Behavioral treatment of automatically reinforced SIB: 1982 – 2015

Abstract

Some individuals diagnosed with intellectual and developmental disabilities engage in automatically reinforced self-injurious behavior (SIB). For these individuals, identifying effective treatments may be difficult due to the nature of the reinforcement contingency. The purpose of this study was to review the literature on the treatment of automatically reinforced SIB to determine commonalities in procedures that produced effective and ineffective treatment outcomes, as well as historical trends in the treatment of this class of SIB. Results of this review indicated that there were many high-quality studies on this topic, but also a wide range in the quality of studies. As for effective treatments, noncontingent reinforcement (the most common treatment component) was found to be more effective when informed by a competing stimulus assessment rather than a preference assessment. Suggestions to improve the quality of the published record and areas in which additional research is needed are discussed.

Behavioral Treatment of Self-Injury: 2001 to 2016

“…Although the findings on punishment and extinction efficacy are consistent with previous reviews (Kahng et al, 2002a, Rooker et al, 2018, concerns about the use of these procedures warrants discussion. Ethical guidelines and compliance codes (e.g., Board Certified Behavior Analyst) consider punishment procedures to be a last resort.…”

“…Conversely, reinforcement-based, antecedent manipulations, response blocking, and mechanical restraint procedures were found to decrease in efficacy, as compared to the original reviews. A decrease in reinforcement efficacy may be correlated with the increase in SIB cases that are maintained by automatic reinforcement (Rooker et al, 2018), and the subsequent resistance to treatment as a result , Hagopian et al, 2017. Additionally, given the low percentage of studies that taught a FERB, appropriate replacement behaviors may have only contacted minimal reinforcement (for further discussion on treatment resistance with automatically reinforced SIB, see Rooker et al, 2018).…”

“…Additionally, the reinforcers for automatically maintained behavior are continuously available to the individual Hagopian et al, 2017). Much of these difficulties are likely due to the lack of precise identification of the maintaining variable that could control the behavior (Rooker et al, 2018).…”

Initial outcomes of an augmented competing stimulus assessment

“…Stimuli associated with the greatest reductions in problem behavior relative to a no‐stimulus control trial are then used in treatment where they are typically delivered noncontingently. This approach has been used to identify stimuli used as a component of interventions targeting automatically maintained problem behavior, including pica (e.g., Saini et al, 2016), self‐injury (see Rooker et al, 2018), and stereotypy (e.g., Groskreutz et al, 2011). The CSA can also be used to identify stimuli that compete with social reinforcers to incorporate into treatments for socially maintained problem behavior (DeLeon et al, 2005; Fisher et al, 2004; Hagopian et al, 2005).…”

Behavioral treatment of spitting in a child with autism spectrum disorder: Functional analysis, intervention evaluation, and maintenance assessment

“…There is good empirical support for several intervention procedures that target automatically reinforced problem behavior (Rapp & Vollmer, 2005; Rooker, Bonner, Dillon, & Zarcone, 2018), for example, providing continuous access to competing stimuli and delivering preferred stimuli noncontingently (NCR) according to fixed‐time and variable‐time schedules (Goh et al, 1995; Piazza, Adelinis, Hanley, Goh, & Delia, 2000; Piazza et al, 1998; Shore, Iwata, DeLeon, Kahng, & Smith, 1997). Response blocking in a punishment procedure that prevents access to automatic reinforcement (Lerman & Iwata, 1996; Saini, Greer, Fisher, Lichtblau, DeSouza, & Mitter, 2016) but is not easily implemented with a behavior such as spitting.…”