Association for Behavior Analysis International

Disruptive behavior with medical demands presents a significant challenge to accessing appropriate medical care, jeopardizing overall health and well-being, especially for autistic children and children with intellectual and developmental disabilities. Many times, doctors revert to invasive measures to perform medical exams such as chemical and physical restraints (Wong & Chien, 2005). The purpose of this study was to compare positive and negative reinforcement to increase medical compliance and reduce disruptive behavior. A multielement functional analysis was run prior to treatment sessions with the following conditions: control, tangible, escape and attention. A reversal embedded with an multielement design was used to evaluate treatment efficacy, followed by a novel person probe using the treatment that was most effective. Results demonstrate that positive reinforcement in the form of a preferred edible was more effective in reducing disruptive behavior and increasing compliance with medical demands for both participants. Clinical implications and future research were discussed to strengthen this study.

Past research has identified that some individuals with intellectual and developmental disabilities who engage in target behavior (e.g., aggression, self-injury) maintained by negative reinforcement engage in the behavior to escape or avoid social interactions specifically (i.e., social avoidance). However, assessment and treatment strategies for this function are understudied when compared to target behavior maintained by other forms of negative reinforcement. The current study builds on this limited research and demonstrates (a) a replication of functional analysis conditions and a negative reinforcement latency assessment to identify the specific types of social interaction that evoke target behavior, and (b) an intervention that includes stimulus fading, social conditioning, and differential reinforcement for five participants with autism spectrum disorder. Participant target behavior decreased within the intervention phase for 4 out of 5 participants. The implications of strategies to guide the use of antecedent-based treatment strategies are discussed for target behavior maintained by social avoidance.

Functional communication training has been shown to be a highly effective treatment for socially maintained problem behavior (Tiger et al., 2008). For problem behavior maintained by multiple social variables, a package of isolated treatments is often utilized to address each variable which is effective but time-consuming (Tsami & Lerman, 2020). A more efficient option of a synthesized treatment utilizing FCT with chained schedules of reinforcement, break-to-choice, has been shown to be effective in decreasing multiply maintained problem behavior (Livingston et al., 2023). However, it is unclear whether effects of the synthesized treatment will transfer to isolated contingencies of each functional reinforcer. In this study, a break-to-choice treatment was implemented with children determined to have multiply maintained problem behavior and the schedule of reinforcement was thinned to caregiver-informed terminal schedules. Additionally, this study extended previous research by implementing isolated contingency tests following schedule thinning criteria being met in the break-to-choice condition. The results of the study showed that the break-to-choice intervention was effective in decreasing multiply-maintained problem behavior and increasing functional communication responses and compliance. Additionally, these effects generalized to the isolated contingencies for each functional reinforcer for 2 out of 3 participants.

Functional Communication Training (FCT; Carr & Durand, 1985) is a commonly used strategy for the treatment of challenging behavior. FCT generally involves teaching a communication response to replace maladaptive behavior. In most cases, communication responses contact reinforcement, while target behavior contacts extinction. These procedures have overwhelming support for their use (Ghaemmaghami, et al., 2021). Concerns sometimes arise when treating escape-maintained behavior in autistic adults. While escape extinction may be clinically indicated, the side effects can present significant risks for older individuals, as well as the therapists implementing the procedure. These risks highlight the need for the development of strategies for teaching communication skills in the absence of extinction. In the current study, we evaluated the effectiveness of FCT in reducing the challenging behavior of adults with ASD. We manipulated the quality and magnitude parameters of reinforcement to favor task completion. We started with symmetrical arrangements (communication/task completion resulting in equal quality/magnitude of reinforcement) with challenging behavior not contacting extinction and shifted to asymmetrical arrangements (arrangements favoring communication). The modified FCT procedure (without extinction) successfully reduced escape-maintained challenging behavior to near-zero levels while increasing on-task behavior for an adult male with ASD.