gregory p. hanley. ph.d., bcba-d functional assessment of severe problem behavior of persons with...
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Gregory P. Hanley. Ph.D., BCBA-D
Functional Assessment of Severe Problem Behavior of Persons with Autism:
A Focus on a Safer, Faster,and Still Effective Process
DatafinchNovember, 2014
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Autism is characterized by:
Impairments in
language developmentsocial interaction
and
Excessive repetitive behavior
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With Autism, there is a higher likelihood of problem behavior
MeltdownsAggression
Self-injuryChronic stereotypy
Sleep problems
References: Baghdadli, Pascal, Grisi, & Aussilloux, 2003; Horner et al., 2002; Kim et al., 2000; Murphy, Healy, & Leader, 2009; Thompson, 2009
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But,
freedom
from these behaviors for persons with Autism and their caregivers
is attainable
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It is attainable
without drugs
without hospitalization
without harsh punishment
without candies, stickers, and token boards
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It is attainable
by first understanding why the child is engaging in the problem behavior
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It is attainable
when children are taught skills to help them navigate our complex social world
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It is attainable
while showing complete respect for their preferences
without altering their rich and unique personalities(i.e., patterns of behavior)
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It is attainable
with proper assessment and treatment by a BCBA
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*Main assumption Severe problem behavior is understood
as learned behavior influenced by its outcomes and context
Problem
Behavior
Autism
*Applied
Behavior Analysis
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behavior analysts conduct functional assessments
To determine the personally relevant outcomes and context that influence problem behavior
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What is a functional assessment?
(You can’t hold it in your hand)
It is a process
through which the variables influencing problem behavior are identified
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Functional Assessment Process
Functional AnalysisSystematic observation within
two different and carefully designed contexts
Indirect Assessment an open ended interview with primary caregivers
Descriptive Assessmentbrief observation
and casual interaction
Test
Control
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The functional analysis is integral to the success of the process
Larger reductions in problem behavior were evident when a functional analysis was part of the functional assessment process
• Campbell, 2002; Kahng, Iwata, and Lewin, 2003
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Why conduct a functional assessment?
In order to identify
an effectiveprecise
personally relevant, and
humane treatment
for problem behavior
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But,
most people,
including most practicing behavior analysts who work with children
with autism
have shied away from conducting functional analyses
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Why?– Took too much time and resources, – Never did one before (i.e., training issue), – Seemed unsafe, – Was unsafe, – Often inconclusive– Still ended up using
behavior modification-based treatment i.e., arbitrary rewards in DROs
& punishment
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It has taken a lot of research, but there are no longer obstacles to conducting functional assessments including functional analyses
Free pdf:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3546636/pdf
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Participants
Pro
blem
Beh
avio
rs(p
er m
in m
eans
)
0
2
4
6 BaselineTreatment
Soci
alSk
ills
(per
min
mea
ns)
0
1
2
3 yo
PDD-NOS
meltdowns,aggression,screaming
11 yo
Autism
meltdowns,aggression,screaming
8 yo
Autism
meltdowns,aggression,screaming
Pseudonym:
Age:
Diagnosis:
Problem Behaviors:
Participants
Gail Dale Bob
Com
plia
nce
(%)
0
50
100
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Outcomes (aggregated)
Pro
blem
Beh
avio
rs(p
er m
in m
eans
)
0
2
4
6 BaselineTreatment
Soci
alSk
ills
(per
min
mea
ns)
0
1
2
3 yoPDD-NOSmeltdowns,aggression,screaming
11 yoAutism
meltdowns,aggression,screaming
8 yoAutism
meltdowns,aggression,screaming
Pseudonym:Age:
Diagnosis:Problem Behaviors:
Participants
Gail Dale Bob
Com
plia
nce
(%)
0
50
100
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Functional Assessment and Treatment Model
Steps (abbreviated)
1 Functional Assessment Process
2 Functional Communication Training
3 Delay and Denial Tolerance Training
4 Treatment Extension
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Case Example (Gail, 3 yo, dx: PDD-NOS)
Hypotheses:
Gail engages in meltdowns and aggression in order to obtain:
(1) preferred (tangible) items, (2) maternal attention, (3) or both
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Case Example (Gail, 3 yo, dx: PDD-NOS)
Hypotheses:
Gail engages in meltdowns and aggression in order to obtain:
(1) preferred (tangible) items, (2) maternal attention, (3) or both
0
1
2
3
4
Tangible /Attention
AnalystMother
AnalystMother
Analyst
Gail
Pro
blem
Beh
avio
r pe
r M
in0
1
2
3
4
Tangible
Sessions
2 4 6 8 10 12 14
0
1
2
3
4
Test
Control
Meltdowns Col 46
Attention
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Case Example (Gail, 3 yo, dx: PDD-NOS)
Hypotheses:
Gail engages in meltdowns and aggression in order to obtain:
preferred (tangible) items, And maternal attention,
0
1
2
3
4
Tangible /Attention
AnalystMother
AnalystMother
Analyst
Gail
Pro
blem
Beh
avio
r pe
r M
in0
1
2
3
4
Tangible
Sessions
2 4 6 8 10 12 14
0
1
2
3
4
Test
Control
Meltdowns Col 46
Attention
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Case Example (Bob, 8 yo, dx: Autism)
Hypothesis:
Bob engages in meltdowns and aggression in order to obtain:
“His way” in the form of escape from adult instructions and access to preferred ways of interacting with electronics or academic materials
Pro
blem
Beh
avio
r pe
r M
in
Sessions
0
1
2
3
4
5
6
1 2 3 4 5
0
2
4
6
8
10
12
14
Escape /Tangible
Escape /Tangible
Bob(Ipad context)
Bob(Math context)
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Case Example (Dale, 11 yo, dx: Autism)
Hypothesis:
Dale engages in meltdowns and aggression in order to obtain:
“His way” in the form of escape from adult instructions and access to preferred (tangible) items, and adult attention.
Pro
blem
Beh
avio
r pe
r M
inSessions
1 2 3 4 5
0
1
2
3
4
5
6
Dale
Analyst
Escape /Tangible /Attention
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1. Extensive descriptive assessments are never part of the process
because they are: time-consuming and usually suggest invalid relations St. Peter et al., 2005; Thompson & Iwata, 2007
Some Important Aspects of our Approach
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Some Important Aspects of our Approach
2. Closed-ended indirect assessments (MAS, QABF, FAST) are never used in the processbecause they do not provide any information about personally unique or qualitative features of potentially influential variables
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3. An open-ended interview is always part of the process (as is one brief and informal observation)
Goals of interview are to:a) Develop rapport with parents or teachersb) Identify idiosyncratic aspects of contingenciesc) Develop “function hunches”d) Set up a safe and efficient analyses
• Interviews allow for discoveries which can then be verified (or not) in a functional analysis
Some Important Aspects of our Approach
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4. A standard 4 or 5 condition analysis (with the play condition as the control, e.g., Iwata et al., 1982) is never part of the process
Probably a mistake to standardize a powerful and flexible tool like a functional analysis
Some Important Aspects of our Approach
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5. A two-condition analysis designed from the open-ended interview is always part of the process (i.e., an interview-informed analysis)
Functional analysis:Direct observation of behavior under at least two conditions in
which some event is manipulated
Two Conditions:Test: Contains the contingency thought to maintain severe
problem behaviorControl: Does not contain the contingency thought to maintain
severe problem behavior
Some Important Aspects of our Approach
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6. We synthesize multiple contingencies into one test condition, if the interview suggests the contingencies are operating simultaneously
Some Important Aspects of our Approach
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Why might problem behavior occur?
• Single contingencies:1. Attention or toys (social-positive reinforcement)2. Escape/avoidance (social-negative reinforcement)3. Sensory/non-social (automatic reinforcement)
• Combinatorial contingencies:1. Attention and Toys2. Escape to toys3. Escape to toys and attention4. Escape to automatic reinforcement5. Compliance with mands6. Escape to access to rituals, preferred conversations7. Escape to control (?)8. Etc…..
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Some standard analyses published a while ago
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Some standard analyses published a while ago
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Some standard analyses published a while ago
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Analyses conducted within a 6- month time span (2012-2013)
0
4
8
12 Bob (Context 2) Will Sam
0
2
4
6
8 Bob (Context 1) Kat (Context 1)
Dale
Jack (Context 1)
Kat (Context 2) Alex (Context 2)
Gail
2 4 6
Jack (Context 2)
TestControl
2 4 6
Dan
2 4 6
Alex (Context 1)
0
2
4
6 Zeke
Sessions
Pro
blem
beh
avio
r pe
r m
in
2 4 60
1
2
3
4 Sid
Jeff
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Important characteristics of interview-informed and synthesized analyses:
they are short, safe, and successful
due to the: – provision of all ecologically relevant reinforcers
immediately and for every problem behavior (precursors and dangerous behavior) in the test condition
– reliance on a “No EO” (continuous Sr) control condition
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An unfortunate standardization of functional analysis has developed in last 10 years
Standard Functional Analysis:• Multiple test conditions• Uniform test conditions• Isolated test conditions• Toy-play control
conditions
0
25
50
75
100
1965-2000 (N = 497)2001-2012 (N = 358)
Multipletest conditions
346
323
341
325 453
358
346
322
Uniformtest conditions
Isolatedtest conditions
Toy-playcontrol conditions
Publication Years
Commitments of a functional analysis
Per
cent
age
of a
ppli
cati
ons
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Consider anInterview InformedSynthesized Contingency Analysis
Standard FunctionalAnalysisMultiple test conditions
Uniform test conditions
Isolated test contingencies
Toy-play control conditions
Reinforce dangerous behavior
Interview-informed Synthesized Contingency AnalysisSingle-test condition
Individualized test conditions
Synthesized contingencies
Test-specific control
Reinforce precursors to and dangerous behavior
IISCA?
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Towards a more efficient analysis
0 200 400 6000 200 400 600
IISC
Latency-based
Brief
Trial-based
Other
Standardized
Within-sessionIISC
N = 115
N = 456
N = 21
N = 64
N = 6
N = 16
N = 10
Analysis duration (min)
Func
tiona
l ana
lysi
s fo
rmat
Min Max
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Towards a more efficient analysis
0 200 400 6000 200 400 600
IISC
Latency-based
Brief
Trial-based
Other
Standardized
Within-sessionIISC
N = 115
N = 456
N = 21
N = 64
N = 6
N = 16
N = 10
Analysis duration (min)
Func
tiona
l ana
lysi
s fo
rmat
Min Max
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Levels of Analytic Control
Strong Test condition: Consistently elevated rates Control condition: Zero or near-zero rates
Moderate Test condition: Some zeros or near-zero ratesControl condition: Zero or near-zero rates
Weak Test Condition: Variable but higher ratesControl condition: Lower but non-zero rates
Pro
blem
Beh
avio
r pe
r M
in
Sessions
1 2 3 4 5 6
0
1
2
3
4Test
Control
Pro
blem
Beh
avio
r pe
r M
in
Sessions
1 2 3 4 5 6 7 8 9 10
0
1
2
3
4Test
Control
Pro
blem
Beh
avio
r pe
r M
in
Sessions
1 2 3 4 5 6 7 8 9 10
0
1
2
3
4Test
Control
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Towards a more controlled analysis
0 25 50 75 100
IISC
Latency-based
Brief
Trial-based
Other
Standardized
Within-SessionIISC
N = 21
N = 64
N = 6
N = 16
N = 10
No Weak Moderate StrongControl
N = 115
N = 456
Percentage of applications
Fun
ctio
nal a
naly
sis
form
at
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Interpretation and Implications of Varying Levels of Analytic Control
Strong experimental control
Interpretation: Have access to all reinforcers and EOs
Implication: Can turn off problem behavior with reinforcement; should achieve meaningful outcome with only function-based treatment
Pro
blem
Beh
avio
r pe
r M
in
Sessions
1 2 3 4 5 6
0
1
2
3
4Test
Control
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Interpretation and Implications of Varying Levels of Analytic Control
Moderate experimental control
Interpretation: Some other EO is probably uncontrolled and interacting
Implication: Skill development may be slower as motivation may vary across sessions, but should achieve meaningful outcome with only function-based treatment
Pro
blem
Beh
avio
r pe
r M
in
Sessions
1 2 3 4 5 6 7 8 9 10
0
1
2
3
4Test
Control
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Interpretation and Implications of Varying Levels of Analytic Control
Weak experimental control
Interpretation: All reinforcers for problem behavior are not identified
Implication: Variable responding will persist throughout skill development, probably necessitating punishment or arbitrary reward system
Pro
blem
Beh
avio
r pe
r M
in
Sessions
1 2 3 4 5 6 7 8 9 10
0
1
2
3
4Test
Control The necessity of punishment when function-based treatments are made more practical is commonly reported:Fisher et al., 2003, Hagopian et al.,1998, Hanley et al., 2005, Wacker et al., 1990
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To achieve the humane outcomes that are possible with exclusive reliance on function-based treatments,
it is important that we do everything we can to exert strong experimental control in our analyses.