The analysis and treatment of vocal stereotypy in a child with autism

This study examined procedures for the assessment and treatment of automatically reinforced vocal stereotypy of a 6‐year‐old girl with autism. Stimulus assessments were conducted to identify toys that were correlated with higher rates of vocal stereotypy and toys that were not. A concurrent operants assessment identified preferred stimuli (toys that produced auditory stimulation), which were then used as reinforcers for the non‐occurrence of vocal stereotypy. A reversal design was used to compare the effects of a fixed time schedule of reinforcement (FT 1‐min) to differential reinforcement for the non‐occurrence of behavior (DRO) to reduce vocal stereotypy. Implementation of the FT schedule revealed no effect, whereas the DRO schedule led to a reduction in the target behavior during treatment sessions and across the school day. This study adds to the body of literature supporting the identification of matched stimuli to reduce non‐socially mediated problem behavior. Copyright © 2005 John Wiley & Sons, Ltd.     

Comparing resetting to non‐resetting DRO procedures to reduce stereotypy in a child with autism

We compared a resetting to a non‐resetting differential reinforcement of other behavior (DRO) procedure to reduce stereotypy exhibited by young boy with autism. During the resetting DRO, a reinforcer was delivered contingent upon the absence of stereotypy during the DRO interval. If stereotypy occurred, the DRO interval was immediately reset. The non‐resetting DRO procedure was identical, except that contingent upon stereotypy, the DRO interval continued until it expired; a new DRO interval then began. Results indicate that the DRO procedures were equally effective to reduce stereotypy, but the participant preferred the resetting DRO procedure.     

Immediate and subsequent effects of differential reinforcement of other behavior and noncontingent matched stimulation on stereotypy

A three‐component multiple‐schedule and brief reversals were used to examine the effects of differential reinforcement of other behavior (DRO) and noncontingent matched stimulation (NMS) on the automatically reinforced mouthing of a child with autism. Both DRO and NMS decreased immediate engagement in mouthing, but NMS produced larger reductions in the behavior. Furthermore, NMS produced subsequent effects (i.e., when the treatment was withdrawn) similar to those of prior access, whereas DRO marginally increased subsequent engagement in mouthing. The results suggest that NMS was a functionally matched intervention for mouthing. Implications for the assessment and treatment of stereotypy and applications for future research are discussed. Copyright © 2010 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.     

A comparison of differential reinforcement procedures for treating automatically reinforced behavior

Children diagnosed with autism spectrum disorder (ASD) often exhibit stereotypy, which can be socially stigmatizing, interfere with daily living skills, and affect skill acquisition. We compared differential reinforcement of alternative behavior (DRA) and differential reinforcement of other behavior (DRO) when neither procedure included response blocking or interruption for (a) reducing stereotypy, (b) increasing task engagement, and (c) increasing task completion. DRA contingencies yielded superior outcomes across each measure when evaluated with 3 individuals with autism spectrum disorder.     

Effects of adjusting DRO schedules on the reduction of stereotypic vocalizations in children with autism

The reduction of stereotypic behavior is important for individuals with developmental disabilities because it may interfere with learning new skills. A common procedure used to reduce stereotypic behavior is differential reinforcement of other behavior (DRO). A DRO schedule is a procedure in which reinforcement is delivered given the absence of a target response for a period of time. Although DRO schedules have been shown to be effective in reducing a variety of stereotypic behavior, empirical studies have not yet determined the most effective way to thin the reinforcement schedule. The current study examined the extent to which the relationship between the inter‐response time (IRT) and the DRO requirement affects the reduction of stereotypic behavior. Results of the current study showed the DRO requirement that was set to the 25th percentile of the IRT distribution was more effective in reducing stereotypic behavior when compared with a DRO requirement set to the 95th percentile of the IRT distribution. Copyright © 2009 John Wiley & Sons, Ltd.     

THERAPIST‐ AND SELF‐MONITORED DRO CONTINGENCIES AS A TREATMENT FOR THE SELF‐INJURIOUS SKIN PICKING OF A YOUNG MAN WITH ASPERGER SYNDROME

The use of differential reinforcement of other behavior (DRO) has decreased, at least partially due to the development of less effortful alternative behavioral interventions (e.g., noncontingent reinforcement; Vollmer, Iwata, Zarcone, Smith, & Mazaleski, 1993). The effort associated with DRO contingencies may be lessened by incorporating self‐monitoring components in which clients are responsible for the delivery of reinforcers for their own behavior. The current study evaluates the effectiveness of DRO in the treatment of self‐injury when implemented first by the therapist and subsequently by the client.     

DIFFERENTIAL REINFORCEMENT OF OTHER BEHAVIOR AND NONCONTINGENT REINFORCEMENT AS CONTROL PROCEDURES DURING THE MODIFICATION OF A PRESCHOOLER'S COMPLIANCE1

Differential reinforcement of other behavior (DRO) and noncontingent reinforcement were compared as control procedures during the modification of a 3-yr-old preschooler's compliance. The recorded reinforcer was teacher proximity (within 3 ft (0.9 m) of the subject for at least 5 sec) which was often accompanied by positive verbal comments that varied in content across experimental conditions. The verbal content during contingent reinforcement might have been: “Thank you for picking up the blocks”; during noncontingent reinforcement: “You're wearing a pretty dress”; and during DRO: “I don't blame you for not picking up because it isn't any fun”. Contingent reinforcement increased compliance in all manipulation conditions. Noncontingent reinforcement decreased compliance during two reversal conditions. However, the behavior was variable and did not decrease to the low levels reached during the two DRO reversals.     

SEPARATE AND COMBINED EFFECTS OF VISUAL SCHEDULES AND EXTINCTION PLUS DIFFERENTIAL REINFORCEMENT ON PROBLEM BEHAVIOR OCCASIONED BY TRANSITIONS

The separate and combined effects of visual schedules and extinction plus differential reinforcement of other behavior (DRO) were evaluated to decrease transition‐related problem behavior of 2 children diagnosed with autism. Visual schedules alone were ineffective in reducing problem behavior when transitioning from preferred to nonpreferred activities. Problem behavior decreased for both participants when extinction and DRO were introduced, regardless of whether visual schedules were also used.     

Comparing fixed‐amount and progressive‐amount DRO Schedules for tic suppression in youth with chronic tic disorders

Chronic tic disorders (CTDs) involve motor and/or vocal tics that often cause substantial distress and impairment. Differential reinforcement of other behavior (DRO) schedules of reinforcement produce robust, but incomplete, reductions in tic frequency in youth with CTDs; however, a more robust reduction may be needed to affect durable clinical change. Standard, fixed‐amount DRO schedules have not commonly yielded such reductions, so we evaluated a novel, progressive‐amount DRO schedule, based on its ability to facilitate sustained abstinence from functionally similar behaviors. Five youth with CTDs were exposed to periods of baseline, fixed‐amount DRO (DRO‐F), and progressive‐amount DRO (DRO‐P). Both DRO schedules produced decreases in tic rate and increases in intertic interval duration, but no systematic differences were seen between the two schedules on any dimension of tic occurrence. The DRO‐F schedule was generally preferred to the DRO‐P schedule. Possible procedural improvements and other future directions are discussed.     

Adventitious reinforcement during long-duration DRO exposure

Differential reinforcement of other behavior (DRO) is a procedure often used to decrease problem behavior, but the processes responsible for behavior reduction are not well understood. This study assessed whether adventitious reinforcement of other behavior contributes to DRO effectiveness when, relative to previous research, DRO exposure is prolonged. Two response options were presented on a computer and target responding was reinforced on a variable-ratio schedule. Response rates were then compared during DRO versus yoked variable-time or extinction probes. Across 2 experiments, DRO decreased target responding and increased other responding more than control conditions. However, increases in other responding did not usually maintain despite target responding remaining at low levels. DRO might adventitiously reinforce other responses transiently but the decreases in target behavior could not be entirely explained by adventitious reinforcement of the other response. Instead, reductions in target responding likely depend on the discriminability of the DRO contingency.     

MAINTENANCE OF THERAPEUTIC CHANGE BY MOMENTARY DRO

Differential reinforcement of other behavior (DRO) involves delivery of reinforcement at the end of an interval during which the target behavior has not occurred. Momentary DRO, however, is a procedure in which reinforcement is delivered if a response did not occur at the end of an interval. We examined the extent to which momentary DRO maintained suppression, following initial treatment with whole-interval DRO, of nine retarded students' maladaptive behavior. Results indicate that momentary DRO maintained response suppression comparable to that obtained by whole-interval DRO.     

A comparison of fixed momentary differential reinforcement of other behavior to variable momentary differential reinforcement of other behavior to reduce challenging behavior

Differential reinforcement of other behavior (DRO) is commonly used to reduce behavioral excesses. Momentary DRO schedules involve delivery of reinforcement contingent upon the absence of the target behavior at a given moment. Two variations of momentary DRO exist: fixed-momentary (FM) DRO and variable-momentary (VM) DRO. In the current study, we directly compared FM-DRO and VM-DRO schedules to reduce challenging behavior maintained by automatic reinforcement exhibited by four children with autism spectrum disorder. The results suggest that both the DRO schedules were equally effective to reduce challenging behavior. A social validity measure showed that most caregivers rated the VM-DRO as a preferred schedule and noted the potential for FM-DRO schedule to become more discriminable over time, which could reduce its effectiveness. However, most caregivers also commented that the FM-DRO schedule was easier to implement.     

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.     

REDUCING WANDERING BY PERSONS WITH DEMENTIA USING DIFFERENTIAL REINFORCEMENT

Wandering behavior of 4 geriatric patients with dementia residing in a long-term care facility was assessed using direct behavioral observations. The consequences identified during the observations as maintaining wandering for each patient were then applied for the absence of wandering using differential reinforcement of other behavior (DRO). The effectiveness of the DRO procedure was evaluated using an ABAB design. Results indicated significant reductions in wandering during treatment.     

A comparison of response cost and differential reinforcement of other behavior to reduce disruptive behavior in a preschool classroom

This study investigated the effectiveness of response cost and differential reinforcement of other behavior (DRO) in reducing the disruptive behaviors of 25 children in a preschool classroom. Using an alternating treatments design, disruptive behavior was reduced when the participants earned tokens for the absence of disruptive behavior (DRO) or lost tokens for the occurrence of disruptive behavior (response cost). Initially, DRO was more successful in reducing the number of disruptive behaviors; however, over time, response cost proved to be more effective.     

Abatement of intractable vocal stereotypy using an overcorrection procedure

We conducted a series of reversals to compare the effects of four different treatments on vocal stereotypy emitted by a 7‐year‐old boy with autism. The results showed that (1) the level of vocal stereotypy decreased during exposure to matched stimulation but returned to high levels immediately upon its removal; (2) stereotypy did not significantly decrease during differential reinforcement of other behavior; and (3) contingent withdrawal of movies and music (i.e., response cost) was only moderately effective. However, positive practice overcorrection decreased vocal stereotypy by clinically significant levels. Further, when differential reinforcement of engagement in a Lego^® building task was implemented, the level of engagement was significantly higher when positive practice overcorrection was in place than when overcorrection was withdrawn. Copyright © 2011 John Wiley & Sons, Ltd.     

Functional communication training and noncontingent reinforcement in treatment of stereotypy

A 6‐year‐old boy with autism spectrum disorder engaged in automatically maintained stereotypy in the form of opening and closing doors. A functional analysis confirmed that he also emitted problem behavior that was maintained by access to stereotypy. We evaluated the separate and combined effects of functional communication training and arbitrary noncontingent reinforcement on both response classes. Results showed that the combination of functional communication training and noncontingent reinforcement was more effective at reducing stereotypy than either intervention on its own, although effects on problem behavior were unclear. These results suggest that combinations of interventions may be useful in the treatment of automatically maintained problem behavior.     

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.     

“Other” behavior and the DRO: The roles of extinction and reinforcement

Jessel et al. (2015) provided some evidence to suggest that “other” behavior is strengthened in the differential reinforcement of other behavior (DRO). The present study is a systematic replication of the Jessel et al. procedures. The effects of DRO and extinction on target responding, target-other responding (a response with an established history of reinforcement), and nontarget-other responding emitted by children with intellectual and developmental disabilities and children with no known diagnoses were compared. Other behavior increased in at least one DRO condition for each participant, suggesting that other behavior increases when using DRO, at least initially. Under extinction, target responding and target-other responding decreased to low rates for three of the five participants; however, rates of nontarget-other responding were elevated compared to the DRO condition. These results suggest that increased rates of target-other responding and nontarget-other responding during the DRO condition may be a result of extinction-induced variability.