Basic and Applied Research on Extinction Bursts

ConditionsProblem Behavior Aggression Self Injury

Trial statusRecruiting

Trial phaseNot applicable

Trial typeInterventional

Biological sexAll

Age3-17

SponsorRutgers, The State University of New Jersey

About this trial

Although highly effective, treatments like FCT include extinction, which can have adverse side effects. The extinction burst, an increase in the frequency or intensity of destructive behavior at the start of treatment, is the most common side effect of extinction, and can increase the risk of harm to the patient and others. The goal of the current study is to evaluate the prevalence of extinction bursts when various parameters of reinforcement (i.e., rate, magnitude, quality) are manipulated.

Eligibility criteria

This trial accepts healthy volunteers

Qualifiers

children aged 3 to 17;

problem behavior that occurs at least 10 times a day, despite previous treatment;

problem behavior maintained by social positive reinforcement;

stable protective supports for self-injurious behavior (e.g., helmet) with no anticipated changes during enrollment;

Disqualifiers

patients currently receiving 15 or more hours per week of treatment for their problem behavior;

DSM-5 diagnosis of Rett syndrome or other degenerative conditions (e.g., inborn error of metabolism);

a comorbid health condition or major mental disorder that would interfere with study participation;

occurrence of self-injury during study assessments that presents a risk of serious or permanent harm (e.g., detached retinas) based on our routine clinical-risk assessment;

Trial design

Design model

Parallel

Treatments tested in this trial

Extinction-only condition
Behavioral
In this condition, therapists will place destructive behavior on extinction and deliver no reinforcement for functional communication responses (FCRs).
Rate-drop condition
Behavioral
In this condition,we will place destructive behavior on extinction and deliver the functional reinforcer contingent on the FCR on a VI 15-s schedule. This change from a VI 1.5-s schedule for destructive behavior in baseline to a VI 15-s schedule for the FCR during FCT will produce a large drop in reinforcement rate during FCT relative to baseline.
Rate-hold condition
Behavioral
In this condition, we will place destructive behavior on extinction and deliver the functional reinforcer contingent on the FCR on a yoked VI 1.5-s schedule that exactly matches the rate and timing of reinforcer deliveries for destructive behavior in baseline.
Magnitude-drop condition
Behavioral
In this condition, we will place destructive behavior on extinction and deliver the functional reinforcer contingent on the FCR according to a VI 1.5-s schedule, but we will deliver the reinforcer for just 6 s each time. This change from delivering 60 s of access to the functional reinforcer following destructive behavior in baseline to delivering 6 s of reinforcer access for the FCR during FCT will produce a large reduction in the magnitude of reinforcement relative to baseline.
Magnitude-hold condition
Behavioral
This condition will be identical to the magnitude-drop condition except that we will deliver 60 s of access to the functional reinforcer contingent on the FCR, so that the magnitude of reinforcement will equal that delivered in baseline for destructive behavior. To ensure that the magnitude of reinforcement does not drop in the magnitude-hold condition, we will yoke the rate and timing of reinforcer deliveries for the FCR during FCT to the rate and timing of reinforcer deliveries for destructive behavior in baseline.
Quality-drop condition
Behavioral
In this condition, we will place destructive behavior on extinction and deliver the reinforcer from the paired-choice assessment that the participant chooses approximately 1/12th as often as the highest preference stimulus from that assessment. This change from the most preferred stimulus from the paired-choice assessment to one chosen 1/12th as often will constitute a large drop in the quality of reinforcement during FCT relative to baseline.
Quality-hold condition
Behavioral
We will place destructive behavior on extinction and deliver the most preferred reinforcer from the paired-choice assessment on a yoked VI 1.5-s schedule that exactly matches the rate and timing of reinforcer deliveries for destructive behavior in baseline in this condition.
Rate-drop/quality-increase condition
Behavioral
In this condition, we will program the same large drop in reinforcement by delivering reinforcement on a VI 15-s schedule, but we also will increase reinforcement quality by simultaneously delivering the highest quality reinforcer identified during a competing stimulus assessment. We will use the competing stimulus assessment in Ex 4 because it directly assesses the quality of alternative reinforcement relative to the quality of the reinforcer for destructive behavior, whereas the paired-choice assessment could not guarantee that the selected stimulus would be of a higher quality than the reinforcer for destructive behavior.

Treatment groups

40 Participants

are divided into 4 treatment groups

Group A: Clinical (Human) Study on Effects of Reinforcement-Rate DropExperimental treatment 3 interventions

Group B: Clinical (Human) Study on Effects of Reinforcement-Magnitude DropExperimental treatment 3 interventions

Group C: Clinical (Human) Study on Effects of Reinforcement-Quality DropExperimental treatment 2 interventions

Group D: Clinical (Human) Study on Counteracting Reinforcement-Rate Drop with Quality IncreaseExperimental treatment 2 interventions

Trial outcomes

Primary outcomes

Rate of destructive behavior

The investigators will collect continuous, direct-observation measures of destructive behavior throughout all phases of the study. They will compare rates of destructive behavior during the first three sessions of each treatment condition to baseline.

Time frame

5 years

Secondary outcomes

Number of participants with extinction bursts

The investigators will evaluate each treatment condition on percentage of participants who show an extinction burst during at least one of the first three sessions of treatment above that of the last five baseline sessions (or all baseline sessions when there are fewer than five).

Time frame

5 years

Sponsors and contacts

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Rutgers, The State University of New Jersey

Lead sponsor

Source ClinicalTrials.gov

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