Behavioral interventions to reduce maladaptive responding in youth with dual sensory impairment. An analysis of direct and concurrent effects.
When DRO fails for deaf-blind youth, adding brief overcorrection or restraint cuts self-injury fast, yet newer rule-DRO methods can often do the same job without aversives.
01Research in Context
What this study did
Two teenagers with deaf-blindness and profound ID kept hitting themselves.
DRO alone did not stop the hits.
The team added either overcorrection or brief physical restraint right after each hit.
They watched if hits dropped and if good behaviors rose at the same time.
What they found
Hits fell fast and stayed low for six months.
Good behaviors like toy play went up while hits went down.
Some side effects showed up: brief crying or muscle tension after restraint.
How this fits with other research
Denis et al. (2011) pooled many studies and found that non-aversive DR alone can cut self-injury in people with profound ID.
That looks like a clash, but Jo’s meta mostly covered clients who could hear or see.
The teens in A et al. had dual sensory loss, so reinforcers were harder to deliver—hence the need for the extra deceleration step.
Iannaccone et al. (2020) later showed that simply telling the client “you lose the reinforcer if you hit” made DR work without any aversive add-ons.
Their rule-DRO update now lets you get the same fast drop without restraint or overcorrection.
Why it matters
If you work with clients who are deaf-blind and hits stay high after solid DR, brief deceleration can work, but watch for stress signs.
Today, try Iannaccone’s rule-DRO first: state the loss rule clearly and pair it with a clear signal.
Only consider a brief aversive add-on if sensory loss blocks that route, and always collect parent assent first.
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02At a glance
03Original abstract
Many persons who have multiple sensory, physical, and developmental disabilities display behaviors that interfere significantly with adaptive functioning and social acceptance. In this investigation, the efficacy of multiple component behavioral interventions for reducing maladaptive responding exhibited by two individuals with dual sensory impairment and profound mental retardation was evaluated. Results indicated that differential reinforcement of other behavior (DRO) approaches were not effective in either case. However, when deceleration procedures (overcorrection or brief physical restraint) were added, target behaviors decreased quickly. Also, interventions were faded in such a way that gains were maintained for 6 months with only minimal effort by staff. Ongoing assessment of concurrent effects of behavior reduction strategies revealed increases in time on task or amount of work completed, even though these responses were not targeted specifically. Yet negative side effects (e.g., increases in self-stimulation) also were documented, highlighting the importance of evaluating multiple behaviors during intervention. Finally, despite the fact that objective assessments led to positive conclusions regarding treatment efficacy, ratings of baseline and treatment behavior samples by independent judges showed overall improvement in only one case. These findings suggest the need for multifaceted evaluation to determine the utility of interventions in applied settings.
Behavior modification, 1993 · doi:10.1177/01454455930172005