Reducing Escape without Escape Extinction: A Systematic Review and Meta-Analysis of Escape-Based Interventions

Individuals with disabilities may engage in challenging behavior to escape aversive stimuli, like academic tasks or non-preferred foods. Interventions to reduce these behaviors often employ escape extinction; that is, the implementer withholds escape following challenging behavior. Escape extinction can increase risk of injury, restrict autonomy, and worsen the learner–implementer relationship. To mitigate collateral effects, interventions can use strategies without escape extinction (i.e., escape-based); that is, implementers can provide escape contingent on challenging behavior during intervention, in conjunction with other intervention components. However, no comprehensive syntheses of these interventions have been conducted. We identified 39 articles that included escape-based interventions, which contained 273 single-case designs. Escape-based interventions were associated with lower levels of challenging behavior and higher levels of adaptive behavior than baseline conditions. Most comparisons between escape-based and escape extinction interventions showed no functional relation, indicating that escape extinction may not add substantial benefit to intervention efficacy.