Bio-Behavioral Approaches to the Assessment and Treatment of Autism
WAYNE W. FISHER
University of Nebraska Medical Center’s
Munroe-Meyer Institute
Center for Autism Spectrum Disorders: Assessment and Treatment Clinics
SevereBehavior Program
Early Intervention
Program
Virtual Care Program
AutismDiagnostic
Clinic
Ph.D ProgramSchool
Consultation Program
Asking what contributes more to human behavior, nurture or nature is like asking what contributes more to the area of a rectangle, its width or length.
Ebbinghaus, circa 1885
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Structural vs. Functional Diagnosis
Structural Approach
1. How often a particular set of symptoms
or responses cluster or covary.
Functional Approach
1. Whether and which environmental
variables influence the response.
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Functional Analysis
Identifies the environmental contexts in
which aberrant behavior is likely and
unlikely.
Identifies the consequences that
reinforce and maintain the behavior.
Used to prescribe effective treatments.
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Direct Observation
"There are three principal means of
acquiring knowledge. . . observation of nature,
reflection, and experimentation. Observation
collects facts; reflection combines them;
experimentation verifies the result of that
combination."
1. Denis Diderot (1713-1784)
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Common Functions of SIB
Social Positive Reinforcement
(Attention, Tangible items)
Social Negative Reinforcement
(Escape)
Automatic Reinforcement (e.g.,
Sensory Stimulation)
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Modifying Functional Analyses to Identify Idiosyncratic Social and Automatic Functions
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Previous Models
Iwata et al. (1982/1994)
1. Multielement Analog Assessment
Mace & Lalli (1991)
1. Linking Descriptive Assessments and
Experimental Analyses
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Previous Models (cont.)
Wacker et al. (1991)
1. Brief Analog Assessments
Vollmer et al. (1993); Iwata et al.
(1994)
1. Reversal and Pairwise Designs
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Previous Models (cont.)
Vollmer et al. (1995)
1. Model That Provided Decision Rules for Moving from Brief to Multielement, to Extended Alone, to Reversal Designs
Current Model
1. No Brief Assessment
2. DAs for Identifying Idiosyncratic Functions
3. Methods for Identifying Specific Automatic Functions
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Conduct Standard
Functional Analysis
If Social Function is Clear, Proceed to Treatment
If Low or Variable Rates, Conduct Descriptive Assessment
If High Rates in Most Conditions, Conduct Extended Alone, Reversals or Pairwise Analyses
If High Rates in Alone, Analyze Automatic Sources of SR+ or SR-
Generate and Test Hypotheses About Idiosyncratic Functions
If Responding Decreases, Conduct Reversals or Pairwise Analyses
If Responding Persists, Analyze Automatic Sources of SR+ or SR-
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Conduct Standard
Functional Analysis
If Social Function is Clear, Proceed to Treatment
If Low or Variable Rates, Conduct Descriptive Assessment
If High Rates in Most Conditions, Conduct Extended Alone, Reversals or Pairwise Analyses
If High Rates in Alone, Analyze Automatic Sources of SR+ or SR-
Generate and Test Hypotheses About Idiosyncratic Functions
If Responding Decreases, Conduct Reversals or Pairwise Analyses
If Responding Persists, Analyze Automatic Sources of SR+ or SR-
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DemandTangible
Attention
Ignore
Play
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per
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KirkKirk
Session
Baseline Extinction BaselineFCT +Extinction
FCT +
DestructiveBehavior
Communication
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Conduct Standard
Functional Analysis
If Social Function is Clear, Proceed to Treatment
If Low or Variable Rates, Conduct Descriptive Assessment
If High Rates in Most Conditions, Conduct Extended Alone, Reversals or Pairwise Analyses
If High Rates in Alone, Analyze Automatic Sources of SR+ or SR-
Generate and Test Hypotheses About Idiosyncratic Functions
If Responding Decreases, Conduct Reversals or Pairwise Analyses
If Responding Persists, Analyze Automatic Sources of SR+ or SR-
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Pica
Pica involves the repeated ingestion of
inedible substances.
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Pica
Pica is the Latin word for magpie, a
species of bird that eats almost anything.
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UNMC Munroe-Meyer Institute
Conduct Standard
Functional Analysis
If Social Function is Clear, Proceed to Treatment
If Low or Variable Rates, Conduct Descriptive Assessment
If High Rates in Most Conditions, Conduct Extended Alone, Reversals or Pair-wise Analyses
If High Rates in Alone, Analyze Automatic Sources of SR+ or SR-
Generate and Test Hypotheses About Idiosyncratic Functions
If Responding Decreases, Conduct Reversals or Pair-wise Analyses
If Responding Persists, Analyze Automatic Sources of SR+ or SR-
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Demand
Play Attention Tangible
Functional Analysis
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SESSIONS
Functional Analysis (Pairwise)
Play
Attention
Tangible
Demand
Attention vs. Play
Tangible vs. Play
Demand vs. Play
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Conduct Standard
Functional Analysis
If Social Function is Clear, Proceed to Treatment
If Low or Variable Rates, Conduct Descriptive Assessment
If High Rates in Most Conditions, Conduct Extended Alone, Reversals or Pairwise Analyses
If High Rates in Alone, Analyze Automatic Sources of SR+ or SR-
Generate and Test Hypotheses About Idiosyncratic Functions
If Responding Decreases, Conduct Reversals or Pairwise Analyses
If Responding Persists, Analyze Automatic Sources of SR+ or SR-
UNMC Munroe-Meyer Institute
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ESocial Attention
AloneDemand
Toy PlayTangible
Functional Analysis
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Descriptive Assessment Methods
Staff and Parent Interviews
Collect ABC Data
1. Sulzer-Azaroff & Mayer, 1977
Selected Naturalist Observations
Probe Sessions
Hypothesis Development
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Case Example: Idiosyncratic Social Function
Hypothesis I: Respondent Behavior Elicited
by Transitions or Changes in Routine
Hypothesis II: Escape from or Avoidance of
Transitions or Changes in Routine
Hypothesis III: Escape from Nonpreferred
Tasks
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Schoolwork Dust Pick Up Trash
Make Bed Fold Clothes
Set Table WashWindows
Vacuum
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Transition From Moderate Preference Task
Transition From HighPreference Task
Task Transition Assessment
Moderate to Low
Moderate to High
Low to Moderate
Low to High
High to Low
High to Moderate
Transition From Low Preference Task
Sarah
UNMC Munroe-Meyer Institute
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Destructive Responses
Compliance
Treatment Evaluation(Transitions to Low Preference)
Sarah
UNMC Munroe-Meyer Institute
Summary of 40 Cases
Clear Function Identified During
Standard Functional Analysis
Social SR+ N = 16 (55.2%)
Automatic SR+ N = 2 (6.9%)
Total N = 18 (62.1%)
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Summary of 40 Cases (cont.)
Function Clarified Through Additional
Analyses
Idiosyncratic Social SR+ N = 7 (24.1%)Pervasive Automatic SR+ N = 4 (13.8%)
Total N = 11 (37.9%)
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Studying Bio-Behavioral Relations Using ABA Methods
Pica with cigarettes
Is there a cross-species preference for
choice (i.e., loosely referred to as freedom)
Sleep, SIB, and Cyclical Behavior in
Individuals with Developmental Disabilities
(Piazza, Fisher, et al.)
Drug-Environment-Behavior Interactions
(Fisher, Piazza, et al.)
Forced Normalization
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Pica
Pica involves the repeated ingestion of
inedible substances.
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Pica
Pica is the Latin word for magpie, a
species of bird that eats almost anything.
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Similarities and Differences Between Human and Nonhuman Species
"Drinking without being thirsty and
making love at any time, Madame, are the
only things that distinguish us from other
animals.”
Beaumarchis:
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Pica (cont’d.)
Pica is often assumed to be
maintained by automatic reinforcement.
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Pica (cont’d.)
Danford and Huber (1982) reported
that 25.8% of persons with mental
retardation residing in an institution
engaged in pica.
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Pica (cont’d.)
Medical risks:
1. intestinal blockages
2. parasites
3. surgery to remove objects
4. lead and other poisoning
5. death
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Pica (cont’d.)
The risk of death associated with pica
may be higher than that for other forms of
self-injurious behavior (Foxx & Livesay,
1984; McLoughlin, 1988).
Death rates associated with pica in
institutions are similar to those associated
with heart disease.
UNMC Munroe-Meyer Institute
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PIC
A P
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Alone
Toy Play
Social Attention
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Herbal
Tobacco
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Tobacco Tobacco Butts Herbs Herbal Butts Paper
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ENCF NCF v.
NCF + InterruptNCF
+ InterruptBL
NCF
NCF + Interrupt
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Does Choice Function as a Reinforcement Across Species
Basic research has shown that pigeons prefer having multiple response options to having just one response option, even when the amount of reinforcement (food) and the size of the response apparatus are held constant (Catania & Sagvolden, 1980).
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Similarities and Differences Between Human and Nonhuman Species
"If you pick up a starving dog and
make him prosperous, he will not bite
you. This is the principal difference
between a dog and a man.”
1. Mark Twain
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Similarities and Differences Between Human and Nonhuman Species
"Man is rated the highest animal, at
least among all animals who returned
the questionnaire.” 1.Robert Brault
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Experiment 1: Does Choice Function as Reinforcement?
The goal of this study was to
determine whether individuals with
disabilities preferred a choice to a no-
choice condition when each produced
the same terminal reinforcer(s).
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Experiment 1: Procedure
Choice = Child selected Sr+ on
VI 30”
No-choice = Therapist selected Sr+ on
yoked schedule
Control = Extinction
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Lower Preference (LP)Stimuli
HP and LP Stimuli
Control
No Choice
Choice
Lauren
UNMC Munroe-Meyer Institute
Experiment 2: Is Choice Preferred over Tangible Reward (i.e., Freedom)?
The goal of this study was to determine whether individuals with disabilities preferred having more response options (i.e., choice) when having fewer options produced a better tangible reward.
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Experiment 2: Procedure
Choice = Child selects between two lower
preference stimuli
No-choice = Therapist selects higher and lower
preference stimuli (50% each)
Control = Extinction
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Lauren
Choice
Control
No Choice
UNMC Munroe-Meyer Institute
Experiment 3: Is Choice Preferred over a Higher Rate of Reward?
The goal of this study was to determine whether individuals with disabilities preferred having more response options (i.e., choice) when having fewer options produced a higher rate of tangible reward.
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Experiment 3: Procedure
Choice = Child selects between multiple, identical 1-oz. Cups of Coke
No-choice = Therapist selects identical 1-oz. Cups of
Coke with a higher Sr+ rate
Control = Extinction
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Choice
No ChoiceControl
VI 30s
VI 60s
VI 150s
VI 300s
VI 600s
(VI 15s)
(VI 15s) Josh
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Sleep and SIB
Piazza et al. conducted lag correlations
between direct observations of SIB and sleep
patterns with 35 patients.
Significant correlations (p < .05) were
identified for 59.3% of participants.
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Sleep and SIB
Increased SIB following sleep deprivation
(42%)
Increased SIB following nights with
increased sleep (28%)
Increased sleep following days in which
high levels of SIB occurred (13%)
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Treatment of Sleep
Faded bedtime with response cost (Piazza,
Fisher, & Sherer, 1997)
Chronotherapy (Piazza, Hagopian,
Hughes, & Fisher, 1997)
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Faded Bedtime with Response Cost Protocol
Establish sleep pressure with a late initial
bedtime
Same night contingency
Next night contingencies
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Chronotherapy
The individual’s bedtime is phase delayed
by 2 to 3 hours each night until the desired
sleep onset time is achieved.
Hou
rs o
f Dis
turb
ed S
leep
Days
Baseline Faded Bedtime + RC
Per
cent
age
of In
terv
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with
Pro
blem
Beh
avio
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Days
Baseline Faded Bedtime + RC
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Baseline Treatment
Ho
urs
of D
istu
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d S
lee
p
Bedtime Scheduling
Faded Bedtime + RC
Randomized Controlled Trial
F = 6.7; p < .03
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Effects of Sleep Treatment on SIB
Does effective sleep treatment result in
collateral improvements in SIB?
UNMC Munroe-Meyer Institute
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Sel
f-In
jurio
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ehav
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Per
Hou
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Non-Sleep Related SIB
Sleep Related SIB
Baseline Sleep Treatment
Baseline Sleep Treatment
Date
Illness
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Rapid Cycles and SIB
Rapid-cycling bipolar affective disorder is
defined as the occurrence of at least four
episodes of either mania or depression
within a year.
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Estimated Prevalence?
Given independent disorders, the
expected prevalence of the co-occurrence of
profound retardation and bipolar disorder
would be 2 per 1,000,000.
We are seeing many more cases than this
estimate would predict, which suggests that
the disorder may not be independent.
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Estimated Prevalence (cont.)
A. H. Reid (1972) Found 1 profoundly
retarded adult with mixed manic- depressive
psychosis in a study of over 500
institutionalized retarded adults.
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Diagnoses Which May Warrant Assessment for Cyclicity
Atypical Bipolar Disorder
Intermittent Explosive Disorder
Temporal lobe Epilepsy
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Detecting Cyclical Behavior Disorders
What specific behaviors should be
monitored to detect cyclical behavior
patterns in individuals with profound mental
retardation?
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Detecting Cyclical Behavior Disorders (cont.)
We reviewed all of the cases in the
literature of cyclical behavior disorders
among nonverbal individuals and identified
ten behaviors reported to increase and
decrease in a cyclical pattern.
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Cyclical Behaviors Reported for Nonverbal Individuals
Aggression Self-Injury
Inappropriate Laughter Insomnia
Food Refusal Food Selectivity
Vocal Agitation Motor Agitation
Restlessness Noncompliance
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Detecting Cyclical Behavior Disorders (cont.)
What types of data collection systems are
most sensitive to the detection of cyclical
behavior patterns?
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Testing Hypotheses About The Cyclicity of a Behavior
Based on a hypothesized cycle, can we
predict whether the behavior is going to
increase or decrease next?
Based on a hypothesized cycle, can we
predict when an increase in behavior is going
to occur?
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Predicting the Next Change
What is the chance probability that behavioral
data will follow a cyclical pattern such as:
H L H L H L H L
Where: H = is a higher data point
L = is a lower data point
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Testing Hypotheses About The Cyclicity of a Behavior (cont.)
Using the formula for the Bernoulli trial
1. the probability of a sequence of 5 is < .05
2. the probability of a sequence of 7 is < .01
3. the probability of a sequence of 10 is < .001
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Testing Hypotheses About The Cyclicity of a Behavior (cont.)
What is the chance probability that a
marked increase in maladaptive behavior will
consistently occur within 5 days of a
predicted dated?
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Testing Hypotheses About The Cyclicity of a Behavior (cont.)
Using the formula for a Bernoulli trial
1. 3 consecutive predicted increases < .05
2. 5 consecutive predicted increases < .01
3. 7 consecutive predicted increases < .001
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TONY
UNMC Munroe-Meyer Institute
Cyclical Mood and Behavioral Changes
If cyclical destructive behavior is a form of
rapid cycling bipolar disorder, then changes
in destructive behavior should covary with
changes in affect.
UNMC Munroe-Meyer Institute
Session Number
-40
-20
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R= - .73DestructiveBehavior
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eg
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UNMC Munroe-Meyer Institute
Behavioral Changes Related to the Menstrual Cycle
In some cases, cyclical changes in
destructive behavior may be related to other
biological processes, such as the menstrual
cycle.
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Menses
Other
UNMC Munroe-Meyer Institute
Effects of Environmental Enrichment on Affect and SIB
Candy was a 23-year-old woman with severe
mental retardation, major depression, mild left
hemiparesis, and autism.
Carbamazepine (5.3 mg/kg/day) and a
behavioral intervention effectively treated her
depression and SIB throughout the day except
when she was left alone.
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Operant Phenotype of Response to Drug Treatment in ADHD
Drugs may influence aberrant behavior associated with a given condition through a variety of operant mechanisms.
Drug ADrug A
BehaviorAntecedents Consequences
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Stimulant Effects On The Behavior Component Of The 3-Term Contingency
Concurrent Arrangement in which appropriate and problem behavior produced equal reinforcement under the same stimulus conditions.
Antecedent – Behavior – Consequence
Concurrent Operants
Problem Behavior Sr+ on FR 1
Appropriate Behavior Sr+ on FR 1
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Problem Behavior
AppropriateBehavior
Adderal Placebo
Adderal Adderal Add. AdderalPlacebo
Placebo
Plac.
UNMC Munroe-Meyer Institute
Medication Evaluation Results
Adderal biased responding toward
appropriate behavior so that almost all
reinforcers were earned through this
response.
UNMC Munroe-Meyer Institute
Forced Normalization and Destructive Behavior in Autism
Force normalization is a term used to
describe a phenomenon in which temporary
remission of poorly controlled seizures is
associated with an emergence or worsening
of psychotic or aberrant behavior.
All or almost all reported cases of forced
normalization have been anecdotal reports.
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SEIZURES
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Mal
UNMC Munroe-Meyer Institute
Studying Bio-Behavioral Relations Using ABA Methods
These data show how direct-observation
and other methods of applied behavior
analysis can be used to improve our
understanding of bio-behavioral relations
and our ability to treat severe destructive
behavior that is influenced by both biological
and environmental variables.
UNMC Munroe-Meyer Institute
"If you are out to describe the truth,
leave elegance to the tailor."
Albert Einstein
UNMC Munroe-Meyer Institute
UNMC Munroe-Meyer InstituteUniversity of Nebraska Medical CenterUniversity of Nebraska Medical Center