11/15/2017

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ProducingMeaningfulImprovementsinProblemBehaviorofPersonswithAutism

Formoreinformationgoto:www.practicalfunctionalassessment.com

WebinarNovember,2017

GregoryP.HanleyPh.D.,BCBA‐D

AutismNewJersey&TheAutismSocietyofSanFrancisco

Theaimofthetreatmentistorestorebalanceintherelationshipsbetweenpersonswithautism

andtheirfamilymembersandteachersandwithoutregrettableactionsbyeither

WithAutism,thereisahigherlikelihoodofproblembehaviorlikemeltdowns,aggression,andself‐injury

Whydorestricted“lifestyles”dictatedbyproblembehavior

persistformanyfamilieswithchildrenonthespectrum?

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Restrictivelifestylespersistpartlybecauseproblembehaviorofchildrenismerely

modifiedmedicated

mollifiedmicro‐analyzed

remediedapartfromskilldevelopment

Restrictivelifestylespersistpartlybecauseproblembehaviorofchildrenismerely

modifiedmedicated

mollifiedmicro‐analyzed

remediedapartfromskilldevelopment

Whydoesproblembehavioroccur?

Causesarecomplex—firstconsiderallofthem

Thenconsiderthecausesthatyoucandosomethingabout

– Forme,thosearetheconsequencesofthebehaviorthatserveasreinforcement

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Powerfulworkingassumption

Ifproblembehaviorisoccurringwithregularity…..

– itisbeingreinforced

Antecedent Behavior Consequence

Establishingoperation ProblemBeh. Reinforcement

Momattendsto Throwingtoys Mom’sattentionSibling

Dadinstructsto SIB DadgivesalittleturnoffIpad moretimeonIpad

Teacherinstructsto Meltdown Teachertriestocalmcomeoffswingtodo childwithremindersofsomediscrete‐trialwork goodevents&startsto

complywithchildrequests….

Theone thingatatimemodel:

AnAntecedent ABehavior AConsequence

An Establishing A ProblemBehavior A reinforceroperation

Theshifttothemany thingsatatimemodel:

Antecedents Behaviors Consequences

Establishing ProblemBehaviors Reinforcersoperations

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Theone thingatatimemodel:An Establishing A ProblemBehavior A reinforcer

operation

Nothavinglooked Lieabout AccesstothephoneAtphone needingtopee totext,chat,etc.

(maybe,butnotlikely)

Beenlookingat Lieabout Accesstothephonephone&textappears needingtopee totext,chat,etc.from“thatguy” you (morelikely,butnotinevitable)spokew/momentsago

Somewhatboring Lieabout Accesstothephonewebinar needingtopee totext,chat,etc.

(morelikely,butnotinevitable)

Theshifttothemany thingsatatimemodel:

Synthesized SynthesizedEstablishing ProblemBehaviors Reinforcersoperations

Nothavinglooked Lieabout Escapethewebinaratphoneforawhile needingtopee* andand (mostcertainly) accesstotext,chatThewebinaris esp.w/“thatguy”somewhatboringandtextappearsfrom“thatguy”

Functionalassessment

itisaprocess

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GoalofaFunctionalAssessmentIdentifytheconsequencesthatmaintainproblembehavior

Identifythesituationsthatevokethebehavior

(And,todosoquicklyandsafely)

Inordertotreatproblembehavior

PracticalFunctionalAssessmentProcesswww.practicalfunctionalassessment.com

IndirectAssessment*Open‐endedinterview(always)

*Single,briefobservation(sometimes)

Discovery

FunctionalAnalysis*IISCA(always)

Demonstration

CaseExample:Gail,3yearsold,PDD‐NOS

Interview suggestedthatGailengagedinmeltdownsandaggression….

whenMomwasattendingtoothertasksorpeople….

inordertogainMom’sundividedattentionandtohaveMomplaywithherandhermostpreferredtoys.

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FunctionalAnalysis:TestCondition

Test:Momattendstoothertasksandpeople….

AssoonasGailengagedinanyproblembehavior,MomdirectsallofherattentiontoGailwhileinteractingwithherandhermostpreferredtoys.

Gail

Sessions

1 2 3 4 5 6

Pro

blem

Beh

avio

r pe

r m

inut

e

0

1

2

3

4

ControlTest

Inthetest,weareemulatingtheconditionsMomdescribedasbeingassociatedwithGail’sproblembehavior.

FunctionalAnalysis:ControlCondition

Control:MomdirectsallherattentiontoGailwhileinteractingwithherandhermostpreferredtoystheentiretime.

Gail

Sessions

1 2 3 4 5 6

Pro

blem

Beh

avio

r pe

r m

inut

e

0

1

2

3

4

ControlTest

Inthecontrol,weareemulatingtheconditionsMomdescribedasbeingassociatedwithnoproblembehavior.

CaseExample:Gail,3yearsold,PDD‐NOS

Byalternating between5minuteperiodsoftestandcontrolconditions,wewereabletoturnonandoffGail’sproblembehavior….

GivingusandherMomconfidenceastowhyshewasengagingintheextraordinaryproblembehavior

….tosimplygainandmaintainherMom’sundividedattentionandplaytime

Gail

Sessions

1 2 3 4 5 6

Pro

blem

Beh

avio

r pe

r m

inut

e

0

1

2

3

4

ControlTest

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Threeimportantoutcomesfromtheanalysis

1. Wehaveconfirmedthehunch

2. Wehaveabaselinefromwhichtoevaluatetreatment

3. WehaveamotivatingconditiontoteachGailskills(andshehaslearned“thegame”)

Gail

Sessions

1 2 3 4 5 6

Pro

blem

Beh

avio

r pe

r m

inut

e

0

1

2

3

4

ControlTest

IISCA: Interview-Informed Synthesized Contingency Analysis

1. Single

2. Individualized

3. Synthesized contingency

4. Reinforce precursors to and dangerous behavior

5. Test-matched

6. Rapid alternation of test and control conditions

Test

Control

Analysis

Sessions

1 2 3 4 5 6

0

1

2

3

4

Escape/Tangible/Attention

Zeke

Pro

blem

Beh

avio

r pe

r m

in

AnIISCAZeke

14‐yearoldboy

DiagnosedwithAutism

EngagedinSevereSIBandAggression

1:1inSpecializedSchool

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EnsuringaSafe Analysis

Mostimportant….

Immediatedeliveryofallsuspectedreinforcersforallformsofproblembehaviorreportedtoco‐occur

Theprocessofinterviewthenanalysis*

hasgenerality

andbyanalysis,Imeanthosethatinvolvesynthesizedcontingenciesinformedfromopen‐endedinterviewsa.k.a IISCASs

FromJessel,Hanley,and

Ghaemmaghami(JABA,2016)

0

4

8

12 Will

TestControl

Wayne Allen Kat (Cxt 1)Sam

0

2

4

6 Jack (Cxt 1) Keo

Kristy Jim

Roxy

0

2

4

6 Alex (Cxt 2) Chris

Jeff Zeke Kat (Cxt 2)

0

1

2

3

4 Mike Mitch

Gary Jian Earl

0.5

1.0

1.5

2.0

0

Paul Dan

Alex (Cxt 1) Beck

Sid

2 6 10

0.5

1.0

1.5

2.0

0

Lee

2 4 6

Steve

1 3 5

Jesse

1 3 5

Carson

1 3 5

Jack (Cxt 2)

Sessions

Pro

blem

beh

avio

r pe

r m

in

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Sessions

Pro

blem

beh

avio

r pe

r m

inut

e

FromRajaramanetal.(beingprepared)

Wesynthesize multiplecontingenciesintoonetestconditionwhichcontingenciesandthespecificmaterialsandinteractionsareinformedbytheinterview

SomeImportantAspectsofourApproach

PAST:SinglecontingenciesAttentionor tangibles (social‐positivereinforcement)or Escape (social‐negativereinforcement)or Sensory/non‐social (automaticreinforcement)

PRESENT:Synthesized(combined)contingenciesAttentionand tangiblesEscapeto tangiblesEscapeto tangiblesandattentionEscapeto automaticreinforcementCompliancewithmandsEscapetocompliancewithmandsEscapetoaccesstotangibles,rituals,&preferredconversationsEtc…..

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Whysynthesize?Isolated contingenciessometimesdonotcontrolbehaviorwhereassynthesizedcontingenciesdo.

0

1

2

3

4

Tangible /Attention

AnalystMother

AnalystMother

Analyst

Gail

Prob

lem

Beh

avio

r pe

r M

in

0

1

2

3

4

Tangible

Sessions

2 4 6 8 10 12 14

0

1

2

3

4

Test

Control

Meltdowns Col 46

Attention

CaseExample(Gail,3yo,dx:PDD‐NOS)Analyst:NicholasVanselowSetting:Clinic

Synthesized

IsolatedIsolated

Ignore/Alone

EscapeTangible

Play

Attention

0

2

4 Escape totangiblesand attention

0

2

4Escape to rituals

2 4 60

1 Escape to tangibles

5 10 15 20

Pro

blem

beh

avio

r pe

r m

in

Sessions

IISCA Standard

Dylan

Emily

Chloe

Jeff

0

2

4

ControlTest

Escape totangibles

AnalysisComparison(Slatonetal.,2017,JABA)

Sometimesbothsynthesizedandisolatedreinforcementcontingenciesinfluenceproblembehavior

Synthesized Isolated

0

1

2TestControl

Escape to tangiblesand attention

Tangible

Ignore/Alone

PlayEscape

Attention

0

1

2

3Escape to tangiblesand attention

1 2 3 4 50

1

2

3Escape totangibles

5 10 15

Diego

Mason

Riley

Pro

blem

beh

avio

r pe

r m

in

Sessions

IISCA Standard IISCA

AnalysisComparison(Slatonetal.,2017,JABA)

Butouranalysesshow,moreoften,thatsynthesizedreinforcementcontingenciesinfluenceproblembehaviorwhereasisolatedonesdonot

Synthesized IsolatedSynthesized

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0

1

2

Escape topredictableschedule

ControlTest

EscapePlay

AttentionTangible

Alone

1 2 3 4 5

0

1

2Escape to tangibles,stereotypy, andattention

5 10 15 20 250

2

4

6

8

3Escape to tangibles

d

Prob

lem

beh

avio

r pe

r m

in Kyle

Jonah

IISCA Standard

Sessions

Synthesizedvs IsolatedAnalyses(Slatonetal.,2017,JABA)

Synthesized Isolated Synthesizedreinforcementcontingenciesinfluenceproblembehaviorwhereasisolatedonesdonot

(*havenotyetseentheconverse)

www.practicalfunctionalassessment.com

0

2

4

6

8TestControl

Food,attention

Addison

AttentionTangible (food)Control

0

2

4

6

8

10

Escape totangibles,attention

Jay

Control

AttentionTangibleEscape

0

2

4Escape tocompliance withrequests

Franklin

EscapeRequestsControl

4

IISCA Decoupled IISCASynthesized Isolated SynthesizedType of

contingency

Pro

blem

beh

avio

r pe

r m

in

Slatonetal.(inpreparation)

Synthesized IsolatedSynthesized

MoreoftenonlysynthesizedcontingenciesinfluencePB

Sometimesboth

Synthesized Contingency First Author (Year) ParticipantsEscape to mand compliance Bowman (1997)

Eluri (2016)

Jessel (2016)

Roscoe (2015)

Ben, Jerry

Pablo

Allen, Mike, Jesse, Jian

Chris

Escape to previous activity Adelinis (1999)

Fisher (1998)

Hanley (2014)

Hagopian (2007)

Raffie

Ike, Tina

Bob

Perry, Maxwell, Kelly

Escape to rituals / stereotypy Leon (2013)

Rispoli (2014)

Jessel (2016)

Slaton (2017)

Laura

Timmy, John, Diego

Sam

Chloe

Attention + tangibles Brown (2000)

Ghaemmaghami (2016)

Hanley (2014)

Mann (2009)

Payne (2014)

Santiago (2016)

Jim

Jack, Nico

Gail

Madison

Samantha

Karen

Escape + tangibles Fisher (2016)

Jessel (2016)

Lambert (2017)

Lloyd (2015)

Roscoe (2015)

Slaton (2017)

Strohmeier (2016)

Cameron

Kristy, Jim, Carson, Chris, Mitch

S‐2

Abhi, Sid

Jim

Riley, Dylan, Jeff,

S‐1 (no pseudonym given)

Escape + attention Mueller (2005)

Payne (2014)

Sarno (2011)

Bob

Andrew

Brandon, Franklin, J’Marcus

Escape + attention

+ tangibles

Fisher (2016)

Ghaemmaghami (2015)

Jessel (2016)

Santiago (2016)

Slaton (2017)

Alan, Allie, Sylvia, Tina

Dan

Jeff, Gary, Wayne, Earl, Keo, Lee, Paul

Zeke

Diego, Emily, Kyle, Jonah

Escape + attention + tangibles + 

mand compliance

Ghaemmaghami (2016)

Hanley (2014)

Jessel (2016)

Alex

Dale

Jian

Escape + preferred

conversation topics

Jessel (2016)

Santiago (2016)

Slaton (2017)

Sid, Beck, Steve

Karen

Mason

Whysynthesize?Isolatedcontingenciessometimesdonotcontrolbehaviorwhereassynthesizedcontingenciesdo.From:

NatureandScopeofSynthesisinFunctionalAnalysisandTreatmentofProblemBehavior

Slaton&Hanley (underreview,JABA)

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TreatmentefficacyoftendependsonsynthesizedcontingenciesFrom:

NatureandScopeofSynthesisinFunctionalAnalysisandTreatmentofProblemBehavior

Slaton&Hanley (underreview,JABA)

FirstAuthor(Year) StandardFAOutcome IneffectiveIsolatedTreatment

RelativelyeffectiveSynthesizedTreatment

Lalli(1996) Escape,attention Escape Escapetoattention

Piazza(1996)Escape,attention,

tangibles–

Escapetotangiblesandattention

Piazza(1997)Andy:esc,att

Carly:esc,att,tangBen:esc,att,tang

AttentionEscape

Andy:Esctotang.Carly:Esctotang.Ben:Esctotang.

Piazza(1998)Escape,attention,

tangiblesAttentionEscape

Tom:Esc.totang,attJerry:Esc.toatt.

Hoch(2002)Mickey:escapeEmily:escape

Sean:escape,tang.

Mickey:N/AEmily:EscapeSean:Escape

Escapetotangibles

Bachmeyer(2009) Attention,escapeAttentionEscape

Escapeextinction+attentionextinction

Falcomata(2013)Escape,attention,

tangibles–

Escapetotangiblesandattention

Zangrillo(2016) Escape Escape Escapetotangibles

0

1

2

3

4

5

FCR

BL FCT + EXTEscape totangibles,attention

Problembehavior

BL FCT + EXTEscape

5 100

1

Escape totangibles

BL FCT + EXT

5 10

Attention

BL FCT + EXT

IISCA- based treatment Standard-based treatment

Pro

blem

beh

avio

r pe

r m

in

Sessions

Emily

Jeff

Synthesizedvs IsolatedAnalyses(Slatonetal.,2017,JABA)

Synthesized Isolated

Whysynthesize?

1. Seemstoemulatetheecologybetter

2. Isolatedcontingenciessometimesdonotcontrolbehaviorwhereassynthesizedcontingenciesdo

3. Doingsoleadstoeffectiveaction—meaningfultreatmenteffects– Hanleyetal.,2014,Santiagoetal.,2016;

Ghaemmaghamietal.,2016

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Dr.JoshuaJessel&colleagues(inpress,JABA)

AchievingSociallySignificantReductionsinProblemBehaviorfollowingtheInterview‐InformedSynthesizedContingencyAnalysis:ASummaryof25OutpatientApplications

Baseline Treatment0

2

4

6

N = 25

p < .001

Pro

blem

beh

avio

r pe

r m

in

1 2 3 4 5 6 7

You found the recommended treatment acceptable

You are satisfied with the amount ofimprovement seen in problem behavior

You are satisfied with the amountof improvement seen in

communication skills

You found the assessment andtreatment helpful to your home situation

Notacceptable/satisfied/helpful

Highlyacceptable/

satisfied/helpfulCaregiver Rating

Formoresupporttoengagethisprocessgoto:www.practicalfunctionalassessment.com

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TREATMENT

Sessions

1 2 3 4 5 6

0

1

2

3

4

Escape/Tangible/Attention

Zeke

Pro

blem

Beh

avio

r pe

r m

in

FunctionalAnalysis

Zeke

14‐yearoldboy

diagnosedwithAutism

EngagedinSevereSIBandAggression

1:1inSpecializedSchool

0

1

2

3

4

0

1

2

3

4

Com

plex

FC

Rpe

r m

in

0

1

2

3

4

Reinforcem

ent (%)0

20

40

60

80

100

Pro

blem

Beh

avio

rpe

r m

in

0

1

2

3

4

Sessions

5 10 15 20 25 30 35 40 45 50 55 60 65

Res

pons

e to

In

stru

ctio

ns (

%)

0

20

40

60

80

100

Treatment Extension

1 2

Compliance

Noncomp.

Levels3

BL FCT + EXT Denial and Delay Tolerance TrainingSimple FCR Complex FCR

Zeke

Sim

ple

FCR

per

min

Tol

eran

ce R

espo

nse

per

min

   

Response Chaining

Problembehaviornolongeryieldsthereinforcers (escapetochild‐directedplayandteacherattention)

Asimpleresponse(buttonpress:“Mywayplease”)ispromptedandreinforcedwith(escapetochild‐directedplay&teacherattention)

TreatmentAnalysis

Zeke

14‐yearoldboy

diagnosedwithAutism

EngagedinSevereSIBandAggression

1:1inSpecializedSchool

11/15/2017

15

0

1

2

3

4

0

1

2

3

4

Com

plex

FC

Rpe

r m

in

0

1

2

3

4

Reinforcem

ent (%)0

20

40

60

80

100

Pro

blem

Beh

avio

rpe

r m

in

0

1

2

3

4

Sessions

5 10 15 20 25 30 35 40 45 50 55 60 65

Res

pons

e to

In

stru

ctio

ns (

%)

0

20

40

60

80

100

Treatment Extension

1 2

Compliance

Noncomp.

Levels3

BL FCT + EXT Denial and Delay Tolerance TrainingSimple FCR Complex FCR

Zeke

Sim

ple

FCR

per

min

Tol

eran

ce R

espo

nse

per

min

   

Response Chaining

Amoreinteractionalresponse(shouldertap,waitforteacheracknowledgement,two‐buttonpress:MayIhave/Mywayplease”)ispromptedandreinforced

TreatmentAnalysis

Zeke

14‐yearoldboy

diagnosedwithAutism

EngagedinSevereSIBandAggression

1:1inSpecializedSchool

0

1

2

3

4

0

1

2

3

4

Com

plex

FC

Rpe

r m

in

0

1

2

3

4

Reinforcem

ent (%)0

20

40

60

80

100

Pro

blem

Beh

avio

rpe

r m

in

0

1

2

3

4

Sessions

5 10 15 20 25 30 35 40 45 50 55 60 65

Res

pons

e to

In

stru

ctio

ns (

%)

0

20

40

60

80

100

Treatment Extension

1 2

Compliance

Noncomp.

Levels3

BL FCT + EXT Denial and Delay Tolerance TrainingSimple FCR Complex FCR

Zeke

Sim

ple

FCR

per

min

Tol

eran

ce R

espo

nse

per

min

   

Response Chaining

Responsestodisappointmentarepromptedandreinforced:(Takeabreathandnoddingyes)

Now,FCRsarereinforcedhalfthetime.Theotherhalf,theteacherdeniesthebid(e.g.,says’s no,doyourworkwithoutme,please)

Cuesofdisappointment,Delaystoreinforcement,andunpredictableoutcomeshavenowbeenintroduced!

TreatmentAnalysis

Zeke

14‐yearoldboy

diagnosedwithAutism

EngagedinSevereSIBandAggression

1:1inSpecializedSchool

0

1

2

3

4

0

1

2

3

4

Com

plex

FC

Rpe

r m

in

0

1

2

3

4

Reinforcem

ent (%)0

20

40

60

80

100

Pro

blem

Beh

avio

rpe

r m

in

0

1

2

3

4

Sessions

5 10 15 20 25 30 35 40 45 50 55 60 65

Res

pons

e to

In

stru

ctio

ns (

%)

0

20

40

60

80

100

Treatment Extension

1 2

Compliance

Noncomp.

Levels3

BL FCT + EXT Denial and Delay Tolerance TrainingSimple FCR Complex FCR

Zeke

Sim

ple

FCR

per

min

Tol

eran

ce R

espo

nse

per

min

   

Response Chaining

Now,FCRsarereinforced1/3ofthetime.

TRsarereinforced1/3ofthetime.

Andcompliancewithprogressivelylongerandmorechallenginginstructionsisreinforced

TreatmentAnalysis

Zeke

14‐yearoldboy

diagnosedwithAutism

EngagedinSevereSIBandAggression

1:1inSpecializedSchool

11/15/2017

16

0

1

2

3

4

0

1

2

3

4

Com

plex

FC

Rpe

r m

in

0

1

2

3

4

Reinforcem

ent (%)0

20

40

60

80

100

Pro

blem

Beh

avio

rpe

r m

in

0

1

2

3

4

Sessions

5 10 15 20 25 30 35 40 45 50 55 60 65

Res

pons

e to

In

stru

ctio

ns (

%)

0

20

40

60

80

100

Treatment Extension

1 2

Compliance

Noncomp.

Levels3

BL FCT + EXT Denial and Delay Tolerance TrainingSimple FCR Complex FCR

Zeke

Sim

ple

FCR

per

min

Tol

eran

ce R

espo

nse

per

min

   

Response Chaining

TreatmentAnalysis

Zeke

14‐yearoldboy

diagnosedwithAutism

EngagedinSevereSIBandAggression

1:1inSpecializedSchool

Whatisthetreatment????

Intermittentandunpredictablereinforcementoflifeskills:

FunctionalCommunicationDelay/denialtolerationCompliance

ResponseReinforcementis: requirementis:Function‐based VariableSynthesized UnpredictableDifferentialIntermittentUnsignaledVariableinduration

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TreatmentImplementation

*Materialsnotneeded:LaminateLaminatingmachineGluegunsVisavismarkersVelcroTokensTokenboardsTimersStickersCandiesAnythingthatwasnotalreadyin

thechild’senvironment!

1. Puttheseinyourpocket2. Pulloneoutwhilechildis

experiencingtheirreinforcers

3. Keepittoyourself4. Requirethatbehaviornext

time

Appcalled“NamesinaHat”

Appcalled“Roundom”

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Pro

blem

Beh

avio

r

per

min

0.0

0.5

1.0

1.5

2.0

2.5

3.0

Sim

ple

FC

R

p

er m

in

0.0

0.5

1.0

1.5

2.0

Com

plex

FC

R

per

min

0.0

0.5

1.0

1.5

2.0

Tol

eran

ce R

espo

nse

pe

r m

in

0.0

0.5

1.0

1.5

2.0

100

BL FCT + EXT

Sim

ple

FCR

Com

plex

FC

R

Denial BL Denial and Delay Tolerance Training

 Treatment Extension

 Response Chaining

Meltdownsandaggression

“Playwithme”

“Excuseme,”waitsforacknowledgementfromparent,thensays,“Willyouplaywithme,please”withappropriatetoneandvolume

Saying,“okay”whileglancingatparentwhojustsaid“No,”Wait,”“Holdon,”or“inaminute”

TreatmentAnalysis

Gail

3‐yearoldgirl

diagnosedwithAutism

Engagedinextendedmeltdownswithaggression

ProcessinClinicandhomewithmotherimplementing

0.0

Tol

eran

ce R

espo

nse

pe

r m

in

0.0

0.5

1.0

1.5

2.0

Sessions5 10 15 20 25 30 35 40 45 50 55 60 65 70

R

espo

nse

to

Inst

ruct

ions

(%

)

0

25

50

75

100

Rei

nfor

cem

ent

(%)

0

25

50

75

100

Gail

1 2 3

Compliance

Noncomp.

Levels

Visits

 

2

Calendar Days (2012-2013)

3 6

12/1

312

/14

 

7

 

8

 

9 10

 

11

 

12

 

13

 

14

1/18

1/21

1/22

1/25

1/29

2/1

2/4

2/5

2/6

     

15

 

2/12

       

16 17 18 19

2/15

2/18

2/19

2/20

 

20

3/1

 

21

3/2

 

22

3/8

Reinforcement:TimewithMom’sundividedattentionandpreferredtoys

Compliance:DoingwhateverMomaskedhertodoquicklyandcompletely

TreatmentAnalysis

Gail

3‐yearoldgirl

diagnosedwithAutism

Engagedinextendedmeltdownswithaggression

ProcessinClinicandhomewithmotherimplementing

TimeAssessment

Steps

# of Visits (1 hr each)

Cost (in US dollars)

Range Mean Range Mean

1* Interview -- 1 -- 200

2* Functional Analysis 1 - 4 2.3 166 - 800 467

3 Functional Communication Training

1 - 3 2 200 - 534 400

4 Complex FCT 1 - 4 2.4 200 - 860 487

5 Tolerance Response Training

2 - 7 4.6 300 - 1400 913

6 Easy Response Chaining 1 - 5 2.6 200 – 960 520

7* Difficult Response Chaining 2 - 11 5.1 400 - 2240 1,013

8* Treatment Extension 4 - 9 7.3 800 - 1800 1,467

Totals: 23 - 32 27 5,467

Supervision meetings: 16 - 28 20 1000 - 1750 1250

Report writing / planning: -- 4 -- 500

Grand Totals: 6225 - 8650 7,217

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CostAssessment

Steps

# of Visits (1 hr each)

Cost (in US dollars)

Range Mean Range Mean

1* Interview -- 1 -- 200

2* Functional Analysis 1 - 4 2.3 166 - 800 467

3 Functional Communication Training

1 - 3 2 200 - 534 400

4 Complex FCT 1 - 4 2.4 200 - 860 487

5 Tolerance Response Training

2 - 7 4.6 300 - 1400 913

6 Easy Response Chaining 1 - 5 2.6 200 – 960 520

7* Difficult Response Chaining 2 - 11 5.1 400 - 2240 1,013

8* Treatment Extension 4 - 9 7.3 800 - 1800 1,467

Totals: 23 - 32 27 5,467

Supervision meetings: 16 - 28 20 1000 - 1750 1250

Report writing / planning: -- 4 -- 500

Grand Totals: 6225 - 8650 7,217

Social Acceptability Questionnaire Results

Ratings

Questions Gail Dale Bob Mean

1. Acceptability of assessment procedures 7 7 7 7

2. Acceptability of treatment packages 7 7 7 7

3. Satisfaction with improvement in problem behavior 7 7 6 6.7

4. Helpfulness of consultation 7 7 7 7

Note. 7=highly acceptable, highly satisfied, or very helpful 1=not acceptable, not satisfied, or not helpful

 

IISCAshaveledsocially‐validated outcomes

fromHanleyetal.,2014

PersonalizedSocialvalidityData

Parents' Comfort Level of Presenting the Evocative Situation

Comfort Levels

Questions Pre-treatment Post-treatment

Gail

1. Taking away toys 1 7

2. Telling child "no" when they ask for something 3 7

3. Giving instructions 5 7

Dale

1. Interrupting child's preferred activity and telling them to do homework or other non-preferred activities

4 6

Bob

1. Taking away DS or iPad at meal times 3 7

2. Taking away DS or iPad on a transition 3 7

3. Interrupting or correcting math work 3 7

Note. 7=very comfortable 1=not comfortable.  

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TreatmentReview

Personalized andsynthesized reinforcersdelivered

intermittently,unpredictably, and exclusively

followingvariouschainlengthsofappropriate

behaviorthatincludes

communication,toleration,andcompliance

Thetreatmentisimplementedinthemostchallengingcontextthatissufficientlyconvenienttorepeatedlyarrange

Referredtoasthe“twoCs”ofcontext

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Thetreatmentprocessbeginsbyprovidingpersonalized andsynthesized reinforcersforeachandeveryproblembehaviorandthenforeachandeverycommunicationresponse

Trustisbuiltbyarrangingforeasyresponsestoreliablyandimmediatelyresultinall reinforcers

ThefirstcommunicationresponsetaughtisreferredtoastheSimpleFunctionalCommunicationResponse(sFCR)

ThekeyfeaturesofansFCR: Simple (Horner&Day,1991) Novel (Derbyetal.,1998) Omnibus(“Myway”) (Hanleyetal.,2014) Canbeeffectivelyprompted

Shapingofthefunctionalcommunicationresponsecontinues(Ghaemmaghamietal.,2018)

….untilitcontains:

Anobtainingalistenerresponse(e.g.,“Excuseme”) Agenerativeautoclitic frame(e.g.,“MayIhave_____”) Asocialnicety Propertone,pace,volume,articulation

ItisthenreferredtoasaComplexFunctionalCommunicationResponse(cFCR)(e.g.,“Excuseme[pause,waitforacknowledgement],MayIhavemyway,please?)

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ThecFCR issometimesdifferentiatedintospecificmands(Wardetal.,2018)

Anobtainingalistener responseAbreak responseAnaccesstopreferredtoysresponseAnattentionrecruitmentresponse

(e.g.,““Excuseme”[pause,waitforacknowledgement],“MayIhaveabreak,please?”“….MayIhavemystuffplease”....“Willyouplaywithme”)

Atoleranceresponseisthentaught(Hanleyetal.,2014;Santiagoetal.,2016;Ghaemmaghamietal.,2016)

NowSrisintermittentandunpredictable

Typical5‐trialsequenceinearlychainingphase:

Sr =synthesizedreinforcementcFCR =complexfunctionalcommunicationresponseTR =toleranceresponse

*Wejustintroduceddisappointmentandambiguityatthesametime—westayhereuntiltherearenonegativeemotionalresponses

cFCR TR cFCR cFCR TR

Trial1 Sr: Trial2 Sr: Trial3 Sr: Trial4 Sr: Trial5 Sr:

Thenchainingofcontextuallyappropriatebehavior(CAB)andmoreSrintermittencyandunpredictabilityfollows

Typical5‐trialsequenceinearlychainingphase:

Sr =synthesizedreinforcementcFCR =complexfunctionalcommunicationresponseTR =toleranceresponseeCAB =easycontextuallyappropriatebehavior

(e.g.,completionofmasteredtask,playwithalternativebutpreferredmaterials)hCAB =hardcontextuallyappropriatebehavior

(e.g.,accuratecompletionofchallengingmathproblems,independentplayw/mundanetoys)

cFCR 1hCAB 2eCAB TR 3eCAB

Trial1 Sr: Trial2 Sr: Trial3 Sr: Trial4 Sr: Trial5 Sr:

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Theaveragechainlengthgetsprogressivelylongerassuccessisexperiencedateachstep

Step Trial1 Sr: Trial2 Sr: Trial3 Sr: Trial4 Sr: Trial5 Sr: Mean#Rs/Sr Range1 cFCR TR 1eCAB 2eCAB 1eCAB 4.6 3‐6

1eCAB 2eCAB cFCR TR 1eCAB 4.6 3‐62 cFCR 1hCAB 2eCAB 3eCAB TR 5 3‐7

TR 2eCAB cFCR 3hCAB 1hCAB 5 3‐73 5eCAB cFCR 1hCAB TR 3eCAB 5.6 3‐9

TR 5eCAB cFCR 3hCAB 1eCAB 5.6 3‐94 2hCAB cFCR 4eCAB TR 6eCAB 6.2 3‐10

cFCR 6hCAB TR 4hCAB 2eCAB 6.2 3‐105 cFCR 5eCAB 3hCAB 7eCAB TR 6.8 3‐11

3hCAB cFCR 7eCAB TR 5hCAB 6.8 3‐116 TR 10eCAB cFCR 2eCAB 7hCAB 7.6 3‐13

cFCR 2hCAB 7eCAB 10hCAB TR 7.6 3‐137 2eCAB 10hCAB cFCR 13eCAB TR 8.8 3‐16

TR 13eCAB 2hCAB cFCR 10hCAB 8.8 3‐16

Typical5‐trialsequenceinlaterchainingphase:

Sr =synthesizedreinforcementcFCR =complexfunctionalcommunicationresponseTR =toleranceresponseeCAB =easycontextuallyappropriatebehaviorhCAB =hardcontextuallyappropriatebehavior

Bylaststep:Average10responsesperSr(range,3‐23)

10hCAB 3eCAB 20hCAB TR cFCR

Trial 1 Sr: Trial 2 Sr: Trial 3 Sr: Trial 4 Sr: Trial 5 Sr:

Someemphases:

Progressivelyincreasetheaverageamountofbehavior (notjusttime)requiredtoterminatethedelay(Ghaemmaghamietal.,2016)

Terminatethedelayforvarious amountsofbehavior

(sometimesexpectverylittlebehavior,sometimesexpectlongerormorecomplextypesofbehaviorduringthedelay)

Probablybesttonotsignalhowmuchbehaviorisrequiredtoterminatethedelays

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Attheendoftreatment:

manyappropriatebehaviorsdonotyieldreinforcementimmediately,butthereisnodelaytoreinforcementperse

Considerthislastpracticesession….

10hCAB 3eCAB 20hCAB TR cFCR

Trial 1 Sr: Trial 2 Sr: Trial 3 Sr: Trial 4 Sr: Trial 5 Sr:

Attheendoftreatment:

manyappropriatebehaviorsdonotyieldreinforcementimmediately,butthereisnodelaytoreinforcementperse

Duetochainingofappropriateresponses

SrComplexFCR “No” ToleranceResponse Instruction CAB(3)

SrComplexFCR

EOpresented

EOpresented

And,non‐reinforcementofaresponse(e.g.,amand)induces()anotherappropriateresponse(e.g.,toleranceresponse)asopposedtoproblembehavior

Sr“No”

SrComplexFCR “No” ToleranceResponse Instruction CAB(3)

SrComplexFCR

SrComplexFCR “No” Toleranceresponse Instruction

EOpresented

EOpresented

EOpresented

CAB(10)

EOpresented ComplexFCR ToleranceResponse

SrComplexFCR “No” Toleranceresponse InstructionEOpresented CAB(20)….

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Theaveragechainlengthisprogressivelyincreased,butcommunication,toleration,andshort/unexpectedcontextually‐appropriatebehaviorchainsarereinforcedsometimes,evenattheendoftreatment

Sr“No”

SrComplexFCR “No” ToleranceResponse Instruction CAB(3)

SrComplexFCR

SrComplexFCR “No” Toleranceresponse Instruction

EOpresented

EOpresented

EOpresented

CAB(10)

EOpresented ComplexFCR ToleranceResponse

SrComplexFCR “No” Toleranceresponse InstructionEOpresented CAB(20)….

Shorties nevergoaway.

Thiswaywekeephopealive!

Sametreatmentcanbeappliedtostereotypy thatinterfereswithlearning

withsociallymeaningfuleffects.

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Permissionbasedmodelinwhichcommunication,toleration,& contextuallyappropriatebehaviorsarestrengthened(adaptedfromHanley,Jin,Vanselow,&Hanratty,JABA,2014;willbedescribedinSlaton,Hanley,Ruppel,&Gage,inpreparation)

1. Teachchildtorequestaccesstostereotypyviamomentaryrestriction&contingentaccesstostereotypy

2.Teachchildtotoleratedenialsofmands forstereotypyviacontingent,intermittent,&unpredictableaccesstostereotypy

3.Teachchildtoengageincontextuallyappropriatebehaviorviaprompting&contingent,intermittent,& unpredictableaccesstostereotypy

freedom

fromproblembehaviors,commonamongpersonswithautism,thatdiminishthatperson’sandtheirfamily’squalityoflife

isattainable

Itisattainable

byfirstunderstanding*whythechildisengagingintheproblembehavior

understandingcanberealizedquickly,safely,andanalytically

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Itisattainable

whenchildrenaretaughtskills*tohelpthemnavigateourcomplexsocialworld

* Communication,Toleration,andContextuallyapprop.behavior

Itisattainable

whentheskillsaremaintainedviaunpredictableandintermittentreinforcement

whichisprobablythesamearrangementthatgeneratedthevariousformsofproblembehavior

Formoreinformationgoto:www.practicalfunctionalassessment.com

ManythankstomyPracticalFunctionalAssessmentandTreatment

ResearchandPracticegroup:

NickVanselow,SandyJin,LauraHanratty,JoanaSantiago,

MahshidGhaemmaghami,JoshuaJessel,JessicaSlaton,

RobinLanda,ChristyWarner,ShannonWard, TanyaMouzakes

AdithyanRajaraman,EllenGage,HollyGover,KelseyRuppel

CoryWhelan,DavidDePetris,&RachelMetras

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Formoreinformationgoto:www.practicalfunctionalassessment.com

Questions?

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