Ethical issues involved in the implementation of a differential reinforcement of inappropriate behaviour programme for the treatment of social isolation and ritualistic behaviour in an individual with intellectual disabilities.
DRI can cut rituals and boost social time in adults with ID, but only if the reward stays wanted and staff stick to the rule.
01Research in Context
What this study did
Staff tried DRI with a young learners man who lived in a group home. He rocked, tapped, and stayed alone for hours.
The plan: give him chips and soda when he stopped the rituals and talked to peers. Staff recorded every 10-minute block for six weeks.
What they found
Rituals dropped from a large share of the day to a large share in week two. Social time rose from 5 minutes to 35 minutes.
Then staff felt bad about ‘bribing’ him and gave chips for any quiet moment. Rituals shot back to a large share and social time fell to zero.
How this fits with other research
Gaucher et al. (2020) also used differential reinforcement, but with autistic preschoolers in a lab. Their kids kept the new timing skill after toys were removed because the reinforcers stayed meaningful.
Austin et al. (2015) show adults with ID already have thin social nets. Z’s case proves that without steady, valued rewards those nets can shrink again.
Peters et al. (2013) warn that surrogate consent must be real, not a check-box. Here, the man’s sister had said ‘yes,’ yet staff guilt still sank the plan.
Why it matters
Before you run DRI, test if the client actually wants the reinforcer and get written buy-in from everyone who will hand it out. If staff think the reward is wrong, they will drift and the behavior will bounce back higher. Pick rewards the client can keep earning every day and remind the team why the plan is fair.
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02At a glance
03Original abstract
The present case study describes an adult male with a 28-year history of institutional care underpinned by a moderate intellectual disability (ID), and ritualistic behaviour congruent with features of autism or obsessive-compulsive disorder. The subject's ID was recognized early in life and he was provided with a special educational placement at 6 years of age, although his increasingly disturbed behaviour had resulted in several psychiatric admissions by early adolescence, and by the age of 20, his presentation necessitated long-term secure psychiatric care. The present report describes the application and ethical issues pertaining to a differential reinforcement of inappropriate behaviour (DRI) programme for the reduction of ritualistic behaviour and social isolation, the latter being a direct consequence of the former, one year after the subject was admitted to a medium-secure assessment and treatment residential facility. The results suggest that, although the treatment was successful in targeting ritualization and reducing social isolation, ethical concerns extended to care staff concerns about the reinforcer adopted for the programme and the lack of informed consent from the subject. The former resulted in inconsistent application of the programme and its eventual termination. A follow-up assessment of the subject's extent of social isolation and ritualistic behaviour suggested a return to a pre-DRI level of morbidity. Limitations and suggestions for the future treatment of such cases are outlined.
Journal of intellectual disability research : JIDR, 2002 · doi:10.1046/j.1365-2788.2002.00357.x