To address dangerous problem behavior exhibited by children while explicitly avoiding physical management procedures, we systematically replicated and extended the skill-based treatment procedures described by Hanley, Jin, Vanselow, and Hanratty (2014) by incorporating an enhanced choice model with three children in an outpatient clinic and two in a specialized public school. In this model, several tactics were simultaneously added to the skill-based treatment package to minimize escalation to dangerous behavior, the most notable of which involved offering children multiple choice-making opportunities, including the ongoing options to (a) participate in treatment involving differential reinforcement, (b) “hang out” with noncontingent access to putative reinforcers, or (c) leave the therapeutic space altogether. Children overwhelmingly chose to participate in treatment, which resulted in the elimination of problem behavior and the acquisition and maintenance of adaptive skills during lengthy, challenging periods of nonreinforcement. Implications for the safe implementation of socially valid treatments for problem behavior are discussed.

为了解决儿童表现出的危险问题行为，同时明确避免物理管理程序，我们系统地复制和扩展了 Hanley、Jin、Vanselow 和 Hanratty (2014) 描述的基于技能的治疗程序，方法是将增强的选择模型与三个儿童结合在一个门诊和两个在一所专门的公立学校。在这个模型中，几种策略同时添加到基于技能的治疗方案中，以尽量减少升级为危险行为，其中最值得注意的是为儿童提供多种选择机会，包括正在进行的选择 (a) 参与涉及差异化的治疗强化，（b）“闲逛”与假定的强化物的非偶然访问，或（c）完全离开治疗空间。绝大多数儿童选择参与治疗，从而消除了问题行为，并在漫长而充满挑战的非强化时期获得并维持了适应性技能。讨论了安全实施对问题行为的社会有效治疗的意义。