Comparison of blocking strategies informed by precursor assessment to decrease pica

Pica is dangerous behavior and often maintained by automatic reinforcement. We conducted a latency functional analysis (FA) using safe consumption items to verify that pica was maintained in part by automatic reinforcement and exclude participants for whom pica was likely maintained solely by attention. Next, we identified precursors to pica through a probability analysis and conducted a brief blocking assessment for participants' whose pica occurred in the alone and attention conditions of the FA. Finally, we compared blocking precursors with pica, touching an inedible item and the pica itself. Results showed that five of the six participants' pica was likely maintained by automatic reinforcement, and pica decreased during the brief blocking assessment for three of four participants. Results of the blocking comparison showed that blocking behaviors earlier in the response hierarchy was as effective as only blocking pica attempts for two participants and more effective for one participant.     

An analysis of response-blocking parameters in the prevention of pica

We manipulated two parameters of response blocking to reduce pica: (a) the criteria for initiating the procedure (either earlier or later in the response chain) and (b) the distance from which the procedure was initiated. Results suggested that response blocking may be effective only when implemented early in the chain and with near-perfect consistency. Further, additional treatment components may be required to eliminate all pica attempts.     

Brief assessment and treatment of pica using differential reinforcement,response interruption and redirection,and competing stimuli

Pica is a life threating form of challenging behavior displayed by individuals with intellectual and developmental disabilities. In most cases, pica is maintained by automatic reinforcement. Common interventions for pica use some combination of response blocking, response interruption and redirection (RIRD), differential reinforcement of alternative behavior (DRA), and noncontingent reinforcement with competing stimuli. However, there is need for additional research regarding DRA procedures that emphasize skills acquisition by teaching alternative behaviors that modify the established behavioral chain of pica responses that occur in the presence of non-edible stimuli. There is also a need to examine the generality of recent advances in competing stimulus assessment (CSA) methodologies—namely, the augmented-CSA (A-CSA)—to pica. Thus, the purpose of the present investigation was to systematically replicate and extend previous research for the assessment and treatment of pica in an individual with IDD. First, we conducted a functional analysis to identify environmental variables associated with pica. Next, taught Patrick a differential response (i.e., discard pica items in trash receptacle) to earn reinforcers in conjunction with a RIRD procedure. Finally, we conducted an A-CSA for pica. Overall, low rates of pica were maintained over time with a combination of these procedures, and treatment was generalized across settings and people.     

Functional assessment and treatment of pica: a single‐case experiment

The pica of a 6‐year‐old girl diagnosed with autism was initially shown to persist in the absence of socially mediated consequences. In an attempt to provide a competing source of oral stimulation, we used a stimulus preference assessment to identify food items that were subsequently presented noncontingently. However, the noncontingent schedule could not be thinned to a practical variation while still maintaining reductions in pica. A subsequent multielement evaluation of response blocking and verbal reprimands demonstrated that neither intervention both produced and maintained low levels of pica. Verbal reprimands were then used in conjunction with noncontingent food presentation, but this intervention did not produce significant reductions in pica. Suppression of pica was ultimately obtained in both a clinic setting and in the child's natural environment using contingent, varied auditory stimulation. The results are discussed in the context of the ‘least restrictive alternative’ model of treatment selection. Copyright © 2001 John Wiley & Sons, Ltd.     

Individual and combined effects of noncontingent reinforcement and response blocking on automatically reinforced problem behavior

Noncontingent reinforcement (NCR) and response blocking are 2 common interventions for problem behavior maintained by automatic reinforcement. We implemented NCR and blocking with 1 boy and found this combined intervention to be effective at decreasing high rates of automatically reinforced pica. With another child, we compared the effects of blocking alone to the combined intervention. With the third child, we compared NCR alone and blocking alone to the combined intervention. Results showed that the combined intervention was effective at reducing automatically reinforced problem behavior while moderate to high levels of item engagement maintained. When evaluated individually, neither NCR nor blocking was sufficient to reduce problem behavior to clinically significant levels.     

Effects of response blocking and competing stimuli on stereotypic behavior

The effects of response blocking and competing stimuli on stereotypy and aggression were examined in an analysis conducted with a young girl diagnosed with autism and intellectual disability. A functional analysis of the stereotypic behavior revealed that blocking stereotypy increased aggression. The treatment analysis revealed that the provision of competing stimuli, without response blocking resulted in decreases in both topographies. Findings suggest that the provision of competing stimuli may be less likely to occasion other behaviors than blocking. Copyright © 2009 John Wiley & Sons, Ltd.     

The use of symmetrical "do" and "don't" requests to interrupt ongoing activities

The results of a modified functional analysis demonstrated that aggression, displayed by a 27-year-old man, was occasioned by the use of "don't" requests to interrupt the client's ongoing and often inappropriate activities (e.g., lying on the floor, pica, inappropriate touching of others). Subsequent analyses demonstrated that aggression was lower when ongoing activities were interrupted with symmetrical "do" requests than with "don't" requests. An intervention utilizing symmetrical "do" requests (i.e., prompting an individual to engage in an incompatible behavior) to interrupt such activities resulted in reduced levels of aggression.     

Varying response effort in the treatment of pica maintained by automatic reinforcement

Pica is a life-threatening behavior displayed by many individuals with developmental disabilities. In the current study, automatic reinforcement maintained the pica of 3 participants. Following functional analyses of pica, response-effort manipulations were conducted in which the effort to obtain pica or alternative items was varied systematically. Several general relations emerged as a result of the study. First, levels of pica were reduced relative to baseline when alternative items were available independent of the effort required to obtain alternative items or pica. Second, increasing the effort for alternative items resulted in increases in pica relative to when effort for alternative items was low. Third, increasing response effort for pica produced reductions in pica relative to baseline when alternative items were unavailable. Fourth, the highest levels of pica occurred when the effort to engage in pica was low or medium and no alternative items were available. These findings are discussed in terms of the relative effects of quality of reinforcement and response effort on behavior.     

Using differential reinforcement of a discard response to treat pica

Previous research on the treatment of pica (i.e., the ingestion of inedible objects) is limited compared to research on the treatment of other types of severe problem behavior. This study involved the use of differential reinforcement of alternative behavior, with a discard response as the alternative behavior, to treat pica presented by a 13‐year‐old girl with an autism spectrum disorder. We extended previous research by thinning the schedule of reinforcement for the alternative response. Substantial reductions in pica were obtained. Limitations and future directions in the treatment of pica are discussed.     

Parent treatment of complex pica in a teen with autism

Pica is a severe behavior disorder involving the persistent consumption of nonnutritive substances. Due to health complications and risks for fatality, designing effective behavioral treatments that are feasible for implementation by family members at home is imperative. This case report presents a parent-conducted functional analysis and treatment evaluation of automatically maintained pica in a teenager with autism spectrum disorder. Initial treatment with a competing stimulus was effective when paired with response interruption and redirection. Although effective, this combination of treatment components required very close parental proximity and led to increases in untargeted body-oriented pica (e.g., ingestion of skin, hair, and nails). Upon extending treatment to include the second topography of pica, both the originally targeted (object-oriented) pica and body-oriented pica decreased. Nonetheless, treatment effects were not sustained while fading parent proximity. The treatment was then augmented a third time with response cost. This final treatment package produced clinically significant reductions in all pica, facilitated parent proximity fading until the participant was alone, extended to their home, and maintained over a year of follow up.     

The evaluation and treatment of aggression maintained by attention and automatic reinforcement.

In the current investigation, we used direct and indirect methods to assess and treat several topographies of aggression that were hypothesized to have separate operant functions in a young boy with severe mental retardation and pervasive developmental disorder. First, a functional analysis of aggression, using the methods described by Iwata, Dorsey, Slifer, Bauman, and Richman (1982/1994), was conducted and produced inconclusive results. Next, indirect methods were used to develop a second functional analysis, which showed that chin grinding (firmly pressing and grinding his chin against the skin and bones of others) persisted independent of social contingencies and that the other topographies of aggression (e.g., hitting, kicking) were maintained by social positive reinforcement (attention). A treatment designed to decrease aggression maintained by attention—functional communication training with extinction—reduced all forms of aggression except chin grinding. This latter topography of aggression, which we hypothesized was maintained by automatic reinforcement, was reduced when the response-reinforcer relation was interrupted through response blocking and the child was provided with an alternative form of chin stimulation.     

FUNCTIONAL ANALYSIS AND TREATMENT OF CIGARETTE PICA

A series of analyses was conducted to assess and treat the pica of cigarette butts by a young man with mental retardation and autism. First, we demonstrated that pica was maintained in a condition with no social consequences when the available cigarettes contained nicotine but not when the cigarettes contained herbs without nicotine. Second, a choice assessment (Fisher et al., 1992) confirmed that tobacco was preferred over the other components of the cigarette (e.g., paper, filter, etc.). Third, an analogue functional analysis (Iwata, Dorsey, Slifer, Bauman, & Richman, 1982/1994) demonstrated that cigarette pica was maintained independent of social consequences. Fourth, a treatment designed to interrupt the hypothesized response—reinforcer relationship reduced consumption of cigarettes to zero. Finally, because cigarette pica occurred primarily when the individual was alone or under minimal supervision, a procedure based on stimulus control was developed to improve the effectiveness of the intervention in these situations.     

Distinguishing instrumental and hostile aggression: Does it make a difference?

An analogue task of instrumental and hostile aggression during a competitive game, modified to minimize overlap between aggressive responses, was evaluated in 8- to 14-year-old clinically referred boys (n=33). Postgame interviews indicated that the hostile response, an aversive noise, was perceived by over 80% of subjects as hostile and not instrumental. In contrast, the instrumental response, blocking the opponent's game, was perceived about equally as having instrumental and hostile functions. The hostile aggressive response was uniquely correlated with continuous performance task impulsive commission errors (r=51), which supported the theoretical relation of hostile aggression to poor impulse control. These results suggest that instrumental and hostile aggression can be distinguished and when precisely defined are distinct in theoretically important ways.The authors are grateful to Mary Milnamow, Susan Panichelli, Nancy Benzal, Elissa Batshaw, and Nancy Stone for assistance in data collection. This research was supported in part by an NIMH First Award MH4682 to the first author and support from NICHD Mental Retardation Research Center Core Center Grant DH26979, and by NIMH grants MH40364 and M00590 awarded to the second author. Preliminary data were presented at the annual meeting of the Society for Research in Child Adolescent Psychopathology, Costa Mesa, California, January 1990.     

Alternative response training with contingent practice as intervention for pica in a school setting

Pica is a serious challenging behavior displayed by some persons with developmental disabilities. We report the near‐elimination of automatically reinforced pica in a 7‐year‐old boy diagnosed with autism by having him practice an alternative response (discarding objects) contingent on attempted or actual pica. Intervention was implemented 6 hours per day, under naturalistic conditions in a school setting, with outcome maintained through a 4 month follow‐up phase of evaluation. Copyright © 2003 John Wiley & Sons, Ltd.     

Response Interruption and Differential Reinforcement of Alternative Behavior for the Treatment of Pica

Pica displayed by two individuals with autism was decreased by a treatment involving differential reinforcement and response interruption that altered the chain of behavior involved in pica (i.e., picking up items and placing them in the mouth). The treatment involved establishing prompts to ‘clean‐up’ as a new discriminative stimulus (SD) for picking up items from the floor; and holding potential pica items was established as an SD for discarding those items in a trash receptacle, putting them away, or using them appropriately. After demonstrating the effectiveness of the treatment in an analog setting, the treatment package was systematically generalized to community settings. Copyright © 2011 John Wiley & Sons, Ltd.     

Children’s competitive peer aggression during reward and punishment

Behavior‐disordered children (N = 65) competed with a presumed unknown peer on consecutive administrations of an analogue aggression task of instrumental aggression (blocking the opponent’s game) and hostile aggression (sending the opponent a noise). The first administration as a reward‐only, nonpunishment condition. The second administration contained both reward and punishment conditions. Results indicated clear differences on aggressive responding during conditions of reward and punishment. Significant correlations were found between instrumental aggression during reward across the two administrations, whereas correlations between aggression during reward and aggression during punishment were nonsignificant. Teacher ratings of Covert‐Proactive Aggression correlated with analogue task instrumental aggression but not with hostile aggression on both administrations. Aggression during punishment was significantly correlated with Continuous Performance Test inattention and impulsivity scores, suggesting that impulsivity and inattention may play an important role in children’s ability to inhibit aggression during cues for punishment. These data indicate the utility of a laboratory analogue procedure to assess conditions associated with childhood aggression and to further our understanding of childhood aggression subtypes. Aggr. Behav. 27:1–13, 2001. © 2001 Wiley‐Liss, Inc.     

Behavioral Treatment of Pica in Children with Lead Poisoning

Lead poisoning, a serious problem that can result in permanent neurological damage, often results from the ingestion of inedible substances that contain lead. The behavior of ingesting nonedible substances in termed pica. In this study, behavior modification procedures were used to eliminate pica in three young children with lead poisoning. Three kinds of procedures were used: (1) discriminate training, in which the subject was taught to recognize that paint and several objects were not edible; (2) reinforcement for the absence of pica; and (3) overcorrection for the occurence of pica. Pica was eliminated in all three subjects. While it was not always clear which component of the treatment was responsible for the decrease, the sequence used had the advantage of an effictive clinical technique proceeding from least to progressively more restrictive procedures.     

A long-term case study of analysis,response suppression,and treatment maintenance involving life-threatening pica

Behavioral assessment and intervention strategies used to treat chronic, life-threatening pica in an institutionalized, 16-year-old male with profoundly retarded collateral self-injurious and aggressive conduct, are described and evaluated. Thirty-minute observation sessions, conducted under baited contitions, revealed that bait saliency and the absence of caregiver supervision were discriminative for high rates of pica. Oral delivery of response-contingent lemon juice suppressed pica to near zero rates, while a procedural package incorporating delivery of water mist contingent on response-antecedant wandering contributed to further reductions in pica. Considerable suppression was maintained for approximately 18 months, with administration by paraprofessional staff. Data spanning nearly four years indicated that pica suppression was primarily a function of the introduction, maintenance, and withdrawal of aversive contingencies, rather than of concurrent schedules of positive reinforcement. Positive and negative side effects, and ethical questions associated with the use of aversive stimuli in treating life-threatening behavior, are discussed.     

MULTICOMPONENT ASSESSMENT AND TREATMENT OF CIGARETTE PICA

We conducted a multicomponent assessment and treatment for 4 individuals who engaged in cigarette pica. During Phase 1, three stimulus preference assessments were conducted to identify (a) the reinforcing component of the cigarette, (b) potential alternative reinforcers that may be used during treatment, and (c) whether the alternative reinforcer would compete effectively with cigarettes. Results were successful in identifying the reinforcing component of the cigarette and suggested the feasibility of using alternative reinforcers during treatment to eliminate cigarette pica. During Phase 2, the effects of two treatment procedures were evaluated. Noncontingent reinforcement (NCR) with the alternative edible reinforcer reduced the pica of 2 of the participants, but effects were not maintained when the initial dense schedule of NCR was thinned. Subsequently, differential reinforcement of alternative behavior with the alternative edible reinforcer was effective in reducing pica for 3 participants. An evaluation of nine treatment procedures failed to identify an effective intervention for the remaining participant; consequently, preventive measures were designed to minimize occurrences of cigarette pica.     

Reactivity and aggression in the rat: induction by alpha-adrenergic blocking agents injected ventral to anterior septum but not into lateral septum.

Intracranial injections were made bilaterally through permanently implanted cannulas ending in the lateral septum or in the region ventral to the anterior septum. The rats were first screened with injections of a local anesthetic, lidocaine, which blocks both synaptic and axonal conduction. Those animals that showed an increase in reactivity and aggression were then injected with a synaptic transmitter blocking agent. The results showed that transmitter blocking agents reproduced the effect of the local anesthetic only in the region ventral to the anterior septum and that alpha-adrenergic (phentolamine, tolazoline), but not beta-adrenergic (propranolol, hydralazine), cholinergic (atropine, hyocine), or dopaminergic (haloperidol) blocking agents were effective. These results suggest that synapses in the forebrain system controlling reactivity and aggression are alpha-asrenergic and are located in the region ventral to the anterior septum just lateral to the diagonal band of Broca. The septum itself may be involved only to the extent that it is traversed by fibers of passage.