Treatment of self-injury and hand mouthing following inconclusive functional analyses

Functional analysis and treatment of elopement

Elopement is a dangerous behavior because children who run away may encounter life-threatening situations (e.g., traffic). We conducted functional analyses of the elopement of 3 children who had been diagnosed with developmental disabilities. The results identified a maintaining reinforcer for the elopement of 1 child, but the data were difficult to interpret for 2 of the children. Subsequent reinforcer assessments were used to help to clarify the reinforcers for elopement for these 2 children. Results of the functional analyses and reinforcer assessments then were used to develop successful treatments to reduce elopement. The findings are discussed in terms of (a) the application of functional analysis methodology to elopement, (b) the use of reinforcer assessments to identify potential reinforcers when standard functional analyses are undifferentiated, and (c) the utility of assessment-based treatments for elopement.

Preference, choice, and persons with disabilities: a synopsis of assessments, interventions, and future directions

A recent revolution in service delivery for persons with developmental disabilities encompasses increased client independence and improved quality of life. Specifically, care providers have focused on client expressions of preference, choice-making, and choice availability as key elements of study in this new revolution. We review and critique the primary methods of assessing preference and choice for persons with disabilities, including interviews and questionnaires, pictorial presentations, technological apparati, and direct observation. We also provide an overview of the burgeoning literature on intervention programs designed to enhance choice for this population, such as giving more choice to clients, teaching choice-making skills, and improving staff member skills regarding choice availability. Finally, we provide a synopsis of the future directions in this area that should receive the most attention from researchers and caregivers.

Assessment of preference for varied versus constant reinforcers

One method that has been demonstrated to improve the effectiveness of reinforcement is stimulus (reinforcer) variation (Egel, 1980). Egel found that bar pressing increased and responding occurred more rapidly during varied reinforcement than during constant reinforcement when identical stimuli were used across phases for 10 individuals with autism. The purpose of the current investigation was to assess the preferences of 7 individuals for varied presentation of slightly lower quality stimuli relative to constant access to the highest quality stimulus. Varied presentation was preferred over constant reinforcer presentation with 4 participants, and the opposite was true for 2 participants. One participant did not demonstrate a preference. These results suggest that stimulus variation may allow less preferred reinforcers to compete effectively with a more highly preferred reinforcer for some individuals.

The effects of implementing program consequences with a group of individuals who engaged in sensory maintained hand mouthing

This study evaluated whether a multicomponent treatment package could be successfully implemented with individuals who engage in self-injurious hand mouthing maintained by sensory consequences in the context of both individual and small group settings. Three ambulatory individuals with profound mental retardation participated on an individual basis followed by treatment within a group setting. Generalization of the intervention results to the natural living environment was then analyzed. Using an ABAB experimental design, the effectiveness of brief response interruption followed by the introduction of a preferred leisure item to reduce hand mouthing during 15-min intervention sessions was analyzed. Results of these experiments showed that the intervention could be successfully implemented during individual and small group sessions and during group sessions conducted in the natural environment. The benefits and limitations of this intervention strategy and future research are discussed.

Time-based lag sequential analysis and the functional assessment of challenging behaviour

This paper describes the application of time-based lag sequential analysis to the functional assessment of challenging behaviours shown by people with severe learning disabilities. The potential uses of the approach are illustrated with regards to identifying: (1) aspects of the stimulus control of challenging behaviour; (2) antecedents to the occurrence of challenging behaviour; and (3) the environmental consequences of challenging behaviour. The uses and limitations of the approach are discussed.

Some current themes in functional analysis research

The purpose of this article is to review and discuss some current themes in functional analysis research. The paper is divided into two general sections; one section discusses clinical application of functional analysis and a second section discusses functional analysis as a research method. In the first section, current issues related to treatment logic and development are reviewed. Also, clinical limitations of functional analysis are described, including treatment and assessment implementation issues (such as time and resource constraints). In the second section, three areas of research are reviewed with suggestions for further research: the analysis of diverse response topographies, the analysis of basic behavioral processes, and the evaluation of methodological refinements.

A preliminary procedure for predicting the positive and negative effects of reinforcement-based procedures

In the current investigation, a modification was made to the preference assessment described by Pace, Ivancic, Edwards, Iwata, and Page (1985) to predict the effects of stimuli when used in a differential-reinforcement-of-other-behavior (DRO) schedule for 2 clients with severe self-injurious behavior (SIB) and profound mental retardation. Based on the results of the preference assessment, three types of stimuli were identified: (a) high-preference stimuli associated with high rates of SIB (HP/HS), (b) high-preference stimuli associated with relatively lower rates of SIB (HP/LS), and (c)low-preference stimuli associated with low rates of SIB (LP/LS). Consistent with the results of the preference assessment, the DRO schedule with HP/HS stimuli resulted in increased SIB, and the DRO schedule with LP/LS stimuli resulted in no change in SIB when used in a DRO schedule. Thus, the stimulus preference assessment may be useful clinically in some situations for predicting both the beneficial and the negative side effects of stimuli in DRO procedures.

Analog baselines: a critical review of the methodology

Analog baselines are an experimental methodology for identifying the functions of maladaptive behavior in the naturally occurring environment (Iwata, Dorsey, Slifer, Bauman, & Richman, 1982; Iwata et al., 1994). This article identifies a number of potential limitations in this methodology. These include: (a) procedural problems inherent in the use of multielement designs, (b) the fidelity of analog baseline design conditions, (c) the relation of the analog conditions to the naturally occurring environment, (d) a narrow analysis of behavior limited by an implicit adherence to an ABC model of behavior, (e) a limited acknowledgement of multifunction and idiosyncratically motivated behaviors, (f) problems in the definition of response classes, and (g) difficulties in the use of analog baselines to design interventions. Future research should attend to three main questions. First, the convergent validity of different assessment methodologies, including analog baselines, should be evaluated. Future research should attend to procedures that can integrate the entire clinical process of referral, identifying the functions of the target behavior, including other methods of identifying the functions of behavior, treatment design, and implementation. Second, assessment failures could be examined carefully to identify ways of developing this methodology further. Third, the process of designing an intervention depends upon input from many sources of information. The use of analog baselines will be enhanced by a greater understanding of the process of clinical decision making.

Descriptive analysis of multiple response topographies of challenging behavior across two settings

Time-based lag sequential analyses were conducted on 23 topographies of challenging behavior shown by five young people with severe mental retardation across two settings. Potential behavioural functions were identified for 21 of the 23 behaviors. Responses classes, including two or more distinct behaviors, were identified for four of the five participants. Two participants showed evidence of two functionally distinct response classes; for one person each response class included both self-injurious and stereotypic behaviors. For 9 of the 11 behaviors for which data were available, the hypothesised function of behaviors was consistent across settings. For one person, data suggested that the function of one self-injurious behavior was contextually determined. Cross-validation with brief experimental analyses resulted in agreement on the general behavioral function for 12 of the 14 instances in which both approaches positively identified a potential function for a behavior. Implications for future research and practice are discussed.

Functional analysis and treatment of eye poking

In four studies we analyzed the eye poking of a youth with profound disabilities. In Study 1, a functional analysis showed that eye poking occurred during the no-attention condition, but not during demand, attention or recreation conditions. The analysis did not identify socially mediated variables involved in the maintenance of eye poking; rather, eye poking may have been maintained by consequences produced directly by the response. In Study 2 we had the student wear goggles to prevent potential reinforcement from finger-eye contact. The results of Study 2 indicated that eye-poking attempts were reduced when the student wore goggles. We then tested in Study 3 the effects of two alternative topographies of stimulation. Study 3 demonstrated that eye poking was reduced when a video game was provided as a competing source of visual stimulation, and that music was less effective in reducing eye poking. In Study 4, a contingency analysis using the video game was conducted in an attempt to (a) reduce the frequency of eye poking and (b) study whether the video game functioned as a reinforcer. The results of Study 4 demonstrated substantive reductions in the frequency of eye poking, and suggested that the video game served as a reinforcer.

Assessing the functions of self-injurious behavior: a case of assessment failure

Seven attempts to assess the function of self-injurious behavior in a person with profound mental retardation are described. Although repeated correlational and experimental methods were implemented to determine the functional role of this behavior no clear functions were identified. A clinical implication of this case and that this methodology is not all-embracing. Different assumptions should be explored after substantial efforts have failed.