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JOURNAL OF APPLIED BEHAVIOR ANALYSIS 1997, 30, 229–237 NUMBER 2 (SUMMER 1997)

NONCONTINGENT PRESENTATION OF ATTENTION AND


ALTERNATIVE STIMULI IN THE TREATMENT OF
ATTENTION-MAINTAINED DESTRUCTIVE BEHAVIOR
GREGORY P. HANLEY, CATHLEEN C. PIAZZA, AND WAYNE W. FISHER
KENNEDY KRIEGER INSTITUTE AND
JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE

Previous research has demonstrated that destructive behavior may be reduced through
noncontingent presentation of attention when attention is identified as the stimulus re-
sponsible for behavioral maintenance. Because it may not always be possible to deliver
attention in all situations, we examined the extent to which alternative stimuli that have
been identified through a choice assessment would substitute for attention (the functional
analysis–based reinforcer) in a noncontingent reinforcement procedure. Prior to treat-
ment, functional analyses demonstrated that the destructive behavior of 2 clients with
mental retardation was maintained by adult attention. Next, a stimulus choice assessment
identified highly preferred tangible items for the 2 clients. Finally, we compared the
effectiveness of two noncontingent reinforcement procedures: continuous noncontingent
access to attention and continuous noncontingent access to the tangible item identified
in the choice assessment. For both clients, these noncontingent reinforcement procedures
reduced destructive behavior. The results are discussed in terms of the clinical implications
for the treatment of destructive behavior using functional and alternative stimuli.
DESCRIPTORS: noncontingent reinforcement, extinction, satiation, developmental
disabilities, preference assessments

Functional analysis is a method for as- been demonstrated to effectively reduce de-
sessing the sensitivity of aberrant behavior to structive behavior maintained by adult at-
environmental events. Attention is one en- tention (Hagopian, Fisher, & Legacy, 1994;
vironmental event that has been hypothe- Vollmer, Iwata, Zarcone, Smith, & Mazales-
sized to maintain maladaptive behavior ki, 1993). NCR involves response-indepen-
(Carr, 1977). For example, Derby et al. dent delivery of the stimuli (usually on a
(1992) found that 23% of clients demon- time-based schedule) that have been dem-
strated problem behavior that was main- onstrated to maintain the problem behavior.
tained by adult attention. Iwata et al. (1994) Vollmer et al. (1993) used NCR with 3 clients
reported a similar outcome for clients with whose SIB was maintained by social atten-
self-injurious behavior (SIB). When a vari- tion. Initially, attention was delivered almost
able such as adult attention is found to continuously, while SIB no longer produced
maintain maladaptive behavior, treatments attention (i.e., extinction). The schedule of
based on the function of the behavior can attention was faded gradually over time until
be developed. noncontingent attention was delivered only
Noncontingent reinforcement (NCR) has once every 5 min. The SIB of all 3 clients
was reduced to low levels with the NCR
This investigation was supported in part by Grant
treatment. Hagopian et al. (1994) replicated
MCJ249149-02 from the Maternal and Child Health and extended the findings of Vollmer et al.
Service of the U.S. Department of Health and Human by showing that NCR could be applied to
Services. behaviors other than SIB and by demon-
Requests for reprints should be sent to Cathleen C.
Piazza, Neurobehavioral Unit, The Kennedy Krieger
strating that a dense schedule of NCR was
Institute, 707 N. Broadway, Baltimore, Maryland more effective initially than a lean schedule
21205. in reducing destructive behavior.

229
230 GREGORY P. HANLEY et al.

Vollmer et al. (1993) suggested that NCR paresis, and mild obesity. His target destruc-
may be effective because the procedure in- tive behaviors included aggression (hitting,
volves delivery of the reinforcer responsible kicking, pinching, hair pulling, biting, and
for behavioral maintenance. However, Fi- throwing objects at others) and property de-
scher, Iwata, and Mazaleski (1997) recently struction (banging, kicking, ripping, break-
showed that noncontingent presentation of ing, or overturning furniture). Rick’s aggres-
a preferred food produced immediate and sive behavior had resulted in the hospitali-
dramatic reductions in problem behavior zation of his teacher and his mother. He was
that was maintained by social positive rein- independent with his self-care skills, could
forcement even when SIB continued to pro- follow complex instructions, and had good
duce attention. That is, food was an effective expressive and receptive communication
substitute for attention. If food or other pre- skills (e.g., he could cook muffins with
ferred stimuli (e.g., toys) are as effective in prompting and could tell you what he did
reducing destructive behavior as the rein- on the weekend). He was not on any med-
forcer responsible for behavioral mainte- ication at the time of this investigation.
nance, clinicians would have more options Hank was a 16-year-old boy who had
when designing NCR treatments. Identify- been diagnosed with severe mental retarda-
ing reinforcers that are substitutable may be tion with autistic-like features, chromosomal
clinically useful, especially when it is difficult (2) deletion, lactose intolerance, cataracts,
to deliver the reinforcer that is responsible and chronic sinusitis. His target destructive
for behavioral maintenance (e.g., when the behaviors were self-injury (fist-to-head hit-
adult is taking a shower, delivery of attention ting and head banging) and aggression (pull-
would not be practical). ing hair and pinching). Hank’s SIB had re-
The goal of the current investigation was sulted in severe tissue damage in the form of
to determine the extent to which alternative bleeding, bruising, and multiple scars to his
stimuli identified through a choice assess- hands, wrists, and head. He was dependent
ment (Fisher et al., 1992) would effectively on others for most of his self-care skills (e.g.,
substitute for attention, which was the re- bathing, dressing). He could follow a few
inforcer that had been identified through the simple instructions (e.g., ‘‘stand up’’ and ‘‘sit
functional analysis as being responsible for down’’) and was semiindependent with feed-
behavioral maintenance (Iwata, Dorsey, Sli- ing (i.e., he could bring food to his mouth
fer, Bauman, & Richman, 1982/1994). To but needed assistance putting food on a
address this goal, two NCR treatments were utensil). He did not use any recognizable
compared: one using attention and the other means to communicate. Hank received 0.1
using an alternative stimulus identified mg BID of clonidine (0.007 mg/kg/day)
through a choice assessment. throughout his hospital admission.

GENERAL METHOD PHASE 1: FUNCTIONAL ANALYSIS


Participants and Setting Procedure
Two participants were admitted to an in- A functional analysis was conducted with
patient unit specializing in the assessment both participants. The conditions during the
and treatment of destructive behavior. Rick functional analyses were similar to those de-
was an 11-year-old boy who had been di- scribed by Iwata et al. (1982/1994) and in-
agnosed with moderate mental retardation, cluded demand, social attention, toy play,
oppositional defiant disorder, left hemi- alone (Hank only), and tangible (Rick only).
NONCONTINGENT REINFORCEMENT 231

A tangible condition was conducted with the targeted destructive behavior did not oc-
Rick because the removal of a preferred item cur. During functional analysis, a multiele-
(specifically, a children’s video) had been ment design was used to assess the target
identified by his caretakers to be a problem behaviors in four conditions for both clients.
at home and school. A tangible condition Sessions were 10 min in length and were
was not conducted with Hank because the conducted in a random order.
removal of preferred items had not been
identified by his caretakers to be a problem Data Collection and Interrater Agreement
at his residence or school. The alone con- During all functional analysis sessions,
dition was not conducted with Rick because observers used laptop computers to record
his primary problem behavior was aggres- the frequency of Rick’s and Hank’s destruc-
sion. Sessions were conducted in an individ- tive behaviors. Rick’s destructive behaviors
ual treatment room (3 m by 3 m) equipped were aggression and property destruction.
with a one-way mirror. During all assess- Hank’s destructive behaviors were SIB and
ment sessions, Hank wore a helmet without aggression. Two independent observers
a face shield. scored the target responses simultaneously
During social attention sessions, the client but independently during 60% of the func-
was given toys and was instructed to play. tional analysis sessions. Agreement coeffi-
The therapist presented attention in the cients were calculated by partitioning each
form of a brief verbal reprimand contingent session into 10-s intervals, dividing the
upon target destructive responses. All other number of exact agreements on the occur-
responses were ignored. During demand ses- rence of behavior by the sum of agreements
sions, the therapist issued simple requests to plus disagreements, and multiplying by
Hank (e.g., ‘‘hand me the block,’’ ‘‘stand 100%. Mean exact agreement for destructive
up’’) and presented academic tasks to Rick behavior was 94.9% for Rick and 97.0% for
(e.g., ‘‘write your name,’’ ‘‘identify the Hank.
word’’) approximately once every 30 s. Re-
quests were delivered using a three-step PHASE 2: STIMULUS
prompting procedure (i.e., verbal, gestural, CHOICE ASSESSMENT
and physical prompts). Destructive behavior
Procedure
resulted in a 30-s break from the task (i.e.,
escape). Compliance, defined as correct Stimulus choice assessments (Fisher et al.,
completion of the request prior to initiation 1992) were conducted to identify preferred
of the third prompt, resulted in brief praise stimuli for each client. Selection of stimuli
and attention from the therapist. During the for inclusion in the preference assessment
alone sessions, Hank was alone in an oth- was based on a structured interview admin-
erwise empty treatment room. During the istered to caregivers (Reinforcer Assessment for
tangible sessions, Rick was given access to Individuals with Severe Disabilities; Fisher,
the children’s video for 2 min prior to the Piazza, Bowman, & Amari, 1996). Each
session. At the onset of the session, the ther- stimulus (nine for Rick, eight for Hank) was
apist turned off the video. Destructive be- presented once with every other stimulus
havior resulted in access to the video for 30 (i.e., paired presentation) in a random order.
s, and all other responses were ignored. Dur- The client was given brief access (5 s) to the
ing toy play, the therapist played with the first stimulus he approached. Simultaneous
client and delivered attention once every 30 approach to both stimuli was blocked, and
s contingent on the first 5-s period in which the two stimuli were re-presented.
232 GREGORY P. HANLEY et al.

Data Collection and Interrater Agreement the beginning of the session. Bite-sized por-
During the stimulus choice assessments, tions of cookies were available to Hank on
observers scored approach responses for all a napkin located on a plastic table in the
stimulus presentations. Approach was de- middle of the session room. Sufficient
fined as moving a hand toward the stimulus amounts of cookies were available on the
within 5 s of presentation. Two independent napkin such that the therapist did not have
observers scored approach responses simul- to put more cookies out at any time during
taneously but independently for 100% of the session. In the NCT condition, the ther-
the trials. Agreement coefficients were cal- apist sat in a chair reading a magazine and
culated by dividing the number of agree- did not interact with the client during the
ments (i.e., both observers agreed that the session. No differential consequence was de-
same stimulus was approached) by the sum livered for destructive behaviors across treat-
of agreements plus disagreements and mul- ment conditions (extinction). A combina-
tiplying by 100%. The mean agreement co- tion multielement and ABAB design was
efficient for Rick was 100% and 86.9% for used in the treatment evaluation for both
Hank. clients. Phase A (baseline) was followed by
Phase B (the simultaneous assessment of the
PHASE 3: SIMULTANEOUS two treatments, NCA and NCT). A return
TREATMENT EVALUATION to baseline and a subsequent return to the
simultaneous treatment evaluation were then
Procedure
conducted.
For each client, baseline sessions were
identical to the attention condition of the Data Collection and Interrater Agreement
functional analysis. The client was given toys During all treatment sessions, observers
and was instructed to play. The therapist used laptop computers to record the fre-
provided a verbal reprimand following each quency of the target destructive behaviors.
occurrence of destructive behavior. Follow- Two independent observers scored the target
ing baseline, two treatment conditions were responses simultaneously but independently
conducted: noncontingent attention (NCA) during 78.7% of the treatment evaluation
and noncontingent tangible (NCT). During sessions for Rick and 72.0% for Hank.
NCA, attention (the reinforcer that had Mean exact agreement for destructive behav-
been identified in the functional analysis of ior was 92.7% for Rick and 97.0% for
destructive behavior) was delivered noncon- Hank.
tingently on a continuous schedule. Atten-
tion consisted of continuous verbal praise
(e.g., ‘‘you’re doing a good job’’), physical RESULTS
interaction (e.g., pats on the back), and in- Results of the functional analyses for Rick
teractive play with the materials present in and Hank are depicted in Figure 1. The
baseline (e.g., bouncing a ball back and mean rates of target behaviors for Rick were
forth). During NCT, the tangible item (the (a) social attention, 24.2 responses per min-
item that had been identified by the stimu- ute; (b) demand, 4.1; (c) tangible, 2.5; (d)
lus choice assessments as most highly pre- toy play, 0. Hank’s mean rates were (a) social
ferred) was available noncontingently on a attention, 6.8; (b) demand, 3.9; (c) alone,
continuous schedule. The tangible item was 5.6; and (d) toy play, 3.1. These results sug-
a computer game for Rick and cookies for gested that Rick’s destructive behavior was
Hank. Rick was given the computer game at sensitive to adult attention, access to a chil-
NONCONTINGENT REINFORCEMENT 233

Figure 1. Number of responses per minute of destructive behavior for Rick (top panel) and Hank (bottom
panel) during functional analyses.

dren’s video, and escape from instructions as The percentage of stimulus choice trials
reinforcement. Hank’s destructive behavior in which each stimulus was approached is
appeared to be sensitive to adult attention as depicted in Figure 2. Rick approached the
reinforcement. computer game on 100% of the trials and

Figure 2. Percentage of trials during which each stimulus was approached by Rick (left panel) and Hank
(right panel) during stimulus choice assessments.
234 GREGORY P. HANLEY et al.

Figure 3. Number of responses per minute of destructive behavior for Rick (top panel) and Hank (bottom
panel) during baseline (contingent attention), noncontingent attention (NCA), and noncontingent tangible
(NCT).

Hank approached the cookies on 87.5% of Hank was 14.1 during baseline, 5.1 during
the trials, indicating high preferences for NCA, and 4.4 during NCT. The return to
those items. baseline resulted in a mean of 9.8 responses
Figure 3 depicts the number of destructive per minute. During the subsequent return
responses per minute during the treatment to the simultaneous treatment evaluation,
evaluation. The mean rate of destructive be- mean rate was 3.0 in NCA and 2.5 in NCT.
haviors for Rick was 22.4 during baseline, Hank’s destructive behavior decreased
0.7 during NCA, and 0 during NCT. The 66.6% from baseline in the NCA condition
return to baseline resulted in a mean of 13.3 and 68.1% from baseline in the NCT con-
responses per minute. During the return to dition.
the simultaneous treatment evaluation, the
mean rate of destructive behavior was 1.7
during NCA and 0 during NCT. Rick’s de- DISCUSSION
structive behavior decreased 86.6% from In the current investigation, a series of
baseline during NCA and 100% from base- analyses was conducted to assess and treat
line during NCT. the destructive behavior of 2 clients with
The mean rate of destructive behaviors for mental retardation. Results of functional
NONCONTINGENT REINFORCEMENT 235

analyses indicated that destructive behavior NCA and NCT resulted from discontinua-
was sensitive to attention as reinforcement. tion of contingent attention for destructive
Stimulus choice assessments identified high- behavior (extinction). NCR packages typi-
ly preferred stimuli for the 2 clients. In the cally include an extinction component (e.g.,
final phase, we compared the effectiveness of Vollmer et al., 1993). Thus, it is possible
two noncontingent reinforcement proce- that the effects of both treatments resulted
dures: continuous access to attention and primarily or exclusively from extinction, and
continuous access to the tangible item iden- it mattered little whether the reinforcer re-
tified through the choice assessment. For sponsible for behavioral maintenance or a
both clients, NCA and NCT were effective substitute stimulus was presented noncon-
in reducing destructive behavior. NCT was tingently. However, Lalli, Casey, and Kates
somewhat more effective than NCA for (1997) have shown that for 1 client, NCR
Rick; the differences between the effects of without extinction was effective in reducing
the two treatments were negligible for Hank. destructive behavior that was maintained by
Continuous presentation of the reinforcer access to tangible items. For Rick, NCA and
that is responsible for behavioral mainte- NCT reduced destructive behavior to zero
nance during NCR generally results in rapid in the first treatment session; therefore, it is
and dramatic decreases in problem behavior difficult to attribute the reductions in his be-
without an extinction burst (e.g., Hagopian havior to extinction (i.e., he never displayed
et al., 1994; Vollmer et al., 1993) by altering destructive behavior during NCT and thus
the establishing operation and thus decreas-
had no opportunity to learn that the behav-
ing motivation to respond (Vollmer et al.,
ior no longer produced attention). The grad-
1993). Thus, one possible explanation for
ual reduction in Hank’s destructive behavior
these results is that the tangible items were
was more characteristic of typical extinction
effective substitutes for attention and altered
curves, and it is not possible to determine
the clients’ motivation to display destructive
behavior. Substitutability is usually discussed from these data whether noncontingent ac-
in terms of relative responding in the pres- cess to attention or the substitute stimulus
ence of concurrently available reinforcers hastened the course of extinction.
(Green & Freed, 1993). In the current in- The primary limitation of the current in-
vestigation, substitutability was not directly vestigation is that the extent to which the
evaluated because the stimuli (attention and alternative stimuli functioned as maintaining
tangible items) were not presented concur- reinforcers for problem behavior was not
rently; therefore, the relative consumption of evaluated. To make such a determination, it
each stimulus under conditions of simulta- would have been necessary to present the
neous availability is unknown. However, un- tangible stimuli contingent on destructive
der conditions that had previously estab- behavior. Thus, it is possible that the tan-
lished attention as reinforcement for destruc- gible items were functional reinforcers, and
tive behavior, alternative high-preference the treatments were effective because the
stimuli were used in an NCR schedule and NCT procedure involved presentation of a
appeared (with Rick, at least) to decrease maintaining reinforcer. However, the clinical
motivation to display destructive behavior findings of the investigation are not substan-
(i.e., functioned as a substitute establishing tially affected by this limitation. That is, our
operation). results have clinical relevance for the treat-
An alternative explanation is that the re- ment of individuals whose aberrant behavior
ductions in destructive behavior during is maintained by attention, regardless of
236 GREGORY P. HANLEY et al.

whether the behavior is also maintained by food are substituted for attention during
access to tangible items. NCR and the individual becomes satiated
Problem behavior that is maintained by on these substitute stimuli, attention-main-
attention is likely to occur when caregivers tained destructive behavior may increase. By
are occupied. Under such conditions, it is contrast, if attention is used during NCR
not always practical for caregivers to inter- and the individual becomes satiated on at-
rupt their ongoing activity to deliver non- tention, attention-maintained destructive
contingent attention. The results of our assess- behavior would be unlikely. If this is true, it
ment suggested that we can provide caregiv- would be important to use substitute stimuli
ers with an alternative and more practical sparingly (i.e., only when it is most difficult
form of noncontingent reinforcement based to deliver the reinforcer that is responsible
on the results of a paired choice assessment, for behavioral maintenance). Future investi-
which may be used to reduce problem be- gations should focus on the relative advan-
havior under stimulus conditions that evoke tages and limitations of substituting alter-
attention-maintained problem behavior. The native stimuli for the reinforcer that is re-
alternative stimulus identified through a sponsible for behavioral maintenance during
paired choice assessment may or may not NCR.
maintain the problem behavior when pre-
sented contingently, but this issue becomes
REFERENCES
less important when the purpose of the as-
Carr, E. G. (1977). The motivation of self-injurious
sessment is to identify an alternative stimu- behavior: A review of some hypotheses. Psycholog-
lus for clinical use in low-attention situations ical Bulletin, 84, 800–816.
(e.g., every time the parent goes to the bath- Derby, K. M., Wacker, D. P., Sasso, G., Steege, M.,
room, he or she could give the child a pre- Northup, J., Cigrand, K., & Asmus, J. (1992).
Brief functional assessment techniques to evaluate
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The findings of the current investigation mary of 79 cases. Journal of Applied Behavior Anal-
are also consistent with those of Steege, ysis, 25, 713–721.
Fischer, S. M., Iwata, B. A., & Mazaleski, J. L.
Wacker, Berg, Cigrand, and Cooper (1989) (1997). Noncontingent delivery of arbitrary re-
and Vollmer, Marcus, and LeBlanc (1994). inforcers as treatment for self-injurious behavior.
Steege et al. conducted a preference assess- Journal of Applied Behavior Analysis, 30, 239–249.
Fisher, W. W., Piazza, C. C., Bowman, L. G., & Ama-
ment to identify stimuli for use in a differ- ri, A. (1996). Integrating caregiver report with a
ential-reinforcement-of-alternative-behavior systematic choice assessment. American Journal on
procedure to reduce the SIB of 1 client. Mental Retardation, 101, 15–25.
Vollmer et al. used a choice assessment to Fisher, W. W., Piazza, C. C., Bowman, L. G., Hago-
pian, L. P., Owens, J. C., & Slevin, I. (1992). A
identify preferred stimuli for 3 clients whose comparison of two approaches for identifying re-
SIB was maintained independent of the so- inforcers for persons with severe to profound dis-
cial environment. These investigations dem- abilities. Journal of Applied Behavior Analysis, 25,
491–498.
onstrated that alternative stimuli that are Green, L., & Freed, D. E. (1993). The substitutabil-
identified through preference assessments ity of reinforcers. Journal of the Experimental Anal-
may be effective in treatments designed to ysis of Behavior, 60, 141–158.
Hagopian, L. P., Fisher, W. W., & Legacy, S. M.
reduce destructive behavior independent of (1994). Schedule effects of noncontingent rein-
the function of the behavior. forcement on attention-maintained destructive be-
One potential limitation of substituting havior in identical quadruplets. Journal of Applied
an alternative preferred stimulus for the re- Behavior Analysis, 27, 317–325.
Iwata, B. A., Dorsey, M. F., Slifer, K. J., Bauman, K.
inforcer that is responsible for behavioral E., & Richman, G. S. (1994). Toward a func-
maintenance is satiation. That is, if toys or tional analysis of self-injury. Journal of Applied Be-
NONCONTINGENT REINFORCEMENT 237

havior Analysis, 27, 197–209. (Reprinted from ments for severely handicapped children. Journal
Analysis and Intervention in Developmental Dis- of Applied Behavior Analysis, 22, 23–33.
abilities, 2, 3–20, 1982) Vollmer, T. R., Iwata, B. A., Zarcone, J. R., Smith, R.
Iwata, B. A., Pace, G. M., Dorsey, M. F., Zarcone, J. G., & Mazaleski, J. L. (1993). The role of atten-
R., Vollmer, T. R., Smith, R. G., Rodgers, T. A., tion-maintained self-injurious behavior: Noncon-
Lerman, D. C., Shore, B. A., Mazaleski, J. L., tingent reinforcement and differential reinforce-
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STUDY QUESTIONS

1. What is the practical value of finding stimuli other than maintaining reinforcers when using
noncontingent reinforcement (NCR) to reduce the frequency of behavior problems?

2. Describe the results obtained during the functional analysis.

3. What were the alternative reinforcers selected for the 2 participants, and how were these
stimuli identified?

4. What type of experimental design was used to compare the two NCR procedures, and what
were the similarities and differences between them?

5. Summarize the results obtained during the treatment phase of the study.

6. What three explanations did the authors provide to account for behavior reduction associated
with the NCT variation of NCR?

7. What additional procedures might permit more definitive statements regarding the above
explanations?

8. What important point did the authors make about satiation to maintaining reinforcers versus
alternative reinforcers, and what are its implications for treatment?

Questions prepared by SungWoo Kahng and Eileen Roscoe, University of Florida


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