Analysis and treatment of finger sucking

Pilot trial of a technology assisted treatment for trichotillomania

The present study examined the usability, acceptability, feasibility, and preliminary efficacy of a prototype wrist-worn motion detection device and accompanying mobile app, developed by HabitAware®, as a system for delivering self-administered Habit Reversal Training (HRT). As an exploratory aim, the effect of the device and HRT app combination was compared to a reminder bracelet. The pilot trial included 15 adults with trichotillomania who interacted with the device and app system (n = 10) or reminder bracelet (n = 5) for 4 weeks. Participants in the device and app condition reported high usability, acceptability, and perceived efficacy of the system. The device and HRT app combination reduced hair pulling severity. Individuals in the reminder bracelet condition also showed a significant improvement in hair pulling. A future efficacy study with a larger sample size, longer timeframe, and improved gesture detection algorithm is warranted.

A retrospective analysis of stereotypy: Applicability of the behavioral subtyping model

Recent research on automatically reinforced self-injurious behavior (ASIB) has identified specific patterns of responding in functional analyses that correlate with intervention efficacy (Hagopian et al., 2015; Hagopian et al., 2017). Whereas research by Hagopian et al. (2015, 2017) points to an important development in the assessment and treatment of ASIB, it is unclear if the applicability extends to automatically reinforced noninjurious behaviors, including stereotypy. Therefore, the current study replicated the methods of Hagopian et al. (2017), extending this research to published cases of stereotypy and related behavior. The behavioral subtype for each case was identified, and where applicable, the subtype was compared to intervention outcome data. The categorization of data sets as either Subtype 1 or Subtype 2 did not correspond with specific treatment outcomes. Unlike the results of Hagopian et al. (2015, 2017), reinforcement-based interventions were not more likely to be effective for Subtype 1 stereotypy than for Subtype 2 stereotypy.

A Systematic Review of Caregiver-Implemented Functional Analyses

The purpose of this systematic review was to systematically locate and analyze the research on caregiver-implemented functional analyses and subsequent function-based interventions. We included 36 studies and examined multiple features of the studies, including participant demographics, functional analysis characteristics, intervention characteristics, procedural fidelity, risks of bias, and social validity. Overall, the studies showed that caregivers were able to implement functional analyses that yielded differential responding, although few studies reported procedural fidelity data. Caregivers were also able to implement function-based interventions that led to socially significant changes in challenging behavior. Implications for practice and future research are discussed.

Reducing risky behavior with habit reversal: A review of behavioral strategies to reduce habitual hand-to-head behavior

Habit reversal training (HRT) has been a mainstay of behavior analysts' repertoire for nearly the last 50 years. HRT has been effective in treating a host of repetitive behavior problems. In the face of the current coronavirus pandemic, HRT has practical public health importance as a possible intervention for reducing hand‐to‐head behaviors that increase the risk of viral infection. The current paper provides a brief review of HRT for hand‐to‐head habits that is designed for a broad audience and concludes with practical suggestions, based on HRT, for reducing face‐touching behaviors.

Alterations to functional analysis methodology to clarify the functions of low rate, high intensity problem behavior

Current research provides few suggestions for modifications to functional analysis procedures to accommodate low rate, high intensity problem behavior. This study examined the results of the extended duration functional analysis procedures of Kahng, Abt, and Schonbachler (2001) with six children admitted to an inpatient hospital for the treatment of severe problem behavior. Results of initial functional analyses (Iwata, Dorsey, Slifer, Bauman, & Richman, 1982/1994) were inconclusive for all children because of low levels of responding. The altered functional analyses, which changed multiple variables including the duration of the functional analysis (i.e., 6 or 7 hrs), yielded clear behavioral functions for all six participants. These results add additional support for the utility of an altered analysis of low rate, high intensity problem behavior when standard functional analyses do not yield differentiated results.

What is the evidence for environmental causes of challenging behaviors in persons with intellectual disabilities and autism spectrum disorders?

An extensive literature on the causes of challenging behaviors has been developed, primarily in the applied behavior analysis literature. One hundred and seventy-three empirical studies were reviewed where functional assessment serves as the primary method of identifying these causes. Most of the studies were able to identify a clear function or functions. Most commonly established causes were attention, the efforts to acquire tangibles, negative reinforcement in the form of escape from tasks or environments, and sensory stimulation, also described as an alone condition. Examples are provided regarding how these conditions are investigated across studies. Biological and cognitive causes have also been demonstrated. However, to date the empirical literature is limited with the bulk of studies being correlational. Considerably more research is needed, but some causes and methods to identify them are beginning to emerge.

What is the function of nail biting: an analog assessment study

OBJECTIVE

To compare the frequency of nail biting in 4 settings (interventions) designed to elicit the functions of nail biting and to compare the results with a self-report questionnaire about the functions of nail biting.

DESIGN

Randomised allocation of participants to order of conditions.

SETTING

University Psychology Department.

SUBJECTS

Forty undergraduates who reported biting their nails.

INTERVENTIONS

Left alone (boredom), solving maths problems (frustration), reprimanded for nail biting (contingent attention), continuous conversation (noncontingent attention).

MAIN OUTCOME MEASURES

Number of times the undergraduates bit their nails.

RESULTS

Nail biting occurred most often in two conditions, boredom and frustration.

CONCLUSION

Nail biting in young adults occurs as a result of boredom or working on difficult problems, which may reflect a particular emotional state. It occurs least often when people are engaged in social interaction or when they are reprimanded for the behavior.

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.

Functional analysis of problem behavior: a review

Functional analysis methodology focuses on the identification of variables that influence the occurrence of problem behavior and has become a hallmark of contemporary approaches to behavioral assessment. In light of the widespread use of pretreatment functional analyses in articles published in this and other journals, we reviewed the literature in an attempt to identify best practices and directions for future research. Studies included in the present review were those in which (a) a pretreatment assessment based on (b) direct observation and measurement of (c) problem behavior was conducted under (d) at least two conditions involving manipulation of an environmental variable in an attempt (e) to demonstrate a relation between the environmental event and behavior. Studies that met the criteria for inclusion were quantified and critically evaluated along a number of dimensions related to subject and setting characteristics, parametric and qualitative characteristics of the methodology, types of assessment conditions, experimental designs, topographies of problem behaviors, and the manner in which data were displayed and analyzed.

A functional analysis of finger sucking in children

In this investigation, the authors experimentally assessed the functions of finger sucking for 3 typically developing children ages 6, 7, and 14. In Experiment 1, a parent-conducted functional analysis, completed in each child's natural environment, showed that each of the children's finger sucking was most likely to occur when the child was alone, suggesting that the behaviors were maintained by automatic reinforcement. Experiment 2 involved assessing the nature of the sensory stimulation that maintained finger sucking by attenuating the sensory stimulation to the fingers via the use of Band-Aids and attenuating the sensory stimulation to the mouth with a mild numbing agent for 2 of the 3 children. For the 3rd child, mouthing objects were made available noncontingently to determine whether access to such items would result in low levels of finger sucking, suggesting reinforcer substitutability. Results of these analyses suggested that finger sucking was maintained by both oral and digital stimulation for 2 children and by oral stimulation for the 3rd.

Functional analysis and treatment of problem behavior evoked by noise

We conducted a four-part investigation to develop methods for assessing and treating problem behavior evoked by noise. In Phase 1, 7 participants with developmental disabilities who were described as being hypersensitive to specific noises were exposed to a series of noises under controlled conditions. Results for 2 of the participants verified that noise was apparently an aversive event. In Phase 2, results of functional analyses indicated that these 2 participants' problem behaviors were maintained by escape from noise. In Phase 3, preference assessments were conducted to identify reinforcers that might be used during treatment. Finally, in Phase 4, the 2 participants' problem behaviors were successfully treated with extinction, stimulus fading, and a differential-reinforcement-of-other-behavior (DRO) contingency (only 1 participant required DRO). Treatment effects for both participants generalized to their home environments and were maintained during a follow-up assessment. Procedures and results were discussed in terms of their relevance to the systematic assessment of noise as an establishing operation (EO) and, more generally, to the identification of idiosyncratic EO influences on behavior.

Evaluation of an awareness enhancement device for the treatment of thumb sucking in children

An evaluation of the awareness enhancement device (AED) described by Rapp, Miltenberger, and Long (1998) was conducted with 2 children who engaged in thumb sucking past the age at which it was developmentally appropriate. The AED effectively suppressed thumb sucking for both children. Future research evaluating the AED is discussed.