USING A STIMULUS CORRELATED WITH REPRIMANDS TO SUPPRESSAUTOMATICALLY MAINTAINED EYE POKING

SCOTT D. MCKENZIE, RICHARD G. SMITH, JASON N. SIMMONS, AND

MICHAEL J. SODERLUND

UNIVERSITY OF NORTH TEXAS

A functional analysis indicated that chronic eye poking exhibited by a woman with profoundmental retardation persisted in the absence of social contingencies. We initiated a procedure inwhich a therapist delivered a punisher (mild reprimand) contingent on eye poking in thepresence, but not the absence, of a neutral stimulus (wristbands). Subsequently, eye poking wassuppressed when the participant wore the wristbands in novel environments without thereprimand contingency.

DESCRIPTORS: generalization, punishment, reprimands, stimulus control

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Although appropriate generalization oftreatment outcomes is critical to the successof behavioral interventions, there is a paucityof applied research addressing generalization ofthe effects of punishment procedures (O’Don-nell, Crosbie, Williams, & Saunders, 2000),and critiques often cite reported failures ofpunishment effects to maintain or generalize(Donnellan, LaVigna, Negri-Shoultz, & Fass-bender, 1988). Piazza, Hanley, and Fisher(1996) implemented a treatment package thatincluded punishment in the form of repri-mands, noncontingent food access, and re-sponse interruption to reduce cigarette-buttpica exhibited by 1 participant and a stimuluscontrol procedure to generalize treatmenteffects to novel settings. During treatmentsessions, the therapist gave a purple card to theparticipant, instructed the participant not totouch the cigarette butts, to eat the availablefood, and to engage in a prespecified activity.If pica occurred, the therapist entered the

room, delivered the verbal reprimand ‘‘nobutts,’’ and blocked the response if necessary.During stimulus control probe sessions, eithera purple or yellow card was present and noprogrammed consequences were delivered forpica. Pica decreased to zero across settings inthe presence of the purple but not the yellowcard. The authors interpreted this finding toindicate that the purple card had acquired SD

properties for pica.Maglieri, DeLeon, Rodriguez-Catter, and

Sevin (2000) used a similar procedure tosuppress covert food stealing in a woman withmoderate mental retardation and Prader-Willisyndrome. By reprimanding consumption offood items that were in a container marked witha sticker, the participant learned to consumeonly unmarked foods. As unauthorized con-sumption decreased in training conditions,probes were conducted in other environmentswith other types of food. Food stealing andconsumption from containers marked with thesticker were eliminated in all environments.

The current study evaluated the effects ofmild verbal reprimands on chronic eye pokingand also investigated whether a previouslyneutral stimulus (set of wristbands), worn bythe participant during intervention but notbaseline conditions, would decrease eye pokingin novel environments in which the reprimandcontingency was inoperative.

This study was conducted in partial fulfillment of therequirements for the MS degree by the first author. Weexpress our appreciation to the administration and staff ofthe Denton State School for their support as well asmembers of the Behavior Analysis Resource Center fortheir assistance in carrying out this research.

Address correspondence to Richard G. Smith, Depart-ment of Behavior Analysis, P.O. Box 310919, Universityof North Texas, Denton, Texas 76203 (e-mail: Rsmith@pacs.unt.edu).

doi: 10.1901/jaba.2008.41-255

JOURNAL OF APPLIED BEHAVIOR ANALYSIS 2008, 41, 255–259 NUMBER 2 (SUMMER 2008)

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METHOD

Participant and Setting

Diane, a 46-year-old woman who had beendiagnosed with profound mental retardation,participated in this study. She resided in a largeresidential facility. She displayed no expressivelanguage, but responded to simple one- andtwo-step requests.

Records indicated that Diane had engaged insevere and chronic eye poking throughout herresidential placement. Eye poking had producedserious damage to her eyes (impaired vision,dislodgement of one of her eyes from the socketon at least two occasions). Anecdotal reportsand informal observations conducted prior tothe study indicated that eye poking occurredalmost continuously across a range of settings,including Diane’s residence, worksite, andcanteen (a cafeteria at the residential facility).Several reinforcement-based interventions im-plemented prior to the study had failed toproduce clinically significant reductions in eyepoking. Functional analysis results (availablefrom the second author) indicated that eyepoking persisted in the absence of socialcontingencies (mean duration of eye pokingacross conditions was 1.03 s per minute inattention, 0.13 s per minute in play, 0 indemand, and 6.6 s in alone).

Sessions were conducted in three environ-ments: an observation room at the treatmentfacility, the canteen, and the living area ofDiane’s home. The observation room was thesite for the functional analysis and was thetreatment environment during treatment. Theroom was 3.04 m by 3.04 m, with a one-waymirror for the purpose of observation, andcontained a bench, a chair, and a table.Materials were present as appropriate duringthe functional analysis. The canteen was a small,one-room cafeteria in which residents and staffpurchased food, ate, and socialized. Sessions inthe canteen were conducted outside mealtimes(e.g., midmornings, midafternoons). The livingarea of Diane’s home was a large room

containing home furnishings (e.g., chairs,tables, a television). Although staff and otherresidents were sometimes present during ses-sions at the canteen and home, staff memberswere asked not to interact with Diane duringsessions. Observers collected data as unobtru-sively as possible in both the canteen and homeenvironments (e.g., sitting at other tables in thecanteen).

Diane attended sessions two to three times aweek for 30 min to 90 min. Two to ninesessions were conducted during each visit. Allsessions were scheduled to be 10 min long, butwere extended during treatment sessions untilthe first eye poke was observed if it did notoccur during the first 10 min.

Prior to sessions, the experimenter broughtDiane to the setting and prepared data-collection equipment. Diane was observed untilone instance of eye poking occurred, after whichsession and data-collection procedures wereinitiated. This procedure was implemented toinsure that, in the absence of treatment, eyepoking was likely to occur in the sessioncontext.

Data Collection and Interobserver Agreement

Laptop computers were used to collect dataon occurrence and duration of eye poking.Onset of eye poking was scored when Dianeinserted any part of her finger or thumb intoeither eye socket for longer than 1 s. Offset wasscored when Diane’s finger broke contact withher eye socket for 1 s. Data are reported asduration (in seconds) of eye poking per session.

A second independent observer recorded dataduring 38% of treatment and generalizationsessions. In each setting, interobserver agree-ment was measured on at least 25% of sessionsand was calculated by dividing each 10-minsession into 10-s intervals, summing the totalnumber of seconds and response occurrencesscored by each observer, and dividing thesmaller number by the larger (if both observersscored zero, a value of 1 was assigned). Theresults were summed across intervals, divided by

256 SCOTT D. MCKENZIE et al.

the total number of intervals (60), andmultiplied by 100%. Mean agreement for eyepoking was 96% (range, 84% to 100%).

Experimental Conditions

No wristbands. Diane was brought to thesetting and, after the first observed occurrenceof eye poking, was observed without anyinteraction for 10 min.

Wristbands (no reprimands). Diane wasbrought to the setting and after the firstobserved occurrence of eye poking, the exper-imenter approached her, placed two red tenniswristbands on her wrists, left the area, andremained out of Diane’s field of vision for theremainder of the session.

Wristbands (reprimands). This condition wasidentical to wristbands (no reprimands) withthe exception that after leaving the room, thetherapist monitored Diane via a one-waymirror. When eye poking was observed thetherapist entered the room and delivered averbal reprimand (e.g., ‘‘Diane, stop poking!’’).The therapist was to repeat the reprimand at 3-sintervals until eye poking ceased, but it wasnever necessary to deliver more than onereprimand. After delivering the reprimand andobserving the termination of eye poking, thetherapist left the room. Sessions lasted for10 min; however, if eye poking had notoccurred within 10 min (this occurred seventimes), sessions were extended until a responseoccurred. The therapist then delivered a verbalreprimand and left the room, and the sessionwas terminated. For those sessions, data arereported for the first 10 min (i.e., the data showzero seconds of eye poking).

RESULTS AND DISCUSSION

The duration of eye poking is displayed inFigure 1. Two baseline conditions were con-ducted prior to treatment. A no-wristbandscondition was conducted to identify pretreat-ment response levels. A wristbands (no repri-mands) condition was then conducted to

ascertain that the wristbands by themselveswould not affect levels of eye poking prior totreatment. The mean duration of eye pokingduring the no-wristbands condition was 278 sper session (range, 151 s to 404 s). During thewristbands (no reprimands) condition, themean duration of eye poking was 209 s persession (range, 24 s to 312 s). When thewristbands (reprimands) sessions were initiated,no-wristbands sessions also continued within amultielement design. The mean duration of eyepoking during the no-wristbands condition was133 s per session (range, 2 s to 402 s). Duringthe wristbands (reprimands) condition, themean duration of eye poking was 2 s persession (range, 0 s to 7 s).

After the reprimands effectively decreased eyepoking in the treatment environment, wrist-bands (no reprimands) and no-wristbandsconditions were introduced in the canteen andhome. Following an initial no-wristbandsbaseline in each setting, both types of sessionscontinued within a multielement design. Dur-ing the initial no-wristbands baselines, the meansession duration of eye poking was 83 s (range,30 s to 180 s) and 146 s (range, 11 s to 256 s)in the canteen and home, respectively. Duringthe multielement analysis, the mean duration ofeye poking during no-wristbands sessions was71 s (range, 20 s to 188 s) in the canteen and114 s (range, 36 s to 243 s) in the home.During the wristbands (no reprimands) condi-tions, no eye poking was observed in thecanteen, and the mean duration in the homewas 20 s (range, 0 s to 90 s).

The results indicate that contingent verbalreprimands effectively decreased eye poking.Immediate and nearly complete suppression ofeye poking was observed during the wristbands(reprimands) condition. The effects of thewristbands (no reprimands) conditions in thecanteen and home environments indicated thatthe wristbands acquired stimulus control overeye poking. A comparison between the wrist-bands (no reprimands) sessions conducted prior

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to and after treatment revealed substantialreductions in eye poking after the wristbandswere associated with the verbal reprimandcontingency, even though no verbal reprimandswere ever delivered in the home or canteenenvironments. Thus, it appears that the wrist-bands mediated generalization of treatment effectsacross environments without implementing treat-ment contingencies in those environments.

Some limitations in the current study shouldbe noted. First, although we attempted toisolate the effects of punishment (reprimands)for experimental reasons, such proceduresshould be combined with reinforcement-basedprocedures in clinical application. Second,

because sessions with reprimands continuedthroughout the study, it is unclear thatwristbands would have continued to controleye poking in the absence of intermittenttreatment sessions. Finally, the current data donot provide evidence about why reprimandsfunctioned as punishment for Diane’s behaviorin the current context.

These findings extend the literature ongeneralization of punishment effects. Ackerman(1972) argued that punishment fails to gener-alize to settings in which the punishing agent isnot present. However, results of this study aswell as those of Piazza et al. (1996) areinconsistent with this claim; stimuli associated

Figure 1. Seconds of eye poking across training (top), canteen (middle), and home (bottom) environments. Filledcircles represent no-wristbands sessions, open triangles represent wristbands (no reprimands) sessions, and open circlesrepresent wristbands (reprimands) sessions.

258 SCOTT D. MCKENZIE et al.

with punishment were sufficient to decreaseproblem behavior when the punishing agentwas absent. Also, whereas Piazza et al. conduct-ed treatment and generalization sessions in thesame setting, generalization in the current studyoccurred in settings in which treatment hadnever occurred. Finally, the outcomes show thatwristbands—highly portable stimuli worn bythe participant—were sufficiently salient toacquire functional control over self-injury.

REFERENCES

Ackerman, J. M. (1972). Operant conditioning techniques forthe classroom teacher. Glenview, IL: Scott, Foresman.

Donnellan, A. M., LaVigna, G. W., Negri-Shoultz, N., &Fassbender, L. L. (1988). Progress without punishment:Effective approaches for learners with behavior problems.New York: Teachers College Press.

Maglieri, K. A., DeLeon, I. G., Rodriguez-Catter, V., &Sevin, B. M. (2000). Treatment of covert foodstealing in an individual with Prader-Willi syndrome.Journal of Applied Behavior Analysis, 33, 615–618.

O’Donnell, J., Crosbie, J., Williams, D. C., & Saunders,K. J. (2000). Stimulus control and generalization ofpoint-loss punishment with humans. Journal of theExperimental Analysis of Behavior, 73, 267–274.

Piazza, C. C., Hanley, G. P., & Fisher, W. W. (1996).Functional analysis and treatment of cigarette pica.Journal of Applied Behavior Analysis, 29, 437–450.

Received March 31, 2005Final acceptance December 7, 2007Action Editor, Iser DeLeon

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