Stereotypic Behaviors and Feeding Difficulties in Adults With Developmental Disabilities

NCT06920615 | Recruiting DMC

• 2 other identifiers: 83033425/05900
• Study Type: interventional
• Target: 8
• Locations: 1 country
• Sites: 1

Brief Summary

Adults with developmental disabilities (DD) and autism represent a vulnerable demographic that transitions into adulthood with diverse etiologies, exhibiting a significantly higher prevalence of various challenging behaviors. These problematic behaviors can lead to adverse health outcomes and a diminished quality of life. Addressing these issues often necessitates an interdisciplinary approach to continuity of care, focusing on enhancing functional skills, empowerment, and independence, as well as preventing and mitigating challenging behaviors. The current research proposal comprises of three studies designed to evaluate the efficacy of behavioral interventions for problematic behaviors in adults with DD and autism. If left unaddressed, these behaviors may worsen over time, potentially hindering community involvement, educational opportunities, and employment prospects. These include harmful stereotypies and feeding difficulties.

Conditions

Harmful Stereotypies; Feeding Difficulties

Keywords

Feeding difficulties, stereotypic behavior, challenging behavior, autism, developmental disabilities

Outcome Measures

Primary Outcomes (1)

• Frequency recording

  Each target behavior in the study will be measured with a frequency recording and graphed as behavior change over time.

  Each experimental phase will last until there is a stable-state performance of the target behavior, typically within 4-8 weeks.

Study Arms (3)

Intake refusal

EXPERIMENTAL

Intervention

Behavioral: Fading and chaining combined with differential reinforcement

Slow pace of self-feeding

EXPERIMENTAL

Intervention

Behavioral: Differential reinforcement of high rate

Debilitating stereotypi

EXPERIMENTAL

Intervention

Behavioral: Response interruption with redirection; Behavioral: Chained schedules

Interventions

Fading and chaining combined with differential reinforcement BEHAVIORAL

Intervention Treatment will involve backward chaining, fading and differential reinforcement.

Intake refusal

Differential reinforcement of high rate BEHAVIORAL

This will be identical to baseline, except a DRH will be introduced: The participant will be instructed to complete his whole meal within set time criteria to receive an identified reinforcer.

Slow pace of self-feeding

Response interruption with redirection BEHAVIORAL

RIRD involves physically blocking a movement from occurring using the least amount of physical contact for max 3 s, and then redirecting behavior to an ongoing activity or movement. Stereotypi that is verbal or not possible to block physically will involve a demand to answer a verbal question or a motor task that sufficiently interrupts the behavior and then redirecting.

Debilitating stereotypi

Chained schedules BEHAVIORAL

The following procedures are based on Slaton et al. (2016): At the start of each session, the candidate or therapist will hold up the red card, prompt the participant to touch the card, while saying "we are in red now, time to work". The participant will have to perform age- or function appropriate tasks without stereotypi to gain access to the green phase. Demand will be designated with a token economy, where each token represents completion of a certain amount of task-related responses. The participant will not be prompted to perform the tasks. If the participant makes an error in a task (e.g. answer a math question incorrectly), this will lead to an error correction and no token will be presented. If stereotypi occurs, it will be blocked for up to 3 s, and then all demands will be reset by removing all earned tokens.

Also known as: Differential reinforcement utilizing access to stereotypi

Debilitating stereotypi

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Participants will be recruited through referrals at the Department of Neurohabilitation, or from other hospitals in the Oslo Region.
• be 18 years or older,
• have a DD, autism spectrum disorder or a PDD-NOS diagnosis
• and be referred to the specialist habilitation service for adults.

You may not qualify if:

• If there are medical causes of the participant's behavioral problem or
• a reasonable possibility that the referred problem is caused by medical variables
• if the client participant receives communal care services and if those are not in accordance with Norwegian standards of services for individuals with DD.
• This could include inappropriate staff-to-client ratio,
• lack of stimulating activities,
• or if on-site training is insufficient.

Sponsors & Collaborators

• Oslo University Hospital: lead
• Oslo Metropolitan University: collaborator

Study Sites (1)

Department of Neurohabilitation, Oslo University Hospital

Oslo, Oslo County, 0424, Norway

RECRUITING

Related Publications (14)

• Williams, E.W., Seiverling, L.J., & Field, D.G. (2014). Feeding problems. In: P. Sturmey & R. Didden (Eds.), Evidence-Based Practice and Intellectual Disabilities (pp. 198-213). Wiley Blackwell.

  BACKGROUND

• Volkert, V.M., Patel, M.R., Peterson, K.M. (2016). Food refusal and selective eating. In: Luiselli, J. (ed) Behavioral Health Promotion and Intervention in Intellectual and Developmental Disabilities. Evidence-Based Practices in Behavioral Health. Springer, Cham. https://doi.org/10.1007/978-3-319-27297-9_7

  BACKGROUND

• Ratnasuriya RH, Marks IM, Forshaw DM, Hymas NF. Obsessive slowness revisited. Br J Psychiatry. 1991 Aug;159:273-4. doi: 10.1192/bjp.159.2.273.

  PMID: 1773246 BACKGROUND

• Kitfield EB, Masalsky CJ. Negative reinforcement-based treatment to increase food intake. Behav Modif. 2000 Sep;24(4):600-8. doi: 10.1177/0145445500244007.

  PMID: 10992614 BACKGROUND

• Association of Professional Behavior Analysts. (2009). The use of restraint and seclusion as interventions for dangerous and destructive behaviors. www.apbahome.net/Restraint_Seclusion%20.pdf

  BACKGROUND

• Kazdin (2021). Single-case research designs: Methods for clinical and applied settings. Oxford University Press.

  BACKGROUND

• Jarness, M., Petursson, P.I. & Eldevik, S. (2019). Trening av verbale operanter og differensiell forsterkning fører til økning i passende vokalisering og reduksjon i upassende vokalisering: Et kasus studie basert på en funksjonell analyse. Norsk Tidsskrift for Atferdsanalyse, 46, 71-83.

  BACKGROUND

• Iwata BA, Dorsey MF, Slifer KJ, Bauman KE, Richman GS. Toward a functional analysis of self-injury. J Appl Behav Anal. 1994 Summer;27(2):197-209. doi: 10.1901/jaba.1994.27-197.

  PMID: 8063622 BACKGROUND

• Hagopian LP, Kurtz PF, Bowman LG, O'Connor JT, Cataldo MF. A Neurobehavioral Continuum of Care for Individuals with Intellectual and Developmental Disabilities with Severe Problem Behavior. Child Health Care. 2023;52(1):45-69. doi: 10.1080/02739615.2021.1987237. Epub 2022 Jan 25.

  PMID: 36643575 BACKGROUND

• Hagopian LP, Farrell DA, Amari A. Treating total liquid refusal with backward chaining and fading. J Appl Behav Anal. 1996 Winter;29(4):573-5. doi: 10.1901/jaba.1996.29-573.

  PMID: 8995838 BACKGROUND

• Grinblat N, Rosenblum S. Why are they late? Timing abilities and executive control among students with learning disabilities. Res Dev Disabil. 2016 Dec;59:105-114. doi: 10.1016/j.ridd.2016.07.012. Epub 2016 Aug 12.

  PMID: 27525557 BACKGROUND

• Fjellstedt N, Sulzer-Azaroff B. Reducing latency of a child's responding to instructions by means of a token system. J Appl Behav Anal. 1973 Spring;6(1):125-30. doi: 10.1901/jaba.1973.6-125.

  PMID: 16795384 BACKGROUND

• Fisher W, Piazza CC, Bowman LG, Hagopian LP, Owens JC, Slevin I. A comparison of two approaches for identifying reinforcers for persons with severe and profound disabilities. J Appl Behav Anal. 1992 Summer;25(2):491-8. doi: 10.1901/jaba.1992.25-491.

  PMID: 1634435 BACKGROUND

• Borrero, C. S., Schlereth, G. J., Rubio, E. K., & Taylor, T. (2013). A comparison of two physical guidance procedures in the treatment of pediatric food refusal. Behavioral Interventions, 28, 261-280. https://doi.org/10.1002/bin.1373

  BACKGROUND

MeSH Terms

Conditions

Stereotypic Movement Disorder; Autistic Disorder; Developmental Disabilities

Condition Hierarchy (Ancestors)

Neurodevelopmental Disorders; Mental Disorders; Autism Spectrum Disorder; Child Development Disorders, Pervasive

Study Officials

• Petur I Petursson, MS, BCBA

  Oslo University Hospital

  PRINCIPAL INVESTIGATOR

• Sigmund Eldevik, PhD, BCBA-D

  Oslo Metropolitan University

  STUDY CHAIR

Central Study Contacts

Sigmund Eldevik, PhD, BCBA-D

CONTACT

+47 91822707; seldevik@oslomet.no

Petur I Petursson, MS, BCBA

CONTACT

+47 94169375; pepetu@ous-hf.no

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: SEQUENTIAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal investigator

Model Details: The research utilizes single-case experimental designs for each individual participant

Study Record Dates

• First Submitted: April 8, 2025
• First Posted: April 10, 2025
• Study Start: April 8, 2025
• Primary Completion (Estimated): August 26, 2030
• Study Completion (Estimated): August 26, 2030
• Last Updated: April 15, 2025

Record last verified: 2025-04

Data Sharing

• IPD Sharing: Will not share

Locations

NO (1)