EXPERIMENTAL ANALYSIS AND EXTINCTION OF SELF-INJURIOUS ESCAPE BEHAVIOR

Three studies are presented in which environmental correlates of self-injurious behavior were systematically examined and later used as the basis for treatment. In Study 1, 7 developmentally disabled subjects were exposed to a series of conditions designed to identify factors that maintain self-injurious behavior: attention contingent on self-injurious behavior (positive reinforcement), escape from or avoidance of demands contingent on self-injurious behavior (negative reinforcement), alone (automatic reinforcement), and play (control). Results of a multielement design showed that each subject's self-injurious behavior occurred more frequently in the demand condition, suggesting that the behavior served an avoidance or escape function. Six of the 7 subjects participated in Study 2. During educational sessions, “escape extinction” was applied as treatment for their self-injurious behavior in a multiple baseline across subjects design. Results showed noticeable reduction or elimination of self-injurious behavior for each subject and an increase in compliance with instructions in all subjects for whom compliance data were taken. The 7th subject, whose self-injurious behavior during Study 1 occurred in response to medical demands (i.e., physical examinations), participated in Study 3. Treatment was comprised of extinction, as in Study 2, plus reinforcement for tolerance of the examination procedure, and was evaluated in a multiple baseline across settings design. Results showed that the treatment was successful in eliminating self-injurious behavior and that its effects transferred across eight new therapists and three physicians. General implications for the design, interpretation, and uses of assessment studies are discussed.     

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.     

Case study: Improving the social interactions of a group home resident with severe and multiple disabilities

A 43-year-old man with severe mental retardation and sensory impairments and a long history of behavior problems was taught to interact more appropriately with staff members at his community-based group home. The following behaviors were targeted for change within a multiple baseline design: use of an appropriate cueing response to initiate a conversation; keeping his hands to himself when conversing with another; and not ‘badgering’ people by repeating the same question over and over. Instructions and feedback produced small, unstable improvements in the subject's behavior. When token reinforcement was added to the treatment package, large and immediate improvements were noted. The improved levels of social interactions were maintained after token reinforcement was withdrawn, suggesting the operation of naturally occurring contingencies of reinforcement.     

EFFECTS OF WRIST WEIGHTS ON SELF-INJURIOUS AND ADAPTIVE BEHAVIORS

The effects of wrist weights on the self-injurious and adaptive behaviors of a young boy with profound mental retardation were evaluated. Application of wrist weights reduced SIB by 92% and was associated with either increases or stable levels of multiple novel and preexisting adaptive behaviors.     

SELF-RESTRAINT AS POSITIVE REINFORCEMENT FOR SELF-INJURIOUS BEHAVIOR

Many individuals who engage in self-injurious behavior (SIB) also exhibit self-restraint. We compared rates of SIB exhibited by a 32-year-old woman diagnosed with profound retardation across conditions in which access to restraint was (a) continuously available, (b) presented as a consequence for SIB, or (c) unavailable. Rates of SIB increased when access to restraint was contingent upon SIB and decreased when restraint was unavailable, suggesting that self-restraint functioned as positive reinforcement for SIB.     

EFFECTS OF REINFORCEMENT FOR ALTERNATIVE BEHAVIOR DURING PUNISHMENT OF SELF-INJURY

A number of variables influence the effectiveness of punishment and may determine the extent to which less intrusive forms of punishment may be used as alternatives to more intrusive interventions. For example, it has been suggested that response suppression during punishment may be facilitated if reinforcement is concurrently available for an alternative response. However, results of basic research demonstrating this finding have not been replicated with interventions more commonly prescribed as treatments for problem behavior. We evaluated the effects of relatively benign punishment procedures (reprimands or brief manual restraint) on the self-injurious behavior of 4 individuals who had been diagnosed with mental retardation, when access to reinforcement for alternative behavior (manipulation of leisure materials) was and was not available. In all cases, punishment produced greater response suppression when reinforcement for an alternative response was available.     

Ten-year follow-up of a successful treatment of self-injurious behavior

Ten years ago, self-injurious behavior that produced blindness in a man with profound mental retardation was treated through behavioral intervention. This person's behavioral history was reviewed for 12 years prior to the intervention through examination of his clinical record and for 10 years following the intervention through examination of his clinical record, direct observation, and interviews with staff. Physical injury occurred only once in the last 46 months; physical restraint has not been used in 10 years; and for the past 9 years, no more than one medication has been prescribed for the control of behavior or seizures. Suggestions are presented for designing behavioral interventions at the beginning of treatment to maintain reductions in behavior.     

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.     

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.     

Acceptability bias: The effects of treatment acceptability on visual analysis of graphed data

Vignettes depicting a mildly or severely self-abusive child with profound mental retardation who received either a differential reinforcement of other behavior or a contingent electric shock treatment were presented to 161 undergraduates. After subjects rated the acceptability of the given treatment on the Treatment Evaluation Inventory (TEI), they evaluated the efficacy of the given treatment based upon six AB data graphs. Visual analytic judgments were not significantly effected by type of treatment, severity of self-injurious behavior (SIB), or the treatment × SIB interaction. TEI scores differed significantly according to type of treatment. Simple and multiple correlations computed between TEI scores and graph evaluations provided evidence ofacceptability bias, such that more favorable appraisals of treatment acceptability were related to perceptions of greater treatment effectiveness.     

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

Three individuals with developmental disabilities were exposed to a series of assessment conditions to identify the source of reinforcement for their self-injurious behavior. In each case, self-injury occurred most often in instructional (demand) situations containing a brief time-out from the task contingent on self-injury, indicating that the behavior was an escape response (i.e., maintained by negative reinforcement). Treatment was implemented in a multiple baseline across subjects design and consisted of extinction (prevention of escape) plus instructional fading (initial elimination of instructions followed by their gradual reintroduction). Results showed that the combined treatment produced immediate and large reductions in self-injury that were maintained as the frequency of instructions was increased across sessions to match the original baseline rate of presentation. Results of a component analysis conducted with 1 subject suggested that stimulus fading accelerated the behavior-reducing effects of extinction.     

Helmet restraint and visual screening as treatment for self-injurious behavior in persons who have profound mental retardation

Enhancement of sensory, cutaneous stimulation may be one reason for self-injurious behavior among persons with mental retardation. For self-injury involving head or face, a contingently applied helmet prevents access to the sensitized skin area. Such a restraint procedure, with visual occlusion superimposed on the helmet, was tested with two women who are profoundly retarded. Helmet and transparent shield reduced target responses by both women to approximately 7% of baseline rates. When the helmet's face shield was made opaque, a small, further response reduction was obtained. Stable, low rates were maintained over a 6-month maintenance period.     

Student learning as the basis for reinforcement to the instructor

The present study reinforced the two instructors of two students with profound mental retardation first for the instructors' training behaviors, then for improved student learning in a multiple baseline across responses design. Reinforcement of the instructors' training behaviors increased their training behaviors, replicating the findings of previous studies, but had no effect on student learning. When the reinforcement for the instructors was instead made contingent upon student learning, the student learning improved and the instructors' high level of training behaviors was maintained. In addition, the instructors began to request training for themselves. These findings suggest that staff motivation programs for instructors might usefully base the reinforcers not only on the instructor's performance, but on the progress of their students.     

EFFECTS AND SIDE EFFECTS OF DRO AS TREATMENT FOR SELF-INJURIOUS BEHAVIOR

A three-part controlled case study is presented in which severe and longstanding self-injurious behavior exhibited by a 9-year-old-boy was treated successfully with differential reinforcement of other behavior. In Phase 1, an experimental analysis demonstrated that the boy's scratching was not maintained by environmental contingencies; instead, it appeared that the self-injurious behavior was a stereotypic (automatically reinforced) response. In Phase 2, the effects of an escalating differential-reinforcement-of-other-behavior schedule mediated through token reinforcement (pennies) were evaluated in a reversal design. Results showed that differential-reinforcement-of-other-behavior eliminated self-injurious behavior very quickly and for periods of time as long as 30 min. A noteworthy side effect observed during Phase 2 was the occurrence of crying behavior following the nondelivery of reinforcement. In Phase 3, the token program was gradually extended in 30-min increments throughout the day. Additionally, results of a brief multielement manipulation showed that the effects of token reinforcement were superior to those of a more easily administered differential reinforcement of other behavior based on social reinforcement, which differed little from baseline.     

ONGOING CONSULTATION AS A METHOD OF IMPROVING PERFORMANCE OF STAFF MEMBERS IN A GROUP HOME

A model of ongoing consultation was implemented in a community group home for 8 adults with severe and profound mental retardation. Two consultants, highly experienced in working with people with mental retardation and in the procedures used in group homes, taught staff members to use a token reinforcement system, to engage the adults in a variety of activities, and to improve the content and style of the staff members' interactions with the adults. The consultants taught skills to 9 staff members through brief mini-workshops, direct observation of the staff members' use of the skills during regular activities in the group home, and individual verbal feedback regarding a staff member's performance of the skills. Evaluation of the ongoing consultation process by the 2 consultants showed it to be effective in improving the performance of the staff members and in changing the behaviors of the adults who lived in the home. Continued implementation of the process, however, appeared to be necessary for the behavior changes of staff members to be maintained at high levels.     

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.     

AUGMENTING SIMPLIFIED HABIT REVERSAL IN THE TREATMENT OF ORAL-DIGITAL HABITS EXHIBITED BY INDIVIDUALS WITH MENTAL RETARDATION

We investigated whether a simplified habit reversal treatment eliminates fingernail biting and related oral-digital habits exhibited by individuals with mild to moderate mental retardation. Although simplified habit reversal did little to decrease the target behaviors for 3 of 4 participants, simplified habit reversal plus additional treatment procedures decreased the behavior to near-zero levels for all participants. These procedures included remote prompting, remote contingencies involving differential reinforcement plus response cost, and differential reinforcement of nail growth. Limitations of habit reversal for individuals with mental retardation along with directions for future research involving therapist-mediated treatment procedures, particularly those involving remote prompting and remote contingencies, are discussed.     

Competition between noncontingent and contingent reinforcement schedules during response acquisition

We examined the extent to which noncontingent reinforcement (NCR), when used as treatment to reduce problem behavior, might interfere with differential reinforcement contingencies designed to strengthen alternative behavior. After conducting a functional analysis to identify the reinforcers maintaining 2 participants' self-injurious behavior (SIB), we delivered those reinforcers under dense NCR schedules. We delivered the same reinforcers concurrently under differential-reinforcement-of-alternative-behavior (DRA) contingencies in an attempt to strengthen replacement behaviors (mands). Results showed that the NCR plus DRA intervention was associated with a decrease in SIB but little or no increase in appropriate mands. In a subsequent phase, when the NCR schedule was thinned while the DRA schedule remained unchanged, SIB remained low and mands increased. These results suggest that dense NCR schedules may alter establishing operations that result in not only suppression of problem behavior but also interference with the acquisition of appropriate behavior. Thus, the strengthening of socially appropriate behaviors as replacements for problem behavior during NCR interventions might best be achieved if the NCR schedule is first thinned.     

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.     

RESPONDING MAINTAINED BY INTERMITTENT REINFORCEMENT: IMPLICATIONS FOR THE USE OF EXTINCTION WITH PROBLEM BEHAVIOR IN CLINICAL SETTINGS

Results of basic research have demonstrated that behavior maintained on an intermittent schedule of reinforcement (INT) will be extinguished more slowly than behavior maintained on a continuous schedule (CRF). Although these findings suggest that problem behaviors may be difficult to treat with extinction if they have been maintained on INT rather than on CRF schedules, few applied studies have examined this phenomenon with human behavior in clinical settings. The purpose of this study was to determine whether problem behavior maintained on CRF schedules would be extinguished more rapidly than behavior maintained on INT schedules. Three individuals diagnosed with profound mental retardation participated after results of pretreatment functional analyses had identified the sources of reinforcement that were maintaining their self-injury, aggression, or disruption. Subjects were exposed to extinction following baseline conditions with CRF or INT schedules alternated within reversal or multielement designs. Results suggested that problem behaviors may not be more difficult to treat with extinction if they have been maintained on INT rather than CRF schedules. However, switching from an INT to a CRF schedule prior to extinction may lower the baseline response rate as well as the total number of responses exhibited during extinction.