Differential Reinforcement of Alternative Behavior

Further investigation of differential reinforcement of alternative behavior without extinction for escape-maintained destructive

behavior

ADAM M. BRIGGS

EASTERN MICHIGAN UNIVERSITY

CLAUDIA L. DOZIER, AMBER N. LESSOR, BERTILDE U. KAMANA AND

RACHEL L. JESS UNIVERSITY OF KANSAS

Previous research indicates that manipulating dimensions of reinforcement during differential reinforcement of alternative behavior (DRA) for situations in which extinction cannot be implemented is a potential approach for treating destructive behavior. Therefore, we replicated and extended previous research by determining (a) the conditions under which DRA without extinction decreased and maintained low levels of destructive behavior and (b) whether interven- tion effects maintained during reinforcement schedule thinning for the alternative response (i.e., compliance). Results showed that effective treatments were developed in the absence of extinction by manipulating the quality of reinforcement for compliance for 2 participants and by combining manipulations of the magnitude and quality of reinforcement for compliance for the other 2 participants. However, maintaining treatment effects during reinforcement schedule thinning required combining the magnitude and quality of reinforcement for 3 of the 4 partici- pants. We discuss the clinical utility of this approach, review limitations of the study, and sug- gest directions for future research. Key words: destructive behavior, differential reinforcement of alternative behavior, escape

extinction, magnitude, quality, schedule thinning

Differential reinforcement of alternative behav- ior (DRA) is a common intervention for treating destructive behavior maintained by social-negative reinforcement (i.e., escape; Petscher, Rey, & Bailey, 2009). Although extinction is often a criti- cal component of a DRA treatment package when

treating escape-maintained destructive behavior (e.g., Fisher et al., 1993; Hagopian, Fisher, Sulli- van, Acquisto, & LeBlanc, 1998), potential side effects of extinction and risks related to implementing escape extinction may lead to dan- gerous levels of destructive behavior, compromised treatment integrity, or both. Thus, escape extinc- tion may not be a feasible option when treating destructive behavior for some individuals or in cer- tain environments (Athens & Vollmer, 2010; Hagopian, Dozier, Rooker, & Jones, 2013; Pace, Ivancic, & Jefferson, 1994; Piazza, Moes, & Fisher, 1996; Vollmer & Athens, 2011). Researchers have circumvented extinction-

related challenges by conceptualizing DRA as a concurrent-operants arrangement (Fisher & Mazur, 1997; Mace & Roberts, 1993; Myerson & Hale, 1984) and using this approach to inform effective DRA without extinction

This study is based on a dissertation submitted by the first author under the supervision of the second author to the Department of Applied Behavioral Science at the Uni- versity of Kansas in partial fulfillment of the requirements of the doctoral degree. We thank Drs. Dave Jarmolowicz, Pamela Neidert, Derek Reed, and Jason Travers for their helpful comments on an earlier version of the manuscript. We also thank Lily Caudill, Gigi Galliani, Alex Hardee, Lindsay Jerwick, Bailey McGuire, Madison McNinch, and Caley Venturella for their assistance with various aspects of this study.

Address correspondence to: Adam M. Briggs, Depart- ment of Psychology, Eastern Michigan University, 301K Mark Jefferson Science Complex, Ypsilanti, Michigan 48197. Email: [email protected].

doi: 10.1002/jaba.648

JOURNAL OF APPLIED BEHAVIOR ANALYSIS 2019, 52, 956–973 NUMBER 4 (FALL)

© 2019 Society for the Experimental Analysis of Behavior

956

procedures. For instance, research has shown that manipulating various response and reinforcer dimensions1 to favor an alternative response over destructive behavior effectively increases the alter- native response, even when destructive behavior continues to produce the functional reinforcer (e.g., Athens & Vollmer, 2010; Borrero et al., 2010; Hoch, McComas, Thompson, & Paone, 2002; Horner & Day, 1991; Kunnavatana, Bloom, Samaha, Slocum, & Clay, 2018; Piazza et al., 1999). Specifically, for escape-maintained destructive behavior, researchers have manipu- lated the magnitude of reinforcement (Athens & Vollmer, 2010), schedule of reinforcement (Lalli & Casey, 1996), delay to reinforcement (Athens & Vollmer, 2010), quality of reinforce- ment (Adelinis, Piazza, & Goh, 2001; Athens & Vollmer, 2010; Carter, 2010; DeLeon, Neidert, Anders, & Rodriguez-Catter, 2001; Hoch et al., 2002; Lalli & Casey, 1996; Lalli et al., 1999; Piazza et al., 1997; Slocum & Vollmer, 2015), or some combined dimensions of reinforcement (Lalli & Casey, 1996), and examined whether these are effective strategies for treating destruc- tive behavior in the absence of extinction. Presently, Athens and Vollmer (2010) repre-

sent the only demonstration of a systematic manipulation of magnitude (i.e., duration) of reinforcement for treating escape-maintained destructive behavior in the absence of extinc- tion. Specifically, the researchers evaluated the effects of a longer duration break following an alternative behavior (i.e., compliance) as com- pared to a shorter duration break following destructive behavior for one participant. Ini- tially, compliance produced a 30-s break from instructions and destructive behavior only pro- duced a 10-s break (30-s/10-s condition); how- ever, a more discrepant condition in which the

parameters of magnitude were adjusted to 45-s/5-s was required to increase compliance and decrease destructive behavior. Researchers manipulating the quality of rein-

forcement during DRA without extinction for escape-maintained destructive behavior have done so by providing an “enhanced” escape period in which access to preferred stimuli such as attention, edible items, or leisure activities (i.e., social-positive reinforcers) are provided during a brief break from instructional demands (i.e., social-negative reinforcement) contingent upon an alternative behavior (e.g., compliance; Athens & Vollmer, 2010; Hoch et al., 2002; Lalli & Casey, 1996; Piazza et al., 1997; cf. Adelinis et al., 2001; Carter, 2010; DeLeon et al., 2001; Lalli et al., 1999; Slocum & Vollmer, 2015). Specifically, four studies conducted with a total of eight children who engaged in escape-maintained (Athens & Vollmer, 2010; Hoch et al., 2002) or multiply- controlled (including escape; Lalli & Casey, 1996; Piazza et al., 1997) destructive behavior have arranged this manipulation in several ways. That is, reinforcement for the alternative response (i.e., compliance) has resulted in a 30–60-s break with access to high-preference tangible items (Athens & Vollmer, 2010; Hoch et al., 2002; Piazza et al., 1997) or a 30-s break with access to high-preference attention and tangible items (Lalli & Casey, 1996) in com- parison to a 30–60-s break delivered for the destructive behavior (Hoch et al., 2002; Lalli & Casey, 1996; Piazza et al., 1997) or a 30-s break with access to a low-preference tangible item (Athens & Vollmer, 2010). Overall, results of the quality manipulation across all studies indicated that relative rates of both compliance and destructive behavior were sensi- tive to the quality of reinforcement available for each alternative, producing high levels of com- pliance and near zero levels of destructive behavior for seven of the eight children. How- ever, due to several limitations including (a) potential influence of confounding variables

1We use “dimension” throughout the manuscript when discussing the various types of reinforcer manipulations (e.g., magnitude, quality) and use “parameter” when dis- tinguishing between the different values of each dimen- sion (e.g., parameters of 30-s, 60-s, and 120-s break for magnitude of reinforcement).

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making it difficult to isolate relative effects of the quality manipulation (i.e., differing rein- forcement schedules across response options; Lalli & Casey, 1996); (b) potential influence of sequence effects preventing clear interpretation of results (i.e., history of positive reinforcement experienced prior to equated consequences con- dition; Hoch et al., 2002); (c) lack of evidence as to whether the intervention would be as effective with individuals whose destructive behavior is sensitive to escape only (Lalli & Casey, 1996; Piazza et al., 1997); and (d) a fail- ure to replicate initial quality manipulation effects (Athens & Vollmer, 2010), additional research is needed. Only one study with one participant has

evaluated the influence of combined dimen- sions for escape-maintained destructive behav- ior. Specifically, after a 30-s break with access to highly preferred tangible items delivered on a fixed-ratio (FR) 1 schedule proved ineffective when destructive behavior resulted in a 30-s break on a variable-ratio (VR) 5 schedule, Lalli and Casey (1996) added preferred adult atten- tion during the break for compliance and dem- onstrated that combining dimensions (i.e., quality and schedule of reinforcement) effec- tively maintained high levels of compliance and low levels of destructive behavior. However, because the quality manipulation was never iso- lated, it is possible these effects would have been obtained without having to manipulate the schedules of reinforcement. Overall, results of the research evaluating

DRA without extinction for escape-maintained destructive behavior suggest a potentially effec- tive approach toward treatment. However, few studies have evaluated whether the reinforce- ment schedule under various manipulations could be thinned to program for a more man- ageable intervention for therapists and care- givers. Of the studies that have attempted to thin the schedule, several have been unsuccess- ful or required extinction for successful thin- ning (DeLeon et al., 2001; Horner & Day,

1991; Piazza et al., 1997), and several others have demonstrated successful schedule thinning to terminal schedules that remained relatively dense (Hoch et al., 2002; Lalli & Casey, 1996; Lalli et al., 1999). In the studies that effectively thinned the schedule of reinforcement, the pro- cedures for increasing the response requirement were vague (i.e., increased by “substantial amount”; Lalli et al., 1999) or it was possible that the effects were due to an additional dimension manipulation during thinning (i.e., magnitude; Hoch et al., 2002) rather than the dimension that was the target of the study (i.e., quality). Therefore, the purpose of this study was to replicate and extend previous research by evaluating the single and combined influence of magnitude and quality of rein- forcement within the context of DRA without extinction for escape-maintained destructive behavior. In addition, we attempted to extend previous research by determining whether treat- ment effects would maintain when reinforce- ment schedules were thinned.

METHOD

Participants and Setting Four individuals diagnosed with an intellec-

tual and developmental disability, and referred for the assessment and treatment of escape- maintained destructive behavior participated. Anna was a 4-year-old girl who could follow simple, one-step instructions and whose expres- sive language was limited to a few mands using basic sign language. Queenie was a 5-year-old girl who could follow complex, multistep instructions and spoke in sentences. Brock was a 16-year-old male who could follow simple, one-step instructions with some prompts and whose expressive language was limited to approximately 10 picture-exchange icons. Jan- ice was a 14-year-old female who could follow complex, multistep instructions and spoke in sentences. These four participants had no

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record that a token economy had been used in previous programming. Therapists conducted sessions either in a

small therapy room (3 m by 3 m) equipped with a one-way mirror (Anna), in a secluded area (1 m by 1 m) within the participant’s classroom (Queenie), or in the participant’s therapy room (5 m by 5 m; Brock and Janice). The therapy room contained padding on all walls, tables, doors, and the floor if the destruc- tive behavior was object- or surface-directed SIB (Janice only). The therapists wore protec- tive equipment and always had a blocking pad available to provide additional protection for the participant and themselves. During all ses- sions, the area contained a table, two chairs, and condition-specific stimuli. The therapists conducted sessions 4 to 12 times per day, 2 to 5 days per week.

Response Measurement and Interobserver Agreement Trained observers used handheld iPod

Touch® devices to collect data on several par- ticipant and therapist behaviors. The primary dependent variable for the functional analysis (FA) was latency to the first occurrence of destructive behavior. We calculated latency by taking the time in seconds from the start of the session until the onset of destructive behavior or until the end of a 5-min session (300 s), whichever came first. Destructive behavior for Anna and Brock was aggression in the form of hitting and pushing. Destructive behavior for Queenie was aggression in the form of hitting, kicking, and pushing. Destructive behavior for Janice was aggression in the form of hitting, kicking, biting, and scratching, and SIB in the form of body-to-object contact and hand-to- body contact. A second independent observer collected data

for an average of 48% of sessions across partici- pants. We calculated interobserver agreement (IOA) for latency to destructive behavior data by

dividing the shorter latency (in seconds) by the longer latency and multiplying it by 100%. Mean IOA was 94% (range, 67%–100%) for Anna, 98% (range, 72%–100%) for Queenie, 98% (range, 77%–100%) for Brock, and 97% (range, 42%–100%) for Janice. Although the IOA percentages were high for mean agreement across measures, the ranges highlight that IOA percentages were low for some sessions for some participants. These low percentages reflect the fact that a small difference between observers’ records for a very short latency represented a large proportional disagreement. The primary dependent variables for the

DRA without extinction evaluation were the participant’s (a) rate of destructive behavior and (b) percentage of compliance with instructional demands. Destructive behavior was defined the same as in the FA; however, we calculated the rate by dividing the frequency of destructive behavior by session duration. Compliance was defined as correctly responding to the therapist’s instruction within 5 s of a vocal or model prompt and in the absence of destructive behav- ior. We converted compliance to a percentage by dividing the frequency of compliance by the total number of therapist’s vocal-verbal only instructions (i.e., instructions that did not include a model or physical prompt) and multi- plying by 100%. Observers also scored the fre- quency of token delivery for participant compliance. Finally, observers used duration recording to score therapist (a) removal of instructional demands, (b) delivery of attention, and (c) delivery of tangible items during each session. The observers collected duration data for each instance by recording the onset and off- set of these events. A second independent observer collected

data on participant and therapist behavior for an average of 32.3% of sessions across partici- pants. For behavior scored using a frequency measure, we calculated IOA by dividing the session into 10-s intervals and using the block- by-block proportional agreement method. We

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divided the smaller number of responses recorded by the larger number of responses within each interval and then summed the results, divided by the total number of inter- vals, and multiplied this number by 100%. Mean IOA was 99% (range, 92%–100%) for Anna, 95% (range, 83%–100%) for Queenie, 98% (range, 96%–100%) for Brock, and 98% (range, 96%–100%) for Janice. For behavior scored using duration recording, IOA was cal- culated for each duration scored by taking the smaller duration divided by the larger duration, summing these proportions, and multiplying this number by 100%. IOA was 99% (range, 95%–100%) for Anna, 98% (range, 87%– 100%) for Queenie, 99% (range, 77%–100%) for Brock, and 99% (range, 93%–100%) for Janice.

Latency-Based Functional Analysis Procedure Latency-based FA sessions were similar to those

described by Thomason-Sassi, Iwata, Neidert, and Roscoe (2011). Trained graduate students conducted all sessions, which were a maximum duration of 5 min. Functional analysis conditions were conducted in the following fixed sequence and included (unless otherwise specified) no inter- action, divided attention (Fahmie, Iwata, Harper, & Querim, 2013), play, social avoidance (Harper, Iwata, & Camp, 2013), escape, tangible (leisure item), and tangible (edible item) condi- tions. Functional analysis conditions included condition-specific stimuli (e.g., moderate- or high-preference items, instructional materials) that were informed by open-ended caregiver interviews (Hanley, 2012), direct observations, and paired- stimulus preference assessments (PSPA; Fisher et al., 1992). Therapists conducted leisure-item PSPAs with all participants and edible-item PSPAs with participants who would and could consume edibles (Queenie and Brock). We omit- ted the no- interaction test condition for Anna, Queenie, and Brock because the topography of their destructive behavior was aggression only;

however, we included it for Janice because her destructive behavior consisted of both aggression and SIB. In addition, we omitted the tangible (edible) test condition in FAs for Anna and Janice because caregivers reported these participants could not or did not reliably consume edibles. Because indirect assessments indicated that Jan- ice’s aggression and SIB were possibly maintained by social-negative reinforcement in the form of escape from therapist interactions, we included a social-avoidance condition to test this hypothesis. In addition, therapists wore different colored T- shirts and placed different colored poster boards on the wall to aid in discrimination across condi- tions (Conners et al., 2000). During divided attention, escape, social

avoidance, and tangible conditions, the thera- pist provided the programmed consequence for the first occurrence of the destructive behavior and terminated the session. During no- interaction and play conditions, the therapist terminated sessions 1 min after the occurrence of destructive behavior to decrease the likeli- hood of intermittent social reinforcement. If destructive behavior did not occur during a ses- sion, the therapist ended the session when 5 min had elapsed. No interaction (Janice only). During these ses-

sions, we arranged a barren environment (i.e., no toys or additional stimuli were present), and the therapist turned away from the partici- pant and did not deliver any programmed con- sequences for participant behavior. Divided attention. During these sessions, we

provided moderately preferred leisure items identified in the PSPA, and the therapist ignored the participant and engaged in contin- uous conversation with an adult confederate. However, if the participant engaged in destruc- tive behavior, the therapist stopped conversing with the confederate and provided a brief period of physical and vocal-verbal attention. Social avoidance (Janice only). During these

sessions, the therapist provided continuous vocal interaction by describing things in the

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immediate environment and delivering physical interaction approximately every 30 s. However, contingent upon the occurrence of the destruc- tive behavior, the therapist discontinued social interaction and moved away from the partici- pant for 30 s prior to terminating the session. Escape. During these sessions, the therapist

continuously presented difficult or non- preferred tasks to the participant using a three- step prompting procedure. However, contin- gent upon the occurrence of the destructive behavior, the therapist removed the materials associated with the task and turned away from the participant for 30 s prior to terminating the session. Tangible (leisure items). Prior to all sessions,

the therapist provided access to two, highly pre- ferred leisure items for 2 min. After 2 min of access, the therapist removed the preferred items and began the session. During these ses- sions, contingent on the occurrence of the destructive behavior, the therapist immediately provided the participant with 30-s access to the item prior to terminating the session. Tangible (edible items; Queenie and Brock

only). Prior to the session, the therapist pro- vided access to two, highly preferred, bite-sized edible items until consumed. Following con- sumption, the therapist removed access to the remaining highly preferred edibles and began the session. During the session, contingent on the occurrence of the destructive behavior, the therapist immediately provided the participant with 30-s access to the edibles prior to termi- nating the session. Play. During these sessions, we provided

continuous access to highly preferred leisure and edible items (if applicable) used in the tan- gible conditions and the therapist provided continuous interaction throughout the session. The therapist did not place any demands. We used a multielement design to evaluate

the effects of the various test and control condi- tions on destructive behavior. For Janice, we also used a sequential, test-control (or pairwise)

design (Iwata, Duncan, Zarcone, Lerman, & Shore, 1994) following inconclusive results of the tangible test condition within the mul- tielement arrangement. To identify the func- tion of destructive behavior, we determined which test condition(s) showed consistently shorter latencies to the destructive behavior when compared to the play (control) condition.

Pretreatment Assessments Attention assessment. We conducted a pictorial

PSPA (Northup, George, Jones, Broussard, & Vollmer, 1996) to determine the most preferred type(s) of attention for each participant, which would be delivered during various phases of the DRA without extinction evaluation. Procedures for the attention assessment were similar to those described by Kelly, Roscoe, Hanley, and Schlichenmeyer (2014). We used seven topogra- phies of attention for each participant, including four common types of attention (i.e., tickles, head rubs, praise, and conversation) reported to function as common reinforcers (e.g., Piazza et al., 1999; Smaby, MacDonald, Ahearn, & Dube, 2007) and three additional types of atten- tion nominated by each participant’s caregiver (e.g., high-fives, hugs, facial expressions). During the attention assessment, therapists used photos, each depicting a different type of attention, and a blank, solid white control card. We affixed each photo to a different color card to aid in dis- crimination. The therapist who would imple- ment the DRA without extinction evaluation for a particular participant conducted the assess- ment. The therapist conducted sessions in a PSPA format (Fisher et al., 1992) and presented pictures of the therapist delivering each type of attention to the participant in pairs along with some trials including a white control card. Con- tingent upon selection of a particular photo, the therapist delivered the type of attention depicted in the photo for approximately 5 s. If the partic- ipant selected the control card, the therapist looked down and provided no attention for 5 s.

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We used an attention type during subsequent conditions of the DRA without extinction evalua- tion if the participant selected it for at least 80% of trials. If the participant did not select a particu- lar type of attention for at least 80% of trials, the therapist determined the top two or three types of attention and either (a) re-conducted the PSPA with just those types of attention (Anna) or (b) conducted a concurrent-operants reinforcer assessment to determine response allocation to each of the pictures (Janice and Queenie). Rein- forcer assessment sessions were 2 min and picture touches resulted in the therapist providing the type of attention depicted on each picture card for a short amount of time. We calculated rate of picture touches, and we used the type of atten- tion that resulted in the highest rate of picture touches during subsequent conditions of the DRA without extinction evaluation. Results of the assessment indicated that Anna preferred hugs, Brock preferred facial expressions, and Queenie and Janice preferred conversation (data available from the first author). Token assessment. In order to determine

whether tokens functioned as neutral stimuli, we conducted a token assessment with each partici- pant prior to introducing them during reinforce- ment schedule thinning. All token assessment sessions were 2 min and were conducted by the therapist who would implement the DRA with- out extinction evaluation for a particular partici- pant. A simple target response (i.e., touching a blank, white card) and a moderately preferred alternate activity were concurrently available dur- ing all sessions. Conditions included baseline and token sessions, and we used a reversal design for experimental control. During baseline sessions, the therapist did not deliver any consequences for engaging in the target response. During token sessions, the therapist delivered a token (i.e., laminated square pieces of white poster board with VELCRO® backing) by placing it on an open spot on a token board (i.e., laminated rectangular piece of white poster board with 20 VELCRO® spots for tokens). At the end of

token sessions, the therapist removed the tokens from the token board, and did not deliver any back-up reinforcers for the token exchange. We used rate of the target response as the primary measure and results showed that all participants engaged in near-zero levels of responding across conditions, suggesting that tokens did not func- tion as reinforcers for the participants (data avail- able from the first author).

DRA without Extinction Evaluation In this evaluation, we attempted to determine

the conditions under which DRA without extinc- tion could be effective for each participant. Specif- ically, although destructive behavior continued to result in the functional reinforcer, this evaluation involved manipulating single and combined dimensions of reinforcement for compliance (see Table 1 for a summary of baseline and DRA without extinction contingencies for destructive behavior and compliance across conditions). The introduction of conditions always progressed in the following sequence: magnitude, quality, and combined dimensions. Our design programmed for the participants to experience conditions in this order to ensure that we evaluated the equated consequences and magnitude manipulation con- ditions prior to the participant receiving positive reinforcers within periods of escape during the quality manipulation to prevent this history from influencing responding during these escape-only

Table 1 Consequences Across Conditions

Conditions Destructive behavior Compliance

Baseline 30-s escape Praise only Equated consequences 30-s escape 30-s escape Magnitude manipulation 30-s escape 2-min escape Quality manipulation 30-s escape 30-s escape with

HP stimuli Combined manipulation 30-s escape 2-min escape with

HP stimuli Enhanced combined manipulation

30-s escape 4-min escape with HP stimuli

Note: HP = high preference.

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conditions. All sessions were 10 min, except for initial sessions with Janice and Brock, which were 5 min. We held session duration constant across all conditions. All DRA without extinc- tion sessions included the instructional materials present during the escape condition of the FA for a particular participant. In addition, preferred leisure items, edible items, and types of attention identified in the PSPAs were included during the quality manipulation. During all sessions, the therapist presented demands continuously using a three-step prompting procedure. Addi- tionally, during all sessions, each occurrence of destructive behavior resulted in a 30-s break in which the therapist removed demand materials and turned away from the participant for the duration of the break. If destructive behavior occurred at high levels on an increasing trend across two consecutive sessions in a given rein- forcement manipulation condition, we deter- mined this condition was not effective at suppressing destructive behavior and progressed to the next reinforcement manipulation condi- tion. Breaks were also provided for compliance during most sessions (with the exception of base- line). We used a reversal design to evaluate the effects of the DRA without extinction. Specifi- cally, if we observed a treatment effect within a particular condition, either the baseline or equated- consequences condition functioned as the control, and we compared levels of destruc- tive behavior across these conditions. Following an empirical demonstration of the treatment effect, we implemented schedule thinning to determine whether treatment effects could main- tain under leaner schedules of reinforcement when destructive behavior continued to result in the functional reinforcer. Baseline (Anna and Janice only). During base-

line sessions, the therapist delivered praise only for each instance of compliance and a 30-s break for each instance of destructive behavior. This condition was only implemented as a con- trol when treatment effects were observed under the equated-consequences condition.

Equated consequences. During this condition, the therapist delivered a 30-s break for each instance of compliance or destructive behavior. This condition was implemented as the primary control condition when we observed treatment effects under the reinforcement dimension manipulation conditions (i.e., magnitude, qual- ity, or combined). Magnitude manipulation. During this condi-

tion, the therapist delivered a high-magnitude (i.e., 2-min) break for each instance of compli- ance and a 30-s break for each instance of destructive behavior. Quality manipulation. During this condition,

the therapist delivered an enhanced or “high- quality” 30-s break for each instance of compli- ance and a 30-s break for each instance of destructive behavior. The quality manipulation included continuous access to highly preferred attention (as determined by the attention assess- ment), the top one (Janice) or two (Anna, Brock, and Queenie) most preferred leisure items as determined by the leisure item prefer- ence assessment, and a choice between the top two most preferred edible items (Brock only) as determined by the edible preference assessment. Combined manipulation. During this condi-

tion, the therapist delivered a high-magnitude and high-quality break for each instance of com- pliance, which included a high-magnitude (i.e., 2-min) break with access to all of the stim- uli provided in the quality manipulation condi- tion. The therapist continued to deliver a 30-s break for each instance of destructive behavior. Enhanced combined manipulation (Janice

only). During this condition, procedures were identical to the combined manipulation proce- dures described above, except that the duration of the break was 4 min.

DRA without Extinction Schedule Thinning When a DRA without extinction condition

produced stable treatment effects and we dem- onstrated experimental control through a

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reversal to a previously ineffective condition, we returned to the effective condition and intro- duced tokens. Because the FR-1 schedule with the tokens also served as the reintroduction of treatment in our demonstration of experimental control, it was important to demonstrate a stable reduction in destructive behavior over time (to control for previous phases that eventually proved ineffective), which also allowed for token delivery for compliance to be paired with imme- diate access to the condition-specific reinforcer. We used a chained schedule to accomplish rein- forcement schedule thinning. Specifically, during all schedule-thinning sessions, the therapist delivered tokens on an FR-1 schedule for com- pliance and provided a 30-s break for instances of destructive behavior; however, we systemati- cally increased the token exchange schedule to access the programmed reinforcer for compli- ance across sessions. That is, following a stable reduction, we increased the token exchange schedule from an FR 1 to an FR 2 and then increased by 2 until the terminal goal of an FR 20 exchange schedule was reached, or until a schedule was reached in which consistent maintained effects were observed. The token board included the number of VELCRO® spots and tokens of the terminal response requirement (i.e., 20 tokens) for each session, but was miss- ing the precise number of tokens of the current response requirement to help signal to the par- ticipant the number of tokens required to fill the board and access the programmed reinforcer. After reaching the FR-2 schedule, increases in the response requirement for token exchanges occurred after two consecutive sessions in which destructive behavior maintained at a 90% reduc- tion from the control condition. However, if destructive behavior occurred on an increasing trend above this criterion for two consecutive sessions, we reduced the chained schedule to the most recently effective response requirement to reestablish effects prior to continuing with sys- tematic thinning. If this procedure was ineffec- tive or the efficacy decreased with reinforcement

schedule thinning, and thus the criterion was not met after two attempts at a given schedule, the participant moved to the next DRA without extinction phase of the treatment evaluation. Throughout the schedule-thinning phase, we conducted brief probes of the terminal response requirement (i.e., FR 20) immediately following every third thinning step in which the partici- pant’s responding met criteria, in an attempt to determine whether tokens would maintain responding without further schedule thinning. During all schedule-thinning and brief-probe

sessions, each time the participant’s responding met the token exchange schedule, the therapist provided praise and told the participant they earned the programmed reinforcer. The thera- pist then delivered the programmed reinforcer for this condition. Next, the therapist removed the token(s) from the token board and placed these materials back in front of the participant following the conclusion of the reinforcement period and prior to the start of a new instruc- tional period.

RESULTS

Figure 1 depicts the results of the latency- based FA for all participants. For Anna (first panel), Queenie (second panel), and Janice, (fourth panel), consistently shorter latencies to destructive behavior occurred in the escape condition as compared to the control condition suggesting escape from demands as the func- tion of destructive behavior for these partici- pants. For Brock (third panel), consistently shorter latencies to physical aggression occurred in the escape condition, divided attention con- dition, tangible (leisure-item) condition, and tangible (edible-item) condition as compared to the control condition. These data suggest that all social reinforcers including escape from demands, access to attention, and access to tan- gible items (leisure and edibles) maintained Brock’s physical aggression.

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Figures 2–5 depict the results of the DRA without extinction evaluation for each partici- pant. Figure 2 depicts the results for Anna. Ini- tially, Anna engaged in low levels of destructive behavior and moderate levels of compliance during the equated-consequences condition; however, following a history in baseline, the equated consequences and magnitude- manipulation conditions failed to recapture treatment effects. These results suggest that simply increasing the duration of escape for

compliance under a dense schedule of rein- forcement was ineffective at increasing compli- ance and decreasing destructive behavior for Anna. Therefore, we implemented the quality- manipulation condition and Anna’s destructive behavior decreased to low rates and compliance increased to high levels. We replicated these effects following a reversal to the equated- consequences condition; however, these effects failed to maintain under this condition at a dense schedule of reinforcement as we observed the rate of destructive behavior increase to high levels across two consecutive sessions. Next, we implemented the combined-manipulation con- dition and rates of destructive behavior reduced to zero and compliance increased to high levels. Following a brief reversal to the equated- consequences condition, we replicated treat- ment effects and introduced tokens. Following stable treatment effects, the therapist began to systematically thin the token exchange sched- ule. Results showed that as we thinned the schedule, rates of destructive behavior contin- ued to maintain at zero levels and compliance remained at high levels as the token exchange schedule increased from an FR 1 to an FR 2 and on to an FR 4. Following maintenance at the FR-4 schedule, we conducted a terminal- schedule probe (FR 20) and demonstrated maintained effects. Figure 3 depicts the results for Queenie.

Queenie engaged in increasing levels of destruc- tive behavior and decreasing levels of compli- ance across the equated and magnitude- manipulation conditions. These results suggest that simply increasing the duration of escape for compliance under a dense schedule of reinforcement is likely not effective at produc- ing lasting behavior change for this participant. Therefore, we implemented the quality manipulation condition and Queenie’s destructive behavior decreased to zero rates and compliance increased to relatively high levels. We replicated these effects following a reversal to the equated-consequences condition;

Figure 1. Latency-based FA results for Anna’s physical aggression (first panel), Queenie’s physical aggression (sec- ond panel), Brock’s physical aggression (third panel), and Janice’s physical aggression and SIB (fourth panel). AGG = physical aggression.

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however, these effects failed to maintain under a relatively dense schedule of reinforcement (i.e., FR 2). Although we observed stable treat- ment effects when the quality of reinforcement favored compliance, suggesting this manipula- tion is an effective treatment under a dense FR- 1 schedule, our goal was to determine the con- ditions under which we could achieve a rela- tively lean schedule of reinforcement while maintaining treatment effects. Thus, we implemented the combined-manipulation con- dition, and rates of physical aggression reduced to zero and compliance increased to high levels.

Following a brief reversal to the equated- consequences condition, we recaptured treat- ment effects and introduced tokens. Following stable treatment effects, the therapist began to systematically thin the token-exchange schedule. Results showed that as the schedule was thinned, rates of destructive behavior continued to maintain at zero and compliance remained at high levels as the token-exchange schedule increased from an FR 1 to an FR 2 and on to an FR 4. Following maintenance at the FR-4 schedule, we conducted a terminal-schedule probe (FR 20) and showed maintained

Figure 2. Results for Anna during the DRA without extinction evaluation in which schedule thinning (the numbers and arrows between the graphs for aggression and compliance indicate the token exchange schedule numbers) and terminal-schedule probes (open data points) were conducted. Horizontal, dashed line (top panel) indicates 90% reduc- tion of physical aggression from the control condition (denoted with an asterisk). BL = baseline.

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treatment effects under this schedule; however, following a brief reversal to the equated- consequences condition, we failed to recapture treatment effects under the FR-20 terminal schedule. Therefore, Queenie’s therapist ret- urned to the previously effective schedule (FR 4) to reestablish treatment effects and continued to implement systematic schedule thinning. Fol- lowing maintenance at the FR-10 schedule, Queenie’s therapist conducted another terminal- schedule probe (FR 20) and observed maintained treatment effects under the terminal schedule for 12 consecutive sessions.

Figure 4 depicts the results for Brock. Ini- tially, Brock engaged in high levels of destruc- tive behavior and low levels of compliance during 5-min sessions of the equated- consequences and magnitude manipulation conditions. Like Anna and Queenie, these results suggest that simply increasing the dura- tion of escape for compliance under a dense schedule of reinforcement is likely not effective for behavior change for this participant. There- fore, we implemented the quality-manipulation condition, and Brock’s destructive behavior decreased to near zero and compliance

Figure 3. Results for Queenie during the DRA without extinction evaluation in which schedule thinning (the num- bers and arrows between the graphs for aggression and compliance indicate the token exchange schedule numbers) and terminal-schedule probes (open data points) were conducted. Horizontal, dashed line (top panel) indicates 90% reduc- tion of physical aggression from the control condition (denoted with an asterisk).

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increased to relatively high levels (albeit on a decreasing trend), even as we increased the ses- sion duration to 10 min. We replicated these effects following a reversal to the equated- consequences condition; however, these effects failed to maintain under this condition as schedule thinning progressed. As with Queenie, we implemented the combined-manipulation condition and rates of destructive behavior reduced to near zero and compliance increased to high, stable levels. Following a brief replica- tion of effects under the equated consequences condition, we recaptured treatment effects and

introduced tokens. Following stable treatment effects, the therapist began to systematically thin the token-exchange schedule. Results showed that as we thinned the schedule, rates of destructive behavior maintained at near zero levels and compliance remained at high levels, even as the token-exchange schedule increased to an FR 14. However, following the introduc- tion of the FR-16 schedule, we lost treatment effects and could not regain them even after returning to denser schedules (FR 14 and FR 12). We reestablished stable treatment effects at an FR-10 schedule and demonstrated

Figure 4. Results for Brock during the DRA without extinction evaluation in which schedule thinning (the numbers and arrows between the graphs for aggression and compliance indicate the token exchange schedule numbers) and terminal-schedule probes (open data points) were conducted. Horizontal, dashed line (top panel) indicates 90% reduc- tion of physical aggression from the control condition (denoted with an asterisk).

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maintenance of treatment effects across 10 con- secutive sessions at this schedule. Figure 5 depicts the results for Janice. We did

not observe maintained treatment effects with Janice until we implemented the enhanced, combined-manipulation condition with a 4-min break for compliance. Under this condition, Jan- ice’s destructive behavior immediately reduced to zero and levels of compliance increased and maintained at high levels. We replicated these effects following a reversal to the equated- consequences condition and introduced tokens.

Following stable treatment effects, the therapist began to systematically thin the token-exchange schedule. Although initial reinforcement sched- ule thinning and probes at the terminal schedule demonstrated some maintenance of treatment effects at relatively lean schedules, levels of com- pliance eventually decreased, and rates of destructive behavior consistently returned to baseline levels. Following multiple failed attempts to thin the schedule, we attempted to replicate the initial effects of the intervention by showing maintained treatment effects under the

Figure 5. Results for Janice during the DRA without extinction evaluation in which schedule thinning (the numbers and arrows between the graphs for aggression/SIB and compliance indicate the token exchange schedule numbers) and terminal-schedule probes (open data points) were conducted. Horizontal, dashed line (top panel) indicates 90% reduc- tion of physical aggression and SIB from the control condition (denoted with an asterisk). BL = baseline.

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FR-1 schedule, which we demonstrated in the final seven consecutive sessions.

DISCUSSION

We identified efficacious treatments in the absence of extinction by manipulating the qual- ity of reinforcement (Queenie and Brock) or the combination of magnitude and quality of reinforcement (Anna and Janice) for compli- ance. However, combining magnitude and qual- ity of reinforcement for compliance was necessary to maintain treatment effects when reinforcement schedules were thinned for three of the four participants. Furthermore, results showed that the equated-consequences and mag- nitude-manipulation conditions were either ineffective or did not maintain effects for par- ticipants with escape-maintained destructive behavior, which replicates findings from previ- ous research (Athens & Vollmer, 2010; Hoch et al., 2002). Previous research suggests manipulating the

magnitude of reinforcement to favor the alter- native response may be a potentially effective manipulation (e.g., Athens & Vollmer, 2010); however, we found that manipulating magni- tude alone was ineffective for all four partici- pants. It is important to note that we did not evaluate the efficacy of a 4-min break alone with Janice, which may have been effective. Thus, future researchers might consider identi- fying whether participants are sensitive to mag- nitude of reinforcement at varying parameters (e.g., 15-s vs. 90-s breaks; Kunnavatana et al., 2018) and comparing the effects of different break durations prior to manipulating them in a formal evaluation. Furthermore, it may also be that in controlling for one sequence effect (i.e., history of positive reinforcement) by pro- gramming a fixed progression across conditions, we may have set up another, unanticipated sequence effect. That is, it may have been diffi- cult for participants to discriminate the change in break duration when transitioning from the

equated-consequences to the magnitude- manipulation condition. Future researchers might program discriminative stimuli (e.g., a timer) or use more salient durations (e.g., break for the rest of the day) to enhance the discrimi- nability of changes in magnitude. The quality-manipulation condition was ini-

tially effective for all four participants; however, these results were either not replicated follow- ing a history of the equated condition (Anna and Janice) or became ineffective during sched- ule thinning under relatively dense schedules of reinforcement (Queenie and Brock). There are several potential reasons for this finding. First, although we attempted to identify high- preference stimuli to include during the quality condition, three of the four participants did not demonstrate a strong preference for attention (i.e., did not choose one type for 80% or more of trials) and we did not use edible reinforcers for three of the four participants for various rea- sons. Second, recent research indicates that accumulated reinforcement can be more pre- ferred and efficacious as compared to distrib- uted reinforcement intervals (DeLeon et al., 2014), which might explain why combining magnitude and quality was necessary for maintaining treatment effects in all cases. It should be noted that our criteria for determin- ing whether a reinforcement dimension manip- ulation condition proved ineffective only required an increase in destructive behavior across two consecutive sessions; therefore, had we continued to run these phases out longer, participants may have eventually shifted their response allocation. We used tokens during reinforcement sched-

ule thinning to help signal the response require- ment. However, there are several limitations associated with this approach, and effects related to the influence of tokens should be interpreted with caution. First, we conducted our token training within the context of our treatment evaluation; therefore, it is unclear whether and at what point tokens were

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conditioned as reinforcers. Second, although tokens may have functioned as conditioned reinforcers that helped bridge the delay under leaner schedules (Hackenberg, 2009, 2018), we cannot speak directly to the effects of tokens because we did not evaluate reinforcement schedule thinning with and without the use of tokens. In addition, based on the decrease in treatment effects with schedule thinning for Brock and Janice, it may be that we thinned too rapidly, producing ratio strain (Ferster & Skinner, 1957), or perhaps the schedules became too predictable. Given this possibility, it would be interesting to evaluate the effects of less predictable schedules of reinforcement such as variable-ratio or random-ratio schedules. A large proportion of Janice’s destructive

behavior occurred during the programmed EO-off periods (i.e., during periods of escape from instructions; data available from first author). Although results of her FA suggested an escape function, it is clear that the contin- gencies delivered throughout her evaluation did not sufficiently address all of the relevant EOs, which may explain why we needed an enhanced, combined condition delivered at a dense FR-1 schedule in order to achieve maintained treatment effects. Further, because Brock’s FA results suggested multiply con- trolled destructive behavior, it makes sense that the quality manipulation was necessary to address all relevant EOs. Although dense schedules of reinforcement

for the alternative response resulted in exclusive allocation towards compliance, once schedule thinning was introduced and compliance did not reliably result in reinforcement, we observed resurgence of destructive behavior (Lieving, Hagopian, Long, & O’Connor, 2004; Volkert, Lerman, Call, & Trosclair-Lasserre, 2009) across all four participants. Recently, Briggs, Fisher, Greer, and Kimball (2018) iden- tified that resurgence occurred in a high pro- portion of reinforcement schedule thinning applications (19 of 25, or 76%) during

functional communication training (FCT). Furthermore, Lichtblau, Greer, and Fisher (provisionally accepted) recently found that greater levels of resurgence were observed fol- lowing FCT without extinction than FCT with extinction in three of four treatment compari- sons. Overall, these findings suggest that future research is needed to explore additional strate- gies for thinning schedules of reinforcement in ways that also prevent destructive behavior from reemerging. For instance, researchers should consider evaluating whether using stim- ulus control technology to clearly signal the availability and unavailability of reinforcement (Fuhrman, Fisher, & Greer, 2016) helps to mitigate resurgence. Overall, the results of the current investiga-

tion suggest that durable treatment effects can be developed in the absence of extinction by manipulating a combination of magnitude and quality of reinforcement for compliance, which can be maintained at relatively lean schedules of reinforcement. These results contribute to the growing body of literature on the use of positive reinforcement in the treatment of escape-maintained destructive behavior (Payne & Dozier, 2013). Furthermore, these results have important clinical implications because they provide further evidence of the efficacy of alternative strategies for treating severe destructive behavior when extinction might not be an option. Finally, because we demonstrated that reinforcement for compli- ance can be thinned while destructive behavior continued to result in a functional reinforcer, these results may indicate an intervention approach with a manageable implementation requirement for caregivers.

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Received March 13, 2018 Final acceptance August 16, 2019 Action Editor, Timothy Vollmer

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