The development and application of individualized levels systems for the treatment of severe problem behavior

Hagopian, Louis P.; Rush, Karena S.; Richman, David M.; Kurtz, Patricia F.; Contrucci, Stephanie A.; Crosland, Kimberly

doi:10.1016/s0005-7894(02)80006-5

Cited by 35 publications

(49 citation statements)

References 13 publications

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“…NCR procedures may also disrupt the response-stimulus relation through differential reinforcement of other behavior. Hagopian et al (2002) implemented NCR with a 14-yearold male diagnosed with an intellectual disability, attention deficit hyperactivity disorder, oppositional defiant disorder, and depression. The participant engaged in public masturbation, displaying his genitals, inappropriately touching others, aggression, disruption, and elopement.…”

Section: Noncontingent Reinforcementmentioning

confidence: 99%

“…While punishment was found to be ineffective, alternative activities promoted the participant's ability to tolerate delay to reinforcement. Hagopian et al (2002) used DRA in combination with NCR for a 14-year-old male participant with DD who engaged in attention-maintained ISB. The DRA component of the intervention consisted of providing the participant with attention contingent on appropriate requests for attention.…”

Section: Differential Reinforcement Of Alternative Behaviormentioning

confidence: 99%

“…The combination of DRO, restitution, and negative practice was found to significantly reduce her ISB as compared to other conditions. Third, Hagopian et al (2002) used time out from positive reinforcement in combination with NCR and DRA, as previously summarized. In this study, non-exclusionary time out included removing all reinforcing materials from the environment and not providing attention to the child's behavior until all ISB had subsided for 15 min.…”

Section: Punishmentmentioning

confidence: 99%

“…Without appropriate intervention, such behaviors might persist and worsen over time as the child continues to develop physically to sexual maturity. Some school age children and adults with DD have been reported to engage in ISB such as disrobing, public masturbation, inappropriately touching others, publicly discussing sexual topics, and sexual arousal to atypical objects or individuals with potentially serious consequences (e.g., Carlson et al 2008;Early et al 2012;Hagopian et al 2002;Sprague et al 1997).…”

mentioning

confidence: 99%

“…These behaviors have included (a) exhibitionism or disrobing (e.g., Carlson et al 2008;Hagopian et al 2002;Lutzker 1974;Sprague and Horner 1992); (b) public masturbation or sexually stereotypical behavior (Hagopian et al 2002;Sailor et al 1968;Sprague et al 1997); (c) inappropriately touching others (Magee and Ellis 2001); (d) publicly discussing sexually inappropriate topics (Early et al 2012;Pritchard et al 2011); (e) aggressively coercing peers into sexual interactions (Polvinale and Lutzker 1980); (f) masochism (Money and Annecillo 1991;Widermannova and Strnad 1963); (g) paraphilia (i.e., sexual arousal to atypical objects, individuals; Early et al 2012); and (h) persistence in pursuing romantic relationships, which may be perceived as stalking (Stokes et al 2007).…”

mentioning

confidence: 99%

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A Review and Treatment Selection Model for Individuals with Developmental Disabilities Who Engage in Inappropriate Sexual Behavior

Davis

Machalicek

Scalzo

et al. 2015

Behav Analysis Practice

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Some individuals with developmental disabilities develop inappropriate sexual behaviors such as public masturbation, disrobing, and touching others in an unwanted sexual manner. Such acts are problematic given the taboo nature of the behaviors and the potential for significant negative consequences, such as restricted community access, injury, and legal ramifications. Therefore, it is necessary to equip caregivers and practitioners with effective treatment options. The purpose of this paper is to review studies that have evaluated behavioral treatments to reduce inappropriate sexual behavior in persons with developmental disabilities. The strengths and weaknesses of each treatment are reviewed, and a model for treatment selection is provided.

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Section: Noncontingent Reinforcementmentioning

confidence: 99%

Section: Differential Reinforcement Of Alternative Behaviormentioning

confidence: 99%

Section: Punishmentmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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A Review and Treatment Selection Model for Individuals with Developmental Disabilities Who Engage in Inappropriate Sexual Behavior

Davis

Machalicek

Scalzo

et al. 2015

Behav Analysis Practice

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A mand analysis and levels treatment in an outpatient clinic

O’Connor

Sorensen-Burnworth

Rush

et al. 2003

Behavioral Interventions

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An adolescent with severe mental retardation and fragile X syndrome who displayed destructive behavior maintained by positive reinforcement in the form of adult compliance with mands was assessed and treated in an outpatient setting. A levels system treatment was assessed, consisting of a continuum of attention and reinforcement ranging from access to the functional reinforcer in level 3 contingent upon appropriate behavior to a 10 min room time-out for level 1 contingent upon aggressive and dangerous behavior. While the efficacy of this treatment has been demonstrated in an inpatient setting (Hagopian et al., 2002), this application extended the findings to outpatient and community settings. The levels system treatment resulted in a 98.1% reduction in destructive behavior from baseline levels. Treatment was successfully transferred to the home and school and reductions were maintained at 6 and 9 months. Treatment acceptability ratings were high across both home and school staff.

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An Individualized Levels System to Increase Independent Mealtime Behavior in Children With Food Refusal

Gonzalez

Taylor

Borrero

et al. 2013

Behavioral Interventions

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An individualized levels system was implemented to increase independent eating in two children with food refusal. Participants earned access to different status levels associated with varying availability of preferred items/activities outside of meals according to criteria based on low levels of prompting throughout the meal. A reversal design was implemented to evaluate the effects of the intervention on independent mealtime behavior. Results demonstrated that the levels system was effective in increasing independent eating and in decreasing prompted bites for both participants. Although the effectiveness of an individualized levels system has been previously demonstrated in the treatment of severe problem behavior, it has not been empirically evaluated in the context of increasing appropriate behavior or with children with food refusal. These findings provide support for such a treatment to promote mealtime independence during an intensive feeding program and at two months follow-up.

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The development and application of individualized levels systems for the treatment of severe problem behavior

Cited by 35 publications

References 13 publications

A Review and Treatment Selection Model for Individuals with Developmental Disabilities Who Engage in Inappropriate Sexual Behavior

A Review and Treatment Selection Model for Individuals with Developmental Disabilities Who Engage in Inappropriate Sexual Behavior

A mand analysis and levels treatment in an outpatient clinic

An Individualized Levels System to Increase Independent Mealtime Behavior in Children With Food Refusal

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