Applied Behavior Analysis in Acquired Brain Injury Rehabilitation: A Meta‐analysis of Single‐case Design Intervention Research

Abstract

The purpose of this meta-analysis was to complete a systematic evidence-based review of published behavioral treatment studies employing single-case designs with both children and adults with acquired brain injury. Peer-reviewed journals were searched using PsycINFO, Medline, and ERIC databases with combinations of terms such as brain injury, behavior disorder, behavior therapy, behavior modification, behavior analysis, and verbal behavior. A total of 112 acquisition and reduction studies met the established inclusion criteria. The data extracted from each study included specific details about the participants, target responses, intervention characteristics, use of functional assessment, and outcome characteristics. A data extraction software program was also used to extract data from graphs to calculate percentage of nonoverlapping data as an effect size . The studies were then evaluated along several dimensions from multiple evidencebased practice frameworks. Collectively, interventions targeted a wide range of behaviors for acquisition and reduction, but only five interventions were classified as well established according to the American Psychological Association Division 12 criteria. Furthermore, methodology of the identified studies was found to be relatively poor. A variety of methodological concerns are discussed. Copyright

Further developments in summarising and meta-analysing single-case data: An illustration with neurobehavioural interventions in acquired brain injury

“…In addition, ancestral searches of recent literature reviews of psychological interventions, including neurobehavioural interventions in brain injury rehabilitation, were also conducted (i.e., Alderman & Wood, 2013;Cattelani, Zettin, & Zoccolotti, 2010;Heinicke & Carr, 2014;Wood & Alderman, 2011;Ylvisaker et al, 2007). The flow of information can be seen in Figure 4, which provides the reasons for excluding records at the different stages; the information about the 28 studies included in the meta-analysis is available in a table in the supplemental online material.…”

“…Wood and Alderman (2011) offer a narrative review of studies on traumatic brain injury that reported positive results of differential reinforcement (for low rates of responding, for other or incompatible behaviours), both in neurobehavioural units and in non-specialized settings, as well as the effectiveness of response-cost (negative punishment) for people who present cognitive impairment and challenging behaviours. In contrast to these three reviews, Heinicke and Carr (2014) performed a meta-analysis of 112 studies (on various aetiologies, including ABI), reporting higher standardised mean differences for skill acquisition (ranging between 14 and 20) than for behaviour reduction-the main object of the current paper-ranging between 4 and 6 SDs. The values obtained in our review (Table 2) are smaller, but the d-statistic controls for small sample bias and autocorrelation, and MPD and SLC control for baseline trend, whereas the standardised mean difference used by Heinicke and Carr (2014) does neither.…”

“…In contrast to these three reviews, Heinicke and Carr (2014) performed a meta-analysis of 112 studies (on various aetiologies, including ABI), reporting higher standardised mean differences for skill acquisition (ranging between 14 and 20) than for behaviour reduction-the main object of the current paper-ranging between 4 and 6 SDs. The values obtained in our review (Table 2) are smaller, but the d-statistic controls for small sample bias and autocorrelation, and MPD and SLC control for baseline trend, whereas the standardised mean difference used by Heinicke and Carr (2014) does neither.…”

“…In contrast, Cattelani and colleagues (2010) stress that the limitations of group-design studies in terms of including participants with very different demographic characteristics, aetiology, site of brain damage, and so forth, hinder the assessment of how large the effect of a treatment would be for a particular patient. Some of these issues of uncontrolled factors affecting the certainty of the causal effect of interventions can be addressed in SCEDs, especially if recommendations on study conduct (Horner et al, 2005;Tate et al, 2013) are followed, including measures of maintenance and generalization (frequently missing according to Ylvisaker et al, 2007), social validity, and procedural fidelity (also rare according to Heinicke & Carr, 2014), among others. Thus, the combination of several methodological options and the integration of results across studies can prove to be very useful in the field.…”

Functional Analysis in Differential Diagnosis

“…FA if often used in the treatment of intractable or maladaptive behaviors of individuals with limited verbal abilities such as people with severe intellectual disabilities (Delgado-Casas, Navarro, Garcia-Gonzalez-Gordon, & Marchena, 2014;Rooker et al, 2014), acquired brain injury (Heinicke & Carr, 2014), or children and adolescents with autism (Foxx, 2008).…”