Behavioral Economics Strategies for Problem Behavior

Recruiting at 1 trial location

Overseen By Michael P Kranak, PhD

Age: < 65

Sex: Any

Trial Phase: Academic

Sponsor: Oakland University

Disqualifiers: Not meeting inclusion criteria

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

Compensation: Varies

Number of Visits: Unknown

Duration: 24 months

24 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

The goal of this clinical trial is to compare a novel tactic for mitigating reinstatement compared to the current standard of care approach using a translational-treatment model. The main questions it aims to answer are: 1. how well does progressive ratio training mitigate response-dependent reinstatement compared to the standard of care approach? 2. how well does progressive ratio training mitigate response-independent reinstatement compared to the standard of care approach?

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

Is Differential Reinforcement of Alternative Behavior (DRA) with or without extinction safe for humans?

The research indicates that Differential Reinforcement of Alternative Behavior (DRA), both with and without extinction, has been used safely in various studies, particularly for individuals with developmental disabilities, to reduce problem behaviors and encourage appropriate behaviors. ^{1 2 3 4 5}

How is the treatment 'Differential Reinforcement of Alternative Behavior with Extinction, Progressive Ratio Training' different from other treatments for problem behavior?

This treatment is unique because it combines rewarding alternative behaviors while ignoring problem behaviors, and it uses a progressive ratio schedule to gradually increase the effort required for rewards, making it more effective in reducing problem behavior without needing to stop all reinforcement for the problem behavior. ^{1 2 4 6 7}

What data supports the effectiveness of the treatment Differential Reinforcement of Alternative Behavior with Extinction?

Research shows that Differential Reinforcement of Alternative Behavior (DRA) is effective in reducing unwanted behaviors, even without using extinction, by adjusting the quality, magnitude, and timing of rewards to encourage positive behaviors. Studies have found success in using DRA to address a range of issues, from minor communication problems to severe destructive behaviors, especially in individuals with developmental disabilities. ^{1 2 3 5 7}

Who Is on the Research Team?

Michael P Kranak, PhD

Principal Investigator

Oakland University

Are You a Good Fit for This Trial?

This trial is for boys and girls aged 6 to 21 who show problem behavior and have been diagnosed with an intellectual or developmental disability, including learning disabilities or expressive language disorder. Those who do not meet these specific criteria cannot participate.

Inclusion Criteria

Engage in problem behavior

Diagnosis of some type of intellectual and developmental disability

I am between 6 and 21 years old.

Exclusion Criteria

Not meeting the inclusion criteria

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either the standard of care approach or progressive ratio training to mitigate problem behavior

24 months

Reinstatement Tests

Participants undergo tests to evaluate the effectiveness of the treatment in preventing reinstatement of problem behavior

24 months

Follow-up

Participants are monitored for safety and effectiveness after treatment

4-8 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Differential Reinforcement of Alternative Behavior with Extinction
• Progressive Ratio Training

Trial Overview The study is testing two methods: Progressive Ratio Training (PRT) and Differential Reinforcement of Alternative Behavior with Extinction, to see how they prevent the return of problem behaviors compared to standard treatments.

How Is the Trial Designed?

Group I: Standard of Care Experimental Treatment 1 Intervention

Participants in the standard of care Arm will receive an analogue to the standard of care approach for problem behavior: differential reinforcement of alternative behavior (DRA) with extinction. In DRA with extinction, the proxy for problem behavior will cease to produce reinforcement while the proxy for communication behavior will produce reinforcement on a fixed-ratio 1 schedule of reinforcement.

Group II: Progressive Ratio Training Experimental Treatment 1 Intervention

Participants in the progressive ratio training Arm will experience the novel reinstatement-mitigation tactic: Progressive Ratio Training (PRT). Progressive ratio training (PRT) is used to prevent recurrence of the proxy response when extinction errors occur. PRT involves providing a reinforcer for the proxy response on a geometric progressive ratio (PR) scale. The schedule requirement will increase for the target response each time a reinforcer is delivered. For example, once a reinforcer is delivered on the PR-2 schedule, the requirement will increase to a PR-4, then to a PR-8, -16, -32, etc.

Who Is Running the Clinical Trial?

Oakland University

Lead Sponsor

Trials

15

Recruited

3,300+

Auburn University

Collaborator

Trials

81

Recruited

14,600+

Published Research Related to This Trial

The study demonstrated that differential reinforcement of alternative behavior (DRA) can be effectively implemented without using extinction, which is often necessary but can be counterproductive if not done correctly.

By assessing individual sensitivities to reinforcement parameters like quality, magnitude, and immediacy, the researchers tailored interventions that significantly reduced problem behavior in all participants, highlighting the importance of personalized approaches in behavioral treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Manipulating parameters of reinforcement to reduce problem behavior without extinction. Kunnavatana, SS., Bloom, SE., Samaha, AL., 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]

Differential reinforcement of alternative behavior (DRA) has been effective in reducing a wide range of unwanted behaviors, from minor issues like communication difficulties to serious problems such as failure to thrive, based on a review of 116 studies over 30 years.

DRA has a strong track record for treating destructive behaviors in individuals with developmental disabilities and is also effective in addressing food refusal, indicating its versatility as a behavioral intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A review of empirical support for differential reinforcement of alternative behavior. Petscher, ES., Rey, C., Bailey, JS.[2019]

Differential reinforcement of alternative behavior (DRA) can be effective without requiring the extinction of problem behaviors, which expands its applicability in behavioral treatments.

The proposed definition of DRA emphasizes providing greater reinforcement for desired behaviors while minimizing reinforcement for undesired behaviors, allowing for flexibility in treatment approaches.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

On the definition of differential reinforcement of alternative behavior. Vollmer, TR., Peters, KP., Kronfli, FR., et al.[2021]

The study involved seven children with developmental disabilities and explored how different aspects of reinforcement (duration, quality, and delay) could encourage appropriate behavior over problem behavior without using extinction methods.

The most significant and consistent improvements in behavior were achieved when multiple reinforcement strategies were combined, indicating that a comprehensive approach can effectively reduce problem behaviors and promote appropriate ones.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An investigation of differential reinforcement of alternative behavior without extinction. Athens, ES., Vollmer, TR.[2021]

In a study with 32 college students, manipulating reinforcement dimensions (magnitude, immediacy, and quality) for appropriate behavior significantly reduced problem behavior during a button-pressing task.

The most effective results were observed when all three dimensions of reinforcement were combined, suggesting that enhancing the appeal of alternative behaviors can improve treatment outcomes without the need for extinction.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Varying reinforcer dimensions during differential reinforcement without extinction: A translational model. Iannaccone, JA., Jessel, J.[2023]

In a study involving 4 participants, one of two preferred stimuli was found to be more effective in promoting responses as the effort required increased, indicating that not all reinforcers work equally under different conditions.

The findings suggest that using progressive-ratio schedules can help identify which reinforcers are more effective for treating destructive behavior, particularly as the effort needed to obtain them increases.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Assessing reinforcers under progressive schedule requirements. Roane, HS., Lerman, DC., Vorndran, CM.[2018]

Citations

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

Manipulating parameters of reinforcement to reduce problem behavior without extinction. [2019]

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

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

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

A review of empirical support for differential reinforcement of alternative behavior. [2019]

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

On the definition of differential reinforcement of alternative behavior. [2021]

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

An investigation of differential reinforcement of alternative behavior without extinction. [2021]

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

Varying reinforcer dimensions during differential reinforcement without extinction: A translational model. [2023]

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

Assessing reinforcers under progressive schedule requirements. [2018]