Side effects of extinction: prevalence of bursting and aggression during the treatment of self-injurious behavior

Findings from basic and applied research suggest that treatment with operant extinction may produce adverse side effects; two of these commonly noted are an increase in the frequency of the target response (extinction burst) and an increase in aggression (extinction-induced aggression). Although extinction is often used to treat problem behavior in clinical settings, few applied studies have examined the prevalence of these side effects or their possible attenuation with other operant procedures. An analysis of 41 data sets for individuals who received treatment for self-injurious behavior indicated that extinction bursts or increases in aggression occurred in nearly one half of the cases. The prevalence of bursting and aggression was substantially lower when extinction was implemented as part of a treatment package rather than as the sole intervention.     

Examining extinction bursts in the treatment of pediatric food refusal

Escape extinction has been shown to be highly effective in the treatment of food refusal; however, unpleasant side effects such as extinction bursts may accompany extinction procedures. Bursting has been reported to occur in 24% to 39% of all cases for which extinction was used as a component during treatment of problem behavior. Although commonly used in treatments, the occurrence of extinction bursts in the treatment of pediatric food refusal has not been studied. This study measured the frequency of bursting in 10 children for whom escape extinction was used to treat food refusal. Results showed that extinction bursts were observed in 30% of the children included in the study, although they were relatively brief and resolved quickly. Considerations for using escape extinction in interventions will be discussed.     

EFFECTIVENESS OF FUNCTIONAL COMMUNICATION TRAINING WITH AND WITHOUT EXTINCTION AND PUNISHMENT: A SUMMARY OF 21 INPATIENT CASES

Functional communication training (FCT) is a frequently used treatment for reducing problem behavior exhibited by individuals with developmental disabilities. Once the operant function of problem behavior is identified by a functional analysis, the client is taught to emit an appropriate communicative response to obtain the reinforcer that is responsible for behavioral maintenance. Studies on FCT have typically used small numbers of participants, have reported primarily on clients for whom FCT was successful, and have varied with respect to their use of other treatment components. The main purposes of the present study were to evaluate the efficacy of FCT for treating severe problem behavior in a relatively large sample of individuals with mental retardation (N = 21) and to determine the contribution of extinction and punishment components to FCT treatment packages. FCT with extinction was effective in reducing problem behavior for the majority of clients and resulted in at least a 90% reduction in problem behavior in nearly half the applications. However, when demand or delay-to-reinforcement fading was added to FCT with extinction, treatment efficacy was reduced in about one half of the applications. FCT with punishment (both with and without fading) resulted in at least a 90% reduction in problem behavior for every case in which it was applied.     

BEHAVIORAL PERSISTENCE AND VARIABILITY DURING EXTINCTION OF SELF-INJURY MAINTAINED BY ESCAPE

The self-injurious escape behavior of a developmentally disabled adult was treated with extinction. Results of a reversal design showed substantial bursts of responding when extinction was introduced and reintroduced: self-injury remained at a variable and elevated rate for some time before stable, low rates were observed. Data on aggression, a nontarget behavior during both baseline and treatment, showed a pattern similar to that seen for self-injury during the extinction conditions.     

Behavioral momentum and resistance to extinction across repeated extinction tests

The present experiments assessed whether resistance to extinction of pigeons' key pecking decreased across repeated extinction tests. An additional impetus for this research was to determine how the quantitative framework provided by behavioral momentum theory might be used to describe any such changes across tests. Pigeons pecked keys in two‐component multiple schedules (one component associated with a higher reinforcer rate and the other with a lower rate) in which baseline and extinction conditions alternated. In Experiment 1, baseline and extinction conditions alternated every session, and, in Experiment 2, these conditions lasted for 10 and 7 sessions, respectively. Resistance to extinction decreased across successive extinction conditions in both experiments. Fits of the behavioral‐momentum based model of extinction to the data returned uncertain results in Experiment 1 but implicated both generalization decrement and response–reinforcer contingency termination as the possible mechanisms responsible for behavior change in Experiment 2. Thus, these data suggest that experimental manipulations that affect discrimination of changes in reinforcement contingencies may influence resistance to extinction by modulating the disruptive impacts of removing reinforcers from the experimental context and of suspending response–reinforcer contingencies.     

Prevalence of resurgence of destructive behavior when thinning reinforcement schedules during functional communication training

Functional communication training is a well‐established treatment for socially reinforced destructive behavior that typically includes differential reinforcement of the functional communication response (FCR) in combination with extinction of destructive behavior. However, when the schedule of reinforcement for the FCR is thinned, destructive behavior may resurge (e.g., Greer, Fisher, Saini, Owen, & Jones, 2016). Currently, data are unavailable on the prevalence and characteristics of resurgence during reinforcement schedule thinning. In this study, we evaluated the prevalence of resurgence during reinforcement schedule thinning on a per‐case and per‐schedule‐step basis and also evaluated the magnitude of resurgence in relation to the functions of destructive behavior. We observed resurgence in 19 of the 25 (76%) applications of reinforcement schedule thinning. In some cases, the magnitude of resurgence exceeded the mean levels of destructive behavior observed in baseline. We discuss these results relative to prior translational and applied research on resurgence.     

Factors that encourage generalization from extinction to test reduce resurgence of an extinguished operant response

Two experiments investigated methods that reduce the resurgence of an extinguished behavior (R1) that occurs when reinforcement for an alternative behavior (R2) is discontinued. In Experiment 1, R1 was first trained and then extinguished while R2 was reinforced during a 5‐ or 25‐session treatment phase. For half the rats, sessions in which R2 was reinforced alternated with sessions in which R2 was extinguished. Controls received the same number of treatment sessions, but R2 was never extinguished. When reinforcement for R2 was discontinued, R1 resurged in the controls. However, the alternating groups showed reduced resurgence, and the magnitude of the resurgences observed during their R2 extinction sessions decreased systematically over Phase 2. In Experiment 2, R1 was first reinforced with one outcome (O1). The rats then had two types of double‐alternating treatment sessions. In one type, R1 was extinguished and R2 produced O2. In the other, R1 was unavailable and R2 produced O3. R1 resurgence was weakened when O2, but not O3, was delivered freely during testing. Together, the results suggest that methods that encourage generalization between R1 extinction and resurgence testing weaken the resurgence effect. They are not consistent with an account of resurgence proposed by Shahan and Craig (2017).     

MOMENTUM AND EXTINCTION EFFECTS ON SELF-INJURIOUS ESCAPE BEHAVIOR AND NONCOMPLIANCE

Previous research on applications of behavioral momentum has indicated that a high-probability (high-p) instructional sequence, in which a series of instructions for which there is a high probability of compliance is presented immediately before an instruction for which there is a low probability of compliance, is an effective method for increasing compliance. It is not dear, however, whether the procedure is effective when individuals actively attempt to escape from the instructional situation. In this study, we examined the effects of the high-p sequence, when implemented first alone and then later with an extinction component, as treatment for the self-injurious escape behavior of 2 individuals. Results showed that when the instructional sequence was implemented without extinction, rates of self-injury increased and percentage of compliance decreased. In addition, the percentage of trials occasioning escape behavior increased for both high- and low-probability instructions. When an extinction component was added to the high-p sequence, rates of self-injury and the percentage of trials containing self-injury decreased, and compliance increased. These findings suggest that extinction may be an important component of treatment when escape behavior such as self-injury accompanies noncompliance in instructional contexts and competes with compliant behavior.     

Stimulus–reinforcer relations established during training determine resistance to extinction and relapse via reinstatement

The baseline rate of a reinforced target response decreases with the availability of response‐independent sources of alternative reinforcement; however, resistance to disruption and relapse increases. Because many behavioral treatments for problem behavior include response‐dependent reinforcement of alternative behavior, the present study assessed whether response‐dependent alternative reinforcement also decreases baseline response rates but increases resistance to extinction and relapse. We reinforced target responding at equal rates across two components of a multiple schedule with pigeons. We compared resistance to extinction and relapse via reinstatement of (1) a target response trained concurrently with a reinforced alternative response in one component with (2) a target response trained either concurrently or in separate components from the alternative response across conditions. Target response rates trained alone in baseline were higher but resistance to extinction and relapse via reinstatement tests were greater after training concurrently with the alternative response. In another assessment, training target and alternative responding together, but separating them during extinction and reinstatement tests, produced equal resistance to extinction and relapse. Together, these findings are consistent with behavioral momentum theory—operant response–reinforcer relations determined baseline response rates but Pavlovian stimulus–reinforcer relations established during training determined resistance to extinction and relapse. These findings imply that reinforcing alternative behavior to treat problem behavior could initially reduce rates but increase persistence.     

Experience with dynamic reinforcement rates decreases resistance to extinction

The ability of organisms to detect reinforcer‐rate changes in choice preparations is positively related to two factors: the magnitude of the change in rate and the frequency with which rates change. Gallistel (2012) suggested similar rate‐detection processes are responsible for decreases in responding during operant extinction. Although effects of magnitude of change in reinforcer rate on resistance to extinction are well known (e.g., the partial‐reinforcement‐extinction effect), effects of frequency of changes in rate prior to extinction are unknown. Thus, the present experiments examined whether frequency of changes in baseline reinforcer rates impacts resistance to extinction. Pigeons pecked keys for variable‐interval food under conditions where reinforcer rates were stable and where they changed within and between sessions. Overall reinforcer rates between conditions were controlled. In Experiment 1, resistance to extinction was lower following exposure to dynamic reinforcement schedules than to static schedules. Experiment 2 showed that resistance to presession feeding, a disruptor that should not involve change‐detection processes, was unaffected by baseline‐schedule dynamics. These findings are consistent with the suggestion that change detection contributes to extinction. We discuss implications of change‐detection processes for extinction of simple and discriminated operant behavior and relate these processes to the behavioral‐momentum based approach to understanding extinction.     

Prevalence of the extinction burst and its attenuation during treatment

Although extinction has been an effective treatment for a variety of behavior disorders, its use may be associated with several adverse side effects, the most common being an initial increase in the frequency of the target response, called an "extinction burst." We attempted to determine the prevalence of the extinction burst in applied research and its possible attenuation with other operant procedures. An analysis of 113 sets of extinction data indicated that bursting may not be as common as previously assumed (it occurred in 24% of the cases) and may be less likely when extinction is implemented with alternative procedures rather than as the sole intervention (bursting was evident in 12% of the former cases and 36% of the latter).     

Further evaluation of differential exposure to establishing operations during functional communication training

Recent research findings (DeRosa, Fisher, & Steege, 2015 ) suggest that minimizing exposure to the establishing operation (EO) for destructive behavior when differential reinforcement interventions like functional communication training (FCT) are introduced may produce more immediate reductions in destructive behavior and prevent or mitigate extinction bursts. We directly tested this hypothesis by introducing FCT with extinction in two conditions, one with limited exposure to the EO (limited EO) and one with more extended exposure to the EO (extended EO) using a combined reversal and multielement design. Results showed that the limited‐EO condition rapidly reduced destructive behavior to low levels during every application, whereas the extended‐EO condition produced an extinction burst in five of six applications. We discuss these findings in relation to the effects of EO exposure on the beneficial and untoward effects of differential reinforcement interventions.     

An experimental analysis of the extinction-induced response burst

The occurrence, time course, and repeatability of response rate increases following the onset of extinction, the extinction burst, were studied in three experiments. Nine pigeons were exposed to at least 5 cycles of 5-session blocks of conditioning followed by 8-session blocks of extinction. In different experiments, conditioning sessions either were a fixed-ratio (FR) or variable-ratio (VR) schedule, and transitions from the last conditioning session in each cycle to the first extinction session were conducted between or within sessions. A single response rate increase occurred when overall response rates were considered. Restricting analyses to the first minute of extinction sessions sometimes revealed increases in response rates, although this finding was inconsistent. The frequency and magnitude of these increases differed across exposures to extinction both across and within pigeons. Additionally, how responding during extinction was measured (i.e., the level of analysis) influenced whether increases above baseline levels were observed. These results suggest that the extinction burst may be influenced by the manner of transition to extinction and the way in which early extinction responding is measured. Under the best conditions, the extinction burst does not appear to be a ubiquitous effect of extinction.     

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

Based on results of a functional analysis indicating that the self-injurious behavior (SIB) of 3 individuals was maintained by negative reinforcement (escape from instructional situations), the effects of stimulus (instructional) fading were evaluated in a multiple baseline design across subjects. The rate of instructions was reduced to zero at the beginning of treatment and was gradually increased (faded in) across sessions as long as SIB remained low. However, if SIB remained high for 10 consecutive sessions, extinction was implemented until SIB decreased, at which point extinction was withdrawn and fading was resumed. Treatment was completed when the rate of instructions was the same as in baseline (two per minute), and SIB remained below 0.5 responses per minute for two consecutive sessions. Results showed that instructional fading (without extinction) virtually eliminated SIB initially, but these effects were not maintained. All 3 subjects required multiple exposures to extinction and over 150 treatment sessions in order to meet the end-of-treatment criteria. Advantages and limitations of fading procedures without an extinction component, as well as extensions of both interventions to other clinical problems, are discussed.     

Further investigation of differential reinforcement of alternative behavior without extinction for escape‐maintained destructive behavior

Previous research indicates that manipulating dimensions of reinforcement during differential reinforcement of alternative behavior (DRA) for situations in which extinction cannot be implemented is a potential approach for treating destructive behavior. Therefore, we replicated and extended previous research by determining (a) the conditions under which DRA without extinction decreased and maintained low levels of destructive behavior and (b) whether intervention effects maintained during reinforcement schedule thinning for the alternative response (i.e., compliance). Results showed that effective treatments were developed in the absence of extinction by manipulating the quality of reinforcement for compliance for 2 participants and by combining manipulations of the magnitude and quality of reinforcement for compliance for the other 2 participants. However, maintaining treatment effects during reinforcement schedule thinning required combining the magnitude and quality of reinforcement for 3 of the 4 participants. We discuss the clinical utility of this approach, review limitations of the study, and suggest directions for future research.     

ON THE EFFECTS OF NONCONTINGENT DELIVERY OF DIFFERING MAGNITUDES OF REINFORCEMENT

We conducted a parametric analysis of response suppression associated with different magnitudes of noncontingent reinforcement (NCR). Participants were 5 adults with severe or profound mental retardation who engaged in a manual response that was reinforced on variable-ratio schedules during baseline. Participants were then exposed to NCR via multielement and reversal designs. The fixed-time schedules were kept constant while the magnitude of the reinforcing stimulus was varied across three levels (low, medium, and high). Results showed that high-magnitude NCR schedules produced large and consistent reductions in response rates, medium-magnitude schedules produced less consistent and smaller reductions, and low-magnitude schedules produced little or no effect on responding. These results suggest that (a) NCR affects responding by altering an establishing operation (i.e., attenuating a deprivation state) rather than through extinction, and (b) magnitude of reinforcement is an important variable in determining the effectiveness of NCR.     

A preliminary evaluation of treatment duration on the resurgence of destructive behavior

Quantitative models of resurgence (e.g., Behavioral Momentum Theory, Resurgence as Choice) suggest that resurgence is partly a function of the duration of extinction exposure, with longer histories of extinction producing less resurgence. This prediction is supported by some laboratory research and has been partially supported by clinical translations that did not isolate the effects of extinction exposure prior to testing for resurgence. The degree to which different histories of extinction impact the likelihood of treatment relapse in therapeutic applications of differential reinforcement is of great interest to the clinical community, including insurance carriers and other financial providers. In the present study, we isolated the effects of extinction history for severe destructive behavior across 6 participants referred for treatment services and examined resurgence of destructive behavior when alternative reinforcement terminated. Our within-subject evaluation showed no difference in the level of resurgence or persistence of destructive behavior following short and long exposures to differential reinforcement with extinction. We discuss our failure to replicate in relation to experimental-design considerations for investigating this and other relapse phenomena in future research with clinical populations.     

MOMENTUM VERSUS EXTINCTION EFFECTS IN THE TREATMENT OF SELF-INJURIOUS ESCAPE BEHAVIOR

An individual's self-injurious escape behavior was treated using a high-probability instructional sequence with and without extinction. When presented alone, the high-probability sequence did not reduce self-injurious behavior. When escape extinction was implemented either alone or in combination with the high-probability sequence, self-injury decreased and compliance increased, suggesting that extinction may be a necessary component of the treatment for behavior problems maintained by escape.     

Early extinction effects following intermittent reinforcement: Little evidence of extinction bursts

The occurrence of extinction bursts—transient increases in response rate in excess of those observed in baseline during the period immediately following discontinuation of reinforcement of a response—was examined. In Experiment 1, key pecking of pigeons was reinforced according to a multiple schedule in which a variable-ratio schedule alternated with an interval schedule in which the reinforcers were yoked to the preceding variable-ratio component. In Experiments 2 and 3, rats were screened such that the lever-press response rates of different rats maintained by variable-interval schedules were either relatively high or relatively low. Following these baseline conditions, in Experiments 1 and 2 responding was extinguished by eliminating the food reinforcer and in Experiment 3 by removing the response–reinforcer dependency. Responses immediately following extinction implementation were examined. Response increases relative to baseline during the first 20 min of a 324.75-min extinction session (Experiment 1) or during the first 30-min extinction session (Experiments 2 and 3) were rare and unsystematic. The results (a) reinforce earlier meta-analyses concluding that extinction bursts may be a less ubiquitous early effect of extinction than has been suggested and (b) invite further experimentation to establish their generality as a function of preceding reinforcement conditions.     

ASSESSING AND PROGRAMMING GENERALIZED BEHAVIORAL REDUCTION ACROSS MULTIPLE STIMULUS PARAMETERS

Generalization across three stimulus parameters was examined for 5 individuals whose self-injurious behavior was maintained by escape from task demands. Prior to treatment, three stimulus parameters (therapist, setting, and demands) were systematically varied across baseline sessions. These variables were held constant during treatment, which consisted of escape extinction. When treatment was completed, three novel stimulus parameters were probed. If the rate of self-injury was high during this probe, treatment was reimplemented with one new stimulus parameter (the other two were the same as in the original treatment condition). Following this second treatment, another probe with three novel stimuli was conducted. If the rate of self-injury was again high, treatment was implemented again while a second stimulus parameter was changed. This sequence continued until generalization was observed across the three parameters. Results showed idiosyncratic differences in generalization. The behavior of 2 subjects showed complete generalization during the first novel probe. A 3rd subject's behavior showed generalization following treatment across two stimulus parameters (setting and therapist). The behavior of the 2 remaining subjects showed a complete lack of generalization across the three parameters; both subjects required training for novelty by randomly varying the stimulus parameters for a substantial number of sessions.