Renewal and resurgence of severe problem behavior in an intensive outpatient setting: Prevalence, magnitude, and implications for practice

Falligant and his team looked back at the kids who got intensive day-treatment for severe problem behavior. They counted how many kids showed renewal or resurgence when therapy hit bumps.

Renewal means the old behavior comes back in a new place. Resurgence means it pops up when reinforcement stops or thins. The kids had autism, ADHD, or ID. All got FCT plus extinction.

Most kids—about 8 in 10—had at least one relapse burst. The bursts were big, often topping their first baseline levels.

Renewal hit 60 % of cases and resurgence hit 70 %. Some kids had both. The take-home: relapse is the rule, not the exception, in outpatient care.

Greer et al. (2024) ran a tight lab test and found the same thing: big, sudden cuts in reinforcement cause the biggest resurgence. Their data extend Falligant’s chart review by proving the link in real time.

Cohenour et al. (2018) showed AAB renewal in most autistic kids under bright lab lights. Falligant saw renewal in a mixed-diagnosis clinic. The rates look different, but both studies agree new rooms or staff can wake up old behavior.

Podlesnik et al. (2023) reviewed 50 years of pigeon and rat work. They begged for more clinical data. Falligant’s case series is exactly the outpatient evidence the review asked for.

You can’t stop relapse, but you can plan for it. Program thin reinforcement steps instead of sudden drops. Teach caregivers to watch for renewal in new places. Add stimuli that were present during treatment to new settings. Build booster sessions into discharge plans. These steps turn an expected setback into a brief bump instead of a crash.