Toward a functional analysis of self-injury

A molecular to molar analysis of communicative and problem behaviors

Few studies have examined the relationship between communicative and problem behaviors that are already present in a behavioral repertoire. In this study, a detailed microanalysis of the antecedents and consequences of aggressive and communicative behavior of a 7-year-old boy was conducted. By using both descriptive and experimental methodologies, the data suggested that problem and communicative behavior were maintained on thin concurrent schedules of social negative reinforcement. A molar analysis of the descriptive data showed that the relative amount of time allocated to each behavior was a function of the relative amount of reinforcement that each behavior accrued. The implications of these findings are discussed in terms of conducting descriptive analyses and for enhancing the efficacy of interventions for problem behavior.

An evaluation of functional variables affecting severe problem behaviors in adults with mental retardation by using the Questions about Behavioral Function Scale (QABF)

We examined the functions of five severe problem behaviors in a sample of 417 institutionalized persons with mental retardation by using the Questions About Behavior Function Scale. The behaviors we examined included self-injurious behavior, aggression, stereotypies, pica, and rumination. The most common function for all behaviors except aggression was nonsocial. Aggression, however, was maintained by external environmental contingencies. Particular items of the Questions About Behavior Function Scale were identified as more frequently occurring and critical in ascertaining behavioral function. Implications of these results for developing more effective treatment plans are discussed.

A brief method for conducting a negative-reinforcement assessment

A brief negative-reinforcement assessment was conducted with developmentally disabled children with severe destructive behavior. Five children were trained to engage in a simple escape response (e.g., a hand clap). Then each child was presented with a variety of stimuli or tasks that ranged on a scale from preferred to nonpreferred, based on parent ranking. The participant received a brief break from the stimuli or task, contingent on each escape response. For one child, an avoidance contingency was also implemented in which he could engage in the response to avoid the presentation of stimuli. Results showed that for each child, several stimuli were identified that may serve as effective negative reinforcers. Results also indicated that the procedure did not elicit any negative side effects for four children and low rates of destructive behavior for the fifth child. For one child, the results of the negative-reinforcement assessment were used to develop an effective treatment for destructive behavior. Additional applications of the reinforcement assessment to treatment interventions is discussed, as well as limitations to the procedure.

Combining descriptive and experimental analyses of young children with behavior problems in preschool settings

This investigation shows the merits of preceding experimental analyses with descriptive analyses of functional variables with preschool children who engage in problematic behavior. A two-phase descriptive analysis was conducted in daycare settings with three children. In Phase 1, the authors assessed the relation between child behavior and structural events. During Phase 2, the same behavior was replotted by functional variables. The results showed that when the descriptive data were plotted via functional variables, specific hypotheses could be generated regarding the variables controlling appropriate behavior. This procedure permitted the subsequent use of very brief experimental analyses to further identify functional relations. The use of descriptive analyses of functional rather than structural variables may be an important component in the assessment of problem behavior in community settings.

Clarifying an ambiguous functional analysis with matched and mismatched extinction procedures

Results of functional analysis were ambiguous in suggesting that self-injurious behavior (SIB) was maintained by escape, sensory reinforcement, or both. To help clarify these results, we compared escape extinction, sensory extinction, and the combined treatments. Sensory extinction proved to be a necessary and sufficient treatment, whereas escape extinction failed to decrease SIB. These analyses helped to clarify the function of SIB and to identify an effective and efficient treatment.

Within-session patterns of responding during functional analyses: the role of establishing operations in clarifying behavioral function

Functional analysis procedures have been demonstrated to be effective for identifying the operant mechanisms underlying problem behavior. However, functional analyses sometimes yield results that are undifferentiated (i.e., show similar levels of responding across test conditions). Within-session (i.e., minute-by-minute) analyses of response patterns during undifferentiated functional analyses have proven useful in clarifying behavioral function. This study extends previous research by examining within-session changes in responding associated with variations in relevant establishing operations. Levels of problem behavior during the presentation and removal of reinforcement were compared when responding occurred in test conditions associated with sources of social reinforcement (i.e., access to attention, materials, escape). Results showed that changes in responding associated with changes in relevant establishing operations could be examined to clarify behavioral function.

On the effects of "quality" of attention in the functional analysis of destructive behavior

Two young children with mental retardation displayed inconclusive patterns of destructive behavior when a functional analysis was conducted using the procedures described by Iwata et al. (1982/1994). A second functional analysis incorporated modifications to the social attention condition that were based on interview data from care providers and descriptive observations. Results of the modified social attention condition indicated that a specific "quality" of attention was needed to identify the maintaining contingency for destructive behavior within an experimental analysis. Results are discussed in terms of considerations for further assessment when traditional analog functional analysis conditions are ineffective in isolating maintaining contingencies for destructive behavior.

An analysis of choice making in the assessment of young children with severe behavior problems

We examined how positive and negative reinforcement influenced time allocation, occurrence of problem behavior, and completion of parent instructions during a concurrent choice assessment with 2 preschool-aged children who displayed severe problem behavior in their homes. The children were given a series of concurrent choice options that varied availability of parent attention, access to preferred toys, and presentation of parent instructions. The results showed that both children consistently allocated their time to choice areas that included parent attention when no instructions were presented. When parent attention choice areas included the presentation of instructions, the children displayed differential patterns of behavior that appeared to be influenced by the presence or absence of preferred toys. The results extended previous applications of reinforcer assessment procedures by analyzing the relative influence of both positive and negative reinforcement within a concurrent-operants paradigm.

On the relation between object manipulation and stereotypic self-injurious behavior

Results from a number of studies have shown an inverse relationship between stereotypic behavior and object manipulation. The purposes of this study were to determine whether techniques similar to those used previously (prompting and reinforcement) would be effective in increasing object manipulation under both prompted and unprompted conditions, and to ascertain whether increases in object manipulation would result in decreases in stereotypic self-injurious behavior (SIB). Two individuals with developmental disabilities who engaged in SIB maintained by automatic reinforcement participated. Results showed that object manipulation increased from baseline levels when experimenters prompted participants to manipulate leisure items, but that object manipulation was not maintained under unprompted conditions, and rates of SIB stayed within baseline levels. We then attempted to increase object manipulation further by (a) reinforcing object manipulation, (b) blocking SIB while reinforcing manipulation, and (c) preventing SIB by applying protective equipment while reinforcing object manipulation. Reinforcing object manipulation alone did not affect levels of object manipulation. Blocking effectively reduced attempts to engage in SIB for 1 participant but produced no increase in object manipulation. When the 2nd participant was prevented from engaging in SIB through the use of protective equipment, rates of object manipulation increased dramatically but were not maintained when the equipment was removed. These results suggest that stimulation derived from object manipulation, even when supplemented with arbitrary reinforcement, may not compete with stimulation produced by stereotypic SIB; therefore, direct interventions to reduce SIB are required.

The use of symmetrical "do" and "don't" requests to interrupt ongoing activities

The results of a modified functional analysis demonstrated that aggression, displayed by a 27-year-old man, was occasioned by the use of "don't" requests to interrupt the client's ongoing and often inappropriate activities (e.g., lying on the floor, pica, inappropriate touching of others). Subsequent analyses demonstrated that aggression was lower when ongoing activities were interrupted with symmetrical "do" requests than with "don't" requests. An intervention utilizing symmetrical "do" requests (i.e., prompting an individual to engage in an incompatible behavior) to interrupt such activities resulted in reduced levels of aggression.

Rapid assessment of the effects of restraint on self-injury and adaptive behavior

We evaluated the effects of restraint on occurrences of self-injurious behavior (SIB) and adaptive responses exhibited by 2 individuals across eight response-effort conditions: baseline (no restraints); restraint sleeves without stays; restraints with 5, 10, 15, 20, or 25 thin metal stays; and restraints with five thick metal stays. From this analysis, we identified a restraint level for each participant that reduced SIB but did not inhibit adaptive responding.

A functional analysis of hair pulling

We experimentally assessed the functions of hair pulling and hair manipulation of a 19-year-old woman (Kris) with moderate mental retardation and cerebral palsy. In Phase 1 a functional analysis revealed that Kris pulled and manipulated hair for the greatest amount of time in the alone condition, suggesting that the behaviors were maintained by some form of automatic reinforcement (Vaughan & Michael, 1982). In Phase 2 we assessed the nature of the sensory stimulation that maintained hair pulling by providing continuous access to previously pulled or cut hair and, thereafter, by having Kris wear a rubber glove. The results suggested that hair pulling was maintained by digital-tactile stimulation (automatic positive reinforcement). These findings are discussed, and recommendations for further analyses of automatically reinforced habit behaviors are provided.

DRO contingencies: an analysis of variable-momentary schedules

We conducted several comparative analyses to determine the relative effectiveness of variable-momentary differential-reinforcement-of-other-behavior (VM DRO) schedules. Three individuals who had been diagnosed with mental retardation participated. Results of functional analyses indicated that their self-injurious behavior (SIB) was maintained by social-positive reinforcement. Two individuals participated in a two-stage comparative analysis within multielement and multiple baseline designs. Fixed-interval (FI) and variable-interval (VI) DRO were compared in the first stage; VI DRO and VM DRO were compared in the second. All three schedules effectively reduced the participants' SIB. Treatment for the 3rd individual was conducted in a reversal design to examine the effects of VM DRO when it was implemented in isolation, and results indicated that the procedure was effective in reducing SIB. These findings suggest that VM DRO schedules may represent attractive alternatives to traditional FI schedules because momentary schedules do not require continuous monitoring and may result in higher rates of reinforcement.

False-positive maintenance of self-injurious behavior by access to tangible reinforcers

Results of a functional analysis indicated that the hand mouthing of a woman with developmental disabilities was maintained by multiple sources of control (sensory stimulation and access to a leisure item). Further assessment revealed that access to several other items also produced high rates of hand mouthing. However, direct observation conducted in the woman's home indicated that none of these items was delivered contingent upon hand mouthing. When the consequence observed most frequently in the home was incorporated into the functional analysis, rates of hand mouthing were no higher than they were during an alone condition. We concluded that hand mouthing, although maintained by automatic reinforcement, was also susceptible to social contingencies when exposed to them during assessment, thereby producing a partially false-positive outcome.

Effects of presession attention on the frequency of attention-maintained behavior

The effect of prior attention was systematically manipulated to study its influence on rates of yelling and head hitting, both maintained by positive reinforcement in the form of attention. Higher levels of head hitting occurred in analogue attention conditions when the person was deprived of attention (no social interactions for 1 hr) prior to the analysis in comparison to when the person received high levels of attention (attention delivered on a fixed-time 30-s schedule for 1 hr) prior to the analysis.

Evaluation of antecedent stimulus parameters for the treatment of escape-maintained aberrant behavior

We evaluated a methodology for identifying the range of stimulus features of antecedent stimuli associated with aberrant behavior in demand contexts in natural settings. For each participant, an experimental analysis of antecedents (Phase 1) was conducted to confirm the hypothesis that task instructions occasioned increases in aberrant behavior. During Phase 2, specific stimulus features associated with the presentation of task instructions were assessed by evaluating the child's behavior across two distinct settings, therapists, and types of tasks in a sequential fashion. Aberrant behavior occurred immediately across settings and therapists, presumably because the presence of a discriminative stimulus for escape-maintained behavior (the delivery of a task instruction) occasioned aberrant behavior. However, aberrant behavior decreased initially across tasks, suggesting that familiarity with the task might be a variable. During Phase 3, an experimental (functional) analysis of consequences was conducted with 2 participants to verify that aberrant behavior was maintained by negative reinforcement. During Phase 4, a treatment package that interspersed play with task instructions was conducted to disrupt the ongoing occurrence of aberrant behavior. Immediate and durable treatment effects occurred for 2 of the 3 participants.

Multicomponent assessment and treatment of cigarette pica

We conducted a multicomponent assessment and treatment for 4 individuals who engaged in cigarette pica. During Phase 1, three stimulus preference assessments were conducted to identify (a) the reinforcing component of the cigarette, (b) potential alternative reinforcers that may be used during treatment, and (c) whether the alternative reinforcer would compete effectively with cigarettes. Results were successful in identifying the reinforcing component of the cigarette and suggested the feasibility of using alternative reinforcers during treatment to eliminate cigarette pica. During Phase 2, the effects of two treatment procedures were evaluated. Noncontingent reinforcement (NCR) with the alternative edible reinforcer reduced the pica of 2 of the participants, but effects were not maintained when the initial dense schedule of NCR was thinned. Subsequently, differential reinforcement of alternative behavior with the alternative edible reinforcer was effective in reducing pica for 3 participants. An evaluation of nine treatment procedures failed to identify an effective intervention for the remaining participant; consequently, preventive measures were designed to minimize occurrences of cigarette pica.

Effects of reinforcement magnitude on spontaneous recovery

Extinction of operant behavior has been associated with a number of undesirable effects. One such effect is the temporary reappearance of behavior after responding appears to be completely extinguished, known as spontaneous recovery. In this report, the occurrence of spontaneous recovery and its attenuation with large amounts of reinforcement were examined during the treatment of disruption.

The impact of functional analysis methodology on treatment choice for self-injurious and aggressive behavior

Self-injurious behavior (SIB) and aggression have been the concern of researchers because of the serious impact these behaviors have on individuals' lives. Despite the plethora of research on the treatment of SIB and aggressive behavior, the reported findings have been inconsistent regarding the effectiveness of reinforcement-based versus punishment-based procedures. We conducted a literature review to determine whether a trend could be detected in researchers' selection of reinforcement-based procedures versus punishment-based procedures, particularly since the introduction of functional analysis to behavioral assessment. The data are consistent with predictions made in the past regarding the potential impact of functional analysis methodology. Specifically, the findings indicate that, once maintaining variables for problem behavior are identified, experimenters tend to choose reinforcement-based procedures rather than punishment-based procedures as treatment for both SIB and aggressive behavior. Results indicated an increased interest in studies on the treatment of SIB and aggressive behavior, particularly since 1988.

Effects of reinforcement for alternative behavior during punishment of self-injury

A number of variables influence the effectiveness of punishment and may determine the extent to which less intrusive forms of punishment may be used as alternatives to more intrusive interventions. For example, it has been suggested that response suppression during punishment may be facilitated if reinforcement is concurrently available for an alternative response. However, results of basic research demonstrating this finding have not been replicated with interventions more commonly prescribed as treatments for problem behavior. We evaluated the effects of relatively benign punishment procedures (reprimands or brief manual restraint) on the self-injurious behavior of 4 individuals who had been diagnosed with mental retardation, when access to reinforcement for alternative behavior (manipulation of leisure materials) was and was not available. In all cases, punishment produced greater response suppression when reinforcement for an alternative response was available.

Further analysis of problem behavior in response class hierarchies

A functional analysis identified the reinforcers for 3 participants' problem behavior, but only relatively mild problem behaviors (e.g., screaming, disruption) were observed when all topographies produced tested consequences. We then conducted an extinction analysis in which specific topographies produced a reinforcer while all other topographies were on extinction. The extinction analysis confirmed that the same reinforcer identified in the initial functional analysis maintained more severe topographies of problem behavior (e.g., aggression). In addition, results of the extinction analysis indicated that 2 of the participants displayed patterns of responding consistent with a response class hierarchy hypothesis, in which less severe problem behavior frequently occurred prior to more severe topographies. The 3rd participant displayed a response pattern indicative of differential reinforcement effects.

Effects of session duration on functional analysis outcomes

We examined the extent to which variations in session duration affected the outcomes of functional analyses. Forty-six individuals, all diagnosed with mental retardation and referred for assessment and treatment of self-injurious or aggressive behavior, participated in functional analyses, consisting of repeated exposure to multiple test conditions during 15-min sessions. For each set of assessment data, new data sets based on session durations of 10 and 5 min were prepared by deleting data from the last 5 and 10 min, respectively, of each session. Each graph (N = 138) was then reviewed individually by graduate students who had previous experience conducting and interpreting functional analyses, but who were blind to both participant identity and session duration. Interpretations of behavioral function based on the 10- and 5-min data sets were then compared with those based on the 15-min data sets. All of the 10-min data sets yielded interpretations identical to those based on 15-min data sets. Interpretations based on the 5-min and 15-min data sets yielded three discrepancies, all of which were the result of increased response rates toward the latter parts of sessions. These results suggest that the efficiency of assessment might be improved with little or no loss in clarity by simply reducing the duration of assessment sessions.

Evaluating self-control and impulsivity in children with severe behavior disorders

Impulsivity and self-control involve a choice between a smaller, more immediate reinforcer and a larger, more delayed reinforcer. Impulsive behavior occurs when responding produces the more immediate, relatively smaller reinforcers at the expense of delayed larger reinforcers. Self-control occurs when responding produces delayed larger reinforcers at the expense of immediate smaller reinforcers. Recently, researchers in applied behavior analysis have suggested that evaluations of self-control and impulsivity are relevant to socially important behaviors. Further, common behavioral treatments such as differential reinforcement may be influenced by variables such as reinforcer delay. In this study, we showed that aggression, reinforced by access to food, could be maintained as impulsive behavior. The participants were 2 young boys with severe developmental disabilities. For both participants, descriptive observations, care provider report, and functional analyses suggested that aggression was reinforced by food access (and television access for 1 participant). Next, we introduced a differential reinforcement procedure in which appropriate mands were reinforced. After various manipulations, we showed that aggression occurred when it produced immediate but small reinforcers even though mands produced larger, more delayed reinforcers. However, both participants displayed self-control when the delay to reinforcement was signaled (with a hand gesture or a timer).

An evaluation of the properties of attention as reinforcement for destructive and appropriate behavior

The analogue functional analysis described by Iwata, Dorsey, Slifer, Bauman, and Richman (1982/1994) identifies broad classes of variables (e.g., positive reinforcement) that maintain destructive behavior (Fisher, Ninness, Piazza, & Owen-DeSchryver, 1996). However, it is likely that some types of stimuli may be more effective reinforcers than others. In the current investigation, we identified 2 participants whose destructive behavior was maintained by attention. We used concurrent schedules of reinforcement to evaluate how different types of attention affected both destructive and appropriate behavior. We showed that for 1 participant praise was not an effective reinforcer when verbal reprimands were available; however, praise was an effective reinforcer when verbal reprimands were unavailable. For the 2nd participant, we identified a type of attention that effectively competed with verbal reprimands as reinforcement. We then used the information obtained from the assessments to develop effective treatments to reduce destructive behavior and increase an alternative communicative response.

Correspondence between outcomes of brief and extended functional analyses

We compared results obtained from 50 sets of functional analysis data from assessments of self-injurious behavior (SIB), 35 of which showed clear response patterns and 15 of which were undifferentiated, with those obtained from two abbreviated methods of assessment: (a) a brief functional analysis, consisting of the first session of each condition from the full functional analysis, and (b) a within-session analysis, in which data from the brief analysis were regraphed to show minute-by-minute changes in response rates during a session. Results indicated that outcomes of the brief and within-session analyses corresponded with those of the full functional analyses in 66.0% and 68.0% of the cases, respectively. Further examination of results indicated a tendency for the brief analysis to identify a large proportion of positive cases (both true and false positives) and for the within-session analysis to identify a large proportion of negative cases (true and false negatives).

Reinforcement of compliance with respiratory treatment in a child with cystic fibrosis

An 8-year-old boy with cystic fibrosis (CF), mental retardation, and autism exhibited noncompliance with respiratory treatments that were essential for the management of his CF. A treatment involving shaping cooperation while still allowing escape for aggression and avoidance behavior resulted in increases compliance with respiratory treatments and decreases in problem behavior. Treatment gains were maintained over 3 months.

Competition between positive and negative reinforcement in the treatment of escape behavior

We compared the effects of reinforcing compliance with either positive reinforcement (edible items) or negative reinforcement (a break) on 5 participants' escape-maintained problem behavior. Both procedures were assessed with or without extinction. Results showed that compliance was higher and problem behavior was lower for all participants when compliance produced an edible item rather than a break. Treatment gains were achieved without the use of extinction. Results are discussed regarding the use of positive reinforcement to treat escape behavior.

Use of noncontingent reinforcement in the treatment of challenging behavior. A review and clinical guide

Recently, noncontingent reinforcement (NCR) has been used to reduce challenging behavior in persons with developmental disabilities. In this context, NCR involves reinforcement on a fixed-time schedule irrespective of behavior. The present article reviews studies involving NCR for the treatment of challenging behavior. Based on this review, a clinical guide for the implementation of NCR is delineated. NCR appears to depend on ensuring that reinforcement matches the function of the challenging behavior. Initially, noncontingent reinforcement should be provided on a continuous basis. The schedule can then be faded from continuous reinforcement to a more appropriate level in a number of ways. NCR can also be combined with additional educationally oriented interventions to promote skill development. Given its ease of implementation and other potential advantages, NCR would appear particularly relevant for applied settings. The clinical guide may offer some assistance to practitioners.

The effects of noncontingent and contingent attention for self-injury, manding, and collateral responses

To date, most functional analysis studies have focused on the effects of treatment contingencies on specific targeted aberrant and alternative responses. In the current investigation, the main and collateral effects of the assessment and treatment of attention-maintained self-injury were assessed. Specifically, we evaluated the effects of noncontingent and contingent social attention on four categories of behavior: self-injury, a novel mand, preexisting prosocial responses (e.g., babbling and reaching out), and other aberrant responses (i.e., aggression and destruction). Results suggested that self-injury, prosocial responses, and other aberrant behaviors were within the same functional response class. Possible impact of these results when selecting mands for functional communication training is discussed.

An analysis of maladaptive behaviors in persons with autism, PDD-NOS, and mental retardation

In this study, we examined three maladaptive behaviors, self-injurious behavior (SIB), stereotypies, and aggression in adults with autism, pervasive developmental disorder, not otherwise specified (PDD-NOS), and mental retardation. We used a brief functional analysis rating scale. The Questions About Behavioral Functions (QABF), to examine the function of each behavior. Across the three groups, our results indicated that aggression was primarily maintained for attentional reasons and stereotypies for nonsocial reasons. No specific function(s) were found to maintain SIB. These results suggest that the function of a maladaptive behavior may be associated more with the particular maladaptive behavior displayed rather than inclusion in a certain diagnostic group. Implications of findings for assessment and treatment issues are discussed.

On the establishing and reinforcing effects of termination of demands for destructive behavior maintained by positive and negative reinforcement

The results of functional analyses suggested that the destructive behavior of two individuals was sensitive to escape and attention as reinforcement. In an instructional context, we evaluated the effects of reinforcing compliance with functional reinforcers when destructive behavior produced a break. For one participant we also evaluated the effects of reinforcing compliance with functional reinforcers when destructive behavior produced no differential consequence (escape extinction). We hypothesized that destructive behavior failed to decrease in an instructional context when compliance resulted in a break because presentation of a break evoked attention-maintained destructive behavior. The results of a reinforcer assessment supported this hypothesis by demonstrating that demands functioned as positive reinforcement when no alternative activities were available. These results are discussed in terms of the importance of establishing operations in determining the appetitive or aversive properties of stimuli when destructive behavior is multiply controlled.

The Motivation Assessment Scale: reliability and construct validity across three topographies of behavior

The psychometric properties of the Motivation Assessment Scale (MAS) were examined. Specifically, reliability, internal consistency, and construct validity were estimated using 90 ratings of different problem behaviors among 86 individuals with mental retardation. Data were analyzed under conditions of (a) three topographies of problem behavior and (b) two methods of calculation. Although reliability and internal consistency were generally poor, the results depended upon the above conditions. Factor analysis revealed that the four factors of the MAS differed from the subscale structure obtained in this study, proposed by the authors of the MAS. Thus, the construct validity of this scale was ambiguous. It is concluded that the MAS should be employed in conjunction with other instruments to assess the functional characteristics of problem behavior with individuals who have mental retardation.

Overview of the treatment of rumination disorder for adults in a residential setting

Rumination, or the chewing and re-swallowing of regurgitated stomach contents, can be found in up to 10% of institutionalized individuals with severe or profound mental retardation. Serious physical consequences, including death, can result from the disorder. Unfortunately, rumination can be subtle and difficult to observe and often continues untreated. Additionally, the research literature has provided divergent results without clear treatment guidance for clinicians. We present an overview of the history of rumination, a review of the literature on its etiology and treatment, and recommendations for future research.

The evaluation and treatment of aggression maintained by attention and automatic reinforcement

In the current investigation, we used direct and indirect methods to assess and treat several topographies of aggression that were hypothesized to have separate operant functions in a young boy with severe mental ratardation and pervasive developmental disorder. First, a functional analysis of aggression, using the methods described by Iwata, Dorsey, Slifer, Bauman, and Richman (1982/1994), was conducted and produced inconclusive results. Next, indirect methods were used to develop a second functional analysis, which showed that chin grinding (firmly pressing and grinding his chin against the skin and bones of others) persisted independent of social contingencies and that the other topographies of aggression (e.g., hitting, kicking) were maintained by social positive reinforcement (attention). A treatment designed to decrease aggression maintained by attention--functional communication training with extinction--reduced all forms of aggression except chin grinding. This latter topography of aggression, which we hypothesized was maintained by automatic reinforcement, was reduced when the response--reinforcer relation was interrupted through response blocking and the child was provided with an alternative form of chin stimulation.

Fixed-time schedules attenuate extinction-induced phenomena in the treatment of severe aberrant behavior

We compared the effects of extinction (EXT) and fixed-time (FT) schedules as treatment for severe problem behavior displayed by 3 individuals with developmental disabilities. First, functional analyses identified the reinforcers maintaining aberrant behavior for all 3 individuals. Next, EXT and FT schedules were compared using a multielement design. During EXT, the reinforcer maintaining problem behavior was withheld. During FT, the reinforcers were presented response independently at preset intervals. Results showed that FT schedules were generally more effective than EXT schedules in reducing aberrant behavior. FT schedules may be used in situations when extinction-induced phenomena are problematic.

Functional analysis and treatment of destructive behavior maintained by termination of "don't" (and symmetrical "do") requests

We used descriptive assessment information to generate hypotheses regarding the function of destructive behavior for 2 individuals who displayed near-zero rates of problem behavior during an experimental functional analysis using methods similar to Iwata, Dorsey, Slifer, Bauman, and Richman (1982/1994). The descriptive data suggested that destructive behavior occurred primarily when caregivers issued requests to the participants that interfered with ongoing high-probability (and presumably highly preferred) behaviors (i.e., a "don't" or a symmetrical "do" request). Subsequent experimental analyses showed that destructive behavior was maintained by contingent termination of "don't" and symmetrical "do" requests but not by termination of topographically similar "do" requests. These results suggested that destructive behavior may have been maintained by positive reinforcement (i.e., termination of the "don't" request allowed the individual to return to a highly preferred activity). Finally, a treatment (functional communication training plus extinction) developed on the basis of these analyses reduced destructive behavior to near-zero levels.

Applying behavior analysis to clinical problems: review and analysis of habit reversal

This article provides a review and analysis of habit reversal, a multicomponent procedure developed by Azrin and Nunn (1973, 1974) for the treatment of nervous habits, tics, and stuttering. The article starts with a discussion of the behaviors treated with habit reversal, behavioral covariation among habits, and functional analysis and assessment of habits. Research on habit reversal and simplified versions of the procedure is then described. Next the article discusses the limitations of habit reversal and the evidence for its generality. The article concludes with an analysis of the behavioral processes involved in habit reversal and suggestions for future research.

Assessment of stimulus generalization gradients in the treatment of self-injurious behavior

Descriptive and experimental analyses suggested that the self-injurious behavior (SIB) of a 10-year-old girl with severe mental retardation was maintained by attention. Additional analyses identified physical contact as the type of attention maintaining SIB; therefore, we hypothesized that physical proximity of an adult was a discriminative stimulus for SIB. Based on these findings, we systematically varied the distance between the participant and a therapist to assess stimulus generalization. Results showed that rates of SIB varied relative to the distance between the participant and therapist; the highest percentage of SIB occurred with the therapist positioned less than 0.5 m from the participant. Treatment consisted of placing the therapist at a specified distance (9.0 m) from the participant (during low-attention situations), noncontingent reinforcement, and extinction.

Reductions in self-injury produced by transcutaneous electrical nerve stimulation

Transcutaneous electrical nerve stimulation is used to reduce pain but also may be useful for self-injurious behavior (SIB). In the current investigation, a microcurrent electromedical device, classified as a transcutaneous electrical nerve stimulator (TENS), was applied with a man with Down syndrome who displayed SIB that persisted in the absence of social contingencies. Although clinically significant results were not maintained, a clear difference in the rates of SIB during active and inactive TENS was observed.

Effects of wrist weights on self-injurious and adaptive behaviors

The effects of wrist weights on the self-injurious and adaptive behaviors of a young boy with profound mental retardation were evaluated. Application of wrist weights reduced SIB by 92% and was associated with either increases or stable levels of multiple novel and preexisting adaptive behaviors.

Treatment of pica through multiple analyses of its reinforcing functions

We conducted functional analyses of the pica of 3 participants. The pica of 1 participant appeared to be maintained by automatic reinforcement; that of the other 2 participants appeared to be multiply controlled by social and automatic reinforcement. Subsequent preference and treatment analyses were used to identify stimuli that would complete with the automatic function of pica for the 3 participants. These analyses also identified the specific aspect of oral stimulation that served as automatic reinforcement for 2 of the participants. In addition, functional analysis-based treatments were used to address the socially motivated components of 2 of the participants' pica. Results are discussed in terms of (a) the importance of using the results of functional analyses to develop treatments for pica and (b) the advantages of developing indirect analyses to identify specific sources of reinforcement for automatically reinforced behavior.

Classroom-based functional and adjunctive assessments: proactive approaches to intervention selection for adolescents with attention deficit hyperactivity disorder

The present investigation evaluated the utility of classroom-based functional and adjunctive assessments of problem behaviors for 2 adolescents who met diagnostic criteria for attention deficit hyperactivity disorder (ADHD) and comorbid oppositional defiant disorder (ODD). For children with ADHD-ODD, environmental classroom variables, when systematically manipulated by teachers, were related to the occurrence and nonoccurrence of problem behaviors. Classroom interventions derived from information that was obtained during functional and adjunctive assessments and from subsequent analyses resulted in substantial reductions in problem behaviors. Teacher and student consumer satisfaction ratings indicated that the interventions were effective and feasible in the classroom setting.

Utilizing increased response effort to reduce chronic hand mouthing

The effects of increased response effort on levels of hand mouthing, leisure engagement, and adaptive elbow flexion were investigated with 2 individuals who had been diagnosed with profound disabilities. Arm restraints designed to alter the amount of physical effort necessary to engage in hand mouthing were used. Results indicated that the treatment strategy reduced levels of hand mouthing but produced only small to moderate reductions in levels of leisure engagement and adaptive elbow flexion. At follow-up, the effects of increased response effort on hand mouthing and leisure engagement were maintained for both participants; however, the restraints were associated with substantial reductions in adaptive elbow flexion for 1 participant.

Establishing discriminative control of responding using functional and alternative reinforcers during functional communication training

Functional communication training (FCT) is a popular treatment for problem behaviors, but its effectiveness may be compromised when the client emits the target communication response and reinforcement is either delayed or denied. In the current investigation, we trained 2 individuals to emit different communication responses to request (a) the reinforcer for destructive behavior in a given situation (e.g., contingent attention in the attention condition of a functional analysis) and (b) an alternative reinforcer (e.g., toys in the attention condition of a functional analysis). Next, we taught the participants to request each reinforcer in the presence of a different discriminative stimulus (SD). Then, we evaluated the effects of differential reinforcement of communication (DRC) using the functional and alternative reinforcers and correlated SDs, with and without extinction of destructive behavior. During all applications, DRC (in combination with SDs that signaled available reinforcers) rapidly reduced destructive behavior to low levels regardless of whether the functional reinforcer or an alternative reinforcer was available or whether reinforcement for destructive behavior was discontinued (i.e., extinction).

The effect of reinforcer preference on functional analysis outcomes

We combined functional analyses and concurrent-schedule assessments to identify reinforcer preference during situations in which problem behavior may have been multiply controlled. Participants were 3 children with developmental delays who engaged in problem behavior during toy play with another child and one adult present, suggesting that problem behavior may have been maintained by adult attention or access to tangible reinforcement. Thus, conditions were designed to test attention and access-to-toys hypotheses. Initial functional analyses suggested multiple control. Subsequent concurrent-schedule assessments identified preference between the reinforcers, and treatments were based on these findings. Findings are discussed regarding the assessment of potentially multiply controlled problem behavior.

A comparison of noncontingent reinforcement and sensory extinction as treatments for self-injurious behavior

We compared the effects of two treatments, noncontingent reinforcement (NCR) and sensory extinction (EXT), on the self-injurious behavior (SIB) exhibited by 3 individuals with developmental disabilities. Results of a functional analysis indicated that their SIB was not maintained by social reinforcement, as indicated by undifferentiated responding across assessment conditions or higher rates of responding in the along condition. Prior to treatment, leisure probes were conducted to identify highly preferred items for use in the NCR condition, and equipment probes were conducted to identify devices that produced the greatest behavioral suppression for use in the EXT condition. Following baseline, treatment was implemented in a multiple baseline across subjects design, and the effects of NCR and EXT were compared in a multielement format. During NCR sessions, participants had continuous access to a highly preferred item. During EXT sessions, participants wore equipment (gloves or protective sleeves) that seemed to attenuate stimulation directly produced by their SIB, while still allowing the behavior to occur. Results indicated that both procedures were effective in reducing SIB, although NCR was associated with either more rapid or greater overall response suppression.

Play versus alone conditions as controls during functional analyses of self-injurious escape behavior

We compared the effects of continuous reinforcement (play) and alone conditions as controls during functional analyses for 66 individuals whose self-injurious behavior (SIB) was maintained by escape. In every case, SIB was lower during both control conditions than it was during the test (demand) condition. However, SIB was lowest during the alone condition more often than it was during the play condition. Circumstances under which the alone condition might serve as an alternative or more suitable control for escape-maintained problem behaviors are discussed.

Effectiveness of functional communication training with and without extinction and punishment: a summary of 21 inpatient cases

Functional communication training (FCT) is a frequently used treatment for reducing problem behavior exhibited by individuals with developmental disabilities. Once the operant function of problem behavior is identified by a functional analysis, the client is taught to emit an appropriate communicative response to obtain the reinforcer that is responsible for behavioral maintenance. Studies on FCT have typically used small numbers of participants, have reported primarily on clients for whom FCT was successful, and have varied with respect to their use of other treatment components. The main purposes of the present study were to evaluate the efficacy of FCT for treating severe problem behavior in a relatively large sample of individuals with mental retardation (N = 21) and to determine the contribution of extinction and punishment components to FCT treatment packages. FCT with extinction was effective in reducing problem behavior for the majority of clients and resulted in at least a 90% reduction in problem behavior in nearly half the applications. However, when demand or delay-to-reinforcement fading was added to FCT with extinction, treatment efficacy was reduced in about one half of the applications. FCT with punishment (both with and without fading) resulted in at least a 90% reduction in problem behavior for every case in which it was applied.