Effects of increased response effort on self-injury and object manipulation as competing responses

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.

Concerns About ABA-Based Intervention: An Evaluation and Recommendations

For over 50 years, intervention methods informed by the principles of applied behavior analysis (ABA) have been empirically researched and clinically implemented for autistics/individuals diagnosed with autism spectrum disorder (ASD). Despite the plethora of evidence for the effectiveness of ABA-based interventions, some autism rights and neurodiversity activists have expressed concerns with ABA-based interventions. Concerns have included discontent with historical events and possible harm from the procedures and goals targeted. The purpose of this manuscript is to examine some expressed concerns about ABA-based intervention and suggest productive ways of moving forward to provide the best outcomes for autistics/individuals diagnosed with ASD. The authors represent stakeholders from multiple sectors including board certified behavior analysts, licensed psychologists, parents, and autistics/individuals diagnosed with ASD.

Microswitch Clusters Promote Adaptive Responses and Reduce Finger Mouthing in a Boy With Multiple Disabilities

The authors assessed new microswitch clusters (i.e., combinations of two microswitches) and contingent stimulation to increase adaptive responses (i.e., foot and head movements) and reduce aberrant behavior (i.e., finger mouthing)in a boy with multiple disabilities. Initially, intervention was directed at increasing the frequency of each adaptive response, individually, through contingent use of preferred stimuli. Subsequently, adaptive responses led to preferred stimuli only if they occurred in the absence of finger mouthing. Postintervention checks occurred 1, 2, and 3 months after the end of the intervention. Data showed that the boy (a) increased the frequency of the adaptive responses extensively, (b) learned to perform these responses largely free from finger mouthing, and (c) maintained these changes over time. The importance of microswitch clusters to simultaneously pursue the dual objective of promoting adaptive responses and reducing aberrant ones is underlined.

Further investigation of a rapid restraint analysis

Research related to the use of mechanical restraint devices (e.g., arm splints) has been limited despite the frequency with which they are used in the clinical treatment of severe and dangerous self-injurious behavior (SIB). Wallace, Iwata, Zhou, and Goff () used a rapid restraint analysis (RRA) to evaluate the effects of different levels of arm-splint flexion on rates of hand-to-head SIB and adaptive behavior. The goal of the current study was 3-fold: (a) to extend previous research on RRA by reporting RRA results for 10 participants and investigating post-RRA outcomes, (b) to investigate whether the RRA might have the potential to eliminate the need for restraint fading altogether for some individuals, and (c) to investigate whether the RRA might help to identify a starting point for restraint fading for individuals for whom fading is necessary. Results suggested that the RRA helped to eliminate the need for restraint fading for 6 participants. With respect to the identification of a starting point for restraint fading, results were mixed. Overall, 8 of the 10 participants were discharged from the inpatient unit at a less restrictive level of flexion or at the same level of flexion identified by the RRA. Implications for adoption of the RRA are discussed.

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 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.

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.

Concurrent reinforcement schedules for problem behavior and appropriate behavior: experimental applications of the matching law

This study evaluated how children who exhibited functionally equivalent problem and appropriate behavior allocate responding to experimentally arranged reinforcer rates. Relative reinforcer rates were arranged on concurrent variable-interval schedules and effects on relative response rates were interpreted using the generalized matching equation. Results showed that relative rates of responding approximated relative rates of reinforcement. Finally, interventions for problem behavior were evaluated and differential reinforcement of alternative behavior and extinction procedures were implemented to increase appropriate behavior and decrease problem behavior. Practical considerations for the application of the generalized matching equation specific to severe problem behavior are discussed, including difficulties associated with defining a reinforced response, and obtaining steady state responding in clinical settings.

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 potency of high- and low-preference reinforcers with respect to response rate and response patterns

Previous research has suggested that the availability of high-preference stimuli may override the reinforcing efficacy of concurrently available low-preference stimuli under relatively low schedule requirements (e.g., fixed-ratio 1 schedule). It is unknown if similar effects would be obtained under higher schedule requirements. Thus, the current study compared high-preference and low-preference reinforcers under progressively increasing schedule requirements. Results for 3 of the 4 participants indicated that high-preference stimuli maintained responding under higher schedule requirements relative to low-preference stimuli. For 1 participant, high-preference and low-preference stimuli were demonstrated to be equally effective reinforcers under increasing schedule requirements. Implications with respect to rate of performance and response patterns are discussed.

An evaluation of intraverbal training to generate socially appropriate responses to novel questions

Four preschool children (with and without disabilities), who often responded inappropriately to questions, participated in the current study. Pretest results were used to create sets of questions that the children either did or did not answer correctly (i.e., known and unknown questions). We then sequentially taught two different responses to a subset of unknown questions: (a) "I don't know" (IDK), and (b) "I don't know, please tell me" (IDKPTM). Results showed that following acquisition with the target set, both responses generalized across questions and teachers for all participants. Following IDK training, some undesirable generalization of IDK to known questions occurred for 3 participants. Training of IDKPTM with the addition of a restricted reinforcement contingency was sufficient to establish correct answers to a portion of previously unknown questions. The importance of teaching generalized responses that enable the acquisition of novel intraverbals is discussed.

Evaluating the influence of postsession reinforcement on choice of reinforcers

Factors that influence reinforcer choice have been examined in a number of applied studies (e.g., Neef, Mace, Shea, & Shade, 1992; Shore, Iwata, DeLeon, Kahng, & Smith, 1997; Tustin, 1994). However, no applied studies have evaluated the effects of postsession reinforcement on choice between concurrently available reinforcers, even though basic findings indicate that this is an important factor to consider (Hursh, 1978; Zeiler, 1999). In this bridge investigation, we evaluated the influence of postsession reinforcement on choice of two food items when task responding was reinforced on progressive-ratio schedules. Participants were 3 children who had been diagnosed with developmental disabilities. Results indicated that response allocation shifted from one food item to the other food item under thinner schedules of reinforcement when no postsession reinforcement was provided. These findings suggest that the efficacy of instructional programs or treatments for problem behavior may be improved by restricting reinforcers outside treatment sessions.

Treatment of self-restraint associated with the application of protective equipment

The current investigation assessed the effectiveness of protective equipment, specifically arm splints, in reducing the occurrence of severe self-injurious behavior (SIB). Although the protective equipment reduced rates of SIB to near-zero levels, self-restraint subsequently emerged. In an attempt to reduce self-restraint while maintaining reductions in SIB, we provided noncontingent access to preferred stimuli. The presentation of preferred stimuli along with the use of protective equipment reduced both the rate of SIB and the duration of self-restraint.

Combination therapy reduces self-injurious behavior in a chimpanzee (Pan Troglodytes Troglodytes): a case report

Self-injurious behavior (SIB) remains a severe and intractable abnormal behavior for nonhuman primates in diverse settings and is a significant concern for veterinarians and behavioral scientists. To date, no single pharmacological, behavioral, social, or environmental intervention method has emerged as a reliable permanent cure for treating SIB in all, or even most, individuals. Implementation and evaluation of a combination therapeutic approach to treating SIB for nonhuman primates is rare. In May 2004, a 25-year-old male chimpanzee with severe SIB (M = 2.09 episodes/day, range = 1-4 episodes/day) underwent intensive behavioral intervention that utilized a combination of techniques. The combination therapy approach entailed the following: (a) pharmacological intervention with a gamma-aminobutyric acid (GABA) analogue to treat suspected HIV-related sensory neuropathic pain, (b) positive reinforcement training, and (c) environmental enrichment, as well as social and environmental modification. The severity of SIB warranted immediate implementation of intensive combination therapy rather than a systematic evaluation of the individual treatment options. The individually tailored, multifaceted combination therapy resulted in the virtual elimination of SIB in this chimpanzee over a 2-year period.

Treatment of hand mouthing in individuals with severe to profound developmental disabilities: a review of the literature

This paper reviews studies investigating the assessment and treatment of hand mouthing in individuals with severe to profound developmental disabilities. A literature search identified 101 studies carried out between 1969 and 2004. The trend in the studies indicated a shift away from aversive interventions in the last 10 years, so this review included studies conducted from 1995. Twenty-three studies were identified within this period and were included in this review. The 23 studies were sorted into seven intervention categories and one assessment category. The seven intervention categories included (a) antecedent interventions, (b) multicomponent interventions (e.g., differential reinforcement and response effort), (c) pharmacological interventions, (d) interventions that utilized reinforcement, (e) response blocking interventions, (f) response effort interventions, and (g) sensory stimulation interventions. The one assessment category included studies that investigated the function of hand mouthing. One main finding in these studies was that the various intervention strategies led to decreases in hand mouthing in individuals with severe to profound developmental disabilities. This finding is discussed in relation to its effect on issues of health, adaptive behavior, and social functioning. A second finding indicated that hand mouthing is often maintained by automatic reinforcement (i.e., non-social contingencies). The implications of this finding are discussed in terms of how assessments and treatments associated with automatically maintained challenging behavior might be more effectively linked. Potential issues for future research are also examined.

Individualized sampling parameters for behavioral observations: enhancing the predictive validity of competing stimulus assessments

Recent studies have used pretreatment analyses, termed competing stimulus assessments, to identify items that most effectively displace the aberrant behavior of individuals with developmental disabilities. In most studies, there appeared to have been no systematic basis for selecting the sampling period (ranging from 30 s to 10 min) in which items were assessed. Unfortunately, estimates based on brief samples of behavior do not always predict the extent to which items will displace aberrant behavior over longer periods. This study first examined a method for determining an accurate individualized sample length for competing stimulus assessments, based on statistical measures of correspondence with extended effects, using a small number of items. The effects of a larger number of items were then assessed using the determined sample length. Finally, the method was validated by comparing its predictions, in terms of the reduction of problem behavior over more extended periods, to predictions based on sample durations typically used in previous investigations. For two participants, predictions based on individualized determination of sample lengths were more accurate than predictions based on typical sample lengths. These results are discussed in terms of the exchange between expediency and accuracy during competing stimulus assessments.

Schedule thinning following communication training: using competing stimuli to enhance tolerance to decrements in reinforcer density

Functional communication training (FCT) is a widely used treatment for individuals with developmental disabilities who exhibit severe behavior problems. One inherent challenge of employing FCT as a treatment in the community is that reinforcement for appropriate communication cannot always be immediate or even possible in some circumstances. Of the few studies that have incorporated some form of schedule thinning for communication, most have reported disruption of communication or increases in problem behavior when the schedule of reinforcement is thinned. In the current study, we compared FCT with extinction to FCT with extinction and access to competing stimuli. After conducting a functional analysis, a competing stimulus assessment was performed to identify stimuli that produce reinforcement that ostensibly competes with reinforcement that maintains problem behavior. It was hypothesized that FCT with competing stimuli would result in more stable reductions in problem behavior during schedule thinning, which would ultimately result in quicker achievement of the treatment goal (low levels of problem behavior under the terminal reinforcement schedule for communication) than FCT without competing stimuli. Results confirmed this hypothesis.

Varying response effort in the treatment of pica maintained by automatic reinforcement

Pica is a life-threatening behavior displayed by many individuals with developmental disabilities. In the current study, automatic reinforcement maintained the pica of 3 participants. Following functional analyses of pica, response-effort manipulations were conducted in which the effort to obtain pica or alternative items was varied systematically. Several general relations emerged as a result of the study. First, levels of pica were reduced relative to baseline when alternative items were available independent of the effort required to obtain alternative items or pica. Second, increasing the effort for alternative items resulted in increases in pica relative to when effort for alternative items was low. Third, increasing response effort for pica produced reductions in pica relative to baseline when alternative items were unavailable. Fourth, the highest levels of pica occurred when the effort to engage in pica was low or medium and no alternative items were available. These findings are discussed in terms of the relative effects of quality of reinforcement and response effort on behavior.