Research Units in Behavioral Intervention (RUBI)
An in-depth description of one package (RUBI) is provided below as an example of how multiple EBPs can be incorporated into one intervention package. This in-depth example is not intended as an endorsement of one approach over another and is intended for illustrative purposes only.
Research Units in Behavioral Intervention (RUBI) is a packaged, parent-mediated outpatient program (1-hour session per week) delivered one-to-one (therapist to caregiver) that is grounded in applied behavior analysis (ABA). RUBI involves therapists teaching caregivers how to implement a range of behavioral strategies over 11 core and 7 supplemental (focal-problem) sessions (e.g., toileting, feeding, sleep issues) in order to build a caregiver behavioral management “toolbox.”
RUBI emphasizes:
- tailoring the intervention to the child;
- identifying behavioral function instead of topography to inform behavioral strategy choice (i.e., targeting what is “driving” the behavior, instead of the behavior itself); and
- decreasing behavioral excess as well as increasing appropriate behaviors.
In the first session of RUBI, caregivers learn to identify the function(s) of a behavior by analyzing its antecedents and consequences. Subsequent sessions present strategies for preventing disruptive behavior (e.g., visual schedules for routine events), positive reinforcement for appropriate behavior, planned ignoring of inappropriate behavior, and techniques to promote compliance. In the final sessions, the therapist instructs caregivers on how to teach new daily living skills and how to maintain improvements over time.
RUBI uses a behavioral skills training approach, which includes direct instruction, modeling, role-play, and practice with feedback in order to effectively train caregivers in the various RUBI skills. Sessions also have accompanying video vignettes that are used to illustrate skills or test parental understanding of session materials. Every session ends with creation of a homework assignment where parents track their daily implementation of the strategies during the week.
RUBI was initially tested in a multi-site feasibility trial with 17 children aged 4 to 13 years old followed by a six-month, randomized trial comparing risperidone to risperidone plus RUBI in 124 school-age children with ASD and serious behavioral problems, defined as having an Aberrant Behavior Checklist-Irritability (ABC-I) subscale raw score of 15 or greater. In that study, risperidone plus parent training was superior to drug only. RUBI was then revised for younger children with ASD and co-occurring disruptive behaviors under the assumption that a downward extension of the manual may prevent the emergence of more severe behaviors in school-age children and avert the need for medication. An open pilot trial of RUBI as a stand-alone treatment in 16 children with ASD between the ages of 3 and 7 years supported its feasibility and initial efficacy.
The RUBI Autism Network then launched a NIMH-funded multisite trial in 180 children (age 3 to 7 years) with ASD and disruptive behavior. Participants were randomly assigned to RUBI or a structured parent education program (PEP) for six months. While both groups improved by Week 24, RUBI response was significantly higher (69% of children in RUBI were rated as “much improved” or “very much improved” compared to 40% in PEP).
