40 Participants Needed

Reward Adjustment Strategies for Problem Behavior

WF
SC
Overseen BySerena Claiborne
Age: < 18
Sex: Any
Trial Phase: Academic
Sponsor: Rutgers, The State University of New Jersey
Must be taking: Psychoactive drugs
No Placebo GroupAll trial participants will receive the active study treatment (no placebo)

What You Need to Know Before You Apply

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.

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.12345

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.16789

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.14101112

Are You a Good Fit for This Trial?

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
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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
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Timeline for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.
How Is the Trial Designed?
4Treatment groups
Experimental Treatment
Group I: Clinical (Human) Study on Effects of Reinforcement-Rate DropExperimental Treatment3 Interventions
Group II: Clinical (Human) Study on Effects of Reinforcement-Quality DropExperimental Treatment2 Interventions
Group III: Clinical (Human) Study on Effects of Reinforcement-Magnitude DropExperimental Treatment3 Interventions
Group IV: Clinical (Human) Study on Counteracting Reinforcement-Rate Drop with Quality IncreaseExperimental Treatment2 Interventions

Find a Clinic Near You

Who Is Running the Clinical Trial?

Rutgers, The State University of New Jersey

Lead Sponsor

Trials
471
Recruited
81,700+

Published Research Related to This Trial

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

Citations

Prevalence of the extinction burst and its attenuation during treatment. [2019]
The use of positive and negative reinforcement in the treatment of escape-maintained destructive behavior. [2019]
Further investigation of differential reinforcement of alternative behavior without extinction for escape-maintained destructive behavior. [2020]
Reemergence and extinction of self-injurious escape behavior during stimulus (instructional) fading. [2018]
Noncontingent reinforcement as treatment for severe problem behavior: some procedural variations. [2018]
A review of reinforcement control procedures. [2019]
The effects of extinction, noncontingent reinforcement and differential reinforcement of other behavior as control procedures. [2019]
Basic and applied research on extinction bursts. [2023]
Resistance to extinction in the steady state and in transition. [2019]
A Theory of the Extinction Burst. [2023]
11.United Statespubmed.ncbi.nlm.nih.gov
The extinction burst: Impact of reinforcement time and level of analysis on measured prevalence. [2021]
12.United Statespubmed.ncbi.nlm.nih.gov
Early extinction effects following intermittent reinforcement: Little evidence of extinction bursts. [2021]
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