Research Patterns in the Treatment of Adults With Problem Behavior and Intellectual and Developmental Disabilities: A Quantitative Systematic Review
Layering several ABA procedures beats using one when you treat adult problem behavior, but most studies still skip basic quality checks.
01Research in Context
What this study did
Khokhar et al. (2025) pulled every adult study that used two or more ABA procedures to treat problem behavior in people with intellectual or developmental disabilities.
They scored each paper for how well it was designed and how big the behavior change was.
What they found
Packages that mixed several ABA procedures cut problem behavior more than any single procedure alone.
Still, most studies were weak on basics like blind raters or treatment fidelity checks.
How this fits with other research
Chowdhury et al. (2011) saw the same thing for differential reinforcement alone: it worked in about half the studies and failed in six. Khokhar’s team shows you can boost your hit rate by adding extra procedures.
Boyle et al. (2024) tell us to test each function one by one before we bundle treatments; Khokhar’s numbers prove the bundle is worth the extra steps.
Sajith et al. (2008) and Matson et al. (2011) found weak evidence for meds in adults and kids. Khokhar’s review shifts the spotlight back to behavioral packages as the first-line option.
Why it matters
If you run one procedure and see only slow progress, layer in a second or third. The data say you will likely get faster, larger drops in problem behavior. Just keep running your fidelity checks and take good data so your work rises above the weak standard seen in most papers.
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02At a glance
03Original abstract
Research featuring adults with intellectual and developmental disabilities who engage in problem behavior has outlined various treatment approaches. The current quantitative systematic literature review identified and coded 76 peer-reviewed and gray literature articles published between January 2002 and September 2022. Following article identification and coding, we calculated effect size estimates (i.e., Tau Baseline Corrected) and assessed the methodological rigor of included articles. Through this work, we uncovered 42 unique multi-protocol treatments (i.e., treatments incorporating multiple therapeutic elements). Multi-protocol treatments were associated with larger effect sizes (more effective) compared to single-protocol treatments. The average methodological rigor score associated with peer-reviewed works was 1.6 (out of 4), while gray literature works scored 1.2. We offer commentary in response to these outcomes, alongside recommendations for future research to address the many avenues of inquiry that appear to remain largely neglected (e.g., component analysis to evaluate individual treatment elements and their efficacy).
Behavior Modification, 2025 · doi:10.1177/01454455251332545