Wayne W. Fisher

Facilitating tolerance of delayed reinforcement during functional communication training.

Fewclinical investigations have addressed the problem of delayed reinforcement. In this investigation, three individuals whose destructive behavior was maintained by positive reinforcement were treated using functional communication training (FCT) with extinction (EXT). Next, procedures used in the basic literature on delayed reinforcement and self-control (reinforcer delay fading, punishment of impulsive responding, and provision of an alternative activity during reinforcer delay) were used to teach participants to tolerate delayed reinforcement. With the first case, reinforcer delay fading alonewas effective at maintaining lowrates of destructive behavior while introducing delayed reinforcement. In the second case, the addition of a punishment component reduced destructive behavior to near-zero levels and facilitated reinforcer delay fading. With the third case, reinforcer delay fading was associated with increases in masturbation and head rolling, but prompting and praising the individual for completing work during the delay interval reduced all problem behaviors and facilitated reinforcer delay fading.

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.

An Assessment of the Necessary Strength of Behavioral Treatments for Severe Behavior Problems

We conducted a clinical assessment of the effects of different levels of treatment implementation for behavioral treatments of aggression and pica for three participants with developmental disabilities. Treatments were based on differential reinforcement of an alternative behavior and brief time-out. Two treatment components, the schedule of reinforcement and time-out, were systematically varied in a range from 100%, to 50%, to 25% of initial treatment recommendations as one measure of treatment “strength.” For all participants, treatment effects were maintained when time-out was implemented at 50%, and for two participants, treatment effects were maintained at even lower levels. The implications of a prior assessment of necessary treatment strength are discussed.

Aberrant sleep patterns in children with the rett syndrome

Previous studies on the characteristics of disturbed sleep/wake patterns in children with the Rett syndrome have yielded inconsistent findings. In the current study, momentary time sampling procedures were used to measure the sleep/wake patterns of 20 girls with classical Rett syndrome. These patients had significantly more total sleep than age peers (M = 110.1; Zm = 2.58; p = .01), significantly less nighttime sleep (M = 80.8; Zm = -7.53; p less than .0001), and significantly more daytime sleep (M = 24.5; Zm = 8.71; p less than .0001). Night sleep was negatively correlated with age (r = -.59; p less than .01); day sleep was positively correlated with age (r = .54; p = .01). These girls also displayed night wakings on 20.9% of nights, delayed sleep onset on 67.8% of nights and early wakings on 24.5% of nights. These data clearly demonstrate that children with the Rett syndrome have markedly impaired sleep/wake patterns and suggests that the sleep dysfunction may worsen over time.

PERVASIVE DISINTEGRATIVE DISORDER: ARE RETT SYNDROME AND HELLER DEMENTIA INFANTILIS SUBTYPES?

Children with developmental regression and emerging symptoms of autism have been given a variety of classifications. The authors compare two boys with Heller dementia with six girls with Rett syndrome. They all differed from children with classic autism in that they had normal prenatal and perinatal periods, followed by marked developmental regression, after which they acquired few or no skills. The boys differed from the girls in terms of estimated prevalence, age at onset, stereotypic breathing patterns, midline hand stereotypies, hand and gait apraxia and speech development. It is suggested that these children should be distinguished from those with classic autism, and should be classified as ‘pervasive disintegrative disorder, Heller type’ and ‘pervasive disintegrative disorder, Rett type’.

Empirically derived consequences: A data-based method for prescribing treatments for destructive behavior

Behavioral treatments are often prescribed on the basis of a functional assessment. However, in a significant number of cases, functional assessment results are equivocal or suggest that internal stimuli are maintaining the behavior. In this investigation, we evaluated an alternative data-based assessment that may be useful in such cases. This assessment was used to identify reinforcers and punishers based on the reinforcement assessment procedure described by Pace, Ivancic, Edwards, Iwata, and Page (1985). We then assessed whether empirically derived reinforcers and punishers could be combined to treat the destructive behaviors of two clients. For both clients, the rates of destructive behavior decreased markedly. The results suggest that empirically derived consequences may be useful in decreasing destructive behavior when a functional assessment is inconclusive or is consistent with the hypothesis that the behavior is stereo-typic and maintained by internal stimuli.

Behavioral treatment of sleep dysfunction in patients with the Rett syndrome.

Aberrant sleep patterns are commonly experienced by girls with the Rett syndrome. In this investigation, the problematic sleep of three girls with the Rett syndrome was regulated using a bedtime fading procedure with response cost. The treatment involved systematically delaying the bedtime and utilized a response cost component, removing the child from bed for one hour, when the child did not experience short latency to sleep onset. Daytime sleep was interrupted, except during regularly scheduled naps. A fading procedure was then successfully utilized to advance the bedtimes. This treatment resulted in more regular sleep patterns for the girls by increasing appropriate nighttime sleep, reducing inappropriate daytime sleep and reducing problematic nighttime behaviors (e.g., night wakings). These preliminary findings are important because they suggest that the dysfunctional sleep patterns of girls with the Rett syndrome may be amenable to behavioral treatments.

Bedtime fading in the treatment of pediatric insomnia

In this paper, the sleep-wake cycles of two children with severe sleep problems were regulated by delaying bedtimes, thus increasing the probability of short latency to sleep onset. A fading procedure was then utilized to advance the bedtimes and gradually increase duration of sleep. Several treatments had previously been attempted with both of these patients without success. The advantages of this treatment over other interventions for pediatric sleep disorders are discussed.

Using Chronotherapy to Treat Severe Sleep Problems: A Case Study

Chronotherapy was used to treat severe sleep problems (irregular sleep onset times, frequent night and early wakings, and short total sleep times) in a girl with mental retardation. Chronotherapy involved systematically delaying the childs bedtime each night while maintaining a regular schedule during waking hours until an age-appropriate bedtime was achieved. Immediate improvements in the childs sleep pattern were observed with the introduction of treatment, and an age-appropriate bedtime was achieved in 11 days. Four months of follow-up data indicated that improvements maintained in the home. Although chronotherapy was developed specifically for adults with delayed sleep phase insomnia, the current results suggest that the treatment may be useful for other populations and problems.

Evaluating the reinforcing effects of choice in comparison to reinforcement rate

A concurrent-operants arrangement was used to evaluate a boys preference for a choice condition (in which he chose the reinforcement) over a no-choice condition (in which the therapist selected the reinforcement for him) when (a) these conditions produced equal rates of reinforcement and (b) lower rates of reinforcement were associated with the choice condition. The boy preferred the choice condition even when it resulted in a much less favorable rate of reinforcement than the no-choice condition (up to 4000% less).