Evaluating a Treatment without Extinction for Elopement Maintained by Access to Stereotypy

Boyle, M. A., Bacon, M. T., Brewer, E. M., Carton, S. M., & Gaskill, L. A. (2020). Evaluating a treatment without extinction for elopement maintained by access to stereotypy. Journal of Applied Behavior Analysis, 53(2), 1531-1541. 10.1002/jaba.682

Reviewed by:
Samantha Van Dean, BA, and Robert H. LaRue, PhD, BCBA-D
Graduate School of Applied and Professional Psychology, Rutgers University

Why research this topic?

Procedures to teach specific skills for individuals with autism Elopement is a form of problem behavior that involves leaving a designated area without permission. This can include running away, bolting, or simply walking from one spot to another. While elopement can occur in any population, the incidence in individuals with autism spectrum disorder (ASD) is especially high. Elopement presents several safety concerns (e.g., getting lost, drowning, traffic accidents) that highlight the importance of sound assessment and intervention.

Intervention strategies for elopement often involve the use of Functional Communication Training (FCT) in conjunction with extinction (e.g., Falcomata et al., 2010; Jessel et al., 2018). FCT is an intervention designed to provide learners with an adaptive request or communication response to replace challenging behavior (e.g., teaching someone to ask for a preferred item or a break). To ensure that the learner acquires and maintains the communication response, the problem behavior should contact extinction (problem behavior no longer “works”). As effective as these procedures are, the use of extinction can present significant practical and safety challenges. For instance, implementing extinction for attention-maintained elopement would involve not chasing the individual, which may be dangerous. Implementing extinction for an individual who elopes to avoid work would involve persisting with demands during the episode, which may be impractical and lead to a loss of control.

A promising approach for circumventing the challenges of using extinction for the treatment of elopement is to change the environment to increase the likelihood of appropriate behavior. In other words, as an alternative to extinction, practitioners may be able to manipulate the duration, quality, and immediacy of reinforcement to favor appropriate behavior. The current study replicated and extended the previous literature by assessing and treating elopement maintained by access to stereotypical behavior (i.e., repetitive door opening/closing) without the use of extinction or response blocking (i.e., denied access to the door) in a university clinic setting.

What did the researchers do?

The participant was an autistic 8-year-old male (Aaron) referred for the assessment and treatment of severe problem behavior. To assess the motivation for elopement, the researchers conducted a latency-based functional analysis. A latency-based functional analysis (FA) is a useful variation of traditional assessment procedures that allows the session to stop following the first instance of problem behavior. In this form of assessment, the latency to the first instance of problem behavior is measured, with shorter latencies suggesting the probable function of problem behavior. This assessment is especially useful for dangerous forms of problem behavior (like elopement) as the occurrence is minimized. Using the latency-based FA in this study, the authors found that Aaron’s elopement was maintained by access to stereotypical door play. The authors defined door play as repeatedly opening and closing doors. During the FA, the session was terminated contingent upon the first instance of elopement, and he was provided with one minute of access following problem behavior.

Following the FA, a functional communication response (FCR) was taught to replace problem behavior. The FCR (i.e., “Can I play with the door?”) was taught using echoic and model prompting. Echoic prompting involved the authors vocally stating the full FCR response for the participant to imitate back to them. Model prompting then involved the authors acting out the trained response for the participant. Each time Aaron used this FCR, ‘Can I play with the door?’, he was allowed to play with the door for 1 minute. As an alternative to extinction, the authors changed the amount of time he was allowed to play with the door for elopement as compared to appropriate communication (FCR). If Aaron eloped to the door, he received only 3-seconds of access while the FCR resulted in 1-minute of access. In other words, the participant was provided with longer access to the door for asking appropriately relative to when he eloped to the door. The authors then gradually increased the length of time the participant had to wait for access after asking to play with the door (reinforcement thinning). The authors started with a 5-second delay and gradually increased waiting in 5-second time increments.

After demonstrating the effectiveness of the FCT intervention, tolerance training was implemented. During tolerance training, the authors taught Aaron to demonstrate a tolerance response when the therapist denied the request for the door. After Aaron’s request was denied, he was given an echoic prompt to slowly breathe in and out while stating “Okay”. Following tolerance training, delay trials were implemented that involved the participant having to wait until he was provided with verbal permission to access the door. Contingent on an FCR, Aaron was granted access to the door for two out of the five total trials, with the other three trials requiring a tolerance response. The researchers then gradually increased the number of times the tolerance response was required. Aaron’s caregivers participated in this part of the treatment. For a total of four trials, the participant’s caregiver requested Aaron to stay next to her and the other therapists who were present.

What did the researchers find?

The overall results showed that FCT without extinction effectively produced a clinically significant decrease in elopement. When tolerance training was implemented, Aaron displayed high rates of tolerance responses along with high rates of appropriate requests. Elopement rarely occurred during the tolerance training treatment. During reinforcement thinning, elopement remained low, and FCRs and tolerance responses remained high and stable. For the delay trials, the mean latency to elopement increased with the time-based criterion, which suggests that implementing the delay criteria was effective in teaching Aaron to wait for access to the door. The four treatment extension probes that were conducted had similar effects, and Aaron was able to wait for 10 minutes without any elopement occurring.

What are the strengths and limitations?

This current study was designed to analyze the effects of FCT, tolerance training, and reinforcement schedule thinning on decreasing elopement maintained by access to stereotypical door play. One strength of this study is that the experimenters demonstrated strong experimental control by assessing the treatment effects via a reversal design and across different multiple response measurements. Another strength of this study is that it expanded on current literature and provided a gateway for future research by providing a treatment that was successful in reducing elopement maintained by access to stereotypy without extinction. The authors accomplished this by providing differential access to higher magnitude reinforcement for appropriate communication, rather than elopement and teaching the child to wait for access. Additionally, the authors implemented tolerance training procedures to teach Aaron to accept circumstances when door play was not permitted at all, which made the intervention more practical to use in the natural environment.

One limitation of this study was that no data were collected on the social validity of the intervention. Although caregiver input was provided during the indirect assessment interview, no further data were taken regarding whether the treatment was effective or meaningful in Aaron’s everyday life outside of the treatment sessions. The caregiver’s acceptability or willingness to apply the intervention following the initial treatment was also not taken into consideration. Another potential limitation of this study is that treatment integrity data were not taken. Although the FCT treatment, tolerance training, and reinforcement schedule thinning were seen to be effective in maintaining the FCR and teaching Aaron to tolerate waiting to contact the desired response, data on whether these were delivered accurately and appropriately could have been taken to further show the strength of the current demonstration. Another potential limitation to this study is that it only involved a single participant. The child in this study was verbal and had the ability to actively participate in mand training. Future research should evaluate the effects of this intervention for participants of different ages, communication abilities (e.g., non-verbal populations), or those who communicate with Assisted Augmentative communication (AAC) to evaluate the generality of the findings.

What do the results mean?

Previous literature has explored treatment packages for elopement that involve both FCT and extinction. As stated previously, implementing extinction for elopement can be accompanied by potential safety concerns for both the individual engaging in the behavior and those who care for them. The current study expanded on previous research by implementing an intervention without extinction or response blocking by manipulating the reinforcement magnitude and arranging reinforcement contingencies for FCT v. elopement. This study was successful in applying the above procedures and provides an opening for future researchers and clinicians to explore and replicate these interventions to treat elopement without extinction or response blocking.

Citation for this article:

Van Dean, S., & LaRue, R. H. (2024). Research synopsis: Evaluating a treatment without extinction for elopement maintained by access to stereotypy. Science in Autism Treatment, 21(03).

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#BehaviorAnalysis #ChallengingBehavior #Communication #Safety