The competing stimulus assessment (CSA) is used to identify stimuli that are associated with high levels of engagement and low levels of problem behavior. However, few studies have used CSA results for adults with problem behavior. The goal of this study was to expand on previous literature by targeting an adult's self-injurious skin picking, while incorporating caregivers into treatment and examining reduction maintenance. Noelle was a 27-year-old female diagnosed with autism spectrum disorder and intellectual disability referred to an intensive outpatient clinic. Functional assessment results suggested that skin picking was maintained by automatic reinforcement. Treatment included noncontingent access to competing stimuli identified via a CSA with response disruption and response promotion tactics. This intervention reduced skin picking to near zero rates, was effectively implemented by caregivers, and treatment gains were maintained over 5 months. Limitations and future considerations for behavior reduction procedures with adults are discussed.

中文翻译：

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与具有刻板皮肤采摘的成年人一起使用竞争性刺激：评估、治疗和概括的案例研究

竞争刺激评估 (CSA) 用于识别与高参与度和低水平问题行为相关的刺激。然而，很少有研究将 CSA 结果用于有问题行为的成年人。本研究的目的是通过针对成年人的自伤皮肤采摘来扩展先前的文献，同时将护理人员纳入治疗和检查减少维护。Noelle 是一名 27 岁的女性，被诊断出患有自闭症谱系障碍和智力障碍，被转诊到重症门诊。功能评估结果表明，皮肤采摘是通过自动强化来维持的。治疗包括非偶然获得通过 CSA 确定的具有反应中断和反应促进策略的竞争刺激。这种干预将皮肤采摘率降低到接近于零的水平，由护理人员有效实施，并且治疗效果保持了 5 个月以上。讨论了成人行为减少程序的局限性和未来考虑。