Therapist effects on functional analysis outcomes with young children

A Systematic Review of Caregiver-Implemented Functional Analyses

The purpose of this systematic review was to systematically locate and analyze the research on caregiver-implemented functional analyses and subsequent function-based interventions. We included 36 studies and examined multiple features of the studies, including participant demographics, functional analysis characteristics, intervention characteristics, procedural fidelity, risks of bias, and social validity. Overall, the studies showed that caregivers were able to implement functional analyses that yielded differential responding, although few studies reported procedural fidelity data. Caregivers were also able to implement function-based interventions that led to socially significant changes in challenging behavior. Implications for practice and future research are discussed.

Measuring Happiness Behavior in Functional Analyses of Challenging Behavior for Children with Autism Spectrum Disorder

This two-experiment study assessed the utility of measuring happiness behavior (e.g., smiling and/or laughing) within functional analyses (FA) of challenging behavior, and using results to inform interventions for children with autism spectrum disorder (ASD). In Exp. 1, we concurrently measured happiness behavior within the trial-based FA's of challenging behavior of four children with ASD. Results showed differentiation for both challenging behavior in test trials and happiness behavior within controls. In Exp. 2, we compared interventions based on challenging and happiness behavior from FA results for three of the participants, using a multiple-baseline across-participants design, with embedded reversals. Results suggested that interventions derived from measures of the children's happiness behavior led to reductions challenging behavior that were similar to interventions informed by challenging behavior, and were also associated with increased happiness behavior. Taken together, these two experiments suggest that the measurement of children's happiness behavior in FA of challenging behavior appears to be helpful in determining interventions for children with ASD.

A Systematic Review of Parent-Implemented Functional Communication Training for Children With ASD

Supporting parents in reducing challenging behavior of children with autism spectrum disorder (ASD) requires the identification of effective, feasible, and sustainable interventions. Functional communication training (FCT) is one of the most well-established interventions in the behavioral literature and is used increasingly by parents. However, there is a need for additional evaluation of the literature related to parent-implemented FCT. In the present review, we identified 26 peer-reviewed studies on parent-implemented FCT. We conducted systematic descriptive and social validity analyses to summarize the extant literature. Across studies, parent-implemented FCT was effective in reducing child challenging behavior, and in some cases, intervention outcomes maintained and generalized to novel settings and implementers. However, few studies reported fidelity data on parent implementation of FCT, and data regarding sustained use of FCT by parents were limited. Results of the social validity analysis indicate that while FCT is often implemented by natural change agents in typical settings, parent training is often provided by professionals not typically accessible to parents. These findings suggest that future research is warranted in the areas of parent training and long-term sustainability of parent-implemented FCT.

Correspondence between the results of functional analyses and brief functional analyses

PURPOSE

This study sought to examine the correspondence between brief functional analyses and more thorough functional analyses as described in the model of functional assessment proposed by Vollmer et al.¹ Methods: A panel of trained clinicians indicated the presence/absence of specific functions of problem behavior based on graphic results from brief functional analyses and functional analyses conducted with 19 participants. These conclusions were compared across assessments.

RESULTS

The functions identified by the panel based on results of brief functional analyses had low correspondence with those of the more thorough functional analysis conducted with the same participants.

CONCLUSIONS

Although brief-functional analyses appear regularly in clinical practice and the literature, findings from this study suggest that results may differ from those of more thorough functional analyses. Additional study is necessary to determine the cause of discrepant results between these two methodologies.

Teacher-Conducted, Latency-Based Functional Analysis as Basis for Individualized Levels System in a Classroom Setting

Latency-based functional analysis (FA) may be appropriate when stakeholders are concerned with safety or feasibility. We trained a first-year special education teacher to collect data while she implemented a latency-based FA and validated a function-based intervention. Treatment effects were generalized across paraeducators and were maintained during a 1-month follow-up.

Therapist and setting influences on functional analysis outcomes

Functional analyses (FAs) of problem behavior typically are conducted in controlled settings to minimize potential sources of confounding. Several studies have reported that results of FAs conducted in controlled settings occasionally differ from those conducted under more naturalistic conditions, although little is known about factors that may contribute to the different outcomes. We examined correspondence between FAs conducted by staff in a clinic and those conducted either by caregivers as therapists or in the home setting. If results of the 2 analyses were dissimilar, we conducted further analyses to identify variables responsible for the different outcomes. Results showed that, in most cases, correspondence of function was observed across familiar and unfamiliar stimuli. Results are discussed in terms of implications for research and clinical practice for the evaluation of problem behavior.

Idiosyncratic variables that affect functional analysis outcomes: a review (2001-2010)

Although typical functional analyses often produce clear outcomes, some studies have reported ambiguous results that cannot be interpreted. Such undifferentiated outcomes may occur if test conditions do not include relevant antecedent or consequent events. Clinicians then may try to modify the functional analysis conditions to include those events. Hanley, Iwata, and McCord (2003) reviewed the functional analysis literature through 2000 and described idiosyncratic variables included in modified functional analyses. The objective of the present review was to present a quantitative analysis of idiosyncratic antecedents and consequences in modified functional analyses during the past decade (2001 to 2010). We discuss the range of stimulus parameters tested and the assessment strategies used for informing the modified analysis conditions.

Functional analysis and functional communication training in individuals with Angelman syndrome

OBJECTIVE

To assess the functions of challenging behaviour in four children with Angelman syndrome (AS) and to study the effects of functional communication training (FCT) with precursor-based prompting. This study builds on and extends the study of Allen et al.

METHOD

Experimental functional analysis assessed behavioural functions. FCT was implemented within an ABAB design and effect sizes were calculated. Burst analyses depict tendencies in (precursor) behaviours surrounding target behaviours.

RESULTS

Results show challenging behaviour to be aimed at receiving attention, tangibles or escape. Burst analysis designated physical and eye contact and reaching for tangibles as precursors. Effects of FCT ranged from small to large.

CONCLUSION

Behavioural functions for challenging behaviour were found and FCT was effective in reducing its frequency, when precursors were used as the onset of prompting. Functional equivalence between challenging and communicative behaviour was found. Implementing treatment for challenging behaviour based on precursors is advised.

The effects of diagnostic group and gender on challenging behaviors in infants and toddlers with cerebral palsy, Down syndrome or seizures

Challenging behaviors are frequently studied in individuals with various developmental disabilities, although specific conditions are rarely compared to one another. Such data would be informative to clinicians who assess and develop treatment plans for children with these disabilities. For that reason, the current study's aim was to analyze problem behavior deficits in infants and toddlers diagnosed with cerebral palsy (CP), Down syndrome (DS), and a history of seizures/seizure disorder. Seventy six children participated in this study and were administered the Baby and Infant Screen for Children with aUtIsm Traits-Part 2 (BISCUIT-Part 2). Inspection of the Tantrum/Conduct Behavior subscale of this measure revealed that children with a history of seizures/seizure disorder exhibited significantly higher scores, indicating greater impairment, than those with CP or DS. Children with DS and those diagnosed with CP did not significantly differ from one another. Additionally, there was no significant main effect by gender. The CP and DS groups also had fewer endorsements on all 18 items of the subscale as compared to the seizures group. Implications of these results are discussed.

Psychopathology and intellectual disability

PURPOSE OF REVIEW

To provide an update on recent trends and developments in the study of psychopathology in persons with intellectual disability. This topic is of considerable importance to mental health professionals as rates of psychopathology are much higher for persons with intellectual disabilities relative to the general population.

RECENT FINDINGS

The number of studies on this topic is growing. The development of several areas is of particular significance. These topics include the impact of the burgeoning study of autism; the development of more specialized measures of psychopathology specific to particular forms of psychopathology, levels of intellectual disability and age; the development of psychologically based treatments, specifically the rise of functional assessment; the recognition that pharmacotherapy treatments are best aimed at core symptoms of classic forms of psychopathology such as psychosis, bipolar disorder, anxiety, and depression versus behavioral equivalents of psychopathology such as aggression, self-injurious behavior, property destruction, and pica; and establishing co-occurring patterns of personal features as they relate to psychopathology and intellectual disability.

SUMMARY

A better understanding of psychopathology and how to assess and treat it in persons with intellectual disability is occurring. However, much is yet to be learned in this relatively new field of study.

Feeding Therapy in a Child With Autistic Disorder: Sequential Food Presentation

The authors describe a feeding intervention for a 9-year-old male diagnosed with autistic disorder and mild mental retardation (also known as intellectual disability) who experienced food refusal related to food selectivity. Based on the results of a functional behavioral assessment, food refusal was found to be maintained by escape and tangible functions. Therefore, an intervention using escape extinction (i.e., nonremoval of nonpreferred foods with physical guidance as a secondary procedure), positive reinforcement (i.e., preferred foods and toys), and sequential food presentation was implemented. The child was successful in eating many novel foods both within the clinic and home environments. A 1-year follow-up found the effects of treatment to be maintained with significant increases in number of foods eaten and significant decreases in mealtime-related behavioral challenges. The treatment implications, recommendations to clinicians, and areas of future research are discussed.

Replacement behaviors for identified functions of challenging behaviors

Functional assessment has become a major feature of learning-based research. A critical element of the majority of these studies includes not only methods and procedures to identify the cause of the challenging behavior, but to establish replacement treatment methods. By far the most common intervention in the 176 studies we reviewed was reinforcement. Noncontingent reinforcement (NCR) was the most common reinforcement method, followed by differential reinforcement of other behavior (DRO). Reinforcement plus extinction was the second most commonly employed treatment followed by functional communication training with or without reinforcement. Researchers proved to be very creative. Forty different treatment methods were employed. The implications of these data are discussed.