Assessment and treatment of elopement maintained by access to stereotypy

We evaluated a treatment for elopement maintained by access to stereotypic door play. First, we conducted a functional analysis of elopement that produced undifferentiated results. Next, we conducted an assessment in which we evaluated the relation between elopement and door play. Results suggested a functional relation between the 2 behaviors (i.e., elopement was maintained by contingent access to door play). Finally, we implemented functional communication training as a treatment for elopement in which access to door play was made contingent on a target appropriate communication response.     

Functional analysis and treatment of elopement.

Elopement is a dangerous behavior because children who run away may encounter life-threatening situations (e.g., traffic). We conducted functional analyses of the elopement of 3 children who had been diagnosed with developmental disabilities. The results identified a maintaining reinforcer for the elopement of 1 child, but the data were difficult to interpret for 2 of the children. Subsequent reinforcer assessments were used to help to clarify the reinforcers for elopement for these 2 children. Results of the functional analyses and reinforcer assessments then were used to develop successful treatments to reduce elopement. The findings are discussed in terms of (a) the application of functional analysis methodology to elopement, (b) the use of reinforcer assessments to identify potential reinforcers when standard functional analyses are undifferentiated, and (c) the utility of assessment-based treatments for elopement.     

FUNCTIONAL ANALYSIS AND TREATMENT OF ELOPEMENT ACROSS TWO SCHOOL SETTINGS

The elopement of a child with Asperger syndrome was assessed using functional analyses and was treated in two school settings (classroom and resource room). Functional analyses indicated that elopement was maintained by access to attention in the resource room and obtaining a preferred activity in the classroom. Attention- and tangible-based interventions were compared in an alternating treatments design in both settings. Results validated the findings of the functional analyses. Implications for the assessment and treatment of elopement are discussed.     

Assessment and treatment of elopement maintained by chase

Elopement can have serious or fatal consequences associated with leaving the presence of an adult or getting lost (e.g., traffic injury and drowning). Given the dangers associated with elopement, caregivers are likely to chase after their child when elopement occurs. Like other forms of attention that follow problem behavior, chasing and retrieving the child may serve as a reinforcer and therefore maintain elopement. However, no study to date has evaluated whether elopement is sensitive to positive reinforcement in the form of chase. We evaluated the effects of chase on elopement with an 8‐year old boy diagnosed with autism. Elopement was maintained, at least in part, by chase. We then conducted a treatment evaluation in which we tested the effects of various antecedent‐ and consequence‐based treatment components within a multiple schedule.     

Treating elopement without extinction in a preschool setting

Elopement is a prevalent and dangerous behavior that is common with children with autism spectrum disorder (ASD). Due to safety, logistics, and effort on the part of stakeholders, recent research has emphasized the need for treatments that do not include extinction or response blocking. Using a multiple-baseline-across-functions design, we successfully decreased elopement with functional communication training, without additional treatment components, for one function but needed to add an additional treatment component (response blocking) for the second function for a 4 year-old boy with ASD who engaged in elopement in a preschool setting. We highlight contributions to the literature on elopement as well as directions for future research.     

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.     

Functional analysis and treatment of elopement for a child with attention deficit hyperactivity disorder

We conducted a functional analysis of elopement in an outdoor setting for a child with a diagnosis of attention deficit hyperactivity disorder. A subsequent treatment consisting of noncontingent attention and time-out was demonstrated to be effective in eliminating elopement. Modifications of functional analysis procedures associated with the occurrence of elopement in a natural setting are demonstrated.     

Evaluating a treatment without extinction for elopement maintained by access to stereotypy

Elopement is a common and potentially dangerous form of problem behavior. Results of a functional analysis found that the elopement of a child with autism was maintained by access to stereotypy in the form of door play. We implemented functional communication training and contingency-based delays dependent on the absence of elopement and increased the amount of time the participant waited prior to engaging in stereotypy. We also conducted treatment-extension probes, with the participant waiting up to 10 min without elopement.     

Differential reinforcement with and without blocking as treatment for elopement

Blocking is a frequent component of treatments for elopement. Unfortunately, blocking may not always be feasible because elopement often occurs when supervision is low or the behavior cannot be prevented. The present study evaluated the use of blocking in the treatment of elopement by using differential reinforcement of other behavior with and without blocking. In this case, results suggested that blocking may be an essential component for differential reinforcement-based treatments of elopement.     

Treatment of elopement following a latency‐based interview‐informed,synthesized contingency analysis

Using a latency measure during a functional analysis of problem behavior increases the brevity of the assessment period and decreases risks resulting from exposure to contexts intended to evoke problem behavior. In addition, latency‐based functional analyses may be especially suitable for discrete behaviors such as elopement, which require resetting the environment after each instance of the response. We evaluated a comprehensive assessment and treatment package for the elopement of two children diagnosed with autism. We observed short latencies to elopement during the test condition of the analysis and no elopement during the control condition. We then taught the participants multiple forms of functional communication responses of increasing complexity while elopement was blocked. This was followed by the thinning of reinforcement to a terminal goal, creating a treatment package that nearly eliminated elopement and was socially validated by caregivers.     

BRIEF REPORT: LATENCY FUNCTIONAL ANALYSIS OF ELOPEMENT

Elopement is a potentially dangerous problem behavior prevalent among individuals with developmental disabilities. However, functional analysis of elopement presents unique challenges including potential confounds because of the need for participant retrieval during functional analysis sessions. In the current study, we implemented a latency functional analysis with an eight‐year‐old child with an intellectual disability, in which the dependent measure was latency to elopement. Following the latency functional analysis, a functional communication intervention was developed and its effectiveness in decreasing elopement was evaluated using an ABAB design. Findings suggest that a functional analysis of latency may be a suitable methodology to identify the operant function of elopement. Copyright © 2013 John Wiley & Sons, Ltd.     

Brief functional anlaysis and treatment of elopement in preschoolers with autism

As a result of the impact of functional analysis methodologies in identifying maintaining variables of problem behavior, considerable research has been devoted to tailoring the methodologies to be practical for an outpatient setting. The purpose of this study was (a) to use brief functional analysis (BFA) methodologies to empirically demonstrate the function of elopement exhibited by two preschoolers diagnosed with autism and (b) to develop function‐based interventions derived from the results of the BFA. In phase one, a BFA consisting of 5‐min sessions with multiple repetitions of each condition was conducted with each participant. In phase two, the efficacy of function‐based interventions was assessed using a pairwise design. Both participants' rates of elopement were differentially lower during the implementation of the function‐based intervention relative to baseline. Collectively, these results demonstrated that brief functional methodologies could be applied successfully to the assessment and treatment of elopement. Moreover, the application of BFA and the ensuing treatment in an outpatient setting extend the existing research on functional analysis. Copyright © 2008 John Wiley & Sons, Ltd.     

Comparison of single and multiple functional communication training responses for the treatment of problem behavior

Two functional communication training (FCT) conditions without extinction were compared to treat the problem behavior of a child with developmental disabilities. The individual was taught to emit a single FCT response to obtain one of six items delivered in a randomized order or multiple FCT responses that specified the exact item. Results showed that only the FCT-multiple condition reduced problem behavior and maintained alternative mands.     

Efficiency in functional analysis of problem behavior: A quantitative and qualitative review

Originating in the mid-1960s, functional analysis (FA) has become the gold standard method for understanding the environmental variables that come to shape and maintain problematic behaviors such as aggression, self-injury, and property destruction. Over the decades, a number of studies have refined FA methods, attempting to improve the overall efficiency of the analysis through experimental design and procedural modifications. In the present review, we used ongoing visual-inspection criteria and basic probability theory to compare and analyze levels of efficiency across FA types. The multielement design and synthesized contingency analyses were about equally efficient with respect to the mean number of sessions conducted per function tested, and the trial-based and synthesized contingency analyses were the 2 most efficient with respect to the mean duration per function tested. We discuss the implications of these findings in the broader context of efficiency and provide recommendations for maximizing efficiency during an FA. We also discuss other qualitative procedural details that may influence the overall efficiency of an FA.     

Evaluating the effects of functional communication training in the presence and absence of establishing operations

We conducted functional analyses of aberrant behavior with 4 children with developmental disabilities. We then implemented functional communication training (FCT) by using different mands across two contexts, one in which the establishing operation (EO) that was relevant to the function of aberrant behavior was present and one in which the EO that was relevant to the function of aberrant behavior was absent. The mand used in the EO-present context served the same function as aberrant behavior, and the mand used in the EO-absent context served a different function than the one identified via the functional analysis. In addition, a free-play (control) condition was conducted for all children. Increases in relevant manding were observed in the EO-present context for 3 of the 4 participants. Decreases in aberrant behavior were achieved by the end of the treatment analysis for all 4 participants. Irrelevant mands were rarely observed in the EO-absent context for 3 of the 4 participants. Evaluating the effectiveness of FCT across different contexts allowed a further analysis of manding when the establishing operations were present or absent. The contributions of this study to the understanding of functional equivalence are also discussed.     

Assessment and treatment of problem behavior maintained by escape from attention and access to tangible items.

The results obtained from two consecutive functional analyses conducted with a 6‐year‐old child with autism are described. In the initial functional analysis, the highest rates of problem behavior occurred in the play condition. In that condition, the delivery of attention appeared to occasion problem behaviors. A second functional analysis was conducted wherein an escape from attention condition and a tangible condition were added. In the second functional analysis, higher rates of responding were observed in the escape from attention and tangible conditions. The results suggested that problem behavior was maintained by negative reinforcement in the form of escape from attention and positive reinforcement in the form of gaining access to preferred tangible items. Problem behavior was treated using functional communication training combined with noncontingent reinforcement.     

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.     

THE WIDENING WORLD OF FUNCTIONAL ASSESSMENT: COMMENTS ON FOUR MANUALS AND BEYOND

An escalating number of materials have been published recently on the topic of functional assessment and assessment‐based behavioral interventions. We review four manuals that purport to provide practical guidance for conducting functional assessment. An examination of these manuals yields encouraging evidence that the field of behavioral support has made notable progress in adopting a functional (behavior‐analytic) approach to unwanted behaviors. The content of the manuals, considered in the context of emerging perspectives in behavioral support, suggests a number of important issues and directions that should be addressed by future functional assessment research and practice.     

A comparison of isolated and synthesized contingencies in functional analyses

Recently, researchers have compared the utility of isolated versus synthesized contingencies in functional analysis (FA) methodology (e.g., Fisher et al., 2016; Slaton et al., 2017). A limitation of these studies is that there were other differences across FA methodologies (e.g., design, contingency) that did not allow for isolation of the influence of isolated versus synthesized contingencies. Therefore, the current study compared outcomes of FAs that involved isolated versus synthesized contingencies for problem behavior of 5 children while controlling for these other differences across FAs (Experiment 1). Next, the current study compared the effects of interventions based on the functions identified in the isolated and synthesized contingencies for each participant (Experiment 2). Results indicated isolated contingency FAs produced differentiated responding for 1 or both functions for all 5 participants, and there were little to no differences between treatments informed by isolated and synthesized contingency FAs.     

Preliminary evidence on the use of telehealth in an outpatient behavior clinic

Previous studies have shown that telehealth can be an effective way to deliver behavior‐analytic services. In this study, we provided a demonstration of the use of telehealth to assess and initiate treatment of problem behavior in an outpatient clinic. We coached parents of children with autism via telehealth to conduct functional analyses during 1 appointment that lasted 1 hr and subsequently coached them as they implemented functional communication training during 3 subsequent appointments (15 min each). Social functions were identified for most children, and problem behavior was reduced by an average of 65.1%.