002/jaba.683
Rohatgi, A. (2021, August). WebPlotDigitizer. https://automeris.io/WebPlotDigitizer
*Rosenbloom, R., Wills, H. P., Mason, R., Huffman, J. M., & Mason, B. A. (2019). The effects of a technology-based self-monitoring intervention on on-task, disruptive, and task-completion behaviors for adolescents with autism. Journal of Autism and Developmental Disorders, 49(12), 5047–5062. https://doi.org/10.1007/s10803-019-04209-4
Ruiter, K. D., & Dekker, M. (2008). Development of parent-and teacher-reported emotional and behavioural problems in young people with intellectual disabilities: Does level of intellectual disability matter? Journal of Applied Research in Intellectual Disabilities, 21, 70–80. https://doi.org/10.1111/j.1468-3148.2007.00370.x
Scattone, D., Wilczynski, S. M., Edwards, R. P., & Rabian, B. (2002). Decreasing disruptive behaviors of children with autism using social stories. Journal of Autism and Developmental Disorders, 32(6), 535–543. https://doi.org/10.1023/A:1021250813367
*Schmidt, C., & Stichter, J. P. (2012). The use of peer-mediated interventions to promote the generalization of social competence for adolescents with high-functioning autism and asperger’s syndrome. Exceptionality, 20(2), 94–113. https://doi.org/10.1080/09362835.2012.669303
Scott, T. M., & Kamps, D. M. (2007). The future of functional behavioral assessment in school settings. Behavioral Disorders, 32(3), 146–157. https://doi.org/10.1177/019874290703200301
Scotti, J. R., Evans, I. M., Meyer, L. H., & Walker, P. (1991). A meta-analysis of intervention research with problem behavior: Treatment validity and standards of practice. American Journal of Mental Retardation, 96(3), 233–256. https://pubmed.ncbi.nlm.nih.gov/1836733/
Scruggs, T. E., Mastropieri, M. A., & Casto, G. (1987). The quantitative synthesis of single-subject research: Methodology and validation. Remedial and Special Education, 8(2), 24–33. https://doi.org/10.1177/074193258700800206
Severini, K. E., Ledford, J. R., & Robertson, R. E. (2018). Systematic review of problem behavior interventions: Outcomes, demographics, and settings. Journal of Autism and Developmental Disorders, 48(100), 3261–3272. https://doi.org/10.1007/s10803-018-3591-0
Shattuck, P. T., Seltzer, M. M., Greenberg, J. S., Orsmond, G. I., Bolt, D., Kring, S., & Lord, C. (2007). Change in autism symptoms and maladaptive behaviors in adolescents and adults with an autism spectrum disorder. Journal of Autism and Developmental Disorders, 37(9), 1735–1747. https://doi.org/10.1007/s10803-006-0307-7
Simó-Pinatella, D., Mumbardó-Adam, C., Alomar-Kurz, E., Sugai, G., & Simonsen, B. (2019). Prevalence of challenging behaviors exhibited by children with disabilities: Mapping the literature. Journal of Behavioral Education, 28(3), 323–343. https://doi.org/10.1007/s10864-019-09326-9
*Slaton, J. D., Hanley, G. P., & Raftery, K. J. (2017). Interview-informed functional analyses: A comparison of synthesized and isolated components. Journal of Applied Behavior Analysis, 50(2), 252–277. https://doi.org/10.1002/jaba.384
Smith, R. G. (2011). Developing antecedent interventions for problem behavior. In W.W. Fisher, C. C. Piazza, & H. S. Roane. Handbook of Applied Behavior Analysis, 297–316. The Guilford Press.
*Stuesser, H. A., & Roscoe, E. M. (2020). An evaluation of differential reinforcement with stimulus fading as an intervention for medical compliance. Journal of Applied Behavior Analysis, 53(3), 1606–1621. https://doi.org/10.1002/jaba.685
*Tomlin, M., & Reed, P. (2012). Effects of fixed-time reinforcement delivered by teachers for reducing problem behavior in special education classrooms. Journal of Behavioral Education, 21(2), 150–162. https://doi.org/10.1007/s10864-012-9147-z
*Van Camp, C. M., Lerman, D. C., Kelley, M. E., Contrucci, S. A., & Vorndran, C. M. (2000). Variable-time reinforcement schedules in the treatment of socially maintained problem behavior. Journal of Applied Behavior Analysis, 33(4), 545–557. https://doi.org/10.1901/jaba.2000.33-545
Van den Noortgate, W., & Onghena, P. (2008). A multilevel meta-analysis of single-subject experimental design studies. Evidence-Based Communication Assessment and Intervention, 2(3), 142–151. https://doi.org/10.1080/17489530802505362
*Vollmer, T. R., Roane, H. S., Ringdahl, J. E., & Marcus, B. A. (1999). Evaluating treatment challenges with differential reinforcement of alternative behavior. Journal of Applied Behavior Analysis, 32(1), 9–23. https://doi.org/10.1901/jaba.1999.32-9
Walker, V. L., Chung, Y. C., & Bonnet, L. K. (2018). Function-based intervention in inclusive school settings: A meta-analysis. Journal of Positive Behavior Interventions, 20(4), 203–216. https://doi.org/10.1177/1098300717718350
Walker, V. L., & Snell, M. E. (2013). Effects of augmentative and alternative communication on challenging behavior: A meta-analysis. Augmentative and Alternative Communication, 29(2), 117–131. https://doi.org/10.3109/07434618.2013.785020
Wehman, P., Sima, A. P., Ketchum, J., West, M. D., Chan, F., & Luecking, R. (2015). Predictors of successful transition from school to employment for youth with disabilities. Journal of Occupational Rehabilitation, 25(2), 323–334. https://doi.org/10.1007/s10926-014-9541-6
*Whatley, A. D., Gast, D. L., & Hammond, D. L. (2009). Visual activity schedules: Teaching independent transitioning during recreation and leisure. Therapeutic Recreation Journal, 43(2), 27–42. https://js.sagamorepub.com/trj/article/view/893
What Works Clearinghouse. (2020). What Works Clearinghouse: Standards handbook, version 4.1. United States Department of Education, Institute of Education Sciences, National Center for Education Evaluation and Regional Assistance. https://ies.ed.gov/ncee/wwc/Docs/referenceresources/WWC-Standards-Handbook-v4-1-508.pdf
Wilcoxon, F. (1945). Individual comparisons by ranking methods. Biometrics Bulletin, 1(6), 80–83. https://doi.org/10.1093/jee/39.2.269
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David, M., Mason, R.A., Davis, J.L. et al. School-Based Interventions Targeting Challenging Behavior of Adolescents with Developmental Disabilities: A Meta-Analysis. J Dev Phys Disabil 35, 17–46 (2023). https://doi.org/10.1007/s10882-022-09841-0
- Challenging behavior