THE EFFECTS OF MANIPULATING MOTIVATING OPERATIONS ON THE
OUTCOME OF EXTINCTION
A Thesis
Presented of the faculty of the Department of Psychology
California State University, Sacramento
Submitted in partial satisfaction of
the requirements for the degree of
MASTER OF ARTS
in
Psychology
by
Lindsey Kathryn Dukes
SUMMER
2012
THE EFFECTS OF MANIPULATING MOTIVATING OPERATIONS ON THE
OUTCOME OF EXTINCTION
A Thesis
by
Lindsey Kathryn Dukes
Approved by:
____________________________, Committee Chair
Becky Penrod, Ph.D.
____________________________, Second Reader
Caio Miguel, Ph.D.
____________________________, Third Reader
Jill Young, Ph.D.
Date: ___________________________
ii
Student: Lindsey Kathryn Dukes
I certify that this student has met the requirements for format contained in the University
format manual, and that this thesis is suitable for shelving in the Library and credit is to
be awarded for the thesis.
_______________________, Graduate Coordinator
Jianjian Qin, Ph.D.
Department of Psychology
iii
_______________
Date
Abstract
of
THE EFFECTS OF MANIPULATING MOTIVATING OPERATIONS ON THE
OUTCOME OF EXTINCTION
by
Lindsey Kathryn Dukes
This study examined the effect of manipulation of motivating operations prior to
intervention on the outcome of the extinction procedure for two children with
developmental disabilities who displayed problem behavior maintained by access to
attention. Following replication of previous studies which showed that problem behavior
occurred at a lower rate during extinction sessions following pre-session non-contingent
access to attention, participants were repeatedly exposed to pre-session non-contingent
attention followed by extinction over many sessions. Results showed that responding for
both participants remained below baseline levels when pre-session attention was no
longer provided. This suggests that the extinction procedure remained effective when
combined with pre-session exposure to the maintaining reinforcer. Implications for
addressing potentially injurious or severe problem behaviors are discussed.
___________________________, Committee Chair
Becky Penrod, Ph.D.
___________________________
Date
iv
ACKNOWLEDGEMENTS
I would like to extend my thanks to my thesis advisor Becky Penrod, Ph.D., for all of her
support through the process of completing this thesis. Thanks are also due to my thesis
committee, Caio Miguel, Ph.D., and Jill Young, Ph.D., who have provided me with
valuable feedback and insight regarding my research. I would also like to thank my
family for their support and assistance in helping me reach this point. Finally and most
importantly, I need to thank my wonderful husband, Donny Dukes, without whose
continuous support, help, and encouragement I would not have been able to complete this
process. I love you, pie!
v
TABLE OF CONTENTS
Page
Acknowledgements………………………………………………………………………v
List of Figures………………………………………………………..…………….……vii
Chapter
1. INTRODUCTION……………………………………………..………………….…1
Review of Research……………………………………..…………………….….1
Purpose………………………………………………….………………….……15
2. METHOD………………………………………………….……...………………...16
Participants and Setting…………………………………….….………………..16
Response Measurement…………………………………….………….………...16
Preference Assessments……………………………………………….………...18
Functional Analysis…………………………………………….…..…...……….19
Experimental Design…………………………………………….……….……...20
3. RESULTS………………………………………………………..…..….………..….22
Preference Assessments...………………………………………………….….…22
Functional Analysis…………………………………………………….…….….24
Experimental Conditions………………………………………………..….……26
4. DISCUSSION……………………………………………………….……….….…..29
References…………………………………………………………..…………….……...36
vi
LIST OF FIGURES
Figures
Page
1. Preference assessment results for Helen...……….…………………………………22
2. Preference assessment results for Vincent…………………………………………24
3. Functional analysis results for both participants..………….………………………25
4. Intervention results for both participants..…….……………………………………27
vii
1
Chapter 1
INTRODUCTION
Many topographies of problem behavior have been found to be maintained by
social positive reinforcement in the form of attention, including aggression (Thompson,
Fisher, Piazza, & Kuhn, 1998), self-injurious behavior (O’Reilly, Lancioni, King, Lally,
& Dhomhnaill, 2000), and even bizarre vocalizations in patients with schizophrenia
(Wilder, Masuda, O’Conner, & Baham, 2001). Common treatments used to eliminate
behaviors maintained by social positive reinforcement include consequence
manipulations, such as differential reinforcement (e.g., Kahng, Hendrickson, & Vu, 2000;
Repp & Deitz, 1974) and extinction (e.g., France & Hudson, 1990); these interventions
may also be applied in combination (e.g., Shukla & Albin, 1996). Other common
treatments include antecedent manipulations, such as noncontingent reinforcement (e.g.,
Van Camp, Lerman, Kelley, Contrucci, & Vorndran, 2000) and satiation (e.g., O’Reilly,
Edrisinha, Sigafoos, Lancioni, & Andrews, 2006).
Review of Research
Consequence manipulations such as extinction (EXT), the withholding of a
stimulus that previously reinforced a behavior, are popular interventions typically used to
eliminate problem behaviors. The EXT procedure may be used independently (e.g.,
France & Hudson, 1990) or in combination with a variety of other procedures, including
differential reinforcement (e.g., Shukla & Albin, 1996). Differential reinforcement of
other behavior (DRO) and differential reinforcement of alternative behavior (DRA)
2
involve presenting a reinforcer periodically in the absence of a target behavior, or upon
the occurrence of some alternative behavior, and are among the most widely used
procedures for decreasing problem behavior (Volmer, Iwata, Zarcone, Smith, &
Mazaleski, 1993). Several studies have demonstrated that withholding the reinforcer that
previously followed the occurrence of the target behavior as well as presenting a stimulus
contingent upon some behavior other than the target behavior not only decreases the
frequency of the target behavior but also teaches the individual an alternative, more
appropriate means of obtaining reinforcers (France & Hudson; Kahng et al., 2000; Repp,
& Deitz, 1974). Although there is an abundance of research that supports the use of
consequence-based interventions such as EXT, there are several undesirable side effects
associated with such procedures.
Lerman, Iwata, and Wallace (1999) examined 41 studies in which an EXT
procedure was used, and found that in 41% of the studies there was an increase in the
frequency and intensity of the target behavior, an increase in emotional or aggressive
behavior, or an increase in both the target behavior and emotional or aggressive behavior
within the first three sessions of the EXT procedure. They further found that when the
EXT procedure was implemented as the sole behavior change procedure, an extinction
burst was observed in 62% of studies, and extinction-induced aggression was observed in
29% of studies. When the EXT procedure was implemented in combination with other
procedures, such as differential reinforcement, undesirable side effects were less
common, but extinction bursts and extinction-induced aggression were still observed to
occur in 15% of the studies evaluated. The prevalence of these side effects may make
3
such a procedure undesirable when addressing potentially dangerous behaviors such as
self-injurious behavior and aggression.
DRA includes an EXT component, in that reinforcement is withheld following
occurrences of the problem behavior and provided contingent upon the occurrence of
some alternative behavior. While not as common, DRA procedures can sometimes result
in negative side effects characteristic of EXT procedures, such as extinction bursts. For
example, Piazza, Moes, and Fisher (1996) observed significant increases in aggression
over the observed baseline rate when initially implementing DRA with extinction to
eliminate escape-maintained aggression in an 11-year-old boy with autism. Another
challenge associated with DRA procedures is finding an alternative response that is less
effortful than the previously reinforced problem behavior. Also, when first implemented,
DRA procedures may require frequent or continuous observation of the individual in
order to ensure that each instance of the alternative behavior contacts reinforcement.
An exception is when the alternative response is a communication response, in
which the individual is able to recruit reinforcers (e.g., attention, access to tangible items)
from others in their environment; however, finding an alternative communication
response that is less effortful than the previously reinforced problem behavior can
represent a significant challenge. Also, providing reinforcement for each alternative
response may be too cumbersome for caregivers (Roane, Fisher, Sgro, Falcomata, &
Pabico, 2004). In addition, some individuals may have an extremely limited repertoire of
potential communication skills, which limits the utility of the DRA procedure.
4
DRO, a consequence manipulation frequently used to address potentially
dangerous behaviors, involves EXT, in that reinforcers for the target behavior are
withheld, and instead, are delivered contingent on any behavior other than the target
behavior (Miltenberger, 2011). In other words, reinforcers are delivered contingent on the
absence of the problem behavior. Although EXT is an inherent component of DRO, DRO
may not occasion bursts of inappropriate behavior given that reinforcers are still being
delivered; however, this procedure does have other drawbacks. In order to determine the
initial time interval for providing reinforcement contingent on the absence of the problem
behavior, interresponse time (i.e., the time that elapses between each occurrence of the
problem behavior) must be measured. It is recommended that the initial interval be set
slightly below the average interresponse time. Also, when first implementing an interval
DRO procedure, the entire interval must be free of problem behavior in order for the
individual to gain access to reinforcement (Milternberger, 2011). As a result, this
procedure requires constant or near constant observation of the individual during the
initial stages, which may compromise the integrity of such treatments in the natural
environment.
There have also been a number of studies that have evaluated the effects of
reinforcing an alternative behavior while continuing to provide reinforcement for the
problem behavior. Because the problem behavior continues to be reinforced, an EXT
burst is seldom observed, but this procedure can have other drawbacks. Typically when
using this DRA procedure, each instance of the alternative behavior must be followed by
the reinforcer in order for responding to continue to be allocated to the alternative
5
behavior rather than the inappropriate behavior. For example, Worsdell, Iwata, Hanley,
Thompson, and Kahng (2000) demonstrated that several participants were able to acquire
and use functional communication skills taught using a DRA procedure even when
problem behavior continued to result in intermittent reinforcement, but also found that
even small errors in the delivery of the reinforcer compromised treatment effects. More
specifically, participants only allocated responding to the appropriate functional
communication response, rather than the problem behavior, if reinforcement for the
appropriate behavior was provided on a continuous or fixed ratio (FR) 1 schedule, while
reinforcement for the problem behavior was provided on an intermittent schedule.
In an effort to address the limitations associated with consequence-based
interventions, research has also been conducted on antecedent manipulations that can be
used to decrease the occurrence of problem behavior. Antecedent manipulations used to
decrease problem behaviors maintained by positive reinforcement often involve altering
the motivating operation (MO) that affects the likelihood of the target behavior occurring.
An MO is defined by Michael (1982) as “any change in the environment which alters the
effectiveness of some object or event as reinforcement and simultaneously alters the
momentary frequency of the behavior that has been followed by that reinforcement” (p.
150). More specifically, MOs have two main effects: the value-altering effect, which
refers to the change in the effectiveness of a stimulus as a reinforcer and includes both
establishing (value-increasing) and abolishing (value-decreasing) functions, and the
behavior-altering effect, which refers to the momentary change in the frequency of
behavior that has previously resulted in that reinforcer, and includes both evocative
6
(behavior-increasing) and abative (behavior-decreasing) functions (Laraway, Snycerski,
Michael, & Poling, 2003). Two primary treatment techniques have been developed to
manipulate MOs for behavior maintained by positive reinforcement: noncontingent
reinforcement and satiation procedures.
Noncontingent reinforcement (NCR) is an antecedent intervention consisting of
the periodic presentation of a stimulus independent of the organism’s behavior. In applied
research, this consists of presentation of either the maintaining reinforcer for the target
behavior or an arbitrary but preferred stimulus. When the reinforcer presented is the same
as the stimulus maintaining the behavior, this manipulation is functionally similar to
extinction in that the contingency between the behavior and the reinforcer is disrupted;
moreover, the delivery of a functional reinforcer on a time-based schedule eliminates the
MO for the behavior (Kahng, Iwata, Thompson, & Hanley, 2000; Wilder & Carr, 1998).
When the noncontingent reinforcer presented is arbitrary but preferred, a stimulus for
which a competing MO is in effect has been introduced, which may result in a shift in
responding from the target behavior to another behavior (Lindberg, Iwata, Roscoe,
Worsdell, & Hanley, 2003).
NCR has been demonstrated to be an effective behavior reduction procedure for
problem behaviors maintained by positive reinforcement, and has further been shown to
address several of the limitations seen with consequence interventions. For example,
Vollmer et al. (1993) directly compared NCR and EXT procedures in the treatment of
self-injurious behavior maintained by social positive reinforcement, and found that
although both procedures were equally effective in decreasing the frequency of the target
7
behavior across sessions, fewer responses occurred per session during the NCR condition
for 2 of the 3 participants. Hence, NCR procedures may be preferred relative to EXT
when treating potentially dangerous behavior.
While NCR procedures require less time on the part of the individual
implementing the treatment and have been associated with fewer negative side effects
than many consequence interventions, these procedures are not without their own
limitations. For example, Lindberg et al. (2003) found that NCR was effective in
reducing problem behavior maintained by automatic reinforcement over a short period of
time (short session durations are typical in much of the research on NCR), but when NCR
was implemented over a longer period of time, the target behavior increased for several
participants. These results suggest that prolonged access to a single reinforcing stimulus
will not result in decreased responding for an extended period of time, even if a
significant decrease is initially observed; however, it should be noted that in this study no
attempt was made to match the function of the stimulus that was delivered to the function
of the target behavior. Therefore, the extent to which the noncontingent delivery of a
functionally matched stimulus would suppress responding over time is not known.
Additionally, because NCR has been demonstrated to work by decreasing or eliminating
the MO that evokes the target behavior (Kahng et al., 2000), treatment effects are not
likely to persist in the absence of continued presentation of noncontingent reinforcers. In
contrast, consequence interventions such as DRA and EXT may produce more lasting
changes in behavior due to allocation of responding away from behaviors that do not
produce reinforcement (problem behaviors) and toward behaviors that do produce
8
reinforcement (alternative behaviors). Also, interventions such as DRA increase the
individual’s control over the environment, as these interventions provide individuals with
a way to recruit their own reinforcers when a MO is in place, unlike NCR procedures in
which stimuli are provided noncontingently regardless of the actions of the individual.
The second type of MO manipulation used to address behavior maintained by
positive reinforcement is commonly referred to in the literature as satiation. This type of
intervention involves providing continuous access to the stimulus identified to maintain
the target behavior prior to the initiation of a treatment session (O’Reilly, Sigafoos, et al.,
2006). This differs from NCR in that reinforcement is not necessarily scheduled during
the treatment session itself, but unlimited access to the reinforcer is provided for some
period of time immediately prior to the initiation of the session in an effort to minimize
responding during treatment. Responding may be decreased due to the value-abolishing
and behavior-abative effects of unlimited access to the stimulus that functions as a
reinforcer for the problem behavior.
Rapp (2006) demonstrated the effectiveness of this procedure when compared to a
response-blocking procedure used to reduce the frequency of automatically reinforced
behavior in one participant. In this study, each session consisted of 15 minutes of
baseline, during which the experimenter did not interact with the participant, 15 minutes
of intervention, and 15 minutes of a post-intervention condition that was identical to
baseline. Intervention varied, and involved either a satiation procedure, during which the
participant was provided with unlimited access to several toys that produced the same
sensory consequences as the target behavior, or a response-blocking procedure, during
9
which all attempts to engage in the target behavior were physically blocked by the
experimenter. Results of this study showed that in the post-intervention conditions
following the satiation intervention, rates of responding were lower than those observed
in baseline sessions, while in the post-intervention conditions following the responseblocking sessions, rates of responding were higher than those observed during baseline
sessions. This finding demonstrates that noncontingent access to a matched stimulus may
result in decreased responding when noncontingent access is discontinued, which
suggests that noncontingent access to a matched stimulus has an abolishing effect on the
MO for the automatically reinforced behavior. In contrast, the response-blocking
procedure, in which the behavior was prevented from occurring for a period of time,
seemed to have an establishing effect on the MO for the automatically reinforced
behavior. If the response-blocking procedure is considered to be an opposing intervention
to the satiation procedure, this result is not unexpected.
O’Reilly and Sigafoos et al. (2006) used the satiation procedure to address selfinjurious behavior, aggression, and elopement which were determined by a functional
analysis to be maintained by positive reinforcement in the form of access to food for one
participant (Sam) and access to attention for the other participant (John). In this study, the
authors provided participants with ongoing noncontingent access to the maintaining
reinforcer for 10 min for Sam and 15 min for John prior to some treatment sessions
(called the pre-session access condition) and withheld the maintaining reinforcer for two
hours for Sam and 15 min for John prior to other treatment sessions (called the presession no access condition). Pre-session access and pre-session no access conditions
10
were evaluated using a multielement design. Treatment sessions during the first phase of
the study mimicked the attention condition of the functional analysis, in which attention
was provided contingent upon the occurrence of the problem behavior on a FR 1
schedule, and participants were otherwise ignored. In the second phase participants were
ignored regardless of behavior, following an EXT procedure. Results showed that rates of
problem behavior for both participants were higher in treatment sessions following the
pre-session no access condition, both when the problem behavior was resulting in
reinforcement and during the EXT phase. For one participant, overall rates of problem
behavior were markedly higher in treatment sessions following the pre-session no access
condition during the EXT phase, and even exceeded rates of problem behavior observed
during the functional analysis. The authors suggested that the satiation procedure is a
viable alternative to consequence manipulations such as EXT and DRO procedures.
O’Reilly and Edrisinha et al. (2006) conducted another study to investigate the
effects of continued access to reinforcement for problem behavior in treatment sessions
following presession access and pre-session no access conditions when compared to
EXT. The study was conducted in two phases; in the first phase, the maintaining
reinforcer was available during the treatment sessions, and in the second phase the EXT
procedure was implemented during the treatment sessions. In the first phase, during the
pre-session access condition, the participant was provided with access to the maintaining
reinforcer (attention) continuously for 15 min prior to the treatment session, while during
the pre-session no access condition, the participant was placed alone in a room for 15 min
prior to the treatment session. All treatment sessions were 5 min in duration, and during
11
sessions the participant sat in a room with the experimenter, with leisure items such as
pens and paper available. The experimenter provided the participant with a brief verbal
instruction contingent upon occurrences of the target behavior, but otherwise did not
interact with the participant. Results of this phase showed that even when the target
behavior continued to come into contact with the reinforcer, rates of the target behavior
were significantly lower in treatment sessions following the pre-session access condition
than in treatment sessions following the pre-session no access condition. In the second
phase of this study, the procedures were identical, with the exception that during sessions
all occurrences of the target behavior were ignored. Results of this phase showed that the
behavior occurred at a significantly lower rate in treatment sessions following the presession access condition than in treatment sessions following the pre-session no access
condition when EXT was implemented. As noted by the authors, this reduction suggests
that the satiation procedure is a desirable alternative to consequence-based interventions;
furthermore, such a procedure may be beneficial when implemented in conjunction with
EXT in that it may minimize the extinction burst and decrease rates of behavior more
rapidly.
In another study on satiation, O’Reilly et al. (2007) investigated the effects of the
satiation procedure on self-injury and aggression maintained by access to food. In this
study, pre-session access to the reinforcer involved unlimited access to preferred snacks
for 15 min immediately prior to an instructional session, and pre-session no access
involved withholding food for a minimum of 2 hours prior to the session. All
instructional sessions were 10 min in duration. Throughout all sessions the preferred food
12
was kept in a transparent container on a table out of the participant’s reach, and all
occurrences of the target behaviors were ignored, essentially duplicating an EXT
procedure. This intervention was implemented in a multielement design, and results
showed that inappropriate behaviors occurred at a significantly lower rate in treatment
sessions following the pre-session access condition (occurring at an average rate of 2
incidents per session) than in treatment sessions following the pre-session no access
condition (occurring at an average rate of 34.9 incidents per session), despite the
continued presence of the discriminative stimulus (SD) throughout the instructional
sessions in both conditions.
In a more recent study on the effects of pre-session access to reinforcement,
Rispoli et al. (2011) examined the effects of the satiation procedure on aggression and
inappropriate vocalizations maintained by access to tangible items. In this study, presession access to the reinforcer involved providing each participant with unlimited access
to desired tangible items until the participant rejected playing with the item(s) three times
within a session. Rejection was defined as transferring the preferred item to the nondominant hand while manipulating other items or dropping the item and failing to pick it
up within 3 s. As a result, the duration of the pre-session access condition was not fixed,
and averaged from 11 to 52 min across both participants. During the pre-session no
access condition, participants were provided with access to typical classroom materials,
but were not provided with access to desired tangible items for a minimum of 2 hours
prior to sessions. All instructional sessions were 20 min in duration. During instructional
sessions, desired items were visible to the participants, but placed out of their reach.
13
Participants were seated at a table with several other students and a teacher, and were
provided with classroom materials. The teacher modeled appropriate engagement with
the materials, but did not prompt the students to manipulate the materials. Target
behaviors were ignored. This intervention was implemented in a multielement design,
and results showed that inappropriate behaviors occurred at a significantly lower rate in
treatment sessions following the pre-session access condition (occurring at an average of
20% of session intervals) than in treatment sessions following the pre-session no access
condition (occurring at an average of 61% of session intervals), despite the continued
presence of the SD throughout the instructional sessions in both conditions. The authors
concluded that the differences in responding during treatment sessions following presession access versus pre-session no access conditions were due to the abolishing and
abative effects of unlimited access to desired items on the MO affecting the inappropriate
behavior that had previously resulted in access to those items. The authors noted that this
procedure might be useful when combined with the EXT procedure, as it may eliminate
or reduce such side effects as the extinction burst.
The significant reduction in occurrences of problem behavior observed in studies
using pre-session exposure to reinforcement has prompted several researchers to
recommend this procedure as a viable alternative to consequence-based manipulations
and NCR procedures for some challenging behaviors. This intervention may be preferred
when addressing behaviors that are potentially dangerous, and for which an extinction
burst may result in serious injury, and also when attempting to address challenging
behavior in an environment in which continuous observation of the individual is very
14
difficult to ensure, or in which frequent presentation of a stimulus or a variety of stimuli
throughout the day (as in the case of the NCR procedure) may be disruptive or otherwise
undesirable, such as in a typical classroom setting. However, there are limitations of
previous research on satiation interventions that must be addressed before such a
recommendation can be adopted.
One significant limitation inherent in the satiation intervention is that like the
NCR procedure it is an antecedent-based manipulation, and as a result will not have a
long-term effect on the rate of responding when the treatment is not in effect, unlike
consequence-based interventions which can result in long-term behavior change
(Chandler & Dahlquist, 2006). In response to this limitation, O’Reilly and Edrisinha et al.
(2006) suggested that the satiation procedure might have additional benefits when
combined with a consequence-based intervention such as EXT. When the satiation
procedure is combined with EXT, undesirable side effects associated with EXT can be
avoided and changes in behavior may be longer lasting. This recommendation to combine
antecedent-based and consequence-based interventions is not uncommon in applied
settings (see Chandler & Dahlquist), but is less common in peer-reviewed research,
which typically attempts to isolate the effects of a single intervention on behavior.
However, it is possible that combining satiation with EXT will not be an effective
treatment package. It is assumed in the definition of extinction that a relevant MO is in
effect when responding occurs (Michael, 1993/2003). Given that the value of the
reinforcer is temporarily abolished during the satiation procedure due to the MO
manipulation in the pre-session access conditions, little or no responding would be
15
observed, in which case extinction would not occur at all, and responding would still be
expected to occur when the MO is again in effect despite the use of the EXT intervention.
However, it should also be noted that in all research on the satiation intervention, the
target behavior did continue to occur, albeit at a very low rate, during the sessions
following pre-session access to the maintaining reinforcer. This suggests that pre-session
exposure diminishes but does not entirely eliminate the MO for the behavior. As a result,
it is possible that the EXT procedure could still be effective despite the decrease in the
rate of responding when the satiation procedure is used. If so, satiation may indeed be a
desirable addition to the EXT treatment, especially when addressing potentially
dangerous or highly injurious behaviors, due to the observed decrease in such undesirable
side effects such as extinction bursts.
Purpose
The purpose of this study was to replicate and extend the study conducted by
O’Reilly and Sigafoos et al. (2006) by investigating the effects of pre-session exposure to
reinforcement on behavior undergoing EXT to determine whether combining pre-session
exposure with an EXT procedure would decrease the occurrence of undesirable side
effects commonly observed during EXT procedures. An additional purpose was to
determine whether the EXT procedure remains effective when applied in combination
with the pre-session exposure procedure, despite the abolishing effect of exposure to the
maintaining reinforcer on the MO for the problem behavior, by determining whether
decreased responding following pre-session exposure plus EXT is maintained when presession exposure is no longer in place and EXT is implemented in isolation.
16
Chapter 2
METHOD
Participants and Setting
Two children with developmental disabilities who engaged in problem behavior
(e.g., aggression, tantrums) maintained by social positive reinforcement participated.
Participants were recruited through direct contact with schools and in-home service
providers who serve children and young adults with developmental disabilities. Helen
was a 7-year-old girl with a primary diagnosis of Angelman syndrome who attended a
non-public school for children with disabilities and received 25 hours per month of inhome ABA services. Vincent was a 6-year-old boy diagnosed with Prader Willi
syndrome and ADHD. Vincent attended a special education full-day Kindergarten class
in a public elementary school, and was taking 5 mg of methylphenidate twice daily
throughout the duration of this study. Sessions were conducted in participants’ homes, in
their bedrooms, which were furnished with a bed, table, several chairs, shelves, and
leisure materials. Bedrooms ranged in size from approximately 12’ x 15’ to 15’ x 20’.
Sessions were 25 min in duration, including 15 min of pre-session exposure or no
exposure to reinforcement, followed by a 10-min treatment session. Two to three sessions
per week were conducted, participant schedules permitting.
Response Measurement
Data were collected using a frequency within interval procedure for Helen, and a
partial interval procedure for Vincent. The specific data collection procedure for each
17
participant was selected based on the types of problem behavior displayed. Helen’s target
problem behaviors included hitting, defined as bringing her hand into contact with any
part of another’s body hard enough to produce an audible sound; kicking, defined as
bringing her foot into contact with any part of another person’s body hard enough to
leave a lasting mark; pulling hair, defined as grasping another person’s hair in her hands
and pulling hard enough to move the person’s head; grabbing, defined as grasping items
that are in another person’s possession and pulling on them hard enough to move them;
and pressing her face into others, defined as pressing her face against any part of another
person’s torso or lap. The frequency of occurrence of the target behaviors was recorded
within 10-s intervals, to determine both the percentage of intervals during which the
target behavior occurred in each session, and any patterns of responding that occurred
within each session. Vincent’s target problem behaviors included yelling or screaming,
defined as emitting a sound loud enough to be heard clearly through the door and
maintaining the sound for at least 3 s; crying, defined as emitting high-pitched nonverbal
vocalizations for at least 3 s; and dropping to the ground, defined as falling to the ground
and remaining in a prone position for at least 5 s. The occurrence of the target behaviors
during any part of a 10-s interval was recorded, in order to determine the percentage of
session intervals during which problem behavior occurred.
A second observer independently collected data on each participant’s behavior
during approximately 36% of all sessions. Interobserver agreement was calculated for
frequency within interval data by calculating the number of intervals in which both
observers recorded the same number of target behaviors, and then dividing the number of
18
agreement intervals by the total number of agreements plus disagreements and dividing
by 100, in order to determine the percentage of agreement. Interobserver agreement was
calculated for partial interval data by calculating the number of occurrence and
nonoccurrence intervals in which both observers agreed, and then dividing the number of
agreements by the total number of agreements plus disagreements and dividing by 100, in
order to determine the percentage of agreement. Mean agreement for Helen’s problem
behaviors was 89.03% (range, 81.67%-95%), and mean agreement for Vincent’s problem
behaviors was 95.29% (range, 91.67%-100%).
Preference Assessments
Two paired-choice preference assessments were conducted prior to the start of
treatment, following procedures described by Fisher et al. (1992). The first preference
assessment was used to identify moderately preferred leisure materials, and the second
assessment was used to identify moderately preferred academic tasks for each participant.
Prior to the leisure item preference assessment, several items and activities were
identified through interviews with parents and staff. During the assessment, two of these
leisure items were presented to the participant at a time, and the participant was prompted
to select one of the items. The participant was then allowed to manipulate the item for 2
min before being presented with another choice of two leisure items. Each leisure item
was paired with every other leisure item. Six items were included for Helen, for a total of
15 trials, and five items were included for Vincent, for a total of 10 trials. The number of
times each item was selected was divided by the total number of times the item was
presented to yield a percentage. Moderately preferred leisure items were identified as the
19
items that were selected between 30% and 80% of opportunities. The academic activity
preference assessment was identical to the leisure preference assessment, except that
academic tasks were presented, rather than leisure items.
Functional Analysis
To determine the function of the problem behaviors, a functional analysis was
conducted for each participant according to the procedures outlined by Iwata, Dorsey,
Slifer, Bauman, and Richman (1982/1994). Three conditions were included in the
functional analysis: attention, demand, and play. In the attention condition, the participant
and experimenter were in the participant’s bedroom, which contained a table, chairs, a
bed, shelves, and moderately preferred leisure and academic materials, as identified
during the preference assessments. The experimenter offered brief verbal interactions on
a FR 1 schedule when the target behavior occurred but otherwise ignored the participant.
In the demand condition, the experimenter presented the participant with academic tasks
similar to those typically presented in the school or in-home treatment program using a
least-to-most prompting hierarchy, and removed the task for 30 s contingent upon
occurrences of the target behavior. During the play condition, the experimenter delivered
positive statements to the participant on a fixed time (FT) 30-s schedule. In addition,
moderately preferred leisure and academic materials were continuously available and no
demands were placed on the participant throughout the session. Target behaviors were
ignored. Functional analysis sessions were 10 min in duration.
20
Experimental Design
A multielement combined with a reversal design was used to compare the effects
of pre-session exposure to reinforcement and pre-session no exposure to reinforcement
when implemented in conjunction with extinction. Pre-session exposure and pre-session
no-exposure conditions were conducted in an alternating fashion in order to demonstrate
that rates of behavior differ during conditions in which the MO is present (pre-session noexposure) versus absent (pre-session exposure). Following a return to baseline, the presession exposure condition was presented for an extended number of sessions, followed
by several sessions of the pre-session no-exposure condition, in an effort to determine
whether observed decreases in problem behavior maintained in the absence of the presession exposure procedure.
The baseline condition was identical to the attention condition of the functional
analysis. The participant and the experimenter were present in the participant’s bedroom
with a table, chairs, a bed, shelves and leisure materials. The experimenter presented the
participant with a brief reprimand (e.g., “I can’t talk right now”) contingent upon
occurrences of the target behavior (FR 1 schedule), and otherwise ignored the participant.
Baseline sessions were 10 min in duration.
During the pre-session exposure condition, attention was delivered prior to
treatment sessions. The pre-session exposure condition was identical to the play condition
of the functional analysis. For 15 min prior to the treatment session, the experimenter
delivered positive statements to the participant on a FT 30-s schedule; leisure materials
were continuously available; no demands were placed on the participant; and all
21
occurrences of the target behavior were ignored. When the treatment session began, the
experimenter made a brief statement to the participant (e.g., “It’s time for me to work
now; we’ll talk later”), and immediately stopped interacting with the participant.
Treatment sessions were 10 min in duration, during which the experimenter and the
participant remained in the room, with leisure materials available, but the experimenter
did not interact with the participant at all, and all occurrences of the target behavior were
ignored.
During the pre-session no exposure condition, the participant was prompted to
work or play independently for 15 min immediately prior to the treatment session, and
was provided with task and leisure materials during that time. Treatment sessions in this
phase were 10 min in duration, and were identical to those in the pre-session exposure
condition. The experimenter made a brief statement to the participant, and then did not
interact with the participant at all during the session.
22
Chapter 3
RESULTS
Preference Assessments
Results of the preference assessments for leisure and task materials for Helen are
depicted in Figure 1 (below).
Figure 1 Preference assessment results for Helen
Leisure Preference Assessment
Percentage of Intervals Selected
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Music Box
Helen
Nesting
Blocks
Keyboard
Play Lawn
Mower
Truck
Mr. Potato
Head
23
Task Preference Assessment
Percentage of Intervals Selected
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Helen
Sorting
Beads
Popsicle
Put-In
Puzzle
Coin Put-In Clothespin Piggy Bank
Pinch
Results indicated a moderate preference for the music box, nesting blocks, a keyboard, a
play lawn mower, a toy truck, and Mr. Potato Head. Results for task materials indicated a
moderate preference for a Popsicle stick put-in task, a puzzle, and a coin put-in task. The
identified moderately preferred leisure and task items were available to her throughout all
sessions of the experimental condition.
Results of the preference assessments for leisure and task materials for Vincent
are depicted in Figure 2 (below). Results for leisure materials showed that Vincent
demonstrated a moderate preference for a toy fire truck, puppets, and a picture book.
Results for task materials showed that Vincent demonstrated a moderate preference for a
marble put-in task, and a color-sorting task. The identified moderately preferred leisure
and task items were available to him throughout all sessions of the experimental
condition.
24
Figure 2 Preference assessment results for Vincent
Leisure Preference Assessment
Percentage of Intervals Selected
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Vincent
Kitchen
Toys
Fire Truck
Puppets
Picture
Books
Blocks
Wooden
Puzzle
Task Preference Assessment
100%
Percentage of Intervals Selected
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Tracing Pages Marble Put-in Color Sorting
Vincent
Matching
Wooden
Puzzles
Functional Analysis
Functional analysis results are depicted in Figure 3 (below). For both participants,
target behaviors occurred almost exclusively in the attention condition (M = 36.25% of
25
intervals for Helen; M = 39.67% of intervals for Vincent), suggesting that target
behaviors for both participants were maintained by access to attention.
Figure 3 Functional analysis results for both participants
% of Intervals in which Bx Occurred
100%
90%
Attention
80%
70%
60%
50%
40%
Control
30%
20%
Demand
10%
0%
1
2
3
4
5
6
7
Session
Helen
8
9
10
11
12
% of Intervals in which Bx Occurred
100%
90%
80%
Attention
70%
60%
50%
40%
30%
Control
Demand
20%
10%
0%
1
Vincent
2
3
4
5
6
7
8
9
Session
10
11
12
13
14
15
26
Experimental Conditions
Results for the experimental conditions for both participants are depicted in
Figure 4 below (results for Helen are depicted in the top panel and results for Vincent are
depicted in the bottom panel). Helen’s level of problem behavior during the initial
baseline condition was similar to that observed during the attention condition of the
functional analsis (M = 36.25% of intervals). During the multielement phase, Helen was
observed to emit problem behaviors during significantly more intervals during the presession no attention condition (M = 49.33%) than during the pre-session attention
condition (M = 23.33%). The level of responding during the pre-session no attention
condition was also higher than that observed during the initial baseline, while the level of
responding during the pre-session attention condition was lower than that observed
during the initial baseline. In the return to baseline condition, the level of target behaviors
was higher than that observed during the initial baseline condition (M = 46.25%).
Following this, the extended pre-session attention condition was implemented, during
which Helen emitted the target behavior in an average of 21.33% of intervals, which was
similar to the percentage observed during the pre-session attention condition in the
multielement phase. In the final condition of reversal to pre-session no attention, Helen’s
level of target behavior was initially higher than that observed during the previous
condition, but quickly decreased to a level similar to that observed during the pre-session
attention condition (M = 22.78%).
27
Figure 4 Intervention results for both participants
% of Intervals in Which Behavior Occurred
Baseline
100%
15 Min Presession
+ EXT
Baseline
15 Min Presession
Attention + EXT
90%
15 Min
Presession
No
Attention+
EXT
No Attention
80%
70%
60%
50%
40%
Attention
30%
20%
10%
0%
1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728293031323334
Session
Helen
15 Min
% of Intervals in Which Behavior Occurred
100% Baseline Presession + Baseline
EXT
90%
15 Min Presession
Attention + EXT
No
Attention
80%
15 Min
Presession
No Attention +
70%
60%
2 week family
vacation
50%
40%
30%
20%
Attention
10%
0%
1
Vincent
3
5
7
9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45
Session
28
Vincent’s level of problem behavior during the initial baseline condition was
similar to that observed during the attention condition of the functional analsis (M =
39.67% of intervals). During the multielement phase, Vincent was observed to emit
problem behaviors during significantly more intervals during the pre-session no attention
condition (M = 55%) than during the pre-session attention condition (M = 35%). In the
return to baseline condition, Vincent’s level of target behavior was similar to that
observed during the initial baseline condition (M = 36.25%). During the extended presession attention condition,Vincent’s level of target behaviors decreased steadily, (M =
25.28% of intervals), which was lower on average than that observed during the presession attention condition in the multielement phase. In the final condition of reversal to
pre-session no attention, Vincent’s level of target behavior was initially higher than that
observed during the previous condition, but steadily decreased to a level similar to that
observed during the extended pre-session attention condition (M = 27.67%).
29
Chapter 4
DISCUSSION
Results of this study replicate and extend those reported by O’Reilly and
Edrisinha et al. (2006), O’Reilly and Sigafoos et al. (2006), O’Reilly et al. (2007), and
Rispoli et al. (2011) on the use of pre-session exposure to reinforcers as an intervention
for addressing inappropriate behavior maintained by social positive reinforcement.
Similar to previous findings, results of the current study demonstrated that following presession exposure to a reinforcer participants’ rate of target behaviors was reduced when
compared to both the baseline rate and the rate of responding observed when no access to
the reinforcer was provided. These results suggest that for both participants,
noncontingent access to the maintaining reinforcer had abolishing and abative effects on
the MO for the problem behavior. This is consistent with the findings in previous studies.
However, as demonstrated by the increase in the target behavior observed for both
participants during the return to baseline condition, this antecedent-based intervention did
not produce lasting changes in behavior in the absence of continued pre-session exposure.
The current study also examined the effects of combining this antecedent-based
intervention with the extinction procedure, as has been recommended in some previous
research (see O’Reilly & Sigafoos et al., 2006). The pre-session attention condition
combined with extinction was implemented for an extended number of sessions, in an
effort to determine whether extinction would continue to be effective even when the MO
for responding was abolished and abated. For both participants, it was observed that
30
responding during the extended pre-session attention condition was decreased when
compared to baseline, but in both cases responding did continue to occur, although at a
reduced rate. When the participants were then exposed to the pre-session no attention +
EXT condition, both showed a brief increase in responding over the rate observed in the
previous condition, followed by a steady decrease in rate of responding to levels similar
to those observed in the pre-session attention + EXT condition. When comparing the rate
of target behaviors during the pre-session no attention + EXT condition from the
multielement phase with the rate observed during the second pre-session no attention +
EXT condition, it is clear that extinction occurred for both participants.
For Helen, responding was immediately reduced when pre-session attention +
EXT was implemented, and her rate of responding remained below baseline throughout
the extended pre-session attention + EXT condition. Upon reversal to the pre-session no
attention + EXT condition, responding temporarily increased to a rate slightly below that
observed during the initial pre-session no attention + EXT condition, but quickly
decreased to a rate slightly below that observed during the pre-session attention + Ext
condition. Comparison between the rate of responding during the first pre-session no
attention + EXT condition and the second clearly demonstrates that extinction did occur
for this participant during the extended pre-session + EXT condition, which suggests that
the pre-session exposure intervention may be effectively combined with the extinction
procedure to produce decreased responding during EXT while still producing lasting
changes in behavior.
31
For Vincent, responding remained near baseline levels when pre-session attention
+ EXT was initially implemented, but his rate of responding steadily decreased from
baseline to below baseline levels across the extended pre-session attention + EXT
condition. Upon reversal to the pre-session no attention + EXT condition, responding
temporarily increased to a rate similar to that observed during the initial pre-session no
attention + EXT condition, which was higher than the rate observed during baseline, but
then quickly decreased to a rate similar to that observed during the pre-session attention +
EXT condition. Based on the steady decrease in responding observed during the extended
pre-session attention + EXT condition, as well as the ultimate differences in rate of
responding between the first pre-session no attention + EXT condition and the second, it
appears that extinction did occur for this participant despite the abative and abolishing
effect of pre-session attention on the MO for the target behavior. With this participant, it
is also interesting to note that even with the inclusion of pre-session attention, the rate of
responding during the extended EXT condition was initially similar to that observed
during baseline, rather than showing an immediate reduction as has often been reported in
the research (see O’Reilly and Edrisinha et al., 2006, O’Reilly and Sigafoos et al., 2006,
O’Reilly et al., 2007, and Rispoli et al., 2011). However, it is clearly demonstrated during
the multielement condition that responding during the pre-session attention + EXT
condition was suppressed when compared to responding during the pre-session no
attention + EXT condition. This suggests that application of extinction alone, without
including pre-session exposure to the maintaining reinforcer, may have evoked a
temporary but significant increase in the rate of responding, or extinction burst, for this
32
participant. Following the reversal to pre-session no attention + EXT, indeed, a brief
increase in the rate of responding to a level slightly above baseline was observed, but this
rate decreased very quickly across sessions, which differs from the pattern observed
during the initial pre-session no attention + EXT condition. Application of the pre-session
exposure intervention combined with EXT likely resulted in a reduction in the intensity
and duration of the extinction burst for this participant, while still allowing the extinction
procedure to be effective in decreasing the rate of responding. This suggests that the presession exposure intervention may be especially useful when combined with extinction
when addressing problem behaviors for which an intense or sustained extinction burst
may result in significant injury or property damage.
Results of the present study suggest that EXT does continue to be an effective
intervention when combined with the pre-session exposure intervention, despite the
abolishing and abative effects that this procedure has on the MO for the target behavior.
In addition, these results suggest that there may be additional benefits in combining these
procedures. The rate of responding during the pre-session exposure + EXT condition may
be significantly decreased compared to the baseline rate, which would allow practitioners
to more easily implement extinction when addressing problem behaviors that may be
dangerous or otherwise very difficult to effectively extinguish in an applied setting. In
addition, even if the rate of responding during pre-session exposure + EXT is not below
that of baseline, it is likely that combining these procedures will help decrease the
intensity and duration of an extinction burst, which is especially important when
addressing injurious behaviors. Results of the current study suggest that the pre-session
33
exposure intervention may be a desirable addition to the EXT procedure, especially when
addressing extremely intense or injurious problem behaviors.
One limitation of the current study is the duration of the pre-session exposure
periods and the duration of treatment sessions. In this study, pre-session exposure or noexposure periods were 15 min in duration, while treatment sessions were only 10 min.
These relatively brief session durations limit the generalizability of this research to the
natural environment. The brief duration of the intervention sessions following pre-session
exposure/no-exposure conditions restricts researchers from identifying the effect this
procedure would have during longer intervals, and it may be theorized that as the presession exposure became more temporally distant, rates of the target behavior would
increase. In addition, the relatively long periods of access to the maintaining reinforcer or
deprivation from the maintaining reinforcer further restrict the application of this
procedure to the natural environment, in which individuals may not be able to provide
long periods of constant interaction, access to tangibles, or frequent snacks, or to
withhold these reinforcers for long periods of time. Also, no research to date has
investigated the effects of different quantities of the maintaining reinforcer on response
rate, and it is not clear whether 15 min is a necessary or optimal duration of time.
An additional limitation of the current study is the arbitrary selection of the
number of pre-session exposure + EXT sessions implemented during the extended
condition. For individuals such as Vincent who demonstrate a clear reduction in target
behavior across sessions, this limitation does not apply, and the number of sessions can
be guided by the observed rate of responding. However, for other individuals such as
34
Helen who demonstrate an immediate suppression in responding and for whom
responding remains low across sessions, it is difficult to determine the optimal number of
sessions to apply before reversing to the pre-session no-exposure + EXT condition. In the
current study, the number of sessions was arbitrarily selected, and appeared to be
effective for that participant; however, this number may vary across participants and may
be difficult to identify consistently when the rate of responding cannot be used as a guide.
Future research on the duration of pre-session exposure/no-exposure conditions
and session durations would provide insight into the viability of implementing shorter
pre-session periods and longer sessions, in order to increase the generalizability of this
procedure to the natural environment. One approach that may be beneficial is to
systematically manipulate the duration of pre-session periods while maintaining a
constant session duration, in order to specifically identify the effect of different durations
of pre-session exposure/no-exposure on rates of responding during sessions. This may
allow researchers to identify a mean pre-session duration that is typically effective for
most participants, although it is also possible that the duration of effective pre-session
exposure will be demonstrated to be highly variable across individuals. Additional
recommendations for future research include varying the number of pre-session exposure
+ EXT treatment sessions implemented prior to returning to pre-session no-exposure +
EXT, in order to determine the number of sessions necessary to successfully extinguish
the target behavior. This would facilitate implementation of this procedure in applied
settings, in which the satiation procedure may be difficult to implement consistently over
long periods of time. An additional possibility to identify the appropriate number of pre-
35
session exposure sessions for each individual is to introduce probe sessions, in which a
single pre-session no-exposure condition is introduced and rate of responding during this
session is observed. Future research may examine how to best determine based on these
data that the participant’s target behavior has been effectively reduced, since the rate of
responding during the initial return to pre-session no-exposure was observed to increase
for both of the current participants.
36
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