Motivational Refinements for Decreasing Destructive Behavior

Recruiting at 1 trial location

Overseen By Daniel R Mitteer, Ph.D.

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: Unknown

Duration: 4 weeks

30 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to find better ways to reduce destructive behavior in children with developmental disabilities, such as autism. The study tests new methods to enhance an established treatment called functional communication training (FCT), which helps children communicate their needs instead of acting out. Participants will try different strategies, including PIA-Informed Schedule Thinning, to determine which best maintains positive behavior over time. Children who frequently display destructive behavior, such as aggression, and have not responded to previous treatments might be suitable for this trial. As an unphased trial, this study offers participants a unique opportunity to explore innovative strategies that could significantly improve their quality of life.

Will I have to stop taking my current medications?

The trial requires that participants be on a stable psychoactive drug regimen for at least 10 half-lives per drug or be drug-free. This means you may need to maintain your current medications without changes during the trial.

What prior data suggests that these methods are safe for decreasing destructive behavior?

Previous studies have shown that a method called PIA-Informed Schedule Thinning effectively reduces problem behavior. These studies found that problem behavior remained low when combined with other activities or rewards, suggesting that the treatment is well-tolerated and can effectively manage destructive behavior.

Similarly, using PIA-Informed Schedule Thinning with additional activities or rewards has shown promising results. Research indicates that offering alternative activities or rewards successfully keeps problem behaviors low. For example, providing an alternative activity or reward during treatment helps maintain low levels of destructive behavior.

Overall, both treatments appear safe and well-tolerated, with evidence showing significant reductions in harmful behaviors. This makes them promising options for managing destructive behavior in children with developmental disabilities. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores new methods for reducing destructive behavior through schedule thinning techniques informed by progressive-interval assessments (PIA). Unlike traditional approaches, these methods tailor the starting points for reinforcement schedule thinning based on individual assessments, potentially making them more effective and efficient. Additionally, the use of competing stimuli, like providing alternative activities or rewards, offers a novel way to enhance the impact of these techniques by keeping individuals engaged and reducing the chance of destructive behavior resurgence. This trial aims to find out if these personalized and innovative approaches can lead to more durable improvements in behavior and communication.

What evidence suggests that this trial's treatments could be effective for decreasing destructive behavior?

Research has shown that Functional Communication Training (FCT) helps reduce harmful behavior by teaching children to express their needs more effectively. However, FCT sometimes struggles to maintain these improvements over time. In this trial, one arm will evaluate PIA-Informed Schedule Thinning, which changes how often rewards are given and has reduced problem behavior by 80% in studies. Another arm will assess the addition of competing activities, which can help maintain low levels of harmful behavior by providing engaging alternatives. Together, these methods aim to enhance FCT's effectiveness and longevity by balancing the reinforcement of good behavior and preventing the return of old habits. ^{1 3 4 6 7}

Who Is on the Research Team?

Brian D Greer, Ph.D.

Principal Investigator

Rutgers, The State University of New Jersey

Are You a Good Fit for This Trial?

This trial is for boys and girls aged 3-17 with developmental disabilities who exhibit destructive behaviors reinforced by social consequences, occurring at least 10 times a day. They must be on a stable drug regimen or drug-free, with no changes in educational placement expected during the study.

Inclusion Criteria

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

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

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

Exclusion Criteria

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

My protective supports and medication for self-injury are stable.

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

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo reinforcement schedule thinning using functional communication training (FCT) with progressive interval assessment (PIA) and competing stimuli

4 weeks

Multiple sessions per week

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• PIA-Informed Schedule Thinning
• PIA-Informed Schedule Thinning with Competing Stimuli
• Traditional Schedule Thinning

Trial Overview The trial tests two enhancements to Functional Communication Training (FCT) aimed at reducing destructive behavior: one speeds up reinforcement schedule thinning using progressive interval assessment; another adds competing stimuli to prevent relapse.

How Is the Trial Designed?

Group I: Evaluation of PIA-Informed Schedule Thinning Experimental Treatment 2 Interventions

The goal of Arm 1 will be to will extend pilot work on the utility of individualizing the starting point for reinforcement schedule thinning based on the results of a progressive-interval assessement (PIA). The investigators will do so by conducting reinforcement schedule thinning using a multielement design in two separate contexts, one informed by the results of a PIA and another not so informed. The criteria for schedule thinning will be identical across both conditions but will be applied to each condition independently. Investigators will determine the efficiency of schedule thinning, reductions of destructive behavior, and durability of functional communication responses across the two conditions.

Group II: Evaluation of Competing Items Experimental Treatment 2 Interventions

The goal of Arm 2 will be to evaluate the utility of competing items (e.g., alternative reinforcement or activities) during schedule thinning. Both conditions will be informed by the PIA, similar to the experimental condition in Arm 1. PIA-informed schedule thinning with competing stimuli will be identical to that of PIA-informed schedule thinning, except (a) the therapist will provide continuous access to the highly competing stimulus identified by that participant's competing stimulus assessment (e.g., providing attention while an iPad is unavailable, playing music while working), and (b) it will occur in the other context (e.g., the yellow context). Investigators will determine the efficiency of schedule thinning, reductions of destructive behavior, the durability of functional communication responses across the two conditions, and resurgence of destructive behavior during prolonged periods of extinction.

Group III: Effects of Competing Items on PIA Outcomes Experimental Treatment 1 Intervention

The goal of Arm 3 will be to examine potential interaction effects between the above two experimental arms by conducting PIAs with no, low, moderate, and high competing stimuli to determine the schedule duration at which schedule thinning should commence with each competing stimulus. All participants will complete this arm prior to enrollment in Arms 1 or 2. The investigators will randomize the sequence of each of the four PIAs (PIA with no competing stimuli, PIA with low competing stimuli, PIA with moderately competing stimuli, PIA with highly competing stimuli) across participants.

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 study involving college students, both methods of thinning reinforcement—differential reinforcement of alternative behavior and differential reinforcement of other behavior—showed tolerance to problem behavior, indicating that both methods can be effective in reducing undesired actions.

However, the differential reinforcement of alternative behavior led to higher rates of contextually appropriate behavior, suggesting it may be a more effective strategy for promoting positive behaviors when reinforcement is delayed.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A translational comparison of contingency-based progressive delay procedures and their effects on contextually appropriate behavior. Iannaccone, JA., Jessel, J.[2021]

Both fixed increment and adjusting interresponse time (IRT) schedules of noncontingent reinforcement (NCR) were effective in reducing self-injurious behavior (SIB) in three individuals diagnosed with mental retardation.

The study demonstrated that both methods maintained their effectiveness in suppressing SIB even as the reinforcement schedules were thinned, indicating their potential utility in behavioral interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A comparison of procedures for programming noncontingent reinforcement schedules. Kahng, SW., Iwata, BA., DeLeon, IG., et al.[2018]

The paper reviews the importance of thinning reinforcement schedules after functional communication training (FCT) to manage excessive communication responses, which can make consistent reinforcement impractical in real-life situations.

It discusses various schedule arrangements and methods for effectively reducing reinforcement while maintaining low levels of problem behavior, highlighting the need for further research on managing the reemergence of such behaviors during this process.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Reinforcement schedule thinning following functional communication training: review and recommendations. Hagopian, LP., Boelter, EW., Jarmolowicz, DP.[2021]

The study evaluated a noncontingent reinforcement treatment that effectively established stimulus control, which helped in gradually reducing the reinforcement schedule, making it easier to implement in clinical settings.

The findings support previous research indicating that using stimulus control across different treatment components can enhance the effectiveness of behavioral interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Multiple Schedules Facilitate Rapid Noncontingent Reinforcement Schedule Thinning. Kelley, ME., Clark, RJ., McGarry, KM., et al.[2023]

In a study involving 3 clients with severe problem behavior, using fixed lean (FL) reinforcement schedules from the start led to quicker achievement of treatment goals for 2 out of the 3 participants compared to starting with dense-to-lean (DTL) schedules.

The findings suggest that beginning treatment with lean reinforcement schedules may be more effective and practical in reducing problem behaviors, potentially improving the overall efficiency of behavior-reduction interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A comparison of dense-to-lean and fixed lean schedules of alternative reinforcement and extinction. Hagopian, LP., Toole, LM., Long, ES., et al.[2019]

In experiments with rats, thinning alternative reinforcement using a progressive-interval schedule led to a significant resurgence of previously suppressed target behaviors, indicating that the method of reinforcement affects behavior recovery.

The study found that the timing of reinforcement and the overall rate of alternative reinforcement play crucial roles in the resurgence of behaviors, suggesting that understanding these mechanisms could help in behavior modification strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Resurgence and repeated within-session progressive-interval thinning of alternative reinforcement. Nist, AN., Shahan, TA.[2021]

Functional communication training (FCT) effectively reduces destructive behaviors while promoting acceptable communication responses, as demonstrated in 25 applications across 20 cases.

Using discriminative stimuli to thin reinforcement schedules for the communication responses helps maintain the effectiveness of FCT, reducing the reliance on punishment or additional interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Functional communication training during reinforcement schedule thinning: An analysis of 25 applications. Greer, BD., Fisher, WW., Saini, V., et al.[2019]

The study evaluated methods to improve communication responses in individuals by using multiple reinforcement schedules, leading to quick reductions in destructive behavior in all 4 participants.

By assessing the initial duration of extinction and using competing stimuli, the researchers were able to effectively thin reinforcement schedules, achieving therapeutic goals more rapidly than traditional methods.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Procedures for determining and then modifying the extinction component of multiple schedules for destructive behavior. Miller, SA., Fisher, WW., Greer, BD., et al.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10592362/

Resurgence of destructive behavior following differential ... Following Tali's participation, experimenters used the PIA to individualize and systematically inform the schedule of reinforcement in baseline.

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10891008/

Updated Recommendations for Reinforcement Schedule ... After dense-to-lean schedule thinning, problem behavior has an 80% reduction from baseline. ... destructive behavior when thinning reinforcement schedules ...

3. researchgate.net researchgate.net/publication/372513444_Resurgence_of_destructive_behavior_following_differential_rates_of_alternative_reinforcement

Resurgence of destructive behavior following differential ... Findings from basic and translational studies have been mixed, and the effects of alternative reinforcement rate on resurgence remain unclear.

4. onlinelibrary.wiley.com onlinelibrary.wiley.com/doi/full/10.1002/jaba.499

Minimizing resurgence of destructive behavior using ... Behavioral momentum theory (BMT) suggests that refinements to FCT could mitigate resurgence of destructive behavior during periods of extinction.

5. researchgate.net researchgate.net/publication/356991644_Procedures_for_determining_and_then_modifying_the_extinction_component_of_multiple_schedules_for_destructive_behavior

Procedures for determining and then modifying the ... In the progressive-interval assessment, the clinician is able to identify the longest duration of extinction an individual will tolerate before engaging in ...

6. digitalcommons.unmc.edu digitalcommons.unmc.edu/cgi/viewcontent.cgi?article=1426&context=etd

Evaluating the Use of Competing Items in a Multiple Schedule ... Results showed that the authors successfully maintained a 90% reduction in problem behavior with an average of a 6 min delay to reinforcement.

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5930149/

Systematic Changes in Preference for Schedule-Thinning ... A chained schedule is generally the preferred compound schedule for thinning the schedule of reinforcement for destructive behavior maintained by social- ...