USE OF NEGATIVE REINFORCEMENT IN THE TREATMENT OF SELF-INJURIOUS BEHAVIOR

Behavioral assessment procedures were used to determine the maintaining conditions of self-injury exhibited by 2 children with severe multiple handicaps. For both children, negative reinforcement (escape from grooming activities) was determined to be the maintaining reinforcer for self-injury (hand/arm biting) within an alternating treatments design. The treatment packages involved the use of negative reinforcement (brief escape from grooming activities) contingent upon a behavior that was incompatible with self-injury (reaching and pressing a microswitch that activated a prerecorded message of “stop”). Treatment was evaluated with a reversal design for 1 child and with a multiple baseline across grooming activities for the 2nd child. The treatment led to a marked decrease in self-injury for both children. At follow-up, high rates of self-injury were reported for the 1st child, but low rates of self-injury and an increase in task-related appropriate behavior were observed for the 2nd child.     

THE USE OF BEHAVIORAL ASSESSMENT TO PRESCRIBE AND EVALUATE TREATMENTS FOR SEVERELY HANDICAPPED CHILDREN

Behavioral assessment procedures were used to prescribe and evaluate treatments of maladaptive behavior for 2 children with severe multiple handicaps. In Experiment 1, the results of an assessment of reinforcer preference were used in conjunction with a functional analysis of the conditions maintaining self-injurious behavior to prescribe a treatment for a child with severe disabilities. The treatment procedure involved the use of a pressure-sensitive microswitch to activate reinforcing stimuli during two solitary conditions, during which self-injurious behavior had occurred at high rates. The results were evaluated with a multiple baseline across settings design and indicated that self-injury decreased with concomitant increases in microswitch activation. Results were maintained at 6 weeks, 8 weeks, and 6 months. In Experiment 2, the results of behavioral assessments of reinforcer preference and self-injurious behavior were combined to develop a treatment for a second severely handicapped child, who exhibited high rates of self-injury in demand situations. This treatment was evaluated with a multiple baseline across tasks design and resulted in the elimination of self-injury for up to 15 months.     

Ecological Variation in Self-Injury Behavior

ABSTRACT: Only recently have efforts been made to discover the extent of self-injury behavior in the general population. The study reported here was designed to ascertain and examine the degree of relationship between the ecological distribution of self-injury behavior and the indices of economic and ethnic status. The general hypothesis predicts that high rates of self-injury behavior are associated with low economic status and high ethnic status census tract populations in a northern metropolitan area. A total of 2,755 cases of self-injury were collected for the year 1972 from the records of the city and county police departments, hospital emergency facilities, and a sample of private physicians. Self-injury behavior was defined as any case of self-inflicted overdosage, asphyxiation, or injury, whether or not there was evidence of suicidal intent. The indices of economic and ethnic status for the various census tracts were computed in the manner suggested by Shevky and Bell (1955) . All the measures of economic status were found significantly related to self-injury in the predicted direction. The relationship between ethnic status and self-injury rates was not significant. When ethnic status was disaggregated, a significant relationship was found between self-injury rates for nonwhites and foreign-born whites. The explanation was offered that ethnic differences in self-injury are mediated by economic status variables and subcultural factors.     

Bare fingers,but no obvious influence of “prickly” Velcro! In the absence of parents’ encouragement,it is not clear that “sticky mittens” provide an advantage to the process of learning to reach

In their critique of our mittens study, Needham et al. (2015. Infant Behavior and Development) describe our findings as “surprising.” Further; they suggest that babies in our “sticky mittens” condition may have been discouraged from reaching because, in our study, infants may have touched “prickly” Velcro with their bare fingers. In this response, we present data analyses that do not support the interpretation that finger contact with our Velcroed toy surfaces was associated with poor reaching performance in our “sticky” mittens group. We also clarify that our toys were mainly covered with “non-prickly” Velcro. To explain discrepancies between studies, we restate the original intent of our study and reasons for our methodological modifications. We point to confounds and lack of critical control conditions in the Needham et al. studies, which prevent the making of firm inferences about the effectiveness of the “sticky mittens experience” on the learning to reach process. We also present additional analyses on our “sticky” mittens group showing that the increasing rate of finger touch on the toy leads to greater reaching performance while the rate of toy sticking to the mittens does not. We discuss the importance of sensory-motor experience on the development of learning to reach in infancy and conclude that our results are not surprising.     

Brief reaching training with “sticky mittens” in preterm infants: Randomized controlled trial

ObjectiveTo examine whether a brief reaching training with sticky mittens was effective to improve reaching behavior in newly reaching preterm infants.MethodsIn this randomized controlled trial, twenty four 5-month-old (±16-week-old corrected age) preterm infants were randomly allocated into experimental or control groups. Infants were assessed three times in a single session: pretraining (immediately before training), posttraining (immediately after training), and retention (4 min after the posttraining). During training, infants in the experimental group wore open fingers Velcro covered mittens. Training consisted of one 4-minute session of stimulated reaching using Velcro covered toys. Controls did not receive the training. During assessments, infants were placed in a baby chair and toys without Velcro were offered at their midline for 2 min. Number of total reaches, proximal adjustments and distal adjustments of reaching were primary outcomes. Grasping was a secondary outcome.ResultsGroups were similar in the pretraining. In the posttraining, trained infants performed greater amount of total reaches and bimanual reaches than untrained infants. Greater amount of bimanual reaches in trained infants was maintained in the retention test. Distal adjustments and grasping outcome were not influenced by the training.ConclusionsA brief-term training with open fingers sticky mittens benefited reaching behavior and favored retention of increased bimanual reaches in newly reaching late preterm infants. However, it was not sufficient to influence hand openness and early grasping.     

Learning to reach with “sticky” or “non-sticky” mittens: A tale of developmental trajectories

The effects of “sticky” and “non-sticky” mittens upon the progression of intentional reaching were examined over 16-day training in 24 non-reaching infants aged 2 months and 21 days. Thirteen age-matched controls did not receive training. Both mittens groups progressed over time; however, by day 16, only the “non-sticky” group made significantly more toy contacts than the controls when looking at the toy. Infants in the “non-sticky” group also directed their looking at the toy more than infants in the “sticky” mittens group. These results support the interpretation that repeated task exposure, with active, reaching-specific experience, was more likely to enhance the formation of object-directed behaviors than with the added provision of grasping simulation via “sticky mittens.”     

Self-destructive behavior in patients with dissociative disorders

Highrates of self-injury have been reported in patients with dissociative disorders, yet no prior study has directly compared these patients with other psychiatric patients. The present study assesses self-destructive behavior in a group of inpatients who have dissociative disorders compared to those who report few dissociative symptoms. These patients more frequently engage in self-destructive behaviors, use more methods of self-injury, and begin to injure themselves at an earlier age then patients who do not dissociate. Results have important implications for understanding the relationship between dissociation, childhood trauma, and self-injury and for assessment and treatment of patients with dissociative disorders.     

Helmet restraint and visual screening as treatment for self-injurious behavior in persons who have profound mental retardation

Enhancement of sensory, cutaneous stimulation may be one reason for self-injurious behavior among persons with mental retardation. For self-injury involving head or face, a contingently applied helmet prevents access to the sensitized skin area. Such a restraint procedure, with visual occlusion superimposed on the helmet, was tested with two women who are profoundly retarded. Helmet and transparent shield reduced target responses by both women to approximately 7% of baseline rates. When the helmet's face shield was made opaque, a small, further response reduction was obtained. Stable, low rates were maintained over a 6-month maintenance period.     

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.     

The Ecology of Self-Injury: A Multivariate Approach

ABSTRACT: In an ecological study of the distribution of self-injury in London, Canada, the authors found that self-injury occurred more frequently in the central areas of the city. Multivariate analysis revealed that living arrangements, such as high density of housing and single-person households, are closely associated with inflated rates on self-injury. Low socio-economic status is also related to self-injury but neither family status nor mobility are significant predictors. Ecological relationships such as these suggest directions for future research on individuals and may also be of direct use to planners who wish to locate treatment services advantageously.     

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.     

青少年自我伤害行为的潜在转变分析:一项纵向研究

研究采用潜在转变分析探究了青少年自我伤害行为的发展。对3600名青少年进行为期18个月的追踪,对其自我伤害行为进行了三次测量。通过纵向数据分析识别出过渡组这一以往研究未发现的群体,该组被试仅出现程度较轻的自我伤害行为,且占总体的比例随时间快速下降。通过转变矩阵解释了过渡组和高发组的不稳定性是自我伤害行为发生率降低的原因,并发现冲动性、负向情绪等个体易感因素比家庭等人际因素对自我伤害行为存在更为显著的预测作用。在性别差异上,女生比男生更容易产生自我伤害行为,也更容易受到各方面因素的影响。最后,文章针对青少年自我伤害行为的预防和控制工作提出了建议。     

Prospective and Concurrent Affective Dynamics in Self-Injurious Thoughts and Behaviors: An Examination in Young Adult Women

Affective dynamics, assessed using ecological momentary assessment (EMA), provide a nuanced understanding of within-person fluctuations of negative affect (NA) and positive affect (PA) in daily life. NA and PA dynamics have been associated with psychopathology and response to psychological treatments. NA and PA dynamics have been rarely studied concurrently in association with self-injurious thoughts and behaviors (SITB), transdiagnostic difficulties encountered regularly in clinical and community settings. Here we present EMA data from a large, diverse sample of young adult women with high rates of SITB to examine NA and PA dynamics (mean intensity, variability, and inertia). Specifically, we considered the prospective associations between past-year suicidal thoughts and past-year nonsuicidal self-injury and affective dynamics, as well as the concurrent associations between affective dynamics, EMA-reported suicidal thoughts, and EMA-reported urges for nonsuicidal self-injury. Results demonstrate that elevated mean NA and NA variability are robustly associated with all types of SITB assessed prospectively or concurrently. Interestingly, these associations were weakest for past-year nonsuicidal self-injurious behaviors, relative to past-year and concurrent suicidal or nonsuicidal self-injurious thoughts. Past-year suicidal thoughts further predicted increased NA inertia. Decreased PA inertia was associated with past-year nonsuicidal self-injury behavior, as well as concurrent EMA suicidal thoughts. We found no associations (prospective or concurrent) between SITB and mean PA intensity or PA variability. These results highlight the importance of understanding affective processes to develop real-world interventions to prevent nonsuicidal self-injury and suicidal behavior in daily life.     

青少年抑郁与自伤关系的追踪研究：亲子沟通的调节作用

为考察青少年抑郁与自伤的双向关系及亲子沟通的调节效应,采用青少年自我伤害问卷、流动中心用抑郁量表和亲子沟通量表对595名初一学生进行为期10个月的追踪研究。结果发现,从初一到初二,抑郁呈增长趋势,且性别差异显著,而自伤的增长趋势不明显,但到初二后表现出了明显的性别差异;抑郁和自伤的同时性相关和继时性相关均显著;前测抑郁对后测自伤有明显的预测作用,但前测自伤对后测抑郁的预测作用不明显;父子沟通和母子沟通在前测抑郁与后测自伤水平之间有显著的负向调节作用。     

Effects of incentives in web-based prevention for adolescents: Results of an exploratory field study

This study examines if the willingness of adolescents to participate in a web-based prevention program can be increased by providing an incentive for participation. Eighth graders (n = 166) were instructed to work on an online stress-prevention program via the internet from home. A subgroup of n = 80 subjects from three school classes were told that they would take part in a raffle if they completed the program. The remaining n = 86 participants (again three classes) served as a control group. The school classes were randomly allocated to the training conditions. During the 8-week intervention period, compliance rates were recorded by means of an online tracking system. In addition, self-reported compliance and training acceptance were assessed. The application of an incentive had considerable effects on retention rates, on training acceptance and self-assessed effectiveness of the intervention. Adolescents in the ‘incentive condition’ completed three times as many program lessons as control subjects did, and–as their self-reports suggest–they worked as attentively. Validity of self-reported compliance was higher among participants of the incentive group and they reported significantly higher program acceptance. As a consequence, the application of incentive systems is recommended for future implementation of web-based prevention programs targeting adolescents.     

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.     

MOMENTUM AND EXTINCTION EFFECTS ON SELF-INJURIOUS ESCAPE BEHAVIOR AND NONCOMPLIANCE

Previous research on applications of behavioral momentum has indicated that a high-probability (high-p) instructional sequence, in which a series of instructions for which there is a high probability of compliance is presented immediately before an instruction for which there is a low probability of compliance, is an effective method for increasing compliance. It is not dear, however, whether the procedure is effective when individuals actively attempt to escape from the instructional situation. In this study, we examined the effects of the high-p sequence, when implemented first alone and then later with an extinction component, as treatment for the self-injurious escape behavior of 2 individuals. Results showed that when the instructional sequence was implemented without extinction, rates of self-injury increased and percentage of compliance decreased. In addition, the percentage of trials occasioning escape behavior increased for both high- and low-probability instructions. When an extinction component was added to the high-p sequence, rates of self-injury and the percentage of trials containing self-injury decreased, and compliance increased. These findings suggest that extinction may be an important component of treatment when escape behavior such as self-injury accompanies noncompliance in instructional contexts and competes with compliant behavior.     

Restraint fading and alternate management strategies to treat a man with Lesch–Nyhan syndrome over a 2 year period

In this study the variables maintaining self-injury and the use of wrist restraints in a man with Lesch–Nyhan Syndrome were identified through a pre-treatment functional assessment. In phase I, the client's self-injury and use of wrist restraints were treated by his participation in a relaxation training class and substituting his wrist restraints with a hockey-type head helmet in order to reduce self-injury and dependency on the use of wrist restraints and increase functional use of his hands. In phase II, a restraint fading procedure was implemented. This consisted of removing his restraints twice daily for 20 min and engaging him in hand over hand training. This was done in order to systematically reduce the amount of time the subject spent in restraint. In phase III, generalization was implemented across settings including work and home and across different staff persons. In phase IV, skills shaping was used to train the subject to use his hands to engage in and improve his activities of daily living. The results demonstrate a decrease in restraint use and an increase in adaptive and social experiences and reductions in challenging behaviors over a 26 month period. © 1997 John Wiley & Sons, Ltd.     

父母冲突与青少年自伤的关系:一个有调节的中介模型

以情绪安全感理论为依据考察父母冲突与青少年自伤的关系,并在此基础上提出一个有调节的中介模型,探讨情绪不安全感的中介作用以及情绪调节自我效能感的调节作用。采用整群抽样法对2800名中学生进行问卷调查,结果表明:(1)在所有青少年被试中有自伤行为的比例占41.49%,青少年的自伤水平在年级、学校类型和是否为独生子女这些人口学变量上有显著差异;(2)父母冲突能显著地正向预测青少年的自伤水平,情绪不安全感在两者之间起部分中介作用;(3)控制消极情绪自我效能感对情绪不安全感的中介作用有显著的负向调节作用,只有当控制消极情绪自我效能感很低时,情绪不安全感在父母冲突和青少年自伤水平的中介作用才是显著的。     

父母“低头族”对青少年自伤行为的影响:基于体验回避模型的视角

本研究基于自伤的体验回避模型,考察父母“低头族”对青少年自伤行为的影响,并检验焦虑和体验回避的序列中介作用。以808名中学生为被试,采用父母低头族量表、抑郁-焦虑-压力简版量表、接纳与行动问卷第二版和青少年自我伤害行为问卷进行测试,结果发现：（1）父母“低头族”与青少年焦虑、体验回避、自伤行为呈显著正相关;焦虑、体验回避与自伤行为呈显著正相关;（2）焦虑和体验回避在父母“低头族”和青少年自伤行为之间均起部分中介作用;（3）焦虑和体验回避在父母“低头族”和青少年自伤行为之间构成序列中介,即父母“低头族”通过增加青少年的焦虑,从而提高体验回避倾向,进而增加青少年自伤行为。研究从情绪和应对手段角度来考察父母“低头族”对青少年自伤行为的作用机制,对青少年自伤行为的预防和干预具有启示意义。