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Published Research 

As a research associate and adjunct faculty at the University of Houston Clear Lake, I had the opportunity to participate in grants and collaborate with various university programs including the Transition Clinic at Baylor College of Medicine. Together with my colleagues, we have successfully published peer-reviewed articles, contributing valuable insights to the field. Our ongoing collaboration aims to advance research and enhance knowledge in our respective areas of expertise.                                                                                                         ~ Loukia Tsami

Loukia-Tsami-Publisher

December 2023
Abstract
Clinicians report primarily using functional behavioral assessment (FBA) methods that do not include functional analyses. However, studies examining the correspondence between functional analyses and other types of FBAs have produced inconsistent results. In addition, although functional analyses are considered the gold standard, their contribution toward successful treatment compared with other FBA methods remains unclear. This comparative effectiveness study, conducted with 57 young children with autism spectrum disorder, evaluated the results of FBAs that did (n = 26) and did not (n = 31) include a functional analysis. Results of FBAs with and without functional analyses showed modest correspondence. All participants who completed functional communication training achieved successful outcomes regardless of the type of FBA conducted.

2

January 2023
Abstract
The use of telehealth to provide supports to families has been a mode of service delivery in some form for decades across healthcare, including behavior analysis. However, the need for telehealth services increased exponentially during the COVID-19 pandemic, especially during the initial months of the public health emergency. With this exponential growth, many families and service providers experienced some of the benefits and limitations of this service modality for the first time. With these experiences in mind, in this chapter, we summarize the existing telehealth literature that provides behavior analytic supports and services to children and their families and then describe critical practice considerations to assist behavior analysts with determinations of when telehealth service delivery is clinically indicated, contraindicated, or somewhere in between.

3

December 2022
Abstract
Adults with intellectual and developmental disabilities (AIDD) experience significant oral health disparities, partially due to perceived behavioral issues. This article describes the preliminary outcomes of a developing interdisciplinary (dental, medical, behavioral) program involving a behavioral intervention for AIDD previously receiving preventative dental care with sedation, general anesthesia, or protective stabilization (SAS). After a baseline assessment, a board-certified behavior analyst implemented increasingly complex behavioral interventions during simulated dental visits. Prior to COVID-19 pandemic-related restrictions, there were 32 active participants; 15 (46.9%) successfully completed a focused, real dental exam with simple behavioral interventions and 17 (53.1%) remain in treatment. These preliminary results suggest that many AIDD previously receiving SAS may participate in a preventative dental exam with minimal behavioral supports, if given the opportunity.

4

July 2022
Abstract
Recent studies evaluating the effectiveness of using telehealth to train caregivers across large geographical distances in the United States and internationally indicate that this modality can increase families’ accessibility to evidence-based interventions for problem behavior. In this study, experimenters and interpreters in the United States remotely coached nine caregivers of children with disabilities residing in three countries in Asia to implement functional analyses (FA) and functional communication training (FCT). Five of the nine families were culturally matched to either the experimenter or the interpreter. Problem behavior was reduced to near-zero levels for all but one participant. Furthermore, all caregivers implemented the procedures with high levels of integrity and rated the assessment and treatment as highly acceptable, regardless of cultural matching or use of interpreters. Overall, findings suggest telehealth-based caregiver coaching and caregiver-implemented FA plus FCT is feasible and acceptable in Asia.

5

April 2022
Abstract
Many individuals diagnosed with intellectual and developmental disabilities (IDD) are uncooperative during routine dental exams, leading to poor oral health in this population. Few studies have evaluated methodologies for preparing dental students and professionals to work effectively with patients diagnosed with IDD. In this study, experimenters used remote behavioral skills training (BST) to train dental students and professionals how to implement a practical intervention that included tell-show-do, contingent praise, and noncontingent reinforcement. Results suggested that group training conducted via videoconferencing was effective for teaching six of seven participants to implement the intervention in the absence of post-training feedback. This approach appears useful for quickly and efficiently training current and future dental professionals to implement behavior techniques to promote patient compliance.

6

February 2022
Abstract
Functional analyses (FA) and functional communication training (FCT) are the most commonly used behavioral assessment and treatment approaches via telehealth for children with autism spectrum disorder (ASD) who display challenging behavior. The FA + FCT telehealth model has been shown to maintain treatment effectiveness (i.e., child behavioral outcomes and parent acceptability), as well as demonstrate treatment efficiency (i.e., cost savings). However, the majority of these studies have been conducted in the United States. Therefore, the purpose of this study was to evaluate the outcomes obtained with the telehealth FA + FCT model that included global applications. Descriptive statistics were used to analyze the results of the 199 participants who enrolled in the telehealth project across all project sites. The results showed that behavioral outcomes and parent acceptability maintained at similar levels to previous studies across all sites. Additionally, very few differences were found across project sites in relation to drop-out rates, visit cancellations, and technology issues. These results demonstrate the effectiveness of the FA + FCT telehealth model for addressing the challenging behavior needs of children with ASD globally and highlight areas in need of additional evaluation (e.g., drop-outs, cancellations) to determine the conditions under which telehealth could be best used.

7

January 2022
Abstract
The COVID‐19 pandemic has led to a dramatic increase in behavior analysts' use of telehealth services. Nonetheless, no research has evaluated the skills or training needed for therapists to provide these services effectively. The purpose of this study was to develop and evaluate a curriculum for providing high‐quality, parent‐training telehealth services. Four in‐service Board Certified Behavior Analysts® (BCBAs®) who received brief behavioral skills training on this curriculum reached 100% fidelity within four sessions. The skills generalized to a novel family and maintained nearly 1 year after the training. All participants rated the training as highly acceptable and effective. The independent ratings of 4 in‐service BCBAs, blinded to the study conditions, also supported the social validity of the outcomes. This curriculum may be considered an initial step towards development of competency for interventionists providing ABA services via telehealth. Further research is warranted as demand for telehealth services continues to grow.

8

May 2021
Abstract
Functional communication training (FCT) is a behavioral treatment that has been shown to reduce problem behavior and increase appropriate communication in young children with autism spectrum disorder (ASD). In this study, we assessed the effects of FCT on targeted and nontargeted problem behaviors outside of the training context, as well as parent stress, for 30 young children with ASD and their parents. Indirect measures of generalization treatment effects were administered prior to and following FCT treatment delivered via telehealth. Children demonstrated significant improvement on both targeted (measured via observation) and nontargeted (measured via checklist) problem behaviors, both within and outside of the training context, and parent stress was significantly reduced following treatment. These results suggest that the impact of FCT may extend beyond the training context for both the children being treated and the parents delivering treatment, even when generalization is not specifically programmed for during treatment.

9

June 2020
Abstract
The use of telehealth technologies to provide clinical services to families of children with autism and other developmental disabilities is a rapidly growing area of research. In particular, remote training of caregivers via video conferencing appears to be a promising approach for disseminating behavior-analytic interventions (Neely et al. in J Dev Phys Disabil 29:849–874, 2017. https://doi.org/10.1007/s10882-017-9550-4; Tomlinson et al. in J Behav Educ 27:172–222, 2018. https://doi.org/10.1007/s10864-018-9292-0). Although remote training offers a number of advantages, it brings a variety of challenges that are unique to this modality. The field would benefit from information on problems that practitioners may encounter when providing these services and how to train caregivers effectively. In this paper, we report on the experiences of 18 practitioners who provided caregiver training via telehealth from four different sites across a 4-year period. We describe a variety of technical and clinical issues that arose during service delivery, suggest strategies for preventing and remediating problems, and include case descriptions and data to illustrate our experiences. This information may help prepare practitioners to deliver telehealth services and guide further research in this area.

10

September 2019
Abstract
Teaching parents to conduct functional analyses and to implement functional communication training is an efficacious approach for treating socially maintained problem behavior (Derby et al., 1997). Research has found that delivering this assessment and intervention package via telehealth technologies is efficient and acceptable to caregivers in the United States (Wacker et al., 2013b). We replicated this work with families residing in rural and urban areas of eight countries. Two behavior therapists located in the United States conducted appointments in the participants' native languages, using interpreters as needed. Parent-implemented functional analyses and treatment with functional communication training were highly effective in reducing problem behavior in children diagnosed with autism. Furthermore, parents rated the procedures as acceptable and indicated that the treatment would be effective with their children. These findings indicate that telehealth technologies are a viable option for clinicians to provide behavior analysis services to families around the world.

11

August 2019
Abstract
Functional communication training (FCT) is highly effective for treating socially maintained problem behavior when based on the results of functional analyses (FA). Research suggests that combining relevant antecedents and consequences of problem behavior during FCT can be an efficient approach to treatment for behavior that is multiply controlled. However, no studies have evaluated whether treatment effects under combined conditions would transfer to single, or isolated, conditions. Participants were 5 children with autism, aged 3 years to 6 years, who engaged in problem behavior maintained by both escape from demands and access to tangibles. An experimenter coached their caregivers via video conferencing to implement FA and FCT in their homes. All participants received FCT under a combined condition, followed by brief exposure to sessions with isolated antecedents and consequences. Treatment effects for just 1 of the 5 participants immediately persisted under isolated conditions. These results suggest that, when caregivers combine variables relevant to multiple functions during FCT, exposure to isolated conditions may at least temporarily produce treatment failures.

12

May 2018
Abstract
Numerous studies have demonstrated the efficacy of response interruption and redirection (RIRD) for reducing vocal stereotypy in children with autism. However, the procedure can be time-consuming to implement. Results of Saini, Gregory, Uran, and Fantetti (2015) suggested that an abbreviated variation of RIRD was just as effective as the commonly used variation of RIRD, but further research is needed. In addition, no studies have evaluated the role of toy removal on the efficacy of RIRD even though this procedural component is frequently combined with RIRD. We examined the separate and combined effects of RIRD and contingent toy removal when three children with autism were required to respond to one demand versus three demands. One-demand RIRD was effective for all participants, and the contingent removal of toys alone reduced responding for two of three participants. Findings have important implications for treating vocal stereotypy in relevant settings.

13

September 2016
Abstract
Sight-word instruction can be a useful supplement to phonics-based methods under some circumstances. Nonetheless, few studies have evaluated the conditions under which pictures may be used successfully to teach sight-word reading. In this study, we extended prior research by examining two potential strategies for reducing the effects of overshadowing when using picture prompts. Five children with developmental disabilities and two typically developing children participated. In the first experiment, the therapist embedded sight words within pictures but gradually faded in the pictures as needed using a least-to-most prompting hierarchy. In the second experiment, the therapist embedded text-to-picture matching within the sight-word reading sessions. Results suggested that these strategies reduced the interference typically observed with picture prompts and enhanced performance during teaching sessions for the majority of participants. Text-to-picture matching also accelerated mastery of the sight words relative to a condition under which the therapist presented text without pictures.

14

June 2015
Abstract
Some individuals with developmental disabilities engage in problem behavior to escape or avoid auditory stimuli. In this study, a 6-year-old boy with autism engaged in severe aggression in the presence of specific sounds. Following an assessment based on the procedures described by McCord, Iwata, Galensky, Ellingson, and Thomson (2001), we treated negatively reinforced behavior using noncontingent reinforcement and time-out from positive reinforcement in the absence of extinction. Treatment was effective in reducing aggression across multiple sounds. © Society for the Experimental Analysis of Behavior.

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