title: Signalling changes to individuals who show resistance to change can reduce challenging behaviour.
abstract: Several neurodevelopmental disorders are associated with resistance to change and challenging behaviours - including temper outbursts - that ensue following changes to routines, plans or expectations (here, collectively: expectations). Here, a change signalling intervention was tested for proof of concept and potential practical effectiveness.
  
  
  
  Twelve individuals with Prader-Willi syndrome participated in researcher- and caregiver-led pairing of a distinctive visual-verbal signal with subsequent changes to expectations. Specific expectations for a planned subset of five participants were systematically observed in minimally manipulated natural environments. Nine caregivers completed a temper outburst diary during a four week baseline period and a two week signalling evaluation period.
  
  
  
  Participants demonstrated consistently less temper outburst behaviour in the systematic observations when changes imposed to expectations were signalled, compared to when changes were not signalled. Four of the nine participants whose caregivers completed the behaviour diary demonstrated reliable reductions in temper outbursts between baseline and signalling evaluation.
  
  
  
  An active control group for the present initial evaluation of the signalling strategy using evidence from caregiver behaviour diaries was outside the scope of the present pilot study. Thus, findings cannot support the clinical efficacy of the present signalling approach.
  
  
  
  Proof of concept evidence that reliable pairing of a distinctive cue with a subsequent change to expectation can reduce associated challenging behaviour is provided. Data provide additional support for the importance of specific practical steps in further evaluations of the change signalling approach.
authors.affiliation: Cerebra Centre for Neurodevelopmental Disorders, University of Birmingham, UK.
authors.forename: Leah E
authors.initials: LE
authors.lastname: Bull
authors.affiliation: Cerebra Centre for Neurodevelopmental Disorders, University of Birmingham, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Oliver
authors.affiliation: Cerebra Centre for Neurodevelopmental Disorders, University of Birmingham, UK. Electronic address: papers@katewoodcock.com.
authors.forename: Kate A
authors.initials: KA
authors.lastname: Woodcock
mesh_terms: D000293:Adolescent; D000328:Adult; D017028:Caregivers / Q000523:psychology*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006184:Habits; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology; D011218:Prader-Willi Syndrome / Q000503:physiopathology / Q000523:psychology*; D000066553:Problem Behavior / Q000523:psychology*; D017603:Signal Detection, Psychological / Q000502:physiology*; D055815:Young Adult
keywords: Autism; Intellectual disability; Prader-Willi syndrome; Preference for routine; Resistance to change; Restricted repetitive behaviour; Stimulus control; Tantrum