Assessing the combined effects of resurgence and reinstatement in children diagnosed with autism spectrum disorder

The Promises and Possibilities of Artificial Intelligence in the Delivery of Behavior Analytic Services

Artificial intelligence (AI) has begun to affect nearly every aspect of our daily lives and nearly every industry and profession. Many readers of this journal likely work in one or more areas of behavioral health. For readers who work in behavioral health and who are interested in AI, the purpose of this article is to highlight the pervasiveness of AI research being conducted around many facets of behavioral health service delivery. To do this, we first provide a brief overview of some of the areas within AI and the types of problems each area of AI attempts to solve. We then outline the prototypical client journey in behavioral healthcare beginning with diagnosis/assessment and ending with intervention withdrawal or ongoing monitoring. Next, for each stage in the client journey, we highlight several areas that parallel existing behavior analytic practice where researchers have begun to use AI, often to improve the efficiency of service delivery or to learn new things that improve the effectiveness of behavioral health services. Finally, for those whose appetite has been whet for getting involved with AI, we close by describing three roles they might consider trying out and that parallel the three main domains of behavior analysis. These three roles are an AI tool designer (akin to EAB), AI tool implementer (akin to ABA), or AI tool supporter (akin to practice).

Relapse and its mitigation: Toward behavioral inoculation

Relapse following the successful treatment of problem behavior can increase the likelihood of injury and the need for more intensive care. Current research offers some predictions of how treatment procedures may contribute to relapse, and conversely, how the risk of relapse can be mitigated. This review describes relapse-mitigation procedures with varying levels of support, the quantitative models that have influenced the research on relapse mitigation, different experimental methods for measuring relapse mitigation, and directions for future research. We propose that by viewing the implementation of relapse-mitigation procedures as a means of producing behavioral inoculation, clinicians are placed in the proactive and intentional role of exposing their client's behavior to an array of reinforcement and stimulus conditions during treatment with the goal of decreasing the detrimental impact of future treatment challenges.

A Comprehensive Systematic Review of Procedures and Analyses Used in Basic and Preclinical Studies of Resurgence, 1970-2020

Resurgence is the return of a previously reinforced response as conditions worsen for an alternative response, such as the introduction of extinction, reductions in reinforcement, or punishment. As a procedure, resurgence has been used to model behavioral treatments and understand behavioral processes contributing both to relapse of problem behavior and flexibility during problem-solving. Identifying existing procedural and analytic methods arranged in basic/preclinical research could be used by basic and preclinical researchers to develop novel approaches to study resurgence, whereas translational and clinical researchers could identify potential approaches to combating relapse during behavioral interventions. Despite the study of resurgence for over half a century, there have been no systematic reviews of the basic/preclinical research on resurgence. To characterize the procedural and analytic methods used in basic/preclinical research on resurgence, we performed a systematic review consistent with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). We identified 120 articles consisting of 200 experiments that presented novel empirical research, examined operant behavior, and included standard elements of a resurgence procedure. We reported prevalence and trends in over 60 categories, including participant characteristics (e.g., species, sample size, disability), designs (e.g., single subject, group), procedural characteristics (e.g., responses, reinforcer types, control conditions), criteria defining resurgence (e.g., single test, multiple tests, relative to control), and analytic strategies (e.g., inferential statistics, quantitative analysis, visual inspection). We make some recommendations for future basic, preclinical, and clinical research based on our findings of this expanding literature.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40614-022-00361-y.

Motivational state-dependent renewal and reinstatement of operant responding under food and water deprivation states

Most studies of operant relapse phenomena have studied the role of exteroceptive discriminative features of context in the recovery of behavior after extinction. Interoceptive stimuli (i.e., stimuli arising from the bodies of organisms) may also serve as a part of learning contexts and contribute to relapse. Recent studies have demonstrated that events that function as motivating operations (MOs) may contribute to relapse both by a) eliciting interoceptive conditions that serve as a discriminative context for relapse (i.e., discriminative function) and b) altering the amount of operant responding in the presence of discriminative stimuli associated with reinforcers (i.e., motivational function). The current study examined interactions between these functions of food and water deprivation MOs in the relapse of operant behavior. During acquisition of an operant response, one group of mice was food-deprived and another was water-deprived. The groups then received extinction sessions under the opposite condition. Renewal and reinstatement tests were conducted under both conditions, and more renewal and reinstatement were observed in the motivational states in which acquisition occurred for each. These results are discussed in the context of state-dependent learning.

Translating Quantitative Theories of Behavior into Improved Clinical Treatments for Problem Behavior

The most important advancement in the treatment of destructive behavior has been the development of the functional analysis, which is used to prescribe effective treatments like functional communication training. Although this approach can be highly effective, extinction bursts and forms of treatment relapse commonly occur when function-based treatments are implemented by caregivers in natural community settings. In recent years, researchers have increasingly applied quantitative theories of behavior like behavioral momentum theory (BMT) and the temporally weighted matching law (TWML) to understand, prevent, or mitigate extinction bursts and treatment relapse. In this paper, we describe BMT and TWML and selectively review the basic, translational, and applied research supporting and opposing each theory. Then, we describe how function-based treatments may be refined based on these theories to improve the effectiveness, generality, and durability of function-based treatments for individuals with autism spectrum and related disorders who display problem behavior.

Evaluating effects of context changes on resurgence in humans

Laboratory models of relapse provide methods for evaluating challenges to behavioral treatments with differential reinforcement of an alternative response (DRA). Resurgence occurs with the worsening of conditions of reinforcement for appropriate behavior and renewal occurs when transitioning out of a treatment context. Across five experiments, participants recruited via online crowdsourcing pressed onscreen buttons to earn points exchangeable for money and contexts sometimes changed through changes in the background image. Returning to the training context (ABA, Experiment 1) and transitioning to a novel context (ABC, Experiment 2) produced greater resurgence when removing alternative reinforcement in comparison with remaining in the treatment context (ABB). In contrast, we observed little difference in resurgence among AAA, ABB, and AAC context manipulations (Experiment 3) and ABA, ABC, and AAC context manipulations (Experiment 4). In Experiment 5, we evaluated relative contributions of the presence versus absence of context changes (ABA vs. ABB) in combination with or without the removal of alternative reinforcement. Both changing context and removing alternative reinforcement increased responding in isolation and the combination produced greater-than-additive effects. Overall, the present findings demonstrate a consistent effect of removing alternative reinforcement on relapse that, under certain conditions, can be enhanced by context change.

Empirically Deriving Omission and Commission Errors for Relapse Tests: A Demonstration of Reverse Translation

Most studies examine treatment relapse by programming contextual changes with perfect treatment integrity or with omission errors in the absence of a context change (i.e., all alternative responses placed on extinction). Recently, Mitteer et al. (2018) examined caregiver behavior in response to a confederate playing the role of a child with destructive behavior, providing the opportunity for researchers to empirically derive reinforcement schedules and test caregiver error patterns within future relapse tests with children. The present study represents a pilot demonstration of methods for reverse translating findings from caregivers to relapse preparations with children. We used a human-operant arrangement with three children with autism spectrum disorder in which they (a) emitted a target response (i.e., pad touch) for a preferred item in a home-like context, (b) emitted an alternative response (e.g., card touch) for the item in a clinic context while the target response was extinguished, and (c) experienced a relapse test in which the experimenter programmed the same low-rate omission and commission errors that caregivers made in the prior study within the home-like context. During the relapse test, target responding approximated or exceeded baseline ranges for all cases, and alternative behavior extinguished for two of the three cases. We discuss how researchers might incorporate similar translation processes in future relapse research.

Examining effects of training duration on humans' resurgence and variability using a novel touchscreen procedure

Resurgence occurs when a previously reinforced and then extinguished target response increases due to reducing/eliminating an alternative source of reinforcement or punishing an alternative response. We evaluated whether duration of reinforcement history for a target response (1) affects the degree to which resurgence is observed in humans and (2) produces different gradients of response generalization around target responding during extinction testing. We arranged a novel touchscreen interface in which university students could swipe a 3D soccer ball to spin any direction. In Phase 1, the first direction swiped became the target and produced points exchangeable for money for 3 or 1 min across 2 groups. The first swipe was recorded but had no programmed consequence in a third group. In Phase 2, swipes 180-degrees from the target resulted in points for 3 min in all groups. Point deliveries ceased for 2 min to test for resurgence in Phase 3. Target responses resurged during testing to a relatively greater extent with longer Phase-1 training but gradients of response generalization did not differ among groups. These findings extend prior research on the role of training duration on resurgence. We discuss methodological and conceptual issues surrounding the assessment of response generalization in resurgence.

Comparing stimulus preference and response force in a conjugate preparation

Researchers used a conjugate preparation to evaluate how response force changed based on participants' preferences for visual stimuli. First, researchers used a verbal preference assessment to evaluate each participant's preference for viewing for five object categories of visual stimuli; this process identified high preference (HP) stimuli and low preference stimuli for most participants. Thereafter, researchers exposed each participant to the five stimulus categories in a randomized order while using a force dynamometer to measure their response force to increase visual clarity of each stimulus. Results indicate the majority of participants' HP stimuli corresponded to the stimulus category for which they exerted the highest mean force. These preliminary findings suggest conjugate preparations involving response force may provide another option for measuring the relative value of some stimulus events.

Sustaining behavior reduction by transitioning the topography of the functional communication response

When a functional communication response (FCR) can be reliably occasioned, destructive behavior tends to be lower. However, the form of FCR may affect the durability of functional communication training, as missing FCR materials may promote resurgence. Experiment 1 demonstrated that resurgence of target responding was lower when a vocal FCR remained available but was placed on extinction compared to when a card-based FCR was unavailable. Experiment 2 replicated the finding that initiating treatment with a card FCR produced less target responding than when initiating treatment with a vocal FCR. We then evaluated a set of procedures for transitioning the card FCR to the previously unlearned vocal FCR. These findings suggest benefits of training different types of FCRs at different stages of treatment and provide a preliminary set of procedures for transitioning between FCR topographies while occasioning minimal target responding.

Recaída de Variabilidade Operante com a Combinação dos Procedimentos de Renovação, Restabelecimento e Ressurgência

Resumo O reaparecimento de variabilidade comportamental previamente extinta (i.e., recaída) foi investigado por meio dos modelos experimentais de renovação, restabelecimento e ressurgência. Na Fase de Treino (contexto A), ao serem expostos ao esquema múltiplo Lag 10 Acoplado, ratos apresentaram níveis similares de variabilidade nos dois componentes. Na Fase de Eliminação (contexto B), o esquema múltiplo Repetição Repetição promoveu a extinção da variabilidade. Na Fase de Teste (contexto A), com a suspensão da contingência de repetição e a liberação de reforços independentes, a variabilidade reapareceu no componente “Lag 10”, anteriormente correlacionado com reforçamento da variação, mas não no componente “Acoplado”. Esse resultado sugere que a variabilidade observada no teste de recaída corresponde à variabilidade operante, e não à variabilidade induzida pela extinção.

Resurgence following differential reinforcement of alternative behavior implemented with and without extinction

In the clinic, differential reinforcement of alternative behavior (DRA) often involves programming extinction for destructive behavior while reinforcing an alternative form of communication (e.g., a functional communication response); however, implementing extinction can be unsafe or impractical under some circumstances. Quantitative theories of resurgence (i.e., Behavioral Momentum Theory and Resurgence as Choice) predict differences in the efficacy of treatments that do and do not involve extinction of target responding when reinforcement conditions maintaining alternative responding worsen. We tested these predictions by examining resurgence following two DRA conditions in which we equated rates of reinforcement. In DRA without extinction, target and alternative behavior produced reinforcement. In DRA with extinction plus noncontingent reinforcement, only alternative behavior produced reinforcement. We conducted this study in a reverse-translation sequence, first with participants who engaged in destructive behavior (Experiment 1) and then in a laboratory setting with rats (Experiment 2). Across both experiments, we observed proportionally lower levels of target responding during and following the DRA condition that arranged extinction for the target response. However, levels of resurgence were similar following both arrangements.

Investigations of operant ABA renewal during differential reinforcement

Operant renewal is a form of relapse in which a previously extinguished response recurs due to a change in context. We designed two experiments to examine the impact of differential reinforcement of alternative behavior on ABA renewal in a translational model of relapse with 12 children. We compared levels of renewal in two 3-phase arrangements. In one arrangement, we reinforced target responding in Context A, extinguished responding in Context B, and returned to Context A while continuing to implement extinction. In a second arrangement, an alternative response produced reinforcement in Context B and during the return to Context A. Results across the 2 experiments indicated 3 general findings. First, extinction plus differential reinforcement disrupted target behavior more consistently in Context B relative to extinction alone. Second, renewal tended to be greater and more persistent during extinction alone relative to extinction plus differential reinforcement. Third, the renewal effect appeared to depend on whether the alternative response had a history of extinction in Context A. We discuss methodological implications for the treatment of severe destructive behavior.

Resurgence of previously taught academic responses

Resurgence is often discussed in relation to the relapse of undesirable behavior. However, resurgence may also describe the recurrence of socially appropriate behavior, including academic responding. The recurrence of academic responses following periods of extinction may aid in the solution of novel problems. The aims of this study were to evaluate the resurgence of complex, desirable behavior related to college-level instruction and to explore problem form as an aspect of environmental context. Each participant was taught 2 response chains to solve quadratic equations across experimental phases, followed by a phase in which neither chain resulted in the correct solution (extinction). During Experiment 1, the equations presented during extinction resembled those presented during reinforcement of the alternative response. Of the 8 participants in Experiment 1, 4 attempted to use the first-taught chain to solve an equation in the extinction phase. During Experiment 2, the equations presented during extinction resembled those presented during reinforcement of the target response. Of the 8 participants in Experiment 2, 6 attempted to use the first-taught chain to solve an equation in the extinction phase. Results demonstrate the resurgence of academic responses and suggest that the form of the problem may constitute a context that affects resurgence.

The reoccurrence of voluntary behavior in humans is reduced by retrieval cues from extinction

Changes in the temporal as well as the physical context produces the reappearance of extinguished behaviors. Furthermore, combining both kinds of contextual stimuli often causes greater levels of recovery. The current experiment explored the impact of extinction reminders on spontaneous recovery, renewal, and a combination of both effects using an instrumental learning task with humans. All participants learned to shoot at enemies in a videogame. Then, throughout extinction, the instrumental response was eliminated. We found a return of the extinguished behavior by introducing a retention interval of 48 h, by changing the physical background and by testing participants in a spatiotemporal context different from the extinction context. However, we also found that the presentation of a stimulus directly associated with extinction attenuates all three forms of operant reoccurrence. These results are consistent with the perspective that emphasizes that context plays a key role in response-recovery phenomena. Moreover, our findings may be promissory for therapeutic strategies involving relapse treatment.

Resurgence in humans: Reducing relapse by increasing generalization between treatment and testing

Resurgence is the increase in performance of an extinguished instrumental (operant) response that accompanies the extinction of a response that has been reinforced to replace it. Resurgence may involve processes that are relevant for understanding relapse in applied and clinical settings. While resurgence is known to be a robust phenomenon in human operant extinction, the processes that control it remain unclear. Here we asked whether human resurgence is controlled by processes that are similar to those that have been identified in animals by asking whether two methods that reduce resurgence in animals also reduce it in humans. Participants first learned to make an operant response (R1) for a tangible food reinforcer (O1). In a second phase (Phase 2), R1 was extinguished while a second response (R2) was introduced and reinforced with a virtual monetary reward (USD $0.10 coins; O2). In a test phase, extinction was then introduced for R2 and resurgence of R1 was assessed. In Experiment 1, resurgence that occurred after the treatment just described was attenuated if there had been periodic exposure to R2 extinction during the treatment phase (Phase 2). In Experiment 2, resurgence was prevented when O2, but not O1, was presented noncontingently during the test. The results are among the first to suggest a mechanism underlying resurgence in humans, namely, renewal caused by contextual change. They also provide initial evidence to suggest that resurgence may be the result of common processes in animals and humans. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Multiple control responses and resurgence of human behavior

Behavior that was previously extinguished may reoccur, or resurge, when an alternative response contacts extinction or when reinforcement conditions worsen. Researchers have studied resurgence of human responding in laboratory settings with procedures commonly used with nonhumans. In contrast to nonhuman responding, researchers have failed to observe resurgence of the target response at rates that differ from an inactive control response with verbally competent humans. But this may have been the result of using a single control response. The current study examined this possibility by randomly allocating participants (N = 20) to a condition with either two or four control responses. When the alternative response contacted extinction, having more control responses did not reduce overall responding to control options, and aggregated responding to control options were similar to target response rates. Interestingly, most participants responded more to one control response over all other control responses when the alternative response contacted extinction. This study provides additional support for previous research that finds consistent differences between human and nonhuman responding during resurgence procedures. Two potential reasons for variability in human responding during resurgence tests include less time in experimental sessions and the influence of verbal behavior.

Resurgence when challenging alternative behavior with progressive ratios in children and pigeons

Resurgence is defined as the recurrence of a previously reinforced and then extinguished target response when reducing or eliminating a more recently reinforced alternative response. In experiments with children and pigeons, we evaluated patterns of resurgence across and within sessions through decreases in reinforcer availability by challenging alternative responding with extinction and progressive-ratio schedules. In Phase 1, we reinforced only target responding. In Phase 2, we extinguished target responding while reinforcing an alternative response. Finally, Phase 3 assessed resurgence by (a) extinguishing alternative responding versus (b) introducing a progressive-ratio schedule of reinforcement for alternative responding. In both children and pigeons, resurgence of target responding occurred in both conditions but generally was greater when assessed during extinction than with progressive ratios. Importantly, within-session patterns of resurgence did not differ between testing with progressive ratios and extinction. Resurgence with progressive ratios tended to be greater with longer durations between reinforcers but we observed similar findings with only simulated reinforcers during extinction testing. Therefore, the present investigation reveals that the events contributing to instances of resurgence remain to be understood, and presents an approach from which to examine variables influencing within-session patterns of resurgence.

A system for the real-time tracking of operant behavior as an application of 3D camera

The capacity of 3D cameras to measure many different aspects of behavior (e.g., velocity, pattern, and posture) could contribute to the understanding of behavior. The present article describes a system for the real-time tracking of operant behavior, which is applicable to other domains of behavioral science as well. Methods for real-time 3D tracking of animal behavior are described, along with sample C++ programs. A demonstration using one zebrafish as a subject indicated that the present system successfully tracked the 3D motion of the fish. Moreover, the acquisition of a target response (i.e., approach to a corner of the aquarium) was demonstrated with the arrangement of a reinforcement contingency at the corner in the absence of a traditional, salient operandum. The system offers the capacity to characterize more completely ongoing behavior in learning tasks across a range of species than simply performance of discrete operant responses. The system also is capable of tracking multiple individuals simultaneously so it is possible both to study social interactions and arrange contingencies for engaging in social behavior. Other possible applications of 3D cameras are discussed.

Resurgence with and without an alternative response

Resurgence is the reemergence of a previously reinforced response that occurs after the elimination or reduction of reinforcement for an alternative response. Resurgence is problematic in the context of treatment because the reemergence of a previously reinforced destructive response could be detrimental to treatment gains. In the current translational study, we examined a modified resurgence procedure in which the alternative response was either present or absent during extinction. Four participants were exposed to three phases that consisted of (1) reinforcement of a target response, (2) extinction of the target response and differential reinforcement of an alternative response, and (3) extinction of both responses. Results for four out of five assessments showed greater resurgence when the alternative response was absent during Phase 3. Results suggest that more robust resurgence might occur if the alternative response is not available as opposed to the alternative response contacting extinction.