Prevalence of renewal of problem behavior: Replication and extension to an inpatient setting
Plan for renewal in half of inpatient cases—run context probes and thin reinforcement gradually.
01Research in Context
What this study did
Falligant et al. (2021) pulled the charts of 34 kids with intellectual or developmental disability treated on an inpatient unit.
They scored each case for renewal: did severe problem behavior come back when the child moved to a new ward or went home?
The team wanted to know how often renewal happens in the hospital, a tougher setting than past outpatient work.
What they found
Renewal showed up in 59 % of the cases—about six in every ten kids.
That rate is lower than the outpatient numbers Falligant et al. (2022) saw, but still high enough to plan for.
How this fits with other research
Falligant et al. (2022) saw even more renewal in their outpatient clinic, so the hospital’s tighter context may shield kids a bit.
Laureano et al. (2024) later showed that big cuts in reinforcement drive bigger resurgence in the same hospital—renewal and resurgence stack.
Greer et al. (2024) found the same rule in a lab study: gradual thinning keeps relapse small, backing the idea that slow steps help in both places.
Why it matters
Expect renewal in about half of your inpatient cases. Probe behavior in every new room, hallway, and home visit before discharge. Pair those probes with slow, small drops in reinforcement to cut both renewal and resurgence at once.
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02At a glance
03Original abstract
Individuals with intellectual and developmental disabilities who exhibit problem behavior often receive behavioral assessment and treatment in specialized inpatient and outpatient clinics. However, problem behavior sometimes reemerges as a function of changes in contexts and stimulus conditions, such as returning to the home environment. This reemergence is called renewal. Recently, Muething et al. (2020) found that renewal occurred in over half (67%) of cases from an outpatient clinic. Their sample was obtained exclusively from an outpatient setting and despite the applied relevance of renewal, its clinical prevalence in other populations is unknown. Accordingly, we replicated Muething et al.’s procedures and analyzed renewal in 37 inpatient treatment applications across 34 cases via consecutive-controlled case series. Renewal was present in 59% of cases; however, we found that renewal occurred in only 24% of context changes compared to 42% reported by Muething et al. Various factors related to the prevalence of renewal were evaluated.
Journal of Applied Behavior Analysis, 2021 · doi:10.1002/jaba.740