Use of treatment analysis following ambiguous functional analysis results

The present study used a treatment analysis following ambiguous functional analysis results to evaluate potential treatments to reduce the SIB of a 32‐year‐old male with profound mental retardation. In addition, effective treatments were determined for increasing compliance with increasingly more complex self‐care tasks. The results indicated that a positive reinforcement procedure with extinction was useful toward reducing SIB and increasing compliance during three increasingly more complex tasks. The usefulness of treatment analysis procedures following ambiguous functional analysis results are discussed. Copyright © 2009 John Wiley & Sons, Ltd.     

Functional analysis of self‐injury maintained by automatic reinforcement: exposing masked social functions

Two functional analyses for self‐injurious behavior (SIB) exhibited by a child diagnosed with mental retardation and autism were conducted. Responding was high and undifferentiated in the first functional analysis, indicating that SIB was maintained by automatic reinforcement. During the second functional analysis, the client wore a padded helmet and all SIB was blocked. SIB decreased in all conditions except attention, suggesting that SIB was multiply controlled (social positive and automatic reinforcement). Copyright © 2001 John Wiley & Sons, Ltd.     

WHAT MAKES EXTINCTION WORK: AN ANALYSIS OF PROCEDURAL FORM AND FUNCTION

We examined methods for determining how extinction should be applied to different functions of self-injurious behavior (SIB). Assessment data indicated that the head banging of 3 children with developmental disabilities was maintained by different reinforcement contingencies: One subject's SIB was positively reinforced by attention from adults, the 2nd subject's SIB was negatively reinforced by escape from educational tasks, and the 3rd subject's SIB appeared to be automatically reinforced or “self-stimulatory” in nature. Three functional variations of extinction—EXT (attention), EXT (escape), and EXT (sensory)—were evaluated, and each subject was exposed to at least two of these variations in reversal or multiple baseline designs. Reductions in SIB were observed only when implementation of “extinction” involved the discontinuation of reinforcement previously shown to be responsible for maintaining the behavior. These results highlight important differences among treatment techniques based on the same behavioral principle (extinction) when applied to topographically similar but functionally dissimilar responses, and further illustrate the practical implications of a functional analysis of behavior disorders for designing, selecting, and classifying therapeutic interventions.     

Injury characteristics across functional classes of self-injurious behavior

Self-injurious behavior (SIB) is inherently problematic because it can lead to injuries, including those that are quite severe and may result in loss of function or permanent disfigurement. The current study replicated and extended Rooker et al. (2018) by classifying the physical characteristics of injuries across groups of individuals with automatically maintained SIB (ASIB Subtypes 2 and 3) and socially maintained SIB. Individuals with Subtype 2 ASIB had the most frequent and severe injuries. Further, an inverse relation was found between the level of differentiation in the functional analysis and the number of injuries across groups. Studying the response products of SIB (the injuries) documents the risks associated with SIB, justifies the need for research and the intensive intervention, and advances knowledge of SIB. Additional research is needed to replicate these findings, and determine the variables that produce different characteristics of injury secondary to SIB.     

Self‐restraint and self‐injury: a demonstration of separate functions and response classes

We evaluated the self‐injurious behavior (SIB) and self‐restraint (SR) of an 11‐year‐old boy with severe mental retardation that were suspected to be functionally unrelated. A functional analysis (consequences provided for SIB) resulted in near‐zero levels of SIB across experimental conditions and did not indicate a specific function of SIB. In contrast, high, undifferentiated levels of SR were observed during the attention, control, alone, and demand conditions. Further analysis of a possible tangible function of SIB using pairwise comparisons resulted in a high rate of SIB during the contingent tangible condition, no SIB in the noncontingent tangible condition, and comparable levels of SR in both conditions. A subsequent analysis using restraint blocking during play and no‐play contexts suggested that SR produced automatic reinforcement under conditions of low ambient stimulation. Thus, SIB and SR were shown to be functionally independent and maintained by distinct consequences. The results are briefly discussed and suggestions for future research are provided. Copyright © 2000 John Wiley & Sons, Ltd.     

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.     

DECREASING SELF‐INJURIOUS BEHAVIOR AND FADING SELF‐RESTRAINT IN A STUDENT WITH AUTISM AND TOURETTE SYNDROME

This clinical case study was conducted with a student diagnosed with autism and Tourette syndrome who displayed severe self‐injurious behavior (SIB). Behavioral assessments and observations suggested that the student demonstrated less SIB during a self‐restraint, where he wrapped his hands tightly in a large blanket. We used an ABAB design with fading to reduce the size of the blanket to keep rates of SIB low. In addition, we also used a fixed interval reinforcement schedule and extinction during the intervention/restraint phases. Results indicated that the student maintained near‐zero rates of SIB for 6 months after use of the blanket was eliminated. Results and implications for practice and future research are discussed. Copyright © 2012 John Wiley & Sons, Ltd.     

Extended analysis and treatment of self‐injurious behavior

In experiment 1, an extended functional analysis of self‐injury was conducted with a 21‐year‐old male diagnosed with autism and profound mental retardation. The multielement phase yielded undifferentiated results. Subsequent blocking of conditions plus the addition of a component allowing access to multiple sensory stimuli suggested that self‐injury was unrelated to programmed positive or negative reinforcement contingencies. The behavior appeared to be automatically reinforced; its occurrence decreased when access to alternative sensory stimuli was provided. Experiment 2 evaluated a treatment condition in which response‐independent access to these sensory stimuli was provided within the participant's everyday environment. Baseline and treatment frequencies of self‐injury were compared in a combined, multiple‐baseline‐across‐settings and ABAB design. The level of self‐injury decreased substantially during treatment. These results support the use of extended analog analyses of aberrant behavior in instances in which undifferentiated responding occurs in the initial analogue analysis. Additionally, a procedure is described for generalizing the intervention derived from the experimental analysis into the participant's everyday environment. Copyright © 2001 John Wiley & Sons, Ltd.     

Self-injurious behavior a biological analysis

A review of self-injurious behavior (SIB) indicates several biological variables that should be considered in future research. A current hypothesis, that SIB is reinforced by attention, receives support but inadequately accounts for evidence that SIB can arise in the absence of reinforcement, is often difficult to modify, and has features unlike those of conditioned behavior. Alternative possibilities are suggested. Neurological damage is common in populations displaying SIB and may produce inadequate pain perception or avoidance. Stereotyped behavior, also common in these populations, may also be related to SIB. Stress and isolation, both strongly correlated with SIB, may evoke this behavior by altering levels of biogenic amines and affecting the probability of aggressive responses. Finally, SIB may have been favored in evolution by group and kin selection, as the loss of a damaged individual may actually favor his genotype through promotion of relatives. These alternatives are not necessarily mutually incompatible nor do they preclude a degree of flexibility in SIB. SIB may result from the interaction of several variables that independently increase its probability.     

FUNCTIONAL ANALYSIS AND TREATMENT OF SELF‐INJURY IN A CAPTIVE OLIVE BABOON

Self‐injurious behavior (SIB), such as self‐biting and head banging, has been reported to occur in approximately 10% of captive, individually housed nonhuman primates. Accounts of the etiology of SIB in primates range from ecological to physiological. However, to date, no research has examined the possible influence of social consequences delivered by handlers and keepers in the maintenance of SIB in this population. The current study investigated the effects of social contact as a potentially reinforcing consequence for the SIB displayed by an olive baboon (Papio hamadryas anubis). Results indicated that the behavior was maintained by attention from humans. As treatment, reinforcement was arranged for an appropriate alternative response, resulting in increases in the appropriate alternative behavior and decreases in SIB.     

DOES FUNCTIONAL COMMUNICATION TRAINING COMPETE WITH ONGOING CONTINGENCIES OF REINFORCEMENT? AN ANALYSIS DURING RESPONSE ACQUISITION AND MAINTENANCE

We examined the effectiveness of functional communication training (FCT) in reducing self-injurious behavior (SIB) and in shaping an alternative (communicative) response while SIB continued to be reinforced. Following a functional analysis of 3 individuals' SIB, we attempted to teach an alternative response consisting of a manual sign to each individual, using the reinforcer that maintained SIB. When FCT was implemented without extinction, SIB remained at baseline rates for all participants, and none of the participants acquired the alternative response. When extinction was added to the training procedure, SIB decreased and manual signing increased for all participants. To determine if signing, when established, would compete with SIB when both were reinforced, extinction was then withdrawn. Signing was maintained and SIB occurred at low rates for 2 individuals, but SIB returned to baseline rates for the 3rd individual, necessitating the reimplementation of extinction. These results suggest that it may be difficult to establish alternative behaviors if inappropriate behavior continues to be reinforced, but that, when established, alternative behavior might compete successfully with ongoing contingencies of reinforcement for inappropriate behavior.     

ANALYSIS OF SOCIAL VARIABLES WHEN AN INITIAL FUNCTIONAL ANALYSIS INDICATES AUTOMATIC REINFORCEMENT AS THE MAINTAINING VARIABLE FOR SELF‐INJURIOUS BEHAVIOR

Self‐injurious behavior (SIB) that occurs at high rates across all conditions of a functional analysis can suggest automatic or multiple functions. In the current study, we conducted a functional analysis for 1 individual with SIB. Results indicated that SIB was, at least in part, maintained by automatic reinforcement. Further analyses using protective equipment (i.e., a helmet with face shield) revealed an attention function for the SIB.     

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.     

The analysis and treatment of vocal stereotypy in a child with autism

This study examined procedures for the assessment and treatment of automatically reinforced vocal stereotypy of a 6‐year‐old girl with autism. Stimulus assessments were conducted to identify toys that were correlated with higher rates of vocal stereotypy and toys that were not. A concurrent operants assessment identified preferred stimuli (toys that produced auditory stimulation), which were then used as reinforcers for the non‐occurrence of vocal stereotypy. A reversal design was used to compare the effects of a fixed time schedule of reinforcement (FT 1‐min) to differential reinforcement for the non‐occurrence of behavior (DRO) to reduce vocal stereotypy. Implementation of the FT schedule revealed no effect, whereas the DRO schedule led to a reduction in the target behavior during treatment sessions and across the school day. This study adds to the body of literature supporting the identification of matched stimuli to reduce non‐socially mediated problem behavior. Copyright © 2005 John Wiley & Sons, Ltd.     

DRO contingencies: an analysis of variable-momentary schedules.

We conducted several comparative analyses to determine the relative effectiveness of variable-momentary differential-reinforcement-of-other-behavior (VM DRO) schedules. Three individuals who had been diagnosed with mental retardation participated. Results of functional analyses indicated that their self-injurious behavior (SIB) was maintained by social-positive reinforcement. Two individuals participated in a two-stage comparative analysis within multielement and multiple baseline designs. Fixed-interval (FI) and variable-interval (VI) DRO were compared in the first stage; VI DRO and VM DRO were compared in the second. All three schedules effectively reduced the participants' SIB. Treatment for the 3rd individual was conducted in a reversal design to examine the effects of VM DRO when it was implemented in isolation, and results indicated that the procedure was effective in reducing SIB. These findings suggest that VM DRO schedules may represent attractive alternatives to traditional FI schedules because momentary schedules do not require continuous monitoring and may result in higher rates of reinforcement.     

Further evaluation of latency measures in the assessment and treatment of severe self‐injurious behavior

Recent research has demonstrated the utility of latency measures during the functional analysis of problem behavior; however, few studies have evaluated the utility of latency measures during subsequent treatment analyses. The current study seeks to extend the literature on the use of latency measures during the treatment of severe self‐injurious behavior (SIB). Following a latency‐based functional analysis, a treatment analysis was conducted using a hybrid procedure in which baseline sessions were terminated following the first instance of SIB, and test sessions ended after a fixed length of time. Latency to SIB was compared across conditions, whereas latency and rate measures for both SIB and functional communication responses were compared for the functional communication training condition. Results suggest that latency measures may be too sensitive during treatment analyses and that it is beneficial to use a hybrid procedure that allows for both latency and rate comparisons.     

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.     

COMPUTER‐ASSISTED MEASUREMENT OF WOUND SIZE ASSOCIATED WITH SELF‐INJURIOUS BEHAVIOR

We evaluated an inexpensive, efficient, and noninvasive technique for measuring tissue damage produced by self‐injurious behavior (SIB). The technique involved computerized measurement of wound surface area (WSA) based on digital photographs. In Study 1, we compared photographic measurement to a more commonly used procedure, transparency measurement, in estimating WSA of 20 wound models. Results showed that both methods were reliable and that there was a high degree of correspondence between the 2 sets of measures. In Study 2, we compared photographic WSA measures to direct‐observation measures in documenting changes over time in the SIB exhibited by a woman with Prader‐Willi syndrome. Results showed that increases and decreases in observed SIB during baseline and treatment conditions corresponded with changes in WSA measures, indicating that the computer‐assisted photographic technique may be useful as a corroborative measure or as a primary measure when direct observation of SIB is not feasible.     

On the relation between object manipulation and stereotypic self-injurious behavior

Results from a number of studies have shown an inverse relationship between stereotypic behavior and object manipulation. The purposes of this study were to determine whether techniques similar to those used previously (prompting and reinforcement) would be effective in increasing object manipulation under both prompted and unprompted conditions, and to ascertain whether increases in object manipulation would result in decreases in stereotypic self-injurious behavior (SIB). Two individuals with developmental disabilities who engaged in SIB maintained by automatic reinforcement participated. Results showed that object manipulation increased from baseline levels when experimenters prompted participants to manipulate leisure items, but that object manipulation was not maintained under unprompted conditions, and rates of SIB stayed within baseline levels. We then attempted to increase object manipulation further by (a) reinforcing object manipulation, (b) blocking SIB while reinforcing manipulation, and (c) preventing SIB by applying protective equipment while reinforcing object manipulation. Reinforcing object manipulation alone did not affect levels of object manipulation. Blocking effectively reduced attempts to engage in SIB for 1 participant but produced no increase in object manipulation. When the 2nd participant was prevented from engaging in SIB through the use of protective equipment, rates of object manipulation increased dramatically but were not maintained when the equipment was removed. These results suggest that stimulation derived from object manipulation, even when supplemented with arbitrary reinforcement, may not compete with stimulation produced by stereotypic SIB; therefore, direct interventions to reduce SIB are required.     

Conjugate reinforcement: a brief review and suggestions for applications to the assessment of automatically reinforced behavior

Procedures involving conjugate reinforcement have been used extensively by researchers in developmental psychology, but sparingly by behavior analysts. Based on this trend, this paper calls for a re‐examination of conjugate reinforcement as a tool for analyzing automatically reinforced behavior. To this end, studies involving popular conjugate reinforcement preparations are briefly reviewed to highlight the impact of conjugate reinforcement outside of behavior analysis. In addition, results from selected behavior analytic studies are compared to studies involving conjugate reinforcement procedures. Throughout the review, recommendations for extending conjugate reinforcement preparations to the assessment of automatically reinforced behavior are provided. Copyright © 2008 John Wiley & Sons, Ltd.