Skip to main content
Log in

Treatment Burst Data Points and Single Case Design Studies: A Bayesian N-of-1 Analysis for Estimating Treatment Effect Size

  • Original Research
  • Published:
Perspectives on Behavior Science Aims and scope Submit manuscript

Abstract

Single-case experimental designs (SCED) evaluate treatment effects for each participant, but it is difficult to aggregate and quantify treatment effects across SCED participants receiving the same type of treatment. We applied Bayesian analytic procedures to SCED data aggregated across participants that have previously only been applied to large-N and group design studies of treatment effect sizes. For the current study, we defined transient elevated treatment data points as (1) above the range of the last five baseline sessions during the first three sessions of treatment (i.e., extinction burst); (2) within or above the range of baseline after the first three treatment sessions (i.e., recurrence burst); or (3) thinning phase data points above the last three prethinning treatment data points (i.e., thinning burst). Results indicated that the treatment effect sizes remained large regardless of controlling for transient elevated treatment data points. Finally, we examined the effects of reinforcer schedule thinning on estimates of treatment effect size. Results indicated a moderate negative impact of schedule thinning on treatment effect size with a 16% decrease in effect size. Recommendations for research and practice are provided, and the utility of using Bayesian analysis in single-case experimental designs is discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  • Barnard-Brak, L., Richman, D. M., Little, T. D., & Yang, Z. (2018). Development of an in-vivo metric to aid visual inspection of single-case design data: Do we need to run more sessions? Behaviour Research & Therapy, 102, 8–15.

    Article  Google Scholar 

  • Bartlett, S. M., Rapp, J. T., Krueger, T. K., & Henrickson, M. L. (2011). The use of response cost to treat spitting by a child with autism. Behavioral Interventions, 26(1), 76–83.

    Article  Google Scholar 

  • Borenstein, M., Hedges, L. V., Higgins, J. P., & Rothstein, H. R. (2011). Introduction to meta-analysis. New York, NY: Wiley.

  • Britton, L. N., Carr, J. E., Kellum, K. K., Dozier, C. L., & Weil, T. M. (2000). A variation of noncontingent reinforcement in the treatment of aberrant behavior. Research in Developmental Disabilities, 21(6), 425–435.

    Article  PubMed  Google Scholar 

  • Carlin, B. P., & Louis, T. A. (2010). Bayes and empirical Bayes methods for data analysis. Chicago, IL: Chapman & Hall/CRC.

  • Carr, J. E., Dozier, C. L., Patel, M. R., Adams, A. N., & Martin, N. (2002). Treatment of automatically reinforced object mouthing with noncontingent reinforcement and response blocking: Experimental analysis and social validation. Research in Developmental Disabilities, 23(1), 37–44.

    Article  PubMed  Google Scholar 

  • Cataldo, M. F., Ward, E. M., Russo, D. C., Riordan, M., & Bennett, D. (1986). Compliance and correlated problem behavior in children: Effects of contingent and noncontingent reinforcement. Analysis & Intervention in Developmental Disabilities, 6(4), 265–282. https://doi.org/10.1016/S0270-4684(86)80009-X.

    Article  Google Scholar 

  • Cohen, J. (1988). The effect size index: d. Statistical Power Analysis for the Behavioral Sciences, 2, 284–288.

    Google Scholar 

  • Cooper, H., & Valentine, J. C. (2008). Research synthesis and meta-analysis. In Handbook of research on adult learning and development (pp. 184–202). New York, NY: Routledge.

    Google Scholar 

  • Davis, D. H., Fredrick, L. D., Alberto, P. A., & Gama, R. (2012). Functional communication training without extinction using concurrent schedules of differing magnitudes of reinforcement in classrooms. Journal of Positive Behavior Interventions, 14(3), 162–172.

    Article  Google Scholar 

  • DeLeon, I. G., Anders, B. M., Rodriguez-Catter, V., & Neidert, P. L. (2000). The effects of noncontingent access to single-versus multiple-stimulus sets on self-injurious behavior. Journal of Applied Behavior Analysis, 33(4), 623–626.

    Article  PubMed  PubMed Central  Google Scholar 

  • Depaoli, S., & Van de Schoot, R. (2017). Improving transparency and replication in Bayesian statistics: The WAMBS-Checklist. Psychological Methods, 22(2), 240.

    Article  PubMed  Google Scholar 

  • Duan, N., Kravitz, R., & Schmid, C. (2013). Single-patient (n-of-1) trials: a pragmatic clinical decision methodology. Journal of Clinical Epidemiology, 66(8), S21–S28.

    Article  PubMed  PubMed Central  Google Scholar 

  • Efron, B. (2012). Large-scale inference: Empirical Bayes methods for estimation, testing, and prediction (Vol. 1). Cambridge, UK: Cambridge University Press.

    Google Scholar 

  • Fisher, W. W., Thompson, R. H., DeLeon, I. G., Piazza, C. C., Kuhn, D. E., Rodriguez-Catter, V., & Adelinis, J. D. (1999). Noncontingent reinforcement: Effects of satiation versus choice responding. Research in Developmental Disabilities, 20(6), 411–427.

    Article  PubMed  Google Scholar 

  • Gabler, N. B., Duan, N., Vohra, S., & Kravitz, R. L. (2011). N-of-1 trials in the medical literature: a systematic review. Medical Care, 49(8), 761–768.

    Article  PubMed  Google Scholar 

  • Hagopian, L. P., Fisher, W. W., & Legacy, S. M. (1994). Schedule effects of noncontingent reinforcement on attention-maintained destructive behavior in identical quadruplets. Journal of Applied Behavior Analysis, 27(2), 317–325. https://doi.org/10.1901/jaba.1994.27-317.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hagopian, L. P., Crockett, J. L., Van Stone, M., Deleon, I. G., & Bowman, L. G. (2000). Effects of noncontingent reinforcement on problem behavior and stimulus engagement: The role of satiation, extinction, and alternative reinforcement. Journal of Applied Behavior Analysis, 33(4), 433–449.

    Article  PubMed  PubMed Central  Google Scholar 

  • Harrington, M., & Velicer, W. F. (2015). Comparing visual and statistical analysis in single-case studies using published studies. Multivariate behavioral research, 50(2), 162–183.

  • Hedges, L. V., Pustejovsky, J. E., & Shadish, W. R. (2012). A standardized mean difference effect size for single case designs. Research Synthesis Methods, 3(3), 224–239.

    Article  PubMed  Google Scholar 

  • Homer, R., Carr, E., Halle, J., McGee, G. Odom. S., & Wolery, M. (2005). Use of single-subject research to identify evidence-based practice in special education. Exceptiomil Children, 71(2), 165–176.

  • Jarosz, A. F., & Wiley, J. (2014). What are the odds? A practical guide to computing and reporting Bayes factors. Journal of Problem Solving, 7(1), 2.

    Article  Google Scholar 

  • Johnston, J. M., & Pennypacker, H. S. (2010). Strategies and tactics of behavioral research. New York, NY: Routledge. https://doi.org/10.4324/9780203837900.

    Book  Google Scholar 

  • Kazdin, A. E. (2011). Single-case research designs: Methods for clinical and applied settings. New York, NY: Oxford University Press.

    Google Scholar 

  • Keeney, K. M., Fisher, W. W., Adelinis, J. D., & Wilder, D. A. (2000). The effects of response cost in the treatment of aberrant behavior maintained by negative reinforcement. Journal of Applied Behavior Analysis, 33(2), 255–258.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kratochwill, T. R. (2015). Selective mutism (psychology revivals): Implications for research and treatment. London: Psychology Press.

  • Lakens, D. (2013). Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs. Frontiers in Psychology, 4, 863.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lerman, D. C., & Iwata, B. A. (1995). Prevalence of the extinction burst and its attenuation during treatment. Journal of Applied Behavior Analysis, 28(1), 93–94.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lillie, E. O., Patay, B., Diamant, J., Issell, B., Topol, E., & Schork, N. (2011). The n-of-1 clinical trial. Personalized Medicine, 8(2), 161–173.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lipsey, M. W., & Wilson, D. B. (2001). Practical meta-analysis. Thousand Oaks, CA: Sage.

  • Long, E. S., Hagopian, L. P., DeLeon, I. G., Marhefka, J. M., & Resau, D. (2005). Competing stimuli in the treatment of multiply controlled problem behavior during hygiene routines. Research in Developmental Disabilities, 26(1), 57–69.

    Article  PubMed  Google Scholar 

  • Maggin, D. M., Swaminathan, H., Rogers, H. J., O’Keeffe, B. V., Sugai, G., & Horner, R. H. (2011). A generalized least squares regression approach for computing effect sizes in single-case research: Application examples. Journal of School Psychology, 49(3), 301–321.

    Article  PubMed  Google Scholar 

  • Marcus, B. A., & Vollmer, T. R. (1996). Combining noncontingent reinforcement and differential reinforcement schedules as treatment for aberrant behavior. Journal of Applied Behavior Analysis, 29(1), 43–51.

    Article  PubMed  PubMed Central  Google Scholar 

  • Meyn, S. P., & Tweedie, R. L. (1993). Markov chains and stochastic stability. London, UK: Springer.

    Book  Google Scholar 

  • Muthén, L., & Muthén, B. O. (2017). In L. Angeles (Ed.), Mplus user’s guide (8th ed.). CA: Author.

    Google Scholar 

  • Parker, R. I., Hagan-Burke, S., & Vannest, K. (2007). Percentage of all non-overlapping data (PAND) an alternative to PND. Journal of Special Education, 40(4), 194–204.

    Article  Google Scholar 

  • Parker, R. I., & Vannest, K. (2009). An improved effect size for single-case research: Nonoverlap of all pairs. Behavior Therapy, 40(4), 357–367.

  • Persel, C. S., Persel, C. H., Ashley, M. J., & Krych, D. K. (1997). The use of noncontingent reinforcement and contingent restraint to reduce physical aggression and self injurious behaviour in a traumatically brain injured adult. Brain Injury, 11(10), 751–760.

    Article  PubMed  Google Scholar 

  • Piazza, C. C., Fisher, W. W., Hanley, G. P., LeBlanc, L. A., Worsdell, A. S., Lindauer, S. E., & Keeney, K. M. (1998). Treatment of pica through multiple analyses of its reinforcing functions. Journal of Applied Behavior Analysis, 31(2), 165–189.

    Article  PubMed  PubMed Central  Google Scholar 

  • Podlesnik, C. A., & Shahan, T. A. (2010). Extinction, relapse, and behavioral momentum. Behavioural Processes, 84(1), 400–411.

    Article  PubMed  PubMed Central  Google Scholar 

  • Powers, K. V., Roane, H. S., & Kelley, M. E. (2007). Treatment of self-restraint associated with the application of protective equipment. Journal of Applied Behavior Analysis, 40(3), 577–581.

    Article  PubMed  PubMed Central  Google Scholar 

  • Punja, S., Bukutu, C., Shamseer, L., Sampson, M., Hartling, L., Urichuk, L., & Vohra, S. (2016). N-of-1 trials are a tapestry of heterogeneity. Journal of Clinical Epidemiology, 76, 47–56.

    Article  PubMed  Google Scholar 

  • Pustejovsky, J. E. (2018). Using response ratios for meta-analyzing single-case designs with behavioral outcomes. Journal of School Psychology, 68, 99–112.

  • Rice, M. E., & Harris, G. T. (2005). Comparing effect sizes in follow-up studies: ROC Area, Cohen's d, and r. Law & Human Behavior, 29(5), 615–620.

    Article  Google Scholar 

  • Richman, D. M., Barnard-Brak, L., Grubb, L., Bosch, A., & Abby, L. (2015). Meta-analysis of noncontingent reinforcement effects on problem behavior. Journal of Applied Behavior Analysis, 48(1), 131–152.

    Article  PubMed  Google Scholar 

  • Scruggs, T. E., & Mastropieri, M. A. (2013). PND at 25: Past, present, and future trends in summarizing single-subject research. Remedial & Special Education, 34(1), 9–19.

    Article  Google Scholar 

  • Shadish, W. R., Hedges, L. V., & Pustejovsky, J. E. (2014). Analysis and meta-analysis of single-case designs with a standardized mean difference statistic: A primer and applications. Journal of School Psychology, 52(2), 123–147.

    Article  PubMed  Google Scholar 

  • Sigafoos, J., & Pennell, D. (1995). Noncontingent application versus contingent removal of tactile stimulation: Effects on self-injury in a young boy with multiple disabilities. Behaviour Change, 12(3), 139–143.

    Article  Google Scholar 

  • Swaminathan, H., Rogers, H. J., & Horner, R. H. (2014). An effect size measure and Bayesian analysis of single-case designs. Journal of School Psychology, 52(2), 213–230.

    Article  PubMed  Google Scholar 

  • Van Zyl, C. J. (2018). Frequentist and Bayesian inference: A conceptual primer. New Ideas in Psychology, 51, 44–49.

    Article  Google Scholar 

  • Vollmer, T. R., Iwata, B. A., Zarcone, J. R., Smith, R. G., & Mazaleski, J. L. (1993). The role of attention in the treatment of attention-maintained self-injurious behavior: Noncontingent reinforcement and differential reinforcement of other behavior. Journal of Applied Behavior Analysis, 26(1), 9–21.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wagenmakers, E. J., Lee, M., Lodewyckx, T., & Iverson, G. J. (2008). Bayesian versus Frequentist Inference. In H. Hoijtink, I. Klugkist, & P. A. Boelen (Eds.), Bayesian evaluation of informative hypotheses (pp. 43–62). New York, NY: Springer.

  • Zucker, D. R., Ruthazer, R., & Schmid, C. H. (2010). Individual (N-of-1) trials can be combined to give population comparative treatment effect estimates: Methodologic considerations. Journal of Clinical Epidemiology, 63(12), 1312–1323.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Lucy Barnard-Brak.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Barnard-Brak, L., Richman, D.M. & Watkins, L. Treatment Burst Data Points and Single Case Design Studies: A Bayesian N-of-1 Analysis for Estimating Treatment Effect Size. Perspect Behav Sci 43, 285–301 (2020). https://doi.org/10.1007/s40614-020-00258-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40614-020-00258-8

Keywords

Navigation