article question and answer

Automatic Negative Reinforcement: Its Possible Role in Problem Behavior With Treatment Implications

Frans van Haaren Autism Early Intervention Clinics and the ABA Academy, Saint Petersburg, Florida

Problem behaviors such as self-stimulation, stereotypy, and some instances of self- injurious behavior have long been assumed to be maintained by automatic positive reinforcement in the absence of socially mediated consequences. This paper presents an alternative interpretation suggesting that these problem behaviors may well be a function of past social negative reinforcers and the stimuli conditioned in the context of their delivery (automatic negative reinforcement). Problem behavior maintained by automatic negative reinforcement needs to be treated by therapeutic interventions different from those based on the automatic positive reinforcement function previously assumed to maintain these behaviors.

Keywords: stereotypy, automatic positive reinforcement, automatic negative reinforcement, functional analysis, reflexive conditioned motivating operation

Self-stimulation and stereotypy are problem behaviors not because they necessarily result in physical damage to an individual, others in the environment, or the physical environment itself, but because they prohibit an individual’s effec- tive participation in educational activities de- signed to remedy behavioral deficits. Of course, self-injurious behavior (SIB) may result in physical damage to the individual, others in the environment, or the environment itself, but sim- ilar to self-stimulation and stereotypy it also interferes with the individual’s participation in activities designed to teach adaptive behavior. It has long been assumed that self-stimulation, stereotypy, vocal stereotypy, and some forms of SIB do not serve any social function, presum- ably because none was obvious at the time these behaviors were observed. For instance, Foxx and Azrin (1973, p. 1) described self-stimula- tion as “repetitive, stereotyped behavior that has no apparent functional effects on the environ- ment [italics added], examples of which are rocking, hand-waving and head-weaving (e.g., Kaufman & Levitt, 1965), mouthing or rubbing parts of one’s body (e.g., Hutt & Hutt, 1965),

and mouthing, or spinning objects (Hutt & Hutt, 1965; Kaufman, 1967).” Lovaas, Newsom, and Hickman (1987) observed that

There exists a class of behaviors that are stereotyped and repetitive, appear in near-identical form across several members of a species, and are functionally autonomous in the sense that they can persist indefi- nitely in the absence of social consequences [italics added]. These behaviors take the form of prolonged body-rocking, head-nodding, flapping the hands at the wrist, tapping or shaking objects, gazing at lights, jumping up and down and so forth. (p. 45)

Others have identified another form of ste- reotypy, vocal stereotypy, that consists of “non- functional vocalizations [italics added] such as singing, babbling, repetitive grunts, squeals, echolalic vocalizations and phrases unrelated to the present situation” (Ahearn, Clark, Mac- Donald, & In Chung, 2007, p. 266). Iwata et al. (1994) summarized the results from 152 single- subject analyses that were conducted to deter- mine the reinforcing functions of SIB. These investigators concluded that approximately one fourth of all cases of SIB of various topogra- phies (e.g., head banging, head hitting, biting, mouthing, scratching) were maintained by au- tomatic reinforcement because these behaviors were observed (a) just during the “alone” con- dition of a functional analysis; (b) predomi- nantly during the alone condition of a functional analysis but also to some extent during the “attention,” “demand,” and “play” conditions;

Correspondence concerning this article should be ad- dressed to Frans van Haaren, Autism Early Intervention Clinics and the ABA Academy, 8950 Dr. M.L. King Street N, Suite 170, Saint Petersburg, FL 33702. E-mail: haaren@ autismclinics.com

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Behavior Analysis: Research and Practice © 2015 American Psychological Association 2015, Vol. 15, Nos. 3– 4, 161–170 2372-9414/15/$12.00 http://dx.doi.org/10.1037/bar0000020

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or (c) at extremely high levels during all exper- imental conditions (see also Beavers, Iwata, & Lerman, 2013 and Hanley, Iwata, & McCord, 2003). It is important to note that these in- stances of SIB are assumed to be maintained by automatic reinforcement by default because their function could not be uniquely assigned to any of the other functions of the behavior (so- cial positive reinforcement in the form of atten- tion or access to tangible items or social nega- tive reinforcement in the form of escape from demands).

Thus, self-stimulation, stereotypy, and some instances of SIB are problem behaviors gener- ally assumed to be maintained by some form of automatic reinforcement. Vaughan and Michael (1982) were the first to review the literature on automatic reinforcement, and they concluded that

In the most general sense, automatic reinforcement is reinforcement that is not mediated by the deliberate action of another person—“deliberate” in the sense of action taken because of consequences for the other person. It is a “natural” result of behavior which op- erates upon the behaver’s own body or the surrounding world. In general, the reinforcement may be condi- tioned or unconditioned, positive or negative. More- over, the behavior reinforced automatically may be verbal or nonverbal. . . . (p. 219)

Vaughan and Michael (1982) emphasized that the concept of automatic reinforcement played a critical role in Skinner’s analysis of human verbal behavior because he used the term predominantly in his writings on verbal behavior and intellectual self-management.1

There may be some heuristic value in refer- encing automatic reinforcement to understand problem behavior maintained in the absence of socially mediated reinforcement, but such has proven to pose serious problems for clinicians charged with the task of treating these problem behaviors through manipulation of its anteced- ents or consequences. This difficulty should not come as a surprise because automatic reinforc- ers have been assumed to be “the ‘natural’ result of behavior which operates upon the behaver’s own body or the surrounding world” (Vaughan & Michael, 1982). For instance, it has been hypothesized that head hitting may occur be- cause it is positively reinforced by the release of endorphins (Sandman & Hetrick, 1995), that rocking may occur because it produces favor- able kinesthetic sensations, that repeatedly

dropping colorful objects in front of the eyes is maintained because it may provide favorable visual sensations, and that lining up objects happens because it brings order to an otherwise confusing environment (Fischer & Bouxsein, 2011). Thus, all of these assumed consequences that involve the presentation of various unde- fined stimuli are properly characterized as au- tomatic positive reinforcers. On the other hand, Fischer and Bouxsein (2011) have also sug- gested that hand flapping may occur during times of physiological excitation because it mit- igates arousal and reduces muscle tension (re- moval or attenuation of various undefined stim- uli), an example of automatic negative reinforcement. Unfortunately, these authors did not elaborate on the variables that might be responsible for the presence of arousal and mus- cle tension in the first place, but such will be further elaborated upon in this treatise.

Kennedy (1994) identified two usages of the term automatic reinforcement. The first uses the term automatic reinforcement to propose a con- trolling response-reinforcer relation in the ab- sence of an experimental demonstration of that relationship. Kennedy argues that this is essen- tially a contradiction in terms that should be avoided. The second usage uses the term auto- matic reinforcement to distinguish between the presence and absence of response-reinforcer re- lations mediated by others in the social environ- ment. Kennedy suggested that in the latter case automatic reinforcement can be used as a hy- pothetical construct for labeling the need for additional research where functional relations have not been experimentally identified, thus setting the occasion for more refined and con- tinued experimental efforts. Many have traveled that road (e.g., Hanley, Iwata, Thompson, & Lindberg, 2000; Potter, Hanley, Augustine, Clay, & Phelps, 2013; Rapp, 2007) with various degrees of success. The present paper is an incremental effort in that direction by arguing that self-stimulation, (vocal) stereotypy, and some forms of SIB cannot only be interpreted to be a function of automatic positive reinforce-

1 It is interesting to note that Skinner did not deem the concept important enough to be included in the index of his numerous writings (Holland & Skinner, 1961; Skinner, 1953, 1957, 1968, 1969, 1974).

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ment but that an automatic negative reinforce- ment function can also be hypothesized.

The Four-Term Contingency

Starting in 1982, Michael has published sev- eral influential papers in which he described the part played by the establishing operation (EO) in the initiation and maintenance of behavior.2

This analysis extended the three-term contin- gency of the traditional functional analysis (stimulus, response, consequence; cf., Beavers et al., 2013; Iwata, Dorsey, Slifer, Bauman, & Richman, 1982/1994) into a four-term contin- gency (motivating operation [MO], stimulus, response, consequence) with which we are all now familiar (Michael, 2004, 2007). As Sund- berg (2013) has stated “The role of the MO in the four-term contingency involving stimulus control is to establish the reinforcement (posi- tive or negative) as an effective consequence allowing behavior to be brought under the con- trol of a stimulus” (p. 24). Thus, Michael (1982, 1993) has defined the MO as an environmental event, operation, or stimulus condition that has two conjoint functions: (a) it alters the effec- tiveness of certain other events as reinforcers and punishers and (b) it alters the frequency of behaviors associated with these reinforcing and punishing events. Michael also has pointed out that MOs are different from discriminative stim- uli (SD) because the former change how much individuals want something whereas the latter define their chances of getting it. Michael (1982, 1983, 1993, 2000, 2004, 2007) further distinguished between unconditioned motivat- ing operations (UMOs) and conditioned moti- vating operations (CMOs). Deprivation of food, water, sleep, and variables related to sexual reinforcement are likely to act as UMOs. He also discussed three types of CMOs. Surrogate CMOs are stimuli that, through correlation in time with an UMO or an already established CMO, acquire similar motivative effects. Tran- sitive CMOs are previously neutral stimuli for which the occurrence alters the reinforcing (or punishing) effectiveness of another event and evokes responses that produce or (suppress) that event. Finally, and most important for our anal- ysis, reflexive CMOs are stimuli that have ac- quired their motivative effect through correla- tion with worsening or improving conditions.

It is the trust of the present interpretation that stereotypy, self-stimulation, vocal stereotypy, and some instances of SIB can be maintained in the absence of any socially mediated conse- quences not only because these behaviors may result in the presentation of observable or un- observable, unconditioned or conditioned stim- uli associated with improving conditions as has previously been argued (automatic positive re- inforcement), but also because they may result in the attenuation or removal of observable and unobservable stimuli associated with worsening conditions (automatic negative reinforcement) that were conditioned when behavior resulted in escape from aversive stimulation in the past (social negative reinforcement).

Table 1 presents an updated version of McGill’s (1999) seminal analysis of MOs and consequences involved in the initiation and maintenance of problem behavior. In this inter- pretation, problem behavior can still be a func- tion of social positive reinforcement in the form of attention and access to tangible items (con- sequence) when the individual is suitably de- prived from attention and access to tangible items (MO). Problem behavior can also still be a function of social negative reinforcement in the form of escape (consequence) when the individual is presented with some aversive event (MO). McGill (1999) assumed that prob- lem behavior could only be a function of auto- matic positive reinforcement in the form of the presentation of (sensory) stimulation (conse- quence) when the individual experiences depri- vation from such stimulation (MO). Most im- portantly, the present interpretation allows for problem behavior to be a function of automatic negative reinforcement in the form of the re- moval of (sensory) stimulation (consequence) when the individual experiences stimuli associ- ated with worsening conditions (i.e., aversive stimulation [MO]).

The conceptual framework upon which this interpretation is based is a straightforward ex- tension of that presented by Michael (1982, 1983, 1993, 2000, 2004, 2007) and others (Lar- away, Snycerski, Michael, & Poling, 2003;

2 The term establishing operation (EO) has since been abandoned for the term motivating operation (MO; Lar- away, Snycerski, Michael, & Poling, 2003). I will use the latter in the remainder of this paper.

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Sundberg, 2013) but one that has not yet been applied to analyze these problem behaviors. As such, this interpretation is different and may seem critical of other accounts that have been proposed in the past to explain self-stimulation, stereotypy, and some instances of SIB. How- ever, science is a cumulative process, and our analysis would not have come to be without important previous conceptual contributions by others (e.g., Ahearn et al., 2007; Rapp & Vollmer, 2005; Vollmer, 1994).

Unsignaled (Sidman) Avoidance, Two-Factor Theory, and Automatic

Negative Reinforcement

Support for this interpretation of self- stimulation, stereotypy, and some forms of SIB as being maintained by automatic negative re- inforcement comes directly from the basic ex- perimental literature. Not too long ago, one could observe, in the undergraduate laboratory, a rat pressing a lever or pulling a chain in an experimental chamber in the absence of any readily observable changes in its environment. Why? One could hypothesize that this rat’s re- sponding was maintained by automatic positive reinforcement in the form of proprioceptive stimuli produced by engaging in the behavior

itself, or by the reinforcement derived from neurochemical changes in its brain. Less likely to be offered as an explanation would be one taking into account the possible contribution of the rat’s learning history. In that context, differ- ent suggestions could be offered. For instance, it could be argued that this rat’s behavior reflected its prior exposure to a schedule of positive re- inforcement that only very intermittently pro- duced access to a reinforcer (e.g., fixed-ratio [FR] 4,000; Findley & Brady, 1965). When only observed for a limited period of time, it appears as if the rat is responding for no good reason at all, when, in fact, it had previously learned to complete a very large FR. It could also be argued that this rat’s learning history may have included exposure to an unsignaled (or Sidman) shock avoidance procedure (Sid- man, 1953, 1962) during which brief inescap- able shocks were delivered at set intervals (the shock-shock or S-S interval) that were only interrupted whenever the rat responded to initi- ate the response-shock (R-S) interval. The R-S interval is usually longer than the S-S interval, and when a rat distributes its responses such that its longest interresponse time (IRT) never ex- ceeds the R-S interval, the aversive stimulus will never be presented. In this case as well, responses do not produce any observable

Table 1 Reinforcers and MOs for Problem Behavior

Class of maintaining consequences Specific consequence MO

Social positive reinforcement Attention Deprivation of attention Tangible items Deprivation of tangible items

Social negative reinforcement Escape Presentation of aversive events (e.g., presentation of new, difficult, high-rate, or nonpreferred demands)

Automatic positive reinforcement, “practical” as when the reinforcement is provided by the presentation of stimuli in the physical environment, or “autistic” as when the reinforcement is provided by the response product emanating from the behavior itself (Skinner, 1957)

Presentation of unconditioned or conditioned sensory stimuli that may or may not be equivalent to the stimulation that the individual is assumed to be deprived of

Deprivation of (unknown) sensory stimulation

Automatic negative reinforcement, “practical” as when the reinforcement is provided by the removal of stimuli from the physical environment, or “autistic” as when the reinforcement is provided by the response product (removal of stimuli) emanating from the behavior itself (Skinner, 1957)

Removal of unconditioned or conditioned exteroceptive or interoceptive stimuli associated with worsening conditions

Presence of (exteroceptive or interoceptive) stimuli associated with worsening conditions (reflexive CMO)

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changes in the subject’s immediate environ- ment; they merely postpone the next scheduled shock. When only observed for a limited period of time, it appears as if the subject is responding for no good reason at all when, in fact, respond- ing occurs in a timely manner to avoid the presentation of the next scheduled shock.

Theories of avoidance learning have ex- plained responding observed during signaled avoidance procedures by pointing to the imme- diate stimulus changes that follow a response (Hoffman, 1966; Mowrer, 1947). In this inter- pretation, a response not only avoids an im- pending aversive stimulus (shock), but it also immediately terminates the presentation of a warning stimulus that had acquired aversive properties because of its consistent pairing with shock presentation. Thus, two factors or pro- cesses have been thought to be involved: a Pavlovian conditioning process by which a pre- viously neutral stimulus (warning stimulus) ac- quired aversive properties because of its pairing with an aversive event (shock presentation) and an operant conditioning process by which a response is strengthened because it terminates the presentation of the conditioned aversive stimulus. In modern parlance (Michael, 1982, 1983, 1993, 2000, 2004, 2007), the onset of the stimulus in the signaled avoidance procedure functions as a reflexive CMO because it has acquired the capacity to establish its own ter- mination as an effective form of reinforcement. Carbone, Morgenstern, Zecchin-Tirri, and Kol- berg (2007) have previously discussed the pos- sible role of the reflexive CMO during discrete- trial instruction.

The unsignaled avoidance procedure of Sid- man (1953, 1962) caused a problem for two- factor theories of avoidance because it did not involve any exteroceptive conditioned stimuli. How then do we account for responding ob- served under unsignaled avoidance schedules? Anger (1963) proposed an adaptation of two- factor theory by hypothesizing that in unsig- naled avoidance procedures presentation of the aversive stimulation is correlated with a fixed time interval after discrete events—responses and previous shocks—and that these times, however they are sensed by the animal (intero- ceptive stimuli), could very well function to replace the exteroceptive stimuli of the signaled avoidance procedure. Thirty years later, Mi- chael (1993) pointed out that the onset of any

aversive stimulation not only has a motivating evocative effect, but that it can also function as a respondent unconditioned elicitor (UE), elic- iting several smooth muscle and gland re- sponses, such as increased heart rate, papillary dilation, adrenal secretion, and so forth. Aver- sive stimulation can also be a respondent un- conditioned conditioner (UC), conditioning these responses to all other stimuli present at the time. Thus, in unsignaled avoidance procedures, it can be argued that a response not only initi- ates a period of time during which aversive events will definitely not be presented, but it also immediately terminates or diminishes the effects of all other stimuli previously associated with the presentation of aversive stimulation. In this interpretation, which, of course, had not yet been put forth at the time of Anger’s writing, interoceptive stimuli from smooth muscles and glands associated with the prior presentation of aversive stimulation can come to function as reflexive CMOs, having acquired the capacity for their own termination to serve as an effec- tive form of reinforcement (automatic negative reinforcement).

Self-Stimulation, Stereotypy, and Some SIB

Parenting, teaching, and treating children with autism or other developmental disabilities is a very difficult task that is likely to result in numerous stressful and potentially aversive in- teractions between the child and those who serve as its caretakers (parents, grandparents, teachers, speech therapists, occupational thera- pists, physical therapists, and others who have been enlisted to provide a therapeutic environ- ment). In that context, it is important to note that Hanley and colleagues (2003) have presented evidence to show that SIB is sensitive to social negative reinforcement at least 30% of the time and that when stereotypy was shown to be sen- sitive to social reinforcement, which it was 35% of the time, it was either exclusively maintained by social negative reinforcement or multiply controlled. In addition, Weeks and Gaylord- Ross (1981) have shown that the frequency of problem behavior was directly related to the difficulty of a task to which severely handi- capped students were exposed. Thus, problem behaviors of the sort described in this paper are frequently maintained by the physical removal

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of aversive stimulation from the child’s envi- ronment and, one could argue, the termination of any other stimulation that had been associ- ated with their presence in the past. Sundberg (1993) also alluded to this when he discussed the concept of the reflexive CMO by pointing out that, “For example, many developmentally disabled individuals have acquired strong rep- ertoires of escape and avoidance behaviors (e.g., tantrums, aggression, self-injurious be- havior, and self-stimulation), these behaviors often reliably occur when attempts are made to teach language and other skills . . .” (p. 213). Alternatively, for the purpose of our analysis, these behaviors occur when (interoceptive or exteroceptive) stimuli are present that have re- liably accompanied these well-intentioned, but ineffective and aversive, attempts at engaging a student in skill acquisition procedures.3 Thus, it appears likely that once different stimuli in the child’s (internal or external) environment have acquired aversive characteristics, the child may then learn that engaging in various forms of behavior such as self-stimulation, stereotypy, and SIB will avoid or reduce these stimuli and that continued engagement in these problem behaviors will maintain that status quo. The child may also learn that when it no longer engages in self-stimulation, stereotypy, or SIB this will not only set the stage for others in the child’s environment to approach and to attempt to engage it (in activities of an aversive nature) but also for other stimuli previously associated with the presentation of aversive stimulation to again gain strength. Problem behavior of the sort discussed in this paper (self-stimulation, stereotypy, and SIB) will then again terminate these attempts, reduce the amount of aversive stimulation, and restart a period of time during which these aversive stimuli will not be pre- sented. The frequency or duration of aversive stimulation in the form of ineffective instruction or therapy will be kept to a minimum as long as the child continues to emit timely problem be- havior, much like timely responding by the rat in the Skinner box continues to postpone the aversive stimulation it would have otherwise been exposed to in an unsignaled avoidance procedure.

In summary, the present interpretation argues that self-stimulation, stereotypy, and some forms of SIB are problem behaviors maintained in the absence of any socially mediated rein-

forcers. Whereas previous interpretations of these observations solely relied on the presen- tation of (interoceptive or exteroceptive) stimuli to explain the existence of these behaviors (au- tomatic positive reinforcement), our interpreta- tion suggests that these behaviors may well be maintained by the removal of (interoceptive or exteroceptive) aversive stimuli (automatic neg- ative reinforcement). Some will argue against an automatic negative reinforcement function for self-stimulation, stereotypy, and some forms of SIB based on the fact that these behaviors are sometimes not observed during the demand condition of a functional analysis (Iwata et al., 1982/1994) when one would expect them to be at full strength. However, it could well be the case that individual histories may have been such that these problem behaviors were effec- tive to avoid the presentation of aversive stim- ulation, but not effective to escape the aversive stimulus once it actually had been presented (see also Harper, Iwata, & Camp, 2013 for a similar argument). In this context it is also ap- propriate to point out that current functional analyses only capture part of the variables of which behavior is known to be a function. De- signed to evaluate the contribution of current circumstances, the functional analysis does not take into account prior learning history as a variable that may affect the outcome of the analysis.

Treatments to Reduce the Frequency of Problem Behavior Assumed to Be

Maintained by Automatic Negative Reinforcement

Self-stimulation, stereotypy, and some in- stances of SIB have traditionally been viewed to be maintained by automatic positive reinforce- ment and many different therapeutic interven- tions have been proposed to reduce their fre- quency (see Ahearn et al., 2007; LeBlanc, Patel, & Carr, 2000; Rapp & Vollmer, 2005; Vollmer, 1994, for an in depth discussion of these inter- ventions). Instead, I have argued that self- stimulation, stereotypy, and some instances of SIB may be behaviors that were established by

3 It should be noted that there is an almost infinite number of stimuli that can acquire these functions in the uncon- trolled environment of everyday life.

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social negative reinforcement in an individual’s past (escape from aversive stimulation) and functionally related to changes in interoceptive stimuli conditioned during their presentation (automatic negative reinforcement).

Several therapeutic interventions are avail- able to effectively treat self-stimulation, stereo- typy, and some forms of SIB assumed to be maintained by automatic negative reinforce- ment. First of all, it can be argued that these problem behaviors will be reduced in frequency by continued exposure to the aversive environ- ment that had resulted in the problem behavior in the first place simply by eliminating the con- tingency between the response and its conse- quence (cf., Moore, 2013). Although this ap- proach will be effective in the long run, it will also cause practical problems because it re- quires exposing individuals to situations that they have shown to rather avoid. This cannot only result in circumstances that are potentially harmful to the individual, others in the environ- ment, or the environment itself, but it also has serious ethical implications.

Another option is to remove the reflexive CMO, but Michael (2007) has rejected the idea of merely removing the reflexive CMO because self-stimulation, stereotypy, and some instances of SIB are a problem specifically because they prohibit the individual’s participation in activi- ties designed to teach adaptive skills that will allow effective participation in everyday activ- ities. Removal of the reflexive CMO (i.e., no longer attempting to engage the individual in activities designed to further skill acquisition) would be counterproductive because it would deny the individual all opportunities to learn adaptive skills.

If removing the reflexive CMO is not an option, then reducing the frequency of self- stimulation, stereotypy, and some instances of SIB by modifying its MO is the next best avail- able alternative, although it will not constitute a permanent solution because the problem behav- ior will return once its MO is again in effect. However, if during the time that the problem behavior is at a low frequency because its MO is weak or absent, a form of reinforcement related to a different MO can be used to gener- ate a repertoire that interferes with the problem behavior when its MO is again in effect, and then the change may be usefully lasting (Mi- chael, 2000). Simply put, the most appropriate

way to reduce the frequency of self-stimulation, stereotypy, and some instances of SIB is to implement treatments that abolish the reflexive CMO by increasing the effectiveness of instruc- tion. As Michael (2000) has indicated, “Increas- ing the effectiveness of instruction results in less failure, more frequent social and other forms of reinforcement, and other general im- provements in the demand situation to the point at which it may not function as a demand but rather as an opportunity” (p. 409).

What should we do to make sure that our clients or children would consider our therapeu- tic interventions an opportunity to be embraced rather than one to be avoided? Several different strategies should be implemented. First of all, it is extremely important for effective instruction to succeed that an appropriate assessment of the present level of performance be conducted be- fore the start of any teaching. In our field, the Assessment of Basic Language and Learning Skills-Revised (ABLLS-R, Partington, 2006), the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP, Sundberg, 2008), the Assessment of Functional Living Skills (AFLS, Partington & Mueller, 2012), and Essential for Living (McGreevy, Fry, & Corn- wall, 2012) are four instruments that are fre- quently used for this purpose. Second, it will be extremely important to implement teaching pro- cedures that have been shown to optimize teach- ing outcomes while keeping potential aversive stimulation to an absolute minimum. Carbone et al. (2007) have previously summarized the dif- ferent ways in which the effectiveness of in- struction may be improved when they discussed the role of the reflexive CMO in the occurrence of problem behavior once the aversive stimulus had been presented. They suggest that first and foremost it is important to reduce the aversive- ness of any teaching situation (at home, in school, and in the community) by embedding the teaching context, personnel, materials, and so on with an “improving set of conditions” through the careful delivery of items and activ- ities that, we know, the individual will enjoy. Next, Carbone and colleauges (2007) have sug- gested that it is also important to include teach- ing strategies that have been shown to facilitate acquisition of new skills while minimizing the aversiveness of the teaching situation. These strategies include, but are not limited to, the effective use of errorless learning procedures

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(Ebanks & Fisher, 2003), stimulus demand fad- ing procedures (Pace, Iwata, Cowdery, Andree, & McIntyre, 1993), task variation (Winterling, Dunlap, & O’Neill, 1987), pace of instruction (Dunlap, Dyer, & Koegel, 1983, but see Smith, Iwata, Goh, & Shore, 1995), choice making (Dyer, Dunlap, & Wintering, 1990), interspersal instruction (Neef, Iwata, & Page, 1980), gradual introduction of novel tasks (Smith et al., 1995) and individual adaptations in session duration (Smith et al., 1995). When properly imple- mented, all of these will serve to increase the positive value of the interaction between parent and child as well as therapist and client and to decrease the probability that problem behavior occasioned by ineffective, aversive intervention procedures will be observed.

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Received April 26, 2015 Revision received October 8, 2015

Accepted October 14, 2015 �

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