Behavior Modification, Ahead of Print.
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.

Behavior Modification, Ahead of Print.
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.

Behavior Modification, Volume 49, Issue 2, Page 224-265, March 2025.
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.

Behavior Modification, Ahead of Print.
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.

Behavior Modification, Volume 49, Issue 2, Page 193-223, March 2025.
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.

Behavior Modification, Volume 49, Issue 2, Page 159-192, March 2025.
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.