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.     

The Student Guided Functional Assessment Interview: An Analysis of Student and Teacher Agreement

Functional assessment strategies are used to guide the treatment of problem behavior with individuals who have severe disabilities. Also, researchers have extended functional assessment applications to individuals with emotional and behavioral disabilities. One such extension is the use of students as informants in the functional assessment process. The present study assessed an interview tool designed to elicit information directly from students regarding their problem behaviors. We examined agreement between students and their teachers. Results showed high agreement on the causes and functions of problem behavior with mixed agreement on support plan recommendations.     

Using Structural Analysis in Natural Settings: A Responsive Functional Assessment Strategy

Since the reauthorization of IDEA (1997), the use of functional assessments to examine factors that are related to students challenging behaviors has gained increasing attention in the literature. Over the past five years, several groups of investigators have conducted systematic analyses of the current status of the use of functional assessment in relation to students with or at risk for emotional/behavioral disorders (EBD). Their findings outline a number of critical, applied research issues for the field to consider. The purpose of this paper is to respond to a number of these issues by highlighting the relevance of structural analysis in addition to and in some cases in lieu of more traditional functional assessments. A brief review of current trends in the functional assessment research is presented as well as a rational for the use of structural analysis to examine the occurrence of appropriate behavior for students with EBD. Finally, illustrations of studies conducting structural analyses in classrooms settings are provided.     

Functional assessment: Contributions and future directions

Functional assessment is at once redefining the standards for clinical interventions and reemphasizing the importance of studying basic behavioral mechanisms. This commentary describes one perception of what we are learning from current research on functional assessment and suggests directions for the future.     

A review of functional assessment use in data-based intervention studies

We reviewed the extent and variety of functional assessment procedures used in behavioral intervention studies. The contents of six research journals dating from 1986 to 1992 were searched for articles describing single-subject intervention studies that targeted problematic social behaviors. Articles meeting this initial criteria were examined to determine if a functional assessment was conducted. If so, the various procedures comprising the functional assessment, types of interventions conducted, and demographic characteristics of study participants were recorded for each study. Results are compared to similar reviews of research dating from 1980–1985. Potential reasons for the paucity of studies incorporating functional assessment procedures are discussed. Finally, directions for future research and applied practice are provided.     

Parent‐implemented brief functional analysis and treatment with coaching via telehealth

We evaluated the use of parent‐implemented brief functional analyses in the home with coaching delivered via telehealth. Parents of 7 children with autism conducted functional analyses of their child's challenging behavior. For 4 participants, the brief functional analysis provided information regarding the function of the child's challenging behavior. A full functional analysis indicated a social function for 1 participant. The brief functional analysis yielded false positive results and subsequent assessment indicated an automatic function for another participant. The final participant did not engage in sufficient rates of challenging behavior to provide information regarding the function of the child's challenging behavior. Treatment evaluations occurred with 4 participants; these evaluations provided support for the results of the functional analysis. Together with previous research, the results indicate that parent‐implemented brief functional analyses, followed by additional assessment as needed, may be an effective method for assessing and treating challenging behavior via telehealth.     

Decreasing student behavior problems and fostering academic engagement through function‐based support and fading of token reinforcement

This study examined the effects of function‐based behavior support plans (BSPs) on the persistent behavior problems and lack of academic engagement of three, 7‐ to 8‐year‐old, male students from two public schools in Iceland. Based on the results of functional behavioral assessments, BSPs were created for each participant. Each plan included a token system. The goal for all students was to foster independent functioning. A multiple baseline across participants showed that disruptive behavior decreased by 85% on average and academic engagement increased by 78% on average. Statistical analyses suggest significant positive effects were obtained. Findings suggest that persistent behavior problems can be reduced and independent academic engagement fostered in inclusive school settings through function‐based BSPs with gradual fading of token reinforcement.     

Response latency as a measure of behavior in the assessment of elopement

Elopement is a common form of problem behavior but is relatively underrepresented in the functional analysis literature. One barrier to assessing elopement experimentally is the need to retrieve the subject following an instance of elopement. This retrieval confounds programmed session contingencies when the goal is to obtain repeated measurement of free‐operant behavior. The current study evaluated latency to elopement as an alternative to free‐operant measurement. We first compared response latency to allocation in 5‐min sessions and then measured latency alone in a trial‐based format. The identified reinforcers matched across both data analysis modalities in the session‐based assessments, and the trial‐based functional analysis showed a significant time savings in identifying the function of behavior over a session‐based assessment. Results indicated that elopement serves idiosyncratic social functions in young children with intellectual and developmental disabilities, and that a latency‐based assessment saves time while yielding equally clear results.     

Generality of the practical functional assessment and skill‐based treatment among individuals with autism and mental health disorders

A practical functional assessment format was recently developed that informed a skill‐based treatment for the problem behavior of children diagnosed with autism spectrum disorder. Since its inception there have been multiple replications of the procedures; however, the comprehensive model has rarely been applied to populations with more complex comorbid disorders and severe problem behavior such as those diagnosed with anxiety or depression. We conducted the current study to systematically replicate the entire practical functional assessment and skill‐based treatment model with two participants diagnosed with multiple mental health disorders admitted to a severe behavior outpatient unit. The practical functional assessment identified reinforcers that were provided contingent on increasingly complex forms of communication. Problem behavior remained low for both participants after reinforcement was thinned by increasing a response requirement of completing difficult tasks. Furthermore, the results were socially validated by the parents and teachers and the treatment was extended to the home setting.     

Functional analysis of problem behavior: a review

Functional analysis methodology focuses on the identification of variables that influence the occurrence of problem behavior and has become a hallmark of contemporary approaches to behavioral assessment. In light of the widespread use of pretreatment functional analyses in articles published in this and other journals, we reviewed the literature in an attempt to identify best practices and directions for future research. Studies included in the present review were those in which (a) a pretreatment assessment based on (b) direct observation and measurement of (c) problem behavior was conducted under (d) at least two conditions involving manipulation of an environmental variable in an attempt (e) to demonstrate a relation between the environmental event and behavior. Studies that met the criteria for inclusion were quantified and critically evaluated along a number of dimensions related to subject and setting characteristics, parametric and qualitative characteristics of the methodology, types of assessment conditions, experimental designs, topographies of problem behaviors, and the manner in which data were displayed and analyzed.     

The effectiveness of function‐based interventions to treat sleep problems,including unwanted co‐sleeping,in children with autism

This study investigated the effectiveness of functional behavioral assessment (FBA)—informed interventions for sleep problems, particularly co‐sleeping, in children with autism spectrum disorder (ASD). Seven children, who exhibited multiple sleep problems including unwanted co‐sleeping, participated. FBA, based on information derived from interviews and parent‐recorded sleep diaries, was used to develop individualized case formulations upon which multicomponent, parent‐implemented interventions were based. These were evaluated using a single‐case, non‐concurrent multiple‐baseline‐across‐participants design. Improvements were observed across all sleep problems, including the elimination of co‐sleeping. Gains were maintained at follow‐up for five out of seven children, though two children did not complete intervention. Parents reported high levels of satisfaction with the program. FBA‐based interventions for sleep problems in children with ASD and their clinical implications are further discussed.     

TRIAL-BASED FUNCTIONAL ANALYSIS AND FUNCTIONAL COMMUNICATION TRAINING IN AN EARLY CHILDHOOD SETTING

Problem behavior is common in early childhood special education classrooms. Functional communication training (FCT; Carr & Durand, 1985 ) may reduce problem behavior but requires identification of its function. The trial‐based functional analysis (FA) is a method that can be used to identify problem behavior function in schools. We conducted trial‐based FAs and FCT with 3 children in an early childhood special education setting. All trial‐based FAs resulted in identification of behavioral functions, and subsequent FCT led to reductions in problem behavior and increases in communication.     

ASSESSING THE UTILITY OF A DEMAND ASSESSMENT FOR FUNCTIONAL ANALYSIS

We evaluated the utility of an assessment for identifying tasks for the functional analysis demand condition with 4 individuals who had been diagnosed with autism. During the demand assessment, a therapist presented a variety of tasks, and observers measured problem behavior and compliance to identify demands associated with low levels of compliance or high levels of problem behavior (low‐probability demands) and demands associated with high levels of compliance or low levels of problem behavior (high‐probability demands). Results showed that clearer functional analysis outcomes were obtained for 3 of the 4 participants when low‐probability rather than high‐probability demands were used.     

Assessing the generality and durability of interview‐informed functional analyses and treatment

Due to the limited research demonstrating socially valid outcomes of function‐based treatments in ecologically relevant environments (Santiago, Hanley, Moore, & Jin, 2016), we replicated and extended the effects of the interview‐informed functional analysis and skill‐based treatment procedure described by Hanley, Jin, Vanselow, and Hanratty (2014) with two children diagnosed with autism in a home setting. The assessment and treatment was implemented by a home‐based service provider and treatment was extended to the participants’ parents. Following the interview‐informed functional analyses, we taught the participants functional communication responses and to engage in less‐preferred activities when functional communication outcomes were delayed. We observed large reductions in problem behavior following the introduction of the function‐based treatment. The effects extended to novel settings, stimuli, and caregivers and the results maintained at 6‐week follow‐ups.     

A Comparison of Results and Acceptability of Functional Behavioral Assessment Procedures with a Group of Middle School Students with Emotional/Behavioral Disorders (E/BD)

There is currently controversy over the validity and applicability of functional behavioral assessment (FBA) procedures with students with emotional/behavioral disorders (E/BD). A set of FBA procedures, including teacher and student interviews and direct classroom observations, were carried out with eight students with disabilities (7 classified E/BD, one classified LD). Results indicated that when all three methods (teacher/student interviews, classroom observations) yielded a ranking for a function they agreed 64% of those occasions. For those situations in which there was overall disagreement there was agreement between teacher interview and classroom observations most of the time. Social validity data indicated that both students and teachers felt that the assessment procedures were a useful and productive process.     

A comparative effectiveness trial of functional behavioral assessment methods

Clinicians report primarily using functional behavioral assessment (FBA) methods that do not include functional analyses. However, studies examining the correspondence between functional analyses and other types of FBAs have produced inconsistent results. In addition, although functional analyses are considered the gold standard, their contribution toward successful treatment compared with other FBA methods remains unclear. This comparative effectiveness study, conducted with 57 young children with autism spectrum disorder, evaluated the results of FBAs that did (n = 26) and did not (n = 31) include a functional analysis. Results of FBAs with and without functional analyses showed modest correspondence. All participants who completed functional communication training achieved successful outcomes regardless of the type of FBA conducted.     

EXPERIMENTAL ANALYSIS AND TREATMENT OF MULTIPLY CONTROLLED SELF-INJURY

A functional analysis of the self-injurious behavior (SIB) of 3 adults with profound developmental disabilities showed that each engaged in SIB in more than one assessment condition. Such outcomes may result from a failure to isolate the variable maintaining SIB, or they may reflect multiple sources of control over SIB. In order to identify more clearly the determinants of SIB, each subject was exposed to a series of treatments appropriate to one or both of the apparent functions of SIB. These treatments, applied sequentially on baselines appropriate to each behavioral function, identified the maintaining variables for SIB through differential outcomes across baselines. Results indicated that the SIB of 2 subjects was multiply controlled, confirming the outcomes of the functional analysis. However, the SIB of the 3rd subject was eliminated using a treatment designed for a single function, suggesting spurious results of the original assessment. Alternative interpretations of undifferentiated assessment data are discussed, as are analysis and treatment issues related to multiply determined behavior disorders.     

A Test of a Model of Consumers' Responses to Product‐Manual Safety Information: A Replication and Extension1

Product manuals play an important role in the delivery of marketplace safety information. The present study extends prior conceptualizations of individuals' responses to threat communication by explicitly incorporating coping response efficacy and assessing relationships among arousal dimensions and coping appraisal processes in a more naturalistic context (i. e., in‐home, self‐paced exposure) than previous research. Proposed relationships among arousal, efficacy, and behavioral intentions are tested and largely supported. Based on the findings of the study, issues relevant to researchers and practitioners in the area are discussed.