How can such an approach be implemented that takes into account the specifics of Sam's behavioral presentation and skill deficits? At least three major reinforcers can be identified in the case description: alone time, an involvement with music, and the attention of multiple caretakers. It appears that caretaking is reinforcing a maintenance level of existence in which the skills needed for autonomous functioning are unnecessary. Presumably the acquisition of such skills would jeopardize this important reinforcer. Sam's involvement with music appears to be part of how he "self-reinforces" while alone. Isolation is, of course, part of his axis II disorder. However, a behavioral analysis of this component would not focus on isolation as a static symptom of a disease process but rather as behavior developing within the context of Sam's reinforcement history. At this point, his isolation leaves him susceptible to medication nonadherence, decompensation, and danger to self and serves as a signal summoning multiple caregivers, whose very presence reinforces the isolation they may be seeking to decrease.