Noncontingent attention for the treatment of excessive medical complaints in a medically fragile man with mental retardation.

Providing medical care to individuals with developmental disabilities who have medical problems may pose several challenges with regard to accurate and reliable report of symptoms. In addition, medical complaints may take on operant functions such as an attention function or an escape function as a result of the natural consequences in the environment. It may be difficult to withhold reinforcers for medical complaints such as attention or escape, making a standard analog functional analysis or extinction-based intervention less appropriate. Recent studies have shown that noncontingent reinforcement without extinction and noncontingent reinforcement using alternative reinforcers can be effective in reducing problem behavior. One practical implication of these findings is that noncontingent reinforcement may be an appropriate treatment in cases where the reinforcer responsible for behavioral maintenance cannot be identified or withheld. In the current study, attention served as a reinforcer for a young man with medical complaints and noncontingent attention without ignoring effectively reduced the participant's excessive medical complaints.

Treatment of covert food stealing in an individual with Prader-Willi syndrome.

Covert food stealing is common among individuals with Prader-Willi syndrome. We found that verbal reprimands, delivered contingent upon eating prohibited foods, were sufficient to decrease the food stealing of a girl with Prader-Willi syndrome. Warning stimuli were then used to help her discriminate between permitted and prohibited foods during sessions in which food stealing was not directly observed. This procedure resulted in decreases in food stealing from containers labeled with the warning stimuli.

Evaluation of client preference for function-based treatment packages.

Functional communication training (FCT) and noncontingent reinforcement (NCR) are commonly prescribed treatments that are based on the results of a functional analysis. Both treatments involve delivery of the reinforcer that is responsible for the maintenance of destructive behavior. One major difference between the two treatment procedures is that client responding determines reinforcement delivery with FCT (e.g., reinforcement of communication is delivered on a fixed-ratio 1 schedule) but not with NCR (e.g., reinforcement is delivered on a fixed-time 30-s schedule). In the current investigation, FCT and NCR were equally effective in reducing 2 participants' destructive behavior that was sensitive to attention as reinforcement. After the treatment analysis, the participants' relative preference for each treatment was evaluated using a modified concurrent-chains procedure. Both participants demonstrated a preference for the FCT procedure. The results are discussed in terms of treatment efficacy and preference for control over when reinforcement is delivered. In addition, a method is demonstrated in which clients with developmental disabilities can participate in selecting treatments that are designed to reduce their destructive behavior.