Use of synthesized analysis and informed treatment to promote school reintegration

On the prevalence and magnitude of resurgence during delay-and-denial tolerance teaching

Resurgence is the recurrence of target behavior (e.g., challenging behavior) during a worsening of reinforcement conditions (e.g., increases in response effort, decreases in alternative reinforcement). Previous studies have examined the prevalence and magnitude of resurgence during functional communication training implemented with discriminative stimuli. We conducted a systematic review of the literature to analyze the magnitude and prevalence of resurgence during delay-and-denial tolerance teaching. Similar to previous studies with discriminative stimuli, resurgence occurred for most participants and in about one third of transitions. When resurgence was present, challenging behavior increased to approximately 26% of baseline levels. Resurgence was less likely to occur during response-effort manipulations (i.e., complexity teaching, tolerance-response teaching) and was most likely to occur during increases in delays that ended following the passage of time rather than a response criterion. We discuss implications for treatment refinements and future treatment-relapse research.

A Two Step Validation of the Performance-Based IISCA: A Trauma-Informed Functional Analysis Model

Functional analyses often involve extended exposure to evocative events and problem behavior, which potentially places the client at risk of retraumatization. The performance-based, interview-informed synthesized contingency analysis (IISCA) is a brief analysis that is conducted in a single session and applies a trauma-assumed framework in the development of the assessment procedures (e.g., measures of calm, reinforcing precursors to avoid escalation and physical management). We conducted 12 applications of the performance-based IISCA in the United States and Brazil and (1) compared the results to a subset of 7 applications who also experienced the original IISCA and (2) incorporated a function-based treatment informed by the performance-based IISCA in a further subset of 5 of those 12 applications. The results support the use of the performance-based IISCA in that this variation of the IISCA corresponded with the original IISCA and informed effective treatment of problem behavior.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40617-023-00792-2.

Are Function-Based Interventions for Students with Emotional/Behavioral Disorders Trauma Informed? A Systematic Review

Students with emotional/behavioral disorders (EBD) commonly engage in both externalizing and internalizing behaviors-a behavioral profile that has been connected to childhood trauma. Although the efficacy of function-based interventions for students with EBD has been documented, the extent to which these interventions align with principles of trauma-informed care (TIC) is unknown. We conducted a systematic review of function-based intervention studies for students with EBD to evaluate whether and how these interventions incorporated critical elements of TIC. We identified 56 articles that met the eligibility criteria and used an iterative process to identify intervention practices consistent with each of six pillars of TIC, then evaluated the extent to which interventions in the study sample incorporated these practices. Despite identifying 45 function-based intervention practices aligned with pillars of TIC, we found most of these practices were absent in most interventions. We identified teaching skills, building healthy relationships, and including family, culture, and community as three pillars of TIC that warrant more attention when developing function-based interventions for students with EBD. For pillars of TIC that lack a strong empirical foundation in behavior analysis, we point to related literatures and disciplines with potential to inform next steps in behavior analytic research and practice.

Long-term effectiveness and generality of practical functional assessment and skill-based treatment

There are several considerations to address when conducting functional communication training for challenging behavior in a school setting, such as the need for schedule thinning and maintenance across staff and the need to establish a variety of appropriate classroom skills. There are several strategies for conducting schedule thinning following functional communication training and for transferring effects across people or settings. However, there are few examples of these processes in natural settings with relevant caregivers and with long-term maintenance of effects. We implemented a functional assessment and skill-based treatment process with six children with autism in a specialized school setting and extended treatment until challenging behavior was reduced to near-zero levels across multiple staff and settings. Follow-up data indicate that effects were still observed 1 year posttreatment and the use of crisis procedures (e.g., physical restraint) was eliminated for all participants.

On the Reliability and Treatment Utility of the Practical Functional Assessment Process

Saini et al. (2019) urged caution with respect to the use of practical functional assessment (PFA) procedures to inform behavioral treatment when they found that responses to an open-ended caregiver interview were only somewhat reliable and showed moderate to weak correspondence with analog functional analyses. Because the practitioner's goal in conducting any functional assessment process is to inform the successful treatment of problem behavior, we replicated and extended Saini et al. by (a) evaluating the reliability of hypotheses gleaned from two independent PFA processes for each of four children, (b) conducting treatment informed by a randomly assigned PFA, and (c) determining the extent to which potentially different levels of reliability impacted the treatment utility of the PFA process. Results indicated that the reliability of the PFA process varied depending on the stringency with which it was evaluated. However, treatments developed from randomly determined PFA processes produced efficacious outcomes on problem behavior and targeted social skills that transferred to the context designed from the other PFA process in all evaluations, suggesting that the PFA has strong treatment utility despite parts of the process having ambiguous levels of reliability. We discuss implications for practitioners tasked with treating severe problem behavior.

Contingency-based delay to reinforcement following functional communication training for autistic individuals: A multilevel meta-analysis

LAY ABSTRACT

Functional communication training, an intervention for challenging behavior rooted in principles of applied behavior analysis, has copious empirical support dating back to the mid-1980s for autistic individuals. Recently, there has been a concerted effort to thin reinforcement delivery during functional communication training using contingency-based delays that, in turn, are designed to enhance practicality and feasibility while not compromising efficacy. In this synthesis, we meta-analyzed the literature base with the goal of investigating both combined and across type effectiveness of contingency-based delays. We also aimed to investigate moderating variables that might impact intervention outcomes. Findings showed that contingency-based delays were effective for individuals with an autism spectrum disorder diagnosis and most effective when the delay incorporated some form of positive reinforcement. In addition, differential reinforcement of alternative-based delays was overall more effective when compared to differential reinforcement of other behavior-based delays. Noteworthy moderating variables found to impact contingency-based delay efficacy included the intervention dosage and the topography of behavior. We discuss these findings and highlight directions where additional empirical research is warranted to improve our understanding about contingency-based delays for individuals diagnosed with autism spectrum disorder.

Evaluating the Potential for Correspondence Between Brief Functional Analysis and Interview-Informed Synthesized Contingency Analysis Procedures

School Psychologists regularly conduct Functional Behavior Assessment (FBA), though, most FBA are completed using indirect procedures, which are inadequate for creating function-based interventions relative to experimental measures, such as functional analysis (FA). However, traditional FA may be considered arduous in the school setting. Alternative procedures like brief functional analysis (BFA) and interview informed synthesized contingency analysis (IISCA), may be as effective and more efficient than FA. Limited research exploring the correspondence of these procedures exists. The current study used an alternating treatment design across eight school aged children to compare control and test conditions for each measure. A within subjects approach was also used to compare the results of BFA and IISCA. Correspondence across the two measures was 54.17%. With average correspondence yielding just over half, the results indicate the two FA methods did not reliably identify the same function. Implications for practice are discussed.

An Evaluation of "Balance": a Home-Based, Parent-Implemented Program Addressing Emerging Problem Behavior

Programs that prevent the development of severe problem behavior in young children with autism spectrum disorder (ASD) are critically needed. We describe a program designed to do this, and we report on a preliminary evaluation of its effects with four 3- and 4-year-old children with ASD. Parents served as the primary implementers, with twice-weekly coaching from a Board Certified Behavior Analyst. Direct measures and Aberrant Behavior Checklist scores reflected decreases in emerging problem behavior. Direct measures also reflected increases in child communication, social, and cooperation skills, and parents rated the process as highly acceptable. A randomized controlled trial will be required to evaluate the extent to which the program prevents the development of problem behavior in young children with ASD.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40617-020-00490-3.

Randomized controlled trial of seminar-based training on accurate and general implementation of practical functional assessments

General and long-term outcomes of functional analysis training have not yet been reported. Within a randomized control trial, we trained 18 behavior analytic practitioners to interview caregivers, design and then conduct a personalized analysis as a part of a practical functional assessment (PFA). Participants were randomly assigned to groups, and those who experienced the seminar prior to conducting PFA with a confederate demonstrated more component skills than those who were provided the same materials but did not experience the seminar (mean scores: 87%, 36% respectively). Participants who experienced the seminar considered the training valuable and reported greater confidence in their ability to achieve control in an analysis. Several participants then conducted a PFA with a client who engaged in SPB. Results showed that skills transferred to these authentic applications. Results suggest that a seminar-based training can increase practitioners' ability to functionally analyze problem behavior and leads to subsequent analytic activity.

Does teaching an omnibus mand preclude the development of specifying mands?

When problem behavior is controlled by a synthesized reinforcement contingency, a simple omnibus mand that yields access to all reinforcers simultaneously has been shown to effectively replace problem behavior. The question arises as to whether teaching an omnibus mand will preclude the acquisition of specifying mands for each of the combined reinforcers. In this study, after 3 students diagnosed with autism acquired an omnibus mand ("My way, please") that yielded all identified reinforcers simultaneously, specifying mands (e.g., "All done," "May I have my toys?" "Play with me") were taught to yield each individual reinforcer (e.g., escape, tangibles, attention). Problem behavior was immediately eliminated for all children, and the omnibus mand was acquired quickly. Teaching an omnibus mand did not preclude acquisition of specifying mands for any learner and instead allowed for the acquisition of specifying mands once problem behavior had been effectively reduced.

On the Standardization of the Functional Analysis

The functional analysis procedures described in the seminal Iwata et al. (1982/1994) study are prominent in the applied behavior analytic literature, having been replicated hundreds of times over the past 30 years (Beavers, Iwata, & Lerman, 2013; Hanley, McCord, Iwata, 2003). However, the extent to which particular components of this functional analysis model have become more or less prominent over time is not clear from these literature reviews. We therefore conducted a review of the functional analysis literature between the years of 1965 and 2016 to determine the trends in the usage of particular components over time and to determine if the published literature reflects a standardization of the manner in which functional analyses of problem behavior are conducted. Furthermore, we discuss whether or not this standardization of a functional analysis model is currently necessary.

Interview-Informed Synthesized Contingency Analysis (IISCA): Novel Interpretations and Future Directions

The functional analysis (FA) methodology was developed to provide an empirical basis for understanding the reinforcers contributing to the maintenance of problem behavior. Previous research has demonstrated that multiple formats have been established to address some areas, such as practicality, efficiency, and safety. We reviewed the research on a new replication and extension of the standard FA format, the interview-informed synthesized contingency analysis (IISCA) and its subsequent treatment. We discuss the efficiency and effectiveness of the IISCA across various populations, settings, topographies of problem behaviors, and maintaining functions across 17 studies. Common treatment trends, novel developments, and other critical intervention components are also reviewed. We provide suggestions for future directions and guidelines for practitioners when considering the use of the IISCA.