DENTIST-IMPLEMENTED CONTINGENT ESCAPE FOR MANAGEMENT OF DISRUPTIVE CHILD BEHAVIOR

We evaluated the effectiveness of a dentist-implemented intervention in which brief escape from dental treatment was provided to manage disruptive child behavior during restorative dental treatment. Within a multiple baseline design across subjects, 4 children, aged 3 to 7 years, were provided temporary escape from dental treatment contingent upon brief periods of cooperative behavior. Disruptive behavior decreased when the appropriate escape contingency was used at least 80% of the time. The escape contingency required no more time than traditional management procedures (e.g., tell-show-do, reprimands and loud commands, restraint) to bring disruptive behavior under control. Independent ratings by two dentists provided social validation of the efficacy of the escape contingency.     

USE OF ESCAPE AND REWARD IN THE MANAGEMENT OF YOUNG CHILDREN DURING DENTAL TREATMENT

A reinforced practice procedure was used to facilitate cooperative behavior in five children, aged 3 to 6 years, during dental treatment. In a multiple baseline design across subjects, the children were rewarded with escape, inexpensive stickers, and praise for cooperative behavior in the presence of the sights, sounds, and some sensations of the dental instruments prior to actual dental treatment. Direct observations of disruptive behavior via a 15-s interval recording system indicated baseline levels as high as 90% were reduced to less than 15% by the final treatment visit. In addition, the procedure was effective in reducing overall heart rate and blood pressure reactivity to dental treatment. All children were rated by the involved dental professionals as more cooperative and relaxed following exposure to reinforced practice.     

DISTRACTION: ITS UTILIZATION AND EFFICACY WITH CHILDREN UNDERGOING DENTAL TREATMENT

We investigated the utilization and efficacy of distraction in reducing the anxious and disruptive behavior of 4 children undergoing dental treatment. During the distraction procedure, the children were shown a poster and told a story about it during dental treatment. They earned a prize if they attended to the poster and story and could correctly answer questions about them following each intervention visit. The children's disruptive behavior was assessed via direct observation, and results were analyzed within a multiple baseline design. The children exhibited high levels of anxious and disruptive behavior across baseline visits, regardless of the length of time in treatment or number of visits. Anxious and disruptive behavior decreased upon introduction of the intervention for all children. This was accompanied by the children meeting the criterion for correct answers on the distraction quiz. However, 2 of the children demonstrated an increase in their anxious and disruptive behavior across intervention visits. Results are discussed in terms of the need to evaluate treatment strategies that promote maintenance as well as initial changes.     

Peer and college-student tutoring as reinforcement in a token economy

Eighteen second-grade children initially received feedback in the form of nonredeemable tokens for reducing their disruptive classroom behavior. Four types of tutoring were then introduced in a Latin Square Design: noncontingent tutoring from fifth-grade peers, contingent peer tutoring, noncontingent college tutoring, and contingent college tutoring. No significant difference was found in the level of disruptive behavior of those children tutored by fifth-grade peers or college students, but contingent tutoring was significantly effective in reducing disruptive classroom behavior.     

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.     

A comparison of procedures for unpairing conditioned reflexive motivating operations

This study compared the effectiveness of two procedures to reduce behavior evoked by a reflexive conditioned motivating operation (CMO‐R). Task demands were shown to evoke escape‐maintained problem behavior for 4 students with disabilities. Alternative communication responses were taught as an appropriate method to request escape and this treatment combined with extinction for problem behavior led to decreases in problem behavior for all students. A beeping timer was then arranged to temporally precede the task demand to create a CMO‐R that evoked communication responses. When data showed that the sound of the timer was functioning as a CMO‐R, two methods to reduce behavior evoked by a CMO‐R—extinction unpairing and noncontingent unpairing—were evaluated. Results indicated that noncontingent unpairing was an effective method to reduce the evocative effects of the CMO‐R. Extinction produced unsystematic effects across participants. Results are discussed in terms of abolishing CMOs and the implications of CMOs.     

NONCONTINGENT ESCAPE AS TREATMENT FOR SELF-INJURIOUS BEHAVIOR MAINTAINED BY NEGATIVE REINFORCEMENT

We extended research on the role of noncontingent positive reinforcement following a functional analysis of attention-maintained self-injurious behavior to self-injury maintained by negative reinforcement in 2 young males with developmental disabilities. During a pretreatment functional analysis, each participant's self-injury was shown to be differentially sensitive to escape from instructional activities as negative reinforcement. During noncontingent escape, escape from learning activities was provided on a fixed-time schedule that was not influenced by the participant's behavior. One participant was also exposed to differential negative reinforcement of other behavior. During this condition, escape from instructional activities was provided contingent on the omission of self-injury for prespecified intervals. Results showed that the provision of escape, even when noncontingent, resulted in significant reductions in self-injury. These results are particularly interesting in light of the experimental history of noncontingent reinforcement as a control rather than as a therapeutic procedure. Noncontingent escape is discussed as a form of extinction that may be less likely than other forms of extinction to produce severe side effects.     

THE USE OF NONCONTINGENT ESCAPE TO REDUCE DISRUPTIVE BEHAVIORS IN CHILDREN WITH SPEECH DELAYS

Noncontingent escape (NCE) was used to reduce disruptive behavior in 3 children during regularly scheduled speech therapy sessions. Results showed rapid decreases in disruptive behavior and accompanying increases in compliance across children. Findings suggest that speech therapists with little expertise in behavior analysis can effectively implement NCE.     

On the relative contributions of noncontingent reinforcement and escape extinction in the treatment of food refusal

In the current investigation, we evaluated the relative effects of noncontingent reinforcement (NCR), escape extinction, and a combination of NCR and escape extinction as treatment for the feeding problems exhibited by 4 children. For each participant, consumption increased only when escape extinction was implemented, independent of whether NCR was present or absent. These results were consistent with prior research suggesting that positive reinforcement alone is insufficient for increasing consumption, and that escape extinction often is necessary to increase and maintain food acceptance. However, NCR appeared to decrease inappropriate behavior for some participants.     

The effects of differential negative reinforcement of other behavior and noncontingent escape on compliance

The present study evaluated the effects of noncontingent escape and differential negative reinforcement of other behavior in reducing problem behaviors and increasing compliance in 2 children with disabilities. Results showed that both methods reduced problem behavior and increased compliance for both children.     

Continuous self-monitoring of discomfort in the dental chair and feedback to the dentist

The purpose of this study was to examine a continuous measurement of discomfort given by patients during aversive and nonaversive dental activities. To demonstrate the sensitivity of the measurement, the degree of feedback to the dentist about discomfort and the belief in that feedback were varied during oral examination, topical application, and injection of anesthesia. Patients operated buttons which were connected to a recorder and to light which signaled levels of discomfort to the dentist. The lights were operating during the dental activities for the Actual Feedback Group but not for the Belief in Feedback or the No Feedback Group. Subjective ratings of discomfort were also taken after each dental activity. The behaviorally based self-monitoring measure was more sensitive to variations in dental activities than were self-ratings. It showed differences across groups during the aversive, but not the nonaversive, events; showed differences in the delay of discomfort across groups; and suggested a decay in the belief in feedback effect with noncontingent dental response to discomfort responses.This study was supported in part by Research and Training Center Grant 16-P-56812, RT-13 from the National Institute of Handicapped Research, Office of Special Education, Department of Education.     

Behavioral variability as a function of noncontingent adult attention,peer availability,and situational demands in three hyperactive boys

Recommendations about placements for children in need of special education are routinely made and carried out without empirical validation for the efficacy of particular approaches nor the appropriateness of an approach for a particular child. A study was designed to examine a methodological model which focuses on empirically deriving recommendations for the most appropriate teaching situation for any given child requiring special education. Prosocial, problem, and task-related behaviors in three hyperactive boys were assessed in eight prearranged situations: (1) group play with one adult supervising; (2) group play with three adults; (3) group teaching with one adult; (4) group teaching with three adults; (5) individual play with low density noncontingent adult attention; (6) individual play with high density noncontingent adult attention; (7) individual teaching with low density noncontingent adult attention; and (8) individual teaching with high density noncontingent adult attention. Behaviors assessed included adult, peer, and target child attention given and received; compliance; aggression; disruption; task involvement; and percent tasks correctly completed of tasks attempted. Data revealed that the most disruptions and least efficient task performance occurred in the group teaching situation with one adult. The most efficient task performance and fewest disruptions in a teaching situation occurred in the individual teaching setting with high density noncontingent adult attention. In addition. overall mean rates of disruptive behavior were higher in group situations than in individual situations. The data strongly validate the need for carefully selecting educational environments for problem children, and that the behavior of such children is, at least, partially influenced by environmental factors.     

Recent advances in the modification of establishing operations to reduce aberrant behavior

The term establishing operation (EO) refers to an event that alters the reinforcement effects of a particular stimulus. Although EOs have received more attention in the basic, non-human literature, reports of EO manipulations in the treatment of aberrant behavior are increasingly appearing. We discuss EO interventions for behaviors maintained by social positive reinforcement (e.g., noncontingent reinforcement), social negative reinforcement (e.g., noncontingent escape, curricular revision, demand fading), and automatic reinforcement (e.g., environmental enrichment, noncontingent stimulation, reduced aversive stimulation). Suggestions for future research concerning both specific EO interventions and the general manipulation of EOs as a behavior-change technique are provided. © 1998 John Wiley & Sons, Ltd.     

Comparing Self-Regulation-Associated Event Related Potentials in Preschool Children with and without High Levels of Disruptive Behavior

Deficient self-regulation plays a key role in the etiology of early onset disruptive behavior disorders and signals risk for chronic psychopathology. However, to date, there has been no research comparing preschool children with and without high levels of disruptive behavior using Event Related Potentials (ERPs) associated with specific self-regulation sub-processes. We examined 15 preschool children with high levels of disruptive behavior (35 % female) and 20 peers with low disruptive behavior (50 % female) who completed a Go/No-go task that provided emotionally valenced feedback. We tested whether 4 ERP components: the Error Related Negativity, the Error Positivity, the Feedback Related Negativity, and the No-go N2, differed in preschool children with and without high levels of disruptive behavior. Preschoolers with high levels of disruptive behavior showed less differentiation between the Error Positivity and corresponding waveforms following correct responses at posterior sites. Preschoolers with high and low disruptive behavior also showed differences in Go/No-go N2 waveform amplitudes across electrodes. These findings suggest that preschool children with high levels of disruptive behavior may show abnormal brain activity during certain self-regulation sub-processes, informing potential advances in conceptualizing and treating early disruptive behavior.     

Reduction of kindergarten children's disruptive behavior with delayed feedback and delayed contingent access to play

After measuring the amount of disruptive behavior exhibited by nine kindergarten children in a lunchroom, delayed feedback about the disruptive behaviors engaged in was given to each child after he left the lunchroom, but there were no additional differential consequences for any behaviors. This delayed feedback alone had little effect on the rates of disruptive behavior. When the delayed feedback was paired with contingent access to play, the rates of disruptive behaviors of six of the children was substantially reduced. A more elaborate form of feedback, still paired with contingent access to play, was later found to be effective in reducing the rates of disruptive behavior of the other three children. When contingencies and feedback were removed, the rates of disruptive behavior of the three children who required the extended feedback increased, but the rates of disruptive behavior for the other six children did not increase upon termination of contingencies and feedback. However, when disruptive behavior was differentially reinforced, the rates of disruptive behavior of all of the children increased.     

Social reinforcement: A treatment component in verbal self-instructional training

This study investigated the effects of noncontingent social reinforcement on social and academic behaviors in grade school children. Twenty-four children in the second through fifth grades were selected on the basis of teacher ratings of disruptive behavior. Subjects were divided into (a) a high social reinforcement verbal self-instructional (VSI) training group, (b) a low social reinforcement VSI group, and (c) a no-contact control group. Children in VSI groups were removed from their classrooms during four 40-minute periods and given VSI training. Significant between-groups differences on measures of social reinforcement were found indicating its successful manipulation. While none of the dependent measures indicated significant differences between experimental groups, a consistent pattern of difference scores emerged giving limited support to the hypothesis that noncontingent social reinforcement contributed to behavioral gains. Results are discussed in terms of the need for future research on the effects of rapport on treatment outcome.Both authors wish to express their thanks to the Missoula public school administration, principals, psychologists, and teachers. Appreciation is also due to Matthew Firpo and Anita Fisher for their help in this project.     

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.     

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.     

Effects of decreasing intersession interval duration on graduated exposure treatment during simulated routine dental care

Reports suggest that individuals with developmental disabilities often engage in behavior during dental visits that precludes regular dental care. Graduated exposure therapies are an effective treatment for avoidant behavior in people with developmental delays, and some studies show that the duration of the intersession interval (ISI) can impact the effectiveness of graduated exposure treatments for typically developing individuals. The current study examined the effects of decreasing ISI on outcomes of a graduated exposure treatment during simulated routine dental care for 3 individuals diagnosed with autism. Treatment consisted of graduated exposure and extinction for disruptive behavior. Initially, sessions were conducted once per week. In subsequent conditions, treatment sessions were conducted 3‐5 times per week. A nonconcurrent multiple baseline across subjects design was used to demonstrate experimental control. Results suggest that decreasing ISI durations can produce improved treatment outcomes.     

Maintenance of appropriate behavior in a token program

Following a baseline period, a token reinforcement program was instituted in three resource-room classes for very disruptive children where the children spent 1 hour per day. The only reinforcers used in the token program were those available to any classroom teacher, viz., free time in an activity area. The effects of the token program were evaluated in the three resource-room classes as well as in the homerooms of all students participating in the resource-room program. Following 4 months of the token program, a return to baseline was made in one resource classroom. As assessed by standard classroom observations, the token program was effective in reducing disruptive behavior in all three resource-room classes; and when it was withdrawn in one resource-room class, the disruptive behavior remained at a very low level in the resource room. Ratings by teachers in the homerooms showed a significant reduction in disruptive behavior, but recordings by homeroom observers showed no such reduction. Possible reasons for maintenance of low rates of disruptive behavior after withdrawal of tokens were discussed in terms of the type of reinforcers used.