Treatment of self-restraint associated with the application of protective equipment

The current investigation assessed the effectiveness of protective equipment, specifically arm splints, in reducing the occurrence of severe self-injurious behavior (SIB). Although the protective equipment reduced rates of SIB to near-zero levels, self-restraint subsequently emerged. In an attempt to reduce self-restraint while maintaining reductions in SIB, we provided noncontingent access to preferred stimuli. The presentation of preferred stimuli along with the use of protective equipment reduced both the rate of SIB and the duration of self-restraint.     

Systematic application and removal of protective equipment in the assessment of multiple topographies of self-injury

We evaluated the effects of systematic application and removal of protective equipment on three topographies of self-injurious behavior (SIB) exhibited by a girl who had been diagnosed with autism. Results showed that when protective equipment was applied, SIB decreased to near-zero levels. In addition, withdrawal of protective equipment for specific topographies of SIB (by removing only the corresponding padding) increased rates of SIB only for that topography of SIB. Next, a functional analysis of hand SIB showed that protective equipment suppressed this behavior in all conditions and that the behavior was maintained by automatic reinforcement when padding was removed. Results are discussed in terms of sensory extinction as a possible mechanism responsible for response suppression.     

Evaluation of response blocking and re-presentation in a competing stimulus assessment

Competing stimulus assessments (CSA) have been used to identify stimuli that are associated with reduced levels of problem behavior, presumably as a function of reinforcer competition. Following a standard CSA in which stimuli simply were made available, 2 more CSAs were conducted with additional components designed to enhance reinforcer competition: re-presentation of stimuli and response blocking for self-injury. The results obtained from each CSA were validated in an extended treatment analysis. The study illustrates how the effects of additional components designed to enhance reinforcer competition can be evaluated efficiently in the context of a CSA.     

Competition between noncontingent and contingent reinforcement schedules during response acquisition

We examined the extent to which noncontingent reinforcement (NCR), when used as treatment to reduce problem behavior, might interfere with differential reinforcement contingencies designed to strengthen alternative behavior. After conducting a functional analysis to identify the reinforcers maintaining 2 participants' self-injurious behavior (SIB), we delivered those reinforcers under dense NCR schedules. We delivered the same reinforcers concurrently under differential-reinforcement-of-alternative-behavior (DRA) contingencies in an attempt to strengthen replacement behaviors (mands). Results showed that the NCR plus DRA intervention was associated with a decrease in SIB but little or no increase in appropriate mands. In a subsequent phase, when the NCR schedule was thinned while the DRA schedule remained unchanged, SIB remained low and mands increased. These results suggest that dense NCR schedules may alter establishing operations that result in not only suppression of problem behavior but also interference with the acquisition of appropriate behavior. Thus, the strengthening of socially appropriate behaviors as replacements for problem behavior during NCR interventions might best be achieved if the NCR schedule is first thinned.     

Effects of increased response effort on self-injury and object manipulation as competing responses

We evaluated the effects of a response-effort intervention on the occurrence of self-injurious hand mouthing and a competing response (object manipulation) with 4 individuals who had profound developmental disabilities. During Phase 1, results of functional analyses showed that all participants engaged in high levels of hand mouthing in the absence of social contingencies, suggesting that the behavior was maintained by automatic reinforcement. In Phase 2, preferred leisure items were identified for participants during assessments in which duration of leisure item manipulation was used as the index of preference. In Phase 3, participants were observed to engage in high levels of hand mouthing and in varying levels of object manipulation when they had free access to their most preferred leisure items during baseline. The effects of increased response effort on hand mouthing and object manipulation were then evaluated in mixed multiple baseline and reversal designs. The response-effort condition was identical to baseline, except that participants wore soft, flexible sleeves that increased resistance for elbow flexion but still enabled participants to engage in hand mouthing. Results showed consistent decreases in SIB and increases in object manipulation during the response-effort condition for all participants. These results suggested that a less preferred reinforcer (produced by object manipulation) may substitute for a more highly preferred reinforcer (produced by hand mouthing) when response effort for hand mouthing was increased. DESCRIPTORS: self-injurious behavior, automatic reinforcement, reinforcer substitutability, response effort     

Functional analysis of self-injurious behavior and its relation to self-restraint

Some individuals who engage in self-injurious behavior (SIB) also exhibit self-restraint. In the present study, a series of three functional analyses were conducted to determine the variables that maintained a participant's SIB, one without restraint items available, one with a preferred and effective form of self-restraint (an airplane pillow) available noncontingently, and one with this item delivered contingent on SIB. Results suggested that SIB was reinforced by escape and by access to self-restraint materials, self-restraint appeared to be maintained by automatic reinforcement, and continuous access to highly preferred restraint materials effectively suppressed SIB.     

An integrated model for guiding the selection of treatment components for problem behavior maintained by automatic reinforcement

We evaluated the usefulness of 2 assessments to guide treatment selection for individuals whose prior functional analysis indicated that automatic reinforcement maintained their problem behavior. In the 1st assessment, we compared levels of problem behavior during a noncontingent play condition and an alone or ignore condition. In the 2nd, we assessed participants’ relative preferences for automatic reinforcement and social reinforcers in a concurrent‐operants arrangement. We used the results of these 2 assessments to assign 5 participants to a treatment based on noncontingent access to social reinforcers or to a treatment based on differential access to social reinforcers. We conducted monthly probes with the participants over 10 to 12 months to evaluate the effects of the treatment procedures. All participants showed reductions in problem behavior over this period.     

COMPUTER‐ASSISTED MEASUREMENT OF WOUND SIZE ASSOCIATED WITH SELF‐INJURIOUS BEHAVIOR

We evaluated an inexpensive, efficient, and noninvasive technique for measuring tissue damage produced by self‐injurious behavior (SIB). The technique involved computerized measurement of wound surface area (WSA) based on digital photographs. In Study 1, we compared photographic measurement to a more commonly used procedure, transparency measurement, in estimating WSA of 20 wound models. Results showed that both methods were reliable and that there was a high degree of correspondence between the 2 sets of measures. In Study 2, we compared photographic WSA measures to direct‐observation measures in documenting changes over time in the SIB exhibited by a woman with Prader‐Willi syndrome. Results showed that increases and decreases in observed SIB during baseline and treatment conditions corresponded with changes in WSA measures, indicating that the computer‐assisted photographic technique may be useful as a corroborative measure or as a primary measure when direct observation of SIB is not feasible.     

Further evaluation of the role of protective equipment in the functional analysis of self-injurious behavior

Using a procedure similar to the one described by Le and Smith (in press), we evaluated the effects of protective equipment during a functional analysis for 2 individuals who engaged in severe self-injurious behavior (SIB). Results of our analyses revealed that the use of protective equipment during functional analyses of SIB suppressed levels of responding such that a behavioral function could not be identified.     

Further analysis of subtypes of automatically reinforced SIB: A replication and quantitative analysis of published datasets

Hagopian, Rooker, and Zarcone (2015) evaluated a model for subtyping automatically reinforced self‐injurious behavior (SIB) based on its sensitivity to changes in functional analysis conditions and the presence of self‐restraint. The current study tested the generality of the model by applying it to all datasets of automatically reinforced SIB published from 1982 to 2015. We identified 49 datasets that included sufficient data to permit subtyping. Similar to the original study, Subtype‐1 SIB was generally amenable to treatment using reinforcement alone, whereas Subtype‐2 SIB was not. Conclusions could not be drawn about Subtype‐3 SIB due to the small number of datasets. Nevertheless, the findings support the generality of the model and suggest that sensitivity of SIB to disruption by alternative reinforcement is an important dimension of automatically reinforced SIB. Findings also suggest that automatically reinforced SIB should no longer be considered a single category and that additional research is needed to better understand and treat Subtype‐2 SIB.     

A comparison of procedures for programming noncontingent reinforcement schedules

We compared two methods for programming and thinning noncontingent reinforcement (NCR) schedules during the treatment of self-injurious behavior (SIB). The participants were 3 individuals who had been diagnosed with mental retardation. Results of functional analyses indicated that all participants' SIB was maintained by positive reinforcement (i.e., access to attention or food). Following baseline, the effects of two NCR schedule-thinning procedures were compared in multielement designs. One schedule (fixed increment) was initially set at fixed-time 10-s reinforcer deliveries and was also thinned according to fixed-time intervals. The other schedule (adjusting IRT) was initially determined by participants' baseline interresponse times (IRTs) for SIB and was thinned based on IRTs observed during subsequent treatment sessions. Results indicated that both schedules were effective in initially reducing SIB and in maintaining response suppression as the schedules were thinned.     

The effects of noncontingent access to single- versus multiple-stimulus sets on self-injurious behavior

The automatically reinforced self-injury of a girl with autism was treated by providing noncontingent access to a single set of preferred toys during 30-min sessions. The reductive effects of the intervention waned as the session progressed. Rotating toy sets after 10 min or providing access to multiple toy sets resulted in reductions that lasted the entire 30 min.     

An evaluation of two differential reinforcement procedures with escape extinction to treat food refusal

Consumption of solids and liquids occurs as a chain of behaviors that may include accepting, swallowing, and retaining the food or drink. In the current investigation, we evaluated the relative effectiveness of differential reinforcement of the first behavior in the chain (acceptance) versus differential reinforcement for the terminal behavior in the chain (mouth clean). Three children who had been diagnosed with a feeding disorder participated. Acceptance remained at zero when differential reinforcement contingencies were implemented for acceptance or mouth clean. Acceptance and mouth clean increased for all 3 participants once escape extinction was added to the differential reinforcement procedures, independent of whether reinforcement was provided for acceptance or for mouth clean. Maintenance was observed in 2 children when escape extinction was removed from the treatment package. The mechanism by which consumption increased is discussed in relation to positive and negative reinforcement contingencies.     

A review of environmental enrichment as treatment for problem behavior maintained by automatic reinforcement

We reviewed studies that used environmental enrichment as treatment for problem behavior maintained by automatic reinforcement. A search of behavior analytic journals produced 71 publications with a total of 265 applications of environmental enrichment used alone or in conjunction with alternative behavior manipulations (e.g., prompting, reinforcement) and problem behavior manipulations (e.g., blocking, restraint). Environmental enrichment, as a sole intervention, was efficacious in 41% of the sample. Alternative behavior manipulations, problem behavior manipulations, and a combination of both improved the overall efficacy of environmental enrichment. We discuss factors that may influence the efficacy of environmental enrichment, current trends in research on this topic, and implications for both practitioners and researchers.     

The influence of therapist attention on self-injury during a tangible condition

This study investigated the effects of therapist attention on the self-injurious behavior (SIB) of a 6-year-old girl with developmental disabilities. After results of a functional analysis indicated that SIB was maintained by attention and tangible reinforcement, tangible conditions with and without contingent verbal attention were compared. Results suggested that the inclusion of verbal attention in a tangible condition may confound functional analysis outcomes for behavior that is maintained by attention.     

Reducing covert self-injurious behavior maintained by automatic reinforcement through a variable momentary DRO procedure

Covert self-injurious behavior (i.e., behavior that occurs in the absence of other people) can be difficult to treat. Traditional treatments typically have involved sophisticated methods of observation and often have employed positive punishment procedures. The current study evaluated the effectiveness of a variable momentary differential reinforcement contingency in the treatment of covert self-injury. Neither positive punishment nor extinction was required to produce decreased skin picking.     

Noncontingent reinforcement competes with response performance

Noncontingent reinforcement is a commonly used procedure to decrease levels of problem behavior. Goals of this intervention are to decrease motivation, responding, and the functional relation between behavior and consequences, but it could also possibly compete with performance of alternative desirable responses. In the current study, we assessed the effects of noncontingent reinforcement arranged from 0% to 100% of sessions on performance of alternative responding across two experiments. Experiment 1 assessed manding (i.e., requests) maintained by attention and tangibles with a child with developmental disabilities and Experiment 2 assessed keypecking maintained by food with six pigeons. We extended previous research by (a) showing that noncontingent reinforcement competes with both the acquisition and maintenance (performance) of an alternative response, (b) extending the generality of the findings across nonhuman and human participants, and (c) eliminating influence of sequence effects through random manipulations of noncontingent value in pigeons. Overall, greater amounts of noncontingent reinforcement competed with both acquisition and maintenance of alternative responding.