Efficacy of competing stimulus assessments: A summary of 35 consecutively encountered cases
Competing-stimulus assessments flop about half the time in real hospital cases, so always pack a backup plan.
01Research in Context
What this study did
Laureano et al. (2023) ran a competing-stimulus assessment on 35 kids in a hospital unit.
They wanted to see how many kids got a "high-competition" item that cut problem behavior by at least 80%.
Every child was tested the same way, one after another, with no extra coaching.
What they found
Only about half of the kids got a toy or snack that truly competed with their problem behavior.
The other half left the room with no useful item, even though earlier papers said the test almost always works.
This real-world hit rate is much lower than the tidy success stories we usually read.
How this fits with other research
Aznar et al. (2005) showed three shining cases where the same test found perfect items and slashed behavior during tooth-brushing.
The new numbers look like a contradiction, but they are not: the 2005 paper hand-picked easy cases, while Laureano took every child who walked in.
Ivancic et al. (1996) already warned that some people simply do not react to any stimulus; the 2023 data confirm that warning for competing-stimulus work.
Together, these studies say: the test can work, yet you should expect it to fail about half the time in everyday caseloads.
Why it matters
Do not stake your whole behavior plan on finding a magic toy. Run the assessment, but have a backup ready—maybe non-contingent breaks, enriched attention, or brief extinction. Tell families the truth: we might get a great item today, and we might not. Either way, we still have a path forward.
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02At a glance
03Original abstract
Competing stimulus assessments (CSAs) are designed to identify stimuli that reduce challenging behavior through competition with its maintaining reinforcers. Recently, Haddock and Hagopian (2020) found that over 92% of CSAs described in published studies identified at least one high-competition stimulus (i.e., a stimulus correlated with at least an 80% reduction in challenging behavior). The current study describes the outcomes of CSAs in a retrospective consecutive controlled case series study of 35 cases (individuals) admitted to an inpatient setting. Findings on the limited relation between the level of stimulus engagement and reductions in challenging behavior were replicated; however, the efficacy of CSAs was lower (only 47% of CSAs were successful in identifying one or more high competition stimuli). Discrepant findings across studies on the efficacy of CSAs are discussed in terms of differences in the sample participants and how outcomes are reported, which vary depending on the study’s research questions.
Journal of Applied Behavior Analysis, 2023 · doi:10.1002/jaba.979