Behavioral case formulation: An experimental assessment study of transient tic disorder

A nine-year-old male, who met DSM III-R criteria for transient tic disorder, participated in an experimental assessment strategy to generate support for a case formulation. In addition to presenting motor disturbance, assessment procedures revealed six problem areas. All problems were formulated as manifestations of a hypersensitivity to evaluation, etiologically related to the boy's relationship with an insecure and critical father. It was hypothesized that the patient's tic disorder was a consequence of his hypersensitivity to father's excessive criticism, which then generalized to other evaluative situations. Using a controlled single-subject design, predictions derived from the formulation were tested by exposing the child to a planned combination of evaluative observers (e.g., father, mother, therapist, etc.) who watched him as he worked on a series of puzzles. The dependent measures included (1) behavioral recordings of tic frequency and (2) frontalis EMG responses. The results indicated significant differences in tic rate and EMG as a function of the type of observer. Consistent with the formulation, the patient displayed the highest levels of tic behavior and EMG response when his father was the observer and lowest in the presence of the mother. Predictions regarding other stimulus conditions were also confirmed. These results provided support for the case formulation that was used to design an effective treatment intervention. Findings suggest that the case formulation model offers a method whereby novel case hypotheses can be generated for poorly understood psychopathology and tested later in the experimental situation.     

Utility maximization and melioration: Internalities in individual choice

How do people go about choosing between alternatives in relatively simple settings? This study explores some of the variables that past work suggests may be relevant. Volunteer subjects worked for money in six procedures in which the probability of a payment from either of two alternatives was 1.0, but the rate of pay (i.e. the speed with which a payment was delivered or the size of the payment) interacted with the subjects recent allocation of choices, which we define as the ‘internalities’. Because of the internalities, choosing the currently more profitable alternative did not maximize total earnings. Subjects were more likely to fail to maximize when the interaction between present pay and past choices was spread over longer sequences of choices, or when the reward variable was the speed, rather than the value, of each payment. Subjects often disregarded the internalities and were instead guided by the current yields of the two alternatives, which is a frequently observed tendency, called ‘melioration’, in experiments on choices by animals. The tendency toward melioration was only partially counteracted by explicit instructions on how to maximize earnings. We discuss a theoretical framework for melioration that postulates both motivational and cognitive sources.     

Nonsuicidal physically self-damaging acts in adolescents

To determine the frequency and correlates of nonsuicidal physically self-damaging acts in 12–14 year olds, a two stage epidemiologic survey with a self-administered questionnaire (N=3283) followed by a psychiatric interview of a subsample of the adolescents and their parents (N=444) was used. Prevalence estimates of interview validated nonsuicidal physically self-damaging acts were 2.46% in males and 2.79% in females. Significant relationships were found between nonsuicidal physically self-damaging acts and suicidal ideation, major depression and undesirable life events. Data suggest that physically self-damaging acts occur at substantial rates during early adolescence. The strong correlation between nonsuicidal self-destructive acts and both suicidal ideation and major depression clarifies prior conflicting reports in the literature and suggests that a history of self-damaging acts should be taken into consideration when evaluating for possible depression and suicide risk.     

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.     

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

Three individuals with developmental disabilities were exposed to a series of assessment conditions to identify the source of reinforcement for their self-injurious behavior. In each case, self-injury occurred most often in instructional (demand) situations containing a brief time-out from the task contingent on self-injury, indicating that the behavior was an escape response (i.e., maintained by negative reinforcement). Treatment was implemented in a multiple baseline across subjects design and consisted of extinction (prevention of escape) plus instructional fading (initial elimination of instructions followed by their gradual reintroduction). Results showed that the combined treatment produced immediate and large reductions in self-injury that were maintained as the frequency of instructions was increased across sessions to match the original baseline rate of presentation. Results of a component analysis conducted with 1 subject suggested that stimulus fading accelerated the behavior-reducing effects of extinction.     

EFFECTS OF MEMORY AIDS ON THE DYADIC CONVERSATIONS OF INDIVIDUALS WITH DEMENTIA

The effects of a prosthetic memory aid on the conversational content and social skills of dyads with dementia were evaluated. Six individuals with moderate to severe dementia served as either subject or partner in dyads during 5-min conversational probes conducted three times per week in daycare and nursing-home settings. During phases when a memory aid, consisting of personally relevant picture and sentence stimuli, was available, most subjects used their own aid to improve the quality of conversations by increasing the frequency of on-topic statements, diminishing nonproductive utterances, lengthening their conversational turn, and/or increasing the frequency of turns taken. Most partners demonstrated awareness of social discourse conventions by appropriately relinquishing conversational dominance, decreasing both content and nonproductive utterances, and increasing acknowledging or affirmative comments when subjects used memory aids. Naive judges' ratings of aided and unaided conversational samples on seven conversational dimensions reflected differences in perceptions of significant improvement as a function of the conversational discourse style of each dyad.     

Effects of differences between stimuli, responses, and reinforcer rates on conditional discrimination performance

In a discrete-trial conditional discrimination procedure, 4 pigeons obtained food reinforcers by pecking a key with a short latency on trials signaled by one stimulus and by pecking the same key with a long latency on trials signaled by a second stimulus. The physical difference between the two stimuli and the temporal separation between the latency values required for reinforcement were varied factorially over four sets of conditions, and the ratio of reinforcer rates for short and long latencies was varied within each set of conditions. Stimulus discrimination varied directly with both stimulus and response differences and was unaffected by the reinforcer ratio. Sensitivity to reinforcement, estimated by generalized-matching-law fits to the data within each set of conditions, varied directly with the response difference but inversely with the stimulus difference arranged between sets of conditions. Because variations in stimulus differences, response differences, and reinforcer differences did not have equivalent effects, these findings question the functional equivalence of the three terms of the discriminated operant: antecedent stimuli, behavior, and consequences.     

TEMPORAL CONTROL ON INTERVAL SCHEDULES: WHAT DETERMINES THE POSTREINFORCEMENT PAUSE?

On fixed-interval or response-initiated delay schedules of reinforcement, the average pause following food presentation is proportional to the interfood interval. Moreover, when a number of intervals of different durations occur in a programmed cyclic series, postreinforcement pauses track the changes in interval value. What controls the duration of postreinforcement pauses under these conditions? Staddon, Wynne, and Higa (1991), in their linear waiting model, propose control by the preceding interfood interval. Another possibility is that delay to reinforcement, signaled by a key peck and/or stimulus change, determines the subsequent pause. The experiments reported here examined the role of these two possible time markers by studying the performance of pigeons under a chained cyclic fixed-interval procedure. The data support the linear waiting model, but suggest that more than the immediately preceding interfood interval plays a role in temporal control.     

Schedule-induced defecation by rats during ratio and interval schedules of food reinforcement.

Lever pressing in rats was maintained by continuous and intermittent schedules of food while defecation was monitored. In Experiment 1, reinforcement densities were matched across variable-ratio and variable-interval schedules for three pairs of rats. Defecation occurred in all 3 rats on the variable-ratio schedule and in all 3 rats on the yoked variable-interval schedule. In Experiment 2, fixed-ratio and fixed-interval schedules with similar reinforcement densities maintained lever pressing. Defecation occurred in 3 of 4 rats on the fixed-ratio schedule and in 4 of 4 rats on the fixed-interval schedule. Almost no defecation occurred during continuous reinforcement in either experiment. These results demonstrate that defecation may occur during both ratio and interval schedules and that the inter-reinforcement interval is more important than the behavioral requirements of the schedule in generating schedule-induced defecation.