Retrospective consecutive controlled case series of outcomes for functional analyses of severe destructive behavior.

Functional analysis methods allow clinicians to determine the variable(s) that maintain destructive behavior. Previous reviews of functional analysis outcomes have included large samples of published and unpublished data sets (i.e., clinical samples). The purpose of this review was to conduct a large retrospective consecutive controlled case series of clinical functional analyses. We sought to identify the prevalence of differentiation, procedural modifications for undifferentiated and differentiated cases, and identified function(s) of destructive behavior. In addition, we extended the existing literature by determining whether functional analysis differentiation and function varied when single or multiple behavior topographies were consequated in the functional analysis. We discuss our findings considering previously published functional analysis reviews, provide avenues for future research, and offer suggestions for clinical practice.

Using e-learning modules to teach ongoing-visual inspection of functional analyses.

Despite the effectiveness of function-based treatments, most clinicians do not conduct functional analyses (FA). The time required to conduct an FA is a major barrier preventing their use. One way to increase FA efficiency is to discontinue the analysis as soon as it has produced clear results. Saini et al. (2018) evaluated a structured procedure for ongoing-visual inspection of FAs and found that it produced accurate interpretations while averaging 40% fewer sessions than author interpretation. This study evaluated the efficacy of an e-learning module for training registered behavior technicians (RBTs) to implement ongoing visual inspection of FAs. Following training, 5 of the 6 participants showed mastery of ongoing visual inspection, and the final participant did so with the addition of supplemental procedures. We discuss how this training may increase the efficiency of FAs by teaching individuals who are less experienced in FA methodology when to seek supervision from a supervising Board Certified Behavior Analyst® (BCBA).

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.

A translational evaluation of potential iatrogenic effects of single and combined contingencies during functional analysis.

Recent research suggests that combining putative reinforcers for problem behavior into a single, synthesized contingency may increase efficiency in identifying behavioral function relative to traditional functional analysis (FA). Other research suggests potential shortcomings of synthesized contingency analysis (SCA), such as the potential for false-positive outcomes. In prior comparisons of traditional FAs and SCAs, investigators could not ascertain with certainty the true function(s) of the participants' problem behavior for use as the criterion variable. We conducted a translational study to circumvent this limitation by training a specific function for a surrogate destructive behavior prior to conducting a traditional FA and SCA. The traditional FA correctly identified the previously established function of the target response in all six cases and produced no iatrogenic effects. The SCA produced differentiated results in all cases and iatrogenic effects (i.e., an additional function) in three of six cases. We discuss these findings in terms of the mechanisms that may promote iatrogenic effects.

A preliminary evaluation of treatment duration on the resurgence of destructive behavior.

Quantitative models of resurgence (e.g., Behavioral Momentum Theory, Resurgence as Choice) suggest that resurgence is partly a function of the duration of extinction exposure, with longer histories of extinction producing less resurgence. This prediction is supported by some laboratory research and has been partially supported by clinical translations that did not isolate the effects of extinction exposure prior to testing for resurgence. The degree to which different histories of extinction impact the likelihood of treatment relapse in therapeutic applications of differential reinforcement is of great interest to the clinical community, including insurance carriers and other financial providers. In the present study, we isolated the effects of extinction history for severe destructive behavior across 6 participants referred for treatment services and examined resurgence of destructive behavior when alternative reinforcement terminated. Our within-subject evaluation showed no difference in the level of resurgence or persistence of destructive behavior following short and long exposures to differential reinforcement with extinction. We discuss our failure to replicate in relation to experimental-design considerations for investigating this and other relapse phenomena in future research with clinical populations.

Establishing initial auditory-visual conditional discriminations and emergence of initial tacts in young children with autism spectrum disorder.

Children with autism spectrum disorder (ASD) often display impaired listener skills, and few studies have evaluated procedures for establishing initial auditory-visual conditional discrimination skills. We developed and evaluated a treatment package for training initial auditory-visual conditional discriminations based on the extant research on training such discriminations in children with ASD with at least some preexisting skills in this area. The treatment package included (a) conditional-only training, (b) prompting the participant to echo the sample stimulus as a differential observing response, (c) prompting correct selection responses using an identity-match prompt, (d) using progressively delayed prompts, and (e) repeating trials until the participant emitted an independent correct response. Results indicated all participants mastered all listener targets, and the two participants for whom we tested the emergence of corresponding tacts showed mastery of most tacts without direct training. We discuss these results relative to prior research on listener skills and tacts.

Noncontingent and differential reinforcement in the treatment of pediatric feeding problems.

We conducted functional analyses of the inappropriate mealtime behavior of 5 children diagnosed with feeding problems. Then, we compared the effects of differential and noncontingent reinforcement, and the relative effects of escape extinction with and without differential or noncontingent reinforcement, when escape extinction appeared necessary. Both reinforcement procedures were effective without escape extinction to treat food refusal for 1 child, but only differential reinforcement was effective without escape extinction to treat the child's liquid refusal. Escape extinction was necessary for 4 of 5 children. The addition of positive reinforcement resulted in beneficial effects (i.e., more stable acceptance, decreased inappropriate mealtime behavior or negative vocalizations) with 3 of 4 children. With escape extinction, differential reinforcement was more effective to treat food refusal for 2 children and noncontingent reinforcement was more effective for 1 child.

An Evaluation of Conditional Manding Using a Four-Component Multiple Schedule.

Most verbal behavior curricula for children with autism spectrum disorder (ASD) focus on teaching multiple mands during the early stages of training (e.g., picture exchange communication system; Bondy & Frost, 1994). However, few, if any, of those curricula train children with ASD to differentially mand only for reinforcers that are reasonable for a caregiver to deliver in a given context (e.g., mands to cuddle at bedtime) and to refrain from manding for reinforcers that would be inappropriate to deliver in that context (e.g., mands to play outside at bedtime). In this study, we first taught a boy with ASD two initial mands. Immediately thereafter we brought those mands under the conditional discriminative control of a four-component multiple schedule with (a) S1 correlated with one reinforcer available (i.e., edibles), (b) S2 correlated with both reinforcers available (i.e., edibles or drink), (c) S3 correlated with another reinforcer available (i.e., drink), and (d) SΔ correlated with no reinforcer available. Following treatment, the child displayed conditionally discriminated manding in accordance with each of the four components of the schedule. We discuss these findings relative to the potential benefits of bringing mands under both evocative and discriminative control.

Predictive validity and efficiency of ongoing visual-inspection criteria for interpreting functional analyses.

Prior research has evaluated the reliability and validity of structured criteria for visually inspecting functional-analysis (FA) results on a post-hoc basis, after completion of the FA (i.e., post-hoc visual inspection [PHVI]; e.g., Hagopian et al., 1997). However, most behavior analysts inspect FAs using ongoing visual inspection (OVI) as the FA is implemented, and the validity of applying structured criteria during OVI remains unknown. In this investigation, we evaluated the predictive validity and efficiency of applying structured criteria on an ongoing basis by comparing the interim interpretations produced through OVI with (a) the final interpretations produced by PHVI, (b) the authors' post-hoc interpretations (PHAI) reported in the research studies, and (c) the consensus interpretations of these two post-hoc analyses. Ongoing visual inspection predicted the results of PHVI and the consensus interpretations with a very high degree of accuracy, and PHAI with a reasonably high degree of accuracy. Furthermore, the PHVI and PHAI results involved 32 FA sessions, on average, whereas the OVI required only 19 FA sessions to accurately identify the function(s) of destructive behavior (i.e., a 41% increase in efficiency). We discuss these findings relative to other methods designed to increase the accuracy and efficiency of FAs.

On the predictive validity of behavioral momentum theory for mitigating resurgence of problem behavior.

We summarize the results of four recent translational studies from our lab that used the predictions of behavioral momentum theory to inform the development of more durable treatments for destructive behavior. Treatments informed by behavioral momentum theory generally showed better suppression of target responding during an extinction challenge than did a comparison treatment. We reanalyze data from each of the four studies to show that this general finding is apparent both at the aggregate (i.e., proportion of baseline response rates averaged across participants) and within participant (i.e., percentage reduction in proportion of baseline response rates, difference in raw response rates during the extinction challenge). Interestingly, participants who experienced multiple cycles of the extinction challenge generally showed less differentiation in target responding between the treatment informed by behavioral momentum theory and the comparison treatment. Overall results suggest that applications of behavioral momentum theory can substantially improve the durability of common treatments for destructive behavior.

Systematic Changes in Preference for Schedule-Thinning Arrangements as a Function of Relative Reinforcement Density.

We treated destructive behavior maintained by both social-positive (i.e., access to tangibles) and social-negative (i.e., escape from demands) reinforcement in an individual diagnosed with autism spectrum disorder using functional communication training (FCT). We then thinned the schedule of reinforcement for the tangible function using a multiple schedule (mult FCT) and later thinned the availability of escape using a chained schedule (chain FCT). Both treatments proved effective at maintaining functional communicative responses while decreasing destructive behavior to near-zero levels. In addition, treatment effects maintained when we rapidly thinned mult FCT to the terminal schedule. Throughout chain-FCT schedule thinning, we assessed client preference for each schedule-thinning arrangement (mult FCT or chain FCT) using a concurrent-chains procedure. Client preference reliably shifted from chain FCT to mult FCT as the response requirement increased and the proportion of session spent in reinforcement began to favor mult FCT. We discuss the clinical implications of these findings.

Escape from rich-to-lean transitions: Stimulus change and timeout.

Extended pausing during discriminable transitions from rich-to-lean conditions can be viewed as escape (i.e., rich-to-lean transitions function aversively). In the current experiments, pigeons' key pecking was maintained by a multiple fixed-ratio fixed-ratio schedule of rich or lean reinforcers. Pigeons then were provided with another, explicit, mechanism of escape by changing the stimulus from the transition-specific stimulus used in the multiple schedule to a mixed-schedule stimulus (Experiment 1) or by producing a period of timeout in which the stimulus was turned off and the schedule was suspended (Experiment 2). Overall, escape was under joint control of past and upcoming reinforcer magnitudes, such that responses on the escape key were most likely during rich-to-lean transitions, and second-most likely during lean-to-lean transitions. Even though pigeons pecked the escape key, they paused before doing so, and the latency to begin the fixed ratio (i.e., the pause) remained extended during rich-to-lean transitions. These findings suggest that although the stimulus associated with rich-to-lean transitions functioned aversively, pausing is more than simply escape responding from the stimulus.