Title: Using Functional Communication Training to Reduce Aggressive Behavior in Autism
1- Using Functional Communication Training to Reduce
Aggressive Behavior in Autism
American Speech-Language-Hearing Association
Convention Miami, FL November 17, 2006
Miriam Chacon, M.S. Oliver Wendt, PhD Lyle L.
Lloyd, PhD Department of Educational
Studies Purdue University
2Pervasive Developmental DisorderAutism
- Individuals with autism present with the
following characteristics - Deficits in social skills
- Deficits in language communication skills
- Exhibit stereotypical behavior
- (DSM IV, 2000)
3Challenging Behavior
4Functional Communication Training (FCT)
- Systematic intervention in which the challenging
behavior is replaced by more socially appropriate
behavior. (Sigafoos Meikle, 1996) - Replacement behavior is intended to serve the
same purpose as the challenging behavior. (Carr,
1988) - Underlying notion that challenging behaviors are
communicative intents (Durand, 1993 Skinner,
1957)
5Purpose of Review
- Evidence Based Practice (EBP)
- Provide evidence about the effectiveness of FCT
for practitioners - Provide a systematic review which uses
quantitative measures to determine treatment
effectiveness - Last review published in 1997 (Mirenda)
- Research Question
- Is FCT an effective treatment in decreasing
aggressive behaviors in individuals with autism?
6Search Strategies
- A comprehensive search strategy was used to
locate intervention studies - numerous databases (e.g., Academic Search Elite,
ERIC, Medline, PsycINFO) - search engines (Google Scholar, MetaPress,
Science Direct) - other strategies (ancestry journal hand
searches) - Keyword and keyword combinations used
- autism, self-injury, challenging behavior,
aggression, functional communication training
(FCT), functional equivalence training,
developmental disabilities, response training,
manual signs, graphic symbols, augmentative
alternative communication (AAC), self-abuse,
problem behaviors
7Inclusion Criteria
- Out of 24 studies, 10 met the inclusion criteria.
- FCT was operationally defined
- Subjects were diagnosed as having autism (other
PDDs excluded) - Single-subject research design
- True experimental design only, no
pre-experimental - Published in peer-reviewed journals from 1976 -
2005 - Aggressive behaviors were targeted in the
intervention
8Rejected Studies
- These articles met the initial keyword criteria.
However, they were rejected upon careful review
for one or more of the following reasons - Was not FCT but rather functional communication
- FCT was not the intervention
- Aggression was not the target behavior
- No intervention was implemented
9Accepted Studies
- FCT only
- Braithwaite Richdale (2000)
- Day, Horner, ONeill (1994)
- Horner Day (1991)
- Sigafoos Meikle (1996)
- Schindler Horner (2005)
- Wacker, et al. (1990)
- FCT within a treatment package
- Fisher et al. (2005)
- Hagopian et al. (2005)
- Lalli, Casey, Kates (1995)
- ONeill Sweetland-Baker (2001)
10Non-parametric Measures
- Percentage of Non-overlapping Data (PND)
- (Scruggs, Mastropieri, Casto, 1987)
- Mean PND
- greater than 90 highly effective
- between 70 - 90 fairly effective
- between 50 - 70 questionable effectiveness
- below 50 unreliable treatments
- Percentage Reduction Data (PRD)
- (µB µI) µB x 100 reduction from baseline
11PND
Calculate the percentage of treatment data points
that do not overlap with the lowest (or highest)
baseline data points Ex 4/5 0.8 80
Campbell, 2004
12PRD
Calculate the mean of last 3 data points for
baseline (µB) treatment (µI) then subtract from
each other, divide by µB to obtain the percent
reduction from the baseline. (µB µI) µB x
100 reduction from baseline Ex µB (4 5
8) / 3 5.7 µB (3 0 0) / 3 1
(5.7 1) / 5.7 x 100 82
Campbell, 2004
13Analysis
- The following replacement behaviors were
identified - Speech (n3)
- Vocalizations were used as the replacement
behavior - Braithwaite Richdale (2000)
- Day, Horner, ONeill (1994)
- Sigafoos Meikle (1996)
- Manual Signs Gestures (n3)
- A combination of manual signs and gestures were
used as the replacement behavior - Day, Horner, ONeill (1994)
- Sigafoos Meikle (1996)
- Wacker, et al. (1990)
- Graphic Symbols (n3)
- Graphic symbols were used as the replacement
behavior - Horner Day (1991)
- Schindler Horner (2005)
- Sigafoos Meikle (1996)
14Analysis Speech Vocalizations were used as the
replacement behavior
15Analysis Manual Signs Gestures A combination
of manual signs and gestures were used as the
replacement behavior
16Analysis Graphic Symbols Graphic symbols were
used as the replacement behavior
17Findings
- FCT ranged from fairly effective to highly
effective in the studies reviewed - FCT yielded greater reduction of challenging
behaviors when speech manual signs/gestures
were used as the replacement behaviors - graphic symbols yielded the least amount of
reduction
18Limitations
- A small number of studies were analyzed
- very specific inclusion criteria
- PND calculations had to be adjusted for some
studies - outliers unusual circumstances in the data
reported in the studies
19Future Directions
- Master theses dissertations are currently under
review and will be included in the future - Inclusion of studies in which FCT is part of a
treatment package is warranted will be analyzed - Reliability analysis
- Inclusion of study coding
- Use of 3rd statistic
- Percentage of Zero Data (PZD) for measuring
behavior reduction - PRD needs to be developed further
- no conventions available for score interpretation
regarding degree of effectiveness
20References
- Campbell, J. M. (2004). Statistical comparison of
four effect sizes for single-subject designs.
Behavior Modification, 28(2), 234-246. - Carr, E. (1988). Functional equivalence as a
mechanism of response generalization. In R.
Horner, R. Koegel, G. Dunlap (Eds.),
Generalization and maintenance Life-style
changes in applied settings (pp. 221-241).
Baltimore Paul H. Brookes. - Carr, E., Durand, V. M., (1985). Reducing
behavior problems through functional
communication training. Journal of Applied
Behavior Analysis, 18, 111-126. - Centers for Disease Control and Prevention
(2005). How common is Autism Spectrum Disorder
(ASDs)? Retrieved November 13, 2005, from
http//www.cdc.gov/about/default.htm. - Diagnostic and statistical manual of mental
disorders (DSM IV) (4th ed.). (2000). Arlington,
VA American Psychiatric Association - Durand, V. M. (1993). Functional communication
training using assistive devices Effects on
challenging behavior and affect. Augmentative and
Alternative Communication, 9, 168-176. - Mirenda, P. (1997). Supporting individuals with
challenging behavior through functional
communication training and AAC Research review.
Augmentative and Alternative Communication, 13,
207-225. - National Institutes of Health (NIH) (1991).
Treatment of destructive behaviors in persons
with developmental disabilities. Washington, DC
Author. - Scruggs, T. E., Mastropieri, M. A., Casto, G.
(1987). The quantitative synthesis of
single-subject research Methodology and
validation. Remedial and Special Education, 8(2),
24-33. - Sigafoos, J., Meikle, B. (1996). Functional
communication training for the treatment of
multiply determined challenging behavior in two
boys with autism. Behavior Modification, 20(1),
60-84. - Skinner, B. F. (1957). Verbal behavior. Englewood
Cliffs, NJ Prentice-Hall. - Wacker, D. P., Steege, M. W., Northup, J., Sasso,
G., Berg, W., Reimers, T., Cooper, L., Cigrand,
K., Donn, L. (1990). A component analysis of
functional communication training across three
topographies of severe behavior problems. Journal
of Applied Behavior Analysis, 23, 417-429.
21Articles Included in the Review
- Braithwaite, K. L., Richdale, A. L. (2000).
Functional communication training to - replace challenging behaviors across two
behavioral outcomes. Behavioral - Interventions, 15, 21-36.
- Day, H. M., Horner, R. H., ONeill, R. E.
(1994). Multiple functions of problem - behaviors Assessment and intervention. Journal
of Applied Behavior Analysis, - 27, 279-289.
- Horner, R. H., Day, H. M. (1991). The effects
of response efficiency on functionally - equivalent competing behaviors. Journal of
Applied Behavior Analysis, 24, 719- - 732.
- Schindler, H. R., Horner, R. H. (2005).
Generalized reduction of problem behavior of
young children with autism Building
trans-situational interventions. American Journal
on Mental Retardation, 110, 36-47. - Sigafoos, J., Meikle, B. (1996). Functional
communication training for the treatment of
multiply determined challenging behavior in two
boys with autism. Behavior - Modification, 20(1), 60-84.
- Wacker, D. P., Steege, M. W., Northup, J., Sasso,
G., Berg, W., Reimers, T., Cooper, L., Cigrand,
K., Donn, L. (1990). A component analysis of
functional - communication training across three topographies
of severe behavior problems. - Journal of Applied Behavior Analysis, 23,
417-429.
22Additional Articles AcceptedFCT within a
treatment package (data analysis not included in
this review)
- Fisher, W. W., Adelinis, J. D., Volkert, V. M.,
Keeney, K. M., Neidert, P. L., Hovanetz, A.
(2005). Assessing preferences for positive and
negative reinforcement during treatment of
destructive behavior with functional
communication training. Research in Developmental
Disabilities, 26, 153-168. - Hagopian, L. P., Kuhn, S. A., Long, E. S.,
Rush, K. S. (2005). Schedule thinning following
communication training Using competing stimuli
to enhance tolerance to decrements in reinforcer
density. Journal of Applied Behavior Analysis,
38, 177-193. - Lalli, J. S., Casey, S., Kates, K. (1995).
Reducing escape behavior and increasing task
completion with functional communication
training, extinction, and response chaining.
Journal of Applied Behavior Analysis, 28,
261-268. - ONeill, R. E., Sweetland-Baker, M. (2001).
Brief report An assessment of stimulus
generalization and contingency effects in
functional communication training with two
students with autism. Journal of Autism and
Developmental Disorders, 31(2), 235-240.
23Rejected Articles
- Bird, F., Dores, P. A., Moniz, D., Robinson, J.
(1989). Reducing severe aggressive and
self-injurious behaviors with functional
communication training. American Journal on
Mental Retardation, 94, 37-48. - Bondy, A. S., Frost, L. A. (1998). The picture
exchange communication system. Seminars in Speech
and Language, 19(4), 373-389. - Brown, K. A. et al. (2000). Evaluating the
effects of functional communication training in
the presence and absence of establishing
operations. Journal of Applied Behavior Analysis,
33, 53-71. - Buckley, S. D., Newchok, D. K. (2005).
Differential impact of response effort within a
response chain on use of mands in a student with
autism. Research in Developmental Disabilities,
26, 77-85. - Carr, E. G., Carlson, J. I. (1993). Reduction
of severe behavior problems in the community
using a multicomponent treatment approach.
Journal of Applied Behavior Analysis, 26,
157-172. - Durand, V. M., Merges, E. (2001). Functional
communication training A contemporary behavior
analytic intervention for problem behaviors.
Focus on Autism and Other Developmental
Disabilities, 16(2), 110-119. - Kemp, D. C., Carr, E. G. (1995). Reduction of
severe problem behavior in community employment
using an hypothesis-driven multicomponent
intervention approach. JASH, 20(4), 229-247. - Koegel, L. K., Stiebel, D., Koegel, R. L.
(1998). Reducing aggression in children with
autism toward infant or toddler siblings. JASH,
23(2), 111-118. - McCord, B. E., Thomson, R. J., Iwata, B. A.
(2001). Functional analysis and treatment of
self-injury associated with transitions. Journal
of Applied Behavior Analysis, 34(2), 195-210. - Mirenda, P. (1997). Supporting individuals with
challenging behavior through functional
communication training and AAC Research review.
Augmentative and Alternative Communication, 13,
207-225. - Polirstok, S. R., Dana, L., Buono, S., Mongelli,
V., Trubia, G. (2003). Improving functional
communication skills in adolescents and young
adults with severe autism using gentle teaching
and positive approaches. Topics in Language
Disorders, 23(2), 146-153. - Symons, F. J., Fox, N. D., Thompson, T. (1998).
Functional communication training and naltrexone
treatment of self-injurious behaviour An
experimental case report. Journal of Applied
Research in Intellectual Disabilities, 11(3),
273-293. - Tincani, M. J., Castrogiavanni, A., Axelrod, S.
(1990). A comparison of the effectiveness of
brief versus traditional functional analyses.
Research in Developmental Disabilities, 20(5),
327-338. - Thompson, R. H., Fisher, W. W., Piazza, C. C.,
Kuhn, D. E. (1998). The evaluation and treatment
of aggression maintained by attention and
automatic reinforcement. Journal of Applied
Behavior Analysis, 31(1), 103-116.
24Contact Information
- Primary Author
- Miriam Chacon, doctoral student
- Purdue University
- 100 N. University Street, BRNG 5163
- West Lafayette, IN 47907-2098
- (765) 494-9668 (office)
- mchacon_at_purdue.edu
25Acknowledgements
- The authors would like to thank the Purdue
University AAC Group for the editorial
contributions and suggestions. - Funding support provided by
- ASHA Student Research Travel Award
- Department of Educational Studies, Purdue
University - College of Education, Purdue University