Evaluating the Effects of Skill-Based Treatment: A Systematic Review and Meta-Analysis of Single-Case Studies

The skill-based treatment for challenging behaviour (SBT) is an intervention package that combines functional communication training with contingency-based delay and denial tolerance training. This systematic review and meta-analysis aimed to (a) investigate the application of SBT across diverse populations, setting, and target behaviours; and (b) to evaluate the effectiveness and social validity of SBT in reducing challenging behaviours.

This review was pre-registered on PROSPERO (ID: CRD42024561455). Seven databases were searched. Data were extracted on characteristics of studies, participants, and applications of SBT. Literature was assessed for quality using the Evaluative Method and Single Case Design Risk of Bias Tool. SBT outcomes were quantified with Baseline-Corrected Tau (Tau-BC).

A total of 28 studies were reviewed, representing 99 individual SBT applications. SBT has been applied across participants with varying diagnoses, challenging behaviours, and levels of ability, though mostly in controlled settings by skilled implementers. Studies provided evidence for the social validity of SBT. Baseline-Corrected Tau indicated SBT shows good reduction in challenging behaviour (M = 0.47, range: - 0.35-1.00). The Evaluative Method indicated the literature to be of varying quality (borderline-strong = 7%; adequate = 13%; borderline-adequate = 43%; weak = 37%), and the evidence-based practice score suggests SBT to be a potentially evidence-based practice.

The evaluative method indicates SBT to be an emerging evidence-based practice for addressing challenging behaviour, although the majority of the literature scored lower than adequate. We make recommendations for strengthening the literature base and outline key implications for practitioners.