A review of environmental enrichment as treatment for problem behavior maintained by automatic reinforcement

Research Patterns in the Treatment of Adults With Problem Behavior and Intellectual and Developmental Disabilities: A Quantitative Systematic Review

Research featuring adults with intellectual and developmental disabilities who engage in problem behavior has outlined various treatment approaches. The current quantitative systematic literature review identified and coded 76 peer-reviewed and gray literature articles published between January 2002 and September 2022. Following article identification and coding, we calculated effect size estimates (i.e., Tau Baseline Corrected) and assessed the methodological rigor of included articles. Through this work, we uncovered 42 unique multi-protocol treatments (i.e., treatments incorporating multiple therapeutic elements). Multi-protocol treatments were associated with larger effect sizes (more effective) compared to single-protocol treatments. The average methodological rigor score associated with peer-reviewed works was 1.6 (out of 4), while gray literature works scored 1.2. We offer commentary in response to these outcomes, alongside recommendations for future research to address the many avenues of inquiry that appear to remain largely neglected (e.g., component analysis to evaluate individual treatment elements and their efficacy).

A Quantitative Systematic Literature Review of Combination Punishment Literature: Progress Over the Last Decade

This review evaluated single-case experimental design research that examined challenging behavior interventions utilizing punishment elements. Thirty articles published between 2013 and 2022 met study inclusion criteria. Study quality was also assessed. Through multiple levels of analysis (e.g., descriptive statistics, non-parametric statistics), we examined (a) participant and study trends, (b) differential outcomes related to temporal reinforcement approaches (antecedent, consequent, or combined reinforcement) applied alongside punishment element(s), (c) differential outcomes related to the punishment type (negative, positive) applied alongside reinforcement, and (d) effect sizes associated with study rigor across peer-reviewed and gray literature. Our results may tentatively suggest that, for certain situations, concurrently applying punishment with antecedent reinforcement approaches may coincide with significantly larger effect sizes compared to combined temporal reinforcement approaches, while positive punishment applied concurrently with reinforcement may coincide with larger but non-significant intervention effects. Most featured articles met rigor criteria, but larger effects were seen in peer-reviewed literature.

Enriching Prison Environments via Peer-Led Activities

Criminologists have long claimed that states of deprivation engendered by restrictive prison environments account for much of the problematic behavior that occurs there. It is logical to assume that any efforts to provide greater access to meaningful and appropriate activities may therefore serve to reduce such behavior by altering motivating operations for misconduct and occasioning reinforcement for other types of behaviors. Given the higher rates of trauma exposure and other mental health issues in prison populations, considering trauma-informed practices in intervention design is prudent. The current study evaluated the effects of environmental enrichment via prisoner-selected, peer-led activities conducted during association times. We used direct observation to assess engagement, existing facility data collection to detect changes in problematic behavior, and prisoner and staff surveys to assess perceptions of the overall acceptability and effects of the intervention. Prisoners engaged with and led a range of activities, with the majority reporting positive effects on behavior, social relationships, and general well-being; staff responses were generally positive but more tempered. Institutional behavior records did not appear sensitive enough to detect treatment effects. We discuss the results in terms of integrating trauma-informed care into prison interventions and the need to develop more robust measures of behavior change.

Evaluation of a latency-based competing stimulus assessment

A competing stimulus assessment is used to identify stimuli that are associated with a low level of challenging behavior and a high level of engagement. These stimuli are often used as a treatment component for challenging behavior that is maintained by automatic reinforcement. One limitation of implementing competing stimulus assessments is that they may be time consuming. The purpose of the current study was to evaluate the efficacy and efficiency of a latency-based competing stimulus assessment. During the asssessment, a therapist presented potential competing stimuli to the participants and contingent on the first occurrence of challenging behavior, the trial was terminated. The results of a brief treatment evaluation indicated that stimuli that were associated with the longest latency to challenging behavior were more effective in competing with challenging behavior relative to stimuli that were associated with shorter latencies. However, procedural modifications were necessary for one participant. The use of latency-based measures improved the efficiency of conducting a competing stimulus assessment.

Using Non-Violent Discipline Tools: Evidence Suggesting the Importance of Attunement

Training in non-violent discipline is important to prevent violence against children and ensure that their caregivers remain a safe base for them. This paper aims to deepen understanding of non-violent discipline by exploring attunement as a mechanism in the effectiveness of non-violent discipline tools. Attunement describes the sensitive responsiveness of caregivers towards their children and has been found to be central to the formation of secure attachment bonds and development of self-regulation. It includes understanding or being "in tune with" the child's needs and signals, matching these with appropriate responses. The objective of this paper is to explore attunement in relation to non-violent discipline. Peer-reviewed systematic reviews previously included in a systematic overview of evidence on non-violent discipline options were screened for information relevant to attunement. All reviews were published in English between 1999 and 2018 and offered evidence on at least one non-violent discipline tool. Although no reviews explicitly addressed attunement, evidence was found suggesting its importance in the use and effectiveness of discipline methods. Research directly investigating attunement in discipline is needed.

Reduction of restricted repetitive behavior by environmental enrichment: Potential neurobiological mechanisms

Restricted repetitive behaviors (RRB) are one of two diagnostic criteria for autism spectrum disorder and common in other neurodevelopmental and psychiatric disorders. The term restricted repetitive behavior refers to a wide variety of inflexible patterns of behavior including stereotypy, self-injury, restricted interests, insistence on sameness, and ritualistic and compulsive behavior. However, despite their prevalence in clinical populations, their underlying causes remain poorly understood hampering the development of effective treatments. Intriguingly, numerous animal studies have demonstrated that these behaviors are reduced by rearing in enriched environments (EE). Understanding the processes responsible for the attenuation of repetitive behaviors by EE should offer insights into potential therapeutic approaches, as well as shed light on the underlying neurobiology of repetitive behaviors. This review summarizes the current knowledge of the relationship between EE and RRB and discusses potential mechanisms for EE's attenuation of RRB based on the broader EE literature. Existing gaps in the literature and future directions are also discussed.

PRN usage before and after discharge from a forensic inpatient unit: A series example of patients with intellectual disabilities

Adults living with intellectual and developmental disabilities are often prescribed psychotropic medication on an "as needed" basis (PRN) in response to behavioural challenges. In the present study we conducted a retrospective analysis of medication administration records in the 6-months preceding and following discharge of 11 adults with intellectual and developmental disabilities to community settings from forensic inpatient units within a mental health hospital. We found a significant reduction in the frequency of PRN usage after discharge. We propose potential reasons for the difference in PRN administration across settings and make suggestions for future research.

A practitioner's guide to emphasizing choice-making opportunities in behavioral services provided to individuals with intellectual and developmental disabilities

Promoting choice is a defining value guiding Positive Behavior Support (PBS) models for serving individuals with intellectual and/or developmental disabilities (IDD). The ability to make independent choices is of paramount importance to self-advocacy and self-determination. Promoting choice is also an essential commitment of trauma-informed care (TIC) in the provision of services to vulnerable individuals, as trauma often involves experiences in which an individual has no control over aversive events that occur, and choice-making opportunities can empower traumatized individuals to regain control over the environments they routinely encounter. However, incorporating meaningful choice making into behavioral programming is often more difficult than it seems. We synthesize the relevant, contemporary literature to provide professionals with actionable suggestions for incorporating choice making into everyday behavioral services. After summarizing the importance of promoting choice into behavioral services based on the values that define both PBS and TIC frameworks, we (a) offer a behavior-analytic interpretation of the skill of making choices, (b) synthesize key literature on how to teach choice making skills, (c) provide recommendations for the situations within one's care in which choice-making opportunities may be most beneficial, and (d) discuss some of the barriers and potential solutions to incorporating choice-making opportunities for individuals with IDD.

Parents Are People Too: Implementing Empirically Based Strategies During Daily Interactions

The outcomes of the COVID-19 pandemic have resulted in decision-making related to in-person versus remote behavior-analytic service delivery. For those service providers who shifted from delivering in-person therapy to remote consultation, parents have presumably, at least at times, assumed a role similar to a registered behavior technician (RBT). We suggest that behavior analysts recommend two empirically based strategies to parents that they could incorporate into their daily lives during service disruptions: environmental enrichment and differential reinforcement of alternative behavior. We provide examples of naturally occurring contexts during which parents could integrate these procedures: (1) self-care or daily living activities, (2) physical activity, and (3) preferred learning activities. We support selecting these strategies and their application during exemplar contexts under the premise that they do not result in additional time expenditure, afford parents opportunities to complete essential (household, work-related, or personal) tasks, and still result in therapeutic gains.

A comparison of RIRD within chained and multiple schedules in the treatment of vocal stereotypy

Slaton and Hanley (2016) compared the effects of multiple and chained schedules on stereotypy and item engagement for 2 individuals who exhibited automatically maintained motor stereotypy. Contingent access to motor stereotypy (i.e., chained schedules) was more effective than time-based access (i.e., multiple schedules) at reducing motor stereotypy, increasing item engagement, and establishing stimulus control for both participants. We systematically replicated Slaton and Hanley with 2 participants by a) targeting vocal stereotypy, b) including response interruption and redirection as a treatment component across conditions, c) conducting sessions in the natural environment with teaching assistants as change agents, and d) conducting an analysis of the effective treatment component(s). Chained schedules were more effective for 1 participant, whereas both treatments were effective for the other participant. The component analysis showed that different components were necessary for effective treatment for each participant.

Biopsychological correlates of repetitive and restricted behaviors in autism spectrum disorders

BACKGROUND

Autism Spectrum Disorder (ASD) is considered a neurodevelopmental condition that is characterized by alterations in social interaction and communication, as well as patterns of restrictive and repetitive behaviors (RRBs). RRBs are defined as broad behaviors that comprise stereotypies, insistence on sameness, and attachment to objects or routines. RRBs can be divided into lower-level behaviors (motor, sensory, and object-manipulation behaviors) and higher-level behaviors (restrictive interests, insistence on sameness, and repetitive language). According to the DSM-5, the grade of severity in ASD partially depends on the frequency of RRBs and their consequences for disrupting the life of patients, affecting their adaptive skills, and increasing the need for parental support.

METHODS

We conducted a systematic review to examine the biopsychological correlates of the symptomatic domains of RRBs according to the type of RRBs (lower- or higher-level). We searched for articles from the National Library of Medicine (PubMed) using the terms: autism spectrum disorders, ASD, and autism-related to executive functions, inhibitory control, inflexibility, cognitive flexibility, hyper or hypo connectivity, and behavioral approaches. For describing the pathophysiological mechanism of ASD, we also included animal models and followed PRISMA guidelines.

RESULTS

One hundred and thirty-one articles were analyzed to explain the etiology, continuance, and clinical evolution of these behaviors observed in ASD patients throughout life.

CONCLUSIONS

Biopsychological correlates involved in the origin of RRBs include alterations in a) neurotransmission system, b) brain volume, c) inadequate levels of growth factors, d) hypo- or hyper-neural connectivity, e) impairments in behavioral inhibition, cognitive flexibility, and monitoring and f) non-stimulating environments. Understanding these lower- and higher-level of RRBs can help professionals to improve or design novel therapeutic strategies.

Decreasing motor stereotypy with competing stimuli and tasks: Analysis of prompted engagement and response blocking

Competing stimulus assessments (CSAs) are used to empirically identify stimuli associated with low levels of problem behavior. For some individuals with automatically maintained behavior, it can be difficult to identify effective competing stimuli. Recent research shows that prompting engagement and response blocking can be employed during the CSA to obtain significant reductions in problem behavior. The purpose of the present study was to replicate and extend prior research on the use of these tactics not only with competing stimuli, but also competing tasks, which require the active completion of a discrete response or response sequence. In addition, the current study validated the results of these pretreatment assessments in an extended treatment analysis, and examined the isolated and combined effects of prompting and response blocking within a component analysis. Future research directions and implications for clinical practice are discussed.

Preparation of TiO2/Ag[BMIM]Cl Composites and Their Visible Light Photocatalytic Properties for the Degradation of Rhodamine B

In order to degrade toxic pollutants such as dyes during the process of sewage treatment, considerable attention has been paid to photocatalytic technologies. In this paper, TiO2/Ag[BMIM]Cl (1-butyl-3-methyl imidazolium chloride ([BMIM]Cl)) nanocomposites were prepared with TiO2 as the carrier, silver ions as dopants and ionic liquids (IL) as modifiers. The morphologies, microstructures, crystalline structure and optical properties of the TiO2/Ag[BMIM]Cl nanospheres are investigated by transmission electron microscopy (TEM), X-ray diffraction (XRD), total organic carbon (TOC), and UV-vis diffuse reflectance spectrum (UV-vis DRS) techniques. The TiO2/Ag[BMIM]Cl nanocomposites can selectively degrade rhodamine B (Rh B) under visible light because of the unstable quaternary ammonium salt. The as-obtained nanocomposites exhibit better photocatalytic activity performance than pure TiO2, TiO2/IL, and TiO2/Ag+. The experimental results show that the Rh B degradation rate can reach 98.87% under optimized producing conditions by using the TiO2/Ag[BMIM]Cl composites as the catalyzer. It shows that simultaneous doping with silver ions and ionic liquids can significantly improve the photocatalytic activity of TiO2 in Rh B degradation, indicating the formation of photosensitive AgCl in the process of TiO2/Ag[BMIM]Cl preparation. Ag+ and IL addition exchange the band gap of TiO2 and lengthen the visible wavelength range of the composite. The material has the advantages of low cost, facile preparation and reusability with the excellent degradation effect of Rh B.

A Predictive Multimodal Framework to Alert Caregivers of Problem Behaviors for Children with ASD (PreMAC)

Autism Spectrum Disorder (ASD) impacts 1 in 54 children in the US. Two-thirds of children with ASD display problem behavior. If a caregiver can predict that a child is likely to engage in problem behavior, they may be able to take action to minimize that risk. Although experts in Applied Behavior Analysis can offer caregivers recognition and remediation strategies, there are limitations to the extent to which human prediction of problem behavior is possible without the assistance of technology. In this paper, we propose a machine learning-based predictive framework, PreMAC, that uses multimodal signals from precursors of problem behaviors to alert caregivers of impending problem behavior for children with ASD. A multimodal data capture platform, M2P3, was designed to collect multimodal training data for PreMAC. The development of PreMAC integrated a rapid functional analysis, the interview-informed synthesized contingency analysis (IISCA), for collection of training data. A feasibility study with seven 4 to 15-year-old children with ASD was conducted to investigate the tolerability and feasibility of the M2P3 platform and the accuracy of PreMAC. Results indicate that the M2P3 platform was well tolerated by the children and PreMAC could predict precursors of problem behaviors with high prediction accuracies.

Competing stimulus assessments: A systematic review

The current review summarizes the literature on competing stimulus assessments (CSAs). CSAs are pretreatment assessments designed to systematically identify stimuli that reduce problem behavior (PB), ostensibly through reinforcer competition or substitution. We report on the participant characteristics, outcomes, and predictive validity of published CSAs that included (a) no-stimulus control trial(s), (b) test trials during which each stimulus was available singly and noncontingently, and (c) measurement of PB and stimulus engagement or contact. Results showed that CSAs have broad utility across a variety of topographies and functions of PB. In the majority of CSA applications for which extended analyses, or validations, were performed, stimuli shown to reduce PB during the CSA produced similar reductions during extended analysis. This was the case regardless of topography or function of PB, or whether the stimuli were assumed to be "matched" to the stimulation thought to be produced by PB. Implications for future research are discussed.

The stability of function of automatically reinforced vocal stereotypy over time

Although prior research has suggested the function of socially reinforced problem behavior can change across time, the stability of the function of automatically reinforced behavior is largely unknown. Further, some authors have suggested automatically reinforced behavior is likely to enter into socially mediated contingencies. The present study compared 2 functional analyses conducted on the same target behavior at least 1 year apart. Participants were 6 individuals diagnosed with an intellectual or developmental disability displaying automatically reinforced vocal stereotypy. Results indicated the function of each participant's vocal stereotypy remained stable over time (i.e., no new functions were acquired); however, future research on functional stability for automatically reinforced behavior of other topographies is needed.