This study examined the efficacy of basing treatment interventions for self-injurious behavior on data gathered in functional assessment sessions designed to evaluate the environmental determinants that control the rate of responding. Two moderate and one severely retarded school-age children served as subjects in this study. Data from the assessments revealed that Subjects 1 and 2 emitted the highest rates of self-injury under positive reinforcement conditions, while Subject 3 exhibited higher rates during sensory-input alone conditions. Treatments, implemented by classroom teachers, consisted of differential reinforcement procedures that sought to replace the self-injury with functionally equivalent responses. Results of the interventions indicate that self-injury that is maintained by socially mediated reinforcers could be reduced through the training of alternative communicative responses. In addition, self-injury that functioned as sensory stimulation was reduced by the application of a mild restraint and differential reinforcement of incompatible response procedure. These results are discussed in relation to the identified motivational determinants of the responses and the limitations of such assessments.

We report the development of a technology for measuring sexual arousal in the natural environment. Experiment 1 demonstrated that levels of sexual arousal obtained in the laboratory when a participant was wearing underwear and trousers were similar to arousal levels obtained without underwear and trousers. In Experiment 2, four sexual offenders' arousal was measured in the natural environment using a portable penile plethysmograph. Measures were taken in three different settings: a setting in which only adults were present, a setting with children present, and a setting with no person other than the data collector present. In each setting, arousal was measured when the data collector was both near and away from the offender. For three of four offenders, pattems of arousal were consistent with previous laboratory assessments and/or previous offenses. Moreover, arousal was greatest when the data collector was away from the participant.

The generalization of relapse-prevention skills of 10 males residing at a state facility for sexual offenders diagnosed with an intellectual disability was assessed in the community using three different experimental probes: (a) treatment staff (TS), (b) nontreatment staff (NTS), and (c) community adults (CAs). Results indicated a decrease in compliance from the TS to NTS and CAs, with the lowest levels of generalization displayed by offenders who were older and displayed a wider range of paraphilias. The degree of generalization also varied as a function of the contingencies for prevention-plan noncompliance, with higher rates of generalization occurring for violations that were more severely consequated. The implications of the findings for future research in promoting the generalization of relapse-prevention skills of sexual offenders, in general, and those who also exhibit intellectual disabilities, in particular, are discussed.

The ability to adequately evaluate medications in the treatment of paraphilias has been limited by reliance upon self-report as a measure of effectiveness over periods of time that may be too short to detect reoffending. One solution to this shortcoming is the development of valid, long-term, stable assessment measures. The purpose of this case study was to analyze the effects of Prozac and Provera on an array of behaviors germane to the successful treatment of paraphilias, including: (a) sexual arousal in the laboratory and natural environment, (b) sexual thoughts (deviant and nondeviant) accompanied by arousal in the natural environment, and (c) overt actions in the community associated with increased risk of reoffending over a 31-month period for an exhibitionist with an intellectual disability. Despite the ineffectiveness of the medications, the measures demonstrated long-term, differentiated significant clinical responding; further underscored the importance of assessing deviant sexual arousal and adherence to relapse-prevention procedures in the natural environment; and provided a new methodology to assess sexual preoccupations and sexual arousal. Use of these in vivo measures raises questions regarding their potential to improve the predictability of risk assessments, and serve as an aide in the analysis of whether a treatment procedure is effective for an individual.