CONTINGENT REINFORCEMENT FOR BENZODIAZEPINE-FREE URINES: EVALUATION OF A DRUG ABUSE TREATMENT INTERVENTION

This study evaluated contingent reinforcement for benzodiazepine-free urines as a therapeutic intervention for promoting reduced use of supplemental benzodiazepine drugs among methadone maintenance outpatients. Ten methadone maintenance patients were selected for participation on the basis of positive urinalysis results. During a 12-week intervention period these patients were offered clinic privileges, including monetary payments or methadone take-home doses, contingent on benzodiazepine negative urinalysis test results. Eight of ten participants responded to the intervention with at least 2.5 weeks of consecutive clean urines. An increase in benzodiazepine-negative tests during the contingent reinforcement period was significant for the group as a whole. The results suggest that more widespread application of contingent reinforcement procedures may be warranted in drug abuse treatment clinics.     

AN EXPERIMENTAL COMPARISON OF THREE DIFFERENT SCHEDULES OF REINFORCEMENT OF DRUG ABSTINENCE USING CIGARETTE SMOKING AS AN EXEMPLAR

The efficacy of three different schedules of reinforcement for promoting and sustaining drug abstinence was compared in this study. Cigarette smoking was studied as an exemplar of stimulant drug self-administration. Sixty cigarette smokers were assigned to one of three groups (progressive rate of reinforcement, fixed rate of reinforcement, and yoked control). Participants in all three groups were asked to refrain from smoking for 1 week. Participants in the progressive and fixed groups achieved greater mean levels of abstinence than those in the control group. Participants in the progressive group were significantly less likely to resume smoking when they became abstinent than participants in the other groups.     

IMPROVING DIETARY PRACTICES OF ELDERLY INDIVIDUALS: THE POWER OF PROMPTING,FEEDBACK, AND SOCIAL REINFORCEMENT

Three intervention packages consisting of (a) enhanced prompts, feedback, and social reinforcement; (b) a lottery; and (c) serving as a confederate were added and removed in sequence as adjacent conditions in an extended withdrawal design to assess their effects on the dietary choices of elderly persons. Participants were 3 elderly residents of an independent living facility who were identified as making consistently poor dietary choices and who had medical conditions that necessitated changes in their eating habits. All 3 participants demonstrated a marked increase in healthy choices of food items in response to the package of enhanced prompts, feedback, and social reinforcement. No additional increase occurred with the introduction of the lottery and serving as a confederate. Food-choice data indicated that most of these improvements could be attributed to healthier entree and dessert choices. Group data for all residents suggested small improvements in dietary practices during the three intervention conditions, with the largest proportion of the group's healthy choices occurring when the lottery was added to enhanced prompts, feedback, and social reinforcement. Food-choice data indicated that most of these improvements could be attributed to healthier dessert choices alone.     

EFFECTS OF REINFORCEMENT CHOICE ON TASK RESPONDING IN INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES

The effects of reinforcement choice on task performance were examined with 6 individuals who had been diagnosed with severe to profound mental retardation. Five highly preferred items were identified for each participant via stimulus preference assessments. Participants then were exposed to choice and no-choice conditions that were alternated within reversal and multielement designs. During choice sessions, participants were permitted to select between two preferred stimuli contingent on responding. During no-choice sessions, the therapist delivered a single item contingent on responding. Preference for the stimuli was held constant across conditions by yoking the items delivered during no-choice sessions to those selected during the immediately preceding choice sessions. All participants exhibited similar rates of responding across choice and no-choice conditions. These findings indicate that for individuals with severe disabilities, access to choice may not improve task performance when highly preferred items are already incorporated into instructional programs.     

CONTINGENCY MANAGEMENT INTERVENTIONS: EFFECTS ON TREATMENT OUTCOME DURING METHADONE DETOXIFICATION

We examined the effectiveness of a contingency management program in preventing relapse to illicit opiate use and increasing treatment retention during outpatient methadone detoxification treatment. Twenty male opiate addicts were randomly assigned to an experimental or control group. Following a 3-week methadone stabilization period, men in both groups received identical gradual methadone dose reductions during Weeks 4 through 9 and were maintained on placebo during Weeks 10 through 13. Beginning in Week 4, control patients received $5.00 for providing a specimen twice weekly. Experimental patients received $10.00 and a take home methadone dose for each opiate-free urine specimen but forfeited the incentives and participated in more intensive clinic procedures when specimens were opiate positive. The contingency management procedure slowed the rate of relapse to illicit opiate use. Experimental patients provided significantly more opiate-free urines during the methadone dose reduction in Weeks 4 through 9 than control patients, although the difference between groups was no longer significant during placebo administration in Weeks 10 through 13. In addition, the contingency management program improved treatment retention and reduced symptom complaints during the detoxification. The usefulness and limitations of contingency management procedures for outpatient methadone detoxification are discussed.     

A BEHAVIORAL INTERVENTION FOR IMPROVING VERBAL BEHAVIORS OF HEROIN ADDICTS IN A TREATMENT CLINIC

Positively reinforcing appropriate behaviors improved verbal behaviors of opioid-dependent patients in a buprenorphine treatment clinic. During B phases of an ABAB design, clients received stickers for engaging in appropriate verbal or nonverbal behaviors. Each sticker provided a chance of winning $25. No reinforcement was provided during the A phases. Appropriate verbal behaviors increased during reinforcement periods, and inappropriate verbal behaviors decreased.     

ASSESSMENT OF STIMULUS PREFERENCE AND REINFORCER VALUE WITH PROFOUNDLY RETARDED INDIVIDUALS

We evaluated a procedure for identifying potential reinforcers with profoundly retarded individuals. In Experiment 1, six persons were repeatedly exposed to 16 stimuli, and approach behaviors to each stimulus were used to identify preferred and nonpreferred stimuli. In Experiment 2, we examined the reinforcing properties of preferred and nonpreferred stimuli by delivering them contingently on the occurrence of arbitrarily selected responses. Results revealed that the preferred stimulus conditions typically produced higher rates of responding than did either the baseline or the nonpreferred stimulus conditions, suggesting that the procedure can be used to assess reinforcer value for individuals with limited behavioral repertoires.     

EVALUATING TREATMENT CHALLENGES WITH DIFFERENTIAL REINFORCEMENT OF ALTERNATIVE BEHAVIOR

In prior research, differential reinforcement of alternative behavior (DRA) has been implemented at optimal treatment values: Problem behavior is never reinforced, and alternative behavior is always reinforced. However, in application, DRA is unlikely to be conducted optimally. In this study, following a functional analysis phase and a differential reinforcement at full implementation phase, we challenged initially positive treatment effects for 3 participants by implementing DRA at less than optimal parameters. For example, some occurrences of problem behavior were reinforced, and some occurrences of alternative behavior were not reinforced. Results suggested that when exposed to DRA at full implementation, participants showed a bias toward appropriate behavior in subsequent conditions during which “mistakes” (treatment challenges) were intentionally introduced. In addition, the negative effects of treatment challenges were quickly reversible, in comparison to the positive effects of DRA, which were not quickly reversible in the face of treatment challenges.     

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.     

COLLATERAL GAINS AND SHORT-TERM MAINTENANCE IN READING AND ON-TASK RESPONSES BY INNER-CITY ADOLESCENTS AS A FUNCTION OF THEIR USE OF SOCIAL REINFORCEMENT WHILE TUTORING

Two experiments are reported concerning the effects of the differential use of verbal approval by problematic adolescents serving as tutors in a remedial reading program for an inner-city school. The experiments, each with 3 tutors and 15 tutees, used a combined multiple baseline and ABCBC design. Data showed that tutors' approvals as well as tutors' and tutees' on-task and reading responses were low and stable during baseline. Tutors were trained to use verbal approval for tutees' on-task behavior. Tokens were presented and withdrawn to control the tutors' use of approval. During phases in which tutors' approvals were raised via token dispensation, tutor reading and on-task scores increased in a nonexperimental setting. Tutee reading scores also increased as a function of tutor approvals. The second experiment replicated these findings and, in addition, (a) tested the validity of changes in reading responses via standardized tests, (b) isolated and compared the covariance between variables in all phases, and (c) provided data on tutee attention to tutors as a possible natural reinforcer for the short-term maintenance found in both studies. Data are discussed as evidence that tutors had acquired the ability to recruit reinforcement from the classroom for appropriate behavior.     

DIFFERENTIAL REINFORCEMENT OF CORRECT RESPONSES TO PROBES AND PROMPTS IN PICTURE-NAME TRAINING WITH SEVERELY RETARDED CHILDREN

A systematic sequence of prompt and probe trials was used to teach picture names to three severely retarded children. On prompt trials the experimenter presented a picture and said the picture name for the child to imitate; on probe trials the experimenter did not name the picture. A procedure whereby correct responses to prompts and probes were nondifferentially reinforced was compared with procedures whereby correct responses to prompts and probes were differentially reinforced according to separate and independent schedules of primary reinforcement. In Phase 1, correct responses to prompts and probes were reinforced nondifferentially on a fixed ratio (FR) 6 or 8 schedule; in Phase 2, correct responses to prompts were reinforced on the FR schedule and correct responses to probes were reinforced on an FR schedule of the same value; in Phase 3, correct responses to prompts were reinforced on the FR schedule and correct responses to probes were reinforced on a continuous reinforcement (CRF; every correct response reinforced) schedule; in Phase 4, correct responses to prompts were reinforced on a CRF schedule and correct responses to probes were reinforced on the FR schedule; in Phase 5, a reversal to the conditions of Phase 3 was conducted. For all three children, the FR schedule for correct responses to prompts combined with the CRF schedule for correct responses to probes (Phases 3 and 5) generated the highest number of correct responses to probes, the highest accuracy (correct responses relative to correct responses plus errors) on probe trials, and the highest rate of learning to name pictures.     

REMEDIATION OF MUTUALLY AVERSIVE INTERACTIONS BETWEEN A PROBLEM STUDENT AND FOUR TEACHERS BY TRAINING THE STUDENT IN REINFORCEMENT TECHNIQUES

This study tested the effect of a social reinforcement training procedure for a problem student on the verbal and nonverbal approval and disapproval of four of the student's teachers. A design incorporating aspects of a multiple baseline within an extended reversal design (ABABA) was employed. Data were taken on the four teachers' approval and disapproval of a student regarded as a major discipline problem and the target student's approval and disapproval of the four teachers during baseline 1, experimental condition 1, baseline 2, experimental condition 2, and a postcheck or baseline 3 condition six weeks after experimental condition 2. Results showed that increased student approval and decreased disapproval were attributable to training procedures. The increased student approval increased three of the four teachers' approval and decreased the disapproval of all four teachers. Six weeks after experimental condition 2, both approval and disapproval by three of the four teachers and the student and disapproval by all four teachers and the student remained changed over baseline conditions. Student and teacher approval and disapproval were highly correlated at statistically significant levels.     

MODIFICATION OF THE EXCESSIVE INAPPROPRIATE CLASSROOM BEHAVIOR OF TWO ELEMENTARY SCHOOL STUDENTS USING HOME-BASED CONSEQUENCES AND DAILY REPORT-CARD PROCEDURES1

Two experiments investigated home-based reinforcement contingencies to control excessive behavior in normal classrooms. Subjects were, respectively, a 12-yr-old fifth-grade boy and a 9-yr-old fourth-grade boy, each in a separate classroom and with a different teacher. Following baseline observations in which observers recorded several categories of student behavior and teacher-student interaction, separate conferences were held including parents of the two children, the principal, teachers, and experimenters. A daily report-card procedure was agreed on, stipulating a one-day suspension from school following three successive “undesirable” daily report cards as well as the supervision of home-based privileges and other reinforcers usually contingent on satisfactory daily reports. Measurements of daily rates of teacher attention indicated no important change in this variable throughout the various experimental conditions. The daily report procedure significantly reduced disruptive classroom behavior. In a second experiment, a teacher-operated timer cued her own time-sample observations. Reliability measures revealed that the teacher could accurately measure the child's behavior while she was teaching the class. The procedure was ultimately successfully expanded to the teacher's total contact hours each day.     

SEPARATE AND COMBINED EFFECTS OF METHYLPHENIDATE AND A BEHAVIORAL INTERVENTION ON DISRUPTIVE BEHAVIOR IN CHILDREN WITH MENTAL RETARDATION

We investigated the separate and combined effects of a behavioral intervention and methylphenidate (Ritalin®) on disruptive behavior and task engagement in 3 children with severe to profound mental retardation. The behavioral intervention involved differential reinforcement of appropriate behavior and guided compliance. All 3 children demonstrated decreased disruptive behavior and improved task engagement in response to the behavioral intervention. Two of the 3 children demonstrated similar improvement in response to methylphenidate. Although both interventions were highly effective for these 2 participants, the relative efficacy of the interventions varied between the 2 children. There was no evidence of an additive or synergistic effect of the two interventions, but the high efficacy of each intervention alone limited our ability to detect such effects.     

COMPARING TREATMENT TACTICS WITH A HYPERACTIVE PRESCHOOL CHILD: STIMULANT MEDICATION AND PROGRAMMED TEACHER INTERVENTION1

Two treatment tactics, food and praise contingent on appropriate play and varying doses of methylphenidate (Ritalin), were evaluated for their effects on a preschool child's activity changes. In addition, other social, verbal, and academic behaviors were monitored to examine possible side effects of the two treatment tactics. Fewer free-play activity changes occurred during contingent reinforcement phases while medication had variable effects: increasing attention to tasks but, at higher doses, decreasing intelligibility of speech and responsiveness to mands. The study outlines a replicable model for comparing medication with alternative behavioral strategies to control hyperactivity and enhance skill development.     

ASSESSING AND TRAINING TEACHERS IN THE GENERAUZED USE OF BEHAVIOR MODIFICATION WITH AUTISTIC CHILDREN1

This study investigated the feasibility of developing reliable, valid criteria for measuring and training the skills necessary to teach autistic children. The behaviors of 11 teachers and 12 autistic children were recorded in a series of different teaching situations. Teacher-training was initiated at different times for different teachers. The results showed: (1) it was possible to assess empirically whether a teacher was correctly using defined behavior-modification techniques; (2) generally, for any given session, systematic improvement in the child's behavior did not occur unless the teacher working in that session had been trained to use the techniques to a high criterion; (3) all 11 teachers were rapidly trained to use these techniques; and (4) the teachers learned generalized skills effective with a variety of children and target behaviors.