Functional Communication Training and Naltrexone Treatment of Self-Injurious Behaviour: An Experimental Case Report
Frank J. Symons,
Nichole D. Fox,
Travis Thompson,
Corresponding Author
Frank J. Symons
John F. Kennedy Center, Peabody College Vanderbilt University, USA
The Frank Porter Graham Child Development Center, University of North Carolina, CB8180,105 Smith Level Road, Chapel Hill, NC27599-8180, USA.Search for more papers by this authorNichole D. Fox
John F. Kennedy Center, Peabody College Vanderbilt University, USA
Search for more papers by this authorTravis Thompson
John F. Kennedy Center, Peabody College Vanderbilt University, USA
Search for more papers by this authorFrank J. Symons,
Nichole D. Fox,
Travis Thompson,
Corresponding Author
Frank J. Symons
John F. Kennedy Center, Peabody College Vanderbilt University, USA
The Frank Porter Graham Child Development Center, University of North Carolina, CB8180,105 Smith Level Road, Chapel Hill, NC27599-8180, USA.Search for more papers by this authorNichole D. Fox
John F. Kennedy Center, Peabody College Vanderbilt University, USA
Search for more papers by this authorTravis Thompson
John F. Kennedy Center, Peabody College Vanderbilt University, USA
Search for more papers by this authorAbstract
The self-injurious behaviour of people with intellectual disabilities, autism, and related developmental disabilities remains one of the most difficult behaviour problems to treat clinically. Two promising approaches to effective treatment involve teaching the person communication skills that are functionally equivalent to the self-injury or administering opiate antagonist medication. Here an experimental case study, in which naltrexone was combined with functional communication training, is reported. Using a within-subject ABCDC experimental design, reductions in rate of self-injury were observed during the naltrexone alone phase as well as during combined treatment phases. The implications of conducting a functional assessment prior to behavioural and pharmacological intervention are discussed.
References
- Bakeman, R. and Gottman, J.M. (1992) Observing interaction: An Introduction to Sequential Analysis. New York: Cambridge University Press.
- Barlow, D.H. and Hersen, M. (1984) Single Case Experimental Designs ( 2nd edn). New York: Pergamon Press.
-
Barrera, F.J.,
Teodoro, J.M.,
Selmeci, T. and
Madappuli, A. (1994) Self-injury, pain and the endorphin theory.
Journal of Developmental and Physical Disabilities
6, 169–92.
10.1007/BF02579358 Google Scholar
- Bernstein, G.A., Hughes, J.R., Mitchell, J.E. and Thompson, T. (1987) Effects of narcotic antagonists on self-injurious behavior. Journal of the Academy of Child and Adolescent Psychiatry 26, 886–9.
- Bird, F., Dores, P.A., Moniz, D. and Robinson, J. (1989) Reducing severe aggressive and self-injurious behaviors with functional communication training. American Journal on Mental Retardation 94, 37–48.
- Borthwick-Duffy, S.A. (1994) Prevalence of destructive behaviors: A study of aggression, self-injury and property destruction. In T. Thompson and D.B. Gray (eds) Destructive Behavior in Developmental Disabilities: Diagnosis and Treatment (pp. 3–23. Thousand Oaks, CA: SAGE Publications.
- Bruininks, R.H., Olson, K.M., Larson, S.A. and Lakin, K.C. (1994) Challenging behaviors among persons with mental retardation in residential settings: Implications for policy, research and practice. In T. Thompson and D.B. Gray (eds) Destructive Behavior in Developmental Disabilities: Diagnosis and Treatment (pp. 24–48. Thousand Oaks, CA: SAGE Publications.
- Campbell, M. (1996) Resolved: Autistic children should have a trial of naltrexone. Journal of the American Academy of Child and Adolescent Psychiatry 35, 246–7.
- Carr, E.G. and Durand, V.M. (1985) Reducing behavior problems through functional communication training. Journal of Applied Behavior Analysis 18, 111–26.
- Carr, E.G., Levin, L., McConnachie, G., Carlson, J.I., Kemp, D.C. and Smith, C.E. (1994) Communication-based Intervention for Problem Behavior: A User's Guide for Producing Positive Change. Baltimore: Paul H. Brookes Publishing Co.
- Casner, J.A., Weinheimer, B. and Gualtieri, C.T. (1996) Naltrexone and self-injurious behavior: A retrospective population study. Journal of Clinical Psychopharmacology 16, 389–94.
- Cohen, J. (1960) A coefficient of agreement for nominal scales. Educational and Psychological Measurement 20, 37–46.
- Day, M.H., Horner, R.H., O'Neill, R.E. (1994) Multiple functions of problem behaviors: Assessment and intervention. Journal of Applied Behavior Analysis 27, 279–90.
- Durand, V.M. (1982) A behavioral/pharmacological intervention for the treatment of severe self-injurious behavior. Journal of Autism and Developmental Disorders 12, 243–51.
- Durand, V.M. (1990) Severe Behavior Problems: A Functional Communication Training Approach. New York: Guilford Press.
- Fisher, W., Piazza, C.C. and Page, T.J. (1989) Assessing independent and interactive effects of behavioral and pharmacological interventions for a client with dual diagnoses. Journal of Behavior Therapy and Experimental Psychiatry 20, 241–50.
- Han, J.S. (1993) Acupuncture and stimulation produced analgesia. In A. Herz (ed.) Opioids II (pp. 105–25. New York: Springer-Verlag.
- Hellings, J.A. and Warnock, J.K. (1994) Self-injurious behavior and serotonin in Prader-Willi syndrome. Psychopharmacology Bulletin 30, 254–250.
- Herman, B.H., Hammock, M.K., Arthur-Smith, A., Kuehl, K. and Appelgate, K. (1989) Effects of acute administration of naltrexone on cardiovascular function, body temperature, body weight and serum concentrations of liver enzymes in autistic children. Developmental Pharmacology and Therapeutics 12, 118–27.
- M. Hersen (ed.) (1985) Pharmacological and Behavioral Treatment: An Integrative Approach. New York: John Wiley and Sons.
- Iwata, B.A., Dorsey, M.F., Slifer, K.J., Bauman, K.E. and Richman, G.S. (1982) Toward a functional analysis of self-injury. Analysis and Intervention in Developmental Disabilities 2, 3–20.
- Johnson, K., Johnson, C.R. and Sahl, R.A. (1994) Behavioral and naltrexone treatment of self-injurious behavior. Journal of Developmental and Physical Disabilities 6, 193–202.
- Kazdin, A.E. (1982) Single-case Research Designs: Methods for Clinical and Applied Settings. New York: Oxford University Press.
- Lalli, J.S., Casey, S. and Kates, K. (1995) Reducing escape behavior and increasing task completion with functional communication training, extinction and response training. Journal of Applied Behavior Analysis 28, 261–8.
-
Lewis, M.H. (1993) Recent advances in pharmacotherapy.
Current Opinion in Psychiatry
6, 659–64.
10.1097/00001504-199310000-00010 Google Scholar
- MacLean, W.E., Jr., Tapp, J.T. and Johnson, W.L. (1985) Alternate methods and software for calculating interobserver agreement for continuous observation data. Journal of Psychopathology and Behavioral Assessment 7, 65–73.
- O'Neill, R.E., Horner, R.H., Albin, R.W., Storey, K. and Sprague, J.R. (1990) Functional analysis of problem behavior: A practical assessment guide. Sycamore, IL: Sycamore Publishing Company.
- Piazza, C.C., Moes, D.R. and Fisher, W. (1996) Differential reinforcement of alternative behavior and demand fading in the treatment of escape-maintained destructive behavior. Journal of Applied Behavior Analysis 29, 569–72.
-
B. Pomeranz and
G. Stux, (eds) (1989) Scientific Bases of Acupuncture. New York: Springer-Verlag.
10.1007/978-3-642-73757-2 Google Scholar
- Repp, A.C., Felce, D. and Barton, L.E. (1988) Basing the treatment of stereotypic and self-injurious behaviors on hypotheses of their causes. Journal of Applied Behavior Analysis 21, 281–9.
-
Ricketts, R.W.,
Ellis, C.R.,
Singh, Y.N. and
Singh, N.N. (1993) Opioid antagonists, II: Clinical effects in the treatment of self-injury in individuals with developmental disabilities.
Journal of Developmental and Physical Disabilities
5, 17–28.
10.1007/BF01046595 Google Scholar
- Ricketts, R.W., Goza, A.B., Ellis, C.R., Singh, Y.N., Chambers, S., Singh, N.N. and Cooke III, J.C. (1994) Clinical effects of busiprone on intractable self-injury in adults with mental retardation. Journal of the American Academy of Child and Adolescent Psychiatry 33, 270–6.
- Sandman, C.A. (19901991) The opiate hypothesis in autism and self-injury. Journal of Child and Adolescent Psychopharmacology 1, 237–48.
- Saunders, M.D., Saunders, J.L. and Saunders, R.R. (1993) A program evaluation of classroom data collection with bar codes. Research in Developmental Disabilities 14, 1–18.
- Schaal, D.W. and Hackenberg, T. (1994) Toward a functional analysis of drug treatment for behavior problems of people with developmental disabilities. American Journal on Mental Retardation 99, 123–40.
- Schroeder, S.R., Mulick, J.A. and Rojahn, J. (1980) The definition, taxonomy, epidemiology and ecology of self-injurious behavior. Journal of Autism and Developmental Disorders 10, 417–32.
-
Shores, R.E.,
Jack, S.L.,
Gunter, P.L.,
Ellis, D.N.,
DeBriere, T.J. and
Wehby, J.W. (1993) Classroom interactions of children with behavior disorders.
Journal of Emotional and Behavioral Disorders
1, 27–39.
10.1177/106342669300100106 Google Scholar
- Sprague, J.R. and Horner, R.H. (1992) Covariation within functional response classes: Implications for treatment of severe problem behavior. Journal of Applied Behavior Analysis 25, 735–46.
- Symons, F.J. (1996) Self-injurious behavior: Diagnostic implications of body site preference (Doctoral dissertation, Vanderbilt University, 1996). Dissertation Abstracts International 57, 4A.
- Symons, F.J. and Thompson, T. (1997) A review of self-injurious behavior and pain in persons with developmental disabilities. International Review of Research in Mental Retardation 21, 69–111.
- Tapp, J. (1995) Time wand behavior analysis program. Unpublished manuscript, Vanderbilt University.
- Thompson, T., Egli, M., Symons, F.J. and Delaney, D. (1994) Neurobehavioral mechanisms of drug action in developmental disabilities. In T. Thompson and D.B. Gray (eds) Destructive Behavior in Developmental Disabilities: Diagnosis and Treatment (pp. 133–81. Thousand Oaks, CA: SAGE Publications.
- Thompson, T., Hackenberg, T., Cerutti, D., Baker, D. and Axtell, S. (1994) Opioid antagonist effects on self-injury in adults with mental retardation: Response form and location as determinants of medication effects. American Journal on Mental Retardaion 99, 85–102.
-
Thompson, T.,
Symons, F. J.,
Delaney, D. and
England, C. (1995) Self-injurious behavior as neurochemical self-administration.
Mental Retardation and Developmental Disabilities Research Reviews
1, 137–48.
10.1002/mrdd.1410010210 Google Scholar
- Wehby, J.H., Symons, F.J. and Shores, R.E. (1995) A descriptive analysis of aggressive behavior in classrooms for children with emotional and behavioral disorders. Behavioral Disorders 20, 87–105.
- Willemsen-Swinkels, S.H.N., Buitelaar, J.K., Nijhof, G.J. and van Engeland, H. (1995) Failure of naltrexone hydrochloride to reduce self-injurious and autistic behavior in mentally retarded adults. Archives of General Psychiatry 52, 766–73.
- Wolery, M., Bailey, D.B. Jr., and Sugai, G.M. (1988) Effective Teaching: Principles and Procedures of Applied Behavior Analysis with Exceptional Students. Boston: Allyn and Bacon, Inc.
