Sleep deprivation is a common health condition among people with intellectual disabilities. Studies have linked sleep problems with challenging behaviors. However, it is unclear if there is a consistent effect on challenging behavior and what reinforcement mechanism(s) might be involved. A systematic review of PsychINFO, PubMed, and Scopus identified seven studies meeting the inclusion criteria that had been published over the past 50 years. Data were extracted regarding participant characteristics, specific aim, sleep deprivation, functional behavioral assessments, results, and key findings. Studies consistently reported increased rates of challenging behavior following bouts of sleep deprivation. Five of the seven studies demonstrated negative reinforcement as the mechanism associated with increased challenging behavior. Results were unclear or lacking for other reinforcer mechanisms. Current evidence shows that sleep deprivation can increase negatively reinforced challenging behavior, but automatic and positive reinforcement mechanisms may be unaffected. Theoretical and practice implications are discussed.

In vivo therapeutic coaching of parent-child interactions is the primary mechanism of change in behavioral parent training programs such as parent-child interaction therapy (PCIT), yet relatively little research has examined the coaching process. The primary aim of this study was to explore the bidirectional interaction between therapist-parent dyads to better understand how therapists influence parent behavior and vice versa. Observational data from two research projects were analyzed separately and together using lag sequential analysis (LSA). Results demonstrate that therapist responsive coaching (e.g., praising parent behavior) led parents to use more child-centered skills. Responsive coaching techniques led to immediate increases in parents' use of the targeted positive parenting skill (10%-25% re-use). Responsive strategies followed targeted parent verbalizations more often than directive strategies, suggesting that therapists reinforce positive parenting skills as soon as parents use them. When directive coaching techniques were used, there was a 18% to 32% chance that parents followed through with a child-centered skill as coached. This study is the first to explore the influence of in vivo coaching on parent skill acquisition on a micro-level and has implications for the therapist training.

The psychometric properties of the Reward Probability Index (RPI), which assesses environmental reward as an indirect measure of response-contingent positive reinforcement (RCPR), were estimated in a Mexican population. With the voluntary participation of 1297 adults, reliability was assessed, and evidence was collected regarding the internal structure and its relationship with emotional symptomatology and other variables. Good internal consistency indices (ω and α) were found for both the total scale and its dimensions. A two-dimensional structure, comprising Reward Probability and Environmental Suppressors, and a second-order factor consistent with RCPR theory, was confirmed. This model demonstrated measurement invariance across sex, mental health treatment status, and the presence or absence of emotional symptomatology. Consistent relationships were observed between RPI scores and emotional symptomatology, psychological inflexibility, and life satisfaction. Additionally, evidence was found supporting the criterion validity of the RPI in relation to depression. RPI is a psychometrically solid instrument, and its use is recommended in the Mexican population to account for environmental reward, utilizing a total score and by dimensions.

The identification of behavioral markers that predict the trajectory of behavior could guide the allocation of limited clinical resources to improve efficacy, efficiency, and safety. As a preliminary exploration of this possibility, we conducted a retrospective records review of incident reports for aggression displayed by residents at a secure juvenile detention center. Our purpose was to evaluate latency to first aggression as a candidate behavioral marker for predicting subsequent high-rate aggression. Our results indicate that latency to first aggression may be a high-quality predictor of subsequent high-rate aggression, and we identified specific cutoff scores that added high levels of predictive value. We use these data to demonstrate a process by which clinicians and researchers can identify predictor variables and use them to guide subsequent allocation of clinical resources. Practical, conceptual, and ethical considerations related to applications of this process as well as potential directions for future research in this area are discussed.

The pyramidal training approach is a promising strategy to train behavioral interventionists in applied settings, as it maximizes efficiency of training by allowing for more trainees to learn and implement a diverse range of behavioral strategies in less time. This systematic review synthesized 30 single-case studies that evaluated pyramidal training in training practitioners to implement behavioral interventions. Results support the effectiveness of the pyramidal training model at the case, tier, and study levels across various settings, targeted skills, and participant types, particularly for improving practitioner implementation fidelity. However, strategies for promoting maintenance of trained skills, such as feedback and coaching, have not been routinely incorporated into pyramidal training procedures. Future researchers should evaluate the utility of post-training observations of implementation fidelity to determine the sustainability and most efficacious methods for promoting fidelity of trained behavioral interventions. Ultimately, the pyramidal training approach shows great promise but requires further optimization and empirical scrutiny.

Persistent inappropriate self-feeding (e.g., finger-feeding food typically consumed using a utensil after 14-24 months of age) is common for children with neurodevelopmental disorders and other delays and can result in energy and nutrient deficiencies. Although interventions for problematic feeding behavior are common, there is limited information for children without a pediatric feeding disorder who self-feed but exclusively do so inappropriately. We used a proactive approach, with a foundation in the skill-acquisition literature, to address the inappropriate self-feeding of seven children with neurodevelopmental disorders or other delays but without a feeding-related diagnosis. We first evaluated response blocking as an assessment to identify motivation and skill deficits. The assessment identified a skill deficit, a motivation deficit, and a combined deficit for four, two, and one participant, respectively. These results informed treatment for six of the seven participants. Treatment for a motivation deficit included response blocking with and without programmed differential reinforcement. Treatment for a skill deficit included backward chaining with response blocking and programmed differential reinforcement. Treatments were generally successful for all six participants. We discuss the usefulness and implications of response blocking as a brief assessment for inappropriate self-feeding.

A reversal design (i.e., ABAB) was used to examine whether increasing steps correlate with higher levels of student interactions. Furthermore, does allowing educators to monitor their steps and set step goals enhance the potential for intervention adoption and lead to lasting teacher behavior change? Each pre-service inclusive early childhood special education teachers were in the final year of their preparation program, during their student teaching practicum. The study took place in two public k-5 elementary schools situated in a mid-size city (approximately 52K in population) in the Southern United States. In addition to visual analysis procedures, nonoverlap of all pairs was used to assess overlap, and Tau-U were used to calculate effect size. The research questions were: (1) Does goal setting and step counting increase the physical steps taken by educators during instruction?; 2) Is there a functional relation between steps taken and teacher-student interactions?; and (3) Are step increases a socially valid approach for increasing teacher-student engagement? Although the results point to minor (positive) effects on teacher steps, the data's variability prevents us from drawing conclusions about the relationship between independent and dependent variables. Nonetheless, when comparing baseline levels to MSI behaviors, we can observe meaningful shifts in a therapeutic direction in the MSI data.. Implications for research and practices are also presented.

Visual analysis is the primary method to detect functional relations in single-case experimental design (SCED) research. Meta-Visual-Analysis (MVA) is a novel approach used to synthesize SCED data where the estimated effect size measures are principally anchored to primary aspects of visual analysis: change in the magnitude of level, trend, variability, and trend-adjusted level of projected trends. For each of these aspects, percentage point differences between baseline and intervention conditions are estimated and quantified for every participant across studies. MVA effect sizes are standardized, and their aggregates are graphically displayed in a manner similar to individual SCED graphs. MVA graphs are compared and visually analyzed with the aim of better understanding the effectiveness and generality of interventions across SCED studies. In this discussion paper we provide general steps to conduct an MVA and describe MVA's utility in reviewing, organizing, and directing future SCED research syntheses.

This review evaluated single-case experimental design research that examined challenging behavior interventions utilizing punishment elements. Thirty articles published between 2013 and 2022 met study inclusion criteria. Study quality was also assessed. Through multiple levels of analysis (e.g., descriptive statistics, non-parametric statistics), we examined (a) participant and study trends, (b) differential outcomes related to temporal reinforcement approaches (antecedent, consequent, or combined reinforcement) applied alongside punishment element(s), (c) differential outcomes related to the punishment type (negative, positive) applied alongside reinforcement, and (d) effect sizes associated with study rigor across peer-reviewed and gray literature. Our results may tentatively suggest that, for certain situations, concurrently applying punishment with antecedent reinforcement approaches may coincide with significantly larger effect sizes compared to combined temporal reinforcement approaches, while positive punishment applied concurrently with reinforcement may coincide with larger but non-significant intervention effects. Most featured articles met rigor criteria, but larger effects were seen in peer-reviewed literature.

Past research has shown the effectiveness of contingent acoustic feedback (CAF) in various human performance settings, but its impact on staff performance in clinical settings remains unclear. The current study replicated and extended Herron et al. (2018) by using vocal instructions and CAF to teach staff to use behavior-specific praise (BSP) to reinforce designated client behavior in a clinical setting. Results from a multiple-baseline-across-staff design revealed that this intervention increased the rate at which staff used BSP to reinforce designated client behavior. Paired sample -tests showed a significant increase in the rate of BSP for each participant from baseline to the intervention phase, and participants maintained increased rates of BSP during probes conducted 1 to 3 weeks after the intervention was complete. Additionally, paired sample -tests showed statistically significant increases in the rates of designated behavior for each client. Participants also rated the instructions and CAF procedure as more worthwhile, helpful, relevant, pleasant, and less disruptive than feedback methods typically used in their agency.

The purpose of this study was to evaluate a progressive functional analysis (FA) model and function-based intervention delivered by caregivers with coaching via telehealth. Children diagnosed with autism and at least one caregiver (e.g., parent) participated in the study. We conducted three assessments prior to and following intervention: a researcher-developed 10-min observation, the Parental Stress Index, and the externalizing section of the Vineland Adaptive Behavior Rating Scales, Third Edition (VABS-3). We included 47 participants in the present evaluation of the progressive FA model. We identified the function of challenging behavior for 36 participants. A function was not identified for nine participants who exhibited low or no challenging behavior during the assessment; the results were inconclusive for two participants. For the 17 participants who participated in the intervention evaluation phase, each of the participants achieved the mastery criterion, which was an 80% reduction in challenging behavior for most participants. Additionally, there was a statistically significant decrease in the VABS-3 externalizing behavior measure from pre- to post-assessment, although neither of the other pre-post measures resulted in statistically significant changes. This study replicates and extends previous research, supporting the use of progressive FA model and function-based interventions to improve challenging behavior.

Many individuals with intellectual and developmental disabilities (DD) encounter difficulties in performing daily living skills, which limits their self-sufficiency and autonomy. Caregivers, such as parents, are often the individuals who interact with individuals with DD the most during daily living skills routines. Therefore, it is critical to teach caregivers to implement daily living skills interventions with their children. A systematic review of the literature related to caregiver-implemented daily living skills interventions yielded 38 articles. Of those, 20 articles, with 21 experiments, were rated as high quality based on What Works Clearinghouse design standards. Behavior skill training was the most common strategy used to teach caregivers to implement interventions. Common daily living skills interventions included prompting, reinforcement, and task analysis. The most common form of prompting was verbal prompting, and the most common schedule of reinforcement was a continuous schedule of reinforcement. Of the 21 high-quality experiments, 86% demonstrated caregiver-implemented interventions yielded improvements in daily living skills. Several studies demonstrated generalization and maintenance of daily living skills. Implications for research and practice are discussed.

Many people with serious mental illness (SMI) experience cognitive disabilities and poor independent living skills which limit their ability to live independently in the community. This study examined the feasibility and initial effectiveness of integrating a new cognitive remediation program, Thinking Skills for Life (TSL), into independent living skills training programs in four secure residential treatment facilities (SRTFs) to facilitate discharge to more independent living situations. Participants were 30 individuals in the SRTF, of whom 11 were forensically committed to the SRTF. Results showed the intervention was feasible to implement, with 97% of participants exposed to TSL and 67% completing the program. Initial promise of the TSL program at improving independent living was suggested by post cognitive program discharge to less restrictive living situations of 63% of participants not on forensic commitment, and 55% of those on forensic commitment. These promising findings set the stage for more rigorous evaluation of the efficacy of the TSL program.

Deficits in positive emotion regulation skills may be an important factor in the development and maintenance of anxiety and mood disorders. A treatment, which includes strategies to build and strengthen positive emotion regulation skills has been provided to patients primarily diagnosed with an anxiety and or mood disorder in an adult mental health outpatient service setting. To study the effects on positive and negative emotion, emotion regulation skills, emotional disorder symptoms, quality of life, and wellbeing during a new developed treatment. An exploratory clinical trial was used to conduct a preliminary assessment of a novel intervention. The intervention was provided in a group format over a 6-week period and independent practice over an 8-week period. Outcome variables were assessed pre- and post-treatment and at a 2-month follow up. Life quality, subjective wellbeing ratings, depressive and anxiety symptoms improved at follow up. The data suggests that the intervention may have the potential to produce desired change in positive emotion regulation. Preliminary findings suggest the intervention can have beneficial effects. These findings are promising and support the possibility that disturbances in positive emotion regulation may be a generative target for treatment research.

School refusal behaviors in adolescents have deleterious immediate and long-term consequences and are associated with mental ill-health such as anxiety and depression. Understanding factors that place youth at higher risk of school refusal behavior may assist in developing effective management approaches. We investigated parental and adolescent factors that may be associated with school refusal behaviors by specifically focusing on the role of parental and adolescent emotion dysregulation, their anxiety and depression, and parental rearing style. First, we hypothesized that adolescents with school refusal behaviors, as well as their parents, will report higher levels of emotion dysregulation, anxiety, and depression compared to their counterparts without school refusal behaviors. Furthermore, we hypothesized that multivariate models testing the role of parental and child factors concurrently will show that parental (emotion dysregulation, anxiety and depression, and rearing styles) and adolescent (emotion dysregulation, anxiety, and depression) factors are associated with school refusal behaviors. One hundred and six adolescents aged 12 to 18 years and their parents completed an online questionnaire measuring both parental and adolescent emotion dysregulation, anxiety, depression, parental rearing styles, and adolescents' school refusal behaviors. Adolescents with school refusal behaviors reported greater anxiety and depression, with their parents showing greater emotion dysregulation. Multivariate analyses showed that parental emotion dysregulation and adolescent age were associated with school refusal behaviors independently. Future management for school refusal behaviors should consider age-tailored approaches by incorporating training for parental emotion regulation skills.

Ecological validity refers to the meaningfulness or practical significance of research outcomes in everyday settings or the extent to which an intervention can be implemented by typical people during naturally occurring opportunities. In education, ecological validity may contribute to the adoption of interventions by teachers working with students in school settings. Our purpose in this review was to examine the evidence for ecological validity of functional communication training (FCT) used to address challenging behavior in school-age individuals with disabilities. We reviewed 19 single-case experimental design (SCED) studies published between 1985 and 2023. First, we used the What Works Clearinghouse (WWC) Standards to evaluate the empirical evidence of each study. Second, we evaluated the extent to which behavioral assessment and FCT procedures were described in the 15 studies that met the WWC Standards. Third, we conducted a systematic analysis of the evidence for ecological validity of behavioral assessment and FCT. Results indicate that 95% of the SCED studies met the WWC Standards. The description of procedures was complete for 50% of the behavioral assessments and for 11% of the FCT. The overall evidence for ecological validity was moderate for 16.7% and low for 83.3% of the behavioral assessments. The evidence for ecological validity for all FCT procedures was low. Future research and implications related to ecological validity are discussed.

Complex motor stereotypies are rhythmic, repetitive, fixed, and non-goal directed movements (e.g., bilateral flapping/waving movements of the hands/arms). Movements typically begin in early childhood and can occur in otherwise normally developing ("primary") or autistic ("secondary") children. Stereotypies persist, occur multiple times a day, have prolonged durations, can be socially stigmatizing, and may lead to bullying and isolation. Prior behavioral treatment studies have focused on older children (ages 6-12) and report modest reductions in stereotypy (i.e., between 14% and 33%). The current study involves the functional assessment and treatment of five children with Primary Complex Motor Stereotypy using a modified awareness training procedure, differential reinforcement of other behavior, and schedule thinning in a nonconcurrent multiple baseline design. Results suggest a 99% reduction of motor stereotypy from baseline across all participants.

Many children with autism spectrum disorder (ASD) exhibit generalization errors following mand training. In this study, we extended the literature on the generalization of positively reinforced explicit mands in three young children with ASD and complex communication needs. First, we used mand training to teach a new, socially appropriate, positively reinforced explicit mand to request preferred toys. Second, we assessed the discriminated generalization of the newly acquired mand by using untrained examples and nonexamples. Results suggest that our mand training resulted in acquisition of a discriminated positively reinforced explicit mand in all three children. Overgeneralization was documented for one of the three children included in the study. We discuss implications for researchers and practitioners related to the importance of assessing for generalization errors following mand training.

Competing stimulus assessments (CSA) are effective tools for identifying stimuli that compete with automatically reinforced behavior. However, Jennett et al. suggests there are cases for which non-contingent access to competing stimuli are insufficient at decreasing target responding and additional treatment components may be necessary. The purpose of the current study was to examine procedural variations (i.e., rotating competing items and prompted engagement) when presenting competing stimuli on increasing functional engagement and decreasing stereotypy. Following a functional analysis, a CSA was conducted to identify competing stimuli for four individuals with autism. Items identified were then used with two procedural variations. Levels of stereotypy, functional engagement, and item contact were measured. Results showed that for two participants both treatments were effective, while for the other two participants prompting functional engagement was more effective. Prompting functional engagement is likely a productive strategy for enhancing engagement with competing stimuli for automatically reinforced problem behavior as it may result in functional engagement becoming reinforcing in and of itself.

Behavior therapy is a well-established and empirically supported treatment for tic disorders (TDs). However, concerns have been expressed about the negative effects of behavioral interventions, such as tic worsening, tic substitution, and excessive effort. This study explored perceived negative effects of tic management strategies in adults with TDs and predictors of these experiences. Participants ( = 72) completed semi-structured interviews 11 years after receiving behavior therapy or supportive therapy in a randomized clinical trial. We examined responses to interview questions about managing tics and predictors of reported negative effects. Most participants did not experience tic worsening (84%) or tic substitution (75%) from tic management strategies. The majority felt they could manage tics while participating in their environment (87%) and did not report life interference from tic management (77%). About half (45%) felt less present when managing tics. Treatment non-responders in the original trial were more likely to report negative effects of tic management strategies. No differences in reported negative consequences were found between those who received behavior therapy versus supportive therapy, suggesting that behavior therapy specifically does not lead to such adverse effects. These findings could reduce misconceptions about behavior therapy for TDs and enhance its acceptability and utilization.

The purpose of this pre-registered study (Peltier & McKenna) was to conceptually replicate if the truncation of the ordinate and DPPXYR increased analysts' estimation of a functional relation and magnitude of treatment effect. Visual analysts ( = 27) evaluated eight data sets reporting null ( = 2), small ( = 2), moderate ( = 2), and large ( = 2) effects. Each data set was graphed six times with manipulations of the ordinate and DPPXYR, resulting in 48 ABAB graphs. We estimated two separate three-level mixed effect models with variations nested in datasets and nested in participants to evaluate the impact of graph characteristics for (1) confidence in determining a functional relation and (2) the estimated magnitude of the treatment effect. We included ordinate scaling and DPPXYR at level 1 and graph effect size at level 2, including all interactions. Overall, graph manipulation consistently did not impact confidence in a functional relation. Results suggest mixed findings for graph manipulation on the estimated magnitude of the treatment effect. Findings will be couched in current literature and recommendations for graph construction and future research will be discussed.

Children with Down syndrome often engage in contextually inappropriate social behavior, which researchers suggest may function to escape from difficult activities to preferred social interactions. Caregivers may reinforce the behavior, perceiving it only as evidence of the child's social strength, when, in fact, the pattern may also prevent or slow the development of critical skills. Unlike overt forms of challenging behavior, contextually inappropriate social behavior had never been subjected to experimental analysis.

Missing data is inevitable in single-case experimental designs (SCEDs) studies due to repeated measures over a period of time. Despite this fact, SCEDs implementers such as researchers, teachers, clinicians, and school psychologists usually ignore missing data in their studies. Performing analyses without considering missing data in an intervention study using SCEDs or a meta-analysis study including SCEDs studies in a topic can lead to biased results and affect the validity of individual or overall results. In addition, missingness can undermine the generalizability of SCEDs studies. Considering these drawbacks, this study aims to give descriptive and advisory information to SCEDs practitioners and researchers about missing data in single-case data. To accomplish this task, the study presents information about missing data mechanisms, item level and unit level missing data, planned missing data designs, drawbacks of ignoring missing data in SCEDs, and missing data handling methods. Since single imputation methods among missing data handling methods do not require complicated statistical knowledge, are easy to use, and hence are more likely to be used by practitioners and researchers, the present study evaluates single imputation methods in terms of intervention effect sizes and missing data rates by using a real and hypothetical data sample. This study encourages SCEDs implementers, and also meta-analysts to use some of the single imputation methods to increase the generalizability and validity of the study results in case they encounter missing data in their studies.

There are numerous effect measures researchers can select when conducting a meta-analysis of single-case experimental design research. These effect measures model different characteristics of the data, so it is possible that a researcher's choice of an effect measure could lead to different conclusions about the same intervention. The current study investigated the impact of effect measure selection on conclusions about the effectiveness of check-in check-out (CICO), a commonly used intervention within School-Wide Positive Behavior Interventions and Supports. Using a multilevel meta-analysis of seven different effect measures across 95 cases in 22 studies, findings suggested that all effect measures indicated statistically significant results of CICO in improving student behavior. However, the magnitude of the effects varied when comparing the results to interpretive guidelines, suggesting that the selection of effect measures may impact conclusions regarding the extent to which an intervention is effective. Implications, limitations, and future directions are discussed.

Past research suggests behavioral treatments are effective for challenging behavior in children and young adults with neurodevelopmental disorders, such as autism spectrum disorder (ASD). However, access to these services can be limited and require substantial resources. To address this issue, the current study provides a programmatic description of an individualized parent-mediated service model targeting moderate challenging behavior. In the program, therapists coached parents to implement functional analyses and individualized function-based treatment packages. Forty-one families of children and young adults with neurodevelopmental disorders participated. Most clients (75.6%) met all admission treatment goals and parents reported significant decreases in frequency and severity of challenging behaviors at discharge. Parents also reported less stress at discharge. Outcomes of the study suggest this parent-mediated treatment model is a viable option to treating moderate challenging behavior in children and young adults with intellectual and developmental disorders.

Single-case experimental designs (SCEDs) have grown in popularity in the fields such as education, psychology, medicine, and rehabilitation. Although SCEDs are valid experimental designs for determining evidence-based practices, they encounter some challenges in analyses of data. One of these challenges, missing data, is likely to be occurred frequently in SCEDs research due to repeated measurements over time. Since missing data is a critical factor that can weaken the validity and generalizability of a study, it is important to determine the characteristics of missing data in SCEDs, which are especially conducted with a small number of participants. In this regard, this study aimed to describe missing data features in SCEDs studies in detail. To accomplish this goal, 465 published SCEDs studies within the recent 5 years in six journals were included in the investigation. The overall results showed that the prevalence of missing data among SCEDs articles in at least one phase, as at least one data point, was approximately 30%. In addition, the results indicated that the missing data rates were above 10% within most studies where missing data occurred. Although missing data is so common in SCEDs research, only a handful of studies (5%) have handled missing data; however, their methods are traditional. In analyzing SCEDs data, several methods are proposed considering missing data ratios in the literature. Therefore, missing data rates determined in this study results can shed light on the analyses of SCEDs data with proper methods by improving the validity and generalizability of study results.

In this study we tested the usability, feasibility, social validity, and effectiveness of , a behavior support program designed to be integrated into small group reading interventions. Participants included eight Grade 3 to 5 students with co-occurring reading difficulties and inattention. A concurrent multiple-baseline design was utilized to test the effects of on engagement outcomes. Visual analysis and effect sizes indicated an improvement in engagement for seven students. Interventionists and students viewed the program to be effective and socially valid. Limitations included lower than expected levels of fidelity for one interventionist and high student absenteeism. More research is needed to identify the extent to which can support reading outcomes. Educators seeking an effective behavior support program that requires minimal training and coaching may consider integrating into their small group reading instruction.

Self-injurious behavior (SIB) among children and youth with developmental disabilities has not diminished in prevalence despite the availability of effective interventions, and the impact on quality of life for people and their families is devastating. The current meta-analysis reviews SIB intervention research between 2011 and 2021 using single-case experimental designs with children and youth up to 21 years old and provides a quantitative synthesis of data from high-quality studies including moderator analyses to determine effects of participant and study characteristics on intervention outcomes. Encouraging findings include a high level of effectiveness across studies in the decrease of SIB (Tau- = -0.90) and increase of positive behavior (Tau- = 0.73), as well as an increase in studies (relative to prior reviews) reporting intervention fidelity, generalization, maintenance, and social validity. However, our findings shed limited light on potential moderating variables in the development of interventions for children and youth who exhibit SIB. Of the potential moderators of intervention effects, only implementer (researcher/therapist vs. parent/caregiver) and setting (clinic vs. home) were significantly associated with improved outcomes. We discuss the need for more robust involvement of natural communities of implementers in SIB intervention research to better equip them to effectively and sustainably meet the needs of people they care for. We also discuss the importance of creating systems enabling broad access for children with SIB to effective interventions in service of reducing burden for people, families, and society over time.

Experimenters provided 33 graphical displays of hypothetical data depicted in a multielement experimental design to editorial board members of prominent, applied, behavior-analytic journals via an online survey. For each display, participants indicated (a) the presence or absence of experimental control and (b) the degree of experimental control (rated on a 1-100 scale). Each depiction varied systematically in (a) the number of data paths, (b) the number of data paths elevated above the control, (c) the mean difference between affected data paths and control conditions, and (d) the degree of variability within conditions. Correspondence among experts' ratings of experimental control was high across all presented graphical displays, supporting the reliability of visual analysis as an evaluative tool for these designs.