Differential reinforcement is a common treatment for escape-maintained problem behavior in which compliance is reinforced on a fixed-ratio (FR) 1 schedule with brief access to positive and/or negative reinforcement. Recent research suggests some individuals prefer to complete longer work requirements culminating in prolonged (i.e. accumulated) reinforcement periods relative to brief (i.e. distributed) periods, but prolonged work exposure may evoke problem behavior and prevent compliance from contacting reinforcement when treating escapemaintained problem behavior. We exposed 3 children with escape-maintained problem behavior to both distributed (FR 1 resulting in 30 s of reinforcement) and accumulated (FR 15 resulting in 7.5 min of reinforcement) arrangements to compare their efficacy in maintaining low levels of problem behavior. We then assessed participants' preferences for these conditions in a concurrent-chains arrangement. Accumulated-reinforcement arrangements did not occasion additional problem behavior, but rather resulted in consistently lower levels of problem behavior for 2 of 3 participants. Participants demonstrated idiosyncratic preferences.

Donnai and Barrow (American Journal of Medical Genetics, 68, 441–444, 1993) reported multiple participants who shared a variety of specific physical and neurological anomalies. Relatively few cases have been reported since then and few of those have progressed to an age such that the developmental progression of the disorder can be ascertained. We describe one participant with Donnai-Barrow syndrome who engaged in repetitive self-injurious behavior (SIB), which heretofore has not be described in this population. Direct observations of the participant’s SIB were conducted across a range of contexts, and the behavior was successfully decreased using a combination of procedures. This case is discussed within the context of the behavioral phenotype of Donnai-Barrow syndrome.

Functional Communication Training (FCT) involves arranging extinction for problem behavior and reinforcement for a more desirable, functionally equivalent, communicative response (FCR). Although effective under ideal arrangements, the introduction of delays to reinforcement following the FCR can result in increased problem behavior. Austin and Tiger (2015) showed that for individuals whose problem behavior was sensitive to multiple sources of reinforcement, providing access to alternative, functional reinforcers during delays mitigated this increase in problem behavior during delay fading. The current study replicated the procedures of Austin and Tiger with 2 individuals displaying multiply controlled problem behavior. Providing alternative functional reinforcers reduced problem behavior during 10-min delays for both participants without requiring delay fading.

Aim and Background: Sexuality is an important aspect of being human, and is affected for people following trauma injuries. This study aimed to examine how sexuality is addressed during rehabilitation following traumatic motor vehicle injuries and to identify barriers to provision of this service. Methods: A convergent mixed methods approach with concurrent timing and an independent level of interaction was used to examine the perspectives and experiences of clients and clinicians towards addressing sexuality. A questionnaire was completed by eligible clients (n = 21) and semi-structured interviews (n = 10) were conducted with clinicians.  Questionnaire data were analysed using descriptive statistics (frequency, means and SD) to provide an outline of sociodemographic and injury related information. Interview data from clinicians were analysed thematically. Results: Sexuality was described as being impacted for over half of clients. One third reported that sexuality was addressed as part of their rehabilitation. Core themes identified from the interviews of clinicians included: (1) ‘whole person’ approach, (2) timing, delivery and responsibility of discussions, (3) culture and comfort, and (4) future tools and skill sets. Conclusion: Clinicians and clients agreed that sexuality was important but inadequately addressed during rehabilitation. Clinicians were lacking comfort, training and resources to address sexuality consistently with clients. Sexuality should be addressed at multiple stages of rehabilitation to grant service-users the option for these discussions to occur.