Reward Adjustment Strategies for Problem Behavior

Overseen By Serena Claiborne

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: Rutgers, The State University of New Jersey

Must be taking: Psychoactive drugs

Disqualifiers: Rett syndrome, Degenerative conditions, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 6

Duration: 8-12 weeks

40 Participants Needed

Trial Summary

What is the purpose of this trial?

Although highly effective, treatments like FCT include extinction, which can have adverse side effects. The extinction burst, an increase in the frequency or intensity of destructive behavior at the start of treatment, is the most common side effect of extinction, and can increase the risk of harm to the patient and others. The goal of the current study is to evaluate the prevalence of extinction bursts when various parameters of reinforcement (i.e., rate, magnitude, quality) are manipulated.

Will I have to stop taking my current medications?

The trial requires that participants be on a stable medication regimen for at least 10 half-lives of each drug or be drug-free. This means you should not change your current medications before or during the study.

What data supports the effectiveness of the treatment for problem behavior?

Research shows that extinction, when combined with other strategies, can effectively reduce problem behaviors. For example, using extinction with alternative procedures reduced the occurrence of extinction bursts, and combining different reinforcement strategies helped decrease destructive behavior. ^{1 2 3 4 5}

Is the Reward Adjustment Strategy for Problem Behavior generally safe for humans?

Research indicates that while extinction procedures can be effective, they may cause an initial increase in the behavior being targeted, known as an 'extinction burst,' in about 24% of cases. However, this effect is less common when extinction is combined with other strategies, and few negative side effects have been observed overall. ^{1 5 6 7 8}

How does the treatment 'Reward Adjustment Strategies for Problem Behavior' differ from other treatments for this condition?

This treatment is unique because it focuses on adjusting rewards to manage problem behavior, potentially reducing the occurrence of an 'extinction burst' (a temporary increase in unwanted behavior when a reward is removed). Unlike traditional methods that may solely rely on removing rewards, this approach combines extinction with alternative reinforcement strategies to minimize adverse effects. ^{1 9 10 11 12}

Eligibility Criteria

This trial is for children aged 3 to 17 who show disruptive behaviors like aggression or self-harm at least 10 times a day, even after treatment. They must have social support and be on stable medication or drug-free, with no changes expected in their educational setting during the study.

Inclusion Criteria

I am between 3 and 17 years old.

Stable protective supports for self-injurious behavior (e.g., helmet) with no anticipated changes during enrollment

Stable educational plan and placement with no anticipated changes during the child's treatment

Exclusion Criteria

Patients currently receiving 15 or more hours per week of treatment for their problem behavior

A comorbid health condition or major mental disorder that would interfere with study participation

Occurrence of self-injury during study assessments that presents a risk of serious or permanent harm (e.g., detached retinas) based on our routine clinical-risk assessment

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Preliminary Procedures

Paired-Stimulus Preference Assessment and Competing-Stimulus Assessment to evaluate participant preferences

4-6 weeks

Multiple sessions (in-person)

Functional Analysis

Conduct functional analysis to identify consequences maintaining destructive behavior

2-4 weeks

Multiple sessions (in-person)

Treatment

Functional Communication Training (FCT) with various experimental conditions to evaluate effects on destructive behavior

8-12 weeks

Multiple sessions (in-person)

In-Home Baseline Generalization Sessions

Conduct baseline sessions in the home to assess generalization of treatment effects

2-4 weeks

3 sessions (in-home)

Post-Study Procedures

Provide relevant treatment services and evaluate reinforcement-schedule thinning

4-6 weeks

In-Home Post-Treatment Generalization Sessions

Caregivers implement treatment sessions in the home to assess for generalization of treatment effects

2-4 weeks

3 sessions (in-home)

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Treatment Details

Interventions

• Extinction-only condition
• Magnitude-drop condition
• Magnitude-hold condition
• Quality-drop condition
• Quality-hold condition
• Rate-drop condition
• Rate-drop/quality-increase condition
• Rate-hold condition

Trial Overview The study tests how changing different aspects of reinforcement (like rate, magnitude, quality) affects the 'extinction burst,' which is an initial increase in problem behavior when trying to stop it through treatments like FCT.

Participant Groups

Group I: Clinical (Human) Study on Effects of Reinforcement-Rate Drop Experimental Treatment 3 Interventions

Based on the TWML, we hypothesize that a large drop in reinforcement rate at the start of treatment with extinction alone or with FCT will increase the probability of an extinction burst. Preventing such drops will lessen the probability of an extinction burst. We will test the effects of eliminating reinforcement in the extinction-only condition and the effects of substantially decreasing the rate of reinforcement in the rate-drop condition. We will compare these two suboptimal treatments with one in which we ensure that the rate of reinforcement remains equal to baseline, called the rate-hold condition, which the TWML predicts will prevent an extinction burst.We will equate reinforcement magnitude (i.e., each reinforcer delivery will be 20 s) and quality (i.e., the functional reinforcer identified during the functional analysis) across the baseline and the rate-drop and rate-hold conditions (no reinforcement will be delivered in the extinction-only condition).

Group II: Clinical (Human) Study on Effects of Reinforcement-Quality Drop Experimental Treatment 2 Interventions

Note: We will conduct Ex 3 with participants who display destructive behavior reinforced by access to tangible items so that we can vary reinforcement quality using the results of a paired-stimulus preference assessment. Based on the TWML, we hypothesize that a large drop in reinforcement quality at the start of FCT will increase the probability of an extinction burst. Preventing such drops will lessen the probability of an extinction burst. Therefore, we will program a large drop in the quality of reinforcement in our quality-drop condition and ensure that the quality of reinforcement remains equal to the quality of reinforcement in baseline in the quality-hold condition. In Experiment 3, we will equate reinforcement rate (i.e., independent, VI 1.5-s schedules) and magnitude (i.e., each reinforcer delivery will be 20 s) across baseline and both FCT conditions.

Group III: Clinical (Human) Study on Effects of Reinforcement-Magnitude Drop Experimental Treatment 3 Interventions

Based on the TWML, we hypothesize that a large drop in reinforcement magnitude at the start of treatment will increase the probability of an extinction burst. Preventing drops will lessen the probability of an extinction burst. We will test the effects of eliminating reinforcement in the extinction-only condition and the effects of substantially decreasing the magnitude of reinforcement in the magnitude-drop condition. We will compare these two suboptimal treatments with one in which we ensure that the magnitude of reinforcement remains equal to baseline, called the magnitude-hold condition, which the TWML predicts will prevent an extinction burst. We will equate reinforcement rate (i.e., independent, VI 1.5-s schedules) and quality (i.e., the functional reinforcer identified during the functional analysis) across baseline and both FCT conditions (no reinforcement will be delivered in the extinction-only condition).

Group IV: Clinical (Human) Study on Counteracting Reinforcement-Rate Drop with Quality Increase Experimental Treatment 2 Interventions

Based on the TWML, we hypothesize that a large drop in reinforcement rate at the start of FCT will increase the probability of an extinction burst but that simultaneously increasing reinforcement quality will counteract the negative effects of a drop in reinforcement rate. We will program a large drop in the rate of reinforcement in the rate-drop-only condition, and in the rate-drop/quality-increase condition we will program the same drop in reinforcement rate but also program a large increase in reinforcement quality.

Who Is Running the Clinical Trial?

Rutgers, The State University of New Jersey

Lead Sponsor

Trials

471

Recruited

81,700+

Findings from Research

In a review of 113 sets of extinction data, an 'extinction burst'—an initial increase in the target behavior—was observed in only 24% of cases, suggesting it may be less common than previously thought.

The likelihood of experiencing an extinction burst was significantly lower (12%) when extinction was combined with other operant procedures, compared to when it was used alone (36%), indicating that combining strategies may help mitigate this side effect.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prevalence of the extinction burst and its attenuation during treatment. Lerman, DC., Iwata, BA.[2019]

In a study involving 3 clients, reinforcing compliance with tangible items and attention effectively reduced destructive behavior, even when that behavior led to breaks from tasks.

For one client, implementing extinction (removing the break as a consequence) was essential to decrease destructive behavior and improve compliance, highlighting the importance of reinforcement strategies in behavior management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The use of positive and negative reinforcement in the treatment of escape-maintained destructive behavior. Piazza, CC., Fisher, WW., Hanley, GP., et al.[2019]

Differential reinforcement of alternative behavior (DRA) can effectively reduce destructive behavior without using extinction, by adjusting the quality and magnitude of reinforcement for compliance in participants.

Maintaining the effectiveness of DRA during reinforcement schedule thinning often requires a combination of both the magnitude and quality of reinforcement, highlighting the need for tailored approaches in behavioral interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Further investigation of differential reinforcement of alternative behavior without extinction for escape-maintained destructive behavior. Briggs, AM., Dozier, CL., Lessor, AN., et al.[2020]

Instructional fading effectively reduced self-injurious behavior (SIB) in three individuals by gradually increasing the rate of instructions after initially reducing them to zero, but the effects were not sustained over time.

All subjects required multiple rounds of extinction and over 150 treatment sessions to achieve lasting results, highlighting the need for careful monitoring and potential adjustments in treatment strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Reemergence and extinction of self-injurious escape behavior during stimulus (instructional) fading. Zarcone, JR., Iwata, BA., Smith, RG., et al.[2018]

A study involving three participants with developmental disabilities found that noncontingent reinforcement (NCR) effectively reduced problem behaviors when tailored to the latency of the first occurrence of the behavior.

The research indicated that NCR could be effective even without the use of extinction, suggesting that the initial schedule of reinforcement is a key factor in the treatment's success.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Noncontingent reinforcement as treatment for severe problem behavior: some procedural variations. Lalli, JS., Casey, SD., Kates, K.[2018]

The study emphasizes the importance of using control conditions to accurately assess the effects of positive and negative reinforcement on response rates, ensuring that extraneous variables do not influence the results.

Several types of control conditions are discussed, highlighting their methodological rigor and practical utility, which can help researchers design better experiments to evaluate reinforcement effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A review of reinforcement control procedures. Thompson, RH., Iwata, BA.[2019]

In a study comparing different reinforcement control techniques, extinction was found to produce the most consistent and rapid decrease in behavior, indicating its effectiveness as a reversal control method.

Extinction also showed minimal negative side effects during transitions, making it a safer option compared to noncontingent reinforcement (NCR) and differential reinforcement of other behavior (DRO).

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effects of extinction, noncontingent reinforcement and differential reinforcement of other behavior as control procedures. Thompson, RH., Iwata, BA., Hanley, GP., et al.[2019]

The phenomenon known as the extinction burst, where a behavior temporarily increases before decreasing after reinforcement is removed, is not well understood, and existing theories do not adequately explain its dynamic nature.

The authors propose a new model called the temporally weighted matching law, which offers insights into controlling response bursts and provides practical recommendations for clinicians to mitigate or prevent these bursts in behavior.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Basic and applied research on extinction bursts. Fisher, WW., Greer, BD., Shahan, TA., et al.[2023]

In a series of three experiments with pigeons, it was found that the rate of food reinforcement during training influenced how many reinforcers were omitted during extinction trials, supporting the idea that higher reinforcement rates lead to more significant resistance to extinction.

The experiments demonstrated that pigeons showed a partial-reinforcement extinction effect, where more reinforcers were omitted in continuous reinforcement trials compared to partial reinforcement, suggesting that the type of reinforcement schedule impacts behavior during extinction.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Resistance to extinction in the steady state and in transition. Nevin, JA., Grace, RC.[2019]

The proposed theory suggests that an extinction burst, or temporary increase in a behavior when reinforcement stops, occurs because the removal of competing activities allows the target response to increase, but this effect is short-lived as the value of the target response diminishes over time.

This theory helps explain why extinction bursts are not always observed, particularly after low reinforcement schedules, and indicates that providing alternative reinforcements can eliminate the burst, suggesting a new perspective on behavior extinction without relying on frustration effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Theory of the Extinction Burst. Shahan, TA.[2023]

The study found that the occurrence of an extinction burst—an increase in response rates immediately after reinforcement stops—was more prevalent when looking at the first minute of extinction rather than the entire session, suggesting timing is crucial in measuring this phenomenon.

Including reinforcement time in the calculations of baseline response rates also increased the prevalence of the extinction burst, indicating that how we define and measure these behaviors can significantly impact our understanding of extinction processes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The extinction burst: Impact of reinforcement time and level of analysis on measured prevalence. Nist, AN., Shahan, TA.[2021]

The study examined extinction bursts in pigeons and rats, finding that increases in response rates immediately after reinforcement discontinuation were rare and inconsistent across different experimental conditions.

These results suggest that extinction bursts may not be as common as previously thought, indicating a need for further research to understand their occurrence based on different reinforcement histories.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Early extinction effects following intermittent reinforcement: Little evidence of extinction bursts. Lattal, KA., Kuroda, T., Cook, JE.[2021]

References

1. United States pubmed.ncbi.nlm.nih.gov

Prevalence of the extinction burst and its attenuation during treatment. [2019]

2. United States pubmed.ncbi.nlm.nih.gov

The use of positive and negative reinforcement in the treatment of escape-maintained destructive behavior. [2019]

3. United States pubmed.ncbi.nlm.nih.gov

Further investigation of differential reinforcement of alternative behavior without extinction for escape-maintained destructive behavior. [2020]

4. United States pubmed.ncbi.nlm.nih.gov

Reemergence and extinction of self-injurious escape behavior during stimulus (instructional) fading. [2018]

5. United States pubmed.ncbi.nlm.nih.gov

Noncontingent reinforcement as treatment for severe problem behavior: some procedural variations. [2018]

6. United States pubmed.ncbi.nlm.nih.gov

A review of reinforcement control procedures. [2019]

7. United States pubmed.ncbi.nlm.nih.gov

The effects of extinction, noncontingent reinforcement and differential reinforcement of other behavior as control procedures. [2019]

8. United States pubmed.ncbi.nlm.nih.gov

Basic and applied research on extinction bursts. [2023]

9. United States pubmed.ncbi.nlm.nih.gov

Resistance to extinction in the steady state and in transition. [2019]

10. Switzerland pubmed.ncbi.nlm.nih.gov

A Theory of the Extinction Burst. [2023]

11. United States pubmed.ncbi.nlm.nih.gov

The extinction burst: Impact of reinforcement time and level of analysis on measured prevalence. [2021]

12. United States pubmed.ncbi.nlm.nih.gov

Early extinction effects following intermittent reinforcement: Little evidence of extinction bursts. [2021]