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.     

Effects of Prevent-Teach-Reinforce on Academic Engagement and Disruptive Behavior

This study assessed the effectiveness of prevent-teach-reinforce (P-T-R), a functional behavioral assessment-based intervention for students with behavior problems, using an A-B-A-B design with follow-up. Participants included three students in kindergarten, fourth grade, and fifth grade in a rural Midwestern school district. P-T-R interventions were implemented with fidelity by all teachers and P-T-R was associated with mean decreases in disruptive behavior for all participants with Tau-U effect sizes ranging from minimal to strong. All three participants demonstrated mean increases in academic engagement with strong effect sizes. P-T-R interventions were associated with moderate to high levels of perceived social validity. Implications for consistent and efficient FBA-based interventions in schools are discussed.     

BEHAVIORAL ASSESSMENT OF FEEDING PROBLEMS OF INDIVIDUALS WITH SEVERE DISABILITIES

As many as 80% of the individuals with severe or profound mental retardation exhibit feeding problems. Although behavioral interventions have been used to treat these problems, no assessment procedure for determining a functional relationship between a person's acceptance of food and the type and texture of that food has been reported. The purpose of this study was to test a behavioral assessment procedure for a feeding problem of limited intake. Five individuals with severe or profound mental retardation were fed 10 to 12 types of foods with one or more textures. Behavioral categories of acceptance, rejection, expulsion, and other negative behavior were recorded. Results indicated that each subject fit into one of four categories of feeding problems: (a) total refusal, (b) type selectivity, (c) texture selectivity, or (d) type and texture selectivity. Thus, although all 5 subjects exhibited limited intake, the food characteristics correlated with the problem were different for each individual. Results suggest that treatments for limited intake may be based on assessments that show the association of food type or texture to a person's rejection or expulsion of food.     

ANALYSIS OF A HIGH-PROBABILITY INSTRUCTIONAL SEQUENCE AND TIME-OUT IN THE TREATMENT OF CHILD NONCOMPLIANCE

This study evaluated the effectiveness of high-probability requests and time-out as treatments for noncompliance that appeared to be maintained by contingent attention in 2 developmental normal children. The introduction of high-probability requests increased compliance for 1 child but not the other. Time-out was effective with both children, and improvements in compliance were maintained at an 8-week follow-up.     

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.     

BEACHES: AN OBSERVATIONAL SYSTEM FOR ASSESSING CHILDREN'S EATING AND PHYSICAL ACTIVITY BEHAVIORS AND ASSOCIATED EVENTS

An integrated system for coding direct observations of children's dietary and physical activity behaviors was developed. Associated environmental events were also coded, including physical location, antecedents, and consequences. To assess the instrument's reliability and validity, 42 children, aged 4 to 8 years, were observed for 8 consecutive weeks at home and at school. Results indicated that four 60-min observations at home produced relatively stable estimates for most of the 10 dimensions. Interobserver reliabilities during live and videotaped observations were high, with the exception of “consequences” categories that occurred in less than 1% of observed intervals. Evidence of validity was provided by findings that antecedents were associated with respective dietary and physical activity behaviors. The five physical activity categories were validated by heart-rate monitoring in a second study. The Behaviors of Eating and Activity for Children's Health Evaluation System is appropriate for studying influences on diet and physical activity in children in a variety of settings.     

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.     

Causal models and the assessment-treatment relationship in behavior therapy

The relationship between causal models in behavior therapy and strategies for designing intervention programs on the basis of assessment data is considered. The evolution away from simple univariate causal models is noted and complex causal models for behavior disorders are stressed. However, complex causal models currently preclude empirically based functional analytic and keystone target behavior assessment strategies for intervention design. Future directions for intervention design involving a combination of diagnostic, functional, analytic, and keystone strategies and markers for causal paths are discussed.     

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.     

Recruitment Strategies for a Home-Based Physical Activity Intervention for Breast Cancer Patients

Recruiting cancer patients for randomized trials investigating psychosocial interventions presents several unique challenges. This paper describes the challenges and yields for different recruitment methods used in Moving Forward, a randomized trial of a home-based moderate-intensity physical activity program for early-stage breast cancer survivors. Recruitment methods included letters sent to patients by their oncologists, direct referrals from oncologists, in-person recruitment in oncology clinics, referrals from nurses and medical assistants, passive recruitment, other mailings, and community outreach strategies. Of the 424 screenings completed, 86 (20.3%) participants were randomized. Physician letters yielded the greatest number of initial screenings (147; 34.7%) and participants randomized (28; 32.5%). In-person recruitment also proved to be a productive recruitment strategy; 14 (16.3%) of the participants were recruited via this strategy. Community outreach efforts did not provide as great a yield and were labor intensive. We discuss suggestions for recruitment of cancer patients in future trials.     

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.     

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.     

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.     

The effects of noncontingent delivery of high- and low-preference stimuli on attention-maintained destructive behavior

An adolescent with severe mental retardation and cerebral palsy who displayed attention-maintained destructive behavior was exposed to noncontingent reinforcer delivery (NCR) with either a high-preference or a low-preference stimulus while reinforcement for destructive behavior with attention remained in effect (i.e., NCR without extinction). NCR without extinction was effective only when the high-preference stimulus was available, suggesting that systematic assessment of stimulus quality may enhance the effectiveness of NCR with alternative stimuli.     

Cognitive Barriers to Successful Weight Management: 7 Stymie Beasts

This paper focuses on one of the most significant barriers, especially for teenagers and their families, to the effectiveness of cognitive behavioral therapy (CBT) for weight management: high rates of attrition. Cognitive barriers contribute to attrition and to decreasing commitment to full engagement in the process (deliberate practice). Excuses capture the essence of one type of those cognitive barriers. Excuses are defined as shifts in attribution from self-focused causes of struggles to achieve goals to more externally-focused causes—resulting in decreasing full engagement. Those excuses (shifts in attribution) do not just happen. People make decisions to implement those shifts away from personal responsibility. Ten cognitive biases lie at the heart of such problematic delusional decision making. This paper identifies seven excuses created by that biased decision making as anthropomorphisms called Stymie Beasts. Such unique simply worded visually distinctive creatures may help improve recall and focus on these powerful antagonists to successful weight control. Then, the use of two CBT techniques, Therapeutic Understanding of Science (TUS) and Rational Emotive Therapy (RET), illustrated with examples for all seven Stymie Beasts, shows how CBT may prevent and dismantle those Beasts (excuses). Ideas for future research using randomized controlled trials to test these notions are also presented.