A methodology for distinguishing between extinction and punishment effects associated with response blocking

A Quantitative Systematic Literature Review of Combination Punishment Literature: Progress Over the Last Decade

This review evaluated single-case experimental design research that examined challenging behavior interventions utilizing punishment elements. Thirty articles published between 2013 and 2022 met study inclusion criteria. Study quality was also assessed. Through multiple levels of analysis (e.g., descriptive statistics, non-parametric statistics), we examined (a) participant and study trends, (b) differential outcomes related to temporal reinforcement approaches (antecedent, consequent, or combined reinforcement) applied alongside punishment element(s), (c) differential outcomes related to the punishment type (negative, positive) applied alongside reinforcement, and (d) effect sizes associated with study rigor across peer-reviewed and gray literature. Our results may tentatively suggest that, for certain situations, concurrently applying punishment with antecedent reinforcement approaches may coincide with significantly larger effect sizes compared to combined temporal reinforcement approaches, while positive punishment applied concurrently with reinforcement may coincide with larger but non-significant intervention effects. Most featured articles met rigor criteria, but larger effects were seen in peer-reviewed literature.

Evaluation of schedule thinning following treatment for aggression maintained by access to higher level restrictive and repetitive behavior

One of the diagnostic characteristics of individuals with autism spectrum disorders includes engaging in restricted and repetitive behavior. Research has shown that individuals will often display problem behavior when access to restricted and repetitive behavior is blocked. The purpose of the current study was to evaluate the use of functional communication training and schedule thinning to treat aggression displayed by three children diagnosed with autism spectrum disorders when higher level restrictive and repetitive behavior was blocked. Further, we assessed whether all steps in a schedule-thinning sequence were necessary as well as extended the practicality of these procedures by removing the continuous signal during the delay to reinforcement. The results indicated that functional communication with schedule thinning reduced aggression related to blocking access to engaging in higher level restrictive and repetitive behavior for all participants.

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.

Assessment and treatment of response to name for children with autism spectrum disorder: Toward an efficient intervention model

Response to name (RTN) is an early developmental milestone, deficits in which are associated with autism spectrum disorder (ASD). This study extends previous research by evaluating an assessment and treatment model for RTN with 13 children with ASD. For all participants, phase 1 was a naturalistic social baseline. The 9 children who did not meet mastery criteria in phase 1 underwent a series of treatment conditions in phase 2. In phase 3, treatment components were removed, and generalization was assessed. Results indicated that tangible reinforcement procedures can produce rapid increases in discriminated RTN, sometimes without prompts. The total number of trials to mastery were reduced in the current study relative to previous research. Results also provide preliminary evidence to suggest that the phase 1 baseline condition may produce distinct patterns of RTN that could be used to predict treatment effects and further reduce trials to mastery in future work.

Increasing item engagement and decreasing automatically reinforced problem behavior within a modified competing stimulus assessment

A competing stimulus assessment (CSA) is commonly used to identify leisure items for use in treatments designed to decrease automatically reinforced problem behavior. However, this type of assessment may not yield useful information if participants do not readily engage with leisure items. The purpose of this study was to evaluate a modified CSA that included additional treatment components (i.e., prompting, prompting plus differential reinforcement of alternative behavior). The modified CSA identified the treatment components and leisure items that were most effective for increasing leisure-item engagement and decreasing problem behavior for each participant. Modified CSA outcomes maintained during an extended treatment analysis in a natural setting and when intervention components were faded.

Comparing response blocking and response interruption/redirection on levels of motor stereotypy: Effects of data analysis procedures

Autism spectrum disorder (ASD) is marked by deficits in social communication and the presence of restrictive and/or repetitive behaviors or interests. Motor stereotypy is a form of repetitive behavior that is common in ASD. Response Interruption and Redirection (RIRD) and response blocking (RB) are two interventions found to be efficacious in reducing motor stereotypy. However, the current literature presents with inconsistencies regarding the relative efficacy of these two procedures. Thus, we sought to replicate and extend previous literature by evaluating the efficacy of both interventions on reducing motor stereotypy among 3 individuals with ASD. We also sought to evaluate how variations in data analysis affected the interpretation of treatment outcomes. Results indicated that both interventions were equally efficacious at reducing stereotypy when analyzing data exclusive of treatment-implementation time. However, when analyzing total session time data, RB produced greater and more sustained reductions in stereotypy across all participants. These results emphasize the importance of data analysis decision-making in evaluating intervention outcomes.

Behavioral Treatment of Self-Injury: 2001 to 2016

Individuals diagnosed with intellectual and developmental disabilities (IDD) frequently exhibit self-injurious behavior (SIB). Previous research has examined the published literature on behavioral treatments of SIB from 1964-2000. Results suggested that these treatments were highly efficacious at decreasing SIB, particularly when based on the results of a functional assessment. The purpose of this review is to update, replicate, and extend the previous research. The current findings indicate an increase in studies reporting automatically maintained SIB as well as less efficacious treatments overall. Discussion of our conclusions and methods of SIB assessment and treatment are discussed, both as they relate to the previous review and for future directions.

Resurgence of a target behavior suppressed by a combination of punishment and alternative reinforcement

Differential-reinforcement-based treatments involving extinction of target problem behavior and reinforcement of an alternative behavior are highly effective. However, extinction of problem behavior is sometimes difficult or contraindicated in clinical settings. In such cases, punishment instead of extinction may be used in combination with alternative reinforcement. Although it is well documented that omitting alternative reinforcement can produce recurrence (i.e., resurgence) of behavior previously suppressed by extinction plus alternative reinforcement, it remains unclear if resurgence similarly occurs for behavior previously suppressed by punishment plus alternative reinforcement. The present experiment examined this question with rats. In Phase 1, a target behavior (lever pressing) was reinforced with food pellets. In Phase 2, the target behavior continued to be reinforced, but it also produced mild foot shock and an alternative behavior (nose poking) also produced food. Finally, all consequences were removed and resurgence of target behavior occurred. Resurgence did not occur for another group that similarly received punishment of target behavior in Phase 2 but not alternative reinforcement. These results indicate that resurgence was a product of the history of exposure to and then removal of alternative reinforcement and that the removal of punishment alone did not produce resurgence of target behavior.

Assessment and treatment of automatically reinforced self-induced emesis

Frequent emesis can cause substantial deleterious effects to a child's health and environment. We conducted a functional analysis of a 3-year-old girl's self-induced emesis and confirmed that emesis was maintained by automatic reinforcement. In a reversal design, we evaluated the efficacy of implementing response blocking at 100% and 50% treatment integrity levels on both attempts and successful production of emesis. One hundred percent blocking, but not 50% blocking, was successful in reducing attempts and emesis below baseline levels.

The primatologist as a behavioral engineer

The field of primate behavior management has had only limited success in preventing and treating abnormal behaviors, such as stereotypy and self-injury, in captive non-human primates (NHP). In contrast, applied behavior analysts have had great success in treating similar topographies of behavior in human clinical settings. By adapting and adopting the behavioral principles and methodologies commonly used by applied behavior analysts, primatologists may be able to develop more effective ways to analyze, reduce, and prevent these aberrant behaviors in NHP. This article reviews studies that have used behavior analytic techniques to successfully address problem behaviors in NHP. Additionally, relevant literature from the field of applied behavior analysis is reviewed to illustrate how adopting a theoretical framework that emphasizes the determination of the underlying operant functions of behavior could lead to new behavioral technologies and advance the field of captive primate management. Am. J. Primatol. 79:e22500, 2017. © 2015 Wiley Periodicals, Inc.

Multiple schedules in practical application: Research trends and implications for future investigation

Researchers began studying multiple schedules in basic laboratories, but recent advances have extended research on multiple schedules to a wide variety of socially significant applications, especially during the last decade. Applied researchers have used multiple schedules to (a) promote stimulus control over high-rate appropriate behaviors, (b) thin the schedule of reinforcement following functional communication training, and (c) obtain stimulus control over problem behaviors maintained by automatic reinforcement. In the current paper, we reviewed 31 studies with 147 applications identified through a search of the applied literature on multiple schedules. Using these studies, we (a) reviewed the empirical literature on multiple schedules, (b) recommended multiple-schedule procedures that serve as best practice guidelines for applied behavior analysts, (c) identified the generality and boundaries of current knowledge about the effectiveness of multiple schedules, and (d) critically analyzed the literature to provide directions for future multiple-schedule research.

Evaluation of multiple schedules with naturally occurring and therapist-arranged discriminative stimuli following functional communication training

Many studies have shown that (a) functional communication training (FCT) is effective for reducing problem behavior, and (b) multiple schedules can facilitate reinforcer schedule thinning during FCT. Most studies tha have used multiple schedules with FCT have included therapist-arranged stimuli (e.g., colored cards) as the discriminative stimuli (S(D) s), but recently, researchers have evaluated similar multiple-schedule training procedures with naturally occurring S(D) s (e.g., overt therapist behavior). The purposes of the current study were to compare the effects of arranged and naturally occurring S(D) s directly during (a) acquisition of discriminated functional communication responses (FCRs) and (b) generalization of discriminated FCRs when we introduced the multiple schedules in novel contexts in which the naturally occurring stimuli were either relatively easy or difficult to discriminate. Results showed that (a) 2 of 3 participants acquired discriminated responding of the FCR more rapidly with arranged than with naturally occurring stimuli, (b) 2 of 3 participants showed resurgence of problem behavior , and (c) 2 of 3 participants showed greater generalization of discriminated responding to novel contexts with arranged stimuli than with naturally occurring stimuli. We discuss these results relative to the conditions under which naturally occurring and arranged S(D) s may promote rapid and generalized treatment gains.

Individual and combined effects of noncontingent reinforcement and response blocking on automatically reinforced problem behavior

Noncontingent reinforcement (NCR) and response blocking are 2 common interventions for problem behavior maintained by automatic reinforcement. We implemented NCR and blocking with 1 boy and found this combined intervention to be effective at decreasing high rates of automatically reinforced pica. With another child, we compared the effects of blocking alone to the combined intervention. With the third child, we compared NCR alone and blocking alone to the combined intervention. Results showed that the combined intervention was effective at reducing automatically reinforced problem behavior while moderate to high levels of item engagement maintained. When evaluated individually, neither NCR nor blocking was sufficient to reduce problem behavior to clinically significant levels.

Noncontingent reinforcement: a further examination of schedule effects during treatment

We conducted 2 studies to determine whether dense and thin NCR schedules exert different influences over behavior and whether these influences change as dense schedules are thinned. In Study 1, we observed that thin as well as dense NCR schedules effectively decreased problem behavior exhibited by 3 individuals. In Study 2, we compared the effects of 2 NCR schedules in multielement designs, one with and the other without an extinction (EXT) component, while both schedules were thinned. Problem behavior remained low as the NCR schedule with EXT was thinned, but either (a) did not decrease initially or (b) subsequently increased as the NCR schedule without EXT was thinned. These results suggest that dense schedules of NCR decrease behavior by altering its motivating operation but that extinction occurs as the NCR schedule is thinned. The benefits and limitations of using dense or thin NCR schedules are discussed.

The effects of matched stimulation and response interruption and redirection on vocal stereotypy

Stereotypy has been classified as repetitive behavior that does not serve any apparent function. Two procedures that have been found to reduce rates of vocal stereotypy effectively are response interruption and redirection (RIRD) and noncontingent access to matched stimulation (MS). The purpose of the current study was to evaluate the effects of RIRD alone, MS alone, and MS combined with RIRD. One participant's results suggested similar suppressive effects on vocal stereotypy across treatment conditions. For the second participant, a slightly greater suppression of stereotypy was associated with MS + RIRD. In addition, both participants emitted a greater frequency of appropriate vocalizations in conditions with RIRD. Data suggest that the addition of MS might facilitate the implementation of RIRD in applied settings.

Preference for blocking or response redirection during stereotypy treatment

Response redirection and response blocking reduce stereotypy maintained by automatic reinforcement. The current study evaluated the effects of redirection and response blocking on the stereotypic responding of three elementary-age children diagnosed with autism. During the treatment evaluation, redirection and response blocking were evaluated using an alternating treatment embedded in a reversal design. Both procedures resulted in comparably low levels of motor stereotypy. Following treatment evaluation, a concurrent chain was conducted to evaluate participant preference for redirection or response blocking. All three participants preferred redirection. Practitioners may wish to consider participant preference when developing and implementing treatments for stereotypy.

The association for behavior analysis international position statement on restraint and seclusion

A task force authorized by the Executive Council of the Association for Behavior Analysis International (ABAI) generated the statement below concerning the techniques called restraint and seclusion. Members of the task force independently reviewed the scientific literature concerning restraint and seclusion and agreed unanimously to the content of the statement. The Executive Council accepted the statement, and it was subsequently approved by a two-thirds majority vote of the general membership. It now constitutes official ABAI policy. The position statement is posted on the ABAI Web site (www.abainternational.org/ABA/statements/RestraintSeclusion.asp). The purpose of the position statement is to provide guidance to behavior analysts and other professionals interested in the position of ABAI on these controversial topics. In extreme cases, abuses of procedures erroneously used in the name of behavior analysis are not defensible. On the other hand, behavior analysts acting ethically and in good faith are provided with guidelines for sound and acceptably safe practice. To the extent that behavior-analytic positions influence public policy and law, this statement can be presented to officials and lawmakers to guide informed decision making. At the conclusion of the document, a bibliography is provided of articles and presentations considered by one or more task force members in developing the position statement.

Assessment and Treatment of Self-Injurious Behavior Associated with Donnai-Barrow Syndrome

Donnai and Barrow (American Journal of Medical Genetics, 68, 441-444, 1993) reported multiple participants who shared a variety of specific physical and neurological anomalies. Relatively few cases have been reported since then and few of those have progressed to an age such that the developmental progression of the disorder can be ascertained. We describe one participant with Donnai-Barrow syndrome who engaged in repetitive self-injurious behavior (SIB), which heretofore has not be described in this population. Direct observations of the participant's SIB were conducted across a range of contexts, and the behavior was successfully decreased using a combination of procedures. This case is discussed within the context of the behavioral phenotype of Donnai-Barrow syndrome.

The effects of verbal operant training and response interruption and redirection on appropriate and inappropriate vocalizations

Past research has shown that response interruption and redirection (RIRD) can effectively decrease automatically reinforced motor behavior (Hagopian & Adelinis, 2001). Ahearn, Clark, MacDonald, and Chung (2007) found that a procedural adaptation of RIRD reduced vocal stereotypy and increased appropriate vocalizations for some children, although appropriate vocalizations were not targeted directly. The purpose of the current study was to examine the effects of directly targeting appropriate language (i.e., verbal operant training) on vocal stereotypy and appropriate speech in 3 children with an autism spectrum disorder. The effects of verbal operant (i.e., tact) training were evaluated in a nonconcurrent multiple baseline design across participants. In addition, RIRD was implemented with 2 of the 3 participants to further decrease levels of vocal stereotypy. Verbal operant training alone produced slightly lower levels of stereotypy and increased appropriate vocalizations for all 3 participants; however, RIRD was required to produce acceptably low levels of stereotypy for 2 of the 3 participants.

The effects of tact training on stereotypic vocalizations in children with autism

This study was a systematic extension of Karmali, Greer, Nuzzulo-Gomez, Ross, and Rivera-Valdes (2005) and Ahearn, Clark, MacDonald, and Chung (2007). We investigated the effects of a tact correction procedure on stereotypic vocalizations in 4 children diagnosed with autism who ranged in age from 6 to 16 years. Participants had limited vocal verbal repertoires and were primarily dependent on prompts for the emission of appropriate vocalizations. A multiple-baseline design across participants was used. Data were collected on instances of stereotypic vocalizations and independent tacts during baseline conditions and on instances of stereotypic vocalizations, independent tacts, and echoic-tacts during intervention. Procedural integrity and social validity data were also obtained. The results indicated a decrease in stereotypic vocalizations for 3 of the 4 participants and a slight increase in appropriate vocal verbal behavior (i.e., tacting) for all participants. The study provides support for the use of tact correction procedures to decrease stereotypic vocalizations and increase appropriate vocalizations in children with autism.

An approach to identifying the conditions under which response interruption will reduce automatically reinforced problem behavior

Response interruption is a common intervention for problem behavior maintained by automatic reinforcement, but this intervention is challenging for caregivers to implement with consistent fidelity. In the current study, we challenged the integrity of response interruption across two participants by examining carry over into conditions in which the procedure was not implemented, by removing the presence of an interventionist, and by introducing delays to implementation. The results indicated that these challenges severely compromised treatment efficacy. Conditions under which response interruption procedures are likely to be effective and possible strategies to increase the effectiveness of response interruption are discussed.

Differential reinforcement with and without blocking as treatment for elopement

Blocking is a frequent component of treatments for elopement. Unfortunately, blocking may not always be feasible because elopement often occurs when supervision is low or the behavior cannot be prevented. The present study evaluated the use of blocking in the treatment of elopement by using differential reinforcement of other behavior with and without blocking. In this case, results suggested that blocking may be an essential component for differential reinforcement-based treatments of elopement.

Evaluation of response blocking and re-presentation in a competing stimulus assessment

Competing stimulus assessments (CSA) have been used to identify stimuli that are associated with reduced levels of problem behavior, presumably as a function of reinforcer competition. Following a standard CSA in which stimuli simply were made available, 2 more CSAs were conducted with additional components designed to enhance reinforcer competition: re-presentation of stimuli and response blocking for self-injury. The results obtained from each CSA were validated in an extended treatment analysis. The study illustrates how the effects of additional components designed to enhance reinforcer competition can be evaluated efficiently in the context of a CSA.

Functional analysis and treatment of arranging and ordering by individuals with an autism spectrum disorder

Of the diagnostic features of autism, relatively little research has been devoted to restricted and repetitive behavior, particularly topographically complex forms of restricted and repetitive behavior such as rigidity in routines or compulsive-like behavior (e.g., arranging objects in patterns or rows). Like vocal or motor stereotypy, topographically complex forms of restricted and repetitive behavior may be associated with negative outcomes such as interference with skill acquisition, negative social consequences, and severe problem behavior associated with interruption of restricted and repetitive behavior. In the present study, we extended functional analysis methodology to the assessment and treatment of arranging and ordering for 3 individuals with an autism spectrum disorder. For all 3 participants, arranging and ordering was found to be maintained by automatic reinforcement, and treatments based on function reduced arranging and ordering.

Further evaluation of response interruption and redirection as treatment for stereotypy

The effects of 2 forms of response interruption and redirection (RIRD)-motor RIRD and vocal RIRD-were examined with 4 boys with autism to evaluate further the effects of this intervention and its potential underlying mechanisms. In Experiment 1, the effects of motor RIRD and vocal RIRD on vocal stereotypy and appropriate vocalizations were compared for 2 participants. In Experiment 2, the effects of both RIRD procedures on both vocal and motor stereotypy and appropriate vocalizations were compared with 2 additional participants. Results suggested that RIRD was effective regardless of the procedural variation or topography of stereotypy and that vocal RIRD functioned as a punisher. This mechanism was further explored with 1 participant by manipulating the schedule of RIRD in Experiment 3. Results were consistent with the punishment interpretation.

Treating Operant Vomiting With Visual Screening

The authors present a case study of an 8-year-old boy with autism who engaged in operant vomiting. Functional assessment indicated that vomiting persisted in the absence of social reinforcement. After interventions involving noncontingent access to preferred items, differential reinforcement of other behavior (DRO), and DRO plus time out failed to produce clinically significant decreases in vomiting, we implemented a contingent mouthwash procedure and a contingent visual screen (VS) procedure. The results show that the contingent mouthwash produced only temporary decreases in vomiting whereas the VS procedure gradually decreased the boy’s vomiting to zero levels over the course of 23 weeks. In addition, a 4-month follow-up assessment showed that ongoing implementation of the VS procedure produced zero levels of vomiting. The gradual reduction in the boy’s vomiting following the introduction of the VS procedure suggests that the intervention extinguished one or more of the sensory consequences that were formerly produced by vomiting.

An investigation of differential reinforcement of alternative behavior without extinction

We manipulated relative reinforcement for problem behavior and appropriate behavior using differential reinforcement of alternative behavior (DRA) without an extinction component. Seven children with developmental disabilities participated. We manipulated duration (Experiment 1), quality (Experiment 2), delay (Experiment 3), or a combination of each (Experiment 4), such that reinforcement favored appropriate behavior rather than problem behavior even though problem behavior still produced reinforcement. Results of Experiments 1 to 3 showed that behavior was often sensitive to manipulations of duration, quality, and delay in isolation, but the largest and most consistent behavior change was observed when several dimensions of reinforcement were combined to favor appropriate behavior (Experiment 4). Results suggest strategies for reducing problem behavior and increasing appropriate behavior without extinction.

A technology-based stimulation program to reduce hand mouthing by an adolescent with multiple disabilities

This study assessed the possibility of reducing hand mouthing, i.e., bringing fingers into or over the mouth, by an adolescent with multiple disabilities through a technology-based stimulation strategy. The strategy ensured that (a) the participant received 10 sec. of preferred stimulation contingent on the response of bringing both hands into a box with objects, and (b) the stimulation would be interrupted prematurely if the participant removed one or both hands from the box for 2 sec. The study involved an ABAB sequence (in which A represented baseline and B intervention phases) and a 3-mo. postintervention check. Data showed that the response of bringing both hands into the box increased from a mean frequency of about four per 10-min. session during baseline to a mean frequency of over 30 per session during the second intervention phase and the postintervention check. During these periods, the participant's mean hand-mouthing time per session was below 1.5 min. (compared to above 7 min. during baseline) and the mean stimulation time per session was about 4 min. Practical implications of the findings are discussed.

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.