MOMENTUM AND EXTINCTION EFFECTS ON SELF-INJURIOUS ESCAPE BEHAVIOR AND NONCOMPLIANCE

Previous research on applications of behavioral momentum has indicated that a high-probability (high-p) instructional sequence, in which a series of instructions for which there is a high probability of compliance is presented immediately before an instruction for which there is a low probability of compliance, is an effective method for increasing compliance. It is not dear, however, whether the procedure is effective when individuals actively attempt to escape from the instructional situation. In this study, we examined the effects of the high-p sequence, when implemented first alone and then later with an extinction component, as treatment for the self-injurious escape behavior of 2 individuals. Results showed that when the instructional sequence was implemented without extinction, rates of self-injury increased and percentage of compliance decreased. In addition, the percentage of trials occasioning escape behavior increased for both high- and low-probability instructions. When an extinction component was added to the high-p sequence, rates of self-injury and the percentage of trials containing self-injury decreased, and compliance increased. These findings suggest that extinction may be an important component of treatment when escape behavior such as self-injury accompanies noncompliance in instructional contexts and competes with compliant behavior.     

EXPERIMENTAL ANALYSIS AND EXTINCTION OF SELF-INJURIOUS ESCAPE BEHAVIOR

Three studies are presented in which environmental correlates of self-injurious behavior were systematically examined and later used as the basis for treatment. In Study 1, 7 developmentally disabled subjects were exposed to a series of conditions designed to identify factors that maintain self-injurious behavior: attention contingent on self-injurious behavior (positive reinforcement), escape from or avoidance of demands contingent on self-injurious behavior (negative reinforcement), alone (automatic reinforcement), and play (control). Results of a multielement design showed that each subject's self-injurious behavior occurred more frequently in the demand condition, suggesting that the behavior served an avoidance or escape function. Six of the 7 subjects participated in Study 2. During educational sessions, “escape extinction” was applied as treatment for their self-injurious behavior in a multiple baseline across subjects design. Results showed noticeable reduction or elimination of self-injurious behavior for each subject and an increase in compliance with instructions in all subjects for whom compliance data were taken. The 7th subject, whose self-injurious behavior during Study 1 occurred in response to medical demands (i.e., physical examinations), participated in Study 3. Treatment was comprised of extinction, as in Study 2, plus reinforcement for tolerance of the examination procedure, and was evaluated in a multiple baseline across settings design. Results showed that the treatment was successful in eliminating self-injurious behavior and that its effects transferred across eight new therapists and three physicians. General implications for the design, interpretation, and uses of assessment studies are discussed.     

Use of the high-probability instructional sequence and escape extinction in a child with food refusal

We used the high-probability (high-p) instructional sequence with and without escape extinction in the treatment of food refusal. Acceptance increased and refusal decreased only with the introduction of escape extinction. These results raise important questions about the high-p sequence in the treatment of food refusal.     

Clarifying an ambiguous functional analysis with matched and mismatched extinction procedures

Results of functional analysis were ambiguous in suggesting that self-injurious behavior (SIB) was maintained by escape, sensory reinforcement, or both. To help clarify these results, we compared escape extinction, sensory extinction, and the combined treatments. Sensory extinction proved to be a necessary and sufficient treatment, whereas escape extinction failed to decrease SIB. These analyses helped to clarify the function of SIB and to identify an effective and efficient treatment.     

BEHAVIORAL PERSISTENCE AND VARIABILITY DURING EXTINCTION OF SELF-INJURY MAINTAINED BY ESCAPE

The self-injurious escape behavior of a developmentally disabled adult was treated with extinction. Results of a reversal design showed substantial bursts of responding when extinction was introduced and reintroduced: self-injury remained at a variable and elevated rate for some time before stable, low rates were observed. Data on aggression, a nontarget behavior during both baseline and treatment, showed a pattern similar to that seen for self-injury during the extinction conditions.     

EXTINCTION OF SELF-INJURIOUS ESCAPE BEHAVIOR WITH AND WITHOUT INSTRUCTIONAL FADING

Three individuals with developmental disabilities participated in a study of the treatment of self-injurious behavior (SIB) maintained by negative reinforcement (escape from educational tasks). Treatment was implemented in a multiple baseline design across subjects, in which two treatments were compared in a multielement format. Both treatment conditions included an escape-extinction component in which SIB no longer produced escape. One of the conditions also included a fading component in which the frequency of instructions was initially reduced to zero and then was gradually faded back in across sessions until the instructional rate matched that of the original baseline. Results indicated that extinction alone reduced SIB to the end-of-treatment criterion in fewer sessions than did extinction plus fading for all 3 subjects. For 2 of the 3 subjects, however, there was an initial increase in the frequency of SIB at the outset of treatment with extinction (an extinction burst) that was not observed when extinction was combined with the fading component.     

ASSESSING AND PROGRAMMING GENERALIZED BEHAVIORAL REDUCTION ACROSS MULTIPLE STIMULUS PARAMETERS

Generalization across three stimulus parameters was examined for 5 individuals whose self-injurious behavior was maintained by escape from task demands. Prior to treatment, three stimulus parameters (therapist, setting, and demands) were systematically varied across baseline sessions. These variables were held constant during treatment, which consisted of escape extinction. When treatment was completed, three novel stimulus parameters were probed. If the rate of self-injury was high during this probe, treatment was reimplemented with one new stimulus parameter (the other two were the same as in the original treatment condition). Following this second treatment, another probe with three novel stimuli was conducted. If the rate of self-injury was again high, treatment was implemented again while a second stimulus parameter was changed. This sequence continued until generalization was observed across the three parameters. Results showed idiosyncratic differences in generalization. The behavior of 2 subjects showed complete generalization during the first novel probe. A 3rd subject's behavior showed generalization following treatment across two stimulus parameters (setting and therapist). The behavior of the 2 remaining subjects showed a complete lack of generalization across the three parameters; both subjects required training for novelty by randomly varying the stimulus parameters for a substantial number of sessions.     

Effects of High-Probability Request Sequences on Preschoolers' Compliance and Disruptive Behavior

A high-probability request sequence was implemented with three preschool children with developmental delays within their classroom during typical activities. A multiple baseline design across subjects was used to evaluate the effects of the high-probability request sequence on compliant responding to low-probability requests and the occurrence of disruptive behavior. Results of the study indicate that the use of the high-probability request sequence was effective in increasing compliant responding to low-probability requests delivered by two different trainers for all children. No increases in disruptive behavior were noted as a result of using the high-probability request sequence. When the high-probability request sequence was withdrawn, compliant responding to low-probability requests was maintained for all children across time and in different settings.     

NONCONTINGENT ESCAPE AS TREATMENT FOR SELF-INJURIOUS BEHAVIOR MAINTAINED BY NEGATIVE REINFORCEMENT

We extended research on the role of noncontingent positive reinforcement following a functional analysis of attention-maintained self-injurious behavior to self-injury maintained by negative reinforcement in 2 young males with developmental disabilities. During a pretreatment functional analysis, each participant's self-injury was shown to be differentially sensitive to escape from instructional activities as negative reinforcement. During noncontingent escape, escape from learning activities was provided on a fixed-time schedule that was not influenced by the participant's behavior. One participant was also exposed to differential negative reinforcement of other behavior. During this condition, escape from instructional activities was provided contingent on the omission of self-injury for prespecified intervals. Results showed that the provision of escape, even when noncontingent, resulted in significant reductions in self-injury. These results are particularly interesting in light of the experimental history of noncontingent reinforcement as a control rather than as a therapeutic procedure. Noncontingent escape is discussed as a form of extinction that may be less likely than other forms of extinction to produce severe side effects.     

FUNCTIONAL ANALYSIS AND TREATMENT OF MULTIPLY CONTROLLED INAPPROPRIATE MEALTIME BEHAVIOR

Functional analyses identified children whose inappropriate mealtime behavior was maintained by escape and adult attention. Function‐based extinction procedures were tested individually and in combination. Attention extinction alone did not result in decreases in inappropriate mealtime behavior or a significant increase in acceptance. By contrast, escape extinction alone resulted in a decrease in inappropriate mealtime behavior and an increase in acceptance. However, inappropriate mealtime behavior did not decrease to clinically acceptable levels. A combined extinction technique (i.e., escape and attention extinction) resulted in a decrease in inappropriate mealtime behavior to clinically acceptable levels and high and stable acceptance.     

On the relative contributions of positive reinforcement and escape extinction in the treatment of food refusal

We compared the effects of positive reinforcement alone, escape extinction alone, and positive reinforcement with escape extinction in the treatment of the food and fluid refusal of 4 children who had been diagnosed with a pediatric feeding disorder. Consumption did not increase when positive reinforcement was implemented alone. By contrast, consumption increased for all participants when escape extinction was implemented, independent of the presence or absence of positive reinforcement. However, the addition of positive reinforcement to escape extinction was associated with beneficial effects (e.g., greater decreases in negative vocalizations and inappropriate behavior) for some participants.     

WHAT MAKES EXTINCTION WORK: AN ANALYSIS OF PROCEDURAL FORM AND FUNCTION

We examined methods for determining how extinction should be applied to different functions of self-injurious behavior (SIB). Assessment data indicated that the head banging of 3 children with developmental disabilities was maintained by different reinforcement contingencies: One subject's SIB was positively reinforced by attention from adults, the 2nd subject's SIB was negatively reinforced by escape from educational tasks, and the 3rd subject's SIB appeared to be automatically reinforced or “self-stimulatory” in nature. Three functional variations of extinction—EXT (attention), EXT (escape), and EXT (sensory)—were evaluated, and each subject was exposed to at least two of these variations in reversal or multiple baseline designs. Reductions in SIB were observed only when implementation of “extinction” involved the discontinuation of reinforcement previously shown to be responsible for maintaining the behavior. These results highlight important differences among treatment techniques based on the same behavioral principle (extinction) when applied to topographically similar but functionally dissimilar responses, and further illustrate the practical implications of a functional analysis of behavior disorders for designing, selecting, and classifying therapeutic interventions.     

On the relative contributions of noncontingent reinforcement and escape extinction in the treatment of food refusal

In the current investigation, we evaluated the relative effects of noncontingent reinforcement (NCR), escape extinction, and a combination of NCR and escape extinction as treatment for the feeding problems exhibited by 4 children. For each participant, consumption increased only when escape extinction was implemented, independent of whether NCR was present or absent. These results were consistent with prior research suggesting that positive reinforcement alone is insufficient for increasing consumption, and that escape extinction often is necessary to increase and maintain food acceptance. However, NCR appeared to decrease inappropriate behavior for some participants.     

STIMULUS (INSTRUCTIONAL) FADING DURING EXTINCTION OF SELF-INJURIOUS ESCAPE BEHAVIOR

Three individuals with developmental disabilities were exposed to a series of assessment conditions to identify the source of reinforcement for their self-injurious behavior. In each case, self-injury occurred most often in instructional (demand) situations containing a brief time-out from the task contingent on self-injury, indicating that the behavior was an escape response (i.e., maintained by negative reinforcement). Treatment was implemented in a multiple baseline across subjects design and consisted of extinction (prevention of escape) plus instructional fading (initial elimination of instructions followed by their gradual reintroduction). Results showed that the combined treatment produced immediate and large reductions in self-injury that were maintained as the frequency of instructions was increased across sessions to match the original baseline rate of presentation. Results of a component analysis conducted with 1 subject suggested that stimulus fading accelerated the behavior-reducing effects of extinction.     

EFFECTS OF WARNING STIMULI FOR REINFORCER WITHDRAWAL AND TASK ONSET ON SELF-INJURY

Results of a functional analysis of self-injurious behavior (SIB) in a child with autism showed that her SIB was maintained by access to preferred objects and escape or avoidance of task demands. Extinction and noncontingent reinforcement treatments were supplemented by presenting a statement combined with a picture cue at 30-s intervals indicating that a preferred object would be removed or a task would be presented. Warning stimuli in combination with extinction and noncontingent reinforcement reduced SIB to acceptable levels. SIB rates remained comparatively high in a control condition consisting of a 2-min delay to onset of reinforcer removal or task demands.     

Further analysis of antecedent interventions on preschoolers' compliance

Functional analyses were conducted to identify reinforcers for noncompliance exhibited by 3 young children. Next, the effects of three antecedent-based interventions-noncontingent access to a preferred item, a warning, and a high-probability instructional sequence-were examined. The high-probability instructional sequence was effective for 1 child. Antecedent interventions were ineffective and extinction was necessary for the other 2 children.     

DISTINGUISHING BETWEEN EXTINCTION AND PUNISHMENT EFFECTS OF RESPONSE BLOCKING: A REPLICATION

Lerman and Iwata (1996) described a method for distinguishing between sensory extinction and punishment effects of response blocking on self-injurious behavior maintained independent of social contingencies. Results of their study suggested that blocking decreased the self-injurious hand mouthing of their participant via punishment. The current replication of these procedures with the self-injurious eye poking of a woman with developmental disabilities produced patterns of responding indicating that, for this participant, blocking functioned as an extinction procedure.     

PLAY VERSUS ALONE CONDITIONS AS CONTROLS DURING FUNCTIONAL ANALYSES OF SELF-INJURIOUS ESCAPE BEHAVIOR

We compared the effects of continuous reinforcement (play) and alone conditions as controls during functional analyses for 66 individuals whose self-injurious behavior (SIB) was maintained by escape. In every case, SIB was lower during both control conditions than it was during the test (demand) condition. However, SIB was lowest during the alone condition more often than it was during the play condition. Circumstances under which the alone condition might serve as an alternative or more suitable control for escape-maintained problem behaviors are discussed.     

Behavioral momentum and stimulus fading in the acquisition and maintenance of child compliance in the home

The provision of a series of requests to which compliance is highly likely (high-probability requests) immediately antecedent to low-probability requests has been used to establish behavioral momentum of compliance. We evaluated a fading procedure for maintaining high levels of compliance obtained with high-probability requests. Fading involved a systematic reduction in the number of high-probability requests and an increase in the latency between the high- and low-probability requests. High levels of compliance for both "do" and "don't" requests were maintained for 16 weeks in a 5-year-old boy with developmental disabilities after the high-probability request sequence was faded. Similar maintenance was obtained for "do" requests in a 15-year-old girl with developmental disabilities. For this subject, however, the high-probability request sequence was ineffective with "don't" requests. When "don't" requests were phrased as "do" requests, the high-probability request sequence produced high levels of compliance to the low-probability request. High levels of compliance to these "do" requests were maintained for 16 weeks after the high-probability request sequence was faded.