Discriminated functional communication: a procedural extension of functional communication training

A demonstration of incorporating discriminative stimuli into an AAC device during functional communication training

Functional communication training (FCT) is an effective intervention for teaching communication responses and reducing challenging behavior. One limitation of FCT is that frequent reinforcement may be impractical or impossible in many situations. Recently, Mitteer et al. published a tutorial in the journal AAC that provided video models on how to implement an empirically supported strategy for thinning reinforcement during FCT, known as FCT with discriminative stimuli, when teaching with an augmentative and alternative communication (AAC) device. However, no study has empirically evaluated the approach described in that tutorial. This paper details a case study using several single-case experimental designs to teach a non-vocal autistic adult who did not use speech to communicate requests only when reinforcement was signaled to be available by the color of the AAC icons. We demonstrated the efficacy of this approach with unique pairs of discriminative stimuli for tangible and edible items, thinning reinforcement for each stimulus class independently. We then rapidly transferred stimulus control to new icons and integrated both classes of stimuli into a single AAC grid. This first demonstration of embedding discriminative stimuli into an AAC device represents a promising advancement for individuals who do not use speech and may not readily respond to delay or denial cues.

A Brief Assessment to Identify Sensitivity to a Conversational Partner's Interest

Individuals diagnosed with autism spectrum disorder (ASD) may seek professional assistance with social skills, such as identifying the function of social cues and responding appropriately to those cues. The purpose of the current study was to develop a brief assessment to determine participant sensitivity to social cues indicating uninterest in continuing a conversation. Results show that the assessment was successful in identifying contexts to address on an individual basis, related to social cues during conversation. Furthermore, the assessment fit within an hourly appointment appropriate for individuals with ASD (we used person-first or identify-first language based on caregiver and individual preference) who display sophisticated conversational repertoires. Future research should evaluate the content of the conversations and other nonvocal stimuli that might be beneficial in assisting with social interactions, in addition to using behavioral skills training to strengthen the specific social skills evaluated in the current study.

Advances in AAC intervention: some contributions related to applied behavior analysis

This article extends Dr. Bob Remington's call for collaborations between those supporting behavioral approaches and those supporting more natural developmental approaches to beginning communication intervention. This article expands areas previously discussed by Dr. Remington. Topics that are addressed include pivotal behaviors that may facilitate communication acquisition, matching law and response efficiency, generalization, maintenance, and the related topics of general case instruction (which involves an understanding of stimulus and response classes). These topics reflect contemporary areas of research that could be better integrated into translational research and have not been extensively integrated into augmentative and alternative communication (AAC) practice. Dr. Remington's article discussed the value of behavioral approaches and corresponding methodology to AAC researchers and practitioners. We agree and discuss the need for greater interaction among proponents of varying approaches to intervention.

An Investigation of Functional Communication Training and Schedule Thinning Using a Multiple Schedule on Elopement to Access Stereotypy

Individuals diagnosed with autism spectrum disorder (ASD) who engage in stereotypy may also emit a prior, temporally contiguous, high-risk response to access stereotypic behaviors. For example, the participant in this study who was diagnosed with ASD engaged in a chained response that included elopement, often in unsafe locations, to access light switch flipping. Previous research indicates that functional communication training (FCT) with delay fading is a viable approach to reduce chained problem behavior. In this study, we extended previous research by (a) evaluating the generalized effect of FCT and schedule thinning using multiple schedule technology for an automatically maintained chained response, and (b) evaluating whether intervention effects maintained in the participant's optimal context. Results for the participant suggested that FCT with schedule thinning mitigated high-risk chained responding across settings and discrimination training using a multiple schedule assessment effectively signaled available and unavailable times for the participant to emit the chained response which matched the participant's natural schedule parameters.

Behavioral Treatment of Self-Injury: 2001 to 2016

Individuals diagnosed with intellectual and developmental disabilities (IDD) frequently exhibit self-injurious behavior (SIB). Previous research has examined the published literature on behavioral treatments of SIB from 1964-2000. Results suggested that these treatments were highly efficacious at decreasing SIB, particularly when based on the results of a functional assessment. The purpose of this review is to update, replicate, and extend the previous research. The current findings indicate an increase in studies reporting automatically maintained SIB as well as less efficacious treatments overall. Discussion of our conclusions and methods of SIB assessment and treatment are discussed, both as they relate to the previous review and for future directions.

Thinning Schedules of Reinforcement Following Functional Communication Training for Children with Intellectual and Developmental Disabilities: A Meta-analytic Review

Functional communication training (FCT) is an evidence-based practice used to mitigate challenging behavior by increasing functional communication skills. To increase the practicality and feasibility of FCT in natural settings, thinning schedules of reinforcement are typically programmed following FCT. In this review, we meta-analyzed 28 studies that incorporated a thinning schedule procedure following FCT for 51 children with intellectual and developmental disabilities ages 8 and younger. Using Tau-U, the results demonstrated overall moderate effect sizes for both challenging behavior and functional communication responses. Additionally, moderator analyses pertaining to participant characteristics, interventions, and study quality were conducted. Thinning procedures were most effective for children who had stronger communication repertoire. Implications for future research and practice are discussed.

Generalization and maintenance of functional communication training for individuals with developmental disabilities: A systematic and quality review

BACKGROUND

Functional communication training (FCT) is considered an evidence-based practice for treating problem behavior in individuals with developmental disabilities (e.g. autism, intellectual disabilities, down syndrome, etc.). However, there is little known on how to sustain behavioral change following FCT interventions. This systematic and quality review synthesizes the current literature base evaluating the maintenance and generalization of behavioral effects following FCT.

METHOD

A systematic review identified 37 studies that met the pre-set inclusion criteria. Those studies were summarized in terms of: (a) generalization dimension, (b) generalization assessment design, (c) maintenance assessment design, (d) maintenance and generalization teaching strategy, and (e) latency to maintenance probes. All studies employed single-case research designs and were evaluated using the What Works Clearinghouse pilot single-case research standards (Kratochwill et al., 2013) as adapted by Maggin, Briesch, and Chafouleas (2013). Maintenance and generalization data were evaluated using a researcher-developed rubric based on the WWC standards.

RESULTS AND DISCUSSION

Results indicate that 30 studies met standards or met standards with reservations while only six studies also met all of the maintenance and generalization standards. Of the six studies, five did not implement any additional strategies beyond the contacting natural contingencies that is inherent in the FCT intervention. Implications for future research and practice are discussed.

Promoting Conditional Use of Communication Skills for Learners With Complex Communication Needs: A Tutorial

PURPOSE

Conditional use of communication skills refers to the ability of a learner to appropriately generalize and discriminate when, where, and how to communicate based on constant variation and shifts in environmental cues.

METHOD

We describe discrimination and generalization challenges encountered by learners with complex communication needs and ways in which these challenges are fostered through traditional communication intervention programming. We address arrangements in instruction that maximize the probability of learners acquiring the conditional use of new vocabulary and the modest instructional technology implemented when planning for generalization.

RESULTS

We propose establishing well-discriminated and generalized use of new vocabulary items through the application of a general case instruction framework to communication intervention programming.

CONCLUSION

We provide intervention methodology, including intervention steps for general case instruction, a plethora of functional examples, and graphic displays to assess and intervene to promote conditional use of communication skills for learners with complex communication needs.

Further evaluation of differential exposure to establishing operations during functional communication training

Recent research findings (DeRosa, Fisher, & Steege, ) suggest that minimizing exposure to the establishing operation (EO) for destructive behavior when differential reinforcement interventions like functional communication training (FCT) are introduced may produce more immediate reductions in destructive behavior and prevent or mitigate extinction bursts. We directly tested this hypothesis by introducing FCT with extinction in two conditions, one with limited exposure to the EO (limited EO) and one with more extended exposure to the EO (extended EO) using a combined reversal and multielement design. Results showed that the limited-EO condition rapidly reduced destructive behavior to low levels during every application, whereas the extended-EO condition produced an extinction burst in five of six applications. We discuss these findings in relation to the effects of EO exposure on the beneficial and untoward effects of differential reinforcement interventions.

Self-Injurious Behavior in Children With Developmental Disabilities: A Systematic Review of Behavioral Intervention Literature

We reviewed single-case research studies examining the effects of behavioral interventions for self-injurious behavior (SIB) in young children with autism and developmental disabilities. Systematic searches of electronic databases, journals, and reference lists identified 46 studies (66 participants younger than the age of 12) meeting inclusion criteria. Studies were examined based on (a) participant demographics, (b) topography and function of SIB, (c) type of functional behavior assessment (FBA), (d) intervention procedures and outcomes, and (e) experimental design and measurement. Intervention strategies were categorized as antecedent manipulations, teaching behavior, consequence-based procedures, and/or extinction procedures. Positive outcomes were reported for 78% of participants in the reviewed studies and 88% of the participants were diagnosed with autism. Results suggest the effectiveness of behavioral interventions to decrease SIB for young children with disabilities; however, the frequent use of packaged interventions without component analysis limits the conclusiveness of any treatment recommendation. Suggestions for future research are discussed.

Communication interventions on conditional requesting or rejecting skills for individuals with moderate to severe developmental disabilities: a scoping review

Objective: To synthesize communication intervention studies that addressed conditional requesting or rejecting skills for individuals with moderate to severe developmental disabilities from 1980 to 2017. Methods: A systematic search was conducted and the yielded 20 studies were coded from three aspects, including participant characteristics, intervention characteristics, and quality of study parameters. Results: The identified studies involved 31 participants who ranged from 4 to 45 years of age and had a diagnosis of a developmental disability with moderate to severe disabilities. These individuals with moderate to severe disabilities were able to learn to request or reject conditionally, with maintenance and generalization reported in some studies. In general, the identified studies differed in their specific intervention goals related to conditional requesting or rejecting skills. The methodological adequacy of the studies identified warrants improvement. Conclusion: There is the need for future research on conditional communication intervention for individuals with developmental disabilities to refine and expand the existing evidence base.

An annotated bibliography of verbal behavior articles published outside of The Analysis of Verbal Behavior: 2016

An annotated bibliography is provided that summarizes journal articles on verbal behavior published outside of The Analysis of Verbal Behavior in 2016, the primary journal for scholarship in this area. Thirty-seven such articles were identified and annotated as a resource for practitioners, researchers, and educators.

Signalling changes to individuals who show resistance to change can reduce challenging behaviour

BACKGROUND & OBJECTIVES

Several neurodevelopmental disorders are associated with resistance to change and challenging behaviours - including temper outbursts - that ensue following changes to routines, plans or expectations (here, collectively: expectations). Here, a change signalling intervention was tested for proof of concept and potential practical effectiveness.

METHODS

Twelve individuals with Prader-Willi syndrome participated in researcher- and caregiver-led pairing of a distinctive visual-verbal signal with subsequent changes to expectations. Specific expectations for a planned subset of five participants were systematically observed in minimally manipulated natural environments. Nine caregivers completed a temper outburst diary during a four week baseline period and a two week signalling evaluation period.

RESULTS

Participants demonstrated consistently less temper outburst behaviour in the systematic observations when changes imposed to expectations were signalled, compared to when changes were not signalled. Four of the nine participants whose caregivers completed the behaviour diary demonstrated reliable reductions in temper outbursts between baseline and signalling evaluation.

LIMITATIONS

An active control group for the present initial evaluation of the signalling strategy using evidence from caregiver behaviour diaries was outside the scope of the present pilot study. Thus, findings cannot support the clinical efficacy of the present signalling approach.

CONCLUSIONS

Proof of concept evidence that reliable pairing of a distinctive cue with a subsequent change to expectation can reduce associated challenging behaviour is provided. Data provide additional support for the importance of specific practical steps in further evaluations of the change signalling approach.

Multiple schedules in practical application: Research trends and implications for future investigation

Researchers began studying multiple schedules in basic laboratories, but recent advances have extended research on multiple schedules to a wide variety of socially significant applications, especially during the last decade. Applied researchers have used multiple schedules to (a) promote stimulus control over high-rate appropriate behaviors, (b) thin the schedule of reinforcement following functional communication training, and (c) obtain stimulus control over problem behaviors maintained by automatic reinforcement. In the current paper, we reviewed 31 studies with 147 applications identified through a search of the applied literature on multiple schedules. Using these studies, we (a) reviewed the empirical literature on multiple schedules, (b) recommended multiple-schedule procedures that serve as best practice guidelines for applied behavior analysts, (c) identified the generality and boundaries of current knowledge about the effectiveness of multiple schedules, and (d) critically analyzed the literature to provide directions for future multiple-schedule research.

Evaluation of multiple schedules with naturally occurring and therapist-arranged discriminative stimuli following functional communication training

Many studies have shown that (a) functional communication training (FCT) is effective for reducing problem behavior, and (b) multiple schedules can facilitate reinforcer schedule thinning during FCT. Most studies tha have used multiple schedules with FCT have included therapist-arranged stimuli (e.g., colored cards) as the discriminative stimuli (S(D) s), but recently, researchers have evaluated similar multiple-schedule training procedures with naturally occurring S(D) s (e.g., overt therapist behavior). The purposes of the current study were to compare the effects of arranged and naturally occurring S(D) s directly during (a) acquisition of discriminated functional communication responses (FCRs) and (b) generalization of discriminated FCRs when we introduced the multiple schedules in novel contexts in which the naturally occurring stimuli were either relatively easy or difficult to discriminate. Results showed that (a) 2 of 3 participants acquired discriminated responding of the FCR more rapidly with arranged than with naturally occurring stimuli, (b) 2 of 3 participants showed resurgence of problem behavior , and (c) 2 of 3 participants showed greater generalization of discriminated responding to novel contexts with arranged stimuli than with naturally occurring stimuli. We discuss these results relative to the conditions under which naturally occurring and arranged S(D) s may promote rapid and generalized treatment gains.

The use of a discrimination-training procedure to teach mand variability to children with autism

We investigated the effects of a script-fading and discrimination-training procedure on mand variability in preschoolers with autism. Participants were taught to vary their vocal mands in the presence of written scripts, a green placemat, and a lag schedule of reinforcement. They were also taught to engage in repetitive mands in the presence of the same written scripts and a red placemat. When the scripts were removed, all 3 participants continued to engage in varied manding in the presence of the green placemat and lag schedule, and they continued to engage in repetitive manding in the presence of the red placemat. When the lag schedule was also removed, 2 of the 3 participants continued to engage in varied responding in the presence of the green placemat and repetitive responding in the presence of the red placemat. Finally, all 3 participants demonstrated generalization and maintenance of mand variability during snack sessions with their peers.

Comparing Visual and Statistical Analysis in Single-Case Studies Using Published Studies

Little is known about the extent to which interrupted time series analysis (ITSA) can be applied to short, single-case study designs and whether those applications produce results consistent with visual analysis (VA). This article examines the extent to which ITSA can be applied to single-case study designs and compares the results based on two methods: ITSA and VA, using papers published in the Journal of Applied Behavior Analysis in 2010. The study was made possible by the development of software called UnGraph®, which facilitates the recovery of raw data from the graphs. ITSA was successfully applied to 94% of the examined graphs with the number of observations ranging from 8 to 136. Moderate to high lag-1 autocorrelations (>.50) were found for 46% of the data series. Effect sizes similar to group-level Cohen's d were identified based on the tertile distribution. Effects ranging from 0.00 to 0.99 were classified as small, those ranging from 1.00 to 2.49 as medium, and large effect sizes were defined as 2.50 or greater. Comparison of the conclusions from VA and ITSA had a low level of agreement (Kappa =.14, accounting for the agreement expected by chance). The results demonstrate that ITSA can be broadly implemented in applied behavior analysis research. These two methods should be viewed as complementary and used concurrently.

How should periods without social interaction be scheduled? Children's preference for practical schedules of positive reinforcement

Several studies have shown that children prefer contingent reinforcement (CR) rather than yoked noncontingent reinforcement (NCR) when continuous reinforcement is programmed in the CR schedule. Preference has not, however, been evaluated for practical schedules that involve CR. In Study 1, we assessed 5 children's preference for obtaining social interaction via a multiple schedule (periods of fixed-ratio 1 reinforcement alternating with periods of extinction), a briefly signaled delayed reinforcement schedule, and an NCR schedule. The multiple schedule promoted the most efficient level of responding. In general, children chose to experience the multiple schedule and avoided the delay and NCR schedules, indicating that they preferred multiple schedules as the means to arrange practical schedules of social interaction. In Study 2, we evaluated potential controlling variables that influenced 1 child's preference for the multiple schedule and found that the strong positive contingency was the primary variable.

Effects of augmentative and alternative communication on challenging behavior: a meta-analysis

The purposes of this review were to (a) use meta-analytic procedures to examine the effectiveness of single-case AAC intervention research on challenging behaviors exhibited by individuals with disabilities, (b) identify study characteristics that moderate intervention effects, and (c) evaluate the quality of research. The authors provided inferential and descriptive analyses of 54 studies representing 111 participants and estimated effect sizes using the Nonoverlap of All Pairs (NAP) method. Overall, AAC interventions were found to be equally effective across a broad spectrum of participants and interventions. AAC interventions were more effective with younger children than with adults. Interventions in which functional behavior assessments (FBA) were used had significantly larger effect sizes than those that did not use FBAs. Further, functional communication training interventions resulted in larger effect sizes than Picture Exchange Communication System interventions. Descriptive analysis revealed that (a) interventions often occurred in atypical environments (e.g., therapy room, experimental room) and with atypical interventionists (e.g., therapists, researchers), and (b) numerous studies did not exhibit quality characteristics of single-case research.

Discrimination training reduces high rate social approach behaviors in Angelman syndrome: proof of principle

This proof of principle study was designed to evaluate whether excessively high rates of social approach behaviors in children with Angelman syndrome (AS) can be modified using a multiple schedule design. Four children with AS were exposed to a multiple schedule arrangement, in which social reinforcement and extinction, cued using a novel stimulus, were alternated. Twenty-five to 35 discrimination training sessions were conducted and levels of approach behaviors were measured before and after the discrimination training for two children. All four participants evidenced discrimination between conditions of reinforcement and extinction after 16-20 teaching sessions as indicated by lower rates of social approach behaviors in the presence of the S(Δ) for extinction. Reversal effects for the two children for whom this design was implemented were evident. The results demonstrate that after repeated training, the use of a novel stimulus can serve as a cue for children with AS to discriminate adult availability. This is a potentially effective component of a broader intervention strategy but highlights the need for sustained teaching procedures within this population.

Reinforcement schedule thinning following functional communication training: review and recommendations

This paper extends the Tiger, Hanley, and Bruzek (2008) review of functional communication training (FCT) by reviewing the published literature on reinforcement schedule thinning following FCT. As noted by Tiger et al. and others, schedule thinning may be necessary when the newly acquired communication response occurs excessively, to the extent that reinforcing it consistently is not practical in the natural environment. We provide a review of this literature including a discussion of each of the more commonly used schedule arrangements used for this purpose, outcomes obtained, a description of methods for progressing toward the terminal schedule, and a description of supplemental treatment components aimed at maintaining low levels of problem behavior during schedule thinning. Recommendations for schedule thinning are then provided. Finally, conceptual issues related to the reemergence of problem behavior during schedule thinning and areas for future research are discussed.

Functional Communication Training and Chained Schedules of Reinforcement to Treat Challenging Behavior Maintained by Terminations of Activity Interruptions

In this article, the authors evaluated functional communication training (FCT) and a chained schedule of reinforcement for the treatment of challenging behavior exhibited by two individuals diagnosed with Asperger syndrome and autism, respectively. Following a functional analysis with undifferentiated results, the authors demonstrated that challenging behavior was occasioned by interruptions of ongoing activities and maintained by terminations of interruptions. Next, they demonstrated the effectiveness of a treatment consisting of FCT with a chained schedule of reinforcement. Last, they modified the chained schedule procedure to increase ease of implementation and promote toleration of activity interruptions, and academic tasks were incorporated into the treatment.

Further examination of discriminated functional communication

One child with developmental disabilities was taught to mand for attention by saying "excuse me." Treatment effects were extended to multiple training contexts by teaching the participant to attend to naturally occurring discriminative stimuli through differential reinforcement of communication during periods of the experimenter's nonbusy activities (e.g., reading a magazine). Results are discussed in terms of future research on the generalization and maintenance of functional communication in the natural environment.