Functional Behavioral Assessment, Diagnosis, and Treatment: A Complete System for Education and Mental Health Settings - Ennio Cipani PhD 2018

Function-Derived Treatment Options

Objectives

✵Students will be able to identify functional treatment options for the DA 1.1 and 1.2 functions, and detail the procedures for the conduct of such with respect to the designated functional category

✵Students will delineate the role of chain interruption for DA and DE functions

✵Students will be able to identify functional treatment options for the SMA 2.1, 2.2, and 2.3 functions, and detail the procedures for the conduct of such with respect to the designated functional category

✵Students will delineate the role of extinction for SMA and SME functions

✵Students will be able to identify functional treatment options for the DE 3.1, 3.2, 3.3, and 3.4 functions, and detail the procedures for the conduct of such with respect to the designated functional category

✵Students will be able to identify functional treatment options for the SME 4.1, 4.2, 4.3, and 4.4 functions, and detail the procedures for the conduct of such with respect to the designated functional category

✵Students will be able to conduct a trigger analysis to assess the possible severity of an extinction burst

✵Students will be able to identify the three classification categories in the Cipani Replacement Function Classification System for replacement functions, and contrast them with the diagnostic criteria for each

✵Students will be able to conduct an experimental analysis with two designated conditions to determine if a selected behavior for the replacement function is currently at minimal rate due to misdirected contingencies or inept repertoire

Chapter 4 Behavior Analysis Certification Board (BACB) Task List

This chapter will examine how to select and design a function-derived treatment. The designation of the treatment requires two contingency considerations. First, the function of the problem behavior should be significantly hampered and disabled. Concurrently, the replacement function involves an alternate behavior(s) that should be enabled under a specified establishing operation (EO). The latter contingency design features are often referred to as the “replacement behavior.” These two sets of considerations will be presented for each of the major categories. A number of potential treatment options will be posed for the four major functions: direct access (DA), socially mediated access (SMA), direct escape (DE), and socially mediated escape (SME). Throughout this chapter, a “text box” is used to highlight the basic rearranged contingencies for treating a problem behavior and its function with the selected treatment option. Finally, a three-category diagnostic system to determine the strength of the behavior(s) to serve in the replacement function will be presented.

WHAT IS A REPLACEMENT BEHAVIOR?

When treating problem behaviors, one must decrease the target unacceptable behaviors while selecting an alternate desirable behavior, termed a replacement behavior, for specific reinforcement. A replacement behavior serves the same environmental function as a problem behavior. Therefore, a replacement behavior cannot be designated without an understanding of the target behavior’s function under specific antecedent contexts (EO & discriminative stimuli). The selected replacement behavior must be capable of producing the same reinforcer as the problem behavior in the identified contexts. The hypothetical example depicted in Table 4.1 illustrates how an alternate, more appropriate form of behavior can replace the current function of the problem behavior.

The designation of the three possible replacement behaviors in Table 4.1 stipulates that each replacement behavior must result in the delivery of the reinforcer. For example, in the first replacement behavior, requesting the toy (from another child) must produce the desired toy at some high level of probability. One cannot simply announce that requesting behavior is an alternate replacement behavior for this child instead of grabbing a toy. Without ensuring that reinforcement will ensue for requesting the toy, the target behaviors may still be more functional than the current designated means for obtaining reinforcement. If the requests are not honored reliably, requesting behavior will not function effectively to access reinforcement. Requesting then becomes a less probable behavior under these circumstances. Meanwhile other behaviors will be exhibited in attempts to get the toy.

TABLE 4.1 ■ EXAMPLE OF ALTERNATE REPLACEMENT BEHAVIORS

Problem Behavior:

Under the conditions of wanting a toy that another child is using, the target child gets the toy from the other child (consequence) by grabbing the toy (behavior problem) and running away with the toy (DA 1.2: Tangible Reinforcers).

Goal:

Decrease the target inappropriate behavior, which is, grabbing the toy from someone else and running away with the toy. Increase an alternate appropriate behavior given the same context.

Possible Appropriate Replacement Behaviors:

1.Requesting toy

Desired Contingency:

Child gets the toy from another child (consequence) by asking nicely if he can play with the toy, and other child gives the toy upon request. The request needs to be honored for such a replacement behavior to be naturally maintained. Further, grabbing the toy results in loss of access to the toy immediately, by adult removing the child from the toy and play area.

2.Offering to play together

Desired Contingency:

Child shares the toy with another child (consequence) by asking nicely if he or she can play with the toy with that child. The request to share the toy needs to be honored for such a replacement behavior to be naturally maintained. Again, grabbing the toy results in loss of access to the toy immediately, by adult removing the child from the toy and play area.

3.Getting another toy, while waiting for the desired toy to become available

Desired Contingency:

Adult specifies time period each child wanting a certain toy will have, e.g., 2 minutes. The target child waits or gets another toy during the interim period. When it is his or her turn to play with the desired toy, he or she is given access by adult requiring the other child to relinquish the toy, and the target child gets a certain amount of time with the toy, e.g., 2 minutes.

Further, the prior functional target behavior, that is, grabbing the toy from another child, must not be allowed to succeed. Such behavior, when exhibited, must result in immediate removal of the toy from the target child. Further, the loss of access to that toy (and others) for a period of time must be invoked. This contingency for grabbing behavior must be in place in order for any potential replacement behaviors to have a chance at becoming functional. Allowing this child to grab a toy from another child without such a contingency dooms the development of alternate behaviors to failure. The removal of the toy must be immediate! If the adult argues with the child, this contingency is considerably weakened, and grabbing toys from other children becomes strengthened relative to more appropriate behaviors.

Similarly, sharing the toy upon request (second example) must also be honored if it is going to take the place of grabbing a toy. Further, the target child’s enjoyment of the sharing of the toy must parallel the reinforcing magnitude of playing with the toy in isolation. Sharing versus playing alone, even with the same toy, are not the same events. Hence, the reinforcing potency of the sharing context needs to be evaluated as being as powerful as playing alone. If it is not as pleasurable, engaging in a request to share will probably not replace grabbing the toy.

Finally, teaching the child to wait for a period of time before getting the desired toy will be effective only if grabbing the toy never (or rarely) produces access to the toy. Therefore, the previously stipulated contingency for toy grabbing must be in place. In addition, the ability to delay gratification often needs to be systematically developed. This plan would probably require a progressive manner of teaching “waiting behavior.”

Suppose access to a toy was achieved through an adult via tantrum behavior (i.e., instead of grabbing the toy)? The diagnostic category for this target behavior is SMA 2.3: Tangible Reinforcer. What might be some of the options for an alternate replacement behavior? Table 4.2 illustrates two possible alternate replacement function options for the designated SMA function of the target behavior of tantrums, that is, access to the toy. In the first option, an appropriate request will replace the tantrum behavior in terms of toy access function. If the child throws a tantrum, he or she does not get the toy. If the child requests the toy in an appropriate tone of voice, he or she gets the toy.

TABLE 4.2 ■ EXAMPLE OF ALTERNATE REPLACEMENT BEHAVIORS FOR TANTRUM BEHAVIOR

Problem Behavior:

When the child desires a toy that someone else has, the child gets the toy from the caregiver (consequence) by throwing a tantrum for several minutes (behavioral problem).

Goal:

Decrease the target inappropriate behavior, i.e., tantrum behavior. Increase an alternate appropriate behavior given the same context.

Appropriate Replacement Behaviors:

1.Request toy from caregiver

Desired Contingency:

The child is given the toy by the caregiver (consequence) after an appropriate request is made for the toy. The request needs to be honored for such a replacement behavior to be naturally maintained. Further, if the child engages in tantrum behavior, such results in a period of time where the desired toy is made not available. (Note: This program should also be supplemented with a delay of gratification training option, to be presented in this chapter.)

2.Finish task or chore first

Desired Contingency:

The child is given the toy by the caregiver (consequence) after the child completes the task or chore assigned (Premack contingency). Completing the chore needs to be honored as the requisite event for accessing the toy. Further, tantrum behavior sets up a period of time whereby the desired toy is not available.

TABLE 4.3 ■ THE STEPS TO IDENTIFYING REPLACEMENT BEHAVIORS

✵Identify the diagnostic category of problem behavior by assigning it to one of the four major diagnostic categories (and sub-categories) presented in Chapter 3.

✵Identify the specific reinforcers that result from the occurrence of the problem behavior (Chapter 3), under the prevailing motivational conditions (EOs) and antecedent contexts.

✵Designate an alternate appropriate behavior(s) or behavioral criteria that will be made to produce the same function as the problem behavior in the identified antecedent social contexts, whether naturally or contrived.

✵If the problem behavior serves more than one function, identify the different functions for each antecedent context and repeat above steps for each unique source of stimulus control.

In the second option, performing a required task or chore is a conditional event prior to getting the toy. It is again essential that completion of the task results in accessing the toy, while ensuring that the tantrum behavior does not produce the toy (or minimally, produces the toy less effectively and efficiently than completing the chore; see Table 4.2). Note how both examples select an alternate appropriate behavior that can serve the same function (i.e., produce the same reinforcer) as the problem behavior. Once the replacement behavior is developed in the client’s repertoire, it will replace the function or purpose of the problem behavior. This will occur only if the dual contingency exists: The replacement behavior achieves reinforcement, while the target problem behavior is significantly less functional, or nonfunctional, in achieving the desired result. Table 4.3 presents the steps to utilize in identifying a functional replacement behavior.

DISABLE ONE FUNCTION, ENABLE ANOTHER

Too often, many inexperienced attempts at developing a replacement behavior involve simply specifying that some selected behavior should replace the target behavior. People who espouse such declarations do not seem to grasp or comprehend the nature of behavior with respect to antecedent and consequent stimuli. To accomplish the successful transition from a currently functional target problem behavior becoming nonfunctional and a currently nonfunctional appropriate behavior becoming functional, social control over the maintaining contingencies is required!

For example, a referral is made for a male client who hits people on the shoulder while sitting on the couch and watching TV in a group home for persons with disabilities. One of the program managers decides that the replacement behavior should be the following: have this client put his hands in his pockets while he is on the couch. That certainly sounds good because it is a state of affairs that is incompatible with hitting people on the couch. However, it offers little in the way of understanding why the hitting behavior occurs (i.e., maintaining contingency under a specific EO). Suppose the hitting occurs because the person next to the target client is talking, and hitting him makes him shut up. Is it reasonable to expect this client will keep his hands in his pockets the next time his listening to the TV program is interrupted? I believe the hands will come out of the pocket and deliver the shot that produces cessation of talking from his neighbor. Then the hands will probably go back into the pockets.

In summary, the behavior analyst needs to produce two changes in the client or child’s environment. First, the target behavior’s current function needs to be disabled or severely impaired by manipulating those current maintaining contingencies (i.e., function). Equally important, the alternate appropriate behavior needs to be enabled in producing the desired environmental function previously produced by the target behavior under relevant motivational conditions.

In this chapter, we present several replacement function options for developing an alternate manner of producing the desired result (i.e., abolishing operation). Determining what the maintaining contingencies are for the problem behavior as well as the current strength of the potential replacement behavior is at the heart of designing an effective functional treatment. The following material presents several functional treatment options for each major diagnostic category for problem 'margin-top:12.0pt;margin-right:0cm;margin-bottom: 3.6pt;margin-left:0cm;line-height:normal'>REPLACEMENT FUNCTION OPTIONS FOR DA PROBLEM BEHAVIORS

There are four replacement function options when treating a target problem behavior that is maintained by to directly contacting the positive reinforcer. In some parts of this chapter, we have slightly altered the term, “replacement behavior,” to embrace a synonymous term, “replacement function.” Some of the options presented below do not have a distinct “replacement behavior.” Rather the intervention strategy produces the desired outcome when a behavioral criterion or standard is achieved, which may involve the absence of the problem behavior (e.g., delay of gratification training). This modification allows the designated term to encompass a desired function rather than identifying just a behavior. All four options require the chain interruption strategy as a component to address client attempts to actually engage in the prohibited target behavior, when unauthorized.

Alternate DA form replacement option: Identify an alternate, more acceptable form of behavior (one that is not as inappropriate or dangerous) that directly produces the same specific reinforcer.

Access mand (request) replacement option: Identify a requesting behavior (mand) that would allow staff to mediate such a request or choice by providing the client with a more appropriate setting (area) in which to engage in the problem behavior (if the problem behavior is not dangerous, but is merely inappropriate in form).

Delay of gratification training option (differential reinforcement of other behavior [DRO]): Identify a length of time that you want the individual not to perform the target DA behavior, that is, the nonoccurrence of behavior for a set time period. Contingent upon the individual not engaging in the target problem behavior for that time period, access to the specific reinforcer is provided, either by request or by direction of staff (functional treatment option rather than a discrete replacement behavior).

Premack contingency replacement option (engagement in lower probability behaviors as the contingency for access to a specific reinforcer): Identify a regimen of tasks that, when completed, allows the client to access the specific reinforcer (consider this criterion for reinforcement access as a chain of sequenced performances).

Chain Interruption Strategy

Chain interruption involves interrupting or blocking the performance of the behavior at its earliest onset. In conjunction with the target replacement function to develop an alternate mechanism, a chain interruption strategy as a contingency is essential for DA problem behaviors. In order for the problem behavior to be ameliorated, it must be weakened in its ability (i.e., disabled) to directly contact the sensory or tangible reinforcer.

Although many professionals espouse the deployment of developing a replacement behavior, they often overlook what must be done to behaviors that produce positive (or negative) reinforcement directly. If the client is not prevented from engaging in the DA behavior, then the desired sensory or tangible reinforcer is contacted ad lib. The replacement behavior option will thus be rendered less functional (i.e., less effective and efficient). As a result, the client will not engage in that designated replacement behavior to access reinforcement.

Therefore, it is essential that you interrupt the target behavior before it contacts reinforcement, or at least before a certain amount or duration of access is attained. For example, if the client is mouthing inedible objects because of the oral stimulation it produces, such a direct behavior-reinforcement relationship would need to be greatly impeded via chain interruption or blocking. Attempts to physically stop the client from placing the object in the mouth are necessary. If the client is stopped only after gnawing on the object for a while, it is too late! Sensory reinforcement has already been achieved. Impeding such a response—reinforcer relationship is critical to the success of any treatment plan.

The staff must become more vigilant in detecting the initial parts of this behavior and interrupting it. Their efforts may be met with the client becoming stealthier in engaging in this behavior. However, the effort to make such a DA to positive reinforcement function more arduous will be essential for the selected replacement behavior to become functional. The replacement behavior option must successfully access sensory reinforcement, while the target problem behavior is obstructed frequently. If staff can fulfill that requirement, the replacement behavior option will increase in frequency while the DA problem behavior will decrease.

Concurrent with the chain interruption strategy, a strategy for developing or increasing an alternate replacement behavioral function needs to be designed. Each of the following four options may be considered. In some cases, one option may be more suited for a specific context and setting than others. This needs to be a clinical decision.

DISCUSSION QUESTION 4A

Why is it necessary to implement a chain interruption procedure for problem behaviors that serve DA and DE functions?

Alternate DA Form Option

In some cases, it is possible to identify an acceptable replacement behavior that varies slightly in topography from the problem behavior but still produces directly the same desired result. In a prior example, a client with severe intellectual disabilities ran to the door, swung it wide open, and ran outside. The maintaining reinforcer for this inappropriate chain of behaviors was getting to go outside. A more acceptable alternate behavior can be walking out the door (not running), and then exiting with staff supervision. Engaging in any previous form of exiting would result in staff stopping the client and delaying access to outside until the behavioral form occurs. The rearranged contingencies are delineated in Table 4.4.

Suppose we determine that sticking inedible things in one’s mouth is maintained by a DA to the ingestion of edible items. A replacement behavior that alters the form to be more acceptable while maintaining the same access to the reinforcer is illustrated in Table 4.5.

The following case examples are further illustrations of the use of this replacement function option.

Pushing and Shoving. A male client was referred to me for behavioral consultation as a result of his pushing and shoving staff in order to get to the refrigerator. He lived in a residential facility with five other adults with autism. You probably think he is going into the refrigerator to get something out to eat or drink. Such was not the case. Once he opened the refrigerator, he would check to see if the lunch bags for the next day were made and placed in their correct space.

Why would he push and shove staff in order to get to the refrigerator? This behavior was the result of staff preventing him from engaging in his obsession with “checking on the lunches.” He learned to run because staff were very good at encumbering a more leisurely approach. Simply walking over to the refrigerator to check out the lunch bags would only result in his being sent back to the living room area. He thereby learned to become both quicker and more aggressive in achieving his goal of getting to the refrigerator. You can see that pushing or shoving staff and running past them when they were not looking was more functional in this circumstance, given the staff’s predilection toward preventing access to the refrigerator.

TABLE 4.4 ■ REARRANGED CONTINGENCIES

Functional Treatment:

DA 1.2: Tangible Reinforcer

Contingency Plan for Target Behavior (Chain Interruption):

If engaging in the target behavior (running outside), the client will be stopped and brought back immediately to the start point. The client will be required to wait a period of time, for example, 1—2 minutes, before being prompted to perform the alternate behavior. Of course staff have to be close to catch any inappropriate exiting behavior immediately, upon which they will perform this regimen.

Contingency Plan for Replacement Behavior:

If the student signs “out,” he or she will be allowed to go outside if walking appropriately. Student may need staff to prompt such behaviors in contrast to running, as well as massed trials of practice (if replacement behavior diagnosis is inept repertoire; see Inept Repertoire Category section of this chapter).

TABLE 4.5 ■ ACCEPTABLE FORM

Functional Treatment:

DA 1.1: Immediate Sensory Stimuli

Contingency Plan for Target Behavior:

If the student attempts to stick inedible items in his or her mouth, the student will be physically prevented from achieving such a result, if possible. Additionally, a 3-minute removal from environment (place him or her in a chair where access to any object is precluded) should be effected before prompting the replacement behavior. The function of this 3-minute time-out is to make such attempts less functional and more arduous in getting edible items (i.e., disabling the function).

Contingency Plan for Replacement Behavior:

If the student walks over to the basket where there is food, he or she may eat in peace. This option would be considered for clients who do not have problems with weight, such as obesity.

The replacement behavior identified for this client was walking appropriately to the refrigerator. He was taught to engage in such behavior, with the result being unobstructed access to the refrigerator. Given his previous history, this behavior had to be prompted for a while. If he walked appropriately to the kitchen, he was allowed to open the refrigerator door and check out the sack lunches. If he ran, pushed, or shoved anyone, he would not get to open the door at that time and was required to return to the area where the running began. He was then to demonstrate the appropriate walking behavior, which resulted in his being allowed to open the refrigerator door. Of course, pushing and shoving would decrease once such behaviors only postponed his access to the refrigerator.

A Unique Sensory Reinforcer Replacing the function of the problem behavior may sometimes be difficult with a problem behavior diagnosed as DA 1.1: Immediate Sensory Stimuli. A more acceptable form that does not produce DA to the positive reinforcer will not replace the problem behavior’s function. Although you may think that the two are equivalent, in the eyes of the client they are not. Here is a case in point.

In the early 1980s, a female client was referred to me for a behavioral plan for an extremely revolting and undesirable behavior. In her day treatment program, she would grab feces left in the toilet bowl from her own use or someone else’s and squish it in her hands. The first plan set up at the program was to prevent her from doing this. The day treatment aides were to restrain her from engaging in such a behavior. Unfortunately, this plan did not work to make her value the activity less. In fact, it seemed to only deprive such an event and make the motivational condition to access it stronger. Such an increased desire on the client’s part to get to the bathroom further compounded the staff’s problem in managing her. Use of the bathroom by other clients was a signal to her that the desired activity may be available. She would then dash to the toilet to determine whether something was left in the toilet bowl from the last user. Because she was now being prevented from going to the bathroom at these times, she began to engage in aggressive and disruptive behavior toward staff when they tried to restrain her from engaging in this behavior. Further, she became more capable of discerning times when staff would be less vigilant and a mad dash to the bathroom might pay off. When another client was engaged in tantrum behavior and staff were involved in some extensive management procedure, she would dart toward the bathroom. Hence, another client’s problem resulted in staff having to deal with two problems.

My analysis of this behavior supported a DA function (DA 1.1: Immediate Sensory Stimuli). The client seemed to like the sensation of squishing the feces in the toilet bowl. I am not sure why this was pleasurable to her, but it certainly seemed that the behavior was producing its own reinforcer. The replacement behavior that was targeted for reinforcement involved the same form of the behavior. When she completed a designated number of tasks, she earned a specified amount of free time. She was then allowed to go to the bathroom and squish feces! However, prior to going to the bathroom, disposable rubber gloves were placed on her hands. She then engaged in the squishing behavior, with the gloves on. When her free time elapsed, she took the gloves off and disposed of them in the garbage can in the bathroom. She then washed her hands thoroughly before going back to the work area. She resumed her work on tasks to earn more free time. Data indicated that the rate of running to the bathroom to “check it out” reduced to zero, as did the wrestling matches with the staff. Her work production was maintained at high levels.

Why was this form chosen and not something else? Suppose we had set up a program that allowed her to squish play dough instead? That certainly would be more appropriate than squishing feces in her hands, even with gloves on. However, squishing play dough may not have resulted in the same sensory reinforcer. Therefore, allowing her access to play dough may not have been equivalent from her perspective. Hence, such a contingency may have had no effect on the rate of the target behaviors, that is, running to the bathroom unauthorized to squish feces with one’s bare hands.

In the designated plan, the form of the replacement behavior left the sensory reinforcer intact, for the most part. Despite the repugnant aspect of this behavior, the designed program had two critical effects. First, it did remove sanitary concerns in regard to the sensory maintained behavior. Second, it resulted in a reduction of the target behavior occurrence to zero for many days. Contrast this with the result obtained when staff tried to obstruct her access to the reinforcer: frequent incidents of aggression and running to the bathroom. Finally, her obsession with this ritual decreased over time until it was not something she chose to do during earned free time.

Don’t Jump! The client mentioned earlier who jumped out of his wheelchair could also have accessed floor time in another manner. If a graded platform was built, he could have been taught to hoist himself up on the top of the platform and then gradually slide down (similar to a children’s slide on the playground). This option would have been easier on the staff. Getting into his wheelchair might have been achieved by a reverse process, that is, him moving himself up the graded platform.

Access Mand (Request) Option

In some cases, it may be possible to teach the individual to request permission to engage in the desired activity (a mand). A request or mand need not be vocal; it could be a manual sign or gesture, such as pointing to a symbol or picture. The only requirement on the form of the request is that it is reliably translated by the receiver of the message.

FUNCTIONAL TREATMENT: DA 1.2: TANGIBLE REINFORCER

Plan for Target Behavior

If the client shows signs of attempting to jump out of the wheelchair, he will be physically prevented for a period of 5 minutes subsequently.

Contingency Plan for Replacement Behavior

With some initial prompting, the client is taught how to wheel his chair over to the platform and engage in a series of physical movements that result in his propping himself onto the platform, and then gradually traversing down the platform safely.

This option is particularly suited where the form of the behavior is not dangerous or unhealthy but is unacceptable in some contexts. Contingent upon a request, staff can then provide an appropriate place for the student or client to engage in the behavior. For example, some stereotypic or self-stimulatory behaviors can be treated effectively by teaching the client to request (vocally or nonvocally) the opportunity to engage in those behaviors. Contingent upon this request, the staff can then direct the client to a private area. One must make sure that the request is honored by staff in a timely manner, especially in the beginning of the program. If the request is not honored, or is delayed to a significant extent, then requesting behavior will not be functional. One would expect that the request will never fully be able to compete with engaging in the stereotypic behavior ad lib. It is therefore important that the dual contingency be operable. The following contingency box illustrates this requirement.

FUNCTIONAL TREATMENT: DA 1.1: IMMEDIATE SENSORY STIMULI

Contingency Plan for Target Behavior (chain interruption)

Interrupt initial chain of stereotypic behavior. Removal for several minutes from any opportunity to perform such behavior (chain interruption).

Contingency Plan for Replacement Behavior

Prompt client to request (in whatever designated form) access to desired activity or event. Contingent upon request, provide client access to desired activity in a designated setting. With some behaviors diagnosed as DA 1.1 (e.g., masturbation, nose picking), the area should be private, away from others seeing the client.

Here is another example of this treatment option. Suppose a client frequently runs out of a female residential facility and lacks safety skills involving roads and cars. She leaves the facility simply to get outside. Such is not an unreasonable behavior because one can stay inside only for so long before wanting to have a change in scenery. However, her unauthorized and spontaneous leaving the facility without staff supervision is a definite serious problem, given her inability to navigate roads and cars safely.

Suppose the client is taught to request an outside activity (with staff supervision) by signing “walk.” When she wants to go outside, she would be prompted to sign “walk.” The staff would then take her hand and let her guide them to the area she wished to go to. This allows her to get outside the house, but with the necessary staff supervision.

The following are some additional illustrations of the mand option with prior clinical examples:

I Need a Change of Clothing. A male client rips off his clothes occasionally because he doesn’t like the clothes he has on. Rather, he prefers other clothes. You can see that reinforcing a request for new clothes, or allowing him to choose which clothes to wear in the morning for work or school, is more preferable from a management perspective than the current “clothes ripping” behavior.

FUNCTIONAL TREATMENT: DA 1.2: TANGIBLE REINFORCER

Contingency Plan for Target Behavior (chain interruption)

If the client begins to engage in the initial forms of the target behavior (tearing at clothes), he or she will be physically stopped (immediately) and required to wait a period of time, for example, 1 to 2 minutes, before being allowed to engage in an alternate behavior.

Contingency Plan for Replacement Behavior

If the student signs “new clothes,” he or she will be allowed to procure a choice of clothes to wear. The student may need staff to prompt such a request immediately when forced to wear undesired clothes, as well as massed trials of practice (if replacement behavior diagnosis is inept repertoire; see Inept Repertoire Category section of this chapter).

FUNCTIONAL TREATMENT: DA 1.2: TANGIBLE REINFORCER

Contingency Plan for Target Behavior (chain interruption)

If the client engages in the target behavior (runs outside), she will be brought back immediately and required to wait a period of time, for example, 1 to 2 minutes, before being prompted to perform requesting behavior. If she is caught running before getting outside, the same contingency is in effect.

Contingency Plan for Replacement Behavior

If she signs “walk,” she will be allowed to go outside if she walks appropriately with staff. Staff should prompt such behaviors initially to replace running outside, as well as massed trials of practice (if replacement behavior diagnosis is inept repertoire; see Inept Repertoire Category section of this chapter).

One should realize that developing these specific communicative behaviors will be functional only if the DA 1.2: Tangible Reinforcer diagnosis was accurate. Suppose clothes ripping is maintained because the client likes the “feel” of ripping clothes? Would teaching the client to request a change of clothes decrease the clothes-ripping behavior? Probably not! In fact, this program might provide “more fuel to the fire!”

Privacy Please. A male client with mental retardation engages in masturbation out in a public, open area of a residential facility. Perhaps such behavior should be done behind closed doors! Teaching him to request privacy via a signal allows staff to mediate this request in the following manner. He is brought to his bedroom area where the door is closed. He is then free to engage in such behavior. Of course, he is not allowed to engage in public displays any more, and such attempts are immediately stopped by removal of the opportunity for a designated time. As the staff become excellent at thwarting his public attempts, requesting privacy becomes more attractive and functional. Exhibiting such a request provides unhindered access to genital stimulation. His behavior changes as a function of differential reinforcement. Public displays undergo extinction, while requests for privacy increase. Everyone is happy!

Delay of Gratification Training Option (Omission Training)

Allowing a client free unrestricted access to the desired reinforcer, contingent upon a request, is certainly a good first strategy to use in many cases. Developing a mand for accessing a reinforcer is certainly more preferable than denying access to the reinforcer with concomitant side effect behaviors. Case in point: Obstructing the client’s access to the bathroom in the prior real-life example resulted in generating other more disastrous behaviors, while not solving the initial problem.

Therefore, teaching the client to mand (request) for a desired reinforcer should have the effect of removing problem behaviors whose function was to access the prohibited reinforcer. Unfortunately, in some circumstances, such a strategy as the replacement function option may run into trouble. Let us take a young girl in an educational program who frequently engages in stereotypic behavior of touching the floor five times each side with her left and then right hand. The teacher decides to develop a requesting option that allows her to sign “play.” Contingent upon signing “play” she is allowed to touch the floor in an area of the classroom designated for such behavior (to develop setting stimulus control).

Such a plan may not reduce the frequency of stereotypic behavior to a more acceptable level. Suppose the client requests permission to engage in stereotypic behavior every 2 minutes? She is requesting it so often it is to the point where the teacher cannot get her to complete any instructional task! What do you do then? Obviously, a client who frequently requests to engage in stereotypic behavior would pose a problem for most school or work environments. In many cases, developing requesting behaviors to access sensory or tangible reinforcement should also be combined with other replacement function options. Such an additional strategy should gradually reduce the level of accessing the reinforcer to a more manageable reasonable level. I have termed it, “weaning them off of frequent reinforcement.”

DISCUSSION QUESTION 4B

Do you think most people expect a skill, such as the ability to delay immediate gratification, to develop naturally, without structured efforts on the part of care providers? Why is that a presumption?

One treatment option of choice for these circumstances is omission training (DRO) or what we term, delay of gratification training. In delay of gratification training, the client is taught to forgo engaging in the target behavior that is producing reinforcement for a designated amount of time. Fulfilling this requirement is the contingency for authorized access to the sensory or tangible reinforcer (Mazaleski, Iwata, Vollmer, Zarcone, & Smith, 1993). By beginning with a small amount of time, termed the DRO interval, the client learns to reliably delay gratification. Contingent upon success being obtained with the initial small DRO interval, the interval is gradually increased. Therefore, the client learns to forego the reinforcer for longer periods of time in a progressive manner. This develops greater self-control in regard to the client’s baseline level of access, in contrast to where she previously required more immediate gratification. Additionally, a chain interruption procedure is deployed contingent upon the behavior, with a restarting of the full DRO interval.

This replacement function option does not develop a specific replacement behavior, or even a systematic chain of behaviors. Hence, it is often not considered by many as a viable treatment option. However, it can be very fruitful in progressively increasing the length of time a client goes without “needing” access to the reinforcing event. The performance criterion for accessing the desired activity or item is the absence of the target behavior (which is not a behavior), or the occurrence of any other behavior(s).

However, such a strategy allows a behavior analyst to dissuade someone of their frequent access of a desired event. It accomplishes this goal by gradually increasing the DRO¹ interval, which develops the ability of the individual to wait for longer periods of time before accessing the desired event. In the common parlance, such a phenomenon is called the “ability to delay gratification” (hence our use of the term, Delay of Gratification Training).

Talking Is Good When It Occurs in the Right Context! Remember the client with dis­abilities who talked loudly to herself while pushing a laundry cart across a parking lot (see Chapter 3)? This behavior was hypothesized by me to produce its own auditory (hearing one’s voice) or kinesthetic stimulation (sensory effect on vocal cords). If a review of antecedent context data reveals that such vocal discourse occurs at a consistent rate during staff absence, what can be done to bring it under more acceptable conditions? When is vocal behavior acceptable? When you talk to other people! When is it OK to talk to oneself without raising suspicions that one is delusional? When it is done as a song!

If vocal behavior produces its own reinforcer, what can compete with that? In some cases, I have used a microphone (Mr. Mike) that enhances the auditory production of voice. How would delay of gratification training work? The use of Mr. Mike to talk or sing can be earned when this client achieves the absence of talking-to-self behavior in the designated DRO interval. Of course, the client would need to be monitored for instances where he or she would engage in self-talk in public, with the following contingency rendered for such occurrences.

FUNCTIONAL TREATMENT: DA 1.2: SENSORY REINFORCER

Contingency Plan for Target Behavior (chain interruption with Reverse Premack)

If the client engages in the target behavior (self-talk in public), he or she will be brought inside immediately and required to engage in a nonpreferred task. Subsequently, the client will be allowed to engage in prior activities with the DRO interval being reset.

Contingency Plan for Replacement Function

If the student does not talk to him- or herself while in public for the entire DRO interval, the student is provided a designated amount of time on Mr. Mike as soon as possible after achieving success. Later in the program, it may be possible to provide points when he or she succeeds in a DRO interval and allow an exchange of points after meeting two or three DRO intervals.

Premack Contingency Option

A common question that comes up when discussing the development of a durable and spontaneous requesting repertoire is, Do you have to give the reinforcer every time it is requested? The response is, Yes, in the initial phase of the program. In order to build a new behavior, all basic behavioral texts will indicate that a continuous schedule is a must! But this may create some problems, as delineated in the previously mentioned treatment option. Should parents, teachers, and staff provide a designated item or activity whenever a client requests it? If people do this, it will create demand machines. Children and clients will spend too much time requesting food and other reinforcers.

Although the answer to the first question is still “Yes,” the ramification of such a strategy does bring up a dilemma. For most of us, we have learned how to delay gratification for some period of time on many activities and events we find reinforcing. A client or child who constantly requests food and particular kinds of food items may be engaging in unhealthy behavior patterns, to say the least!

What can be done for such cases? How will the child learn to be reasonable in regard to access to reinforcing items and events? The answer lies in utilizing the Premack contingency. In simple terms, access to the desired sensory or tangible event is made contingent on performing a less preferred (or nonpreferred) activity. In this option, before a client can request a reinforcer and receive it, certain tasks have to be completed. In the case of school settings, the teacher would use this strategy in the following manner. The student would be required to complete certain academic or instructional tasks prior to requesting and receiving access to certain reinforcers.

The Premack contingency could be tagged on to the request (mand) replacement function option delineated previously. This strategy, like delay of gratification training, would also begin to develop the individual’s ability to delay gratification. The Premack contingency requires some low probability behavior (e.g., completion of a task or series of tasks) to occur prior to the client being allowed to request access to the desired sensory reinforcer. Hence, access to the reinforcer can be at designated times (after tasks are completed) and suitable settings (engaging in the behavior only in certain nonpublic or nontraining areas). The task completion criteria for accessing the positive reinforcer can be progressively altered as a function of the success of the program in producing the contingency.

TABLE 4.6 ■ CONTRASTING REPLACEMENT FUNCTION OPTIONS FOR DA 1.1: IMMEDIATE SENSORY SIMULI

Table 4.6 illustrates how the Premack contingency option contrasts with the other replacement function options detailed previously. The target behavior is stereotypic hand flapping and is maintained by the direct sensory result it produces.

Similar to delay of gratification training, the Premack contingency option will eventually reduce the frequency of accessing the reinforcer. In contrast to delay of gratification training, the Premack contingency requires some performance on designated tasks as the conditional event for reinforcement of the requesting behavior. Again, chain interruption procedures are utilized should the client attempt to access the sensory or tangible reinforcer without prior authorization. Such unauthorized attempts also can be punished by increasing the number of tasks required contingent upon the attempt to access the reinforcer prematurely (see “Reverse Premack Principle” box).

REPLACEMENT FUNCTION OPTIONS FOR SMA PROBLEM BEHAVIORS

There are five replacement function options when treating a problem behavior that is maintained by SMA to positive reinforcement. With all SMA problem behaviors, withdrawal of reinforcement (extinction) for the occurrence of the target behavior is a requisite for making the alternate behavior functional.

DA (to tangible reinforcer) replacement option: Developing or strengthening a chain of behaviors that produce the desired tangible reinforcer directly.

Access mand (request) replacement option: Identify a requesting behavior (mand) that would allow staff to mediate such a request or choice by providing the client with the desired person’s attention or tangible reinforcer.

Differential reinforcement of low rates (DRL) group contingencies for peer attention: Designating a lower rate of the target behavior (differential reinforcement of low-rate behavior), which is the criterion for providing a powerful reinforcer to the group. The target rate may be for either the individual client’s behavior or a group’s level of behavior or performance.

Delay of gratification training option: Identify a length of time that you want the individual not to perform the target behavior, that is, the nonoccurrence of target behavior for a set time period. Contingent upon the client not engaging in the target behavior in the DRO interval, access to the desired adult or staff attention or tangible reinforcer is provided.

Premack contingency replacement option: Identify a regimen of tasks that, when completed, allows the client to access the reinforcer (Premack Principle).

Extinction

With SMA problem behaviors, there is usually no need for a chain interruption strategy, unless the problem behavior can be dangerous to the client or others (e.g., self-abuse, aggression, property destruction). In those cases, simply for safety requirements, a chain interruption procedure delineated in the previous section should be used. With other SMA behavioral functions, there is no need to physically interrupt the behavior. Simply not providing the positive reinforcer contingent upon the problem behavior will be sufficient to facilitate its demise. In other words, extinction is necessary.

Extinction is defined as the removal of the functional reinforcer contingent upon the target behavior occurring. Given that problem behaviors in this category are maintained by the behavior of others, it becomes obvious how the reinforcer will have to be removed. People will have to behave differently when the target behavior occurs!

To implement extinction, one must be able to tolerate the occurrence of the target behavior (Iwata, 2006). Staff, parents, care providers, and teachers need to refrain from the delivery of the reinforcer for the problem behavior, whether it be adult attention or a tangible item or event. Peer reinforcement of the previously reinforced target behavior needs to be removed, but the mechanism for this SMA 2.2 function is somewhat different than with other socially mediated reinforcers.

All the functional behavioral treatment plans would require that the maintaining reinforcer for the target problem behavior be eliminated, or at least weakened (i.e., disabled). If complete elimination of the contingency is not plausible (humans will be humans), then there needs to be a significant disabling of the previous temporal and reliable relationship. The weakening of the relationship can be based on the contingency being less reliable than the one that should exist for the replacement function.

For example, let us say that the tantrum behavior of an adolescent in a group home results in getting the desired reinforcer within 5 minutes of the tantrum onset, 70% of the time. To disable this relationship, tantrum behavior should not produce the desired reinforcer at all. This designation would be specified in the behavioral plan. Once the plan is enacted, we can hope for a 0% relationship between tantrums and access to socially mediated reinforcers. However, in human service and educational settings, perfect performance is something to strive for, but not always the case. However, if the staff or teachers are able to remove the delivery of the reinforcer for 80% of the tantrums, they have significantly disabled the functional ability of tantrums to produce reinforcement. In addition, if doing a simple chore in 5 minutes results in 100% access to the reinforcer, the previous relationship between tantrums and reinforcement has been further weakened. Given that data, the most efficient behavior for accessing desired reinforcers is doing a designated 5-minute chore.

In summary, complete removal of the functional reinforcer for the target problem behavior is preferred. However, perfection is not always viable in practice. But if one can seriously weaken the existing maintaining contingency for problem behavior relative to the replacement function, change in client behavior should occur.

Here are some strategies to achieve this contrast. Making the replacement behavior easy to perform is an excellent strategy. Concurrently, making the target behavior less efficient at accessing the desired reinforcer enhances the “attractiveness” of the replacement function. It is also possible to add a punishing effect by instituting a Reverse Premack Principl.² The Reverse Premack Principle would involve making the occurrence of the target behavior serve as a mand for a nonpreferred regimen of tasks. Such a punishment contingency can also be an adjunct complementing extinction.

DA to Tangible Reinforcer

In some cases, if appropriate, the client can be taught to access directly the tangible reinforcer that was maintaining the problem behavior. Teaching a client to pour his or her own drink instead of throwing a tantrum (to have someone else get it) is obviously a great solution, once the function of tantrum behavior is discovered.

Using Reverse Premack

Narrated PowerPoint Presentation

REVERSE PREMACK PRINCIPLE

Assignment: Reverse Premack

Another method of disabling the function of the target behavior is to have such a behavior serve as a mand for a regimen of nonpreferred tasks. In other words, the occurrence of a higher probability behavior (target ­behavior) is followed by the client engaging in a behavior of lower probability, thus setting up a punishment contingency (Premack, https://en.wikipedia.org/wiki/Premack%27s_principle).

After reviewing the narrated PowerPoint lecture entitled, “Reverse Premack,” write a paper that delineates the following in order:

1.Explain the premise of the contingency, and how it differs from the traditional use of the Premack Contingency.

2.Identify what effect the Reverse Premack has on the behavior that produces the contingency. Is the Reverse Premack used to increase or decrease a behavior?

3.Delineate how such a contingency would be used for a DA function, (e.g., pica: putting inedible items in one’s mouth). Explain what would happen when the pica incident occurs by depicting a hypothetical client with such behavior. Make sure you indicate how you selected the particular socially mediated contingency of pica in terms of its relative probability to the pica behavior.

4.“Using an AB design, generate hypothetical data for a client who mouths inedible objects and create a table or graph that displays data from six 1-hour sessions for a baseline (control) condition. The B condition should then be an equal number of sessions with a Reverse Premack condition in effect. Then explain what the results of your graphed hypothetical data indicate; that is, what is the efficacy of the Reverse Premack contingency compared to the control condition.

I Want a Sandwich, Please. A male adolescent with developmental disabilities would throw a tantrum and yell loudly when hungry, and staff on an intermittent basis would provide food to him contingently (LaVigna, Willis, & Donnelan, 1989). Teaching him to make his own sandwiches and snacks negated the need for tantrums when he was hungry. Note that the behavioral effects of the tantrums and the sandwich-making behavior are the same, but one alternate is obviously more desirable than the other.

FUNCTIONAL TREATMENT: SMA 2.3: TANGIBLE REINFORCER, FOOD ITEM

Contingency Plan for Target Behavior

If the client throws a tantrum and yells loudly, the client will not receive food.

Contingency Plan for Replacement Behavior

If the student makes his or her own sandwich, the student can proceed to eat it.

Access Mand (Request) Option

In this treatment option, the desired reinforcer, whether it be adult attention or access to a tangible reinforcer, is provided by staff upon an appropriate request. Concurrently, the previous access function of the target behavior is negated through extinction. As an example, let us look at how this differential reinforcement process would work for a young girl with autism who falls on the floor. The functional behavioral assessment (FBA) data point to the maintaining contingency as access to tangible reinforcer (SMA 2.3: Tangible Reinforcer). Currently falling on the floor is followed by teacher attention in the form of cajoling her to get up, rubbing her shoulders as an incentive to get up. All these teacher behaviors have nothing to do with the function of the tantrum behavior. Finally, the teacher gets her favorite picture book out and shows her the pictures while coaxing her to sit at the table (Bingo! there is the function!). It should now be evident that to make tantrum behavior nonfunctional, the book should not be rendered during an episode. Hence, the plan calls for a nonvocal request (i.e., raise hand) to serve as the behavior that will bring the teacher or aide over to her with the book and begin showing her the pictures. This replacement behavior, that is, raising her hand, would now substitute for dropping on the floor as a means to get attention. Such a request will now result in an adult interacting with her while looking at the book. If access to the book is the maintaining contingency for the student’s target behavior, then reinforcing requests at 100% levels negates the function of the target behavior.

Let us examine how such a replacement behavior ameliorates the prior function of the target behavior. Previously, book reading was delivered when this child dropped to the floor. Now such behavior results only in a postponement of this activity. The extinction plan might be designed so that the exhibition of the tantrum behaviors results in a time period where access to the book is withheld. The request for the book would be reinforced only after this extinction period. However, if hand raising occurs prior to the target behavior, it immediately produces this event. To reiterate, disable one function, enable another!

FUNCTIONAL TREATMENT: SMA 2.3: TANGIBLE REINFORCER, BOOK-READING ACTIVITY

Contingency Plan for Target Behavior

If the young girl drops to the floor, she will not receive the book-reading activity for 5 minutes after getting up and sitting back down in her seat.

Contingency Plan for Replacement Behavior

If the young girl raises her hand, she will immediately receive the desired activity for a 3-minute period (unless first contingency is in place). Such behavior may need to be prompted in the beginning, particularly if replacement behavior diagnosis is inept repertoire (see Inept Repertoire Category section of this chapter).

Realize that requesting will be functional only if you are correct in your analysis. If this child’s dropping to the floor is the result of getting a book, making it more profitable for her to request the book than drop to the floor will prove effective. If this is not the actual function, that is, the reinforcer maintaining the dropping behavior is not the book-reading activity, this plan will be ineffective. Why? A misdiagnosis of function means that the primary purpose of dropping to the floor was not to get the book-reading activity, but rather something else. A wrong hypothesis about the behavior’s function leads to selecting a wrong replacement function, which then leads to an ineffective treatment.

A Pinch Here, a Pinch There. How would this replacement option be used to treat the client’s pinching behavior I observed in the previous chapter? Because pinching is currently maintained by the resulting staff interaction, this contingency needs to be rectified. Pinching should obviously result in no (or little) staff interaction. However, a sign for “communication desired” by this individual (e.g., signing “me”) would result in someone coming over and shaking his hand and talking with him for a while. Replacing access to social interaction from the target behavior to a request for interaction will switch the schedule of reinforcement in favor of the more appropriate behavior. It is quite plausible that the signing response will need to be shaped and prompted frequently before becoming more spontaneous.

SIMULATION EXERCISE: THE “YES” GAME

This exercise can be used to simulate how an alternate response (e.g., a mand or request) is differentially reinforced in functional treatment. It is a great exercise in illustrating how both reinforcement and extinction are juxtaposed when developing an alternate behavior while diminishing other behaviors.

Select a behavior that represents the desired target skill, but do not disclose this to the role respondent (a student who volunteers for class simulation is sent outside the classroom). When the volunteer leaves the classroom, the remainder of the class is informed what the behavior is so they can observe how differential reinforcement is applied. The volunteer is then asked back inside the classroom and to engage in any behavior (that is suitable for public display). The volunteer is told that “yes” (or you can use applause) means he or she is on the right track and its absence indicates he or she is not. You say “yes” when an approximation of the target behavior occurs, and say nothing when the exhibited behavior does not meet the criterion of reinforcement at that time. Once the target behavior occurs (hopefully), switch roles so that the student gets practice at being the therapist. Such a simulation illustrates the basics of differential reinforcement by reinforcing approximations to the target request or mand, while learning to produce extinction for other forms of behaviors (i.e., undesirable behaviors that occur). Make sure that the volunteer just relies on “yes” versus its absence in getting the respondent to engage in the designated behavior.

FUNCTIONAL TREATMENT: SMA 2.1: ADULT ATTENTION

Contingency Plan for Target Behavior

If the student pinches a staff member, he or she will not receive any attention for 5 minutes subsequently.

Contingency Plan for Replacement Behavior

If the student signs “me,” he or she will immediately receive the desired social interaction activity for a 3-minute period. Such behavior may need to be prompted in the beginning, particularly if such a sign is not currently in the person’s repertoire.

A Request for Food to Replace Self-Injury. In the previous chapter, a hypothetical student with severe disabilities exhibits an unacceptable level of self-abusive behavior. Your observations revealed that the teacher was unwittingly developing the child’s self-abuse as a functional behavior when the student wanted food, by giving him food to “calm down.” Because this student is unable to vocally request food, how would one replace self-injury with requesting behavior? Simply teach the student how to sign (or use other nonvocal system) indicating a request for food at times when the student wants food. The staff would reinforce such behaviors with food while self-injury does not result in food, that is, undergoes extinction. Therefore, self-abuse becomes less probable under the motivational condition of desiring food, being weakened by its inability to access food, while signing becomes stronger.

FUNCTIONAL TREATMENT: SMA 2.3: TANGIBLE REINFORCER, FOOD ITEMS CONTINGENCY

Plan for Target Behavior

If the student engages in self-injury, a chain interruption procedure will be used (to include restraint for a specified period of time), and the student will not receive any food item for 3 minutes subsequently. In addition, a Reverse Premack Principle would be instituted during the 3 minutes of nonaccess.

Contingency Plan for Replacement Behavior

If the student signs “food,” the student will immediately receive the desired food item, in small quantity, with an opportunity to continue requesting to get more (until a designated amount has been consumed). Such behavior may need to be prompted in the beginning, particularly if the replacement behavior diagnosis is inept repertoire (see Inept Repertoire Category section of this chapter).

DRL Group Contingencies for Peer Attention

Removing peer reinforcement for undesirable problem behaviors requires a different mechanism. One cannot often successfully instruct peers to ignore the problem behavior (i.e., remove peer attention) so the target student will behave more appropriately. What is in it for them? To remove peer reinforcement for problem behavior, it is necessary to contrive the following contingency: powerful contrived reinforcers for the group are made available if the child’s exhibition of target problem behavior meets a selected behavioral criterion. In many cases a group criterion level can be designated, for example, the class cannot go over five disruptive incidents in the morning in order for everyone in the class to earn 10 minutes of extra recess after lunch. Here are some examples.

Everyone Loves a Clown (Except the Teacher). Let us take the case of a hypothetical junior high school special education student, Billy. Billy engages in frequent, verbally inappropriate behavior toward teachers. Subsequent to such behavior the class laughs, girls smile, boys nod their heads, and all have a good time. He has peers wanting to hang out with him during recess and at lunch. Unfortunately, this is exacerbated even when Billy is disciplined by being sent to the principal’s office. How can one make his peers responsible for not feeding into this behavior?

DISCUSSION QUESTION 4C

When you were in junior high school, did everyone love a class clown? Were there some classes where such “clowning” behaviors were more prevalent? Why?

A group contingency involves the setting of a contingency in which the group attains (or not) a group reward, contingent upon the group behavior or performance. As an example, the following contingency can be enacted with extra peer conversation time at the end of the period as the reinforcer. If the class stays at or below a certain level of inappropriate comments (taking into account Billy’s rate), the whole class earns conversation time. If the class goes beyond the designated number of allowed inappropriate comments, they all lose out. Do you think that peer attention and approval for Billy’s inappropriate verbal behavior will still be forthcoming?

Do Not Argue! Simply asking Antonio and his sister to stop arguing, separating them, and/or intermittently sending them to their rooms did not work. There were great bouts of verbal abuse inflicted upon each other during these arguments. Antonio and his sister were foster children living in a two-parent household. Like many other parents, these foster parents (actually his grandmother and grandfather) attempted to figure out who started the argument and why. This strategy often led down the path of no return. Hence, the referral for my behavioral intervention services to address this problem behavior as well as others that were occurring at school.

Why do children argue? Arguing is usually maintained by the listener’s response. One cannot argue with a wall, but one can attempt to have the last word with another human being. Sometimes the arguments between Antonio and his sister were about silly things. Other times they were about who gets what TV show or favored item or activity. After collecting behavioral assessment data, my behavioral specialist (Ron Pekarek, BCBA) designed a plan to address this interlocking dynamic. It was obvious that we were going to discontinue attempting to find out who started it as a method of dealing with such interactions.

Therefore, rather than deal with the incident as a CSI forensic specialist, the designed intervention simply counted each argument against both children. An argument was counted when both children said something to each other in a negative or derogatory tone. With behaviors that are maintained by peers, it is essential to allocate consequences to all concerned. Individual contingencies for the one who started it, even if such could be ascertained, would probably be ineffective. To remove peer reinforcement, one has to make the levied contingency affect all those involved during the incident.

Ron taught the grandmother how to use early bedtime as a contingency for unacceptable levels of arguing on a given day. In the DRL contingency, if Antonio and his sister had two or fewer arguments in a given day, then they both go to bed at their normal 8 o’clock time period. However, three or more arguments resulted in earlier bedtime. The data on average frequency of arguments between Antonio and his sister follows. Table 4.7 shows what it did for Antonio.

Note that in the first 2-week period (3/8—3/17), the average daily rate of arguing was 1.5. This translates to the two children rarely having three arguments because you know what kicks in if that happens. Apparently these two children really liked staying up until 8:00 p.m. The effect on behavior becomes even more pronounced in the weeks to follow. The period from 4/21 to 5/14 did not have one incident of arguing behavior. There are not too many families that can boast that, especially those with children who were previously experiencing severe difficulty in dealing with each other without taunting and arguing.

It is important to note that arguing might still produce the desired listener response, yet the punishment contingency overrides this relationship. While the discriminative stimuli for verbal aggression were still present, a concurrent contingency involving removal of a reinforcer, contingent upon the verbal arguments, successfully competed with the behavior’s functionality.

DISCUSSION QUESTION 4D

Describe how Ron Pekarek intervened with the brother and sister who argued and fought a lot. Why was it necessary to provide a uniform group contingency for arguing that affected both of them (and not find out who started the argument)?

TABLE 4.7 ■ AVERAGE FREQUENCY OF ARGUING ACROSS BASELINE AND CONSEQUENCE TIME PERIODS

Delay of Gratification Training Option (Omission Training)

The use of the delay of gratification training option for SMA problem behaviors is similar to the previous application for DA behavior problems. If the client goes without engaging in the target problem behavior for a designated period of time, the delivery of the desired reinforcing event occurs. The occurrence of the target behavior results in the postponement of the reinforcer, in that the DRO interval is extended. For example, if a DRO interval is set at 4 minutes, the delivery of the reinforcer is contingent on the client not performing the target behavior for that period of time. The client can engage in a variety of other behaviors, but the functional reinforcer is conditional upon the absence of the target behavior during the 4-minute DRO interval. However, if the behavior does occur within the 4-minute period, the DRO interval is reset for the full time period contingent upon the occurrence. The following examples illustrate this dual contingency.

Waiting to Get New Clothes. Delay of gratification training can be added as a component to a requesting option for SMA problem behaviors. A previous example involved a client who would rip off his or her clothes to get staff to bring new clothes. How would delay of gratification training be used to decrease the clothes ripping behavior? Perhaps the behavior analyst might consider building in a certain amount of time to elapse without the target behavior occurring following a request for a change of clothing. Initially, the length of the DRO interval would be small to promote success in the beginning of the program. The DRO interval would be gradually increased once the client has learned to tolerate the nonpreferred clothes for some small period of time. Further, ripping off nonpreferred clothes during the DRO interval would result in a resetting of the DRO interval back to zero. Remember, extinction of the previously reinforced response has to occur. When the DRO interval elapses, the client would be allowed to request, in whatever manner, more preferred clothes. In this gradual progressive manner, the client is being taught how to delay gratification for longer periods of time.

FUNCTIONAL TREATMENT: SMA 2.3: TANGIBLE REINFORCER, FOOD ITEM

Contingency Plan for Target Behavior

If the client rips off clothes, he or she will not be given preferred clothes. Further, the DRO interval is reset. If the client engages in a tantrum subsequent to not getting new clothes, the DRO interval is reset after the tantrum behavior has subsided.

Contingency Plan for Replacement Function

If the student signs “shirt please,” a wait interval (DRO) is designated. Following the lapse of the designated DRO interval, the student will receive the desired clothing item. The DRO period should be short in the beginning (e.g., 2 minutes). It can be progressively lengthened with success.

Get to the Student Quicker. What about the student who bangs her desk to get the teacher to come over to her when she needs help (see I Want Your Attention, Now! in Chapter 3)? This scenario from the prior chapter found that the behavioral function of this target behavior was a quicker access to teacher help and attention. When this student wanted the teacher to come over to her, raising her hand was not as effective or efficient as banging on the desk. Banging on the desk produced faster results. Hence, that form of behavior was strengthened under the conditions of wanting teacher attention and the teacher being with other students.

Of course, waiting and raising one’s hand appropriately are alternate behaviors that are desirable. But as long as banging the desk produces attention more quickly, the alternate behaviors do not have a chance of competing with this behavior. Hence, a DRO would provide a consequence to the target behavior that further disables its ability to access the positive reinforcer. The rearranged contingencies should be as shown in the following box.

FUNCTIONAL TREATMENT: SMA 2.1: ADULT ATTENTION, TEACHER HELP

Contingency Plan for Target Behavior

If the student bangs on desk, there is a delay in teacher attention for 3 more minutes with each incident.

Contingency Plan for Replacement Function

If the student raises his or her hand (request for help) and waits up to 30 seconds, the teacher will come over and provide help. The wait period can be progressively extended with repeated success at prior wait periods (however, the DRO interval for the target behavior should also be proportionally lengthened).

How Long Should the DRO Interval Be? Unfortunately, in some cases, an interval length for the DRO is not determined by baseline data. Rather, the naive program designer may arbitrarily set the DRO interval at some value perceived as fair, such as 5 minutes. This arbitrary decision can often lead to program failure. The DRO interval should be set as a function of the baseline data. The baseline data collected should allow for the user to determine the average interval of nonoccurrence of the target behavior. This can be achieved simply by dividing the length of the data collection session by the frequency of target behavior. Table 4.8 provides this analysis for four sessions of data collection.

One can see that the average nonoccurrence interval ranged from a low of 3 minutes to a high of 10 minutes (best session). Therefore, selecting a DRO interval of 20 minutes would probably result in the student not earning the desired reinforcer very often (or not at all). Setting it at 1 minute would be comparatively easy. Setting it at 5 minutes would be reasonable. If this data was not available, an arbitrary selection might be 20 minutes or more. Setting it at 20 minutes would probably result in continued failure. Hence, the client rarely, if ever, earns reinforcement. The designer is then forced to go back to the target behavior to access reinforcement, or some other behavior that is equally unacceptable.

DISCUSSION QUESTION 4E

Let us say a parent has a 6-year-old child (nondisabled) who has severe tantrum behavior during shopping trips. The hypothesized access function is desired items (on the store shelves). Such tantrum behavior occurs subsequent to the child asking for the item, and being told, “No, you cannot have that, it is not on the list.” This child asks for several desired items during the trips. The usual outcome of a shopping trip is that three or more preferred items (that were not on the shopping list) end up in the shopping cart, often as a result of a screaming bout. What intervention strategy would be suitable for such an SMA function that does not entail honoring every request for some item? What would you recommend for the initial length of the shopping trip (and why)?

TABLE 4.8 ■ FOUR SESSIONS OF DATA

Premack Contingency Option

In this option, the desired reinforcer is produced following the client’s successful compliance to a designated regimen of tasks or demands. In a school setting, getting free time would be contingent on performing a certain number of tasks. During free time, the student would be allowed to access desired events and activities.

School Placement (and Mom’s Job) in Jeopardy. In the early 1990s, a 10-year-old boy in a special education classroom (SDC) who engaged in extreme disruptive behavior and low rates of task engagement was referred to me. When he was younger, the school staff would put him in time-out, but as he became older and of significantly greater weight (over 110 pounds), they could no longer guide him to the time-out area. The solution to such a quandary was to send him outside to “cool off.” As one might imagine, he was spending quite a significant part of the day “cooling off.” When he refused to work subsequent to a reasonable “cooling off” session, the school staff called his mother to take him home for the remainder of the day. His mother was being called several times a week to take him home. This “call mom” practice was having a deleterious effect on the mother’s employment situation, placing her current job in jeopardy. Additionally, the school was examining the possibility that he could not attend school if such behavior continued.

My behavioral specialist, Steve Taylor, noted that once he was outside he accessed a number of preferred activities, including playing with his matchbox cars. Such access to play activities contingent on disruptive and “agitated” behaviors produced an SMA function for those problem behaviors (SMA 2.3: Tangible Reinforcer). The proposed functional treatment would change how outside play with his toys would be obtained. Instead of disruptive behavior resulting in play, his completion of a few short instructional tasks would result in access to a specified amount of outside playtime. The use of this Premack contingency also required that disruptive and agitated behavior should no longer result in being sent outside. Fortunately, such behaviors seemed to decrease dramatically with the implementation of this Premack contingency. Further, during intervention, his willingness to come in from outside play and work again, to earn the opportunity for more time with his toys, seemed to be in stark contrast to the baseline.

The beneficial outcomes of this intervention involved the following. First, since the intervention ensued, mom was not contacted once to take him home early. Second, neither the student study team (SST) nor the principal any longer received referrals for the student’s problem behavior in the SDC. Third, compliance to tasks was optimal, with the amount of work required being progressively increased and reaching levels that were deemed nonproblematic. At 6-month follow-up, problem behaviors remained at very low levels.

Potato Chips: Bet You Can’t Have Just One. As you will recall, the hypothetical female client with schizophrenia in a day treatment program engages in property destruction to get another bag of potato chips. Such behavior is functional in that subsequent to the programmed time-out for this behavior, she is sometimes given another bag of chips. Although such behavior does not result in a second bag of chips every time, it is more successful in getting “seconds” than simply asking staff. Obviously, engaging in property-destructive behaviors needs to be seriously weakened in her ability to get potato chips. However, simply programming extinction for such behaviors may make the client engage in other more inappropriate behaviors that access this reinforcer. If left to chance, behaviors that may naturally develop may be as bad (or worse) than property destruction, such as self-abuse and aggression to others. Selecting an acceptable replacement function and training the staff to reinforce this behavior with extra chips is essential.

This case poses a significant problem. Her desire for more potato chips is after she has already had a bag. One could just reinforce her request for an additional bag of chips. However, such a contingency may lead to increased unacceptable levels of eating potato chips. She may satiate at six bags per mealtime! Simply reinforcing requesting behavior is often not a practical plan with food items.

However, requiring her to perform certain tasks to get another quarter bag of chips may prove useful. She would be required to complete three small tasks and then be allowed to request chips. What if she wants more? She would be required to perform another six tasks before being allowed to ask for chips and receive such. In these types of plans, increasing the performance requirement with each delivery makes the client want the chips less and less.

FUNCTIONAL TREATMENT: SMA 2.3: TANGIBLE REINFORCER, FOOD ITEM

Contingency Plan for Target Behavior

If the client engages in property-destructive behavior, she will not be given more potato chips following the planned time-out. Rather, following the time-out, she is given the opportunity to perform a set of tasks designated below to receive more chips. Also, a chain interruption procedure should be in place for property-destructive behavior, followed by removal from the area to a time-out.

Contingency Plan for Replacement Behavior

If the student requests more chips, she can complete/comply with three task demands, and then she will earn a quarter bag of chips. She can repeat this until one additional bag is consumed. The number of tasks required to earn chips can be progressively increased by three tasks with each new request.

Why Does the Premack Contingency Work With SMA Diagnoses? The Premack Principle designates a relationship between a high-probability behavior (i.e., engaging in desired event) and a low-probability behavior (i.e., complying with certain task demands). But what is the point of the arbitrary selection of performing a set number of tasks as the replacement function?

It is often the case that the social environment has made it too easy for some children or clients to get certain events or reinforcers. Therefore, “ad-lib” access of such events occurs at unreasonable levels. To want someone’s attention is not a sin, but it surely is tough to accommodate when it is demanded every few minutes. Although this may be an acceptable state of affairs for infants, as children get older they have to be weaned off of such frequent and lengthy attention from their parent. Unfortunately, some children do not undergo such conditioning and learn to engage in disruptive and disastrous behaviors to continually access attention or preferred items or activities.

To reduce the client’s constant desire for a given reinforcer, a Premack contingency is well suited. Requiring the performance of a less preferred event as a condition for access to reinforcement is a strategy that will eventually wean them off of frequent access. I have viewed the success of several clinical applications of the Premack contingency in dramatically reducing the problem behavior (by hampering its function). A nice side benefit of this treatment option is that the “desire” for such an activity or event becomes lessened compared to when ad-lib access existed. If the client has to perform a series of tasks to get something, she becomes “happy” with getting a lesser amount of that something over a period of time.

Table 4.9 contrasts four replacement function options for self-injurious behavior involving an SMA 2.3 function: Tangible Reinforcer of food.

TABLE 4.9 ■ CONTRASTING REPLACEMENT FUNCTION OPTIONS FOR AN SMA 2.3 DIAGNOSIS

SMA, socially mediated access.

REPLACEMENT FUNCTION OPTIONS FOR DE PROBLEM BEHAVIORS

There are four replacement function options when treating a problem behavior serving a DE function. All the options below require a chain interruption procedure (delineated in a prior section of this chapter) for the target problem behavior. Chain interruption would involve stopping the child or client from directly escaping the aversive condition or stimulus. If chain interruption is not used, it is less likely that a designated alternate escape behavior will be able to compete with the problem behavior’s ability to effectively and efficiently terminate the aversive event. Of course, the selection of which option is best suited for a particular circumstance is a clinical decision.

Alternate DE form replacement option: Identify an alternate acceptable behavior that also produces escape from the aversive situation. Such a behavior should not be inappropriate or dangerous but does directly and immediately produce escape from the aversive condition in a more socially desirable manner.

Escape mand replacement option: The protesting or negotiating response is mediated by teacher, staff, or others by their removing or postponing the aversive condition from the client or removing the client from the aversive condition.

Tolerance training replacement option (i.e., differential negative reinforcement of other behavior [DNRO]): Identify a length of time that you want the individual not to perform the target behavior, that is, he “tolerates” the aversive condition for a designated period of time. The nonoccurrence of the target behavior for the DNRO interval period provides for the child or client to escape or avoid the aversive event (either by request or by direction of staff).

Premack contingency replacement option: Identify a regimen of tasks that, when completed, allows the client to escape the aversive condition or situation (Premack Principle utilized in an escape fashion).

Alternate DE Form

In some cases, a more acceptable alternate form of escape behavior can be identified and developed. Such a behavior must be just as capable of producing escape from the aversive situation as the target problem behavior. This is the same principle that was used for DA problems except that the alternate form now produces DE. Many problem behaviors with young children may fall into this category. For example, spitting food out is unacceptable, yet everyone occasionally has food in the mouth that they find extremely distasteful. There are acceptable and unacceptable ways to remove food from the mouth. The acceptable behavior is for the child to use a napkin or go to the bathroom and spit out the food (see Table 4.10).

Night Waking Problems. Some children have problems with nighttime sleeping by themselves in a dark room. They often wake up and go into their parents’ bed. This pattern then becomes another problem, especially when it occurs frequently. The behavior of getting into the parents’ bed is directly reinforced by the termination of an aversive event (i.e., being alone in the bed at night when it is dark). If the aversive event is being in the dark at night, perhaps some alternate behavior that eliminates that condition might be feasible. Teaching the child to turn on the light whenever he or she wakes up would be a desirable alternative. If darkness is the only aversive event, turning on the light would remove the aversive event without getting into the parents’ bed. However, if getting into the parents’ bed is also a function of some positive reinforcers, other contingency arrangements would be needed.

TABLE 4.10 ■ REPLACEMENT BEHAVIOR—MORE ACCEPTABLE FORM

Nude Clients. This treatment option can apply to clients who frequently engage in ripping or tearing off their clothes. If such behavior is maintained by the direct removal of nonpreferred clothing, simply allowing them to change clothes or select their own clothing would do the trick! Of course, if such a behavior is maintained by social attention, this strategy would be ineffective in reducing the rate of clothes ripping. However, if the clothes the client is currently wearing are less desired, or the client is used to some other fabric (e.g., cotton, silk), this DE alternative form is well suited.

If the client is not capable of self-dressing, then this behavior may have to be taught (i.e., prompted and shaped) in order for it to be a useful replacement behavior. Other clients may not have previously changed clothes spontaneously because such behavior was (or would be) thwarted or punished by staff. Increasing their independent changing of clothes may require just a simple differential reinforcement plan—let them do it in a private area.

FUNCTIONAL TREATMENT: DE 3.1: NONPREFERRED CLOTHES

Contingency Plan for Target Behavior

If the student engages in clothes-ripping or tearing behavior, a chain interruption procedure will be used. The client will then be required to perform three nonpreferred tasks under staff supervision (Reverse Premack).

Contingency Plan for Replacement Behavior

If the student chooses his or her own clothes from a sample of acceptable clothing, he or she will be allowed to wear them. If the student changes clothes without engaging in any problem behavior, he or she will be allowed to wear those clothes. The student can change no more than three times in a given time period each day.

Escape Mand

The client’s ability to terminate or avoid an undesired social or instructional condition can also be enhanced by developing two types of communicative skills: verbal protests and negotiating skills. Saying in a calm voice “I prefer not to do that” instead of screaming to avoid an aversive task is certainly more preferable from the standpoint of the caregiver or staff. However, if the client is incapable of appropriate protesting behavior, unfortunately, undesirable forms of protest fill the void under conditions where escape behavior is likely.

In some cases, protesting skills are not viable. For example, when the client or student is required to complete some assigned task that is essential for the client’s well-being, protesting the task probably should not lead to termination of the request. However, negotiation skills may be appropriate for this circumstance and should be developed. Negotiating for a smaller amount of an assigned task or for a shorter period of time to engage in the activity can often be successful and produce escape earlier than if negotiation had not been undertaken. Some examples might help illustrate this replacement behavior option.

How About Only Five Pages, Please? Suppose an FBA reveals that a student engages in a variety of “procrastination” behaviors (goes to bathroom, lies down, watches TV) when the homework assignment is relatively lengthy. Simply allowing the student to protest doing any homework would not be feasible. However, reducing the number of pages to read before a short break would seem to be more reasonable. Perhaps the student can be taught to negotiate with the parent the number of pages that must be read before taking a break. If the student commits to following through, the parent agrees to allow a short break following completion of the agreed upon task.

FUNCTIONAL TREATMENT: DE 3.1: SCHOOL HOMEWORK ASSIGNMENTS

Contingency Plan for Target Behavior

If the student engages in direct avoidance of doing homework at the scheduled time, a chain interruption procedure will be used that involves terminating any event the client is currently engaged in immediately, other than sitting at the table with books out.

Contingency Plan for Replacement Behavior

If the student, while at the table, negotiates a certain amount of the homework assignment to be done prior to taking a break, the parent authorizes such a plan and provides a break if the agreement is upheld.

In developing appropriate forms of negotiation, the verbal form should contain elements of a request instead of a refusal. For example, “How about if I—,” is an appropriate form of verbal behavior. In contrast, “I won’t do this!” is likely to result in lack of results from the staff person, teacher, or parent. Certainly negotiating the time or amount of a task is a much better alternative to the previous manner of dealing with the situation, that is, doing all kinds of things to avoid sitting at the table and studying.

Can I Do My Household Task at 4 p.m.? With regard to household tasks that people find unpleasant, negotiating the time at which they will be completed may be the solution for some clients. With some clients, staff have to constantly remind them to complete their chores. Such reminders and prompts often end in arguing, yelling, and sometimes worse, behavioral problems on the part of the client. Negotiating with the client a time in which a task will be completed allows the individual to postpone the aversive event until a time when other more preferred activities are not interrupted. This strategy would not be useful for some clients who detest ever doing the task or chore. The selection of a replacement behavior for them would require a different option, such as the Premack contingency.

FUNCTIONAL TREATMENT: DE 3.2: LENGTHY CHORE

Contingency Plan for Target Behavior

If the client engages in direct avoidance of doing a chore, without negotiating an agreed upon time, a chain interruption procedure will be used. This procedure involves immediately terminating whatever the client is currently engaged in and requiring him or her to perform the chore immediately. Further, the ability to negotiate the time the task is to be done the next day is removed as a consequence, and the task will be initiated immediately after school.

Contingency Plan for Replacement Behavior

If the client negotiates a certain time when he or she will initiate and complete the assigned chore, the parent authorizes such a plan and does not constantly remind the client, providing the contract is upheld (i.e., chore is completed by agreed upon time).

Tolerance Training Option³

The previous two options involve a replacement behavior that allows the child or client to escape or certainly ameliorate an aversive condition. However, in many circumstances, one may not simply opt out of a social or instructional situation. For example, if an elementary grade student did not want to do go to large assemblies, it is unacceptable to simply opt out. However, keeping him or her there for over 15 minutes results in frequent disruptive behavior until he or she is removed for being too disruptive. Therefore, a more reasonable option may be to allow the child to leave the assembly when going without the target behavior for a reasonably shorter period of time. The child would have to tolerate the assembly for a designated period of time before being allowed to opt out. For example, if the child stays in the assembly for at least 10 minutes without engaging in the target behaviors, he or she could then leave.

In tolerance training, you identify a length of time for the nonoccurrence of behavior (a DNRO interval). When this criterion is met, you terminate the child or client’s involvement in the social or instructional situation. In this manner, you are developing an individual’s tolerance for a nonpreferred event. With success at lower DNRO intervals, you can progressively increase the DNRO interval required to escape, thus increasing the individual’s tolerance of aversive events of some duration.

I Need a Break. Remember the student with severe disabilities who lays her head on the table when asked to complete lengthy tasks? The use of tolerance training could provide such a reinforcer contingent on not doing such a behavior for a designated period of time. Let us say that the teacher has collected baseline data. The average length of time this child would go before putting her head on the table was 7 minutes (range of 3—10 minutes). With this baseline data, one can be guided to select a reasonable initial standard for reinforcement. The program designed thereby sets the DNRO interval at 6 minutes. If she does not lay her head down on the table for 6 minutes, she earns the right to do so for a 6-minute period and take a break. If she engages in the behavior prior to the timer elapsing, a chain interruption strategy is used. The teacher will immediately prompt her to pick her head back up. Additionally, the teacher will reset the DNRO interval length. Of course, with success, the DNRO interval could be progressively increased.

DISCUSSION QUESTION 4F

How important is it to be able to tolerate aversive events as one gets older? Why is it some people seem to be able to “handle” aversive and unpleasant events (e.g., breaking up of a love relationship) while other people “fall to pieces,” sometimes to the point of being hospitalized for behaving in a manner that is dangerous to themselves?

Premack Principle (Escape)

Again, the Premack contingency can be utilized, but under this option the completion of a designated number of tasks results in escape and avoidance of further tasks for some period of time. Where can a Premack contingency be useful? Some adult clients with disabilities are either at an employment setting or working in a site that is getting them ready for employment. In some of these cases, the actual task or job is not the problem. Rather, it is the fact that the client may not be used to working for lengthy periods of time without a break. Clients’ inability to work for a designated period of time produces an uncomfortable (aversive) situation for them. Hence, they engage in behaviors that are aimed at getting away from the tasks, that is, escape behaviors. If such behaviors occur often enough or are of a severe or dangerous nature, their placement is jeopardized.

The Premack contingency would progressively build these clients’ stamina for working continuously, possibly in a noncompetitive site beforehand. Initially, the break may need to come sooner (i.e., shorter number of tasks required to complete) than the criterion level (e.g., 2 hours). Setting up a Premack contingency would be effective in eventually reducing the number of behavior problems that previously terminated the work task directly, such as leaving the area.

A note of caution on the use of the Premack Principle for escape-motivated problem behaviors: Rearrangement of contingencies may not be the sole solution to problems that occur during certain academic tasks. In many cases, children are very inept at performing the assigned tasks. Simply arranging a contingency is not the answer. They will continue to find such tasks aversive as long as their competence in completing such tasks is lacking. It is not the purpose of this manual to go into great detail on instructional procedures; however, do realize that good teaching procedures are usually at the heart of problems that occur with instructional tasks that are relatively difficult for the child.

Psychotic Student? A junior high school—aged male student in a residential and day treatment program for severe emotionally disturbed children engaged in a number of disruptive behaviors (termed psychotic by some staff). During baseline, his work production on assignments was extremely low. Off-task behavior as well as out-of-seat occurrences (producing DE of assignment) were ignored; this student frequently was allowed to avoid completing any work. An FBA pointed to such behaviors as effective in escape and avoidance of his engagement of academic tasks.

The rearranged contingencies I set up were the following. In order to leave his seat and engage in free time activities, this student was required to complete a minimal amount of math work in one period, a minimal amount of reading in another period, and a minimal amount of writing in another period. Failure to do so resulted in his inability to get out of his seat to go “play.” He had been assigned a staff person prior to my involvement. This person ensured that he completed his assigned task prior to being allowed to get out of his seat. Failure to complete any assigned work at school resulted in the work being sent home and being finished prior to any TV time (this contingency was invoked several times). With success, the amount of material was increased progressively in all three periods until he was performing adequately by the end of the year.

I Need a Break. A Premack contingency can also be used with the hypothetical student who lays her head on the table. The contingency for laying her head on the table would still involve chain interruption. In addition to being required to pick her head up, she would also have to begin the designated number of tasks all over again. For example, let us say she is required to perform five tasks to earn a break (number of tasks determined with baseline data). If she completes five tasks in a row without putting her head down, she would be authorized to take a 6-minute break where she could put her head down. But the contingency for engaging in the target behavior requires a “re-set” of the task completion requirement. For example, let us say she puts her head down after just completing three tasks. Obviously, she would be interrupted at that point, but she would also have an additional five tasks to complete in order to get a break (Reverse Premack Principle). Putting her head down on the table unauthorized is quickly interrupted and leads to a further postponement of break time. (Such a strategy should receive written consent for school settings, and be within regulations affecting student behavioral plans.)

Note that with this dual contingency, completing five tasks “right off the bat” is far more efficient in getting an authorized substantial break than simply taking it unauthorized. The contingencies are stacked in favor of completing one’s work without taking an unauthorized break. Taking a break leads only to a postponement of the substantial break period. With success, the number of tasks required for a break could be progressively increased.

There are several considerations when utilizing the Premack option for escape-motivated behaviors. Once the student has finished the assigned tasks, he or she gets free time (access to preferred activities) for a designated period of time. It is unacceptable for the teacher or staff to provide additional tasks in this break period. Second, one needs to make certain that the student is capable of performing the assigned tasks. Third, start with a small number of tasks initially to ensure you don’t burn out the student before he or she is able to finish those tasks.

REPLACEMENT FUNCTION OPTIONS FOR SME PROBLEM BEHAVIORS

There are four replacement function options when treating a problem behavior that is maintained by SME of negative reinforcement. Extinction of the target problem behavior is essential. Extinction of escape maintained behavior requires a different repertoire from parents, staff, or teachers. Ignoring the behavior is not what is required for such a function. Rather, continuance of the aversive condition is required. It is essential that the termination or withdrawal of the aversive event not occur as a result of the target behavior occurring. If the schedule of negative reinforcement of the target behavior is not weakened, the replacement behavior will probably not be able to compete with the target behavior’s effectiveness in producing escape/avoidance under aversive EOs.

Alternate DE form replacement option: Identify an alternate acceptable behavior that also produces escape from the aversive situation. Such a behavior should not be inappropriate or dangerous but does directly and immediately produce escape from the aversive condition in a more socially desirable manner.

Escape mand replacement option: A designated appropriate protesting or negotiating response is mediated by teacher, staff, or others by their removing or postponing the aversive condition from the client or removing the client or child from the aversive condition.

Tolerance training replacement option (i.e., DNRO): Identify a length of time that you want the individual not to perform the behavior. The nonoccurrence of the target behavior for a set time period provides escape or avoidance of the aversive event (either by request or by direction of staff).

Premack contingency replacement option: Identify a regimen of tasks that, when completed, allows the client to escape the aversive condition or situation (Premack Principle utilized in an escape fashion).

Extinction Burst for SME Problem Behaviors

How resistant to extinction will a given target problem behavior be? In applied settings, an inherent requirement of the professional behavior analyst is to consider the possibility that the target problem behavior may occur in bursts when an extinction condition is imposed. Problem behavior under intermittent schedules of escape that serves an SME function can pose a tremendous problem for implementation of a treatment plan requiring an extinction condition.

The durability of a target behavior in the absence of reinforcement can be assessed using a trigger analysis for escape maintained behavior (Rolider, 2003). This assessment method should be conducted only with written informed consent from the client or guardian. Additionally there should be an imperative for conducting such based on safety and/or training considerations. The same caveats apply to dangerous behavior, and use of precursors to end the session should be deployed.

In this variation of the trigger analysis assessment method (review this section in Chapter2 for details), the therapist presents the aversive condition for a period of time in a brief session. Unlike the prior procedure where the trial was ended contingent upon the target behavior, this variation continues for a period of time after the target behavior. Depending on the circumstance and the target behavior involved, a professional may need to apriori institute a behavioral criterion for ending the session by providing for escape (e.g., session ends if form of target behavior becomes more dangerous to self or others).

In some cases, it might be necessary for the staff person who has stimulus control over the behavior to be involved in the session, especially if the problem behavior has not generalized to different people. During the session, the aversive condition is maintained while the rate and duration of the problem behavior is recorded. For example, if a client hits him- or herself when asked to put his or her clothes in the hamper, the session would be conducted by providing this request. Specify a uniform limited time for each assessment session, such as, 2, 5, 10, or 15 minutes. The length of time should be in relation to the probable frequency of behavior. Remember, with extinction during these sessions, one may get an exacerbation of the rate and intensity of the problem behavior, as well as possible other disruptive behaviors. Therefore, for high frequency behaviors, a short time period should provide sufficient evidence of the problem’s initial operant level under extinction. If necessary, a control condition could be deployed, which would be the absence of the aversive event.

Here is an example of a trigger analysis of a possible extinction burst for an SME problem. A hypothetical inpatient male adult in a large institution for developmental disabilities engages in property destruction about three to four times a month. He will throw chairs and objects and kick furniture during these tirades. The board-certified behavior analyst Ms. Carr believes that such behavior is functional under conditions of lengthy tasks or chores. Prior to the destructive behavior, he will chant repeatedly about his dislike of certain chores assigned to him during the day. He will state, “I cannot do it! I cannot do it.” This verbal behavior (most likely a mand) seems to be part of the behavioral chain that involves property destruction at the end of the tirade (also a mand). Ms. Carr decides to deploy the trigger analysis evaluation method with this chanting behavior. She realizes that conducting a rate analysis of property destruction is not suitable given the disruptive nature of this behavior to the environment. Therefore, the session will be terminated if he attempts to throw chairs or objects or becomes aggressive to the staff person conducting the session. The session will also be terminated if he kicks furniture. Demands to engage in some chore will be presented each minute on a fixed time schedule (1 minute). Three sessions of hypothetical data are delineated in Table 4.11.

For SMA problem behaviors, the deprivation condition hypothesized to be the relevant EO for the problem behavior is produced. The time before the assessment session would deprive the event or item from the client to ensure the EO is in effect. If this presession deprivation is insufficient to create a strong EO, then it might be necessary to provide the item or activity at the onset of the session and then abruptly remove it. The occurrence of the target behavior during this evaluation procedure should not result in the delivery of the reinforcer.

Let us use a hypothetical child with autism to illustrate this analysis for SMA problems. You observe that this child screams at the mother to turn on the TV cartoon channel in the morning. You see that extinction is the functional approach for solving this problem, but you are unsure how long this child might scream if extinction will be deployed. You determine that a lengthy extinction burst might not result in treatment fidelity and want to discern if extinction is an ecologically feasible procedure to deploy. To obtain this data, the therapist asks the mom to delay turning on the TV for 5 minutes when the child sits down on the couch to watch TV. An interval recording method is selected to quantify the screaming behavior.

TABLE 4.11 ■ THREE SESSIONS OF HYPOTHETICAL DATA

PROTOCOL FOR TRIGGER ANALYSIS SESSION

Target 'font-size:12.0pt;font-family:"Times New Roman",serif; color:black'> Screaming

EO: Withholding of favorite TV channel

Trigger analysis: Removal of TV for a 5-minute period in the beginning of the morning.

Method of Measurement: 10-second interval recording system, partial interval method of scoring within intervals

Protocol for implementing test session: When it is time for the child’s favorite cartoon to come on, and the child is sitting on the couch waiting for you to turn on the TV, delay turning on the TV for 5 minutes. You should use an oven timer to monitor the length of time. Do not turn on the TV during this time. Every 10 seconds, indicate on the data sheet whether the child screamed in a given interval by marking an x next to that designated interval. If the child begins engaging in destructive behaviors, note these and end the session, and mark the interval where that occurred. The percentage of occurrence would be computed only on the intervals up to that point.

Control Sessions: TV is not removed as the control condition with data still collected

You obtain data across a 5-day period for each of the two conditions: test and control. The following percentage of occurrences of screaming was obtained when the mom delayed the TV time by 5 minutes for 5 days (respectively): 100, 83, 100, 100, 83. The last session was stopped early due to destructive behavior. When the TV was not withheld, the percentage of intervals where the child screamed was 0%. Based on this data, you surmise that a functional approach needs to consider the aversive condition that may arise with extinction imposed for screaming behavior.

This method can also be valuable in evaluating functional treatment effects. Again the trigger analysis identifies the rate of the problem behavior, given the presence of the relevant EO and extinction for the target behavior. Collecting data using this assessment method can be particularly apt if it is difficult for staff to collect continuous data on the target behavior and alternate replacement behavior. The same procedural elements of the trigger analysis are deployed, except that the display of the replacement behavior identified in the treatment program would result in the removal of the aversive event (unpleasant social situation, lengthy task or chore, aversive physical stimulus, or difficult task or chore). This can provide excellent data in determining whether the intervention program has been successful in ameliorating the problem behavior while increasing the probability of the replacement behavior under the EO.

Alternate DE Form

This option can also be applied for escape behaviors that are socially mediated (i.e., SME). The client or child is taught how to perform a series of acceptable behaviors that result in direct termination of the aversive events (Table 4.12). The following examples might help illustrate this replacement behavior option.

Nude Clients. How would this replacement behavior option apply to a client who engages in tantrum behavior until staff intervene? Simply allowing the client to change clothes or select his or her own clothing would do the trick! If the clothes the client is currently wearing are clothes that are less desired, or he or she is used to some other fabric (e.g., cotton, silk), this DE alternative form is well suited.

TABLE 4.12 ■ REPLACEMENT BEHAVIOR—MORE ACCEPTABLE FORM MAINTAINED BY NEGATIVE REINFORCEMENT

If the client is not capable of selecting clothes or self-dressing, then this behavior may have to be taught (i.e., prompted and shaped) in order for it to be a useful replacement behavior. In some cases, the chain of behaviors is already acquired but does not currently occur under the motivating operation. These clients do not spontaneously change clothes when uncomfortable because such a chain of behavior was (or would be) thwarted or punished by staff. Increasing their independent changing of clothes may require just a simple differential reinforcement plan, that is, let them do it in a private area. Staff have to be directed to allow such behavior when it occurs.

FUNCTIONAL TREATMENT: SME 4.4: AVERSIVE STIMULUS

Contingency Plan for Target Behavior

If the student engages in tantrum behavior, he or she will not receive new clothes. Rather, after a short period of time following cessation of tantrum, the student will be prompted to go and select new clothes and put them on. Over time, prompts for the sequence of behaviors needed to produce this outcome will be faded until he or she performs this independently under the conditions of wanting new clothes to wear.

Contingency Plan for Replacement Behavior

If the student changes clothes without engaging in any problem behavior, he or she will be allowed to wear those clothes. The student can change no more than three times in a given time period each day.

Escape Mand (Protest or Negotiation Behavior)

This option can also be applied for escape behaviors that are socially mediated (i.e., SME). Again, two types of acceptable communicative responses to deal with aversive social situations are: (a) protesting behaviors and (b) negotiating skills. The following examples might help illustrate this replacement behavior option.

“I’m Bored.” This child (from a previous hypothetical example) had learned how to get a 5-minute break by throwing things. Its function was escape from relatively lengthy tasks (4.3 SME). Baseline data reveals that she will engage in such property-destructive behaviors once or twice in a half day. How could the teacher make throwing things ineffectual while reinforcing an alternate, more appropriate behavior? Suppose the student could request a 5-minute recess. Would that impact the student’s frequency of throwing things?

Here are the basics of the contingencies. In any given morning, this student is given only two recess cards that she can use. The same applies for afternoons. Whenever she needs to have a break, she can simply pull out one of her two cards, give it to the teacher, and set the timer for 5 minutes. Subsequently, after the break she returns to work. If she goes without a tantrum for a morning or afternoon period and also uses only two or fewer cards per morning, she earns five points. The following chart depicts the contingencies for target and replacement behavior.

FUNCTIONAL TREATMENT: SME 4.2: LENGTHY TASK//CHORE/ASSIGNMENT

Contingency Plan for Target Behavior

If the student engages in self-injury, the current activity is maintained. Staff would prompt the student to perform the communicative replacement behavior.

Contingency Plan for Replacement Behavior

If the student performs the protest behavior, the staff change the activity. Such behavior may have to be prompted in the beginning prior to the self-injury for it to occur in the presence of the student’s motivational condition to escape the activity. This is assuming that, in most cases, the replacement behavior is not currently in the repertoire of the student (see Inept Repertoire Category section of this chapter).

Enough Is Enough. The same methodology can be used for students with severe disabilities when problem behavior is maintained by SME of tasks. This young girl hits herself in the head and face when she is pressed to continue the task (SME 4.2: Lengthy Tasks/Chores/Assignments). In the past, when she engaged in this behavior, she was then moved to another activity, whereupon such self-injury ceases. If you were this child, what would you do the next time you felt you did enough work on a particular task or activity and wanted to change activities? Under the current social arrangement, you would continue hitting yourself! The following chart illustrates how self-injury can be disabled as a functional behavior while enabling protesting as functional in the same circumstance.

FUNCTIONAL TREATMENT: SME 4.1: SCHOOL ASSIGNMENTS

Contingency Plan for Target Behavior

If the student engages in tantrum and property destructive behavior, any break cards left are immediately removed for the remainder of the morning or afternoon session. If she cannot be stopped from continuing to throw materials, she will be removed from the area for the protection of other students and placed in time-out until she calms down. Following time-out, she is told that she has extra work to do during recess at the principal’s office area (Reverse Premack Principle). Further, she does not earn five points and has to return to the assignment during the class period.

Contingency Plan for Replacement Behavior

If the student uses a recess card, she can take a 5-minute recess break. Any period (morning or afternoon) when the student does not go over her recess cards and has no tantrums, she earns five points toward a selected Friday video at her parents’ home that evening. She has to earn 30 points by Friday afternoon in order to earn the Friday video (i.e., no more than two opportunities where she did not earn points).

Table 4.13 depicts how protesting behavior can function as an effective replacement behavior with an SME problem behavior. The four different subcategories of SME are used to illustrate how protesting behavior can produce an escape of the relevant aversive event.

TABLE 4.13 ■ PROTESTING BEHAVIORS ACROSS DIFFERENT SME CATEGORIES

Tolerance Training Option

In many circumstances, protesting an instructional task or required event is not feasible. For example, if an elementary grade student does not want to do math today, it is unacceptable to simply opt out. To allow the child to escape whenever he or she says “I don’t feel like doing this today, sorry, it is not in the cards,” would not be in the child’s long-term best interest. Although such a strategy may significantly reduce the level of problem behaviors in math period for this child, it would affect the child’s progress on math content. Therefore, protesting is not always an acceptable alternate replacement behavior.

For these circumstances there is a better option. In tolerance training, the task is terminated when a certain time interval passes in which no target behaviors occur. Therefore, escape from the aversive condition is conditional upon “not doing the behavior” for some designated period of time. To use tolerance training, identify a reasonable DNRO interval to begin the program based on baseline data.⁴ If the client is successful in not engaging in the target behavior for that period, the parent or staff allows the client to leave the activity and engage in a more preferred event.

Out-of-Seat Behavior. Many young children have difficulty staying in their seats for a protracted period of time. Although most of these children learn over time to tolerate sitting in a seat or desk, or sitting on a carpet square in preschool, some children do not. They frequently get up, wander around, and disrupt the learning environment. The basic strategy of tolerance training can be used to progressively develop continuous in-seat behavior.

After deriving the average in-seat interval from baseline data, the DNRO interval is set at the average in-seat interval. If the child does not get out of his or her seat once during the interval, the child earns several minutes of out-of-seat time (hence the Premack contingency). If the child gets out of his or her seat unauthorized during this time, the child is returned to the seat and the timer is reset for the full DRO interval. As the number of times the DNRO interval is reset decreases, the length of the DNRO interval can be progressively increased.

JUST BECAUSE IT SOUNDS GOOD DOES NOT MEAN IT WILL WORK!

Curriculum modification as an antecedent positive behavioral ­intervention strategy is often recommended. Its indiscriminate use can have little or no effect on some target behaviors whose function is unrelated to the task or instruction. For example, if the target behavior’s function is one of ­accessing adult attention (i.e., a diagnosis of SMA 2.1: Adult Attention), then modifying the curriculum is not clinically indicated and is probably superfluous. Changing the curriculum will have an inconsequential effect on the rate of the target behavior. In contrast, modifying the curriculum is ­clinically indicated when the target behavior is diagnosed as SME 4.3: if the curriculum modification removes the source of the difficulty in the current instructional material. Behavioral interventions should be prescribed as a function of the controlling ­variables for the particular target behavior, not haphazardly.

Tolerance training would be effective only if a child’s out-of-seat behavior is the result of the lengthy condition of instruction (or being required to sit for lengthy periods). If task difficulty is the condition driving the behavior (DE 3.3: Difficult Tasks/Chores/Assignments), then curriculum modification is needed in addition to tolerance training or another replacement option. The question for SME problem behaviors occurring during instruction should be: Is it too long or too difficult (or both)?

The 20-Minute Child. This hypothetical child hits the desk to temporarily terminate the presentation of a lengthy instructional task. When this child hits the desk, the teacher “deals” with the problem behavior, thus temporarily terminating the instructional assignment. If an FBA reveals that this temporary halt to task engagement is maintaining the behavior (SME 4.2, task duration), then such a contingency obviously needs to be disabled, while a more appropriate behavior needs to be enabled to produce escape.

First, the teacher would no longer substantially interrupt the instructional presentation to “deal” with the target behavior. What would occur contingent on the target behavior is the resetting of the DNRO interval to the full amount. With this contingency, the target behavior no longer results in teacher mediation of temporary escape. Rather, the target behavior serves only to lengthen the instructional period, via the resetting of the DNRO interval. What happens when this child goes the entire interval without engaging in target behavior? The teacher would then allow the child to terminate engagement in the current task and spend a designated amount of time on a more preferred task. This plan strengthens one set of behaviors (i.e., behaviors other than the target behavior), while weakening a problem behavior (target behavior) by selectively producing escape from the task.

Premack Principle (Escape)

The Premack contingency can also be utilized for SME behavior. The completion of a designated number of tasks results in escape and avoidance of further tasks or chores for some period of time. The use of a Premack contingency is well suited as a strategy for developing increased persistence at work or in school. A break from work or school assignments can be progressively developed until the persistence needed for most jobs or classrooms is achieved.

This strategy would require the client to complete a small number of designated tasks. Once these are completed to criterion, the client is allowed to take a break from work. Setting up a Premack contingency would be effective in eventually reducing the number of behavior problems that previously terminated the work task directly.

The following examples depict the use of this contingency for SME 4.0: Problem Behaviors.

I Need a Break, My Brain Is Swelling. How would the Premack option apply to the tantrum behavior of the mainstreamed fourth-grade student? The contingencies that would be in effect for the target behavior of tantrums (SME 4.2: Lengthy Tasks/Chores/Assignments) as well as the replacement option are delineated in the following box.

FUNCTIONAL TREATMENT: SME 4.2: LENGTHY TASKS

Contingency Plan for Target Behavior

Contingent upon tantrum behavior, another assignment will be added to the student’s task assignment board (Reverse Premack Principle).

Contingency Plan for Replacement Behavior

A set number of tasks/assignments is issued at the beginning of the independent seat work session. When all the tasks are completed, the student earns the remainder of the time to engage in more preferred activities (listed on a menu chart). Once the period is up, the same contingencies are put in effect for the next content instructional session.

CIPANI REPLACEMENT FUNCTION CLASSIFICATION SYSTEM

How many times have you heard a teacher or parent say, “She can do that! She is just being lazy. I know she knows that stuff. She just does not finish her work because she is lazy [implying motivation is the sole issue]. That is why I have taken away recess every day for the last 30 school days. Someday I will get to her. I will teach her that she needs to be a responsible student and finish her work.”

Obviously this plan needs a critical examination! But why is it failing? There exists a faulty conjecture about the student’s capability. This hypothetical teacher strongly believes that the student’s “motivation” is the sole factor in whether the daily assignment will be completed or not. As a result of this assumption, the teacher determines that utilizing consequences for failing to complete the assignment is the requisite strategy. Although this strategy might make “sense” if the child is capable of performing the designated assignments competently, it is doomed to failure if the child needs active instruction in order to perform the task assignment to a mastery level of performance. If the child is incapable of competently performing the specific requirements of the assignment, all the reinforcement in the world, or removal thereof, will be of little utility. Contingency rearrangement “works” only if the behavior to be increased is in the current repertoire in the form required for such reinforcement.

Perhaps an example from the animal laboratory would be informative and entertaining. Let us say Ms. Jones, an undergraduate student in an animal-learning class, was given an assignment. She has to teach her slightly food-deprived rat to press the bar in the operant chamber to get food. She accomplished that in a reasonable period of time. She notices that her rat, when not pressing the bar, enjoys the following activities while in the chamber: sniffing one of the corners, grooming its underbelly, and standing up on its hind legs. These behaviors occur with some regularity once the rat has received some food for its bar-pressing responses.

Ms. Jones’s lab instructor now gives the class a second assignment. They are to place bar pressing on extinction, while selecting an alternate replacement response that will now result in food. If Ms. Jones wants to complete this second assignment as quickly as possible, what replacement behavior should she pick? If she selects a behavior she has not seen before, will simple differential reinforcement be effective in developing such a behavior? When the animal fails to access reinforcement at all, would it be a matter of improper motivation? Would it be more prudent for Ms. Jones to select “standing up on hind legs” as the behavior that should produce food? Why? (Table 4.14).

As this example illustrates, selecting an alternate behavior that is already in the repertoire merely requires a simple rearrangement of reinforcement contingencies. However, selecting an alternate behavior that is not currently in the repertoire of the animal requires more than differential reinforcement. If Ms. Jones selects a behavior that is already at some level of occurrence, the process will ensure that the transition to such a new functional behavior will be relatively easy. Just as Ms. Jones must diagnose the strength of potential replacement behaviors, so, too, must the applied behavior analyst.

Too often, implicit or explicit assumptions are made about the presence or strength of the selected alternate replacement behavior. Evidence demonstrating the strength of the selected replacement behavior during the assessment process is rarely considered or collected. As a result, mistakes in the subsequent intervention plan can happen. It is therefore essential that one consider the strength of the alternate acceptable behavior that is selected to replace the problem behavior’s environmental function in the functional treatment plan.

The three diagnostic categories in Table 4.14 are offered to classify the current status of the strength of a selected replacement behavior in a client’s repertoire (adapted from Bailey & Bostow, 1976; Cipani & Trotter, 1990). These three diagnostic categories are: (a) misdirected contingencies, (b) inept repertoire, and (c) faulty discriminations.

TABLE 4.14 ■ CIPANI REPLACEMENT FUNCTION CLASSIFICATION SYSTEM

MISDIRECTED CONTINGENCIES CATEGORY

In this diagnostic category, alternate replacement behaviors do not occur as frequently as needed because they produce a rate of reinforcement that is far less (or nonexistent) than the reinforcement ratio for problem behaviors. For example, while in the grocery store, a little girl nicely asks her mother for a box of cookies.

What just happened? The child asks nicely but is told that she is not getting cookies. Then the child begins crying and screaming for the cookies. The mother continues to explain why she cannot get cookies for her daughter today. After several minutes of the child’s tirade with the mother’s retorts, the mother gives the child the cookies (to terminate the tantrum when she falls to the floor of the grocery store). We can all see that the tantrum serves an SMA function (2.3 SMA: tangible reinforcer). However, what is important to note in this hypothetical scenario is that an acceptable behavior did occur, yet, it was not as effective (from the child’s viewpoint) in getting cookies as the tantrums. We would expect tantrums to become more probable and requesting nicely less probable (and profitable), given these misdirected contingencies. The current social environment selects tantrums as the means to getting cookies, not requesting. Yet, this parent will be adamant about not giving cookies, saying her child should learn how to not beg for things. She will often forget that cookies are given on occasion, and unfortunately, it is the undesirable behavior that wins out.

What is needed is a change in the rate of reinforcement for the replacement behavior and the current target unacceptable behavior. The child is capable of requesting. To solve this behavior problem, requesting just needs to have a stronger density of reinforcement relative to tantrum behavior during shopping outings. Perhaps the child can earn a desired item if she goes for a period of time without asking or throwing a tantrum during the shopping trip⁵ (if such a behavioral criterion is also in the current repertoire).

Similarly, suppose a male client demonstrates a high rate of tantrum behavior to escape or avoid certain staff requests. When this client is requested to perform some cleaning activity in his room, such as dusting or vacuuming, he throws a tantrum. He will often verbally protest such a task vociferously, and then he slams doors, kicks furniture and walls, and walks outside. When the client does occasionally comply, such compliance to one request is typically followed by the presentation of additional tasks. If he dusts the table in his room and completes the task, the staff praise him for his work and then tell him to vacuum the rug! Compliance seems only to bring on more work. However, severe tantrums result in the staff terminating current and future task demands until a later time. The staff claim that the client is too upset to perform chores during those times, and they decide to try asking him when he is feeling better.

What is the contingency analysis of behavioral function in this example? Terminating task demands occurs when the client throws a tantrum. In contrast, completing an assigned chore or task results in staff issuing additional requests (while we have him on a roll!). It is not that some reasonable acceptable behavior is nonexistent. Rather, when it does occur, it is followed by another chore, thus creating an aversive EO at that point in time. Tantrum behavior is more capable of getting the desired results: temporary termination of the task or chore demand. The questions in Table 4.15 help you determine if a misdirected contingencies diagnosis fits the nature of the replacement behavior problem.

TABLE 4.15 ■ QUESTIONS FOR MISDIRECTED CONTINGENCY DIAGNOSIS

1.Does an appropriate replacement behavior occur at all, under the same or similar conditions as the problem behavior? Record both the occurrence of the target problem behavior as well as any occurrence of an alternate replacement behavior when the motivational condition is present (i.e., state of deprivation or state of aversion).

2.If the client performed the appropriate behavior recently, was it successful? Was the behavior effective at producing either access to a desired activity or escape from an aversive situation?

3.Does the problem behavior appear to be maintained because the reinforcement contingencies are of greater density for the problem behavior relative to the replacement behavior?

4.If the problem behavior was eliminated, would the alternate replacement behavior exist in the client’s repertoire? Would it increase in frequency if reinforced (similar to Question 1)?

5.Does the rate of the replacement behavior vary across time, ranging from low levels on some days or time periods to some days on which there is an adequate level of the behavior?

The basic characteristic of this classification category is the misdirected reinforcement contingencies for both the problem and replacement behaviors. Problems in this diagnostic category can be simply addressed by rearranging contingencies in favor of replacement behavior. Shifting the schedule of reinforcement to be denser for the replacement behavior, while eliminating (or at least drastically reducing) the rate of reinforcement for the problem behavior, should produce the desired effect. If one has accurately identified the maintaining reinforcer for either the access or escape function, this strategy will be successful in altering the rates of problem and replacement behaviors in the desired directions.

INEPT REPERTOIRE CATEGORY

Not all cases involve merely increasing an already existing operant behavior as the replacement function. Many children and adult clients, particularly individuals with severe disabilities, often engage in the problem behavior because of the lack of alternate appropriate behaviors in their repertoire. Communication deficits often translate into a person’s inability to produce an appropriate response to allow care agents to meet the individual’s needs. Aberrant behaviors such as self-abuse, tantrums, and aggression often fill the void and eventually result in the delivery of the desired reinforcer. Such problem behaviors are often strengthened through reinforcement because of the substantial lack of an alternate competing response.

This diagnostic category involves the client not having the capability to perform an alternate replacement behavior that recruits reinforcement. An inept repertoire can exist because the client cannot perform the target replacement behavior. As an example, a child with autism may throw a tantrum when wanting cookies. If one assumes the child is capable of requesting the cookies, an adult would wait until such occurs before giving the cookies. However, if the child is either nonvocal, or not capable of asking nicely, then one will have to wait a long time. What happens then? Staff eventually succumb to reinforcing the target problem behavior with the cookies. Failure to diagnose this situation accurately leads to inevitably making the problem behavior worse, both in frequency and severity.

Misdiagnosing inept repertoire problems can have disastrous results with escape functions as well. A client may act aggressively against teaching personnel under conditions of excessive demands or requests. The client may not be capable of communicating to the staff that he or she does not understand the task, that the number of demands is excessive, or some other such factor. The staff understand that aggression should not function to escape demands, but they are not aware that more acceptable forms of protest, negotiating, or requests for help need to be taught to the client. Staff may assume the client “knows” how to communicate his or her needs. Consequently, they attribute the aggressive behavior to being “spoiled.” The following real-life case illustrates this misdiagnosis and how contingencies are ineffective with an inept repertoire.

I Still Will Not Do My Work!

I was consulted on a case in the mid-1990s involving a boy who was placed in a mainstream third-grade class but also served part time in a special day class for students with mild disabilities. My involvement occurred as a result of county mental health’s involvement in the family situation. The involvement of mental health and Child Protective Services was the result of a family problem, whereupon he was removed from the home and placed in foster care. Prior to his removal from his biological parents, he was expelled from school. His expulsion from school was a result of attacking two teachers and the principal in two separate incidents. When he returned back home, he was placed on home instruction, 1 hour a day.

Unfortunately, his home instruction was not going well. Every day the resource teacher would show up after school hours. On a regular basis, she would leave within 20 to 25 minutes when he refused to do his assignments and work that she brought for him. Of course, her contingent leaving upon his initial verbal refusal and subsequent failure to engage in the assignment was not a wise behavioral intervention. Such a plan would make verbal opposition very viable in terms of its ability to avoid performing the assignment. I felt that what was primarily needed was a powerful contrived reinforcer to compete with the power of the avoidance contingency inherent in the home instruction setting.

As a result of some interviews of school staff and his resource teacher, I discovered an interesting phenomenon regarding this student. Prior to his expulsion, he would go into his former teacher’s first-grade class and help her with the first-grade students every so often. This teacher indicated that she did not have any problems with him and that she did not have problems with him when he was in first grade. Here was the powerful unique reinforcer needed, and it was something to which he currently had no access. The contingency I designated was the following: Every day you complete your work during the home instruction period, you earn a star. When you have four stars, you can go on campus and help the first-grade teacher. This had all the makings of a successful intervention on paper. As a side note, it took some time on my part talking to the principal about the student’s return to campus. The principal required the presence of a psychiatric technician everywhere he went, funded by mental health, before relenting to this request.

However, the first week results were discouraging to say the least, with the student having earned only one star. This result was confusing to me. I wondered why he would not want to engage in his assigned work, given it was only about 45 minutes of work at most. I innocently asked the resource teacher how the assignments were prepared. Her answer was the shining light: The third-grade teacher prepared them. Of note is the following: This is a student who functions competently at a first-grade level in reading and math. This student was inept when it came to third-grade level content in math and reading. The third-grade material created an instructional mismatch. Even a strong contingency would not override his aversion to workbook material that he was incapable of performing. Once that instructional mismatch was fixed, the contingency worked just fine, with him reliably earning four stars in about four days. He did so well the resource teacher advanced the idea to bring him back to the school.

An inept repertoire can still exist even if the target behavior can be performed. In some cases, a client may be able to perform the replacement behavior but not fluently. In this circumstance, an inept repertoire is still relevant. The inept repertoire consists of an appropriate behavior that may occur, but takes too long to occur. A child who uses his fingers to add, subtract, multiply, and divide may be able to come up with a correct answer, but he will need more time to complete an assignment. Hence, simply placing a reinforcement contingency on completion may do little good. One can only go so fast on one’s fingers! Teaching this child to memorize the facts would prove beneficial. Typing on a keyboard with one finger is obviously less fluent than proficient keyboarding skills. If typing takes too long with the one-finger approach, the individual will probably prefer handwriting. In contrast, the person who has great keyboarding skills will probably prefer to type an essay out on the computer rather than write it by hand.

Table 4.16 presents questions to pose when considering an acquisition diagnosis as well as the data sets needed to answer these questions.

TABLE 4.16 ■ QUESTIONS FOR AN INEPT REPERTOIRE DIAGNOSIS

1.Does the appropriate replacement behavior occur at a zero or nonexistent level across time and stimulus conditions?

2.Does the replacement behavior occur, but not at a fluent level that produces reinforcement?

3.Under the best circumstances, does the client appear unable to perform the alternate replacement behavior either in topography, level, or fluency?

Is it ADHD?

Narrated PowerPoint Presentation

ASSIGNMENT: IS IT ADHD? NARRATED LECTURE

After reviewing the narrated PowerPoint lecture entitled “Is it ADHD?” submit the following with a target behavior involving on-task 'margin-top:0cm;margin-right:5.0pt;margin-bottom:0cm; margin-left:21.6pt;text-align:justify;text-indent:-21.6pt;line-height:normal'>1.A table or graph depicting a misdirected classification in an ABA design

2.A table or graph depicting an inept repertoire classification in an ABA design

FAULTY DISCRIMINATION CATEGORY

This diagnosis presents frequency data for the replacement behavior that can mimic the first diagnostic category, misdirected contingencies. The telling sign that it is not a misdirected contingency problem is that the replacement behavior occurs only under restricted conditions, that is, a failure to generalize.

Let us use a previous example to illustrate such a stimulus control problem. The child may be able to request cookies when wanting them, but this behavior occurs only when the mother is at home in front of the cookie jar. Under these conditions, requesting occurs regularly when the child wants cookies. However, if the mother is not present (e.g., the father is the only one in the room), requesting does not occur. Rather, the child throws tantrums and whines when the father is present, which the father reinforces. Additionally, the tantrum also occurs if the mother and child are in a different area of the house or outside. This describes a scenario that illustrates a stimulus control problem with the replacement behavior.

Faulty discrimination as a diagnosis is different from the inept repertoire diagnosis in that the behavior is in the current repertoire of the client, but its occurrence is limited to certain conditions. With faulty discrimination problems, the replacement behavior would occur (with regularity) to one setting or one person, but does not occur to other, different settings (or persons) at an acceptable level. Table 4.17 presents two questions to consider in evaluating the possibility that a replacement behavior should be diagnosed as a stimulus control problem.

These problems are treated with generalization strategies, whereby the behavior is transferred to new settings, people, or time. If the replacement behavior occurs in one to a few settings and the treatment goal is to generalize the behavior to settings and antecedent conditions where it is not currently occurring, then a systematic approach to programming for generalization needs to occur. Reinforcement of the behavior when it does occur in the new target settings or conditions will certainly be a part of the program. However, the design of the behavioral intervention for the replacement behavior will involve methods to generalize the behavior from its current antecedent conditions to new conditions. Strategies involving discrimination and generalization training and errorless transfer of stimulus control are appropriate.

An excellent example of this classification category (faulty discrimination) is selective mutism. Some children, who are able to vocally communicate in at least one setting (usually home environment with parent(s)), fail to do so in another (usually school setting with teachers and classmates). The vocal behavior fails to generalize to such environments, sometimes in spite of efforts at the school to get the child to “use his or her words.” In some cases, nonvocal communication can persist across several grade levels.

TABLE 4.17 ■ QUESTIONS FOR FAULTY DISCRIMINATION DIAGNOSIS

1.Does the replacement behavior occur under one or just a few antecedent conditions?

2.Does it not occur under other relevant antecedent conditions?

Three-phase treatment model for selective mutism Narrated Presentation

ASSIGNMENT: THREE-PHASE TREATMENT MODEL FOR SELECTIVE MUTISM

After reviewing the narrated PowerPoint lecture entitled “Three-phase treatment model for selective mutism,” write a paper that discusses a concurrent schedule of reinforcement as used in the treatment of selective mutism. Please address the following points in order regarding the Phase 2 procedures:

1.What are the two different behaviors/performances that result in the reinforcer being delivered, and what happens when the schedule for either behavioral requirement is fulfilled?

2.How is vocal behavior progressively made more prevalent (i.e., increase in words, sentences exhibited) in the session in Phase 2?

3.What is the utility of having a different, but demanding requirement for reinforcement for nonvocal behavior? Why is a concurrent schedule (two different requirements) needed to make vocal behavior occur?

Diagnosing the current strength of the behavior or behavioral criteria designated for the replacement function is just as necessary as the prior assessment and diagnostic activities for the problem behavior. In some circumstances, to increase the designated replacement behavior, you need to alter just the functional contingencies for problem and replacement behaviors. However, in other cases, such a strategy would prove ineffective in increasing the alternate behavior. If the replacement behavior is nonexistent in the client’s repertoire, merely strengthening the rate of reinforcement for the replacement behavior would not have the desired effect. In these cases, it is necessary to utilize techniques that shape and build a new behavior. It is critical to understand the nature and extent of the replacement behavior in the client’s current repertoire. The focus is on determining the reasons for the low (or nonexistent) occurrence of alternate acceptable behavior.

SUMMARY

This chapter presented behavioral treatment options for each of the four major classification categories of problem behavior, as well as a classification system for replacement functions. The next chapter provides a further delineation of these replacement function options with a clinical hypothetical example illustrating the process from functional behavioral assessment to the diagnosis of the problem behavior’s function to functional treatment using the designated replacement behavior option.

SELF-ASSESSMENT EXERCISES

✵Explain how an access mand replacement behavior option can be used for SMA functions.

✵Discuss how the DRL group contingencies was used by Ron Pekarek to decrease the arguing behavior between Antonio and his sister. Why was a group contingency necessary? What might be the result if the parent had to determine who started the argument (in order to provide a contingency for that child only)?

✵Examine the case of the hypothetical individual who rips off clothes so that staff will give new ones? Explain how delay of gratification training can be used to progressively increase a tolerance of nonpreferred clothing.

✵Examine the “Potato Chip” example. Delineate how the Premack contingency was utilized. What happens to the amount of extra chips a client consumes when she or he has to engage in a task requirement to earn potato chips as opposed to having to ad-lib access?

✵Contrast a misdirected contingency function with an inept repertoire function for classifying the potential replacement behavior. Which one would need contingency manipulations only and why?

✵Describe the basic elements of an experimental test to determine if the replacement behavior is lacking as a result of an inept repertoire, or due to misdirected contingencies. On what behavior is reinforcement contingent upon in the control condition? What behavior gets reinforced in the test condition? Why is this conducted?

✵Present a graph of data that reflects a misdirected contingency classification for a hypothetical replacement behavior. Do the same for an inept repertoire.

✵Describe what a faulty discrimination function is.

Notes

1.For review of the differential reinforcement procedures, including the DRO, the reader is enjoined to consult the pdf in the student portal entitled “Differential Reinforcement Procedures for Access and Escape Functions.”

2.I have termed this reversal of conditional probabilities typical of reinforcement operations the Reverse Premack Principle.

3.See pdf in student portal for “Differential Reinforcement Procedures for Access and Escape Functions.”

4.For specifics of this program using DNRO, the pdf “Differential Reinforcement Procedures for Access and Escape Functions” in the student portal should be consulted.

5.For a free downloadable pdf resource addressing such problem areas for parents, “A Clinical Treatment Guide to 10 Common Behavioral Pediatric Problems”, go to: www.freepsychotherapybooks.org/behavior-therapy/product/109-a-clinical-treatment-guide-to-10-common-pediatric-behavioral-problems

REFERENCES

Bailey, J. S., & Bostow, D. E. (1976). Research methods in applied behavior analysis. Tallahassee, FL: Copy Grafix.

Cipani, E. (2008a). Analogue assessment for replacement behaviors. International Journal of Behavioral Consultation and Therapy, 4, 374—379.

Cipani, E. (2008b). Triumphs in early autism treatment. New York, NY: Springer Publishing.

Cipani, E., & Trotter, S. (1990). Basic methods of behavioral intervention. In E. Cipani & A. F. Rotatori (Eds.), Behavior modification in special education (pp. 137—201). Greenwich, CT: JAI Press.

Iwata, B. A. (2006, May). On extinction. Paper presented at the meeting of the Association for Behavior Analysis, Atlanta, GA.

LaVigna, G. W., Willis, T. J., & Donnellan, A. M. (1989). The role of positive programming in behavioral treatment. In E. Cipani (Ed.), The treatment of severe behavior disorders: Behavior analysis approaches (pp. 55—84). Washington, DC: American Association on Mental Retardation.

Mazaleski, J. L., Iwata, B. A., Vollmer, T. R., Zarcone, J. R., & Smith, R. G. (1993). Analysis of the reinforcement and extinction component contingencies with self-injury. Journal of Applied Behavior Analysis, 26, 143—156.

Rolider, A. (2003, September). The use of antecedent analysis driven intervention to treat complex anti-social behavior among children in school settings. Paper presented at the meeting of the Florida Association for Behavior Analysis, St. Petersburg Beach, FL.