Association for Behavior Analysis International

The use of intrusive and restrictive interventions, especially for the treatment of intense and persistent challenging behavior, is sometimes warranted. Translational research and contemporary research synthesis practices may help researchers and practitioners identify the extent to which the use of restrictive or intrusive interventions is advisable under certain conditions. In this symposium, two systematic reviews of applied research conducted in relation to escape-maintained challenging behaviors (Presentation 1) and response interruption and redirection (Presentation 2) and one translational study assessing extinction bursts in low-stakes contexts (Presentation 3) are discussed in relation to the provision of supports for individuals who engage in challenging behavior or stereotypy. These studies have the potential to provide information to the field about the contexts under which certain interventions should be used and/or are most likely to be effective.

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Individuals sometimes engage in challenging behavior to escape aversive stimuli. Interventions to reduce escape-maintained behaviors often use escape extinction (EE; e.g., physically prompting a student to complete an academic task, even if aggression occurs). Use of EE can increase risk of injury, escalate challenging behavior, restrict autonomy, and impact relationships between clients and implementers. To mitigate collateral effects, we can employ interventions without EE (i.e., non-EE)—that is, implementers can provide escape contingent on challenging behavior during intervention, in conjunction with other intervention components. No comprehensive syntheses of non-EE interventions have been conducted. In this systematic review, we identified 39 manuscripts that included non-EE interventions, with 273 separate single case designs. Non-EE interventions were associated with lower levels of challenging behavior and higher levels of alternative behavior than baseline conditions. Interventions that were effective included (a) antecedent modifications to decrease the value of escape as a reinforcer and (b) concurrent reinforcement schedules with more favorable reinforcement for alternative behavior relative to challenging behavior. Most comparisons between non-EE and EE interventions showed no functional relation, indicating that EE may not add substantial benefit to intervention efficacy in some situations.