Module 3 Discussion

 In the last course, we discussed that we should avoid coercive measures. Define how escape extinction (EE) falls under this category and how the high-p sequence may reduce reliance on EE. 

_______________________________________________________________________________

JOURNAL OF APPLIED BEHAVIOR ANALYSIS 2010, 43, 569–589 NUMBER 4 (WINTER 2010)

AN INVESTIGATION OF DIFFERENTIAL REINFORCEMENT OF
ALTERNATIVE BEHAVIOR WITHOUT EXTINCTION

ELIZABETH S. ATHENS

MARCUS AUTISM CENTER

AND

TIMOTHY R. VOLLMER

UNIVERSITY OF FLORIDA

We manipulated relative reinforcement for problem behavior and appropriate behavior using
differential reinforcement of alternative behavior (DRA) without an extinction component.
Seven children with developmental disabilities participated. We manipulated duration
(Experiment 1), quality (Experiment 2), delay (Experiment 3), or a combination of each
(Experiment 4), such that reinforcement favored appropriate behavior rather than problem
behavior even though problem behavior still produced reinforcement. Results of Experiments 1
to 3 showed that behavior was often sensitive to manipulations of duration, quality, and delay in
isolation, but the largest and most consistent behavior change was observed when several
dimensions of reinforcement were combined to favor appropriate behavior (Experiment 4).
Results suggest strategies for reducing problem behavior and increasing appropriate behavior
without extinction.

Key words: attention deficit hyperactivity disorder, autism, concurrent schedules, differential
reinforcement, extinction, problem behavior

Differential reinforcement is a fundamental
principle of behavior analysis that has led to the
development of a set of procedures used as
treatment for problem behavior (Cooper,
Heron, & Heward, 2007). One of the most
frequently used of these procedures is the
differential reinforcement of alternative behav-
ior (DRA). DRA typically involves withholding
reinforcers following problem behavior (extinc-
tion) and providing reinforcers following ap-
propriate behavior (Deitz & Repp, 1983).
Pretreatment identification of the reinforcers
that maintain problem behavior (i.e., functional
analysis) permits the development of extinction
procedures, which, by definition, must match

We thank Brian Iwata, Lise Abrams, and Stephen Smith
for their comments on an earlier draft of this manuscript.
Portions of this manuscript were included as part of the
dissertation of the first author at the University of Florida.

Address correspondence concerning this article to
Elizabeth Athens, who is now at ABA Learning Centre,
#100–21320 Gordon Way, Richmond, British Columbia
V6W 1J8, Canada (e-mail: elizabeth@abacentre.ca).

doi: 10.1901/jaba.2010.43-

569

the function of problem behavior (Iwata, Pace,
Cowdery, & Miltenberger, 1994). In addition,
the reinforcer maintaining problem behavior
can be delivered contingent on the occurrence
of an alternative, more appropriate response.
Under these conditions, DRA has been success-
ful at reducing problem behavior (Dwyer-
Moore & Dixon, 2007; Vollmer & Iwata,
1992).

Although extinction is an important and
powerful component of DRA, it is, unfortu-
nately, not always possible to implement it
(Fisher et al., 1993; Hagopian, Fisher, Sullivan,
Acquisto, & LeBlanc, 1998). For example, a
caregiver may be physically unable to prevent
escape with a large or combative individual,
leading to compromises in integrity of escape
extinction. It would also be difficult to withhold
reinforcement for behavior maintained by
attention in the form of physical contact if
physical blocking is required to protect the
individual or others. For example, if an
individual’s attention-maintained eye gouging

569

mailto:elizabeth@abacentre.ca

570 ELIZABETH S. ATHENS and TIMOTHY R. VOLLMER

is a threat to his or her eyesight, intervention is
necessary to protect vision.

Several studies have found that DRA is less
effective at decreasing problem behavior when
implemented without extinction (Volkert, Ler-
man, Call, & Trosclair-Lasserre, 2009). For
example, Fisher et al. (1993) evaluated func-
tional communication training (FCT; a specific
type of DRA procedure) without extinction,
with extinction, and with punishment contin-
gent on problem behavior. Results showed that
when FCT was introduced without an extinc-
tion or punishment component for problem
behavior, the predetermined goal of 70%
reduction in problem behavior was met with
only one of three participants. FCT was more
effective at reducing problem behavior when
extinction was included, and the largest and
most consistent reduction was observed when
punishment was included.

Hagopian et al. (1998) conducted a replica-
tion of the Fisher et al. (1993) study and found
that a predetermined goal of 90% reduction in
problem behavior was not achieved with any of
11 participants exposed to FCT without
extinction. When FCT was implemented with
extinction, there was a 90% reduction in
problem behavior for 11 of 25 applications,
with a mean percentage reduction in problem
behavior of 69% across all applications.

McCord, Thomson, and Iwata (2001) found
that DRA without extinction had limited effects
on the self-injurious behavior of two individu-
als, one whose behavior was reinforced by
avoidance of transition and another whose
behavior was reinforced by avoidance of
transition and avoidance of task initiation. In
both cases, DRA with extinction and response
blocking produced sustained decreases in self-
injury. These examinations of research on DRA
without extinction have shown a bias in
responding toward problem behavior when the
rate and immediacy of reinforcement of
problem and appropriate behavior are equiva-
lent.

When considering variables that contribute
to the effectiveness (or ineffectiveness) of DRA
without extinction as a treatment for problem
behavior, it is helpful to conceptualize differ-
ential reinforcement procedures in terms of a
concurrent-operants arrangement (e.g., Fisher et
al., 1993; Mace & Roberts, 1993). Concurrent
schedules are two or more schedules in effect
simultaneously. Each schedule independently
arranges reinforcement for a different response
(Ferster & Skinner, 1957). The matching law
provides a quantitative description of respond-
ing on concurrent schedules of reinforcement
(Baum, 1974; Herrnstein, 1961). In general,
the matching law states that the relative rate of
responding on one alternative will approximate
the relative rate of reinforcement provided on
that alternative. Consistent with the predictions
of the matching law, some studies have reported
reductions in problem behavior without extinc-
tion when differential reinforcement favors
appropriate behavior rather than problem
behavior (Piazza et al., 1997; Worsdell, Iwata,
Hanley, Thompson, & Kahng, 2000).

For example, Worsdell et al. (2000) exam-
ined the effect of reinforcement rate on response
allocation. Five individuals whose problem
behavior was reinforced by social positive
reinforcement were first exposed to an FCT
condition in which both problem and appro-
priate behavior were reinforced on fixed-ratio
(FR) 1 schedules. During subsequent FCT
conditions, reinforcement for problem behavior
was made more intermittent (e.g., FR 2, FR 3,
FR 5), while appropriate behavior continued to
be reinforced on an FR 1 schedule. Four of the
participants showed shifts in response allocation
to appropriate behavior as the schedule of
reinforcement for problem behavior became
more intermittent. There were several limita-
tions to this research. For example, reinforce-
ment rate was thinned in the same order for
each participant such that reductions in prob-
lem behavior may have been due in part to
sequence effects. In addition, the reinforcement

571 DIFFERENTIAL REINFORCEMENT

schedule was thinned to FR 20 for two
individuals. For these two participants, problem
behavior rarely contacted reinforcement. The
schedule in these cases may have been func-
tionally equivalent to extinction rather than
intermittent reinforcement. Nevertheless, these
results suggest that extinction may not be a
necessary treatment component when the rate
of reinforcement favors appropriate behavior
rather than problem behavior.

In another example of DRA without extinc-
tion, Piazza et al. (1997) examined the effects of
increasing the quality of reinforcement for
compliance relative to reinforcement associated
with problem behavior. Three individuals
whose problem behavior was sensitive to
negative reinforcement (break from tasks) and
positive reinforcement (access to tangible items,
attention, or both) participated. Piazza et al.
systematically evaluated the effects of reinforc-
ing appropriate behavior with one, two, or three
of the reinforcing consequences (a break,
tangible items, attention), both when problem
behavior produced a break and when it did not
(escape extinction). For two of the three
participants, appropriate behavior increased
and problem behavior decreased when appro-
priate behavior produced a 30-s break with
access to tangible items and problem behavior
produced a 30-s break. The authors suggested
that one potential explanation for these findings
is that the relative rates of appropriate behavior
and problem behavior were a function of the
relative value of the reinforcement produced by
escape. It is unclear, however, whether the
intervention would be effective with individuals
whose problem behavior was sensitive to only
one type of reinforcement.

Together these and other studies have shown
that behavior will covary based on rate, quality,
magnitude, and delay of reinforcement. Re-
sponding will favor the alternative associated
with a higher reinforcement rate (Conger &
Killeen, 1974; Lalli & Casey, 1996; Mace,
McCurdy, & Quigley, 1990; Neef, Mace, Shea,

& Shade, 1992; Vollmer, Roane, Ringdahl, &
Marcus, 1999; Worsdell et al., 2000), greater
quality of reinforcement (Hoch, McComas,
Johnson, Faranda, & Guenther, 2002; Lalli et
al., 1999; Neef et al.; Piazza et al., 1997),
greater magnitude of reinforcement (Catania,
1963; Hoch et al., 2002; Lerman, Kelley,
Vorndran, Kuhn, & LaRue, 2002), or more
immediate delivery of reinforcement (Mace,
Neef, Shade, & Mauro, 1994; Neef, Mace, &
Shade, 1993; Neef, Shade, & Miller, 1994).

Although previous research suggests that
extinction may not always be a necessary
component of differential reinforcement treat-
ment packages, as described above there were
certain limitations inherent in previous investi-
gations. In addition, there has not been a
comprehensive analysis of several different
reinforcement dimensions both singly and in
combination. The current study sought to
extend this existing research by examining the
influence of multiple dimensions of reinforce-
ment and by incorporating variable-interval
(VI) reinforcement schedules.

Interval schedules are less likely than ratio
schedules to push response allocation exclusively
toward one response over another. Under ratio
schedules, reinforcer delivery is maximized
when responding favors one alternative (Herrn-
stein & Loveland, 1975). Under interval
schedules, reinforcer delivery is maximized by
varying response allocation across alternatives
(MacDonall, 2005). If responding favors one
response alternative over another under an
interval schedule, this would indicate a bias in
responding that is independent of the schedule
of reinforcement. This bias would not be as
easily observable during ratio schedules of
reinforcement. In the current application, an
interval schedule allowed us to identify poten-
tial biases in responding that were independent
of the reinforcement schedule. In addition, the
application of a VI schedule mimics, to a
degree, the integrity failures that could occur in
the natural environment.

572 ELIZABETH S. ATHENS and TIMOTHY R. VOLLMER

In the natural environment, caregivers may
not always implement extinction procedures
accurately. They also may fail to implement
reinforcement procedures accurately (Shores et
al., 1993). Therefore, it may be important to
identify a therapeutic differential reinforcement
procedure that is effective despite intermittent
reinforcement of both appropriate and problem
behavior. The use of concurrent VI schedules in
the current experiments allowed the examina-
tion of the effects of failure to withhold
reinforcement following every problem behav-
ior and failure to reinforce every appropriate
behavior in a highly controlled analogue setting.

We evaluated several manipulations that
could be considered in the event that extinction
either cannot or will not be implemented. In
Experiments 1 to 3, we manipulated a single
dimension of reinforcement such that reinforce-
ment favored appropriate behavior along the
lines of duration (Experiment 1), quality
(Experiment 2), or delay (Experiment 3). In
Experiment 4, we combined each of these
dimensions of reinforcement such that rein-
forcement favored

appropriate behavior.

GENERAL METHOD

Participants and Setting

Seven individuals with developmental disor-
ders who engaged in severe problem behavior
participated. These were the first seven individ-
uals who engaged in problem behavior sensitive
to socially mediated reinforcement (as identified
via functional analysis) and were admitted to an
outpatient clinic (Justin, Henry, Corey, Ken-
neth, Lana) or referred for behavioral consulta-
tion services at local elementary schools
(George, Clark). (See Table 1 for each partic-
ipant’s age, diagnosis, problem behavior, and
appropriate behavior.) We selected the targeted
appropriate behavior for each participant based
on the function of problem behavior. For
example, if an individual engaged in problem
behavior to access attention, we selected a mand
for attention as the appropriate behavior.

Targeted response forms were in the partici-
pants’ repertoires, although the behavior typi-
cally occurred at low rates.

Session rooms in the outpatient clinic (3 m
by 3 m) were equipped with a one-way
observation window and sound monitoring.
We conducted sessions for George and Clark in
a classroom at their elementary schools. The
rooms for all participants contained materials
necessary for a session (e.g., toys, task materi-
als), and the elementary school classrooms
contained materials such as posters and tables
(George and Clark only). With the exception of
the final experimental condition assessing
generality, no other children were in the room
during the analyses with George and Clark.

Trained clinicians served as therapists and
conducted sessions 4 to 16 times per day, 5 days
per week. Sessions were 10 min in duration, and
there was a minimum 5-min break between
each session. We used a multielement design
during the functional analysis and a reversal
design during all subsequent analyses.

Response Measurement and
Interobserver Agreement

Observers were clinicians who had received
training in behavioral observation and had
previously demonstrated high interobserver
agreement scores (.90%) with trained observ-
ers. Observers in the outpatient clinic sat behind
a one-way observation window. Observers in
the school sat out of the direct line of sight of
the child. All observers collected data on
desktop or laptop computers that provided
real-time data and scored events as either
frequency (e.g., aggression, disruption, self-
injury, and screaming) or duration (e.g.,
delivery of attention, escape from instructions;
see Table 1 for operational definitions of
behavior). Observations were divided into 10-s
bins, and observers scored the number (or
duration) of observed responses for each bin.
The smaller number (or duration) of observed
responses within each bin was divided by the
larger number and converted to agreement

573 DIFFERENTIAL REINFORCEMENT

Table 1

Participants’ Characteristics

Name Age (years) Diagnosis Problem behavior Appropriate behavior

Justin 7 Attention deficit
hyperactivity disorder
instructional (ADHD)

Aggression: forcefully hitting, kicking,
biting others’ body parts, pinching skin
between fingers, scratching others with nails,
forceful pushing, and head head butting
others. Behavior drew blood or caused bruises
on his victims. Disruption: forcefully
throwing objects and hitting walls.
Inappropriate sexual behavior: touching
himself or the therapist in a sexual way by
contact of the hand to the torso, bottom, or
genitals.

Compliance with demands such
as ‘‘fold the clothing’’ or ‘‘pick
up the trash.’’

Henry 8 Autism Aggression: forcefully hitting and kicking
others resulting in bruising his victims.
Disruption: forcefully throwing objects.

Exchange of a picture card

Corey 9 Autism and ADHD Aggression: forcefully hitting, biting,
spitting, and kicking resulting in
bruising or bleeding of victims.
Disruption: forcefully throwing
objects around room and at people,
tearing paper materials.

Vocal request (‘‘May I have my
toy please?’’)

Kenneth 6 Autism Aggression: forcefully hitting, scratching,
and pinching resulting in bleeding or
bruising of victims. Disruption:
throwing objects around room and
at people.

Exchange of a picture card

Lana 4 Autism Aggression: forcefully hitting, kicking, and
scratching resulting in bruising or
bleeding in victims.

Sign language (sign for ‘‘play’’)

George 10 Autism Aggression: forcefully hitting, kicking, and
biting resulting in bruising or bleeding
victims. Disruption: throwing objects
around the room and at people.

Exchange of a picture card

Clark 12 Autism Aggression: hitting, kicking, and scratching
resulting in bruising or bleeding of victims.

Vocal request (‘‘toy please’’)

percentages for frequency measures (Bostow &
Bailey, 1969). Agreement on the nonoccurrence
of behavior within any given bin was scored as
100% agreement. The agreement scores for bins
were then averaged across the session.

Two independent observers scored the target
responses simultaneously but independently
during a mean of 37% of functional analysis
sessions (range, 27% to 49%) and 29% of
experimental analysis sessions (range, 25% to
32%). We assessed interobserver agreement for
problem behavior (aggression, disruption, inap-
propriate sexual behavior) and appropriate
behavior (compliance and mands) of all partic-
ipants and for the therapist’s behavior, which
included therapist attention, delivery of tangible
items, and escape from demands.

For Justin, mean agreement was 98% for
aggression (range, 87% to 100%), 96% for
disruption (range, 85% to 100%), 100% for
inappropriate sexual behavior, and 98% for
compliance (range, 86% to 100%). For Henry,
mean agreement was 100% for aggression,
99.9% for disruption (range, 99.7% to
100%), and 97% for mands (range, 95% to
99%). For Corey, mean agreement was 100%
for aggression and disruption and 97% for
mands (range, 95% to 100%). For Kenneth,
mean agreement was 98% for aggression (range,
94% to 100%), 99% for disruption (range,
97% to 100%), and 99% for mands (range,
95% to 100%). For Lana, mean agreement was
99% for aggression (range, 99% to 100%) and
100% for mands. For George, mean agreement

574 ELIZABETH S. ATHENS and TIMOTHY R. VOLLMER

was 99% (range, 98% to 100%) for aggression,
99% for disruption (range, 98% to 100%), and
93% for mands (range, 88% to 99%). Mean
interobserver agreement scores for 39% of all
sessions was 100% for therapist attention,
99.9% for access to tangible items (range,
99% to 100%), and 100% for escape from
instructions.

Stimulus Preference Assessment

We conducted a paired-stimulus preference
assessment for each participant to identify a
hierarchy of preferred items for use in the
functional analysis (Fisher et al., 1992). In
addition, for those participants whose problem
behavior was reinforced by tangible items
(Corey, Lana, and Clark), a multiple-stimulus-
without-replacement (MSWO) preference as-
sessment (DeLeon & Iwata, 1996) was con-
ducted immediately prior to each session of the
treatment analyses. We used informal caregiver
interviews to select items used in the preference
assessments, and a minimum of six items were
included in the assessments.

Functional Analysis

We conducted functional analyses prior to
the treatment evaluation. Procedures were
similar to those described by Iwata, Dorsey,
Slifer, Bauman, and Richman (1982/1994)
with one exception to the procedures for
George. His aggression was severe and primarily
directed toward therapists’ heads; therefore, a
blocking procedure was in place throughout the
functional analysis for the safety of the
therapist. Blocking consisted of a therapist
holding up his arm to prevent a hit from
directly contacting his head. During the
functional analysis, four test conditions (atten-
tion, tangible, escape, and ignore) were com-
pared to a control condition (play) using a
multielement design.

Figure 1 shows response rates of problem
behavior during the functional analyses for
Justin, Corey, Kenneth, and Henry. We
collected data for aggression and disruption

separately and obtained similar results for each
topography for all participants; therefore, both
topographies were combined in these data
presentations. We obtained similar results for
inappropriate sexual behavior for Justin, which
we combined with aggression and disruption.

Justin engaged in the highest rates of
problem behavior in the escape condition.
Although the overall trend in the escape
condition is downward, inspection of the data
showed that he was becoming more efficient in
escape behavior by responding only when the
therapist presented demands. Corey engaged in
the highest rates of problem behavior during the
tangible condition. Kenneth engaged in the
highest rates of aggression and disruption
during the attention and escape conditions.
Henry displayed the highest rates of aggression
and disruption in the escape condition.

Figure 2 shows the results of the functional
analyses for Lana, Clark, and George. Lana and
Clark displayed the highest rates of aggression
during the tangible condition. George engaged
in the highest rates of aggression and disruption
during the attention condition.

Baseline

During baseline and all subsequent condi-
tions of Experiments 1 to 4, equal concurrent
VI schedules of reinforcement (VI 20 s VI 20 s)
were in place for both problem and appropriate
behavior. A random number generator selected
intervals between 1 s and 39 s, with a mean
interval length of 20 s, and the programmed
intervals for each session were available on a
computer printout. A trained observer timed
intervals using two timers set according to the
programmed intervals. The first instance of
behavior following availability of a reinforcer
resulted in delivery of the reinforcer for 30 s
(for an exception, see Experiment 1 involving
manipulations of reinforcer duration). When
reinforcement was available for a response (i.e.,
the interval elapsed) and the behavior occurred,
the observer discreetly tapped on the one-way
window from the observation room (clinic) or

575 DIFFERENTIAL REINFORCEMENT

Figure 1. Response rates during the functional analysis for Justin, Corey, Kenneth, and Henry.

briefly nodded his head (classroom) to prompt
the therapist to reinforce a response. After 30 s
of reinforcer access (or the pertinent duration
value in Experiment 1), the therapist removed
the reinforcer and reset the timer for that
response. The VI clock for one response (e.g.,
appropriate behavior) stopped while the partic-
ipant consumed the reinforcer for the other
response (e.g., problem behavior). The therapist
reinforced responses regardless of the interval of
time since the last changeover from the other

response alternative. The reinforcer identified
for problem behavior in the functional analysis
served as the reinforcer for both responses
during baseline. In Experiments 2 and 4, which
involved manipulations of quality, participants
received the same high-quality toy contingent
on appropriate or problem behavior during
baseline.

We conducted each baseline in the experi-
ment as described but labeled them differently
in order to highlight the dimensions of

576 ELIZABETH S. ATHENS and TIMOTHY R. VOLLMER

Figure 2. Response rates during the functional analysis for Lana, Clark, and George.

reinforcement that varied across experiments.
For example, in Experiment 1 we manipulated
duration of reinforcement, and baseline is
labeled 30-s/30-s dur to indicate that reinforce-
ment was provided for 30 s (duration) following
problem and appropriate behavior. In Experi-
ment 2, we manipulated quality of reinforce-
ment, and baseline is labeled 1 HQ/1 HQ to
indicate that a high-quality reinforcer was
delivered following appropriate and problem
behavior. In Experiment 3, we manipulated
delay to reinforcement, and baseline is labeled
0-s/0-s delay. In Experiment 4 we manipulated
duration, quality, and delay in combination,
and baseline is labeled 30-s dur 1 HQ 0-s delay/
30-s dur 1 HQ 0-s delay.

EXPERIMENT 1: DURATION

Method

The purpose of Experiment 1 was to examine

whether we could obtain clinically acceptable
changes in behavior by providing a longer dura-
tion of access to the reinforcer following appro-
priate behavior and shorter duration of access to
the reinforcer following problem behavior.

30-s/10-s dur. Justin and Lana participated in
the 30-s/10-s dur condition. For Justin, appro-
priate behavior produced a 30-s break from
instructions. Problem behavior produced a 10-s
break from instructions. For Lana, appropriate
behavior produced access to the most preferred
toy for 30 s, and problem behavior produced
access to the same toy for 10 s.

577 DIFFERENTIAL REINFORCEMENT

Figure 3. Justin’s and Lana’s response rates during the duration analysis for problem behavior and appropriate behavior.

45-s/5-s dur. Justin participated in the 45-s/5-
s dur condition during which the duration of
reinforcement was more discrepant across
response alternatives. Appropriate behavior
produced a 45-s break from instructions, and
problem behavior produced a 5-s break from
instructions.

Results and Discussion

Figure 3 shows the results for Justin and
Lana. For Justin, during the 30-s/30-s dur
baseline condition, problem behavior occurred
at higher rates than appropriate behavior. In the
30-s/10-s dur condition, there was a slight
decrease in the rate of problem behavior, and
some appropriate behavior occurred. Because

problem behavior still occurred at a higher rate
than appropriate behavior, we conducted the
45-s/5-s dur condition. In the last five sessions
of this condition, problem behavior decreased
to low rates, and appropriate behavior in-
creased. In a reversal to the 30-s/30-s dur
baseline, problem behavior returned to levels
higher than appropriate behavior. In the
subsequent return to the 45-s/5-s dur condition,
the favorable effects were replicated. Respond-
ing stabilized in the last five sessions of this
condition, with problem behavior remaining
low and appropriate behavior remaining high.
In a reversal to the 30-s/30-s dur baseline,
however, there was a failure to replicate previous
baseline levels of responding. Instead, low rates

578 ELIZABETH S. ATHENS and TIMOTHY R. VOLLMER

of problem behavior and high rates of appro-
priate behavior occurred.

During the 30-s/30-s dur baseline, Lana’s
problem behavior occurred at higher rates than
appropriate behavior. During the 30-s/10-s dur
condition, appropriate behavior occurred at
higher rates, and problem behavior decreased
to zero. The effects of the 30-s/30-s dur baseline
and the 30-s/10-s dur condition were replicated
in the final two conditions.

In summary, the duration analysis indicated
that for both participants, the relative rates of
problem behavior and appropriate behavior
were sensitive to the reinforcement duration
available for each alternative in four of the five
applications in which duration of reinforcement
was unequal. This finding replicates the
findings of previous investigations on the effects
of reinforcement duration on choice responding
(Catania, 1963; Lerman et al., 2002; Ten Eyck,
1970).

There were several limitations to this exper-
iment. For example, the participants did not
show sensitivity to the concurrent VI schedules

when both the rate and duration of reinforce-
ment were equal. Under this arrangement, the
participants would have collected all of the

available reinforcers had they distributed their
responding roughly equally between the two
response options. The failure to distribute

responding across responses indicates a bias
toward problem behavior. Additional research
into this failure to show sensitivity to the

concurrent VI schedules is warranted but was
outside the scope of this experiment.

With Justin, we were unable to recapture
baseline rates of problem and appropriate
behavior in our final reversal to the 30-s/30-s
dur baseline. This failure to replicate previous
rates of responding may be a result of his recent
history with a condition in which reinforcement
favored appropriate behavior (i.e., the 5 s/45-s
dur condition). Nevertheless, this lack of
replication weakens the demonstration of
experimental control with this participant. With

both participants, there was a gradual change in
responding in the condition that ultimately
produced a change favoring the alternative
behavior, which is not surprising given that
extinction was not in place. Responding under
intermittent schedules of reinforcement can be
more resistant to change (Ferster & Skinner,
1957).

EXPERIMENT 2: QUALITY

The purpose of Experiment 2 was to examine
whether we could obtain clinically acceptable
changes in behavior by providing a higher
quality reinforcer following appropriate behav-
ior and lower quality reinforcer following
problem behavior.

Method

Reinforcer assessment. We conducted a rein-
forcer assessment using procedures described by
Piazza et al. (1999) before conducting the
quality analysis with Kenneth. The assessment
identified the relative efficacy of two reinforcers
(i.e., praise and reprimands) in a concurrent-
operants arrangement. During baseline, the
therapist stood in the middle of a room that
was divided by painter’s tape and provided no
social interaction; toy contact (e.g., playing with
green or orange blocks on either side of the
divided room) and problem behavior resulted in
no arranged consequences. Presession prompt-
ing occurred prior to the beginning of the initial
contingent attention phase and the reversal
(described below). During presession prompt-
ing, the experimenter prompted Kenneth to
make contact with the green and orange toys.
Prompted contact with green toys resulted in
praise (e.g., ‘‘Good job, Kenneth,’’ delivered in
a high-pitched, loud voice with an excited
tone). Prompted contact with the orange toys
resulted in reprimands (e.g., ‘‘Don’t play with
that,’’ delivered in a deeper pitched, loud voice
with a harsh tone). Following presession
prompting, we implemented the contingent
attention phase. The therapist stood in the

579 DIFFERENTIAL REINFORCEMENT

middle of a room divided by painter’s tape and
delivered the consequences to which Kenneth
had been exposed in presession prompting. The
therapist delivered continuous reprimands or
praise for the duration of toy contact and
blocked attempts to play with two different-
colored toys simultaneously.

During the second contingent attention
phase, we reversed the consequences associated
with each color of toys such that green toys were
associated with reprimands and orange toys
with praise. The different-colored toys were
always associated with a specific side of the
room, and the therapist ensured that they
remained on that side. Kenneth selected the
colored toy associated with praise on a mean of
98% of all contingent attention sessions.

1 HQ/1 LQ. For Justin, problem behavior
produced 30 s of escape with access to one low-
quality tangible item identified in a presession

MSWO. Appropriate behavior produced 30 s of
escape with access to one high-quality tangible

item identified in a presession MSWO. Al-
though the variable that maintained his prob-
lem behavior was escape, we used disparate

quality toys as a way of creating a qualitative
difference between the escape contingencies for
appropriate and problem behavior.

For Kenneth, problem behavior produced
reprimands (e.g., ‘‘Don’t do that, I really do not
like it, and you could end up hurting
someone’’), which the reinforcer assessment
identified as a less effective form of reinforce-
ment than social praise. Appropriate behavior
produced praise (e.g., ‘‘Good job handing me
the card; I really like it when you hand it to me
so nicely.’’), which was identified as a more
effective form of reinforcement in the reinforcer
assessment.

3 HQ/1 LQ. For Justin and Kenneth,
problem behavior did not decrease to therapeu-
tic levels in the 1 HQ/1 LQ condition. For
Justin, within-session analysis showed that as
sessions progressed during the 1 LQ/1 HQ
condition, he stopped playing with the toy and

showed decreases in compliance, possibly due to
reinforcer satiation. Unfortunately, we did not
have access to potentially higher quality toys
that Justin had requested (e.g., video game
systems). Given this limited access, we increased
the number of preferred toys provided contin-
gent on appropriate behavior as a way of
addressing potential satiation with the toys.
We provided three toys selected most frequently
in presession MSWO assessments. Therefore,
for Justin, in the 3 HQ/1 LQ condition,
appropriate behavior produced 30 s of escape
with access to three high-quality toys. Problem
behavior produced 30 s of escape with access to
one low-quality tangible item.

For Kenneth, anecdotal observations be-
tween sessions showed that he frequently
requested physical attention in the forms of
hugs and tickles by guiding the therapist’s hands
around him or to his stomach. Based on this
observation, we added physical attention to the
social praise available following appropriate
behavior. Therefore, during the 3 HQ/1 LQ
condition, appropriate behavior produced
praise and the addition of physical attention
(e.g., ‘‘Good job handing me the card,’’
hugs and tickles). Problem behavior produced
reprimands.

Results and Discussion

During the 1 HQ/1 HQ baseline condition,
Justin (Figure 4, top) engaged in higher rates of
problem behavior than appropriate behavior. In
the 1 HQ/1 LQ condition, rates of problem
behavior decreased, and appropriate behavior
increased. However, toward the end of the
phase, problem behavior increased, and appro-
priate behavior decreased. Lower rates of
problem behavior than appropriate behavior
were obtained in the 3 HQ/1 LQ condition.
During the subsequent 1 HQ/1 HQ baseline
reversal, there was a failure to recapture previous
rates of problem and appropriate behavior.
Instead, problem behavior occurred at a lower
rate than appropriate behavior. Despite this,
problem behavior increased relative to what was

580 ELIZABETH S. ATHENS and TIMOTHY R. VOLLMER

Figure 4. Response rates for Justin and Kenneth during the quality analysis for problem behavior and

appropriate behavior.

observed in the immediately preceding 3
HQ/1 LQ condition. Problem behavior de-
creased, and appropriate behavior increased to
high levels during the return to the 3 HQ/1 LQ
condition.

Kenneth (Figure 4, bottom) engaged in
higher rates of problem behavior than appro-
priate behavior in the 1 HQ/1 HQ baseline. In
the 1 HQ/1 LQ condition, rates of problem
behavior decreased, and appropriate behavior
increased. During the last five sessions, re-
sponding shifted across response alternatives
across sessions. During a replication of 1 HQ/1
HQ baseline, we observed high rates of problem
behavior and relatively lower rates of appropri-

ate behavior. During a subsequent replication of
the 1 HQ/1 LQ condition, slightly higher rates
of problem behavior than appropriate behavior
were obtained, with responding again shifting
across response alternatives across sessions. In a
replication of 1 HQ/1 HQ baseline, high rates
of problem behavior and lower rates of
appropriate behavior were obtained. Following
this replication, we conducted the 3 HQ/1 LQ
condition, and problem behavior decreased to
rates lower than observed in previous conditions
and appropriate behavior increased to high
rates. The effects of the 1 HQ/1 HQ baseline
and the 3 HQ/1 LQ condition were replicated
in the final two conditions.

581 DIFFERENTIAL REINFORCEMENT

In summary, results of the quality analyses
indicated that for both participants, the relative
rates of both problem behavior and appropriate
behavior were sensitive to the quality of
reinforcement available for each alternative.
These results replicate the findings of previous
investigations on the relative effects of quality of
reinforcement on choice responding (Conger &
Killeen, 1974; Hoch et al., 2002; Martens &
Houk, 1989; Neef et al., 1992; Piazza et al.,
1997).

One drawback to this study was the
manipulation of both magnitude and quality
of reinforcement with Justin. Given the cir-
cumstances described above, a greater number
of higher quality toys were provided contingent
on appropriate behavior relative to problem
behavior prior to obtaining a consistent shift in
response allocation.

As in Experiment 1, the failure to replicate
prior rates of appropriate behavior in our final
reversal to the 1 HQ/1 HQ baseline weakened
experimental control with Justin. Again, base-
line levels of behavior were not recaptured after
an intervening history in which the reinforce-
ment quality and magnitude favored appropri-
ate behavior.

EXPERIMENT 3: DELAY

Method

The purpose of Experiment 3 was to examine
whether we could produce clinically acceptable
changes in behavior by providing immediate
reinforcement following appropriate behavior
and delayed reinforcement following problem
behavior.

0-s/30-s delay. Corey and Henry participated
in the 0-s/30-s delay condition. For Corey,
appropriate behavior produced 30-s immediate
access to a high-quality toy (selected from a
presession MSWO). Problem behavior pro-
duced 30-s access to the same high-quality toy
after a 30-s unsignaled delay. For Henry,
appropriate behavior produced an immediate
30-s break from instructions. Problem behavior

produced a 30-s break from instructions after a
30-s unsignaled delay. With both participants,
once a delay interval started, additional instanc-
es of problem behavior did not reset the
interval. When problem behavior occurred,
the data collector started a timer and signaled
the therapist to provide reinforcement when the
timer elapsed by a discreet tap on the one-way
window. If a participant engaged in appropriate
behavior during the delay interval for problem
behavior, the therapist immediately delivered
the reinforcer for appropriate behavior (as
programmed), and the delay clock for problem
behavior temporarily stopped and then resumed
after the reinforcement interval for appropriate
behavior ended.

0-s/60-s delay. When the initial delay interval
did not result in therapeutic decreases in
problem behavior for Corey, we altered the
delay interval such that problem behavior
produced 30-s access to a high-quality toy
(selected from a presession MSWO) after a 60-s
unsignaled delay. Appropriate behavior contin-
ued to produce 30-s immediate access to the
same high-quality toy. For Henry, problem
behavior produced a 30-s break from instruc-
tions after a 60-s unsignaled delay, and
appropriate behavior continued to produce an
immediate 30-s break.

Results and Discussion

During the 0-s/0-s delay baseline, Corey
(Figure 5, top) engaged in higher rates of
problem behavior than appropriate behavior.
In the 0-s/30-s delay condition, problem
behavior continued to occur at a higher rate
than appropriate behavior. Given this, the 0-s/
60-s delay condition was implemented, and a
gradual decrease in problem behavior and
increase in appropriate behavior was obtained.
During a reversal to the 0-s/0-s delay baseline,
there was an increase in problem behavior and a
decrease in appropriate behavior. In the final
reversal to the 0-s/60-s delay condition, Corey
became ill with strep throat. His caregiver
continued to bring him to the clinic and did not

582 ELIZABETH S. ATHENS and TIMOTHY R. VOLLMER

Figure 5. Corey’s and Henry’s response rates during the delay analysis for problem behavior and
appropriate behavior.

inform us until after he began treatment. (We
have indicated this period on the graph.)
Following his illness, problem behavior ceased,
and appropriate behavior increased to high,
steady rates.

During the 0-s/0-s delay baseline, Henry
(Figure 5, bottom) engaged in higher rates of
problem behavior than appropriate behavior. In
the 0-s/30-s delay condition, Henry continued
to engage in a higher rate of problem behavior
than appropriate behavior. In a reversal to 0-s/
0-s delay baseline, there was a slight increase in
problem behavior from the previous condition
and a decrease in appropriate behavior. During
the 0-s/60-s delay condition, there was a
decrease in problem behavior to zero rates and

an increase in appropriate behavior to steady
rates of two per minute (perfectly efficient
responding given 30-s access). These results
were replicated in the reversals to 0-s/0-s delay
baseline and 0-s/60-s delay condition.

In summary, results of the delay analysis
indicate that the relative rates of problem
behavior and appropriate behavior were sensi-
tive to the delay to reinforcement following
each alternative. These results replicate the
findings of previous investigations on the effects
of unsignaled delay to reinforcement (Sizemore
& Lattal, 1978; Vollmer, Borrero, Lalli, &
Daniel, 1999; Williams, 1976). For example,
Vollmer et al. showed that aggression occurred
when it produced immediate but small rein-

583 DIFFERENTIAL REINFORCEMENT

forcers even though mands produced larger
reinforcers after an unsignaled delay. In their
study, participants displayed self-control when
therapists signaled the delay to reinforcement.

It is important to note that the programmed
delays were not necessarily those experienced by
the participant. The occurrence of problem
behavior started a timer that, when elapsed,
resulted in delivery of reinforcement. Additional
problem behavior during the delay did not add
to the delay in order to prevent extinction-like
conditions. It was therefore possible that prob-
lem behavior occurred within the delay interval
and resulted in shorter delays to reinforcement.
This rarely occurred with Henry. By contrast,
Corey’s problem behavior sometimes occurred in
bursts or at high rates. In these cases, problem
behavior was reinforced after delays shorter than
the programmed 30 s or 60 s. Nevertheless, the
differential delays to reinforcement following
inappropriate and appropriate behavior eventu-
ally shifted allocation toward appropriate re-
sponding. One way to address this potential
limitation would be to add a differential
reinforcement of other behavior (DRO) compo-
nent with a resetting reinforcement interval. The
resetting feature would result in the occurrence
of problem behavior during the interval resetting
the interval and therefore delaying reinforce-
ment. With high-rate problem behavior, this
DRO contingency would initially result in very
low rates of reinforcement, making the condition
similar to extinction. We did not add a DRO
component in the current experiment because
our aim was to evaluate treatments without
extinction.

Another potential limitation to the current
experiment was the possibility of adventitious
reinforcement of chains of problem and
appropriate behavior. For example, when
appropriate behavior occurred during the delay
interval for problem behavior and the VI
schedule indicated reinforcement was available
for that response, there was immediate rein-
forcement of appropriate behavior. This rein-

forcement could have strengthened a chain of
problem and appropriate behavior. Although
this did not seem to be a concern in the current
experiment, one way to control for this
limitation would be to add a changeover delay
(COD). A COD allows a response to be
reinforced only if a certain interval has passed
since the last changeover from the other
response alternative. The COD could prevent
adventitious reinforcement of problem and
appropriate behavior and result in longer
periods of responding on a given alternative
and thus greater control by the relative
reinforcement available for those alternatives
(Catania, 1966).

EXPERIMENT 4: DURATION, QUALITY,
AND DELAY

The purpose of Experiment 4 was to evaluate
the effects of delivering immediate, longer
duration access to high-quality reinforcement
following appropriate behavior and delayed,
shorter duration access to low-quality reinforce-
ment following problem behavior. We observed
gradual treatment effects in the previous
experiments. This was to be expected, because
both types of responding were reinforced, but is
not an ideal clinical outcome. In addition,
experimental control was not clear in several of
the cases, and none of the experiments clearly
demonstrated how reinforcement that favored
appropriate behavior could be used in a
practical manner as a treatment for problem
behavior. The focus of Experiment 4, therefore,
was to combine all the variables and examine
whether clinically acceptable changes in behav-
ior could be produced by making reinforcement
for appropriate behavior greater along several
dimensions. We also assessed the maintenance
and generality of treatment effects. George and
Clark participated in Experiment 4.

Method

Reinforcer assessment. Before conducting the
experimental analyses with George, we con-

584 ELIZABETH S. ATHENS and TIMOTHY R. VOLLMER

ducted a reinforcer assessment using procedures
similar to those described in Experiment 2. We
compared the reinforcing efficacy of praise (e.g.,
‘‘Good job, George’’) and physical contact (e.g.,
high fives, pats on the back) with reprimands
(e.g., ‘‘Don’t do that’’) and physical contact
(e.g., therapist using his hands to block
aggression from George for safety reasons).
George allocated a mean of 96% of his
responses to the colored toys that resulted in
praise and physical contact.

30-s dur HQ 0-s delay/5-s dur LQ 10-s delay.
As in previous experiments, equal concurrent VI
schedules of reinforcement (VI 20 s VI 20 s) were
in place for both problem and appropriate
behavior throughout the experiment. For
George, appropriate behavior immediately pro-
duced 30 s of high-quality attention in the form
of social praise and physical attention (e.g., high
fives, pats on the back). Problem behavior
produced 5 s of low-quality attention in the
form of social disapproval and brief blocking of
aggression after a 10-s unsignaled delay. For
Clark, appropriate behavior produced 30 s of
immediate access to a high-preference toy.
Problem behavior produced 5 s of access to a
low-preference toy after a 10-s unsignaled delay.
The therapist timed delays to reinforcement in
the same manner as described in Experiment 3.
We assessed maintenance of treatment effects
and extended treatment across therapists with
both participants. George’s participation con-
cluded with a 1-month follow-up to evaluate the
maintenance of treatment effects. His teacher
conducted the final three sessions of this
condition. Clark’s participation concluded with
a 2-month follow-up during which his teacher
conducted sessions. Teachers received written
descriptions of the protocol, one-on-one training
with modeling of the procedures, and feedback
after each session regarding the accuracy of their
implementation of the procedures.

Results and Discussion

During the 30-s dur 1 HQ 0-s delay/30-s dur
1 HQ 0-s delay baseline, George (Figure 6, top)

engaged in higher rates of problem behavior
than appropriate behavior. In the 30-s dur HQ
0-s delay/5-s dur LQ 10-s delay condition, there
was a decrease in problem behavior and an
increase in appropriate behavior. In a reversal to
baseline, there was an increase in problem
behavior and a decrease in appropriate behavior.
In the final reversal to the 30-s dur HQ 0-s
delay/5-s dur LQ 10-s delay condition, there
was a further decrease in problem behavior and
an increase in appropriate behavior. At the 1-
month follow-up, no problem behavior oc-
curred, and appropriate behavior remained
high.

During the 30-s dur 1 HQ 0-s delay/30-s dur
1 HQ 0-s delay baseline, Clark (Figure 6,
bottom) engaged in higher rates of problem
behavior than appropriate behavior. In the
initial 30-s dur HQ 0-s delay/5-s dur LQ 10-s
delay condition, there was a decrease in
problem behavior and an increase in appropri-
ate behavior. In a reversal to baseline, there was
an increase in problem behavior and a decrease
in appropriate behavior. In a reversal to the 30-s
dur HQ 0-s delay/5-s dur LQ 10-s delay
condition, there was a further decrease in
problem behavior and an increase in appropri-
ate behavior. At the 2-month follow-up, no
problem behavior occurred, and appropriate
behavior remained high.

In summary, results of the combined analyses
indicate that for these participants the relative
rates of problem behavior and appropriate
behavior were sensitive to a combination of
the quality, delay, and duration of reinforce-
ment following each alternative. Compared to
the first three experiments, Experiment 4
resulted in clear experimental control; there
were rapid changes in response allocation across
conditions and consistent replications of re-
sponding under previous conditions, despite the
fact that we did not include an extinction
component.

There were several limitations to this exper-
iment. We did not conduct within-subject

585 DIFFERENTIAL REINFORCEMENT

Figure 6. George’s and Clark’s response rates for problem behavior and appropriate behavior.

comparisons of manipulating single versus
multiple dimensions of reinforcement. In
addition, the response blocking included in
George’s case limits conclusions regarding
efficacy of treatments that do not include
extinction because response blocking may
function as either extinction or punishment
(Lerman & Iwata, 1996). Unfortunately,
George’s aggression tended to cause substantial
harm to others and warranted the use of the
briefest sufficient block to prevent harm. The
blocking used during treatment was the same as
that used in the functional analysis. The
blocking response did not serve to suppress

aggression in the functional analysis, and it is
doubtful that it exerted any such suppressive
effects during the intervention. We did attempt
to control for the addition of physical contact
required following problem behavior by adding
physical contact contingent on appropriate
behavior.

A potential strength of this investigation was
that we assessed both maintenance and gener-
ality of the procedures in a 1-month follow-up,
with George’s and Clark’s teachers serving as
therapists in several of the sessions. George’s
teacher reported that he had a history of
attacking peers, making his behavior too severe

586 ELIZABETH S. ATHENS and TIMOTHY R. VOLLMER

to ignore. His teacher also indicated that the
presence of four other children in the room
limited the amount of attention she could
deliver following appropriate behavior. Clark’s
behavior was so severe that prior to this
investigation, he had been moved to a classroom
in which he was the only student; he returned to
a small-size (four peers) classroom following
this investigation. The current procedure iden-
tified an effective treatment in which teachers
delivered a relatively long duration of high-
quality reinforcement immediately following
some appropriate behavior and brief, low-
quality reinforcement after a short delay
following some problem behavior. Our specific
recommendation to both teachers was to follow
the procedures in Experiment 4 to the best of
their abilities, with the caveat that each should
immediately intervene for aggression that was
directed toward peers or was likely to cause
severe harm.

GENERAL DISCUSSION

The current experiments attempted to
identify differential reinforcement procedures
that were effective without extinction by
manipulating several dimensions of reinforce-
ment. We sought to extend prior research that
focused solely on multiply maintained problem
behavior (Piazza et al., 1997) and examined
only single manipulations of reinforcement
(Lalli & Casey, 1996; Piazza et al.). The
present studies showed the effectiveness of
DRA that provided some combination of more
immediate, longer duration, or higher quality
of reinforcement for appropriate behavior
relative to reinforcement for problem behavior.
In cases in which extinction is not feasible, the
current studies offer a method of decreasing
problem behavior and increasing appropriate
behavior without the use of extinction. For
example, if problem behavior is so severe (e.g.,
severe aggression, head banging on hard
surfaces) that it is not possible to withhold or
even delay reinforcement, it may be possible to

manipulate other parameters of reinforcement
such as duration and quality to favor appro-
priate behavior. If attention maintains problem
behavior in the form of severe self-injury, for
example, problem behavior could result in brief
social attention and appropriate behavior could
result in a longer duration of attention in the
form of praise, smiles, conversation, laughter,
and physical attention such as hugs and
tickling.

One potential contribution of the current
experiments was procedural. The use of inter-

mittent schedules of reinforcement in the
treatment of problem behavior had several
benefits. For example, these schedules likely
mimic to a degree the schedules of reinforce-
ment in the natural environment. It is unlikely

that at home or school, for example, each
instance of behavior produces reinforcement. It
is likely, however, that variable amounts of
appropriate and problem behavior are rein-
forced or that varying amounts of time pass

between reinforced episodes. Further, concur-
rent VI arrangements allow comparisons to and
translations from experimental work on the
matching law.

One limitation of these experiments is the
brevity and varying length of the conditions.
In a laboratory, it may be possible to
conduct conditions until meeting a stability
criterion (e.g., a difference of less than 5%
between data points); however, in a clinical
setting, it is not always possible to bring
each condition to stability before exposing
behavior to another condition (i.e., Corey
and Kenneth).

A second potential limitation to the current
experiment is the difference in obtained versus
programmed schedules of reinforcement. VI
schedules of reinforcement involve delivery of a
reinforcer for the first response after an average
length of time has passed since the last
reinforcer. Participants did not always respond
immediately after the required length of time
elapsed, resulting at times in a less dense

587 DIFFERENTIAL REINFORCEMENT

reinforcement schedule than programmed. The
differences in obtained versus programmed
reinforcement schedules were neither large nor
consistent, however.

Our study suggests several areas for future
research. These experiments included concur-
rent schedules of VI 20-s reinforcement for
problem and appropriate behavior. Future
research may involve similar analyses using
concurrent-schedules arrangements based on
naturalistic observations. The extent to which
relative response allocation is similar under
descriptive and experimental arrangements may
suggest values of reinforcement parameters that
may increase both the acceptability and integ-
rity of treatment implementation by caregivers.
For example, researchers could conduct descrip-
tive analyses (Bijou, Peterson, & Ault, 1968)
with caregivers and analyze the results using
reinforcers identified in a functional analysis
with procedures similar to those described by
Borrero, Vollmer, Borrero, and Bourret (2005).
If descriptive analysis data show that problem
behavior is reinforced on average every 15 s and
appropriate behavior is reinforced on average
every 30 s, treatment might involve reinforcing
appropriate behavior every 15 s and problem
behavior every 30 s.

Investigations similar to the current exper-
iments could further explore the dimensions of
quality, duration, and delay with more
participants and with additional values of
these dimensions. In addition, future research-
ers could investigate the effect of concurrent
manipulations of the dimensions of reinforce-
ment as treatment for problem behavior. For
example, when it is not possible to withhold
reinforcement for problem behavior, it may be
that the rate of reinforcement can continue to
favor problem behavior if several dimensions
of reinforcement, such as magnitude, quality,
and duration, favor appropriate behavior. This
area of research may result in the development
of more practical and widely adopted inter-
ventions for problem behavior.

REFERENCES

Baum, W. M. (1974). Choice in free-ranging wild
pigeons. Science, 185, 78–79.

Bijou, S. W., Peterson, R. F., & Ault, M. H. (1968).
A method to integrate descriptive and experimental
field studies at the level of data and empirical
concepts. Journal of Applied Behavior Analysis, 1,
175–191.

Borrero, C. S. W., Vollmer, T. R., Borrero, J. C., &
Bourret, J. (2005). A method for evaluating the
dimensions of reinforcement in parent-child interac-
tions. Research in Developmental Disabilities, 26,
577–592.

Bostow, D. E., & Bailey, J. B. (1969). Modification of
severe disruptive and aggressive behavior using brief
timeout and reinforcement procedures. Journal of
Applied Behavior Analysis, 2, 31–37.

Catania, A. C. (1963). Concurrent performances: A
baseline for the study of reinforcement magnitude.
Journal of the Experimental Analysis of Behavior, 6,
299–300.

Catania, A. C. (1966). Concurrent operants. In W. K.
Honig (Ed.), Operant behavior: Areas of research and
application (pp. 213–270). Englewood Cliffs, NJ:
Prentice Hall.

Conger, R., & Killeen, P. (1974). Use of concurrent
operants in small group research. Pacific Sociological
Review, 17, 399–416.

Cooper, J. O., Heron, T. E., & Heward, W. L. (2007).
Applied behavior analysis (2nd ed.). Upper Saddle
River, NJ: Prentice Hall.

Deitz, D. E. D., & Repp, A. C. (1983). Reducing
behavior through reinforcement. Exceptional Educa-
tion Quarterly, 3, 34–46.

DeLeon, I. G., & Iwata, B. A. (1996). Evaluation of a
multiple-stimulus presentation format for assessing
reinforcer preferences. Journal of Applied Behavior
Analysis, 29, 519–532.

Dwyer-Moore, K. J., & Dixon, M. R. (2007). Functional
analysis and treatment of problem behavior of elderly
adults in long-term care. Journal of Applied Behavior
Analysis, 40, 679–683.

Ferster, C. B., & Skinner, B. F. (1957). Schedules
of reinforcement. New York: Appleton-Century-
Crofts.

Fisher, W., Piazza, C. C., Bowman, L. G., Hagopian, L.
P., Owens, J. C., & Slevin, I. (1992). A comparison
of two approaches for identifying reinforcers for
person with severe and profound disabilities. Journal
of Applied Behavior Analysis, 25, 491–498.

Fisher, W., Piazza, C. C., Cataldo, M. F., Harrell, R.,
Jefferson, G., & Conner, R. (1993). Functional
communication training with and without extinction
and punishment. Journal of Applied Behavior Analysis,
26, 23–36.

Hagopian, L. P., Fisher, W. W., Sullivan, M. T.,
Acquisto, J., & LeBlanc, L. A. (1998). Effectiveness
of functional communication training with and

588 ELIZABETH S. ATHENS and TIMOTHY R. VOLLMER

without extinction and punishment: A summary of 21
inpatient cases. Journal of Applied Behavior Analysis,
31, 211–235.

Herrnstein, R. J. (1961). Relative and absolute strength of
response as a function of frequency of reinforcement.
Journal of the Experimental Analysis of Behavior, 4,
267–272.

Herrnstein, R. J., & Loveland, D. H. (1975). Maximizing
and matching on concurrent ratio schedules. Journal
of the Experimental Analysis of Behavior, 24, 107–116.

Hoch, H., McComas, J. J., Johnson, L., Faranda, N., &
Guenther, S. L. (2002). The effects of magnitude and
quality of reinforcement on choice responding during
play activities. Journal of Applied Behavior Analysis,
35, 171–181.

Iwata, B. A., Dorsey, M. F., Slifer, K. J., Bauman, K. E., &
Richman, G. S. (1994). Toward a functional analysis
of self-injury. Journal of Applied Behavior Analysis, 27,
197–209. (Reprinted from Analysis and Intervention in
Developmental Disabilities, 2, 3–20, 1982)

Iwata, B. A., Pace, G. M., Cowdery, G. E., &
Miltenberger, R. G. (1994). What makes extinction
work: An analysis of procedural form and function.
Journal of Applied Behavior Analysis, 27, 131–144.

Lalli, J. S., & Casey, S. D. (1996). Treatment of multiply
controlled problem behavior. Journal of Applied
Behavior Analysis, 29, 391–395.

Lalli, J. S., Vollmer, T. R., Progar, P. R., Wright, C.,
Borrero, J., Daniel, D., et al. (1999). Competition
between positive and negative reinforcement in the
treatment of escape behavior. Journal of Applied
Behavior Analysis, 32, 285–296.

Lerman, D. C., & Iwata, B. A. (1996). A methodology for
distinguishing between extinction and punishment
effects of response blocking. Journal of Applied
Behavior Analysis, 29, 231–233.

Lerman, D. C., Kelley, M. E., Vorndran, C. M., Kuhn, S.
A. C., & LaRue, R. H. J. (2002). Reinforcement
magnitude and responding during treatment with
differential reinforcement. Journal of Applied Behavior
Analysis, 35, 29–48.

MacDonall, J. S. (2005). Earning and obtaining reinforc-
ers under concurrent interval scheduling. Journal of
the Experimental Analysis of Behavior, 84, 167–183.

Mace, F. C., McCurdy, B., & Quigley, E. A. (1990). A
collateral effect of reward predicted by matching
theory. Journal of Applied Behavior Analysis, 23,
197–205.

Mace, F. C., Neef, N. A., Shade, D., & Mauro, B. C.
(1994). Limited matching on concurrent-schedule
reinforcement of academic behavior. Journal of
Applied Behavior Analysis, 24, 719–732.

Mace, F. C., & Roberts, M. L. (1993). Factors affecting
selection of behavioral interventions. In J. Reichle &
D. P. Wacker (Eds.), Communicative alternatives to
challenging behavior: Integrating functional assessment
and intervention strategies (pp. 113–134). Baltimore:
Brookes.

Martens, B. K., & Houk, J. L. (1989). The application of
Herrnstein’s law of effect to disruptive and on-
task behavior of a retarded adolescent girl. Journal
of the Experimental Analysis of Behavior, 51, 17–
27.

McCord, B. E., Thomson, R. J., & Iwata, B. A. (2001).
Functional analysis and treatment of self-injury
associated with transitions. Journal of Applied Behavior
Analysis, 34, 195–210.

Neef, N. A., Mace, F. C., & Shade, D. (1993).
Impulsivity in students with serious emotional
disturbance: The interactive effects of reinforcer rate,
delay, and quality. Journal of Applied Behavior
Analysis, 26, 37–52.

Neef, N. A., Mace, F. C., Shea, M. C., & Shade, D.
(1992). Effects of reinforcer rate and reinforcer
quality on time allocation: Extensions of matching
theory to educational settings. Journal of Applied
Behavior Analysis, 25, 691–699.

Neef, N. A., Shade, D., & Miller, M. S. (1994). As-
sessing influential dimensions of reinforcers on
choice in students with serious emotional distur-
bance. Journal of Applied Behavior Analysis, 27,
575–583.

Piazza, C. C., Bowman, L. G., Contrucci, S. A.,
Delia, M. D., Adelinis, J. D., & Goh, H. (1999).
An evaluation of the properties of attention as
reinforcement for destructive and appropriate be-
havior. Journal of Applied Behavior Analysis, 32,
437–449.

Piazza, C. C., Fisher, W. W., Hanley, G. P., Remick,
M. L., Contrucci, S. A., & Aitken, T. L. (1997).
The use of positive and negative reinforcement in
the treatment of escape-maintained destructive be-
havior. Journal of Applied Behavior Analysis, 30,
279–298.

Shores, R. E., Jack, S. L., Gunter, P. L., Ellis, D. N.,
DeBriere, T. J., & Wehby, J. H. (1993). Classroom
interactions of children with behavior disorders.
Journal of Emotional and Behavioral Disorders, 1,
27–39.

Sizemore, O. J., & Lattal, K. A. (1978). Unsignalled delay
of reinforcement in variable-interval schedules. Jour-
nal of the Experimental Analysis of Behavior, 30,
169–175.

Ten Eyck, R. L., Jr. (1970). Effects of rate of reinforce-
ment-time upon concurrent operant performance.
Journal of the Experimental Analysis of Behavior, 14,
269–274.

Volkert, V. M., Lerman, D. C., Call, N. A., & Trosclair-
Lasserre, N. (2009). An evaluation of resurgence
during treatment with functional communication
training. Journal of Applied Behavior Analysis, 42,
145–160.

Vollmer, T. R., Borrero, J. C., Lalli, J. S., & Daniel, D.
(1999). Evaluating self-control and impulsivity in
children with severe behavior disorders. Journal of
Applied Behavior Analysis, 32, 451–466.

589 DIFFERENTIAL REINFORCEMENT

Vollmer, T. R., & Iwata, B. A. (1992). Differential
reinforcement as treatment for behavior disorders:
Procedural and functional variations. Research in
Developmental Disabilities, 13, 393–417.

Vollmer, T. R., Roane, H. S., Ringdahl, J. E., & Marcus,
B. A. (1999). Evaluating treatment challenges with
differential reinforcement of alternative behavior.
Journal of Applied Behavior Analysis, 32, 9–23.

Williams, B. A. (1976). The effects of unsignalled delayed
reinforcement. Journal of the Experimental Analysis of
Behavior, 26, 441–449.

Worsdell, A. S., Iwata, B. A., Hanley, G. P., Thompson,
R. T., & Kahng, S. W. (2000). Effects of continuous
and intermittent reinforcement for problem behavior
during functional communication training. Journal of
Applied Behavior Analysis, 33, 167–179.

Received December 30, 2008
Final acceptance November 18, 2009
Action Editor, Rachel Thompson

• Structure Bookmarks

AN INVESTIGATION OF DIFFERENTIAL REINFORCEMENT OF ALTERNATIVE BEHAVIOR WITHOUT EXTINCTION

GENERAL METHOD

EXPERIMENT 1: DURATION

EXPERIMENT 2: QUALITY

EXPERIMENT 3: DELAY

EXPERIMENT 4: DURATION, QUALITY, AND DELAY

GENERAL DISCUSSION

REFERENCES

Research in Developmental Disabilities 30 (2009) 409–425

Contents lists available at ScienceDirect

Research in Developmental
Disabilities

Review

A review of empirical support for differential reinforcement
of alternative behavior

Erin S. Petscher a,*, Catalina Rey b, Jon S. Bailey b

a University of Florida, United States
b Florida State University, United States

A R T I C L E I N F O A B S T R A C T

Article history:
Received 16 July 2008
Received in revised form 12 August 2008
Accepted 30 August 2008

Keywords:
Differential reinforcement of alternative
behavior
Functional communication training
Empirically supported treatments
Destructive behavior
Problem behavior
Aberrant behavior
Behavior analysis

Differential reinforcement of alternative behavior (DRA) is one of
the most common behavior analytic interventions used to decrease
unwanted behavior. We reviewed the DRA literature from the past
30 years to identify the aspects that are thoroughly researched and
those that would benefit from further emphasis. We found and
coded 116 empirical studies that used DRA, later grouping them
into categories that met APA Division 12 Task Force criteria. We
found that DRA has been successful at reducing behaviors on a
continuum from relatively minor problems like prelinguistic
communication to life-threatening failure to thrive. DRA with
and without extinction is well established for treating destructive
behavior of those with developmental disabilities, and to combat
food refusal.

� 2008 Elsevier Ltd. All rights reserved.

Contents

1. Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411
1.1. Inclusion and exclusion criteria. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411
1.2. Experimental design. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411
1.3. Participant and setting characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411
1.4. Behavior topography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411
1.5. Assessments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 412
1.6. Procedural manipulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 412
1.7. Generalization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 412

* Corresponding author. Tel.: +1 850 322 1797.
E-mail address: epetscher@gmail.com (E.S. Petscher).

0891-4222/$ – see front matter � 2008 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ridd.2008.08.008

mailto:epetscher@gmail.com

http://www.sciencedirect.com/science/journal/08914222

http://dx.doi.org/10.1016/j.ridd.2008.08.008

410 E.S. Petscher et al. / Research in Developmental Disabilities 30 (2009) 409–425

1.8. Task Force criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 412
1.9. Inter-rater reliability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 412

2. Results and discussion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 412
2.1. Experimental design. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413
2.2. Participants and settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 414
2.3. Behavior topography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 416
2.4. Assessments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 417
2.5. Procedural variations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 417

2.5.1. Schedule thinning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 417
2.6. Generalization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 418
2.7. Empirically supported treatments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 418

2.7.1. DRA with extinction is a well-established treatment for destructive behavior . . . 419
2.7.2. DRA without extinction is a well-established treatment for destructive behavior . . . 419
2.7.3. DRA with extinction is well established for the treatment of food refusal. . . . . . . 419
2.7.4. DRA plus NCR is an experimental treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 419

3. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 420
Acknowledgements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 420
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 420

Differential reinforcement is the withholding of reinforcers for one behavior and delivering them
for another. Through the years many specific variations of differential reinforcement have emerged to
demonstrate impressive behavior reductions with difficult clients (see Vollmer & Iwata, 1992). In fact,
Lennox, Miltenberger, Spengler, and Efanian (1988) found that differential reinforcement (DR)
procedures are among the most frequently used to suppress unwanted behaviors.

In recent years the field of behavior analysis has moved toward the use of function-based
treatments to reduce unwanted behaviors. Function-based treatments are considered to be among the
most efficient and effective behavioral interventions (Beare, Severtson, & Brandt, 2004; Iwata, Dorsey,
Slifer, Bauman, & Richman, 1982/1994). Differential reinforcement is particularly appropriate today as
the extinction component requires the assessment of maintaining variables, helping it meet the
definition a function-based treatment.

Extinction alone may produce more unwanted side effects than when it is combined with another
intervention (Lerman, Iwata, & Wallace, 1999; Petscher & Bailey, 2008). Differential reinforcement of
alternative behavior (DRA) withholds the reinforcer for unwanted behavior while simultaneously
reinforcing a specific, alternative response (Cooper, Heron, & Heward, 2007; Vollmer, Roane, Ringdahl,
& Marcus, 1999). DRA may be the ideal intervention in many cases because it reduces behavior
without the concern of extinction-induced side effects and provides an appropriate option for the
clients to earn valuable reinforcers once they are no longer provided for unwanted behaviors (Rolider
& Van Houten, 1990).

Some DRA literature has been reviewed for specific client types. For example, Mirenda reviewed
the use of functional communication training through augmentative alternative communication
devices (1997). Matson, Dixon and Matson (2005) reviewed treatment of aggressive behaviors among
those with developmental disabilities, finding that a variation of DRA, functional communication
training (FCT), is one of the most common interventions. However, a comprehensive review of DRA has
not yet been performed. The authors of the current study feel that demonstrating the empirical
support of DRA to those outside of applied behavior analysis is important for the dissemination of the
field. Therefore, in addition to summarizing the status of DRA literature, the current study also utilizes
the model offered by Severtson, Carr, and Lepper (2008) by coding articles according to the Task Force
criteria.

Since 1995, The Division 12 Task Force on the Promotion and Dissemination of Psychological
Procedures (Task Force) has been identifying treatments that meet the criteria they set to demonstrate
empirical validation. Members of the Task Force publish lists of interventions found to meet their
standards as well established, probably efficacious, or experimental (Chambless et al., 1996; Task
Force, 1995). Unfortunately, while many behavioral interventions may be effective and efficacious,
few have been included in the Task Force lists (see Chambless & Hollon, 1998).

411 E.S. Petscher et al. / Research in Developmental Disabilities 30 (2009) 409–425

The purposes of the current study are to review the published studies on DRA in the past 30 years,
report the characteristics that meet criteria for being well established or probably efficacious, and to
identify the variants that need further research.

1. Methods

The articles selected were each evaluated by the first or second author, and some were also
reviewed by a second, independent observer who was trained to search for the relevant elements.
Observers coded information about the participants, variables, interventions, results and follow-up.

1.1. Inclusion and exclusion criteria

Peer-reviewed journal articles that reported data on an intervention with DRA since 1977 were
reviewed for this paper. The search terms, ‘‘differential reinforcement of alternative behavior’’, and
‘‘functional communication training’’, ‘‘DRA’’, and ‘‘FCT’’, were used within the search engines
PsychInfo and Educational Resources Information Center (ERIC), Journal of Applied Behavior Analysis
abstracts and Journal of the Experimental Analysis of Behavior abstracts. Reference lists of the articles
obtained were also scanned for interventions that matched the definition but did not actually report it
as DRA or FCT (e.g., Coe et al., 1997; Riordan, Iwata, Finney, Wohl, & Stanley, 1984). Search criteria
permitted all dates through the end of 2007 and only the English language. Eliminations were made
for those who either did not present data or used non-human subjects. Review articles and group
designs that did not present individual participants’ data were excluded.

1.2. Experimental design

Experimental design was tracked by participants rather than studies. The designs were matched by
definitions given by Bailey and Burch (2002). AB designs were listed if intervention just followed
baseline. A multielement design involved the rapid alternation between at least two conditions. A
reversal design required that at least two conditions were introduced twice. Variations of reversal
designs, such as an ABCBA, where additional conditions were added to the design, were included. A
multiple baseline was marked if two or more baselines of different durations were followed by the
intervention. Those that added other conditions without replication, such as an ABCDE were
categorized as additive designs. Changing criterion designs involved the stepwise progression of
behavior requirements. Finally, if the participants were introduced to designs with multiple
characteristics, this was tracked as a combination.

The experimenter who implemented the intervention was recorded as staff, parents or family
members, teachers, therapist, or a behavior analyst. When not specified or the data collectors were
trained observers or interns, these were considered behavior analysts.

1.3. Participant and setting characteristics

The number and age of participants was recorded, along with the first two diagnoses reported for
each. Participants were grouped as children (up to 18 years old), or adults (19 and over). If a participant
was diagnosed with an intellectual or physical disability that could be considered a developmental
disability other than autism this was also recorded. Autism was tracked separately to show any
distinction, although it was combined with developmental disabilities when studies were evaluated
for Task Force criteria. The settings were inpatient facilities, clinics, schools, home, and vocational
programs.

1.4. Behavior topography

The topographies of alternative behavior and problem behaviors were reported. Aggression, self-
injurious behavior, property destruction, and disruptions were later grouped to encompass
destructive behavior (Fisher, Thompson, Hagopian, Bowman, & Krug, 2000). The article reviewers

412 E.S. Petscher et al. / Research in Developmental Disabilities 30 (2009) 409–425

also tracked whether the individual data were presented for problem behavior, replacement behavior
or both.

1.5. Assessments

Articles were scanned for reports and results of preference, reinforcer, and functional assessments.
Functional assessments were tracked as descriptive, indirect, antecedent-behavior-consequence,
motivation assessment scale (Durand, 1990), functional analysis or as a modified experimental
analysis.

1.6. Procedural manipulations

While all studies included in this paper involved the use of DRA, some could be further
distinguished as differential negative reinforcement of alternative behavior (DNRA) and FCT. DNRA
specifies that the alternative behavior is negatively reinforced by the removal of an aversive stimulus.
FCT requires that the presumed function of the unwanted behavior is made contingent upon the
alternative response, rather than utilizing any or several arbitrary reinforcers. The specific style of DRA
used was coded by reviewers.

Many studies manipulated antecedents and consequences in addition to the DRA intervention.
Some were combined with DRA and these modifications were tracked as function-based or arbitrary.
In addition, recorders reported the schedule thinning techniques that were utilized.

1.7. Generalization

When experimenters reported a generalization or follow-up condition these and the data trend
were monitored. In addition, if side effects were reported, the perceived value of them was tracked as
desired or undesired.

1.8. Task Force criteria

The criteria set by the Task Force for single subject designs require that the intervention is
compared to a control or other acceptable treatment, has a treatment manual or other specific
instructions, appropriate design and practically significant results, participants with details reported
and similar characteristics, and at least two different investigators performed the studies (Chambless
et al., 1996; Task Force, 1995). It is well established if at least 10 single subject cases meet criteria.

The Task Force criteria were used to group studies along identical interventions and similar
participant characteristics and target behaviors. Reversal, multielement, some combinations and
concurrent multiple baselines were all considered appropriate experimental designs if the first author
found visually significant differences in trend, level, and variability (Bailey & Burch, 2002). However, a
multiple baseline differed from the previous definition as a minimum of three panels were required to
have the possibility of demonstrating control (Chambless & Hollon, 1998).

1.9. Inter-rater reliability

A trained, second reader independently analyzed 35% of the articles to determine inter-rater
agreement on the evaluation of the studies. Agreement was calculated by an item-by-item
comparison of data sheets. The number of item agreements was divided by the total number of
agreements plus disagreements and multipled by 100 (Hanley, Iwata, & McCord, 2003). Average inter-
rater agreement was 93% (range 82–100%).

2. Results and discussion

The initial search identified 538 articles and 116 remained after the exclusionary criteria were
applied. These articles were each reviewed multiple times, and are all denoted in the reference list.

413 E.S. Petscher et al. / Research in Developmental Disabilities 30 (2009) 409–425

Table 1
Experimental design and experimenter type for all reviewed studies

Number Percent

Design
AB 5 4.3
Additive 8 6.9
Combination 32 27.6
Multielement 7 6.0
Multiple baseline 29 25.0
Other 10 8.7
Reversal 25 21.6

Experimenter
Behavior analyst 70 60.3
Combination 3 2.6
Parent/family 11 9.5
Staff 13 11.2
Teacher 8 6.9
Therapist 11 9.5

Although the findings and designs of all 116 did not meet Task Force criteria, many still offered
substantial contributions to the DRA body of literature, so were included in the sample of articles used
for Tables 1–4.

2.1. Experimental design

Table 1 displays the experimental design and experimenter type for 116 articles that utilized DRA.
Many research designs replicated variables in order to properly demonstrate experimental control
(Ringdahl et al., 2002; Roberts, Mace, & Daggett, 1995; Vollmer, Iwata, Smith, & Rodgers, 1992). Some
authors selected experimental designs that involved no or limited opportunity to demonstrate
experimental control (Beare et al., 2004; Dura, 1991; Earles & Myles, 1994; Walsh, 1991). As the
control is demonstrated by the replication of the findings in single subject designs, such findings

Table 2
Age of participants, different settings, and first two diagnoses for participants

Characteristic Number Percent

Age category
Child 277 82.4
Adult 59 17.6

Total participants 336 100

Diagnosis
Autism 116 27.4
Developmental disability 271 64.1
Gastroesophageal reflux 6 1.4
None 3 0.7
Other 27 6.4

Total diagnoses 423 100

Setting
Clinic 17 14.7
Home 21 18.1
Hospital 36 31.0
Multiple 4 3.4
Other 3 2.6
School 32 27.6
Vocational 3 2.6

Total studies 116 100

414 E.S. Petscher et al. / Research in Developmental Disabilities 30 (2009) 409–425

Table 3
Topography of alternative and unwanted behaviors

Number Percent

Problem behavior
Aggression 31 9.2
Destruction/combination 160 47.6
Disruption 9 2.7
Food rejection/packing 15 4.5
Not specified/unclear 11 3.3
Other 26 7.7
Self-Injury 74 22.0
Vocalizations 10 3.0

Alternative behavior
Communication 287 85.4
Compliance 8 2.4
Exchange cigarette 4 1.1
Food acceptance 18 5.4
Play/social 4 1.1
Task engagement 13 3.9
Transitions 2 0.6

should be replicated either across participants, settings, behaviors, or intervention phases. The AB and
most additive designs alone, therefore, added little to indicate that the interventions were responsible
for any behavior changes.

Most studies used a combination of at least two designs, which often were needed to evaluate
multiple components of interventions. For example, in one study a reversal design was used first with
full implementation of DRA compared to baseline. Next, modified versions of DRA were alternated to
demonstrate the effects of partial DRA implementation on problem and alternative behavior (Vollmer
et al., 1999). Other combination designs did not provide the opportunity to display experimental
control, but still suggested interventions for further inquiry. For example, Fisher et al. (2005)
combined a reversal and multielement design for Kim. However, the baseline conditions were too
short to indicate a trend. These data suggested a positive response to the intervention and indicated
that further study could be beneficial.

Behavior analysts typically performed the interventions. Such studies are likely to produce
consistent results and treatment fidelity (Vollmer et al., 1999). However, those studies in which
parents or staff implemented the intervention were programmed for generalization from the
beginning. For example, Bird, Dores, Moniz, and Robinson (1989) performed their study in a classroom
and the teacher enforced the intervention. This should increase consumer’s confidence that the
intervention would continue successfully after the study ended. Unfortunately, it can be especially
difficult to train teachers or parents to perform interventions while they are also held responsible for
their typical duties. It can also confound the intervention and cause confusion if it does not sufficiently
produce behavior change. Therefore, an approach commonly employed is to implement the
intervention first with a trained experimenter, then transfer the training to someone who naturally
interacts with the participant in the absence of a study. For example, after Goh, Iwata, and Kahng
(1999) successfully reduced cigarette pica, they reportedly transferred the intervention to multiple
settings and therapists.

2.2. Participants and settings

The number, first two diagnoses and age of participants are reported in Table 2. Over 80% of the
participants were children, which corresponded with a similarly high percent of studies located in
schools. Wright-Gallo et al. (2006) performed one such study, in which they achieved their goal of
performing classroom-based functional analyses and DRA treatments for students diagnosed with
emotional/behavioral disorders. Furthermore, their findings support the use of function-based
interventions in the actual classroom, rather than an empty treatment room at a school or other location.

415 E.S. Petscher et al. / Research in Developmental Disabilities 30 (2009) 409–425

Table 4
Studies that demonstrated DRA with extinction as a well-established treatment of destructive behavior for children and adults
with developmental disabilities

Study Participant Problem behaviora Alternative behaviorb Function

Children
Bowman et al. (1997) Ben PD, SIB, AGG COM Compliance from

others
Carr and Durand (1985) Jim AGG, TAN, OP Academic tasks Attention
Carr and Durand (1985) Eve AGG, SIB, OP Academic tasks Attention
Carr and Durand (1985) Tom AGG, TAN, OS Academic tasks Attention
Carr and Durand (1985) Sue AGG, TAN, SIB Academic tasks Attention
DeLeon et al. (2000) Jake AGG COM Tangible
Derby et al. (1998) Lana SIB COM Attention
Durand (1999) Allison Crying, screaming COM Tangible
Durand (1999) Mike SIB, PD COM Tangible
Durand (1999) Ron AGG COM Attention
Durand (1999) David SIB COM Escape
Durand (1999) Matt SIB, screaming COM Escape
Durand and Carr (1991) Hal SIB Correct responses Escape
Durand and Carr (1991) Ben AGG Correct responses Attention, escape
Durand and Carr (1991) Tim SIB, AGG Correct responses Escape
Durand and Carr (1992) Sam TAN, PD Correct responses Attention
Durand and Carr (1992) Ted TAN, PD, OP Correct responses Attention
Durand and Carr (1992) Ian TAN, PD, OP Correct responses Attention
Durand and Carr (1992) Ray AGG, TAN, PD Correct responses Attention
Durand and Carr (1992) Mike TAN Correct responses Attention
Durand and Carr (1992) Jaynie OP, TAN Correct responses Attention
Fisher, Adelinis, Thompson, Tina AGG COM Escape

Worsdell, and Zarcone (1998)
Fisher, Adelinis, et al. (1998) Ike AGG COM Escape
Fisher, Kuhn, et al. (1998) Ned AGG, PD COM Attention
Fisher, Kuhn, et al. (1998) Amy SIB, AGG, PD COM Tangible, attention
Fisher et al. (2000) Ken AGG, SIB, PD COM Attention
Fyffe, Kahng, Fittro, and Russell Matt ISB COM Attention

(2004)
Hagopian et al. (1998) Case 17 SIB, AGG, DIS COM Tangible
Hagopian et al. (1998) Case 19 SIB, AGG, DIS COM Attention, escape
Hagopian, Kuhn, Long, and Rush Stephen SIB, AGG, DIS COM Attention

(2005)
Hagopian et al. (2005) James SIB, AGG, DIS COM Attention
Hagopian et al. (2005) Matt AGG COM Tangible
Hanley et al. (1997) Tony AGG, DIS COM Attention
Hanley et al. (1997) Carla DIS, AGG COM Attention
Kahng, Hendrickson, and Vu (2000) Ashby SIB, AGG, DIS COM Tangible
Kelley, Lerman, and Van Camp Gary AGG COM Escape

(2002)
Lalli et al. (1995) Joe SIB COM Escape
Lalli et al. (1995) Jen SIB COM Escape
Lalli et al. (1995) Kim AGG COM Escape
Mancil et al. (2006) Scott TAN COM Tangible
Marcus and Vollmer (1996) CJ SIB, AGG, DIS COM Tangible
Piazza et al. (1999) Ike TAN COM Attention
Roane et al. (2004) Carl AGG COM Tangible
Roberts et al. (1995) Mary SIB Tasks Escape
Sigafoos and Meikle (1996) Pete AGG, SIB, DIS COM Attention, tangible
Sigafoos and Meikle (1996) Dale AGG, SIB, DIS COM Attention, tangible
Thompson, Fisher, Piazza, Ernie AGG COM Attention

and Kuhn (1998)
Vollmer et al. (1999) Rachel SIB, AGG Compliance, COM Escape
Vollmer et al. (1999) Todd SIB Compliance, COM Tangible
Vollmer et al. (1999) Kyle AGG Compliance, COM Escape

Adults
Bird et al. (1989) Jim AGG, SIB COM Multiple
Fisher et al. (2000) Glen SIB, AGG, PD COM Tangible

416 E.S. Petscher et al. / Research in Developmental Disabilities 30 (2009) 409–425

Table 4 (Continued )

Study Participant Problem behaviora Alternative behaviorb Function

Hanley, Iwata, and Thompson Karen SIB COM Attention
(2001)

Hanley et al. (2001) Jake SIB COM Tangible
Hanley et al. (2001) Julie SIB, AGG COM Attention
Kahng, Iwata, DeLeon, and Todd SIB COM Escape

Worsdell (1997)
Kahng et al. (1997) Lynn SIB COM Attention
Kahng et al. (1997) Bob SIB COM Escape
Lindauer et al. (2002) Sam SIB COM Attention
Vollmer et al. (1992) Bob SIB Compliance Escape, attention

a AGG = aggression; SIB = self-injurious behavior; DIS = disruption; ISB = inappropriate sexual behavior; TAN = tantrum; PD = property
destruction; OP = oppositional behavior; OS = out of seat.
b COM = communication.

Adults exhibiting behavior problems may pose additional challenges as their longer learning
histories and physical size is difficult when aggression or escape-maintained behaviors are present. In
one study, a 24-year old with a developmental disability was treated in a multielement design
comparing baseline and two forms of FCT. Although one form of FCT improved communication, both
still resulted in variable rates of aggression (Bailey, McComas, Benavides, & Lovascz, 2002).

Most studies were performed in inpatient hospitals, where clients typically have severe and urgent
needs for interventions that work quickly. The choice to utilize DRA in these cases indicates that
experimenters are confident of its efficacy. Schools housed many studies as well, supporting the use of
FCT as an instructional technique necessary for successful school behavior.

The vast majority of participants in DRA studies were diagnosed with autism or another
developmental disability. Considering the impressive overall findings of this literature, the preference
for clients with developmental disabilities over other diagnoses may suggest that they are the best fit
for DRA interventions. However, some authors also utilized DRA to improve problem behavior of those
with other diagnoses. Wilder and colleagues used DRA to decrease bizarre vocalizations for a 43-year
old diagnosed with Schizophrenia (2001). The impressive behavior reduction indicated that DRA may
be effective with similar clients and aberrant behavior in the future.

2.3. Behavior topography

Table 3 lists the unwanted and alternative behavior topographies that were targeted during DRA
studies. Destruction included a combination of aggressive and disruptive behaviors, and was the most
common presenting problem. Many authors published data on several of their clients’ destructive
behaviors (e.g., LeBlanc, Hagopian, Marhefka, & Wilke, 2001; Piazza et al., 1999), while others opted to
demonstrate how DRA improved specific topographies (e.g., McCord, Thomson, & Iwata, 2001). In one
study, authors tracked changes in aggression and self-injury separately, demonstrating that the
behavior frequencies varied based on the corresponding reinforcer schedule (Lindauer, Zarcone,
Richman, & Schroeder, 2002).

In addition to reducing destructive behaviors, DRA has been effective in treating severe behaviors
for children diagnosed with a failure to thrive (Kahng, Tarbox, & Wilke, 2001; Peck, Wacker, Berg, &
Cooper, 1996). In these cases it may be vital for effective interventions to be provided immediately,
and the data show that DRA satisfies the requirements.

Some behaviors targeted by authors are less severe but can lead to more restrictive placements if
left untreated. For example, inappropriate vocalizations are often targeted in schools and many
produce positive results (e.g., Dixon et al., 2004; Keen, Sigafoos, & Woodyatt, 2001; Lee, McComas, &
Jawor, 2002). Alternative behaviors ranged from task completion to cigarette exchanges, with
appropriate communication being the most frequent. It is an obvious target with DRA because
conceptually the need is to improve client’s repertoires by adding appropriate ways for them to obtain
reinforcers. When these reinforcers become available for other behaviors, those that require the least
response effort will be utilized. In a fascinating display, the DRA intervention was provided as baseline

417 E.S. Petscher et al. / Research in Developmental Disabilities 30 (2009) 409–425

in which responses already in the participant’s repertoire were reinforced. During a Lag 1 DRA phase,
only appropriate novel responses were reinforced. When reinforcers were provided for appropriate
responses, novel (i.e., more difficult) behaviors rarely occurred. However, when the reinforcers were
contingent upon appropriate and novel responses, participants exhibited many more of these (Lee
et al., 2002).

2.4. Assessments

It may be important to perform functional analyses even if the function of behavior appears clear, as
an incorrect hypothesis could waste time and other resources (Vollmer et al., 1992). The studies
reviewed in this article provide further support for the use of functional analysis in developing high-
quality treatments. Seventy-nine of the studies reported the use of an experimental analysis of
maintaining variables prior to the intervention. Out of the 27 studies with at least one data set meeting
Task Force criteria for reducing destructive behavior of children, 85% performed some type of functional
analysis, and only one study did not specify methods to identify the function. This indicates that the
articles that used functional analyses were more likely to produce good data and designs. However, it is
also possible that those researchers who designed studies with the good validity and reliability needed to
produce good results were those that included a functional analysis prior to training.

Since 1982, Iwata and colleagues have suggested that function-based treatments may be more
beneficial than those based on arbitrary reinforcers (Iwata et al., 1982/1994). Apparently the authors
of DRA studies agreed as 84% of the articles utilized the hypothesized maintaining variable during
DRA. However, some of the studies that employed functional analyses did not use the maintaining
reinforcer for the intervention. Two studies used a functional analysis and concluded that multiple
reinforcers maintained the behavior. Thus, they provided a preferred item for appropriate behavior
but the interventions did not yield adequate results until response cost was added for problem
behavior (Bowman, Fisher, Thompson, & Piazza, 1997; Ross, 2002).

2.5. Procedural variations

The DRA intervention in over 70% of the studies would be considered FCT. The emphasis on many of
these designs is on the increase of appropriate communication rather than the reduction of unwanted
behavior. As such, several experimenters used FCT without extinction to increase appropriate
communication (Fisher, Kuhn, & Thompson, 1998; Johnson, McComas, Thompson, & Symons, 2004;
Koegel, Stiebel, & Koegel, 1998; Schindler & Horner, 2005).

Many studies used a DNRA intervention successfully, supporting the use of DRA among various
functions of problem behavior. For example, Fisher and colleagues demonstrated nice results of a
DNRA intervention in which the alternate behavior resulted in the termination of prompts that
interfered with their preferred activities.

Most studies used extinction to reduce target behaviors, but other techniques were also examined.
In some cases DRA was paired with another intervention such as demand fading (Piazza, Moes, &
Fisher, 1996), punishment (Fisher et al., 2000), or time out (Derby et al., 1997). In other situations, the
experimenters compared DRA to approaches other than no-treatment baseline like noncontingent
reinforcement (Goh et al., 1999), differential reinforcement of other behavior (Wacker, Steege,
Northup, & Sasso, 1990), and escape-extinction (McConnachie & Carr, 1997). Many variables were
combined with or compared to DRA.

2.5.1. Schedule thinning
Some authors altered the schedules of reinforcement for unwanted or alternative behaviors. In a

few studies, reinforcer delivery was incrementally delayed for the alternative behavior (Fisher et al.,
2000; Hagopian, Fisher, Sullivan, Acquisto, & LeBlanc, 1998). Others increased the fixed ratio of
delivery from continuous to more reasonable frequencies (Lalli, Casey, & Kates, 1995). Finally, Roane
et al. (2004) restricted access to the operandum needed for the participant to perform the response.
Such schedule thinning techniques have resulted in appropriate levels of replacement behaviors
without the high cost of excessive reinforcer delivery.

418 E.S. Petscher et al. / Research in Developmental Disabilities 30 (2009) 409–425

In some cases, the reinforcer rate for problem behavior was manipulated until an appropriate level
of both targeted behaviors occurred (Deleon, Fisher, Herman, & Crosland, 2000; Vollmer et al., 1999).
Another approach to this was the addition of noncontingent reinforcement, which was faded over
time (Goh, Iwata, & Deleon, 2000; Marcus & Vollmer, 1996).

Reinforcer magnitude was also studied for the alternative behavior in a DRA intervention. The
experimenters monitored post-reinforcement pauses and response frequency to discover that the
duration of access to reinforcers did not affect overall response rates (Lerman, Kelley, Vorndran, Kuhn,
& LaRue, 2002).

2.6. Generalization

Almost 20% of the studies included a generalization phase after the conclusion of the primary
intervention. For example, Jensen, McConnachie, and Pierson (2001) demonstrated that the
intervention generalized across locations. Similarly, Mancil, Conroy, Nakao, and Alter (2006)
discovered that the treatment successfully generalized from the experimenter to the participant’s
mother.

Twenty-eight studies reported results of follow-up data collection. Koegel et al. (1998) collected
encouraging evidence that the intervention maintained as much as 1 year after the intervention had
ended. Even when demonstrated by a few probe data points, the application of this technique adds
considerably to the quality of such studies. The follow-up data collected by many authors provide
evidence that the results of DRA are longstanding rather than being produced by either reactivity or
novelty effects.

Seventeen of the studies reported some type of side or collateral effects, and eight of these used
data to illustrate the phenomena. The desirable collateral effects varied from necessary weight gain
(Kahng et al., 2001), to less teacher stress (McConnachie & Carr, 1997), and attention to tasks (Sisson,
Hersen, & Van Hasselt, 1993). Only two of the studies mentioned the presence of unwanted side
effects. Roane et al. (2004) reported that the participant tried harder to obtain the reinforcer when it
was unavailable, while Carr and Carlson (1993) found that participants performed the alternative
response too frequently.

2.7. Empirically supported treatments

The 116 articles using DRA were grouped by participant diagnosis and problem behavior to
identify those that had sufficient empirical support according to Task Force criteria. As most
participants were diagnosed with a developmental disability, most of the findings involved this
type of client. Task Force criteria require that participant characteristics such as age and gender
are described in the studies but do not specify that the treatments are only applied by these

Table 5
Studies that demonstrate FCT without extinction is a well-established intervention for persons with developmental disabilities

Study Participant Problem behaviora Alternative behavior Function

Fisher, Kuhn, et al. (1998) Amy SIB, PD, aggression Communication Tangible
Johnson et al. (2004) Abe Aggression Communication Escape
Koegel et al. (1998) Child 1 Aggression Communication Multiple
Koegel et al. (1998) Child 2 Aggression Communication Multiple
Koegel et al. (1998) Child 3 Aggression Communication Multiple
Roane et al. (2004) Juan Aggression Communication Attention
Schindler and Horner (2005) Neal Pinch, whine Communication Activity
Schindler and Horner (2005) Ellie Scream Communication Escape
Schindler and Horner (2005) Kit Scream, whine, Communication Avoid transition

noncompliance
Worsdell, Iwata, Hanley, Thompson, Jedb SIB Communication Tangible

and Kahng (2000)
a SIB = self-injurious behavior; PD = property destruction.
b Adult participant.

419 E.S. Petscher et al. / Research in Developmental Disabilities 30 (2009) 409–425

Table 6
Students that demonstrate DRA is a well-established treatment for food refusal

Study Participant Diagnosisa

Kahng, Boscoe, and Byrne (2003) Clara Speech delay, possible PDD
Najdowski, Wallace, Doney, and Ghezzi (2003) Jack Autism
Patel et al. (2002) Alex Congenital heart disease, GER
Patel et al. (2002) Sunshine GER, DD
Patel et al. (2002) Jarred GER, DD
Piazza et al. (2003) Chris Feeding disorder, FTT
Piazza et al. Cameron Feeding disorder, FTT
Piazza et al. Zane Feeding disorder, FTT
Piazza et al. Zack Feeding disorder, FTT
Riordan et al. (1984) Joan Cerebral palsy
Riordan et al. (1984) Nancy Chromosomal aberration
Riordan et al. (1984) Jerry Seizures, left hemiplegia
Riordan et al. (1984) Holly FTT, hydrocephalus

a PDD = pervasive developmental disorder; GER = gastroesophageal reflux; DD = developmental disabilities; FTT = failure to thrive.

characteristics. Therefore, since so many studies demonstrated visually significant results, in
Table 4 the studies are grouped into child and adult participants. In Tables 5 and 6 the participants
are all children except when noted.

Tables 4–6 display the lists of studies that met Task Force criteria to determine that DRA with and
without extinction is well established for treating destructive behaviors of children and adults with
developmental disabilities. It is also well established for the treatment of food refusal. DRA with
noncontingent reinforcement meets criteria of an experimental approach.

2.7.1. DRA with extinction is a well-established treatment for destructive behavior
Table 4 shows the studies that contributed to our finding that DRA with extinction is a well-

established treatment for destructive behavior of both adults and children with developmental
disabilities. The participants in the list all showed marked behavior improvements when DRA with
extinction was compared to either a baseline or other treatment. In all these cases, graphs displayed
problem behavior but it was not required that they reported data for the alternative. In a specific case,
Roberts et al. (1995) reported positive results on the presence of self-injury, but compliance data were
not included in the report.

2.7.2. DRA without extinction is a well-established treatment for destructive behavior
DRA without extinction is a well-established treatment for destructive behavior of persons with

developmental disabilities. These studies are listed in Table 5. It is important to note that, while the
Task Force criteria were met for this intervention, several other participants were exposed to it in a
similar way and it failed to produce sufficient behavior change. For example, Fisher et al. (2000)
introduced Ken to FCT without extinction but his destruction remained with high variability until
extinction was added to the intervention. Therefore, when extinction can be performed in conjunction
with DRA, it will likely produce more rapid and complete behavior changes.

2.7.3. DRA with extinction is well established for the treatment of food refusal
Table 6 lists the participants who refused food prior to treatment and accepted more as a result of

the DRA intervention. In 1984, Riordan and colleagues ignored food expulsion and received praise for
bites accepted. The intervention improved food accepted in four severe cases.

2.7.4. DRA plus NCR is an experimental treatment
The studies that used DRA with NCR to treat destructive behavior for persons with developmental

disabilities showed promise. Some authors were concerned about the presence of side effects that
could have resulted from DRA, so added NCR to their intervention. Two participants were found who
had visually significant results from this intervention (Hagopian, Wilson, & Wilder, 2001; Marcus &
Vollmer, 1996). In another study, two adult participants with self-injurious behavior improved with

420 E.S. Petscher et al. / Research in Developmental Disabilities 30 (2009) 409–425

DRA plus NCR (Goh et al., 2000). However, the multiple baseline design did not meet Task Force
criteria as a third participant would have been required.

3. Conclusion

DRA has been successful at reducing severe behaviors for many participants, while replacing the
unwanted response with appropriate behaviors that can enhance participants’ quality of life. It rarely
produced unwanted side effects but instead commonly resulted in positive collateral changes.
However, in those cases where the alternative behavior rate would be difficult to maintain, schedule
thinning has been shown to successfully reduce the rate to acceptable levels.

DRA has been performed in many studies and is a well-established treatment for food refusal and
participants with developmental disabilities exhibiting destructive behavior. The published studies
with participants otherwise diagnosed, such as Schizophrenia (Wilder, Masuda, O’Connor, & Baham,
2001) were generally positive and warrant further study.

Many studies were identified whose data were promising but the designs did not meet Task Force
criteria. Most often the design did not replicate findings appropriately, such as the ABCD design in
Derby et al. (1997), and multiple baselines whose lengths were not varied enough in Durand (1993).
While they were commonly successful at answering their research questions, the data could not be
used for the current review. Over time this can cause problems because the interventions cannot
demonstrate empirical validity accepted by mainstream psychology. If behavior analysts desire to
increase such awareness, we suggest that designs are tweaked when possible to meet the Task Force
criteria.

Future research should focus on DRA with NCR for the treatment of destructive behavior of persons
with developmental disabilities in order for it to be considered a well-established treatment.
Additional directions of interest would include participants without diagnoses or with those other
than developmental disabilities, and with behaviors other than destruction and food refusal. Other
promising areas include the studies manipulating response effort and reinforcer magnitude.

Acknowledgements

This paper includes some information submitted as a qualifying examination by the first author in
partial fulfillment of the PhD degree at the Florida State University. We thank committee members
Barbara and Mark Licht, Bruce Thyer, and Tom Welsh for their input and review of the original
manuscript. Our gratitude extends to David Lee and Kellyn Johnson for their collection of inter-rater
reliability data, and to Gregory Hanley and his anonymous reviewers for their comments on an earlier
version of this manuscript.

References1

Bailey, J. S., & Burch, M. R. (2002). Research methods in applied behavior analysis. Thousand Oaks, CA: Sage Publications.
*Bailey, J., McComas, J., Benavides, C., & Lovascz, C. (2002). Functional assessment in a residential setting: Identifying an effective

communicative replacement response for aggressive behavior. Journal of Developmental and Physical Disabilities, 14, 353–369.
*Beare, P., Severson, S., & Brandt, P. (2004). The use of a positive procedure to increase engagement on-task and decrease challenging

behavior. Behavior Modification, 28, 28–44.
*Bird, F., Dores, P., Moniz, D., & Robinson, J. (1989). Reducing severe aggressive and self-injurious behaviors with functional

communication training. American Journal on Mental Retardation, 94, 37–48.
*Bowman, L., Fisher, W., Thompson, R., & Piazza, C. (1997). On the relation of mands and the function of destructive behavior. Journal

of Applied Behavior Analysis, 30, 251–265.
*Carr, E., & Carlson, J. (1993). Reduction of severe behavior problems in the community using a multicomponent treatment approach.

Journal of Applied Behavior Analysis, 26, 157–172.
*Carr, E., & Durand, V. (1985). Reducing behavior problems through functional communication training. Journal of Applied Behavior

Analysis, 18, 111–126.
Chambless, D. L., & Hollon, S. D. (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66, 7–

18.
Chambless, D. L., Sanderson, W. C., Shoham, V., Bennett Johnson, S., Pope, K. S., & Crits-Christoph, et al. (1996). An update on

empirically validated therapies. The Clinical Psychologist, 49, 5–18.

Asterisk (*) denotes articles reviewed for DRA characteristics. 1

421 E.S. Petscher et al. / Research in Developmental Disabilities 30 (2009) 409–425

*Coe, D. A., Babbitt, Williams, K. E., Hajihalis, C., Snyder, A. N., Ballard, C., et al. (1997). Use of extinction and reinforcement to increase
food consumption and reduce expulsion. Journal of Applied Behavior Analysis, 30, 581–583.

Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied behavior analysis (2nd ed.). Upper Saddle River, New Jersey: Pearson Prentice
Hall.

*DeLeon, I. G., Fisher, W. W., Herman, K. M., & Crosland, K. C. (2000). Assessment of a response bias for aggression over functionally
equivalent appropriate behavior. Journal of Applied Behavior Analysis, 33, 73–77.

*Derby, K., Fisher, W., Piazza, C., Wilke, A., & Johnson, W. (1998). The effects of noncontingent and contingent attention for self-injury,
manding, and collateral responses. Behavior Modification, 22, 474–484.

*Derby, K., Wacker, D., Berg, W., DeRaad, A., Ulrich, S., Asmus, J., et al. (1997). The long-term effects of functional communication
training in home settings. Journal of Applied Behavior Analysis, 30, 507–531.

*Dixon, M. R., Guercio, J., Falcomata, T., Horner, M. J., Root, S., Newell, C., et al. (2004). Exploring the utility of functional analysis
methodology to assess and treat problematic verbal behavior in persons with acquired brain injury. Behavioral Interventions, 19,
91–102.

*Dura, J. (1991). Controlling extremely dangerous aggressive outbursts when functional analysis fails. Psychological Reports, 69, 451–
459.

Durand, V. M. (1990). Severe behavior problems: A functional communication training approach. New York: Guilford.
*Durand, V. (1993). Functional communication training using assistive devices: Effects on challenging behavior and affect. AAC:

Augmentative and Alternative Communication, 9, 168–176.
*Durand, V. (1999). Functional communication training using assistive devices: Recruiting natural communities of reinforcement.

Journal of Applied Behavior Analysis, 32, 247–267.
Durand, V., & Carr, E. (1991). *Functional communication training to reduce challenging behavior: Maintenance and application in

new settings. Journal of Applied Behavior Analysis, 24, 251–264.
*Durand, V., & Carr, E. (1992). An analysis of maintenance following functional communication training. Journal of Applied Behavior

Analysis, 25, 777–794.
*Earles, T., & Myles, B. (1994). Using behavioral interventions to decrease coprolalia in a student with Tourette’s syndrome and

autism: A case study. Focus on Autistic Behavior, 8, 1–10.
*Fisher, W., Adelinis, J., Thompson, R., Worsdell, A., & Zarcone, J. (1998a). Functional analysis and treatment of destructive behavior

maintained by termination of ‘don’t’ (and symmetrical ‘do’) requests. Journal of Applied Behavior Analysis, 31, 339–356.
*Fisher, W., Adelinis, J., Volkert, V., Keeney, K., Neidert, P., & Hovanetz, A. (2005). Assessing preferences for positive and negative

reinforcement during treatment of destructive behavior with functional communication training. Research in Developmental
Disabilities, 26, 153–168.

*Fisher, W., Kuhn, D., & Thompson, R. (1998b). Establishing discriminative control of responding using functional and alternative
reinforcers during functional communication training. Journal of Applied Behavior Analysis, 31, 543–560.

*Fisher, W., Thompson, R., Hagopian, L., Bowman, L., & Krug, A. (2000). Facilitating tolerance of delayed reinforcement during
functional communication training. Behavior Modification, 24, 3–29.

*Fyffe, C., Kahng, S., Fittro, E., & Russell, D. (2004). Functional analysis and treatment of inappropriate sexual behavior. Journal of
Applied Behavior Analysis, 37, 401–404.

*Goh, H., Iwata, B., & DeLeon, I. (2000). Competition between noncontingent and contingent reinforcement schedules during
response acquisition. Journal of Applied Behavior Analysis, 33, 195–205.

*Goh, H., Iwata, B., & Kahng, S. (1999). Multicomponent assessment and treatment of cigarette pica. Journal of Applied Behavior
Analysis, 32, 297–316.

*Hagopian, L., Fisher, W., Sullivan, M., Acquisto, J., & LeBlanc, L. (1998). Effectiveness of functional communication training with and
without extinction and punishment: A summary of 21 inpatient cases. Journal of Applied Behavior Analysis, 31, 211–235.

*Hagopian, L., Kuhn, S., Long, E., & Rush, K. (2005). Schedule thinning following communication training: Using competing stimuli to
enhance tolerance to decrements in reinforcer density. Journal of Applied Behavior Analysis, 38, 177–193.

*Hagopian, L., Wilson, D., & Wilder, D. (2001). Assessment and treatment of problem behavior maintained by escape from attention
and access to tangible items. Journal of Applied Behavior Analysis, 34, 229–232.

Hanley, G., Iwata, B., & McCord, B. (2003). Functional analysis of problem behavior: A review. Journal of Applied Behavior Analysis, 36,
147–185.

*Hanley, G., Iwata, B., & Thompson, R. (2001). Reinforcement schedule thinning following treatment with functional communication
training. Journal of Applied Behavior Analysis, 34, 17–38.

*Hanley, G., Piazza, C., Fisher, W., Contrucci, S., & Maglieri, K. (1997). Evaluation of client preference for function-based treatment
packages. Journal of Applied Behavior Analysis, 30, 459–473.

Iwata, B. A., Dorsey, M. F., Slifer, K. J., Bauman, K. E., & Richman, G. S. (1994). Toward a functional analysis of self-injury. Journal
of Applied Behavior Analysis, 27, 197–209 [reprinted from (1982) Analysis and Intervention in Developmental Disabilities, 2,
3–20].

*Jensen, C., McConnachie, G., & Pierson, T. (2001). Long-term multicomponent intervention to reduce severe problem behavior: A 63-
month evaluation. Journal of Positive Behavior Interventions, 3, 225–236.

*Johnson, L., McComas, J., Thompson, A., & Symons, F. J. (2004). Obtained versus programmed reinforcement practical considerations
in the treatment of escape-reinforced aggression. Journal of Applied Behavior Analysis, 37, 239–242.

*Kahng, S., Boscoe, J., & Byrne, S. (2003). The use of escape contingency and a token economy to increase food acceptance. Journal of
Applied Behavior Analysis, 36, 349–353.

*Kahng, S., Hendrickson, D., & Vu, C. (2000). Comparison of single and multiple functional communication training responses for the
treatment of problem behavior. Journal of Applied Behavior Analysis, 33, 321–324.

*Kahng, S., Iwata, B., DeLeon, I., & Worsdell, A. (1997). Evaluation of the ‘control over reinforcement’ component in functional
communication training. Journal of Applied Behavior Analysis, 30, 267–277.

*Kahng, S., Tarbox, J., & Wilke, A. (2001). Use of a multicomponent treatment for food refusal. Journal of Applied Behavior Analysis, 34,
93–96.

*Keen, D., Sigafoos, J., & Woodyatt, G. (2001). Replacing prelinguistic behaviors with functional communication. Journal of Autism and
Developmental Disorders, 31, 385–398.

422 E.S. Petscher et al. / Research in Developmental Disabilities 30 (2009) 409–425

*Kelley, M., Lerman, D., & Van Camp, C. (2002). The effects of competing reinforcement schedules on the acquisition of functional
communication. Journal of Applied Behavior Analysis, 35, 59–63.

*Koegel, L., Stiebel, D., & Koegel, R. (1998). Reducing aggression in children with autism toward infant or toddler siblings. Journal of
the Association for Persons with Severe Handicaps, 23, 111–118.

*Lalli, J., Casey, S., & Kates, K. (1995). Reducing escape behavior and increasing task completion with functional communication
training, extinction, and response chaining. Journal of Applied Behavior Analysis, 28, 261–268.

*LeBlanc, L., Hagopian, L., Marhefka, J., & Wilke, A. (2001). Effects of therapist gender and type of attention on assessment and
treatment of attention-maintained destructive behavior. Behavioral Interventions, 16, 39–57.

*Lee, R., McComas, J. J., & Jawor, J. (2002). The effects of differential and lag reinforcement schedules on varied verbal responding by
individuals with autism. Journal of Applied Behavior Analysis, 35, 391–402.

Lennox, D. B., Miltenberger, R. G., Spengler, P., & Erfanian, N. (1988). Decelerative treatment practices with persons who have mental
retardation: A review of five years of the literature. American Journal on Mental Retardation, 92, 492–501.

Lerman, D. C., Iwata, B. A., & Wallace, M. D. (1999). Side effects of extinction Prevalence of bursting and aggression during the
treatment of self-injurious behavior. Journal of Applied Behavior Analysis, 32, 1–8.

*Lerman, D., Kelley, M., Vorndran, C., Kuhn, S., & LaRue, R. (2002). Reinforcement magnitude and responding during treatment with
differential reinforcement. Journal of Applied Behavior Analysis, 35, 29–48.

*Lindauer, S., Zarcone, J., Richman, D., & Schroeder, S. (2002). A comparison of multiple reinforcer assessments to identify the function
of maladaptive behavior. Journal of Applied Behavior Analysis, 35, 299–303.

*Mancil, G., Conroy, M., Nakao, T., & Alter, P. (2006). Functional communication training in the natural environment: A pilot
investigation with a young child with autism spectrum disorder. Education & Treatment of Children, 29, 615–633.

*Marcus, B., & Vollmer, T. (1996). Combining noncontingent reinforcement and differential reinforcement schedules as treatment for
aberrant behavior. Journal of Applied Behavior Analysis, 29, 43–51.

Matson, J., Dixon, D., & Matson, M. (2005). Assessing and treating aggression in children and adolescents with developmental
disabilities: A 20-year overview. Educational Psychology, 25, 151–181.

*McConnachie, G., & Carr, E. (1997). The effects of child behavior problems on the maintenance of intervention fidelity. Behavior
Modification, 21, 123–158.

*McCord, B., Thomson, R., & Iwata, B. (2001). Functional analysis and treatment of self-injury associated with transitions. Journal of
Applied Behavior Analysis, 34, 195–210.

Mirenda, P. (1997). Supporting individuals with challenging behavior through functional communication training and AAC: Research
review. AAC: Augmentative and Alternative Communication, 13, 207–225.

*Najdowski, A. C., Wallace, M. D., Doney, J. K., & Ghezzi, P. M. (2003). Parental assessment and treatment of food selectivity in natural
settings. Journal of Applied Behavior Analysis, 36, 383–386.

*Patel, M. R., Piazza, C. C., Martinez, C. J., Volkert, V. M., & Santana, C. M. (2002). An evaluation of two differential reinforcement
procedures with escape extinction to treat food refusal. Journal of Applied Behavior Analysis, 35, 363–374.

*Peck, S., Wacker, D., Berg, W., & Cooper, L. (1996). Choice-making treatment of young children’s severe behavior problems. Journal of
Applied Behavior Analysis, 29, 263–290.

Petscher, E. S., & Bailey, J. S. (2008). Comparing main and collateral effects of extinction and differential reinforcement of alternative
behavior. Behavior Modification, 32, 468–488.

*Piazza, C. C., Bowman, L. G., Contrucci, S. A., Delia, M. D., Adelinis, J. D., & Goh, H. (1999). An evaluation of the properties of attention
as reinforcement for destructive and appropriate behavior. Journal of Applied Behavior Analysis, 32, 437–449.

*Piazza, C., Moes, D., & Fisher, W. (1996). Differential reinforcement of alternative behavior and demand fading in the treating fading
in the treatment of escape-maintained destructive behavior. Journal of Applied Behavior Analysis, 29, 569–572.

*Piazza, C. C., Patel, M. R., Gulotta, C. S., Sevin, B. M., & Layer, S. A. (2003). On the relative contributions of positive reinforcement and
escape extinction in the treatment of food refusal. Journal of Applied Behavior Analysis, 36, 309–324.

*Ringdahl, J., Kitsukawa, K., Andelman, M., Call, N., Winborn, L., Barretto, A., et al. (2002). Differential reinforcement with and without
instructional fading. Journal of Applied Behavior Analysis, 35, 291–294.

*Riordan, M. M., Iwata, B. A., Finney, J. W., Wohl, M. K., & Stanley, A. E. (1984). Behavioral assessment and treatment of chronic food
refusal in handicapped children. Journal of Applied Behavior Analysis, 17, 327–341.

*Roane, H., Fisher, W., Sgro, G., Falcomata, T., & Pabico, R. (2004). An alternative method of thinning reinforcer delivery during
differential reinforcement. Journal of Applied Behavior Analysis, 37, 213–218.

*Roberts, M. L., Mace, F. C., & Daggett, J. A. (1995). Preliminary comparison of two negative reinforcement schedules to reduce self-
injury. Journal of Applied Behavior Analysis, 28, 579–580.

Rolider, A., & Van Houten, R. (1990). The role of reinforcement in reducing inappropriate behavior: Some myths and misconceptions.
In Repp, A. C., & Singh, N. N. (Eds.), Perspectives on the use of nonaversive and aversive interventions for persons with developmental
disabilities. Vol. xiii (pp.119–127). Sycamore, IL, US: Sycamore Publishing Company. 533 pp..

*Ross, D. (2002). Replacing faculty conversational exchanges for children with autism by establishing a functionally equivalent
alternative response. Education & Training in Mental Retardation & Developmental Disabilities, 37, 343–362.

*Schindler, H., & Horner, R. (2005). Generalized reduction of problem behavior of young children with autism: Building trans-
situational interventions. American Journal on Mental Retardation, 110, 36–47.

Severtson, J. M., Carr, J. E., & Lepper, T. L. (2008). Noncontingent reinforcement is an empirically supported treatment for problem
behavior exhibited by individuals with developmental disabilities. Research in Developmental Disabilities 10.1016/j.ridd.2008.03.002.

*Sigafoos, J., & Meikle, B. (1996). Functional communication training for the treatment of multiply determined challenging behavior
in two boys with autism. Behavior Modification, 20, 60–84.

*Sisson, L., Hersen, M., & Van Hasselt, V. (1993). Improving the performance of youth with dual sensory impairment: Analyses and
social validation of procedures to reduce maladaptive responding in vocational and leisure settings. Behavior Therapy, 24, 553–
571.

Task Force Promoting Dissemination of Psychological Procedures. (1995). Training in and dissemination of empirically-validated
psychological treatments: Report and recommendations. Clinical Psychology, 48, 3–23.

*Thompson, R., Fisher, W., Piazza, C., & Kuhn, D. (1998). The evaluation and treatment of aggression maintained by attention and
automatic reinforcement. Journal of Applied Behavior Analysis, 31, 103–116.

http://dx.doi.org/10.1016/j.ridd.2008.03.002

423 E.S. Petscher et al. / Research in Developmental Disabilities 30 (2009) 409–425

Vollmer, T. R., & Iwata, B. A. (1992). Differential reinforcement as treatment for behavior disorders: Procedural and functional
variations. Research in Developmental Disabilities, 13, 393–417.

*Vollmer, T., Iwata, B., Smith, R., & Rodgers, T. (1992). Reduction of multiple aberrant behaviors and concurrent development of self-
care skills with differential reinforcement. Research in Developmental Disabilities, 13, 287–299.

*Vollmer, T., Roane, H., Ringdahl, J., & Marcus, B. (1999). Evaluating treatment challenges with differential reinforcement of
alternative behavior. Journal of Applied Behavior Analysis, 32, 9–23.

*Wacker, D., Steege, M., Northup, J., & Sasso, G. (1990). A component analysis of functional communication training across three
topographies of severe behavior problems. Journal of Applied Behavior Analysis, 23, 417–429.

*Walsh, P. (1991). The use of differential reinforcement in affecting multiple behavioural change in a woman with severe mental
handicap. Irish Journal of Psychology, 12, 382–392.

*Wilder, D. A., Masuda, A., O’Connor, C., & Baham, M. (2001). Brief functional analysis and treatment of bizarre vocalizations in an
adult with schizophrenia. Journal of Applied Behavior Analysis, 34, 65–68.

*Worsdell, A., Iwata, B., Hanley, G., Thompson, R., & Kahng, S. (2000). Effects of continuous and intermittent reinforcement for
problem behavior during functional communication training. Journal of Applied Behavior Analysis, 33, 167–179.

*Wright-Gallo, G., Higbee, T., Reagon, K., & Davey, B. (2006). Classroom-based functional analysis and intervention for students with
emotional/behavioral disorders. Education & Treatment of Children, 29, 421–436.

Further reading2

+Arndorfer, R., Miltenberger, R., Woster, S., & Rortvedt, A. (1994). Home-based descriptive and experimental analysis of

problem behaviors in children. Topics in Early Childhood Special Education, 14, 64–87.
+Braithwaite, K., & Richdale, A. (2000). Functional communication training to replace challenging behaviors across two

behavioral outcomes. Behavioral Interventions, 15, 21–36.
+Brown, K., Wacker, D., Derby, K., Peck, S., Richman, D., Sasso, G., et al. (2000). Evaluating the effects of functional

communication training in the presence and absence of establishing operations. Journal of Applied Behavior
Analysis, 33, 53–71.

*Buckley, S., & Newchok, D. (2005). Differential impact of response effort within a response chain on use of mands in a

student with autism. Research in Developmental Disabilities, 26, 77–85.
+Buckley, S., Strunck, P., & Newchok, D. (2005). A Comparison of two multicomponent procedures to increase food

consumption. Behavioral Interventions, 20, 139–146.
+Campbell, R., & Lutzker, J. (1993). Using functional equivalence training to reduce severe challenging behavior: A case

study. Journal of Developmental and Physical Disabilities, 5, 203–216.
+Carr, E., Levin, L., McConnachie, G., Carlson, J., Kemp, D., Smith, C., et al. (1999). Comprehensive multisituational

intervention for problem behavior in the community: Long-term maintenance and social validation. Journal of
Positive Behavior Interventions, 1, 5–25.

+Casey, S., & Merical, C. (2006). The use of functional communication training without additional treatment procedures

in an inclusive school setting. Behavioral Disorders, 32, 46–54.
+Day, H., Horner, R., & O’Neill, R. (1994). Multiple functions or problem behaviors: Assessment and intervention.

Journal of Applied Behavior Analysis, 27, 279–289.
+Doughty, S., & Anderson, C. (2006). Effects of noncontingent reinforcement and functional communication training on

problem behavior and mands. Education & Treatment of Children, 29, 23–50.
+Drasgow, E., Halle, J., Ostrosky, M., & Harbers, H. (1996). Using behavioral indication and functional communication

training to establish an initial sign repertoire with a young child with severe disabilities. Topics in Early Childhood
Special Education, 16, 500–521.

+Dunlap, G., Ester, T., Langhans, S., & Fox, L. (2006). Functional communication training with toddlers in home

environments. Journal of Early Intervention, 28, 81–96.
+Durand, V., & Kishi, G. (1987). Reducing severe behavior problems among persons with dual sensory impairments: An

evaluation of a technical assistance model. Journal of the Association for Persons with Severe Handicaps, 12, 2–

10.
+Fisher, W., Piazza, C., Cataldo, M., & Harrell, R. (1993). Functional communication training with and without extinction

and punishment. Journal of Applied Behavior Analysis, 26, 23–36.
+Flood, W., & Wilder, D. (2002). Antecedent assessment and assessment-based treatment of off-task behavior in a child

diagnosed with attention defcit-hyperactivity disorder (ADHD). Education & Treatment of Children, 25, 331–338.
+Gerra, L., Dorfman, S., Plaue, E., & Schlackman, S. (1995). Functional communication as a means of decreasing self-

injurious behavior: A case study. Journal of Visual Impairment & Blindness, 89, 343–348.
+Hagopian, L., Toole, L., Long, E., Bowman, L., & Lieving, G. (2004). A comparison of dense-to-lean arid fxed lean

schedules of alternative reinforcement and extinction. Journal of Applied Behavior Analysis, 37, 323–337.

Plus (+) denotes article reviewed for DRA characteristics but not cited within manuscript. 2

424 E.S. Petscher et al. / Research in Developmental Disabilities 30 (2009) 409–425

+Hanley, G., Piazza, C., Fisher, W., & Maglieri, K. (2005). On the effectiveness of and preference for punishment and

extinction components of function-based interventions. Journal of Applied Behavior Analysis, 38, 51–65.
+Harding, J., Wacker, D., Berg, W., Barretto, A., & Ringdahl, J. (2005). Evaluation of relations between specifc

antecedent stimuli and self-injury during functional analysis conditions. American Journal on Mental Retardation,
110, 205–215.

+Kemp, D., & Carr, E. (1995). Reduction of severe problem behavior in community employment using an hypothesis-

driven multicomponent intervention approach. Journal of the Association for Persons with Severe Handicaps, 20,

229–247.
+Kennedy, C., Meyer, K., Knowles, T., & Shukla, S. (2000). Analyzing the multiple functions of stereotypical behavior for

students with autism: Implications for assessment and treatment. Journal of Applied Behavior Analysis, 33, 559–571.
+Konarski, E., & Johnson, M. (1989). The use of brief restraint plus reinforcement to treat self-injurious behavior.

Behavioral Residential Treatment, 4, 45–52.
+Kurtz, P., Chin, M., Huete, J., Tarbox, R., O’Connor, J., Paclawskyj, T., et al. (2003). Functional analysis and treatment of

self-injurious behavior in young children: A summary of 30 cases. Journal of Applied Behavior Analysis, 36, 205–

219.
+Lucas, R. (2000). The effects of time-out and DRA on the aggressive behavior of a spirited two-year-old. Child & Family

Behavior Therapy, 22, 51–56.
+Martin, C., Drasgow, E., Halle, J., & Brucker, J. (2005). Teaching a child with autism and severe language delays to

reject: Direct and indirect effects of functional communication training. Educational Psychology, 25, 287–304.
+McComas, J., Wacker, D., & Cooper, L. (1998). Increasing compliance with medical procedures: Application of the

high-probability request procedure to a toddler. Journal of Applied Behavior Analysis, 31, 287–290.
+Mildon, R., Moore, D., Dixon, R., & Koegel, R. (2004). Combining noncontingent escape and functional communication

training as a treatment for negatively reinforced disruptive behavior. Journal of Positive Behavior Interventions, 6,

92–102.
+Moes, D., & Frea, W. (2002). Contextualized behavioral support in early intervention for children with autism and their

families. Journal of Autism and Developmental Disorders, 32, 519–533.
+O’Neill, R., & Sweetland-Baker, M. (2001). Brief report: An assessment of stimulus generalization and contingency

effects in functional communication training with two students with autism. Journal of Autism and Developmental
Disorders, 31, 235–240.

+Peterson, S., Caniglia, C., Royster, A., Macfarlane, E., Plowman, K., Baird, S., et al. (2005). Blending functional

communication training and choice making to improve task engagement and decrease problem behaviour. Educa-
tional Psychology, 25, 257–274.

+Reed, G. K., Ringdahl, J. E., Wacker, D. P., Barretto, A., & Andelman, M. S. (2005). The effects of fxed-time and

contingent schedules of negative reinforcement on compliance and aberrant behavior. Research in Developmental
Disabilities, 26, 281–295.

+Reeve, C., & Carr, E. (2000). Prevention of severe behavior problems in children with developmental disorders. Journal
of Positive Behavior Interventions, 2, 144–160.

+Richman, D., Berg, W., Wacker, D., Stephens, T., Rankin, B., & Kilroy, J. (1997). Using pretreatment and posttreatment

assessments to enhance and evaluate existing treatment packages. Journal of Applied Behavior Analysis, 30, 709–712.
+Richman, D., Wacker, D., & Winborn, L. (2001). Response effciency during functional communication training: Effects

of effort on response allocation. Journal of Applied Behavior Analysis, 34, 73–76.
+Richman, D., Wacker, D., Asmus, J., & Casey, S. (1998). Functional analysis and extinction of different behavior

problems exhibited by the same individual. Journal of Applied Behavior Analysis, 31, 475–478.
+Saloviita, T. (1988). Elimination of self-injurious behaviour by brief physical restraint and DRA. Scandinavian Journal

of Behaviour Therapy, 17, 55–63.
+Shirley, M., Iwata, B., Kahng, S., & Mazaleski, J. (1997). Does functional communication training compete with ongoing

contingencies of reinforcement? An analysis during response acquisition and maintenance. Journal of Applied
Behavior Analysis, 30, 93–104.

+Shukla, S., & Albin, R. (1996). Effects of extinction alone and extinction plus functional communication training on

covariation of problem behaviors. Journal of Applied Behavior Analysis, 29, 565–568.
+Symons, F., Fox, N., & Thompson, T. (1998). Functional communication training and naltrexone treatment of self-

injurious behaviour: An experimental case report. Journal of Applied Research in Intellectual Disabilities, 11, 273–

292.
+Tait, K., Sigafoos, J., Woodyatt, G., O’Reilly, M., & Lancioni, G. (2004). Evaluating parent use of functional

communication training to replace and enhance prelinguistic behaviours in six children with developmental and

physical disabilities. Disability and Rehabilitation: An International, Multidisciplinary Journal, 26, 1241–1254.

425 E.S. Petscher et al. / Research in Developmental Disabilities 30 (2009) 409–425

+Tarbox, R. S. F., Wallace, M. D., & Williams, L. (2003). Assessment and treatment of elopement: A replication and

extension. Journal of Applied Behavior Analysis, 36, 239–244.
+Tincani, M., Castrogiavanni, A., & Axelrod, S. (1999). A comparison of the effectiveness of brief versus traditional

functional analyses. Research in Developmental Disabilities, 20, 327–338.
+Vollmer, T., & Vorndran, C. (1998). Assessment of self-injurious behavior maintained by access to self-restraint

materials. Journal of Applied Behavior Analysis, 31, 647–650.
+Wacker, D., Berg, W., Harding, J., Barretto, A., Rankin, B., & Ganzer, J. (2005). Treatment effectiveness, stimulus

generalization, and acceptability to parents of functional communication training. Educational Psychology, 25,

233–256.
+Watson, T., Ray, K., Turner, H., & Logan, P. (1999). Teacher-implemented functional analysis and treatment: A method

for linking assessment to intervention. School Psychology Review, 28, 292–302.
+Wickstrom-Kane, S., & Goldstein, H. (1999). Communication assessment and intervention to address challenging

behavior in toddlers. Topics in Language Disorders, 19, 70–89.
+Winborn, L., Wacker, D., Richman, D., Asmus, J., & Geier, D. (2002). Assessment of mand selection for functional

communication training packages. Journal of Applied Behavior Analysis, 35, 295–298.
+Woods, D., Fuqua, R., & Waltz, T. (1997). Evaluation and elimination of an avoidance response in a child who stutters: A

case study. Journal of Fluency Disorders, 22, 287–297.

• A review of empirical support for differential reinforcement of alternative behavior

Methods

Inclusion and exclusion criteria

Experimental design

Participant and setting characteristics

Behavior topography

Assessments

Procedural manipulations

Generalization

Task Force criteria

Inter-rater reliability

Results and discussion

Experimental design

Participants and settings

Behavior topography

Assessments

Procedural variations

Schedule thinning

Generalization

Empirically supported treatments

DRA with extinction is a well-established treatment for destructive behavior

DRA without extinction is a well-established treatment for destructive behavior

DRA with extinction is well established for the treatment of food refusal

DRA plus NCR is an experimental treatment

Conclusion

Acknowledgements

References11Asterisk (*) denotes articles reviewed for DRA characteristics.

Further reading22Plus (+) denotes article reviewed for DRA characteristics but not cited within manuscript.