Data are summarized from 152 single-subject analyses of the reinforcing functions of self-injurious behavior (SIB). Individuals with developmental disabilities referred for assessment and/or treatment over an 11-year period were exposed to a series of conditions in which the effects of antecedent and consequent events on SIB were examined systematically by way ofmultielement, reversal, or combined designs. Shook, Keith Slifer, and G. Linden Thorn for the special panel concluded that, although much is known about SIB at the present time, thorough understanding and eventual reduction in the frequency of SIB will require continued research on all aspects of the disorder, induding prevalence, etiology, treatment, and prevention.In an attempt to define the general parameters of SIB as a clinical disorder, a number of investigators have conducted group surveys using methods roles they played in developing or maintaining the clinical environments that accommodated this research. Michael Dorsey is now at the South Bay

Three studies are presented in which environmental correlates of self-injurious behavior were systematically examined and later used as the basis for treatment. In Study 1, 7 developmentally disabled subjects were exposed to a series of conditions designed to identify factors that maintain self-injurious behavior: attention contingent on self-injurious behavior (positive reinforcement), escape from or avoidance of demands contingent on self-injurious behavior (negative reinforcement), alone (automatic reinforcement), and play (control). Results of a multielement design showed that each subject's self-injurious behavior occurred more frequently in the demand condition, suggesting that the behavior served an avoidance or escape function. Six of the 7 subjects participated in Study 2. During educational sessions, "escape extinction" was applied as treatment for their self-injurious behavior in a multiple baseline across subjects design. Results showed noticeable reduction or elimination of self-injurious behavior for each subject and an increase in compliance with instructions in all subjects for whom compliance data were taken. The 7th subject, whose self-injurious behavior during Study 1 occurred in response to medical demands (i.e., physical examinations), participated in Study 3. Treatment was comprised of extinction, as in Study 2, plus reinforcement for tolerance of the examination procedure, and was evaluated in a multiple baseline across settings design. Results showed that the treatment was successful in eliminating self-injurious behavior and that its effects transferred across eight new therapists and three physicians. General implications for the design, interpretation, and uses of assessment studies are discussed.DESCRIPTORS: avoidance behavior, escape behavior, extinction, functional analysis, negative reinforcement, self-injurious behavior.Results from a number of studies indicate that self-injurious behavior (SIB), a chronic and serious disorder occurring in approximately 10% of the developmentally disabled population, may be ac-

Study Objectives: We investigated the effectiveness of a lighting intervention tailored to maximally affect the circadian system as a nonpharmacological therapy for treating problems with sleep, mood, and behavior in persons with Alzheimer disease and related dementias (ADRD). Methods: This 14-week randomized, placebo-controlled, crossover design clinical trial administered an all-day active or control lighting intervention to 46 patients with ADRD in 8 long-term care facilities for two 4-week periods (separated by a 4-week washout). The study employed wrist-worn actigraphy measures and standardized measures of sleep quality, mood, and behavior. Results: The active intervention significantly improved Pittsburgh Sleep Quality Index scores compared to the active baseline and control intervention (mean ± SEM: 6.67 ± 0.48 after active intervention, 10.30 ± 0.40 at active baseline, 8.41 ± 0.47 after control intervention). The active intervention also resulted in significantly greater active versus control differences in intradaily variability. As for secondary outcomes, the active intervention resulted in significant improvements in Cornell Scale for Depression in Dementia scores (mean ± SEM: 10.30 ± 1.02 at baseline, 7.05 ± 0.67 after active intervention) and significantly greater active versus control differences in Cohen-Mansfield Agitation Inventory scores (mean ± SEM: −5.51 ± 1.03 for the active intervention, −1.50 ± 1.24 for the control intervention). Conclusions: A lighting intervention tailored to maximally entrain the circadian system can improve sleep, mood, and behavior in patients with dementia living in controlled environments.

A field study was conducted at two U.S. federal government office sites and two U.S. embassies to demonstrate whether circadian-effective lighting (providing circadian stimulus (CS) values of CS ≥ 0.3) could be installed in office buildings, and to determine whether this lighting intervention would reduce sleepiness and increase alertness, vitality and energy in office workers while at work. Desktop and/or overhead luminaires provided circadian-effective lighting at participants’ eyes during a two-day intervention. A pendant-mounted Daysimeter device was used to measure participant-specific CS values during the baseline and the intervention days. Participants also completed questionnaires inquiring about sleep habits, stress and subjective feelings of vitality and energy. The Daysimeter data showed that participants were exposed to significantly higher amounts of circadian-effective light while at work during the two intervention days compared to the baseline day. Self-reported sleepiness scores were significantly reduced during the intervention days compared to the baseline day. As hypothesised, participants also reported feeling significantly more vital, energetic and alert on the intervention days compared to the baseline day. The present results from four independent office environments demonstrate that lighting systems delivering a CS ≥ 0.3 can reduce sleepiness and increase vitality and alertness in office workers.

Safety belt use on a university campus was substantially increased by offering faculty/ staff and students who signed and returned “buckle up” pledge cards the opportunity to win prizes donated by community merchants. The 28,000 pledge cards, committing signers to buckle up for an academic quarter, were distributed during the spring and fall of 1985. One portion of the card was designed to be hung from a vehicle's rearview mirror as a reminder of the pledge to buckle up. The other portion served as a sweepstakes ticket and was deposited in boxes located throughout the campus community. Each quarter, winners were drawn from the returned pledge cards during three consecutive weeks. Although a relatively small proportion of the pledge cards were signed and turned in (i.e., 11.9% during spring and 9.4% during fall), those who signed and returned a pledge card (n = 3117) increased their safety belt use significantly. Across both quarters, faculty/ staff pledgers went from a high pre‐pledge belt use level of 32.2% to a post‐pledge level of 46.7%, and students increased their belt use from a pre‐pledge use of 21.4% to a post‐pledge level of 36.6%.