Functional analysis and treatment of inappropriate verbal behavior

Application of functional analytic psychotherapy to manage schizophrenia

INTRODUCTION

Cognitive behavioral therapy (CBT) and third-wave CBT approaches have been shown to ameliorate symptoms of schizophrenia. However, this study uses the functional analytic psychotherapy which focuses on the environmental causes of behavior which includes the client's present environment as well as his history of past interactions with it, to bring about a change in the client and reduce the symptoms. This therapy has never been used earlier with patients having schizophrenia in India; therefore, it was taken up for this study.

METHODOLOGY

A pre-post design with control group was used in the present study. Ten patients were taken. Positive and Negative Syndrome Scale for measuring symptoms of schizophrenia, Schizophrenia Quality of Life Scale for assessing quality of life, Coping Response Inventory-Adult form for assessing coping skills, Apathy Evaluation Scale-Clinician Version for assessing apathy, Family Adaptability and Cohesion Evaluation Scale for assessing perceived interpersonal relationship were used for assessment pre- and postintervention. Fifteen sessions were done with each patient within a period of 10 months at the rate of one session per week. Chi-square test, Wilcoxon signed-rank test, and Mann-Whitney U-test were used for the analysis of data.

RESULTS

Significant improvements were found in positive symptoms, general psychopathology, approach coping mechanisms, psychosocial and motivation domains in quality of life, and perceived cohesion in family among the patients postintervention.

CONCLUSION

Functional analytic psychotherapy is an effective method for treating patients having schizophrenia with the application of its specifically modified rules for use with patients having psychosis.

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.

A comparison of sources of baseline data for treatments of problem behavior following a functional analysis

It is common practice in research on the treatment of problem behavior to compare levels of targeted behaviors during treatment to levels when treatment is not in place. Some researchers use data collected as part of a multielement functional analysis as the initial baseline, whereas others collect new baseline data following completion of the functional analysis. We evaluated whether the source of baseline data influences the reliability and efficiency of decision-making. Results suggest that similar decisions are made in regard to treatment efficacy using the different sources of baseline data, but using data from a multielement functional analysis as baseline may save time. Interrater agreement was adequate, but lower for some graphs than has been observed in past studies. Several potential explanations for this discrepancy are discussed.

Applying behavior analysis to school violence and discipline problems: Schoolwide positive behavior support

School discipline is a growing concern in the United States. Educators frequently are faced with discipline problems ranging from infrequent but extreme problems (e.g., shootings) to less severe problems that occur at high frequency (e.g., bullying, insubordination, tardiness, and fighting). Unfortunately, teachers report feeling ill prepared to deal effectively with discipline problems in schools. Further, research suggests that many commonly used strategies, such as suspension, expulsion, and other reactive strategies, are not effective for ameliorating discipline problems and may, in fact, make the situation worse. The principles and technology of behavior analysis have been demonstrated to be extremely effective for decreasing problem behavior and increasing social skills exhibited by school children. Recently, these principles and techniques have been applied at the level of the entire school, in a movement termed schoolwide positive behavior support. In this paper we review the tenets of schoolwide positive behavior support, demonstrating the relation between this technology and applied behavior analysis.

Functional analysis and treatment of the delusional statements of a man with multiple disabilities: a four-year follow-up

Although delusional statements in people with intellectual disabilities and traumatic brain injury can be treated using behavioral interventions, none have demonstrated long-term treatment effects. In the current study, a functional analysis demonstrated that delusional statements were maintained by attention. Differential reinforcement of alternative behavior and extinction of delusional statements resulted in near elimination of delusional statements and an increase in nondelusional statements. Follow-up at 6 months, 1, 2, and 4 years indicated that treatment gains were maintained with continued staff training.

Aplicação dos princípios analítico-comportamentais para alterar o comportamento de uma esquizofrênica

O presente estudo investigou o comportamento de uma esquizofrênica crônica via princípios da análise do comportamento. A participante era do sexo feminino, 57 anos, solteira e com histórico de várias internações desde os 18 anos de idade. As classes de comportamentos-problema que sofreram intervenção: contato olho a olho, isolar-se no pátio, participar dos eventos da instituição, etc. Para o controle dos procedimentos foi utilizado o delineamento de reversão do tipo ABAB, seguido de follow-up. O delineamento foi iniciado com a fase de linha de base I. Nas fases de intervenções I e II foram utilizados procedimentos de reforçamento positivo, modelagem e extinção. Os resultados demonstraram que os procedimentos da análise do comportamento foram efetivos para controlar os comportamentos-problema apresentados pela participante.

Use of differential reinforcement to reduce behavior problems in adults with intellectual disabilities: a methodological review

The least-restrictive-alternative guideline for providing treatment emphasizes the use of non-aversive procedures to reduce maladaptive behaviors in individuals with intellectual disability (ID). Differential reinforcement (DR) is an excellent example of such a non-aversive, reinforcement based behavioral intervention. The purpose of this literature review was to summarize and provide a methodological analysis of studies, conducted between 1980 and 2009, using a DR contingency to reduce problem behaviors in adults with ID. A total of 31 studies were located that met the inclusion criteria. Of these, 15 reported DR to be an effective intervention when used independently. Of the remaining, 10 studies found DR to be useful as part of a treatment package, and six found a DR contingency used independently to be ineffective, and only observed treatment effects when an aversive component was added. Very few studies assessed the use of DR in older adults and in individuals with mild ID; these reflect areas of future research. A methodological analysis found that several studies did not report information on key methodological variables; for example, conducting a functional analysis and a stimulus preference assessment to guide choice of treatment and reinforcers, thinning very dense DR schedules, assessing collateral behaviors, generalization of behavior change across settings and implementers, and following up treatment outcomes over time. The overall positive findings about the effectiveness of DR are encouraging; however, more methodologically robust studies would serve to make such findings more conclusive and practically relevant for implementation in natural settings for adults with ID.

What is the evidence for environmental causes of challenging behaviors in persons with intellectual disabilities and autism spectrum disorders?

An extensive literature on the causes of challenging behaviors has been developed, primarily in the applied behavior analysis literature. One hundred and seventy-three empirical studies were reviewed where functional assessment serves as the primary method of identifying these causes. Most of the studies were able to identify a clear function or functions. Most commonly established causes were attention, the efforts to acquire tangibles, negative reinforcement in the form of escape from tasks or environments, and sensory stimulation, also described as an alone condition. Examples are provided regarding how these conditions are investigated across studies. Biological and cognitive causes have also been demonstrated. However, to date the empirical literature is limited with the bulk of studies being correlational. Considerably more research is needed, but some causes and methods to identify them are beginning to emerge.

Influence of motivating operations and discriminative stimuli on challenging behavior maintained by positive reinforcement

We examined the effects of an establishing operation (EO) and abolishing operation (AO) on stimulus control of challenging behavior. Two participants with developmental disabilities and challenging behavior participated. In Phase I, a functional analysis was conducted to identify the consequences maintaining challenging behavior. In Phase II, a discrimination between SD and SΔ was trained. In Phase III, pre-session MOs (i.e., EO and AO conditions) were arranged to assess their effects on challenging behavior. Finally in Phase IV, in addition to manipulating pre-session MOs the challenging behavior was evaluated under extinction in both SD and SΔ conditions. Results indicated that in the context of extinction when pre-session EO and AO conditions were manipulated, responding not only became differentiated but was higher in both SD and SΔ conditions in the pre-session EO condition when compared to the pre-session AO condition.

Análise funcional de comportamentos verbais inapropriados de um esquizofrênico

O presente estudo registrou as verbalizações inapropriadas de um esquizofrênico adulto e do sexo masculino. Os comportamentos verbais inapropriados foram observados durante breves períodos de exposição a quatro condições: atenção, atenção não contingente, demanda e sozinho. Os resultados indicaram que as condições afetaram os comportamentos verbais inapropriados diferentemente. Esses resultados são discutidos em termos das suas implicações para as avaliações funcionais antes de intervenções psicológicas.

Coping with challenges to memory in people with mild to moderate Alzheimer's disease: observation of behaviour in response to analogues of everyday situations

OBJECTIVES

To describe ways of coping in people with mild to moderate AD when faced with situations that are challenging to their memory.

METHOD

Twenty-four participants (12 with mild and 12 with moderate AD) were presented with a set of seven tasks that were analogues of everyday situations that tax memory. The participants' responses were videotaped and analysed.

RESULTS

Participants' coping responses were grouped into seven categories to best reflect the main strategies. Individuals used a significantly greater frequency of effortful problem solving (self-reliance and reliance on carers) (p < 0.01) than other ways of coping. Positive acknowledgement of memory difficulties was used significantly more than negative acknowledgement and defensive coping (concealment and avoidance) (p < 0.01).

CONCLUSION

This study used novel methodology of observation of behavioural responses in analogues of everyday situations. The predominance of effortful problem-solving emphasizes the role of the person with AD as an active agent in the management of memory loss. An emphasis in previous literature on defensive coping and denial is counter-balanced by the finding that participants commonly coped by acknowledging their memory impairment.

The reinforcing effect of contingent attention on verbal perseverations of two children with severe visual impairment

The frequency of verbal perseverations of two children with severe visual impairment was reduced using differential reinforcement of appropriate speech coupled with extinction of perseverative utterances. A reversal design in which baseline and intervention were alternated in an A-B-A-B sequence was employed to show the functional relationship between the target behaviors and the treatment procedure. There was a marked increase in appropriate utterances and a correlated decrease in perseverative ones. These findings suggest that this singular feature of the language of certain children with visual impairment is, under natural conditions, probably maintained by the attention provided by their caregivers.

Functional analysis and treatment of the bizarre speech of dually diagnosed adults

Nine behavior-analytic studies, each reporting data for a single participant, have shown that bizarre speech can be maintained by social reinforcement. In the current study, we controlled for a possible referral bias in this literature by including nonreferred participants with dual diagnoses. Functional analyses identified attention functions for 2 participants and nonsocial functions for the others. Noncontingent reinforcement decreased the bizarre speech of both participants who displayed attention-maintained bizarre speech.

Functional analysis and treatment of verbal perseverations displayed by an adult with autism

The function of perseverative speech for an adult man who had been diagnosed with autism and mental retardation was examined. Results showed that verbal perseverations were maintained by social attention. An intervention consisting of differential reinforcement of appropriate verbal responses and extinction of perseverative verbal responding was effective in decreasing verbal perseverations.

Covariation between bizarre and nonbizarre speech as a function of the content of verbal attention

A functional analysis suggested that the bizarre speech of an individual with developmental disabilities was maintained by attention. The content of verbal attention was manipulated in two subsequent analyses and revealed that (a) bizarre speech was more frequent when attention was related to the participant's bizarre speech and (b) the participant's statements tended to reflect the content of the therapist's attention, whether bizarre or nonbizarre.