Reduction of eye gouging using a response interruption procedure.

A profoundly retarded male with severe congenital impairment of vision and hearing was treated for self-inflicted eye gouging. Prior to intervention, continuous mechanical restraint was required to prevent the response, precluding participation in educational and play activities. The response topography, the nature of the client's deficits, and a preliminary behavioral and medical assessment suggested that the response functioned as a source of sensory self-stimulation. Presentation of toys plus differential reinforcement of other behavior (DRO) as alternate sources of stimulation during baseline had no impact on eye gouging. The introduction of a contingent response interruption procedure reduced eye gouging and decreased the amount of time spent in restraints. Treatment effects were replicated in a group setting, and in the natural environment. Parents and school personnel were trained to use the treatment, and eye gouging remained infrequent at a 9-month follow-up.

Behavior analysis, program development, and transfer of control in the treatment of self-injury.

This case study illustrates an empirical approach to the diagnosis, treatment, and controlled follow-up of self-injurious clients. Following an assessment period, during which environmental factors associated with a severely retarded adolescent's self-injury were identified, the contingent application of protective equipment was combined with a differential reinforcement procedure (DRO) and implemented in a multiple baseline design across two hospital settings. Results showed a marked decrease in the rate of self-injury. Upon discharge from the hospital, the program was successfully replicated at the adolescent's residential center, again using a multiple baseline design across settings.

Reduction of food theft and long-term maintenance of weight loss in a Prader-Willi adult.

Behavioral interventions have had limited success in managing the chronic hyperphagia and obesity that are of presumed organic etiology in Prader-Willi syndrome. Thus, frequent foraging for food and covert consumption continue to be health-threatening problems for many Prader-Willi individuals. This case study was designed to replicate methods for assessment and treatment of food theft. A token program based on differential-reinforcement-of-other-behavior and response-cost eliminated theft in three hospital settings. Prior to discharge, the program was expanded to include contingencies on exercise behavior and weight loss, and staff from the subject's group home residence were trained to implement a modified program in the natural environment. Reduced food theft and continued weight loss were maintained in the group home and an apartment-living arrangement. A total of 81 lb (37 kg) was lost during a 2-yr period.

A sequential, test-control methodology for conducting functional analyses of self-injurious behavior.

Multielement and reversal designs used to identify maintaining variables for behavior disorders such as self-injury have several potential limitations, including interaction effects (multielement), inefficiency (reversal), and lack of a continuous control (reversal). This article describes a methodology that minimizes these problems yet captures the best features of both designs. This design consists of several phases implemented in a sequential (A-B-C) fashion, as in the reversal design. However, each phase consists of two conditions, a test and a control, presented concurrently in a multielement format. Five subjects' self-injury was assessed using both the multielement design and the sequential, test-control (or pairwise) design. Results for two subjects indicated that the multielement design produced clear assessment outcomes, and similar findings were obtained using the pairwise design. For two other subjects, the multielement assessments were somewhat undifferentiated, and clearer results were obtained using the pairwise design. The fifth subject's self-injury showed cyclical patterns using both assessment techniques. Benefits and limitations of the sequential assessment methodology are discussed.

Differential reinforcement as treatment for behavior disorders: procedural and functional variations.

For many years, differential reinforcement has been a prevalent and preferred treatment procedure for the reduction of behavior disorders. This paper reviews the procedural variations of differential reinforcement and discusses their functional properties. It is proposed that such procedures are more likely to be successful if behavioral function is a primary consideration in prescribing treatments; furthermore, limited success noted in previous research may be due to the arbitrary relationship that often exists between reinforcers and target behaviors when behavioral function is unknown. Despite the promise of a function-based approach to differential reinforcement, several current limitations exist in the identification and manipulation of relevant variables. Thus, further research is required to elucidate the relationship between aberrant behaviors and the variables responsible for maintaining them; otherwise, successful treatment cannot be expected. Several areas for future research are discussed conceptually as extensions of current and past experimentation.

A comparison of shock intensity in the treatment of longstanding and severe self-injurious behavior.

A comparison of shock intensity was conducted while treating a young woman with mental retardation and severe self-injurious behavior (SIB). Two levels of shock intensity were evaluated: 3.5 milliamps (mA) delivered via the Self-Injurious Behavior Inhibiting System (SIBIS) and 18.5 mA delivered via the Hot Shot Power Mite. A combined reversal and multiple baseline across behaviors design was used to evaluate treatment effects. SIBIS in conjunction with differential reinforcement and extinction of self-injurious escape behavior produced minimal reductions in SIB. The Hot Shot combined with extinction of self-injurious escape behavior and reinforcement for compliance resulted in immediate and large reductions in SIB. Residential staff were trained to implement contingencies by the fourth day of treatment with excellent generalization from 30-min sessions to the natural environment across all waking hours. Continuous protective restraints were eliminated within the first month of treatment. Progress occurred in personal care, vocational training, independence, and communication. Treatment effects were maintained for approximately 6 months until a relapse occurred after home visits.

A content analysis of written behavior management programs.

A method is described for assessing the elements of individual behavior management programs. The content analysis, consisting of 24 items covering the general categories of behavior specification, objectives, program procedures, data collection, and quality assurance, was applied to 141 written behavior programs of two large institutions from different regions of the United States. These data can be utilized readily to establish a data base for program evaluation at both the individual and institutional levels. In addition, to provide a measure of validity, the items included in the content analysis were rated by experts in the treatment of severe behavior disorders. General strengths and weaknesses of the programs, and of the content analysis itself, are discussed in light of their implications for program implementation and evaluation.

Reduction of multiple aberrant behaviors and concurrent development of self-care skills with differential reinforcement.

A modified functional analysis was used to assess the behavioral function of a profoundly retarded man's self-injurious behavior (SIB). Results of that analysis showed that the behavior was most likely to occur in a demand context (self-care instructions) but was maintained by positive reinforcement in the form of attention and physical contact. The results of the functional analysis also prescribed a treatment involving differential reinforcement of alternative behavior (DRA). Further investigation showed that other aberrant behaviors, such as aggression and disruption, were members of the same functional response class as SIB. The differential reinforcement of alternative behavior (DRA) procedure effectively reduced those behaviors while compliance to a self-care acquisition task increased markedly. The results are discussed in terms of the importance of determining behavioral function prior to treatment.

Reliability analysis of the Motivation Assessment Scale: a failure to replicate.

The Motivation Assessment Scale (MAS) has been proposed as an efficient questionnaire for identifying the source of reinforcement for an individual's self-injurious behavior (SIB). A previous reliability analysis of the MAS (Durand & Crimmins, 1988) reported interrater correlation coefficients ranging from .66 to .92, based on a comparison of responses provided by classroom teachers. In this study, the reliability of the MAS was reexamined with two independent groups of developmentally disabled individuals who exhibited SIB (N = 55). For the institutional sample (n = 39), the MAS was given to two staff members (a supervisor and therapy aide) who work with the individual daily. For the school sample (n = 16), the MAS was given to the teacher and teacher's aide who taught the student. The correlational analyses completed by Durand and Crimmins (1988) were repeated; in addition, a more precise analysis of interrater reliability was calculated based on the actual number of scoring agreements between the two raters. Results showed that only 16 of the 55 raters agreed on the category of reinforcement maintaining their client's or student's SIB, that only 15% of the correlation coefficients obtained were above .80, and that none of the reliability scores based on percent agreement between raters was above 80%.

Within-session patterns of self-injury as indicators of behavioral function.

Functional analysis assessment procedures have proven to be highly useful in identifying variables maintaining aberrant behavior like self-injury. When successful, assessments can lead to more effective treatment than when behavioral function is unknown. Because of practical limitations, not all clinicians can conduct extensive and thorough analyses prior to treatment implementation. Although relatively brief assessments have proven successful in a number of published studies, it is unclear under what conditions those assessments would match the results of a more extended analysis. This study examined a method for assessing the behavioral function of severe self-injury in four adult participants. For each participant, the initial assessment involved analyzing within-session trends and fluctuations in rates of self-injury by plotting the frequency within each minute of a session. The results of these analyses were then compared to a set of more traditional, longer-term functional analyses conducted with each participant. Results suggested that within-session analyses are viable procedures for the assessment of self-injury. Potential benefits of within-session analyses over other brief assessments and longer-term analyses are discussed.

Negative reinforcement in applied behavior analysis: an emerging technology.

Although the effects of negative reinforcement on human behavior have been studied for a number of years, a comprehensive body of applied research does not exist at this time. This article describes three aspects of negative reinforcement as it relates to applied behavior analysis: behavior acquired or maintained through negative reinforcement, the treatment of negatively reinforced behavior, and negative reinforcement as therapy. A consideration of research currently being done in these areas suggests the emergence of an applied technology on negative reinforcement.

Functional analysis methodology: Some closing comments.

Functional analysis methodologies have emerged as powerful tools in research on the assessment and treatment of severe behavior disorders. Although the defining feature of these approaches is the systematic identification of environmental determinants of behavior, research methodology has varied widely with respect to the arrangements used to demonstrate experimental control as well as the types of variables subject to analysis. This commentary summarizes methodological and conceptual issues that have been raised in current research and offers some suggestions for their resolution.

Antecedent influences on behavior disorders.

The influence of antecedent events on behavior disorders has been relatively understudied by applied behavior analysts. This lack of research may be due to a focus on consequences as determinants of behavior and a historical disagreement on a conceptual framework for describing and interpreting antecedent variables. We suggest that antecedent influences can be described using terms derived from basic behavioral principles and that their functional properties can be adequately interpreted as discriminative and establishing operations. A set of studies on assessment and treatment of behavior disorders was selected for review based on their relevance to the topic of antecedent events. These studies were categorized as focusing on assessment of antecedent events, antecedent treatments for behavior disorders maintained by either positive or negative reinforcement, and special cases of antecedent events in behavior disorders. Some directions for future research on antecedent influences in the analysis and treatment of behavior disorders are discussed.

Artifactual effects of sensory-integrative therapy on self-injurious behavior.

Three individuals who exhibited self-injurious behavior (SIB) were exposed to sensory-integrative therapy. Prior to treatment, a functional analysis baseline was conducted to identify the motivational features of their SIB. One subject's SIB appeared to be an attention-getting response (maintained by positive reinforcement), which varied subsequently as a function of attention being either withheld or provided noncontingently during sensory-integration sessions. The 2nd subject displayed a pattern of responding suggestive of stereotypic SIB (maintained by automatic reinforcement), which paradoxically increased during sensory-integration sessions. The 3rd subject's SIB appeared to function as an escape response (maintained by negative reinforcement), and his behavior during sensory-integration sessions was similar to that observed during baseline sessions in which demands were not present. The SIB of all 3 subjects later was reduced when behavior interventions were applied. The data presented raise questions about the active components of sensory-integrative therapy and the functional types of SIB for which it might be appropriate.

Evaluation of a multiple-stimulus presentation format for assessing reinforcer preferences.

We compared three methods for presenting stimuli during reinforcer-preference assessments: a paired-stimulus format (PS), a multiple-stimulus format in which selections were made with replacement (MSW), and a multiple-stimulus format in which selections were made without replacement (MSWO). Results obtained for 7 participants showed moderate to high rank-order correlations between the MSWO and PS procedures and a similar number of identified reinforcers. In addition, the time to administer the MSWO procedure was comparable to that required for the MSW method and less than half that required to administer the PS procedure. Subsequent tests of reinforcement effects revealed that some stimuli selected in the PS and MSWO procedures, but not selected in the MSW procedure, functioned as reinforcers for arbitrary responses. These preliminary results suggest that the multiple-stimulus procedure without replacement may share the respective advantages of the other methods.

A methodology for distinguishing between extinction and punishment effects associated with response blocking.

We present one method for distinguishing between extinction and punishment effects. The proportion of responses that produced a consequence (blocking) was varied while hand mouthing was treated in a man diagnosed with profound mental retardation. Response patterns across the schedule changes suggested that the blocking procedure functioned as a punishing event.

Increasing senior citizen participation in a community-based nutritious meal program.

Two experiments were conducted to compare the effects of several prompting and reinforcement procedures on the participation of elderly citizens in a nutritious meal program. Experiment I employed a variation of the multiple-baseline design across three groups of approximately 60 households each. Elderly persons not previously participating in the program were introduced to the following conditions: (1) public service radio announcements for four weeks to advertise the meal program and the availability of free transportation, (2) a home visit that served as a personal invitation and a second prompt for participation, (3) a followup telephone call, and (4) an incentive menu for participation, which was sent through the mail. Results indicated that the home visits and incentives were both effective as recruitment procedures and superior to other conditions; however, incentives proved to be the most cost-effective intervention. Experiment II used a variation of the multi-element design to compare the effects of scheduled activities and incentives in maintaining higher levels of participation by those persons who had attended the meal program at least once in the past, but whose current rate of participation was low. Results showed that activities improved attendance levels somewhat and that incentives substantially increased the number of meal program participants. Data from these experiments thus indicate that relatively inexpensive procedures may be used effectively to increase the extent to which elderly persons make use of potentially beneficial community-based services.

Behavioral research in preventive dentistry: educational and contingency management approaches to the problem of patient compliance.

This study examined the effects of reinforcement on compliance with an oral hygiene education program. Patients 18 years of age or older who enrolled in an ongoing program at a periodontal practice received 3-5 sessions of instruction in preventive dental care. Using a between-subjects design, patients who entered the program during alternating months also had a portion of their fees refunded contingent upon improvements in their dental plaque scores. Pre- and posttreatment data showed that all subjects exhibited lower plaque levels following the program, but that greater improvements were seen in patients who were exposed to the fee reduction contingency. Plaque scores taken at a 6-month follow-up revealed some relapse for the Fee Reduction subjects. However, their scores were still substantially better than pretreatment, and better than those of the Education only subjects, whose data differed little from untreated Controls. Methodological and practical issues related to behavioral research in preventive dentistry are discussed.

An analysis of error-correction procedures during discrimination training.

Mechanisms involved in error-correction procedures during behavioral acquisition were examined. Seven developmentally delayed subjects participated in match-to-sample discrimination training, consisting of three conditions arranged in a multielement design. Correct responses in all conditions were followed by praise and either food or pennies. In the baseline condition (differential reinforcement), an error produced no consequences. In the practice condition, an error was followed by repetition of the trial until a correct response occurred. In the avoidance condition, an error was followed by additional trials consisting of irrelevant stimuli; this condition separated the effects of repeated exposure to the same task from those of negative reinforcement, both of which existed in the practice condition. All 7 subjects made noticeable progress in the baseline condition. However, 5 of the 7 performed better in one of the error-correction conditions: 2 performed better in the practice condition, and 3 performed better in the avoidance condition. These data indicate that error-correction procedures may serve multiple functions and suggest that the practice requirement in this study included both avoidance and stimulus control components. More generally, the data indicate that additional control procedures should be included in acquisition studies to identify the relevant behavioral mechanism(s).

Establishing operations and reinforcement effects.

Positive reinforcement procedures have had a major impact on educational programs for the developmentally disabled; nevertheless, variation in reinforcer effectiveness both within and across individuals is a common phenomenon. This study examined one class of variables--establishing operations--that might influence the effectiveness of reinforcers. Five developmentally disabled adult males participated. Responding on one of two motor tasks--switch closure or block placement--was assessed during baseline, satiation, and deprivation conditions with respect to three classes of consequences: small food items, music, and social praise. Deprivation and satiation conditions were constructed so as not to alter significantly the normal course of events in a subject's day. For example, food deprivation entailed scheduling sessions just prior to a subject's regular lunch, and social deprivation involved limiting a subject's access to social interaction for 15 minutes, during which time the subject had access to an assortment of other activities. Results showed that each stimulus class functioned as reinforcement with different degrees of effectiveness during satiation versus deprivation conditions. These results are discussed in light of previous research on enhancement of reinforcer efficacy as well as the assessment and identification of functional reinforcers, and implications are presented for future research and client habilitation.