Noncontingent reinforcement for the treatment of severe problem behavior: An analysis of 27 consecutive applications

Abstract

Noncontingent reinforcement (NCR) is a commonly used treatment for severe problem behavior displayed by individuals with intellectual and developmental disabilities. The current study sought to extend the literature by reporting outcomes achieved with 27 consecutive applications of NCR as the primary treatment for severe problem behavior. All applications of NCR were included regardless of treatment outcome to minimize selection bias favoring successful cases. Participants ranged in age from 5 to 33 years. We analyzed the results across behavioral function and with regard to the use of functional versus alternative reinforcers. NCR effectively treated problem behavior maintained by social reinforcement in 14 of 15 applications, using either the functional reinforcer or alternative reinforcers. When we implemented NCR to treat problem behavior maintained by automatic reinforcement, we often had to add other treatment components to produce clinically significant effects (five of nine applications). Results provide information on the effectiveness and limitations of NCR as treatment for severe problem behavior.

Self-injurious behavior among individuals with intellectual and developmental disabilities

“…Studies examining functional analysis outcomes by Iwata et al [65] and Hagopian et al [66] reporting on 154 and 176 consecutively encountered cases, respectively found the relative prevalence of functional classes of problem behavior to be comparable to that reported in the literature. Larger scale studies on functional communication training (n=21;n=58 [66,67]); noncontingent reinforcement ( [68],n=27); automatically reinforced SIB [48,49] produced findings comparable that reported across smaller scale studies in body of literature as a whole.…”

The consecutive controlled case series: Design, data‐analytics, and reporting methods supporting the study of generality

“…A number of other studies which share features of what we define as a CCCS study have examined the outcomes of functional behavioral assessment procedures, including the analog FA conducted with inpatients (Hagopian et al, ), with outpatients (Kurtz et al, ), and with students (Mueller et al, ); and the interview‐informed synthesized contingency analysis (IISCA; Greer et al, 2019; Jessel et al, ; Slaton et al, ) . These methods have also been used to examine the outcomes associated with treatment procedures including FCT (Greer et al, ; Hagopian et al, ; Rooker et al, ) and NCR (Phillips et al, ). In addition to evaluating the general efficacy of assessment and treatment procedures, these methods have been used to examine the generality of procedures to specific populations, including preschool children with severe behavior (Kurtz et al, ), individuals with fragile X syndrome (Kurtz et al, ), and for specific problem behaviors (e.g., pica; Call et al, ).…”

“…Findings from CCCS studies can also help to build an empirical base for defining limits of the generality of the procedures. For example, Phillips et al () examined the general efficacy of NCR and defined some of its limits in what they termed a CCCS study of 27 cases (inpatients). They reported on the general efficacy of NCR across all cases and across functional classes of behavior.…”

“…A third way to substantiate that a SCED was used with each case would involve combining two methods: (a) presenting a summary table reporting on the experimental design used with each individual case and the magnitude of effects across all conditions (e.g., mean rates of responding for each condition for each case; see Phillips et al, ), in combination with (b) the use of a structured and validated set of criteria for interpretation of outcomes. The use of such interpretative criteria, in combination with quantitative data, could provide a sufficient level of evidence that an effect was observed, as structured interpretation methods require the user to take into consideration the design, magnitude of effects, its replication, and response patterning in order to arrive at a conclusion.…”

Token reinforcement: Translational research and application

“…Such procedures could easily be adapted to applied research. Indeed, presenting tokens irrespective of behavior (such as the yoked‐control methods of Raiff et al, ) is a variant of a commonly used procedure in applied research—noncontingent reinforcement (NCR; Phillips, Iannaccone, Rooker, & Hagopian, ). Incorporating NCR‐like procedures as control procedures into token‐loss punishment programs will help reveal key behavioral functions of tokens.…”