Was your first inclination to cringe at the title of this blog? If so, great! You'll enjoy this topic. What's less enjoyable is how common forced compliance is in the field of applied behavior analysis. Other names for forced compliance include "escape extinction," "teaching compliance," and more. No matter its name, traditional forced compliance looks somewhat like this:1. child is given a prompt (verbal, physical, other)2. staff continues to present the prompt (often with increasing intrusiveness) until child complies3. child exhibits many additional behaviors until either the target behavior is produced, the staff is exhausted and reinforces the maladaptive behavior, or the staff physically hand-over-hand completes the behavior topography for the childFor a video example, click this link. In this description, they simplify it even more: when escape is the function, extinction procedures are conducted by simply "Deny opportunity for breaks. For example, the learner screams whenever he is asked to complete a new task to avoid the demand. The teacher/practitioner continues with task even though the learner is screaming."
We even have ethical obligations to avoid escape extinction. Really! 1.01- relying on scientific knowledge and 2.0- treatment efficacy demand that we update our knowledge to include the many studies that demonstrate more effective procedures for dealing with escape maintained behaviors. 4.07- avoidance of implementing when there are environmental conditions that prohibit treatment fidelity means that we can't suggest a default technology that we KNOW is not going to be implemented all of the time. Extinction needs to be continous to be effective, which makes it impossible in most applied settings (especially in-home).
In a recent presentation by Dr. Megan Marie Miller of Navigation Behavioral Consulting, she pointed out that not only is escape extinction unethical in a majority of cases, but there are better, more effective technologies to use when the target behavior is maintained by escape from demand. First, let's summarize the concerns with the use of escape extinction:1. Non-compliance can be multiply maintained (Rodriguez, Thompson, & Baynham, 2010). Applying escape extinction to a multiply maintained behavior would likely be unsuccessful as it would not address the other functions of the behavior. 2. It's VERY intrusive! Physical guidance can increase problem behavior (Laraway etal., 2003; Lerman & Iwata, 1995; Piazza et al.,1996; Sidman, 1989). There are already high rates of injury in this field, why exacerbate it?3. Parents and caregivers are not likely to use traditional procedures (McConnachie & Carr,1997). They are socially invalid and VERY difficult to implement with fidelity. If we know it's not going to be implemented correctly, why would we use this?4. There are side effects to forcing compliance. We could teach too much compliance and create children who are at risk of abuse as adults (failure to discriminate when and when not to comply). We can pair ourselves as aversive stimuli and affect future treatment efficacy. We have to see an extinction burst (it's not necessary since there are alternatives). Is this ethical? Of course not. 5. There is more than 25 years of research indicating how ineffective escape extinction can be AND what tod do instead. Why would we rely on default technology when we have a better way to address escape-maintained target behaviors?Some Selected Alternatives:• Lerman, Iwata, and Wallace (1992) Bursts or increases in aggression in nearly half of thecases. Recommendation: Identify strategies that reduce these side effects• Piazza, Moes, and Fisher (1996) Recognized issues with traditional escape extinctionand extinction burst. Used DRA and demand fading• Hoch, McComas, Thompson, and Paone (2002) Behavior change without extinction. Gave break with tangible and break without tangible• Ringhdahl et al. (2002) Used DRA and Demand Fading to reduce without extinction. • Behavioral Economics (DeLeon, 2011) Choosing to work for a reinforcer vs choosing a break. Some children need the break and choose the break no matter the price. Some children will continue to choose the edible even at high prices. Having a choice between the break and edible resulted in the highestlevels of responding• Task as a reinforcer (Ward, Parker, & Perdikaris, 2017) Reinforcers are not available until work is complete. Contingent on target escape behavior, removed the work and withheld access to reinforcement. When target “ready” behavior occurred, presented work
Clearly we have a lot of potential alternatives that are less likely to produce emotional side effects, poor pairing, and low treatment integrity. Using effective methods to gain instructional control is also important. Robert Schramm explains the seven steps to instructional control which can create HUGE changes in escape-maintained behavior. A free tutorial webinar from the Colorado Department of Education is available if you'd like to learn more about how to apply it to your practice. In addition to being more effective and less restrictive, alternatives to escape extinction are evidence-based, more likely to be accepted by the public, and easier to implement with treatment fidelity for maximum efficacy.
Some more links for additional reading:FCT by Tiger, Hanley, and BruzekPositive and Negative Reinforcement by Piazza et alForm and Function of Extinction by Iwata and colleaguesSide Effects of Extinction by Lerman, Iwata, and Wallace
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