Latency and persistence of renewal in an intensive outpatient clinic

Abstract

Treatment durability can be compromised when challenging behavior recurs following context changes (i.e., renewal), yet the temporal features of lapses have not been well described in large clinical samples. We examined latency to onset and persistence of renewal to inform clinical monitoring and planning following context changes. Using a retrospective consecutive case series of 98 patients receiving intensive outpatient treatment for challenging behavior, we analyzed 749 context changes involving person, setting, and task variables. Renewal emerged quickly (M = 1–2 sessions), with half beginning in the first postchange session. Persistence was often brief (49.74% resolved within one session), whereas 32.28% persisted for three or more sessions and 12.17% for five or more. Latency and persistence did not differ meaningfully across context-change types. Latency was not systematically associated with magnitude or persistence, whereas greater renewal magnitude predicted prolonged persistence. Results support extended monitoring and high-fidelity implementation following context changes.