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Cortical Vision Impairment (CVI)-informed assessment and treatment of challenging behavior in a child with

Benjamin R Thomas1,2, Natasha N Ludwig3,4, Danielle Pelletier5

  • 1Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA. Benjamin.thomas2@nationwidechildrens.org.

Journal of Neurodevelopmental Disorders
|November 28, 2024
PubMed

Insights

Parent-implemented behavioral treatments effectively addressed challenging behaviors in a child with cortical visual impairment (CVI) and autism spectrum disorder (ASD). Integrating CVI accommodations was key to successful interventions.

Area of Science:

  • Behavioral Psychology
  • Developmental Disabilities
  • Neurogenetics

Background:

  • Children with SCN2A-related disorder often present with complex co-occurring conditions including cortical visual impairment (CVI), intellectual disability (ID), epilepsy, and autism spectrum disorder (ASD).
  • Challenging behaviors in this population can be difficult to assess and treat due to sensory and cognitive impairments.
  • Functional behavior assessment (FBA) and functional vision assessment (FVA) are crucial for understanding behavior-environment interactions.

Purpose of the Study:

  • To describe parent-implemented behavioral interventions for a child with CVI, ID, epilepsy, and ASD associated with an SCN2A pathogenic variant.
  • To demonstrate the integration of CVI-specific accommodations into behavioral treatment plans.
  • To highlight the utility of FVAs in informing behavioral assessments and interventions.

Main Methods:

  • Combined FBA and FVA to identify maintaining variables for challenging behaviors.
  • Implemented parent-delivered behavioral treatments including prompting, extinction (EXT), differential reinforcement, functional communication training (FCT), and schedule thinning.
  • Incorporated CVI-related accommodations into all intervention strategies.

Main Results:

  • Behavioral interventions, informed by CVI accommodations, successfully reduced escape-maintained challenging behavior and behavior problems maintained by access to tangible-edibles.
  • Functional communication training and schedule thinning with visual signals were effective for addressing food-related behavior problems.
  • Parent implementation of strategies was integral to treatment success.

Conclusions:

  • Integrating child-specific CVI accommodations is essential for effective behavioral interventions in children with complex developmental disabilities.
  • FVAs provide practical and accessible information for behavior analysts to inform vision-informed assessment and treatment.
  • Parent-implemented behavioral treatments can be highly effective when tailored to individual needs and sensory profiles.

Keywords:
Applied behavior analysisAutism spectrum disorderCortical visual impairmentFunctional behavior assessmentFunctional vision assessmentParent trainingSCN2A-related disorder

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