Applying a DRO schedule and compliance training to reduce aggressive and self-injurious behavior in an autistic man: a case report.

An autistic man who displayed aggressive, self-injurious, and destructive behavior in a psychiatric hospital ward despite administration of psychotropic medications and repeated application of physical restraints was treated with a differential reinforcement of other behavior (DRO) schedule and compliance training. These were employed in conjunction with ongoing medical interventions. After introduction of behavioral procedures, the frequency of applying restraints for violent behavior declined from an average of more than once per day to less than once per month. Data taken while the program was maintained over a 1-year period showed that violent behavior remained at a very low level.

Re-establishing conversational skills in overtly psychotic, chronic schizophrenic patients. Discrete trials training on the psychiatric ward.

A discrete trials procedure incorporating graduated prompts, social and consumable reinforcement, corrective feedback, delay of reinforcement, and a chaining procedure was used to teach four actively psychotic, chronic schizophrenic patients rudimentary conversational skills. In a multiple-baseline design, training was sequentially applied to the target conversational skills of giving a salutation, addressing the trainer by his or her name, making a personal inquiry, and asking a conversational question. Results showed systematic training effects in three of the four subjects. Training gains were reliable but slow, requiring over 70 trials to reach acquisition criterion on certain skills. The fourth subject exhibited only unstable gains on the first target response and minor improvements on the second target response, the latter of which disappeared when training procedures were withdrawn. All subjects displayed spontaneous recovery on the generalization measure of answering a personal inquiry.

Behavioral treatment of violent psychiatric patients.

This article reviewed major accelerative and decelerative behavioral treatments for aggressive and destructive behavior in psychiatric patients. Accelerative procedures supplant antagonistic behavior by teaching adaptive skills, and by strengthening competing responses; they are realized in token economies, social skills training, differential reinforcement of other behavior, and activity programming. Current decelerative procedures reduce violent behavior by decreasing reinforcement accessible to the patient following violent acts; they are exemplified by social extinction, response cost, time out from reinforcement, overcorrection, and contingent restraint. All behavioral interventions are applied within a philosophic framework that emphasizes observable behavior, measurement of treatment effects, and restructure of the social and physical environment to improve patients' response patterns. This approach extends beyond a problem-oriented model and presents proven techniques for developing and maintaining patients' adaptive functioning.