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Reliability analysis of the Motivational Assessment Scale
Abstract
The motivation Assessment Scale (MAS) has been proposed as an efficient questionnaire for identifying the source of reinforcement for an individual's self-injurious behavior (SIB). A previous reliability analysis of the MAS (Durand & Crimmins, 1988) reported interrater correlation coefficients ranging from .66 to .92, based on a comparison of responses provided by classroom teachers. In this study, the reliability of the MAS was reexamined with two independent groups of developmentally disabled individuals who exhibited SIB (N = 55). For the institutional sample (n = 39), the MAS was given to two staff members (a supervisor and therapy aide) who work with the individual daily. For the school sample (n = 16), the MAS was given to the teacher and teacher's aide who taught the student. The correlational analyses completed by Durand and Crimmins (1988) were repeated; in addition, a more precise analysis of interrater reliability was calculated based on the actual number of scoring agreements between the two raters. Results showed that only 16 of the 55 raters agreed on the category of reinforcement maintaining their client's or student's SIB, that only 15% of the correlation coefficients obtained were above .80, and that none of the reliability scores based on percent agreement between raters was above 80%.
... reactions right after a behavioral occurrence, (viii) how does the student typically communicate, and what efforts have already been made to reduce the behavior. The advantage of these interviews includes providing the informants with an opportunity to explain scenarios in detail, however, this can also present as a disadvantage as there may be errors or biases in the interpretation of the informants' choice of explanation (Lennox & Miltenberger, 1989;Zarcone et al., 1991). ...
... In this respect, these scales can be relatively easy to administer and score, however, the research demonstrates that reliability of these instruments tend to be low. For instance, the FAST has a reliability of only 67%, whereas the reliability of the MAS is an extremely low 20% (Lennox & Miltenberger, 1989;Zarcone et al., 1991). The greatest disadvantage with using indirect methods is that informants are relying on memory of events, mixed in with their own biases, thoughts, and opinions, thus, the data are very subjective in nature (Lennox & Miltenberger, 1989;Zarcone et al., 1991). ...
... For instance, the FAST has a reliability of only 67%, whereas the reliability of the MAS is an extremely low 20% (Lennox & Miltenberger, 1989;Zarcone et al., 1991). The greatest disadvantage with using indirect methods is that informants are relying on memory of events, mixed in with their own biases, thoughts, and opinions, thus, the data are very subjective in nature (Lennox & Miltenberger, 1989;Zarcone et al., 1991). Given this subjectivity, the information provided may be inaccurate and as a result, lead to an incorrect conclusion about the function of the behavior. ...
A functional behavior assessment is an evidence-based process that identifies the function of challenging behaviors in order for educators to develop behavior intervention plans for students with disabilities. All behaviors are under stimulus control and research indicates that behaviors typically serve four functions: tangible, escape, attention, and automatic. However, when individuals with developmental disabilities engage in inappropriate sexual behaviors such as exposing their genitalia in public places or groping a stranger, it is not typical for practitioners to implement this functional behavior assessment process as these sexual behaviors are often viewed as different from non-sexual inappropriate behaviors like screaming in class or throwing school materials. This article presents information of how to complete a comprehensive functional behavior assessment for three students with developmental disabilities who exhibit sexually inappropriate behaviors in school settings to highlight the usefulness of the functional behavior assessment process for developing behavior intervention plans for long lasting behavior change
... 대표적으로는 행동기능질문지(Questions about Behavioral Function; QABF, Paclawskyj et al., 2000)와 동기평정척도 I & II(Motivation Assessment Scale; MAS, Durand & Crimmins, 1988;Haim, 2002) (Applegate, Matson, & Cherry, 1999;Simó-Pinatella, et al., 2014;Healy et al., 2013). 또 다른 연구에서는 공격행동 뿐 아니라 자해와 상동행동 역시 사회적 강화의 일부 인 회피기능을 보인다고 보고한다 (Rojahn et al., 2012 (Sigafoos, Kerr, & Roberts, 1994;Zarcone et al., 1991), 자해행동의 경우 관찰자 간 일치도가 높았던 반면 (Zarcone et al.,1991), 공격행동에서는 이러한 일치도가 나타나지 않았다 (Sigafoos et al., 1994). 하지만 관찰자간 신뢰도를 파악한 경우에도, 치료사 및 기관종사자끼리 (Paclawskyj et al., 2000;Sigafoos et al., 1994;Zarcone et al.,1991), 혹은 교사 (Zarcone et al., 1991) ...
... 대표적으로는 행동기능질문지(Questions about Behavioral Function; QABF, Paclawskyj et al., 2000)와 동기평정척도 I & II(Motivation Assessment Scale; MAS, Durand & Crimmins, 1988;Haim, 2002) (Applegate, Matson, & Cherry, 1999;Simó-Pinatella, et al., 2014;Healy et al., 2013). 또 다른 연구에서는 공격행동 뿐 아니라 자해와 상동행동 역시 사회적 강화의 일부 인 회피기능을 보인다고 보고한다 (Rojahn et al., 2012 (Sigafoos, Kerr, & Roberts, 1994;Zarcone et al., 1991), 자해행동의 경우 관찰자 간 일치도가 높았던 반면 (Zarcone et al.,1991), 공격행동에서는 이러한 일치도가 나타나지 않았다 (Sigafoos et al., 1994). 하지만 관찰자간 신뢰도를 파악한 경우에도, 치료사 및 기관종사자끼리 (Paclawskyj et al., 2000;Sigafoos et al., 1994;Zarcone et al.,1991), 혹은 교사 (Zarcone et al., 1991) ...
... 또 다른 연구에서는 공격행동 뿐 아니라 자해와 상동행동 역시 사회적 강화의 일부 인 회피기능을 보인다고 보고한다 (Rojahn et al., 2012 (Sigafoos, Kerr, & Roberts, 1994;Zarcone et al., 1991), 자해행동의 경우 관찰자 간 일치도가 높았던 반면 (Zarcone et al.,1991), 공격행동에서는 이러한 일치도가 나타나지 않았다 (Sigafoos et al., 1994). 하지만 관찰자간 신뢰도를 파악한 경우에도, 치료사 및 기관종사자끼리 (Paclawskyj et al., 2000;Sigafoos et al., 1994;Zarcone et al.,1991), 혹은 교사 (Zarcone et al., 1991) ...
Although identification of the function of problem behavior can be influenced by observers or types of problem behaviors, there is lack of studies analyzing these factors. The purpose of this study, which is focused on people with developmental disabilities, was to identify the functions of problem behaviors reported by three different groups of caregivers(teachers, staff/therapists, and parents), and types of problem behaviors(self-injurious, attack, destroy, stereotype, tantrum, others). Total of 473 participants answered basic information record and Functional Assessment for the Challenging/Problem Behaviors (FAPB). Results show that there was no significant difference in function of problem behavior across observers, but the main effect of the problem behavior type was observed. As a result of post-analysis of observer variables, demand was reported the least in the parent group. Attack and self-injurious behavior were significantly related to demand and avoidance, which was consistent with previous studies. interaction between two independent variables was not significant. Utilization of the result in the clinical field and further research was suggested.
... However, the results of subsequent evaluations have yielded more variable results. In marked contrast to the initial reports, Zarcone, Rodgers, Iwata, Rourke, and Dorsey (1991) evaluated interrater reliability of the MAS for 55 subjects, a sample mixed with respect to setting (school and residential) and problem behavior, and found that mean score correlation coefficients on categories ranged from -.80 to .99 (M = .41). Furthermore, these authors calculated exact agreement scores and adjacent agreement scores (where an agreement was counted if one rater's score fell within plus or minus 1 of the other rater's score) and found agreement percentages with means of 20% and 48%, respectively. ...
... Of the studies listed above, three reported agreement measures on primary function, again with varied results. Zarcone et al. (1991) found that in only 16 of the 55 administrations (29.1%) did raters agree on the primary function of the behavior. Sigafoos et al. (1994) found agreement for 8 of 18 pairs (44.44%). ...
... Another study of note was conducted by Arndorfer, Miltenberger, Woster, Rorvedt, and Gaffaney (1994), who measured test-retest reliability (after 1-2 weeks) of the MAS using correlation coefficients and the adjacent agreement method described by Zarcone et al. (1991). ...
... The information gathered from indirect assessments may be used to develop treatments for self-injury or to provide a foundation for a more direct assessment. In weighing benefits and limitations of indirect assessments, most practitioners recommend that they should not be used as a sole source of information but rather in conjunction with direct assessment methods (e.g., Zarcone, Rodgers, Iwata, Rourke, & Dorsey, 1991). ...
... Or, for example, the assessment could be administered to the teacher at one point in time and then again at another point in time. The reliability studies on indirect assessments have yielded mixed results (e.g., Durand and Crimmins (1988); Arndorfer, Miltenberger, Woster, Rortvedt, & Gaffaney, 1994;Zarcone, Rodgers, Iwata, Rourke, & Dorsey, 1991). Durand and Crimmins (1988) administered the MAS to classroom teachers of students who engaged in severe problem behavior including self-injury. ...
... The authors reported a high level of inter-rater reliability (e.g., correlation coefficients ranging from 0.62 to 0.90). Zarcone, Rodgers, Iwata, Rourke, and Dorsey (1991) conducted a replication of the study with both teachers and direct care staff of 55 individuals who engaged in self-injury. In addition to the overall correlation coefficient calculation, Zarcone et al. evaluated point-to-point correspondence between responses to specific questions. ...
... In other words, the degree to which two caregivers agreed on the same item was not evaluated. Follow-up studies on the MAS failed to yield high levels of inter-rater reliability when researchers used itemby-item agreement (Conroy et al., 1996;Duker & Sigafoos, 1998;Sigafoos et al., 1994;Zarcone et al., 1991). Nicholson et al. (2006) evaluated the inter-rater reliability for the QABF and reported agreement scores between 69.5-84.8%. ...
... High test re-test reliability has been reported for the QABF (Nicholson et al., 2006;Paclawskyj et al., 2000) and the MAS (Durand & Crimmins, 1988a, 1988b. However, these findings have not been replicated (e.g., Zarcone et al., 1991;Conroy et al., 1996;Barton-Arwood et al., 2003). ...
... Most indirect assessments suffer from poor interrater reliability, which is defined as the extent to which two independent raters (or interviewers) produce the same rating or results regarding the conditions under which problem behavior occurs after the interview is administered (Barton-Arwood, Wehby, Gunter, & Lane, 2003;Iwata, DeLeon, & Roscoe, 2013;Sigafoos, Kerr, & Roberts, 1994;Zarcone, Rodgers, Iwata, Rourke, & Dorsey, 1991). For example, Zarcone et al. (1991) evaluated interrater agreement of the Motivation Assessment Scale (MAS) by administering the interview to teachers, teachers' aids, and therapists working with individuals who engaged in self-injurious behavior. ...
... Most indirect assessments suffer from poor interrater reliability, which is defined as the extent to which two independent raters (or interviewers) produce the same rating or results regarding the conditions under which problem behavior occurs after the interview is administered (Barton-Arwood, Wehby, Gunter, & Lane, 2003;Iwata, DeLeon, & Roscoe, 2013;Sigafoos, Kerr, & Roberts, 1994;Zarcone, Rodgers, Iwata, Rourke, & Dorsey, 1991). For example, Zarcone et al. (1991) evaluated interrater agreement of the Motivation Assessment Scale (MAS) by administering the interview to teachers, teachers' aids, and therapists working with individuals who engaged in self-injurious behavior. They obtained only 29% agreement between raters when comparing reinforcement categories that were hypothesized to maintain the client's problem behavior. ...
Indirect assessments are a commonly used component of functional behavior assessment by behavior analysts in practice who work with individuals with severe behavior disorders. Although used frequently, closed-ended indirect assessments have repeatedly been shown to have low to moderate interrater reliability and poor concurrent validity with functional analysis. Recently, the use of open-ended interviews has become more commonly adopted in applied clinical practice, despite no studies evaluating the psychometric properties of such assessments. In the present study, we evaluated the interrater reliability and concurrent validity of an open-ended functional assessment interview. We compared the results of two open-ended indirect assessments conducted with a common caregiver and subsequently conducted functional analyses in an attempt to validate hypotheses generated from the interviews. Interrater agreement for the open-ended interviews was higher than previous research on closed-ended interviews (75%); however, concurrent validity with functional analysis was relatively poor (50%). We discuss these findings in the context of assessment and treatment for severe behavior disorders, as well as best practice methods during functional behavior assessment.
... Over the past few years, researchers in ABA have examined the utility of FBA questionnaires (Herzinger & Campbell, 2007;Horner, 1994;Iwata & DeLeon, 1996;Iwata & Dozier, 2008;Matson et al., 2011), such as the Motivational Assessment Scale (MAS; Durand & Crimmins, 1988, 1992 and the Functional Analysis Screening Tool (FAST; Iwata & DeLeon, 1996). The MAS had frequently been utilized prior to the FAST's development, but research has provided evidence that the tool is not reliable (Sigafoos, Kerr, Roberts, & Couzens, 1993;Zarcone, Rodgers, Iwata, Rourke, & Dorsey, 1991). Zarcone et al. (1991) reexamined the reliability of the MAS and found a poor interrater reliability of 20% for the tool. ...
... The MAS had frequently been utilized prior to the FAST's development, but research has provided evidence that the tool is not reliable (Sigafoos, Kerr, Roberts, & Couzens, 1993;Zarcone, Rodgers, Iwata, Rourke, & Dorsey, 1991). Zarcone et al. (1991) reexamined the reliability of the MAS and found a poor interrater reliability of 20% for the tool. Similar to Zarcone et al.'s (1991) study, Sigafoos et al. (1993) found that the lowest percentage of interrater agreement, an overall mean of 43% across participants and questions, was on questions that were most indicative of behavioral function. ...
This study examined the extent to which using functional communication training (FCT) in a delayed gratification context reduced temper tantrums in children with autism spectrum disorders (ASD). Three children with ASD whose mean age was 3 and a half year old participated in the study. In the first phase, a functional behavioral assessment (FBA) was conducted to identify the functions of the participants' temper tantrums. Then, a stimulus preference assessment was utilized to determine the appropriate reinforcers to be used in each treatment session. Next, a multiple baseline across participants design was used to reduce temper tantrums and increase the use of appropriate communication behaviors, i.e., FCT. Once FCT was taught, delayed gratification interventions were implemented by manipulating three conditions: (a) a fixed time delay (FD), (b) a progressive time delay with verbal praises (PDVP), and (c) a progressive time delay with visual cues (PDVC). A multiple baseline, multi-element design across participants was used to compare the three conditions and determine which was the most effective in teaching delayed gratification. The behavioral changes in participants' temper tantrums, use of alternative communicative behaviors taught by FCT, and the ability to wait were measured through direct observations by two independent observers. The results showed that the progressive time delay with visual cues (PDVC) was the most effective intervention that promoted the participants' ability to wait and decreased their temper tantrums. Based on the evaluation of the findings, implications and future research directions are discussed. Keywords: autism spectrum disorders (ASD), fixed time delay (FD), functional communication training (FCT), progressive time delay with visual cues (PDVC), progressive time delay with verbal praises (PDVP) iv
... Across studies of IAs, one area that has received little investigation is the specific respondents. Although researchers have repeatedly found that caregivers cannot reliably predict the function of problem behavior (e.g., Paclawskyj et al., 2001;Zarcone et al., 1991), other respondents may be better able to reliably and accurately identify the function of problem behavior. For example, a Board Certified Behavior Analyst ® (BCBA ® ) trained in the design and implementation of FBA and function-based treatment ("experts") may be better able to accurately identify the environmental variables that evoke and maintain problem behavior than caregivers. ...
... For example, although caregivers may be restricted to one environment (e.g., parents at home, teachers at school), professionals may observe an individual across multiple environments. Therefore, following brief observations, an expert may be able to complete an IA and use those results to design a valid, yet more efficient, FA as compared to relying on unreliable caregiver IA results (e.g., Paclawskyj et al., 2001;Zarcone et al., 1991). ...
Clinicians often conduct indirect assessments (IAs; e.g., Durand & Crimmins, 1988; Iwata, DeLeon, & Roscoe, 2013; Matson & Vollmer, 1995) such as questionnaires and interviews with caregivers to gain information about the variables influencing problem behavior. However, researchers have found poor reliability and validity of IAs with respect to determining functional variables. There are numerous variables that might influence the efficacy of IAs as an assessment tool, one of which is the skill set of the person completing the IA. For example, it may be possible to increase the validity and reliability of IAs by having individuals with certain skill sets such as a background in behavior analysis and FBA (“experts”) complete them. Thus, the purpose of this study was to compare the reliability (i.e., agreement with respect to function and specific IA questions) and validity (i.e., agreement between the outcome of IAs and a functional analysis) of IAs completed by caregivers and “experts” for each of eight children who emitted problem behavior. We found that experts were more likely than caregivers to agree on IA outcomes with respect to (a) overall interrater agreement, (b) item-by-item agreement, and (c) the highest-rated function(s) of problem behavior. Experts were also more likely to correctly identify the function(s), based on comparisons of the results of the IAs and FAs. In addition, caregivers were more likely to (a) disagree on hypothesized functions and (b) identify multiple incorrect functions. The use of experts for completing IAs could have significant impact on their utility and provide a novel method for more rapidly completing the FBA process and developing a function-based treatment.
... Several researchers have examined the predictive validity of indirect functional assessments by comparing the results of these measures with the findings of a traditional FA, and the results have typically yielded unacceptably low levels of agreement between the two approaches (e.g., Newton & Sturmey, 1991;Paclawskyj, Matson, Rush, Smalls, & Vollmer, 2001;Zarcone, Rodgers, Iwata, Rourke, & Dorsey, 1991). The results of studies that have examined the predictive validity of direct assessments using traditional FAs as the criterion variable have produced similarly disappointing results (e.g., Lerman & Iwata, 1993;Piazza et al., 2003;St. ...
... Unfortunately, with the current participants, the IISCA was no more accurate than other approaches that rely heavily on the results of indirect and direct assessments. That is, the individualized IISCA that we developed from the indirect and direct measures produced no appreciable improvements in predictive validity over levels of convergence with a traditional FA observed in prior studies (e.g., Lerman & Iwata, 1993;Paclawskyj et al., 2001;Thompson & Iwata, 2007;Zarcone et al., 1991). Similar to the results of direct assessment methods, the openended interview and structured observations most often erroneously implicated contingent attention as a reinforcer for problem behavior (Thompson & Iwata, 2001, 2007. ...
Researchers typically modify individual functional analysis (FA) conditions after results are inconclusive (Hanley, Iwata, & McCord, 2003). Hanley, Jin, Vanselow, and Hanratty (2014) introduced a marked departure from this practice, using an interview-informed synthesized contingency analysis (IISCA). In the test condition, they delivered multiple contingencies simultaneously (e.g., attention and escape) after each occurrence of problem behavior; in the control condition, they delivered those same reinforcers noncontingently and continuously. In the current investigation, we compared the results of the IISCA with a more traditional FA in which we evaluated each putative reinforcer individually. Four of 5 participants displayed destructive behavior that was sensitive to the individual contingencies evaluated in the traditional FA. By contrast, none of the participants showed a response pattern consistent with the assumption of the IISCA. We discuss the implications of these findings on the development of accurate and efficient functional analyses.
... Therefore, the strengths of the indirect assessment come from its ability to be conducted at the caregivers' convenience without placing anyone in danger of being exposed to SIB. These practical considerations, however, come at the expense of efficacy, and indirect assessments have been found to have limited reliability and concurrent validity Zarcone et al., 1991). With that being said, closed-ended indirect assessments (i.e., questions that can only be answered from a select list provided) may not be particularly useful for informing function-based treatment, and answers are likely to vary depending on who you ask. ...
Self-injurious behavior (SIB) has the potential to inflict severe bodily harm on an individual who exhibits a particularly worrisome challenging behavior. The best practice for treating SIB involves a process of identifying environmental contributors to problem behavior (i.e., functional assessment) and presenting those identified contributors in a manner that eliminates any contingent relation between SIB and reinforcement. Although multiple behavioral treatment strategies exist for reducing problem behavior, the most successful outcomes have been associated with a comprehensive strategy that includes teaching a range of skills to replace SIB, such as communication skills, tolerance skills, and cooperation skills. Special considerations are necessary for SIB sensitive to automatic reinforcement and the pervasiveness of those who exhibit SIB to experience trauma. We discuss how a trauma-informed framework can be incorporated with comprehensive strategies for reducing SIB.
... Test-retest reliability estimates for measures of behavioural function may be influenced by behavioural presentation, the frequency of behaviour (Matson & Wilkins, 2009), or the extent of operationalisation to ensure the same behaviour is being rated between informants or test and retest administrations (McAtee et al., 2004). More frequent BtC may provide informants with more information to identify contingencies with increased reliability when compared to less frequent behaviour; therefore, lower reliability estimates obtained for some measures may be attributable to lower frequencies of behaviour topographies or ambiguity of subscales (Durand & Crimmins, 1988;Matson & Wilkins, 2009;Zarcone, Rodgers, Iwata, Rourke, & Dorsey, 1991). ...
Behaviours that challenge (BtC) are common in people with intellectual disability (ID) and associated with negative long-term outcomes. Reliable characterisation of BtC and behavioural function is integral to person-centred interventions. This systematic review and meta-analytic study quantitatively synthesised the evidence-base for the internal consistency, inter-rater reliability, and test-retest reliability of measures of BtC and behavioural function in people with ID (PROSPERO: CRD42021239042). Web of Science, Embase, PsycINFO and MEDLINE were searched from inception to March 2024. Retrieved records (n = 3691) were screened independently to identify studies assessing eligible measurement properties in people with ID. Data extracted from 83 studies, across 29 measures, were synthesised in a series of random-effects meta-analyses. Subgroup analyses assessed the influence of methodological quality and study-level characteristics on pooled estimates. COSMIN criteria were used to evaluate the measurement properties of each measure. Pooled estimates ranged across measures: internal consistency (0.41–0.97), inter-rater reliability (0.29–0.93) and test-retest reliability (0.52–0.98). The quantity and quality of evidence varied substantially across measures; evidence was frequently unavailable or limited to a single study. Based on current evidence, candidate measures with the most evidence for internal consistency and reliability are discussed; however, continued assessment of measurement properties in ID populations is a key priority.
... These methods may help to identify relevant stimuli to assess further but are neither observational nor experimental. Therefore, they can only provide correlational but not causational information about possible consequences that maintain problem behavior and have mixed psychometric evidence supporting their reliability and validity (e.g., Zarcone et al., 1991). These tools may be a useful starting place for identifying potential sources of reinforcement to test in later analysis (Sturmey, 1994), but the information gained rarely identifies sources of reinforcement without additional assessment. ...
... This study contributes an SRL instrument with good overall internal consistency and acceptable levels or reliability at its Forethought and Self-reflection subscales. The lower levels of internal consistency in the Performance subscale may be due to too few items in each subscale or that the open-ended question prompts included may have signalled the items as challenging or provided a sense of ambiguity to students with SEN (Zarcone et al., 1991). The instrument has been validated with mainstream students (H. ...
Self-regulated learning (SRL) has been promoted as playing a key role in proactive, life-long learning. The present study aimed to investigate the effect of different types of teacher feedback on students’ self-regulated learning (SRL) in a special educational needs (SEN) context. It employed a mixed method, quasi-experimental with repeated-measures pre-test-treatment-post-test design. Forty-five students from a SEN school were explicitly taught SRL strategies over nine sessions. Participants were divided into two matched groups and provided different types of feedback (DF group) or corrective feedback only (CF group). Data was collected from individual interviews and student artefacts. Consistent with research on the benefits of explicit SRL instruction in mainstream school contexts, this study in the SEN context found statistically significantly higher student SRL scores at post-test than pre-test. Comparing scores between the feedback groups turned out not statistically significant. However, insightful qualitative differences were found in analyses of assignments and interview data at all three phases of SRL. Findings coalesced around the themes of Skill and Will, providing insights to students’ motivation and affect, influencing student volition. These findings suggest both changes at the practice and policy level in SEN contexts to bring about feedback-rich learning environments to facilitate SRL.
... Beyond the difficulties sometimes reported regarding validity and reliability of indirect functional assessments (e.g., Lerman & Iwata, 1993;Piazza et al., 2003;Thompson & Iwata, 2007;Zarcone, Rodgers, Iwata, Rourke, & Dorsey, 1991), and the fact that their samples were smaller, other procedural and sampling issues may help to reconcile this discrepancy across studies. Dawson et al. (1998) included only individuals diagnosed with profound mental retardation, who may be less prone to socially mediated behavior independent of ASD diagnosis; whereas the sample in our analysis included individuals across the entire range of cognitive functioning. ...
... These calculated values create additional concerns of their own, the assumption now being that some number exists that reliably corresponds to a functional relation. Unfortunately, correspondence between closed-ended interviews and functional analyses have been found to be quite low (e.g., Iwata et al., 2013;Paclawskyj et al., 2001;Zarcone et al., 1991), suggesting that indirect measures may not be useful in replacing functional analyses. Instead, it is probably best to use them supplemental to other functional assessment procedures (Hanley, 2012). ...
Problem behavior exhibited by individuals diagnosed with autism spectrum disorder (ASD) can be quite debilitating and can take many forms such as aggression, self-injurious behavior, or property destruction. The applied behavior analytic (ABA) approach to treating problem behavior involves understanding the circumstances that are contributing to problem behavior and re-arranging the contextual variables (i.e., antecedents and consequences) to support an appropriate repertoire. The two-part process involves conducting a functional assessment and implementing a function-based treatment. In this chapter we identify different functional assessment approaches and multiple function-based treatment strategies that have been empirically validated in the ABA literature. In addition, we describe a comprehensive ABA approach intended to reduce problem behavior and improve a set of complex skills to ensure successful reintegration into the home or school environment.
... This is not to say that indirect and descriptive assessments have no purpose. Many researchers have pointed out the shortcomings of closedended approaches for implicating general classes of reinforcement (e.g., Thompson & Iwata, 2007;Zarcone et al., 1991), but open-ended approaches that obtain qualitative information have been empirically validated as a means for identifying individualized and ecologically relevant contingencies to be evaluated during subsequent functional analyses . That is, closed-ended assessments that force the implementer to choose between predetermined functions of problem behavior tend to lack correspondence with the outcomes of the more empirically rigorous, functional analysis (Fryling & Baires, 2016). ...
The practical functional assessment (PFA) is a three-step process designed to evaluate problem behavior’s sensitivity to individualized contingencies informed by caregivers in an efficient manner. The PFA begins with an open-ended interview collecting qualitative information from caregivers used to inform the development of a synthesized contingency. That contingency is then calibrated during a brief observation and validated during the subsequent functional analysis, which has been uniquely termed the interview-informed, synthesized contingency analysis (IISCA) based on its commitment to five core procedural components. Multiple IISCA formats currently exist, each improving elements of practical relevance such as efficiency, safety, and ecological validity. Function-based treatments using the results of the PFA have been found to produce socially meaningful change in problem behavior on repeated occasions across individuals and settings, leading to the PFAs classification as a practical and effective alternative to more intensive approaches to functional assessment.
... According to Kazdin (2011), there are various ways to assess the reliability of a particular assessment tool (e.g., test-retest, internal consistency, interrater), each of which speaks to different ways in which the assessment may or may not produce consistent findings. With respect to indirect functional assessments for problem behavior, interrater reliability has most commonly been evaluated and refers to the degree to which two individuals agree on hypotheses regarding the variables influencing problem behavior (e.g., Alter et al., 2008;Barton-Atwood et al., 2003;Fisher et al., 2016;Iwata et al., 2013;Newton & Sturmey, 1991;Saini et al., 2019;Sigafoos et al., 1994;Zarcone et al., 1991). It has been argued that this type of reliability is a necessary precondition for an assessment's validity-a construct that generally describes the accuracy with which an assessment identifies the variables influencing behavior (Cooper et al., 2019;Hanley, 2010Hanley, , 2012Iwata & Dozier, 2008;Johnston et al., 2019). ...
Saini et al. (2019) urged caution with respect to the use of practical functional assessment (PFA) procedures to inform behavioral treatment when they found that responses to an open-ended caregiver interview were only somewhat reliable and showed moderate to weak correspondence with analog functional analyses. Because the practitioner’s goal in conducting any functional assessment process is to inform the successful treatment of problem behavior, we replicated and extended Saini et al. by (a) evaluating the reliability of hypotheses gleaned from two independent PFA processes for each of four children, (b) conducting treatment informed by a randomly assigned PFA, and (c) determining the extent to which potentially different levels of reliability impacted the treatment utility of the PFA process. Results indicated that the reliability of the PFA process varied depending on the stringency with which it was evaluated. However, treatments developed from randomly determined PFA processes produced efficacious outcomes on problem behavior and targeted social skills that transferred to the context designed from the other PFA process in all evaluations, suggesting that the PFA has strong treatment utility despite parts of the process having ambiguous levels of reliability. We discuss implications for practitioners tasked with treating severe problem behavior.
... In fact, of the 90% of respondents that reported using functional behavior assessments, most reported using descriptive assessments more frequently than FAs, and 54% of respondents reported that they believed descriptive assessments were as useful as FAs. Given the unreliability of indirect function-based assessment methods (e.g., Zarcone et al., 1991) and the lack of correspondence between descriptive assessments and FA outcomes (e.g., Borrero et al., 2016), clinicians could be over-identifying attention as a reinforcer (Thompson & Iwata, 2007). We have anecdotally observed that some caregivers struggle to withhold attention when their child engages in inappropriate mealtime behavior; in some cases, they do not realize they have provided attention until given feedback or when shown videos of their own behavior. ...
Previous literature supports the use of functional analyses to prescribe treatments for children with feeding disorders (Bachmeyer et al., 2009). Nevertheless, clinicians often train caregivers to use healthy contingencies, independent of whether those contingencies are function based. However, it is unclear whether including nonfunction-based contingencies differentially affects inappropriate mealtime behavior. In the current investigation, the caregivers of 3 children with feeding disorders provided escape from bites and drinks and attention following inappropriate mealtime behavior. Results of a functional analysis showed escape from bites or drinks, but not attention, reinforced inappropriate mealtime behavior. We then tested the effects of escape extinction when the feeder either provided or withheld attention following inappropriate mealtime behavior. Inappropriate mealtime behavior decreased and acceptance increased when the feeder implemented escape extinction independent of whether they provided or withheld attention. We discuss the implications of including nonfunction-based components in the treatment of pediatric feeding disorders.
... • Motivation Assessment Scale (M.A.S., [13][14][15][16]) ...
The prevalence of challenging behaviours and psychopathologies is particularly high in people with autism spectrum disorder (ASD) both during the developmental and adult age. These two states, often overlapping or confused, produce a significant deterioration of the quality of life of people with autism and their caregivers. Today the scientific evidence we possess does not allow us to cure people with autism, but it significantly reduces both challenging behaviours and psychopathologies by improving not only the subjective well-being of people with ASD, but also their adaptive behaviour and their chances of social inclusion. The chapter will review the most successful methodological approaches to the treatment of challenging behaviours starting from the differential diagnosis of psychopathology and the definition of the problematic nature of challenging behaviours, to the identification of the functional value of behaviour and the most effective treatments.
... To illustrate, a recent investigation found the Functional Analysis Screening Tool (Iwata & DeLeon, 1995), a function-specific rating scale, identified the correct function of behavior in only 63.8% of 69 cases (Iwata, DeLeon, & Roscoe, 2013). Additional studies have found the Motivation Assessment Scale (Durand & Crimmins, 1988), another rating scale, to yield inconsistent interrater reliability, resulting in variance in functional decisions across raters (Zarcone, Rodgers, Iwata, Rourke, & Dorsey, 1991). Beyond these specific tools, more general concerns might be raised in relation to indirect data sources. ...
The purpose of this study was to evaluate the reliability, validity, and accuracy of scores from the Intervention Selection Profile-Function (ISP-Function): a brief functional assessment tool founded upon Direct Behavior Rating (DBR) methodology. Participants included 34 teacher-student dyads. Using the ISP-Function, teachers rated the extent to which students exhibited disruptive behavior, as well as the frequency with which disruptions were met with four consequences. Ratings were completed across three 10-min sessions, during which a research assistant also collected systematic direct observation (SDO) data regarding the same behavior and consequences. Results indicated adequate temporal reliability (≥.70) was attained for the adult attention and peer attention targets across the three ratings; in contrast, up to 8-18 data points would be needed to achieve adequate reliability across the remaining targets. Findings further suggested that while ISP-Function ratings of disruptive behavior, adult attention, and peer attention were moderately to highly correlated with SDO data, correlations were in the low range for the access to items/activities and escape/avoidance targets. Finally, analysis of difference scores showed that on average, mean ISP-Function scores fell within only 0.33 to 1.81 points of mean SDO scores (on the 0-10 DBR scale). Agreement coefficients indicative of exact score agreement were less consistent, suggesting accuracy ranged from poor to substantial. Results are promising, but future research is necessary to support applied ISP-Function use. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
... Overall, many studies that have evaluated coping-skills interventions have only shown qualitative improvements in behavior, such as a teacher's report that problem behavior decreased (Prinz, Blechman, & Dumas, 1994), which could be unreliable (Zarcone, Rodgers, Iwata, Rourke, & Dorsey, 1991). Further investigation is needed to assess quantitative decreases in problem behavior and the actual use of coping skills by participants. ...
Coping skills, such as diaphragmatic breathing, are commonly recommended to help individuals work through challenging situations. We evaluated diaphragmatic breathing as treatment for aggression of three individuals diagnosed with autism spectrum disorder or Angelman syndrome. Functional analysis results demonstrated that each participant engaged in aggression maintained by social‐negative reinforcement. Diaphragmatic breathing treatment without extinction was conducted in a work context and involved prompting diaphragmatic breathing contingent on precursors to aggression; treatment was effective in reducing the rate of aggression for one of three participants. For the two other participants, other reinforcement‐based interventions (differential reinforcement of other behavior or functional communication training with extinction) were necessary to decrease aggression.
... An experimental-psychopathology approach to treatment is considered the standard of care in other populations (e.g., treating behavior problems in individuals with intellectual disabilities [ID]) and involves direct manipulation of variables that contribute to the maintenance or exacerbation of problem behavior (Forsyth & Zvolensky, 2001). Although structured interviews and other forms of indirect functional assessment are consistent with the goals of an experimental-psychopathology approach, their results do not always converge with those of more rigorous experimental analyses in persons with ID (e.g., Iwata, DeLeon, & Roscoe, 2013;Zarcone, Rodgers, Iwata, Rourke, & Dorsey, 1991) or in persons with tic disorders. For example, Barnea et al. (2016) asked participants via indirect assessment to evaluate how specific contexts influenced their tics, then observed the participants in these contexts and compared the correspondence between the two measures. ...
Tic disorders are characterized by a class of responses assumed to be neurobiological in origin. Still, several studies have shown that tic frequency can be influenced by antecedent environmental events and social consequences. Prior reviews have summarized the effects of environmental events but have not examined relations between tic diagnosis, behavioral deficits (e.g., intellectual disability), tic topography, and the consequences observed to maintain tics. These variables might be important when attempting to predict or identify relevant consequences. A more thorough understanding of the variables that maintain and give rise to tics might also be useful in predicting responsiveness to treatment and intervention refinement. We reviewed and summarized results from the 13 attempts to experimentally identify maintaining consequences for tics (i.e., functional analyses) that have been published to date. We examined patterns of functions across tic diagnoses (i.e., Tourette's syndrome or not), communication impairments (i.e., an intellectual disability or reported language difficulty), and tic topography. Results suggested that individuals with Tourette's syndrome and those without communication impairments are more likely to have functional analysis outcomes consistent with automatic reinforcement, but exceptions in both directions highlight the utility of functional analysis in treating tics.
... Furthermore, bias may lead the teacher to report that they SIB occurred because the student did not want to do their work, as opposed to reporting the consequence (i.e., the student was given a break) that occurred, the teacher may also forget about instances of the behavior that have happened in the past. Due to the serious limitations of indirect assessments multiple authors have recommended using direct assessments in conjunction with indirect assessments (Beavers, Iwata, & Lerman, 2013;Iwata et al., 2013;Smith, Smith, Dracobly, & Pace, 2012;Vollmer et al., 2009, Zarcone, Rodgers, Iwata, Rourke, & Dorsey, 1991 ...
Self-injurious behavior (SIB) is a behavior which produces physical injury to the individual’s own body. Common forms of SIB include, but are not limited to, head banging, biting, scratching, skin picking, hair pulling, pinching, and eye gouging. Among individuals with intellectual and developmental disabilities (IDD), there is a higher prevalence of SIB in children than in adults. Proper measurement (e.g., frequency and duration) and assessment (i.e., direct and indirect) of SIB are needed prior to starting treatment. In this chapter, we review the assessment and treatment procedures found to be effective in reducing and eliminating SIB in children with IDD.
... The lower level of consistency may be due to the fact that some of ratings on these scales require memories and speculation rather than observation. However, there exists research in the area of functional behavior analysis (Newton & Sturmey, 1991;Paclawskyj et al., 2001;Sigafoos, Kerr, & Roberts, 1994;Thompson & Emerson, 1995;Shogren & Rojahn, 2003;Zarcone, Rodgers, Iwata, Rourke, & Dorsey, 1991) that supports the position that the findings of this research transfer to ratings of adaptive behavior. ...
The question as to whether the assessment of adaptive behavior (AB) for evaluations of intellectual disability (ID) in the community meet the level of rigor necessary for admissibility in legal cases is addressed. AB measures have made their way into the forensic domain, in which scientific evidence is put under great scrutiny. Assessment of ID in capital murder proceedings has garnished a lot of attention, but assessments of ID in adult populations also occur with some frequency in the context of other criminal proceedings (e.g., competence to stand trial, competence to waive Miranda rights), as well as eligibility for social security disability, social security insurance, Medicaid/Medicare, government housing, and postsecondary transition services. As will be demonstrated, markedly disparate findings between raters can occur on measures of AB even when the assessment is conducted in accordance with standard procedures (i.e., the person was assessed in a community setting, in real time, with multiple appropriate raters, when the person was younger than 18 years of age), and similar disparities can be found in the context of the unorthodox and untested retrospective assessment used in capital proceedings. With full recognition that some level of disparity is to be expected, the level of disparity that can arise when these measures are administered retrospectively calls into question the validity of the results and, consequently, their probative value.
... Although indirect methods continue to be recommended (Herzinger & Campbell, 2007), they have been shown repeatedly to be unreliable (Arndorfer, Miltenberger, Woster, Rortvedt, & Gaffaney, 1994;Conroy, Fox, Bucklin, & Good, 1996;Duker, & Sigafoos, 1998;Newton & Sturmey, 1991;Sigafoos, Kerr, & Roberts, 1994;Sigafoos, Kerr, Roberts, & Couzens, 1993;Spreat & Connelly, 1996;Sturmey, 1994;Zarcone, Rodgers, Iwata, Rourke, & Dorsey, 1991) and, as a result, inadequate as the basis for developing an intervention program. Their use seems justifiable only when there are no opportunities whatsoever to collect direct-observation data, and these types of situations, in which client verbal report defines both the extent and cause of the initial problem, as well as when it is resolved, more closely resemble a traditional counseling context rather than the practice of behavior analysis. ...
Functional analysis (FA) methodology is a well-established standard for assessment in applied behavior analysis research. Although used less commonly in clinical (nonresearch) application, the basic components of an FA can be adapted easily in many situations to facilitate the treatment of problem behavior. This article describes practical aspects of FA methodology and suggests ways that it can be incorporated into routine clinical work.
... Function-based treatments have been demonstrated to be more effective than treatments that are not based on function (Campbell, 2003;Heyvaert, Saenen, Campbell, Maes, & Onghena, 2014). Furthermore, there is evidence that FAs are more reliable and valid than indirect or descriptive assessments when identifying the function of problem behavior (Zarcone, Rodgers, Iwata, Rourke, & Dorsey, 1991). ...
... Various instruments have been developed to standardize the indirect assessment process such as the Motivation Assessment Scale (MAS, Durand & Crimmins, 1988 ), the Functional Analysis Screening Tool (FAST, Iwata, DeLeon, & Roscoe, 2013 ), the Questions About Behavioral Function (QABF, Matson, Bamburg, Cherry, & Paclawskyj, 1999 ). The research on the validity and reliability of these instruments is mixed, with some fi ndings showing that indirect instruments have high agreement with functional analyses and can lead to effective treatment (e.g., Matson et al., 1999 ;Matson, Tureck, & Rieske, 2012 ), and others reporting the opposite (e.g., Iwata et al., 2013 ;Zarcone, Rodgers, Iwata, Rourke, & Dorsey, 1991 ). Higher correspondence between indirect assessment instruments and functional analyses was found when there was agreement on the function identifi ed by the instruments across multiple (4-5) raters (Smith, Smith, Dracobly, & Pace, 2012 ). ...
This chapter discusses the importance of conducting a functional assessment to identify environmental determinants of problem behavior and develop functional interventions. The chapter describes the functions of problem behaviors and three approaches to functional intervention; extinction, differential reinforcement, and antecedent manipulations. The chapter then describes three functional assessment approaches: indirect assessment involving behavioral interviews and rating scales, direct assessment involving direct observation and recording of antecedents, behavior, and consequences, and functional analysis involving manipulation of antecedents and consequences to demonstrate a functional relationship between these events and the problem behavior. Research and application related to each functional assessment method are described and conclusions for best practice are provided.
Many individuals diagnosed with intellectual and developmental disabilities engage in challenging behaviors such as aggression and self-injury. These behaviors may interfere with the quality of life of the individual and their families. Although biological factors may contribute to the development of challenging behavior, research has shown that the environment plays a significant role in developing all behaviors, including challenging behavior. Thus, the current chapter highlights the importance of understanding how consequences impact the development of challenging behavior and provides a discussion of the functional behavior assessment process used to isolate potential environmental factors contributing to the challenging behavior. This includes a review of indirect assessments, descriptive assessments, and functional analysis methods followed by a review of common treatments for reducing challenging behavior, including antecedent manipulations, extinction procedures, and differential reinforcement.
This study attempted to revalidate the validity of the Motivation Assessment Scale (MAS) through psychometric verification. Participants were 145 children with developmental disabilities including 104 autism and 41 intellectual disabilities. 145 parents of children with developmental disabilities were participated as a examiner. Results of this study were as follows: First, the MAS was composed of four factors and 15 questions through exploratory factor analysis. Second, the MAS was revised by using the confirmatory factor analysis and the Modification Index(MI), and goodness-of-fit and convergent validity were verified. Third, the discriminant validity between potential variables of the MAS was verified. As a result of this study, the MAS was reconstructed into 4 factors 16 items including ‘complex’ factor 6 items, ‘tangible’ factor 3 items, ‘sensory’ 4 items, and ‘attention’ 3 items. However, the revised MAS did not fully fit the theoretical hypothesis. The results of this study were discussed. Finally, the implications and suggestions for further research were presented.
Functional assessment checklists and experimental functional analysis have become standard practice in applied behavior analysis. This chapter incudes an overview of existing methods and how they are utilized in various applied contexts. We discuss the standard functional analysis model first described by Iwata et al. (1982/1994) and significant variations on the standard model, such as trial-based functional analysis, interview-informed synthesized contingency analysis, among others. We also comment on the strengths and weaknesses of these methods and how they can complement one another during clinical decision-making. The article also discusses methods of analyzing functional assessments and assessment informed treatment. Finally, we discuss barriers and criticism of functional assessment and how these can be addressed by behavior analysts.KeywordsFunctional assessmentFunctional analysisDescriptive analysisInformant methodsClinical decision-makingDifferential reinforcementMotivating operationsSchool-based assessment
The experimental functional analysis (EFA) was the pioneer strategy among functional assessments. However, it may not always be possible to implement an EFA. Factors such as the need for well-trained staff, expense, time requirements, potential putting clients and/or staff in danger, and low rates of behavior may rule out this approach. As a result, alternative means of conducting functional assessments are required and have been developed. Among the methods reviewed in this chapter are standardized tests, standardized interviews, and natural observation methods, such as scatterplots and antecedent, behavior, consequence (ABC) data. Specific methods and research on these approaches are discussed.KeywordsStandardized functional assessment Experimental functional analysis QABF MAS ABC cards Interviews Scatterplot Antecedent Behavior Consequence Maintaining variables
Background
Understanding the operant function of self-injurious behavior in autistic individuals is imperative to understanding its etiology and designing effective prevention strategies.
Methods
We conducted a postal survey of residential care facilities including two functional assessment tools: QABF and IfES. Questionnaires for N = 178 residents were returned.
Results
For 21.2% a single, and for 62.9% multiple functions were identified by the QABF, with the most frequent function being escape (51.8%). The IfES identified unable to cope with a situation as primary antecedent for 39.8% of the residents. Non-vocal individuals presented a higher number of functions and had overall higher subscale scores.
Conclusion
The study was the first to investigate single and multiple functions of SIB within a large sample of autistic adults. Results suggest that multiple functions of SIB are common with negative reinforcement contingencies being most important. Results have to be interpreted with caution due to psychometric limitations of the instruments used.
This chapter reviews assessment for treatment, that is, assessment that is conducted prior to treatment of aggression and violence to guide the decision about what kind of treatment is best for each individual. The two approaches reviewed here are functional assessment and analysis and case formulation, including forensic case formulation. Functional assessment methods include indirect methods such as interviews and questionnaires, and naturalistic observation to identify target behaviors and their potential antecedents and consequences. Indirect approaches are limited because they do not manipulate the environment, and hence, the observations may include confounds. Experimental analyses involve direct and systematic manipulation of the environment to discover functional relationships between the environment and aggressive or violent behavior. Experimental analyses may be conducted on less dangerous forms of behavior when it would be unethical or impractical to conduct functional analyses of aggression and violence. Over time, research has developed briefer and potentially more efficient forms of functional analyses that can be used more readily in typical service settings. Case formulation similarly involves pretreatment assessment and typically uses indirect methods such as case record reviews, interviews, and client self-reports. Case formulation has been used extensively in the clinical assessment of aggression and violence, including the more severe forms of violence seen in forensic services. Case formulation sometimes uses concepts from functional assessment and analysis and may be integrated into risk assessment. One challenging area for both the approaches is training routine practitioners to conduct and use pretreatment assessments effectively and efficiently.KeywordsAggressionViolenceFunctional assessmentFunctional analysisIndirect methodsDirect methodsAntecedentsConsequencesIISCACase formulationForensic case formulationRisk assessment
Background:
Although stimulus preference assessments are widely used to identify reinforcers and to inform positive reinforcement conditions in a functional analysis (FA), direct assessments of potential negative reinforcers are not as commonly employed. Demands are often selected from caregiver report alone.
Aims:
The purpose of the current study is to (a) replicate the Demand Assessment for Individuals with Severe Disabilities (DAISD) indirect assessment interview for caregivers to identify demands that may evoke challenging behavior; (b), compare the correspondence of the DAISD in relation to an established direct assessment, the demand latency assessment (DLA); and (c) evaluate if the demands that caregivers identify as the most aversive are more likely to evoke challenging behavior and identify an escape function in an FA than those demands caregivers identify as least aversive and replicate validation of the DLA.
Methods and procedures:
This study evaluated caregiver accuracy at identifying demands most likely to evoke escape-maintained challenging behavior for four children with developmental disabilities. Caregiver-informed aversiveness hierarchies from the DAISD were compared to child-informed aversiveness hierarchies from the DLA. Functional analyses included separate escape conditions with DAISD and DLA most and least aversive demands.
Outcomes and results:
Although all caregivers identified at least eight demands, caregivers' accuracy with demand aversiveness was variable as indicated by (a) a false negative FA outcome for one of four participants with the caregiver-nominated most aversive demand; (b) higher rates of challenging behavior with the caregiver-nominated least aversive demand than most aversive for three of four participants; and (c) lack of a strong positive rank order correlation between caregiver- and child-hierarchies for all participants (range, -0.76 to .48). Compliance was not a strong predictive variable of challenging behavior with either assessment.
Conclusions and implications:
Results indicate that the DAISD interview is useful at identifying multiple demands presented in the natural environment, but should be followed up with direct assessment to determine demand aversiveness rather than used for caregivers to rank demand aversiveness.
Objective
To compare speech outcome and self-reported speech and communicative ability (SOK) in young adults treated with one-stage (OS) or two-stage (TS) palatal repair. Furthermore, to compare with normative data on individuals without cleft lip and palate and to study the relationship between patients’ and experts’ judgments.
Design
A cross-sectional group comparison study with long-term follow-up. Participants: Patients born with unilateral cleft lip and palate treated at 2 cleft centers; 17 with OS at 14 months and 25 with TS, soft palate repair at 7 months and hard palate repair at 6.2 years. Pharyngeal flap surgery was performed in 53% (OS) and 24% (TS) of patients.
Main Outcome Measure(s)
Speech characteristics were blindly assessed by speech and language pathologist from audio recordings, SOK at 19 years of age.
Results
No group differences were found. Although the occurrence of nasality symptoms was low in both groups, only 60% (OS)/65% (TS) were assessed with competent velopharyngeal function (VPC). Articulation proficiency (percentage of consonants correct [PCC]) was 91%/97%, the /s/-sound specifically 87%/91%. Good intelligibility was found in 91%/87%. Patient opinion was in agreement with norms and significantly associated with intelligibility ( rs = 0.436, P < .01), PCC ( rs = −0.534, P < .01), and correct /s/ ( rs = −0.354, P < .05).
Conclusions
No differences in speech outcome were related to operation method. The low prevalence of VPC was not clearly reflected in nasality symptoms. Patient opinion was related to articulation and intelligibility. A higher burden of care in terms of pharyngeal flap surgery was seen after the OS technique.
Both function-based interventions and group contingency strategies have been used by behavior analysts for multiple decades to both promote desired behavior and reduce challenging behavior. The current study assessed the comparative impact on off-task behavior of students with mild to moderate intellectual disabilities of interdependent group contingencies employing either function-matched or nonfunction-matched reinforcers during academic work periods. The results demonstrated that both versions had a positive impact in reducing off-task behavior, with some indication that the function-matched reinforcer condition may have been somewhat more effective. Limitations of the study are discussed along with suggestions for future research in this area.
This chapter discusses approaches to functional behavioral assessment (FBA) within applied settings. The chapter begins with an overview of the FBA process as best practice in the assessment and treatment of challenging behavior. The next section provides a review of FBA methods with a focus on indirect and descriptive assessments. Within this section, common FBA procedures are reviewed, considerations in the selection of FBA methods are discussed, and a summary of relevant literature is provided. The chapter ends with practice guidelines for practitioners and future areas of study for researchers.
Challenging behaviors (e.g., self-injurious behavior, aggression, property destruction, and stereotypies) are common among individuals with developmental disabilities. Several function-based assessments exist to identify the primary factors reinforcing and maintaining challenging behavior and aid in implementing effective treatment plans. A number of normed scales have been developed to serve as primary or complementary methods of functional analysis. This chapter provides a brief overview of the benefits and limitations to indirect and direct functional analysis strategies and discusses the most popular scaling methods in detail.
Objective
To investigate the effect of maxillary osteotomy on velopharyngeal function in cleft lip and palate (CLP) using instrumental measures.
Design
A prospective study.
Participants
A consecutive series of 20 patients with CLP undergoing maxillary osteotomy by a single surgeon were seen at 0 to 3 months presurgery (T1), 3 months (T2), and 12 months (T3) post-surgery.
Interventions
Nasalance was measured on the Nasometer II 6400. For videofluoroscopy and nasendoscopy data, visual perceptual ratings, for example, palatal lift angle (PLAn), and quantitative ratiometric measurements, for example, closure ratio (CRa), were made using a validated methodology and computer software. Reliability studies were undertaken for all instrumental measures.
Main Outcome Measures
Repeated measures analysis of variance (with time at 3 levels) for nasalance and each velar parameter. Planned comparisons across pairs of time points (T1-T2, T1-T3, and T2-T3) including effect sizes.
Results
A significant difference over time was found for nasalance ( P = .001) and planned comparisons across pairs of time points were significant between T1 and T2 ( P = .008), T1 and T3 ( P = .002), but not between T2 and T3 ( P = .459) providing evidence that maxillary osteotomy can impact on nasalance adversely and that the changes seen are permanent and stable. There were also significant differences over time for PLAn ( P = .012) and CRa ( P = −.059) and planned comparisons for both velar parameters reflected similar findings to those of nasalance.
Conclusions
Maxillary osteotomy can adversely affect velopharyngeal function in patients with CLP. The study provides evidence for a much earlier post-surgery review even as early as 3 months after surgery.
This chapter describes a systematic approach to assessment of the person engaging in self-injurious behavior, including developmental, medical, behavioral, psychological, psychiatric, and contextual issues. The chapter shows how the integrated biobehavioral model of the development of self-injury presented in Chap. 3 can be used to structure an assessment of the critical factors and processes involved in maintaining an individual’s self-injury. Topics include diagnosis of physical/medical and psychiatric conditions related directly or indirectly to self-injury, functional behavioral assessment, and assessment of Pavlovian processes, overactivity/impulsivity, and arousal and anxiety. Emphasis is placed on methods (including interviews, rating scales, structured observations, and brief functional analyses) applicable in outpatient/consulting contexts, although more extended assessments feasible in residential treatment settings are also considered. The chapter describes a method for assessment of the processes predominant in maintaining SIB in the individual case, relating these to options for intervention, and using assessment results to develop an intervention plan.
Although a demand analysis is helpful for identifying potential establishing operations for the functional analysis (FA) demand condition, it may not always be practical due to time constraints. A potential alternative is the Negative Reinforcement Rating Scale (NRRS), an indirect assessment tool that may serve as a time efficient alternative to a demand analysis. The experimenter assessed the reliability and validity of the NRRS for 5 individuals with autism spectrum disorder who exhibited problem behavior. Multiple types of interrater reliability were assessed across 2 informants, and NRRS outcomes were compared to a subsequent demand analysis and FA to assess its validity. Reliability was high (M = 84%) for NRRS numerical ratings of categories but low (M = 32.9%) for specific examples provided. NRRS-identified highly aversive tasks yielded better correspondence with demand analysis outcomes than did NRRS-identified less aversive tasks.
Background
Abnormal facial growth is a well‐known sequelae of cleft lip and palate (CLP) resulting in maxillary retrusion and a class III malocclusion. In 10–50% of cases, surgical correction involving advancement of the maxilla typically by osteotomy methods is required and normally undertaken in adolescence when facial growth is complete. Current evidence for the impact of the surgery on velopharyngeal function is weak and mixed.
Aims
The first objective of the study was to investigate the nature of the effect of maxillary osteotomy on the perceptual outcomes of velopharyngeal function in CLP. The second objective was to establish if speech changes seen early at 3 months post‐operation persisted for a year after/following surgery’, when it is considered that the maxilla is relatively stable.
Methods & Procedures
Twenty consecutive patients with CLP undergoing maxillary osteotomy by a single surgeon were seen pre‐operatively (T1), 3 months (T2) and 12 months (T3) post‐operation. A non‐cleft control group (NonCLP) undergoing surgery was also recruited. Speech data were collected using the Cleft Audit Protocol for Speech—Augmented (CAPS‐A). A velopharyngeal composite score‐summary (VPC‐SUM) was derived from specific CAPS‐A‐rated parameters. An external CAPS‐A‐trained therapist, blinded to the study, rated the randomized samples and inter‐rater reliability was established.
Outcomes & Results
For the CLP group, hypernasality and nasal turbulence increased significantly post‐operation. Planned comparisons were significant for T1–T2 only with a medium effect size. For hypernasality, the CLP group differed statistically from the NonCLP group at T2 and T3. For nasal turbulence, the CLP group differed statistically from the NonCLP group at T2. For VPC‐SUM, there were statistically significant changes post‐operatively between T1–T2 and T1–T3 only with medium effect sizes for the CLP group only.
Conclusions & Implications
This study provides evidence that maxillary osteotomy affects patients with and without CLP differently. In patients with CLP, surgery may impact negatively on velopharyngeal function for speech and changes seen early on at 3 months post‐operatively appear to persist at 12 months postoperatively. The findings in this study have implications for the speech care pathway of patients with CLP undergoing maxillary osteotomy in terms of assessment, review and management.
Feeding problems are common among children but occur at much higher rates in children with developmental disabilities. Difficulties range from mild to severe and may be exacerbated by the symptoms and deficits the child experiences. Due to the functional impairments associated with feeding problems, intervention is often necessary. This chapter reviews the common feeding problems observed in children with developmental disabilities (e.g., food selectivity, food refusal, developmentally inappropriate feeding skills), outcomes of children requiring intervention (e.g., medical, developmental, and social outcomes), assessment methods, treatments, and treatment planning. Clinical considerations are also discussed.
The Individuals with Disabilities Education Improvement Act requires that functional behavior assessments be conducted under certain circumstances for students with disabilities. Functional assessments may include indirect assessments (e.g., rating scales, interviews), direct-descriptive assessments (e.g., direct observations with conditional probabilities), and/or experimental functional analyses. Despite being legally required in schools, and consequently commonly conducted, there is limited research establishing the technical adequacy of indirect functional assessment instruments. This review provides an update on the availability and status of indirect functional assessment instruments available for school-based use. Results of the review are consistent with previous reviews identifying deficiencies in existing instruments. In particular, indirect functional assessment instruments for school-based use lack sufficient evidence for temporal stability, internal consistency, inter-rater reliability, treatment utility, and social validity. Results of this review are discussed in terms of directions for future research and implications for applied practice as they relate to school-based functional assessments.
Irritable, aggressive behavior can present a substantial impediment to the development and current functioning of individuals with autism. This chapter presents a brief review of the history of aggression treatment in autism and focuses on recent data concerning combined behavioral and medication treatment. An assessment-based model for the selection of initial treatment approaches and revision of the initial plan is presented. This model is based on a comprehensive biopsychosocial evaluation of the individual exhibiting aggression, including medical/neurological/psychiatric evaluations, neurobehavioral assessment, and functional behavioral assessment. Case examples applying the model are provided. Finally, the importance of balancing between least intrusive and maximally effective treatment approaches is discussed, as are future directions in research focusing on improving the assessment and treatment of aggressive behavior.
Autism spectrum disorders represent a set of neurodevelopmental conditions that impact relationships, learning, and daily functioning. Unfortunately, irritable, aggressive behaviors are also common in autism-affected individuals (Lecavalier. J Autism Dev Disord 36(8):1101–14; 2006), further diminishing their functioning and quality of life. The present chapter begins by defining the problem of irritable, aggressive behavior in autism and the impact of this behavior on the individual, their family, and surrounding environment. We then briefly review the history of treatment for irritable, aggressive behavior in autism, focusing on behavioral and medication interventions. After providing historical context, the most recent research findings regarding combined medication and behavioral treatment are presented. This review is followed by presentation of an iterative model for assessment-driven treatment of aggressive behavior in autism and case examples demonstrating the application of this model. Finally, we end by discussing gaps in our current knowledge and future direction for research in aggressive behavior. The chapter does not specifically address self-injurious behaviors. While many of the concepts discussed would apply to self-injurious behavior as well, because of the unique nature of these behaviors, we chose to focus exclusively on irritable, aggressive behaviors directed toward others.
Challenging behaviors are common in those with developmental disabilities (DD) and intellectual disabilities (ID) (Matson, Cooper, Malone, & Moskow, 2008; Matson, Kiely, & Bamburg, 1997; Murphy et al., 2005) and also in typically developing children with emotional and behavioral problems (Brestan & Eyberg, 1998). Estimates suggest that in those with DD, such as Autism Spectrum Disorders (ASD), 8–17% of individuals exhibit challenging behaviors (Emerson & Bromley, 1995; Kiernan et al., 1997; Lowe et al., 2007). These behaviors range from physical aggression (i.e., hitting, kicking, and biting others) to self-injurious behavior (SIB; i.e., hitting self, head banging, skin picking) to property destruction. While severe challenging behaviors are common in those with DD and ID, a similar number of typically developing children also exhibit challenging behaviors that may lead to emotional and behavioral disorders later on (Webster-Stratton, 1997). It has been well established in the literature that the most effective treatments are interventions based on the functions of the behavior (DuPaul & Ervin, 1996; Gettinger & Callan Stoiber, 2006). As such, functional assessments have grown in popularity. One review found that previous to 1985, approximately 35% of studies which used behavioral intervention for aggressive behavior in those with DD or ID used some form of functional assessment. However, this percentage increased to 71% for more recent studies which used functional assessment (Hile & Desrochers, 1993). Functional assessments allow for the identification of the maintaining factor of the behavior so that prevention and intervention strategies can be added to a treatment program, as well as replacement behaviors which allow the person to achieve the goal of the challenging behavior by more appropriate means. Furthermore, functional assessment for each challenging behavior is required as topographically similar behaviors may serve drastically different functions (Iwata et al., 1994).
Three studies are presented in which environmental correlates of self-injurious behavior were systematically examined and later used as the basis for treatment. In Study 1, 7 developmentally disabled subjects were exposed to a series of conditions designed to identify factors that maintain self-injurious behavior: attention contingent on self-injurious behavior (positive reinforcement), escape from or avoidance of demands contingent on self-injurious behaviour (negative reinforcement), alone (automatic reinforcement), and play (control). Results of a multielement design showed that each subject's self-injurious behavior occurred more frequently in the demand condition, suggesting that the behavior served an avoidance or escape function. Six of the 7 subjects participated in Study 2. During educational sessions, "escape extinction" was applied as treatment for their self-injurious behavior in a multiple baseline across subjects design. Results showed noticeable reduction or elimination of self-injurious behavior for each subject and an increase in compliance with instructions in all subjects for whom compliance data were taken. The 7th subject, whose self-injurious behavior during Study 1 occurred in response to medical demands (i.e., physical examinations), participated in Study 3. Treatment was comprised of extinction, as in Study 2, plus reinforcement for tolerance of the examination procedure, and was evaluated in a multiple baseline across settings design. Results showed that the treatment was successful in eliminating self-injurious behavior and that its effects transferred across eight new therapists and three physicians. General implications for the design, interpretation, and uses of assessment studies are discussed.
It is generally agreed that serious misbehavior in children should be replaced with socially appropriate behaviors, but few guidelines exist with respect to choosing replacement behaviors. We address this issue in two experiments. In Experiment 1, we developed an assessment method for identifying situations in which behavior problems, including aggression, tantrums, and self-injury, were most likely to occur. Results demonstrated that both low level of adult attention and high level of task difficulty were discriminative for misbehavior. In Experiment 2, the assessment data were used to select replacements for misbehavior. Specifically, children were taught to solicit attention or assistance or both verbally from adults. This treatment, which involved the differential reinforcement of functional communication, produced replicable suppression of behavior problems across four developmentally disabled children. The results were consistent with an hypothesis stating that some child behavior problems may be viewed as a nonverbal means of communication. According to this hypothesis, behavior problems and verbal communicative acts, though differing in form, may be equivalent in function. Therefore, strengthening the latter should weaken the former.
We tested the hypothesis that the "self-stimulatory" behaviors exhibited by some individuals may be socially mediated. Four developmentally disabled children who exhibited hand flapping and body rocking participated in a series of three experiments conducted to assess the influence of social variables on stereotyped behavior and to develop a treatment based on the assessment. Experiment 1 used an assessment procedure to determine the relative influences of social attention and task demands on stereotyped behavior. For all four children, hand flapping and body rocking increased when difficult academic tasks were introduced. Experiment 2 involved the use of a procedural time-out and demonstrated that removing task demands contingent on stereotyped behavior resulted in increased rates of hand flapping and body rocking. In Experiment 3, these results were used to develop a communication treatment that consisted of teaching the children to request assistance on the difficult tasks. This treatment resulted in significant reductions in self-stimulatory behavior. These results are consistent with the hypothesis that some forms of repetitive stereotyped behavior may come to serve social functions (e.g., escape from aversive situations). Teaching a functionally equivalent communicative alternative to escape-motivated stereotyped behavior can be an effective form of intervention for this problem.
This study describes the use of an operant methodology to assess functional relationships between self-injury and specific environmental events. The self-injurious behaviors of nine developmentally disabled subjects were observed during periods of brief, repeated exposure to a series of analogue conditions. Each condition differed along one or more of the following dimensions: (1) play materials (present vs absent), (2) experimenter demands (high vs low), and (3) social attention (absent vs noncontingent vs contingent). Results showed a great deal of both between and within-subject variability. However, in six of the nine subjects, higher levels of self-injury were consistently associated with a specific stimulus condition, suggesting that within-subject variability was a function of distinct features of the social and/or physical environment. These data are discussed in light of previously suggested hypotheses for the motivation of self-injury, with particular emphasis on their implications for the selection of suitable treatments.
This study describes the use of an operant methodology to assess functional relationships between self-injury and specific environmental events. The self-injurious behaviors of nine developmentally disabled subjects were observed during periods of brief, repeated exposure to a series of analogue conditions. Each condition differed along one or more of the following dimensions: (1) play materials (present vs absent), (2) experimenter demands (high vs low), and (3) social attention (absent vs noncontingent vs contingent). Results showed a great deal of both between and within-subject variability. However, in six of the nine subjects, higher levels of self-injury were consistently associated with a specific stimulus condition, suggesting that within-subject variability was a function of distinct features of the social and/or physical environment. These data are discussed in light of previously suggested hypotheses for the motivation of self-injury, with particular emphasis on their implications for the selection of suitable treatments.
review historical and contemporary research on the functional analysis of behavior disorders / the motivation properties (functions) of problems such as SIB [self-injurious behavior] and aggression will be described, and methods by which these functions may be identified will be examined / treatment implications, as well as potential limitations of the functional analysis model, will be discussed / the development of treatment programs based on functional analysis assessment (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Behavioral assessment procedures were used to prescribe and evaluate treatments of maladaptive behavior for 2 children with severe multiple handicaps. In Experiment 1, the results of an assessment of reinforcer preference were used in conjunction with a functional analysis of the conditions maintaining self-injurious behavior to prescribe a treatment for a child with severe disabilities. The treatment procedure involved the use of a pressure-sensitive microswitch to activate reinforcing stimuli during two solitary conditions, during which self-injurious behavior had occurred at high rates. The results were evaluated with a multiple baseline across settings design and indicated that self-injury decreased with concomitant increases in microswitch activation. Results were maintained at 6 weeks, 8 weeks, and 6 months. In Experiment 2, the results of behavioral assessments of reinforcer preference and self-injurious behavior were combined to develop a treatment for a second severely handicapped child, who exhibited high rates of self-injury in demand situations. This treatment was evaluated with a multiple baseline across tasks design and resulted in the elimination of self-injury for up to 15 months.
This study extends an operant methodology for the analysis of variables which control aberrant responses displayed by mentally handicapped people. The proportion of time spent in individual, stereotyped topographies by three profoundly mentally handicapped subjects was observed by momentary time-sampling whilst they were repeatedly exposed to four analogue environments: Alone, Social Disapproval, Academic Demand and Unstructured Play. Two of the three subjects showed replicable effects of the analogue environments. One subject showed evidence of an interaction between stereotyped topography and type of analogue environment. This study shows that the operant methodology of Iwata et al. (1982), originally developed with self-injurious responses, can be successfully refined and extended to the analysis of a wider range of aberrant topographies.
Reliability and validity data are reported for an instrument designed to identify variables maintaining self-injurious behavior. The Motivation Assessment Scale (MAS) is a 16-item questionnaire that addresses the situational determinants of self-injurious behavior in persons with autism and other developmental disorders. The reliability study indicated that teachers of 50 developmentally disabled persons could agree on the variables presumably maintaining their student's self-injury (interrater reliability), and that they would be in agreement again 30 days later (test-retest reliability). The validity study indicated that teacher's ratings on the MAS of 8 subjects' self-injury predicted how their students would behave in analogue situations. Specifically, the MAS predicted the subjects' self-injurious behavior in situations with decreased adult attention, with increased academic demands, with restricted access to tangibles, and in unstructured settings. The MAS is presented as an alternative or adjunct to more formal functional analyses in efforts to identify the variables controlling self-injurious behavior.
This study evaluated methods for empirically identifying environmental determinants of aggressive and disruptive behavior in three developmentally delayed children. A variety of sessions conducted on an inpatient treatment unit were designed to stimulate contingencies maintaining aggression and disruption in the subjects' natural environments. The basic analog conditions included: instructional demands, contingent social disapproval, and structured play. In addition, variations of the three basic conditions were developed based on informal observation and parental reports of naturally occurring contingencies. Results showed considerable variability both between and within subjects. However, for each subject a specific analog condition was shown to produce relatively higher rates of aberrant behavior. Subsequently, behavioral treatments based on assessment results were successfully implemented with two of the subjects. Results are discussed in terms of the importance and practical limitations of conducting systematic assessment of aberrant repertoires in developmentally delayed clients.
A two-phase functional analysis of a profoundly retarded 19-year-old male's pica facilitated the design of an effective intervention containing no aversive components. In the first analysis, frequent staff-client interaction resulted in 25% and 66% less pica than limited and no interaction, respectively. Paradoxical effects were obtained in the second analysis, where no protective helmet resulted in 38% and 26% less pica than the helmet with face shield and helmet without face shield, respectively. On the basis of these analyses, limited interaction and no helmet conditions were combined in an effective, staff-implemented treatment at a medium-sized institution.
Experimental analysis and extinction of self-injurious escape behavior
- J R Zarcone
J. R. Zarcone et al. Iwata, B. A., Pace, G. M., Cowdery, G. E., Kalsher, M. J., & Cataldo, M. F. (1990). Experimental analysis and extinction of self-injurious escape behavior. Journal of Applied Behavior Analysis, 23, 11-27.
Analysis of environmental determinants of aggression and disruption in mentally retarded children
- E C Mace
- T J Page
- M T Ivancic
- S Brien
Mace, E C., Page, T. J., Ivancic, M. T., & O'Brien, S. (1986). Analysis of environmental determinants of aggression and disruption in mentally retarded children. Applied Research in Mental
Retardation, 7,203-221.