Where would I even start

[u/SnooFoxes7643]

Looking for articles, research, and interventions around disrobing/stripping within a 12-13 year old population.

Other important notes: Non ASD, has Rett syndrome Escalated from shoes all last year and September, to complete disrobing for the entire school day in the last 6 weeks.

Any help would be grateful before I sift through the articles myself.

[u/Mitteer]

As others have alluded to, I would start with a functional analysis to determine the reason for clothing removal. I generally use the Querim et al. consecutive alone/no interaction condition to rule out auto first. You may have to look at a latency based FA if disrobing is a one-and-done event.

With that said, this issue can be really uncomfortable for caregivers and staff if the child gets completely naked. Although reinforcement-based strategies are ideal to keep clothing on, sometimes it's necessary (particularly if disrobing is auto) to place the child in adaptive clothing: https://adaptiveclothingshowroom.com/jumpsuits-for-kids/

Finally, the biggest concern with Rett's from my experience has been loss of adaptive skills and difficulty teaching new skills. That might mean highly consistent procedural fidelity and dense reinforcement conditions, though it is hard to say for each particular client.

[u/SnooFoxes7643 → u/Mitteer]

We can't find a condition of HRE in order to complete a functional assessment at this time. That's our first goal, and it isn't happening.
We speculate that this individual really needs a smaller team of BTs working with her right now, to rule out any procedural flaws across teh seven staff with her on any given day. However, our schedulers are not able to do that just yet.

I think we are close to needign to use adaptive clothing. The parents tried over alls and a leotard, but she could still easily get out of it.

I really appreciate your statement on Rett's syndrome. we are seeing similar concerns in this case

[u/Mitteer → u/SnooFoxes7643]

Those are good thoughts. If you can't find a social FA control condition that turns off behavior, just consider that it may in fact be behavior maintained by automatic reinforcement. I'm not a PFA guy but I believe Jessel et al. (2018) also endorsed the consecutive alone/no interaction condition in cases of suspected auto, too. Heck, even my toddler prefers to be commando when he has the chance 😂

[u/SnooFoxes7643 → u/Mitteer]

Thanks for the advice. The additional piece that we're trying to figure out is how we progressed so quickly in recent weeks after maintaining at one level of behavior for an entire school year. (ie; trying to identify if it's changeover of staff with the new year, too many staff involved in the case, medication changes, something at home) So far we've decided possibilities: we took away "breaks" at the auditorium because it started there regularly, she recently started a new med that should have helped, there are so many staff, over half are new this school year and we can't measure the continuity of programming.

We're also in a public school setting, where she is meant to be in a classroom with four or more peers at a time, and in groups 2 of 8 blocks in the day. She can no longer access those learning opportunities.

[u/Mitteer → u/SnooFoxes7643]

I give you props, I remember consulting in schools the year of my predoc and it's so challenging dealing with the many stakeholders and uncontrollable variables. You're doing great trying to consult the literature and addressing the client's needs. To your point that disrobing is impacting her ability to access many other reinforcers, it does seem like adaptive clothing might be a good immediate step. There are some that have button latches in the back that prevent removal and are tear-proof. Expensive but effective and can be faded (e.g., noncontingent to contingent application).

[u/SnooFoxes7643 → u/Mitteer]

Thank you, the challenges you mention are definitely in my mind as I decide where I’d like to work post-exam next year. It’s drawing to me that it is challenging, but also pushes me toward a private school setting.

I’ll bring up the adaptive clothing when we come back from break.

[u/newyorklogic]

I personally use Google scholar as a jumping point for topics I want to research. The BACB gives access to a lot of journals for free so I’ll often log in, take the titles from Google scholar and plug them into the respective journals (for some reason I can’t just click the Google scholar link)

If you don’t have some type of access you’re going to be limited to the NIH articles or some of the more popular ones, which while not a bad thing may not be enough info.

Also, it may not be a 1:1 with the population the article used but still may be useful. Not very familiar with Rett syndrome so I would want to see if having that would add any layers of complexity to an otherwise fairly straightforward intervention irrespective of dx.

[u/SnooFoxes7643 → u/newyorklogic]

Thanks, I'm mostly looking for any information if there are people who have done deep research into this topic before I go on the endeavor on my own. If people have done this dive before and found a solid collection of research to refer me to, it would help to not reinvent the wheel.
I'm already doing separate research on Rett syndrome.

[u/AuntieCedent]

Could they be hot? Depending on where you are, the past six weeks tracks pretty well with when indoor spaces would have started being heated and getting stuffy. I don’t know if taking their temperature at different points in the day could help figure this out, and/or maybe experimenting with different types of clothing.

[u/SnooFoxes7643 → u/AuntieCedent]

No, our heaters borderline don’t work. She stands there naked and shivering. We all have double layers on

[u/PuzzleheadedYou6751]

Have you identified a function?

[u/SnooFoxes7643 → u/PuzzleheadedYou6751]

We haven't been able to. We believe it's attention, but the BCBA is having trouble within it. It's almost like an attention-control (I know, not a formal function) piece. We can't even find a reliable HRE condition to do an assessment.

[u/Overall-Abroad1239]

Does it feel like a discrimination error? I wonder what the individual's undressing routine is at home, to bathe, change clothes, etc, whether taking shoes off is typically followed by undressing, and whether they've had any recent changes in that environment.

If taking shoes off is the first step to getting undressed, it could be a pretty strong chain. You might consider stimulus control/teaching a new chain of what comes next after removing shoes at school.

[u/SnooFoxes7643 → u/Overall-Abroad1239]

I had to put on my ABA hat when you said discrimination 😂

The behavior started at home with her "babysitter" PCA. We either don't know, or haven't been told all the events surrounding that.