A Meta-Analysis of Intervention Research with Problem Behavior: Treatment Validity and Standards of Practice

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NICHCY’s Structured Abstract 60 describes the following:

Title | A Meta-Analysis of Intervention Research with Problem Behavior: Treatment Validity and Standards of Practice

Authors | Scotti, J.R., Evans, I.M., Meyer, L.H., & Walker, P.

Source American Journal on Mental Retardation, 96(3), 233-56.

Year Published | 1991

Abstract
Used meta-analysis to evaluate standards of practice (SOP) and validity of treatment outcomes in studies designed to remediate behavior problems. The review included 318 articles, which covered 403 studies on problem behavior in persons with developmental disabilities that were published between January 1976 and December 1987 in 18 journals. Two measures of intervention (ITV) effectiveness (percentage of nonoverlapping data and percentage of zero data) were used to evaluate relations between standards of practice (SOP), ITV, and participant characteristics and the treatment validity of different levels of ITV for a range of behaviors. Only 44 studies were highly effective on both measures. The reviewed research revealed a lack of evidence that the ITVs selected had been based on a systematic determination of individual clinical needs. (PsycINFO Database Record (c) 2004 APA, all rights reserved)

The ERIC abstract is as follows:

This meta-analysis of the developmental disabilities literature on remediation of problem behaviors evaluated relations between standards of practice, intervention and participant characteristics, and treatment validity. Results largely failed to support widespread assumptions of clinical practice such as the superiority of more intrusive interventions. Standards for treatment evaluation research are offered. (Author/DB)

Background
Maladaptive, self-injurious, dangerous or inappropriate behaviors are common among people with developmental disabilities and many different interventions have been developed to treat them over the years. Certain behavior treatment principles for people with developmental disabilities have become generally accepted, such as the use of functional behavioral assessment and teaching generalization of positive behaviors to different settings. Other issues, such as the use of intrusive or aversive behavior interventions on people with developmental disabilities, have been continually debated. This meta-analysis examines whether accepted treatment principles are actually practiced in schools and treatment centers, and whether or not controversial aversive interventions are effective or not.

Research Questions

  1. What types of behavioral interventions are most effective in reducing the problem behaviors of students with developmental disabilities?
  2. Are different intensities of intervention more or less successful depending on the severity of problem behaviors?

Research Design
Meta-Analysis*

  • Number of Studies Included | 403
  • Number of Subjects | 795
  • Years Spanned | 1976-1987

Research Subjects
Subjects were children and adults with developmental disabilities participating in interventions to reduce undesirable behaviors. There were approximately 2 male participants for every 1 female participant.

Age/Grade of Subjects
The age breakdown of participants was as follows:

  • 67% were between 6 and 21 years old,
  • 9% were preschool age (5 or younger)
  • 24% were adults

Specified Disability
Subjects had developmental disabilities (mental retardation and/or autism). Of these, 74% had severe or profound mental retardation (MR), and 26% had mild to moderate MR; 13% of subjects also had autism.

Intervention
Interventions to reduce undesirable behaviors in children and adults with developmental disabilities.

Duration of Intervention
N/A

Findings

  1. Of the 403 studies in this meta-analysis, only 44 studies met the researchers’ criteria to be considered highly effective.
  2. Treatments across different levels of intervention from positive reinforcement to aversive stimulation were equally effective.
  3. However, when severity of behavior was factored into the analysis, the more intensive interventions such as Response Cost (e.g., removal of object, token-economy fine, or restriction from activity), Time-Out, restraint, medication, or aversive stimuli were found to more successfully suppress behavior than lower-level interventions such as reinforcement or task modifications.

Combined Effects Size
Percentage of Zero Data (PZD) for the primary intervention fell in the low or questionable effects range (PZD between 18 and 54) in the following intervention classes: Visual screening, brief restraint/redirection, time-out, response cost, environmental change, resolution/positive practice, teaching a skill, reinforcement-based, social disapproval, and medication. Four interventions fell in the moderate effects range (PZD between 55 and 80). Those interventions were extinction, physical/mechanical restraint, over-correction, and contingent-aversive stimulation.

Conclusion/Recommendations
This meta-analysis showed that many of the generally accepted treatment principles of behavior intervention are often neglected in practice. Findings from this synthesis include:

  • Only 22% of studies did any form of functional behavioral analysis to determine the most appropriate intervention.
  • Less than half of the studies did any follow-up activities to see what the long term effects of behavioral intervention had been.
  • Only 30% of studies reported attempts to generalize treatments to other relevant settings or situations.
  • In 38% of studies researchers reported previous interventions used with the study participants. However, only 22% showed they tried the less intrusive interventions before using more severe interventions.
  • Women were more likely than men to be treated with intrusive or aversive interventions. However, several treatment principles were upheld to a degree by this synthesis. Primarily, carrying out the intervention in the setting or situation in which the target behavior usually occurred resulted in improved effectiveness at follow-up, and interventions conducted in integrated setting were more effective than those conducted in segregated settings.
  • More research must be done on behavioral interventions for people with developmental disabilities, with better data collected on participant characteristics, use of functional behavioral analysis, previous treatment attempts, intervention setting, baseline and intervention data, effects on collateral behaviors, and follow-up.

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* Meta-Analysis | A widely-used research method in which (1) a systematic and reproducible search strategy is used to find as many studies as possible that address a given topic; (2) clear criterion are presented for inclusion/exclusion of individual studies into a larger analysis; and (3) results of included studies are statistically combined to determine an overall effect (effect size) of one variable on another.

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