Minimizing Escalation by Treating Dangerous Problem Behavior Within an Enhanced Choice Model

Adithyan Rajaraman; Gregory P Hanley; Holly C Gover; Johanna L Staubitz; John E Staubitz; Kathleen M Simcoe; Rachel Metras

doi:10.1007/s40617-020-00548-2

Minimizing Escalation by Treating Dangerous Problem Behavior Within an Enhanced Choice Model

Behav Anal Pract. 2021 Apr 28;15(1):219-242. doi: 10.1007/s40617-020-00548-2. eCollection 2022 Mar.

Authors

Adithyan Rajaraman¹, Gregory P Hanley², Holly C Gover^{2

3}, Johanna L Staubitz⁴, John E Staubitz⁵, Kathleen M Simcoe⁵, Rachel Metras²

Affiliations

¹ Department of Psychology, UMBC, 1000 Hilltop Cir, Baltimore, MD 21250 USA.
² Department of Psychology, Western New England University, Springfield, MA USA.
³ Ivymount School, Rockville, MD USA.
⁴ Department of Special Education, Vanderbilt University, Nashville, TN USA.
⁵ Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN USA.

Abstract

To address dangerous problem behavior exhibited by children while explicitly avoiding physical management procedures, we systematically replicated and extended the skill-based treatment procedures described by Hanley, Jin, Vanselow, and Hanratty (2014) by incorporating an enhanced choice model with three children in an outpatient clinic and two in a specialized public school. In this model, several tactics were simultaneously added to the skill-based treatment package to minimize escalation to dangerous behavior, the most notable of which involved offering children multiple choice-making opportunities, including the ongoing options to (a) participate in treatment involving differential reinforcement, (b) "hang out" with noncontingent access to putative reinforcers, or (c) leave the therapeutic space altogether. Children overwhelmingly chose to participate in treatment, which resulted in the elimination of problem behavior and the acquisition and maintenance of adaptive skills during lengthy, challenging periods of nonreinforcement. Implications for the safe implementation of socially valid treatments for problem behavior are discussed.

Keywords: Dangerous problem behavior; Enhanced choice model; Extinction without physical guidance; Practical functional assessment; Skill-based treatment.