A laboratory model for evaluating relapse of undesirable caregiver behavior

Descriptive characteristics of extinction bursts: A record review

Procedural extinction is sometimes associated with a temporary increase in responding known as an extinction burst. Extinction bursts present unique challenges in the context of treating behavior targeted for reduction. The present study updates the prevalence of extinction bursts using a clinical sample (N = 108) receiving treatment for targeted behavior. The prevalence of extinction bursts in our sample (24%) was consistent with that in prior literature. The extinction-burst magnitude decreased across sessions after extinction was contacted during treatment, but this sample did not demonstrate decreased persistence or magnitude of extinction bursts across successive transitions from baseline to treatment. We also examined the prevalence and magnitude of extinction bursts based on the function and topography of targeted behavior and treatment components and found no consistent relation among these variables. These findings should lead clinicians to prepare for transient extinction bursts when implementing extinction-based treatment for challenging behavior.

A systematic review of enhanced resurgence paradigms

Following successful treatment in which problem behavior is reduced, it may reemerge as a function of changes in contextual stimuli or the worsening of reinforcement conditions for an alternative response. Although understudied, preliminary research suggests that simultaneous changes in contextual stimuli and reinforcement conditions may represent particularly exigent treatment challenges that create the condition for additive or superadditive relapse. The purpose of the present review was to systematically examine the relapse literature involving simultaneous changes in contextual stimuli and reinforcement conditions in relapse tests and experimental preparations arranged to evaluate their effect on response recovery. We identified 16 empirical articles spanning 27 experiments. Although all experiments included at least one condition that experienced a change in contextual stimuli and worsening of alternative reinforcement conditions, only two experiments included the comparison conditions needed to precisely evaluate additive and superadditive relapse. Our findings establish the preclinical generality of relapse effects associated with simultaneous changes to reinforcement conditions and contextual stimuli across a range of subjects, schedule arrangements, response topographies, reinforcers, and types of contextual changes. We make several recommendations for future research based on our findings from this nascent and clinically relevant subdomain of the relapse literature.

Further evidence of renewal in automatically maintained behavior

Renewal is a relapse phenomenon that refers to the recurrence of a previously reduced behavior following a change in stimulus conditions. Muething et al. (2022) examined the phenomenology of renewal among individuals with automatically maintained challenging behavior treated at an outpatient clinic. We replicated their findings by retrospectively examining renewal across various topographies of automatically maintained behavior treated at an inpatient hospital, and we extended their work by also examining differences across subtypes of automatically maintained self-injurious behavior. The prevalence of renewal was comparable to that observed by Muething et al., supporting the notion that automatically maintained challenging behavior is susceptible to relapse phenomena. Furthermore, renewal was twice as likely to occur for individuals with Subtype 2 versus Subtype 1 self-injurious behavior, providing additional evidence of behavioral differentiation between subtypes. Our findings suggest that even after apparent stability in treatment, practitioners should remain vigilant for the recurrence of automatically maintained behavior during generalization.

Expanding a laboratory model for evaluating relapse of caregiver nonadherence

Caregiver adherence to treatment plans is likely maintained by negative reinforcement and can contact extinction when child responding relapses. When caregiver adherence contacts extinction, caregiver nonadherence, such as reinforcing their child's challenging behavior, relapses, threatening treatment efficacy. Previous laboratory models demonstrating the relapse of caregiver nonadherence only evaluated treatment for behavior maintained by social-positive reinforcement, not that maintained by social-negative reinforcement. These models only measured caregiver nonadherence as discrete events, which cannot capture the magnitude of each error. The present study was an evaluation of the relapse of caregiver nonadherence during simulated treatments for escape-maintained challenging behavior. First, caregivers placed demands in a home-like setting and a research confederate responded to these demands in a manner mimicking clinical clients. Next, caregivers were taught to implement treatment in a clinical setting and the confederate's behavior gradually improved. Last, caregivers returned to the home-like setting and confederate challenging behavior relapsed. Nonadherence relapsed for all caregivers, demonstrating the need for additional research on methods for mitigating caregiver relapse during treatment of children's challenging behavior and the usefulness of the proposed measurement system for future research.

Developing the Parent-Coaching Assessment, Individualization, and Response to Stressors (PAIRS) Tool for Behavior Analysts

Parent engagement in early behavioral intervention is essential to achieving meaningful intervention outcomes. However, parents may experience multiple barriers to engagement. The Parent-coaching Assessment, Individualization, and Response to Stressors (PAIRS) was developed to help practitioners assess families' barriers and facilitators, individualize their intervention, and respond to stressors using a contextual, functional approach. An expert panel of Board Certified Behavior Analysts ® (BCBAs) evaluated the content validity of the PAIRS. Average scale values (S-CVI/Ave) were 0.92 for relevance, 0.85 for effectiveness, and 0.91 for appropriateness. The PAIRS was revised, and a follow-up evaluation was conducted to rate the tool's utility. This led to the final version of the PAIRS. Clinical implications and future directions are discussed.

Recommendations Regarding Use of the Term "Ignore" in Applied Behavior Analysis

Ignore is a common term used in behavioral assessment, behavior intervention plans, textbooks, and research articles. In the present article, we recommend against the typical usage of the term in most applications of behavior analysis. First, we briefly outline some history of the use of the term in behavior analysis. Then, we describe six main concerns about ignore and the implications for its continued use. Finally, we address each of these concerns with proposed solutions, such as alternatives to the use of ignore.

The impact of prolonging extinction on the ABC "super renewal" of instrumental responses in rats

Two free operant conditioning experiments with rats examined the impact of conducting a large amount of extinction training on situations that enhance the ABC renewal effect (ABC super renewal). In Experiment 1, ABC renewal was strengthened by conducting acquisition in multiple contexts. All rats were trained to press a lever for food. One group was trained in one context, while the other two groups were trained in three contexts. Then, all rats received extinction in context B. For two groups this phase lasted 4 sessions, whereas it lasted 36 sessions for the other group. In Experiment 2, ABC renewal was strengthened by using a large number of acquisition sessions. Rats were trained to perform an operant response to obtain food in context A. One group received a moderate amount of training, while the rest of the rats received a larger number of acquisition sessions. Responses underwent extinction in context B. Two groups received 4 sessions, while 36 extinction sessions were used for the remaining group. In both experiments, rats were tested in context B (extinction context) and C (renewal context). Greater ABC renewal occurred both when acquisition training was conducted in multiple contexts (Experiment 1) and by increasing the amount of acquisition training (Experiment 2). Nevertheless, we found that conducting a large number of extinction sessions reduced ABC super renewal in Experiment 1 only.

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.

Basic and applied research on extinction bursts

Discontinuation of the contingency between a response and its reinforcer sometimes produces a temporary increase in the response before its rate decreases, a phenomenon called the extinction burst. Prior clinical and basic studies on the prevalence of the extinction burst provide highly disparate estimates. Existing theories on the extinction burst fail to account for the dynamic nature of this phenomenon, and the basic behavioral processes that control response bursting remain poorly understood. In this paper, we first review the basic and applied literature on the extinction burst. We then describe a recent refinement of the concatenated matching law called the temporally weighted matching law that appears to resolve the above-mentioned issues regarding the extinction burst. We present illustrative translational data based conceptually on the model. Finally, we discuss specific recommendations derived from the temporally weighted matching law regarding procedures clinicians could implement to potentially mitigate or prevent extinction bursts.

Quantifying increases in problem behavior following downshifts in reinforcement: A retrospective analysis and replication

The recurrence of a previously eliminated or reduced behavior following a downshift in alternative reinforcement is referred to as resurgence. Resurgence as Choice (RaC) is a quantitative model of behavioral persistence that posits that resurgence is governed by the same behavioral principles that underlie choice behavior. Consistent with the predictions of RaC, extant basic research with animals indicates that resurgence increases as an exponential function of the size of the downshift in alternative reinforcement. Recently, Shahan and Greer (2021) extended this finding to resurgence of problem behavior during schedule thinning following functional communication training (FCT). They found that when resurgence occurred, it increased exponentially as a function of relative decrements in reinforcer availability during schedule thinning with compound schedules of reinforcement. The purpose of the current study was to directly replicate the analytic procedures described in Shahan and Greer to examine resurgence of problem behavior during schedule thinning following FCT using two novel clinical datasets. Our results closely replicate the findings from Shahan and Greer, providing additional support for the generality of resurgence during downshifts in alternative reinforcement in clinical contexts. These results also highlight the potential applicability of RaC for modeling resurgence of problem behavior during FCT schedule thinning.

Effects of environmental distractions on teachers' procedural integrity with three function-based treatments

Past research has demonstrated the effectiveness of teacher-implemented, function-based treatments for problem behavior, but no studies have evaluated the impact of distractions on teachers' procedural integrity. In this proof-of-concept study, the experimenters employed a laboratory analog to examine the impact of distractions on levels of integrity when 5 teachers implemented 3 different treatments. Although integrity was similar across treatments when the setting was free of distractions, integrity declined for all teachers in the presence of student-driven distractions. In general, distractions had a greater impact on the integrity of differential negative reinforcement of alternative behavior (DNRA) compared to differential negative reinforcement of other behavior (DNRO) and noncontingent escape (NCE), particularly for the delivery of reinforcement. However, teachers tended to have lower levels of integrity when responding to problem behavior during DNRO. These findings support the potential viability of this approach for studying factors that impede procedural integrity in the classroom.

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.

Renewal and resurgence phenomena generalize to Amazon's Mechanical Turk

Amazon's Mechanical Turk (MTurk) is a crowdsourcing platform that provides researchers with the potential for obtaining behavioral data for very little cost. However, the extent to which the results of common behavioral phenomena found in basic, translational, and applied laboratories may be reproduced (as a first step towards prospective research) via MTurk remains relatively unexplored. We evaluated renewal and resurgence arrangements using MTurk as the subject recruitment platform as a first step to determining the generality of the obtained data. Results suggested that MTurk participants produced renewal and resurgence data similar to those reported in basic, translational, and applied studies.

Resurgence Following Traditional and Interdependent Differential Reinforcement of Alternative Behavior

Clinicians frequently prescribe functional communication training (FCT) as a treatment for severe destructive behavior. Recent research has shown that FCT treatments are susceptible to treatment relapse in the form of resurgence of destructive behavior when individuals contact periods in which reinforcers are unavailable. Results of preliminary studies suggest that teaching multiple response alternatives can mitigate the resurgence of target behavior. The current evaluation serves as a preliminary study in which we used a laboratory arrangement to evaluate the effects of a novel approach to training multiple alternative responses on the resurgence of target behavior. Findings showed that multiple-response training did not decrease resurgence of target responding consistently; however, it increased the total amount of target and alternative responding observed during the resurgence phase and decreased the overall probability of the target response.

An evaluation of a renewal-mitigation procedure for inappropriate mealtime behavior

Renewal, the increase in behavior during extinction following context changes, may be particularly concerning during intervention for feeding disorders because context changes are often necessary for intervention generality and maintenance (Podlesnik et al., 2017). In the current study, we tested for renewal and evaluated a renewal-mitigation procedure when we transferred intervention from a therapist to a caregiver, from clinic to the home, and changed the foods the feeder presented. We used an ABA arrangement to evaluate the generality of the renewal effect with 7 participants who engaged in inappropriate mealtime behavior. Context A was functional reinforcement. Context B was function-based extinction during the control and mitigation conditions and our renewal-mitigation procedure in the mitigation condition. The renewal test was function-based extinction in Context A. We observed renewal of inappropriate mealtime behavior in 4 of 7 participants, and our renewal-mitigation procedure was effective for 4 of 4 participants.

Prevalence of renewal of problem behavior: Replication and extension to an inpatient setting

Individuals with intellectual and developmental disabilities who exhibit problem behavior often receive behavioral assessment and treatment in specialized inpatient and outpatient clinics. However, problem behavior sometimes reemerges as a function of changes in contexts and stimulus conditions, such as returning to the home environment. This reemergence is called renewal. Recently, Muething et al. (2020) found that renewal occurred in over half (67%) of cases from an outpatient clinic. Their sample was obtained exclusively from an outpatient setting and despite the applied relevance of renewal, its clinical prevalence in other populations is unknown. Accordingly, we replicated Muething et al.'s procedures and analyzed renewal in 37 inpatient treatment applications across 34 cases via consecutive-controlled case series. Renewal was present in 59% of cases; however, we found that renewal occurred in only 24% of context changes compared to 42% reported by Muething et al. Various factors related to the prevalence of renewal were evaluated.

Incorporating discriminative stimuli into functional communication training with augmentative and alternative communication devices: a tutorial

Functional communication training (FCT) is a commonly used and effective treatment for problem behavior maintained by social reinforcement (e.g., an individual engages in self-injurious behavior to gain access to adult attention). FCT involves teaching an individual to emit an appropriate communication response to access the reinforcer maintaining problem behavior (e.g., pressing a "Play, please" symbol on a device to gain the communication partner's attention) and withholding that reinforcer following problem behavior (e.g., the communication partner minimizes attention-following problem behavior and waits for a communication response). Techniques such as incorporating discriminative stimuli (e.g., differently colored cards) can make FCT more practical for caregivers by teaching individuals when reinforcement is and is not available for communication responses while simultaneously mitigating treatment relapse. Despite the effectiveness of FCT with discriminative stimuli, no studies have leveraged the capabilities of augmentative and alternative communication (AAC) devices by embedding discriminative stimuli within AAC software (e.g., by coloring communication symbols or grids). Our tutorial provides a comprehensive overview of how practitioners can incorporate FCT with discriminative stimuli into practice and includes video models of how to design these treatments on two common AAC apps.

Operant renewal of desirable behavior in a simulated workplace: A translational model

Organizational settings are replete with changing stimulus contexts and contingencies, which makes relapse a particularly relevant framework for understanding the ways in which controlling stimuli influence employee responding. The purpose of the current study was to develop a translational model to assess renewal of desirable behavior in a simulated workplace with neurotypical adults. Experiment 1 assessed renewal of desirable behavior using a computerized check processing task. Experiment 2 extended the findings and the translational utility of the experimental arrangement to implementation of a behavior-analytic teaching procedure. Results across both experiments demonstrated renewal of desirable behavior. Overall, the current methodology and findings extend the human operant literature on renewal and demonstrate a translational model that brings together operant renewal and organizational behavior management.

A review of investigations of operant renewal with human participants: Implications for theory and practice

Operant renewal is the recurrence of a previously eliminated target behavior as a function of changing stimulus contexts. Renewal as a model of treatment relapse in humans suggests that a change in stimulus conditions or context is sufficient to produce relapse of a previously eliminated maladaptive behavior. The extent to which general findings from operant renewal studies involving nonhuman animal subjects are supported by relapse studies involving human participants is unknown. We conducted a systematic review of studies demonstrating or mitigating operant renewal in human participants in peer-reviewed studies found in PsycINFO, ERIC, PubMed, and Scopus between 1980 and 2019. We identified 12 studies involving 61 participants and 93 cases of operant renewal. We coded descriptive data on participant and study characteristics and calculated summary statistics. Results indicated that the renewal effect was a robust phenomenon, supported by demonstrations in both clinical and human-laboratory studies, and across a variety of variables and experimental preparations. However, there were relatively few studies involving human participants that attempted to reduce or eliminate renewal of clinically meaningful behavior. We discuss variables relevant for studying renewal in socially meaningful contexts, practical limitations of observing the renewal effect in real-world settings, implications for theoretical models of renewal, and identify barriers to methodology unique to human participants. We provide directions for future research related to implementing and translating nonhuman animal studies of renewal to applied settings.

Mitigating resurgence of destructive behavior using the discriminative stimuli of a multiple schedule

Results of several recent translational studies have suggested that correlating contextual or discriminative stimuli with the delivery and withholding of reinforcement for the functional communication response (FCR) may mitigate resurgence of destructive behavior, but few, if any, have isolated the effects of those stimuli. In the present study, we first trained the FCR, brought it under stimulus control of a multiple schedule, and thinned its reinforcement schedule in one stimulus context. Next, we conducted resurgence evaluations (i.e., baseline, functional communication training [FCT], extinction challenge) in two novel contexts to test the effects of the discriminative stimuli on resurgence. We programmed one context to include the (a) S^D during the FCT phase to signal the availability of reinforcement for the FCR and (b) S^Δ during a subsequent extinction challenge to signal the unavailability of reinforcement for the FCR. The other context did not include the S^D during the FCT phase, nor the S^Δ during the extinction challenge. We expected to see greater persistence of the FCR in the context that included the S^D during FCT and less persistence of the FCR and less resurgence of destructive behavior in the context that included the S^Δ during the extinction challenge. Obtained results confirmed this latter prediction, but we observed no reliable difference when the S^D was present or absent during the FCT phase. Our results have relevance for practitioners in that they provide further empirical support for the use of discriminative stimuli when treating destructive behavior.

Resurgence as Choice: Implications for promoting durable behavior change

Resurgence is an increase in a previously suppressed behavior resulting from a worsening in reinforcement conditions for current behavior. Resurgence is often observed following successful treatment of problem behavior with differential reinforcement when reinforcement for an alternative behavior is subsequently omitted or reduced. The efficacy of differential reinforcement has long been conceptualized in terms of quantitative models of choice between concurrent operants (i.e., the matching law). Here, we provide an overview of a novel quantitative model of resurgence called Resurgence as Choice (RaC), which suggests that resurgence results from these same basic choice processes. We review the failures of the only other quantitative model of resurgence (i.e., Behavioral Momentum Theory) and discuss its shortcomings with respect to the limited range of circumstances about which it makes predictions in applied settings. Finally, we describe how RaC overcomes these shortcomings and discuss implications of the model for promoting durable behavior change.

Prevalence of resurgence of destructive behavior when thinning reinforcement schedules during functional communication training

Functional communication training is a well-established treatment for socially reinforced destructive behavior that typically includes differential reinforcement of the functional communication response (FCR) in combination with extinction of destructive behavior. However, when the schedule of reinforcement for the FCR is thinned, destructive behavior may resurge (e.g., Greer, Fisher, Saini, Owen, & Jones, 2016). Currently, data are unavailable on the prevalence and characteristics of resurgence during reinforcement schedule thinning. In this study, we evaluated the prevalence of resurgence during reinforcement schedule thinning on a per-case and per-schedule-step basis and also evaluated the magnitude of resurgence in relation to the functions of destructive behavior. We observed resurgence in 19 of the 25 (76%) applications of reinforcement schedule thinning. In some cases, the magnitude of resurgence exceeded the mean levels of destructive behavior observed in baseline. We discuss these results relative to prior translational and applied research on resurgence.