Applications of operant demand to treatment selection I: Characterizing demand for evidence‐based practices

Abstract

Various treatment approaches have been determined efficacious for improving child behavior outcomes. Despite a variety of evidence‐based options, consumers often disregard empirically supported treatments to pursue alternatives that lack empirical support, such as ‘fad' therapies. The choice to pursue therapies lacking empirical support has been considered a ‘gamble’ on therapeutic outcomes and this form of risky choice has historically been explained using various cognitive heuristics and biases. This report translates quantitative analyses from the Operant Demand Framework to characterize how caregivers of children with behavioral issues consume treatment services. The Operant Demand Framework is presented, its utility for characterizing patterns of treatment consumption is discussed, and a preliminary application of cross‐price analyses of demand is performed to illustrate how various factors jointly influence treatment‐related choice. Results indicated that caregivers endorsing interest in receiving behavioral parent training regularly pursued pseudoscientific alternatives as a functional substitute for an established therapy, despite explicit language stating a lack of evidence. These findings question the presumption of rationality in models of treatment choice and degree to which scientific evidence influences the consumption of therapies. This report concludes with a discussion of Consumer Behavior Analysis and how quantitative analyses of behavior can be used to better understand factors that enhance or detract from the dissemination of evidence‐based practices.

Applications of operant demand to treatment selection II: Covariance of evidence strength and treatment consumption

“…That is, one would assume that a perfectly rational agent would favor choices more associated with larger and more probable returns (i.e., EBPs) over alternatives with lesser, or at least less probable, returns (i.e., fads, pseudoscience). Indeed, Rational Choice Theory holds that individuals seek to maximize utility (Hantula, 2017), and in the case of behavioral therapies, should choose EBPs more often than not (Gilroy et al, 2022). However, research with human and nonhuman animals has found that organisms rarely behave rationally and regularly demonstrate patterns of "irrational" or "suboptimal" choice (Ainslie, 1975(Ainslie, , 1992.…”

“…That is, findings from behavioral science have been used to characterize the situations in which organisms deviate from optimal (e.g., EBPs) to suboptimal choices (e.g., fad therapies; Mazur, 1987;Odum, 2011). Abstracting this perspective to treatment choice, a behavioral economic approach may help characterize the situations in which caregivers deviate from optimal prospects (EBPs) and fall prey to questionable (potentially unsafe) treatment practices Gilroy et al, 2022). For example, behavioral economic research has found treatment-related choices to be more reliably influenced by proximal environmental factors, such as delays (Call et al, 2015;.…”

“…A behavioral economic account of treatment choice is well suited to evaluating the consumption of EBPs because these can be considered the optimal (or at least recommended) choice(s) in the context of behavior therapy Gilroy et al, 2022). Borrowing from the economic concept of demand (Hursh, 1980(Hursh, , 1984, hypothetical treatment choices can be evaluated under a variety of constraints (e.g., varying costs, available alternatives).…”

“…Borrowing from the economic concept of demand (Hursh, 1980(Hursh, , 1984, hypothetical treatment choices can be evaluated under a variety of constraints (e.g., varying costs, available alternatives). Specifically, the Operant Demand Framework can be used to construct a hypothetical marketplace (see Roma et al (2016) for a recent review and Gilroy et al (2022) for a representative example) in which to examine how caregivers would "spend" their limited time and resources. For example, Gilroy et al simulated a treatment "marketplace" to evaluate how caregivers would select behavior therapies when costs and levels of evidence varied across treatment options (for an initial demonstration of the approach, see Quisenberry et al, 2015).…”

“…The purpose of this study was to build upon and extend the findings presented in Gilroy et al (2022). Specifically, the focus was not on evaluating how the absence of scientific evidence affects caregiver choice, but rather, how differences in the level of scientific evidence between treatments influence caregiver choice.…”