THE FUNCTIONS OF SELF-INJURIOUS BEHAVIOR: AN EXPERIMENTAL-EPIDEMIOLOGICAL ANALYSIS

Data are summarized from 152 single-subject analyses of the reinforcing functions of self-injurious behavior (SIB). Individuals with developmental disabilities referred for assessment and/or treatment over an 11-year period were exposed to a series of conditions in which the effects of antecedent and consequent events on SIB were examined systematically by way of multielement, reversal, or combined designs. Data were collected during approximately 4,000 experimental sessions (1,000 hr), with the length of assessment for individuals ranging from 8 to 66 sessions (M = 26.2) conducted over 2 to 16.5 hr (M = 6.5). Differential or uniformly high responding was observed in 145 (95.4%) of the cases. Social-negative reinforcement (escape from task demands or other sources of aversive stimulation) accounted for 58 cases, which was the largest proportion of the sample (38.1%). Social-positive reinforcement (either attention or access to food or materials) accounted for 40 (26.3%) of the cases, automatic (sensory) reinforcement accounted for 39 (25.7%), and multiple controlling variables accounted for 8 (5.3%). Seven sets of data (4.6%) showed either cyclical or inconsistent patterns of responding that were uninterpretable. Overall results indicated that functional analysis methodologies are extremely effective in identifying the environmental determinants of SIB on an individual basis and, subsequently, in guiding the process of treatment selection. Furthermore, an accumulation of assessment data from such analyses across a large number of individuals provides perhaps the most rigorous approach to an epidemiological study of behavioral function.     

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.     

Psychological side effects of breast cancer screening

Evaluated the impact of receiving abnormal mammogram results on women's anxiety and breast cancer worries and on their breast self-examination (BSE) frequency and intentions to obtain subsequent mammograms. A telephone survey was conducted with 308 women 50 years old and older approximately 3 months following a screening mammogram. Subjects included women with suspicious abnormal mammograms, nonsuspicious abnormal mammograms, and normal mammograms. Women with suspicious abnormal mammograms exhibited significantly elevated levels of mammography-related anxiety and breast cancer worries that interfered with their moods and functioning, despite the fact that diagnostic work-ups had ruled out breast cancer. Women with moderate levels of impairment in mood or functioning were more likely to practice monthly BSE than women with either high or low levels of impairment. Breast cancer worries, perceived susceptibility to breast cancer, and physician encouragement to get mammograms all exhibited independent positive relationships to mammogram intentions.     

EFFECTS OF INTERMITTENT PUNISHMENT ON SELF-INJURIOUS BEHAVIOR: AN EVALUATION OF SCHEDULE THINNING

Although the use of punishment often raises ethical issues, such procedures may be needed when the reinforcers that maintain behavior cannot be identified or controlled, or when competing reinforcers cannot be found. Results of several studies on the effects of intermittent schedules of punishment suggest that therapists must use fairly rich schedules of punishment to suppress problem behavior. However, residential caretakers, teachers, and parents often have difficulty implementing programs that require constant monitoring of the client's behavior. In this study, we examined the feasibility of gradually thinning the delivery of punishment from a continuous schedule to an intermittent schedule during the course of treatment for self-injurious behavior (SIB). Results of functional analyses for 5 individuals who had been diagnosed with profound mental retardation indicated that their SIB was not maintained by social consequences. Treatment with continuous schedules of time-out (for 1 participant) or contingent restraint (for the other 4 participants) produced substantial reductions in SIB. When they were exposed to intermittent schedules of punishment (fixed-interval [FI] 120 s or FI 300 s), SIB for all but 1 of the participants increased to levels similar to those observed during baseline. For these 4 participants, the schedule of punishment was gradually thinned from continuous to FI 120 s or FI 300 s. For 2 participants, SIB remained low across the schedule changes, demonstrating the utility of thinning from continuous to intermittent schedules of punishment. Results for the other 2 participants showed that intermittent punishment was ineffective, despite repeated attempts to thin the schedule.     

Variable-time reinforcement schedules in the treatment of socially maintained problem behavior

Noncontingent reinforcement (NCR) consists of delivering a reinforcer on a time-based schedule, independent of responding. Studies evaluating the effectiveness of NCR as treatment for problem behavior have used fixed-time (FT) schedules of reinforcement. In this study, the efficacy of NCR with variable-time (VT) schedules was evaluated by comparing the effects of VT and FT reinforcement schedules with 2 individuals who engaged in problem behavior maintained by positive reinforcement. Both FT and VT schedules were effective in reducing problem behavior. These findings suggest that VT schedules can be used to treat problem behavior maintained by social consequences.     

Discrete‐trial training performance of behavior interventionists with autism spectrum disorder: A systematic replication and extension

Further research is needed on strategies to improve employment outcomes for individuals with autism spectrum disorder (ASD). We replicated and extended prior research by examining the acquisition, maintenance, and generalization of discrete‐trial training (DTT) performance of adults with ASD who were interested in careers as behavior technicians. Three participants received training on how to implement DTT with children and we assessed the maintenance and generalization of DTT performance in the absence of feedback. Results indicated that procedural integrity generalized across children and targets and maintained for 6 to 17 session days without feedback. Results have implications for the successful employment of individuals with ASD as behavior technicians and for future research on strategies to enhance their performance on the job.     

Inserting mastered targets during error correction when teaching skills to children with autism

Research has identified a variety of effective approaches for responding to errors during discrete‐trial training. In one commonly used method, the therapist delivers a prompt contingent on the occurrence of an incorrect response and then re‐presents the trial so that the learner has an opportunity to perform the correct response independently. Some authors recommend inserting trials with previously mastered targets between the prompted response and opportunities to respond independently, but no studies have directly examined the benefits of this approach. In this study, we manipulated the placement of trials with mastered targets during discrete‐trial training to compare the effectiveness of error correction with and without this recommended insertion procedure. Four children with autism participated, and each was taught 18 targets across 3 target sets. Results indicated that embedding trials with mastered targets into error correction may not confer benefits for most children and that doing so may lead to less efficient instruction.     

Psychosocial Impact of Predictive Testing for Illness on Children and Families: Challenges for a New Millennium

Predictive testing for adult- and child-onset diseases is becoming widely available. The identification of individuals prone to develop certain illnesses is often medically advantageous in that it may afford opportunities to engage in risk reduction behaviors to detect or delay disease onset. However, sometimes the knowledge gained from these tests can be ambiguous, generate distress, and potentially affect several generations of family members. Overall, these factors create a challenging set of circumstances for persons considering genetic and other forms of predictive testing, particularly parents and children. In this article, we (1) address conceptual issues involved in determining the impact of predictive testing on child and family well-being, (2) review empirical data on this topic, and (3) provide a case example to illustrate these findings. Recommendations are made for additional psychological research on child- and family-focused outcomes associated with participation in testing, highlighting their clinical implications.     

Development of Social Anxiety: Social Interaction Predictors of Implicit and Explicit Fear of Negative Evaluation

Little is known about how to predict which individuals with known temperament vulnerabilities will go on to develop social anxiety problems. Adolescents (N = 185) were followed from age 13 to 18 to evaluate psychosocial, prospective predictors of social anxiety symptoms and fears of negative evaluation (FNE), after accounting for pre-existing social withdrawal symptoms. Results from structural equation modeling suggest that lack of perceived social acceptance predicts subsequent explicit social anxiety and FNE, whereas the emotional intensity of close peer interactions predicts subsequent implicit FNE. Results are discussed in terms of the importance of peer interaction in the development of social anxiety, and the value of measuring both implicit and explicit FNE.     

Why did the white bear return? Obsessive-compulsive symptoms and attributions for unsuccessful thought suppression

The current study examined the nature and consequences of attributions about unsuccessful thought suppression. Undergraduate students with either high (n=67) or low (n=59) levels of obsessive–compulsive symptoms rated attributions to explain their unsuccessful thought suppression attempts. We expected that self-blaming attributions and attributions ascribing importance to unwanted thoughts would predict more distress and greater recurrence of thoughts during time spent monitoring or suppressing unwanted thoughts. Further, we expected that these attributions would mediate the relationship between obsessive–compulsive symptom levels and the negative thought suppression outcomes (distress and thought recurrence). Structural equation models largely confirmed the hypotheses, suggesting that attributions may be an important factor in explaining the consequences of thought suppression. Implications are discussed for cognitive theories of obsessive–compulsive disorder and thought suppression.