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

项目摘要 了解复杂的、并存的智能发育障碍(IDD)是一种NICHD 优先考虑。IDD儿童的严重问题行为(例如，自残行为、攻击性)很普遍， 具有潜在危险，并对社会融合和生活质量产生负面影响。基于函数的差分- 强化替代行为干预有效地减少了这种行为，但治疗复发 当照顾者不能为替代行为提供增援时，这种情况很常见。这种复发被称为 东山再起。在此之前，我们基于两个久负盛名的理论发展了一种定量的复苏理论 原则：(1)个人按比例分配更多，以回应按比例生产更多的选项 加固，以及(2)过去加固的价值随着时间的推移以双曲线形式衰减。这一理论 提供动态变化的钢筋条件下的行为的定量说明，包括 所有的强化都会停止(即灭绝)--这是导致复活的条件。在这个项目的第一阶段， 我们用实验动物展示了许多理论预测的定量准确性，我们已经 临床上IDD儿童严重问题行为的复发表现出相似的关系。然而， 第一阶段最重要和最有希望的发现是该理论未能预测到的。我们发现 接触一种治疗(即，应急歧视训练，CDT)，涉及交替治疗，其中 在目标反应持续消退期间，替代增援是可用的，然后是不可用的 大大缓解了经济复苏的趋势。为了解释这些影响，我们开发了一个改进版本的 量化理论表明，接触CDT的人很快就会学会区分连续的 目标行为的加固不可用，即使加固不可用于 另一种反应，从而为它们接种疫苗，防止后来的卷土重来。这些发现和提炼 来自阶段1的定量理论表明，治疗重症患者的方法是有前途的、创新的和未被探索的 问题行为可能比现有方法产生更好的缓解回潮的效果，同时还 避免当前方法的一些缺点，以减轻问题行为的卷土重来(即，任意性 照顾者可能丢失或使用不当的刺激)。该项目的第二阶段将重点关注这一极具创新性的 在阶段1中确定的方法有两个目的：(1)第一个随机对照试验，评估 CDT对IDD儿童严重问题行为的缓解作用和(2)一系列 用实验室动物进行实验，在一系列条件下测试改进的理论，预计会有所改善 CDT在未来临床应用中的有效性、效率和实用性。这个项目代表着一个结束 基础和临床科学家之间的合作，证明他们有能力使用基础定量 改进临床实践以防止严重问题行为复发的理论和实证研究， 从而减少其对儿童及其家庭的破坏性影响。

Project Summary 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 interventions reduce such behavior effectively, but treatment relapse is common when a caregiver cannot deliver reinforcement for the alternative behavior. Such relapse is known as resurgence. Previously, we developed a quantitative theory of resurgence based on two well-established principles: (1) individuals allocate proportionally more responding to options that produce proportionally more reinforcement, and (2) the value of past reinforcement decays hyperbolically as time passes. The theory provides a quantitative account of behavior in dynamically changing reinforcement conditions, including when all reinforcement ceases (i.e., extinction)—the conditions giving rise to resurgence. In Period 1 of this project, we showed the quantitative accuracy of many of the theory’s predictions with laboratory animals and we have shown similar relations in resurgence of severe problem behavior of children with IDD in the clinic. However, the most important and promising finding from Period 1 was one the theory failed to predict. We found that exposure to a treatment (i.e., contingency discrimination training, CDT) involving alternating sessions in which alternative reinforcement was and then was not available during continued extinction of a target response substantially mitigated resurgence. To account for these effects, we have developed a refined version of the quantitative theory suggesting that individuals exposed to CDT rapidly learn to discriminate the continued unavailability of reinforcement for the target behavior, even when reinforcement is not available for the alternative response, thus serving to inoculating them against later resurgence. These findings and the refined quantitative theory from Period 1 suggest promising, innovative, and unexplored procedures for treating severe problem behavior that are likely to produce better resurgence mitigation than existing approaches, while also avoiding some downsides of the current methods to mitigate resurgence of problem behavior (i.e., arbitrary stimuli that caregivers may lose or use incorrectly). Period 2 of this project will focus on this highly innovative approach identified in Period 1 in two aims by conducting: (1) the first randomized controlled trial evaluating the resurgence-mitigating effects of CDT on severe problem behavior of children with IDD and (2) a series of experiments with laboratory animals testing the refined theory under a range of conditions predicted to improve the efficacy, efficiency, and practicality of CDT in future clinical applications. This project represents a close collaboration between basic and clinical scientists with a demonstrated ability to use basic quantitative theoretical and empirical research to improve clinical practice to prevent relapse of severe problem behavior, and thus, to reduce its devastating impact on children and their families.