A comparison of noncontingent reinforcement and sensory extinction as treatments for self-injurious behavior

Behavioral treatment of automatically reinforced SIB: 1982 - 2015

Some individuals diagnosed with intellectual and developmental disabilities engage in automatically reinforced self-injurious behavior (SIB). For these individuals, identifying effective treatments may be difficult due to the nature of the reinforcement contingency. The purpose of this study was to review the literature on the treatment of automatically reinforced SIB to determine commonalities in procedures that produced effective and ineffective treatment outcomes, as well as historical trends in the treatment of this class of SIB. Results of this review indicated that there were many high-quality studies on this topic, but also a wide range in the quality of studies. As for effective treatments, noncontingent reinforcement (the most common treatment component) was found to be more effective when informed by a competing stimulus assessment rather than a preference assessment. Suggestions to improve the quality of the published record and areas in which additional research is needed are discussed.

Reliability, Validity, and Usability of Data Extraction Programs for Single-Case Research Designs

Single-case experimental designs (SCEDs) have been increasingly used in recent years to inform the development and validation of effective interventions in the behavioral sciences. An important aspect of this work has been the extension of meta-analytic and other statistical innovations to SCED data. Standard practice within SCED methods is to display data graphically, which requires subsequent users to extract the data, either manually or using data extraction programs. Previous research has examined issues of reliability and validity of data extraction programs in the past, but typically at an aggregate level. Little is known, however, about the coding of individual data points. We focused on four different software programs that can be used for this purpose (i.e., Ungraph, DataThief, WebPlotDigitizer, and XYit), and examined the reliability of numeric coding, the validity compared with real data, and overall program usability. This study indicates that the reliability and validity of the retrieved data are independent of the specific software program, but are dependent on the individual single-case study graphs. Differences were found in program usability in terms of user friendliness, data retrieval time, and license costs. Ungraph and WebPlotDigitizer received the highest usability scores. DataThief was perceived as unacceptable and the time needed to retrieve the data was double that of the other three programs. WebPlotDigitizer was the only program free to use. As a consequence, WebPlotDigitizer turned out to be the best option in terms of usability, time to retrieve the data, and costs, although the usability scores of Ungraph were also strong.

Delineating subtypes of self-injurious behavior maintained by automatic reinforcement

Self-injurious behavior (SIB) is maintained by automatic reinforcement in roughly 25% of cases. Automatically reinforced SIB typically has been considered a single functional category, and is less understood than socially reinforced SIB. Subtyping automatically reinforced SIB into functional categories has the potential to guide the development of more targeted interventions and increase our understanding of its biological underpinnings. The current study involved an analysis of 39 individuals with automatically reinforced SIB and a comparison group of 13 individuals with socially reinforced SIB. Automatically reinforced SIB was categorized into 3 subtypes based on patterns of responding in the functional analysis and the presence of self-restraint. These response features were selected as the basis for subtyping on the premise that they could reflect functional properties of SIB unique to each subtype. Analysis of treatment data revealed important differences across subtypes and provides preliminary support to warrant additional research on this proposed subtyping model.

The Effectiveness of the Snug Vest on Stereotypic Behaviors in Children Diagnosed With an Autism Spectrum Disorder

Various reviews of the effects of sensory integration therapy (SIT) have concluded that such interventions fail to reduce stereotypy. However, a new, and as yet untested, SIT iteration, an inflatable wearable vest known as the Snug Vest purports to decrease such repetitive behavior. In the current study, three children who emitted different forms of stereotypy participated in an alternating treatments design in which each participant wore a fully inflated vest and either a fully deflated vest or no vest. The results of the study show that the Snug Vest failed to reduce any participants’ stereotypy. We highlight our findings in the context of professional practice and discuss several potential limitations.

Treating Individuals With Intellectual Disabilities and Challenging Behaviors With Adapted Dialectical Behavior Therapy

Approximately one third of adults with intellectual and developmental disabilities have emotion dysregulation and challenging behaviors (CBs). Although research has not yet confirmed that existing treatments adequately reduce CBs in this population, dialectical behavior therapy (DBT) holds promise, as it has been shown to effectively reduce CBs in other emotionally dysregulated populations. This longitudinal single-group pilot study examined whether individuals with impaired intellectual functioning would show reductions in CBs while receiving standard DBT individual therapy used in conjunction with the Skills System (DBT-SS), a DBT emotion regulation skills curriculum adapted for individuals with cognitive impairment. Forty adults with developmental disabilities (most of whom also had intellectual disabilities) and CBs, including histories of aggression, self-injury, sexual offending, or other CBs, participated in this study. Changes in their behaviors were monitored over 4 years while in DBT-SS. Large reductions in CBs were observed during the 4 years. These findings suggest that modified DBT holds promise for effectively treating individuals with intellectual and developmental disabilities.

The Three-Level Synthesis of Standardized Single-Subject Experimental Data: A Monte Carlo Simulation Study

Previous research indicates that three-level modeling is a valid statistical method to make inferences from unstandardized data from a set of single-subject experimental studies, especially when a homogeneous set of at least 30 studies are included ( Moeyaert, Ugille, Ferron, Beretvas, & Van den Noortgate, 2013a ). When single-subject data from multiple studies are combined, however, it often occurs that the dependent variable is measured on a different scale, requiring standardization of the data before combining them over studies. One approach is to divide the dependent variable by the residual standard deviation. In this study we use Monte Carlo methods to evaluate this approach. We examine how well the fixed effects (e.g., immediate treatment effect and treatment effect on the time trend) and the variance components (the between- and within-subject variance) are estimated under a number of realistic conditions. The three-level synthesis of standardized single-subject data is found appropriate for the estimation of the treatment effects, especially when many studies (30 or more) and many measurement occasions within subjects (20 or more) are included and when the studies are rather homogeneous (with small between-study variance). The estimates of the variance components are less accurate.

Does engagement in meaningful occupation reduce challenging behaviour in people with intellectual disabilities? A systematic review of the literature

Over several years, there has been much debate about the best way to manage challenging behaviour. Although national guidance highlights the importance of meaningful occupation, it is unclear to what extent this helps. This systematic review of the literature aimed to answer the question, 'does engagement in meaningful occupation reduce challenging behaviour in people with intellectual disability?' By searching a range of databases, electronic resources and web pages, 13 relevant articles were identified. Additionally, experts in the field were contacted, hand searches were performed and citation searches were carried out. These 13 articles were critically appraised and analysed using narrative synthesis. Although the amount of research identified was limited and the methodological quality was variable, some broad themes arose. A skilled and structured approach for carrying out occupation may be effective in reducing challenging behaviour; however, more robust research is needed before definitive conclusions can be drawn.

Evaluation of extinction as a functional treatment for binge eating

Binge eating is a serious behavior problem exhibited by individuals diagnosed with binge eating disorder and bulimia nervosa. Binge eating is thought to be maintained by automatic negative reinforcement in the form of relief from negative emotional responding. Current treatments produce only moderate abstinence, perhaps because they do not attempt to alter the functional consequences of the behavior. Although extinction has been thought impossible with behaviors maintained by automatic negative reinforcement, this study evaluated the application of extinction with binge eating. Four women who reported engaging in binge eating at least twice per week participated. Participants listened to an audio tape recording of the covert verbal behavior associated with their negative emotional responding during the binge to prevent alleviation of the negative emotional responding, thus eliminating the reinforcer in an attempt to reduce the behavior. The procedure effectively reduced frequency of the binges when correctly implemented. Implications and suggestions for future research are discussed.

Leisure items as controls in the attention condition of functional analyses

Leisure items (e.g., games, toys) are commonly made available as controls during attention conditions of functional analyses (Ringdahl, Winborn, Andelman, & Kitsukawa, 2002). However, Ringdahl et al. raised questions about this practice. This paper reviews research that supports and conflicts with the inclusion of leisure items as controls, including a quantitative analysis of relevant articles published in the Journal of Applied Behavior Analysis over a 10-year period. Data reviewed suggest that practitioners may consider omitting leisure items as controls or including such items strategically based on the accumulation of assessment information.

Stereotypy I: a review of behavioral assessment and treatment

In this paper, we review definitional issues related to stereotypy, behavioral interpretations of stereotypy, procedures for determining operant function(s) of stereotypy, and behavioral interventions for stereotypy. In general, a preponderance of the assessment literature suggests that most forms of stereotypy are maintained by automatic reinforcement. Review of the treatment literature suggests that antecedent (e.g., environmental enrichment) and consequent (e.g., differential reinforcement of alternative behavior) interventions produce at least short-term reductions in stereotypy. Suggestions for further assessment and treatment of stereotypy are provided.

Treatment efficacy of noncontingent reinforcement during brief and extended application

We evaluated the long-term therapeutic effects of noncontingent reinforcement (NCR). In Experiment 1, NCR effects were examined with 2 participants' arbitrary responses; in Experiment 2, NCR was used as treatment with 3 participants whose self-injurious behavior (SIB) was maintained by automatic reinforcement. In both experiments, NCR consisted of continuous access to a highly preferred leisure item and was implemented initially during 10-min and later during 120-min sessions. Varied reinforcers (leisure items) were subsequently introduced during 120-min sessions to determine if treatment effects might be extended. Finally (Experiment 2 only), NCR was implemented throughout the day in participants' homes. Results of Experiments 1 and 2 showed that reinforcers obtained through object manipulation can compete with those obtained automatically by engaging in SIB during brief NCR sessions. However, data from the 120-min sessions indicated that satiation to a specific leisure item might occur over periods of time more typical of those during which treatment would be implemented. Access to a variety of highly preferred leisure items extended the effectiveness of NCR for some individuals. When NCR was implemented throughout the day (Experiment 2), therapeutic effects were shown to be maintained for up to 1 year.

Treatment of automatically reinforced object mouthing with noncontingent reinforcement and response blocking: experimental analysis and social validation

A brief functional analysis indicated the object mouthing of a young girl diagnosed with autism was maintained independent of social consequences. Separate and combined effects of response blocking and noncontingent reinforcement (with preferred stimuli) were then evaluated as treatments for object mouthing. Although both interventions were unsuccessful when implemented separately, combining them resulted in generalized reductions that were socially valid.

A review of "noncontingent" reinforcement as treatment for the aberrant behavior of individuals with developmental disabilities

The term noncontingent reinforcement (NCR) refers to the delivery of an aberrant behavior's known reinforcer on a response-independent basis. The typical result is a decrease in responding from baseline (i.e., reinforcement) levels. NCR has become one of the most reported function-based treatments for aberrant behavior in the recent literature. The purpose of this review is to briefly discuss the history of the procedure and summarize the findings from the treatment research literature. The review is organized into the following sections: (a) basic research on NCR, (b) NCR as a control procedure, (c) NCR as a function-based treatment, (d) considerations in the programming of NCR schedules, (e) behavior-change mechanisms underlying NCR effects, and (t) directions for future research.

Recent advances in the assessment of aberrant behavior maintained by automatic reinforcement in individuals with developmental disabilities

Many aberrant behaviors exhibited by individuals with developmental disabilities are maintained by "automatic reinforcement". These behaviors are often difficult to treat, with the most effective behavioral interventions often resulting in only moderate success. However, a series of recent studies has advanced our ability to understand and treat these behaviors through the innovative use of behavioral assessment. We review the recent development of three categories of assessments: (a) nonhypothesis-based stimulus preference assessments, (b) hypothesis-based stimulus preference assessments, and (c) hypothesis-based assessments incorporating noncontingent reinforcement and sensory extinction procedures. We consider each category's contribution to both our ability to prescribe effective behavioral interventions and our ability to more fully understand the concept of automatic reinforcement.

Analysis and treatment of finger sucking

We analyzed and treated the finger sucking of 2 developmentally typical children aged 7 and 10 years. The functional analysis revealed that the finger sucking of both children was exhibited primarily during alone conditions, suggesting that the behavior was maintained by automatic reinforcement. An extended analysis provided support for this hypothesis and demonstrated that attenuation of stimulation produced by the finger sucking resulted in behavior reductions for both children. Treatment consisted of having each child wear a glove on the relevant hand during periods when he or she was alone. Use of the glove produced zero levels of finger sucking for 1 participant, whereas only moderate reductions were obtained for the other. Subsequently, an awareness enhancement device was used that produced an immediate reduction in finger sucking.

Competition between noncontingent and contingent reinforcement schedules during response acquisition

We examined the extent to which noncontingent reinforcement (NCR), when used as treatment to reduce problem behavior, might interfere with differential reinforcement contingencies designed to strengthen alternative behavior. After conducting a functional analysis to identify the reinforcers maintaining 2 participants' self-injurious behavior (SIB), we delivered those reinforcers under dense NCR schedules. We delivered the same reinforcers concurrently under differential-reinforcement-of-alternative-behavior (DRA) contingencies in an attempt to strengthen replacement behaviors (mands). Results showed that the NCR plus DRA intervention was associated with a decrease in SIB but little or no increase in appropriate mands. In a subsequent phase, when the NCR schedule was thinned while the DRA schedule remained unchanged, SIB remained low and mands increased. These results suggest that dense NCR schedules may alter establishing operations that result in not only suppression of problem behavior but also interference with the acquisition of appropriate behavior. Thus, the strengthening of socially appropriate behaviors as replacements for problem behavior during NCR interventions might best be achieved if the NCR schedule is first thinned.