Board certified behavior analysts are ethically required to first address destructive behavior using reinforcement-based and other less intrusive procedures before considering the use of restrictive or punishment-based procedures (ethics standard 2.15; Behavior Analyst Certification Board, 2020). However, the inclusion of punishment in reinforcement-based treatments may be warranted in some cases of severe forms of destructive behavior that poses risk of harm to the client or others. In these cases, behavior analysts are required to base the selection of treatment components on empirical assessment results (ethics standard 2.14; Behavior Analyst Certification Board, 2020). One such preintervention assessment is the stimulus avoidance assessment (SAA), which allows clinicians to identify a procedure that is likely to function as a punisher. Since the inception of this assessment approach, no studies have conducted a systematic literature review of published SAA cases. These data may be pertinent to examine the efficacy, generality, and best practices for the SAA. The current review sought to address this gap by synthesizing findings from peer-reviewed published literature including (1) the phenomenology and epidemiology of the population partaking in the SAA; (2) procedural variations of the SAA across studies (e.g., number of series, session length); (3) important quality indicators of the SAA (i.e., procedural integrity, social validity); and (4) how the SAA informed final treatment efficacy. We discuss findings in the context of the clinical use of the SAA and suggest several avenues for future research.

从道德上讲，委员会认证的行为分析师必须首先使用基于强化和其他侵入性较小的程序来解决破坏性行为，然后再考虑使用限制性或基于惩罚的程序（道德标准 2.15；行为分析师认证委员会，2020）。然而，在某些严重形式的破坏性行为对服务对象或其他人造成伤害的风险的情况下，在基于强化的治疗中纳入惩罚可能是必要的。在这些情况下，行为分析师需要根据经验评估结果选择治疗成分（道德标准 2.14；行为分析师认证委员会，2020 年）。其中一种干预前评估是刺激回避评估（SAA），它允许临床医生识别可能起到惩罚作用的程序。自这种评估方法开始以来，还没有研究对已发表的 SAA 案例进行系统的文献综述。这些数据可能与检查 SAA 的有效性、通用性和最佳实践相关。当前的审查试图通过综合同行评审的已发表文献的研究结果来解决这一差距，包括（1）参与 SAA 的人群的现象学和流行病学； (2) 不同研究中 SAA 的程序差异（例如，系列数量、会话长度）； （三）SAA的重要质量指标（即程序完整性、社会有效性）； (4) SAA 如何告知最终治疗效果。我们讨论了 SAA 临床应用的研究结果，并提出了未来研究的几种途径。