Expanding a laboratory model for evaluating relapse of caregiver nonadherence

Williams et al. (2023) built a lab model to watch caregiver nonadherence come back. They first taught five adults to follow a behavior plan for child escape behavior. Then they stopped the child’s problem behavior so the caregivers’ correct use of the plan got no more payoff. Later they let the child’s escape behavior return while the researchers tracked every caregiver response.

The team used continuous measurement—every second of caregiver action was coded. This tight lens let them spot the exact moment adherence slipped.

All five caregivers dropped the plan steps as soon as the child’s problem behavior returned. Their nonadherence returned fast—within minutes—showing the model works.

Continuous data drew a clear picture: when escape behavior paid off again, caregivers stopped using the taught steps.

The result lines up with Hopkins et al. (1977). That team showed maintenance needs planned reinforcers outside treatment. Williams adds the caregiver side: if child behavior brings back natural reinforcers, caregiver adherence can collapse without booster support.

It also echoes Storch et al. (2012). A et al. saw relapse in pigeons when stimulus contexts shifted. Williams shows the same relapse pattern in human caregivers, just with nonadherence as the target response.

Lord et al. (1986) proved thinning reinforcement and keeping some child verbal rules can lock in gains. Williams warns that without these maintenance tricks, caregiver adherence can still unravel later.

You now have lab proof that caregiver adherence is fragile. Plan for booster sessions right before discharge and again when problem behavior is likely to return. Add intermittent caregiver praise and child coping responses to make the plan stick.