Psychological Services 2010, Vol. 7, No.

2, 103113

In the public domain DOI: 10.1037/a0018791

Behavior Analysis in Intellectual and Developmental Disabilities

Pamela L. Neidert and Claudia L. Dozier
University of Kansas

Brian A. Iwata
University of Florida

Megan Hafen
University of Kansas Individuals with intellectual and developmental disabilities (IDD) have decits in adaptive behavior, slow rates of learning, and behavior disorders that interfere with learning or place them or others at risk. Since the 1960s, researchers and clinicians in the eld of applied behavior analysis have used methods based on principles of learning to increase adaptive behavior and decrease the occurrence of behavior disorders of individuals with IDD. This article provides an overview of assessment and treatment strategies used in behavior analysis to effect positive changes in the quality of life for individuals with IDD and presents an illustrative case study. Keywords: functional analysis, function-based treatment, behavior disorders, adaptive behavior

Intellectual and developmental disabilities (IDD) are (a) genetic or acquired conditions that (b) begin prior to 22 years of age, (c) result in decits in several areas of functioning (e.g., self-care, language), and (d) include relatively permanent and chronic conditions such as mental retardation, autism, Downs syndrome, and so forth (Developmental Disabilities Assistance and Bill of Rights Act, 2000). The causes of IDD may include genetic or chromosomal aberrations, infection, nutritional deciencies, exposure to environmental toxins, perinatal and neonatal insult, and trauma (Howard, Williams, & Port, 1999; McIlvane & Deutsch, 2004). Depending on the population surveyed and the survey method used, reported prevalence estimates for IDD have been as high as 10% (McDermott, Durkin, Schufp, & Stein, 2007). Diagnosis and classication of IDD often are based on syndromes, some of which have unique behavioral characteristics. For example, PraderWilli syndrome (PWS) is a genetic dis-

Pamela L. Neidert, Claudia L. Dozier, and Megan Hafen, Department of Applied Behavioral Science, University of Kansas; and Brian A. Iwata, Department of Psychology, University of Florida. Correspondence concerning this article should be addressed to Pamela L. Neidert, Department of Applied Behavioral Science, University of Kansas, Lawrence, KS 660457555. E-mail: pneidert@ku.edu 103

order involving chromosome 15 and usually is associated with mild mental retardation (Dykens & Shah, 2003). Individuals with PWS also share a number of behavioral characteristics, including excessive eating, leading to extreme obesity, and self-injurious behavior. Other IDD diagnoses such as autism are based exclusively on behavioral characteristics (e.g., impairments in social interaction and communication, repetitive and stereotyped patterns of behavior). Thus, the term IDD encompasses a large constellation of disorders not well-dened by any particular marker except for (a) decits in adaptive behavior, (b) slow rates of learning (i.e., it may take longer for these individuals to learn a particular skill or set of skills, or they may require a more systematic method of teaching to learn a particular skill), and (c) behavior disorders that interfere with learning or place them or others at risk (Condillac, 2007; Harris & Glasberg, 2007). IDDs are a signicant concern because they produce emotional and nancial strain on individuals, their families, and (ultimately) society (Condillac, 2007). Although a variety of instructional methods facilitate many students learning, more systematic and structured approaches are required for individuals with IDD due to their pervasive and multifaceted decits. One such approach, behavior analysis, consists of learning principles, often discovered in laboratory research, that de-

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scribe the ways in which specic environmental changes inuence observable features of behavior. Applied behavior analysis (ABA) is the eld that applies these principles to problems of social importance by way of empirical (experimental) demonstration (Baer, Wolf, & Risley, 1968). ABA has had a special interest in problems related to IDD for many years. Since the 1960s, results of ABA research have shown that therapeutic procedures based on principles of learning have produced marked improvements in both adaptive and problem behavior of individuals with IDD (Whitman, Sciback, & Reid, 1983). Approximately 50 studies were published during the 1960s in the major journals devoted to IDD; currently, there are more than 600 such studies in the Journal of Applied Behavior Analysis alone, and a number of federal and state statutes and regulations require the use of ABA procedures under certain conditions (Neef, 2001). The purpose of this article is to briey describe some key elements of ABA procedures and their use with problems in individuals with IDD. In addition, a case study with an individual diagnosed with profound mental retardation is described to illustrate ABA assessment and intervention with severe problem behavior. Adaptive Behavior Motivation Motivation is of central importance to the learning process, and reinforcement is usually the key to motivation. As early as the 1940s, researchers demonstrated the critical role of positive reinforcement (contingent presentation of a stimulus resulting in an increased probability of behavior) in facilitating skill acquisition in individuals with IDD. Fuller (1949) reported one of the earliest demonstrations, in which arm movements of a teenage boy with profound mental retardation (described as vegetative and unable to show any evidence of learning prior to the study) increased as a function of the experimenter squirting a warm sugar-milk solution into the boys mouth via a syringe. Negative reinforcement (contingent removal or postponement of a stimulus resulting in an increased probability of behavior) has also been shown to play a critical role in the development of adaptive behavior. Azrin, Rubin, OBrien, Ayllon,

and Roll (1968) developed an apparatus that provided a warning stimulus followed by a tone for slouching; that is, maintenance of correct posture avoided the warning stimulus, and correction of slouching terminated the tone. Results showed increases in correct posture for all 25 adults who participated in the study. Foxx (1977) showed that 5 min of functional movement training, an overcorrection procedure involving the practice of varying head positions, was superior to positive reinforcement in developing and maintaining appropriate eye contact in three children with mental retardation. A substantial body of literature now exists demonstrating applications of positive and negative reinforcement to increase a wide range of socially important behaviors in individuals with IDD, such as on-task behavior (Zarcone, Fisher, & Piazza, 1997), self-help skills (K. L. Pierce & Schreibman, 1994), communication (Reid & Hurlbut, 1977), social behavior (Williams, Donley, & Keller, 2000), and community survival skills (Page, Iwata, & Neef, 1976) across a range of settings such as psychiatric hospitals, classrooms, sheltered workshops, and the home environment. A more fundamental aspect of motivation often taken for granted is the selection of stimuli to use as reinforcers and is particularly important for individuals with IDD for at least two reasons. First, reinforcers commonly used with typically developing individuals may be ineffective with those who have IDD. For example, many individuals are responsive to praise and other forms of attention, but those with IDD may nd attention to have little reinforcing value, and those with severe language and social decits (e.g., individuals with autism) may nd any type of social interaction highly aversive (Bijou & Ghezzi, 1999). Second, although reinforcers may be identied simply by asking most people what they want, this strategy often is ineffective for individuals with IDD who exhibit severe skill decits (communication decits, multiple sensory impairments, limited response repertoires, and intrusive problem behaviors). As a result, reinforcer selection based on systematic preference assessments has become a standard feature of clinical research and treatment for individuals with IDD. A variety of assessment methods have been developed; the most common arrangement is to present test stimuli and then to provide brief access to them

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if the individual either approaches them or selects them from an array. A reinforcer test is conducted subsequently in which highly ranked items from the preference assessment are used as reinforcers for an arbitrary response prior to their use during training or treatment programs. Research has shown that stimuli selected in this manner are much more likely to serve as reinforcers than those identied through less formal means (e.g., caretaker report) and has led to a number of renements in methodology to accommodate different types of items, client disabilities, presentation formats, and measurement procedures (see Cannella, OReilly, & Lancioni, 2005, for a review). In addition to stimulus selection, numerous factors can determine whether a reinforcer is effective in a given situation or if it will continue to be effective over time. One inuential variable is comprised of the antecedent conditions to which one is exposed prior to reinforcement, also known as establishing operations (Michael, 1993). For example, Vollmer and Iwata (1991) showed that exposure to reinforcers immediately prior to training sessions decreased their effectiveness (via satiation), whereas deprivation from access to the same reinforcers prior to sessions increased their effectiveness. In a similar way, Egel (1981) showed that varying reinforcers within training sessions was effective in mitigating satiation effects. Other determinants of reinforcement efcacy include the manner in which reinforcers are delivered. All things being equal, reinforcement is more likely to be effective when it is delivered immediately and frequently. Cooper, Heron, and Heward (2007) recommended the following guidelines when designing reinforcement-based training programs: (a) during initial stages of skill acquisition, reinforcement should be continuous (delivered for each occurrence of the target behavior), and a strong contingency should be arranged such that the probability of reinforcement given behavior is higher than the probability of reinforcement given the absence of behavior; (b) the scheduled reinforcement should gradually be made intermittent only when behavior is well established; (c) reinforcers should be delivered immediately following the target response; and (d) higher quality reinforcers and/or a larger magnitude of reinforcers should be delivered for behaviors that require greater response effort.

Instruction Individuals with IDD often require intensive intervention to address their learning challenges, but a prerequisite to instruction is to rst determine whether the difculty is a motivational versus a skill decit. That is, it must be determined if the target behavior exists in the individuals repertoire but occurs at a low frequency due to a lack of motivation or if the individual has yet to acquire the skill despite sufcient motivation to do so (Lerman, Vorndran, Addison, & Kuhn, 2004). In the former situation, arrangement of optimal conditions for reinforcement will be an effective strategy. In the latter, however, reinforcement alone may have little effect because the desired performance never occurs. Amelioration of skills deficits requires supplementary instructional procedures. Prompting is the most frequently used procedure to produce new learning. Prompts are cues that facilitate the occurrence of a desired response. The simplest form of prompt is a verbal instruction; however, many individuals with IDD may be unresponsive to spoken cues. If so, a demonstration of the desired behavior (modeling) by an instructor may serve as the basis for imitation by the student (Foxx, 1982). Through reinforcement of imitative behavior, a student may eventually acquire a generalized imitative repertoire that facilitates faster learning and/or acquisition of more complex behavior (see W. D. Pierce & Cheney, 2004, for review). Finally, if modeling is ineffective in producing a desired response, physical prompting such as hand-over-hand guidance may be necessary. Initial attempts to perform a new response may yield a behavior that only approximates the desired outcome; nevertheless, it is important to reinforce these intermediate topographies to maintain motivation while eventually requiring more skilled performance. This is accomplished through the process of shaping, which involves selective reinforcement of successive approximations to a target behavior combined with discontinuation of reinforcement (extinction) for previously reinforced topographies. Horner (1971) used shaping with a 5-year-old child with mental retardation and spina bida who was able to crawl but not able to walk. Initially, successive approximations to taking steps while holding onto parallel bars were reinforced with

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drinks of root beer. Once walking with parallel bars was established, successive approximations to using forearm crutches were reinforced. Eventually, the child was able to use the crutches to walk independently to and from his daily activities (meals, play, school, speech therapy, etc.). Shaping procedures have been widely used to establish important skills in individuals with IDD including compliance with medical treatments (Hagopian & Thompson, 1999), approaching feared stimuli (Ricciardi, Luiselli, & Camare, 2006), requests for reinforcers (Bourrett, Vollmer, & Rapp, 2004), and visual-motor skills (Mosk & Bucher, 1984). Whereas shaping develops a behavior that an individual does not currently exhibit, chaining involves the development of sequences of behavior that comprise a larger functional unit (e.g., cooking, brushing teeth). A task analysis is preformed initially to identify the component behaviors (steps) to be taught and the sequence in which the steps are to occur. Each step in the sequence is taught using one or more prompting techniques, which are faded out as more parts of the sequence are performed, until the student has mastered the entire chain. As learning progresses, each component behavior becomes a reinforcer for performing the previous component behavior and a cue for performing the subsequent component behavior (see Foxx, 1982, for a detailed analysis). Cuvo, Leaf, and Borakove (1978) used chaining procedures to teach janitorial skills to six adolescents with moderate mental retardation. The task of cleaning a restroom was analyzed into six general subtasks with a total of 181 component steps. More difcult steps were taught using a mostto-least intrusive prompt sequence (physical guidance, model, verbal instruction) to reduce participant errors; less difcult steps were taught using a least-to-most intrusive prompt sequence in which physical guidance was provided only if the participant was unable to perform a component step following verbal instruction or model prompts. Chaining procedures have been used to teach a variety of skills such as mending (Cronin & Cuvo, 1979), cooking (Schleien, Ash, Kiernan, & Wehman, 1981), following picture schedules (MacDuff, Krantz, & McClannahan, 1993), completing vocational tasks (Maciag, Schuster, Collins, & Cooper, 2000), and engaging in appropriate play skills

(Libby, Weiss, Bancroft, & Ahearn, 2008) to individuals with IDD. Behavior learned through some combination of reinforcement, prompting, shaping, and chaining may occur when these interventions are implemented during training sessions but may fail to occur in other situations. Successful treatment involves not only the initial acquisition of behavior change but also its generalization across settings (Baer et al., 1968). That is, the goal is for newly acquired skills to be performed independently in a variety of situations for extended periods of time. Control exerted by stimuli (e.g., prompts) in the initial training environment must be transferred to naturally occurring relevant stimuli outside of the training environment. Research suggests that skill acquisition by individuals with IDD often fails to generalize to settings outside of training because the behavior of these learners came under the control of irrelevant features of the environment during training. For example, Rincover and Koegel (1975) found during the course of teaching simple responses (e.g., touching body parts in response to a verbal instruction) to children with autism that their behavior came under the control of unintended stimuli (e.g., arrangement of tables/chairs) rather than the instruction. Halle and Holt (1991) described a procedure to assess the inuence of training stimuli on newly acquired behavior for the purpose of programming generalization more effectively and efciently. Their analysis consisted of systematically assessing each of four training stimuli by presenting it in isolation (while the remaining stimuli were varied). Results were idiosyncratic across participants (i.e., stimuli that exerted control over behavior were different for each participant). The results of these studies underscore the importance of explicitly programming the generalization and maintenance of learned skills. Stokes and Baer (1977) described several strategies for use during training to facilitate generalization and maintenance including: teaching behaviors that are likely to contact naturally occurring reinforcers, training a sufcient number of exemplars, training under varied conditions (use different instructions, reinforcers, etc.), using intermittent and delayed schedules of reinforcement, and including in the training setting stimuli that are likely be present in other settings.

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Comprehensive Skill Training Programs Together, the basic elements of motivation and instruction can be combined in a variety of ways into formal training programs for teaching individuals with IDD a wide range of skills. Azrin and Foxx (1971) described one of the rst comprehensive training programs, which focused on independent toileting and made use of positive and negative reinforcement, shaping, chaining, stimulus control, and punishment to increase continence in nine individuals with profound mental retardation. The procedure included the use of a urine-sensing apparatus to detect and signal elimination, positive reinforcement for appropriate elimination, inhibitory training for inappropriate elimination, prevention of incompatible behaviors, increasing the frequency of urinations via increased liquid intake, stimulus control of elimination, teaching independent dressing skills associated with toileting, and modeling of appropriate elimination responding. Results showed that incontinence decreased to near-zero levels and maintained at this low level for up to 140 days. The results of the study were signicant because little to no empirical research on effective procedures for increasing and maintaining continence of individuals with severe to profound mental retardation existed in the literature at that time. The program was extremely effective because it resulted in rapid skill acquisition, maintenance, and generalization. Today, researchers and clinicians continue to use similar types of programs to teach toileting skills not only to adults with IDD but also to young children of typical development (Simon & Thompson, 2006), children with IDD (Cicero & Pfadt, 2002), and the elderly (Schnelle et al., 1983). Extensions of the above model currently are used to teach skills beyond those of a self-help nature that facilitate independent functioning in the community. As an example, Sievert, Cuvo, and Davis (1988) developed a program to establish self-advocacy skills in individuals with mild disabilities. A list of commonly abridged legal rights was generated and divided into four categories: personal rights, community rights, human services rights, and consumer rights. Individuals were rst trained via role playing to discriminate between examples and nonexamples of rights violations. Tests were conducted before and after training in each general

rights category to assess skill acquisition. Following successful training in legal rights discriminations, individuals were taught a general complaint process to redress rights violations under role-play contexts in different settings (i.e., classroom, community, etc.). Specically, participants were taught to identify the proper persons to whom a complaint should be made and to exhibit a specic response that included an assertion of ones rights, an explanation of why ones rights were violated, and a description of the steps previously taken to resolve the problem. Results showed increases in the percentage of correct responding in both legal rights discrimination and redressing rights violation as a function of training. In addition, data collected after 1 and 3 months showed maintenance of learned skills for several of the individuals. In summary, applied behavior analysis in the context of acquisition emphasizes (a) clear specication of the behavior to be established, (b) objective measurement of performance, (c) analysis of the relevant antecedent and consequent variables, and (d) the design and evaluation of the effectiveness of an intervention that leads to the generalization and maintenance of the learned behavior (Baer et al., 1968). These fundamental principles not only guide adaptive behavior training programs but they also guide the assessment and treatment of behavior disorders exhibited by individuals with IDD. Behavior Disorders In addition to learning decits, behavior disorders exhibited by many individuals with IDD pose challenges to instruction or place them and others at risk. Common behavior problems include self-injurious behavior (SIB), aggression, property destruction, sexual misconduct, stereotypy, tantrums, noncompliance, and running away (elopement). There is no correlation between the emergence of any particular problem and a specic IDD syndrome except in rare cases; instead, the problems are distributed somewhat randomly. As such, they are viewed as learned behavior that is acquired and maintained through the same processes that account for the development of adaptive behavior (Iwata, Kahng, Wallace, & Lindberg, 2000). These include positive reinforcement (i.e., gaining attention or access to tangible items such as

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snacks or toys) and negative reinforcement (i.e., avoiding or escaping aversive social or demand situations), as well as automatic reinforcement (i.e., producing sensory stimulation or terminating aversive sensory stimulation such as loud noise or a toothache). See Iwata et al. (2000) for a detailed discussion of these functions. Functional Analysis Reinforcer selection is as critical to the treatment of problem behavior as it is to the process of behavioral acquisition. The difference is that, although any reinforcer may sufce during acquisition because unlearned behavior has no function, specic reinforcers currently maintain problem behavior. These reinforcers need to be identied to design interventions that will neutralize their effects, and a diagnostic method known as functional assessment has been developed for this purpose. Three general approaches are used to conduct functional assessments: anecdotal (indirect) methods, usually consisting of caregiver interviews or questionnaires; descriptive (naturalistic) analysis, in which observational data are taken on environmental events that precede and follow problem behavior (e.g., Bijou, Peterson, & Ault, 1968); and functional (experimental) analysis, in which suspected determinants of problem behavior are directly manipulated (Iwata, Dorsey, Slifer, Bauman, & Richman, 1982/1994). Although all three methods are common to some extent in clinical practice, anecdotal methods are unreliable (Zarcone, Rodgers, Iwata, Rourke, & Dorsey, 1991; Sigafoos, Kerr, Roberts, & Couzens, 1993), and descriptive analyses often provide information that is erroneous (St. Peter et al., 2005; Thompson & Iwata, 2007). The only method that provides direct evidence of cause and effect relations between the occurrence of a particular behavior and environmental events is the functional analysis. Although a number of procedural variations exist (see Hanley, Iwata, & McCord, 2003, for a review), all functional analyses have in common the following: (a) direct and quantitative observation of behavior under (b) controlled conditions that involve (c) comparison between one or more test conditions and control conditions. The most common model for conducting a functional analysis was described by Iwata et al. (1982/1994) and includes three test condi-

tions and one control condition. The test conditions represent environmental contingencies that have been shown to maintain problem behavior: social positive reinforcement (attention condition), social negative reinforcement (demand/escape condition), and automatic reinforcement (alone condition) whereas the control condition (play) eliminates these inuences. In the attention condition, for example, a therapist withholds attention from the client during the session (i.e., the therapists sits in the room with the client but reads a book or a magazine) and provides attention (i.e., a reprimand or statement of concern or comfort) only contingent on occurrences of problem behavior. In the play condition, by contrast, attention is delivered freely throughout the session. Individuals are exposed to test and control conditions during brief sessions until differential responding is observed between one or more of the test conditions and the control condition. Consistently higher levels of problem behavior during the attention condition relative to the control condition would indicate that problem behavior is maintained by attention. Descriptions of specic functional analysis conditions are found in Table 1, and for a detailed description of functional analysis methodology see Iwata et al. (1982/1994). Treatment Strategies The development of functional analysis (FA) has resulted not only in a better understanding of the conditions under which problem behavior occurs but also in greater precision with which intervention programs based on the use of reinforcement can be developed (Didden, Duker, & Korzilius, 1997; Pelios, Morren, Tesch, & Axelrod, 1999; Scotti, Evans, Meyer, & Walker, 1991). Results of FAs allow therapists to design individualized, reinforcement-based treatment programs that alter or compete with the specic sources of reinforcement that maintain an individuals problem behavior. There are three general ways to alter environmental conditions to reduce the occurrence of problem behavior, although specic treatment procedures differ based on the function of problem behavior: (a) modify antecedent conditions to decrease the motivation to engage in problem behavior (e.g., if assessment results suggest that behavior is maintained by attention, attention is delivered

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Table 1 Test and Control Conditions in Functional Analyses

Condition Attention Escape Antecedent Therapist withholds attention from client Therapist presents learning trials to client Therapist is absent from the room, and client does not have access to preferred items Therapist provides social interaction to client; no learning trials or other demands are presented; leisure items are available Consequence Therapist provides attention for problem behavior Therapist removes tasks and instructions (30-s break) for problem behavior None Contingency Social positive reinforcement Social negative reinforcement Automatic reinforcement

Alone

Play

None

Control condition

frequently and noncontingently), (b) implement extinction to terminate the contingency that maintains behavior (e.g., no longer provide attention for problem behavior), and (c) deliver the functional reinforcer (e.g., attention) for the occurrence of an alternative response (e.g., deliver attention for a more socially acceptable response). Descriptions of the treatments according to function of problem behavior are found in Table 2 (and see
Table 2 General Treatment Descriptions Across Functions
Function Social positive reinforcement (e.g., access to attention) Social negative reinforcement (e.g., escape from aversive event) Antecedent TX A: Deprivation from attention TX: Noncontingent access to attention A: Aversive event (e.g., instruction trials) TX: Noncontingent task removal or task alteration (decrease no. of trials or task difculty) A: General deprivation

Carr, Coriaty, & Dozier, 2000, for a detailed discussion). Case Example: Harold Harold was a 3-year-old boy diagnosed with profound mental retardation who lived at home with his parents. He displayed no productive language or instruction following skills but he did appear to be socially respon-

Extinction TX Maintaining SR: Attention TX: No longer providing attention for problem behavior (planned ignoring) Maintaining SR: Escape TX: No longer providing escape for problem behavior (continuation of instruction trials) Maintaining SR: Sensory stimulation TX: Eliminate sensory consequences produced by problem behavior via protective equipment (e.g., helmets, gloves) or response blocking Maintaining SR: Pain reduction TX: N/A not applicable.

Differential SR TX Establish and provide attention for alternative attentionseeking response Establish and provide escape for alternative escape behavior (asking for a break), or strengthen compliance (provide escape or other reinforcers for compliance) Establish an alternative selfstimulatory response (appropriate toy play)

Automatic positive reinforcement

TX: Noncontingent access to stimulation

Automatic negative reinforcement Note. TX

A: Medical condition or discomfort TX: Alleviate condition reinforcer; A

Establish alternative pain reduction response

treatment; SR

antecedent event; N/A

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sive (e.g., to hugs and smiles). Harold engaged in SIB in the form of head banging. A functional analysis of his SIB was conducted that included the attention, escape, alone, and play conditions. The results of Harolds FA are shown in the rst phase of Figure 1. Higher rates of SIB were observed in the attention condition relative to other conditions, indicating that Harolds SIB was maintained by social positive reinforcement in the form of attention. The effects of two function-based interventions to reduce Harolds SIB were evaluated across several phases (see Phases 2 4 in Figure 1). During Phase 2, a baseline was conducted to establish a rate of SIB and the designated replacement behavior prior to treatment. During this baseline, high rates of SIB and zero rates of waving occurred. During Phase 3, an intervention was implemented that consisted of two components: (noncontingent reinforcement, [NCR] and extinction [EXT]). That is, the therapist delivered attention to Harold frequently throughout treatment sessions on a responseindependent basis (NCR) but turned away from Harold when SIB occurred (EXT). Results of this phase indicated that NCR EXT was effective in reducing the occurrence of SIB to near-zero rates. The procedure, however, did not contain any explicit means for strengthening alternative behavior (waving) that would allow Harold to appropriately request attention from others. Thus, during Phase 3

differential reinforcement of alternative behavior plus extinction (DRA EXT), noncontingent attention was replaced by prompting and shaping, which were used to teach Harold to wave his hand to gain access to attention and a small piece of an edible item, and all instances of SIB continued to be ignored. Initially, all instances of waving resulted in the delivery of attention; later, however, the schedule of attention delivery was thinned gradually, with the terminal reinforcement delivery schedule being approximately every 4 min (i.e., a xed interval [FI] schedule of reinforcement, in which attention and edibles were delivered after the rst response that occurred after 240 s). In addition, the delivery of edibles was faded out across the phase. Results of this phase indicated that DRA EXT was effective in maintaining near-zero rates of SIB and increasing the rate of waving. Furthermore, the schedule of reinforcement delivery was made more practical (i.e., less effortful for the caregivers) via schedule thinning. Conclusions It is not surprising that behavior analysis has had a major impact on the eld of IDD. With its emphasis on empirical evaluation and its interest in all types of performances (behavior acquisition, maintenance, and reduction), researchers in behavior analysis have examined

Harold 15 Functional Analysis RESPONSES PER MINUTE Attention 10

Baseline

NCR + EXT

DRA + EXT

FI-30 FI-60 FI-120

Alone Demand Sign Play 0 10 20 30 40 50 SESSIONS 60 70

FI-240

80

90

Figure 1. Responses per minute of self-injurious behavior and sign (waving) displayed by Harold during functional analysis (Phase 1), baseline (Phase 2), and treatment (Phases 3 4) conditions. NCR noncontingent reinforcement; EXT extinction; DRA differential reinforcement of alternative behavior; FI xed interval schedule of reinforcement.

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almost every behavioral characteristic of IDD, resulting in a systematic body of data on environmental approaches to assessment and treatment. In addition to providing an effective technology for improving the behavior of individuals with severe learning challenges, research methods used in behavior analysis have been helpful in evaluating other forms of treatment that involve learning, including some that have not held up to close scrutiny, such as facilitated communication (Neef, 2001). Future research in this area will likely focus on procedural renement, long-term maintenance and generalization of acquired skills in increasingly complex environmental conditions, prevention of problem behavior before it becomes a serious concern, and system-wide interventions capable of producing effective outcomes for large numbers of individuals despite limited agency resources (Horner, 1997). The results of this work will not only lead to direct improvements in service but also will contribute to a more general science of behavior.

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