A consecutive controlled case series (CCCS) is a
clinical study
Clinical trials are prospective biomedical or behavioral research studies on human participants designed to answer specific questions about biomedical or behavioral interventions, including new treatments (such as novel vaccines, drugs, dietar ...
that involves aggregating multiple cases consecutively encountered wherein an experimentally controlled
single-case experimental design was employed with each case. The CCCS design differs from the
consecutive case series A consecutive case series is a clinical study that includes all eligible patients identified by the researchers during the study registration period. The patients are treated in the order in which they are identified. This type of study usually does ...
, because the latter reports on multiple cases where experimental control was not demonstrated, usually because a pre-post non experimental design was used. In contrast, a CCCS includes only cases where the intervention was evaluated using single-case experimental designs, such as a reversal design, where experimental control is demonstrated through the replication of treatment effects for each individual participant. Thus, the CCCS design has better
internal validity
Internal validity is the extent to which a piece of evidence supports a claim about cause and effect, within the context of a particular study. It is one of the most important properties of scientific studies and is an important concept in reason ...
than a consecutive case series. The CCCS design also address some concerns about the
external validity
External validity is the validity of applying the conclusions of a scientific study outside the context of that study. In other words, it is the extent to which the results of a study can be generalized to and across other situations, people, stim ...
or generality of findings of small-''n'' single-case experimental design studies because it explicitly includes all cases encountered, regardless of outcome. By including all cases, any bias favoring a particular outcome in controlled for, resulting in stronger external validity relative to studies describing fewer cases that were not consecutively encountered. Moreover, when a large number of individuals are included in the series, this provides opportunities to identify variables that may predict treatment outcomes. Consecutive controlled case-series studies examining behavior analytic interventions of late have examined functional communication training. schedule thinning during functional communication training, and functional analysis and treatment using caregivers.
As with any experimental design, the CCCS design has limitations. When the sample in the series is drawn from a particular clinic, there is the potential that that sample may not be representative of the broader population because of
referral bias. One additional limitation of reporting on a series of cases receiving clinical treatment (as opposed to participants enrolled in a formal research protocol) is that there tend to be variations in how the treatment is applied across participants. This is particularly the case with behavioral interventions which are individualized, and continuously evaluated, and altered based on the individual’s response. An ideal middle ground would involve the use of treatment algorithms to structure how treatment components are sequenced while still preserving the response-guided approach that is the hallmark of
good clinical practice Good clinical practice (GCP) is an international quality standard, which governments can then transpose into regulations for clinical trials involving human subjects. GCP follows the International Council for Harmonisation of Technical Requirements ...
in applied behavior.
See also
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Single-subject research
Single-subject research is a group of research methods that are used extensively in the experimental analysis of behavior and applied behavior analysis with both human and non-human participants. This research strategy focuses on one participant a ...
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Applied behavior analysis
Applied behavior analysis (ABA), also called behavioral engineering, is a psychological intervention that applies empirical approaches based upon the principles of respondent and operant conditioning to change behavior of social significance. ...
References
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External links
Scientific Support for Applied Behavior AnalysisApplied Behavior Analysis: The Scientific Approach to Autism Therapy, Part II
Clinical research