Association for Behavior Analysis International

This symposium includes four papers describing current trends and refinements in the treatment of automatically reinforced problem behavior. The author of the first paper will describe the use of a rating scale to characterize behavioral and medical interventions for 75 individuals exhibiting severe self-injury. The results of the survey were compared in individuals who exhibited SIB that was and was not maintained by social reinforcement. In the second paper, the author will discuss a study comparing two preference assessment formats for identifying reinforcers for use during two commonly used interventions for automatically reinforced problem behavior. The outcomes of noncontingent reinforcement and differential reinforcement of other behavior interventions, using two different highly preferred stimuli, will be reviewed. In the third paper, the author will describe a multiple-component treatment evaluation with a punisher assessment for reducing automatically reinforced problem behavior. The results of the punisher assessment that included four or five potential punishers identified via interview will be reviewed. In the forth paper, the author will discuss a comparison of two redirection procedures, a standard redirection procedure and a physical redirection procedure, for decreasing the public masturbation (PM) of three children with an autism spectrum disorder. The relative utility of these two redirection procedures for decreasing PM will be discussed.

The purpose of the study was to develop outcome measures to characterize the complexity of behavioral and medical treatment plans for patients receiving assessment and treatment for severe problem behavior. The Treatment Intensity Rating Form (TIRF) is a 10-item scale with three categories: pharmacological interventions, behavior supports, and protective equipment. The TIRF was scored using the treatment plans of 75 individuals with self-injurious behavior (SIB). We compared individuals for whom SIB occurred across conditions of a functional analysis (i.e., the behavior was maintained by automatic reinforcement) and those whos SIB was maintained by social reinforcement (e.g., attention, escape from tasks, or access to toys/activities). Results indicated that those individuals with SIB maintained by automatic reinforcement had significantly more complex interventions including psychotropic medications, behavior plans with more components including reactive ones, and the use of more protective equipment than individuals with SIB maintained by social reinforcement. We also further delineated the automatic reinforcement group into 3 subtypes and found that there were differences in the degree to which protective equipment and medications were used within the automatic group.

Treatment of automatically reinforced problem behavior often requires the identification of preferred stimuli. However, it remains unclear whether certain preference assessment formats may better predict the reinforcing efficacy of stimuli in the context of treatment. The purpose of the current study was to compare the relative utility of two preference assessment formats in identifying reinforcers for inclusion in a differential reinforcement of other (DRO) intervention and in a noncontingent reinforcement (NCR) intervention. Four individuals with an autism spectrum disorder who exhibited high levels of automatically reinforcing motor stereotypy participated. Preference assessment formats that were compared were the paired-stimulus (PS) method and the competing items (CI) method. After ensuring stability in preference assessment outcomes, a highly preferred stimulus from each method was included in a subsequent reinforcer assessment and treatment evaluation. The effects of DRO and NCR interventions were evaluated using a reversal design, and the effects of the two different highly preferred stimuli were compared using an embedded multielement design. The CI highly preferred item did not consistently function as a reinforcer but was more effective than the PS highly preferred stimulus during NCR. Reliability data were collected in a minimum of 33% of sessions and averaged over 87%.

Individuals with disabilities often engage in sexual behavior that is developmentally appropriate, but occurs in inappropriate places or at inappropriate times due to a lack of social skills and/or sexual education. This study evaluated two redirection procedures to for decreasing the public masturbation (PM) of three children with an autism spectrum disorder. First, no interaction sessions were completed to establish baseline levels of PM. Then both redirection procedures were evaluated in an alternating treatments comparison. During the standard redirection procedure, the therapist presented a verbal comment to interrupt engagement of PM and redirected the participant's hands away from the groin area. In the physical redirection procedure, when the student engaged in PM, the teacher immediately instructed him/her to stand up and engage in 3-5 minutes of physical activity requiring both hands, and reinforced compliance with the activity upon completion. Following a return to baseline, these two redirection procedures were evaluated again. Interobserver agreement data were collected for at least 33% of the sessions. Across all three participants both redirection procedures decreased PM to low levels; however, in some cases the physical redirection procedure required multiple therapists for implementation and resulted in overall longer treatment sessions.