Non-aversive treatment of repetitive absconding behaviour in clients with severe neuropsychiatric disorders

Abstract

Research relating to the causes and treatment of absconding behaviour among individuals with severe neuropsychiatric disability is reviewed and a non-aversive intervention is reported. Interventions with two clients with severe neuropsychiatric disability and repetitive absconding behaviour are presented in a multiple-baseline within-client single-case format. Multiple empirical treatment approaches were applied to culminate in a successful non-aversive intervention. The effective intervention used reinforcement approaches that were congruent with the client's goals rather than increased restriction. The design of one case included reversal, indicating that it was the intervention, not other factors, that reduced the absconding behaviour. Absconding attempts and absconding incidents were reduced to zero using non-aversive interventions where more restrictive interventions had failed to have a lasting impact. A counter-intuitive non-aversive intervention was effective in eliminating dangerous absconding behaviour in two clients with severe neuropsychiatric disorders.

Rehabilitation Approaches to the Management of Aggressive Behaviour Disorders after Acquired Brain Injury

“…However, more recently, methods that successfully manage setting events and immediate antecedents to behaviour have been advocated in the management of children and adults with ABI (see, for example, Ylvisaker, Turkstra, & Coelho, 2005; Ylvisaker et al, 2007). These approaches have attracted a range of descriptors, including ‘non-aversive’ (Giles, Wilson, & Dailey, 2009), ‘errorless rehabilitation’ (Ducharme & Harris, 2005) and ‘low arousal’ (McDonnell, 2010), although the term ‘positive behaviour supports’ (PBS) appears to be most widely cited (Johnston, Foxx, Jacobson, Green, & Mulick, 2006). All these approaches endeavour to increase the likelihood that individuals will engage in behaviours that enable them to succeed in their social contexts, and are applicable to many settings, including the community and people's own homes.…”

The relational neurobehavioral approach: can a non-aversive program manage adults with brain injury-related aggression without seclusion/restraint?

“…In a report of two patients with traumatic brain injury [34], preliminary evidence of the RNA showed eliminating absconding behaviors from a residential facility. In a sample of 40 brain-injured patients [29] over a 20-month period, preliminary evidence of the RNA showed successful management of aggression in six especially aggressive patients who were responsible for 78% of the aggressive incidents in a skilled nursing facility (SNF).…”

Staff-reported antecedents to aggression in a post-acute brain injury treatment programme: What are they and what implications do they have for treatment?

“…However, literature on TBI often limits discussion of the origins of aggression to demographic and neurological factors such as neurologically mediated “irritability” (Alderman, 2003; Medley & Powell, 2010; Tateno, Jorge, & Robinson, 2003). Ways in which caregivers are to manage moment-to-moment interactions with persons with severe cognitive impairment after TBI has been the subject of only limited attention (Finfgeld-Connett, 2009; Giles & Manchester, 2006; Giles, Wilson, & Dailey, 2009; Pryor, 2006; Yody et al, 2000). This is unfortunate as it omits the potentially large role that staff behaviour may play in eliciting client aggression.…”

“…A general trend can be recognised in the literature to utilise approaches that attempt to avoid eliciting frustration-related aggression and avoid the use of extinction procedures that elicit frustration. These approaches have been variously described as relational therapy (Giles & Manchester, 2006), non-aversive (Giles, Wager, Fong, & Waraich, 2005; Giles et al, 2009; Manchester, Hodgkinson, Pfaff, & Nguyen, 1997; Rothwell, LaVigna, & Willis, 1999), errorless rehabilitation (Ducharme & Harris, 2005), intensive positive behavioural supports (Gardner, Bird, Maguire, Carreiro, & Abenaim, 2003), and low arousal (McDonnell, 2010). Slifer and co-workers (1997) reported the successful use of the titration of environmental and interpersonal stimulation to reduce aggression in the acute rehabilitation of children and adolescents with TBI.…”