FURTHER ANALYSIS OF THE RELATIONSHIP BETWEEN SELF-INJURY AND SELF-RESTRAINT

It has been suggested that self-restraint, a phenomenon often correlated with self-injurious behavior (SIB), may be maintained by negative reinforcement in the form of escape from the aversive properties of SIB (e.g., pain). We examined the effects of blocking SIB (and presumably removing any aversive effects) on the self-restraint of a 19-year-old male with severe mental retardation. Consistent with the negative reinforcement hypothesis, blocking SIB resulted in near-zero levels of SIB and moderate reductions in self-restraint.     

REDUCING SELF-INJURY AND CORRESPONDING SELF-RESTRAINT THROUGH THE STRATEGIC USE OF PROTECTIVE CLOTHING

We examined the use of protective clothing to reduce a retarded male's face-punching and leg-kicking and two corresponding forms of self-restraint—arm and leg self-restraint. The resident was observed each day in three sessions of randomly ordered conditions (one condition per session): without any protective clothing, with a padded helmet, and with a padded helmet and padded slippers. Use of the padded helmet substantially reduced face-punching and arm self-restraint. The addition of padded slippers reduced leg-kicking and leg self-restraint. These results suggest a practical and effective means of controlling self-injury and self-restraint. They are also consistent with the possibility that the resident's arm restraint was maintained in part by escape or avoidance of face-punching and that his leg restraint was maintained in part by escape or avoidance of leg-kicking.     

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.     

ON THE RELATIONSHIP BETWEEN SELF-INJURIOUS BEHAVIOR AND SELF-RESTRAINT

Many individuals who exhibit self-injurious behavior (SIB) also exhibit self-restraint. Three hypotheses about the determinants of self-restraint have been suggested: (a) Self-restraint is maintained by escape from or avoidance of aversive aspects of SIB, (b) self-restraint and SIB are members of the same functional class, and (c) self-restraint and SIB are functionally independent. This study examined a method by which the relationship between self-restraint and SIB may be investigated using functional analysis. Data were collected on the self-restraint and SIB exhibited by 5 mentally retarded males, while conditions suspected to maintain SIB were manipulated. Results suggested that self-restraint, like SIB, may be maintained by idiosyncratic contingencies. Implications of an understanding of self-restraint for the analysis and treatment of SIB are discussed, as are some general possibilities for future research.     

ON THE EFFECTS OF NONCONTINGENT DELIVERY OF DIFFERING MAGNITUDES OF REINFORCEMENT

We conducted a parametric analysis of response suppression associated with different magnitudes of noncontingent reinforcement (NCR). Participants were 5 adults with severe or profound mental retardation who engaged in a manual response that was reinforced on variable-ratio schedules during baseline. Participants were then exposed to NCR via multielement and reversal designs. The fixed-time schedules were kept constant while the magnitude of the reinforcing stimulus was varied across three levels (low, medium, and high). Results showed that high-magnitude NCR schedules produced large and consistent reductions in response rates, medium-magnitude schedules produced less consistent and smaller reductions, and low-magnitude schedules produced little or no effect on responding. These results suggest that (a) NCR affects responding by altering an establishing operation (i.e., attenuating a deprivation state) rather than through extinction, and (b) magnitude of reinforcement is an important variable in determining the effectiveness of NCR.     

COMBINING NONCONTINGENT REINFORCEMENT AND DIFFERENTIAL REINFORCEMENT SCHEDULES AS TREATMENT FOR ABERRANT BEHAVIOR

Research has shown that noncontingent reinforcement (NCR) can be an effective behavior-reduction procedure when based on a functional analysis. The effects of NCR may be a result of elimination of the contingency between aberrant behavior and reinforcing consequences (extinction) or frequent and free access to reinforcers that may reduce the participant's motivation to engage in aberrant behaviors or mands. If motivation is momentarily reduced, behavior such as mands may not be sensitive to positive reinforcement. In this study, for 3 children with aberrant behavior maintained by tangible positive reinforcement, differential-reinforcement-of-alternative-behavior schedules were superimposed on NCR schedules to determine if mands could be strengthened. Results for the participants indicated that NCR did not preclude reinforcement of mands.     

STIMULUS FADING AND TRANSFER IN THE TREATMENT OF SELF-RESTRAINT AND SELF-INJURIOUS BEHAVIOR

We conducted several manipulations of mechanical restraint properties during the course of treatment for two profoundly retarded adolescents who exhibited both self-restraint and self-injurious behavior. In study 1, a combination of prompting, differential reinforcement, and stimulus fading reduced one subject's self-restraint, which consisted of holding rigid tubes on his arms. Subsequently, stimulus control of both self-restraint and self-injurious behavior was transferred to tennis wrist bands. In study 2, a second subject's self-restraint—placing his hands in his pants—was immediately eliminated by the use of air splints. Additionally, differential reinforcement and air-pressure fading resulted in the complete mobility of his arms and a substantial increase in appropriate behaviors. Results of this investigation suggest that stimulus fading and transfer may be valuable components in the elimination of self-restraint.     

EFFECTS OF REINFORCEMENT FOR ALTERNATIVE BEHAVIOR DURING PUNISHMENT OF SELF-INJURY

A number of variables influence the effectiveness of punishment and may determine the extent to which less intrusive forms of punishment may be used as alternatives to more intrusive interventions. For example, it has been suggested that response suppression during punishment may be facilitated if reinforcement is concurrently available for an alternative response. However, results of basic research demonstrating this finding have not been replicated with interventions more commonly prescribed as treatments for problem behavior. We evaluated the effects of relatively benign punishment procedures (reprimands or brief manual restraint) on the self-injurious behavior of 4 individuals who had been diagnosed with mental retardation, when access to reinforcement for alternative behavior (manipulation of leisure materials) was and was not available. In all cases, punishment produced greater response suppression when reinforcement for an alternative response was available.     

SELF-RESTRAINT AS POSITIVE REINFORCEMENT FOR SELF-INJURIOUS BEHAVIOR

Many individuals who engage in self-injurious behavior (SIB) also exhibit self-restraint. We compared rates of SIB exhibited by a 32-year-old woman diagnosed with profound retardation across conditions in which access to restraint was (a) continuously available, (b) presented as a consequence for SIB, or (c) unavailable. Rates of SIB increased when access to restraint was contingent upon SIB and decreased when restraint was unavailable, suggesting that self-restraint functioned as positive reinforcement for SIB.     

A COMPARISON OF NONCONTINGENT REINFORCEMENT AND SENSORY EXTINCTION AS TREATMENTS FOR SELF-INJURIOUS BEHAVIOR

We compared the effects of two treatments, noncontingent reinforcement (NCR) and sensory extinction (EXT), on the self-injurious behavior (SIB) exhibited by 3 individuals with developmental disabilities. Results of a functional analysis indicated that their SIB was not maintained by social reinforcement, as indicated by undifferentiated responding across assessment conditions or higher rates of responding in the alone condition. Prior to treatment, leisure probes were conducted to identify highly preferred items for use in the NCR condition, and equipment probes were conducted to identify devices that produced the greatest behavioral suppression for use in the EXT condition. Following baseline, treatment was implemented in a multiple baseline across subjects design, and the effects of NCR and EXT were compared in a multielement format. During NCR sessions, participants had continuous access to a highly preferred item. During EXT sessions, participants wore equipment (gloves or protective sleeves) that seemed to attenuate stimulation directly produced by their SIB, while still allowing the behavior to occur. Results indicated that both procedures were effective in reducing SIB, although NCR was associated with either more rapid or greater overall response suppression.     

ASSESSMENT OF SELF-INJURIOUS BEHAVIOR MAINTAINED BY ACCESS TO SELF-RESTRAINT MATERIALS

This study replicates and extends prior research showing that access to self-restraint materials can reinforce self-injurious behavior (SIB). A functional analysis was conducted showing that SIB occurred at differentially high rates when access to restraint materials (a leather jacket) was made contingent on the behavior. In addition, an alone condition during the functional analysis showed that SIB did not occur in the absence of restraint materials. Finally, a treatment analysis showed that functional communication training was effective using an alternative reinforcer.     

NONCONTINGENT PRESENTATION OF ATTENTION AND ALTERNATIVE STIMULI IN THE TREATMENT OF ATTENTION-MAINTAINED DESTRUCTIVE BEHAVIOR

Previous research has demonstrated that destructive behavior may be reduced through noncontingent presentation of attention when attention is identified as the stimulus responsible for behavioral maintenance. Because it may not always be possible to deliver attention in all situations, we examined the extent to which alternative stimuli that have been identified through a choice assessment would substitute for attention (the functional analysis—based reinforcer) in a noncontingent reinforcement procedure. Prior to treatment, functional analyses demonstrated that the destructive behavior of 2 clients with mental retardation was maintained by adult attention. Next, a stimulus choice assessment identified highly preferred tangible items for the 2 clients. Finally, we compared the effectiveness of two noncontingent reinforcement procedures: continuous noncontingent access to attention and continuous noncontingent access to the tangible item identified in the choice assessment. For both clients, these noncontingent reinforcement procedures reduced destructive behavior. The results are discussed in terms of the clinical implications for the treatment of destructive behavior using functional and alternative stimuli.     

NEGATIVE SIDE EFFECTS OF NONCONTINGENT REINFORCEMENT

Noncontingent reinforcement (NCR) has emerged as a treatment package for severe behavior problems. Although concerns about potential side effects (such as incidental reinforcement) have been raised, there have been few reported negative side effects in published studies to date. In this article, we report an NCR treatment evaluation for severe aggression that produced (a) an extinction burst and (b) incidental reinforcement. These side effects were evaluated by examining within-session response patterns and response distributions. As a solution, a brief omission contingency was added to the reinforcement schedule. The omission contingency resulted in decreased aggression rates.     

THE EFFECTS OF CONTINGENT AND NONCONTINGENT REWARDS ON THE I.Q. SCORES OF CHILDREN OF ABOVE-AVERAGE INTELLIGENCE1

This study investigated the effects of candy reinforcement on I.Q. test scores in first and second graders of above-average intelligence. Thirty-six subjects were randomly assigned to one of three groups and either given candy contingent on correct responses, noncontingently, or not given candy. After measuring all subjects on Form L of the revised Stanford Binet, each subject in the contingent group was given an M & M immediately following each correct answer on Form M, while a yoked-comparison subject received the same number of M & M's before responding to a question and therefore without regard to correctness of answers. It was expected that both types of candy administration would produce higher I.Q. change scores than the no-candy control group, but there were no statistically significant differences among the three treatments. The differences between the first and second test scores were 4.17 (contingent), 4.67 (noncontingent), and 1.00 (no reinforcement). Reasons for this failure to replicate previous findings were discussed.     

NONCONTINGENT DELIVERY OF ARBITRARY REINFORCERS AS TREATMENT FOR SELF-INJURIOUS BEHAVIOR

Results of recent research have shown that noncontingent reinforcement (NCR) can be effective in reducing the frequency of behavior problems. In typical NCR applications, the reinforcer that is responsible for behavioral maintenance (as demonstrated through a functional analysis) no longer follows occurrences of the target behavior but instead is delivered according to a time-based schedule. Thus, it is unclear if NCR would be effective if the target behavior continued to be reinforced or if arbitrary reinforcers (i.e., those irrelevant to behavioral maintenance) were substituted for the maintaining reinforcers in the NCR procedure. In this study, 2 individuals whose self-injurious behavior (SIB) was maintained by positive reinforcement were exposed to conditions in which arbitrary and maintaining reinforcers were withheld and were delivered either contingently or noncontingently. Results indicated that noncontingent delivery of arbitrary reinforcers was effective in reducing SIB even though occurrences of SIB produced access to the maintaining reinforcer. These results suggest that (a) arbitrary reinforcers may sometimes be substituted for maintaining reinforcers, (b) an important component of NCR procedures is alteration of a behavior's establishing operation, and (c) NCR with arbitrary reinforcers might therefore be effective when maintaining reinforcers cannot be identified or withheld during the course of treatment.     

NONCONTINGENT REINFORCEMENT AS TREATMENT FOR SEVERE PROBLEM BEHAVIOR: SOME PROCEDURAL VARIATIONS

Noncontingent reinforcement (NCR) as a treatment for problem behavior has typically included (a) continuous access to reinforcers at the onset of treatment and (b) extinction. We extended research on NCR by conducting a three-phase preliminary investigation of these components. In Phase 1, a functional analysis showed that the problem behavior of 3 participants with developmental disabilities was maintained by tangible positive reinforcement. In Phase 2, treatment started with the initial NCR interval based on the latency to the first problem behavior during baseline. In Phase 3, treatment consisted of NCR without extinction to determine whether extinction was an essential treatment component. Results showed that the initial NCR schedule based on latency (Phase 2) and NCR without extinction (Phase 3) were effective for reducing rates of problem behavior compared with baseline. Findings are discussed regarding the initial schedule of reinforcement and extinction as components of NCR.     

ANALYSIS OF THE REINFORCEMENT AND EXTINCTION COMPONENTS IN DRO CONTINGENCIES WITH SELF-INJURY

Previous research has shown that self-injurious behavior (SIB) maintained by positive reinforcement may be reduced under differential-reinforcement-of-other-behavior (DRO) contingencies. In this study, we conducted an analysis of the reinforcement and extinction components of DRO while treating the self-injury of 3 women with developmental disabilities. A functional analysis revealed that each subject's SIB was maintained by positive reinforcement in the form of attention. Subsequent reinforcer assessments identified preferred and nonpreferred stimuli for later use in conjunction with DRO. Results showed high rates of SIB for all 3 subjects during baseline, which persisted when DRO was implemented without the relevant extinction component (withholding of attention for SIB) for 2 of the subjects. Low rates of SIB were observed for all subjects when DRO plus extinction was implemented or when extinction was implemented alone, suggesting that extinction may be a critical component of DRO schedules.     

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.     

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.