Motivational Refinements for Facilitating Reinforcement Schedule Thinning
Recruiting now · Not applicable
Conditions studied: Decreasing Destructive Behavior, Increasing Functional Communicative Behavior
In brief
Destructive behavior represents a comorbid condition of developmental disability for which risk increases with intellectual disability severity, communication deficits, and co-occurring autism spectrum disorder. Destructive behavior, such as self-injurious behavior and aggression, causes harm to the child and others and increases the risk for institutionalization, social isolation, physical restraint, medication overuse, and abuse. Clinicians have used functional analyses to identify the variables that reinforce destructive behavior and to develop effective, function-based treatments. Functional communication training (FCT) is an empirically supported, function-based treatment that decreases destructive behavior. Using FCT, the clinician teaches the child to use a functional communication response (FCR) to request the reinforcer maintaining destructive behavior, while placing destructive behavior on extinction. For example, if functional analysis results showed that attention reinforced destructive behavior, the clinician would provide attention when the child used the FCR ("Play with me, please") and would not provide attention for destructive behavior. Two limitations of FCT are that (a) schedules of reinforcement maintaining the FCR must often be thinned gradually to levels that are practical for caregivers to implement consistently in the home and in the community, and (b) this necessary process of reinforcement schedule thinning regularly causes destructive behavior to increase following initially effective treatment, a form of treatment relapse called resurgence. The current project aims to improve these limitations of FCT by (a) hastening the process of reinforcement schedule thinning by removing unnecessary schedule-thinning steps using the results of a progressive interval assessment and (b) mitigating the resurgence of destructive behavior by providing stimuli that highly compete with the reinforcer maintaining destructive behavior. The investigators will conduct a randomized clinical trial to evaluate the extent to which these two promising refinements to FCT improve the process of reinforcement schedule thinning, and an exploratory experiment will examine the interactive effects of these two approaches. This novel project has the potential to substantially improve standards of care guiding the treatment of severe destructive behavior and to improve the long-term outcomes for children and families afflicted by these debilitating behavior disorders.
Key facts
- Study ID
- NCT05790668
- Run by
- Rutgers, The State University of New Jersey
- People needed
- 30
- Starts
- 2023-10-24
- Expected to finish
- 2028-08-31
- Last updated by the study team
- 2025-07-24
Who can join
Age: 3 and older, up to 17. Sex: any. Healthy volunteers: accepted.
You may qualify if…
- boys and girls from ages 3 to 17
- destructive behavior that occurs at least 10 times a day, despite previous treatment
- destructive behavior reinforced by social consequences
- stable protective supports for self-injurious behavior (e.g., helmet) with no anticipated changes during enrollment
- on a stable psychoactive drug regimen for at least 10 half-lives per drug or drug free
- stable educational plan and placement with no anticipated changes during the child's treatment
You may not qualify if…
- patients who do not meet the inclusion criteria
- patients currently receiving 15 or more hours per week of treatment for their destructive behavior
- Diagnostic and Statistical Manual-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 routine clinical-risk assessment
- patients requiring changes to protective supports for self-injury or drug treatment, but investigators will invite these patients to participate when protective supports and drug regimen are stable
Where it is running
- Douglass Developmental Disabilities Center — New Brunswick, New Jersey, United States (enrolling)
- Rutgers University Center for Autism Research, Education, and Services — Somerset, New Jersey, United States (enrolling)
Full record on ClinicalTrials.gov
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