LAURA C. CHEZAN

Discrete -Trial Functional Analysis of Problem Behavior and Functional

Communication Training in Three Adults with a Dual Diagnosis of an Intellectual

Disability and a Mental Illness

INTRODUCTION

Context

Intellectual

Disability

Mental Illness

Dual Diagnosi

s

Problem Behavior

Context Cont’d

Approach to Problem Behavior

BEHAVIORAL INTERVENTIONS

Behavior is influenced by environmental variables

1. Assess to identify function2. Teach replacement behavior

Participants’ Selection

All Participants

Functional

Assessment

Trial-Based Functional Analysis

Intervention (FCT)

Discrimination

Assessment

Behavioral

Assessment

PARTICIPANTS AND SETTINGS

Participants’ Selection

Meeting with directors

Informal observation of potential participants

Meeting with staff members

Selection of participants

Participants’ Characteristics

Participa

nt

Age Diagnosis Problem Behavior

Antoine 27 moderate ID

bipolar-

disorder

autism

SIB

repetitive verbal and

motor behavior

Rick 32 profound ID

mood disorder

SIB

physical aggression

property destruction

Tonya 23 severe ID

psychosis

NOS

snatching food

physical aggressionNote: ID = intellectual disability; SIB = self-injurious behavior

Participant

Type of Program

Location

Assessment & Training Setting

Antoineday

programrural dining room,

instructional room

Rickday

programrural dining room,

instructional room, hallway

Tonya workshop urban work areas, dining area

Settings

ASSESSMENT AND ANALYSIS

OF PROBLEM BEHAVIOR

Functional Assessment (FA) PURPOSE

Collect information

Background Information

Topography of problem behavior

Environmental variables

Develop Hypotheses

FA – Methods and Outcomes

INDIRECT METHODS

DIRECT METHODS

DefinitionsHypotheses

Temporal Relationships

Verify Hypotheses

Record Review

ABC observations(Bijou, Peterson, & Ault,

1968)

Interview(FAI; O’Neill et al., 1997)

Background information

FA - DTFA

Hypotheses

DTFA

Test Hypotheses

Develop DTFA

DTFA - Conditions

AttentionAutomatic

Reinforcement

AttentionTangible

1Tangible

2

AttentionTangibles

Antoine’s FA Hypotheses

Rick’s FA Hypotheses

Tonya’s FA Hypotheses

FA HYPOTHESIS

ANTECEDENT(No Access to Reinforcer)

CONSEQUENCE(Access to Reinforcer)

ASSESSMENT ( 2 min)

DTFA Components

REINFORCEMENT (2 min)

Present Antecedent STOP if:(a) problem behavior(b) time elapsed

Present Consequence hypothesized to maintain

problem behavior

+

DTFA - Protocols

AttentionAutomatic Reinforcement

AttentionTangible 1Tangible 2

AttentionTangibles

Antoine Rick Tonya

Target Behavior and Recording System

Problem Behavior No Response

TARGET BEHAVIOR

Occurrence or non-occurrence of the 2 responses (data sheet)Latency to first response

®WHO?

® researcher, staff member, or behavioral consultant

®WHEN?

® naturally-occurring opportunities during typical

routines throughout the day

®HOW?

® 1-5 trials per day under one or multiple conditions

® wait 10-15 min between trials

DTFA Implementation

ASSESSMENT

(No access to reinforcer)

REINFORCEMENT

(Access to reinforcer)

What Did We Anticipate?

Problem behavior

Few or No Problem behavior

RESULTS

Latency to Problem Behavior

Social Validity

WHO?

Staff Questionnaire End of assessment

HOW? WHEN?

OUTCOME – Information about:

Significance of outcomesAppropriateness of proceduresContinuation of procedures in the future

Social Validity

Easy to conduct (M=3.0)

SD (1) SA(4)D (2) A (3)

Procedures were clear

Interested in learning more

(M=3.5)Took a long time

(M=1.0)

Interfered with other

responsibilities (M=1.5)

DISCUSSION

® Clear patterns of behavior for all three participants

® Applicable to adults with dual diagnosis

® Few number of trials across conditions

® Variability in the topography of problem behavior and

number of trials with problem behavior

Effectiveness of DTFA

®Variations in stimulus control

® Individual motivation

® Fluctuation in the reinforcing value of certain

people, items, or activities

Factors That May Have Influenced Variability in the Topography of Problem Behavior and

Number or Trials with Problem Behavior

® Efficient and less intrusive way to determine the

function of problem behavior

® Guide the delivery of reinforcement during

intervention and increase tolerance for delayed

reinforcement

Latency to First Occurrence of Problem Behavior

® Implemented by staff members

® Embedded within typical routines

® Rated by staff members as:

® Easy to implement

® No time consuming

Social Validity

CONCLUSION

DTFA was effective in identifying the function of

problem behavior for all three adults

Conclusion

FUTURE STUDIES

Future research may include:

Staff training for implementation of DTFA

Replication of findings

FUNCTIONAL COMMUNICATION

TRAINING (FCT)

FCT

Identification of

replacement behavior

Teaching replaceme

nt behavior

STEPS

Identification of Functionally Equivalent Replacement Behavior

Reviewed DTFA results

Consulted with staff members

Identified a behavior that was easily discriminable

and functionally equivalent

Defined behavior

Constant time delay

Differential reinforcement

Error correction

Protocol

Teaching the Replacement Behavior

Develop Instructional Procedures

Provide Instruction and Progress Monitoring

Assess Current Level of

Performance

8 opportunitiesDaily routinesBehavioral indicationResearcher & staff

BASELINE Protocol and Data Sheet

INTERVENTION Protocol and Data Sheet

Target Behavior and Recording System

Prompted Response or Problem Behavior

Independent Response

TARGET BEHAVIOR

Occurrence or non-occurrenceof the two responses for each

opportunity (data sheet)

RESULTS

RESULTS

Discrimination Assessment

Identify Example and Non-Example Discrimination

Probes and Develop Protocol

Administer Probes and Collect Data

100% across all participants for both

example probes and non-example probes

Discrimination Probes

Social Validity

WHO?

Staff Questionnaire End of study

HOW? WHEN?

OUTCOME – Information about:

Significance of outcomesAppropriateness of proceduresContinuation of procedures in the future

Social Validity

PB affected QOL

(M=3.5)

Benefited from learning a new response and it

reduces the frequency of PB

Willing to continue the intervention

(M=3.0)

Easy to conduct (M=2.5)

Interfered with other

responsibilities (M=2.0)

SD (1) SA(4)D (2) A (3)

DISCUSSION

® Applicable to adults with dual diagnosis

® Mental illness may influence the

acquisition pattern of some adults with

dual diagnosis

® Effective in producing acquisition of a

replacement behavior for all three adults

Effectiveness of FCT

® Response competition

® Variations in stimulus control

® History of reinforcement

Factors That May Influence Different Acquisition Patterns

® Teach in the presence of behavioral indication

® Increases the likelihood of the precise use of

replacement behavior

Discriminated Use of the Replacement Behavior

® Implemented by staff members

® Embedded within naturally-occurring opportunities

® Rated as:

® Beneficial for participants

® Relatively easy to implement

® No time consuming

Social Validity

CONCLUSIONS

1. FCT produced acquisition of a functionally

equivalent replacement behavior

2. FCT produced discriminated use of the newly

acquired replacement behavior

Conclusions

FUTURE STUDIES

Future research may include

Relationship between behavioral indication and

generalization of replacement behavior

Staff training to identify teaching opportunities

Replication of findings

?