Single-case experimental design intervention for inappropriate sexualised behaviour in adolescent traumatic brain injury

Figures & data

Figure 1. The line graphs show a decrease in frequency of sexualised talk in the three settings after the introduction of the PBS intervention.

Three line graphs are displayed vertically to show frequency of sexualised talk behaviour decreasing after the staggered introduction of the PBS intervention in each of the three settings.

Figure 2. The line graphs show a decrease in the impact ratings in the three settings after the introduction of the PBS intervention. The impact ratings remained low in the School Boarding setting.

Three line graphs are displayed vertically to show the impact ratings of sexualised talk decreasing after the staggered introduction of the PBS intervention in the Home and Teaching School settings. The Boarding School setting’s impact ratings remain stable and low before and after the PBS intervention.

Table 1. The table described the procedure within each phase of the intervention for the baseline and three settings.

Baseline	Day 1: continuous monitoring of frequency and impact of sexualised talk begins across three settings: home by parent, school teaching staff and school boarding staff. Treating clinician completes functional analysis of behaviour. Generalised objective measure of Overt Behaviour Scale is completed
Home Setting	PBS intervention delivered to home setting on Day 15, involving family members, including functional analysis results and collaboratively developing risk management plan and antecedent-based intervention to manage antecedents for home setting. Continuous monitoring of frequency and impact of sexualised talk and touch across setting throughout remainder of the study. Face to face and telephone check-in with family at two points in the active intervention.
Teaching School Setting	PBS intervention delivered to school teaching staff, involving teaching and classroom support staff on Day 30, including functional analysis results and collaboratively developed risk management plan and intervention to manage antecedents for school teaching setting. Continuous monitoring of frequency and impact of sexualised talk across setting throughout remainder of the study. Face to face and telephone check-in with school teaching staff at two points in the active intervention.
Boarding School Setting	PBS intervention delivered to school boarding staff, involving evening leisure and night support staff on Day 44, including functional analysis results and collaboratively developed risk management plan to manage antecedents for school boarding setting. Continuous monitoring of frequency and impact of sexualised talk across setting throughout remainder of the study. Face to face and telephone check-in with school boarding staff at two points in the active intervention. Overt Behaviour Scale measure repeated.

Figure 3. The line graph shows a decrease in the frequency of sexualised touch in the home setting after the introduction of the PBS intervention.

A line graph showing the decreasing frequency of sexualised touch behaviour within the Home setting after the introduction of the PBS intervention.

Figure 4. The line graph shows a decrease in the impact ratings within the home setting for sexualised touch after the introduction of the PBS intervention.

A line graph showing the decreasing impact ratings for sexualised touch following the PBS intervention in the home setting.

Table 2. The table shows an example of a behaviour observation form to record behaviour and impact ratings.

Date /Day / Time	(A) Antecedents: What was happening prior to behaviour?	(B) Behaviour Please provide detailed description?(Tone of voice? Facial expression? Physical stance/ proximity/ demeanour?)	(C) Consequences: What was happening after the behaviour occurred?	Impact / distress caused Scale 1(no impact/distress)-5 (severe impact/distressed caused)
Monday	Came downstairs and walks into kitchen. Mother present alone in the room. Engage in conversation together. Physically walks towards mother.	“You look good, I could do you” Facial expression neutral. Eye contact is direct and intense – looks up and down mother’s body. Tone of voice – serious Stands beside her, very close proximity.	Stepfather enters the room and joins conversation. Mother walks towards stepfather. Walks out of kitchen into garage.	4

Recorder: Mother.

Table 3. The table shows the GAS goals utilised within the PBS intervention alongside baseline, outcome and improvement scores.

GAS Goal	Importance (1–3)	Difficulty (1–3)	Baseline measure (-2 to + 2)	Outcome measure (-2 to +2)	Measure of change
To reduce the frequency of inappropriate sexualised behaviour (sexual touch and talk)	3	2	Much Worse than Expected (-2)	Much Better than Expected (+2)	+4
To reduce the impact on females of his inappropriate sexualised behaviour (sexualised touch and talk)	3	2	Much Worse than Expected (-2)	Much Better than Expected (+2)	+4
To develop and maintain a relationship with a girl	2	2	Worse than Expected (-1)	Much Better than Expected (+2)	+3
Overall GAS Score	Baseline: 26.20 Outcome: 77.21 Overall GAS Improvement: 51.01

Figure 5. The column chart shows a decrease in Total Severity and Sexualised Behaviour Impact in the Overt Behaviour Scale scores when comparing pre and post intervention measures. Sexualised Behaviour Cluster remains stable due to continued sexualised talk behaviour.

A column chart showing the decreasing Total Severity score and Sexualised Behaviour Impact score on the Overt Behaviour Scale when comparing Baseline to Outcome measures. The Sexualised Behaviour Cluster remained stable because sexualised talk remained present after the intervention.