Positive Approaches to the Treatment of Severe Behavior ...

P10159

Positive Approaches to the Treatment of

Severe Behavior Problems in Persons

with Developmental Disabilities:

A Review and Analysis of Reinforcement

and Stimulus-Based Procedures

Edward G. Carr

Sarah Robinson

Jill C. Taylor

Jane I. Carlson

Monograph of The Association for Persons with Severe Handicaps

Monograph No. 4

Positive Approaches to the Treatment of

Severe Behavior Problems in Persons

with Developmental Disabilities:

A Review and Analysis of Reinforcement

and Stimulus-Based Procedures

Edward G. Carr

Sarah Robinson

Jill C. Taylor

Jane I. Carlson

State University of New York at Stony Brook

and

Suffolk Child Development Center

Editor

Lori Goetz

San Francisco State U n i v e r s i t y

Managing Editor

Sharon Franklin

P r e p a r a t i o n of this m o n o g r a p h was supported in part by

Cooperative Agreement G 0 0 8 7 C 0 2 3 4 from the

National Institute on Disability and Rehabilitation Research,

"A Rehabilitation Research a n d Training C e n t e r on C o m m u n i t y Referenced Technologies for Nonaversive Behavior M a n a g e m e n t . "

An earlier version of this m o n o g r a p h was presented as a

b a c k g r o u n d p a p e r at the Consensus Development Conference on

the Treatment of Destructive Behaviors in Persons with

Developmental Disabilities, National Institutes of Health,

Washington, D C , S e p t e m b e r 1989.

T h e authors t h a n k R o b Horner, Wayne Sailor, Lori Goetz,

a n d two a n o n y m o u s reviewers for their helpful critiques.

All correspondence should be addressed to

E d w a r d Carr, D e p a r t m e n t of Psychology,

State University of New York, Stony Brook, NY 11794-2500.

Published by The Association for Persons with Severe Handicaps

Copyright ? 1990

TASH membership communications and requests for permission to reprint

all or part of this monograph should be addressed to

The Association for Persons with Severe Handicaps,

7010 Roosevelt Way N.E., Seattle, WA 98115; ph. 206/523-8446.

Table of Contents

Foreword

I. I N T R O D U C T I O N

T h e Nature of Positive Approaches to Treatment ? 3

Reinforcement-Based Treatments ? 3

Differential Reinforcement of Other Behavior ( D R O ) ? 3

Differential Reinforcement of Incompatible Behavior (DRI) ? 4

Skills Acquisition ? 4

Compliance training ? 4

Self-management ? 4

Differential reinforcement of communicative behavior (DRC) ? 5

Functional independence training ? 5

Stimulus-Based Treatments ? 5

Introduce Stimuli T h a t Control Low Rates of Behavior Problems ? 5

Modify Stimuli That Control High Rates of Behavior Problems ? 5

Embed Stimuli That Control High Rates of Behavior Problems Among Those

That Control Low Rates of Behavior Problems ? 5

Modify Educational Curricula Associated with Behavior Problems ? 6

Ameliorative Use of Setting Events ? 6

II. I N C L U S I O N C R I T E R I A FOR S T U D I E S E X A M I N E D

Target Behaviors ? 7

Literature Reviewed ? 7

Methodological Adequacy ? 8

1

3

7

III. A S S E S S M E N T ISSUES

Need for Measures of Severity ? 11

Need for Measures of Treatment Fidelity ? 11

Functional Analysis ? 11

Primacy of Conditional Probability ? 13

11

IV. E V A L U A T I O N I S S U E S

Treatment Effects ? 15

How Measured ? 15

Reliability of Computation ? 15

Speed of Effect ? 15

T h e Issue of Crisis Management ? 15

Relation to Positive Approaches ? 15

D R O ? 15

D R I ? 16

Skills acquisition ? 16

Stimulus-based treatments ? 16

Conclusion ? 16

Combination Treatments ? 17

Interpretive Problems ? 17

T h e Issue of Hierarchy of Treatments ? 17

Variables That Appear to be Peripheral ? 17

Gender ? 17

Diagnosis ? 18

Age ? 19

Degree of Retardation ? 19

Treatment Setting ? 19

Target Behavior ? 20

Conclusion ? 20

15

Variables T h a t Appear to be Central ? 20

Motivational Factors ? 21

Positive reinforcers: Extrinsic (social and tangible) ? 21

Positive reinforcers: Extrinsic and intrinsic (sensory) ? 21

Positive reinforcers: Intrinsic (organic) ? 21

Negative reinforcers: Extrinsic and intrinsic (escape) ? 22

Antecedent Factors ? 22

Impact on Treatment Planning ? 23

Generalization ? 23

Stimulus Generalization ? 23

Response Generalization ? 23

Maintenance ? 23

V. I N T E R V E N T I O N S

D R O ? 25

Treatment Effects ? 25

Relation to Central Variables ? 25

Advantages and Disadvantages ? 26

D R I ? 26

Treatment Effects ? 26

Relation to Central Variables ? 26

Advantages and Disadvantages ? 27

Skills Acquisition ? 27

Treatment Effects ? 27

Relation to Central Variables ? 27

Advantages and Disadvantages ? 27

Stimulus-Based Treatments ? 28

Treatment Effects ? 28

Relation to Central Variables ? 28

Advantages and Disadvantages ? 28

Comparative Effectiveness ? 29

Generalization ? 29

Stimulus Generalization ? 29

Response Generalization ? 30

Maintenance ? 31

25

VI. R E C O M M E N D A T I O N S

33

References

34

List of Tables

1

2

3

4

5

6

7

8

9

10

11

Sources Used to Identify Studies Involving Reinforcement and Stimulus-Based

Treatments for Severe Behavior Problems in Developmental Disabilities

Studies Reviewed in the Evaluation of Positive Procedures

Relationship of Gender to Treatment Outcome for Various Procedures

Relationship of Diagnosis to Treatment Outcome for Various Procedures

Relationship of Age to Treatment Outcome for Various Procedures

Relationship of Degree of Retardation to Treatment Outcome for Various Procedures

Relationship of Treatment Setting to Treatment Outcome for Various Procedures

Relationship of Target Behavior to Treatment Outcome for Various Procedures

Summary of Effectiveness of Positive Approaches

Comparative Effectiveness of Positive Approaches Using a 90% or More Suppression Criterion

Maintenance of Treatment Effects for Positive Approaches

7

9

17

18

19

19

20

20

25

29

31

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