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Precursor Behaviors to Severe Challenging Behaviors
Abstract
Behaviors occur in chains. Upon analysis of a given challenging behavior, the response rarely occurs without the appearance of lesser problematic behaviors linked to the target behavior. In many instances, these may also be viewed as maintaining behaviors. This chapter covers the literature on this topic, along with strategies on how to identify and treat these responses.KeywordsPrecursor behaviors Precursor assessments Precursor functional analysis Precursor-based treatment
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Challenging behavior is a significant barrier in accessing the general education curriculum for students with developmental disabilities. This necessitates the identification of evidence-based practices for addressing challenging behavior in inclusive settings. The purpose of our meta-analysis is to (a) quantify the magnitude of effect of interventions targeting the reduction of challenging behavior in students with developmental disabilities in inclusive educational settings and (b) determine if participant and intervention characteristics moderate intervention effects. A systematic search of academic databases was conducted to identify studies, which were evaluated for methodological rigor and analyzed for effects using Tau-U. Results indicate a strong overall effect of .94 (95% CI [.87, 1]) and moderating variables associated with behavior topography, interventionist, and intervention components were identified.
Functional communication training (FCT) is one of the most common treatments for challenging behavior and is considered an empirically supported practice for children and adolescents with autism spectrum disorder (ASD). However, no previous systematic review has evaluated the quality of FCT for adults with ASD, and the empirical support for this practice among adults is unknown. The purpose of the current review was to synthesize the extant research, including a quality appraisal of the literature on the use of FCT to treat challenging behavior for adults with ASD. We identified 20 studies that evaluated the efficacy of FCT in reducing challenging behavior for adults with ASD. The quality of each article was evaluated based on the What Works Clearinghouse design and evidence standards. Following the quality and evidence evaluations, eight studies, including eight experiments, were found to have moderate or strong evidence of effectiveness. The current body of literature provides some evidence for the efficacy of FCT in reducing challenging behavior for adults with ASD, but additional research in this area is warranted.
In their review of synthesis within the functional analysis (FA) literature, Slaton and Hanley (2018) reported that most synthesized contingency analyses have included multiple topographies of problem behavior in the reinforcement contingency class. This leaves the question of whether one, some, or all forms of problem behavior are sensitive to the synthesized reinforcement contingencies in published analyses. To address this ambiguity, all topographies of problem behavior that were reported by caregivers to co‐occur with the most concerning problem behavior were analyzed for 10 participants. We implemented extinction across one or more forms of problem behavior to determine whether all forms reported to co‐occur were sensitive to the same synthesized reinforcement contingency. For nine of 10 participants, the most concerning topographies were sensitive to the same synthesized reinforcement contingencies as the less concerning topographies (results were inconclusive for one). Implications for inferring response class membership from single analyses are discussed.
Prevalence studies of challenging behaviors among children with disabilities have a potential value, as they provide information for intervention and evaluation. However, the results from these studies seem to vary according to the population involved, the behaviors explored and the selected methodological procedures and instruments used. The purpose of this study was to identify the prevalence data of challenging behaviors considering the behaviors assessed, how the behavior is measured and which procedures are used to collect the prevalence of these behaviors among school-aged participants with disabilities. We performed a systematic review and selected 20 studies for analysis according to their methodological characteristics. The findings indicated that the most common behaviors studied were aggression and self-injury. Moreover, a wide disparity with respect to procedures and methods (e.g., sampling methods and instruments) to assess the prevalence of challenging behavior was identified. Recommendations for addressing these issues are presented, and implications and suggestions for future research are discussed.
Background: Understanding the nature of work-related stress and burnout among intellectual disability care staff is important to protect the well-being of these workers and encourage their retention in the sector. Though reviews of specific aspects of this literature have been conducted no article has sought to fully chart the range and nature of this research.
Objective: This article addresses this gap by synthesizing the findings of such research with consideration to the future implications for protecting the well-being of care workers.
Methods: A scoping review of the published literature was undertaken using a framework described in a previous article.
Results: The findings of this review are presented thematically across six primary categories: challenging behavior; reciprocity; coping and stress; role issues; individual differences; and settings. A seventh theme, namely the positive aspects of intellectual disability care work was also identified through this process and is discussed.
Conclusion: Occupational stress and strain is an internationally experienced issue in this sector. Challenging behavior and inequality in the relationships between staff and their clients, their colleagues, and their organization appear to exert a significant impact on the stress and well-being of workers in this sector. Excessive workplace demands, a low level of control, and a lack of support have been shown to be related to higher levels of stress and burnout among intellectual disability care workers.
Mental health problems in children and adolescents include several types of emotional and behavioural disorders, including disruptive, depression, anxiety and pervasive developmental (autism) disorders, characterized as either internalizing or externalizing problems. Disruptive behavioural problems such as temper tantrums, attention deficit hyperactivity disorder, oppositional, defiant or conduct disorders are the commonest behavioural problems in preschool and school age children. The routine Paediatric clinic or Family Medicine/General Practitioner surgery presents with several desirable characteristics that make them ideal for providing effective mental health services to children and adolescents. DSM-5 and ICD-10 are the universally accepted standard criteria for the classification of mental and behaviour disorders in childhood and adults. The age and gender prevalence estimation of various childhood behavioural disorders are variable and difficult to compare worldwide. A review of relevant published literature was conducted, including published meta-analyses and national guidelines. We searched for articles indexed by Ovid, PubMed, PubMed Medical Central, CINAHL, EMBASE, Database of Abstracts and Reviews, and the Cochrane Database of Systematic reviews and other online sources. The searches were conducted using a combination of search expressions including “childhood”, “behaviour”, “disorders” or “problems”. Childhood behaviour and emotional problems with their related disorders have significant negative impacts on the individual, the family and the society. They are commonly associated with poor academic, occupational, and psychosocial functioning. It is important for all healthcare professionals, especially the Paediatricians to be aware of the range of presentation, prevention and management of the common mental health problems in children and adolescents.
Methods for assessing the response class structure of challenging behavior utilizing the concepts of the response class hierarchy and precursor responses have been evaluated. However, the lack of a cohesive examination of the current literature or practice guidelines may impede practitioners’ efforts to evaluate the methods for their relevance to a given clinical problem. A multistep search strategy identified 17 peer-reviewed studies. Participant and study characteristics and assessment methods were quantified, summarized, and described, and some potential benefits and limitations of each assessment type are proposed. The results suggest that there are useful methods for assessing response class structure at each stage of functional behavior assessment and treatment and that some methods are useful for developing effective function-based treatments. Replication studies and additional methods for assessing response class structure during treatment are needed. Some tentative practice guidelines are proposed.
Parents of children with intellectual and developmental disabilities (IDD) generally report high levels of parenting stress, although research indicates that the degree of stress parents experience varies by type of stress and child disability. Numerous studies have examined predictors of parenting stress among families of children with IDD, and child behavior problems appear to be the most robust predictor of stress among these parents. Research indicates that the relationship between parenting stress and child behavior problems in transactional, and, therefore, parenting stress may exacerbate child behavior problems over time. Thus, designing effective evidenced-based interventions to address parental stress among families of children with IDD with critical in promoting positive outcomes for both parents and children with IDD.
This study examined the relative effectiveness of interventions based on a pre-intervention functional behavioral assessment (FBA), compared to interventions not based on a pre-intervention FBA. We examined 19 studies that included a direct comparison between the effects of FBA- and non-FBA-based interventions with the same participants. A random effects meta-analysis of effect sizes indicated that FBA-based interventions were associated with large reductions in problem behaviors when using non-FBA-based interventions as a reference intervention (Effect size = 0.85, 95% CI [0.42, 1.27], p < 0.001). In addition, non-FBA based interventions had no effect on problem behavior when compared to no intervention (0.06, 95% CI [− 0.21, 0.33], p = 0.664). Interestingly, both FBA-based and non-FBA-based interventions had significant effects on appropriate behavior relative to no intervention, albeit the overall effect size was much larger for FBA-based interventions (FBA-based: 1.27, 95% CI [0.89, 1.66], p < 0.001 vs. non-FBA-based: 0.35, 95% CI [0.14, 0.56], p = 0.001). In spite of the evidence in favor of FBA-based interventions, the limited number of comparative studies with high methodological standards underlines the need for further comparisons of FBA-based versus non-FBA-based interventions.
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Functional behavioral assessment (FBA) and functional analyses (FA) are grounded in the applied behavior analysis principle that posits problem behavior is functionally related to the environment in which it occurs and is maintained by either providing access to reinforcing outcomes or allowing the individual to avoid or escape that which they find aversive. Previous research has pointed to the limitations across FBA methodologies in comparison to the direct experimental trials used in FA. The purpose of this study was to evaluate the degree to which hypotheses generated by common FBA strategies (i.e., interview, rating scale, and direct observation) match hypotheses generated through FA trials. Results of a multiphase descriptive study indicated that traditional school personnel with behavioral expertise were able to generate FBA hypotheses that were later confirmed by independent review and largely aligned with FA outcomes. The impact of the findings for the field and implications for future research and practice are discussed.
The present study was conducted to determine whether elevated response rates that occurred in an experimental functional analysis were correlated with higher post-session response rates in the natural environment. Functional analyses indicated that the problem behavior of four children with developmental disabilities was maintained by common sources of reinforcement. Observational assessment in the natural environment showed no differences in post-session rates compared with pre-session rates for three participants, and the data for the fourth participant were equivocal. Overall, no convincing evidence was found to suggest that functional analyses might worsen post-session problem behavior in the natural environment. The use of the experimental functional analysis to identify the maintaining variables of problem behavior has become ubiquitous in applied behavior analysis (Iwata & Dozier, 2008). The most prevalent form of functional analysis, at least in the empirical literature, involves arranging consequences for problem behavior during the analysis (Hanley, Iwata, & McCord, 2003). During such procedures, stimuli that are implicated in the maintenance of problem behavior (e.g., attention) are contingently delivered under controlled conditions. Elevated rates of problem behavior (compared with a methodological control) are indicative of a reinforcement function. Over the years, we have encountered individuals (e.g., teachers and paraprofessionals in applied settings) who have expressed concern that the deliberate reinforcement of problem behavior (and resulting higher rates) during functional analysis sessions might
Background:
Experimental functional analysis is an assessment methodology to identify the environmental factors that maintain problem behavior in individuals with developmental disabilities and in other populations. Functional analysis provides the basis for the development of reinforcement-based approaches to treatment.
Methods:
This article reviews the procedures, validity, and clinical implementation of the methodological variations of functional analysis and function-based interventions.
Results:
We present six variations of functional analysis methodology in addition to the typical functional analysis: brief functional analysis, single-function tests, latency-based functional analysis, functional analysis of precursors, and trial-based functional analysis. We also present the three general categories of function-based interventions: extinction, antecedent manipulation, and differential reinforcement.
Conclusions:
Functional analysis methodology is a valid and efficient approach to the assessment of problem behavior and the selection of treatment strategies.
Most functional analyses of problem behavior include a common condition (play or noncontingent reinforcement) as a control for both positive and negative reinforcement. However, test-specific conditions that control for each potential source of reinforcement may be beneficial occasionally. We compared responding during alone, ignore, play, and differential reinforcement of other behavior (DRO) control conditions for individuals whose problem behavior was maintained by positive or negative reinforcement. Results showed that all of the conditions were effective controls for problem behavior maintained by positive reinforcement; however, the DRO condition was consistently ineffective as a control for problem behavior maintained by negative reinforcement. Implications for the design of functional analyses and future research are discussed.
The current study evaluated risk factors for the occurrence, frequency and severity of challenging behavior among a sample of individuals with a diagnosis of autism, under the age of eighteen, in Ireland. Age, gender, hours of intervention received, age at diagnosis, presence of challenging behavior at diagnosis and treatment type at diagnosis were not found to be significant predictors for the frequency or severity of challenging behavior. The participants’ IQ was found to be a significant predictor of the frequency and severity of the behaviors measured. Lower IQ predicted greater frequencies of stereotyped behavior, aggression and self-injurious behavior along with increased severity of stereotyped behavior and self-injurious behavior. The intervention participants were currently receiving was not significant in predicting the frequency of challenging behavior, nor the severity of aggressive or self-injurious behaviors. However, this variable was a significant predictor of severity of stereotyped behaviors with individuals currently in Applied Behavior Analysis interventions presenting with more severe stereotyped behavior than those currently in “eclectic” interventions. Additional findings and implications in relation to these variables are discussed.
The aim of this study was to identify risk factors for the occurrence of challenging behavior along with the specific topographies of challenging behavior shown by a sample of children with autism spectrum disorder in Ireland. The occurrence of challenging behavior was examined in comparison with the following variables: gender, age, level of intellectual disability, type of intervention and the hours of intervention being received. The Behavior Problems Inventory – 01 was used to gather data for 157 participants. Results indicated that 64.3% (n=101) of the participants showed challenging behavior, with a high co-occurrence across categories of behavior. The present study found no correlation between age and gender and the presence of challenging behavior. Findings in relation to level of intellectual disability, type and hours of intervention received are discussed.
This study analyzed the effects of social stories in reducing precursors to tantrum behavior in two social environments, morning work time and lunchtime. The student was a 12-year-old boy diagnosed with autism, Fragile X syndrome, and intermittent explosive disorder. Using an ABAB design, two social stories were implemented and withdrawn as data were collected to determine the frequency of two behaviors, inappropriate vocalizations and dropping to the floor, which served as precursors to tantrum behavior. The data revealed a decrease in precursors to tantrum behavior when the social stories were available to the student and an increase in targeted behavior when the intervention was withdrawn.
Young children with autism and behavioral challenges are at great risk for lives that are characterized by social isolation and segregated placements. These restrictive placements often occur when the child’s challenging behavior interferes with successful adaptation in educational, therapeutic, and community environments. In this article, positive behavior support is described as a process that may be used to understand and intervene effectively with the challenging behavior of young children with autism. The article describes the history, empirical support, and implementation steps of positive behavior support. A case study is provided to illustrate successful application of the process.
Reviews evidence for behavioral interrelationships and reveals an absence of systematic effort to assess the multiple effects of behavioral treatments undertaken with single target behaviors. Documented reports of concomitant behavior change are relatively rare in the intervention literature, cannot always be evaluated as a function of the targeted change, and include both positive and negative side effects for a variety of target and nontarget behaviors with no obvious patterns across children. Descriptive and clinical–experimental multivariate studies of behavioral repertoires are suggestive but even more infrequent, and bring new urgency to the solution of a number of traditional problems in observational methodology. The implications of behavioral interrelationships for within-S experimental designs, the nature and extent of the assessment task, and the evaluation of treatment validity are discussed. (4½ p ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This multiple-study experiment evaluated the utility of assessing and treating severe self-injurious behavior SIB based on the outcomes of a functional analysis of precursor behavior. In Study 1, a precursor to SIB was identified using descriptive assessment and conditional probability analyses. In Study 2, a functional analysis of precursor behavior was conducted. Finally, study 3 evaluated the effects of a treatment in which precursor behavior produced the maintaining variable identified in the precursor functional analysis. Studies 1 and 3 were conducted in two settings in the participants natural environment, where data collection was ongoing throughout the course of the study. Results showed that it was possible to identify a precursor to infrequent but severe SIB, that a functional analysis of precursor behavior suggested a clear operant function, and that treatment based on the results of the precursor functional analysis reduced SIB in the natural environment.
Researchers have developed precursor functional analyses to provide an alternative, and presumably safer, format for functional analysis of severe problem behavior. When researchers use functional analysis contingencies for precursor behaviors, it is possible to infer functional characteristics about severe problem behaviors based on patterns of less severe precursor behaviors, permitting practitioners to complete the assessment with less risk to clients, practitioners, or others. The current paper discusses recent advances in the development and validation of precursor identification, and offers suggestions and future directions for investigating and implementing precursor functional analyses. We propose a decision‐making model, in which practitioners integrate procedures to identify precursors into the functional‐analysis process, to expedite the analysis of severe problem behaviors.
Clinicians assisting children with deficits in social interaction and communication are likely to be tasked with assessing and treating their problem behavior as well. While problem behavior can range in severity, clinicians are at an advantage when they know the function of the problem behavior, and the child’s relative or normative deficits in communication, tolerance for instruction, and preference for play. Thus, clinicians are positioned to implement or train parents on interventions that are functionallybased and/or empirically-supported which also have a greater likelihood of being effective. While intervention selection is a good place to start toward more positive outcomes for a child and family, there are other variables to consider that can further contribute to the success of an intervention plan. Once a clinician selects an intervention, the usability and fidelity can be improved by assessing and incorporating social validity factors into the decision-making process. Prior to implementation, clinicians should develop a detailed, yet succinct, intervention plan to establish consistency, train parents, and monitor integrity. This strategic approach to function-based intervention is rooted within an evidence-based framework.
Pica is dangerous behavior and often maintained by automatic reinforcement. We conducted a latency functional analysis (FA) using safe consumption items to verify that pica was maintained in part by automatic reinforcement and exclude participants for whom pica was likely maintained solely by attention. Next, we identified precursors to pica through a probability analysis and conducted a brief blocking assessment for participants' whose pica occurred in the alone and attention conditions of the FA. Finally, we compared blocking precursors with pica, touching an inedible item and the pica itself. Results showed that five of the six participants' pica was likely maintained by automatic reinforcement, and pica decreased during the brief blocking assessment for three of four participants. Results of the blocking comparison showed that blocking behaviors earlier in the response hierarchy was as effective as only blocking pica attempts for two participants and more effective for one participant.
Functional communication training (FCT) is a commonly used, often recommended intervention that involves teaching a functionally equivalent communicative response to replace challenging behavior. The purpose of this literature review was to evaluate the strength of the evidence for the use of FCT. A systematic review of the literature resulted in the identification of 215 single-case-design articles that evaluated the efficacy of FCT to reduce challenging behavior for individuals diagnosed with a disability. FCT resulted in a decrease in challenging behavior for 135 participants. The reviewers rated FCT as an evidence-based practice for individuals with autism, intellectual disability, other health impairments, and multiple disabilities based on What Works Clearinghouse standards. Overall, the extant literature indicates FCT consistently results in the reduction of challenging behavior in children with disabilities. Implications for practice and directions for future research are discussed.
At the 2016 TASH Conference in St. Louis, a research colloquium was held that focused on the state of selected life-span services for people with severe disabilities. Topics addressed by leading experts in the field included inclusion, teaching academic skills, family support, challenging behavior, supported employment, and voting. This article summarizes the information presenters shared at the colloquium. The presenters prepared a short response with a minimum number of citations based on the material they presented, which focused on the description of the practice, extent to which practices are implemented, challenges to implementing the practice, and recommended practices. Although all contributors suggested that much progress has been made, they concurred that there is still much to do in serving people with severe disabilities and their families.
Parents and carers frequently report that individuals with learning disabilities who demand access to preferred activities present challenging behavior when they are denied access to these activities. The present research systematically replicated a pilot study by Mace, Pratt, Prager and Pritchard (in press) demonstrating that an escalating response class hierarchy of challenging behaviors could be reliably avoided if a child’s demands for access to a computer game were denied by either: (a) denying the child access to the computer game while at the same time offering an alternative activity; or (b) denying the child access to the computer game until the child had completed an academic task. The current study extended the pilot research by demonstrating the effectiveness of the two interventions with a 17 year-old male of large stature who engaged in dangerous challenging behavior when his demands for access to computers were denied.
Functional communication training (FCT) is one of the most common and effective interventions for severe behavior problems. Since the initial description of FCT by Carr and Durand (1985), various aspects of the FCT treatment process have been evaluated, and from this research, best practices have emerged. This manuscript provides a review of these practices as they arise during the development of effective FCT interventions.
We replicated Fritz, Iwata, Hammond, and Bloom (2013) by evaluating the efficacy of an
experimental methodology to identify precursors to aggression displayed by an adolescent with
autism spectrum disorder. Using their trial-based precursor analysis, we identified seven precursors
to aggression. Next, we compared the outcomes of separate precursor and aggression functional
analyses and showed that both precursors and aggression were multiply controlled by the
same variables.
Hanley, Jin, Vanselow, and Hanratty (2014) described a functional analysis (FA) format that relied on a synthesis of multiple contingencies described by caregivers during open-ended interviews. These interview-informed synthesized contingency analyses (IISCA) provided effective baselines from which to develop socially validated treatments, but the synthesis precluded a precise understanding of individual contingencies influencing problem behavior. We conducted IISCAs and standard FAs (Iwata, Dorsey, Slifer, Bauman, & Richman, 1982/1994) for nine children with autism to evaluate the likelihood of differentiation given a number of synthesized versus isolated variables. The IISCA was differentiated for all. The standard FA was differentiated for four; this number increased to six when we included precursors in the standard FA. We then compared treatments based on sets of differentiated analyses for four children. Treatment based on the IISCA was effective for all four; treatments based on the standard FA were effective for two. The role of synthesis in analysis is discussed.
It has been suggested that reinforcing problem behavior during functional analyses (FAs) may raise ethical questions, such as resulting in an increase in problem behavior outside of FA sessions. The current translational study assessed whether conducting an FA resulted in increases in problem behavior outside of the FA setting for six participants using a nonconcurrent multiple baseline across participants design. The rate of problem behavior was measured outside the FA setting prior to and during an FA. Idiosyncratic results suggest that problem behavior outside of the FA setting may increase, decrease, or be unaffected by conducting an FA.
Challenging behavior exhibited by young children is becoming recognized as a serious impediment to social-emotional development and a harbinger of severe maladjustment in school and adult life. Consequently, professionals and advocates from many disciplines have been seeking to define, elaborate, and improve on existing knowledge related to the prevention and resolution of young children's challenging behaviors. Of particular concern for the field of behavioral disorders is the lack of correspondence between what is known about effective practices and what practices young children with challenging behavior typically receive. To increase the likelihood that children receive the best of evidence-based practices, the current analysis was conducted to provide a concise synthesis and summary of the principal evidence pertaining to the presence and impact, prevention, and intervention of challenging behaviors in young children. A consensus building process involving review and synthesis was used to produce brief summary statements encapsulating core conclusions from the existing evidence. This article presents these statements along with descriptions of the strength of the supporting evidence. The discussion addresses directions and priorities for practice and future research.
Resurgence may be defined generally as the extinction-induced recurrence of previously learned response patterns. Understanding the conditions under which this phenomenon occurs has theoretical, clinical, and applied implications, particularly with respect to a related area of research on response-class hierarchies. In the current study, we examined resurgence with 2 participants who exhibited response-class hierarchies consisting of various topographies of severe problem behavior maintained by positive reinforcement. Baseline levels of responding were maintained by brief access to tangible items. In a second condition, reinforcement was produced by an alternative topography of severe problem behavior, and the initial topography was extinguished concurrently. When the reinforcement contingency for alternative behavior was removed, previously reinforced topographies recovered. This resurgence was specific to behavior that recently produced the reinforcer, which suggests that the recovery was not simply extinction-induced variation or emotional responding. The clinical implications of the results are discussed and related to results that have been produced in the laboratory by a variety of methods.
In the developed world alone an increasing number of people have a severe learning disability leading to challenging behaviour. This can encompass aggression, self-injury, destructiveness, hyperactivity, inappropriate sexual or social conduct and bizarre mannerisms, which adversely affects the health and safety of both the sufferer and the carer. In this thoroughly revised and updated new edition, Eric Emerson provides a comprehensive overview of the current findings about the nature, epidemiology, causes and treatment outcomes of challenging behaviour caused by learning disability. The material about motivational factors and the relationship between challenging behaviour and psychiatric disorder has been considerably expanded, and the book combines evidence and research drawn from the fields of psychology, psychiatry and medicine. It will be essential reading for clinicians and all health care professionals involved in the assessment and treatment of challenging behaviour.
The current review examined 368 articles, published between 1967 and 2013, which evaluated punishment-based procedures for the treatment of challenging behavior among persons with developmental disabilities and quantitatively analyzed: (a) the amount of research that has assessed different types of punishment procedures; (b) the characteristics of the participants, behaviors, and treatments included in these studies, and (c) the relative efficacy of the various punishment procedures in general and with regard to the inclusion of reinforcement-based components, method of treatment selection and development, and function of the targeted challenging behaviors. Further, the study evaluated the included studies for the presence of important quality indicators. It was intended that such an analysis would provide a useful overview of the extant research on punishment procedures as a behavior reduction technique. Suggestions regarding research methodology and areas for further investigation are made for future research evaluating punishment-based interventions.
Functional analysis is the most precise method of identifying variables that maintain self-injurious behavior (SIB), and its use may lead to more effective treatment. One criticism and potential limitation of a functional analysis is that it may unnecessarily expose individuals to a higher risk of injury (Betz & Fisher, 2011). The purpose of this study was to determine if there were higher levels and severity of injury during the functional analysis than outside the functional analysis. We conducted a retrospective records review of 99 participants admitted to an inpatient unit for the treatment of SIB. The results showed that injury rates were relatively low across all situations and that when injuries occurred, they were usually not severe. These findings suggest that the functional analysis of SIB is relatively safe when appropriate precautions are taken.
A multi-component intervention was used to treat chronic rumination exhibited by an adult female diagnosed with a developmental disability. The intervention consisted of: (a) interruption of precursor behavior, (b) the alternation of 10-min periods of continued instruction that involved walking and working with (c) 10-min periods in which instructions were not delivered but a variable time 5-s schedule of noncontingent attention was programmed, and (d) a 1-min differential reinforcement of other behavior (DRO) schedule. During the intervention, rumination decreased by 82% relative to baseline. Next, components of the multi-component intervention were systematically removed to evaluate their individual contribution. Results suggested that each individual component contributed to the overall treatment effects. Copyright © 2010 John Wiley & Sons, Ltd.
We evaluated the effects of extinction and negative reinforcement on the latency of response-class members following requests made to a 15-year-old female with moderate mental retardation and autism. A functional analysis showed that the class members (screams, aggression, and self-injury) were escape maintained. Informal observations suggested that these topographies generally occurred in the sequence listed above and therefore may have been hierarchically related. A therapist provided escape from demands contingent on a specific member of the class to determine the effects on the latency of the members' occurrence. Results showed that the latencies occurred in a predictable order. In addition, we expanded the response class to include a vocal response that was functionally equivalent to other members. Findings are discussed regarding the covariation and sequence of response-class members and treatment development.
Training programs on the topic of challenging behaviors have often been offered to teaching staff and family carers of children with intellectual disabilities (ID). These efforts have been found to be effective in bringing about positive changes for both children with ID and those who support them. Generally, such training has been offered to either staff or family carers but not at the same time. The authors conducted a study to evaluate the efficacy of a brief training program delivered at the same time to teaching staff and family carers (who were involved with the same child). The study also examined differences in outcomes between the two groups, which were drawn from local schools where some children exhibited challenging behaviors. Both teaching staff and family carers completed the Checklist of Challenging Behaviour, the Challenging Behaviour Attributions Scale, and the Emotional Reactions to Challenging Behaviour Scale prior to, and following, the training workshops. The workshops were divided into two segments. The content was the same, but in the first segment, one was held for teaching staff and one for parent carers. In the second segment, both groups met together. After the first segment, all participants completed a related homework task before joining each other for the second segment. Training used a functional model of challenging behavior and facilitated the production of individualized support plans for the target children. Significant positive changes were found regarding ratings of challenging behavior, participants' causal attributions, and emotional reactions following the training. Some differences were found regarding outcomes for teaching staff vs. family carers. The study showed that teaching staff and family carers can benefit from receiving combined training to support challenging behavior in children with ID.
Some individuals engage in both mild and severe forms of problem behavior. Research has shown that when mild behaviors precede severe behaviors (i.e., the mild behaviors serve as precursors), they can (a) be maintained by the same source of reinforcement as severe behavior and (b) reduce rates of severe behavior observed during assessment. In Study 1, we developed an objective checklist to identify precursors via videotaped trials for 16 subjects who engaged in problem behavior and identified at least 1 precursor for every subject. In Study 2, we conducted separate functional analyses of precursor and severe problem behaviors for 8 subjects, and obtained correspondence between outcomes in 7 cases. In Study 3, we evaluated noncontingent reinforcement schedule thinning plus differential reinforcement of alternative behavior to reduce precursors, increase appropriate behavior, and maintain low rates of severe behavior during 3 treatment analyses for 2 subjects. Results showed that this treatment strategy was effective for behaviors maintained by positive and negative reinforcement.
Hanley, Iwata, and McCord (2003) reviewed studies published through 2000 on the functional analysis (FA) of problem behavior. We update that review for 2001 through 2012, including 158 more recent studies that reported data from 445 FAs. Combined with data obtained from Hanley et al., 435 FA studies, with line graphs for 981 FAs, have been published since 1961. We comment on recent trends in FA research and introduce the studies in the 2013 special issue of the Journal of Applied Behavior Analysis.
A response class hierarchy (RCH) is a ranking of the behaviors within a response class, such that the behaviors occur in a predictable, temporal order. In the current study, we identified a RCH through an extinction analysis for two individuals who exhibited multiple topographies of problem behavior. Potential replacement communication responses were identified during the extinction analysis for each participant. We then examined the emergence and subsequent reinforcement of the identified communication responses in the absence of explicit training during treatment analyses. Reinforcement of communication in combination with other treatment components (e.g., extinction; discriminative stimuli) resulted in expansion of the RCH and decreased occurrences of problem behavior.
Functional analysis procedures have been revolutionary in the field of applied behavior analysis. Their ability to identify the contingencies maintaining problem behavior has allowed clinicians to develop function-based treatments and minimised the use of aversive procedures to reduce problem behavior. However, limitations including their time consuming nature, the expertise they require, their unsuitability for certain settings and types of behavior, and their reinforcement of the problem behavior, often preclude their use in applied settings. Several alternative types of functional analysis have been developed to compensate for these limitations. This review includes studies that investigated the use of brief functional analysis, latency functional analysis, precursor functional analysis, functional analysis with protective equipment, and trial-based functional analysis. Studies that met the inclusion criteria were evaluated with respect to various aspects including sample and setting characteristics, target behaviors, additional assessments, outcomes of the analyses, and efficacy of function-based treatments applied.
Ethical guidelines for behavior analysts state that functional assessment should be used before implementing treatment plans. In this paper, we discuss the ethical implications of this position using self-injurious behavior in people with developmental disabilities as a focus. Evidence is reviewed that suggests that treatment based on results of a functional assessment is likely to be more effective, less likely to be considered restrictive, more likely to be perceived as socially valid, and also focuses on principles of a constructional approach to behavior change. Alongside this generally positive evidence, there are ethical problems with the validity of some assessment methods, their potential lack of clarity, and the intensive resources required by a functional assessment. Effective, socially valid, and constructional interventions for self-injury might also be developed using preventative interventions. The balance of all of these ethical issues needs to be considered in the design of any treatments for self-injurious behavior.
Functional behavioral assessment (FBA) has been suggested for facilitating the development and effectiveness of behavior intervention plans. In this study, the researchers examined whether behavior intervention plans based on FBA information (function-based) were more effective than behavior intervention plans not based on FBA information (non—functionbased) in affecting rates of problem behaviors displayed by two middle school students. Single-subject ABCBC designs were used to demonstrate a functional relationship between student responding and function-based and non—function-based behavior intervention plans. Results indicated that the use of FBA-based intervention plans was associated with greater improvements in lowering the number of problem behaviors. Implications and limitations for practitioners and researchers are discussed.
The purpose of this pilot study was to review the effects of professional staff training in crisis management and de-escalation techniques on the use of seclusion timeout and restraint procedures with at-risk students in a K-12 special day school. An exploratory pre-post study was conducted over a two-year period, comparing the use of these behavior management interventions when all staff members were provided crisis intervention training. In addition, a brief survey was administered to all staff members concerning their training in and use of behavioral interventions. Results indicated professional staff training was effective in reducing (a) seclusion timeout procedures by more than one-third (39.4%) and (b) physical restraints (17.6%). This study also found staff members were not initiating seclusion timeout procedures primarily for the reasons they were trained (e.g., physical aggression) but rather for nonviolent behaviors such as leaving an assigned area and disrupting the classroom environment.
Hundreds of studies have shown the efficacy of treatments for problem behavior based on an understanding of its function. Assertions regarding the legitimacy of different types of functional assessment vary substantially across published articles, and best practices regarding the functional assessment process are sometimes difficult to cull from the empirical literature or from published discussions of the behavioral assessment process. A number of myths regarding the functional assessment process, which appear to be pervasive within different behavior-analytic research and practice communities, will be reviewed in the context of an attempt to develop new lore regarding the functional assessment process. Frequently described obstacles to implementing a critical aspect of the functional assessment process, the functional analysis, will be reviewed in the context of solutions for overcoming them. Finally, the aspects of the functional assessment process that should be exported to others versus those features that should remain the sole technological property of behavior analysts will be discussed.
Challenging behaviors were assessed in 313 children, and it was demonstrated that children with autism spectrum disorders (ASD) exhibited greater levels of challenging behavior than both normally developing controls and children with psychopathology or atypical development. Next, we examined the relation between challenging behaviors and symptoms of autism in children with ASD. Severity of ASD was positively related to the number and intensity of challenging behaviors, and those with severe ASD exhibited significantly higher levels of problem behaviors than children with mild or moderate ASD. In addition, clusters of ASD symptoms were able to accurately predict endorsements of 8 of the 18 challenging behaviors assessed. Implications for the assessment and intervention of ASD and challenging behaviors are discussed.
Discusses how the technique of teaching social behavior using the construction of social stories (SCSs) has helped strengthen the cognitive skills needed for social interaction in children with autism. SCSs seek to minimize potentially confusing instructional interactions to provide students with autism direct access to social information. Once the information is presented, new skills are practiced in the targeted situation with needed, but not excessive, support. SCSs are most likely to benefit students functioning intellectually in the trainable mentally impaired range or higher who possess basic language skills. Guidelines for writing and techniques for implementing SCSs are presented. Case examples of SCSs in practice for 2 girls (aged 7 and 9 yrs), a 6-yr-old boy, and a boy in high school are also detailed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The prevalence of challenging behaviors in the autism spectrum disorders (ASD)
population is often assumed to be high but relatively little research has actually been
published on it. Furthermore, challenging behaviors are likely to impede progress in
evidence-based treatment programs, such as early intensive behavioral intervention
(EIBI). Little or no previous research has evaluated the prevalence of various topographies
of challenging behavior in a population of children with ASD receiving EIBI services, nor
evaluated the relationship between such behaviors and the severity of ASD symptoms.
Using data from the ASD–DC and the ASD–BPC in 84 children with autism receiving EIBI
services, the current study conducted a regression analysis of relations between
endorsement of challenging behaviors and ASD symptom severity. Results indicated that
94% of the sample reported the presence of challenging behavior, stereotypical behaviors
were the most commonly reported, and that the presence of challenging behavior was
predicted by ASD severity.