A Brief Review of Expanded-Operant Treatments for Mitigating Resurgence.

Resurgence following expanded-operant treatments (i.e., increasing the number or variability of alternative responses to problem behavior) has been the focus of numerous studies over the last five years. Researchers have evaluated several techniques for expanding the operant such as serial-, lag-, and concurrent-training procedures. Given the increasing number of recent studies on the topic, the various forms of training used, and the variability in outcomes, it is critical to review this area of research and identify clear future directions. Our brief review identified 10 published studies and eight unpublished theses or dissertations on this topic; however, only three published studies directly evaluated expanded-operant treatments as a strategy for relapse mitigation. All three studies evaluated serial-training procedures, and results across the studies were inconsistent. We summarize the findings of each study and provide recommendations for future research.

An Organizational Model for Increasing Access to the Scholarly Literature.

Incorporating literature into practice can help behavior analysts provide better services and achieve better outcomes. In addition, behavior analysts have an ethical obligation to remain current with the scholarly literature and to use it to inform services. Despite the merits of maintaining regular contact with the published literature, barriers exist to doing so. In this tutorial, we present a system that was created for a human service agency to increase practitioner access to the scholarly literature. The system consisted of an electronic search request form, a literature team, and a liaison. We present 7 years of data including the frequency of use, topics of interest, and other noteworthy patterns of submitter responding. We discuss the value of this type of system, limitations of its design, and considerations for practitioners who may wish to implement a similar system in their agency. We discuss modifications that could be made to fit organizations of diverse sizes and with different resources, while presenting ideas for improvement and expansion of the system.

Resurgence of destructive behavior following decreases in alternative reinforcement: A prospective analysis.

Basic and retrospective translational research has shown that the magnitude of resurgence is determined by the size of the decrease in alternative reinforcement, with larger decreases producing more resurgence. However, this finding has not been evaluated prospectively with a clinical population. In Experiment 1, five participants experienced a fixed progression of reinforcement schedule-thinning steps during treatment of their destructive behavior. Resurgence occurred infrequently across steps and participants, and when resurgence did occur, its clinical meaningfulness was often minimal. In Experiment 2, five new participants experienced these same schedule-thinning steps but in a counterbalanced order. Resurgence occurred most often and was generally largest with larger decreases in alternative reinforcement programmed earlier in the evaluation. Large decreases in alternative reinforcement may be more problematic clinically when they occur earlier in treatment. Whether larger transitions can be recommended in the clinic following the success of smaller ones will require additional research.

Relapse and its mitigation: Toward behavioral inoculation.

Relapse following the successful treatment of problem behavior can increase the likelihood of injury and the need for more intensive care. Current research offers some predictions of how treatment procedures may contribute to relapse, and conversely, how the risk of relapse can be mitigated. This review describes relapse-mitigation procedures with varying levels of support, the quantitative models that have influenced the research on relapse mitigation, different experimental methods for measuring relapse mitigation, and directions for future research. We propose that by viewing the implementation of relapse-mitigation procedures as a means of producing behavioral inoculation, clinicians are placed in the proactive and intentional role of exposing their client's behavior to an array of reinforcement and stimulus conditions during treatment with the goal of decreasing the detrimental impact of future treatment challenges.

Further evaluation of treatment duration on the resurgence of destructive behavior.

Translation of promising procedures for mitigating treatment relapse has received considerable attention recently from researchers across the basic-applied continuum. One procedure that has demonstrated mixed support involves increasing the duration of treatment as a strategy for blunting resurgence. In a recent translational study, Greer et al. (2020) failed to detect a mitigation effect of increased treatment duration on the resurgence of destructive behavior. However, design limitations may have been responsible. The present study corrected these limitations by (a) employing a sequential design to decrease the possibility of multiple-treatment interference, (b) evaluating more treatment durations, (c) arranging treatments of fixed durations, and (d) conducting treatments of more extreme duration in a different clinical sample. Despite these improvements in experimental rigor and the testing of more extreme boundary conditions, the present study also failed to detect a mitigation effect of increased treatment duration. Likely explanations are discussed.

Resurgence of destructive behavior following differential rates of alternative reinforcement.

Behavioral momentum theory (BMT) suggests that resurgence of destructive behavior may be at least partly determined by the rate of alternative reinforcement, with lean schedules of reinforcement producing less resurgence than dense schedules. Findings from basic and translational studies have been mixed, and the effects of alternative reinforcement rate on resurgence remain unclear. In the current study, we conducted a within-subject evaluation of resurgence during extinction with four children following functional communication training using dense and lean (BMT-informed) schedules of alternative reinforcement. We observed no reliable differences in resurgence across the dense and lean conditions. We discuss implications of these findings in relation to future research using quantitative analyses to evaluate the relative effects of alternative reinforcement rate and other BMT-based strategies for mitigating resurgence in applied settings.

Conducting Translational Research in the Context of Patient Care.

Although much has been written on the importance of translational research for bridging the continuum of basic science to clinical practice, few authors have described how such work can be carried out practically when working with patient populations in the context of ongoing clinical service delivery, where the priorities for patient care can sometimes conflict with the methods and goals of translational research. In this article, we explore some of the considerations for conducting this type of work while balancing clinical responsibilities that ensure high-quality patient care. We also discuss strategies we have found to jointly facilitate translational research and improve routine, clinical service delivery. A primary goal of this article is to encourage others working in applied settings to contribute to the increasingly important role that translational research plays in our science and practice by helping to better characterize and potentially lessen or remove barriers that may have impeded such investigations in the past.

Translating quantitative theories of behavior into improved clinical treatments for problem behavior.

The most important advancement in the treatment of destructive behavior has been the development of the functional analysis, which is used to prescribe effective treatments like functional communication training. Although this approach can be highly effective, extinction bursts and forms of treatment relapse commonly occur when function-based treatments are implemented by caregivers in natural community settings. In recent years, researchers have increasingly applied quantitative theories of behavior like behavioral momentum theory (BMT) and the temporally weighted matching law (TWML) to understand, prevent, or mitigate extinction bursts and treatment relapse. In this paper, we describe BMT and TWML and selectively review the basic, translational, and applied research supporting and opposing each theory. Then, we describe how function-based treatments may be refined based on these theories to improve the effectiveness, generality, and durability of function-based treatments for individuals with autism spectrum and related disorders who display problem behavior.

On the Efficacy of and Preference for Signaling Extinction in a Multiple Schedule.

Previous basic research has shown that signaling the extinction component of a compound schedule can be aversive and nonpreferred. However, such discriminative stimuli are common when thinning schedules of reinforcement in practice, and they provide several advantages to clinicians. A limitation of previous applied studies on different arrangements of discriminative stimuli is that researchers have used identical stimuli to signal the availability of reinforcement across conditions that do and do not signal extinction, often doubling exposure to the stimulus signaling the availability of reinforcement. The present experiments corrected this limitation by comparing multiple-schedule arrangements that do and do not signal extinction when unique stimuli signal each component across conditions. Results from three participants indicated that both multiple-schedule arrangements were similarly efficacious when teaching the successive discrimination. However, response patterns differed when testing under a concurrent-operants arrangement, suggesting different patterns of preference across various multiple-schedule arrangements.

Resurgence Following Traditional and Interdependent Differential Reinforcement of Alternative Behavior.

Clinicians frequently prescribe functional communication training (FCT) as a treatment for severe destructive behavior. Recent research has shown that FCT treatments are susceptible to treatment relapse in the form of resurgence of destructive behavior when individuals contact periods in which reinforcers are unavailable. Results of preliminary studies suggest that teaching multiple response alternatives can mitigate the resurgence of target behavior. The current evaluation serves as a preliminary study in which we used a laboratory arrangement to evaluate the effects of a novel approach to training multiple alternative responses on the resurgence of target behavior. Findings showed that multiple-response training did not decrease resurgence of target responding consistently; however, it increased the total amount of target and alternative responding observed during the resurgence phase and decreased the overall probability of the target response.

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.

Using e-learning modules to teach ongoing-visual inspection of functional analyses.

Despite the effectiveness of function-based treatments, most clinicians do not conduct functional analyses (FA). The time required to conduct an FA is a major barrier preventing their use. One way to increase FA efficiency is to discontinue the analysis as soon as it has produced clear results. Saini et al. (2018) evaluated a structured procedure for ongoing-visual inspection of FAs and found that it produced accurate interpretations while averaging 40% fewer sessions than author interpretation. This study evaluated the efficacy of an e-learning module for training registered behavior technicians (RBTs) to implement ongoing visual inspection of FAs. Following training, 5 of the 6 participants showed mastery of ongoing visual inspection, and the final participant did so with the addition of supplemental procedures. We discuss how this training may increase the efficiency of FAs by teaching individuals who are less experienced in FA methodology when to seek supervision from a supervising Board Certified Behavior Analyst® (BCBA).

Mitigating resurgence of destructive behavior using the discriminative stimuli of a multiple schedule.

Results of several recent translational studies have suggested that correlating contextual or discriminative stimuli with the delivery and withholding of reinforcement for the functional communication response (FCR) may mitigate resurgence of destructive behavior, but few, if any, have isolated the effects of those stimuli. In the present study, we first trained the FCR, brought it under stimulus control of a multiple schedule, and thinned its reinforcement schedule in one stimulus context. Next, we conducted resurgence evaluations (i.e., baseline, functional communication training [FCT], extinction challenge) in two novel contexts to test the effects of the discriminative stimuli on resurgence. We programmed one context to include the (a) SD during the FCT phase to signal the availability of reinforcement for the FCR and (b) SΔ during a subsequent extinction challenge to signal the unavailability of reinforcement for the FCR. The other context did not include the SD during the FCT phase, nor the SΔ during the extinction challenge. We expected to see greater persistence of the FCR in the context that included the SD during FCT and less persistence of the FCR and less resurgence of destructive behavior in the context that included the SΔ during the extinction challenge. Obtained results confirmed this latter prediction, but we observed no reliable difference when the SD was present or absent during the FCT phase. Our results have relevance for practitioners in that they provide further empirical support for the use of discriminative stimuli when treating destructive behavior.

Baseline reinforcement rate and resurgence of destructive behavior.

Concepts from behavioral momentum theory, along with some empirical findings, suggest that the rate of baseline reinforcement may contribute to the relapse of severe destructive behavior. With seven children who engaged in destructive behavior, we tested this hypothesis in the context of functional communication training by comparing the effects of different baseline reinforcement rates on resurgence during a treatment challenge (i.e., extinction). We observed convincing resurgence of destructive behavior in four of seven participants, and we observed more resurgence in the condition associated with high-rate baseline reinforcement (i.e., variable-interval 2 s in Experiment 1 or fixed-ratio 1 in Experiment 2) compared to a low-rate baseline reinforcement condition. We discuss the implications of these results relative to schedules of reinforcement in the treatment of destructive behavior and strategies to mitigate resurgence in clinical settings.

Evaluating competing activities to enhance functional communication training during reinforcement schedule thinning.

Arranging periods in which requests for reinforcement are denied in a multiple schedule may result in increased destructive behavior during these periods for individuals who receive functional communication training (FCT) as treatment for severe destructive behavior. Providing access to competing activities during periods of reinforcer unavailability has been shown to minimize destructive behavior. We evaluated methods to identify effective competing activities for use when thinning reinforcement availability in a multiple schedule and compared competing activities embedded within the multiple schedule using an alternating-treatments design. Results suggested at least one competing activity facilitated favorable treatment outcomes for each participant. We discuss building on this empirical approach to identify effective competing activities for use during reinforcement schedule thinning.

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

Recent research findings (DeRosa, Fisher, & Steege, ) 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.

Minimizing resurgence of destructive behavior using behavioral momentum theory.

The resurgence of destructive behavior can occur during functional communication training (FCT) if the alternative response contacts a challenge (e.g., extinction). Behavioral momentum theory (BMT) suggests that refinements to FCT could mitigate resurgence of destructive behavior during periods of extinction. Following a functional analysis and treatment with FCT, we combined three refinements to FCT (i.e., the use of a lean schedule of reinforcement for destructive behavior during baseline, a lean schedule for the alternative response during FCT, and an increase in the duration of treatment) and compared the magnitude of resurgence relative to a condition in which FCT was implemented in a traditional manner. Results suggested that the combination of these three refinements to FCT was successful in decreasing the resurgence of destructive behavior during an extinction challenge. We discuss the implications of these findings, as well as areas for future research.

On the predictive validity of behavioral momentum theory for mitigating resurgence of problem behavior.

We summarize the results of four recent translational studies from our lab that used the predictions of behavioral momentum theory to inform the development of more durable treatments for destructive behavior. Treatments informed by behavioral momentum theory generally showed better suppression of target responding during an extinction challenge than did a comparison treatment. We reanalyze data from each of the four studies to show that this general finding is apparent both at the aggregate (i.e., proportion of baseline response rates averaged across participants) and within participant (i.e., percentage reduction in proportion of baseline response rates, difference in raw response rates during the extinction challenge). Interestingly, participants who experienced multiple cycles of the extinction challenge generally showed less differentiation in target responding between the treatment informed by behavioral momentum theory and the comparison treatment. Overall results suggest that applications of behavioral momentum theory can substantially improve the durability of common treatments for destructive behavior.

A preliminary investigation on improving functional communication training by mitigating resurgence of destructive behavior.

Despite the effectiveness and widespread use of functional communication training (FCT), resurgence of destructive behavior can occur if the functional communication response (FCR) contacts a challenge, such as lapses in treatment integrity. We evaluated a method to mitigate resurgence by conducting FCT using a multiple schedule of reinforcement prior to extinction. After functional analyses of 2 boys' destructive behavior and treatment with FCT (Study 1), we compared levels of resurgence during an extinction challenge either after a typical FCT sequence or after exposure to schedule thinning in the context of a multiple-schedule arrangement (Study 2). Results for both participants suggested that schedule thinning using discriminative stimuli in a multiple schedule mitigated the resurgence of destructive behavior.

Using multiple schedules during functional communication training to promote rapid transfer of treatment effects.

Multiple schedules with signaled periods of reinforcement and extinction have been used to thin reinforcement schedules during functional communication training (FCT) to make the intervention more practical for parents and teachers. We evaluated whether these signals would also facilitate rapid transfer of treatment effects across settings and therapists. With 2 children, we conducted FCT in the context of mixed (baseline) and multiple (treatment) schedules introduced across settings or therapists using a multiple baseline design. Results indicated that when the multiple schedules were introduced, the functional communication response came under rapid discriminative control, and problem behavior remained at near-zero rates. We extended these findings with another individual by using a more traditional baseline in which problem behavior produced reinforcement. Results replicated those of the previous participants and showed rapid reductions in problem behavior when multiple schedules were implemented across settings.