Renewal of challenging behavior in an intensive outpatient clinic: Replication and extension to task changes

TL;DR

This study shows that changing tasks can lead to a return of challenging behaviors in outpatient clinic patients, similar to changes in people or settings.

Contribution

The study introduces task changes as a new context factor that can trigger renewal of challenging behavior.

Findings

Renewal prevalence was 25.23% using a max-of-5 criterion among 98 patients.

Task changes led to higher renewal rates compared to person or setting changes, though not statistically significant.

Challenging behavior rarely returned to prechange levels even after five sessions.

Abstract

Retrospective analyses have shown that renewal of challenging behavior following person or setting changes is common. This study replicates and extends prior work by evaluating renewal after a third type of context change: task changes. Among 98 patients in an intensive outpatient clinic who experienced 749 context changes, overall renewal prevalence was 25.23% using a max‐of‐5 criterion (39.79% using a mean‐of‐2 criterion), consistent with prior reports across this large sample. Of the 63 patients who experienced at least one task change, 36 (57.14%) exhibited renewal. Task changes produced higher renewal rates than person or setting changes across criteria, but differences were not statistically significant. Renewal magnitude generally declined across sessions; however, challenging behavior rarely returned to prechange levels, even after five sessions. Findings highlight the broader range of contextual variables that may evoke renewal and the need for strategies to reduce its intensity and persistence during treatment.

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