Practical Functional Assessment and Skill-Based Treatment ...

Practical Functional Assessment

and Skill-Based Treatment of

Severe Problem Behavior

Presented by

Gregory P. Hanley, Ph.D., BCBA-D, LBA

2019

The Problem

• Problem behavior is prevalent among children with autism and is sometimes severe and intractable

• Many “solutions” often exacerbate or prolong the problem▫ Behavior modification

▫ Behavior medication

▫ Behavior mollification

▫ Behavior micro-analysis

▫ Behavior remediation without developing a replacement repertoire

A Probable Solution

• Practical Functional Assessment and Skill-Based Treatment▫ Shown to produce socially meaningful outcomes

▫ Shown to be a socially valid and generally applicable process

▫ Shown to be effective without coercion or physical management

History, Rationale, and Evidence

*Use front and back of page 1 of PFA Notebook to take notes

Assumptions of Traditional Functional Assessment

An event evokes problem behavior

e.g., demand issued, toy removed, or attention diverted

An event reinforces problem behavior

e.g., escape, tangibles, or attention

Different forms of problem behavior are likely to be evoked and maintained by different reinforcers

Antecedent → Behavior → Consequence

Establishing operation → Problem Beh. → Reinforcement

Mom attends to Throwing toys Mom’s attention

Sibling

Dad instructs to SIB Dad gives a little turn off Ipad more time on Ipad

This is the “one thing at a time” model

Or the traditional model of relying on isolated reinforcement contingencies

Aim of Traditional Functional Assessment

To identify the function of a problem behavior

Attention,

Tangibles,

Escape, or

Sensory

Outcomes of Traditional Functional AssessmentThe good (based on published research)

-Standard analyses show control of problem behavior

-Standard analyses have generality

-Better treatment efficacy if preceded by a traditional analysis

Outcomes of Traditional Functional AssessmentThe unfortunate (based on published research)

-No treatment utility shown for closed-ended indirect or desc. assessments

-Traditional analyses: -have not yet yielded a socially meaningful treatment outcome, -are not being employed by practicing behavior analysts or others

Why?-take too long, -can be unsafe, -are not socially valid, -are not ecologically valid, -often do not control problem behavior enough

Past Working Assumption retained in the Practical Functional Assessment Process

ASSUMPTION: If problem behavior is occurring with regularity…..

▫ it is being reinforced Even when important biological/medical factors are known or suspected

Transition from traditional reductionist approach to a more pragmatic approach requires changes to

Assumptions, Aims, Procedures

A change is warranted

“New” Assumptions

Multiple events co-occur to evoke problem behavior

Multiple events occur simultaneously to reinforce (strengthen) problem behavior

Different forms of problem behavior by the same child are often maintained by the same synthesized reinforcement contingency

The “many things at a time” model of a reinforcement contingency:

Antecedents → Behaviors → ConsequencesEstablishing operations → Problem Behaviors → Reinforcers

Put away iPad → Noncompliance + → Avoidance of chores + to do chores resistance + continued time on iPad + (brother present) negotiating + choices +

screaming + undivided attentionflopping +slapping

*also known as a synthesized reinforcement contingency

The “many things at a time” TREATMENT model:

Antecedents → Behaviors → ConsequencesSame establishing → New Skills → Same reinforcersoperations

Put away iPad → “excuse me” → break from more chores+ to do chores Listens to parent time on iPad + (brother present) “May I have my way please” choices of activity +

“Okay, no problem” some undivided attnComplies with multiple

instructions and corrections

*involves the same synthesized reinforcement contingency

Similar effects reported in these studies from other research groups

The PFA process has strong and unprecedented treatment utility

(2014) JABA

(2016) Beh. Int.

Strand & Eldevik (2017) Beh. Int.

Herman, Healy, & Lydon (2018) Dev. Ne.

Jessel, Ingvarsson, Metras, Hillary, & Whipple (2018) JABA

Beaulieu, Clausen, Williams, & Herscovitch (2018) BAP

Taylor, Phillips, & Gertzog (2018) Beh. Int.

Rose & Beaulieu (2018) JABA

Positive outcomes from the PFA process are not only possible they may be probable

Baseline Treatment

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N = 25

p < .001

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You found the recommended treatment acceptable

You are satisfied with the amount ofimprovement seen in problem behavior

You are satisfied with the amountof improvement seen in

communication skills

You found the assessment andtreatment helpful to your home situation

Notacceptable/satisfied/helpful

Highlyacceptable/satisfied/helpfulCaregiver Rating

Jessel, Ingvarsson, Metras, Hillary, & Whipple (2018, JABA)Achieving Socially Significant Reductions in Problem Behavior following the Interview-Informed Synthesized Contingency Analysis: A Summary of 25 Outpatient Applications

*Similar CCCSD evidence for any other functional assessment process does not exist.

PFA procedural overview

*Turn to page 2 of PFA Notebook

Procedures*What is involved in a Practical Functional Assessment (PFA) process?

• An open-ended interview (always)

• An informal observation (perhaps, but not necessary)

• A functional analysis (always)

▫ An IISCA An Interview-Informed

Synthesized Contingency

Analysis

Example Case: Brandon

• Age: 3

• Diagnosis: None

• Language: Speaks in short sentences

• Referred for: Aggression, meltdowns,

noncompliance

• To: Life Skills Clinic

(outpatient model) at Western New England University

*Mission to identify:

1. the most concerning problem behavior and all other forms of problem behavior that co-occur in the same situations with (or prior to) the most concerning problem behavior

2. the events that seem to co-occur and reliably evoke problem behavior

3. the types of events and interactions that have occurred following problem behavior and are reported to stop the problem behavior

1. Hitting, kicking, biting, throwing objects, dropping to the floor while crying, refusing to follow parental instructions

2. Interrupting his play/game, removing toys (e.g., action figures), seeing others playing with his toys, adult noncompliance with mands, instructions to play differently, to play quietly on iPad, to sit quietly with books, or to clean up toys

3. Escape from parental instructions to his toys, parental attention/interaction, and mand compliance

The open-ended interview

Sessions1 2 3 4 5

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Control

Test

Escape to tangibles, attention, andmand compliance

Example IISCA: Brandon

All sessions are repeated at least once

Because replication is the key to believability (Baer, Wolf, & Risley, 1968)

Note:

There should be no problem behavior in the control sessions, if there is, either repeat or redesign

Sessions1 2 3 4 5

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Control

Test


Example IISCA: Brandon

Notes:

Test sessions are repeated at least twice

Control and test sessions are alternated to evaluate whether suspected contingency influences problem behavior

An IISCAis an Interview-Informed Synthesized Contingency Analysis. It involves:

Test

Control

Analysis

• Provision of personalized and synthesized reinforcers for problem behaviors, reported to co-occur, in a single condition

• Provision of same reinforcers continuously in a second condition, otherwise matched

• Rapid alternation of these test and control conditions, which differ only by the presence/absence of the contingency

Diego / test session• Age: 11

• Diagnosis: Autism

• Language Level: Speaks in Short Sentences

• Referred for: Self-injurious behavior,Aggression, Property Destruction

Sessions1 3 5

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0.0

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1.0

1.5

2.0

Control

Test

Diego

Escape from academic work to

tangibles, attendion

*Why bother with analysis? Why spend time? Why invite the risk?

Because it gives the practitioner:

• a context to demonstrate whether they can safely influence problem behavior

• a scientific verification of the hypothesis from the interview

• a properly motivating set of conditions to teach important life skills

And the teaching of these skills is the key to a meaningful life

What is aim of a PFA process?

*Use Notes sections on pages 2-3 of PFA Notebook

Aim of a Practical Functional Assessment

*NOT to identify the function of a problem behavior*

Aim is strong control of problem behavior

via ecologically-relevant reinforcement contingency

Practical Functional Assessment

Focuses on Functional Control

not Functional Classification

From Jessel, Hanley, & Ghaemmaghami (JABA, 2016)

0

4

8

12Will

TestControl

Wayne Allen Kat (Cxt 1)Sam

0

2

4

6Jack (Cxt 1) Keo

Kristy Jim

Roxy

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2

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6Alex (Cxt 2) Chris

Jeff Zeke Kat (Cxt 2)

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Gary Jian Earl

0.5

1.0

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Paul Dan

Alex (Cxt 1) Beck

Sid

2 6 10

0.5

1.0

1.5

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Lee

2 4 6

Steve

1 3 5

Jesse

1 3 5

Carson

1 3 5

Jack (Cxt 2)

Sessions

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From Rajaraman, Hanley, et al. (in prep.)

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Sessions

Strong control of problem behavior is paramount and evident in IISCAs

Sessions

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ControlTest

Session 2

Reinforcement

Problem Behavior during Establishing Operation Problem Behavior during Reinforcement

Seconds

0 50 100 150 200 250 300

Session 5

Session 4

BrandonEscape to attention,tangibles, andmand compliance

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Control

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Strong control of problem behavior is paramount and evident withinIISCA test sessions

Typical Aggregate Display

Intimate Display of Test Sessions

Why is strong control over problem behavior important to obtain in a pre-treatment functional analysis?

Implications of strong control of problem behavior

You can turn off problem behavior = analysis informed treatment process can be safe & effective

You can turn on problem behavior = skills may be developed in treatment

With an ecologically relevant contingency = problem behavior reductions and skills

may transfer to relevant context

Why synthesize reinforcement contingencies?

*Use Notes sections on pages 2-3 of PFA Notebook

Isolated contingencies sometimes do not control behavior whereas synthesizedcontingencies do.

This is not a paradox, just a classic example of an interaction without main effects

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Tangible /

Attention

Analyst

Mother

Analyst

Mother

Analyst

Gail

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Tangible

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2 4 6 8 10 12 14

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Test

Control

Meltdowns

Col 46 Attention

Case Example Gail, 3 yo, dx: PDD-NOS

Setting: Clinic

Synth

esizedIso

lated Iso

latedFrom Hanley et al., 2014, JABA

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2TestControl

Escape to tangiblesand attention

Tangible

Ignore/Alone

PlayEscape

Attention

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5 10 15

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Diego

Mason

Riley

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IISCA Standard IISCA

From Slaton et al., 2017, JABA

Most often, our comparative analyses show that synthesized reinforcement contingencies influence problem behavior whereas isolated ones do not

Synthesized Isolated Synthesized

Whole contingencies have properties that sometimes cannot be found in the parts of the contingency

Single tests of individual reinforcers are not capable of verifying the irrelevance of synthesized reinforcers

Treatment Comparison Results

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FCR

BL FCT + EXT

Escape totangibles,attention

Problembehavior

BL FCT + EXT

Escape

5 10

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BL FCT + EXT

5 10

Attention

BL FCT + EXT

IISCA- based treatment Standard-based treatment

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Emily

Jeff

(From Slaton et al., 2017, JABA)

Comparative treatment analyses reliably reveal advantage of synthesized contingenciesFrom:

NATURE AND SCOPE OF SYNTHESISIN FUNCTIONAL ANALYSIS AND TREATMENT OF PROBLEM BEHAVIOR

Slaton & Hanley (JABA, 2018)

10 20 30 40 50 60 70 80

-500

-100

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Synthesized Isolated

Within-subject comparisons Applications without comparisons

Treatment applicationsM

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Synthesized contingencies had a better effect size in 25 of 26 cases (96%)

EO Sr

R

With single reinforcers, there is relatively short motivational distance travelled as child transitions from:

no skittle sliver to having a skittle sliver , or

work to no work , or

no attention to attention (reprimands)

*that’s one interpretation

EO Sr

R

EOEOEOEO Sr Sr Sr Sr

With IISCA, there is relatively long motivational distance travelled as child transitions from:

No tangibles, no mand compliance, tangibles, mand compliance,

limited sensory reinforcers, to all sensory reinforcers,

no high quality attention, & work high quality attention, and no work

EO Sr

R

EOEOEOEO Sr Sr Sr Sr

With IISCA, there is relatively long motivational distance travelled as child transitions from:

But, don’t forget about possible interactions:

which probably creates even greater motivational distance travelled

Deciding on the contingency class in your analysis

Lev

el of C

oncern

Acro

ss

Top

ogra

ph

ical C

ateg

ories

Level of Concern

Within

Topographical Categories

Self

inju

ryA

ggressio

n Scream

ing

Body

Ten

sing

(MC

T)

(AL

CT

)(MCT) (ALCT)

This schematic provides a visual

display of a possible repertoire of

problem behavior whose

members were reported by

caregivers as co-occurring in the

same evocative situations. If the

primary concern of the caregivers

is high-intensity head banging, a

behavior analyst must then decide

on the contingency class for their

functional analysis, weighing the

factors of risk, efficiency, and

inference.

Level

of C

oncern

Acro

ss To

po

gra

ph

ical

Ca

teg

orie

s

Selfinjury

Aggression

Screaming

BodyTensing

(Mo

st)(L

ea

st)(M

ost)

(Lea

st)

Level of Concern

Within Topographical Categories

(Most) (Least) (Most) (Least)

A B

C D

Selfinjury

Aggression

Screaming

BodyTensing

Select the responses to be consequated in analysis:

A

B

C or

D ?

That which you can safely infer from your functional analysis:

✓Response class membershipProblem Behaviors reported to co-occur (in order of concern)A. SIBB. AggressionC. Disruptive BehaviorD. Disruptive vocalizationsE. Whining/complaining

If control is shown over behavior E, for example, and caregivers report that behavior A, B, C, D, & E co-occur in similar situations, then we can infer that the reinforcers for behaviors A and E are the probably same

Problem Behaviors reported to co-occur (in order of concern)A. SIBB. AggressionC. Disruptive BehaviorD. Disruptive vocalizationsE. Whining/complaining

This analysis shows all forms of problem behavior are influenced by the same synthesized reinforcement contingency.

This happened for 9 of 10 consecutive analyses (Warner et al., 2018)

This also happens when others conduct progressive extinction analyses (Smith and Churchill,

2002, Borrero & Borrero, 2008, Herscovitch et al., 2009)

Which is why it is a reasonable thing to make inferential leap.

Conducting low inference analyses

of severe problem behavior is

inefficient,

potentially dangerous,

and difficult to defend at this point

Consider also that:

A focus on the safety and acceptability of analyses

*Turn to page 4 of the PFA Notebook

Safety

Safety is primarily insured through:

• Immediate delivery

• Of all suspected reinforcers

• For any member of the response class

(an “open” contingency class)

in test conditions

• Continuous access to all reinforcers

in control conditions.

Other safety considerations:

• Salient cues for EO and SR intervals

• Everybody has session termination authority

Risk

Risk is primarily invited through:

• Delayed delivery

• Of one/some of the suspected reinforcers

• For a single member of the response class (a “closed” contingency class)

in test conditions

• Discontinuous access to all reinforcers

in control conditions.

Other safety considerations:

• Ambiguity regarding EO and SR intervals

• Only supervisor has session termination authority

Important point to consider…

Children/clients should appear happy, relaxed, and engaged during reinforcement periods of analyses (and prior to each session start)

Conducting the interview

Interviewer attempts to build rapport with parents/teachers while identifying:

1. ??

2. ??

3. ??

The open-ended interview

General Tips:

• Interview those who spend the most time with the child/client and who witness the PB the most.

• Interview people together as needed (no separate interviews), develop consensus, and if not, just move forward (i.e., design an analysis).

• Start by asking for vivid recounting of episodes of severe problem behavior then ask hypotheticals and restrictions

• Be sure to ask about specific materials for the analysis that allow for the programming of the EOs and SRs.

Conducting the analysis

*See page 5 of the PFA Notebook

The IISCA Task Analysis

Implement CONTROL session first

If zero PB in control, conduct TEST session next

Gain Assent

Analyze as you conduct sessions; be responsive to the data

Design checkIs the distinction between the EO and SR ridiculously salient?

Tables, Mat and Table, Bins, Trays, Analyst body position, tone of voice

Is the motivational distance travelled long? Can it be longer?Add more positive reinforcers, strengthen EO for escape, ….

Are there at least 3 sets of materials in the EO and SR areas?

Is there anything about the space or materials that may lead to injury?

Is there enough space for movement? Are there activities to evoke mands?

Is there anything more reinforcing in the building but not in the analysis space?

Is the importance of happy, relaxed, and engaged fully embraced?

PFA Questions?

*See page 6 of PFA Notebook

Overview of the skills-based treatment

*Take out SBT Notebook and use page 1 for notes.

Diego / treatment session*The skills of functional communication,

delay/denial toleration, and contextually appropriate behavior are shaped via

intermittent and unpredictable delivery of the same synthesized reinforcers during the same

synthesized establishing operations.

Effects are extended to relevant people implementing in relevant contexts over relevant time periods.

Effects are socially validated.

• Age: 11

• Diagnosis: Autism


• Referred for: Self-injurious behavior,Aggression, Property Destruction

Functional communicationrequest (FCR)

DeniedTolerance

response (TR)

Variable amount of work/playexpectations

Compliance

ReinforcementGranted

20%

60%

What is the treatment????

Intermittent and unpredictable reinforcement of life skills:

Functional CommunicationDelay/denial tolerationCompliance

Treatment Implementation

*Materials not needed: Laminate Laminating machineGlue gunsVis a vis markersVelcroTokensToken boardsTimersStickersCandiesAnything that was not already in

the child’s environment!

1. Put these in your pocket2. Pull one out while child is experiencing their reinforcers3. Keep it to yourself4. Require that behavior next time

App called “Names in a Hat”

App called “Roundom”

Detailed review of the skills-based treatment

✓The treatment is implemented in the most challenging context that is sufficiently convenient to repeatedly arrange

▪ Referred to as the “two Cs” of context

▪ FIRST THINGS FIRSTDistinct contextually appropriate behavior is shaped in the other relevant contexts only following success in the initial context

Brandon / Simple FCT• Age: 4

• Diagnosis: None


• Referred for: Aggression, Meltdowns, Noncompliance

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Context A- Analyst 1Context B- Analyst 2Context A- Analyst 3

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in Reinforcementin Establishing Operation

Baseline Simple BL Simple Complex Tolerance response Contextually appropriate behavior Transfer

FCT FCT FCT training chaining test

Brandon

TIPS:

1. Select initial FCRs that are:Low effortPromptableNovelOmnibus

2. Initially prompt prior to when PB was evoked in the analysis.

3. If PB occurs, prompt the FCR and reinforce the prompted response

*See page 2 of SBT Notebook

Brandon / Complex FCT• Age: 4

• Diagnosis: None



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TIPS:

Shape until FCR contains:

An obtaining a listener response (e.g., “Excuse me”)

A generative autoclitic frame (e.g., “May I have _____”)

A social nicety

Proper tone, pace, volume, articulation

See Ghaemmaghami et al. (JABA, 2018)


FCT – RajAge: 5 Diagnosis: Autism Language Level: Single word utterances Referred for: Self-Injury, Aggression, Property Destruction

TIP:

Or at least be sure the cFCR has some “intentionality”

FCT – ColeAge: 8 Diagnosis: Autism Language Level: Fully Fluent Speech Referred for: Self-Injury, Aggression, Property Destruction

But once FCR is shaped until it contains:

An obtaining a listener response (e.g., “Excuse me”)

A generative autoclitic frame (e.g., “May I have _____”)

A social nicety

Proper tone, pace, volume, articulation

…..

FCT – ColeAge: 8 Diagnosis: Autism Language Level: Fully Fluent Speech Referred for: Self-Injury, Aggression, Property Destruction It is sometimes

differentiated into specific mands prior to tolerance training:

• An obtaining a listener response

• A break response

• An access to preferred toys response

• An attention recruitment response

Brandon / TRT• Age: 4

• Diagnosis: None



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Brandon / CAB Chaining• Age: 4

• Diagnosis: None



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Process Steps and Data sheet review

*Review p. 8 of SBT Workbook

Wicked important tips when developing Contextually Appropriate Behavior (CABs)

1. Start by gaining instructional control over relinquishing positive reinforcers.

*See pages 2-3 (planning sheets),

10-13 (implementation/data sheets)

of SBT workbook

*See pages 2, 10 of SBT workbook

7. Describe the initial contextually appropriate behaviors (CAB 1). These are the

behaviors that will be instructed following tolerance responses and strengthened via the

termination of the delay (i.e., access to the synthesized reinforcers).

CAB 1: Instructional control of stopping ongoing activity & relinquishing all positive

reinforcers

Example:

a) “Pause the game please.”

b) “Hand me the iPad.”

c) prompt or wait for the look to you



2. Then gain instructional control over transitioning and readying to listen/learn


CAB 2: Instructional control of transitioning to

alternative area and readying to listen/learn

a)

b)

c)

d)

Examples:

To table-top academics:

a) stand up

b) walk to that table

c) sit up in the chair

d) hand in lap

To participate in gym games:

a) turn to me

b) walk over there

c) get ready like this

(model stance)

To play alone:

a) stand up

b) walk over there

c) take a seat




3. Then gradually increase the average amount of behavior (not just time) required to terminate the delay

*See page 3, 11-12 of SBT workbook

CAB 3: Instructional control of a few (1-3) responses/time

units of cooperation within a single, relevant activity

Activity:

Examples:

To table-top academics:

a.) Show me the ____

b.) Show me the ____

c.) Show me the ____

To participate in gym games:

a) Catch

b) Throw to me

c) Put ball in basket

To….

CAB 4: Instructional control of a few (1-3) responses/time

units of cooperation within multiple relevant activities

Activity:

Activity:

Activity:

CAB 5: Instructional control of 1-12+ responses/time units of

cooperation w/in multiple activities

Consider this progression from 1, 2, 3:

a. 1, 3, 5

b. 1, 3, 6, 10

c. 1, 3, 6, 10, 12+

Wicked Important Guidelines when Developing Contextually Appropriate Behavior (CABs)




4. Terminate the delay for various amounts of behavior (sometimes expect very little behavior sometimes request larger or more complex types of behavior during the delay)

Wicked Important Guidelines when Developing Contextually Appropriate Behavior (CABs)




4. Terminate the delay for various amounts of behavior (sometimes expect very little behavior sometimes request larger or more complex types of behavior during the delay)

5. Probably best to not signal how much behavior or what type of behavior is required to terminate the delays


CAB 6: Instructional control of 1-12+ responses/time units of

cooperation w/in multiple activities while being challenged

Examples:

a) Require more complex/conditional discrimination

b) Interrupt correct performance

c) Change activity or rules of activity

d) Require completion in new, different way

e) Issue vague instructions

f) Program for missing items from task

g) Introduce unknown tasks

In case it is not apparent:

Shorties never go away.

This is the way we keep hope alive!

Process Steps and Data sheet

Questions?

Dosage considerations when implementing SBT

Shaping Models

Light dosage approaches (approx. 8-12 weeks to full day treatment)

Implementation by BCBA: at least 1hr/day for 4/days week

Collaborative approach: Implementation by 1 parapro/staff at least 1hr/day for 4/days week

High dosage approaches (approx. 1-3 weeks to full day treatment)

Implementation by BCBA: 4-5hrs/day for 5/days week

Collaborative approach: Implementation by 1 parapro/staff 4-5 hrs/day for 5/days weekwith two daily 30 min check-ins by BCBA for 4 days/week

* requires consideration of out-of-session programming: (a) business as usual or (b) NCR

Take Home Point: What is required for a Meaningful Outcome?

Personalized & Synthesized Reinforcement Contingencies

and

a progressively developing, skill-Based treatment process thatrelies on unpredictable and intermittent reinforcement to maintain effects

Limitations of the PFA process

General and durable elimination of severe problem behavior is still elusive for some following successful PFA processes

▫ Developing a replacement repertoire requires time, expertise or expert supervision, and the ability to problem solve as skills are developed

▫ Transferring positive effects from one or a few people and one or a few contexts to all people and all contexts is still a formidable challenge

▫ Methods require adjustment to expand scope of practice

SBT Questions?

*See page 5 of your SBT Notebook

Recent Extensions of the PFA process

1) Expanding Reach with the Enhanced Choice Model

(Rajaraman, Hanley et al., in review)

2) Skill-Based Treatment of Interfering Stereotypy (Slaton, Hanley, Ruppel, & Gage, in review)

Extinction sometimes, but consider….

Okay Alternative to Full Extinction:

Partial Extinctionescape always available

PB = escape to nothing vs.

Skills = escape to everything

The Enhanced Choice ModelHangout Context

Treatment

(Contingent SR)

No EOs

(NoncontingentSR)

Return to Home or classroom

Enhanced Choice Model

Practice Context

• Similar outcomes in similar time frames• No escalation to severe problem behavior• Allowed expansion of clients served

Why would children choose to participate in treatment?

Partly due to the universal preference for contingent over noncontingent reinforcers

(i.e., due to a preference for yearning and earning)

ContingentReinforcement

Blue Switch

Red Switch

White Switch

FR-1

NoncontingentReinforcement

NoReinforcement

Response Contingent Attention (FR-1)

NoncontingentAttention (yoked)

No Attention Available

Initial Link Terminal Links

2 min period:

2 min period:

2 min period:

FromHanley, Piazza, Fisher, & Contrucci, 1997, JABA

1 2 3 4 5 6 7

Num

ber

of

Sw

itch

Pre

sses

0

2

4

6

8

10

FCTNCREXT

Tony

1 2 3 4 5 6 7 8 9

Nu

mb

er o

fS

wit

ch P

ress

es

0

2

4

6

8

10

Carla

Sessions

Preference for contingent over noncontingent

reinforcement

FromHanley, Piazza, Fisher, & Contrucci, 1997, JABA

CRNCREXT

% o

f re

spond

ing

allo

cate

d t

o c

ont

inge

nt r

einf

orc

emen

t

0

25

50

75

100

Preferred Indifferent Did not prefer

71% of individuals

n = 96

20

5696

20 8040 20

40

40

20

11

20

15

57% of aggregates

preferred contingent reinforcement

120

Preference for contingent reinforcement has generality

Literature Review:Gover & Hanley (in prep.)

Analysis - Jeffrey• Age: 9

• Diagnosis: Attention Deficit Hyperactivity Disorder, Generalized Anxiety Disorder

• Language Level: Speaks with Sophistication

• Referred for: Aggression, Elopement, Meltdowns

▫ required several police escorts from school

Test (later session on same day)

LIFE SKILLS CLINICAT WESTERN NEW ENGLAND UNIVERSITY

Sessions1 2 3 4 5 6

Pro

ble

m B

ehav

ior

per

Min

0

2

4

6

8

ControlTest

Escape to tangibles,

attention, and

mand compliance

Modifications to Hanley et al. (2014)

1. General transparency on day’s activities

2. Choices offered during CAB chaining• Dunlap et al., 1994; Moes, 1998; Powell & Nelson, 1997

3. Extinction of problem behavior never involved physical guidance of any sort• Piazza, Moes, & Fisher, 1996

4. Choice to hangout or leave always available

Practice Context

TREATMENT- Jeffrey

LIFE SKILLS CLINICAT WESTERN NEW ENGLAND UNIVERSITY

Sim

ple

FC

R

per

min

0

1

2

Pro

ble

m B

ehav

ior

per

min

0

2

4

6

8

Context A - Analyst 1

Context B - Analyst 2



Com

ple

x F

CR

per

min

0

1

2

Tole

rance

Res

ponse

p

er m

in

0.0

0.5

1.0

Sessions

5 10 15 20 25 30 35 40 45 50 55 60

Dura

tion o

f se

ssio

n

(s)

0

300

600

900

1200

1500

1800

2100

2400

in Reinforcement

in EO

Com

pli

ance

(

%)

0

25

50

75

100

Baseline Simple Complex Contextually appropriate behavior TransferFCT FCT TRT chaining test

Jeffrey

* * *

* Terminated session

* *

Parent feedback (following transfer to home)

Results - Allie

1----------------2----------------3-----------4---------5---------6-------------7--------8------9----------10------11----12---13

BL Complex

TR

per

min

0.0

0.2

0.4

0.6

0.8

1.0

Tolerance Response Training

Sessions10 20 30 40 50

Dura

tion o

f se

ssio

n

(s)

0

300

600

900

1200

Reinforcement Establishing Operation

BL

Visits

Tota

l m

inute

s of

ther

apy

0

30

60

90

120

Practice

Hang out

Simp.

CA

B

(%

)

0

25

50

75

1002

4

5 61 3

Contextually Appropriate Behavior Chaining

FCT

5/7-------------5/9-------------5/16-----5/17-----5/21-----5/23----------6/4-----6/5----6/6--------6/8-----6/18---6/19--6/20

Dates

F

CR

per

min

0.0

0.5

1.0

1.5

2.0

Simple

Complex

Pro

ble

m B

ehav

ior

per

min

0.0

0.5

1.0

1.5

2.0Simp.

Allie

Level Demands related to playing,

doing something the adults

way, or cleaning up

Frequency/

Duration

Examples

1 Discrete demands 1-3 demands Put the stickers in the

bag, put the block in the

box

Make the frog jump, put

a sticker on my paper

2 Continuous demands Avg. 60 s

45 s

5 s

35 s

Go clean up the blocks

Let’s play with the

dinosaurs

3 Mix of discrete and continuous

demands

6 demands,

Avg. 120 s

Same as above,

longer durations


demands

+ sharing items she is playing

with

6 demands,

Avg. 180 s

Same as above,

longer durations +

asking her for a turn

with what she is playing

with.


demands

+sharing

+playing with something else

6 demands,

Avg. 240 s

Same as above +

sharing +

playing with something

else while other plays

with her toy


demands

+sharing

+playing with something else

+letting others go first

Avg. 300 s

Results - Allie

1----------------2----------------3-----------4---------5---------6-------------7--------8------9----------10------11----12---13

BL Complex

TR

per

min

0.0

0.2

0.4

0.6

0.8

1.0

Tolerance Response Training

Sessions10 20 30 40 50

Du

rati

on o

f se

ssio

n

(s)

0

300

600

900

1200

Reinforcement Establishing Operation

BL

Visits

Tota

l m

inute

s o

f th

erap

y

0

30

60

90

120

Practice

Hang out

Simp.

CA

B

(%

)

0

25

50

75

1002

4

5 61 3

Contextually Appropriate Behavior Chaining

FCT

5/7-------------5/9-------------5/16-----5/17-----5/21-----5/23----------6/4-----6/5----6/6--------6/8-----6/18---6/19--6/20

Dates

F

CR

per

min

0.0

0.5

1.0

1.5

2.0

Simple

Complex

Pro

ble

m B

ehav

ior

per

min

0.0

0.5

1.0

1.5

2.0Simp.

Allie

Socially validated outcome in13 1-hour visitsacross 6 weeks(>95% of time in treatment)

Results - Allie

1--------3---------5------------7-----------------9---------11---------13---15----17--------19--21----23---25---27---------29

Visits

Tota

l min

utes

of

ther

apy

0

15

30

45

60

75

90

105

120

Practice

Hang out

6/15----6/19-----6/26-------6/29-----------7/06--------7/12------7/19-7/26-7/31----8/07-8/10-8/16-8/21-8/24-----8/28

Dates

Socially validated outcome in29 1-hour visitsacross 10 weeks(>90% of time in treatment)

Recent Extensions of the PFA process

1) Expanding Reach with the Enhanced Choice Model

(Rajaraman, Hanley et al., in review)

2) Skill-Based Treatment of Interfering Stereotypy (Slaton, Hanley, Ruppel, & Gage, in review)

Skill-Based Treatment Applied to Interfering Stereotypy(Distance-Support Model)

S-

Stereotypy blocked

Mand for stereotypy

20%

DeniedTolerance response

Variable work/play

60%

S+

Stereotypy is allowed

15 – 45 seconds

Compliance

20%

Participants

Name Age Diagnosis Communication Work tasks

Grant 7 Autism 1-2 word phrases Numbers, letters, sight words, pictures, matching

Milo 12 Autism No phrases Match and identify objects, pictures, numbers, letters;

short ADL tasks

Marco 21 Autism 1-3 word phrases Leisure and time management on iPad

Stereotypy types

Grant Milo Marco

• Hand flapping• Finger wiggling• Object flapping• Clapping• Holding objects to

eyes and rotating

• Hand flapping• Tapping on teeth• Rubbing or poking face• Finger play• Shaking objects• Tapping work materials

• Pacing or galloping• Jumping• Tapping body, furniture• Hair twirling• Knuckle cracking

0

25

50

75

100

0

5

10

15

20

BL

S-S+

FCT TRT Response ChainingM

oto

r

ster

eoty

py

% o

f co

mpone

nt

S- d

uratio

n (min)

0

5

10

15

20

Sim

ple

F

CR

per

min

0

2

4

6

15

Com

ple

x F

CR

per

min

0

2

4

6

TR

per

min

20 40 60 80 100

0

25

50

75

100

0

20

40

60

801 2 3 4 7 5 6 7 8 94 10

Milo

Sessions

Acc

ura

cy (

%) #

dem

ands

Level Task Demandrange

Total demands

Field size

1 Match pictures 1 - 3 12 3

2 +Letters, numbers 1 - 3 12 3

3 (Same) 1 - 6 18 3

4 (Same) 1 - 10 27 3

5 (Same) 1 - 10 27 4

6 (Same) 1 - 10 27 5

7 (Same) 1 - 10 27 6

8 +Sort objects 1 - 10 27 6

9 +ADLs 1 - 10 27 6

10 +Identify pictures 1 - 10 27 6

Treatment: Intermittent and unpredictable delivery of escape and access to stereotypy for communication, toleration, and for ACCURATE work completion while inhibiting stereotypy

Five Hidden Themes Exposed

1. Have professional humility

2. Hold high expectations for your clients

3. Trust the universal preference for “yearning and earning”

4. Know that “free to be and do but not alone” is important

5. Craft your whole process to be televised

The Problem• Problem behavior is prevalent among children with autism and is

sometimes severe and intractable, leading to highly restrictive lifestyles, stunted skill development, or both.

A Potent Solution• Practical Functional Assessment (PFA) and Skill-Based Treatment (SBT)▫ Shown to produce socially meaningful outcomes▫ Shown to be a socially valid and generally applicable process▫ Shown to be effective within an Enhanced Choice Model

Important for use with adults or high-risk clients

Thanks for listening.

For implementation assistance go to:

www.practicalfunctionalassessment.com

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