The purpose of this case study was to examine the potential of using noncontingent reinforcement (NCR) to reduce the frequency of disruptive behaviors of three elderly persons in personal care home (PCH) settings. Assessment indicated that participants were engaging in the disruptive behaviors to obtain social attention from PCH staff. Social attention, up to 1 min of staff making eye contact with the participant and directing positive verbal statements toward the participant, was given on a fixed time interval (from morning through early evening) beginning every 20 min and fading to every 30 min. Results indicate that NCR reduced the frequency of the disruptive behaviors.
AlgaseD. L.BeckC.KolanowskiA.WhallA.BerentS.RichardsK.BeattieE. (1996). Need-driven dementia-compromised behavior: An alternative view of disruptive behavior. American Journal of Alzheimer’s Disease, 11(6), 10-19.
2.
ArcherN.BrownR. G.ReevesS. J.BoothbyH.NicholasH.FoyC.. . . LovestoneS. (2007). Premorbid personality and behavioral and psychological symptoms in probable Alzheimer disease. American Journal of Geriatric Psychiatry, 15, 202-213.
3.
BilanakisN.PapamichaelG.PeritogiannisV. (2011). Chemical restraint in routine clinical practice: A report from a general hospital psychiatric ward in Greece. Annals of General Psychiatry, 10. Retrieved from http://www.annals-general-psychiatry.com/content/10/1/4
4.
BuchananJ. A.FisherJ. E. (2002). Functional assessment and noncontingent reinforcement in the treatment of disruptive vocalization in elderly dementia patients. Journal of Applied Behavior Analysis, 35, 68-72.
5.
BuhrG. T.WhiteH. K. (2006). Difficult behaviors in long-term care patients with dementia. Journal of the American Medical Directors Associations, 7, 180-192.
6.
CarrJ. E.BaileyJ. S.EcottC. L.LuckerK. D.WeilT. M. (1998). On the effects of noncontingent delivery of differing magnitudes of reinforcement. Journal of Applied Behavior Analysis, 31, 313-321.
7.
CarrJ. E.LeBlancL. A. (2006). Noncontingent reinforcement as antecedent behavior support. In LuiselliJ. K. (Ed.), Antecedent assessment and intervention: Supporting children and adults with developmental disabilities in community settings (pp. 147-164). Baltimore, MD: Brookes.
8.
Cohen-MansfieldJ. (2000). Nonpharmacological management of behavioral problems in persons with dementia: The TREA model. Alzheimer’s Care Quarterly, 1, 22-34.
9.
Cohen-MansfieldJ.JensenB. (2008). Physicians’ perceptions of their role in treating dementia-related behavior problems in the nursing home: Actual practice and the ideal. Journal of the American Medical Directors Associations, 9, 552-557.
10.
Cohen-MansfieldJ.MarxM. S.Dakheel-AliM.RegierN. G.TheinK.FreedmanL. (2010). Can agitated behavior of nursing home residents with dementia be prevented with the use of standardized stimuli?Journal of the American Geriatrics Society, 58, 1459-1464.
11.
Cohen-MansfieldJ.MarxM. S.RosenthalA. S. (1989). A description of agitation in a nursing home. Journal of Gerontology, 44, M77-M84.
12.
Cohen-MansfieldJ.WernerP.MarxM. S. (1989). An observational study of agitation in agitated nursing home residents. International Journal of Psychogeriatrics, 1, 153-165.
13.
DonatD. C. (2005). Encouraging alternatives to seclusion, restraint, and reliance on PRN drugs in a public psychiatric hospital. Psychiatric Services, 56, 1105-1108.
14.
Forbes-ThompsonS.GessertC. E. (2006). Nursing homes and suffering: Part of the problem or part of the solution?Journal of Applied Gerontology, 25, 234-251.
15.
HagopianL. P.CrockettJ. L.van StoneM.DeLeonI. G.BowmanL. G. (2000). Effects of noncontingent reinforcement on problem behavior and stimulus engagement: The role of satiation, extinction, and alternative reinforcement. Journal of Applied Behavior Analysis, 33, 433-449.
16.
HagopianL. P.FisherW. W.LegacyS. M. (1994). Schedule effects of noncontingent reinforcement on attention-maintained destructive behavior in identical quadruplets. Journal of Applied Behavior Analysis, 27, 317-325.
17.
HoldenB. (2005). Noncontingent reinforcement: An introduction. European Journal of Behaviour Analysis, 6, 1-8.
18.
KovachC. R.NoonanP. E.SchlidtA. M.WellsT. (2005). A model of consequences of need-driven, dementia-compromised behavior. Journal of Nursing Scholarship, 37, 134-140.
19.
LalliJ. S.CaseyS. D.KatesK. (1997). Noncontingent reinforcement as treatment for severe problem behaviors: Some procedural variations. Journal of Applied Behavior Analysis, 30, 127-137.
20.
LeoneA. F.StandoliF.HirthV. (2009). Implementing a pain management program in a long-term care facility using a quality improvement approach. Journal of the American Medical Directors Association, 10, 67-73.
21.
MarcusB. A.VollmerT. R. (1996). Combining noncontingent reinforcement and differential reinforcement schedules as treatment for aberrant behavior. Journal of Applied Behavior Analysis, 29, 43-51.
22.
MarxM. S.Cohen-MansfieldJ.WernerP. (1990). Agitation and falls in institutionalized elderly persons. Journal of Applied Gerontology, 9, 106-117.
23.
MilkeD. L.BeckC. H.DanesS. (2006). Meeting the needs of continuing care of facility-based residents diagnosed with dementia: Comparison of ratings by families, direct care staff, and other staff. Journal of Applied Gerontology, 25, 103-119.
24.
NobiliA.PasinaL.TrevisanS.RivaE.LuccaU.TettamantiM.. . . TarantolaM. (2009). Use and misuse of antipsychotic drugs in patients with dementia in Alzheimer special care units. International Clinical Psychopharmacology, 24, 97-104.
25.
PelletierI. C.LandrevilleP. (2007). Discomfort and agitation in older adults with dementia. BMC Geriatrics, 7, 27.
26.
RabinowitzJ.DavidsonM.De DeynP. P.KatzI.BrodatyH.Cohen-MansfieldJ. (2005). Factor analysis of the Cohen-Mansfield Agitation Inventory in three large samples of nursing home patients with dementia and behavioral disturbance. American Journal of Geriatric Psychiatry, 13, 991-998.
27.
TestadI.AaslandA. M.AarslandD. (2005). The effect of staff training on the use of restraint in dementia: A single-blind randomised controlled trial. International Journal of Geriatric Psychiatry, 20, 587-590.
28.
TestadI.AuerS.MittelmanM.BallardC.FosseyJ.DonabauerY.AarslandD. (2010). Nursing home structure and association with agitation and use of psychotropic drugs in nursing home residents in three countries: Norway, Austria and England. International Journal of Geriatric Psychiatry, 25, 725-731.
29.
VollmerT. M.IwataB. A.ZarconeJ. R.SmithR. G.MazaleskiJ. L. (1993). The role of attention in the treatment of attention-maintained self-injurious behavior: Noncontingent reinforcement and differential reinforcement of other behavior. Journal of Applied Behavior Analysis, 26, 9-21.
30.
WhallA. L.CollingK. B.KolanowskiA.KimH.HongG. S.DeCiccoB.. . . BeckC. (2008). Factors associated with aggressive behavior among nursing home residents with dementia. Gerontologist, 48, 721-731.
31.
YuryC. A.FergusonK.CucciareM.FisherJ. E. (2005). Aging and developmental disabilities. In WilliamsL. (Ed.), Developmental disabilities (pp. 283-297). Reno, NV: Context.
