Motivational Refinements for Facilitating Reinforcement Schedule Thinning

促进强化计划细化的激励细化

• 批准号: 10729562
• 负责人: Brian D. Greer
• 金额: $ 38.08万
• 依托单位: RUTGERS BIOMEDICAL AND HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-06 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10729562
• 关键词: Acceleration; Affect; Aggressive behavior; Animals; Attention; Behavior; Behavior Disorders; Caregivers; Caring; Child; Clinical; Clinical Research; Clinical Services; Communication; Communities; Dangerousness; Developmental Disabilities; Educational process of instructing; Equation; Exhibits; Extinction; Family; Future; Home; Institutionalization; Intellectual functioning disability; Intervention; Laboratory Research; Methods; Motivation; Outcome; Patients; Pharmaceutical Preparations; Physical Restraint; Play; Process; Psychological reinforcement; Quality of life; Randomized, Controlled Trials; Reinforcement Schedule; Relapse; Research; Resources; Risk; Role; Schedule; Self-Injurious Behavior; Services; Severities; Signal Transduction; Social isolation; Source; Stimulus; Testing; Thinness; Time; Training; Work; autism spectrum disorder; comorbidity; developmental disease; effective therapy; improved; novel; prevent; process improvement; reinforcer; response; service delivery; social integration; theories

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.

项目概要 严重的破坏性行为是发育障碍的一种共病，其风险 随着智力障碍严重程度、沟通缺陷和同时发生的自闭症谱系的增加而增加 障碍。1,2 破坏性行为，例如自残行为和攻击行为，会对儿童造成伤害，并且 并增加收容、社会隔离、身体束缚、药物过度使用的风险， 3 临床医生使用功能分析来识别强化服务的变量 破坏性行为并开发有效的、基于功能的治疗方法。4-7 功能性沟通训练 (FCT) 是一种基于经验的、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）来请求强化物 维持破坏性行为，同时将破坏性行为置于灭绝的境地。10-12 例如，如果 功能分析结果表明，注意力会强化破坏性行为，临床医生会提供 当孩子使用 FCR（“请和我一起玩”）时注意，并且不会对破坏性行为给予注意 FCT 的两个重要限制是 (a) 维持 FCR 的强化时间表必须。 通常会逐渐减少到照顾者在家中持续实施的实际水平 在社区中，13-15 和 (b) 这种必要的强化计划稀疏过程经常导致 最初有效的治疗后破坏性行为会增加，这是一种称为治疗复发的形式 复兴。16-19 当前项目旨在通过以下方式改善 FCT 的这些局限性：(a) 加快 通过使用结果删除不必要的计划细化步骤来安排强化细化 渐进间隔评估20-23和(b)通过提供 与维持破坏性行为的强化物高度竞争的刺激。23-27 我们将进行 随机对照试验评估这两项有前途的 FCT 改进在多大程度上改善了 强化计划细化的过程，一项探索性研究将检验以下因素的相互作用 这两种方法有可能大幅提高护理指导标准。 治疗严重破坏性行为并改善儿童和家庭的长期结果 受到这些使人衰弱的行为障碍的影响。