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Autism Information for Parents, Practitioners & Professionals…

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A Functional Approach to the Assessment and Treatment of Challenging Behavior: A Description with Video Examples

September 2013

By John Lee, Patrick Romani, David Wacker, Scott Lindgren and Todd Kopelman for the exclusive use by the authors and the website http://www.travisithompson.net/


Applied behavior analysts are a science-based professional group who focus on observable behaviors, such as challenging behavior, and the environmental variables, such as demands, that increase or decrease those behaviors. One subgroup of professionals within Applied Behavior Analysis are interested in autism and focus on the reduction of challenging behaviors that interfere with learning, working, recreating, and living a better quality of life. The purpose of this article is to describe and show how functional analysis (FA) plus functional communication training (FCT) can be implemented by parents via telehealth to assess and treat challenging behavior and increase appropriate behavior.  In the current funded project (Lindgren & Wacker 2011) parents conducted all procedures in their homes while being coached by experienced applied behavior analysts via telehealth from the University of Iowa Children’s Hospital. All participating children were 6 years old or younger, had challenging behavior and were diagnosed with autism.  Included are video examples provided by one family who conducted these procedures within their home with coaching provided by applied behavior analysts. We thank all the families who participated and those that agreed to let us use their videos for this newsletter. 

The image at the end of this sentence is a clickable link that will take you to a video example of play conducted as part of an FA and will appear when a video example is available.

Anchor and image with link to “Play” video were in my version here. (Please look in the folder “TT_NewsLetter\Video_Examples\index.files\html5video” for the videos in .mov and .mp4 formats that should be compatible with your software. There are also videos in .m4v and .webm formats there too.)
Applied behavior analysts typically look at most challenging behavior as being functional; some people exhibit these behaviors because they result in a more preferred situation (e.g. the removal of demands). Behavior analysts often seek to understand the ways that challenging behaviors are functional for a person. Typical benefits can be that a person gains something that is desired, such as attention or toys, or avoids something that is not desired, such as a disliked food or non-preferred work tasks. A frequently used procedure to identify function, the FA, was first described by Dr. Brian Iwata and colleagues in 1982.
The first step of the FA is typically to create a situation in which there is no reason for the child to use challenging behavior for any of the purposes listed above. This situation is typically called a free play or control condition, and was shown to you in the previous video clip. In this condition applied behavior analysts try to provide the optimal type and amount of attention, unrestricted access to toys and activities, and removal of demands, non-preferred items and non-preferred activities. If we do not see any challenging behavior in this condition, we have a control condition that shows that challenging behavior may be functional; challenging behavior may function to change the environment. These results are also used to compare against other test conditions of the FA. If challenging behavior occurs much more often in a test condition than during free play, we have identified a specific environmental function. Test conditions often involve the parent: (a) ignoring the child (and then attending only when challenging behavior occurs), (b) restricting access to preferred toys (and presenting the toy only when challenging behavior occurs), and (c) presenting demands (but removing the demand only when challenging behavior occurs). Each of these conditions tests the role of a specific function.  Does challenging behavior increase if it produces attention, preferred items, or breaks from demands? If challenging behavior occurs in any of the test conditions, and stops when that condition stops or during free play, then we have identified a function.
Once the FA shows that challenging behavior is functional for a person, applied behavior analysts then employ treatment based on the identified function. FCT is the most common reinforcement-based treatment and was first described by Dr. Edward Carr and Dr. Mark Durand in 1985. FCT is an intervention that attempts to replace challenging behavior with a more appropriate communicative behavior that serves the same function. The goal of this approach is to teach and reinforce an appropriate communicative response(s) (e.g. “play please”) that can be used in place of the challenging behavior. We try to make the communicative response as easy to use and as effective as the challenging behavior because we want the children to use their communication to make requests to control their environment rather than to use their challenging behavior. Many research teams, including our team at Iowa, have experienced a great deal of success with these procedures and high acceptability ratings by parents 
In the following video example you will see the parent conducting an example of FCT that was based on the results of the FA. This is early in treatment and the child is required to do a brief amount of work before returning to play. John (first author) is coaching the family via telehealth and is shown in the upper right-hand corner. It is his voice that you hear coaching mom.
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As you saw, the family is conducting the FCT treatment independently and even their son seems to be enjoying completing the work. The next clip occurred 6 months after the end of treatment.
Our overall results of implementing FA plus FCT in families’ homes have been great. The average reduction in challenging behavior for the first 9 families has been 99%. This compares very favorably with the results achieved when the procedures were conducted via telehealth in clinic settings (86% reductions across 14 children) or by trained therapists working with parents in their homes (90% reduction across 84 children). For more information on the procedures please see the following articles or contact John Lee at John-F-Lee@uiowa.edu with “Travis Thompson article” in the subject line.
Citations
Beavers, G. A., Iwata, B.A., & Lerman, D.C. (2013). Thirty years of research on the functional analysis of problem behavior. Journal of Applied Behavior Analysis, 46 (1), 1-21. doi: 10.1002/jaba.30
Carr, E.G. & Durand, V.M. Reducing behavior problems through functional communication training. Journal of Applied Behavior Analysis, 18 (2), 111-126. doi: 10.1901/jaba.1985.18-111
Harding, J.W., Wacker, D.P., Berg, W.K., Lee, J.F., & Dolezal, D. (2009). Conducting functional communication training in home settings: A case study and recommendations for practitioners. Behavior Analysis in Practice, 2 (1), 21-33.
Iwata, B.A., Dorsey, M.F., Slifer, K.J., Bauman, K.E., & Richman, G.S. (1982). Toward a functional analysis of self-injury. Analysis & Intervention in Developmental Disabilities, 2 (1), 3-20. doi: 10.1016/0270-4684(82)9003-9
Wacker, D.P., Lee, J.F., Padilla-Dalmau, Y.C., Kopelman, T.G., Lindgren, S.D., Kuhle, J., Pelzel, K.E., & Waldron, D.B. (2013). Conducting functional analyses of problem behavior via telehealth. Journal of Applied Behavior Analysis, 46 (1), 31-46
Wacker, D.P., Lee, J.F., Padilla-Dalmau, Y.C., Kopelman, T.G., Lindgren, S.D., Kuhle J., Pelzel, K.E., Dyson, S., Schieltz, K.M., & Waldron, D.B. (2013). Conducting functional communication training via telehealth to reduce the problem behavior of young children with autism.Journal of Developmental and Physical Disabilities, 25 (1), 35-48. doi: 10.1007/s10882-012-9314-0