FUNCTIONAL ASSESSMENT AND TREATMENT OF LIFE-THREATENING DRUG INGESTION IN A DUALLY DIAGNOSED YOUTH

Few data exist on operant mechanisms associated with drug overdose. In this investigation, a functional analysis indicated that life-threatening drug ingestion exhibited by a dually diagnosed youth was maintained by negative reinforcement. An operant intervention, derived from behavioral assessment data, reduced drug ingestion to near-zero levels.     

COMMENTS ON FUNCTIONAL ANALYSIS PROCEDURES FOR SCHOOL-BASED BEHAVIOR PROBLEMS

Functional analysis procedures were developed in the 1980s in an effort to determine whether clinicians could identify the function of behavior problems like self-injury and aggression. More recently, several groups of researchers have been attempting to extend that procedure to classroom environments. The following commentary reflects my viewpoint of this transition.     

FUNCTIONAL ASSESSMENT,CURRICULAR REVISION,AND SEVERE BEHAVIOR PROBLEMS

An adolescent female with multiple handicaps and a long history of severely disruptive behavior participated in a functional assessment linked directly to specific revisions in her school curriculum. During Phase 1, reversal designs were used to test hypotheses pertaining to antecedent and auricular influences on problem behavior. During Phase 2, a multiple baseline across afternoon and morning time periods demonstrated that the auricular revisions were effective in eliminating severely disruptive behavior and increasing on-task responding. Data also showed that inappropriate “psychotic” speech was reduced and appropriate social interactions were increased. Follow-up results showed that the changes were maintained throughout the school year. Questionnaire data provided social validation of the procedures and outcomes. The findings are discussed in relation to their implications for functional assessment, individualized curricula, and positive programming for students with disabilities and serious behavior problems.     

FUNCTIONAL ANALYSIS AND TREATMENT OF SEVERE PICA

A two-phase functional analysis of a profoundly retarded 19-year-old male's pica facilitated the design of an effective intervention containing no aversive components. In the first analysis, frequent staff-client interaction resulted in 25% and 66% less pica than limited and no interaction, respectively. Paradoxical effects were obtained in the second analysis, where no protective helmet resulted in 38% and 26% less pica than the helmet with face shield and helmet without face shield, respectively. On the basis of these analyses, limited interaction and no helmet conditions were combined in an effective, staff-implemented treatment at a medium-sized institution.     

ON THE RELATION OF MANDS AND THE FUNCTION OF DESTRUCTIVE BEHAVIOR

When standard analogue functional analysis procedures produce inconclusive results in children with conversational speech, the child's mands may help to identify the function of destructive behavior. In the current investigation, functional analyses conducted with 2 children who exhibited self-injury, aggression, and property destruction were undifferentiated across conditions. Based on informal observations and school and parental report, an analysis was conducted using mands to help determine the function of the destructive behavior. Using a multielement design, the therapist's compliance with the child's mands occurred either on a fixed-ratio (FR) 1 schedule or contingent on destructive behavior. Destructive behavior occurred at high and consistent levels when reinforcement of mands was contingent on destructive behavior and at near-zero levels when reinforcement of mands occurred on the FR 1 schedule. Based on these results, a second analysis was conducted in which compliance to mands occurred only when the child appropriately requested it (i.e., functional communication training plus extinction) and, for 1 child, compliance with mands was terminated contingent upon destructive behavior (i.e., functional communication training plus response cost). For both children, the rates of destructive behavior decreased markedly. The results suggest that assessing the child's mands may be useful in decreasing destructive behavior when a functional analysis is inconclusive.     

TOWARD THE DEVELOPMENT OF STRUCTURED CRITERIA FOR INTERPRETATION OF FUNCTIONAL ANALYSIS DATA

Using functional analysis results to prescribe treatments is the preferred method for developing behavioral interventions. Little is known, however, about the reliability and validity of visual inspection for the interpretation of functional analysis data. The purpose of this investigation was to develop a set of structured criteria for visual inspection of multielement functional analyses that, when applied correctly, would increase interrater agreement and agreement with interpretations reached by expert consensus. In Study 1, 3 predoctoral interns interpreted functional analysis graphs, and interrater agreement was low (M = .46). In Study 2, 64 functional analysis graphs were interpreted by a panel of experts, and then a set of structured criteria were developed that yielded interpretive results similar to those of the panel (exact agreement = .94). In Study 3, the 3 predoctoral interns from Study 1 were trained to use the structured criteria, and the mean interrater agreement coefficient increased to .81. The results suggest that (a) the interpretation of functional analysis data may be less reliable than is generally assumed, (b) decision-making rules used by experts in the interpretation of functional analysis data can be operationalized, and (c) individuals can be trained to apply these rules accurately to increase interrater agreement. Potential uses of the criteria are discussed.     

THE IMPACT OF FUNCTIONAL ANALYSIS METHODOLOGY ON OUTPATIENT CLINIC SERVICES

The impact of the article by Iwata, Dorsey, Slifer, Bauman, and Richman (1982) on research in severe behavior disorders has been impressive. Equally impressive, however, but not as fully recognized, has been the impact of this methodology on the routine professional activities of those who employ functional analysis methods in their daily work. As one example of this impact, we describe the evolution of assessment procedures based on “brief functional analysis” methodology in our outpatient clinics. Less apparent have been the collateral effects that occur from using these procedures. Interactions with clients and colleagues have changed in ways that result in increased positive reinforcement. In this article, we briefly discuss the positive impact functional analysis has had on one specific work behavior—outpatient clinic assessment—and describe some of the generalized effects we have experienced in related aspects of our daily professional activities.     

EFFECTS OF EQUAL AND UNEQUAL REINFORCER DURATION DURING FUNCTIONAL ANALYSIS

In the functional analysis described by Iwata, Dorsey, Slifer, Bauman, and Richman (1982/1994), reinforcer duration varied across conditions (e.g., brief attention vs. 30 s of escape); this may result in unequal exposure to the establishing operations for aberrant behavior. In this study, we compared the effects of unequal and equal reinforcer duration during a functional analysis. The results showed that reinforcer duration affects the rate of aberrant behavior and may potentially alter functional analysis interpretation.     

MULTIPLE FUNCTIONS OF PROBLEM BEHAVIORS: ASSESSMENT AND INTERVENTION

Three individuals with severe intellectual disabilities participated in separate analyses of problem behavior. In each case, a functional analysis was conducted under two parallel conditions. In one condition, self-injury or aggression resulted in escape from difficult tasks; in the second condition, the same problem behavior resulted in access to preferred items. Results indicated that the problem behaviors for each participant were maintained by both types of contingencies. Functional communication training was then delivered first in one condition and then in the second. After each participant was trained in a functionally equivalent mode of communication for one condition, levels of problem behavior decreased in that condition but not in the untrained condition. Only after separate communication forms were trained in both conditions was problem behavior reduced to clinically acceptable levels. These results document three examples of problem behaviors under multiple control, and emphasize the need to organize interventions that address different contingencies of reinforcement that maintain the same problem behavior.     

MULTICOMPONENT ASSESSMENT AND TREATMENT OF CIGARETTE PICA

We conducted a multicomponent assessment and treatment for 4 individuals who engaged in cigarette pica. During Phase 1, three stimulus preference assessments were conducted to identify (a) the reinforcing component of the cigarette, (b) potential alternative reinforcers that may be used during treatment, and (c) whether the alternative reinforcer would compete effectively with cigarettes. Results were successful in identifying the reinforcing component of the cigarette and suggested the feasibility of using alternative reinforcers during treatment to eliminate cigarette pica. During Phase 2, the effects of two treatment procedures were evaluated. Noncontingent reinforcement (NCR) with the alternative edible reinforcer reduced the pica of 2 of the participants, but effects were not maintained when the initial dense schedule of NCR was thinned. Subsequently, differential reinforcement of alternative behavior with the alternative edible reinforcer was effective in reducing pica for 3 participants. An evaluation of nine treatment procedures failed to identify an effective intervention for the remaining participant; consequently, preventive measures were designed to minimize occurrences of cigarette pica.     

ON THE REINFORCING EFFECTS OF THE CONTENT OF VERBAL ATTENTION

During a functional analysis, a boy with autism and oppositional defiant disorder displayed destructive behavior that was maintained by attention in the form of verbal reprimands (e.g., “Don't hit me”). In a second analysis, contingent verbal reprimands produced higher rates of the behavior than contingent statements that were unrelated to the target response (e.g., “It is sunny today”), suggesting that some forms of attention were more reinforcing than others. A treatment based on these analyses reduced the behavior to near-zero levels.     

FUNCTIONAL ANALYSIS AND EXTINCTION OF DIFFERENT BEHAVIOR PROBLEMS EXHIBITED BY THE SAME INDIVIDUAL

Specific extinction procedures were matched to the function of two target behaviors displayed by the same individual, with results indicating that the matched extinction procedure suppressed the behavior for which it was designed. One of the target behaviors was exposed to an irrelevant extinction procedure, which produced no beneficial effects. These results support previous research indicating the need to match extinction procedures to the function of problem behavior.     

A BRIEF FUNCTIONAL ANALYSIS OF AGGRESSIVE AND ALTERNATIVE BEHAVIOR IN AN OUTCLINIC SETTING

We conducted a brief functional analysis to identify maintaining variables for aggressive behavior and an alternative replacement response during a 90-min outpatient evaluation of 3 individuals with severe handicaps. During the initial analogue assessment, which focused on identifying maintaining contingencies for aggressive behavior, each participant displayed a substantially greater frequency of aggressive behavior during one condition than during any other. The contingency that produced the highest percentage of aggressive behavior was then presented for the occurrence of a specific alternative behavior (a mand). During this contingency reversal phase, each participant displayed a substantial reduction in aggressive behavior and a substantial increase in alternative behavior, thus providing a direct analysis of the equivalency of the contingency for maintaining either behavior.     

FUNCTIONAL ANALYSIS AND TREATMENT OF CIGARETTE PICA

A series of analyses was conducted to assess and treat the pica of cigarette butts by a young man with mental retardation and autism. First, we demonstrated that pica was maintained in a condition with no social consequences when the available cigarettes contained nicotine but not when the cigarettes contained herbs without nicotine. Second, a choice assessment (Fisher et al., 1992) confirmed that tobacco was preferred over the other components of the cigarette (e.g., paper, filter, etc.). Third, an analogue functional analysis (Iwata, Dorsey, Slifer, Bauman, & Richman, 1982/1994) demonstrated that cigarette pica was maintained independent of social consequences. Fourth, a treatment designed to interrupt the hypothesized response—reinforcer relationship reduced consumption of cigarettes to zero. Finally, because cigarette pica occurred primarily when the individual was alone or under minimal supervision, a procedure based on stimulus control was developed to improve the effectiveness of the intervention in these situations.