Discounting of Delayed Outcomes of Treatments for Problem Behavior or Language Development by Parents of Children with Autism

Background: Behavior analytic treatments have been shown to be relatively effective in addressing many symptoms of autism, including remediating skill deficits and decreasing problem behaviors (Campbell, 2003; Smith et al. 2008). However, these treatments can require implementation over extended periods of time. Delay discounting refers to the degree to which individuals devalue delayed outcomes. Typically, discounting has been evaluated by presenting individuals with choices between hypothetical immediate and delayed rewards of varying magnitudes. However, to date, no literature exists examining whether delay discounting influences the manner in which caregivers of children with autism value treatment outcomes. Additionally, there may be differences between the manner in which caregivers discount the value of delayed treatment outcomes based on the type of treatment goals (i.e., reduction of problem behavior vs. skill acquisition).

Objectives: The objective of this study was to extend the existing literature on delay discounting to caregivers of individuals with autism by examining the extent to which they discount delayed outcomes of behavioral treatments for their child’s problem behavior.

Methods: Caregivers of children with autism who were receiving treatment in one of two day-treatment programs for children with autism served as participants. Half were receiving treatment to reduce significant problem behavior, whereas the other half were receiving treatment to remediate skill deficits. Each caregiver was asked to operationally define their treatment goals for their child. Participants were then asked to make choices between hypothetical treatment outcomes. Each outcome varied with respect to the percentage of the treatments goals they had identified and the latency to achieving the stated outcome. Choices were presented in pairs of outcomes, one of which was always an immediate outcome. The value of the delayed treatment outcome was always fixed at 100% of the treatment goal achieved. For example, one choice trial consisted of “Would you prefer a treatment that will achieve 60% of your treatment goals immediately, or a treatment that will achieve 100% of your treatment goals 6 months from now?” If the caregiver selected the immediate treatment, then the next choice would ask “Would you prefer a treatment that will achieve 55% of your treatment goals immediately, or a treatment that will achieve 100% of your treatment goals 6 months now?” This titrating procedure continued until the caregiver switched from the immediate outcome to the delayed one. The process was repeated at 7 delay values (i.e., 1 week, 2 weeks, 1 month, 6 months, 1 year, 3 years, and 10 years).

Results: Both groups of participants demonstrated significant discounting of the delayed treatment outcomes.  However, preliminary results do not indicate any significant differences between the two groups with respect to the extent to which discounting occurred.  

Conclusions: This study demonstrates caregivers of children with autism discount the value of treatment outcomes based on the delay to those outcomes. This result highlights the need for those who deliver or develop treatment services to those with autism to continually refine their interventions to make them increasingly efficient.