Using Functional Communication Training to Reduce Aggressive Behavior in Autism

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• 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
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Pervasive 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)

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Challenging Behavior
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Functional 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)

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Purpose 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?

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Search 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

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Inclusion 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

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Rejected 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

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Accepted 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)

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Non-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

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PND
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
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PRD
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
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Analysis

• 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)

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Analysis Speech Vocalizations were used as the
replacement behavior
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Analysis Manual Signs Gestures A combination
of manual signs and gestures were used as the
replacement behavior
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Analysis Graphic Symbols Graphic symbols were
used as the replacement behavior
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Findings

• 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

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Limitations

• 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

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Future 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

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References

• 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.

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Articles 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.

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Additional 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.

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Rejected 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.

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Contact Information

• Primary Author
• Miriam Chacon, doctoral student
• Purdue University
• 100 N. University Street, BRNG 5163
• West Lafayette, IN 47907-2098
• [phone] (office)
• mchacon_at_purdue.edu

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Acknowledgements

• 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