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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to explore how different reward strategies affect problem behaviors in children, with a focus on the "extinction burst" phenomenon, where behaviors temporarily worsen before improving. Researchers will test several approaches by adjusting the frequency, amount, or quality of rewards. Children who experience problem behaviors at least ten times a day, despite past treatments, might be suitable candidates for this study. The goal is to reduce these initial bursts and improve treatment outcomes. As an unphased trial, this study offers a unique opportunity to contribute to innovative strategies that could enhance treatment for problem behaviors.

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 there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that about 70% of treatments using extinction, a method where a behavior is no longer rewarded, can lead to sudden increases in unwanted behavior, known as extinction bursts. These bursts often occur early in the treatment process.

This study tests different ways to give rewards to see if they can reduce these bursts. For instance, changing the type or amount of rewards might influence behavior differently. However, these changes might still cause some initial bursts, especially if the reward system is suddenly altered.

Overall, while extinction methods can be effective, they may temporarily increase problem behavior. The researchers aim to find a way to manage these bursts while still reducing unwanted behaviors over time. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these treatments because they focus on different ways to adjust rewards to manage problem behaviors effectively. Traditional approaches often involve consistent reinforcement, but this trial explores how changes in the magnitude, rate, or quality of rewards can impact behavior. The unique aspect of these treatments is their potential to prevent or reduce the likelihood of an "extinction burst," which is a temporary increase in unwanted behavior when reinforcement stops. By experimenting with holding or adjusting the quality and rate of rewards, this trial aims to find more nuanced strategies for behavior management that could lead to better, more tailored treatments.

What evidence suggests that this trial's treatments could be effective for managing extinction bursts?

Research has shown that treatments like Functional Communication Training (FCT) can effectively reduce problem behavior. This trial tests different strategies for adjusting rewards. One arm examines the effects of decreasing reward quality, while another maintains consistent reward quality to prevent extinction bursts. A separate arm studies the impact of reducing reward frequency, and another maintains the reward frequency. Additionally, one arm explores combining reduced reward frequency with increased reward quality to counteract potential increases in unwanted behavior. These strategies aim to optimize treatment effectiveness while minimizing behavior spikes. ^{1 2 5 6 7}

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've been on the same mental health medication for a while or not taking any.

Problem behavior that occurs at least 10 times a day, despite previous treatment

Problem behavior maintained by social positive reinforcement

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 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?

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+

Published Research Related to This Trial

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 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 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]

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]

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]

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]

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]

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 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]

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]

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]

Citations

1.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC9868065/

Basic and applied research on extinction bursts - PMC

In general terms, the equation suggests that FCT reduces problem behavior relative to baseline because extinction reduces the value of this ...

2.

clinicaltrials.gov

clinicaltrials.gov/study/NCT05925101

Basic and Applied Research on Extinction Bursts

In this condition, therapists will place destructive behavior on extinction and deliver no reinforcement for functional communication responses (FCRs).

3.

pubmed.ncbi.nlm.nih.gov

pubmed.ncbi.nlm.nih.gov/39829057/

The extinction burst: Effects of reinforcement magnitude

This experiment examined the effects of reinforcement magnitude on the extinction burst with rats.

4.

researchgate.net

researchgate.net/publication/395382379_The_extinction_burst_Effects_of_alternative_reinforcement_magnitude

The extinction burst: Effects of alternative reinforcement ...

For all participants, problem behavior decreased during only the large differential magnitude condition, and including reinforcer access ...

5.

onlinelibrary.wiley.com

onlinelibrary.wiley.com/doi/full/10.1002/jaba.1088

Reinforcer value moderates response magnitude and ...

Reinforcer consumption relative to demand intensity were most influential across all dependent variables.

6.

withpower.com

withpower.com/trial/phase-aggression-5-2023-a6b25

Reward Adjustment Strategies for Problem Behavior

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.

7.

researchgate.net

researchgate.net/publication/13097323_Side_effects_of_extinction_Prevalence_of_bursting_and_aggression_during_the_treatment_of_self-injurious_behavior

Side effects of extinction - Self-Injurious Behavior

Extinction, especially in blunt applications that are sustained through a "burst", can come with negative side effects (Lerman, Iwata, & Wallace ...