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Negative reinforcement to alter disruptive behavior of an adolescent in a day treatment setting
NEGATIVE REINFORCEMENT TO ALTER DISRUPTIVE BEHAVIOR OF AN ADOLESCENT IN A DAY TREATMENT SETTING THEODORE Astor Child Guidance
H. WASSERMAN*
Center,
Bronx, New York. U.S.A.
Summary-This report describes the treatment of disruptive behavior in an adolescent in a day treatment program (by a negative reinforcement proccdure).‘The use of a negative reinforcer was necessitated by the unavailability of effective positive reinforcers.
Authors who advocate the practice of behavior therapy usually encourage the application of positive reinforcement procedures as the primary treatment approach (Bandura, 1969; Graziano, 1974; Homme, 1970; Krumboltz and Thorenson, 1969; and Shaefer and Martin, 1969). In this regard, great attention is paid to the selection of an appropriate positive reinforcer from a “Reinforcement Menu” (Daley, 1969). There are instances, however, when appropriate positive reinforcers may be impossible. Specifically, for children who are placed in residential treatment settings, their primary motivation is return to their homes. To provide this appropriate positive reinforcer often becomes impossible because of the aversive features of the home situation, or the refusal of the parent to take the child home. In such cases, secondary treatment procedures must be considered. Within the rubric of such secondary procedures, negative reinforcement procedures are feasible. A negative reinforcer is defined by Homme (1970) as “some threatening situation that a person, by his performance, seeks to avoid.” Homme states that contingency contracting using negative reinforcement can be justifiably applied in a treatment setting. Negative reinforcement is often confused with punishment. Rimm and Masters (1974) define punishment “as the withdrawal of a positive reinforcer or the application of a
They further state that negative reinforcer.” “negative reinforcement describes the termination of an aversive event, following the performance of a desired behaiior.” A “increases the frequency negative reinforcer of the behavior, upon whose occurrence it is contingent.”
TREATMENT
BACKGROUND
The client. a 12-yr-old male, had been placed in a distant psychiatric residential treatment program by his mother, three years prior to his present enrollment in a local day treatment program. The typical residential treatment plan for children consists of placement in a group home in his community and enrollment in a day treatment program. The day treatment program, which contains a school component, serves as the intervening placement between residential care and community school. When the child is able to function within the group home and day treatment school, the program places him into the community school. Day treatment is usually viewed by all clients of the agency as the final step before returning home. In this client’s case, however, he could not return to his parents’ home because his mother refused to accept him. She would not tell him this directly, but instead blamed various state, city and local agencies for the delay in placement. As a result, the child did not believe his counselor when told the real reason for the delay in his return. Shortly after enrollment in the day treatment program, he refused to do any work, began destroying property, made animal noises and refused to wash himself in the group home. He stated that he wanted to return to his mother’s home and would only begin working when this demand was met. A review of his case history showed that the client evidenced the same behavior earlier in the residential treatment setting. There, he had resisted all attempts to change these disruptive behaviors.
The writer wishes to thank Al Pielusko for assisting in collection of the data. *Requests for reprints should be sent to Theodore H. Wasserman, Ph.D., Astor Child Guidance Avenue. Bronx. New York 10466. U.S.A. 31s
Center,
3984 Bronxwwd
THEODORE
316
H. WASSERMAN
The present day treatment center is a psychiatric treatment program that utilizes a token economy to reinforce positive behavior. This client did not respond to the token program, nor did he respond to any of several individual treatment procedures based on positive reinforcers. ln addition, he repeatedly stated that he only wanted to return to his mother’s home and would only work towards that goal. At the day treatment center, individual cases are reviewed at three-month intervals. When a child consistently fails to respond to the various treatment attempts over the course of two review periods, a full re-evaluation of the case is conducted. For this particular client, the clinical staff determined that since returning home was not a possibility and since the youth’s behavior was deteriorating rapidly, a long-term highly structured residential treatment facility would provide the most appropriate psychiatric care. Therefore, it was recommended that he be returned to the residential treatment facility afftliated with the day treatment program. The usual procedural steps would mandate an immediate referral and then informing the youth of the forthcoming transfer to residence. At the request of the psychology staff, it was agreed that return to residence for this child be made contingent upon his continued inappropriate behavior. The clinical team agreed that the continuation of this inappropriate behavior would warrant residential treatment.
non-occurrence of a negative behavior. a page of referral data would be sent. If he did attain the criteria, it would be raised until he was consistently responding at a rate of 90% correct behavior (18120). (cl The client was informed that while he remained in the local community, every effort would be made to return him to his mother’s home. However, no promises could be made because of the unpredictability of his mother’s behavior. (d) Additionally, following the procedure of Houck (1%7). the client was helped to accept his mother’s rejection of him. The client was also informed that while he remained in the local community. regardless of whether he met criteria for a particular week, weekly meetings between him and his mother would be attempted to try to clarify the issue of his going home and to arrange for him to return home on weekends. (4) Reversal phase-The program was continued until the end of the winter program. After a one-week vacation, the client attended a summer program. without the treatment being reinstated. After the end of the second week, the treatment program was reinstated.
RESULTS
TREATMENT The client was told. in one of the therapy sessions, that the following decisions concerning him had been made: (I) The program would not tolerate his disruptive and uncooperative behaviors. (2) His mother could not take him home at the present time, since she was not ready, and the staff did not know when she would be ready. (3) While the program could not guarantee that he could go home to his mother, if his disruptive behavior persisted, he would be returned to the upstate residential treatment facility. This was a step backward from returning to his mother’s home, located in the immediate area of the day treatment center whose location afforded him more contact with her. (a) To this end, all the referral papers necessary to return him to the upstate treatment facility were collected. (When the reports were collected, this material totaled 32 pages.) (b) His teacher and group home parent monitored his behavior each day in the following areas: completing school work (defined as completing all assigned work for the day). not destroying school property (defined as not ripping up papers or drawing on the desks), not making animal noises (defined as grunting or snorting). and washing before coming to school (defined as washing his face and hands with soap and water). The teacher or group home counselor indicated on an index card if he did not engage in the negative behavior (by placing a checkmark next to the behavior) or if he did engage in the negative behavior (by placing an “X” next to the behavior listed on the card). For the first week, if he did not attain the criteria on IS/20 (4 behaviors X 5 days) 75% observations of the
T \ 123
“l”“”
’
12345678910 Treatment Date
grouped
I” Fig.
5 day
”
I2 Reversal
I I I I 12 34 Re,“,tO+~me”t
blocks
1.
The data in Fig. 1 represents the weekly total of the four categories of behavior. These are the number of times during the week that disruptive behavior did not occur. It can be seen from this figure that criteria were quickly attained, with the exception of
NEGATIVE
REINFORCEMENT
TO ALTER
DISRUPTIVE
one week of treatment (the fifth, when the client discovered that he would not be going home for the Easter visit). Otherwise, there was a rapid dramatic decrease in the rate of negative behaviors and concomitant increase in positive behaviors.
DISCUSSION At no point were the required number of criterion responses exceeded. That is, the client always just reached criteria. This might have been predicted with the use of a negative reinforcer since there is no additional reward gained for surpassing criteria. Inclusion of a positive contingency would probably increase the power of the technique. In addition, overall improvement ~‘9s noted in other behaviors not controlled by this program. This is suggestive of generalized effects. No attempts have been planned to withdraw the procedure until the mother’s acceptance has been resolved. At this point, no positive environmental reinforcements have been found to support the newly established behavior. It may be argued that threatening the child with return to the residential treatment setting constituted unusual punishment. This is not the case, however. when it is realized that children who behave disruptively in the local community facility. are often returned to the residential center for further treatment. This return, however, was never previously made
BEHAVIOR
OF AN ADOLESCENT
317
systematically contingent on the occurrence or non-occurrence of a specific set of behaviors. It may also be argued that the new program presented the possibility that the client could
see his mother
and thus these visits could
serve as a powerful reinforcer for behaviors allowing the child to remain in the local community facility. It would be these potential visits, therefore. that were positively reinforcing the behavior change and thereby producing the effect. However, though these visits were scheduled, the client’s mother never attended them. Instead. these meetings became a weekly review of behavior, and therefore the behavior change evidenced must be due to the introduction of the negative reinforcement procedure.
REFERENCES Bandura A. ( 1969). Principles of Behavior Modj/icution. 217-225. 234.232. 501-505. Holt. Rinehart Sr Winston, New York. Daley M. F. (1969). The Rrin/brcentcnt Menu. Finding Efji*ctirx* Reitl/iwcers it, Krumboltz’s J. and Thorenson. C. .Uc~hu\kru/ Cowtsellirrg. Holt. Rinehart S; Winston, New York. Graziano A. (197-i). f;;l Bchutkr Therop_v with Chi/drcn. 37-44.318-340. 357-376. Aldine. Chicago. Homme L. (1974). How 10 Use Cottrirrgtwcy Conrrucring itt rhc C/u.ssroom. 9-31. Research Press, Champaign. Illinois. Houck R. (1967). The* Rutiomrl M~~nogmrenr 0-j Children. Libra Publishing. New York. Rimm D. C. and Masters _I. C. (1974). Behavior Therapy, Academic Press. New York. 354-357. Shaefer H. H. and Martin P. L. (1969). Behuvior Therapy. McCraw.Hill. New York. 5.33-35.
H. WASSERMAN*
Center,
Bronx, New York. U.S.A.
Summary-This report describes the treatment of disruptive behavior in an adolescent in a day treatment program (by a negative reinforcement proccdure).‘The use of a negative reinforcer was necessitated by the unavailability of effective positive reinforcers.
Authors who advocate the practice of behavior therapy usually encourage the application of positive reinforcement procedures as the primary treatment approach (Bandura, 1969; Graziano, 1974; Homme, 1970; Krumboltz and Thorenson, 1969; and Shaefer and Martin, 1969). In this regard, great attention is paid to the selection of an appropriate positive reinforcer from a “Reinforcement Menu” (Daley, 1969). There are instances, however, when appropriate positive reinforcers may be impossible. Specifically, for children who are placed in residential treatment settings, their primary motivation is return to their homes. To provide this appropriate positive reinforcer often becomes impossible because of the aversive features of the home situation, or the refusal of the parent to take the child home. In such cases, secondary treatment procedures must be considered. Within the rubric of such secondary procedures, negative reinforcement procedures are feasible. A negative reinforcer is defined by Homme (1970) as “some threatening situation that a person, by his performance, seeks to avoid.” Homme states that contingency contracting using negative reinforcement can be justifiably applied in a treatment setting. Negative reinforcement is often confused with punishment. Rimm and Masters (1974) define punishment “as the withdrawal of a positive reinforcer or the application of a
They further state that negative reinforcer.” “negative reinforcement describes the termination of an aversive event, following the performance of a desired behaiior.” A “increases the frequency negative reinforcer of the behavior, upon whose occurrence it is contingent.”
TREATMENT
BACKGROUND
The client. a 12-yr-old male, had been placed in a distant psychiatric residential treatment program by his mother, three years prior to his present enrollment in a local day treatment program. The typical residential treatment plan for children consists of placement in a group home in his community and enrollment in a day treatment program. The day treatment program, which contains a school component, serves as the intervening placement between residential care and community school. When the child is able to function within the group home and day treatment school, the program places him into the community school. Day treatment is usually viewed by all clients of the agency as the final step before returning home. In this client’s case, however, he could not return to his parents’ home because his mother refused to accept him. She would not tell him this directly, but instead blamed various state, city and local agencies for the delay in placement. As a result, the child did not believe his counselor when told the real reason for the delay in his return. Shortly after enrollment in the day treatment program, he refused to do any work, began destroying property, made animal noises and refused to wash himself in the group home. He stated that he wanted to return to his mother’s home and would only begin working when this demand was met. A review of his case history showed that the client evidenced the same behavior earlier in the residential treatment setting. There, he had resisted all attempts to change these disruptive behaviors.
The writer wishes to thank Al Pielusko for assisting in collection of the data. *Requests for reprints should be sent to Theodore H. Wasserman, Ph.D., Astor Child Guidance Avenue. Bronx. New York 10466. U.S.A. 31s
Center,
3984 Bronxwwd
THEODORE
316
H. WASSERMAN
The present day treatment center is a psychiatric treatment program that utilizes a token economy to reinforce positive behavior. This client did not respond to the token program, nor did he respond to any of several individual treatment procedures based on positive reinforcers. ln addition, he repeatedly stated that he only wanted to return to his mother’s home and would only work towards that goal. At the day treatment center, individual cases are reviewed at three-month intervals. When a child consistently fails to respond to the various treatment attempts over the course of two review periods, a full re-evaluation of the case is conducted. For this particular client, the clinical staff determined that since returning home was not a possibility and since the youth’s behavior was deteriorating rapidly, a long-term highly structured residential treatment facility would provide the most appropriate psychiatric care. Therefore, it was recommended that he be returned to the residential treatment facility afftliated with the day treatment program. The usual procedural steps would mandate an immediate referral and then informing the youth of the forthcoming transfer to residence. At the request of the psychology staff, it was agreed that return to residence for this child be made contingent upon his continued inappropriate behavior. The clinical team agreed that the continuation of this inappropriate behavior would warrant residential treatment.
non-occurrence of a negative behavior. a page of referral data would be sent. If he did attain the criteria, it would be raised until he was consistently responding at a rate of 90% correct behavior (18120). (cl The client was informed that while he remained in the local community, every effort would be made to return him to his mother’s home. However, no promises could be made because of the unpredictability of his mother’s behavior. (d) Additionally, following the procedure of Houck (1%7). the client was helped to accept his mother’s rejection of him. The client was also informed that while he remained in the local community. regardless of whether he met criteria for a particular week, weekly meetings between him and his mother would be attempted to try to clarify the issue of his going home and to arrange for him to return home on weekends. (4) Reversal phase-The program was continued until the end of the winter program. After a one-week vacation, the client attended a summer program. without the treatment being reinstated. After the end of the second week, the treatment program was reinstated.
RESULTS
TREATMENT The client was told. in one of the therapy sessions, that the following decisions concerning him had been made: (I) The program would not tolerate his disruptive and uncooperative behaviors. (2) His mother could not take him home at the present time, since she was not ready, and the staff did not know when she would be ready. (3) While the program could not guarantee that he could go home to his mother, if his disruptive behavior persisted, he would be returned to the upstate residential treatment facility. This was a step backward from returning to his mother’s home, located in the immediate area of the day treatment center whose location afforded him more contact with her. (a) To this end, all the referral papers necessary to return him to the upstate treatment facility were collected. (When the reports were collected, this material totaled 32 pages.) (b) His teacher and group home parent monitored his behavior each day in the following areas: completing school work (defined as completing all assigned work for the day). not destroying school property (defined as not ripping up papers or drawing on the desks), not making animal noises (defined as grunting or snorting). and washing before coming to school (defined as washing his face and hands with soap and water). The teacher or group home counselor indicated on an index card if he did not engage in the negative behavior (by placing a checkmark next to the behavior) or if he did engage in the negative behavior (by placing an “X” next to the behavior listed on the card). For the first week, if he did not attain the criteria on IS/20 (4 behaviors X 5 days) 75% observations of the
T \ 123
“l”“”
’
12345678910 Treatment Date
grouped
I” Fig.
5 day
”
I2 Reversal
I I I I 12 34 Re,“,tO+~me”t
blocks
1.
The data in Fig. 1 represents the weekly total of the four categories of behavior. These are the number of times during the week that disruptive behavior did not occur. It can be seen from this figure that criteria were quickly attained, with the exception of
NEGATIVE
REINFORCEMENT
TO ALTER
DISRUPTIVE
one week of treatment (the fifth, when the client discovered that he would not be going home for the Easter visit). Otherwise, there was a rapid dramatic decrease in the rate of negative behaviors and concomitant increase in positive behaviors.
DISCUSSION At no point were the required number of criterion responses exceeded. That is, the client always just reached criteria. This might have been predicted with the use of a negative reinforcer since there is no additional reward gained for surpassing criteria. Inclusion of a positive contingency would probably increase the power of the technique. In addition, overall improvement ~‘9s noted in other behaviors not controlled by this program. This is suggestive of generalized effects. No attempts have been planned to withdraw the procedure until the mother’s acceptance has been resolved. At this point, no positive environmental reinforcements have been found to support the newly established behavior. It may be argued that threatening the child with return to the residential treatment setting constituted unusual punishment. This is not the case, however. when it is realized that children who behave disruptively in the local community facility. are often returned to the residential center for further treatment. This return, however, was never previously made
BEHAVIOR
OF AN ADOLESCENT
317
systematically contingent on the occurrence or non-occurrence of a specific set of behaviors. It may also be argued that the new program presented the possibility that the client could
see his mother
and thus these visits could
serve as a powerful reinforcer for behaviors allowing the child to remain in the local community facility. It would be these potential visits, therefore. that were positively reinforcing the behavior change and thereby producing the effect. However, though these visits were scheduled, the client’s mother never attended them. Instead. these meetings became a weekly review of behavior, and therefore the behavior change evidenced must be due to the introduction of the negative reinforcement procedure.
REFERENCES Bandura A. ( 1969). Principles of Behavior Modj/icution. 217-225. 234.232. 501-505. Holt. Rinehart Sr Winston, New York. Daley M. F. (1969). The Rrin/brcentcnt Menu. Finding Efji*ctirx* Reitl/iwcers it, Krumboltz’s J. and Thorenson. C. .Uc~hu\kru/ Cowtsellirrg. Holt. Rinehart S; Winston, New York. Graziano A. (197-i). f;;l Bchutkr Therop_v with Chi/drcn. 37-44.318-340. 357-376. Aldine. Chicago. Homme L. (1974). How 10 Use Cottrirrgtwcy Conrrucring itt rhc C/u.ssroom. 9-31. Research Press, Champaign. Illinois. Houck R. (1967). The* Rutiomrl M~~nogmrenr 0-j Children. Libra Publishing. New York. Rimm D. C. and Masters _I. C. (1974). Behavior Therapy, Academic Press. New York. 354-357. Shaefer H. H. and Martin P. L. (1969). Behuvior Therapy. McCraw.Hill. New York. 5.33-35.