The functions of self-injurious behavior: an experimental-epidemiological analysis

Extended pausing by humans on multiple fixed-ratio schedules with varied reinforcer magnitude and response requirements

We conducted three experiments to reproduce and extend Perone and Courtney's (1992) study of pausing at the beginning of fixed-ratio schedules. In a multiple schedule with unequal amounts of food across two components, they found that pigeons paused longest in the component associated with the smaller amount of food (the lean component), but only when it was preceded by the rich component. In our studies, adults with mild intellectual disabilities responded on a touch-sensitive computer monitor to produce money. In Experiment 1, the multiple-schedule components differed in both response requirement and reinforcer magnitude (i.e., the rich component required fewer responses and produced more money than the lean component). Effects shown with pigeons were reproduced in all 7 participants. In Experiment 2, we removed the stimuli that signaled the two schedule components, and participants' extended pausing was eliminated. In Experiment 3, to assess sensitivity to reinforcer magnitude versus fixed-ratio size, we presented conditions with equal ratio sizes but disparate magnitudes and conditions with equal magnitudes but disparate ratio sizes. Sensitivity to these manipulations was idiosyncratic. The present experiments obtained schedule control in verbally competent human participants and, despite procedural differences, we reproduced findings with animal participants. We showed that pausing is jointly determined by past conditions of reinforcement and stimuli correlated with upcoming conditions.

Response latency as an index of response strength during functional analyses of problem behavior

Dependent variables in research on problem behavior typically are based on measures of response repetition, but these measures may be problematic when behavior poses high risk or when its occurrence terminates a session. We examined response latency as the index of behavior during assessment. In Experiment 1, we compared response rate and latency to the first response under acquisition and maintenance conditions. In Experiment 2, we compared data from existing functional analyses when graphed as rate versus latency. In Experiment 3, we compared results from pairs of independent functional analyses. Sessions in the first analysis were terminated following the first occurrence of behavior, whereas sessions in the second analysis lasted for 10 min. Results of all three studies showed an inverse relation between rate and latency, indicating that latency might be a useful measure of responding when repeated occurrences of behavior are undesirable or impractical to arrange.

Classroom application of a trial-based functional analysis

We evaluated a trial-based approach to conducting functional analyses in classroom settings. Ten students referred for problem behavior were exposed to a series of assessment trials, which were interspersed among classroom activities throughout the day. Results of these trial-based functional analyses were compared to those of more traditional functional analyses. Outcomes of both assessments showed correspondence in 6 of the 10 cases and partial correspondence in a 7th case. Results of the standard functional analysis suggested reasons for obtained differences in 2 cases of noncorrespondence, which were verified when portions of the trial-based functional analyses were modified and repeated. These results indicate that a trial-based functional analysis may be a viable assessment method when resources needed to conduct a standard functional analysis are unavailable. Implications for classroom-based assessment methodologies and future directions for research are discussed.

The effects of variable-time delivery of food items and praise on problem behavior reinforced by escape

Prior research indicates that reinforcement of an appropriate response (e.g., compliance) can produce concomitant reductions in problem behavior reinforced by escape when problem behavior continues to produce negative reinforcement (e.g., Lalli et al., 1999). These effects may be due to a preference for positive over negative reinforcement or to positive reinforcement acting as an abolishing operation, rendering demands less aversive and escape from demands less effective as negative reinforcement. In the current investigation, we delivered a preferred food item and praise on a variable-time 15-s schedule while providing escape for problem behavior on a fixed-ratio 1 schedule in a demand condition for 3 participants with problem behavior maintained by negative reinforcement. Results for all 3 participants showed that variable-time delivery of preferred edible items reduced problem behavior even though escape continued to be available for these responses. These findings are discussed in the context of motivating operations.

Pre-assessment exposure to schedule-correlated stimuli affects choice responding for tasks

Establishing compliance with academic and daily-living-skills instructions is important for shaping and maintaining behavior. In the current study, we exposed two participants to two stimulus conditions that were correlated with different consequences (more work vs. reinforcement) subsequent to a baseline in which responding was undifferentiated. Exposure to the differential consequences produced greater cooperation with the instruction to "pick one" task and response allocation towards the stimulus that was correlated with reinforcement as a consequence for task completion. These results suggest that clarifying the consequences of choice making may facilitate cooperation with task instructions.

Validity Issues in Cognitive-Behavioral Case Formulation

Despite considerable interest and growth in methods to develop or generate cognitive behavioral case formulations (CBCFs), relatively little conceptual and empirical work has focused on the validation or testing of these formulations. A case formulation can be regarded as an idiographic theory of the person and his or her life situation. This complex set of clinical judgments consists of a measurement model including the behavior problems or distress constructs and how they are measured; and a causal model involving variables such as thoughts or beliefs hypothesized to trigger and maintain this person’s distress or dysfunction. This article describes four types of validity issues in CBCF and how these validity issues can be evaluated using person-specific, intraindividual data collected daily or multiple times a day. Specific topics include the evaluation of content and construct (convergent and discriminant) validity for the measurement model, and the evaluation of predictive and treatment-related validity for the causal model. One goal of the person-specific evaluation of CBCF validity is to develop an intraindividual statistical prediction model that has the advantages of actuarial prediction yet is fine-grained and tailored to the specific issues and life circumstances of greatest relevance for a particular individual. Greater attention to evaluation of validity issues in CBCF is important for future research comparing formulation-based to manualized treatment. Implications and applications to clinical practice and training are discussed.

Reviewing risk for individuals with developmental disabilities

There are many categories of risky behaviors that are of interest to individuals, agencies, and institutions interested in care for developmentally disabled persons. These include challenging behaviors such as aggression and self-injury, psychiatric diagnoses, medical problems, criminal behaviors, and victimization. The literature in this area is difficult to digest due to a number of methodological problems. This paper reviews the research on one of these behaviors, self-injury, and provides a framework that can be applied to other research on predicting risk. Additionally, it attempts to organize the findings in such a way as to maximize the utility to providers and suggest useful directions for future research.

Individual differences in vulnerability for self-injurious behavior: studies using an animal model

Self-injurious behavior (SIB) is a debilitating characteristic that is prevalent across a broad spectrum of neurodevelopmental disorders. In most of these disorders, some individuals exhibit SIB, whereas others do not. However, the neurobiological mechanisms that confer vulnerability are virtually unexplored. We examined innate characteristics that contribute to vulnerability or resistance for SIB in an animal model of the behavioral pathology. Eighteen outbred Long-Evans rats were screened for behavioral responsiveness to the mild stress of a novel environment. The rats were then categorized as high responders (HR; those rats that had the highest locomotor counts) or low responders (LR; those rats that had lower locomotor counts) by median split. All the rats were then given daily injections of the indirect monoamine agonist pemoline (150 mg/kg/day) for 10 days, and self-injury was evaluated. All 9 HR rats and 5 of the 9 LR rats exhibited self-injury. The HR rats spent more time self-injuring, injured more body sites, and caused larger areas of tissue damage than the LR rats did. Furthermore, the behavioral responsiveness to novelty stress was significantly correlated with each of these measures of self-injury. The HR rats did not exhibit substantially enhanced responses on other measures of psychostimulant action (stereotypy, grooming, locomotion, rearing). Accordingly, vulnerability to develop pemoline-induced SIB is positively correlated with, and can be predicted based upon, a behavioral measure of innate stress responsiveness. These findings suggest that characteristics that are common in developmental disorders may help predispose afflicted individuals to self-injure. The findings also extend the variety of behavioral pathologies (e.g. drug addiction) for which the HR/LR model predicts vulnerability.

On the use of fluency training in the behavioral treatment of autism: a commentary

The substantial demand for behavior-analytic treatment of early childhood autism has been associated with rapid dissemination of treatment procedures to practitioners and caregivers. This level of demand could plausibly induce premature dissemination of treatments that do not yet have sufficient empirical support. We argue that this might have happened with the use of fluency training for learners with autism and identify four areas of research that are necessary to ensure that dissemination efforts are better matched to the available empirical support for this instructional strategy.

Functional analysis and treatment of self-injury in a captive olive baboon

Self-injurious behavior (SIB), such as self-biting and head banging, has been reported to occur in approximately 10% of captive, individually housed nonhuman primates. Accounts of the etiology of SIB in primates range from ecological to physiological. However, to date, no research has examined the possible influence of social consequences delivered by handlers and keepers in the maintenance of SIB in this population. The current study investigated the effects of social contact as a potentially reinforcing consequence for the SIB displayed by an olive baboon (Papio hamadryas anubis). Results indicated that the behavior was maintained by attention from humans. As treatment, reinforcement was arranged for an appropriate alternative response, resulting in increases in the appropriate alternative behavior and decreases in SIB.

The functional assessment of maladaptive behaviors: a preliminary evaluation of binge eating and purging among women

This study applied a functional approach to the study of bingeing and purging behaviors. Based on a four-function theoretical model of bingeing and purging, it was hypothesized that these behaviors are performed because of their intrapersonally reinforcing (e.g., emotion regulation) and/or interpersonally reinforcing (e.g., help-seeking, attention-getting behavior) properties. Participants were 298 adult females who had engaged in bingeing or purging in the last 3 months and who provided data via an online survey of these behaviors. Confirmatory factor analyses revealed support for a four-function model of bingeing and purging in which people use these behaviors for intrapersonal reinforcement functions and also for interpersonal reinforcement. Understanding the functions of binge eating and purging has direct implications for assessment and treatment of these behaviors.

Self-injury

People have engaged in self-injury-defined as direct and deliberate bodily harm in the absence of suicidal intent-for thousands of years; however, systematic research on this behavior has been lacking. Recent theoretical and empirical work on self-injury has significantly advanced the understanding of this perplexing behavior. Self-injury is most prevalent among adolescents and young adults, typically involves cutting or carving the skin, and has a consistent presentation cross-nationally. Behavioral, physiological, and self-report data suggest that the behavior serves both an intrapersonal function (i.e., decreases aversive affective/cognitive states or increases desired states) and an interpersonal function (i.e., increases social support or removes undesired social demands). There currently are no evidence-based psychological or pharmacological treatments for self-injury. This review presents an integrated theoretical model of the development and maintenance of self-injury that synthesizes prior empirical findings and proposes several testable hypotheses for future research.

Progressing from brief assessments to extended experimental analyses in the evaluation of aberrant behavior

The role of experimental analyses in guiding treatment is well established. However, not all experimental analyses yield conclusive results. Outcomes may be inconclusive due to time limitations that preclude extended observation and detailed experimental manipulations, or may result from interactions across experimental conditions, multiple control, or other unknown factors. In this study, we describe an assessment sequence that moves through four phases beginning with relatively brief (1 to 2 hr) analyses and culminating in extended analyses that may control for experimental confounding effects (e.g., interaction effects). Data illustrating the model are presented for 20 individuals referred for severe behavior problems including self-injury, aggression, stereotypy, and tantrums. Analyses were considered to be complete only when clear and replicable response patterns emerged. Results showed that clear and replicable response patterns emerged for 85% of the participants.

Self-injury and mental retardation in a 7-year-old boy

Mark is a 7 year old with severe mental retardation and self-injurious behavior. The behaviors include hitting his face with his fist and banging his head against the wall, floor, or table. These behaviors occurred intermittently in the past. During the past 6 months, they have increased in frequency and intensity and caused bruising and swelling of his forehead. The behaviors have occurred in both the home and school environment, but seem to be more frequent and intense at home. Mark's parents state that occasionally the behaviors occur when Mark is so frustrated that he can't do something that he wants to do, but more frequently they occur for "no reason at all." Mark could be watching TV or playing with a toy and begin head banging. His parents have managed the behavior by verbal reprimands. If that is not effective, they will hold Mark to prevent him from hitting himself or move him onto his bed with pillows against the wall. These procedures are very disruptive to the family now that the behavior is occurring at least a couple times on most days. Mark is not on any medications. He has not had seizures. He has had ear infections and constipation in the past and was treated for gastroesophageal reflux as an infant. He sleeps 9 hours each night without snoring. There has been no change in his appetite or sleep. His parents estimate that he has about 20 words that he uses communicatively. Mark lives at home with both parents and 2 younger siblings. For the past 2 years, he has attended the same life skills class with 8 students, a teacher and 2 assistants. Mark's mother had postpartum depression after the birth of his 5-year-old brother. The physical examination does not demonstrate any change in his growth percentiles. The skin on the right side of his face is erythematous as he was hitting it prior to the examination. There is no sign of otitis media.

Progressing from initially ambiguous functional analyses: three case examples

Most often functional analyses are initiated using a standard set of test conditions, similar to those described by Iwata, Dorsey, Slifer, Bauman, and Richman [Iwata, B. A., Dorsey, M. F., Slifer, K. J., Bauman, K. E., & Richman, G. S. (1994). Toward a functional analysis of self-injury. Journal of Applied Behavior Analysis, 27, 197-209 (Reprinted from Analysis and Intervention in Developmental Disabilities, 2, 3-20, 1982)]. These test conditions involve the careful manipulation of motivating operations, discriminative stimuli, and reinforcement contingencies to determine the events related to the occurrence and maintenance of problem behavior. Some individuals display problem behavior that is occasioned and reinforced by idiosyncratic or otherwise unique combinations of environmental antecedents and consequences of behavior, which are unlikely to be detected using these standard assessment conditions. For these individuals, modifications to the standard test conditions or the inclusion of novel test conditions may result in clearer assessment outcomes. The current study provides three case examples of individuals whose functional analyses were initially undifferentiated; however, modifications to the standard conditions resulted in the identification of behavioral functions and the implementation of effective function-based treatments.

Effects of Nonverbal Social Disapproval on Attention-Maintained Spitting and Disruptive Vocalizing in a Child With Autism

This study addressed attention-maintained problem behaviors (spitting and disruptive vocalizing) of a child with autism. The intervention procedures consisted of service providers cleaning up the presence of saliva and demonstrating a “quiet” cue when the child spit and vocalized respectively. In two single-case reversal designs, the procedures reduced both behaviors to low frequency. Factors responsible for intervention success are discussed.

Self-injurious behaviour in Cornelia de Lange syndrome: 2. Association with environmental events

BACKGROUND

Self-injurious behaviour is commonly seen in Cornelia de Lange syndrome (CdLS). However, there has been limited research into the aetiology of self-injury in CdLS and whether environmental factors influence the behaviour.

METHODS

We observed the self-injury of 27 individuals with CdLS and 17 participants who did not have CdLS matched for age, gender, level of intellectual disability and mobility. Descriptive analyses were used to determine the extent to which environmental events were associated with self-injury.

RESULTS

Lag sequential analysis of the association between self-injurious behaviour and environmental events revealed no differences between the two groups in terms of either the number or degree of environmental associations.

CONCLUSIONS

The results suggest that the associations between the environment and self-injury in CdLS do not differ from those seen in the broader population of people with intellectual disability. By implication the social reinforcement hypothesis is equally applicable to both groups.

Why do People Hurt Themselves? New Insights Into the Nature and Functions of Self-Injury

Nonsuicidal self-injury (NSSI) is a prevalent but perplexing behavior problem in which people deliberately harm themselves without lethal intent. Research reveals that NSSI typically has its onset during early adolescence; most often involves cutting or carving the skin; and appears equally prevalent across sexes, ethnicities, and socioeconomic statuses. Less is known about why people engage in NSSI. This article presents a theoretical model of the development and maintenance of NSSI. Rather than a symptom of mental disorder, NSSI is conceptualized as a harmful behavior that can serve several intrapersonal (e.g., affect regulation) and interpersonal (e.g., help-seeking) functions. Risk of NSSI is increased by general factors that contribute to problems with affect regulation or interpersonal communication (e.g., childhood abuse) and by specific factors that influence the decision to use NSSI rather than some other behavior to serve these functions (e.g., social modeling). This model synthesizes research from several different areas of the literature and points toward several lines of research needed to further advance the understanding of why people hurt themselves.

Applied Behavior Analysis Assessment and Intervention for Health

The case of a 26-year-old man who had Prader-Willi syndrome and health threatening self-injury in the form of rectal picking is described. Functional behavioral assessment and analysis before intervention suggested that both nonrectal and rectal picking occurred because the behaviors sometimes produced social attention, escape from nonpreferred situations, and sensory pleasurable stimulation. Intervention was evaluated at the man's vocational training program. The behavior support plan included time-limited bathroom visits, functional communication training, and differential positive reinforcement. Intervention eliminated rectal picking, was associated with improved health status, and remained effective over a nearly 8-month period.

Stimuli, reinforcers, and the persistence of behavior

This article reviews evidence from basic and translational research with pigeons and humans suggesting that the persistence of operant behavior depends on the contingency between stimuli and reinforcers, and considers some implications for clinical interventions.

Some effects of noncontingent positive reinforcement on multiply controlled problem behavior and compliance in a demand context

Functional analysis suggested that the problem behavior of an 8-year-old girl with autism was maintained by escape from demands and access to edible items. Noncontingent delivery of an edible item was sufficient to increase compliance and reduce the rate of problem behavior without the use of escape extinction in a demand context. Leaner and richer schedules of noncontingent reinforcement were equally effective, and there were minimal differences between noncontingent reinforcement and differential reinforcement of compliance.

Further evaluation of leisure items in the attention condition of functional analyses

Research suggests that including leisure items in the attention condition of a functional analysis may produce engagement that masks sensitivity to attention. In this study, 4 individuals' initial functional analyses indicated that behavior was maintained by nonsocial variables (n = 3) or by attention (n = 1). A preference assessment was used to identify items for subsequent functional analyses. Four conditions were compared, attention with and without leisure items and control with and without leisure items. Following this, either high- or low-preference items were included in the attention condition. Problem behavior was more probable during the attention condition when no leisure items or low-preference items were included, and lower levels of problem behavior were observed during the attention condition when high-preference leisure items were included. These findings suggest how preferred items may hinder detection of behavioral function.

Treatment of challenging behavior exhibited by children with prenatal drug exposure

A large body of literature exists describing the harmful effects of prenatal drug exposure on infant and child development. However, there is a paucity of research examining strategies to ameliorate sequelae such as externalizing behavior problems. In the present study, functional analysis procedures were used to assess challenging behavior exhibited by two children who were prenatally exposed to drugs of abuse. Results for both children indicated that challenging behavior was maintained by access to positive reinforcement (adult attention and tangible items). For one child, challenging behavior was also maintained by negative reinforcement (escape from activities of daily living). Function-based interventions were effective in reducing challenging behavior for both children. Implications for utilizing methods of applied behavior analysis in research with children with prenatal drug exposure are discussed.

Assessment and behavioral treatment of feeding and sleeping disorders in children with autism spectrum disorders

Children diagnosed with autism or autism spectrum disorders (ASD) are more likely than other children to exhibit behaviors characteristic of a feeding or sleeping disorder. Parents of children with these disorders may be extremely concerned about the health and safety of their child. Sleeping and feeding problems can cause a great deal of stress to parents and other family members. Behavioral assessment and treatment procedures have been developed to address behavior problems related to sleeping and feeding disorders. This article reviews the literature about assessment and treatment, and provides recommendations regarding services to family members of individuals diagnosed with ASD and feeding or sleeping disorders.

Behavioral assessment and treatment of self-injurious behavior in autism

Self-injurious behaviors (SIB) are common in individuals who have autism and related developmental disabilities. When an individual engages in SIB, these behaviors frequently become the primary treatment target because of the potential for injury. A thorough behavioral assessment aimed at determining the function of the behaviors is the first step to developing a treatment plan. This article presents a brief background of SIB and a discussion of the behavioral assessment and treatment of these behaviors to familiarize readers with the behavioral perspective on SIB in individuals who have autism and other developmental disabilities.

Actions speak louder than words: An elaborated theoretical model of the social functions of self-injury and other harmful behaviors

The question of why some people do things that are intentionally harmful to themselves continues to puzzle scientists, clinicians, and the public. Prior studies have demonstrated that one fairly extreme, direct form of self-harm, non-suicidal self-injury (NSSI), is maintained by both automatic (i.e., intrapersonal) as well as social (i.e., interpersonal) reinforcement. However, the majority of theoretical and empirical papers on this topic focus almost exclusively on the automatic functions. The purpose of this paper is to provide a more comprehensive analysis of the social functions of NSSI. Evidence is presented supporting the notion that NSSI is maintained by social reinforcement in at least a substantial minority of instances. Moreover, an elaborated theoretical model of the social functions of NSSI is outlined that proposes that this behavior represents a high intensity social signal used when less intense communication strategies fail (e.g., speaking, yelling, crying). The model further proposes that NSSI can serve not only as a signal of distress that is reinforced primarily by the caregiving behavior it elicits from others, but that it also can serve as a signal of strength and fitness that is reinforced by warding off potential threats (e.g., peer victimization), and in some cases can strengthen affiliation with others. Support for this theoretical model is drawn from diverse literatures including psychology, evolutionary biology, and cultural anthropology. The paper concludes with specific recommendations for empirical tests of the proposed model of the social functions of NSSI, as well as other harmful behaviors such as alcohol and drug use.

Recommendations for reporting independent variables in outcome studies of early and intensive behavioral intervention for autism

Early and intensive behavioral intervention (EIBI) has been established as an effective treatment for autism. However, the complexity and intensity of EIBI programs make it difficult to fully report all critical aspects of the independent variable. Consequently, scientific reports of EIBI outcomes have been criticized for providing less than comprehensive treatment descriptions. In an effort to address this problem, the present article provides a template to aid outcome researchers in (a) clearly reporting each participant's curricular targets and (b) describing critical aspects of treatment.

The effect of active support training on engagement, opportunities for choice, challenging behaviour and support needs

BACKGROUND

The aim of this study was to evaluate active support (AS) training and to investigate changes to perceived engagement in domestic tasks, opportunities for choice, frequency of challenging behaviour, and level of support needs.

METHOD

Participants were 12 adults with ID aged 27-57 years (M = 37 years) residing in three group homes, and their support workers. The support workers completed assessments on three occasions (at baseline, post-training, and at follow-up).

RESULTS

Residents' engagement in domestic tasks increased over time, and overall choice increased, although perceived choice in two life domains initially increased, but decreased to baseline levels at follow-up. Residents exhibited an overall decrease in anxiety, self-absorbed behaviour, disruptive behaviour, and problem behaviour in general. There was also an overall decrease in perceived support needs for five activity domains, with no change for one domain.

CONCLUSIONS

The results contribute to a growing body of evidence demonstrating favourable outcomes of AS in terms of engagement and challenging behaviour in people with ID. Surprising results are presented for choice and perceived support needs, warranting further investigation.

Functional assessment of problem behavior in children with autism spectrum disorders: a summary of 32 outpatient cases

The purpose of this study was to examine archival data from an outpatient clinic serving children with autism spectrum disorders to investigate the occurrence of problem behavior functions in this sample. Results indicated that social reinforcement (e.g., attention from others) was involved in maintaining problem behavior for the majority of cases, suggesting that these children lacked socially appropriate responses to access such reinforcement, or that their social environments contained insufficient social reinforcement. Further, the data suggest that problem behavior exhibited by children with autism spectrum disorders can be conceptualized similarly to the problem behavior of children with other developmental disabilities.

Comparing functional assessment methodologies: a quantitative synthesis

There has been much research concerning functional assessment over the past 20 years, but several important research considerations have yet to be explained. One is the comparison of different types of functional assessment (e.g., experimental functional analysis and non-experimental functional assessment). The current study aims to compare the different methodologies of functional assessment and their effectiveness in ascribing function to a target behavior and in the treatment selection that follows such an assessment. Quantitative synthesis data were used to answer questions regarding behavioral function, assessment type, and treatment effectiveness. Results indicate that assessment type can impact treatment effectiveness and that there is a relationship between behavior type and ascribed function.

Children with severe developmental disabilities and behavioral disorders have increased special healthcare needs

We studied whether children with severe developmental disabilities (SDDs) who have a comorbid behavioral disorder also have higher rates of special healthcare needs (SHCNs). We used a matched-comparison control group design to establish whether SHCNs were higher in children with SDDs with behavioral disorders versus children with SDDs without behavioral disorders. Thirty-six children were matched for age (mean 12 y 6 mo; range 5 y 2 mo-18 y 8 mo), sex (24 males, 12 females), ethnicity (22 non-white), mental retardation level (22 moderate, eight severe, six profound), and Diagnostic and Statistical Manual of Mental Disorders, 4th edition axis I diagnosis (18 autism spectrum disorder, 10 specified syndrome, eight mental retardation not otherwise specified). Measures included the Achenbach Child Behavior Checklist, behavioral observation, health status examination, and Childhood Health Questionnaire (CHQ). Children with SDDs with behavioral disorders had significantly higher levels of SHCN, as measured by the CHQ and health status examination. Children with SDDs with behavioral disorders had a twofold higher incidence of SHCNs than children with SDDs without behavioral disorders. No difference was observed in the number or types of prescription medication that children received. The findings suggest that SHCNs contribute to the occurrence and/or intensity of behavioral disorders in children with SDD and may require interdisciplinary care coordination.

Autism spectrum disorders in early childhood: an overview for practicing physicians

Autism spectrum disorders (ASDs) affect approximately 1 in 166 children in the United States, making it likely for the average physician to encounter patients with ASDs in his or her practice. In particular, pediatricians and developmental neurologists play a critical role in early identification, resource referrals, and management of a variety of comorbid physical and medical concerns. This article reviews the current literature on ASDs and provides recommendations for practice in areas critical to the provision of medical services.

Assessing and treating vocal stereotypy in children with autism

Previous research implies that stereotypic behavior tends to be maintained by the sensory consequences produced by engaging in the response. Few investigations, however, have focused on vocal stereotypy. The current study examined the noncommunicative vocalizations of 4 children with an autism spectrum disorder. First, functional analyses were conducted in an attempt to identify the function of each child's behavior. For each of the participants, it was found that vocal stereotypy was likely not maintained by the social consequences. Following assessment, response interruption and redirection (RIRD) was implemented in an ABAB design to determine whether vocal stereotypy could be successfully redirected. RIRD involved a teacher issuing a series of vocal demands the child readily complied with during regular academic programming. Vocal demands were presented contingent on the occurrence of vocal stereotypy and were continuously presented until the child complied with three consecutively issued demands without emitting vocal stereotypy. For each child, RIRD produced levels of vocal stereotypy substantially lower than those observed in baseline. For 3 of the children, an increase in appropriate communication was also observed. The children's teachers were trained to implement RIRD. Brief follow-up probes and anecdotal information implied that the treatment had a positive impact in the natural environment.

Fragile X syndrome: assessment and treatment implications

Fragile X syndrome (FraX) is the most common known cause of inherited mental impairment. FMR1 gene mutations, the cause of FraX, lead to reduced expression of FMR1 protein and an increased risk for a particular profile of cognitive, behavioral, and emotional dysfunction. The study of individuals with FraX provides a unique window of understanding into important disorders such as autism, social phobia, cognitive disability, and depression. This review highlights the typical phenotypic features of individuals with FraX, discussing the apparent strengths and weaknesses in intellectual functioning, as evidenced from longitudinal follow-up studies. It also discusses recent neuroanatomic findings that may pave the way for more focused disease-specific pharmacologic and behavioral interventions. This article describes the results of recent medication trials designed to target symptoms associated with FraX. It also describes some recent behavioral interventions that were conducted in our laboratory.

Further examination of factors that influence preference for positive versus negative reinforcement

Factors that influence choice between qualitatively different reinforcers (e.g., a food item or a break from work) are important to consider when arranging treatments for problem behavior. Previous findings indicate that children who engage in problem behavior maintained by escape from demands may choose a food item over the functional reinforcer during treatment (DeLeon, Neidert, Anders, & Rodriguez-Catter, 2001; Lalli et al., 1999). However, a number of variables may influence choice between concurrently available forms of reinforcement. An analogue for treatment situations in which positive reinforcement for compliance is in direct competition with negative reinforcement for problem behavior was used in the current study to evaluate several variables that may influence choice. Participants were 5 children who had been diagnosed with developmental disabilities and who engaged in problem behavior maintained by escape from demands. In the first phase, the effects of task preference and schedule of reinforcement on choice between a 30-s break and a high-preference food item were evaluated. The food item was preferred over the break, regardless of the preference level of the task or the reinforcement schedule, for all but 1 participant. In the second phase, the quality of the break was manipulated by combining escape with toys, attention, or both. Only 1 participant showed preference for the enriched break. In the third phase, choice of a medium- or low-preference food item versus the enriched break was evaluated. Three of 4 participants showed preference for the break over the less preferred food item. Results extend previous research by identifying some of the conditions under which individuals who engage in escape-maintained behavior will prefer a food reinforcer over the functional one.