Targeting Family Accommodation of Problem Behavior to Increase Parent Adherence With Behavioral Treatment Plans

Conducting a functional analysis and implementing derived treatments can produce effective behavior plans for severe problem behavior (e.g., self-injury, aggression, and disruptive behavior). Nonetheless, skills training and an effective plan may not be sufficient to produce parent adherence. Low levels of treatment adherence may persist because parent responses that reinforce problem behavior also produce negative reinforcement for the parent response through immediate problem behavior cessation. This case study presents a contextual behavioral informed approach to target the negative maintaining contingencies supporting parent accommodation of problem behavior, and to increase adherence with behavioral treatment plans. Despite parent mastery of treatment components while under direct clinical observation, accommodation of the child’s severe problem behavior persisted periodically between clinical appointments. Case conceptualization highlights the borrowed concept of family accommodation as it relates to parent-child interactions that exacerbate and maintain the maladaptive behaviors of both. The course of intervention outlines strategies aimed at undermining the contingencies that maintain accommodation while providing parents with new behavioral treatment-related committed actions that are consistent with adherence. Outcomes are reviewed and presented within a multiple-baseline single case design across parents. Implications of the findings are discussed, along with recommendations for clinicians and students who identify parent accommodation of problem behavior within their clinical work.