The efficacy of noncontingent escape for decreasing children's disruptive behavior during restorative dental treatment

We evaluated the effectiveness of a dentist-implemented behavioral intervention in which brief escape from dental treatment was provided on a regular basis, independent of the child's behavior. Within a multiple baseline design across subjects, 5 children, ages 4 to 7 years, were provided with temporary escape from dental treatment on a fixed-time schedule. The intervals were signaled by an electronic timer worn by the dentist. Clinically significant reductions were observed in physically disruptive behavior across all 5 children with the introduction of noncontingent escape, and verbally disruptive behavior was markedly reduced in 4 of the 5 children. In addition, the dental staff s use of physical restraint was reduced to near zero across all 5 children. The research extends the literature in both clinical dentistry and in applied behavior analysis by demonstrating that a dentist can easily and effectively implement noncontingent reinforcement to produce clinically significant and socially important changes in children's health behavior.     

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.     

THE USE OF NONCONTINGENT ESCAPE TO REDUCE DISRUPTIVE BEHAVIORS IN CHILDREN WITH SPEECH DELAYS

Noncontingent escape (NCE) was used to reduce disruptive behavior in 3 children during regularly scheduled speech therapy sessions. Results showed rapid decreases in disruptive behavior and accompanying increases in compliance across children. Findings suggest that speech therapists with little expertise in behavior analysis can effectively implement NCE.     

A COMPARISON OF DIFFERENTIAL REINFORCEMENT AND NONCONTINGENT REINFORCEMENT TO TREAT FOOD SELECTIVITY IN A CHILD WITH AUTISM

We compared differential reinforcement plus escape extinction to noncontingent reinforcement plus escape extinction to treat food selectivity exhibited by a young child with autism. The interventions were equally effective for increasing bite acceptance and decreasing problem behaviors. However, a social validity measure suggested that noncontingent reinforcement was preferred by the child's caregiver.     

Some effects of noncontingent positive reinforcement on multiply controlled problem behavior and compliance in a demand context

Functional analysis suggested that the problem behavior of an 8-year-old girl with autism was maintained by escape from demands and access to edible items. Noncontingent delivery of an edible item was sufficient to increase compliance and reduce the rate of problem behavior without the use of escape extinction in a demand context. Leaner and richer schedules of noncontingent reinforcement were equally effective, and there were minimal differences between noncontingent reinforcement and differential reinforcement of compliance.     

Sound attenuation and preferred music in the treatment of problem behavior maintained by escape from noise

We examined the extent to which different sounds functioned as motivating operations (MO) that evoked problem behavior during a functional analysis for two participants. Results suggested that escape from loud noises reinforced the problem behavior for one participant and escape from arguing reinforced problem behavior for the other participant. Noncontingent delivery of preferred music through sound‐attenuating headphones decreased problem behavior without the use of extinction for both participants. We discuss the results in terms of the abolishing effects of the intervention.     

Providing an escape option reduces retaliatory aggression

The purpose of this study was to examine whether providing an explicit means to escape future attacks by a provocative fictitious participant reduces retaliatory aggression. Using a laboratory measure of aggression (the Point Subtraction Aggression Paradigm), 25 participants were given the opportunity to earn points with monetary value on a fixed ratio (FR) 100 schedule, and to subtract points from a fictitious participant on an FR 10 schedule. Aggressive responding was defined as the number of point subtraction responses by the participant. Aggressive responding also produced intervals free from further attack by the fictitious participant. Provocation was manipulated by having the fictitious person subtract points from the participant. Each participant next completed the same task with an explicit FR 10 escape response option added. The escape option produced intervals free from attack identical to the aggressive option, but without taking points away from the fictitious participant. Results indicate that the availability of an escape response attenuated aggressive behavior in response to provocation. Aggr. Behav. 00:000–000, 2005. © 2005 Wiley‐Liss, Inc.     

On the relative contributions of noncontingent reinforcement and escape extinction in the treatment of food refusal

In the current investigation, we evaluated the relative effects of noncontingent reinforcement (NCR), escape extinction, and a combination of NCR and escape extinction as treatment for the feeding problems exhibited by 4 children. For each participant, consumption increased only when escape extinction was implemented, independent of whether NCR was present or absent. These results were consistent with prior research suggesting that positive reinforcement alone is insufficient for increasing consumption, and that escape extinction often is necessary to increase and maintain food acceptance. However, NCR appeared to decrease inappropriate behavior for some participants.     

Learning strategies during fear conditioning

This paper describes a model of fear learning, in which subjects have an option of behavioral responses to impending social defeat. The model generates two types of learning: social avoidance and classical conditioning, dependent upon (1) escape from or (2) social subordination to an aggressor. We hypothesized that social stress provides the impetus as well as the necessary information to stimulate dichotomous goal-oriented learning. Specialized tanks were constructed to subject rainbow trout to a conditioning paradigm where the conditioned stimulus (CS) is cessation of tank water flow (water off) and the unconditioned stimulus (US) is social aggression from a larger conspecific. Following seven daily CS/US pairings, approximately half of the test fish learned to consistently escape the aggression to a neutral chamber through a small escape hole available only during the interaction. The learning curve for escaping fish was dramatic, with an 1100% improvement in escape time over 7 days. Fish that did not escape exhibited a 400% increase in plasma cortisol and altered brain monoamine response to presentation of the CS alone. Elevated plasma cortisol levels represent classical fear conditioning in non-escaping fish, while a lack of fear conditioning and a decreased latency to escape over the training period in escapers indicates learned escape.     

ESCAPE AS A FACTOR IN THE AGGRESSIVE BEHAVIOR OF TWO RETARDED CHILDREN

This study sought to identify some of the variables controlling the severely aggressive behavior of two retarded children. In Experiment 1, each child was presented with several demand and nondemand situations. Aggression was frequent in the demand situations and rare in the nondemand situations. When a stimulus correlated with the termination of demands was introduced, aggression fell to a near zero level. In Experiment 2, for one child, a variety of preferred reinforcers was introduced into the demand situation contingent on correct responding. Aggression abruptly decreased to a low level. Experiments 3 and 4 involved the second child. In Experiment 3, this child was permitted, in one condition, to leave the demand situation if he emitted a nonaggressive response. Aggression decreased to a low level. In Experiment 4, he was prevented, in one condition, from leaving the demand situation in spite of high levels of aggression. Aggression fell to a near zero level. In Experiments 3 and 4, he was permitted, in several conditions, to leave the demand situation following aggressive behavior. Aggression increased to a high level. The results suggested that: (1) aggression can sometimes function as an escape response; and (2) escape-motivated aggression can be controlled by: (a) introducing strongly preferred reinforcers to attenuate the aversiveness of the demand situation; (b) strengthening an alternative, nonaggressive escape response; or (c) using an escape-extinction procedure.     

THE EFFECTS OF FIXED‐TIME ESCAPE ON INAPPROPRIATE AND APPROPRIATE CLASSROOM BEHAVIOR

Few studies have explored the effects of fixed‐time (FT) reinforcement on escape‐maintained behavior of students in a classroom setting. We measured the effects of an FT schedule on the disruptive and appropriate academic behaviors of 2 junior high students in a public school setting. Results demonstrated that FT escape from tasks resulted in a substantial decrease in disruptive behavior and an increase in time engaged in tasks for both participants.     

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.     

A COMPARISON OF SENSORY INTEGRATIVE AND BEHAVIORAL THERAPIES AS TREATMENT FOR PEDIATRIC FEEDING DISORDERS

We compared the effects of escape extinction (EE) plus noncontingent reinforcement (NCR) with sensory integration therapy as treatment for the feeding problems of 2 children. Results indicated that EE plus NCR was more effective in increasing acceptance, decreasing inappropriate behavior, and increasing amount consumed relative to sensory integration for both children. The results are discussed in terms of the challenges of evaluating sensory‐integration‐based treatments, and the reasons why component analyses of multicomponent treatments like sensory integration are important.     

NEGATIVE SIDE EFFECTS OF NONCONTINGENT REINFORCEMENT

Noncontingent reinforcement (NCR) has emerged as a treatment package for severe behavior problems. Although concerns about potential side effects (such as incidental reinforcement) have been raised, there have been few reported negative side effects in published studies to date. In this article, we report an NCR treatment evaluation for severe aggression that produced (a) an extinction burst and (b) incidental reinforcement. These side effects were evaluated by examining within-session response patterns and response distributions. As a solution, a brief omission contingency was added to the reinforcement schedule. The omission contingency resulted in decreased aggression rates.     

Noncontingent and differential reinforcement in the treatment of pediatric feeding problems

We conducted functional analyses of the inappropriate mealtime behavior of 5 children diagnosed with feeding problems. Then, we compared the effects of differential and noncontingent reinforcement, and the relative effects of escape extinction with and without differential or noncontingent reinforcement, when escape extinction appeared necessary. Both reinforcement procedures were effective without escape extinction to treat food refusal for 1 child, but only differential reinforcement was effective without escape extinction to treat the child's liquid refusal. Escape extinction was necessary for 4 of 5 children. The addition of positive reinforcement resulted in beneficial effects (i.e., more stable acceptance, decreased inappropriate mealtime behavior or negative vocalizations) with 3 of 4 children. With escape extinction, differential reinforcement was more effective to treat food refusal for 2 children and noncontingent reinforcement was more effective for 1 child.     

Parental assessment and treatment of food selectivity in natural settings

This study evaluated the effects of a parent-conducted functional analysis and treatment consisting of differential reinforcement of an alternative behavior, escape extinction, and demand fading on food selectivity in a young child with autism. Increases in food acceptance at home and in a restaurant were obtained.     

A multicomponent approach to thinning reinforcer delivery during noncontingent reinforcement schedules

We evaluated a noncontingent reinforcement procedure that involved initially providing three subjects with signaled, continuous access to the functional reinforcer for aggression and slowly increasing the amount of time subjects were exposed to the signaled unavailability of the reinforcer. Additionally, alternative potential reinforcers were available throughout the sessions. Results showed immediate and substantial reductions in aggression for all three subjects. The clinical utility of this intervention is discussed, and future research directions are recommended.     

Nondirective prompting and noncontingent reinforcement in the treatment of destructive behavior during hygiene routines.

The escape-maintained destructive behavior of a girl with mental retardation persisted during hygiene routines with directive prompting, differential reinforcement for compliance, and extinction as treatment. Using nondirective prompting and noncontingent reinforcement, destructive behavior was reduced to near-zero levels during the hygiene routine.     

Putative behavioral history effects and aggression maintained by escape from therapists

Differentially higher rates of aggression in treatment sessions occurred in the presence of two staff members who had previously worked with the participant at another facility. Adding an edible reinforcer for compliance and the absence of aggression in sessions conducted by these two staff members decreased aggression to rates similar to those obtained with less familiar therapists. Results suggest that embedding positive reinforcement within a demand context may reduce the aversiveness of therapists correlated with a history of demand situations.     

FUNCTIONAL ANALYSIS AND TREATMENT OF ESCAPE-MAINTAINED AGGRESSION CORRELATED WITH SLEEP DEPRIVATION

Functional analysis identified the consequences that maintained aggressive behavior and the relationship between those consequences and sleep deprivation for an individual with severe mental retardation. Results showed that aggression was maintained by negative reinforcement contingencies (escape from demand) and that aggression was more severe when sleep deprivation was present. A multicomponent intervention resulted in reductions of aggression for up to 7 months.