Functional analysis of self-injurious behavior and its relation to self-restraint

Some individuals who engage in self-injurious behavior (SIB) also exhibit self-restraint. In the present study, a series of three functional analyses were conducted to determine the variables that maintained a participant's SIB, one without restraint items available, one with a preferred and effective form of self-restraint (an airplane pillow) available noncontingently, and one with this item delivered contingent on SIB. Results suggested that SIB was reinforced by escape and by access to self-restraint materials, self-restraint appeared to be maintained by automatic reinforcement, and continuous access to highly preferred restraint materials effectively suppressed SIB.     

A descriptive analysis of social consequences following problem behavior.

The social consequences delivered for problem behavior during functional analyses are presumed to represent common sources of reinforcement; Final acceptance however, the extent to which these consequences actually follow problem behavior in natural settings remains unclear. The purpose of this study was to determine whether access to attention, escape, or tangible items is frequently observed as a consequence of problem behavior under naturalistic conditions. Twenty‐seven adults who lived in a state residential facility and who exhibited self‐injurious behavior, aggression, or disruption participated. Observers recorded the occurrence of problem behavior by participants as well as a variety of consequences delivered by caregivers. Results indicated that attention was the most common consequence for problem behavior and that aggression was more likely to produce social consequences than were other forms of problem behavior.     

Progressing from brief assessments to extended experimental analyses in the evaluation of aberrant behavior

The role of experimental analyses in guiding treatment is well established. However, not all experimental analyses yield conclusive results. Outcomes may be inconclusive due to time limitations that preclude extended observation and detailed experimental manipulations, or may result from interactions across experimental conditions, multiple control, or other unknown factors. In this study, we describe an assessment sequence that moves through four phases beginning with relatively brief (1 to 2 hr) analyses and culminating in extended analyses that may control for experimental confounding effects (e.g., interaction effects). Data illustrating the model are presented for 20 individuals referred for severe behavior problems including self-injury, aggression, stereotypy, and tantrums. Analyses were considered to be complete only when clear and replicable response patterns emerged. Results showed that clear and replicable response patterns emerged for 85% of the participants.     

Effects of continuous and intermittent reinforcement for problem behavior during functional communication training

We evaluated the effectiveness of functional communication training (FCT) in reducing problem behavior and in strengthening alternative behavior when FCT was implemented without extinction. Following the completion of functional analyses in which social-positive reinforcement was identified as the maintaining variable for 5 participants' self-injurious behavior (SIB) and aggression, the participants were first exposed to FCT in which both problem behavior and alternative behavior were reinforced continuously (i.e., on fixed-ratio [FR] 1 schedules). During subsequent FCT conditions, the schedule of reinforcement for problem behavior was made more intermittent (e.g., FR 2, FR 3, FR 5, etc.), whereas alternative behavior was always reinforced according to an FR 1 schedule. Results showed that 1 participant's problem behavior decreased and alternative behavior increased during FCT when both behaviors were reinforced on FR 1 schedules. The remaining 4 participants shifted response allocation from problem to alternative behavior as the schedule of reinforcement for problem behavior became more intermittent. These results suggest that individuals might acquire alternative responses during FCT in spite of inconsistencies in the application of extinction, although even small errors in reinforcement may compromise treatment effects.     

Relative influences of establishing operations and reinforcement contingencies on self-injurious behavior during functional analyses

In the typical functional analysis in which the antecedent and consequent events associated with problem behavior are manipulated, the control condition involves elimination of both the relevant establishing operation (EO) and its associated contingency through a schedule of noncontingent reinforcement (usually fixed-time [FT] 30 s). In some functional analyses, however, antecedent events are manipulated in the absence of differential consequences, and a common test condition in such analyses also involves the delivery of reinforcement on an FT 30-s schedule. Thus, the same schedule of reinforcement (FT 30 s) is not considered to be an EO in the former type of analysis but is considered to be an EO in the latter. We examined the relative influences of EOs and reinforcement contingencies on problem behavior by exposing 6 individuals who engaged in self-injurious behavior (SIB) to four combinations of functional analysis conditions: EO present/contingency present, EO absent/contingency present, EO present/contingency absent, and EO absent/contingency absent. Results indicated that the only condition in which high rates of SIB were observed consistently was one in which the EO and the reinforcement contingency were both present. Implications of these results for the design of functional analysis test and control conditions are discussed.     

The influence of therapist attention on self-injury during a tangible condition

This study investigated the effects of therapist attention on the self-injurious behavior (SIB) of a 6-year-old girl with developmental disabilities. After results of a functional analysis indicated that SIB was maintained by attention and tangible reinforcement, tangible conditions with and without contingent verbal attention were compared. Results suggested that the inclusion of verbal attention in a tangible condition may confound functional analysis outcomes for behavior that is maintained by attention.     

Functional analysis and treatment of self-injurious behavior in young children a summary of 30 cases

The assessment and treatment of self-injurious behavior (SIB) has received much attention in the literature; however, few studies have focused on early intervention for this behavior. In the current study, functional analyses with developmentally appropriate modifications were conducted in an outpatient clinic with 30 children (aged 10 months to 4 years 11 months) to assess SIB and problem behavior in its early stages. The reported mean age of SIB onset was 17 months, and head banging was the most prevalent topography. Functional analyses identified sources of reinforcement for SIB in 62.1% of cases; with the inclusion of all forms of problem behavior, sources of reinforcement were identified for 87.5% of cases. Function-based treatments were developed for 24 cases, with functional communication training prescribed most often (70.8% of cases). Implications of these findings for the development of early intervention programs for SIB are discussed.     

A review of environmental enrichment as treatment for problem behavior maintained by automatic reinforcement

We reviewed studies that used environmental enrichment as treatment for problem behavior maintained by automatic reinforcement. A search of behavior analytic journals produced 71 publications with a total of 265 applications of environmental enrichment used alone or in conjunction with alternative behavior manipulations (e.g., prompting, reinforcement) and problem behavior manipulations (e.g., blocking, restraint). Environmental enrichment, as a sole intervention, was efficacious in 41% of the sample. Alternative behavior manipulations, problem behavior manipulations, and a combination of both improved the overall efficacy of environmental enrichment. We discuss factors that may influence the efficacy of environmental enrichment, current trends in research on this topic, and implications for both practitioners and researchers.     

A method for identifying satiation versus extinction effects under noncontingent reinforcement schedules

We evaluated one method for determining whether response suppression under noncontingent reinforcement (NCR) is a function of satiation or extinction. Three individuals with developmental disabilities who engaged in self-injurious behavior (SIB) or aggression participated. Results of functional analyses indicated that their problem behavior was maintained by social-positive reinforcement. NCR procedures, individualized for each participant, were implemented in a multiple baseline across subjects design and were associated with decreases in all participants' problem behavior. Identification of the mechanism by which NCR produced these effects was based on examination of cumulative records showing response patterns during and immediately following each NCR session. Satiation during NCR should lead to a temporary increase in responding during the post-NCR (extinction) period due to a transition from the availability to the unavailability of reinforcement (satiation to deprivation). Alternatively, extinction during NCR should reveal no increase in responding during the extinction period because the contingency for the problem behavior would remain unchanged and the transition from satiation to deprivation conditions would be irrelevant. Results suggested that the operative mechanisms of NCR were idiosyncratic across the 3 participants and appeared to change during treatment for 1 of the participants.     

Further analysis of subtypes of automatically reinforced SIB: A replication and quantitative analysis of published datasets

Hagopian, Rooker, and Zarcone (2015) evaluated a model for subtyping automatically reinforced self‐injurious behavior (SIB) based on its sensitivity to changes in functional analysis conditions and the presence of self‐restraint. The current study tested the generality of the model by applying it to all datasets of automatically reinforced SIB published from 1982 to 2015. We identified 49 datasets that included sufficient data to permit subtyping. Similar to the original study, Subtype‐1 SIB was generally amenable to treatment using reinforcement alone, whereas Subtype‐2 SIB was not. Conclusions could not be drawn about Subtype‐3 SIB due to the small number of datasets. Nevertheless, the findings support the generality of the model and suggest that sensitivity of SIB to disruption by alternative reinforcement is an important dimension of automatically reinforced SIB. Findings also suggest that automatically reinforced SIB should no longer be considered a single category and that additional research is needed to better understand and treat Subtype‐2 SIB.     

The effects of response cost in the treatment of aberrant behavior maintained by negative reinforcement

Positive reinforcement contingencies can sometimes be used to decrease problem behavior maintained by negative reinforcement (e.g., escape). In the current study, we evaluated the extent to which response cost (i.e., contingent removal of a preferred stimulus) would compete with the negative reinforcer maintaining destructive behavior. The response cost contingency reduced destructive behavior by 87% from baseline levels even though the negative reinforcement contingency (i.e., escape) remained in place.     

An integrated model for guiding the selection of treatment components for problem behavior maintained by automatic reinforcement

We evaluated the usefulness of 2 assessments to guide treatment selection for individuals whose prior functional analysis indicated that automatic reinforcement maintained their problem behavior. In the 1st assessment, we compared levels of problem behavior during a noncontingent play condition and an alone or ignore condition. In the 2nd, we assessed participants’ relative preferences for automatic reinforcement and social reinforcers in a concurrent‐operants arrangement. We used the results of these 2 assessments to assign 5 participants to a treatment based on noncontingent access to social reinforcers or to a treatment based on differential access to social reinforcers. We conducted monthly probes with the participants over 10 to 12 months to evaluate the effects of the treatment procedures. All participants showed reductions in problem behavior over this period.     

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.     

NONCONTINGENT REINFORCEMENT: A FURTHER EXAMINATION OF SCHEDULE EFFECTS DURING TREATMENT

We conducted 2 studies to determine whether dense and thin NCR schedules exert different influences over behavior and whether these influences change as dense schedules are thinned. In Study 1, we observed that thin as well as dense NCR schedules effectively decreased problem behavior exhibited by 3 individuals. In Study 2, we compared the effects of 2 NCR schedules in multielement designs, one with and the other without an extinction (EXT) component, while both schedules were thinned. Problem behavior remained low as the NCR schedule with EXT was thinned, but either (a) did not decrease initially or (b) subsequently increased as the NCR schedule without EXT was thinned. These results suggest that dense schedules of NCR decrease behavior by altering its motivating operation but that extinction occurs as the NCR schedule is thinned. The benefits and limitations of using dense or thin NCR schedules are discussed.     

A comparison of procedures for programming noncontingent reinforcement schedules

We compared two methods for programming and thinning noncontingent reinforcement (NCR) schedules during the treatment of self-injurious behavior (SIB). The participants were 3 individuals who had been diagnosed with mental retardation. Results of functional analyses indicated that all participants' SIB was maintained by positive reinforcement (i.e., access to attention or food). Following baseline, the effects of two NCR schedule-thinning procedures were compared in multielement designs. One schedule (fixed increment) was initially set at fixed-time 10-s reinforcer deliveries and was also thinned according to fixed-time intervals. The other schedule (adjusting IRT) was initially determined by participants' baseline interresponse times (IRTs) for SIB and was thinned based on IRTs observed during subsequent treatment sessions. Results indicated that both schedules were effective in initially reducing SIB and in maintaining response suppression as the schedules were thinned.     

Systematic application and removal of protective equipment in the assessment of multiple topographies of self-injury

We evaluated the effects of systematic application and removal of protective equipment on three topographies of self-injurious behavior (SIB) exhibited by a girl who had been diagnosed with autism. Results showed that when protective equipment was applied, SIB decreased to near-zero levels. In addition, withdrawal of protective equipment for specific topographies of SIB (by removing only the corresponding padding) increased rates of SIB only for that topography of SIB. Next, a functional analysis of hand SIB showed that protective equipment suppressed this behavior in all conditions and that the behavior was maintained by automatic reinforcement when padding was removed. Results are discussed in terms of sensory extinction as a possible mechanism responsible for response suppression.