TREATMENT OF SELF-INJURIOUS BEHAVIOR USING A WATER MIST: INITIAL RESPONSE SUPPRESSION AND GENERALIZATION

This study evaluated the effects of a fine mist of water applied to the face contingent upon self-injurious behavior (SIB) exhibited by profoundly retarded persons. In Experiment 1, results of individual reversal designs showed substantial reductions in a variety of SIB's (mouthing, hand biting, skin tearing, and head banging) for seven participants. In Experiment 2, two participants who frequently bit their hands were each observed in two different settings. Following initial baselines in each setting, a series of manipulations was undertaken to compare the effects of mild verbal punishment (“No”) with those of a combined treatment (“No” plus mist procedure). Results in one setting indicated that “No” suppressed SIB only after it was first paired with the water mist. Data also suggested that, once acquired, the punishing properties of “No” could be extended to a second setting in which the mist was never applied, and that these effects could be generalized across therapists. Results of these experiments indicate that the water mist procedure may be an effective alternative to traditional punishment techniques. Although conclusions regarding generalization are limited due to the brevity of the maintenance conditions, the data suggest that treatment gains may be transferred to more acceptable forms of social punishment and reinforcement.     

Differential responding in the presence and absence of discriminative stimuli during multielement functional analyses

We evaluated the extent to which discriminative stimuli (S(D)s) facilitate differential responding during multielement functional analyses. Eight individuals, all diagnosed with mental retardation and referred for assessment and treatment of self-injurious behavior (SIB) or aggression, participated. Functional analyses consisted of four or five assessment conditions alternated in multielement designs. Each condition was initially correlated with a specific therapist and a specific room color (S(D)s), and sessions continued until higher rates of target behaviors were consistently observed under a specific test condition. In a subsequent analysis, the programmed S(D)s were removed (i.e., all conditions were now conducted by the same therapist in the same room), and sessions continued until differential responding was observed or until twice as many sessions were conducted with the S(D)s absent (as opposed to present), whichever came first. Results indicated that the inclusion of programmed S(D)s facilitated discrimination among functional analysis conditions for half of the participants. These results suggest that the inclusion of salient cues may increase either the efficiency of functional analyses or the likelihood of obtaining clear assessment outcomes.     

Analysis of response repetition as an error-correction strategy during sight-word reading

A great deal is known about the effects of positive reinforcement on response acquisition; by contrast, much less research has been conducted on contingencies applied to errors. We examined the effects of response repetition as an error-correction procedure on the sight-word reading performance of 11 adults with developmental disabilities. Study 1 compared single-response (SR) repetition and multiple-response (MR) repetition, and results showed that all 6 participants acquired more sight words with the MR procedure. Study 2 compared MR error correction following every incorrect response (continuous) and following one third of incorrect responses (intermittent), and results showed that all 6 participants acquired more sight words when error correction was continuous. Study 3 compared MR error correction in which errors required practice of the training word (relevant) versus a different word (irrelevant), and results showed that 3 of 9 participants showed better performance under the relevant condition; however, all participants showed improvement even under the irrelevant condition. Findings are discussed in terms of the behavioral processes by which error correction may enhance performance during acquisition.     

Effects of stimulus variation on the reinforcing capability of nonpreferred stimuli

We examined the effects of stimulus (reinforcer) variation in several different contexts. In Study 1, we identified high-quality (HQ) and low-quality (LQ) stimuli based on results of a paired-stimulus assessment and examined their effects when available under concurrent-reinforcement schedules for 8 participants. No participants showed preference for the LQ stimuli when compared singly or in a varied arrangement to the HQ stimulus. In Study 2, we identified nonpreferred (NP) stimuli based on results of a single-stimulus assessment and examined their effects when available under single-reinforcement schedules for 3 participants. Results of Study 2 were mixed. One participant's data indicated that the varied presentation of NP stimuli produced a modest improvement in performance over that observed when the stimuli were presented singly. By contrast, a second participant's data showed no facilitative effect for the varied delivery of NP stimuli and that the inclusion of an HQ stimulus in the varied arrangement obscured the reinforcing effects of the HQ stimulus. The 3rd participant's data showed no effect for the varied delivery of NP stimuli but an apparent facilitative effect when an HQ stimulus was included in the varied arrangement, which was attributable solely to the presence of the HQ stimulus.     

Treatment efficacy of noncontingent reinforcement during brief and extended application

We evaluated the long-term therapeutic effects of noncontingent reinforcement (NCR). In Experiment 1, NCR effects were examined with 2 participants' arbitrary responses; in Experiment 2, NCR was used as treatment with 3 participants whose self-injurious behavior (SIB) was maintained by automatic reinforcement. In both experiments, NCR consisted of continuous access to a highly preferred leisure item and was implemented initially during 10-min and later during 120-min sessions. Varied reinforcers (leisure items) were subsequently introduced during 120-min sessions to determine if treatment effects might be extended. Finally (Experiment 2 only), NCR was implemented throughout the day in participants' homes. Results of Experiments 1 and 2 showed that reinforcers obtained through object manipulation can compete with those obtained automatically by engaging in SIB during brief NCR sessions. However, data from the 120-min sessions indicated that satiation to a specific leisure item might occur over periods of time more typical of those during which treatment would be implemented. Access to a variety of highly preferred leisure items extended the effectiveness of NCR for some individuals. When NCR was implemented throughout the day (Experiment 2), therapeutic effects were shown to be maintained for up to 1 year.     

Relative versus absolute reinforcement effects: implications for preference assessments

We compared results obtained in two previous studies on reinforcer identification (Fisher et al., 1992; Pace, Ivancic, Edwards, Iwata, & Page, 1985) by combining methodologies from both studies. Eight individuals with mental retardation participated. During Phase 1, two preference assessments were conducted, one in which stimuli were presented singly (SS method) and one in which stimuli were presented in pairs (PS method). Based on these results, two types of stimuli were identified for each participant: High-preference (HP) stimuli were those selected on 75% or more trials during both preference assessments; low-preference (LP) stimuli were those selected on 100% of the SS trials but on 25% or fewer of the PS trials. During Phase 2, the reinforcing effects of HP and LP stimuli were evaluated in reversal designs under two test conditions: concurrent and single schedules of continuous reinforcement. Two response options were available under the concurrent-schedule condition: One response produced access to the HP stimulus; the other produced access to the LP stimulus. Only one response option was available under the single-schedule condition, and that response produced access only to the LP stimulus. Results indicated that 7 of the 8 participants consistently showed preference for the HP stimulus under the concurrent schedule. However, when only the LP stimulus was available during the single-schedule condition, response rates for 6 of the 7 participants were as high as those observed for the HP stimulus during the concurrent-schedule condition (1 participant showed no reinforcement effect). These results indicate that, although the concurrent-schedule procedure is well suited to the assessment of relative reinforcement effects (preference for one reinforcer over another), absolute reinforcement effects associated with a given stimulus may be best examined under single-schedule conditions.     

Rapid assessment of the effects of restraint on self-injury and adaptive behavior

We evaluated the effects of restraint on occurrences of self-injurious behavior (SIB) and adaptive responses exhibited by 2 individuals across eight response-effort conditions: baseline (no restraints); restraint sleeves without stays; restraints with 5, 10, 15, 20, or 25 thin metal stays; and restraints with five thick metal stays. From this analysis, we identified a restraint level for each participant that reduced SIB but did not inhibit adaptive responding.     

MULTICOMPONENT ASSESSMENT AND TREATMENT OF CIGARETTE PICA

We conducted a multicomponent assessment and treatment for 4 individuals who engaged in cigarette pica. During Phase 1, three stimulus preference assessments were conducted to identify (a) the reinforcing component of the cigarette, (b) potential alternative reinforcers that may be used during treatment, and (c) whether the alternative reinforcer would compete effectively with cigarettes. Results were successful in identifying the reinforcing component of the cigarette and suggested the feasibility of using alternative reinforcers during treatment to eliminate cigarette pica. During Phase 2, the effects of two treatment procedures were evaluated. Noncontingent reinforcement (NCR) with the alternative edible reinforcer reduced the pica of 2 of the participants, but effects were not maintained when the initial dense schedule of NCR was thinned. Subsequently, differential reinforcement of alternative behavior with the alternative edible reinforcer was effective in reducing pica for 3 participants. An evaluation of nine treatment procedures failed to identify an effective intervention for the remaining participant; consequently, preventive measures were designed to minimize occurrences of cigarette pica.     

TOWARD A FUNCTIONAL ANALYSIS OF SELF-INJURY

This study describes the use of an operant methodology to assess functional relationships between self-injury and specific environmental events. The self-injurious behaviors of nine developmentally disabled subjects were observed during periods of brief, repeated exposure to a series of analogue conditions. Each condition differed along one or more of the following dimensions: (1) play materials (present vs absent), (2) experimenter demands (high vs low), and (3) social attention (absent vs noncontingent vs contingent). Results showed a great deal of both between and within-subject variability. However, in six of the nine subjects, higher levels of self-injury were consistently associated with a specific stimulus condition, suggesting that within-subject variability was a function of distinct features of the social and/or physical environment. These data are discussed in light of previously suggested hypotheses for the motivation of self-injury, with particular emphasis on their implications for the selection of suitable treatments.