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.     

Response blocking with and without redirection for the treatment of pica.

Although response blocking can decrease problem behavior, one potential adverse side effect is the induction of aggression. In the current study, we report on a young adult who engaged in high rates of pica maintained by automatic reinforcement. Blocking pica, however, led to aggression. When redirection to an alternative preferred food item was added to an intervention consisting of response blocking, pica was effectively treated without increasing aggression.     

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.     

The effects of a vitamin supplement on the pica of a child with severe mental retardation

The effects of a common multiple vitamin on the pica of a child with severe mental retardation and anemia were evaluated. A BAB design revealed that pica was decreased by the vitamin. The results suggest that pica can be effectively treated by implementation of a simple nutritional or biological intervention. Further research investigating the generality of this finding and the effects of combining biological and behavioral interventions are discussed.     

Assessment and treatment of foot-shoe fetish displayed by a man with autism

Results of a functional analysis indicated that a man diagnosed with autism engaged in bizarre sexual behavior in the presence of women wearing sandals. Several treatments proved to be ineffective or impractical. By contrast, a response-interruption/time-out procedure quickly eliminated the problem behavior in multiple settings.     

Assessment and treatment of rumination in a young man with autism

After a pretreatment screening analysis suggested that rumination by a 19‐year‐old man with autism was maintained by automatic reinforcement, we evaluated his preference for three snack foods and the frequency of his rumination after consuming each. Rumination was more common after eating high‐preference foods. We then examined noncontingent access to a type of lollipop (i.e., a Ring Pop?) to decrease rumination. The Ring Pop? reduced rumination to moderately low levels. Next, to further decrease rumination, we added a reprimand, which reduced rumination to near zero levels. Finally, we evaluated the reprimand by itself, which resulted in a reduction in rumination roughly equivalent to that produced by the Ring Pop?. Results are discussed in terms of the source of reinforcement for rumination and the behavioral mechanisms responsible for intervention effects.     

Increasing response diversity in children with autism

Repetitive and invariant behavior is a diagnostic feature of autism. We implemented a lag reinforcement schedule to increase response diversity for 6 participants with autism aged 6 to 10 years, 4 of whom also received prompting plus additional training. These procedures appeared to increase the variety of building-block structures, demonstrating that an intervention that includes differential reinforcement can increase response diversity for children with an autism spectrum disorder.     

Evaluation of response blocking and re-presentation in a competing stimulus assessment

Competing stimulus assessments (CSA) have been used to identify stimuli that are associated with reduced levels of problem behavior, presumably as a function of reinforcer competition. Following a standard CSA in which stimuli simply were made available, 2 more CSAs were conducted with additional components designed to enhance reinforcer competition: re-presentation of stimuli and response blocking for self-injury. The results obtained from each CSA were validated in an extended treatment analysis. The study illustrates how the effects of additional components designed to enhance reinforcer competition can be evaluated efficiently in the context of a CSA.     

The effects of response cost in the treatment of aberrant behavior maintained by negative reinforcement

Positive reinforcement contingencies can sometimes be used to decrease problem behavior maintained by negative reinforcement (e.g., escape). In the current study, we evaluated the extent to which response cost (i.e., contingent removal of a preferred stimulus) would compete with the negative reinforcer maintaining destructive behavior. The response cost contingency reduced destructive behavior by 87% from baseline levels even though the negative reinforcement contingency (i.e., escape) remained in place.     

Establishing compliance with liquid medication administration in a child with autism

Children with autism often display difficulty with swallowing pills and liquid medications. In the current study, stimulus fading and positive reinforcement established compliance with liquid medication administration in a young boy with autism. The boy's mother eventually administered liquid medication on her own.     

COVARIATION WITHIN FUNCTIONAL RESPONSE CLASSES: IMPLICATIONS FOR TREATMENT OF SEVERE PROBLEM BEHAVIOR

Two studies examined the effects of a reductive treatment versus instruction-based treatments on the generalized reduction of problem behaviors. Each study involved a detailed analysis of multiple problem behaviors performed by school-aged youth with severe intellectual disabilities. The analysis examined the contrasting effects of one of two different positive intervention procedures (teaching a positive alternative behavior or providing additional teacher assistance during instruction) versus blocking and/or verbally reprimanding a problem behavior. The focus of each analysis was on the covariation of multiple problem behaviors within functional response classes. Results of the investigation indicated that when only one member of the response class was blocked, a collateral increase was observed in one or more different problem behaviors from the same response class. Alternatively, when 1 participant was taught a functionally equivalent mand response, all problem behaviors in the response class were reduced. Problem behaviors also were reduced for the remaining participant by presenting antecedent teacher assistance. Implications of the research extend to analysis of covariation within response classes and to procedures that result in generalized reduction of problem behaviors within a response class.     

Functional analysis and treatment of verbal perseverations displayed by an adult with autism

The function of perseverative speech for an adult man who had been diagnosed with autism and mental retardation was examined. Results showed that verbal perseverations were maintained by social attention. An intervention consisting of differential reinforcement of appropriate verbal responses and extinction of perseverative verbal responding was effective in decreasing verbal perseverations.     

The treatment of muscle tics with dissimilar competing response practice

Prior research has shown that muscle tics can be suppressed by the performance of a competing response contingent on the occurrence of the muscle tics. In an effort to determine whether the topography of the competing response was important to the muscle tic suppressing effects of contingent competing response practice, we evaluated the effects of a competing response that was topographically dissimilar to the muscle tic. Three subjects engaged in dissimilar competing responses contingent on the occurrence of a muscle tic; 2 of these subjects subsequently engaged in similar competing response practice. The results showed a decrease in objective measures of muscle tic frequency with the introduction of dissimilar competing response practice for each subject; subsequent exposure to similar competing response practice for 2 subjects resulted in no additional decrement in the level of muscle tics. These results suggest that the topography of the competing response may not be crucial for the suppression of muscle tics. Discrepancies between the objective measures of muscle tics and self-recorded measures are noted and discussed.     

Embedding an identity-matching task within a prompting hierarchy to facilitate acquisition of conditional discriminations in children with autism

Least-to-most prompting hierarchies (e.g., progressing from verbal to modeled to physical prompts until the target response occurs) may be ineffective when the prompts do not cue the individual to attend to the relevant stimulus dimensions. In such cases, emission of the target response persistently requires one or more of the higher level prompts, a condition called prompt dependence (Clark & Green, 2004). Reinforcement of differential observing responses (DORs) has sometimes been used to ensure that participants attend to the relevant stimulus dimensions in matching-to-sample (MTS) tasks (e.g., Dube & McIlvane, 1999). For 2 participants with autism, we embedded an identity-matching task within a prompting hierarchy as a DOR to increase the likelihood that the participants attended to and discriminated the relevant features of the comparison stimuli in an MTS task. This procedure was compared with a traditional least-to-most prompting hierarchy and a no-reinforcement control condition in a multielement design. Results for both participants indicated that mastery-level acquisition of spoken-word-to-picture relations occurred only under the identity-matching condition. Findings are discussed relative to the use of DORs to facilitate acquisition of conditional discriminations in persons with autism or other conditions who do not attend to the comparison stimuli.     

Toward establishing a qualifying autoclitic repertoire in children with autism spectrum disorder

Autoclitics are secondary verbal operants that are controlled by a feature of the conditions that occasion or evoke a primary verbal operant such as a tact or mand. Qualifying autoclitics extend, negate, or assert a speaker's primary verbal response and modify the intensity or direction of the listener's behavior. Howard and Rice (1988) established autoclitics that indicated weak stimulus control (e.g., “like a [primary tact]”) with four neurotypical preschool children. However, generalization to newly acquired tacts was limited. In Experiment 1, we addressed similar behavior as in Howard and Rice but with autistic children while using simultaneous teaching procedures, and we observed generalization across sets and with newly acquired tacts. In Experiment 2, we evaluated the effects of multiple-exemplar training on generalization of autoclitics across sets of naturalistic stimuli. Across participants, gradual increases in the frequency of autoclitics occurred with untaught stimuli after teaching with one or more sets.     

Reducing rapid eating in teenagers with autism: use of a pager prompt

This study assessed the effects of a vibrating pager for increasing the duration of meal consumption in 3 teenagers with autism who were observed to eat too quickly. Participants were taught to take a bite only when the pager vibrated at predetermined intervals. A reversal design indicated that the vibrating pager successfully increased the total duration of mealtime, thereby slowing the pace of consumption for all 3 participants.