Assessment of the influence of background noise on escape-maintained problem behavior and pain behavior in a child with Williams syndrome

Hyperacusis in children: a scoping review

Background

Hyperacusis is a chronic condition commonly defined as a lowered tolerance or increased sensitivity to everyday environmental sounds. It has been viewed as a paediatric disorder which can cause significant impairment to a child’s normal functioning. Although clinical guidance highlights the importance of identifying whether the child has intolerance to loud sounds and managing this appropriately, there are currently no assessment or treatment methods that have been designed and tested for use with children with hyperacusis. A review is therefore indicated to consider the profile of children with hyperacusis as a basis for future research into their assessment and treatment.

Method

A scoping review methodology was followed with literature searches conducted in Embase, PsychINFO, PubMed CENTRAL, Scopus, Web of Science and Google Scholar. Research articles were included if they reported on research studies describing children diagnosed with hyperacusis, providing clinical profile information, and/or reporting on an assessment or management method for children with a primary complaint of hyperacusis. Data were charted on Excel and verified by a second researcher. Twenty-one research articles were included.

Results

Children with hyperacusis are typically described in terms of age at presentation, troublesome sounds, physical sensation, behavioural reactions, coping strategies, comorbid conditions and impact on daily life. Methods of assessing the children include semi-structured interviews, questionnaires, neurological assessment, observation and uncomfortable loudness levels. Management methods include psychological therapy, sound therapy, tinnitus retraining therapy, medication and neuro-rehabilitation.

Conclusion

The information we catalogued on various elements of clinical profile, assessment and management can serve as a stepping stone in future research developing questionnaires for clinical measurement of the impact of hyperacusis on children, and the measurement of treatment related change in clinic and in trials. Positive outcomes were noted by the authors following all of the above treatments; future research must compare these and specify the parameters for optimal results.

Using stimulus preference assessments to identify preferred break environments

A pictorial preference assessment was conducted for 2 individuals with autism who had programmed breaks in their behavior plans. Assessed break environments were individualized, based on indirect assessments and direct observations. The most highly (HP) and least preferred (LP) environments and a control with no associated break were included in a subsequent reinforcer assessment using a concurrent-chains arrangement within a reversal design. Participants selected a multitask sequence (initial link) associated with one of the break environments. Phase A evaluated the reinforcing properties of all three breaks; the HP was removed in Phase B. Both participants allocated more responding to HP than LP, and to LP than control, suggesting that breaks functioned as reinforcers. The results indicated that preference assessment technology can be used to identify highly preferred breaks that function as reinforcers. Social validity measures indicated that the individuals' clinicians found the results useful for future clinical programming.

Emission of 22 kHz vocalizations in rats as an evolutionary equivalent of human crying: Relationship to depression

There is no clear relationship between crying and depression based on human neuropsychiatric observations. This situation originates from lack of suitable animal models of human crying. In the present article, an attempt will be made to answer the question whether emission of rat aversive vocalizations (22 kHz calls) may be regarded as an evolutionary equivalent of adult human crying. Using this comparison, the symptom of crying in depressed human patients will be reanalyzed. Numerous features and characteristics of rat 22 kHz aversive vocalizations and human crying vocalizations are equivalent. Comparing evolutionary, biological, physiological, neurophysiological, social, pharmacological, and pathological aspects have shown vast majority of common features. It is concluded that emission of rat 22 kHz vocalizations may be treated as an evolutionary vocal homolog of human crying, although emission of 22 kHz calls is not exactly the same phenomenon because of significant differences in cognitive processes between these species. It is further concluded that rat 22 kHz vocalizations and human crying vocalizations are both expressing anxiety and not depression. Analysis of the relationship between anxiety and depression reported in clinical studies supports this conclusion regardless of the nature and extent of comorbidity between these pathological states.

Sound attenuation and preferred music in the treatment of problem behavior maintained by escape from noise

We examined the extent to which different sounds functioned as motivating operations (MO) that evoked problem behavior during a functional analysis for two participants. Results suggested that escape from loud noises reinforced the problem behavior for one participant and escape from arguing reinforced problem behavior for the other participant. Noncontingent delivery of preferred music through sound-attenuating headphones decreased problem behavior without the use of extinction for both participants. We discuss the results in terms of the abolishing effects of the intervention.

Intensive, Short-Term Cognitive-Behavioral Treatment of OCD-Like Behavior With a Young Adult With Williams Syndrome

In contrast to the application of applied behavior analysis principles in autism and developmental disorders, there is a general paucity of research examining effectiveness of cognitive-behavioral interventions with individuals with mental retardation and even less with mental retardation of a specific etiology. The authors present a case study of cognitive-behavioral treatment for emotional and behavioral difficulties in a young man with Williams syndrome, a genetic disorder characterized by developmental and psychosocial impairments. Following a functional assessment, an intensive intervention was designed and implemented to address social skills difficulties, obsessions, and compulsions. Results suggest that cognitive-behavioral interventions may be promising with this population. Obstacles encountered and lessons learned are discussed.

Functional analysis and treatment of problem behavior exhibited by children with fragile X syndrome

The efficacy of function-based interventions for the treatment of severe problem behavior exhibited by individuals with intellectual and developmental disabilities (IDD) is well established. However, few studies have reported on behavioral interventions in fragile X syndrome (FXS) specifically. The present study is a consecutive case-series analysis that reports on functional analysis and treatment of problem behavior of nine children with FXS. Assessment findings were consistent with previous research indicating that among individuals with FXS, problem behavior is more commonly maintained by escape from demands and access to tangible items, relative to the broader population of individuals with IDD. Functional analysis-based behavioral interventions resulted in a mean reduction in problem behavior of 95.2% across the nine participants. Additionally, generalization of treatment effects from controlled clinical settings to home, school, and community was demonstrated. The current findings suggest that function-based behavioral interventions shown to be effective with the broader population of individuals with IDD are also effective for individuals with FXS. Our results in combination with those of previous studies describing functional analysis outcomes provide additional evidence for a unique functional behavioral phenotype for severe problem behavior in individuals with FXS. Implications of study findings for early intervention and prevention of problem behavior in children with FXS are discussed.

The effect of the magnitude of the food deprivation motivating operation on free operant preference in mice

A number of recent studies have demonstrated that organisms prefer stimuli correlated with food under high deprivation conditions over stimuli correlated with food under low deprivation conditions. The purpose of the present study was to extend the literature on this phenomenon by testing for preference under extinction conditions, testing for preference at baseline, employing a free operant preference test, and using mice as subjects. Our results appear to support the existing literature in that most subjects preferred a stimulus correlated with food under high deprivation conditions in the post-training preference test. We provide an analysis of this phenomenon based on the concept of the motivating operation (MO) and discuss how this analysis suggests a number of avenues for further research on this topic.

Habit Reversal Therapy for Body-Focused Repetitive Behaviors in Williams Syndrome: A Case Study

Williams syndrome (WS) is genetic neurodevelopmental disorder with a well-characterized cognitive and behavioral phenotype. Research has consistently demonstrated high rates of psychopathology in this population; however, little research has examined the use of empirically-supported psychosocial interventions in those with WS. The current case study reports on the use of Habit Reversal Therapy (HRT) to treat multiple body-focused repetitive behaviors in a child with WS. Although HRT is a well-established cognitive-behavioral intervention for body-focused repetitive behaviors, it has been infrequently used in populations with developmental disabilities. An etiologically-informed approach was used to adapt HRT to fit the known behavioral and cognitive phenotype of WS. Results suggest that HRT may be beneficial for this population. Modified treatment elements are described and future research areas highlighted.

The motivating operation and negatively reinforced problem behavior: a systematic review

The concept of motivational operations exerts an increasing influence on the understanding and assessment of problem behavior in people with intellectual and developmental disability. In this systematic review of 59 methodologically robust studies of the influence of motivational operations in negative reinforcement paradigms in this population, we identify themes related to situational and biological variables that have implications for assessment, intervention, and further research. There is now good evidence that motivational operations of differing origins influence negatively reinforced problem behavior, and that these might be subject to manipulation to facilitate favorable outcomes. There is also good evidence that some biological variables warrant consideration in assessment procedures as they predispose the person's behavior to be influenced by specific motivational operations. The implications for assessment and intervention are made explicit with reference to variables that are open to manipulation or that require further research and conceptualization within causal models.

Knowledge and perceptions about fragile X syndrome: implications for diagnosis, intervention, and research

We surveyed 439 professionals in the field of autism to assess their knowledge and perceptions about fragile X syndrome (FXS) and related issues. Almost half had worked with at least one child diagnosed with FXS, yet most lacked basic knowledge about the condition, underestimated its significance in the etiology of autism spectrum disorders, and rarely accessed fragile X-specific resources. A majority perceived etiology to be an important variable in therapeutic response while three quarters felt that professionals in the field of autism should play an active role in referring children for etiological evaluation. Despite these opinions, most respondents either rarely or never inquired about etiology when working with a new client. The survey results underscore the need for training and education so that autism professionals can become effective partners in diagnostic genetic referral and in research and implementation of syndrome-specific interventions.

Examination of an antecedent communication intervention to reduce tangibly maintained challenging behavior: a controlled analog analysis

We examined the influence of an antecedent communication intervention on challenging behavior for three students with developmental disorders. Students were taught to request tangible items that were identified as reinforcers for challenging behavior in a prior functional analysis. Individual participant multielement and reversal designs were used to compare the effects of the antecedent communication intervention versus a no antecedent communication intervention condition. Immediately following the antecedent manipulations students were exposed to the tangible condition of the functional analysis. Results indicate that the antecedent communication intervention reduced challenging behavior in the subsequent tangible test condition for all three students. The importance of examining antecedent interventions to treat challenging behavior from a function analytic perspective is discussed.

Types of Motivating Operations in Interventions With Problem Behavior

A motivating operation (MO) alters both the effectiveness of a stimulus as a reinforcer and the current frequency of all behavior that has been reinforced by that particular stimulus. This article reviews studies that have manipulated a MO during interventions with school-age participants with intellectual disabilities and problem behavior. A systematic review was conducted using the following major electronic databases: PsychInfo, Education Resources Information Center, Science Direct, Blackwell, SAGE, and Medline. A total of 31 published articles representing 55 participants was examined. Findings from this study suggest that the modification of a MO usually has an effect on the problem behavior by either establishing or abolishing its motivation. Furthermore, a relationship was found between the type of MO and the behavioral function identified. The theoretical and practical implications of these findings, limitations of this study and potential issues for future research are discussed.

A systematic examination of different parameters of presession exposure to tangible stimuli that maintain problem behavior

We examined the effects of three different presession conditions on tangibly maintained problem behavior for 2 students with autism, using individual-participant multielement designs. First, an analogue functional analysis demonstrated that problem behavior was maintained by access to tangible items. Next, topographies of item rejection were identified. Finally, students were exposed to (a) brief access, (b) no access, and (c) satiation to the tangible items prior to tangible sessions. The results demonstrated high levels of problem behavior following the brief-access and no-access presession conditions and low levels of problem behavior following the satiation condition. The findings are discussed in the context of how satiation might best be defined for these sorts of evaluations.

Functional Communication Training and Chained Schedules of Reinforcement to Treat Challenging Behavior Maintained by Terminations of Activity Interruptions

In this article, the authors evaluated functional communication training (FCT) and a chained schedule of reinforcement for the treatment of challenging behavior exhibited by two individuals diagnosed with Asperger syndrome and autism, respectively. Following a functional analysis with undifferentiated results, the authors demonstrated that challenging behavior was occasioned by interruptions of ongoing activities and maintained by terminations of interruptions. Next, they demonstrated the effectiveness of a treatment consisting of FCT with a chained schedule of reinforcement. Last, they modified the chained schedule procedure to increase ease of implementation and promote toleration of activity interruptions, and academic tasks were incorporated into the treatment.

Phenotype-environment interactions in genetic syndromes associated with severe or profound intellectual disability

The research literature notes both biological and operant theories of behavior disorder in individuals with intellectual disabilities. These two theories of genetic predisposition and operant reinforcement remain quite distinct; neither theory on its own is sufficient to explain challenging behavior in genetic syndromes and an integrated approach is required. This literature review integrates the two approaches by exploring how environmental factors can influence problem behavior in genetic syndromes associated with intellectual disability. Particular attention is paid to studies that describe evidence that problem behaviors in syndromes that are considered to be phenotypic are associated with other aspects of an established behavioral phenotype. The review highlights how the study of phenotype-environment interactions within syndromes can promote understanding of the aetiology of problem behaviors both within genetic syndromes and, ultimately, the wider population of individuals with severe intellectual disabilities. The review also evaluates the current status of research and the methods typically employed. Implications for intervention, future research and extending existing causal models of challenging behavior are discussed.

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.

The Effects of an Abolishing Operation Intervention Component on Play Skills, Challenging Behavior, and Stereotypy

The purpose of this study was to reduce stereotypy and challenging behavior during play skills instruction by adding an abolishing operation component (AOC) to the intervention strategy. An alternating treatments design compared one condition in which participants were allowed to engage in stereotypy freely before beginning the play skills intervention (AOC condition) to a second condition without this free access period (No AOC condition). Across 4 participants with autism spectrum disorders (ASD), levels of stereotypy and challenging behavior were lower and functional play was higher during play intervention sessions that followed the AOC. These data provided support for the inclusion of an AOC in interventions aimed at increasing the play skills of children with ASD who present with stereotypy.

Functional Analysis of the Early Development of Self-Injurious Behavior: Incorporating Gene–Environment Interactions

The analysis of the early development of self-injurious behavior (SIB) has, to date, reflected the wider distinction between nature and nurture. Despite the status of genetic factors as risk markers for the later development of SIB, a model that accounts for their influence on early behavior–environment relations is lacking. In the current paper we argue that the investigation of gene–environment interactions (GxE) and other forms of gene–environment interplay could potentially enhance current approaches to the study of self-injury. A conceptual model of the early development of SIB based explicitly on such relations is presented. The model is consistent with the basic tenets of functional analysis. Implications for research and the assessment, treatment, and prevention of SIB are discussed.

Early intervention and prevention of self-injurious behaviour exhibited by young children with developmental disabilities

The ontogeny of self-injurious behaviour exhibited by young children with developmental delays or disabilities is due to a complex interaction between neurobiological and environmental variables. In this manuscript, the literature on emerging self-injury in the developmental disability population is reviewed with a focus on an operant conceptual model of how topographies of self-injurious behaviour can change structurally and become sensitive to various environmental consequences. Results of previous studies are reviewed in terms of extending our research focus from a reactive model of assessment and treatment of well-established cases of self-injury to an early intervention and prevention model.

Incorporating "motivation" into the functional analysis of challenging behavior: on the interactive and integrative potential of the motivating operation

Sensitivity theory attempts to account for the variability often observed in challenging behavior by recourse to the "aberrant motivation" of people with intellectual and developmental disabilities. In this article, we suggest that a functional analysis based on environmental (challenging environments) and biological (challenging needs) motivating operations provides a more parsimonious and empirically grounded account of challenging behavior than that proposed by sensitivity theory. It is argued that the concept of the motivating operation provides a means of integrating diverse strands of research without the undue inference of mentalistic constructs. An integrated model of challenging behavior is proposed, one that remains compatible with the central tenets of functional analysis.

Analysis and treatment of problem behavior evoked by music

The present study investigated the effects of differential negative reinforcement of other behavior (DNRO) on problem behavior evoked by music in a 7-year-old child with pervasive developmental disorder. Following an auditory stimulus assessment, DNRO was used to reduce problem behavior to near-zero levels. Results are discussed in terms of identifying establishing operations to govern treatment options and the use of negative reinforcement when arbitrarily imposed positive reinforcers do not compete with escape from auditory stimulation.

Combined antecedent variables as motivating operations within functional analyses

Functional analysis test conditions typically manipulate a single antecedent variable and an associated consequence to better isolate response-reinforcer relations. In some instances no problem behavior is observed, perhaps representing a false-negative finding. The present study evaluated one approach to assess potentially false-negative findings within functional analyses. Participants were exposed to single-antecedent functional analysis test conditions and combined-antecedent test conditions within a multielement design. Both participants engaged in problem behavior primarily during the combined-antecedent test conditions, and treatments matched to the results were effective in reducing problem behavior. Findings are discussed in terms of clinical implications of combining antecedent variables to further examine potentially false-negative functional analysis results.

Assessing preferences for positive and negative reinforcement during treatment of destructive behavior with functional communication training

Results of prior studies (e.g. [J. Appl. Behav. Anal. 32 (1999) 285]) showing that participants chose alternative behavior (compliance) over escape-reinforced destructive behavior when this latter response produced escape and the former response produced positive reinforcement may have been due to (a) the value of the positive reinforcer overriding the value of the negative reinforcer or (b) the presence of the positive reinforcer altering the value of the negative reinforcer (i.e., lessening the aversiveness of the demands). In this investigation we evaluated the relative contributions of these alternative mechanisms with two girls with autism. We compared the relative effects of positive and negative reinforcement using equivalent communication responses under both a restricted-choice condition (in which participants could choose positive or negative reinforcement, but not both) and an unrestricted-choice condition (in which participants could choose one or both reinforcers). Both participants often chose positive over negative reinforcement in the restricted-choice condition. However, in the unrestricted-choice condition (in which participants could choose one or both reinforcers), one participant consistently chose both reinforcers by the end of the analysis whereas the other primarily chose only positive reinforcement. Results suggested that for one participant the value of the positive reinforcer overrode the value of the negative reinforcer, whereas for the other participant, the presence of the positive reinforcer in the demand context lessened the aversiveness of the demands.

Assessment of aberrant behavior maintained by wheelchair movement in a child with developmental disabilities

A child that used a wheelchair was anecdotally observed to display little aggressive behavior when being pushed in his wheelchair, but higher rates of aggressive behavior when movement was terminated. A functional analysis was conducted to systematically assess the relationship between aggression and wheelchair movement. The functional analysis results revealed elevated rates of aggression when it resulted in being briefly pushed in the wheelchair. This functional hypothesis was subsequently validated by teaching the child to request movement through appropriate means and demonstrating that aggression decreased under treatment conditions. These results extend prior research on functional analysis by demonstrating a previously unreported behavioral function particular to individuals with motor deficits.

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.