laura c. chezan. intellectual disability mental illness dual diagnosis problem behavior
TRANSCRIPT
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LAURA C. CHEZAN
Discrete -Trial Functional Analysis of Problem Behavior and Functional
Communication Training in Three Adults with a Dual Diagnosis of an Intellectual
Disability and a Mental Illness
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INTRODUCTION
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Context
Intellectual
Disability
Mental Illness
Dual Diagnosi
s
Problem Behavior
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Context Cont’d
Approach to Problem Behavior
BEHAVIORAL INTERVENTIONS
Behavior is influenced by environmental variables
1. Assess to identify function2. Teach replacement behavior
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Participants’ Selection
All Participants
Functional
Assessment
Trial-Based Functional Analysis
Intervention (FCT)
Discrimination
Assessment
Behavioral
Assessment
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PARTICIPANTS AND SETTINGS
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Participants’ Selection
Meeting with directors
Informal observation of potential participants
Meeting with staff members
Selection of participants
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Participants’ Characteristics
Participa
nt
Age Diagnosis Problem Behavior
Antoine 27 moderate ID
bipolar-
disorder
autism
SIB
repetitive verbal and
motor behavior
Rick 32 profound ID
mood disorder
SIB
physical aggression
property destruction
Tonya 23 severe ID
psychosis
NOS
snatching food
physical aggressionNote: ID = intellectual disability; SIB = self-injurious behavior
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Participant
Type of Program
Location
Assessment & Training Setting
Antoineday
programrural dining room,
instructional room
Rickday
programrural dining room,
instructional room, hallway
Tonya workshop urban work areas, dining area
Settings
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ASSESSMENT AND ANALYSIS
OF PROBLEM BEHAVIOR
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Functional Assessment (FA) PURPOSE
Collect information
Background Information
Topography of problem behavior
Environmental variables
Develop Hypotheses
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FA – Methods and Outcomes
INDIRECT METHODS
DIRECT METHODS
DefinitionsHypotheses
Temporal Relationships
Verify Hypotheses
Record Review
ABC observations(Bijou, Peterson, & Ault,
1968)
Interview(FAI; O’Neill et al., 1997)
Background information
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FA - DTFA
Hypotheses
DTFA
Test Hypotheses
Develop DTFA
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DTFA - Conditions
AttentionAutomatic
Reinforcement
AttentionTangible
1Tangible
2
AttentionTangibles
Antoine’s FA Hypotheses
Rick’s FA Hypotheses
Tonya’s FA Hypotheses
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FA HYPOTHESIS
ANTECEDENT(No Access to Reinforcer)
CONSEQUENCE(Access to Reinforcer)
ASSESSMENT ( 2 min)
DTFA Components
REINFORCEMENT (2 min)
Present Antecedent STOP if:(a) problem behavior(b) time elapsed
Present Consequence hypothesized to maintain
problem behavior
+
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DTFA - Protocols
AttentionAutomatic Reinforcement
AttentionTangible 1Tangible 2
AttentionTangibles
Antoine Rick Tonya
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Target Behavior and Recording System
Problem Behavior No Response
TARGET BEHAVIOR
Occurrence or non-occurrence of the 2 responses (data sheet)Latency to first response
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®WHO?
® researcher, staff member, or behavioral consultant
®WHEN?
® naturally-occurring opportunities during typical
routines throughout the day
®HOW?
® 1-5 trials per day under one or multiple conditions
® wait 10-15 min between trials
DTFA Implementation
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ASSESSMENT
(No access to reinforcer)
REINFORCEMENT
(Access to reinforcer)
What Did We Anticipate?
Problem behavior
Few or No Problem behavior
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RESULTS
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Latency to Problem Behavior
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Social Validity
WHO?
Staff Questionnaire End of assessment
HOW? WHEN?
OUTCOME – Information about:
Significance of outcomesAppropriateness of proceduresContinuation of procedures in the future
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Social Validity
Easy to conduct (M=3.0)
SD (1) SA(4)D (2) A (3)
Procedures were clear
Interested in learning more
(M=3.5)Took a long time
(M=1.0)
Interfered with other
responsibilities (M=1.5)
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DISCUSSION
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® Clear patterns of behavior for all three participants
® Applicable to adults with dual diagnosis
® Few number of trials across conditions
® Variability in the topography of problem behavior and
number of trials with problem behavior
Effectiveness of DTFA
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®Variations in stimulus control
® Individual motivation
® Fluctuation in the reinforcing value of certain
people, items, or activities
Factors That May Have Influenced Variability in the Topography of Problem Behavior and
Number or Trials with Problem Behavior
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® Efficient and less intrusive way to determine the
function of problem behavior
® Guide the delivery of reinforcement during
intervention and increase tolerance for delayed
reinforcement
Latency to First Occurrence of Problem Behavior
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® Implemented by staff members
® Embedded within typical routines
® Rated by staff members as:
® Easy to implement
® No time consuming
Social Validity
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CONCLUSION
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DTFA was effective in identifying the function of
problem behavior for all three adults
Conclusion
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FUTURE STUDIES
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Future research may include:
Staff training for implementation of DTFA
Replication of findings
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FUNCTIONAL COMMUNICATION
TRAINING (FCT)
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FCT
Identification of
replacement behavior
Teaching replaceme
nt behavior
STEPS
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Identification of Functionally Equivalent Replacement Behavior
Reviewed DTFA results
Consulted with staff members
Identified a behavior that was easily discriminable
and functionally equivalent
Defined behavior
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Constant time delay
Differential reinforcement
Error correction
Protocol
Teaching the Replacement Behavior
Develop Instructional Procedures
Provide Instruction and Progress Monitoring
Assess Current Level of
Performance
8 opportunitiesDaily routinesBehavioral indicationResearcher & staff
BASELINE Protocol and Data Sheet
INTERVENTION Protocol and Data Sheet
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Target Behavior and Recording System
Prompted Response or Problem Behavior
Independent Response
TARGET BEHAVIOR
Occurrence or non-occurrenceof the two responses for each
opportunity (data sheet)
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RESULTS
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RESULTS
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Discrimination Assessment
Identify Example and Non-Example Discrimination
Probes and Develop Protocol
Administer Probes and Collect Data
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100% across all participants for both
example probes and non-example probes
Discrimination Probes
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Social Validity
WHO?
Staff Questionnaire End of study
HOW? WHEN?
OUTCOME – Information about:
Significance of outcomesAppropriateness of proceduresContinuation of procedures in the future
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Social Validity
PB affected QOL
(M=3.5)
Benefited from learning a new response and it
reduces the frequency of PB
Willing to continue the intervention
(M=3.0)
Easy to conduct (M=2.5)
Interfered with other
responsibilities (M=2.0)
SD (1) SA(4)D (2) A (3)
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DISCUSSION
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® Applicable to adults with dual diagnosis
® Mental illness may influence the
acquisition pattern of some adults with
dual diagnosis
® Effective in producing acquisition of a
replacement behavior for all three adults
Effectiveness of FCT
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® Response competition
® Variations in stimulus control
® History of reinforcement
Factors That May Influence Different Acquisition Patterns
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® Teach in the presence of behavioral indication
® Increases the likelihood of the precise use of
replacement behavior
Discriminated Use of the Replacement Behavior
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® Implemented by staff members
® Embedded within naturally-occurring opportunities
® Rated as:
® Beneficial for participants
® Relatively easy to implement
® No time consuming
Social Validity
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CONCLUSIONS
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1. FCT produced acquisition of a functionally
equivalent replacement behavior
2. FCT produced discriminated use of the newly
acquired replacement behavior
Conclusions
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FUTURE STUDIES
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Future research may include
Relationship between behavioral indication and
generalization of replacement behavior
Staff training to identify teaching opportunities
Replication of findings
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?
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