Search PubMed⌕ Search

Biomedical subjects

D C Lerman

Publications and source records attributed to D C Lerman.

At least 19 recordsLinked to original sources
PubMed1999

Side effects of extinction: prevalence of bursting and aggression during the treatment of self-injurious behavior.

Findings from basic and applied research suggest that treatment with operant extinction may produce adverse side effects; two of these commonly noted are an increase in the frequency of the target response (extinction burst) and an increase in aggression (extinction-induced aggression). Although extinction is often used to treat problem behavior in clinical settings, few applied studies have examined the prevalence of these side effects or their possible attenuation with other operant procedures. An analysis of 41 data sets for individuals who received treatment for self-injurious behavior indicated that extinction bursts or increases in aggression occurred in nearly one half of the cases. The prevalence of bursting and aggression was substantially lower when extinction was implemented as part of a treatment package rather than as the sole intervention.

Adult↗
PubMed1999

Effects of reinforcement magnitude on spontaneous recovery.

Extinction of operant behavior has been associated with a number of undesirable effects. One such effect is the temporary reappearance of behavior after responding appears to be completely extinguished, known as spontaneous recovery. In this report, the occurrence of spontaneous recovery and its attenuation with large amounts of reinforcement were examined during the treatment of disruption.

Adult↗
PubMed1997

Effects of intermittent punishment on self-injurious behavior: an evaluation of schedule thinning.

Although the use of punishment often raises ethical issues, such procedures may be needed when the reinforcers that maintain behavior cannot be identified or controlled, or when competing reinforcers cannot be found. Results of several studies on the effects of intermittent schedules of punishment suggest that therapists must use fairly rich schedules of punishment to suppress problem behavior. However, residential caretakers, teachers, and parents often have difficulty implementing programs that require constant monitoring of the client's behavior. In this study, we examined the feasibility of gradually thinning the delivery of punishment from a continuous schedule to an intermittent schedule during the course of treatment for self-injurious behavior (SIB). Results of functional analyses for 5 individuals who had been diagnosed with profound mental retardation indicated that their SIB was not maintained by social consequences. Treatment with continuous schedules of time-out (for 1 participant) or contingent restraint (for the other 4 participants) produced substantial reductions in SIB. When they were exposed to intermittent schedules of punishment (fixed-interval [FI] 120 s or FI 300 s), SIB for all but 1 of the participants increased to levels similar to those observed during baseline. For these 4 participants, the schedule of punishment was gradually thinned from continuous to FI 120 s or FI 300 s. For 2 participants, SIB remained low across the schedule changes, demonstrating the utility of thinning from continuous to intermittent schedules of punishment. Results for the other 2 participants showed that intermittent punishment was ineffective, despite repeated attempts to thin the schedule.

Adult↗
PubMed1997

Effects of reinforcement choice on task responding in individuals with developmental disabilities.

The effects of reinforcement choice on task performance were examined with 6 individuals who had been diagnosed with severe to profound mental retardation. Five highly preferred items were identified for each participant via stimulus preference assessments. Participants then were exposed to choice and no-choice conditions that were alternated within reversal and multielement designs. During choice sessions, participants were permitted to select between two preferred stimuli contingent on responding. During no-choice sessions, the therapist delivered a single item contingent on responding. Preference for the stimuli was held constant across conditions by yoking the items delivered during no-choice sessions to those selected during the immediately preceding choice sessions. All participants exhibited similar rates of responding across choice and no-choice conditions. These findings indicate that for individuals with severe disabilities, access to choice may not improve task performance when highly preferred items are already incorporated into instructional programs.

Adolescent↗
PubMed1997

Does functional communication training compete with ongoing contingencies of reinforcement? An analysis during response acquisition and maintenance.

We examined the effectiveness of functional communication training (FCT) in reducing self-injurious behavior (SIB) and in shaping an alternative (communicative) response while SIB continued to be reinforced. Following a functional analysis of 3 individuals' SIB, we attempted to teach an alternative response consisting of a manual sign to each individual, using the reinforcer that maintained SIB. When FCT was implemented without extinction. SIB remained at baseline rates for all participants, and none of the participants acquired the alternative response. When extinction was added to the training procedure, SIB decreased and manual signing increased for all participants. To determine if signing, when established, would compete with SIB when both were reinforced, extinction was then withdrawn. Signing was maintained and SIB occurred at low rates for 2 individuals, but SIB returned to baseline rates for the 3rd individual, necessitating the reimplementation of extinction. These results suggest that it may be difficult to establish alternative behaviors if inappropriate behavior continues to be reinforced, but that, when established, alternative behavior might compete successfully with ongoing contingencies of reinforcement for inappropriate behavior.

Adult↗
PubMed1996

Responding maintained by intermittent reinforcement: implications for the use of extinction with problem behavior in clinical settings.

Results of basic research have demonstrated that behavior maintained on an intermittent schedule of reinforcement (INT) will be extinguished more slowly than behavior maintained on a continuous schedule (CRF). Although these findings suggest that problem behaviors may be difficult to treat with extinction if they have been maintained on INT rather than on CRF schedules, few applied studies have examined this phenomenon with human behavior in clinical settings. The purpose of this study was to determine whether problem behavior maintained on CRF schedules would be extinguished more rapidly than behavior maintained on INT schedules. Three individuals diagnosed with profound mental retardation participated after results of pretreatment functional analyses had identified the sources of reinforcement that were maintaining their self-injury, aggression, or disruption. Subjects were exposed to extinction following baseline conditions with CRF or INT schedules alternated within reversal or multielement designs. Results suggested that problem behavior may not be more difficult to treat with extinction if they have been maintained on INT rather than CRF schedules. However, switching from an INT to a CRF schedule prior to extinction may lower the baseline response rate as well as the total number of responses exhibited during extinction.

Adult↗
PubMed1996

Developing a technology for the use of operant extinction in clinical settings: an examination of basic and applied research.

Extinction of operant behavior, which involves terminating the reinforcement contingency that maintains a response, is important to the development, generalization, and reduction of behavior in clinical settings. We review basic and applied research findings on variables that influence the direct and indirect effects of extinction and discuss the potential value of a general technology for the use of extinction. We suggest that current research findings are not sufficient for the development of a comprehensive, applied technology of extinction and provide extensive guidelines for further studies on factors that may affect the course of extinction in clinical settings.

Adult↗
PubMed1996

Self-restraint as positive reinforcement for self-injurious behavior.

Many individuals who engage in self-injurious behavior (SIB) also exhibit self-restraint. We compared rates of SIB exhibited by a 32-year-old woman diagnosed with profound retardation across conditions in which access to restraint was (a) continuously available, (b) presented as a consequence for SIB, or (c) unavailable. Rates of SIB increased when access to restraint was contingent upon SIB and decreased when restraint was unavailable, suggesting that self-restraint functioned as positive reinforcement for SIB.

Adult↗
PubMed1995

An analysis of the reinforcing properties of hand mouthing.

Hand mouthing often has been described as a stereotypic response that is maintained by nonsocial (automatic) reinforcement; however, data supporting this conclusion can be found in relatively few studies. This series of studies presents an experimental analysis of conditions associated with the maintenance of hand mouthing. In Experiment 1, a functional analysis was conducted for 12 individuals who engaged in chronic hand mouthing, to determine whether the behavior is usually maintained independent of social contingencies. Results obtained for 10 subjects were consistent with an automatic reinforcement hypothesis; the remaining 2 subjects' hand mouthing was maintained by social-positive reinforcement. Based on these results, Experiment 2 was designed to identify the specific reinforcing properties of hand mouthing. Each of 4 subjects was provided with a toy that substituted for hand mouthing, and preference for a specific topography of toy manipulation (hand-toy contact or mouth-toy contact) was measured. Results indicated that hand stimulation was the predominant reinforcer for all subjects. Experiment 3 provided an extension of Experiment 2 in that the same responses were measured across a variety of toys presented to each of 5 subjects. Results again indicated that hand stimulation was the predominant reinforcer for all subjects. Implications of these results are discussed with relevance to treatment.

Adult↗
PubMed1995

Pyramidal staff training in the extension of treatment for severe behavior disorders.

We implemented a pyramidal training procedure for staff working with individuals who exhibited self-injurious behavior (SIB), aggression, and disruption. Two adults with developmental disabilities and their direct-care staff and supervisors participated. Following successful treatment by the experimenters, two types of baselines were conducted with the clients and their direct-care staff. During an initial baseline, the staff implemented preexisting procedures. Staff members then received instruction on the new treatment procedures using training methods common throughout the institution, and data were collected during this "post-in-service" baseline. Experimenters then taught unit supervisors to implement treatment, collect and interpret data, and provide similar instructions and feedback to the staff members. The supervisor training was implemented in a multiple baseline design across subjects (clients and direct-care staff). Results showed little change following in-service training but noticeable improvements in direct-care staff behaviors and corresponding decreases in the clients' inappropriate behavior following the pyramidal training intervention with supervisors. Six additional clients (along with their direct-care staff and supervisors) participated in pre- and posttreatment replication designs, and their results provided additional support for the efficacy of the supervisor training procedures.

Activities of Daily Living↗
PubMed1994

Restraint fading and the development of alternative behaviour in the treatment of self-restraint and self-injury.

Restraint fading and differential reinforcement were used to reduce the self-injurious behaviour (SIB) and self-restraint of a profoundly retarded man. The variables maintaining both behaviours could not be identified via pre-treatment functional analysis; however, self-restraint exerted at least some stimulus control over SIB. In Phase 1, the subject's topography of self-restraint (wrapping arms in shirt) was replaced with another topography (wrapping wrists in towel) that could be more easily faded to a headband. However, the subject's restraints could not be completely faded, and any movement was accompanied by SIB; thus, in Phase 2, a compliance training procedure was implemented to reduce his SIB while increasing time out of restraint. In Phase 3, the subject was taught to mand for edibles during training sessions. Results indicated that restraint fading combined with the development of alternative behaviour could be an effective treatment procedure for those who engage in both self-restraint and SIB.

Adult↗
PubMed1994

A sequential, test-control methodology for conducting functional analyses of self-injurious behavior.

Multielement and reversal designs used to identify maintaining variables for behavior disorders such as self-injury have several potential limitations, including interaction effects (multielement), inefficiency (reversal), and lack of a continuous control (reversal). This article describes a methodology that minimizes these problems yet captures the best features of both designs. This design consists of several phases implemented in a sequential (A-B-C) fashion, as in the reversal design. However, each phase consists of two conditions, a test and a control, presented concurrently in a multielement format. Five subjects' self-injury was assessed using both the multielement design and the sequential, test-control (or pairwise) design. Results for two subjects indicated that the multielement design produced clear assessment outcomes, and similar findings were obtained using the pairwise design. For two other subjects, the multielement assessments were somewhat undifferentiated, and clearer results were obtained using the pairwise design. The fifth subject's self-injury showed cyclical patterns using both assessment techniques. Benefits and limitations of the sequential assessment methodology are discussed.

Adult↗
PubMed1994

The functions of self-injurious behavior: an experimental-epidemiological analysis.

Data are summarized from 152 single-subject analyses of the reinforcing functions of self-injurious behavior (SIB). Individuals with developmental disabilities referred for assessment and/or treatment over an 11-year period were exposed to a series of conditions in which the effects of antecedent and consequent events on SIB were examined systematically by way of multielement, reversal, or combined designs. Data were collected during approximately 4,000 experimental sessions (1,000 hr), with the length of assessment for individuals ranging from 8 to 66 sessions (M = 26.2) conducted over 2 to 16.5 hr (M = 6.5). Differential or uniformly high responding was observed in 145 (95.4%) of the cases. Social-negative reinforcement (escape from task demands or other sources of aversive stimulation) accounted for 58 cases, which was the largest proportion of the sample (38.1%). Social-positive reinforcement (either attention or access to food or materials) accounted for 40 (26.3%) of the cases, automatic (sensory) reinforcement accounted for 39 (25.7%), and multiple controlling variables accounted for 8 (5.3%). Seven sets of data (4.6%) showed either cyclical or inconsistent patterns of responding that were uninterpretable. Overall results indicated that functional analysis methodologies are extremely effective in identifying the environmental determinants of SIB on an individual basis and, subsequently, in guiding the process of treatment selection. Furthermore, an accumulation of assessment data from such analyses across a large number of individuals provides perhaps the most rigorous approach to an epidemiological study of behavioral function.

Adolescent↗
PubMed1994

Reemergence and extinction of self-injurious escape behavior during stimulus (instructional) fading.

Based on results of a functional analysis indicating that the self-injurious behavior (SIB) of 3 individuals was maintained by negative reinforcement (escape from instructional situations), the effects of stimulus (instructional) fading were evaluated in a multiple baseline design across subjects. The rate of instructions was reduced to zero at the beginning of treatment and was gradually increased (faded in) across sessions as long as SIB remained low. However, if SIB remained high for 10 consecutive sessions, extinction was implemented until SIB decreased, at which point extinction was withdrawn and fading was resumed. Treatment was completed when the rate of instructions was the same as in baseline (two per minute), and SIB remained below 0.5 responses per minute for two consecutive sessions. Results showed that instructional fading (without extinction) virtually eliminated SIB initially, but these effects were not maintained. All 3 subjects required multiple exposures to extinction and over 150 treatment sessions in order to meet the end-of-treatment criteria. Advantages and limitations of fading procedures without an extinction component, as well as extensions of both interventions to other clinical problems, are discussed.

Adult↗
PubMed1994

Transfer of behavioral function as a contributing factor in treatment relapse.

When relapse occurs following successful treatment to reduce problem behavior, it is often attributed to inconsistent implementation of maintenance programs. Although less likely, another potential cause for relapse is a change in the behavior's maintaining contingency over time. To examine this possibility, additional assessment was conducted with 4 individuals who were rereferred to a day-treatment program due to recurrence of their self-injurious behavior (SIB) 2 months to 2 years following successful treatment. In each case, the original treatment had been developed and implemented based on the outcome of functional analysis assessments. For 1 subject, results of a second functional analysis were consistent with those from the original assessment, indicating that the function of her SIB had remained unchanged. For the other 3 subjects, results of the second assessment suggested that their SIB had acquired new or additional functions. These findings indicate that factors other than program inconsistency can lead to relapse, and that clinical reevaluation for such cases should include a current functional analysis to determine if new treatment components are needed.

Adult↗
PubMed1994

Assessing and programming generalized behavioral reduction across multiple stimulus parameters.

Generalization across three stimulus parameters was examined for 5 individuals whose self-injurious behavior was maintained by escape from task demands. Prior to treatment, three stimulus parameters (therapist, setting, and demands) were systematically varied across baseline sessions. These variables were held constant during treatment, which consisted of escape extinction. When treatment was completed, three novel stimulus parameters were probed. If the rate of self-injury was high during this probe, treatment was reimplemented with one new stimulus parameter (the other two were the same as in the original treatment condition). Following this second treatment, another probe with three novel stimuli was conducted. If the rate of self-injury was again high, treatment was implemented again while a second stimulus parameter was changed. This sequence continued until generalization was observed across the three parameters. Results showed idiosyncratic differences in generalization. The behavior of 2 subjects showed complete generalization during the first novel probe. A 3rd subject's behavior showed generalization following treatment across two stimulus parameters (setting and therapist). The behavior of the 2 remaining subjects showed a complete lack of generalization across the three parameters; both subjects required training for novelty by randomly varying the stimulus parameters for a substantial number of sessions.

Adult↗
PubMed1994

Assessment of stereotypic and self-injurious behavior as adjunctive responses.

Certain responses of both humans and nonhumans appear to be maintained indirectly by intermittent reinforcement schedules and have been referred to collectively as adjunctive behavior. Although basic research has examined adjunctive behavior extensively, relatively few studies have been conducted with humans, particularly those with developmental disabilities who often engage in frequent and varied stereotypic behavior. This study assessed possible adjunctive characteristics of self-injurious and stereotypic behaviors using a multielement design containing two types of control conditions. Four subjects who engaged in both self-injurious behavior and stereotypy participated after variables maintaining their self-injury were identified via functional analyses. Each day, subjects were exposed to three 15-min sessions in random order: (a) noncontingent presentation of food on a fixed-time schedule (e.g., FT 30 s), (b) a massed-reinforcement (food) control, and (c) a no-reinforcement control. A variety of fixed-time schedules were examined during different experimental phases. Results of this preliminary study suggested that self-injury was not induced by intermittent reinforcement schedules, whereas the stereotypic behavior of some individuals showed characteristics of adjunctive behavior. The importance of research on adjunctive behavior and suggestions for future studies are discussed.

Adult↗