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Biomedical subjects

C C Piazza

Publications and source records attributed to C C Piazza.

At least 37 records · Page 2Linked to original sources

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.

Aggression↗

Functional analysis and treatment of elopement.

Elopement is a dangerous behavior because children who run away may encounter life-threatening situations (e.g., traffic). We conducted functional analyses of the elopement of 3 children who had been diagnosed with developmental disabilities. The results identified a maintaining reinforcer for the elopement of 1 child, but the data were difficult to interpret for 2 of the children. Subsequent reinforcer assessments were used to help to clarify the reinforcers for elopement for these 2 children. Results of the functional analyses and reinforcer assessments then were used to develop successful treatments to reduce elopement. The findings are discussed in terms of (a) the application of functional analysis methodology to elopement, (b) the use of reinforcer assessments to identify potential reinforcers when standard functional analyses are undifferentiated, and (c) the utility of assessment-based treatments for elopement.

Behavior Therapy↗

Sleep patterns in children and young adults with mental retardation and severe behavior disorders.

The 24-hour sleep-wake schedules of 51 individuals (age 3 to 21 years) with mental retardation and severe behavior disorders were recorded using a direct-observation data collection system over an average period of approximately one month. The patients in the study had significantly less total sleep and less night sleep than their peers of the same age, and 88% had disturbances of sleep: delays in getting to sleep, frequent night waking or early waking. 'Appropriate' sleep, a measure of the amount and regularity of sleep, correlated positively with standardized measures of IQ and expressive language. 'Total' sleep, that is, the overall number of hours, was not correlated with measures of cognitive functioning. The findings are compared with those from other studies describing the sleep of individuals with mental retardation.

Adolescent↗

Using a choice assessment to predict reinforcer effectiveness.

A choice assessment has been found to be a more accurate method of identifying preferences than is single-item presentation. However, it is not clear whether the effectiveness of reinforcement varies positively with the degree of preference (i.e., whether the relative preference based on the results of a choice assessment predicts relative reinforcer effectiveness). In the current study, we attempted to address this question by categorizing stimuli as high, middle, and low preference based on the results of a choice assessment, and then comparing the reinforcing effectiveness of these stimuli using a concurrent operants paradigm. High-preference stimuli consistently functioned as reinforcers for all 4 clients. Middle-preference stimuli functioned as reinforcers for 2 clients, but only when compared with low-preference stimuli. Low-preference stimuli did not function as reinforcers when compared to high- and middle-preference stimuli. These results suggest that a choice assessment can be used to predict the relative reinforcing value of various stimuli, which, in turn, may help to improve programs for clients with severe to profound disabilities.

Adult↗

The effects of contingent and noncontingent attention on self-injury and self-restraint.

Self-restraint and self-injurious behavior (SIB) are two responses that can sometimes be members of the same functional response class (i.e., maintained by the same contingency). In such cases, a single treatment should be effective for both responses. In this investigation, we examined the effects of providing attention (the presumed reinforcer) both noncontingently and contingent upon either SIB or self-restraint. Results were consistent with our hypothesis that both responses were maintained by attention and suggested that noncontingent reinforcement was a potentially effective treatment.

Attention↗

Effects of equal and unequal reinforcer duration during functional analysis.

In the functional analysis described by Iwata, Dorsey, Slifer, Bauman, and Richman (1982/1994), reinforcer duration varied across conditions (e.g., brief attention vs. 30 s of escape); this may result in unequal exposure to the establishing operations for aberrant behavior. In this study, we compared the effects of unequal and equal reinforcer duration during a functional analysis. The results showed that reinforcer duration affects the rate of aberrant behavior and may potentially alter functional analysis interpretation.

Aggression↗

A preliminary procedure for predicting the positive and negative effects of reinforcement-based procedures.

In the current investigation, a modification was made to the preference assessment described by Pace, Ivancic, Edwards, Iwata, and Page (1985) to predict the effects of stimuli when used in a differential-reinforcement-of-other-behavior (DRO) schedule for 2 clients with severe self-injurious behavior (SIB) and profound mental retardation. Based on the results of the preference assessment, three types of stimuli were identified: (a) high-preference stimuli associated with high rates of SIB (HP/HS), (b) high-preference stimuli associated with relatively lower rates of SIB (HP/LS), and (c)low-preference stimuli associated with low rates of SIB (LP/LS). Consistent with the results of the preference assessment, the DRO schedule with HP/HS stimuli resulted in increased SIB, and the DRO schedule with LP/LS stimuli resulted in no change in SIB when used in a DRO schedule. Thus, the stimulus preference assessment may be useful clinically in some situations for predicting both the beneficial and the negative side effects of stimuli in DRO procedures.

Adult↗

On the reinforcing effects of the content of verbal attention.

During a functional analysis, a boy with autism and oppositional defiant disorder displayed destructive behavior that was maintained by attention in the form of verbal reprimands (e.g., "Don't hit me"). In a second analysis, contingent verbal reprimands produced higher rates of the behavior than contingent statements that were unrelated to the target response (e.g., "It is sunny today"), suggesting that some forms of attention were more reinforcing than others. A treatment based on these analyses reduced the behavior to near-zero levels.

Aggression↗

Analysis of free-time contingencies as positive versus negative reinforcement.

Providing a short break contingent on completed work may increase responding through positive reinforcement (e.g., access to preferred activities) or negative reinforcement (e.g., escape form work). In this investigation, three analyses conducted with a boy with profound mental retardation showed that (a) a 20-s break increased responding more than a positive reinforcer (cola) did, and (b) the reinforcing effect of a 20-s break were affected by the availability of positive reinforcers during the break were affected by the availability of positive reinforcers during the break.

Autistic Disorder↗

Functional analysis and treatment of cigarette pica.

A series of analyses was conducted to assess and treat the pica of cigarette butts by a young man with mental retardation and autism. First, we demonstrated that pica was maintained in a condition with no social consequences when the available cigarettes contained nicotine but not when the cigarettes contained herbs without nicotine. Second, a choice assessment (Fisher et al., 1992) confirmed that tobacco was preferred over the other components of the cigarette (e.g., paper, filter, etc.). Third, an analogue functional analysis (Iwata, Dorsey, Slifer, Bauman & Richman, 1982/1994) demonstrated that cigarette pica was maintained independent of social consequences. Fourth, a treatment designed to interrupt the hypothesized response-reinforcer relationship reduced consumption of cigarettes to zero. Finally, because cigarette pica occurred primarily when the individual was alone or under minimal supervision, a procedure based on stimulus control was developed to improve the effectiveness of the intervention in these situations.

Adolescent↗

Integrating caregiver report with systematic choice assessment to enhance reinforcer identification.

To determine client preferences, we asked caregivers to rank-order, according to predicted client preference, a standard list of items and a list generated using a structured interview for caregivers, the Reinforcer Assessment for Individuals with Severe Disabilities. Systematic choice assessments were then conducted with both sets of stimuli. A concurrent operants paradigm was used to compare the reinforcing effects of the highest preference stimulus identified from each list. Results indicated that caregiver predictions of client preferences were slightly better for the set of stimuli they generated than for the standard set, and the choice assessment identified more potent reinforcers from the set of stimuli generated by the caregivers than from the standard set.

Adolescent↗

A preliminary evaluation of empirically derived consequences for the treatment of pica.

Individualized treatment packages were developed for 3 children with high-rate severe pica using a discrimination training paradigm and a behavioral assessment-based procedure known as empirically derived consequences. Children received empirically derived reinforcers for eating under appropriate stimulus conditions (i.e., eating food only from a plate and placemat that served as a discriminative stimulus) and empirically derived punishers for attempts to engage in pica. This treatment package resulted in marked reductions in pica and an increase in appropriate eating for all 3 children in a "baited" analogue condition. In addition, low rates of pica were maintained for 9 months for all 3 children. These results suggest that treatment effectiveness may be enhanced when behavioral assessment data are used to identify potent consequences.

Behavior Therapy↗

Teaching self-feeding skills to patients with Rett syndrome.

Few studies have examined the extent to which functional hand-use may be taught to girls with Rett syndrome after those skills have been lost. In this investigation, five females with classic Rett syndrome were taught to feed themselves using a method of prompting and reinforcement. All patients demonstrated improvements in their self-feeding skills. The results are discussed in terms of the factors that may influence the acquisition of skills in girls with Rett syndrome, and directions for future research and proposed.

Adolescent↗

A water-prompting procedure for the treatment of urinary incontinence.

Based on clinical observations of a naturally occurring phenomenon, a water-prompting procedure was used to facilitate toilet training with a 9-year-old boy with profound mental retardation. Other frequently used toilet-training procedures were either ineffective or were associated with increased self-injury. The water-prompting treatment package may increase continence by eliciting and reinforcing urination under specific stimulus conditions.

Child↗

A comparison of two approaches for identifying reinforcers for persons with severe and profound disabilities.

The development of effective training programs for persons with profound mental retardation remains one of the greatest challenges for behavior analysts working in the field of developmental disabilities. One significant advancement for this population has been the reinforcer assessment procedure developed by Pace, Ivancic, Edwards, Iwata, and Page (1985), which involves repeatedly presenting a variety of stimuli to the client and then measuring approach behaviors to differentiate preferred from nonpreferred stimuli. One potential limitation of this procedure is that some clients consistently approach most or all of the stimuli on each presentation, making it difficult to differentiate among these stimuli. In this study, we used a concurrent operants paradigm to compare the Pace et al. (1985) procedure with a modified procedure wherein clients were presented with two stimuli simultaneously and were given access only to the first stimulus approached. The results revealed that this forced-choice stimulus preference assessment resulted in greater differentiation among stimuli and better predicted which stimuli would result in higher levels of responding when presented contingently in a concurrent operants paradigm.

Child↗