Positive behavior support (PBS) with children with fetal alcohol spectrum disorders: Characterizing caregivers' use of PBS using follow-up clinical trial data.
Teach FASD caregivers to stack several antecedent accommodations per problem behavior and the strategies will still be in place months later.
01Research in Context
What this study did
The team called 24 parents who had finished the Families Moving Forward PBS course.
They asked open questions about which PBS tools they still used 4.5 months later.
All children had fetal alcohol spectrum disorders and were 3-8 years old.
What they found
Every parent was still using at least one PBS strategy.
The parents who stacked several antecedent fixes for the same behavior had the best luck.
Example: one mom both shortened the task and moved it to a quiet corner.
How this fits with other research
Eussen et al. (2016) showed parents who see FASD behavior as brain-based pick antecedent tools.
Cruz-Montecinos et al. (2024) now shows those same tools stick if you layer them.
Ruppel et al. (2021) got similar parent-use results with ASD toddlers, so the model crosses diagnoses.
Shih et al. (2024) found parents with richer starter skills kept gains longer, hinting that a quick baseline probe could flag who needs extra booster calls.
Why it matters
You can shorten parent training by teaching one behavior at a time and piling on antecedent fixes.
Ask caregivers to list three tiny changes they can make before the trigger hits.
Add a follow-up call at one month to tweak the stack and you may save re-referrals later.
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02At a glance
03Original abstract
BACKGROUND: Fetal alcohol spectrum disorders (FASD) are associated with neurodevelopmental challenges leading to difficulties with everyday life tasks. The Families Moving Forward (FMF) Program teaches caregivers to use positive behavior support (PBS), integrated with other techniques. However, it is unknown how caregivers retain and use these PBS strategies after the intervention. METHODS: About 4.5 months after completing the FMF Program, twenty-three caregivers of children with FASD aged 4-12 were interviewed about problem behaviors targeted during the FMF Program and their continued use of PBS strategies. Interviews were recorded and coded thematically by a five-coder team. Higher-level pattern codes were developed to facilitate themes across descriptive codes. RESULTS: Caregivers commonly targeted task incompletion and rule breaking, and problem behaviors were often complex or combined. Caregivers identified environmental and interpersonal triggers for problem behavior. They used many accommodations to prevent problem behaviors, most often related to task or environment simplification. Caregivers also used consequence-based strategies. CONCLUSIONS: This study is the first to characterize caregivers' use of PBS strategies for children with FASD using mixed methods. Problem behaviors such as rule breaking were more difficult to target. Caregivers found most success when using a combination of multiple different accommodations per problem behavior. WHAT THIS PAPER ADDS: This is the first study to use mixed methods to characterize how caregivers of children with fetal alcohol spectrum disorders (FASD) use positive behavior support (PBS) strategies to target problem behavior after completion of the empirically validated Families Moving Forward (FMF) Program. Among other techniques involved in the FMF Program, PBS strategies are taught to caregivers and are used to target two distinct, caregiver-identified problem behaviors. This data provides essential information about behaviors responsive to PBS supports, for children with FASD, to inform clinical intervention and research. Notably, multiple problem behaviors often occurred together, emphasizing complexity of behavior challenges in this population and the resulting need for individualized supports. This study is the first to describe commonly observed triggers (antecedents) and commonly used supports (accommodations) from the perspective of caregivers of children with FASD. Importantly, results indicate that use of a wide variety of accommodations, or antecedent-based strategies, are effective in supporting behavior in children with FASD. However, success was most common when caregivers used multiple accommodations for any given concerning behavior. Findings represent 'real-world' strategies caregivers use to support adaptive behavior in their children several months after completion of the FMF Program, suggesting these strategies are applicable to clinical practice.
Research in developmental disabilities, 2024 · doi:10.1016/j.ridd.2024.104773