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Neurobehavioral Unit (NBU)
Kennedy Krieger Institute • 707 North Broadway • Baltimore, MD 21205
About Our Program:
The Neurobehavioral Unit (NBU) is a 16-bed inpatient unit dedicated to the assessment and treatment of severe problem behavior displayed by individuals with autism and intellectual disabilities. This is a unique program that specializes in the treatment of severe and highly treatment resistant problems, provides intensive behavioral assessment and treatment services not available elsewhere, offers integrated and targeted application of behavioral and pharmacological interventions and espouses a data-based approach.
The program has been in existence since the early 1980's, and over the past five years alone has served patients from 20 states and several countries. The NBU is recognized as one of the leading programs in the nation for providing intensive behavioral treatment to individuals with severe behavior disorders and developmental disabilities as well as for offering advanced training in applied behavior analysis. Individuals up to the age of 21 years who are admitted to the NBU present with a variety of severe and sometimes life-threatening behavioral problems, as well as complex medical issues. Criteria for admission are that behavior is of such a severity and/or intensity that the individual is a danger to him or herself and is at risk for long-term residential placement. Admission length typically varies from three to six months. Referrals for individuals below age two, or over 19 years are considered for outpatient services.
Individuals admitted to the NBU inpatient service receive behavioral, psychiatric, educational, developmental and social assessments and interventions. Behavioral assessment and treatment strategies are derived from an applied behavior analysis (ABA) model. Interventions are developed based on the results of systematic behavioral assessments, including functional behavioral assessments (e.g., functional analysis), analysis of parent-child interactions and reinforcer assessments. The interventions are individually designed to decrease problem behavior, while increasing adaptive more appropriate responses. Furthermore, concomitant psychiatric disorders (e.g., mood disorders, ADHD) are also systematically evaluated and treated. Treatment effectiveness is systematically evaluated using reliable objective measures (i.e., direct-observation) and single-case designs. Behavioral and psychiatric interventions are developed and applied in an integrated manner to achieve the goal of formulating the safest, least restrictive and most effective treatment regimen for each patient. Outcome data collected over the past eight years indicate that the primary treatment goal of reducing problem behavior by at least 80 percent is achieved for more than 80 percent of patients.
A critical component of the program is to train caregivers (e.g., parents and teachers) to implement prescribed behavioral treatments. When possible, pre-admission home and school visits are conducted to assess both child and caregiver behavior. These assessments continue while the child is an inpatient. Once an effective treatment has been developed during the hospitalization, caregivers are trained to implement the intervention at mastery level (90 percent accuracy). Caregivers practice implementation of the treatment in a variety of naturalistic settings under the supervision of a behavior therapist to promote maintenance of treatment gains. Intensive outpatient services are initiated at the time of discharge by the NBU outpatient department to help ensure a smooth transition from the hospital to the client's home. Thereafter, the intensity of outpatient services varies depending on the needs of the patient and family.
The NBU has a long history of developing new and innovative procedures for the assessment and treatment of severe behavior disorders. In fact, over the past decade, there have been over 150 publications by NBU faculty related to behavioral assessments, communication training, behavior analysis, reinforcer identification, treatment development, pharmacological interventions and behavioral medicine. NBU faculty are also federally-funded research scientists, with several ongoing research grants sponsored by the National Institutes Health related to the study of autism, early intervention for problem behavior and basic behavioral processes. A recent article (Shabani et al., 2004, Scholarly Productivity in Applied Behavioral Analysis) identified several current and former NBU behavioral psychology faculty members as among the most prolific behavioral researchers and identified the Kennedy Krieger Institute/Johns Hopkins University as the most prolific clinical institution (third overall, among all clinical and non-clinical research institutions) for behavioral research.
Primary Program Goals:
- Serve as a model program for the evaluation and treatment of severe behavior disorders displayed by persons with developmental disabilities.
- Foster the development of new therapeutic procedures through systematic research on the nature and management of destructive behaviors.
- Promote the effective application of currently available treatments through training and consultation.
Application for Admission:
To make a referral or request for an international patient:
For additional assistance related to visas, travel and translation services appointments for international patients, please contact our affiliate, Johns Hopkins International.
Resources for Practitioners
- References: Automatic SIB & Self-Restraint (Hagopian, L. P. (2014). Delineating subtypes of self-injurious behavior. Invited address presented at the 17th Annual Meeting of the Maryland Association for Behavior Analysis, Baltimore, MD.) (PDF)
- Reinforcer Assessment for Individuals with Severe Disability (RAISD) (PDF)
- Paired Stimulus Preference Assessment Session Description & Data Sheet (PDF)
- Multiple Stimulus Without Replacement (MSWO) Preference Assessment Session Description & Data Sheet (PDF)
- Single Stimulus Preference Assessment Session Description & Data Sheet (PDF)