Functional Communication Training in Schools: A Systematic Analysis of the Evidence for Ecological Validity

Ecological validity refers to the meaningfulness or practical significance of research outcomes in everyday settings or the extent to which an intervention can be implemented by typical people during naturally occurring opportunities. In education, ecological validity may contribute to the adoption of interventions by teachers working with students in school settings. Our purpose in this review was to examine the evidence for ecological validity of functional communication training (FCT) used to address challenging behavior in school-age individuals with disabilities. We reviewed 19 single-case experimental design (SCED) studies published between 1985 and 2023. First, we used the What Works Clearinghouse (WWC) Standards to evaluate the empirical evidence of each study. Second, we evaluated the extent to which behavioral assessment and FCT procedures were described in the 15 studies that met the WWC Standards. Third, we conducted a systematic analysis of the evidence for ecological validity of behavioral assessment and FCT. Results indicate that 95% of the SCED studies met the WWC Standards. The description of procedures was complete for 50% of the behavioral assessments and for 11% of the FCT. The overall evidence for ecological validity was moderate for 16.7% and low for 83.3% of the behavioral assessments. The evidence for ecological validity for all FCT procedures was low. Future research and implications related to ecological validity are discussed.

A Quantitative Systematic Literature Review of Combination Punishment Literature: Progress Over the Last Decade

This review evaluated single-case experimental design research that examined challenging behavior interventions utilizing punishment elements. Thirty articles published between 2013 and 2022 met study inclusion criteria. Study quality was also assessed. Through multiple levels of analysis (e.g., descriptive statistics, non-parametric statistics), we examined (a) participant and study trends, (b) differential outcomes related to temporal reinforcement approaches (antecedent, consequent, or combined reinforcement) applied alongside punishment element(s), (c) differential outcomes related to the punishment type (negative, positive) applied alongside reinforcement, and (d) effect sizes associated with study rigor across peer-reviewed and gray literature. Our results may tentatively suggest that, for certain situations, concurrently applying punishment with antecedent reinforcement approaches may coincide with significantly larger effect sizes compared to combined temporal reinforcement approaches, while positive punishment applied concurrently with reinforcement may coincide with larger but non-significant intervention effects. Most featured articles met rigor criteria, but larger effects were seen in peer-reviewed literature.

Generalization and Discrimination of Positively Reinforced Explicit Mands in Young Children with Autism Spectrum Disorder

Many children with autism spectrum disorder (ASD) exhibit generalization errors following mand training. In this study, we extended the literature on the generalization of positively reinforced explicit mands in three young children with ASD and complex communication needs. First, we used mand training to teach a new, socially appropriate, positively reinforced explicit mand to request preferred toys. Second, we assessed the discriminated generalization of the newly acquired mand by using untrained examples and nonexamples. Results suggest that our mand training resulted in acquisition of a discriminated positively reinforced explicit mand in all three children. Overgeneralization was documented for one of the three children included in the study. We discuss implications for researchers and practitioners related to the importance of assessing for generalization errors following mand training.

Further Progress Toward Automating Functional Analysis Interpretation

It is considered best practice to conduct a functional analysis and visually inspect data collected to determine the function of problem behavior, which then informs the intervention approaches applied. Visual inspection has been described as a "subjective" process that may be affected by factors unrelated to the data. Structured decision-making guidelines have been established to address some of these shortcomings. The current paper is a follow-up to earlier work describing positive outcomes related to the viability of a decision support system based on structured criteria from Roane et al. Here, we demonstrate important improvements in a computer script's interpretation of functional analysis data, including improvement in agreement between the updated computer script version and experienced human raters (89%) compared to our original agreement outcomes (81%). This paper further supports the use of decision support systems for functional analysis interpretation.

When Science Cannot Guide us: A Call to Action for Applied Behavior Analysts

Evidence presented in the ABAI Task Force Report on Contingent Electric Skin Shock (CESS) revealed serious ethical, clinical, and practical problems with the contemporary use of CESS. As a member of the task force, I ultimately concluded that our recommended position statement ("Position A") was a misguided attempt to uphold the field's commitment to client choice. Furthermore, information gathered by the task force supports an urgent call to find solutions to two additional troubling issues: a severe shortage of treatment services for severe problem behavior and the near-absence of research on treatment-resistant behavior. In this commentary, I discuss reasons Position A was not a tenable stance and why we must do better to help our most vulnerable clients.

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.

An Interdisciplinary Approach to Treating Severe Behavior in a Juvenile Justice Facility: Teaching Behavioral Self-Management via Telehealth

Adolescents living in residential juvenile justice facilities often receive mental health services during their stay to address committed offenses, yet some display challenging behavior during moments of conflict within the facility. These challenging behaviors could result in risk of harm to self or others, or the individual may experience punishment from facility staff. The purpose of this study was to explore the effects of an additive voluntary focused intervention for individuals who continued to display challenging behavior despite participation in "treatment as usual" in a juvenile justice facility. We implemented a self-management intervention, supported through interprofessional collaboration, via telehealth with four male adolescents. Using Behavior Skills Training, we taught participants to self-monitor precursors for challenging behavior and identify an alternative behavior to engage in to prevent overt challenging behavior events. Alternative behaviors were responses incompatible with the challenging behavior, or served as a rule to prompt self-management of further behavior. Results show all four participants increased their selection of alternative behaviors when presented with an evocative situation and a precursor for a severe behavior event during simulations. In addition, three participants stated they would use alternative behaviors across precursors not presented during teaching; however, two participants required booster sessions to maintain appropriate responding during simulations. Outside of simulated sessions, facility staff reported modest decreases in participants' challenging behavior during and after the intervention.

Functional analysis of problem behavior: A 40-year review

Extensive reviews of functional analysis literature were conducted 10 (Beavers et al., 2013) and 20 (Hanley et al., 2003) years ago; we expanded this review to capture the vast and innovative functional analysis research that has occurred over the past decade. Our review produced 1,333 functional analysis outcomes from 326 studies on the functional analysis of problem behavior between June 2012 and May 2022. Some characteristics of functional analysis studies were similar across the current and previous two reviews (e.g., child participants, developmental disability diagnosis, use of line graphs depicting session means, differentiated response outcomes). Other characteristics deviated from the previous two reviews (e.g., increase in autistic representation, outpatient settings, use of supplementary assessments, the inclusion of tangible conditions, and multiple function outcomes; decrease in session durations). We update previously reported participant and methodological characteristics, summarize outcomes, comment on recent trends, and propose future directions in the functional analysis literature.

A Practitioner’s Guide for Selecting Functional Communication Responses

Functional communication training (FCT) is an effective and widely used procedure to reduce problem behaviors. The purpose of FCT is to replace a problem behavior with a socially appropriate and communicative behavior - the functional communication response (FCR), which produces the same reinforcer as the problem behavior. Recent reviews of FCT have focused on providing overall recommendations for how the procedure should be implemented. A relatively small body of literature has been devoted to the selection of the FCR. The purpose of this article is to propose a set of considerations for practitioners in selecting FCRs.

Parents Are People Too: Implementing Empirically Based Strategies During Daily Interactions

The outcomes of the COVID-19 pandemic have resulted in decision-making related to in-person versus remote behavior-analytic service delivery. For those service providers who shifted from delivering in-person therapy to remote consultation, parents have presumably, at least at times, assumed a role similar to a registered behavior technician (RBT). We suggest that behavior analysts recommend two empirically based strategies to parents that they could incorporate into their daily lives during service disruptions: environmental enrichment and differential reinforcement of alternative behavior. We provide examples of naturally occurring contexts during which parents could integrate these procedures: (1) self-care or daily living activities, (2) physical activity, and (3) preferred learning activities. We support selecting these strategies and their application during exemplar contexts under the premise that they do not result in additional time expenditure, afford parents opportunities to complete essential (household, work-related, or personal) tasks, and still result in therapeutic gains.

On the Occurrence of Dangerous Problem Behavior during Functional Analysis: An Evaluation of 30 Applications

Functional analyses are often conducted by behavior analysts to understand the environmental variables contributing to an individual's problem behavior to better inform treatment implementation. While functional analyses are integral for designing function-based interventions, they often arrange contingencies to evoke and reinforce dangerous problem behavior. In Study 1 we reviewed 22 functional analyses with open-contingency classes including non-dangerous topographies of problem behavior and we found that participants were more likely to exhibit the non-dangerous behavior in 82% of the applications. We then conducted a single-subject comparison of closed and open-contingency classes with four additional participants in Study 2. Our results suggest that the functional analyses with the open-contingency class reduced the likelihood of observing dangerous problem behavior.

A Clinical Demonstration of Correlational and Experimental Analyses of Precursor Behavior

Individuals with intellectual and developmental disabilities are at an increased risk for engaging in severe problem behavior, which is often preceded by less intense precursor behaviors. These precursor behaviors may be a viable option as target behaviors for functional analyses in situations where evoking severe problem behavior is not ideal. We identified precursor behaviors through a correlational analysis and confirmed their membership in the same response class as more severe problem behavior through an experimental analysis.

A comparison of single-case evaluation tools applied to functional communication training with augmentative and alternative communication supports for students with developmental disabilities

BACKGROUND

Students with developmental disabilities frequently present with both limited vocal speech and challenging behavior. Functional communication training (FCT) with augmentative and alternative communication (AAC) supports, is a commonly recommended intervention to reduce challenging behavior for these students, while also increasing appropriate communication.

AIMS

Current research on this topic has not applied multiple evaluation tools, despite the recent suggestion to do so. Further, there are limited studies in the field of special education that have (a) applied multiple evaluation tools and (b) compared the results of the tools.

METHOD

In the current review, we applied three evaluation tools to intervention studies examining the use of FCT with AAC supports in school-based settings to determine the current level of scientific support for this intervention. We identified 38 studies, which contained 59 single-case designs (SCDs). Next, we compared the methodological rigor and/or quality, outcome scores, and Evidence-Based Practice (EBP) ratings provided by the three evaluation tools.

RESULTS AND CONCLUSION

Our results yielded inconsistent methodological rigor and/or quality, participant outcome measures, and EBP classifications between the evaluation tools. No two evaluation tools completely aligned. Limitations and future research are discussed.

On the Standardization of the Functional Analysis

The functional analysis procedures described in the seminal Iwata et al. (1982/1994) study are prominent in the applied behavior analytic literature, having been replicated hundreds of times over the past 30 years (Beavers, Iwata, & Lerman, 2013; Hanley, McCord, Iwata, 2003). However, the extent to which particular components of this functional analysis model have become more or less prominent over time is not clear from these literature reviews. We therefore conducted a review of the functional analysis literature between the years of 1965 and 2016 to determine the trends in the usage of particular components over time and to determine if the published literature reflects a standardization of the manner in which functional analyses of problem behavior are conducted. Furthermore, we discuss whether or not this standardization of a functional analysis model is currently necessary.

Efficiency in functional analysis of problem behavior: A quantitative and qualitative review

Originating in the mid-1960s, functional analysis (FA) has become the gold standard method for understanding the environmental variables that come to shape and maintain problematic behaviors such as aggression, self-injury, and property destruction. Over the decades, a number of studies have refined FA methods, attempting to improve the overall efficiency of the analysis through experimental design and procedural modifications. In the present review, we used ongoing visual-inspection criteria and basic probability theory to compare and analyze levels of efficiency across FA types. The multielement design and synthesized contingency analyses were about equally efficient with respect to the mean number of sessions conducted per function tested, and the trial-based and synthesized contingency analyses were the 2 most efficient with respect to the mean duration per function tested. We discuss the implications of these findings in the broader context of efficiency and provide recommendations for maximizing efficiency during an FA. We also discuss other qualitative procedural details that may influence the overall efficiency of an FA.

Autism, Insurance, and Discrimination: The Effect of an Autism Diagnosis on Behavior-Analytic Services

This paper discusses variables contributing to behavior analysis's growth within the autism community and the effect of an autism diagnosis on behavior-analytic services and access to those services. Recent insurance reforms in 47 states, the District of Columbia, and the U.S. Virgin Islands require insurance companies to offer, or cover, behavior-analytic services to individuals diagnosed with autism spectrum disorder. However, despite many benefits associated with increased coverage for individuals with autism, potential limitations exist, such as age and disability discrimination. Furthermore, this paper examines factors influencing the growing number of behavior analysts practicing in the area of autism and steps to ensure the field's growth beyond autism.

Implementation of interventions informed by precursor functional analyses with young children: A replication

Individuals who engage in problem behavior may also engage in precursor behavior maintained by the same functional reinforcers as the more severe target problem behavior. This study replicates and extends previous research by examining precursor assessments and interventions with three preschool-aged children. We conducted assessments to identify precursor behavior, and conducted subsequent functional analyses targeting the precursor behavior. We then implemented function-based interventions to address the precursor behavior, resulting in reductions in precursor behavior and continued low or zero rates of severe problem behavior.

Identifying predictive behavioral markers: A demonstration using automatically reinforced self-injurious behavior

Predictive biomarkers (PBioMs) are objective biological measures that predict response to medical treatments for diseases. The current study translates methods used in the field of precision medicine to identify PBioMs to identify parallel predictive behavioral markers (PBMs), defined as objective behavioral measures that predict response to treatment. We demonstrate the utility of this approach by examining the accuracy of two PBMs for automatically reinforced self-injurious behavior (ASIB). Results of the analysis indicated both functioned as good to excellent PBMs. We discuss the compatibility of this approach with applied behavior analysis, describe methods to identify additional PBMs, and posit that variables related to the mechanisms of problem behavior and putative mechanism of treatment action hold the most promise as potential PBMs. We discuss how this technology could guide individualized treatment selection, inform our understanding of problem behavior and mechanisms of treatment action, and help determine the conditional effectiveness of clinical procedures.

Discrimination and Generalization of Negatively-Reinforced Mands in Young Children With Autism Spectrum Disorder

In this study, we extended the literature on the generalization of negatively-reinforced mands in three young children with autism spectrum disorder (ASD). First, we used example and nonexample stimuli embedded in mand training to teach a new, socially appropriate, negatively-reinforced mand to reject unpreferred food items while continuously assessing mand discrimination. Second, we evaluated the discriminated generalization of the newly acquired mand by using untrained example and nonexample stimuli. Finally, we conducted maintenance probes to examine if the new, discriminated mand occurred over time in the absence of training. Results suggest that our mand training produced acquisition of a discriminated negatively-reinforced mand in all three children. Data indicate that the newly acquired, discriminated mand generalized to untrained food items and was maintained after training was discontinued. We discuss the conceptual significance and clinical implications of using example and nonexample stimuli to produce acquisition, generalization, and maintenance of negatively-reinforced mands in young children with ASD and language delays.

Within-subject analysis of a prevention strategy for problem behavior

Although decades of research on functional analysis methodology have identified common contingencies that maintain problem behavior and effective interventions, relatively little research has been conducted on strategies to prevent the initial development of problem behavior. We conducted a 2-part case study, the purposes of which were to illustrate the use of sensitivity tests as the bases for intervention (Study 1) and subsequently to assess the efficacy of a prevention strategy using a single-subject design (Study 2). Results showed that the sensitivity tests identified establishing operations that may set the occasion for the development of problem behavior and that interventions based on differential reinforcement prevented increases in the severity of problem behavior relative to untreated and control baselines. Benefits and limitations to this individualized approach to prevention are discussed.

Negatively-Reinforced Mands

In this study, we extended the literature on negatively-reinforced mands by teaching multiple novel, socially appropriate alternative mands to two young children with autism spectrum disorder (ASD). First, we replaced existing mands (e.g., pushing away) with two novel, socially appropriate, negatively-reinforced mands. Next, we examined responding under immediate- and delayed-reinforcement conditions to assess resurgence to existing mands and to determine whether the function of the communicative behavior influences the consistency with which different mands are emitted. Finally, we examined generalization to different social partners. Our data suggest that both children acquired the new mands and used them to avoid nonpreferred items. Resurgence to existing mands during delayed-reinforcement conditions was documented for one child, and the sequence in which mands were emitted within a response class was not influenced by the function of the communicative behavior. Generalization data indicate that both children emitted the new mands and one of the two children alternated between the two mands with a social partner who was not involved in the training. We discuss the importance of teaching multiple negatively-reinforced alternative mands to children with autism in applied settings.

Parent Training Intervention to Manage Externalizing Behaviors in Children With Autism

Children with autism spectrum disorder (ASD) are more likely than their typically developing peers to exhibit externalizing behaviors; however, the etiology in children with ASD may be different and related to the core deficits of the disorder. Although parent training interventions have been effective in decreasing externalizing behaviors in typically developing children, the effectiveness in children with ASD has not been established. An in-depth analysis of the child's behavior may provide the foundation upon which to develop an individualized parent training approach. This case study illustrates how a functional assessment interview was used to obtain in-depth information about externalizing behaviors exhibited by a child with ASD who is high functioning and how this information was used to develop an individualized parent training intervention.

Effects of an idiosyncratic stimulus on functional analysis of vocal stereotypy in two settings

OBJECTIVE

This study evaluated the effects of an idiosyncratic stimulus (Legos plastic blocks) on vocal stereotypy by a child with pervasive developmental disorder during functional analysis sessions conducted in analogue and natural settings.

METHODS

The presence and absence of the idiosyncratic stimulus was controlled in a multielement experimental design that incorporated four functional analysis conditions.

RESULTS

The background presence of the idiosyncratic stimulus was associated with a higher percentage of vocal stereotypy in all functional analysis sessions in both settings when compared with phases where the stimulus was absent.

CONCLUSIONS

The presence or absence of specific stimuli can alter the results of a functional analysis and produce inaccurate conclusions about the environmental conditions that occasion problem behavior.

REDUCING AMBIGUITY IN THE FUNCTIONAL ASSESSMENT OF PROBLEM BEHAVIOR

Severe problem behavior (e.g., self-injury and aggression) remains among the most serious challenges for the habilitation of persons with intellectual disabilities and is a significant obstacle to community integration. The current standard of behavior analytic treatment for problem behavior in this population consists of a functional assessment and treatment model. Within that model, the first step is to assess the behavior-environment relations that give rise to and maintain problem behavior, a functional behavioral assessment. Conventional methods of assessing behavioral function include indirect, descriptive, and experimental assessments of problem behavior. Clinical investigators have produced a rich literature demonstrating the relative effectiveness for each method, but in clinical practice, each can produce ambiguous or difficult-to-interpret outcomes that may impede treatment development. This paper outlines potential sources of variability in assessment outcomes and then reviews the evidence on strategies for avoiding ambiguous outcomes and/or clarifying initially ambiguous results. The end result for each assessment method is a set of best practice guidelines, given the available evidence, for conducting the initial assessment.

Functional analysis of challenging behavior in people with severe intellectual disabilities

Challenging behaviors exhibited by individuals with developmental disabilities often hinder the acquisition of academic, social, and life skills. Functional analysis has been useful for assessing challenging behavior in various settings. The purpose of this study was to implement an operant methodology for recognizing the functional properties of challenging behavior in people with intellectual disabilities. Four adults diagnosed with profound intellectual disability received assessment under several experimental conditions using a functional analysis methodology: social attention as positive reinforcement, negative reinforcement such as the termination of demands, positive tangible reinforcements, absence of social contingencies, and escape from noisy stimuli. Results showed that different types of reinforcement or avoiding contingencies affected the rate of aggression, self-injury, disruption, stereotypy, or socially offensive behaviors, and functional analysis may potentially be a viable alternative for identifying challenging behaviors.

Thirty years of research on the functional analysis of problem behavior

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.