Transcript of the video Q&A with Julie Wambaugh.

The essence of single-subject design is using repeated measurements to really understand an individual's variability, so that we can use our understanding of that variability to determine what the effects of our treatment are.

For me, one of the first steps in developing a treatment is understanding what an individual does. So, if I were doing a group treatment study, I would not necessarily be able to see or to understand what was happening with each individual patient, so that I could make modifications to my treatment and understand all the details of what's happening in terms of the effects of my treatment. For me it's a natural first step in the progression of developing a treatment.

Also with the disorders that we deal with, it's very hard to get the number of participants that we would need for the gold standard randomized controlled trial. Using single-subject designs works around the possible limiting factor of not having enough subjects in a particular area of study.

My mentor was Dr. Cynthia Thompson, who was trained by Leija McReynolds from the University of Kansas, which was where a lot of single-subject design in our field originated, and so I was fortunate to be on the cutting edge of this being implemented in our science back in the late '70s early '80s. We saw, I think, a nice revolution in terms of attention to these types of designs, giving credit to the type of data that could be obtained from these types of designs, and a flourishing of these designs really through the 1980s into the 1990s and into the 2000s. But I think -- I've talked with other single-subject design investigators, and now we're seeing maybe a little bit of a lapse of attention, and a lack of training again among our young folks. Maybe people assume that people understand the foundation, but they really don't. And more problems are occurring with the science. I think we need to re-establish the foundations in our young scientists. And this project, I think, will be a big plus toward moving us in that direction.

Transcript of the video Q&A with Ralf Schlosser.

So what has happened recently, is with the onset of evidence-based practice and the adoption of the common hierarchy of evidence in terms of designs. As you noted the randomized controlled trial and meta-analyses of randomized controlled trials are on top of common hierarchies. And that's fine. But it doesn't mean that single-subject cannot play a role.

For example, single-subject design can be implemented prior to implementing a randomized controlled trial to get a better handle on the magnitude of the effects, the workings of the active ingredients, and all of that. It is very good to prepare that prior to developing a randomized controlled trial.

After you have implemented the randomized controlled trial, and then you want to implement the intervention in a more naturalistic setting, it becomes very difficult to do that in a randomized form or at the group level. So again, single-subject design lends itself to more practice-oriented implementation.

So I see it as a crucial methodology among several. What we can do to promote what single-subject design is good for is to speak up. It is important that it is being recognized for what it can do and what it cannot do.

The conditions in a single-subject experimental study are often assigned letters such as the A phase and the B phase, with A being the baseline, or no-treatment phase, and B the experimental, or treatment phase. (Other letters are sometimes used to designate other experimental phases.)

Generally, the A phase serves as a time period in which the behavior or behaviors of interest are counted or scored prior to introducing treatment.

In the B phase, the same behavior of the individual is counted over time under experimental conditions while treatment is administered.

Decisions regarding the effect of treatment are then made by comparing an individual's performance during the treatment, B phase, and the no-treatment.

McReynolds and Thompson (1986) 

Transcript of the video Q&A with Julie Wambaugh.

One of the biggest mistakes, that is a huge problem, is misunderstanding that a case study is not a single-subject experimental design. There are controls that need to be implemented, and a case study does not equate to a single-subject experimental design.

People misunderstand or they misinterpret the term "multiple baseline" to mean that because you are measuring multiple things, that that gives you the experimental control. You have to be demonstrating, instead, that you've measured multiple behaviors and that you've replicated your treatment effect across those multiple behaviors. So, one instance of one treatment being implemented with one behavior is not sufficient, even if you've measured other things. That's a very common mistake that I see.

There's a design -- an ABA design -- that's a very strong experimental design where you measure the behavior, you implement treatment, and you then to get experimental control need to see that treatment go back down to baseline, for you to have evidence of experimental control. It's a hard behavior to implement in our field because we want our behaviors to stay up! We don't want to see them return back to baseline.

Oftentimes people will say they did an ABA. But really, in effect, all they did was an AB. They measured, they implemented treatment, and the behavior changed because the treatment was successful. That does not give you experimental control. They think they did an experimentally sound design, but because the behavior didn't do what the design requires to get experimental control, they really don't have experimental control with their design.

In case study reports, procedures used in treatment of a particular client’s behavior are documented as carefully as possible, and the client’s progress toward habilitation or rehabilitation is reported. These investigations provide useful descriptions. . . .However, a demonstration of treatment effectiveness requires an experimental study.

A better role for case studies is description and identification of potential variables to be evaluated in experimental studies. An excellent discussion of this issue can be found in the exchange of letters to the editor by Hoodin (1986) [Article] and Rubow and Swift (1986) [Article].

McReynolds and Thompson (1986) 

Transcript of the video Q&A with Ralf Schlosser.

Myth 1: Single-subject experiments only have one participant.

• Obviously, it requires only one subject, one participant. But that's a misnomer to think that single-subject is just about one participant. You can have as many as twenty or thirty.

Myth 2: Single-subject experiments only require one pre-test/post-test.

• I think a lot of students in the clinic are used to the measurement of one pre-test and one post-test because of the way the goals are written, and maybe there's not enough time to collect continuous data.

  But single-case experimental designs require ongoing data collection. There's this misperception that one baseline data point is enough. But for single-case experimental design you want to see at least three data points, because it allows you to see a trend in the data. So there's a myth about the number of data points needed. The more data points we have, the better.

Myth 3: Single-subject experiments are easy to do.

• Single-subject design has its own tradition of methodology. It seems very easy to do when you read up on one design. But there are lots of things to consider, and lots of things can go wrong.

  It requires quite a bit of training. It takes at least one three-credit course that you take over the whole semester.