The effects of a video vignette on increasing treatment acceptability

The effects of a video vignette on the treatment acceptability ratings of four behavioral interventions were evaluated. Two interventions involved positive reinforcement (DRO and DRI) and two negative consequences (contingent physical restraint and contingent electric shock). Eighty-five individuals involved in programs for individuals with developmental disabilities were randomly assigned into two groups. The experimental group (n=41) viewed a video vignette of an extremely aggressive individual whereas the control group (n=44) did not. Acceptability ratings prior to the video showed no differences between the experimental and control groups except for the physical restraint intervention. The experimental group’s post video ratings indicated significant acceptability increases for electric shock and significant decreases for DRO. There also was a significant group by testing effect with the means for the experimental group rising whereas the control group means were stable. These results showed that acceptability is alterable through video. © 1997 John Wiley & Sons, Ltd.     

Evaluation of fixed momentary dro schedules under signaled and unsignaled arrangements

Fixed momentary schedules of differential reinforcement of other behavior (FM DRO) generally have been ineffective as treatment for problem behavior. Because most early research on FM DRO included presentation of a signal at the end of the DRO interval, it is unclear whether the limited effects of FM DRO were due to (a) the momentary response requirement of the schedule per se or (b) discrimination of the contingency made more salient by the signal. To separate these two potential influences, we compared the effects of signaled versus unsignaled FM DRO with 4 individuals with developmental disabilities whose problem behavior was maintained by social-positive reinforcement. During signaled FM DRO, the experimenter presented a visual stimulus 3 s prior to the end of the DRO interval and delivered reinforcement contingent on the absence of problem behavior at the second the interval elapsed. Unsignaled DRO was identical except that interval termination was not signaled. Results indicated that signaled FM DRO was effective in decreasing 2 subjects' problem behavior, whereas an unsignaled schedule was required for the remaining 2 subjects. These results suggest that the response requirement per se of FM DRO may not be problematic if it is not easily discriminated.     

ACCEPTABILITY OF ALTERNATIVE TREATMENTS FOR DEVIANT CHILD BEHAVIOR

The acceptability of alternative treatments for deviant child behavior was evaluated in two experiments. In each experiment, clinical cases were described to undergraduate students along with four different treatments in a Replicated Latin Square Design. The treatments included reinforcement of incompatible behavior, time out from reinforcement, drug therapy, and electric shock and the treatments were described as they were applied to children with problem behaviors. Experiment 1 developed an assessment device to evaluate treatment acceptability and examined whether treatments were rated as differentially acceptable. Experiment 2 replicated the first experiment and examined whether the severity of the presenting clinical problem influenced ratings of acceptability. The results indicated that treatments were sharply distinguished in overall acceptability. Reinforcement of incompatible behavior was more acceptable than other treatments which followed, in order, time out from reinforcement, drug therapy, and electric shock. Case severity influenced acceptability of alternative treatments with all treatments being rated as more acceptable with more severe cases. However, the strength of case severity was relatively small in relation to the different treatment conditions themselves which accounted for large portions of variance.     

CONTEXTUAL CONTROL OF PROBLEM BEHAVIOR IN STUDENTS WITH SEVERE DISABILITIES

We investigated the impact of contextual variation on the effectiveness of two interventions. The problem behavior of 2 students with severe disabilities was analyzed across two contexts (task and leisure). Effects of differential reinforcement of other behavior (DRO) and time-out procedures were examined in the two contexts. Results indicated that in the task context the DRO procedure effectively reduced the problem behavior and increased task performance, whereas the time-out procedure was ineffective. In addition, rate of correct task performance increased during DRO relative to baseline and time-out. In contrast, in the leisure context, the time-out procedure effectively reduced the same problem behavior and the DRO procedure was ineffective. The results are discussed in terms of contextual control of problem behavior and alternative strategies for the design of DRO procedures.     

INCREASING TREATMENT ACCEPTABILITY THROUGH VIDEO

The effects of a video vignette on the treatment acceptability ratings of four behavioral interventions were evaluated. Two interventions involved positive reinforcement (DRO and DRI) and two negative consequences (contingent physical restraint and contingent electric shock). Seventy-four undergraduate psychology students were randomly assigned into two groups. The experimental group (n=36) viewed a video vignette of a self-abusive individual whereas the control group (n=38) did not. Acceptability ratings prior to the video showed no differences between the experimental and control groups. The post video ratings indicated significant acceptability increases for physical restraint for the experimental group. There also was a significant group by testing effect because the means for the experimental group rose whereas the control group's means were stable. These results replicated and extended Foxx, McHenry and Bremer (in press) who showed that treatment acceptability is alterable through video.     

Case study: Reinforcement control of assaultive behavior in a sensory impaired child

This clinical case study describes the residential treatment of severe assaultive behavior in a 13-year-old sensory impaired child using two methods of positive reinforcement. Only slight reductions in the frequency of assaults occurred when the child was reinforced for compliance with task demands. Control was established quickly when reinforcement for the absence of responding was programmed in the form of a differential reinforcement of other behavior (DRO) contingency. Treatment fading was accomplished by gradually decreasing the immediacy and frequency of reinforcement. Extended follow-up assessment revealed near-zero levels of responding.     

Provision of leisure activities for the reduction of challenging behavior

Behavioral treatment of challenging behaviors, such as aggression, self-injury, property destruction, and stereotyped movement is often a priority in residential facilities for persons with developmental disabilities. If these behaviors occur when the client is otherwise unengaged, a potentially effective treatment may be to provide alternative activities. In the present study, 3 adults with severe disabilities were observed. During baseline, these 3 individuals frequently displayed challenging behavior at times when they were otherwise unengaged. Opportunities to participate in leisure activities were then provided to each client in a multiple-baseline design. Provision of leisure opportunities was associated with increased adaptive behavior and collateral reductions in problem behaviors. The effectiveness of the intervention procedures suggest that these challenging behaviors may have been related to the lack of alternative activities.     

THE ROLE OF ATTENTION IN THE TREATMENT OF ATTENTION-MAINTAINED SELF-INJURIOUS BEHAVIOR: NONCONTINGENT REINFORCEMENT AND DIFFERENTIAL REINFORCEMENT OF OTHER BEHAVIOR

Because there are potentially serious limitations to differential reinforcement of other behavior (DRO) (which is probably the most widely used treatment procedure for behavior problems), we examined an alternative procedure—noncontingent reinforcement (NCR). Three females with developmental disabilities, all of whom engaged in severe self-injurious behavior, participated. During a pretreatment functional analysis, each subject's self-injury was shown to be differentially sensitive to social attention as a maintaining consequence. Next, each subject was exposed to a DRO treatment and an NCR treatment. During DRO, attention was delivered contingent on the absence of self-injury for prespecified intervals. During NCR, attention was delivered on a fixed-time schedule that was not influenced by the subject's behavior. Results showed that both procedures were highly effective in reducing self-injury, probably because the functional reinforcer for self-injury was used during treatment. Furthermore, there was evidence that NCR attenuated several of the limitations of DRO. These results are particularly interesting in light of the long experimental history of NCR as a control rather than as a therapeutic procedure.     

An Emotion Regulation Treatment for Young People With Complex Substance Use and Mental Health Issues: A Case-Series Analysis

Individuals accessing treatment within the youth alcohol and other drug (AoD) sector represent a highly vulnerable population who present with complex patterns of substance use and mental health comorbidity. Current treatments often fail to address this complexity. Emotion regulation (ER) has been identified as a promising transdiagnostic treatment target for this population of young people. The current study aimed to investigate the acceptability and feasibility of an adjunct ER intervention, ERIC (Emotion Regulation and Impulse Control) in young people receiving AoD treatment at a residential rehabilitation service. A mixed methods case series design was utilized. Ten participants aged between 16–20 years old completed 4–6 sessions of ERIC as an adjunct to their existing residential treatment. Participants undertook a post intervention feedback session and completed a number of self-report measures of ER, depression and anxiety at baseline and 2 weeks after receiving ERIC. Qualitative feedback from young people following the delivery of ERIC was positive, and suggested that ERIC was a viable and useful intervention. Participants reported that the components of ERIC, which involved metaphors and experiential exercises, were particularly beneficial and memorable. Pre-post measures indicated that 60% of the young people had both reliable and clinically significant reductions in overall emotion dysregulation, while reliable and clinically significant reductions in depression and anxiety were observed in 50% and 60% of participants respectively. Results support the acceptability of ERIC for this cohort of young people with complex substance use and mental health needs. Furthermore, these findings support the viability of delivering flexible and adjunctive ER treatments to young people seeking AoD treatment.     

Staff management procedures and changes in the distribution of nontargeted activities by residential staff members: A secondary analysis

Staff management procedures are increasingly used to improve quality of care in residential facilities for individuals with mental retardation. Typically, residential staff members are prompted to increase and then maintain their frequency of activities within one or more target categories of behavior (e. g., training residents) and are regularly fed back on their performance. There is, however, no evidence as to what are the effects of staff management procedures on other, nontargeted activities of residential staff. Six groups of residential staff members (n=49) and 58 individuals with severe and profound levels of mental retardation participated. Observational data on staff behaviors were collected within eight mutually exclusive and exhaustive categories. When a procedure of staff management was in effect, a statistically significant increase in the time spent on the target categories of stimulative custodial care and training was associated with a statistically significant (a) increase in time spent on organization, (b) decrease in time spent on routine custodial care, and (c) decrease in time being engaged in off-task behavior. There were no statistically significant differences found with respect to staff members' time spent on housekeeping, in offering individuals recreational activities, and in taking rest.     

A comparison of differential reinforcement and noncontingent reinforcement for the treatment of a child's multiply controlled problem behavior

Noncontingent reinforcement (NCR) and differential reinforcement of other behavior (DRO) with escape as the reinforcer were evaluated after an initial functional analysis indicated the problem behaviors exhibited by a 7 year old child were maintained by escape. When NCR and DRO did not decrease the problem behaviors, a second functional analysis was conducted and showed that the behaviors were maintained by attention and escape. DRO with attention and escape as reinforcers was compared to NCR with attention and escape as reinforcers for the treatment of the child's multiply controlled behavior problems. Results showed that DRO and NCR were both effective at reducing the problem behavior to low levels and increasing compliance. Copyright © 2003 John Wiley & Sons, Ltd.     

Delivering alternative reinforcement in a distinct context reduces its counter‐therapeutic effects on relapse

Delivery of alternative reinforcers in the presence of stimuli previously associated with reinforcement for target behavior increases the susceptibility of target behavior to relapse. To explore contingencies that might mitigate this counter‐therapeutic effect, we trained pigeons on a procedure that entailed extinction of previously reinforced target‐key pecking, access to a distinct stimulus context contingently on refraining from target behavior (differential‐reinforcement‐of‐other‐behavior; DRO), and reinforcement of alternative‐key pecks (differential‐reinforcement of alternative behavior; DRA) in that context. This DRO‐DRA treatment was compared with standard DRA in successive conditions, counterbalanced across pigeons. Target behavior extinguished more rapidly in the Standard‐DRA condition. When alternative reinforcement was discontinued, however, there was less resurgence after DRO‐DRA than after Standard DRA. In a third condition, the DRO contingency was suspended so that the former DRA stimuli were not presented (DRO‐NAC), and resurgence was greater than in the Standard‐DRA and DRO‐DRA conditions. Reinstatement produced by response‐independent reinforcers was small and similar across conditions. Subsequent reacquisition of target‐key pecking under baseline reinforcement conditions was faster following DRO‐NAC than Standard‐DRA or DRO‐DRA. These findings suggest that DRO‐DRA might serve as a useful method in clinical settings for reducing problem behavior while minimizing the threat of posttreatment relapse.     

Evaluating the influence of problem function on treatment acceptability

Direct care staff from community agencies serving individuals with developmental disabilities rated the acceptability of two treatments, time out and guided compliance, applied to a problem behavior maintained by attention or escape. The results showed that time out was significantly more acceptable than guided compliance regardless of problem function. The results indicate that the less restrictive treatment was rated as more acceptable. However, the functional treatment was not rated as more acceptable than the nonfunctional treatment. ©1997 John Wiley & Sons, Ltd.     

Reducing stereotyped behavior using momentary dro: An experimental analysis

Momentary DRO, a little-used variant of DRO, was compared with a more traditional DRO procedure in the reduction of stereotyped behavior displayed by five subjects with severe mental retardation. Momentary DRO appeared to be more effective than the traditional procedure for three subjects, less effective for one subjects and to increase the stereotyped behavior of the final subject above baseline levels, These findings are discussed in relation to response covariation effects, treatment maintenance and case of implementation.     

Case study: Reinforcement control of severe aggression exhibited by a child with autism in a family home

This clinical case study describes in-home treatment of severe aggression and tantrum behavior exhibited by an 11 -year-old child with autism, using methods of differential reinforcement comparable to those of a case study by Luiselli (1990). No significant reductions in problem conduct occurred when a parent implemented differential reinforcement of other behavior (DRO) in conjunction with publicly posted ‘good behavior rules,’ physical management training, and redirection to relaxation. Control was established when the child was reinforced for compliance with task demands in conjunction with extinction, implemented directly by professional support staff working in the home. Despite demonstrable parental consistency, systematic training, and fading of supports, results were not maintained at follow-up. The generality of differential reinforcement as a practical intervention for severe aggression in family homes is questioned.     

Treating Self-Injurious Behavior:

The present study attempted to investigate the effects and possible side effects of a response cost and DRO treatment procedure on a subject's self-injurious behavior. Additionally, a number of staff management strategies were evaluated as to their effect on the maintenance of the behavior change. Finally, the acceptability of the treatment utilized was subjectively evaluated. Implications for designing maintenance strategies that are effective, feasible and acceptable are discussed.     

Acceptability of aversive procedures and medication as treatment alternatives for deviant child behavior

The present investigation evaluated the acceptability of alternative treatments for deviant child behavior. Clinical cases of children who displayed severe behavioral problems at home and at school were described along with three different treatments. The treatments, time-out from reinforcement, locked seclusion, and medication, were rated by psychiatric inpatient children and parents in a 3 × 3 replicated Latin-square design. The investigation also evaluated whether acceptability ratings were influenced by the clinical effectiveness of treatment in altering behavior. Although children and parents did not differ overall in acceptability ratings, they differed in their ranking of different treatments. Children viewed medication as the most acceptable treatment, whereas parents viewed time out as the most acceptable treatment. For both children and parents, treatments described as producing marked effects were rated as more acceptable than treatments producing weaker effects. The results indicated that disturbed children and their parents can readily distinguish the acceptability of alternative treatments. The implications of treatment acceptability for clinical applications of treatment are discussed.Completion of this investigation was facilitated by a Research Scientist Development Award (MH00353) and a grant (MH35408) from the National Institute of Mental Health. The author is grateful for the assistance of the clinical research team of the Child Psychiatric Treatment Service, especially that of Irene Heidish, M.A., who assisted with the data analyses.