Active versus passive management of post-acquired brain injury challenging behaviour: a case study analysis of multiple operant procedures in the treatment of challenging behaviour maintained by negative reinforcement.
OBJECTIVE
Operant conditioning interventions are effective in the management of post-acute ABI challenging behaviour. However, when this serves an avoidance or escape function, reinforcement approaches may be ineffective. In this paper the utility of a range of operant-derived ABI interventions is considered specifically with regard to behaviour whose prime function is avoidance or escape from rehabilitation activities.


METHODS
Efficacy of three operant interventions was determined by describing a single case study whose aggressive behaviour served an avoidance-escape function. Two interventions comprised variants of differential reinforcement: differential reinforcement of incompatible behaviour (DRI) and differential reinforcement of low rates of responding (DRL). The third intervention comprised situational time out (STO) and sustained verbal prompting.


RESULTS
Despite reports of the efficacy of DRI and DRL, neither was beneficial in this case. However, STO and sustained verbal prompting proved highly effective in reducing aggression.


CONCLUSIONS
Results are discussed in relation to two levels of explanation: function and cognition. Special emphasis is laid upon the extent to which interventions actively involve the patient and the degree of intrusiveness necessary for staff to implement therapeutic procedures. The case demonstrates how a scientifically-derived formulation regarding behaviour disorder can support multiple treatment options.
National Brain Injury Centre, St Andrew's Healthcare, Northampton, UK.
Inga
I
Stewart
Nick
N
Alderman
D000328:Adult; D000374:Aggression / Q000523:psychology*; D001521:Behavior Therapy / Q000379:methods*; D001930:Brain Injuries / Q000503:physiopathology / Q000523:psychology* / Q000534:rehabilitation; D003216:Conditioning, Operant / Q000502:physiology*; D006801:Humans; D008297:Male; D012054:Reinforcement, Psychology; D012919:Social Behavior