Reducing Escape without Escape Extinction: A Systematic Review and Meta-Analysis of Escape-Based Interventions

Individuals with disabilities may engage in challenging behavior to escape aversive stimuli, like academic tasks or non-preferred foods. Interventions to reduce these behaviors often employ escape extinction; that is, the implementer withholds escape following challenging behavior. Escape extinction can increase risk of injury, restrict autonomy, and worsen the learner–implementer relationship. To mitigate collateral effects, interventions can use strategies without escape extinction (i.e., escape-based); that is, implementers can provide escape contingent on challenging behavior during intervention, in conjunction with other intervention components. However, no comprehensive syntheses of these interventions have been conducted. We identified 39 articles that included escape-based interventions, which contained 273 single-case designs. Escape-based interventions were associated with lower levels of challenging behavior and higher levels of adaptive behavior than baseline conditions. Most comparisons between escape-based and escape extinction interventions showed no functional relation, indicating that escape extinction may not add substantial benefit to intervention efficacy.

     

A translational evaluation of renewal of inappropriate mealtime behavior

The term renewal describes the recurrence of previously extinguished behavior that occurs when the intervention context changes. Renewal has important clinical relevance as a paradigm for studying treatment relapse because context changes are necessary for generalization and maintenance of most intervention outcomes. The effects of context changes are particularly important during intervention for pediatric feeding disorders because children eat in a variety of contexts, and extinction is an empirically supported and often necessary intervention. Therefore, we used an ABA arrangement to test for renewal during intervention with 3 children diagnosed with a feeding disorder. The A phase was functional reinforcement of inappropriate mealtime behavior in a simulated home setting with the child's caregiver as feeder, B was function‐based extinction in a standard clinic setting with a therapist as feeder, and the return to the A phase was function‐based extinction in a simulated home setting with caregiver as feeder. Returning to Context A resulted in renewal of inappropriate mealtime behavior across children, despite the caregivers' continued implementation of function‐based extinction with high levels of integrity.     

An evaluation of differential reinforcement with stimulus fading as an intervention for medical compliance

Individuals with autism spectrum disorder (ASD) often exhibit noncompliance during medical exams. One intervention used to address this concern is differential reinforcement. Although differential reinforcement includes extinction, it may not be feasible or safe to implement extinction during medical exams. In the current study, we evaluated differential reinforcement without extinction and differential reinforcement without extinction plus stimulus fading, for increasing compliance during routine medical exams exhibited by 4 individuals with ASD. An indirect assessment identified problematic medical procedures, and a functional analysis showed that participants' disruptive behavior was maintained by escape from medical tasks. Differential reinforcement without extinction was insufficient in increasing medical compliance with 3 of 4 participants. The addition of a modified stimulus fading procedure that involved gradually introducing smaller components of problematic exam steps was effective in increasing medical compliance with all exam steps.     

Bully Busters: A Psychoeducational Intervention for Reducing Bullying Behavior in Middle School Students

The present study examined the effectiveness of a bully prevention program counselors may use to modify teachers' knowledge/use of bullying intervention skills, teachers' self‐efficacy, and students' classroom bullying behaviors. Participants attended 3 training sessions and participated on a support team. The findings indicated that the treatment program effectively increased teachers' knowledge/use of intervention skills, teachers' personal self‐efficacy, and self‐efficacy related to working with specific types of children and reduced classroom bullying as measured by disciplinary referrals.     

Behavioral treatments for sleep problems in autism: empirically supported or just universally accepted?

With health maintenance organizations and insurance companies requiring proof of treatment efficacy, clinicians must determine whether research supports commonly used treatment methods. To determine the effectiveness of applied behavior analysis (ABA) for treating sleep problems in children with autism, a computer search of all relevant literature was conducted. The resulting articles revealed four basic themes of behavioral techniques for treating sleep disorders for children with autism: bedtime routines, extinction, stimulus fading, and faded bedtimes. Research on each technique was evaluated based on the Chambless criteria of treatment efficacy (Chambless and Hollon, 1998 ; Lonigan, Elbert, and Johnson, 1998 ). Of the ABA methods, only research on extinction provided sufficient evidence for a possibly efficacious intervention for sleep problems in children with autism. However, the lack of available research indicates significantly more research must be conducted before endorsing other ABA methods. Copyright © 2001 John Wiley & Sons, Ltd.     

Manipulating parameters of reinforcement to reduce problem behavior without extinction

Differential reinforcement of alternative behavior (DRA) most often includes extinction as a treatment component. However, extinction is not always feasible and it can be counter‐therapeutic if implemented without optimal treatment integrity. Researchers have successfully implemented DRA without extinction by manipulating various parameters of reinforcement such that alternative behavior is favored. We extended previous research by assessing three participants' sensitivities to quality, magnitude, and immediacy using arbitrary responses and reinforcers that maintain problem behavior. The results were used to implement an intervention for problem behavior using DRA without extinction. Our findings indicate that arbitrary responses can be used to identify individual and relative sensitivity to parameters of reinforcement for reinforcers that maintain problem behavior. Treatment was effective for all participants when we manipulated parameters of reinforcement to which they were most sensitive, and, for two participants, the treatment was less effective when we manipulated parameters to which they were least sensitive.     

The Moderating Effect of Within‐Group Similarity on Change in a Strengths‐Based Programme for Incarcerated Young Men

Many youth who are incarcerated within juvenile correctional facilities experience mental health disorders, histories of victimization and suicide ideation. Strengths‐based intervention programmes are intended to enhance participants' resilience against such challenges. However, little is known about how the composition of intervention groups contributes to programmes' efficacy. This study addresses the impact of within‐group similarity on the success of a strengths‐based intervention for incarcerated young men (n = 141). Similarity was assessed in terms of self‐reported demographics and behaviours and belief systems. Youths' masculine ideology, caring and cooperative behaviours, ethnic pride and respect for differences, self‐efficacy regarding education and non‐violence, and attitudes about criminal behaviour were measured before and after intervention. Results indicate that participants' caring and cooperative behaviour increased during the intervention. However, their education‐related self‐efficacy was reduced, and the perceived benefits of criminal activity increased. These changes were moderated by group composition: less similarity between participants and their group members was associated with less negative change. In the context of juvenile corrections facilities, where staying the same may be a relatively positive outcome, perhaps the more relevant question is not which processes and characteristics of others better enable youth to change but which experiences help them retain positive aspects of themselves. Copyright © 2014 John Wiley & Sons, Ltd.     

The behavioural treatment of sleep difficulties in children with an intellectual disability

Reinforcement, instruction giving, partner support strategies, bedtime routine, and standard extinction were taught to the parents of three boys (aged 5–10 years) with an intellectual disability and sleeping difficulties. Sleep was measured using sleep diaries and actigraphy, and daytime behaviour was monitored using diaries and direct observation. At referral, all children needed a parent present to fall asleep, two had co‐sleeping difficulties, and two had night waking difficulties. At post‐intervention, all children were falling asleep independently, co‐sleeping was eliminated for two children, and night waking was reduced in one child. An extinction burst was experienced by two children, with one family putting their child back to bed 259 times on the first night. Though one child still had night waking difficulties following intervention, actigraph recording demonstrated an improvement in his sleep quality. In addition to the children's independence, improvements were seen for sleep length, sleep latency, and morning wake time. However, improvements in daytime behaviour showed inconsistency across behaviours and settings. Improvement in sleep was maintained at a three month follow‐up. It was concluded that using extinction to address sleep problems in children with an intellectual disability is effective and approved of by parents, but any impact on daytime behaviour is equivocal. Copyright © 2002 John Wiley & Sons, Ltd.     

Targeting avoidance via compound extinction

ABSTRACT

Avoidance towards innocuous cues is a key diagnostic criterion across anxiety-related disorders. Importantly, the most effective intervention for anxiety-related disorders, exposure therapy with response prevention, sometimes does not prevent the relapse of anxiety's symptomatology. We tested whether extinction effects, the experimental proxy of exposure, are enhanced by increasing the discrepancy between the prediction of an unpleasant event happening (shock presentation), and the actual event (shock omission). Forty-eight individuals first saw pictures of three stimuli. Two pictures (CSA, CSB) were followed by a shock (US) and one (CS-) was not. Next, participants learned to avoid the US by pressing a computer key. An extinction and response prevention procedure followed. In the first part of it, participants saw unreinforced presentations of all CSs. In the second part, the single group saw unreinforced presentations of the CSA and CS-. The compound group encountered compound unreinforced presentations of the CSA and CSB, and separate presentations of the CS-. Return of avoidance and fear was tested after unsignalled presentations of the US. Compound extinction resulted in comparable reduction of fear and avoidance compared to standard extinction. We discuss how future research could enhance extinction effects by adding costs to the avoidance behaviour.     

A microcomputer simulation to evaluate and train effective intervention techniques in listening partners of preschool stutterers

A microcomputer-based simulation is being developed to assist parents and speech clinicians-in-training in intervening effectively with a stuttering child. The experience centers on the participant's maintenance of an active verbal dialogue with a computer-generated preschool stutterer whose speech-synthesized fluency level can be directly linked to the participant's verbal behavior. In an initial test of the system's evaluation efficacy, the intervention behaviors exhibited by a group of eight experienced speech pathologists were compared with those exhibited by a group of eight entry-level speech pathology students. The experienced group showed superior intervention particularly on rate-of-speech variables. Efforts are also focusing on increasing the system's coding sensitivity and on assessing its potential as a vehicle for the direct training of effective intervention skills.     

Response production during extinction training is not sufficient for extinction of evaluative conditioning

Two high-powered experiments examined the role of evaluative response production in the extinction of evaluative conditioning (EC) by positioning EC in the procedural and conceptual framework of classical conditioning (CC). According to Rescorla's response inhibition hypothesis, more frequent responding during extinction training results in larger extinction during testing. Experiment 1 used three extinction conditions following response acquisition in an EC procedure: evaluative responses were measured only after extinction; after acquisition and after extinction; or were continuously measured after acquisition, during extinction and after extinction. Based on Rescorla's response inhibition hypothesis, we predicted that extinction of EC would be the highest in the third condition. Experiment 2 was aimed at further facilitating extinction of EC by encouraging participants to experience that their evaluation may change over the course of the experiment. To this end, half of the participants completed pre- and post-acquisition ratings prior to practicing continuous response expression in the extinction phase. Contrary to our predictions, no extinction of EC was observed in either of these experiments. We conclude that Rescorla's inhibition response hypothesis may not apply to EC and discuss the theoretical implications of this finding.     

Teachers' and coaches' role perceptions for supporting young people's mental health: Multiple group path analyses

Teachers and youth sports coaches are in prominent positions to support young people and their mental health. However, the way these professionals perceive their roles is likely to be a powerful influence on such behaviour. This article investigates and compares the effect of four types of role perceptions—role breadth, instrumentality, efficacy, and discretion—on teachers' and coaches' engagement in helping behaviour that supports young people's mental health through promotion, prevention, and early intervention. An online survey was completed by 117 teachers and 131 coaches. Results from three multiple group path analyses revealed role breadth, instrumentality, and efficacy significantly influenced teachers' and coaches' helping behaviour. The extent to which role perceptions predicted helping behaviour did not differ between teachers and coaches. Assisting teachers and coaches to carry out promotion, prevention, and early intervention behaviour increases young people's access to mental health support and may help to reduce the burden of mental health problems among Australian young people.     

Reorganization of learning-associated prefrontal synaptic plasticity between the recall of recent and remote fear extinction memory

We have previously shown that fear extinction is accompanied by an increase of synaptic efficacy in inputs from the ventral hippocampus (vHPC) and mediodorsal thalamus (MD) to the medial prefrontal cortex (mPFC) and that disrupting these changes to mPFC synaptic transmission compromises extinction processes. The aim of this study was to examine whether these extinction-related changes undergo further plasticity as the memory of extinction becomes more remote. Changes in synaptic efficacy in both vHPC-mPFC and MD-mPFC inputs were consequently analyzed when the memory was either 1 d or 7 d old. Increases of synaptic efficacy in the vHPC-mPFC pathway were observed when the memory was 1 d old, but not 7 d after initial extinction. In contrast, potentiation of synaptic efficacy in the MD-mPFC pathway increased over time. In rats that received low-frequency vHPC stimulation immediately after extinction, both vHPC-mPFC and MD-mPFC inputs failed to develop potentiation, and the recall of extinction (both recent and remote memories) was impaired. These findings suggest that post-extinction potentiation in vHPC-mPFC inputs may be necessary for both the recall of recent memory and post-extinction potentiation in the MD-mPFC inputs. This late potentiation process may be required for the recall of remote extinction memory.     

Career Decision‐Making Self‐Efficacy Change in Italian High School Students

The authors explored the effects of a structured‐group career intervention among 280 Italian high school students. Hierarchical linear models indicated the intervention's effectiveness in increasing career decision‐making self‐efficacy and, consequently, career exploration, but not in decreasing career choice anxiety. In addition, partial confirmation was found for the moderating effects of participants' expectations and motivation to change on the relationship between career decision‐making self‐efficacy and career choice anxiety. The findings support the development of a systematic vocational guidance program in Italian schools.     

Pilot Study of a Program to Increase Mothers’ Understanding of Dads

The present study evaluated the effects of mothers' participation in an 8‐week coparenting intervention program, Understanding Dad^?, on mothers' awareness and attitudes regarding how their relationships with fathers influence paternal involvement with children, knowledge of healthy pro‐relationship skills, and relationship self‐efficacy. Thirty‐four mothers were recruited from four sites to participate in a study that used a pretest/posttest one‐group design. Over the course of this 8‐week program, mothers demonstrated moderate to large gains in each of the outcome measures, after controlling for mothers' educational level. Moreover, there was one significant within‐subjects interaction effect for time × location. That is, mothers made significantly greater gains in pro‐relationship knowledge in one of the intervention sites. Implications for future research are discussed.     

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.     

Side effects of extinction: prevalence of bursting and aggression during the treatment of self-injurious behavior

Findings from basic and applied research suggest that treatment with operant extinction may produce adverse side effects; two of these commonly noted are an increase in the frequency of the target response (extinction burst) and an increase in aggression (extinction-induced aggression). Although extinction is often used to treat problem behavior in clinical settings, few applied studies have examined the prevalence of these side effects or their possible attenuation with other operant procedures. An analysis of 41 data sets for individuals who received treatment for self-injurious behavior indicated that extinction bursts or increases in aggression occurred in nearly one half of the cases. The prevalence of bursting and aggression was substantially lower when extinction was implemented as part of a treatment package rather than as the sole intervention.     

Examining extinction bursts in the treatment of pediatric food refusal

Escape extinction has been shown to be highly effective in the treatment of food refusal; however, unpleasant side effects such as extinction bursts may accompany extinction procedures. Bursting has been reported to occur in 24% to 39% of all cases for which extinction was used as a component during treatment of problem behavior. Although commonly used in treatments, the occurrence of extinction bursts in the treatment of pediatric food refusal has not been studied. This study measured the frequency of bursting in 10 children for whom escape extinction was used to treat food refusal. Results showed that extinction bursts were observed in 30% of the children included in the study, although they were relatively brief and resolved quickly. Considerations for using escape extinction in interventions will be discussed.     

A functional analysis and treatment of the irrational and rational statements of an elderly woman with Alzheimer's disease

Speech problems are a hallmark of Alzheimer's disease. Although often attributed to neurological damage common to the disease speech problems have been successfully treated through the use of behavior analytic techniques. This study was a replication and extension of that line of research. The participant in this study was an elderly woman diagnosed with Alzheimer's who was referred for services due to frequent irrational statements and infrequent rational statements. Both standard functional analysis and modified functional analysis conditions were conducted. It appeared the irrational statements were controlled by social reinforcement. Several treatment packages consisting of differential reinforcement of incompatible behaviors and extinction components were implemented in an ABCDEAE treatment design. Results of the study suggest the intervention successfully increased rational statements but had no effect on irrational statements. These results indicate the need for further research on the conditions under which behavior analysis techniques will be most effective. Copyright © 2006 John Wiley & Sons, Ltd.     

Evaluation of a finger prompt variation in the treatment of pediatric feeding disorders

Children with feeding disorders often engage in refusal behavior to escape or avoid eating. Escape extinction combined with reinforcement is a well-established intervention to treat food refusal. Physical guidance procedures (e.g., jaw prompt, finger prompt) have been shown to increase food acceptance and decrease inappropriate mealtime behavior when more commonly employed escape extinction (e.g., nonremoval of the spoon) procedures are ineffective. The finger prompt, however, has not been extensively evaluated as a treatment adjunct to target food refusal, thus necessitating further examination. The purpose of this prospective study was to assess a variation of a finger prompt procedure to treat food refusal and to assess caregivers' acceptability of the procedure. Three children age 1 to 4 years admitted to an intensive feeding disorders program and their caregivers participated. The finger prompt was effective in increasing bite acceptance across all participants and decreasing or maintaining low levels of inappropriate behavior for 2 participants. The procedure was also acceptable to all caregivers.