Exploring factors that influence the efficacy of functional communication training

Understanding factors that influence the efficacy of functional communication training has both practical and conceptual benefits. The current study extended research in this area by exploring data from 95 consecutive applications of functional communication training with extinction across two independent clinics. We selected candidate predictor variables based on conceptual analysis, conducted preliminary exploratory analyses, and then selectively applied quantitative methods that are used in precision medicine to examine their accuracy and predictive utility. Treatment outcomes were better when challenging behavior was maintained by a single function than they were when it was maintained by multiple functions; however, these differences were most apparent among cases with an escape function. We also analyzed within-session responding to explore the potential influence of unprogrammed establishing operations on decrements in treatment efficacy. Our within-session measure only distinguished responders from nonresponders when escape was one of the multiple functions. Additional research is needed to validate these findings with an independent sample and to address a number of clinical conceptual issues.

Differential Reinforcement without Extinction: An Assessment of Sensitivity to and Effects of Reinforcer Parameter Manipulations

Although functional communication training (FCT) usually includes extinction, withholding reinforcement is not possible or ethical with certain individuals, for some topographies of problem behavior, or in certain contexts. The current study evaluates the effects of two variations of FCT, both without extinction, on problem behavior and communication. Further, the intervention procedures were designed to evaluate participant reactivity to reinforcer parameters (e.g., magnitude, delay, and quality) in the context of the FCT variations. The parameter sensitivity assessments were effective at identifying relevant reinforcer parameters for each participant and both FCT interventions were effective in decreasing problem behavior and increasing communication for all participants. The results demonstrated that FCT was effective regardless of which reinforcer parameter was manipulated. Moreover, all sessions were conducted in participants' homes and caregivers reported high degrees of social validity for the intervention procedures and outcomes.

Examining resurgence in rats following expanded-operant treatments

Resurgence of previously reinforced behavior represents a challenge to otherwise successful interventions based on differential reinforcement of alternative behavior (DRA). Expanded-operant treatments seek to increase the number of functional alternative behaviors through DRA, thereby potentially mitigating resurgence. However, the few studies that have directly examined these methods as a tool for resurgence mitigation have provided limited and unclear results. Thus, the present experiments were designed to investigate the effect of expanded-operant DRA methods on resurgence of previously reinforced behavior using rat subjects. In two experiments, following a baseline phase in which a target response was trained, groups of rats experienced concurrent (i.e., five simultaneous alternative responses), serial (i.e., five sequentially available alternative responses), or single DRA interventions arranging similar rates of alternative reinforcement in order to examine potential differences in resurgence. Both experiments showed that neither serial nor concurrent DRA expanded-operant treatments reduced resurgence compared with single DRA regardless of whether stimuli associated with previously reinforced alternative responses were removed (Experiment 1) or remained present (Experiment 2) for the serial-DRA group. Further, a primacy effect in resurgence was obtained for the serial-DRA group in both experiments. Overall, these results suggest that expanded-operant treatments may not help to reduce resurgence.

Resurgence of destructive behavior following differential rates of alternative reinforcement

Behavioral momentum theory (BMT) suggests that resurgence of destructive behavior may be at least partly determined by the rate of alternative reinforcement, with lean schedules of reinforcement producing less resurgence than dense schedules. Findings from basic and translational studies have been mixed, and the effects of alternative reinforcement rate on resurgence remain unclear. In the current study, we conducted a within-subject evaluation of resurgence during extinction with four children following functional communication training using dense and lean (BMT-informed) schedules of alternative reinforcement. We observed no reliable differences in resurgence across the dense and lean conditions. We discuss implications of these findings in relation to future research using quantitative analyses to evaluate the relative effects of alternative reinforcement rate and other BMT-based strategies for mitigating resurgence in applied settings.

Relapse and its mitigation: Toward behavioral inoculation

Relapse following the successful treatment of problem behavior can increase the likelihood of injury and the need for more intensive care. Current research offers some predictions of how treatment procedures may contribute to relapse, and conversely, how the risk of relapse can be mitigated. This review describes relapse-mitigation procedures with varying levels of support, the quantitative models that have influenced the research on relapse mitigation, different experimental methods for measuring relapse mitigation, and directions for future research. We propose that by viewing the implementation of relapse-mitigation procedures as a means of producing behavioral inoculation, clinicians are placed in the proactive and intentional role of exposing their client's behavior to an array of reinforcement and stimulus conditions during treatment with the goal of decreasing the detrimental impact of future treatment challenges.

A Comprehensive Systematic Review of Procedures and Analyses Used in Basic and Preclinical Studies of Resurgence, 1970-2020

Resurgence is the return of a previously reinforced response as conditions worsen for an alternative response, such as the introduction of extinction, reductions in reinforcement, or punishment. As a procedure, resurgence has been used to model behavioral treatments and understand behavioral processes contributing both to relapse of problem behavior and flexibility during problem-solving. Identifying existing procedural and analytic methods arranged in basic/preclinical research could be used by basic and preclinical researchers to develop novel approaches to study resurgence, whereas translational and clinical researchers could identify potential approaches to combating relapse during behavioral interventions. Despite the study of resurgence for over half a century, there have been no systematic reviews of the basic/preclinical research on resurgence. To characterize the procedural and analytic methods used in basic/preclinical research on resurgence, we performed a systematic review consistent with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). We identified 120 articles consisting of 200 experiments that presented novel empirical research, examined operant behavior, and included standard elements of a resurgence procedure. We reported prevalence and trends in over 60 categories, including participant characteristics (e.g., species, sample size, disability), designs (e.g., single subject, group), procedural characteristics (e.g., responses, reinforcer types, control conditions), criteria defining resurgence (e.g., single test, multiple tests, relative to control), and analytic strategies (e.g., inferential statistics, quantitative analysis, visual inspection). We make some recommendations for future basic, preclinical, and clinical research based on our findings of this expanding literature.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40614-022-00361-y.

Primacy and recency effects in hierarchical renewal in rats

Previous studies on hierarchical resurgence produced mixed results regarding the order and magnitude of recurrence of responses trained initially (primacy effect) or more recently (recency effect). Although changes in contextual stimuli could explain such differences, in resurgence procedures contextual stimuli are not commonly presented, thus their effects on multiple operants trained sequentially remain unclear. Renewal procedures, in contrast, have been useful to determine the effects of exteroceptive contextual stimuli on response recurrence. Thus, primacy and recency effects were studied using a renewal procedure in which three contexts were presented sequentially. Lever presses by rats were reinforced on a different lever under each training context and were then exposed to extinction in a different context. Presses on a fourth lever were never reinforced. During renewal testing, the three training contexts were presented in the same or inverse order relative to training. A strong primacy effect was found in rats exposed to the original training order. Both primacy and recency effects were found when the rats were exposed to contexts in inverse order. These results suggest that the magnitude of renewal of hierarchically trained responses is affected by training order and order of presentation of contextual stimuli during testing.

Relapse during the treatment of pediatric feeding disorders

Resurgence and renewal are treatment-relapse phenomena in which previously extinguished behavior returns after the conditions for an alternative response worsen or the context changes, respectively. Recently, researchers have evaluated the prevalence of resurgence and renewal when treating destructive behavior with functional communication training. However, resurgence of inappropriate mealtime behavior has yet to be evaluated; perhaps because treatments involve qualitatively different resurgence opportunities (e.g., increased bite-presentation rate). We evaluated the prevalence of resurgence and renewal of inappropriate mealtime behavior across 22 and 25 applications of extinction-based treatments, respectively. Resurgence occurred in 41% (9/22) of applications, most often following presentation-rate increases. Renewal occurred in 52% (13/25) of applications, most often following feeder changes from therapist to caregiver. We discuss these findings in terms of their ability to inform relapse-mitigation strategies for resurgence and renewal of inappropriate mealtime behavior.

Extending functional communication training to multiple language contexts in bilingual learners with challenging behavior

Little research has highlighted how evidence-based practices (e.g., functional communication training [FCT]) might be adapted for bilingual learners with disabilities. In the current study, we served 2 children with autism spectrum disorder (ASD) and challenging behavior whose parents primarily spoke Spanish at home, and whose teachers primarily spoke English at school. Following traditional FCT (i.e., 1 language only), we systematically replicated the findings of Neely, Graber et al. (2020) by demonstrating that mands in the untrained language (i.e., English) did not emerge when trained mands (i.e., Spanish) contacted extinction in alternative-language contexts. Simultaneously, challenging behavior consistently resurged. After children received explicit training with both languages and were taught to change the language of request when initial attempts were unsuccessful (i.e., "repair the message" training), these same children successfully obtained high rates of reinforcement in both language contexts, and challenging behavior rarely occurred.

Resurgence Following Traditional and Interdependent Differential Reinforcement of Alternative Behavior

Clinicians frequently prescribe functional communication training (FCT) as a treatment for severe destructive behavior. Recent research has shown that FCT treatments are susceptible to treatment relapse in the form of resurgence of destructive behavior when individuals contact periods in which reinforcers are unavailable. Results of preliminary studies suggest that teaching multiple response alternatives can mitigate the resurgence of target behavior. The current evaluation serves as a preliminary study in which we used a laboratory arrangement to evaluate the effects of a novel approach to training multiple alternative responses on the resurgence of target behavior. Findings showed that multiple-response training did not decrease resurgence of target responding consistently; however, it increased the total amount of target and alternative responding observed during the resurgence phase and decreased the overall probability of the target response.

Increased number of responses may account for reduced resurgence following serial training

Abrupt discontinuation of functional communication training can cause resurgence of challenging behavior. Teaching multiple alternative responses in sequence (serial training) may reduce resurgence, relative to teaching a single alternative. However, previous evaluations of serial training included a different number of response options across comparison conditions. In Experiment 1, we varied both training type (single and serial) and number of response options, and replicated previous findings showing that more resurgence occurred following single training relative to serial training. In Experiment 2, we varied the training type while holding the number of alternative responses constant and obtained no consistent differences in resurgence. In Experiment 3, we varied the number of alternative responses while holding training type constant (i.e., single). More resurgence occurred in the condition with fewer response options, suggesting that the number of available alternative responses, and not explicit serial training of alternatives, was critical to outcomes.

Mitigating resurgence of destructive behavior using the discriminative stimuli of a multiple schedule

Results of several recent translational studies have suggested that correlating contextual or discriminative stimuli with the delivery and withholding of reinforcement for the functional communication response (FCR) may mitigate resurgence of destructive behavior, but few, if any, have isolated the effects of those stimuli. In the present study, we first trained the FCR, brought it under stimulus control of a multiple schedule, and thinned its reinforcement schedule in one stimulus context. Next, we conducted resurgence evaluations (i.e., baseline, functional communication training [FCT], extinction challenge) in two novel contexts to test the effects of the discriminative stimuli on resurgence. We programmed one context to include the (a) S^D during the FCT phase to signal the availability of reinforcement for the FCR and (b) S^Δ during a subsequent extinction challenge to signal the unavailability of reinforcement for the FCR. The other context did not include the S^D during the FCT phase, nor the S^Δ during the extinction challenge. We expected to see greater persistence of the FCR in the context that included the S^D during FCT and less persistence of the FCR and less resurgence of destructive behavior in the context that included the S^Δ during the extinction challenge. Obtained results confirmed this latter prediction, but we observed no reliable difference when the S^D was present or absent during the FCT phase. Our results have relevance for practitioners in that they provide further empirical support for the use of discriminative stimuli when treating destructive behavior.

Hierarchical resurgence

In resurgence, conventionally a target response is trained and then extinguished while some alternative response is reinforced. In the most common procedure, when the latter is extinguished, the former resurges. The present experiments examined resurgence after two responses were trained sequentially and subsequently extinguished. In Experiments 1 and 2, keypecking to one key was trained and then extinguished as keypecking to a different key was trained then later extinguished. In both experiments, regardless of the spatial location of the different keys, the last-trained response resurged before the first-trained one. The results were replicated in Experiment 3 where reinforcement rate of the first-trained response was four times that of the second-trained response. The results in conjunction with earlier experiments suggest that resurgence occurs hierarchically, although whether more or less recently trained target responses resurge first or later may depend on both current and historical variables. The results also raise questions about the interpretation of responding on a control key that sometimes is included in resurgence experiments to isolate resurgence from extinction-induced responding.

Impact of language on behavior treatment outcomes

Resurgence of problem behavior following effective functional communication training (FCT) can occur if the functional communication response contacts extinction. For children from dual-language households, extinction may unintentionally occur due to language variations among communication partners. In the current study, the experimenters evaluated the effect of language on FCT outcomes. Participants were 3 children with autism who engaged in problem behavior and whose parents reported Spanish as the primary home language. The experimenters conducted FCT in the English language followed by probes in the Spanish language. Results suggest that functional communication responses (FCRs) learned in the first language (English) may lead to resurgence of problem behavior when English FCRs do not contact reinforcement in the untaught language (e.g., Spanish). Two of the participants required additional teaching in the secondary language (Spanish), while the third participant eventually emitted Spanish FCRs in the Spanish condition without explicit teaching.

Resurgence when challenging alternative behavior with progressive ratios in children and pigeons

Resurgence is defined as the recurrence of a previously reinforced and then extinguished target response when reducing or eliminating a more recently reinforced alternative response. In experiments with children and pigeons, we evaluated patterns of resurgence across and within sessions through decreases in reinforcer availability by challenging alternative responding with extinction and progressive-ratio schedules. In Phase 1, we reinforced only target responding. In Phase 2, we extinguished target responding while reinforcing an alternative response. Finally, Phase 3 assessed resurgence by (a) extinguishing alternative responding versus (b) introducing a progressive-ratio schedule of reinforcement for alternative responding. In both children and pigeons, resurgence of target responding occurred in both conditions but generally was greater when assessed during extinction than with progressive ratios. Importantly, within-session patterns of resurgence did not differ between testing with progressive ratios and extinction. Resurgence with progressive ratios tended to be greater with longer durations between reinforcers but we observed similar findings with only simulated reinforcers during extinction testing. Therefore, the present investigation reveals that the events contributing to instances of resurgence remain to be understood, and presents an approach from which to examine variables influencing within-session patterns of resurgence.

Decreasing Food Stealing of Child with Prader-Willi Syndrome Through Function-Based Differential Reinforcement

Challenging behaviors involving food are common for individuals with Prader-Willi syndrome (PWS) and often lead to obesity and other chronic health conditions. Efforts to decrease these behaviors, such as isolation during meals and strict monitoring of food consumption, can be stigmatizing. To decrease the food stealing of a 7 year-old girl with PWS, therapists conducted a latency-based functional analysis in a clinic setting before implementing a function-based intervention to facilitate her inclusion at the family dinner table. Intervention components entailed differential reinforcement procedures which incorporated a token board and schedule thinning. The intervention successfully generalized to the home setting and across food preferences and implementers.

Recurrence of phonetic responding

This study determined if previously reinforced academic responding recurred when alternative responses were differentially reinforced and subsequently placed on extinction, and whether the magnitude of resurgence was related to the rate of differential reinforcement for the alternative behavior. Three kindergarten students read Greek letters aloud as arbitrary consonant-vowel blends. Resurgence was reliably demonstrated within and across participants, and the magnitude of resurgence was related to the prior rate of differential reinforcement of alternative behavior.

Effects of a lag schedule of reinforcement with progressive time delay on topographical mand variability in children with autism

OBJECTIVE

Evaluate the effects of a Lag 1 schedule of reinforcement and progressive time delay (TD) on topographical mand variability in children with autism.

METHODS

Using single-subject design methodology, a multiple baseline across behaviors with embedded reversal design was employed. During Lag 0, reinforcement was delivered contingent on any independent instances of manding. During Lag 1 + TD, prompts were faded and reinforcement was delivered contingent on independent or prompted variant mand topographies.

RESULTS

Higher levels of topographical mand variability were observed during Lag 1 + TD for both participants.

CONCLUSIONS

A Lag 1 schedule of reinforcement with progressive TD increased variability across functionally equivalent vocal mand topographies for both participants. This finding extends prior literature by providing a novel model for studying reinforced mand variability in children, and by demonstrating how practitioners could use prompts and differential reinforcement to increase topographical mand variability in children with autism.

Assessing Mand Topography Preference When Developing a Functional Communication Training Intervention

Functional communication training (FCT) is a common function-based behavioral intervention used to decrease problem behavior by teaching an alternative communication response. Therapists often arbitrarily select the topography of the alternative response, which may influence long-term effectiveness of the intervention. Assessing individual mand topography preference may increase treatment effectiveness and promote self-determination in the development of interventions. This study sought to reduce arbitrary selection of FCT mand topography by determining preference during response training and acquisition for two adults with autism who had no functional communication skills. Both participants demonstrated a clear preference for one mand topography during choice probes, and the preferred topography was then reinforced during FCT to reduce problem behavior and increase independent communication. The implications of the results for future research on mand selection during FCT are discussed.

Lag Schedules and Functional Communication Training: Persistence of Mands and Relapse of Problem Behavior

We evaluated the effects of lag schedules of reinforcement and functional communication training (FCT) on mand variability and problem behavior in two children with autism spectrum disorder. Specifically, we implemented FCT with increasing lag schedules and compared its effects on problem behavior with baseline conditions. The results showed that both participants exhibited low rates of problem behavior during treatment relative to baseline during and following schedule thinning (up to a Lag 5 schedule arrangement). Variable and total mands remained high during schedule thinning. With one participant, variable manding persisted when the value of the lag schedule was reduced to zero. The current results are discussed in terms of implications for training multiple mand topographies during FCT for the potential prevention and/or mitigation of clinical relapse during challenges to treatment.

Individualized Levels System and Systematic Stimulus Pairing to Reduce Multiply Controlled Aggression of a Child With Autism Spectrum Disorder

Research has shown that physical aggression is common in individuals with autism spectrum disorder (ASD). Interventions for multiply controlled aggression may be complex and difficult to implement with fidelity. As a result, the probability of treatment efficacy for this class of behavior may suffer. We designed an individualized levels system to reduce the physical aggression of an 11-year-old female with ASD. We then employed a systematic stimulus pairing procedure to facilitate generalization. Results suggest individualized levels systems can suppress multiply controlled aggression and that systematic stimulus pairing is an effective way to transfer treatment effects from trained therapists to caregivers.

An Evaluation of Lag Schedules of Reinforcement During Functional Communication Training: Effects on Varied Mand Responding and Challenging Behavior

We evaluated the effects of lag schedules of reinforcement during functional communication training (FCT) on the varied use of mands and challenging behavior by two individuals diagnosed with autism. Specifically, we compared the effects of Lag 0 and Lag 1 schedules of reinforcement during FCT. The results showed that each participant exhibited increases in varied mand responding during FCT with the Lag 1 schedule of reinforcement relative to Lag 0; challenging behavior remained low during both FCT lag conditions relative to baseline. Results are discussed in terms of treatment implications relating to FCT and the potential prevention and/or mitigation of clinical relapse during challenges to treatment.

Resurgence as Choice

Resurgence is typically defined as an increase in a previously extinguished target behavior when a more recently reinforced alternative behavior is later extinguished. Some treatments of the phenomenon have suggested that it might also extend to circumstances where either the historic or more recently reinforced behavior is reduced by other non-extinction related means (e.g., punishment, decreases in reinforcement rate, satiation, etc.). Here we present a theory of resurgence suggesting that the phenomenon results from the same basic processes governing choice. In its most general form, the theory suggests that resurgence results from changes in the allocation of target behavior driven by changes in the values of the target and alternative options across time. Specifically, resurgence occurs when there is an increase in the relative value of an historically effective target option as a result of a subsequent devaluation of a more recently effective alternative option. We develop a more specific quantitative model of how extinction of the target and alternative responses in a typical resurgence paradigm might produce such changes in relative value across time using a temporal weighting rule. The example model does a good job in accounting for the effects of reinforcement rate and related manipulations on resurgence in simple schedules where Behavioral Momentum Theory has failed. We also discuss how the general theory might be extended to other parameters of reinforcement (e.g., magnitude, quality), other means to suppress target or alternative behavior (e.g., satiation, punishment, differential reinforcement of other behavior), and other factors (e.g., non- contingent versus contingent alternative reinforcement, serial alternative reinforcement, and multiple schedules).

Behavioral momentum theory fails to account for the effects of reinforcement rate on resurgence

The behavioral-momentum model of resurgence predicts reinforcer rates within a resurgence preparation should have three effects on target behavior. First, higher reinforcer rates in baseline (Phase 1) produce more persistent target behavior during extinction plus alternative reinforcement. Second, higher rate alternative reinforcement during Phase 2 generates greater disruption of target responding during extinction. Finally, higher rates of either reinforcement source should produce greater responding when alternative reinforcement is suspended in Phase 3. Recent empirical reports have produced mixed results in terms of these predictions. Thus, the present experiment further examined reinforcer-rate effects on persistence and resurgence. Rats pressed target levers for high-rate or low-rate variable-interval food during Phase 1. In Phase 2, target-lever pressing was extinguished, an alternative nose-poke became available, and nose-poking produced either high-rate variable-interval, low-rate variable-interval, or no (an extinction control) alternative reinforcement. Alternative reinforcement was suspended in Phase 3. For groups that received no alternative reinforcement, target-lever pressing was less persistent following high-rate than low-rate Phase-1 reinforcement. Target behavior was more persistent with low-rate alternative reinforcement than with high-rate alternative reinforcement or extinction alone. Finally, no differences in Phase-3 responding were observed for groups that received either high-rate or low-rate alternative reinforcement, and resurgence occurred only following high-rate alternative reinforcement. These findings are inconsistent with the momentum-based model of resurgence. We conclude this model mischaracterizes the effects of reinforcer rates on persistence and resurgence of operant behavior.

Implications for practice: Resurgence and differential reinforcement of alternative responding

During the maintenance stages of differential reinforcement of alternative responding (DRA), failure to reinforce alternative responses could result in a resurgence of problem behavior. However, translational work done with arbitrary human responses suggests that teaching individuals to emit multiple alternative responses in sequential order may facilitate the resurgence of appropriate, rather than problem, behavior. This paper discusses the practical implications of serial DRA training on problem and appropriate behavior resurgence, as presented in the preceding article, "Serial Alternative Response Training As Intervention for Target Response Resurgence." Clinical scenarios as well as implications for self-advocacy and acceptability of behavioral interventions are considered.