Behavioral Treatment of Self-Choking in a Developmentally Normal Child

ABSTRACT

In the past, self-choking behavior has been associated with individuals who were either developmentally disabled or experienced psychosis symptoms, and has usually been treated with aversive procedures. A time-series design using several different non-aversive behavioral procedures was used to analyze these treatment effects on an 11-year-old girl whose habit of self-choking interfered with normal functioning. Habit reversal procedures, which implement an incompatible response in place of the target behavior, did not, as first hypothesized, have a positive effect on self-choking behavior. However, attention from a male therapist as a positive reinforcer initially decreased the frequency of self-chokes and percent of time spent self-choking. Attention contingent on performance was not as effective on the child's behavior as attention administered noncontingently. Overall, the behavioral treatment approach applied here does not appear to reduce the target behavior in a clinically significant manner. Implications for future treatment approaches for this behavior are discussed.     

The effects of response interruption,DRO and positive reinforcement on the reduction of hand-mouth behavior

The present study was designed to determine the effects of response interruption and differential reinforcement of other behavior (DRO) on the reduction of hand-mouthing behavior in a quadriparesic adult male client who functions at the profound level of mental retardation. In order to determine the effectiveness of the treatment package, a withdrawal design was used in which baseline (A) and treatment (B) conditions were alternated in an ABAB sequence. The treatment phase consisted of two 10 min treatment periods per day for four consecutive days. Two treatment/withdrawal rotations were followed by nine follow-up observation periods. A preliminary fading process was started following the follow-up periods, which included removal of the reinforcer. Hand-mouthing was reduced by 80% through the use of response interruption and DRO. Hand-mouthing continued to decrease during the nine follow-up observation periods and formal fading procedure. Implications for the extended use of such nonaversive procedures to decrease hand-mouthing behavior in persons with developmental disabilities are discussed. © 1997 John Wiley & Sons, Ltd.     

Functional analysis and treatment of problem behavior evoked by noise.

We conducted a four‐part investigation to develop methods for assessing and treating problem behavior evoked by noise. In Phase 1, 7 participants with developmental disabilities who were described as being hypersensitive to specific noises were exposed to a series of noises under controlled conditions. Results for 2 of the participants verified that noise was apparently an aversive event. In Phase 2, results of functional analyses indicated that these 2 participants' problem behaviors were maintained by escape from noise. In Phase 3, preference assessments were conducted to identify reinforcers that might be used during treatment. Finally, in Phase 4, the 2 participants' problem behaviors were successfully treated with extinction, stimulus fading, and a differential‐reinforcement‐of‐other‐behavior (DRO) contingency (only 1 participant required DRO). Treatment effects for both participants generalized to their home environments and were maintained during a follow‐up assessment. Procedures and results were discussed in terms of their relevance to the systematic assessment of noise as an establishing operation (EO) and, more generally, to the identification of idiosyncratic EO influences on behavior.     

“Other” behavior and the DRO: The roles of extinction and reinforcement

Jessel et al. (2015) provided some evidence to suggest that “other” behavior is strengthened in the differential reinforcement of other behavior (DRO). The present study is a systematic replication of the Jessel et al. procedures. The effects of DRO and extinction on target responding, target-other responding (a response with an established history of reinforcement), and nontarget-other responding emitted by children with intellectual and developmental disabilities and children with no known diagnoses were compared. Other behavior increased in at least one DRO condition for each participant, suggesting that other behavior increases when using DRO, at least initially. Under extinction, target responding and target-other responding decreased to low rates for three of the five participants; however, rates of nontarget-other responding were elevated compared to the DRO condition. These results suggest that increased rates of target-other responding and nontarget-other responding during the DRO condition may be a result of extinction-induced variability.     

REDUCING AGGRESSIVE AND SELF-INJURIOUS BEHAVIOR OF INSTITUTIONALIZED RETARDED CHILDREN THROUGH REINFORCEMENT OF OTHER BEHAVIORS1

Aggressive and self-injurious behaviors of four retarded children were reduced by combining various techniques with the differential reinforcement of other behaviors (DRO). In one study, aggressive responses of a severely retarded child were reduced when DRO was combined with a 30-sec timeout. In a second study, various aggressive classroom behaviors were reduced when the child was told “no” for an inappropriate response but earned puzzle pieces for periods of time when inappropriate responses did not occur. Exchangeable tokens were given to a third subject for every 15 min in which aggressive responding did not occur, while each inappropriate response resulted in the loss of all tokens accrued. Responding was decreased to a level far below baseline. For a fourth child, self-injurious responses were followed by “no”, and intervals of time in which no self-injurious responding occurred earned candy. The rate of this behavior reduced significantly. In each case, the DRO procedure combined with the other techniques proved to be manageable for the teacher and successful in reducing the inappropriate behavior.     

Comparing resetting to non‐resetting DRO procedures to reduce stereotypy in a child with autism

We compared a resetting to a non‐resetting differential reinforcement of other behavior (DRO) procedure to reduce stereotypy exhibited by young boy with autism. During the resetting DRO, a reinforcer was delivered contingent upon the absence of stereotypy during the DRO interval. If stereotypy occurred, the DRO interval was immediately reset. The non‐resetting DRO procedure was identical, except that contingent upon stereotypy, the DRO interval continued until it expired; a new DRO interval then began. Results indicate that the DRO procedures were equally effective to reduce stereotypy, but the participant preferred the resetting DRO procedure.     

CONTEXTUAL CONTROL OF PROBLEM BEHAVIOR IN STUDENTS WITH SEVERE DISABILITIES

We investigated the impact of contextual variation on the effectiveness of two interventions. The problem behavior of 2 students with severe disabilities was analyzed across two contexts (task and leisure). Effects of differential reinforcement of other behavior (DRO) and time-out procedures were examined in the two contexts. Results indicated that in the task context the DRO procedure effectively reduced the problem behavior and increased task performance, whereas the time-out procedure was ineffective. In addition, rate of correct task performance increased during DRO relative to baseline and time-out. In contrast, in the leisure context, the time-out procedure effectively reduced the same problem behavior and the DRO procedure was ineffective. The results are discussed in terms of contextual control of problem behavior and alternative strategies for the design of DRO procedures.     

Comparing fixed‐amount and progressive‐amount DRO Schedules for tic suppression in youth with chronic tic disorders

Chronic tic disorders (CTDs) involve motor and/or vocal tics that often cause substantial distress and impairment. Differential reinforcement of other behavior (DRO) schedules of reinforcement produce robust, but incomplete, reductions in tic frequency in youth with CTDs; however, a more robust reduction may be needed to affect durable clinical change. Standard, fixed‐amount DRO schedules have not commonly yielded such reductions, so we evaluated a novel, progressive‐amount DRO schedule, based on its ability to facilitate sustained abstinence from functionally similar behaviors. Five youth with CTDs were exposed to periods of baseline, fixed‐amount DRO (DRO‐F), and progressive‐amount DRO (DRO‐P). Both DRO schedules produced decreases in tic rate and increases in intertic interval duration, but no systematic differences were seen between the two schedules on any dimension of tic occurrence. The DRO‐F schedule was generally preferred to the DRO‐P schedule. Possible procedural improvements and other future directions are discussed.     

Adventitious reinforcement during long-duration DRO exposure

Differential reinforcement of other behavior (DRO) is a procedure often used to decrease problem behavior, but the processes responsible for behavior reduction are not well understood. This study assessed whether adventitious reinforcement of other behavior contributes to DRO effectiveness when, relative to previous research, DRO exposure is prolonged. Two response options were presented on a computer and target responding was reinforced on a variable-ratio schedule. Response rates were then compared during DRO versus yoked variable-time or extinction probes. Across 2 experiments, DRO decreased target responding and increased other responding more than control conditions. However, increases in other responding did not usually maintain despite target responding remaining at low levels. DRO might adventitiously reinforce other responses transiently but the decreases in target behavior could not be entirely explained by adventitious reinforcement of the other response. Instead, reductions in target responding likely depend on the discriminability of the DRO contingency.     

Multiple reinforcement contingencies to reduce aggression,self-injury and dysfunctional verbal behaviors in an adult who is sensory impaired

Differential reinforcement of other behavior (DRO) and differential reinforcement of low rates of responding (DRL) have been effective techniques in reducing maladaptive behaviors in therapeutic settings. Reported studies of these reinforcement-based procedures indicate that they are usually implemented in isolation, targeting only a single behavior or class of behaviors. In this study, multiple DRO and DRL contingencies were utilized concurrently in reducing two distinct classes of behaviors with a 26 year-old blind man with moderate retardation. One class of behaviors included socially inappropriate verbalizations, while the other included aggressive, self-injurious and environmentally destructive behaviors. Distinct contingencies were established according to the functions of the targeted behaviors and their severity and separate schedules of reinforcement were derived from baseline frequencies. Over a period of 20 months, the differential reinforcement interventions resulted in rapid reduction of behaviors in both classes to near-zero rates and frequencies were maintained at this low level while contingency schedules were systematically lengthened. Collateral effects are discussed including performance in functional academics and participation in community integration activities.     

COMPARISON OF EXTINCTION,DRO 0-SEC,AND DRO 6-SEC IN THE ELIMINATION OF IMITATIVE RESPONDING UNDER DISCRETE-TRIAL PARADIGMS1

Imitative response levels were observed for normal 5-yr-old children within a discrete-trial imitation paradigm. Following imitation training sessions, children were observed under conditions of contingent reinforcement for three experimental sessions. Following the contingent reinforcement phase, children were then observed under reversal conditions for four sessions. A 3 × 4 repeated measures design was employed for observing response decrements under conditions of extinction, DRO 6-sec, and DRO 0-sec. The DRO 0-sec group demonstrated a significantly greater decrement in imitative responding than did the DRO 6-sec and extinction group. The differences in effects between the two DRO conditions and results from previous studies in which DRO procedures have had little effect in reducing imitative responding, suggest an incomplete understanding of the ways in which DRO procedures may operate.     

A comparison of fixed momentary differential reinforcement of other behavior to variable momentary differential reinforcement of other behavior to reduce challenging behavior

Differential reinforcement of other behavior (DRO) is commonly used to reduce behavioral excesses. Momentary DRO schedules involve delivery of reinforcement contingent upon the absence of the target behavior at a given moment. Two variations of momentary DRO exist: fixed-momentary (FM) DRO and variable-momentary (VM) DRO. In the current study, we directly compared FM-DRO and VM-DRO schedules to reduce challenging behavior maintained by automatic reinforcement exhibited by four children with autism spectrum disorder. The results suggest that both the DRO schedules were equally effective to reduce challenging behavior. A social validity measure showed that most caregivers rated the VM-DRO as a preferred schedule and noted the potential for FM-DRO schedule to become more discriminable over time, which could reduce its effectiveness. However, most caregivers also commented that the FM-DRO schedule was easier to implement.     

A PRELIMINARY PROCEDURE FOR PREDICTING THE POSITIVE AND NEGATIVE EFFECTS OF REINFORCEMENT-BASED PROCEDURES

In the current investigation, a modification was made to the preference assessment described by Pace, Ivancic, Edwards, Iwata, and Page (1985) to predict the effects of stimuli when used in a differential-reinforcement-of-other-behavior (DRO) schedule for 2 clients with severe self-injurious behavior (SIB) and profound mental retardation. Based on the results of the preference assessment, three types of stimuli were identified: (a) high-preference stimuli associated with high rates of SIB (HP/HS), (b) high-preference stimuli associated with relatively lower rates of SIB (HP/LS), and (c) low-preference stimuli associated with low rates of SIB (LP/LS). Consistent with the results of the preference assessment, the DRO schedule with HP/HS stimuli resulted in increased SIB, and the DRO schedule with LP/LS stimuli resulted in no changes in SIB. HP/LS stimuli were demonstrated reinforcers but did not result in a change in SIB when used in a DRO schedule. Thus, the stimulus preference assessment may be useful clinically in some situations for predicting both the beneficial and the negative side effects of stimuli in DRO procedures.     

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.     

Acceptability of behavioral interventions: Perceptions of superintendents of public residential facilities

The acceptability of behavioral procedures has been examined with many groups of individuals that have significant roles in the lives of persons with mental retardation. However, for those individuals that live in public residential facilities, one critical person in the decision making process is the superintendent. The purpose of this study was to assess the acceptability of treatments to superintendents of public residential facilities. Using the Treatment Evaluation Inventory (Kazdin, 1980), superintendents rated the acceptability of five treatments (DRO, Time-out, medication, overcorrection and contingent shock) applied to a mild and severe behavior problem. The results showed a significant main effect for treatment and problem and a problem by treatment interaction. Acceptability was inversely related to treatment restrictiveness and, except for differential reinforcement of other behaviors (DRO), all treatments were more acceptable for the severe problem than for the mild problem.     

Comparing the effects of differential reinforcement of other behavior and response-cost contingencies on tics in youth with tourette syndrome

Tics are rapid, repetitive, stereotyped movements or vocalizations that arise from neurobiological dysfunction and are influenced by environmental factors. Although persons with tic disorders often experience aversive social reactions in response to tics, little is known about the behavioral effects of such consequences. Along several dimensions, the present study compared the effects of two treatments on tics: response cost (RC) and differential reinforcement of other behavior (DRO). Four children with Tourette syndrome were exposed to free-to-tic baseline, DRO, RC, and quasibaseline rebound evaluation conditions using an alternating treatments design. Both DRO and RC produced substantial decreases in tics from baseline levels. No differential effects of DRO and RC contingencies were seen on self-reported stress or in the strength of the reflexive motivating operation (i.e., premonitory urge) believed to trigger tics, and neither condition produced tic-rebound effects. Implications of these findings and directions for future research are discussed.     

Effectiveness of DRO tokens in decreasing disruptive behavior in the classroom with five multiply handicapped children

In this study the effectiveness of differential reinforcement of other behavior (DRO) with tokens was assessed in the treatment of various topographies of disruptive behavior in the classroom with five children who were multiply handicapped. Prior to implementation of the treatment, reinforcer assessment was conducted to identify items to be used as back-up reinforcers. Data were analyzed using time-series analysis. Results show that DRO tokens were highly effective in decreasing disruptive behavior of all participants. ©1997 by John Wiley & Sons, Ltd.     

Caregiver preference for reinforcement‐based interventions for problem behavior maintained by positive reinforcement

Social validity of behavioral interventions typically is assessed with indirect methods or by determining preferences of the individuals who receive treatment, and direct observation of caregiver preference rarely is described. In this study, preferences of 5 caregivers were determined via a concurrent‐chains procedure. Caregivers were neurotypical, and children had been diagnosed with developmental disabilities and engaged in problem behavior maintained by positive reinforcement. Caregivers were taught to implement noncontingent reinforcement (NCR), differential reinforcement of alternative behavior (DRA), and differential reinforcement of other behavior (DRO), and the caregivers selected interventions to implement during sessions with the child after they had demonstrated proficiency in implementing the interventions. Three caregivers preferred DRA, 1 caregiver preferred differential reinforcement procedures, and 1 caregiver did not exhibit a preference. Direct observation of implementation in concurrent‐chains procedures may allow the identification of interventions that are implemented with sufficient integrity and preferred by caregivers.     

A Comparison of Function-Based Differential Reinforcement Interventions for Children Engaging in Disruptive Classroom Behavior

This study provides a direct comparison of differential reinforcement of other behavior (DRO) and differential reinforcement of alternative behavior (DRA). Participants included three children in center-based classrooms referred for functional assessments due to disruptive classroom behavior. Functional assessments included interviews and brief functional analyses. An alternating treatments design was used to evaluate the relative effectiveness of function-based DRO and DRA interventions. Results indicated that both intervention procedures effectively reduced disruptive behavior, but the DRA procedure consistently resulted in greater reductions in disruptive behavior across all participants. Results are discussed in terms of directions for future functional assessment and intervention research as well as implications for applied practice.     

Delivering alternative reinforcement in a distinct context reduces its counter‐therapeutic effects on relapse

Delivery of alternative reinforcers in the presence of stimuli previously associated with reinforcement for target behavior increases the susceptibility of target behavior to relapse. To explore contingencies that might mitigate this counter‐therapeutic effect, we trained pigeons on a procedure that entailed extinction of previously reinforced target‐key pecking, access to a distinct stimulus context contingently on refraining from target behavior (differential‐reinforcement‐of‐other‐behavior; DRO), and reinforcement of alternative‐key pecks (differential‐reinforcement of alternative behavior; DRA) in that context. This DRO‐DRA treatment was compared with standard DRA in successive conditions, counterbalanced across pigeons. Target behavior extinguished more rapidly in the Standard‐DRA condition. When alternative reinforcement was discontinued, however, there was less resurgence after DRO‐DRA than after Standard DRA. In a third condition, the DRO contingency was suspended so that the former DRA stimuli were not presented (DRO‐NAC), and resurgence was greater than in the Standard‐DRA and DRO‐DRA conditions. Reinstatement produced by response‐independent reinforcers was small and similar across conditions. Subsequent reacquisition of target‐key pecking under baseline reinforcement conditions was faster following DRO‐NAC than Standard‐DRA or DRO‐DRA. These findings suggest that DRO‐DRA might serve as a useful method in clinical settings for reducing problem behavior while minimizing the threat of posttreatment relapse.