Lockwood K, Williams D E
Behavioral Services Division, Richmond State School, TX 77469.
J Behav Ther Exp Psychiatry. 1994 Jun;25(2):161-9. doi: 10.1016/0005-7916(94)90011-6.
This study evaluated the relative effectiveness of differential reinforcement of other behaviors (DRO), differential reinforcement of incompatible behavior (DRI), and contingent watermist (CWM) in treating chronic self-injurious hand mouthing. The participant, a man with profound mental retardation, lived in a large residential facility. Prior to treatment he had participated in ineffective nonaversive treatments and was continuously mechanically restrained by his attending physician to promote healing of his hands. Baseline data collected in daily 30-minute sessions showed a hand mouthing rate of 1.5 responses/minute. Implementing the DRO, DRI, and CWM procedures in combination resulted in an initial 85% rate reduction. Each treatment component subsequently was withdrawn and reintroduced systematically in order to evaluate its relative effective upon hand mouthing. Only CWM plus differential reinforcement (DRO and/or DRI) had a significant effect upon hand mouthing. DRO plus DRI procedures were ineffective. In an effort to promote generalization of treatment effects, subsequent manipulations evaluated the effects of therapist proximity to the participant (one foot, 21 feet, or a random distance between one and 21 feet). Hand mouthing rates were reliably lower in the one-foot condition than in the 21-feet condition. The random proximity condition produced an intermediate performance. Direct care staff have implemented the DRI and CWM procedures throughout the participant's waking hours for nearly 3 years with almost complete elimination of hand mouthing.
本研究评估了其他行为的差别强化（DRO）、不相容行为的差别强化（DRI）和应急水雾（CWM）在治疗慢性自伤性咬手行为方面的相对有效性。参与者是一名重度智力障碍男性，居住在一个大型寄宿机构。在接受治疗之前，他曾参与过无效的非厌恶疗法，并且一直被主治医生机械性约束以促进手部愈合。在每天30分钟的时段内收集的基线数据显示，咬手频率为每分钟1.5次反应。联合实施DRO、DRI和CWM程序导致咬手频率最初降低了85%。随后，系统地撤回并重新引入每个治疗成分，以评估其对咬手行为的相对有效性。只有CWM加差别强化（DRO和/或DRI）对咬手行为有显著影响。DRO加DRI程序无效。为了促进治疗效果的泛化，后续操作评估了治疗师与参与者接近程度（1英尺、21英尺或1至21英尺之间的随机距离）的影响。在1英尺的条件下，咬手频率可靠地低于21英尺的条件。随机接近条件产生了中等表现。直接护理人员在参与者清醒的时间里实施DRI和CWM程序近3年，几乎完全消除了咬手行为。
