DIFFERENTIAL REINFORCEMENT OF ALTERNATIVE BEHAVIOR AND DEMAND FADING IN THE TREATMENT OF ESCAPE-MAINTAINED DESTRUCTIVE BEHAVIOR

The escape-maintained destructive behavior of a boy with autism was reduced during instructional sequences with differential reinforcement of compliance (DRA), escape extinction without physical guidance, and demand fading. The procedure decreased destructive behaviors to near-zero levels and greatly increased compliance.     

Functional analysis and generalized treatment of disruptive behavior during dental exams

Patient disruption during dental visits can impede treatment and may result in invasive approaches to care. The current study evaluated the efficacy of graduated exposure with and without extinction to decrease disruption during dental treatment for 4 young men with autism spectrum disorder (ASD). Modified functional analyses confirmed that disruption was maintained by escape from dental demands for all four young men. Initial treatment consisted of graduated exposure, whereby exam steps were initially removed and then gradually reintroduced as disruption remained low; throughout this phase, disruption resulted in a break from the exam. During the subsequent treatment phase, graduated exposure procedures continued and extinction for disruption was added. Graduated exposure alone did not result in sufficient treatment effects; however, the addition of extinction resulted in greater reductions in disruption and increases in exam completion for all 4 young men, and treatment effects generalized to a dental clinic setting.     

COMBINING STIMULUS FADING,REINFORCEMENT, AND EXTINCTION TO TREAT FOOD REFUSAL

The food refusal of a 6-year-old girl with destructive behavior was treated using stimulus fading, reinforcement, and escape extinction. Intake increased and compliance with prompting procedures remained relatively stable despite the increased consumption requirement.     

Stimulus fading and differential reinforcement for the treatment of needle phobia in a youth with autism

Stimulus fading in the form of gradually increased exposure to a fear-evoking stimulus, often combined with differential reinforcement, has been used to treat phobias in children who are otherwise normal and in children with autism. In this investigation, we applied stimulus fading plus differential reinforcement with an adolescent with autism and diabetes whose needle phobia had prevented medical monitoring of his blood glucose levels for over 2 years. Results showed that the treatment was successful in obtaining daily blood samples for measuring glucose levels.     

Further investigation of differential reinforcement of alternative behavior without extinction for escape‐maintained destructive behavior

Previous research indicates that manipulating dimensions of reinforcement during differential reinforcement of alternative behavior (DRA) for situations in which extinction cannot be implemented is a potential approach for treating destructive behavior. Therefore, we replicated and extended previous research by determining (a) the conditions under which DRA without extinction decreased and maintained low levels of destructive behavior and (b) whether intervention effects maintained during reinforcement schedule thinning for the alternative response (i.e., compliance). Results showed that effective treatments were developed in the absence of extinction by manipulating the quality of reinforcement for compliance for 2 participants and by combining manipulations of the magnitude and quality of reinforcement for compliance for the other 2 participants. However, maintaining treatment effects during reinforcement schedule thinning required combining the magnitude and quality of reinforcement for 3 of the 4 participants. We discuss the clinical utility of this approach, review limitations of the study, and suggest directions for future research.     

Establishing motion control in children with autism and intellectual disability: Applications for anatomical and functional MRI

Excessive motion makes magnetic resonance imaging (MRI) extremely challenging among children with autism spectrum disorder (ASD). The medical risks of sedation establish the need for behavioral interventions to promote motion control among children with ASD undergoing MRI scans. We present a series of experiments aimed at establishing both tolerance of the MRI environment and a level of motion control that would be compatible with a successful MRI. During Study 1, we evaluated the effects of prompting and contingent reinforcement on compliance with a sequence of successive approximations to an MRI using a mock MRI. During Study 2, we used prompting and progressive differential reinforcement of other behaviors (DRO) to promote motion control in a mock MRI for increasing periods of time. Finally, during Study 3, some of the participants underwent a real MRI scan while a detailed in‐session motion analysis informed the quality of the images captured.     

Some determinants of inhibitory stimulus control

Interspersed reinforcement and extinction during discrimination learning generate a U-shaped gradient of inhibition about the stimulus correlated with extinction. The present work showed that extinction is not a necessary determinant of inhibitory stimulus control. In Exp. I, a reduction in the rate of reinforcement, through a shift from a multiple variable-interval 1-min variable-interval 1-min schedule to a multiple variable-interval 1-min variable-interval 5-min schedule, resulted in a post-discrimination line orientation gradient of inhibition about the stimulus correlated with the variable-interval 5-min schedule. In Exp. II, the rates of reinforcement, correlated with a pair of stimuli, were held constant during a shift from a multiple variable-interval 1-min variable-interval 1-min schedule to a multiple variable-interval 1-min differential-reinforcement-of-low-rate schedule. Inhibitory stimulus control about the stimulus correlated with the differential reinforcement of low rate was obtained. In both experiments, a reduction in the rate of responding during one stimulus and behavioral contrast during the other stimulus preceded the observation of inhibitory stimulus control.     

REEMERGENCE AND EXTINCTION OF SELF-INJURIOUS ESCAPE BEHAVIOR DURING STIMULUS (INSTRUCTIONAL) FADING

Based on results of a functional analysis indicating that the self-injurious behavior (SIB) of 3 individuals was maintained by negative reinforcement (escape from instructional situations), the effects of stimulus (instructional) fading were evaluated in a multiple baseline design across subjects. The rate of instructions was reduced to zero at the beginning of treatment and was gradually increased (faded in) across sessions as long as SIB remained low. However, if SIB remained high for 10 consecutive sessions, extinction was implemented until SIB decreased, at which point extinction was withdrawn and fading was resumed. Treatment was completed when the rate of instructions was the same as in baseline (two per minute), and SIB remained below 0.5 responses per minute for two consecutive sessions. Results showed that instructional fading (without extinction) virtually eliminated SIB initially, but these effects were not maintained. All 3 subjects required multiple exposures to extinction and over 150 treatment sessions in order to meet the end-of-treatment criteria. Advantages and limitations of fading procedures without an extinction component, as well as extensions of both interventions to other clinical problems, are discussed.     

Alternative response training, differential reinforcement of other behavior, and extinction in squirrel monkeys (Saimiri sciureus)

In Experiment I, (a) extinction, (b) extinction plus reinforcement of a discrete alternative response, and (c) differential reinforcement of other behavior were each correlated with a different stimulus in a three-component multiple schedule. The alternative-response procedure more rapidly and completely suppressed behavior than did differential reinforcement of other behavior. Differential reinforcement of other behavior was slightly more effective than extinction alone. In Experiment II, reinforcement of specific alternative behavior during extinction and differential reinforcement of other behavior were used in two components, while one component continued to provide reinforcement for the original response. Once again, the alternative-response procedure was most effective in reducing responding as long as it remained in effect. However, the responding partially recovered when reinforcement for competing behavior was discontinued. In general, responding was less readily reduced by differential reinforcement of other behavior than by the specific alternative-response procedure.     

Case study: Reinforcement control of severe aggression exhibited by a child with autism in a family home

This clinical case study describes in-home treatment of severe aggression and tantrum behavior exhibited by an 11 -year-old child with autism, using methods of differential reinforcement comparable to those of a case study by Luiselli (1990). No significant reductions in problem conduct occurred when a parent implemented differential reinforcement of other behavior (DRO) in conjunction with publicly posted ‘good behavior rules,’ physical management training, and redirection to relaxation. Control was established when the child was reinforced for compliance with task demands in conjunction with extinction, implemented directly by professional support staff working in the home. Despite demonstrable parental consistency, systematic training, and fading of supports, results were not maintained at follow-up. The generality of differential reinforcement as a practical intervention for severe aggression in family homes is questioned.     

Effects of noncontingent reinforcement on problem behavior and stimulus engagement: the role of satiation, extinction, and alternative reinforcement

This study examined the effects of noncontingent reinforcement (NCR) with and without extinction on problem behavior and stimulus engagement (consumption of reinforcement) of 4 participants. Reductions in problem behavior using NCR have frequently been attributed to both satiation of the reinforcer and extinction. In the current study, aspects of the NCR treatment effects were difficult to explain based solely on either a satiation or an extinction account. Specifically, it was found that stimulus engagement remained high throughout the NCR treatment analysis, and that problem behavior was reduced to near-zero levels during NCR without extinction. The implications of these findings are discussed with respect to the satiation and extinction hypotheses frequently described in the applied literature. Findings from basic studies examining the effects of response-independent schedules are presented, and are used as the basis for a matching theory account of NCR-related effects. It is proposed that reductions in problem behavior observed during NCR interventions may be a function of the availability of alternative sources of reinforcement.     

Functional Communication Training and Demand Fading Using Concurrent Schedules of Reinforcement

Demand fading, a schedule thinning procedure for escape-maintained behaviors, typically includes an escape extinction component. The purpose of this study was to examine the effectiveness of demand fading with alternative reinforcement utilizing concurrent reinforcement schedules without extinction. During demand fading, aggression and requests emitted prior to meeting the task completion criterion were reinforced with short, low-quality breaks, but requests emitted following the task completion criterion were reinforced with long, high-quality breaks. Results suggest that concurrent schedules of reinforcement may be an effective alternative to extinction as a component of demand fading.     

STIMULUS FADING AND TRANSFER IN THE TREATMENT OF SELF-RESTRAINT AND SELF-INJURIOUS BEHAVIOR

We conducted several manipulations of mechanical restraint properties during the course of treatment for two profoundly retarded adolescents who exhibited both self-restraint and self-injurious behavior. In study 1, a combination of prompting, differential reinforcement, and stimulus fading reduced one subject's self-restraint, which consisted of holding rigid tubes on his arms. Subsequently, stimulus control of both self-restraint and self-injurious behavior was transferred to tennis wrist bands. In study 2, a second subject's self-restraint—placing his hands in his pants—was immediately eliminated by the use of air splints. Additionally, differential reinforcement and air-pressure fading resulted in the complete mobility of his arms and a substantial increase in appropriate behaviors. Results of this investigation suggest that stimulus fading and transfer may be valuable components in the elimination of self-restraint.     

THE USE OF POSITIVE AND NEGATIVE REINFORCEMENT IN THE TREATMENT OF ESCAPE-MAINTAINED DESTRUCTIVE BEHAVIOR

We identified 3 clients whose destructive behavior was sensitive to negative reinforcement (break from tasks) and positive reinforcement (access to tangible items, attention, or both). In an instructional context, we then evaluated the effects of reinforcing compliance with one, two, or all of these consequences (a break, tangible items, attention) when destructive behavior produced a break and when it did not (escape extinction). For 2 clients, destructive behavior decreased and compliance increased when compliance produced access to tangible items, even though destructive behavior resulted in a break. For 1 client, extinction was necessary to reduce destructive behavior and to increase compliance. Subsequently, when the schedule of reinforcement for compliance was faded for all clients, destructive behavior was lower and fading proceeded more rapidly when compliance produced multiple functional reinforcers (i.e., a break plus tangible items or attention) and destructive behavior was on extinction. The results are discussed in terms of the effects of relative reinforcement value and extinction on concurrent operants.     

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.     

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.     

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.     

The effectiveness of fading in programming a simultaneous form discrimination for retarded children

A non-verbal teaching program, combined with reinforcement and extinction (Program Group), was compared with reinforcement and extinction alone (Test Group) in teaching retarded children to discriminate circles from ellipses. In the Program Group, fading techniques were used to transfer stimulus control from “bright vs. dark” to “form vs. no-form” and then to “circle vs. ellipse”. The Test Group had the task of learning the circle-ellipse discrimination with no prior teaching program. With the program, seven of 10 children learned the circle-ellipse discrimination. Without the program, one of nine learned. The eight Test-Group children who failed to learn circle vs. ellipse were then given the opportunity to learn the form no-form discrimination by reinforcement and extinction alone, without fading. Six of the eight learned, but only three of these six then learned circle vs. ellipse on a second test. All seven Program-Group children who had learned form vs. no-form also learned the circle-ellipse discrimination by means of fading; each of the seven made fewer errors than any of the three who succeeded on the second test. Children who failed to learn circle vs. ellipse adopted response patterns incompatible with the development of appropriate stimulus control.     

Food-avoidance in hungry pigeons, and other perplexities

Twenty-three pigeons were subjected to a series of procedures in which the key-peck's effects ranged from immediate, differential food reinforcement, through delayed reinforcement, the production of stimulus changes with and without probable secondary reinforcement, the prevention of food presentation ("food-avoidance"), to extinction. Neither primary nor secondary food reinforcement appeared to be essential for the maintenance or acquisition of key pecking. The food-avoidance contingency failed to suppress responding in any subject. Only complete extinction, when pecking produced neither food nor stimulus changes, eliminated all pecking for most subjects. A combination of stimulus-change reinforcement and food reinforcement appeared to account for the results, but only if it could be assumed that the presence of food in a procedure enhanced the reinforcing power of stimulus change, whether or not the food was also dependent upon responding. Such an interaction between reinforcers may be involved in the phenomenon of autoshaping.     

LIQUID TO BABY FOOD FADING IN THE TREATMENT OF FOOD REFUSAL

In the current investigation, we identified two young children who consistently consumed liquids, but not baby food, after treatment with positive reinforcement for mouth clean (an indirect measure of swallowing) and physical guidance with re‐presentation of food. We examined the effects of an 11‐step stimulus fading procedure that involved gradually altering the concentration of liquid by adding baby food to the liquid. High levels of mouth clean were maintained in both children throughout fading, and increased mouth clean during probes of 100% baby food was obtained after conducting all 11 fading steps with one child and 6 of 11 fading steps with the second child. Negative vocalizations decreased during probes of 100% baby food after conducting the remaining fading steps with the second child. Gram intake of 100% baby food increased with both children after we completed all fading steps. Copyright © 2013 John Wiley & Sons, Ltd.