An evaluation of resurgence following functional communication training conducted in alternative antecedent contexts via telehealth

Treatments based on differential reinforcement may inadvertently increase the recurrence of problem behavior in the face of challenges because reinforcers for appropriate behavior occur in the same context as problem behavior. The current study evaluated one potential approach to mitigating these problems with differential reinforcement treatments based on behavioral momentum theory. Specifically, appropriate behavior was trained in contexts without a history of reinforcement prior to intervening with problem behavior. Participants were 4 children with autism spectrum disorder. Treatment used telehealth to implement functional communication training (FCT) in three alternative contexts with minimal or no history of reinforcement for problem behavior before initiating FCT in the treatment context. Evaluations of the effects of treatment and tests of resurgence were conducted intermittently during treatment to evaluate maintenance. When FCT treatment was initiated in alternative contexts, initial results were comparable to more typical implementations of FCT. Resurgence was reduced to similar levels during tests of resurgence for all participants when compared to more typical previously published implementations of FCT, but clinically significant reductions in resurgence occurred more quickly in the present study. These findings support training appropriate behavior in an alternative context to mitigate the resurgence of problem behavior during differential reinforcement treatments.     

Mitigating resurgence of destructive behavior using the discriminative stimuli of a multiple schedule

Results of several recent translational studies have suggested that correlating contextual or discriminative stimuli with the delivery and withholding of reinforcement for the functional communication response (FCR) may mitigate resurgence of destructive behavior, but few, if any, have isolated the effects of those stimuli. In the present study, we first trained the FCR, brought it under stimulus control of a multiple schedule, and thinned its reinforcement schedule in one stimulus context. Next, we conducted resurgence evaluations (i.e., baseline, functional communication training [FCT], extinction challenge) in two novel contexts to test the effects of the discriminative stimuli on resurgence. We programmed one context to include the (a) S^D during the FCT phase to signal the availability of reinforcement for the FCR and (b) S^Δ during a subsequent extinction challenge to signal the unavailability of reinforcement for the FCR. The other context did not include the S^D during the FCT phase, nor the S^Δ during the extinction challenge. We expected to see greater persistence of the FCR in the context that included the S^D during FCT and less persistence of the FCR and less resurgence of destructive behavior in the context that included the S^Δ during the extinction challenge. Obtained results confirmed this latter prediction, but we observed no reliable difference when the S^D was present or absent during the FCT phase. Our results have relevance for practitioners in that they provide further empirical support for the use of discriminative stimuli when treating destructive behavior.     

Schedule thinning following communication training: using competing stimuli to enhance tolerance to decrements in reinforcer density

Functional communication training (FCT) is a widely used treatment for individuals with developmental disabilities who exhibit severe behavior problems. One inherent challenge of employing FCT as a treatment in the community is that reinforcement for appropriate communication cannot always be immediate or even possible in some circumstances. Of the few studies that have incorporated some form of schedule thinning for communication, most have reported disruption of communication or increases in problem behavior when the schedule of reinforcement is thinned. In the current study, we compared FCT with extinction to FCT with extinction and access to competing stimuli. After conducting a functional analysis, a competing stimulus assessment was performed to identify stimuli that produce reinforcement that ostensibly competes with reinforcement that maintains problem behavior. It was hypothesized that FCT with competing stimuli would result in more stable reductions in problem behavior during schedule thinning, which would ultimately result in quicker achievement of the treatment goal (low levels of problem behavior under the terminal reinforcement schedule for communication) than FCT without competing stimuli. Results confirmed this hypothesis.     

A preliminary investigation on improving functional communication training by mitigating resurgence of destructive behavior

Despite the effectiveness and widespread use of functional communication training (FCT), resurgence of destructive behavior can occur if the functional communication response (FCR) contacts a challenge, such as lapses in treatment integrity. We evaluated a method to mitigate resurgence by conducting FCT using a multiple schedule of reinforcement prior to extinction. After functional analyses of 2 boys’ destructive behavior and treatment with FCT (Study 1), we compared levels of resurgence during an extinction challenge either after a typical FCT sequence or after exposure to schedule thinning in the context of a multiple‐schedule arrangement (Study 2). Results for both participants suggested that schedule thinning using discriminative stimuli in a multiple schedule mitigated the resurgence of destructive behavior.     

AN EVALUATION OF RESURGENCE DURING TREATMENT WITH FUNCTIONAL COMMUNICATION TRAINING

Extinction‐induced resurgence is the recurrence of previously reinforced behavior when another behavior is placed on extinction (Lieving, Hagopian, Long, & O'Connor, 2004). This phenomenon may account for some instances of treatment relapse when problem behavior recovers during extinction‐based treatments. The current study sought to determine whether resurgence of problem behavior would reliably occur with 5 participants who received treatment with FCT. Results showed that problem behavior reemerged for all but 1 participant when the communicative response was exposed to extinction or thin schedules of reinforcement. These findings suggest that resurgence may account for some instances of response recovery during treatment, and that the described procedure may be useful for the further study of resurgence and eventual prevention of this phenomenon.     

Renewal during functional communication training

Functional communication training (FCT) is one of the most commonly prescribed interventions for the treatment of severe destructive behavior exhibited by individuals with intellectual disabilities. Although highly effective, FCT has been shown to fail in some cases when treatment is introduced into the child's typical environment. Basic and translational research on renewal provides a model for studying the relapse of destructive behavior following successful response to treatment in clinic settings using FCT. In the present study, we evaluated whether relapse of destructive behavior could be attributed to the discriminative control of the home context, which was historically correlated with reinforcement for destructive behavior. We implemented baseline contingencies in the home setting with caregivers acting as interventionists (i.e., Context A). We then implemented FCT in a treatment clinic with trained therapists (i.e., Context B). Finally, we introduced FCT in the home setting with caregivers implementing the treatment procedures (i.e., return to Context A). For three of four participants we observed the relapse of destructive behavior consistent with operant renewal. We discuss the implications of these findings with respect to strategies designed to promote generalization of FCT across settings during the treatment of severe destructive behavior.     

DRA contingencies promote improved tolerance to delayed reinforcement during FCT compared to DRO and fixed-time schedules

Following Functional Communication Training (FCT), clinicians often gradually expose newly taught communicative responses to delayed reinforcement contingencies to prepare clients for the normative environment in which requests are frequently reinforced after a delay. The introduction of delays may result in the resurgence and maintenance of problem behavior and the weakening of the newly trained communicative response. The current study compared delay tolerance with three individuals diagnosed with intellectual and developmental disabilities when reinforcement for the functional communication response (FCR) was delivered following (a) the passage of time, (b) the omission of problem behavior, or (c) the occurrence of an alternative behavior. We measured delay tolerance in terms of minimizing problem behavior and maintaining efficient FCRs. Outcomes support requiring alternative responding during delays to attain optimal treatment results.     

Effects of continuous and intermittent reinforcement for problem behavior during functional communication training

We evaluated the effectiveness of functional communication training (FCT) in reducing problem behavior and in strengthening alternative behavior when FCT was implemented without extinction. Following the completion of functional analyses in which social-positive reinforcement was identified as the maintaining variable for 5 participants' self-injurious behavior (SIB) and aggression, the participants were first exposed to FCT in which both problem behavior and alternative behavior were reinforced continuously (i.e., on fixed-ratio [FR] 1 schedules). During subsequent FCT conditions, the schedule of reinforcement for problem behavior was made more intermittent (e.g., FR 2, FR 3, FR 5, etc.), whereas alternative behavior was always reinforced according to an FR 1 schedule. Results showed that 1 participant's problem behavior decreased and alternative behavior increased during FCT when both behaviors were reinforced on FR 1 schedules. The remaining 4 participants shifted response allocation from problem to alternative behavior as the schedule of reinforcement for problem behavior became more intermittent. These results suggest that individuals might acquire alternative responses during FCT in spite of inconsistencies in the application of extinction, although even small errors in reinforcement may compromise treatment effects.     

Serial functional communication training: Extending serial DRA to mands and problem behavior

Functional communication training (FCT) is commonly used to eliminate problem behavior. Not surprisingly, the efficacy of the intervention depends on fidelity to programmed procedures. For instance, problem behavior is likely to resurge if caregivers fail to reinforce mands during the maintenance stages of FCT. Despite this, recent translational work on arbitrary human responses suggests that incorporating multiple‐mand instruction into a serial‐training format may increase the probability of a recency effect, and a reversion of response resurgence (both desirable outcomes when mands are the most recently reinforced responses prior to extinction). Although promising, this effect has not been replicated with socially significant human behavior. Thus, we compared the relative effect of traditional FCT with that of serial FCT on the resurgence of the problem behavior, and mands, of 2 children. In contrast to previous research, we observed primacy effects for both subjects (i.e., the magnitude of the resurgence of problem behavior was greater than it was for any subsequently trained mand), and mand resurgence never occurred for one subject. Notwithstanding these limitations, the percentage of total responding allocated toward the resurgence of problem behavior was less in the serial FCT component relative to the traditional FCT component, and we observed a reversion of response resurgence for one subject.     

Effects of thinning the rate at which the alternative behavior is reinforced on resurgence of an extinguished instrumental response

Three experiments with rats examined the effects of thinning the rate of reinforcement for the alternative behavior in the resurgence paradigm. In all experiments, pressing one lever (L1) was first reinforced and then extinguished while pressing a second alternative lever (L2) was then reinforced. When L2 responding was then extinguished, L1 responses "resurged." Resurgence was always observed when L2 was reinforced on an unchanging reinforcement schedule during Phase 2. However, other rats received systematic decreases in the rate of L2 reinforcement before extinction of L2 began. Such a "thinning" procedure was predicted to reduce final resurgence by associating L1 extinction with longer and longer periods without a reinforcer. The procedure did reduce the resurgence effect observed when L2 was put on extinction (Experiment 3). However, in each experiment, thinned groups also returned to L1 responding, and continued to make L1 responses, while the reinforcement schedule for L2 was being thinned. Fine-grained analysis of behavior in time suggested that this early resurgence was not due to adventitious reinforcement of L1, occasion setting of L1 by reinforcer presentation, or the entrainment of L1 as a schedule-induced interim behavior. The results are overall consistent with the hypothesis that resurgence is a renewal effect in which extinguished L1 responding recovers when the context provided by the L2 reinforcement schedule is changed. Challenges for this view are also discussed.     

EVALUATION OF THE “CONTROL OVER REINFORCEMENT” COMPONENT IN FUNCTIONAL COMMUNICATION TRAINING

The effectiveness of functional communication training (FCT) as a treatment for behavior disorders has been attributed to a number of variables, one of which is the individual's ability to exert control over the delivery of reinforcement. We evaluated this component of FCT by exposing individuals to conditions in which their behavior either did or did not affect the delivery of reinforcement. Three adults with mental retardation who engaged in self-injurious behavior (SIB) participated. Following a functional analysis of their SIB, the effects of FCT were compared to those of noncontingent reinforcement (NCR) in a multielement design. The amount of reinforcement during both conditions was equated by yoking the schedule of reinforcement during NCR sessions to that in effect during FCT sessions. Results indicated that FCT and NCR were equally effective in reducing the SIB of all participants and suggest that control over reinforcement delivery may not affect the degree to which FCT produces behavioral suppression. However, a different benefit of FCT was evident in the results: More consistent increases in the alternative response were observed during the FCT condition than during the NCR condition.     

Impact of language on behavior treatment outcomes

Resurgence of problem behavior following effective functional communication training (FCT) can occur if the functional communication response contacts extinction. For children from dual-language households, extinction may unintentionally occur due to language variations among communication partners. In the current study, the experimenters evaluated the effect of language on FCT outcomes. Participants were 3 children with autism who engaged in problem behavior and whose parents reported Spanish as the primary home language. The experimenters conducted FCT in the English language followed by probes in the Spanish language. Results suggest that functional communication responses (FCRs) learned in the first language (English) may lead to resurgence of problem behavior when English FCRs do not contact reinforcement in the untaught language (e.g., Spanish). Two of the participants required additional teaching in the secondary language (Spanish), while the third participant eventually emitted Spanish FCRs in the Spanish condition without explicit teaching.     

Prevalence of resurgence of destructive behavior when thinning reinforcement schedules during functional communication training

Functional communication training is a well‐established treatment for socially reinforced destructive behavior that typically includes differential reinforcement of the functional communication response (FCR) in combination with extinction of destructive behavior. However, when the schedule of reinforcement for the FCR is thinned, destructive behavior may resurge (e.g., Greer, Fisher, Saini, Owen, & Jones, 2016). Currently, data are unavailable on the prevalence and characteristics of resurgence during reinforcement schedule thinning. In this study, we evaluated the prevalence of resurgence during reinforcement schedule thinning on a per‐case and per‐schedule‐step basis and also evaluated the magnitude of resurgence in relation to the functions of destructive behavior. We observed resurgence in 19 of the 25 (76%) applications of reinforcement schedule thinning. In some cases, the magnitude of resurgence exceeded the mean levels of destructive behavior observed in baseline. We discuss these results relative to prior translational and applied research on resurgence.     

A preliminary evaluation of treatment duration on the resurgence of destructive behavior

Quantitative models of resurgence (e.g., Behavioral Momentum Theory, Resurgence as Choice) suggest that resurgence is partly a function of the duration of extinction exposure, with longer histories of extinction producing less resurgence. This prediction is supported by some laboratory research and has been partially supported by clinical translations that did not isolate the effects of extinction exposure prior to testing for resurgence. The degree to which different histories of extinction impact the likelihood of treatment relapse in therapeutic applications of differential reinforcement is of great interest to the clinical community, including insurance carriers and other financial providers. In the present study, we isolated the effects of extinction history for severe destructive behavior across 6 participants referred for treatment services and examined resurgence of destructive behavior when alternative reinforcement terminated. Our within-subject evaluation showed no difference in the level of resurgence or persistence of destructive behavior following short and long exposures to differential reinforcement with extinction. We discuss our failure to replicate in relation to experimental-design considerations for investigating this and other relapse phenomena in future research with clinical populations.     

Further evaluation of differential exposure to establishing operations during functional communication training

Recent research findings (DeRosa, Fisher, & Steege, 2015 ) suggest that minimizing exposure to the establishing operation (EO) for destructive behavior when differential reinforcement interventions like functional communication training (FCT) are introduced may produce more immediate reductions in destructive behavior and prevent or mitigate extinction bursts. We directly tested this hypothesis by introducing FCT with extinction in two conditions, one with limited exposure to the EO (limited EO) and one with more extended exposure to the EO (extended EO) using a combined reversal and multielement design. Results showed that the limited‐EO condition rapidly reduced destructive behavior to low levels during every application, whereas the extended‐EO condition produced an extinction burst in five of six applications. We discuss these findings in relation to the effects of EO exposure on the beneficial and untoward effects of differential reinforcement interventions.     

The effects of competing reinforcement schedules on the acquisition of functional communication

The initial efficacy of functional communication training (FCT) was evaluated when problem behavior continued to produce intermittent reinforcement. Results for 2 of 3 participants showed that FCT was most effective when problem behavior was also exposed to extinction, response blocking, or both.     

Resurgence following differential reinforcement of alternative behavior implemented with and without extinction

In the clinic, differential reinforcement of alternative behavior (DRA) often involves programming extinction for destructive behavior while reinforcing an alternative form of communication (e.g., a functional communication response); however, implementing extinction can be unsafe or impractical under some circumstances. Quantitative theories of resurgence (i.e., Behavioral Momentum Theory and Resurgence as Choice) predict differences in the efficacy of treatments that do and do not involve extinction of target responding when reinforcement conditions maintaining alternative responding worsen. We tested these predictions by examining resurgence following two DRA conditions in which we equated rates of reinforcement. In DRA without extinction, target and alternative behavior produced reinforcement. In DRA with extinction plus noncontingent reinforcement, only alternative behavior produced reinforcement. We conducted this study in a reverse-translation sequence, first with participants who engaged in destructive behavior (Experiment 1) and then in a laboratory setting with rats (Experiment 2). Across both experiments, we observed proportionally lower levels of target responding during and following the DRA condition that arranged extinction for the target response. However, levels of resurgence were similar following both arrangements.     

EVALUATION OF CLIENT PREFERENCE FOR FUNCTION-BASED TREATMENT PACKAGES

Functional communication training (FCT) and noncontingent reinforcement (NCR) are commonly prescribed treatments that are based on the results of a functional analysis. Both treatments involve delivery of the reinforcer that is responsible for the maintenance of destructive behavior. One major difference between the two treatment procedures is that client responding determines reinforcement delivery with FCT (e.g., reinforcement of communication is delivered on a fixed-ratio 1 schedule) but not with NCR (e.g., reinforcement is delivered on a fixed-time 30-s schedule). In the current investigation, FCT and NCR were equally effective in reducing 2 participants' destructive behavior that was sensitive to attention as reinforcement. After the treatment analysis, the participants' relative preference for each treatment was evaluated using a modified concurrent-chains procedure. Both participants demonstrated a preference for the FCT procedure. The results are discussed in terms of treatment efficacy and preference for control over when reinforcement is delivered. In addition, a method is demonstrated in which clients with developmental disabilities can participate in selecting treatments that are designed to reduce their destructive behavior.     

Indirect Effects of Functional Communication Training on Non-Targeted Disruptive Behavior

The purpose of this study was to evaluate the effects of functional communication training (FCT) on the occurrence of non-targeted disruptive behavior. The 10 participants were preschool-aged children with developmental disabilities who engaged in both destructive (property destruction, aggression, self-injury) and disruptive (hand flapping, spinning in circles, shrill laughter, screaming, crying) behaviors. Only destructive behavior was targeted for the functional analyses and FCT, but data were also collected on disruptive behaviors. All procedures were conducted in the participants’ homes by their mothers with investigator coaching. Phase 1 consisted of conducting a functional analysis within a multielement design. Phase 2 consisted of conducting FCT with demand fading and repeated extinction baselines within a reversal design. Single-case data are provided for 3 participants, and summary data are provided for all 10 participants. Results of phase 1 showed that all participants’ destructive and disruptive behavior was maintained, at least in part, by negative reinforcement. Results of phase 2 showed that both destructive behavior and non-targeted disruptive behavior occurred at lower levels during FCT when compared to the functional analysis demand condition and baseline conditions, suggesting that FCT was effective in decreasing both target destructive behavior and non-targeted disruptive behaviors.     

Resurgence Following Higher or Lower Quality Alternative Reinforcement

Resurgence is a temporary increase in a previously suppressed target behavior following a worsening in reinforcement conditions. Previous studies have examined how higher rates or magnitudes of alternative reinforcement affect suppression of the target behavior and subsequent resurgence. However, there has been no investigation of the effects of higher versus lower qualities of alternative reinforcement on resurgence. Using a three-phase resurgence preparation with rats, the present experiments examined the effects of an alternative reinforcer that was of higher (Experiment 1) or lower (Experiment 2) quality than the reinforcer that had previously maintained the target behavior. The results of both experiments showed greater reductions in target behavior with a higher quality alternative reinforcer and larger increases in target responding when a higher quality alternative reinforcer was removed. Along with prior findings with higher rates and magnitudes of alternative reinforcement, these findings suggest that variations in reinforcer dimensions that increase the efficacy of alternative reinforcement also tend to increase resurgence when alternative reinforcement is removed. The results are discussed in terms of the resurgence as choice in context model and in terms of potential clinical implications.