Basic and Clinical Studies in Reinforcing Positive Behaviors in Intellectual and Developmental Disabilities

摘要 了解复杂的智力发育障碍(IDD)并存状况是NICHD的优先事项。 IDD儿童的严重问题行为(例如，自残行为、攻击性)很普遍，可能 这很危险，对社会融合和生活质量有负面影响。基于函数的差分补强 替代行为(DRA)干预有效地减少了这种行为，但治疗复发通常发生在 照顾者不会为替代行为提供支持。这种复发被称为死灰复燃。这个 长期以来，DRA干预在减少严重问题行为方面的有效性一直被认为与 在可同时获得的加固源之间进行选择的基本流程。然而，量化的 这种选择行为的理论(例如，匹配定律)以前并不适用于随后的复苏 DRA，因为他们不能解释其中一种或两种行为不再产生强化的情况。 该项目代表了基础科学家/理论家和具有DRA专业知识的临床科学家之间的合作 评估和翻译一种新的基于选择的复兴理论预测的治疗方法。这是一项创新 理论建立在强化的两个基本和公认的原则上：(A)个人分配 按比例更多地响应产生按比例更多强化的反应(即，匹配定律)； 以及(B)加固的价值随着它进一步退回到过去而以双曲线的方式减小。通过将这些组合起来 将两个原理转化为一个数学模型，理论说明在复活的情况下唯一存在的 复苏的量化理论(行为动量理论)已经失败。基于选择的理论产生了 关于预计复苏可能发生的确切条件以及如何发生的新预测 可以改变治疗以减少复发(例如，延长治疗持续时间、动态调整时间表 间伐)。该项目对这些和其他关于高潜在临床变量的新预测进行了实证检验。 相关性，但缺乏明确的数据(例如，对目标和备选方案的不同应对努力的影响 回应)，并直接翻译来自理论和动物基础研究的见解，以便改进 在临床上治疗问题行为，减少治疗复发。我们的首要假设是DRA 受这一新理论启发的干预措施将不太容易出现问题行为：(A)在 增强剂不可用的时间段；(B)在增强剂计划期间增强剂可用性减少的情况 变薄；以及(C)当其他响应或加固参数改变时，例如响应努力的增加。 因此，这个项目试图填补关于复兴的基本/理论知识方面的现有空白，并代表着一种罕见的 基础和临床科学家之间的密切合作，以更好地使基础研究和临床实践保持一致。

Abstract Understanding complex comorbid conditions of intellectual developmental disorder (IDD) is an NICHD priority. Severe problem behavior (e.g., self-injurious behavior, aggression) of children with IDD is prevalent, potentially dangerous, and negatively impacts social integration and quality of life. Function-based differential reinforcement of alternative behavior (DRA) interventions reduce such behavior effectively, but treatment relapse often occurs when a caregiver does not deliver reinforcement for the alternative behavior. Such relapse is known as resurgence. The efficacy of DRA interventions in reducing severe problem behavior has long been theorized to be related to the same basic processes that govern choice between concurrently available sources of reinforcement. However, quantitative theories of such choice behavior (e.g., the matching law) have not previously been applicable to resurgence following DRA because they could not account for situations in which one or both behaviors no longer produced reinforcement. This project represents a collaboration between a basic scientist/theorist and clinical scientists with expertise in DRA treatments to evaluate and translate the predictions of a novel choice-based theory of resurgence. This innovative theory is built from two fundamental and well-established principles of reinforcement: (a) individuals allocate proportionally more responding to responses that produce proportionally more reinforcement (i.e., the matching law); and (b) the value of reinforcement decreases hyperbolically as it recedes further into the past. By combining these two principles into a mathematical model, the theory accounts for resurgence in situations in which the only existing quantitative theory of resurgence (behavioral momentum theory) has failed. The choice-based theory generates novel predictions about the precise conditions under which resurgence might be expected to occur and how treatments might be altered to reduce resurgence (e.g., extending treatment duration, dynamically adjusting schedule thinning). This project empirically examines these and other novel predictions about variables of high potential clinical relevance, but for which clear data are lacking (e.g., effects of different response efforts for the target and alternative responses) and directly translates insights from the theory and basic research with animals in order to improve treatment of problem behavior in the clinic and reduce treatment relapse. Our overarching hypothesis is that DRA interventions informed by this novel theory will be less susceptible to resurgence of problem behavior: (a) during periods when reinforcers are unavailable; (b) when reinforcer availability diminishes during reinforcement schedule thinning; and (c) when other response or reinforcement parameters change, such as increases in response effort. Thus, this project seeks to fill existing gaps in basic/theoretical knowledge about resurgence and represents a rare close collaboration between basic and clinical scientists to better align basic research and clinical practice.