Self-control in children with autism: response allocation during delays to reinforcement

Self-Control Training: A Scoping Review

We conducted a scoping review of the behavior analytic self-control training (SCT) literature. To identify included articles, we searched key terms in six databases for articles published between 1988 and 2021. We included empirical articles that used a behavioral approach to self-control training with human participants for whom increasing self-control choice was a clinically significant goal and measured self-control and impulsive choice as dependent variables. Twenty-five experiments from 24 articles with a total of 79 participants were included in the review. This review aims to summarize the characteristics of SCT procedures and outcomes, provide recommendations for future research directions, and offer practical suggestions to clinicians incorporating SCT into practice. We examined similarities across studies regarding the independent variables manipulated in SCT, dependent variables measured, metrics of successful interventions, and assessment of generalization and maintenance of self-control choice. Twenty-one experiments arranged concurrent self-control- and impulsive-choice options with positive reinforcement, and four experiments arranged self-control training with negative-reinforcement contingencies. Variations of SCT included progressively increasing delays, intervening activities, signaled delays, antecedent rules, and commitment responses. Providing an intervening activity during the delay was largely successful at increasing self-control choice. Maintenance and generalization of increased self-control choice were assessed in two and three experiments, respectively. Future research should focus on improving the generality of SCT procedures in clinical settings by increasing terminal delays, fading out intervening activities, including probabilistic outcomes, and combining appetitive and aversive outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40617-023-00885-y.

Reducing perseverative requesting and other problem behavior in a young girl with autism: a sequentially implemented intervention package

Purpose

This study aims to use a sequentially implemented intervention package to reduce the occurrence of perseverative requesting and other problem behavior in a young girl with autism spectrum disorder (ASD).

Design/methodology/approach

In this single-case study, subsequent to a functional analysis and a preference assessment, an intervention package consisting of three components (i.e. a tolerance for delay to reinforcement, choice-making and visual schedule) was implemented sequentially to address perseverative requesting and other problem behavior maintained by access to preferred items/activities in a young girl with ASD.

Findings

Via the intervention package, the girl demonstrated higher self-control skills (i.e. delaying access to preferred items/activities, choosing more preferred items/activities with delayed access over less preferred ones with immediate access, completing tasks before having access to preferred items/activities) with a reduction of perseverative requesting or other problem behavior.

Originality/value

The current case study presents concrete steps that could be applied to address tangible-maintained perseverative requesting using more natural and educationally relevant signals while improving the child’s appropriate skills (e.g. delay to reinforcement, self-control and task engagement).

Gradual Change Procedures in Behavior Analysis

A wide variety of procedures within behavior analysis use gradual change in stimuli, response requirements, reinforcement, or some combination thereof, to effectively change behavior. Such procedures include shaping, thinning, fading, and chaining. Collectively, gradual change procedures represent a conceptually systematic technology of behavior change with wide-ranging empirical support across diverse settings and contexts. However, navigating the gradual change literature can be challenging. Similar terms are used to describe functionally distinct procedures (e.g., stimulus fading, delay fading, demand fading), and distinct terms are used to describe functionally similar procedures (e.g., leaning, demand fading). I propose a taxonomy in which gradual change procedures are categorized according to the functional component of the contingency on which they act. Three broad categories are proposed: Gradual Changes in Discriminative Stimuli, Response Requirement, and Reinforcement. I provide examples of research in each category, across basic and applied settings, including terminology used by the author(s) to describe each procedure. Finally, I discuss benefits of this framework for consumers of the literature.

Using Delay Fading Procedures to Increase Self-Control

Children and adolescents, relative to adults, disproportionately favor smaller, immediate outcomes over larger, delayed outcomes. From a behavioral perspective, this sensitivity toward immediate rewards constitutes impulsive choice, which characterizes numerous behavioral health problems commonly observed during childhood (particularly among individuals with neurobehavioral disabilities). Accordingly, a variety of behavioral technologies have been developed and are widely implemented in applied settings (e.g., self-monitoring programs, interdependent group contingencies, individualized token reinforcement programs) to reduce impulsive responding and promote self-control. Although there is a plethora of research literature detailing these interventions, several promising delay fading procedures may also have clinical utility in applied treatment contexts. The purpose of the present review is to highlight contemporary behavior-analytic research involving delay fading procedures that may increase self-control among children and adolescents and facilitate additional research in the area of self-control.

Effects of self-control training for elementary students with emotional and behavioral disorders

Progressive delay training (PDT) has been used to promote self-controlled choices (i.e., selecting a larger, later reward over a smaller, immediate reward) for people with a variety of developmental characteristics. However, the efficacy of PDT has not been evaluated in children with emotional and behavioral disorders (EBD), who often have co-occurring symptoms of impulsivity. The purpose of this study was to evaluate the effects of PDT with a rule-following requirement on the impulsive choices of 6 elementary students with EBD using a modified changing criterion design. Results indicated that PDT alone did not improve self-control, but a modified version of PDT with a rationale and rule for selecting the delayed reward promoted self-control for 3 participants. The remaining 3 participants continued to make impulsive choices despite further modifications to the PDT protocol. We discuss implications of our results and directions for future research on treating impulsivity in children with EBD.

Transfer of treatment effects from combined to isolated conditions during functional communication training for multiply controlled problem behavior

Functional communication training (FCT) is highly effective for treating socially maintained problem behavior when based on the results of functional analyses (FA). Research suggests that combining relevant antecedents and consequences of problem behavior during FCT can be an efficient approach to treatment for behavior that is multiply controlled. However, no studies have evaluated whether treatment effects under combined conditions would transfer to single, or isolated, conditions. Participants were 5 children with autism, aged 3 years to 6 years, who engaged in problem behavior maintained by both escape from demands and access to tangibles. An experimenter coached their caregivers via video conferencing to implement FA and FCT in their homes. All participants received FCT under a combined condition, followed by brief exposure to sessions with isolated antecedents and consequences. Treatment effects for just 1 of the 5 participants immediately persisted under isolated conditions. These results suggest that, when caregivers combine variables relevant to multiple functions during FCT, exposure to isolated conditions may at least temporarily produce treatment failures.

Changing Delay Discounting and Impulsive Choice: Implications for Addictions, Prevention, and Human Health

Delay discounting describes the tendency to devalue delayed consequences or future prospects. The degree to which an individual discounts delayed events appears trait-like in that it is stable over time and across functionally similar situations. Steeply discounting delayed rewards is correlated with most substance-use disorders, the severity of these disorders, rates of relapse to drug use, and a host of other maladaptive decisions impacting human health. Longitudinal data suggest steep delay discounting and high levels of impulsive choice are predictive of subsequent drug taking, which suggests (though does not establish) that reducing delay discounting could have a preventive health-promoting effect. Experimental manipulations that produce momentary or long-lasting reductions in delay discounting or impulsive choice are reviewed, and behavioral mechanisms that may underlie these effects are discussed. Shortcomings of each manipulation technique are discussed and areas for future research are identified. While much work remains, it is clear that impulsive decision-making can be reduced, despite its otherwise trait-like qualities. Such findings invite technique refinement, translational research, and hope.

Negatively-Reinforced Mands

In this study, we extended the literature on negatively-reinforced mands by teaching multiple novel, socially appropriate alternative mands to two young children with autism spectrum disorder (ASD). First, we replaced existing mands (e.g., pushing away) with two novel, socially appropriate, negatively-reinforced mands. Next, we examined responding under immediate- and delayed-reinforcement conditions to assess resurgence to existing mands and to determine whether the function of the communicative behavior influences the consistency with which different mands are emitted. Finally, we examined generalization to different social partners. Our data suggest that both children acquired the new mands and used them to avoid nonpreferred items. Resurgence to existing mands during delayed-reinforcement conditions was documented for one child, and the sequence in which mands were emitted within a response class was not influenced by the function of the communicative behavior. Generalization data indicate that both children emitted the new mands and one of the two children alternated between the two mands with a social partner who was not involved in the training. We discuss the importance of teaching multiple negatively-reinforced alternative mands to children with autism in applied settings.

Self-control as generalized operant behavior by adults with autism spectrum disorder

The present investigation attempted to teach self-control to 3 adults who had been diagnosed with autism spectrum disorder. Using a self-control training procedure that coupled a gradual fading of delay to access a large delayed reinforcer with a concurrent work requirement, each participant was exposed to conditions in which baseline levels of choices for large delayed reinforcers and task engagement increased 10-fold. Furthermore, generalization effects were partially demonstrated in a novel context.

Mand Training

Our primary purpose in this study was to examine the structure of a response class when new members are acquired through mand training. To do this, we replaced existing mands (e.g., reaching) in three children with autism with two new functionally equivalent mands. Next, we examined their responding under immediate- and delayed-reinforcement conditions. Then, we assessed generalization to novel social partners. We employed a reversal design to examine the effectiveness of mand training and to assess responding under both immediate- and delayed-reinforcement conditions. Our results suggest that all children acquired the new mands and that two of the children emitted these responses as replacements when the social partner did not provide access to the reinforcer contingent on the child’s first mand. Generalization data indicate that all three children emitted the new mands and two of the children alternated between the new mands with novel social partners. We discuss the clinical implications and the conceptual significance of teaching multiple replacement mands to children with autism and severe language delays.

The effect of response rate on reward value in a self-control task

To understand how effort, defined by number of responses required to obtain a reward, affects reward value, five pigeons were exposed to a self-control task. They chose between two alternatives, 2 s of access to food after a delay of 10 s, and 6 s of access to food after an adjusting delay. The adjusting delay increased or decreased depending on the pigeons' choices. The delay at which the two alternatives were equally chosen defined the indifference point. To determine whether requiring responses during the delay led to more impulsive (smaller-sooner rewards) or self-controlled (larger-later rewards) choices, we varied the number of required pecks during the 10-s delay to the 2-s reinforcer, and assessed how the requirement affected the indifference points. In the High Rate Phase, they had to peck at least 10 times during the delay; in the Low Rate Phase, they could peck at most 5 times during the delay. For four pigeons the indifference point increased with the response requirement; for one pigeon it decreased. The results suggest that, in general, reward value varies inversely with effort.

The nature of impulsivity: visual exposure to natural environments decreases impulsive decision-making in a delay discounting task

The benefits of visual exposure to natural environments for human well-being in areas of stress reduction, mood improvement, and attention restoration are well documented, but the effects of natural environments on impulsive decision-making remain unknown. Impulsive decision-making in delay discounting offers generality, predictive validity, and insight into decision-making related to unhealthy behaviors. The present experiment evaluated differences in such decision-making in humans experiencing visual exposure to one of the following conditions: natural (e.g., mountains), built (e.g., buildings), or control (e.g., triangles) using a delay discounting task that required participants to choose between immediate and delayed hypothetical monetary outcomes. Participants viewed the images before and during the delay discounting task. Participants were less impulsive in the condition providing visual exposure to natural scenes compared to built and geometric scenes. Results suggest that exposure to natural environments results in decreased impulsive decision-making relative to built environments.

Assessing preference and reinforcer effectiveness in dogs

The paired-stimulus (PS) preference assessment has been shown to be effective in assessing preference with animal subjects, including dogs; however, evaluations on whether preferred stimuli would also function as reinforcers are lacking. The purpose of the current study was to evaluate the use of the PS preference assessment as a predictor of reinforcer effectiveness in eight dogs. The assessment was followed by concurrent and progressive ratio schedules to evaluate the reinforcer efficacy of food items. Results showed that the preference assessment predicted reinforcer efficacy for all subjects. Benefits of using this assessment with dogs are discussed.

A comparison of the effects of brief rules, a timer, and preferred toys on self-control

Some children make impulsive choices (i.e., choose a small but immediate reinforcer over a large but delayed reinforcer). Previous research has shown that delay fading, providing an alternative activity during the delay, teaching participants to repeat a rule during the delay, combining delay fading with an alternative activity, and combining delay fading with a countdown timer are effective for increasing self-control (i.e., choosing the large but delayed reinforcer over the small but immediate reinforcer). The purpose of the current study was to compare the effects of various interventions in the absence of delay fading (i.e., providing brief rules, providing a countdown timer during the delay, or providing preferred toys during the delay) on self-control. Results suggested that providing brief rules or a countdown timer during the delay was ineffective for enhancing self-control. However, providing preferred toys during the delay effectively enhanced self-control.

A tutorial on the use of Excel 2010 and Excel for Mac 2011 for conducting delay-discounting analyses

In recent years, researchers and practitioners in the behavioral sciences have profited from a growing literature on delay discounting. The purpose of this article is to provide readers with a brief tutorial on how to use Microsoft Office Excel 2010 and Excel for Mac 2011 to analyze discounting data to yield parameters for both the hyperbolic discounting model and area under the curve. This tutorial is intended to encourage the quantitative analysis of behavior in both research and applied settings by readers with relatively little formal training in nonlinear regression.

Recent research on aetiology, development and phenomenology of self-injurious behaviour in people with intellectual disabilities: a systematic review and implications for treatment

BACKGROUND

Behavioural interventions conceptualise self-injurious behaviour (SIB) as developing from early repetitive behaviours through acquisition of homeostatic functions in regulating stimulation and subsequent shaping into SIB through socially mediated or automatic operant reinforcement. Despite high success rates, such interventions rarely completely eliminate SIB, and overall effectiveness has not increased since the 1960s.

METHODS

Research (excluding studies of single genetic syndromes) on the early development, functional properties and phenomenology of SIB in persons with intellectual disabilities (IDs) published from 1999 to 2010 inclusive is reviewed.

RESULTS

Despite evidence to support the operant shaping hypothesis, in some cases tissue-damaging SIB, especially head-banging, emerges at a similar or younger age than stereotyped behaviours or 'proto-SIB', often associated with tantrums following frustrative non-reward and/or abrupt situational transitions. Many young children show undifferentiated patterns of responding in functional analyses of SIB, and SIB is associated with aggression and impulsivity as well as with repetitive behaviour.

CONCLUSIONS

One dynamic in the development of SIB may be Pavlovian conditioning of aggression, originally elicited by aversive events or frustrative non-reward, to stimuli associated with such situations. Integration into operant technology of interventions based on Pavlovian principles such as graduated exposure (with or without counterconditioning) to aversive stimuli may enhance the effectiveness of behavioural interventions.

Delay discounting: trait variable?

Delay discounting refers to the tendency for outcomes that are remote in time to have less value than more immediate outcomes. Steep discounting of delayed outcomes is associated with a variety of social maladies. The degree of sensitivity to delayed outcomes may be a stable and pervasive individual characteristic. In analyses of archival data, the present study found positive correlations between the degree of delay discounting for one outcome (as measured by the Area Under the Curve), and the degree of discounting for other outcomes. Along with additional evidence reviewed, these data suggest that delay discounting may be considered a personality trait. Recent research in epigenetics, neuroscience, and behavior suggests delay discounting may prove to be a beneficial target for therapeutic attempts to produce global reductions in impulsivity related to delay discounting.

The effects of choice on self-control

Three adolescents with traumatic brain injury performed a physical therapy task in the absence of programmed consequences or duration requirements. Next, the experimenter gave the participants the options of a smaller immediate reinforcer with no response requirement or a larger delayed reinforcer with a response requirement. Self-control training exposed participants to a procedure during which they chose between a smaller immediate reinforcer and a progressively increasing delayed reinforcer whose values varied and were determined by a die roll. The participants chose whether they or the experimenter rolled the die. All participants initially demonstrated low baseline durations of the physical therapy task, chose the smaller immediate reinforcer during the choice baseline, and changed their preference to the larger delayed reinforcer during self-control training.

Using a Time Timer to increase appropriate waiting behavior in a child with developmental disabilities

This study aimed to examine the use of a predictive stimulus (Time Timer) and delayed reinforcement to increase appropriate waiting behavior in a child with developmental disabilities and problem behavior maintained by access to tangible items and activities. The study employed a changing criterion design across settings to gradually increase reinforcement delay from 1s to 10 min. Firstly a baseline phase was conducted to measure the duration of appropriate waiting behavior to access tangible reinforcers/activities. Phase 2 involved the use of a red cue card and the verbal instruction "wait". Phase 3 involved the introduction of the Time Timer with the cue card attached, and the verbal instruction "wait". Finally, Phase 4 utilised the Time Timer without the cue card. This method was an effective strategy for increasing appropriate waiting behavior with this participant in a school setting. The role of adding a concurrent activity during the reinforcement delay, using cues to predict reinforcement, future generalization, maintenance and the teaching of functionally equivalent skills are discussed.

Preference for progressive delays and concurrent physical therapy exercise in an adult with acquired brain injury

The purpose of this study was to increase self-control and engagement in a physical therapy task (head holding) for a man with acquired traumatic brain injury. Once impulsivity was observed (i.e., repeated impulsive choices), an experimental condition was introduced that consisted of choices between a small immediate reinforcer, a large fixed-delay reinforcer, and a large progressive-delay reinforcer. The participant showed a preference for the progressive-delay option, even when the duration of the delay exceeded that of the fixed delay. The results have implications for establishing optimal choice making and teaching life-enhancing skills.

Self-control and the preference for delayed reinforcement an example in brain injury

We investigated the effects of a concurrent physical therapy activity (keeping the hand open) during delays to reinforcement in an adult man with acquired brain injuries. Once a relatively stable level of hand-open behavior was obtained, the participant was asked to choose between a small immediate reinforcer and a larger delayed reinforcer contingent on keeping the hand open at greater-than-baseline duration. Afterwards, the participant was asked to select between a larger delayed reinforcer with no hand-open requirement and the identical larger delayed reinforcer with a progressively increasing hand-open requirement. Results suggest a shift in preference to larger delayed reinforcers and an eventual preference for the hand-open requirement option.

Discrete-trial training for autistic children when reward is delayed: a comparison of conditioned cue value and response marking

Three children with autism were taught to identify pictures of objects. Their speed of acquisition of receptive speech skills was compared across two conditions. In the cue-value condition, a compound audiovisual stimulus was presented after correct responses and again when a primary reinforcer was delivered after a 5-s delay; in the response-marking condition, a second stimulus was presented after both correct and incorrect responses, but not prior to the primary reinforcer. In both conditions primary reinforcement was delayed for 5 s. Although the children learned receptive speech skills in both conditions, acquisition was faster in the cue-value condition.

Concurrent reinforcement schedules: behavior change and maintenance without extinction

We evaluated the effects of concurrent schedules of reinforcement on negatively reinforced problem behavior and task completion with 3 children with autism. Results indicated that problem behavior occurred at high levels and relatively few tasks were completed when problem behavior produced a break (from tasks) and task completion produced either no consequence or a break. By contrast, problem behavior was eliminated and tasks were completed when problem behavior produced a break and task completion produced a break with access to preferred activities. Treatment gains were maintained without the use of extinction when the response requirement was increased and the schedule of reinforcement was thinned.

The effects of magnitude and quality of reinforcement on choice responding during play activities

Three boys with autism participated in a study of the effects of magnitude and quality of reinforcement on choice responding. Two concurrent response alternatives were arranged: (a) to play in an area where a peer or sibling was located, or (b) to play in an area where there was no peer or sibling. During one condition, the magnitude (i.e., duration of access to toys) or quality (level of preference) of reinforcement provided for both responses was equal. During the other condition, the magnitude or quality of reinforcement was relatively greater for choosing the play area where the peer or sibling was located than the area where the peer or sibling was not located. Results showed that after repeated exposure to the unequal magnitude or quality condition, the participant increasingly allocated his responses to the play area where the peer or sibling was located. For 2 participants, this pattern of responding was maintained in the subsequent equal magnitude or quality condition. Overall, the analysis suggests that the dimensions of magnitude and quality of reinforcement can be arranged to influence choice responding in favor of playing near a peer or sibling rather than playing alone.