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

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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.

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Acknowledgement

We wish to thank Abigail Morgan, Jarrah Korba, Emily Eames, Jake Amatruda, and Rachel DiVerdi for their assistance with data collection and the implementation of this study.

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Authors and Affiliations

  1. Department of Psychology, UMBC, 1000 Hilltop Cir, Baltimore, MD, 21250, USA

    Adithyan Rajaraman

  2. Department of Psychology, Western New England University, Springfield, MA, USA

    Gregory P. Hanley, Holly C. Gover & Rachel Metras

  3. Ivymount School, Rockville, MD, USA

    Holly C. Gover

  4. Department of Special Education, Vanderbilt University, Nashville, TN, USA

    Johanna L. Staubitz

  5. Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA

    John E. Staubitz & Kathleen M. Simcoe

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  1. Adithyan Rajaraman
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Correspondence to Adithyan Rajaraman.

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All procedures performed in this study were in accordance with the ethical standards of the institutional review board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study does not contain any experimentation with animals performed by any authors.

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Research Highlights

• Although problem behavior occurred at consistently high rates for all children during baseline, it was eliminated in treatment, and all children cooperated with nearly 100% of adult expectations shown to evoke problem behavior in baseline—a process and outcome deemed highly satisfactory by caregivers.

• It is possible to achieve socially meaningful outcomes with children who exhibit dangerous problem behavior without any physical management.

• By committing to open-contingency-class analyses, by offering choices to clients, and by committing to a hands-off treatment model, practitioners attempting to treat dangerous problem behavior can do so effectively without evoking any dangerous behavior during any part of the process.

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Rajaraman, A., Hanley, G.P., Gover, H.C. et al. Minimizing Escalation by Treating Dangerous Problem Behavior Within an Enhanced Choice Model. Behav Analysis Practice 15, 219–242 (2022). https://doi.org/10.1007/s40617-020-00548-2

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