Abstract
Behavior analysis has made contributions in the development of evidence-based interventions for people with intellectual and developmental disabilities (IDD), and there is a growing evidence base for behavior-analytic interventions for older adults with dementia. As there is an increased number of adults with IDD living to old age, and an increased prevalence of comorbid dementia in people with IDD, a review of the behavior-analytic contributions with this population is warranted. We searched Web of Science and PsycInfo and manually reviewed the last 20 years of five behavioral journals. Six behavior-analytic studies with people with IDD and dementia were identified, and all but one were published outside of core behavior-analytic journals. These articles were analyzed in terms of Baer, Wolf, and Risley’s (Journal of Applied Behavior Analysis, 1, 91–97, 1968) seven dimensions of applied behavior analysis (ABA). The possible explanations and implications of these findings are discussed with consideration of the unique features of a comorbid diagnosis of IDD and dementia that may make it appropriate for increased focus in behavior-analytic research and practice.
Similar content being viewed by others
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Baer, D. M., Wolf, M. M., & Risley, T. R. (1968). Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 1, 91–97. https://doi.org/10.1901/jaba.1968.1-91.
Baer, D. M., Wolf, M. M., & Risley, T. R. (1987). Some still-current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 20, 313–327. https://doi.org/10.1901/jaba.1987.20-313.
Baker, J. C., Hanley, G. P., & Mathews, R. M. (2006). Staff-administered functional analysis and treatment of aggression by an elder with dementia. Journal of Applied Behavior Analysis, 39, 469–474. https://doi.org/10.1901/jaba.2006.80-05.
Behavior Analyst Certification Board. (2016). Professional and ethical compliance code for behavior analysts. Retrieved June 16, 2017, from https://bacb.com/ethics-code/
Bojak, S. L., & Carr, J. E. (1999). On the displacement of leisure items by food during multiple-stimulus preference assessments. Journal of Applied Behavior Analysis, 32, 515–518. https://doi.org/10.1901/jaba.1999.32-515.
Bowman, L. (1996). Behavior modification and Down syndrome dementia: a case study of treatment in a “real life” setting. Developmental Disabilities Bulletin, 24, 58–67.
Boyle, M. A., & Adamson, R. M. (2017). Systematic review of functional analysis and treatment of elopement (2000–2015). Behavior Analysis in Practice, 10, 375–385. https://doi.org/10.1007/s40617-017-0191-y.
Buchanan, J., Husfeldt, J., Berg, T., & Houlihan, D. (2008). Publication trends in behavioral gerontology in the past 25 years: are the elderly still an understudied population in behavioral research? Behavioral Interventions, 23(1), 65–74. https://doi.org/10.1002/bin.254.
Buchanan, J. A., & Fisher, J. E. (2002). Functional assessment and noncontingent reinforcement in the treatment of disruptive vocalization in elderly dementia patients. Journal of Applied Behavior Analysis, 35, 99–103. https://doi.org/10.1901/jaba.2002.35-99.
Burgio, L., & Kowalkowski, J. D. (2011). Alive and well: the state of behavioral gerontology in 2011. Behavior Therapy, 42(1), 3–8. https://doi.org/10.1016/j.beth.2010.08.003.
Burgio, L. D., & Burgio, K. L. (1986). Behavioral gerontology: application of behavioral methods to the problems of older adults. Journal of Applied Behavior Analysis, 19, 321–328. https://doi.org/10.1901/jaba.1986.19-321.
Carr, J. E., & Briggs, A. M. (2010). Strategies for making regular contact with the scholarly literature. Behavior Analysis in Practice, 3(2), 13–18. https://doi.org/10.1007/BF03391760.
Cavalari, R. N., DuBard, M., Luiselli, J. K., & Birtwell, K. (2013). Teaching an adolescent with autism and intellectual disability to tolerate routine medical examination: effects of a behavioral compliance training package. Clinical Practice in Pediatric Psychology, 1(2), 121. https://doi.org/10.1037/cpp0000013.
Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied behavior analysis (2nd ed.). Upper Saddle River, NJ: Pearson.
Cooper, S. A. (1997). High prevalence of dementia among people with learning disabilities not attributable to Down’s syndrome. Psychological Medicine, 27(3), 609–616. https://doi.org/10.1017/S0033291796004655.
Coppus, A. M. W. (2013). People with intellectual disability: what do we know about adulthood and life expectancy? Developmental Disabilities Research Reviews, 18(1), 6–16. https://doi.org/10.1002/ddrr.1123.
Cowley, B. J., Green, G., & Braunling-McMorrow, D. (1992). Using stimulus equivalence procedures to teach name-face matching to adults with brain injuries. Journal of Applied Behavior Analysis, 25, 461–475. https://doi.org/10.1901/jaba.1992.25-461.
Cox, A. D., & Virués-Ortega, J. (2016). Interactions between behavior function and psychotropic medication. Journal of Applied Behavior Analysis, 49, 85–104. https://doi.org/10.1002/jaba.247.
Crook, N., Adams, M., Shorten, N., & Langdon, P. E. (2016). Does the well-being of individuals with Down syndrome and dementia improve when using life story books and rummage boxes? A randomized single case series experiment. Journal of Applied Research in Intellectual Disabilities, 29(1), 1–10. https://doi.org/10.1111/jar.12151.
Deleon, I. G., Iwata, B. A., & Roscoe, E. M. (1997). Displacement of leisure reinforcers by food during preference assessments. Journal of Applied Behavior Analysis, 30, 475–484. https://doi.org/10.1901/jaba.1997.30-475.
Dickson, C. A., Deutsch, C. K., Wang, S. S., & Dube, W. V. (2006). Matching-to-sample assessment of stimulus overselectivity in students with intellectual disabilities. American Journal on Mental Retardation, 111(6), 447–453. https://doi.org/10.1352/0895-8017(2006)111[447:MAOSOI]2.0.CO;2.
Drossel, C., & Trahan, M. (2015). Behavioral interventions are first-line treatments for managing changes associated with cognitive decline. The Behavior Therapist, 38(5), 126–131.
Feliciano, L., Steers, M. E., Elite-Marcandonatou, A., McLane, M., & Areán, P. A. (2009). Applications of preference assessment procedures in depression and agitation management in elders with dementia. Clinical Gerontologist, 32(3), 239–259. https://doi.org/10.1080/07317110902895226.
Feliciano, L., Vore, J., LeBlanc, L. A., & Baker, J. C. (2004). Decreasing entry into a restricted area using a visual barrier. Journal of Applied Behavior Analysis, 37, 107–110. https://doi.org/10.1901/jaba.2004.37-107.
Ferri, C. P., Prince, M., Brayne, C., Brodaty, H., Fratiglioni, L., Ganguli, M., et al. (2006). Global prevalence of dementia: a Delphi consensus study. The Lancet, 366(9503), 2112–2117. https://doi.org/10.1016/S0140-6736(05)67889-0.
Gallagher, S. M., & Keenan, M. (2009). Stimulus equivalence and the Mini Mental Status Examination in the elderly. European Journal of Behavior Analysis, 10(2), 159–165. https://doi.org/10.1080/15021149.2009.11434316.
Glasson, E. J., Sullivan, S. G., Hussain, R., Petterson, B. A., Montgomery, P. D., & Bittles, A. H. (2002). The changing survival profile of people with Down’s syndrome: implications for genetic counselling. Clinical Genetics, 62(5), 390–393. https://doi.org/10.1034/j.1399-0004.2002.620506.x.
Horovitz, M., Kozlowski, A. M., & Matson, J. L. (2010). Compliance training in an adult with dementia of the Alzheimer’s type and Down syndrome. Clinical Case Studies, 9(3), 207–217. https://doi.org/10.1177/1534650110368262.
Ikejima, C., Yasuno, F., Mizukami, K., Sasaki, M., Tanimukai, S., & Asada, T. (2009). Prevalence and causes of early-onset dementia in Japan: a population-based study. Stroke, 40, 2709–2714. https://doi.org/10.1161/STROKEAHA.108.542308.
Janicki, M. P., & Dalton, A. J. (2000). Prevalence of dementia and impact on intellectual disability services. Mental Retardation, 38(3), 276–288. https://doi.org/10.1352/0047-6765(2000)038<0276:PODAIO>2.0.CO;2.
Kazdin, A. E. (1982). Single-case research designs: methods for clinical and applied settings. New York, NY: Oxford University Press.
LeBlanc, L. A., Geiger, K. B., Sautter, R. A., & Sidener, T. M. (2007). Using the natural language paradigm (NLP) to increase vocalizations of older adults with cognitive impairments. Research in Developmental Disabilities, 28, 437–444. https://doi.org/10.1016/j.ridd.2006.06.004.
LeBlanc, L. A., & Matson, J. L. (1997). Aging in the developmentally disabled: assessment and treatment. Journal of Clinical Gerontology, 3(1), 37–56.
LeBlanc, L. A., Raetz, P. B., Baker, J. C., Strobel, M. J., & Feeney, B. J. (2008). Assessing preference in elders with dementia using multimedia and verbal pleasant events schedules. Behavioral Interventions, 23(4), 213–225. https://doi.org/10.1002/bin.266.
Matson, J. L., & Jang, J. (2014). Treating aggression in persons with autism spectrum disorders: a review. Research in Developmental Disabilities, 35, 3386–3391. https://doi.org/10.1016/j.ridd.2014.08.025.
Millichap, D., Oliver, C., McQuillan, S., Kalsy, S., Lloyd, V., & Hall, S. (2003). Descriptive functional analysis of behavioral excesses shown by adults with Down syndrome and dementia. International Journal of Geriatric Psychiatry, 18(9), 844–854. https://doi.org/10.1002/gps.930.
Money, E. A., Kirk, R. C., & McNaughton, N. (1992). Alzheimer’s dementia produces a loss of discrimination but no increase in rate of memory decay in delayed matching to sample. Neuropsychologia, 30(2), 133–143. https://doi.org/10.1016/0028-3932(92)90023-F.
Morgan, D. L., & Morgan, R. K. (2001). Single-participant research design: bringing science to managed care. American Psychologist, 56(2), 119–127. https://doi.org/10.1037/0003-066X.56.2.119.
Normand, M. P. (2014). Opening Skinner’s box: an introduction. The Behavior Analyst, 37(2), 67–68. https://doi.org/10.1007/s40614-014-0016-z.
Normand, M. P., & Kohn, C. S. (2013). Don’t wag the dog: extending the reach of applied behavior analysis. The Behavior Analyst, 36(1), 109–122. https://doi.org/10.1007/BF03392294.
Oliver, C. (1999). Perspectives on assessment and evaluation. In M. P. Janicki & A. J. Dalton (Eds.), Dementia, aging, and intellectual disabilities (pp. 123–140). Philadelphia, PA: Brunner/Mazel.
Parsons, M. B., Rollyson, J. H., & Reid, D. H. (2012). Evidence-based staff training: a guide for practitioners. Behavior Analysis in Practice, 5(2), 2–11. https://doi.org/10.1007/BF03391819.
Paton, C., Flynn, A., Shingleton-Smith, A., McIntyre, S., Bhaumik, S., Rasmussen, J., ... Barnes, T. (2011). Nature and quality of antipsychotic prescribing practice in UK psychiatry of intellectual disability services. Journal of Intellectual Disability Research, 55(7), 665–674. https://doi.org/10.1111/j.1365-2788.2011.01421.x
Raetz, P. B., LeBlanc, L. A., Baker, J. C., & Hilton, L. C. (2013). Utility of the multiple-stimulus without replacement procedure and stability of preferences of older adults with dementia. Journal of Applied Behavior Analysis, 46, 765–780. https://doi.org/10.1002/jaba.88.
Royal College of Psychiatrists. (2015). Dementia and people with intellectual disabilities: guidance on the assessment, diagnosis, interventions and support of people with intellectual disabilities who develop dementia (Report No. REP77 4/2015). Retrieved on June 17, 2017, from the British Psychological Society website: www.bps.org.uk/system/files/Public%20files/rep77_dementia_and_id.pdf
Sharp, R. A., Lucock, Z. R., Brand, D., & Cowie, S. (2018). Behavior analytic approaches to working with adults with major neurocognitive disorder: a review. Manuscript in preparation.
Steingrimsdottir, H. S., & Arntzen, E. (2011). Using conditional discrimination procedures to study remembering in an Alzheimer’s patient. Behavioral Interventions, 26(3), 179–192. https://doi.org/10.1002/bin.334.
Steingrimsdottir, H. S., & Arntzen, E. (2015). On the utility of within-participant research design when working with patients with neurocognitive disorders. Clinical Interventions in Aging, 10, 1189. https://doi.org/10.2147/CIA.S81868.
Strydom, A., Chan, T., King, M., Hassiotis, A., & Livingston, G. (2013). Incidence of dementia in older adults with intellectual disabilities. Research in Developmental Disabilities, 34, 1881–1885. https://doi.org/10.1016/j.ridd.2013.02.021.
Taylor, B. A., Hughes, C. E., Richard, E., Hoch, H., & Coello, A. R. (2004). Teaching teenagers with autism to seek assistance when lost. Journal of Applied Behavior Analysis, 37, 79–82. https://doi.org/10.1901/jaba.2004.37-79.
Trahan, M. A., Kahng, S., Fisher, A. B., & Hausman, N. L. (2011). Behavior-analytic research on dementia in older adults. Journal of Applied Behavior Analysis, 44, 687–691. https://doi.org/10.1901/jaba.2011.44-687.
Virués-Ortega, J., Iwata, B. A., Nogales-González, C., & Frades, B. (2012). Assessment of preference for edible and leisure items in individuals with dementia. Journal of Applied Behavior Analysis, 45, 839–844. https://doi.org/10.1901/jaba.2012.45-839.
Visser, F. E., Aldenkamp, A. P., van Huffelen, A. C., & Kuilman, M. (1997). Prospective study of the prevalence of Alzheimer-type dementia in institutionalized individuals with Down syndrome. American Journal on Mental Retardation, 101(4), 400–412.
Vogl, M., & Rapp, J. T. (2011). Differential reinforcement of other behavior and extinction to reduce loitering and stealing for an adult with an intellectual disability and dementia. Clinical Case Studies, 10(3), 229–235. https://doi.org/10.1177/1534650111405188.
Yang, Q., Rasmussen, S. A., & Friedman, J. M. (2002). Mortality associated with Down’s syndrome in the USA from 1983 to 1997: a population-based study. The Lancet, 359(9311), 1019–1025. https://doi.org/10.1016/S0140-6736(02)08092-3.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
Zoe Lucock declares that she has no conflict of interest. Rebecca Sharp declares that she has no conflict of interest. Robert Jones declares that he has no conflict of interest.
Ethical approval
This article does not contain any studies with human participants performed by any of the authors.
Additional information
This article is based on work submitted by the first author under the supervision of the second and third authors for a Doctor of Philosophy in Psychology degree at Bangor University.
Rights and permissions
About this article
Cite this article
Lucock, Z.R., Sharp, R.A. & Jones, R.S.P. Behavior-Analytic Approaches to Working with People with Intellectual and Developmental Disabilities who Develop Dementia: a Review of the Literature. Behav Analysis Practice 12, 255–264 (2019). https://doi.org/10.1007/s40617-018-0270-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40617-018-0270-8