Brief assessment and treatment of pica using differential reinforcement,response interruption and redirection,and competing stimuli

Pica is a life threating form of challenging behavior displayed by individuals with intellectual and developmental disabilities. In most cases, pica is maintained by automatic reinforcement. Common interventions for pica use some combination of response blocking, response interruption and redirection (RIRD), differential reinforcement of alternative behavior (DRA), and noncontingent reinforcement with competing stimuli. However, there is need for additional research regarding DRA procedures that emphasize skills acquisition by teaching alternative behaviors that modify the established behavioral chain of pica responses that occur in the presence of non-edible stimuli. There is also a need to examine the generality of recent advances in competing stimulus assessment (CSA) methodologies—namely, the augmented-CSA (A-CSA)—to pica. Thus, the purpose of the present investigation was to systematically replicate and extend previous research for the assessment and treatment of pica in an individual with IDD. First, we conducted a functional analysis to identify environmental variables associated with pica. Next, taught Patrick a differential response (i.e., discard pica items in trash receptacle) to earn reinforcers in conjunction with a RIRD procedure. Finally, we conducted an A-CSA for pica. Overall, low rates of pica were maintained over time with a combination of these procedures, and treatment was generalized across settings and people.     

Parental use of escape extinctionand differential reinforcement to treat food selectivity.

Escape extinction combined with differential reinforcement for acceptance has been demonstrated to be an effective treatment for food selectivity when implemented by trained professionals in clinic settings. This study evaluated the efficacy of parent-implemented escape extinction in the child''s natural environment using video monitoring to train parents and assess intervention efficacy. Parents were able to use intervention to significantly increase bites accepted and decrease problem behavior.     

Varying response effort in the treatment of pica maintained by automatic reinforcement

Pica is a life-threatening behavior displayed by many individuals with developmental disabilities. In the current study, automatic reinforcement maintained the pica of 3 participants. Following functional analyses of pica, response-effort manipulations were conducted in which the effort to obtain pica or alternative items was varied systematically. Several general relations emerged as a result of the study. First, levels of pica were reduced relative to baseline when alternative items were available independent of the effort required to obtain alternative items or pica. Second, increasing the effort for alternative items resulted in increases in pica relative to when effort for alternative items was low. Third, increasing response effort for pica produced reductions in pica relative to baseline when alternative items were unavailable. Fourth, the highest levels of pica occurred when the effort to engage in pica was low or medium and no alternative items were available. These findings are discussed in terms of the relative effects of quality of reinforcement and response effort on behavior.     

Modification of a response bias through differential amount of reinforcement

A procedure is described for assessing response bias to either the form or color dimension of a compound standard stimulus. Responding was assessed under conditions of equal reinforcement (three tokens) for responding to either the form or color dimension. Under these conditions, the four male subjects (aged 7 to 11 yr) differentially responded to the form dimension. After a bias was assessed, the number of tokens delivered contingent upon form responses was reduced. After a reversal in differential responding, the equal-reinforcement condition was reintroduced. Two of the subjects returned to their initial response bias when equal reinforcement for either dimensional response was reintroduced, and two maintained the reversal established during the differential-reinforcement phase. For the latter two subjects, differential reinforcement was again imposed, in favor of form. This partial replication reinstated their original pattern of response bias.     

An evaluation of two differential reinforcement procedures with escape extinction to treat food refusal

Consumption of solids and liquids occurs as a chain of behaviors that may include accepting, swallowing, and retaining the food or drink. In the current investigation, we evaluated the relative effectiveness of differential reinforcement of the first behavior in the chain (acceptance) versus differential reinforcement for the terminal behavior in the chain (mouth clean). Three children who had been diagnosed with a feeding disorder participated. Acceptance remained at zero when differential reinforcement contingencies were implemented for acceptance or mouth clean. Acceptance and mouth clean increased for all 3 participants once escape extinction was added to the differential reinforcement procedures, independent of whether reinforcement was provided for acceptance or for mouth clean. Maintenance was observed in 2 children when escape extinction was removed from the treatment package. The mechanism by which consumption increased is discussed in relation to positive and negative reinforcement contingencies.     

Using differential reinforcement of low rates to reduce children's requests for teacher attention

We evaluated the effectiveness of full-session differential reinforcement of low rates of behavior (DRL) on 3 primary school children's rates of requesting attention from their teacher. Using baseline rates of responding and teacher recommendations, we set a DRL schedule that was substantially lower than baseline yet still allowed the children access to teacher assistance. The DRL schedule was effective in reducing children's requests for assistance and approval, and the teacher found the intervention highly useful and acceptable. The possible mechanisms that account for behavior change using full-session DRL schedules are discussed.     

Behavioral case consultation with parents and teachers: An example using differential reinforcement to treat psychogenic cough

This study presents a demonstration of successful behavioral case consultation combined with case study methodology in the treatment of a 13-year-old female who presented with a brief history of psychogenic cough. Psychogenic cough is diagnosed when there is no organic or physiologic basis for the repeated, harsh coughing. We first present a brief review of treatments for psychogenic cough and then describe how we used differential reinforcement of low rate responding (DRL) and differential reinforcement of zero responding (DRO) within an A-B-C design. The DRL schedule produced significant decreases in coughing but plateaued at about one-third the baseline rate. Thereafter, a DRO schedule was employed which resulted in complete and lasting elimination of coughing. Discussion focuses on the limitations of case study methodology as well as its usefulness for conducting service related research in the schools, implications of some of the findings for practitioners, and other issues related to treatment.     

An evaluation of simultaneous presentation and differential reinforcement with response cost to reduce packing

We evaluated the effects of multiple treatment procedures, including simultaneous presentation of preferred foods, on the packing behavior of a 9-year-old girl with autism. A reversal design was used to assess the effects of differential reinforcement with response cost alone and with simultaneous presentation. In addition, simultaneous presentation was assessed independent of differential reinforcement with response cost. Results indicated that simultaneous presentation reduced packing and that differential reinforcement with response cost was not necessary to maintain these reductions. Results are discussed in terms of the use of simultaneous presentation for packing as an alternative to consequence manipulations.     

Children discard a resource to avoid inequity

Elucidating how inequity aversion (a tendency to dislike and correct unequal outcomes) functions as one develops is important to understanding more complex fairness considerations in adulthood. Although previous research has demonstrated that adults and children reduce inequity, it is unclear if people are actually responding negatively to inequity or if people dislike others getting more than them (motivated by social comparison) and like to share maximal resources, especially with those who have few resources (motivated by social welfare preferences). In order to evaluate if children are truly averse to inequity, we had 3- to 8-year-old children distribute resources to 3rd parties and found that 6- to 8-year-old children would rather throw a resource in the trash than distribute unequally, suggesting that concerns with equity can trump concerns with maximal sharing. We also demonstrated that children's reactions were not based on wanting to avoid upsetting the recipients or based on a preference for visual symmetry and that children will even throw away a resource that could have gone to themselves in order to avoid inequity. These results demonstrate the existence of inequity aversion in children, provide a new method for studying inequity aversion specifically, and suggest the need for new models to explain why inequity aversion may have evolved.     

A comparison of response cost and differential reinforcement of other behavior to reduce disruptive behavior in a preschool classroom

This study investigated the effectiveness of response cost and differential reinforcement of other behavior (DRO) in reducing the disruptive behaviors of 25 children in a preschool classroom. Using an alternating treatments design, disruptive behavior was reduced when the participants earned tokens for the absence of disruptive behavior (DRO) or lost tokens for the occurrence of disruptive behavior (response cost). Initially, DRO was more successful in reducing the number of disruptive behaviors; however, over time, response cost proved to be more effective.     

Intermittent reinforcement of a continuous response

Konorski showed that when a go/no-go procedure was used, sound quality discriminations were rapidly acquired and sound location discriminations were slowly acquired. These findings have been interpreted as a general constraint on the acquisition of auditory discriminations (quality-location effect). However, experiments carried out within an evolutionary framework (Harrison, 1984) have shown that the rate of acquisition of sound location discriminations varies widely as a function of the inclusion or exclusion of naturalistic features. These data suggest that Konorski's findings were a function of the special conditions of the experiments. The first purpose of the present experiments was to assess whether rats showed the effects noted by Konorski when studied under similar conditions. The second purpose was to study the effect of manipulating two natural features (novelty and stimulus-response adjacency) to assess whether the acquisition rates of quality and location discriminations could be greatly modified or made approximately equal, or both. When a go/no-go procedure was used and the other conditions were similar to those of Konorski, rats acquired a quality discrimination but did not acquire a location discrimination. However, when the S+ or S- were presented through a closely adjacent speaker, the sound location discrimination was acquired as rapidly as the quality discrimination. Finally, preexposing the animal to either S+ or S- retarded the rate of or prevented the acquisition of the quality discrimination. The experiments showed that the quality-location effect was determined primarily by the conditions used in Konorski's experiments, and that the effect is not a general constraint on learning.     

The use of brief restraint plus reinforcement to treat self-injurious behavior

This study evaluated the use of brief arm restraint plus differential reinforcement of alternative behavior to treat the self-injurious behavior of two residents with multiple handicaps and profound mental retardation. The study took place in a nursing home and sessions were conducted for 15 minutes, Monday through Friday. The design contained both multiple baseline and reversal components. Mean levels of self-injurious behavior and stripping for one client were reduced from 92 to 16% and 81 to 2%, respectively, by the treatment. Her appropriate behavior increased from a mean of 18% in baseline to 100% in treatment. The second client's self-injurious behavior averaged 39% in baseline, but was reduced to a mean of 9% in treatment. His throwing decreased from a mean of 54% prior to treatment to a mean of 2%, while appropriate object manipulation increased from 26 to 99%. These data support the use of brief restraint plus reinforcement for decelerating severe self-injurious behaviors and accelerating appropriate behaviors in adults with profound mental retardation. The advantages of this treatment are that it appears to be less intrusive and to offer more educational benefits than other commonly used techniques.     

A comparison of fixed momentary differential reinforcement of other behavior to variable momentary differential reinforcement of other behavior to reduce challenging behavior

Differential reinforcement of other behavior (DRO) is commonly used to reduce behavioral excesses. Momentary DRO schedules involve delivery of reinforcement contingent upon the absence of the target behavior at a given moment. Two variations of momentary DRO exist: fixed-momentary (FM) DRO and variable-momentary (VM) DRO. In the current study, we directly compared FM-DRO and VM-DRO schedules to reduce challenging behavior maintained by automatic reinforcement exhibited by four children with autism spectrum disorder. The results suggest that both the DRO schedules were equally effective to reduce challenging behavior. A social validity measure showed that most caregivers rated the VM-DRO as a preferred schedule and noted the potential for FM-DRO schedule to become more discriminable over time, which could reduce its effectiveness. However, most caregivers also commented that the FM-DRO schedule was easier to implement.     

Treating excessively slow responding of a young man with Asperger syndrome using differential reinforcement of short response latencies

Fjellstedt and Sulzer-Azaroff (1973) used differential reinforcement of short latencies to decrease a child's latency to comply with instructions. We replicated this contingency with a young man diagnosed with Asperger syndrome across two tasks (question answering and math problem solving). We added a differential reinforcement contingency to teach the participant to discriminate between math problems that could be answered rapidly and those that required more time for accurate performance.     

Failure to produce response variability with reinforcement

Two experiments attempted to train pigeons to produce variable response sequences. In the first, naive pigeons were exposed to a procedure requiring four pecks on each of two keys in any order, with a reinforcer delivered only if a given sequence was different from the preceding one. In the second experiment, the same pigeons were exposed to this procedure after having been trained successfully to alternate between two specific response sequences. In neither case did any pigeon produce more than a few different sequences or obtain more than 50% of the possible reinforcers. Stereotyped sequences developed even though stereotypy was not reinforced. It is suggested that reinforcers have both hedonic and informative properties and that the hedonic properties are responsible for sterotyped repetition of reinforced responses, even when stereotypy is negatively related to reinforcer delivery.     

Use of a lag differential reinforcement contingency to increase varied selections of classroom activities

The present study evaluated the effects of a lag differential reinforcement contingency on 2 students' activity selections using reversal designs. Results showed that the lag contingency was responsible for promoting increased novel selections, engagement in diverse activities, and greater progress with respect to programmed academic activities.     

Effects of a history of differential reinforcement on preference for choice

The effects of a history of differential reinforcement for selecting a free-choice versus a restricted-choice stimulus arrangement on the subsequent responding of 7 undergraduates in a computer-based game of chance were examined using a concurrent-chains arrangement and a multiple-baseline-across-participants design. In the free-choice arrangement, participants selected three numbers, in any order, from an array of eight numbers presented on the computer screen. In the restricted-choice arrangement, participants selected the order of three numbers preselected from the array of eight by a computer program. In initial sessions, all participants demonstrated no consistent preference or preference for restricted choice. Differential reinforcement of free-choice selections resulted in increased preference for free choice immediately and in subsequent sessions in the absence of programmed differential outcomes. For 5 participants, changes in preference for choice were both robust and lasting, suggesting that a history of differential reinforcement for choice may affect preference for choice.     

Using negative reinforcement to increase self-feeding in a child with food selectivity

We examined the effects of a negative reinforcement-based treatment on the self-feeding of 1 child with food selectivity by type and texture. Self-feeding increased when the child could choose to either self-feed 1 bite of a target food or be fed 1 bite of the target food and 5 bites of another food. Possible mechanisms that underlie the effectiveness of the intervention and implications for future research are discussed.     

Effects of reinforcement history on response rate and response pattern in periodic reinforcement

Several researchers have suggested that conditioning history may have long-term effects on fixed-interval performances of rats. To test this idea and to identify possible factors involved in temporal control development, groups of rats initially were exposed to different reinforcement schedules: continuous, fixed-time, and random-interval. Afterwards, half of the rats in each group were studied on a fixed-interval 30-s schedule of reinforcement and the other half on a fixed-interval 90-s schedule of reinforcement. No evidence of long-term effects attributable to conditioning history on either response output or response patterning was found; history effects were transitory. Different tendencies in trajectory across sessions were observed for measures of early and late responding within the interreinforcer interval, suggesting that temporal control is the result of two separate processes: one involved in response output and the other in time allocation of responding and not responding.