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.     

USE OF NEGATIVE REINFORCEMENT IN THE TREATMENT OF SELF-INJURIOUS BEHAVIOR

Behavioral assessment procedures were used to determine the maintaining conditions of self-injury exhibited by 2 children with severe multiple handicaps. For both children, negative reinforcement (escape from grooming activities) was determined to be the maintaining reinforcer for self-injury (hand/arm biting) within an alternating treatments design. The treatment packages involved the use of negative reinforcement (brief escape from grooming activities) contingent upon a behavior that was incompatible with self-injury (reaching and pressing a microswitch that activated a prerecorded message of “stop”). Treatment was evaluated with a reversal design for 1 child and with a multiple baseline across grooming activities for the 2nd child. The treatment led to a marked decrease in self-injury for both children. At follow-up, high rates of self-injury were reported for the 1st child, but low rates of self-injury and an increase in task-related appropriate behavior were observed for the 2nd child.     

MANIPULATION OF POTENTIAL PUNISHMENT PARAMETERS IN THE TREATMENT OF SELF-INJURY1

The self-injurious behavior (SIB) of a blind, profoundly retarded male was observed within a field setting as multiple forms of punishment were applied. The effects of hair-tug punishment were first systematically examined, then hair-tug and electric shock punishment were administered in varing ratios (of punishment deliveries per SIB response) supplemented by continuous restraint contingencies and made contingent on recurrent antecedents of SIB cycles. Treatments were applied over six months of consecutive daily sessions ranging from 30 min to 8 hr duration. Posttreatment followup observations were taken 12, 24, and 34 months after treatment. Partial suppression was produced as a direct function of hair-tug punishment in the initial phase. A generally progressive decrement was produced on already lowered SIB rates with the succeeding components of the treatment package. Extended periods of total SIB suppression occurred as punishment was rendered contingent on antecedent components of each SIB response cycle. Followup observations of nearly 3 yr duration indicated total suppression generalized over all settings in which the subject functioned. The findings were related to the contrasting limits prevailing in most reports of punishment-based SIB suppression.     

ANALYSIS OF THE REINFORCEMENT AND EXTINCTION COMPONENTS IN DRO CONTINGENCIES WITH SELF-INJURY

Previous research has shown that self-injurious behavior (SIB) maintained by positive reinforcement may be reduced under differential-reinforcement-of-other-behavior (DRO) contingencies. In this study, we conducted an analysis of the reinforcement and extinction components of DRO while treating the self-injury of 3 women with developmental disabilities. A functional analysis revealed that each subject's SIB was maintained by positive reinforcement in the form of attention. Subsequent reinforcer assessments identified preferred and nonpreferred stimuli for later use in conjunction with DRO. Results showed high rates of SIB for all 3 subjects during baseline, which persisted when DRO was implemented without the relevant extinction component (withholding of attention for SIB) for 2 of the subjects. Low rates of SIB were observed for all subjects when DRO plus extinction was implemented or when extinction was implemented alone, suggesting that extinction may be a critical component of DRO schedules.     

EXPERIMENTAL ANALYSIS AND TREATMENT OF MULTIPLY CONTROLLED SELF-INJURY

A functional analysis of the self-injurious behavior (SIB) of 3 adults with profound developmental disabilities showed that each engaged in SIB in more than one assessment condition. Such outcomes may result from a failure to isolate the variable maintaining SIB, or they may reflect multiple sources of control over SIB. In order to identify more clearly the determinants of SIB, each subject was exposed to a series of treatments appropriate to one or both of the apparent functions of SIB. These treatments, applied sequentially on baselines appropriate to each behavioral function, identified the maintaining variables for SIB through differential outcomes across baselines. Results indicated that the SIB of 2 subjects was multiply controlled, confirming the outcomes of the functional analysis. However, the SIB of the 3rd subject was eliminated using a treatment designed for a single function, suggesting spurious results of the original assessment. Alternative interpretations of undifferentiated assessment data are discussed, as are analysis and treatment issues related to multiply determined behavior disorders.     

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.     

THE ROLE OF ATTENTION IN THE TREATMENT OF ATTENTION-MAINTAINED SELF-INJURIOUS BEHAVIOR: NONCONTINGENT REINFORCEMENT AND DIFFERENTIAL REINFORCEMENT OF OTHER BEHAVIOR

Because there are potentially serious limitations to differential reinforcement of other behavior (DRO) (which is probably the most widely used treatment procedure for behavior problems), we examined an alternative procedure—noncontingent reinforcement (NCR). Three females with developmental disabilities, all of whom engaged in severe self-injurious behavior, participated. During a pretreatment functional analysis, each subject's self-injury was shown to be differentially sensitive to social attention as a maintaining consequence. Next, each subject was exposed to a DRO treatment and an NCR treatment. During DRO, attention was delivered contingent on the absence of self-injury for prespecified intervals. During NCR, attention was delivered on a fixed-time schedule that was not influenced by the subject's behavior. Results showed that both procedures were highly effective in reducing self-injury, probably because the functional reinforcer for self-injury was used during treatment. Furthermore, there was evidence that NCR attenuated several of the limitations of DRO. These results are particularly interesting in light of the long experimental history of NCR as a control rather than as a therapeutic procedure.     

REDUCING SELF-INJURY AND CORRESPONDING SELF-RESTRAINT THROUGH THE STRATEGIC USE OF PROTECTIVE CLOTHING

We examined the use of protective clothing to reduce a retarded male's face-punching and leg-kicking and two corresponding forms of self-restraint—arm and leg self-restraint. The resident was observed each day in three sessions of randomly ordered conditions (one condition per session): without any protective clothing, with a padded helmet, and with a padded helmet and padded slippers. Use of the padded helmet substantially reduced face-punching and arm self-restraint. The addition of padded slippers reduced leg-kicking and leg self-restraint. These results suggest a practical and effective means of controlling self-injury and self-restraint. They are also consistent with the possibility that the resident's arm restraint was maintained in part by escape or avoidance of face-punching and that his leg restraint was maintained in part by escape or avoidance of leg-kicking.     

THE USE OF POSITIVE AND NEGATIVE REINFORCEMENT IN THE TREATMENT OF ESCAPE-MAINTAINED DESTRUCTIVE BEHAVIOR

We identified 3 clients whose destructive behavior was sensitive to negative reinforcement (break from tasks) and positive reinforcement (access to tangible items, attention, or both). In an instructional context, we then evaluated the effects of reinforcing compliance with one, two, or all of these consequences (a break, tangible items, attention) when destructive behavior produced a break and when it did not (escape extinction). For 2 clients, destructive behavior decreased and compliance increased when compliance produced access to tangible items, even though destructive behavior resulted in a break. For 1 client, extinction was necessary to reduce destructive behavior and to increase compliance. Subsequently, when the schedule of reinforcement for compliance was faded for all clients, destructive behavior was lower and fading proceeded more rapidly when compliance produced multiple functional reinforcers (i.e., a break plus tangible items or attention) and destructive behavior was on extinction. The results are discussed in terms of the effects of relative reinforcement value and extinction on concurrent operants.     

DIRECT AND COLLATERAL EFFECTS OF RESTRAINTS AND RESTRAINT FADING

Mechanical restraints are commonly used to reduce the risks associated with severe self-injurious behavior (SIB), but may result in movement restriction and adverse side effects (e.g., bone demineralization). Restraint fading may provide a method for decreasing SIB while increasing movement and reducing these side effects. In the current investigation, rigid arm sleeves and restraint fading (gradually reducing the rigidity of the sleeves) were used with 3 clients who engaged in hand-to-head SIB. Restraints and fading reduced the hand-to-head SIB of all clients. However, for 1 client, the addition of a water mist procedure further reduced SIB to near-zero levels. For a 2nd client, another form of SIB developed that was not prevented by the rigid sleeves. For a 3rd client, a topography of SIB that was not physically prevented by the rigid sleeves was also reduced when restraints and fading were introduced.     

COMBINING NONCONTINGENT REINFORCEMENT AND DIFFERENTIAL REINFORCEMENT SCHEDULES AS TREATMENT FOR ABERRANT BEHAVIOR

Research has shown that noncontingent reinforcement (NCR) can be an effective behavior-reduction procedure when based on a functional analysis. The effects of NCR may be a result of elimination of the contingency between aberrant behavior and reinforcing consequences (extinction) or frequent and free access to reinforcers that may reduce the participant's motivation to engage in aberrant behaviors or mands. If motivation is momentarily reduced, behavior such as mands may not be sensitive to positive reinforcement. In this study, for 3 children with aberrant behavior maintained by tangible positive reinforcement, differential-reinforcement-of-alternative-behavior schedules were superimposed on NCR schedules to determine if mands could be strengthened. Results for the participants indicated that NCR did not preclude reinforcement of mands.     

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.     

PROTECTIVE EQUIPMENT: CONTINUOUS AND CONTINGENT APPLICATION IN THE TREATMENT OF SELF-INJURIOUS BEHAVIOR

This study evaluated the use of protective equipment in treating self-injurious behavior (SIB) exhibited by three retarded persons. In Experiment 1, the equipment was first applied continuously during 20-min sessions in individual multiple baseline designs across settings. Results showed substantial reductions in head hitting, eye gouging, and hand biting. Brief periods of time-out with the protective equipment were later made contingent on SIB and combined with a differential reinforcement procedure. Reduced levels of SIB was maintained with all subjects. Additionally, the amount of time during which the equipment was applied decreased as the SIB diminished. Experiment 2 evaluated the use of contingent protective equipment (the final condition in Experiment 1) when applied directly in the subjects' living uints during the day. During Experiment 2, SIB remained at or below the levels found at the termination of Experiment 1. Finally, in an effort to assess the long-term effectiveness of the procedure, responsibility for implementation was given to the staff who were typically assigned to provide therapy to the subjects. Follow-up probe observations conducted up to 104 days after termination of the final experimental condition showed continued low levels of both SIB and equipment usage. Results of these experiments suggest that contingent protective equipment and differential reinforcement may be effective in reducing chronic self-injury.     

THE EFFECTS OF CONTINGENT AND NONCONTINGENT ATTENTION ON SELF-INJURY AND SELF-RESTRAINT

Self-restraint and self-injurious behavior (SIB) are two responses that can sometimes be members of the same functional response class (i.e., maintained by the same contingency). In such cases, a single treatment should be effective for both responses. In this investigation, we examined the effects of providing attention (the presumed reinforcer) both noncontingently and contingent upon either SIB or self-restraint. Results were consistent with our hypothesis that both responses were maintained by attention and suggested that noncontingent reinforcement was a potentially effective treatment.     

FURTHER ANALYSIS OF THE RELATIONSHIP BETWEEN SELF-INJURY AND SELF-RESTRAINT

It has been suggested that self-restraint, a phenomenon often correlated with self-injurious behavior (SIB), may be maintained by negative reinforcement in the form of escape from the aversive properties of SIB (e.g., pain). We examined the effects of blocking SIB (and presumably removing any aversive effects) on the self-restraint of a 19-year-old male with severe mental retardation. Consistent with the negative reinforcement hypothesis, blocking SIB resulted in near-zero levels of SIB and moderate reductions in self-restraint.     

THE TREATMENT OF COVERT SELF-INJURY THROUGH CONTINGENCIES ON RESPONSE PRODUCTS

Assessment and treatment of covert self-injurious behavior are complicated because it is difficult to quantify and apply differential consequences to covert responses. In this study, both tangible and social reinforcers were identified using reinforcer assessment methods. These reinforcers were then provided contingent upon the absence of tissue damage identified during physical examinations, resulting in near 100% success in physical assessment checks that was maintained over 10 months.     

COMPETITION BETWEEN POSITIVE AND NEGATIVE REINFORCEMENT IN THE TREATMENT OF ESCAPE BEHAVIOR

We compared the effects of reinforcing compliance with either positive reinforcement (edible items) or negative reinforcement (a break) on 5 participants' escape-maintained problem behavior. Both procedures were assessed with or without extinction. Results showed that compliance was higher and problem behavior was lower for all participants when compliance produced an edible item rather than a break. Treatment gains were achieved without the use of extinction. Results are discussed regarding the use of positive reinforcement to treat escape behavior.     

TREATMENT OF SELF-INJURY AND HAND MOUTHING FOLLOWING INCONCLUSIVE FUNCTIONAL ANALYSES

Numerous studies have used functional analyses to prescribe interventions for severe behavior disorders. The majority of these studies have focused on behavior that is clearly maintained by socially mediated reinforcement, such as contingent access to attention, tangibles, or escape from instructional demands. However, a significant proportion of functional analyses do not yield conclusive results. We examined interventions for 3 children with severe disabilities following inconclusive functional analyses. First, preferred stimuli were identified for each child via a stimulus preference assessment. Second, a functional analysis was conducted for 2 of the 3 children. High rates of aberrant behavior were seen even (if not especially) in no-interaction sessions. The 3rd child was observed for several consecutive no-interaction sessions; behavior persisted in this condition. Third, interventions based on environmental enrichment were analyzed in an analogue setting. For all of the children, environmental enrichment decreased aberrant behavior if preferred stimuli were used in the procedure. To obtain further reductions in aberrant behavior, explicit reinforcement of toy play was required for 2 children, and a brief (5-s) time-out was necessary with 1 child. Finally, effects of treatment carried over to the school or home environment following teacher or family training. Results are discussed in the context of basic reinforcement principles and future directions for research.     

AN ANALYSIS OF REINFORCER SUBSTITUTABILITY USING OBJECT MANIPULATION AND SELF-INJURY AS COMPETING RESPONSES

The concept of reinforcer substitutability proposes a continuum of interactions among reinforcers in a given situation. At one end of this continuum, reinforcers are substitutable, with one reinforcer being readily traded for another. We conducted an analysis of reinforcers that were substitutable with those produced by self-injurious behavior (SIB). Three individuals with profound developmental disabilities, whose SIB appeared to be maintained by automatic reinforcement, participated. Results of three experiments showed that (a) object manipulation and SIB were inversely related when leisure materials and SIB were concurrently available, with participants showing almost complete preference for object manipulation; (b) attempts to reduce SIB using the preferred objects as reinforcers in differential reinforcement contingencies were unsuccessful for all 3 participants; and (c) participants' preferences for SIB or object manipulation systematically changed when reinforcer cost (the amount of effort required to obtain the object) was varied. Results of the three experiments illustrate the importance of examining interactions among concurrently available reinforcers when conducting reinforcer assessments.     

ATTENTION AS AN ESTABLISHING OPERATION AND AS REINFORCEMENT DURING FUNCTIONAL ANALYSES

Results of functional analyses for 36 individuals whose self-injurious behavior (SIB) was maintained by attention indicated that SIB was highest during a condition in which the individual was deprived of attention (establishing operation) except as a consequence (reinforcer). Deprivation in the absence of reinforcement produced marginal increases in SIB in 5 individuals, and a relatively rich schedule of noncontingent attention produced the lowest levels of SIB. These results suggest that clearer functional analysis outcomes are likely to be obtained when test conditions contain both an establishing operation to evoke behavior as well as a reinforcement contingency to maintain it.