Patricia F. Kurtz

An analysis of functional communication training as an empirically supported treatment for problem behavior displayed by individuals with intellectual disabilities

This paper examines the literature on the use of functional communication training (FCT) as a treatment for problem behavior displayed by individuals with intellectual disabilities (ID). Criteria for empirically supported treatments developed by Divisions 12 and 16 of the American Psychological Association (Kratochwill & Stoiber, 2002; Task Force, 1995) and adapted by Jennett and Hagopian (2008) for evaluation of single-case research studies were used to examine the support for FCT. Results indicated that FCT far exceeds criteria to be designated as a well-established treatment for problem behavior exhibited by children with ID and children with autism spectrum disorder, and can be characterized as probably efficacious with adults.

An Assessment of the Necessary Strength of Behavioral Treatments for Severe Behavior Problems

We conducted a clinical assessment of the effects of different levels of treatment implementation for behavioral treatments of aggression and pica for three participants with developmental disabilities. Treatments were based on differential reinforcement of an alternative behavior and brief time-out. Two treatment components, the schedule of reinforcement and time-out, were systematically varied in a range from 100%, to 50%, to 25% of initial treatment recommendations as one measure of treatment “strength.” For all participants, treatment effects were maintained when time-out was implemented at 50%, and for two participants, treatment effects were maintained at even lower levels. The implications of a prior assessment of necessary treatment strength are discussed.

Functional communication training with and without alternative reinforcement and punishment: An analysis of 58 applications

Functional communication training (FCT) is an empirically supported treatment for problem behavior displayed by individuals with intellectual disabilities. Hagopian, Fisher, Sullivan, Acquisto, and LeBlanc (1998) analyzed 25 applications of FCT and showed that extinction was a necessary component of FCT, but sometimes punishment was needed to maintain low levels of problem behavior. The current consecutive case series summarized data from 58 applications of FCT in more recent cases. This analysis extended and updated Hagopian et al. by examining FCT when used in combination with alternative reinforcement (noncontingent and differential reinforcement) and multiple schedules during schedule thinning. Although it is difficult to make direct comparisons with the 1998 study, the results of the current case series analysis suggest that FCT can be enhanced when used in combination with alternative reinforcement and when multiple schedules are used during schedule thinning.

Therapist effects on functional analysis outcomes with young children

Analog functional analyses (FAs) are commonly used to assess factors that maintain problem behavior of individuals with intellectual disabilities. These analyses are usually conducted by trained staff in clinic settings. However, recent research suggests that FAs conducted by unfamiliar individuals, such as hospital or clinic staff, may result in inaccurate or at least different outcomes. This finding, though, has not been sufficiently examined with young children (i.e., under 5 years of age), where therapist familiarity likely has more influence. The current study compared the outcomes of FAs conducted by unfamiliar staff with FAs conducted by parents for five children ages 2-5 years. Results demonstrate that FAs conducted by unfamiliar therapists may result in a number of differing outcomes, including no responding from the child, failure to identify a particular behavioral function, and decreased rates of responding.

The development and application of individualized levels systems for the treatment of severe problem behavior

Behavioral levels systems are commonly used in a variety of settings and are usually applied at the group level to promote socially desirable behavior and compliance with institutional rules. Despite their widespread use, however, there is surprisingly little empirical data supporting the effectiveness of these interventions. In addition, some researchers have suggested that such group-based interventions may not be consistent with laws mandating individualized educational programming. The current investigation examined the effectiveness of individualized levels systems for decreasing severe problem behaviors exhibited by 4 individuals with developmental disabilities. An individualized multilevel system was developed for each participant based on functional analysis and preference assessment results. These interventions were highly effective in decreasing problem behaviors for each participant. For 2 participants, a component analysis was conducted to identify the necessary components of the levels system. Generalization and care provider training were conducted for all participants. The results suggest that levels systems based on functional analysis and preference assessment results can be effectively generalized and implemented by care providers with good treatment integrity. This approach is presented as a potential alternative to the group-based levels systems that are described in the literature and commonly applied in the community.

Identification of Emerging Self-Injurious Behavior in Young Children: A Preliminary Study

Self-injurious behavior (SIB) is a chronic disorder that often begins in early childhood; however, few studies have examined the onset of SIB in young children. This preliminary study reports on the identification, assessment, and observation of SIB in 32 children who had begun to engage in SIB within the previous 6 months. Participants were under 5 years of age and presented with or were at risk for intellectual and/or developmental disabilities. Assessment measures included parental interviews, developmental and language measures, standardized measures of problem behavior, and direct observations conducted in the home. Results indicated that for most children, SIB emerged prior to age 1 year, and most children developed multiple topographies of SIB and other problem behaviors. Multiple measures were useful in identifying SIB and in characterizing the behavior by topography, frequency, and severity. Findings from the examination of child communication in relation to SIB were inconclusive. Results are discussed in relation to theories of SIB emergence and previous observational studies of young children with SIB.

EVALUATION OF COMBINED-ANTECEDENT VARIABLES ON FUNCTIONAL ANALYSIS RESULTS AND TREATMENT OF PROBLEM BEHAVIOR IN A SCHOOL SETTING

Call, Wacker, Ringdahl, and Boelter (2005) conducted an analysis in which a single-antecedent condition was compared to a multiple-antecedent condition. The present study extended Call et al. by conducting a structured descriptive assessment (SDA) to identify the antecedent variables most associated with problem behavior in a student with traumatic brain injury and intellectual disabilities. Results indicated that the SDA was effective in identifying relevant antecedent variables that led to the development of an effective intervention in the classroom.

Functional analysis and treatment of problem behavior exhibited by children with fragile X syndrome

The efficacy of function-based interventions for the treatment of severe problem behavior exhibited by individuals with intellectual and developmental disabilities (IDD) is well established. However, few studies have reported on behavioral interventions in fragile X syndrome (FXS) specifically. The present study is a consecutive case-series analysis that reports on functional analysis and treatment of problem behavior of nine children with FXS. Assessment findings were consistent with previous research indicating that among individuals with FXS, problem behavior is more commonly maintained by escape from demands and access to tangible items, relative to the broader population of individuals with IDD. Functional analysis-based behavioral interventions resulted in a mean reduction in problem behavior of 95.2% across the nine participants. Additionally, generalization of treatment effects from controlled clinical settings to home, school, and community was demonstrated. The current findings suggest that function-based behavioral interventions shown to be effective with the broader population of individuals with IDD are also effective for individuals with FXS. Our results in combination with those of previous studies describing functional analysis outcomes provide additional evidence for a unique functional behavioral phenotype for severe problem behavior in individuals with FXS. Implications of study findings for early intervention and prevention of problem behavior in children with FXS are discussed.

Caregiver- and staff-conducted functional analysis outcomes: a summary of 52 cases.

In the present study, caregivers were trained as therapists to conduct functional analyses (FAs) after staff-conducted FAs were inconclusive with 52 participants. Caregiver-conducted FAs identified at least 1 function for problem behavior when staff-conducted FAs were undifferentiated. When results of the staff-conducted FAs were questionable, subsequent caregiver-conducted FAs resulted in an exact match with staff-conducted FA in about 68% of cases but identified new functions in about 30% of cases. Function-based treatments based on caregiver-conducted FAs were effective in reducing problem behavior by an average of 96% relative to baseline. Results suggest that when staff-conducted FA outcomes yield inconclusive findings, using caregivers to conduct FAs is likely to produce differentiated results and ultimately result in the development of effective treatments.

An evaluation of the Aberrant Behavior Checklist for children under age 5.

Severe problem behaviors such as self-injury and aggression are frequently observed in young children under age 5 with intellectual and developmental disabilities (IDD). Although early identification of problem behavior is critical to effective intervention, there are few standardized measures available that identify severe problem behavior in this population. The Aberrant Behavior Checklist-Community (ABC-C; Aman & Singh, 1994) is a rating scale that measures the severity of a range of problem behaviors commonly observed in individuals with IDD. While it has been used with children under 5, investigations into the fit of the ABC-C for this population are sparse. The purpose of the present study was to report on ABC-C scores in a sample of 97 children under age 5 with problem behavior. Analyses included evaluating differences in scores between age groups, comparing sample norms to established norms for older children, and conducting a confirmatory factor analysis. Results indicated differences in mean scores based on age with younger children generally scoring higher on some subscales of the ABC-C. Furthermore, the original 5-factor structure of the ABC-C was not fully supported. In general, the ABC-C may over- or underestimate behavior problems in younger children; therefore more extensive investigation into the utility of the ABC-C for children under age 5 is warranted.