Linking descriptive and experimental analyses in the treatment of bizarre speech

Functional analysis: what have we learned in 85 years?

Purpose

Even though the term "functional analysis" (FA) is prevalent in the current behavioral literature, the concept and process have roots in the early days of basic research in behavior analysis. Furthermore, the methodology developed in the field of FA has been one of the most significant advances in research on challenging behaviors over the past four decades. The current article reviews the history of the term "functional analysis" and research related to experimental FA. The aim is to summarize what the field of behavior analysis has learned about this powerful methodology.

Views

FA is considered a gold standard of functional assessment. However, several arguments about limitations relating to methodological issues in FA and its ecological validity have been put forward. Some of these shortcomings include constraints on the time available for assessment, the risk posed by severe problem behavior, and the inability to exert tight control over environmental conditions.

Conclusions

The literature on the subject clearly shows that refinements have been aimed not only at improving some of the methodological characteristics of FA but also at adapting the strategy for real-world application. Practical functional assessment (known as interview-informed synthesized contingency analysis [IISCA]) is a contemporary approach to assessing and treating problem behavior. Recent research on IISCA offers empirical support for the practical functional assessment and skill-based treatment model, confirming that it can obtain sustainable and socially meaningful reductions in problem behavior. Nevertheless, more research is needed to address procedural variations in, and the utility and social validity of, IISCA.

A systematic review of the correspondence between descriptive assessment and functional analysis

Clinicians report that they often rely on descriptive assessments when developing behavior-reduction plans despite literature suggesting that functional analysis is the most rigorous assessment method. Further, research comparing the outcomes of descriptive assessments and functional analyses is mixed, with some studies showing low correspondence and others showing high correspondence. Such persistent use of descriptive assessments suggests that they may yield useful information despite inconsistent correspondence with functional analyses. A more fine-grained analysis of the relation between descriptive assessments and functional analyses may elucidate variables affecting their utility. We conducted a review of 48 studies that included descriptive assessments and functional analyses and evaluated several measures of correspondence between each pair of assessments. Results indicated that descriptive assessments had exact correspondence with functional analyses in 50% of comparisons. Results also suggested that descriptive assessments were more likely to accurately identify and predict the absence of a function relative to the presence of a function and that structured descriptive assessments were more likely to accurately predict functions.

Impact of a Training Package to Improve the Effectiveness of Descriptive Assessment Data

Identifying the maintaining contingencies of problem behavior can lead to effective treatment that reduces the occurrence of problem behavior and increases the potential for the occurrence of alternative behaviors. Many studies use descriptive assessments, but results vary in effectiveness and validity. Comparative research further supports the superior utility of analog functional analyses over descriptive assessments, but clinicians continue to report the consistent use of descriptive assessments in practice. Direct training on the recording of descriptive assessments as well as the process for interpreting the results are limited. The absence of research-based guidance leaves clinicians to interpret the results as they see fit rather than following best practice guidelines for this critical activity. This study examined the potential impact of direct training on several components of descriptive assessment: the recording of narrative antecedent-behavior-consequence data, interpretation of the data, and the selection of a function-based treatment. Implications for training and practice are reviewed.

Peer influence on problem behaviors among students with intellectual disabilities

BACKGROUND

Students with intellectual disabilities (ID) exhibit increased rates of problem behaviors compared to those without ID.

AIMS

Given the evidence of peer influence in typical development, we examined the impact of classmates' characteristics on problem behaviors of students with ID. We expected higher levels of problem behaviors in special needs classrooms will influence individual development of such behaviors.

METHODS

A longitudinal design with measurements at the beginning and the end of a school year was applied. Staff reported on problem behaviors of 1125 students with ID (69 % boys; age 11.30 years,SD = 3.75) attending 16 Swiss special needs schools.

RESULTS

The peer influence hypothesis was not supported for an overall problem behavior score. However, exploratory analyses suggested that peer influence did occur for the domains anxiety, problems in relating socially, and communication disturbances (not disruptive/antisocial, self-absorbed and other types of problem behaviors). The influence of classmates on anxiety was lower when there was more variability in anxiety within the classroom. The development of communication skills benefitted from attending a classroom that was heterogeneous in the level of communication problems.

CONCLUSION

Our results suggest that the influence of peers on problem behaviors in special needs schools is not universal but varies between domains and depends on classroom characteristics.

Investigations of operant ABA renewal during differential reinforcement

Operant renewal is a form of relapse in which a previously extinguished response recurs due to a change in context. We designed two experiments to examine the impact of differential reinforcement of alternative behavior on ABA renewal in a translational model of relapse with 12 children. We compared levels of renewal in two 3-phase arrangements. In one arrangement, we reinforced target responding in Context A, extinguished responding in Context B, and returned to Context A while continuing to implement extinction. In a second arrangement, an alternative response produced reinforcement in Context B and during the return to Context A. Results across the 2 experiments indicated 3 general findings. First, extinction plus differential reinforcement disrupted target behavior more consistently in Context B relative to extinction alone. Second, renewal tended to be greater and more persistent during extinction alone relative to extinction plus differential reinforcement. Third, the renewal effect appeared to depend on whether the alternative response had a history of extinction in Context A. We discuss methodological implications for the treatment of severe destructive behavior.

Functional Behavioral Assessment-based interventions on adults' delusions, hallucinations and disorganized speech: A single case meta-analysis

The Functional Behavioral Assessment (FBA) approach involves the use of single-case designs (SCD) to study the problem behavior-environment contingencies and conduct interventions that consider this functional relationship. Although this approach has been considered an evidence-based practice (EBP) for the treatment of several psychological problems, no meta-analytic studies of FBA-based interventions on delusions, hallucinations and disorganized speech -commonly operationalized as "atypical vocalizations"- have been carried out. Therefore, the purpose of this study was to review and synthesize the results of FBA-based interventions on adults' atypical vocalizations. We conducted a systematic review and a multi-level meta-analysis of these interventions, using a recently developed effect size estimator for SCD studies (i.e., log response ratio). All the studies that met our eligibility criteria provided evidence supporting the effectiveness of FBA-based interventions on atypical vocalizations, with an overall average effect size of a 72% reduction. Both the publication year and the methodological quality were found to be significant moderators. Despite some methodological limitations, we can conclude that FBA-based interventions are effective to reduce atypical vocalizations. The implications of these results could be of interest for the mental health community.

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.

Resurgence with and without an alternative response

Resurgence is the reemergence of a previously reinforced response that occurs after the elimination or reduction of reinforcement for an alternative response. Resurgence is problematic in the context of treatment because the reemergence of a previously reinforced destructive response could be detrimental to treatment gains. In the current translational study, we examined a modified resurgence procedure in which the alternative response was either present or absent during extinction. Four participants were exposed to three phases that consisted of (1) reinforcement of a target response, (2) extinction of the target response and differential reinforcement of an alternative response, and (3) extinction of both responses. Results for four out of five assessments showed greater resurgence when the alternative response was absent during Phase 3. Results suggest that more robust resurgence might occur if the alternative response is not available as opposed to the alternative response contacting extinction.

Conducting Functional Communication Training in Home Settings: A Case Study and Recommendations for Practitioners

We coached a parent to conduct functional analysis and functional communication training (FCT) procedures in her home to reduce the destructive behavior displayed by her 2-year-old son. Descriptive assessment information and functional analysis results suggested that destructive behavior was maintained by escape from demands. After conducting a series of baseline probes, the parent implemented an FCT program to teach her son to comply with designated task requests and to mand for a break to play. Results showed that destructive behavior decreased and manding and independent task completion increased during FCT. Positive intervention outcomes were maintained for 1 year. Results are discussed with respect to developing an FCT program that is both efficient and acceptable for parents to implement in their homes.

Recent Developments in Functional Assessment: Implications for School Counselors and Psychologists

New developments in the technology of behavioral assessment call for a different approach to consultation with teachers in the resolution of serious behavior problems. A "cookbook" approach based on the teacher's description of the student's actions is no longer recommended. Instead, it is necessary to conduct an individual functional assessment of the events that predict and maintain the challenging behavior, and to identify the contextual factors that are relevant to effective behavioral support. Although this approach requires more work initially than the traditional topography-only assessment, it is worthwhile because functional assessment increases the probability that the intervention will be effective.

The Changing Character of Behavioral Assessment and Treatment: A Historical Introduction and Review of Functional Analysis Research

This paper presents a brief introduction to the historical development of functional analysis as an important pretreatment assessment and analysis strategy for treating academic and social behavior problems. Studies considered to be seminal or influential are reviewed to highlight the historical and contemporary refinement of functional analysis methodologies. Conclusions are presented in terms of functional analysis' conceptual and methodological impact on behavioral assessment and treatment, and its advancement into various human service sectors concerned with the care of individuals with special needs.

An Empirical Investigation of Time-Out With and Without Escape Extinction to Treat Escape-Maintained Noncompliance

The present study evaluates the effectiveness of two time-out (TO) procedures in reducing escape-maintained noncompliance of 4 children. Noncompliant behavioral function was established via a functional assessment (FA), including indirect and direct descriptive procedures and brief confirmatory experimental analyses. Following FA, parents were taught to consequate noncompliance with two different TO procedures, one without and one with escape extinction following TO release. Although results indicate TO without escape extinction is effective in increasing compliance above baseline levels, more optimal levels of compliance were obtained for all 4 children when escape extinction was added to the TO procedures already in place. Results indicate efficacy of TO with escape extinction when applied to escape-maintained noncompliance and are discussed as an initial example of the successful application of TO to behaviors maintained by negative reinforcement.

The Validity of Functional Behavioral Assessment with Students of Average Intellectual Ability

In the United States, functional behavioral assessment (FBA) is a new requirement of the 1997 Amendments to Individuals with Disabilities Education Act for students who exhibit challenging behavior. FBA has been extensively studied with persons with severe and profound intellectual disabilities within clinical settings. However, there is limited research with students with average intellectual ability in public education settings. This article reviews seven pertinent validity indices associated with FBA: external validity, content validity, convergent validity, criterion validity, treatment validity, social validity, and habilitative validity. In short, much research is needed to inform practitioners about conducting valid FBAwith students with average intellectual ability.

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 communication training: a review and practical guide

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.

The functional analysis of problematic verbal behavior

This study describes procedures and outcomes in a functional analysis of problem behavior of 2 public school students. For a 13-year-old honors student, bizarre tacts (labeled as psychotic speech by school staff) were maintained by attention. For a 15-year-old with autism, the functional analysis revealed that perseverative mands for toileting were controlled by attention; mands for edible items were controlled by access to any food item; and mands for nonedible items were maintained by access to the specific item manded. The "problematic" aspects of the verbal behavior differed-the bizarre speech was problematic based on its content, but the perseverative verbalizations resulted in high response cost for classroom staff. Research in the area of problematic verbal behavior is sparse and warrants further attention from behavior analysts who work in public school settings. This research demonstrates the applicability and relevance of functionally analyzing problematic verbal behavior in public school settings.

Alterations to functional analysis methodology to clarify the functions of low rate, high intensity problem behavior

Current research provides few suggestions for modifications to functional analysis procedures to accommodate low rate, high intensity problem behavior. This study examined the results of the extended duration functional analysis procedures of Kahng, Abt, and Schonbachler (2001) with six children admitted to an inpatient hospital for the treatment of severe problem behavior. Results of initial functional analyses (Iwata, Dorsey, Slifer, Bauman, & Richman, 1982/1994) were inconclusive for all children because of low levels of responding. The altered functional analyses, which changed multiple variables including the duration of the functional analysis (i.e., 6 or 7 hrs), yielded clear behavioral functions for all six participants. These results add additional support for the utility of an altered analysis of low rate, high intensity problem behavior when standard functional analyses do not yield differentiated results.

Functional assessment of problem behavior: dispelling myths, overcoming implementation obstacles, and developing new lore

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.

Vocal Stereotypy in Individuals With Autism Spectrum Disorders

Vocal stereotypy is a common problem behavior in individuals with autism spectrum disorders that may interfere considerably with learning and social inclusion. To assist clinicians in treating the behavior and to guide researchers in identifying gaps in the research literature, the authors provide an overview of research on vocal stereotypy in individuals with autism spectrum disorders. Specifically, the authors review the research literature on behavioral interventions to reduce engagement in vocal stereotypy with an emphasis on the applicability of the procedures in the natural environment and discuss the clinical implications and limitations of research conducted to date. Researchers have shown that several antecedent-based and consequence-based interventions may be effective at reducing vocal stereotypy. However, the review suggests that more research is needed to assist clinicians in initially selecting interventions most likely to produce desirable changes in vocal stereotypy and collateral behavior in specific circumstances.

The significance and future of functional analysis methodologies

Iwata, Dorsey, Slifer, Bauman, and Richman (1982) presented the first comprehensive and standardized methodology for identifying operant functions of aberrant behavior. This essay discusses the significance functional analysis has had for applied behavior analysis. The methodology has lessened the field's reliance on default technologies and promoted analysis of environment-behavior interactions maintaining target responses as the basis for selecting treatments. It has also contributed to the integration of basic and applied research. Future directions for this research are suggested.

Functional analysis methodology: Some closing comments

Functional analysis methodologies have emerged as powerful tools in research on the assessment and treatment of severe behavior disorders. Although the defining feature of these approaches is the systematic identification of environmental determinants of behavior, research methodology has varied widely with respect to the arrangements used to demonstrate experimental control as well as the types of variables subject to analysis. This commentary summarizes methodological and conceptual issues that have been raised in current research and offers some suggestions for their resolution.

Progressing from brief assessments to extended experimental analyses in the evaluation of aberrant behavior

The role of experimental analyses in guiding treatment is well established. However, not all experimental analyses yield conclusive results. Outcomes may be inconclusive due to time limitations that preclude extended observation and detailed experimental manipulations, or may result from interactions across experimental conditions, multiple control, or other unknown factors. In this study, we describe an assessment sequence that moves through four phases beginning with relatively brief (1 to 2 hr) analyses and culminating in extended analyses that may control for experimental confounding effects (e.g., interaction effects). Data illustrating the model are presented for 20 individuals referred for severe behavior problems including self-injury, aggression, stereotypy, and tantrums. Analyses were considered to be complete only when clear and replicable response patterns emerged. Results showed that clear and replicable response patterns emerged for 85% of the participants.

Descriptive analyses of pediatric food refusal: the structure of parental attention

Mealtime observations were conducted and occurrences of appropriate and inappropriate mealtime behavior and various forms of parental attention (e.g., coaxing, reprimands) were recorded for 25 children admitted to an intensive feeding program and their parents. Using the data from the observations, lag sequential analyses were conducted to identify changes in the probability of child appropriate and inappropriate mealtime behavior before and after various forms of parental attention. A combination of univariate and repeated measures ANOVAs using frequency of child behavior were also conducted to corroborate conclusions drawn from the visual analysis of individual participant data. Results showed that parental attention was frequently followed by temporary decreases in inappropriate mealtime behavior and increases in bite acceptance. Moreover, various forms of parental attention resulted in statistically significant changes in child behavior, which supports the clinical utility of these data.

Antecedent versus consequent events as predictors of problem behavior

Comparisons of results from descriptive and functional analyses of problem behavior generally have shown poor correspondence. Most descriptive analyses have focused on relations between consequent events and behavior, and it has been noted that attention is a common consequence for problem behavior even though it may not be a functional reinforcer. Because attention may be prescribed simply as a means of stopping serious problem behavior, it is possible that naturally occurring antecedent events (establishing operations) might be better predictors of problem behavior than consequences. We conducted descriptive and functional analyses of the problem behaviors of 7 participants. Conditional probabilities based on combined antecedent and consequent events showed correspondence with the functional analysis data for 4 of the 7 participants, but antecedent events were no better than consequent events in identifying the function of problem behavior.

Relationship among challenging, repetitive, and communicative behaviors in children with severe intellectual disabilities

We used experimental and descriptive functional analyses and lag sequential analyses to examine the functional and temporal relationship among the self-injurious (SIB), potentially injurious, repetitive, challenging, and pragmatic communicative behaviors of 6 children with intellectual disabilities. Functional analyses revealed social function for SIB, potentially injurious, and repetitive behaviors across 5, 4, and 5 participants, respectively. Sixteen functionally equivalent response classes were identified across participants using both experimental and naturalistic observation data. Repetitive, potentially injurious, and SIB behaviors were significantly temporally associated, and pragmatic communicative behaviors were strongly temporally associated with challenging behaviors. The importance of the temporal and functional relationship between imperative communicative acts and challenging behavior is discussed.

Using descriptive assessment in the treatment of bite acceptance and food refusal

The feeding behaviors of two children who maintained failure to thrive diagnoses and displayed food refusal are assessed in their homes. Descriptive assessments are used to identify schedules of consequence provided by each child's care providers for bite acceptance and food refusal behaviors. Assessments reveal rich schedules of praise and access to social interaction and preferred activities for bite acceptance and escape for food refusal. These schedule arrangements result in hypotheses that modifications to the schedule of praise and access to social interaction and preferred activities for bite acceptance would result in little to no effect and that modifications to the schedule of escape for food refusal would be necessary for treatment success. Successful interventions are subsequently implemented by manipulating the existing schedules of escape for food refusal by each child's care providers. Implications for the use of descriptive assessments for feeding problems are discussed.

Applied implications of reinforcement history effects

Although the influence of reinforcement history is a theoretical focus of behavior analysis, the specific behavioral effects of reinforcement history have received relatively little attention in applied research and practice. We examined the potential effects of reinforcement history by reviewing nonhuman, human operant, and applied research and interpreted the findings in relation to possible applied significance. The focus is on reinforcement history effects in the context of reinforcement schedules commonly used either to strengthen behavior (e.g., interval schedules) or commonly used to decrease behavior (e.g., extinction).