Motivational Refinements for Facilitating Reinforcement Schedule Thinning

项目摘要 严重的破坏性行为是发育障碍的共病， 随着智力残疾严重程度、沟通障碍和同时发生的自闭症谱系而增加 1，2破坏性行为，如自我伤害行为和攻击，对儿童造成伤害， 其他人，并增加了机构化，社会孤立，身体限制，药物过度使用， 拒绝服务和滥用。3临床医生已经使用功能分析来确定加强 破坏性行为，并制定有效的，基于功能的治疗。4 -7功能性沟通训练 (FCT)是一种经验支持的、基于功能的治疗方法，可减少破坏性行为。8，9使用FCT， 临床医生教孩子使用功能性沟通反应（FCR）来请求医生 保持破坏性行为，同时将破坏性行为置于预防之上。10 -12例如，如果 功能分析结果表明，注意力强化破坏性行为，临床医生将提供 当孩子使用FCR（“请和我一起玩”）时，注意力不集中， 行为FCT的两个重要局限性是：（a）维持FCR的加固计划必须 通常逐渐变薄到护理人员在家中一致实施的实际水平， 在社区，13-15和（B）这个必要的过程，加固时间表稀疏定期导致 破坏性行为增加后，最初有效的治疗，一种形式的治疗复发称为 16 -19目前的项目旨在改善家庭现金转移支付的这些局限性，办法是：（a）加快 增强计划细化通过使用的结果删除不必要的计划细化步骤， 渐进式间隔评估20 -23和（B）通过提供 与维持破坏性行为的行为者高度竞争的刺激。23 -27我们将进行 随机对照试验，以评估这两种有希望的FCT改进在多大程度上改善了 强化时间表细化的过程，探索性研究将检查的相互影响， 这两种方法。这个新项目有可能大大提高护理指导标准， 治疗严重的破坏性行为，改善儿童和家庭的长期结果 被这些令人衰弱的行为障碍所折磨

Project Summary Severe destructive behavior represents a comorbid condition of developmental disability for which risk increases with intellectual disability severity, communication deficits, and co-occurring autism spectrum disorder.1,2 Destructive behavior, such as self-injurious behavior and aggression, causes harm to the child and others and increases the risk for institutionalization, social isolation, physical restraint, medication overuse, service denial, and abuse.3 Clinicians have used functional analyses to identify the variables that reinforce destructive behavior and to develop effective, function-based treatments.4-7 Functional communication training (FCT) is an empirically supported, function-based treatment that decreases destructive behavior.8,9 Using FCT, the clinician teaches the child to use a functional communication response (FCR) to request the reinforcer maintaining destructive behavior, while placing destructive behavior on extinction.10-12 For example, if functional-analysis results showed that attention reinforced destructive behavior, the clinician would provide attention when the child used the FCR (“Play with me, please”) and would not provide attention for destructive behavior. Two important limitations of FCT are that (a) schedules of reinforcement maintaining the FCR must often be thinned gradually to levels that are practical for caregivers to implement consistently in the home and in the community,13-15 and (b) this necessary process of reinforcement schedule thinning regularly causes destructive behavior to increase following initially effective treatment, a form of treatment relapse called resurgence.16-19 The current project aims to improve these limitations of FCT by (a) hastening the process of reinforcement schedule thinning by removing unnecessary schedule-thinning steps using the results of a progressive interval assessment20-23 and (b) mitigating the resurgence of destructive behavior by providing stimuli that highly compete with the reinforcer maintaining destructive behavior.23-27 We will conduct a randomized controlled trial to evaluate the extent to which these two promising refinements to FCT improve the process of reinforcement schedule thinning, and an exploratory study will examine the interactive effects of these two approaches. This novel project has the potential to substantially improve standards of care guiding the treatment of severe destructive behavior and to improve the long-term outcomes for children and families afflicted by these debilitating behavior disorders.