Three nominally nonaversive response-deceleration treatment packages, "gentle teaching," differential reinforcement of incompatible behavior plus interruption, and graduated guidance, were administered to two profoundly retarded men who exhibited topographically similar selfinjurious head-hitting maintained under contrasting contingencies identified by functional analysis. Following No Demand and Instructional Demand baseline sessions, the three intervention packages were balanced across 18, 30-minute analog training sessions and three trainers in each subject's prevocational setting, using a simple panel-pressing task as the training objective. There were significant differences between the three packages in rates of target response suppression, effects on collateral behaviors, acquisition of panel pressing, and immediate post-treatment carry-over, both within and between subjects. It is concluded that both functional analysis and within-subject treatment comparison may assist in identification of the least restrictive alternative in applied service settings, and that topographic similarity of self-injury between subjects may not necessarily indicate selection of similar treatment packages.There is no current equivalent to a hierarchy of relative restrictiveness that can reliably guide treatment selection within the proliferation of nonaversive approaches to behavior reduction. Behavioral treatment selection for persons with profound mental retardation and high rates of self-injurious behavior (SIB) may present a particular challenge in this regard, due to the necessity
Treatment of stereotypic hand mouthing in a 3-year-old girl with Rett syndrome by differential reinforcement of competing functional responses plus response interruption is described and evaluated in this case study. A package of graduated guidance with social and edible reinforcers successfully established stable rates of functional hand movements to activate toys, gross motor responses to verbal prompts, palmar grasp and release, and some vocal imitation. Contingent response interruption virtually eliminated hand mouthing during instructional sessions. Instruction alone did not maintain hand mouthing suppression when interruption was withdrawn, and treatment gains appeared highly discriminated. Post-hoc comparison indicated differential reinforcement plus response interruption (DRI +I) to be superior to hand splints in reducing hand stereotypies, with approximately equivalent increases in collateral tongue thrusting.
Behavioral assessment and intervention strategies used to treat chronic, life-threatening pica in an institutionalized, 16-year-old male with profoundly retarded collateral self-injurious and aggressive conduct, are described and evaluated. Thirty-minute observation sessions, conducted under baited contitions, revealed that bait saliency and the absence of caregiver supervision were discriminative for high rates of pica. Oral delivery of response-contingent lemon juice suppressed pica to near zero rates, while a procedural package incorporating delivery of water mist contingent on response-antecedant wandering contributed to further reductions in pica. Considerable suppression was maintained for approximately 18 months, with administration by paraprofessional staff. Data spanning nearly four years indicated that pica suppression was primarily a function of the introduction, maintenance, and withdrawal of aversive contingencies, rather than of concurrent schedules of positive reinforcement. Positive and negative side effects, and ethical questions associated with the use of aversive stimuli in treating life-threatening behavior, are discussed.Pica behavior, the ingestion of non-nutritive substances, can be categorized as "specific" or "nonspecific" (Danford & Huber,
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