Further Evaluation of Presentation Format of Competing Stimuli for Treatment of Automatically Maintained Challenging Behavior.
After a competing-stimulus assessment, give one winning item continuously—rotation or multiple items just dilute the effect.
01Research in Context
What this study did
The team ran a multielement design with kids with autism who skin-picked for automatic reinforcement. They first did a competing-stimulus assessment to find items that cut skin picking. Then they compared three ways to give those items: one item all the time, several items at once, or items rotated every few minutes.
What they found
Single-item, continuous access won. Skin picking dropped the most when the child kept one strong competing item for the whole session. Rotating or piling items on the table worked less well.
How this fits with other research
Llinas et al. (2022) later showed the same thing with stereotypy: continuous access beat dense or lean fixed-time schedules. Their larger effect size updates and strengthens the 2018 advice.
Rooker et al. (2018) already said CSA-based NCR beats preference-based NCR. Verriden et al. (2025) confirmed CSA items outperformed PSPA items for most kids, so the 2018 paper sits inside a growing best-practice chain.
Greenlee et al. (2024) extended the idea by adding brief prompts to engage with the item; two of four kids did even better. No conflict—prompting is an extra tool, not a replacement.
Why it matters
If you have already done a competing-stimulus assessment, skip the toy buffet. Hand the learner one top item and let them keep it. You will see faster, bigger drops in automatically maintained SIB, and caregivers like the simpler setup. Start there next session; add prompting only if needed.
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02At a glance
03Original abstract
Behavioral interventions have been effective in reducing automatically maintained skin picking for individuals with disabilities including autism spectrum disorder (ASD). A competing stimulus assessment (CSA) is typically utilized in behavioral intervention and assessment to identify potential stimuli which compete with the reinforcer for various forms of challenging behavior (CB). Treatment evaluations have validated the results of these assessments by demonstrating competing stimuli may reduce levels of CB. In Phase 1 of this study, we conducted a functional analysis (FA) to determine what variables were maintaining skin picking of an 11-year-old girl diagnosed with ASD. In Phase 2, we conducted a CSA to determine which stimulus competed the most with skin picking. In Phase 3, we utilized a multielement with reversal design to compare the effectiveness of three presentation formats: (a) single stimulus (single), (b) multiple stimuli (multiple), and (c) alternating stimuli (alternating) in reducing levels of automatically maintained CB. We found noncontingent access to a single item was the most effective intervention to decrease skin picking. This study adds to the literature on reducing CB in children with ASD by incorporating a CSA before the evaluation of different formats of delivering competing stimuli, across extended duration session times.
Behavior modification, 2018 · doi:10.1177/0145445517740322