Preventing relapse of destructive behavior using behavioral momentum theory

 描述（由申请人提供）：智力残疾儿童经常表现出严重的破坏性行为（例如，攻击性、自伤行为）构成重大风险 对自己或他人，并代表压倒性的障碍，以社区融合。这些破坏性的行为往往被视为行为干预来自功能分析（FA），这是用来确定环境的前因和后果的场合，并加强目标的反应。一种这样的治疗方法被称为功能性沟通训练（FCT），它包括消除破坏性行为和加强替代性沟通反应，其结果是先前加强的破坏性行为。流行病学研究和Meta分析的结果表明，基于FA的干预措施，如FCT，通常可以减少90%或更多的问题行为，比其他行为治疗更有效。尽管有这些令人印象深刻的发现，但文献中报道的FCT干预措施通常是由训练有素的专家在严格控制的研究环境中开发和评估的，并且治疗复发（即，增加的破坏性行为）经常发生在自然环境中当护理者由于竞争责任而不能加强FCT反应时（例如，照顾生病的兄弟姐妹）。行为动量理论有助于解释为什么在这些情况下会发生治疗复发，并提供数学方程，可用于建模和预测增加和减少治疗复发可能性的变量。在目前的项目中，我们使用这些方程来确定FCT的几种潜在改进，这些改进可能会显着降低FCT应答未得到加强时治疗复发的可能性。在某些情况下，这些改进与FCT临床文献中的建议不一致。因此，至关重要的是，我们将这些源自行为动量理论的改进与当前的临床实践进行比较，以确定实施FCT的最佳方式，以便在自然环境中由护理人员以不太完美的精度实施治疗时保持有效。

 DESCRIPTION (provided by applicant): Children with intellectual disability often display severe destructive behaviors (e.g., aggression, self-injurious behavior) that pose significant risk to self or others and represent overwhelming barriers to community integration. These destructive behaviors are often treated with behavioral interventions derived from a functional analysis (FA), which is used to identify the environmental antecedents and consequences that occasion and reinforce the target response. One such treatment is called functional communication training (FCT), which involves extinction of destructive behavior and reinforcement of an alternative communication response with the consequence that previously reinforced destructive behavior. Results from epidemiological studies and meta analyses indicate that interventions based on FA, like FCT, typically reduce problem behavior by 90% or more and are much more effective than other behavioral treatments. Despite these impressive findings, FCT interventions reported in the literature have typically been developed and evaluated by highly trained experts in tightly controlled research settings, and treatment relapse (i.e., increased destructive behavior) often occurs in the natural environment when a caregiver is unable reinforce the FCT response due to competing responsibilities (e.g., caring for a sick sibling). Behavioral momentum theory helps to explain why treatment relapse occurs under these circumstances and also provides mathematical equations that can be used to model and predict the variables that increase and decrease the likelihood that treatment relapse will occur. In the current project, we have used these equations to identify several potential refinements to FCT that are likely to markedly decrease the probability that treatment relapse will occur when the FCT response is not reinforced. In some cases, these refinements are at odds with what is recommended in the clinical literature on FCT. Therefore, it is critically important that we compare these refinements that are derived from behavioral momentum theory with current clinical practice in order to determine the best way to implement FCT, so that treatment remains effective when it is implemented with less than perfect precision by caregivers in the natural environment.