Increasing meal consumption in individuals with competing protective equipment

Individuals diagnosed with autism spectrum disorder may engage in self‐injurious behavior that can cause tissue damage. Protective equipment is sometimes used to decrease the severity of tissue damage when self‐injury occurs. However, wearing protective equipment may be incompatible with some forms of adaptive behavior, such as meal consumption. The purpose of the present analysis was to identify a treatment for increasing meal consumption in two adolescent males diagnosed with an autism spectrum disorder who wore protective equipment that interfered with self‐feeding. Three interventions were evaluated: modifying the protective equipment, manipulating the reinforcing efficacy of the meal, and arranging additional positive reinforcement for meal consumption in the absence of protective equipment. Modifying protective equipment and manipulating the reinforcing efficacy of the meal were effective for both participants. Additional positive reinforcement was evaluated and effective for one participant.     

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.     

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.     

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.     

Effects of therapist‐worn protective equipment during functional analysis of aggression

The effects of therapist‐worn protective equipment (PE) on functional analysis (FA) outcomes for aggression were evaluated. Independent FAs with and without PE were conducted concurrently. Both FAs showed the same function of aggression for all participants. These results suggest that therapists may wear PE during FAs of aggression to reduce risk without altering the interpretation of the analysis.     

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.     

Relative influences of establishing operations and reinforcement contingencies on self-injurious behavior during functional analyses

In the typical functional analysis in which the antecedent and consequent events associated with problem behavior are manipulated, the control condition involves elimination of both the relevant establishing operation (EO) and its associated contingency through a schedule of noncontingent reinforcement (usually fixed-time [FT] 30 s). In some functional analyses, however, antecedent events are manipulated in the absence of differential consequences, and a common test condition in such analyses also involves the delivery of reinforcement on an FT 30-s schedule. Thus, the same schedule of reinforcement (FT 30 s) is not considered to be an EO in the former type of analysis but is considered to be an EO in the latter. We examined the relative influences of EOs and reinforcement contingencies on problem behavior by exposing 6 individuals who engaged in self-injurious behavior (SIB) to four combinations of functional analysis conditions: EO present/contingency present, EO absent/contingency present, EO present/contingency absent, and EO absent/contingency absent. Results indicated that the only condition in which high rates of SIB were observed consistently was one in which the EO and the reinforcement contingency were both present. Implications of these results for the design of functional analysis test and control conditions are discussed.     

Functional analysis and treatment of self-injurious behavior in young children a summary of 30 cases

The assessment and treatment of self-injurious behavior (SIB) has received much attention in the literature; however, few studies have focused on early intervention for this behavior. In the current study, functional analyses with developmentally appropriate modifications were conducted in an outpatient clinic with 30 children (aged 10 months to 4 years 11 months) to assess SIB and problem behavior in its early stages. The reported mean age of SIB onset was 17 months, and head banging was the most prevalent topography. Functional analyses identified sources of reinforcement for SIB in 62.1% of cases; with the inclusion of all forms of problem behavior, sources of reinforcement were identified for 87.5% of cases. Function-based treatments were developed for 24 cases, with functional communication training prescribed most often (70.8% of cases). Implications of these findings for the development of early intervention programs for SIB are discussed.     

PROTECTIVE EQUIPMENT: CONTINUOUS AND CONTINGENT APPLICATION IN THE TREATMENT OF SELF-INJURIOUS BEHAVIOR

This study evaluated the use of protective equipment in treating self-injurious behavior (SIB) exhibited by three retarded persons. In Experiment 1, the equipment was first applied continuously during 20-min sessions in individual multiple baseline designs across settings. Results showed substantial reductions in head hitting, eye gouging, and hand biting. Brief periods of time-out with the protective equipment were later made contingent on SIB and combined with a differential reinforcement procedure. Reduced levels of SIB was maintained with all subjects. Additionally, the amount of time during which the equipment was applied decreased as the SIB diminished. Experiment 2 evaluated the use of contingent protective equipment (the final condition in Experiment 1) when applied directly in the subjects' living uints during the day. During Experiment 2, SIB remained at or below the levels found at the termination of Experiment 1. Finally, in an effort to assess the long-term effectiveness of the procedure, responsibility for implementation was given to the staff who were typically assigned to provide therapy to the subjects. Follow-up probe observations conducted up to 104 days after termination of the final experimental condition showed continued low levels of both SIB and equipment usage. Results of these experiments suggest that contingent protective equipment and differential reinforcement may be effective in reducing chronic self-injury.     

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.     

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 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.     

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 and treatment of self-injury associated with transitions.

We applied functional analysis methodology to the assessment and treatment of 2 individuals' self‐injurious behavior (SIB), which was reported to be occasioned by transitions from one activity or location to another. A structural (task) analysis of activity transitions identified at least three separate components that might influence behavior either alone or in combination: (a) termination of a prechange activity, (b) initiation of a postchange activity, and (c) movement from one location to another. Results of preference and avoidance assessments were used to identify activities to which participants were exposed in varying arrangements during transitions in a functional analysis. Results of 1 participant's functional analysis indicated that his SIB was maintained by avoidance of having to change locations, regardless of the activity terminated prior to the change or the activity initiated following it. The 2nd participant's analysis revealed the same function but also an additional one: avoidance of certain task initiations. This information was used to identify transition contexts during intervention and to design treatment procedures appropriate for a given context and behavioral function. A procedure involving advance notice of an upcoming transition had no effect on SIB, and differential reinforcement of alternative behavior (DRA) had limited effects in the absence of extinction. Sustained decreases in SIB were observed when DRA was combined with extinction and response blocking. Further extensions of functional analysis methodology to the assessment of problem behavior in situations characterized by multiple or protracted stimulus changes are discussed.     

Using brief assessments to evaluate aberrant behavior maintained by attention

We examined the use of brief functional assessments to identify idiosyncratic variables associated with aberrant behavior maintained by positive reinforcement in the form of attention. Two participants with severe developmental disabilities and their parents were involved in the assessment and treatment evaluation process. A modified attention condition was introduced, which involved both parents interacting with a third person. Results of the assessment demonstrated that aberrant behavior occurred only in the modified attention condition for both participants. Treatment consisted of the parents delivering attention on a fixed-time schedule during this specific social context. Results indicated that the treatment reduced problem behavior. Follow-up evaluations with 1 participant indicated maintenance of treatment effects for up to 6 months.     

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.     

FUNCTIONAL ANALYSIS AND TREATMENT OF SELF‐INJURY IN A CAPTIVE OLIVE BABOON

Self‐injurious behavior (SIB), such as self‐biting and head banging, has been reported to occur in approximately 10% of captive, individually housed nonhuman primates. Accounts of the etiology of SIB in primates range from ecological to physiological. However, to date, no research has examined the possible influence of social consequences delivered by handlers and keepers in the maintenance of SIB in this population. The current study investigated the effects of social contact as a potentially reinforcing consequence for the SIB displayed by an olive baboon (Papio hamadryas anubis). Results indicated that the behavior was maintained by attention from humans. As treatment, reinforcement was arranged for an appropriate alternative response, resulting in increases in the appropriate alternative behavior and decreases in SIB.