|Toward a Better Understanding of Resurgence in Clinical Settings
|Monday, May 27, 2019
|11:00 AM–12:50 PM
|Hyatt Regency West, Lobby Level, Crystal Ballroom A
|Area: DDA; Domain: Applied Research
|Chair: William Sullivan (Upstate Medical University)
|Discussant: Maggie Sweeney (Johns Hopkins University School of Medicine)
|CE Instructor: Ashley Marie Fuhrman, M.S.
Resurgence can be conceptualized as a form of treatment relapse that occurs when a previously extinguished behavior reemerges once a more recently reinforced behavior also contacts extinction. In clinical settings, resurgence of destructive behavior poses a serious threat to the individual, their caregivers, and the longevity of treatment effects. This symposium will describe four studies that examined resurgence of destructive behavior in clinical settings. The first two presentations will be given by Sean Smith and Dr. Valdeep Saini, respectively. Their presentations will describe a two-experiment study that examined the impact of baseline reinforcement rate on the magnitude of resurgence. More specifically, these studies tested a prediction of Behavioral Momentum Theory that suggests higher rates of baseline reinforcement will lead to greater resurgence. The third study will be presented by Dr. William Sullivan. This presentation will illustrate that when a target destructive behavior resurges, other destructive behaviors that are members of the same functional response class may also emerge. In the final presentation, Ashley Furhman will present a study that utilized discriminative stimuli under a multiple-schedule arrangement to mitigate resurgence. Each presentation will provide new insights into clinically meaningful variables that affect the resurgence of destructive behavior. Finally, Dr. Mary Margaret Sweeney will discuss the collective findings and provide directions for future research.
|Instruction Level: Intermediate
|Keyword(s): destructive behavior, resurgence, treatment relapse
BCBA's, graduate students, clinicians, and researchers
|Learning Objectives: 1. Participants will describe a treatment relapse phenomena, known as resurgence. 2. Participants will describe key variables (e.g., baseline rates of reinforcement) that affect the magnitude of resurgence. 3. Participants will describe target response resurgence within the context of a response class. 4. Participants will describe the use of discriminative stimuli under mutliple-schedule arrangements as a mitigation strategy for resurgence.
|A Preliminary Investigation of Baseline Reinforcement Rate and Resurgence of Destructive Behavior
|SEAN SMITH (University of Nebraska Medical Center), Wayne W. Fisher (Munroe-Meyer Institute, University of Nebraska Medical Center), Valdeep Saini (Brock University), Brian D. Greer (University of Nebraska Medical Center's Munroe-Meyer Institute), William Sullivan (Upstate Medical University), Henry S. Roane (Upstate Medical University), Ashley Marie Fuhrman (University of Nebraska Medical Center), Andrew R. Craig (SUNY Upstate Medical University)
|Abstract: Although functional communication training (FCT) is a highly effective intervention for destructive behavior, FCT is susceptible to resurgence, a type of relapse that occurs when the functional communication response (FCR) contacts extinction. Behavioral momentum theory predicts that higher rates of reinforcement for destructive behavior during baseline will lead to greater resurgence than lower rates of reinforcement (Nevin & Shahan, 2011). The purpose of the present study was to evaluate the effects of high and low rates of baseline reinforcement on the resurgence of destructive behavior following FCT with four children diagnosed with autism spectrum disorder. We used a two-component multiple schedule across three phases. During Phase 1, destructive behavior produced reinforcement according to a dense-VI schedule in one component and a lean-VI schedule in the other component. Following FCT pre-training, Phase 2 arranged reinforcement for the FCR according to these same VI schedules in each respective component, while destructive behavior resulted in extinction. During Phase 3, neither the FCR nor destructive behavior produced reinforcement in either component. When resurgence occurred, it was consistently higher in the component associated with the dense schedule of reinforcement during baseline.
Clinically-Meaningful Baseline Schedules of Reinforcement and Resurgence of Problem Behavior
|Valdeep Saini (Brock University), Wayne W. Fisher (Munroe-Meyer Institute, University of Nebraska Medical Center), BRIAN GREER (University of Nebraska Medical Center's Munroe-Meyer Institute), William Sullivan (Upstate Medical University), Henry S. Roane (Upstate Medical University), Ashley Marie Fuhrman (University of Nebraska Medical Center), Andrew R. Craig (SUNY Upstate Medical University)
Behavioral momentum theory predicts that the magnitude of resurgence of problem behavior, when extinction is introduced, will be greater if the targeted response(s) previously produced a high rate of reinforcement during baseline relative to a low rate of reinforcement during baseline. A number of laboratory and translational investigations of resurgence using children who engage in severe problem behavior as participants have shown this to be accurate when comparing high and low variable-interval (VI) schedules of reinforcement. However, one limitation of these studies has been the use of VI schedules, whereas in most clinical studies evaluating the effects of behavioral interventions for problem behavior use dense fixed-ratio (FR) schedules. As a result, a more clinically relevant comparison would be one that uses a baseline schedule of reinforcement more common to the treatment of problem behavior. With three children who engaged in problem behavior we compared the magnitude of resurgence when participants were exposed to lean-VI schedules of reinforcement during baseline or dense FR-1 schedules during baseline. For all participants we observed greater resurgence of problem behavior in the condition that was associated with FR-1 compared to the condition associated with VI.
|Resurgence: Examining the Role of the Response Class
|WILLIAM SULLIVAN (Upstate Medical University), Valdeep Saini (Brock University), Nicole M. DeRosa (SUNY Upstate Medical University), Andrew R. Craig (SUNY Upstate Medical University), Henry S. Roane (Upstate Medical University)
|Abstract: Treatment of severe destructive behavior often involves withholding reinforcement for destructive behavior (i.e., extinction) while simultaneously reinforcing an appropriate alternative behavior (e.g., functional communication training; Carr & Durand, 1985). Research has demonstrated that if reinforcement of the alternative behavior is reduced or eliminated, resurgence of destructive may ensue (Volkert, Lerman, Call, & Trosclair-Lasserre, 2009). The current study evaluated the resurgence of a target destructive behavior while also assessing the emergence of other, non-targeted forms of destructive behavior. Following an initial functional analysis, a response-class analysis was conducted to confirm that various topographies of destructive behavior were functionally equivalent to the target. Next, a three-phase resurgence paradigm was conducted in which one topography of destructive behavior was targeted and reinforced in Phase 1. An alternative functional communication response was reinforced in Phase 2, while the target was placed on extinction. In Phase 3, the target and alternative responses were both placed on extinction. Furthermore, all other non-targeted forms of destructive behavior that were members of the same functional response class as the target were measured but never reinforced throughout the evaluation. Results suggested that when a target destructive behavior resurges, other response-class members may also emerge. These findings will be discussed in relation to the treatment of challenging behavior.
|Mitigating Resurgence of Destructive Behavior Using the Discriminative Stimuli of a Multiple Schedule
|ASHLEY MARIE FUHRMAN (University of Nebraska Medical Center), Wayne W. Fisher (Munroe-Meyer Institute, University of Nebraska Medical Center), Brian D. Greer (University of Nebraska Medical Center's Munroe-Meyer Institute), Daniel R. Mitteer (University of Nebraska Medical Center's Munroe-Meyer Institute), Cathleen C. Piazza (Munroe-Meyer Institute, University of Nebraska Medical Center)
|Abstract: Resurgence is a form of treatment relapse that involves the reoccurrence of a previously reinforced response following extinction of a subsequently reinforced alternative response. Results of recent translational studies have suggested that correlating contextual or discriminative stimuli with the delivery or withholding of reinforcement for the FCR may mitigate resurgence of destructive behavior, but none have isolated the effects of those stimuli. In this study, we (a) trained the FCR, brought it under stimulus control of a multiple schedule, and thinned its reinforcement schedule in one stimulus context and then (b) tested the effects of the discriminative stimuli from the multiple schedule during a resurgence sequence (baseline, FCT, extinction) in a novel context relative to an equivalent resurgence sequence in another novel context without the discriminative stimuli. Participants included four children between the ages of 4 and 16 years old. Results showed greater persistence of the FCR and more resurgence of destructive behavior in the context with the discriminative stimuli present relative to the context without those stimuli. We discuss the applied and theoretical implications of these results relative to theories of resurgence that do and do not accommodate the effects of discriminative and contextual stimuli.