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. (+info)
On the relation between object manipulation and stereotypic self-injurious behavior.
Results from a number of studies have shown an inverse relationship between stereotypic behavior and object manipulation. The purposes of this study were to determine whether techniques similar to those used previously (prompting and reinforcement) would be effective in increasing object manipulation under both prompted and unprompted conditions, and to ascertain whether increases in object manipulation would result in decreases in stereotypic self-injurious behavior (SIB). Two individuals with developmental disabilities who engaged in SIB maintained by automatic reinforcement participated. Results showed that object manipulation increased from baseline levels when experimenters prompted participants to manipulate leisure items, but that object manipulation was not maintained under unprompted conditions, and rates of SIB stayed within baseline levels. We then attempted to increase object manipulation further by (a) reinforcing object manipulation, (b) blocking SIB while reinforcing manipulation, and (c) preventing SIB by applying protective equipment while reinforcing object manipulation. Reinforcing object manipulation alone did not affect levels of object manipulation. Blocking effectively reduced attempts to engage in SIB for 1 participant but produced no increase in object manipulation. When the 2nd participant was prevented from engaging in SIB through the use of protective equipment, rates of object manipulation increased dramatically but were not maintained when the equipment was removed. These results suggest that stimulation derived from object manipulation, even when supplemented with arbitrary reinforcement, may not compete with stimulation produced by stereotypic SIB; therefore, direct interventions to reduce SIB are required. (+info)
Clarifying an ambiguous functional analysis with matched and mismatched extinction procedures.
Results of functional analysis were ambiguous in suggesting that self-injurious behavior (SIB) was maintained by escape, sensory reinforcement, or both. To help clarify these results, we compared escape extinction, sensory extinction, and the combined treatments. Sensory extinction proved to be a necessary and sufficient treatment, whereas escape extinction failed to decrease SIB. These analyses helped to clarify the function of SIB and to identify an effective and efficient treatment. (+info)
Decreasing signs of negative affect and correlated self-injury in an individual with mental retardation and mood disturbances.
We evaluated the effects of an enriched environment, based on a paired-choice preference assessment, on both rates of self-injurious behavior (SIB) and percentage of session intervals during which signs of negative affect were displayed by a woman with mental retardation and a mood disorder. Results suggested that SIB and signs of negative affect were highly correlated and that the enriched environment effectively reduced both. (+info)
An investigation of primary care patients receiving extended treatment with selective serotonin reuptake inhibitors.
OBJECTIVE: To determine the psychiatric characteristics of a sample of primary care patients receiving extended treatment with selective serotonin reuptake inhibitors (SSRIs) as well as to assess the appropriateness of extended treatment. STUDY DESIGN: A prospective case series of patients (convenience sample) assessed with survey, psychological testing, interview, and medical record review. METHODS: Participants (n = 39) were patients in a health maintenance organization primary care setting receiving treatment with SSRI-type antidepressants for 12 months or longer, with no psychiatric evaluation or treatment immediately before commencement of antidepressant therapy. Each participant completed measures of self-destructive behavior and personality disturbance, underwent a clinical psychiatric interview, and had their medical record reviewed to determine psychiatric diagnoses by the primary care physician at the initiation of antidepressant treatment. RESULTS: On psychiatric interview, 64.1% of participants were diagnosed with major depression, the majority recurrent (46.2% of the entire sample); 46.2% with dysthymia; and 38.5% with panic disorder. Psychiatric morbidity in this sample was reflected by recurrent depressive episodes, long-standing depression, comorbid psychiatric diagnoses on interview (average of 1.8 diagnoses per participant), self-harm behaviors, and personality pathology. Seventy-seven percent of primary care diagnoses gleaned from medical records reflected depressive diagnoses. The approximate "match" rate for a depression-spectrum diagnosis between psychiatric interviewer and primary care physicians was 90%; however, on psychiatric interview, 16.7% of participants had bipolar disorder and 38.5% had panic disorder, which were not noted in the primary care medical record. CONCLUSIONS: Patients in primary care settings receiving extended treatment with SSRIs may have complex psychopathology for which long-term antidepressant treatment appears appropriate. (+info)
DRO contingencies: an analysis of variable-momentary schedules.
We conducted several comparative analyses to determine the relative effectiveness of variable-momentary differential-reinforcement-of-other-behavior (VM DRO) schedules. Three individuals who had been diagnosed with mental retardation participated. Results of functional analyses indicated that their self-injurious behavior (SIB) was maintained by social-positive reinforcement. Two individuals participated in a two-stage comparative analysis within multielement and multiple baseline designs. Fixed-interval (FI) and variable-interval (VI) DRO were compared in the first stage; VI DRO and VM DRO were compared in the second. All three schedules effectively reduced the participants' SIB. Treatment for the 3rd individual was conducted in a reversal design to examine the effects of VM DRO when it was implemented in isolation, and results indicated that the procedure was effective in reducing SIB. These findings suggest that VM DRO schedules may represent attractive alternatives to traditional FI schedules because momentary schedules do not require continuous monitoring and may result in higher rates of reinforcement. (+info)
Correspondence between outcomes of brief and extended functional analyses.
We compared results obtained from 50 sets of functional analysis data from assessments of self-injurious behavior (SIB), 35 of which showed clear response patterns and 15 of which were undifferentiated, with those obtained from two abbreviated methods of assessment: (a) a brief functional analysis, consisting of the first session of each condition from the full functional analysis, and (b) a within-session analysis, in which data from the brief analysis were regraphed to show minute-by-minute changes in response rates during a session. Results indicated that outcomes of the brief and within-session analyses corresponded with those of the full functional analyses in 66.0% and 68.0% of the cases, respectively. Further examination of results indicated a tendency for the brief analysis to identify a large proportion of positive cases (both true and false positives) and for the within-session analysis to identify a large proportion of negative cases (true and false negatives). (+info)
Effects of session duration on functional analysis outcomes.
We examined the extent to which variations in session duration affected the outcomes of functional analyses. Forty-six individuals, all diagnosed with mental retardation and referred for assessment and treatment of self-injurious or aggressive behavior, participated in functional analyses, consisting of repeated exposure to multiple test conditions during 15-min sessions. For each set of assessment data, new data sets based on session durations of 10 and 5 min were prepared by deleting data from the last 5 and 10 min, respectively, of each session. Each graph (N = 138) was then reviewed individually by graduate students who had previous experience conducting and interpreting functional analyses, but who were blind to both participant identity and session duration. Interpretations of behavioral function based on the 10- and 5-min data sets were then compared with those based on the 15-min data sets. All of the 10-min data sets yielded interpretations identical to those based on 15-min data sets. Interpretations based on the 5-min and 15-min data sets yielded three discrepancies, all of which were the result of increased response rates toward the latter parts of sessions. These results suggest that the efficiency of assessment might be improved with little or no loss in clarity by simply reducing the duration of assessment sessions. (+info)