Escape and avoidance hypothesis testing using an alternating treatment design

Persons with acquired brain injuries (ABIs) are frequently confused, disoriented, and frightened. Many of the procedures used in rehabilitation are experienced by the person with a brain injury as aversive, frustrating, and intrusive. The therapeutic modalities of PT, OT, speech, education, and medical procedures are frequently occasions for clients to emit escape and avoidance behaviors, which interfere with therapy and result in the client redirecting the therapy, teacher, or medical personnel from their treatment objective(s). Three treatment methods were compared: (i) earned escape, where the child was able to earn short breaks for treatment cooperation; (ii) praise for treatment cooperation; (iii) graphic representation of progress, where the therapist helped the child to graph his performance. An alternating treatment design (Barlow & Hersen, 1984) was used to compare the effectiveness of three behavioral contingencies for escape and attention motivated behavior. Results clearly demonstrated the differential effectiveness of the three as well as a general decrease in target behaviors across all conditions. Copyright © 2000 John Wiley & Sons, Ltd.