Evaluation of a Sequential Extinction Procedure on Preference for Communication Modalities During Functional Communication Training

Parent education programs have become an effective mode of treatment delivery for teaching families effective behavioral strategies to manage challenging behavior in young children with autism. Functional assessment and functional communication training (FCT) are empirically validated procedures that have recently been introduced into parent education programming to help resolve challenging behaviors. The success of these procedures, however, is contingent on family members' ability to integrate them into the specific contexts in which challenging behaviors occur. Consequently, the application of these procedures in home settings necessitates consideration of the family context in the assessment and treatment planning process. A study is presented that investigated the use of information on family context (i.e., caregiving demands, family support, patterns of social interaction) to direct the assessment and intervention planning process. More specifically, information on family context was used to individualize behavioral support plans designed to support family use of functional communication training within important family routines. Through parent-investigator collaboration we individualized the manner in which functional communication training procedures were taught and implemented so they were contextually relevant. Utilizing a multiple baseline design, the challenging behaviors and functional communication of three children with autism were monitored across baseline, intervention (i.e., FCT, and contextulized FCT), and follow-up phases. Multiple routines for each participant were selected and monitored across all phases to evaluate changes in the dependent measures within training and generalization routines. A self-report questionnaire was administered intermittently to parents to determine if consideration of family context improved the "goodness of fit" of the functional communication training treatment packages across FCT and contextualized FCT intervention phases. Results from the study indicate that consideration of family context in the assessment and intervention planning process does not jeopardize and may contribute to the stability and durability of reductions in challenging behavior achieved with functional assessment and functional communication training procedures.

Objectives: For individuals with challenging behavior, antecedent interventions such as modifying the motivation for the behavior have shown to be effective. In this study, we examined the effects of giving the participants the opportunity to continuously request tangible items (e.g. toys and activities) prior to instruction to determine if allowing them to satiate on the item would serve as an effective intervention to reduce challenging behavior maintained by access to the items.Method: Functional analyses identified that access to tangible items maintained the challenging behavior of four children with autism spectrum disorder. The children were then trained using Functional Communication Training (FCT) to request the items. Prior to 15 mins academic and/or functional skill instructional sessions, participants were exposed to either an FCT session and allowed to request the tangible items or did not receive an FCT session. The no FCT condition consisted of the child’s typically scheduled activities, without access to the preferred items maintaining challenging behavior for at least one hour prior to instruction. Following the FCT or no FCT conditions, we measured challenging behavior and academic engagement during 15-mins sessions of one-on-one instruction.Results: When instruction was preceded with FCT as a satiation intervention, we observed lower levels of challenging behavior and higher levels of academic engagement compared to no FCT conditions for two of four participants.Conclusion: Overall, the results of this study appear to support the use of FCT as a viable satiation procedure to reduce challenging behavior in instructional settings.

Objective: To assess the functions of challenging behaviour in four children with Angelman syndrome (AS) and to study the effects of functional communication training (FCT) with precursor-based prompting. This study builds on and extends the study of Allen et al.Method: Experimental functional analysis assessed behavioural functions. FCT was implemented within an ABAB design and effect sizes were calculated. Burst analyses depict tendencies in (precursor) behaviours surrounding target behaviours.Results: Results show challenging behaviour to be aimed at receiving attention, tangibles or escape. Burst analysis designated physical and eye contact and reaching for tangibles as precursors. Effects of FCT ranged from small to large.Conclusion: Behavioural functions for challenging behaviour were found and FCT was effective in reducing its frequency, when precursors were used as the onset of prompting. Functional equivalence between challenging and communicative behaviour was found. Implementing treatment for challenging behaviour based on precursors is advised.

Effectiveness of functional analysis (FA) and functional communication training (FCT) on challenging behavior was assessed in three children with Angelman syndrome (AS). Analogue FA conditions were used to assess the behavioral function of the challenging behavior. FA and FCT protocols were administered in the children’s classroom and were performed by their teachers. Replacement behavior was prompted upon the onset of precursor behavior. One or more function(s) of their challenging behavior were identified and challenging behavior appeared to be escape or tangibly motivated. Making physical contact with the teacher was found to be a precursor of challenging behavior in one child. In all children, challenging behavior decreased as a function of FCT. Functional equivalence of both challenging and replacement behavior was evinced. Clinical and research implications are discussed.

Functional communication training (FCT) is highly effective in reducing challenging behavior and increasing appropriate communication in children with developmental disabilities. However, the challenging behavior may re-occur following successful treatment with functional communication training when the functional communication response contacts extinction. Therefore, it is imperative to evaluate the variables that reduce resurgence of challenging behavior following successful treatment. For the current review, the systematic search yielded 14 articles from the current literature that evaluated resurgence following functional communication training. The effect of demand fading, the language of instruction, the presence of stimuli associated with the intervention, previous exposures to extinction, schedule of reinforcement during baseline, and reinforcing multiple mands were evaluated in the present literature review. Overall, relatively few applied studies with human participants have evaluated variables that affect resurgence. It is imperative that future research utilizes systematic manipulation to identify variables that reduce the resurgence of challenging behavior. Implications for practice and directions for future research are discussed.

Functional communication training (FCT) is a widely used behavioral intervention for reducing challenging behavior for students with disabilities. As more students with disabilities are being served in educational settings, it is essential to understand and evaluate the evidence base of FCT in educational contexts. A clear synthesis of how FCT has been applied, by whom, under what conditions, and with what outcomes is needed to evaluate its evidence base and inform translational practice. This mega-review aggregated six systematic reviews and meta-analyses of FCT implemented in educational settings, following PRISMA guidelines. Data were extracted at the review level on participant characteristics (e.g., age, gender, race, disability), functional behavior assessment (FBA) methods and identified functions of behavior, interventionist roles, procedural components of FCT, methodological quality, and outcomes (behavioral change, communication, social validity), as well as documented recommendations. Findings revealed consistent positive effects of FCT on challenging behavior reduction, with variability in reported moderators (e.g., setting, communication modality, and implementer). Notable gaps included limited demographic reporting, overrepresentation of male participants, and variability in review rigor. Implications of this mega-review include the need for greater transparency in methodological reporting, inclusion of culturally responsive and demographically disaggregated data, and appropriate individualized modification of FBA and FCT implementation by natural change agents in educational settings to support generalization, maintenance, and equity.

Functional communication training (FCT) is an evidence-based practice used to mitigate challenging behavior by increasing functional communication skills. To increase the practicality and feasibility of FCT in natural settings, thinning schedules of reinforcement are typically programmed following FCT. In this review, we meta-analyzed 28 studies that incorporated a thinning schedule procedure following FCT for 51 children with intellectual and developmental disabilities ages 8 and younger. Using Tau-U, the results demonstrated overall moderate effect sizes for both challenging behavior and functional communication responses. Additionally, moderator analyses pertaining to participant characteristics, interventions, and study quality were conducted. Thinning procedures were most effective for children who had stronger communication repertoire. Implications for future research and practice are discussed.

Ample research indicates that functional communication training (FCT) is an effective intervention to reduce challenging behavior. The purpose of this study was to evaluate the effect of demand fading on escape-maintained challenging behavior, mands, and task completion for 2 children with autism spectrum disorder. The study utilized an embedded reversal and alternating-treatments design to evaluate the efficacy of the intervention and compare the efficacy of the demand fading and dense schedule conditions. During FCT, participants were taught 2 mand topographies, one of which was associated with demand fading. FCT with and without demand fading resulted in decreases in challenging behavior for both participants. FCT with demand fading resulted in higher task completion for both participants. The effect of demand fading on the rate of mands varied by participant. Results provide further support for the use of FCT. The importance of intervention fading in the treatment of challenging behavior is discussed.

More is known about how to reduce challenging behavior with functional communication training (FCT) than how to mitigate its resurgence during or following a course of treatment. Research suggests reinforcing mand variability during FCT may mitigate the resurgence of challenging behavior, but validated procedures for reinforcing mand variability are limited and poorly understood. Lag schedules can reinforce variability in verbal behavior such as manding in individuals with autism, but studies have been largely limited to nonvocal mand modalities. Therefore, in the current study, we further evaluated the effects of FCT with lag schedules on vocal mand variability and challenging behavior in children with autism. The results suggest lag schedules alone or in combination with response prompt-fading strategies during FCT can increase mand variability and expand mand response classes but may fail to produce clinically significant reductions in challenging behavior.

Children with autism spectrum disorder often exhibit challenging behavior to avoid exposure to common daily tasks or routines. There is a need to investigate methods to teach appropriate communication to replace challenging behavior and increase tolerance for daily routines. However, the data to support its use to decrease challenging behavior associated with an activity or routine is limited. In the present study, the authors evaluated the use of parent‐implemented functional communication training (FCT) with a modified chained schedule of reinforcement to reduce challenging behavior associated with a nonpreferred daily routine. One 6‐year‐old male diagnosed with autism participated in this study. The functional analysis indicated that he engaged in challenging behavior to terminate throwing trash away. The authors then conducted a treatment evaluation to assess the efficacy of the FCT with a modified chained schedule of reinforcement in reducing challenging behavior and increasing the number of items that could be thrown in the trash. Results indicated that FCT with a modified chained schedule of reinforcement was effective in decreasing challenging behavior.

BackgroundA significant proportion of boys with fragile X syndrome (FXS), the most common known genetic cause of intellectual disability, exhibit challenging behaviors such as aggression and self-injury that can cause significant distress to families. Recent evidence suggests that coaching caregivers to implement functional communication training (FCT) with their child via telehealth can help to ameliorate these behaviors in FXS. In the present study, we followed families who had participated in our previous randomized controlled trial of FCT to evaluate the longer-term effects of FCT on challenging behaviors in this population.MethodsIn study 1, follow-up emails, phone calls, text messages, and letters were sent to caregivers of 48 boys with FXS who had completed our previous study conducted between 2016 and 2019. The main outcome measures administered at follow-up were the Aberrant Behavior Checklist–Community (ABC-C) and the Parenting Stress Index, 4th Edition (PSI-4). In study 2, families who had received FCT treatment but whose child exhibited challenging behaviors daily at follow-up received a 1-h parent training booster session to determine whether the intervention effect could be recovered.ResultsSixteen (66.7%) of 24 families who had received FCT treatment and 18 (75.0%) of 24 families who had received treatment as usual were traced and consented between March and August 2021. The mean follow-up time was 3.1 years (range, 1.4 to 4.2 years). Longitudinal mixed effects analyses indicated that boys who had received FCT were more likely to show improvements on the irritability and lethargy/social withdrawal subscales of the ABC-C over the follow-up interval compared to boys who had continued with treatment as usual. Four of the six boys who had received the booster parent training session via telehealth were reported to exhibit fewer forms of challenging behavior at a 4-week follow-up.ConclusionsEmpowering parents to implement behavior analytic treatments with their child in their own home can have durable effects on maintaining low levels of challenging behaviors in boys with FXS. These data further support the need to implement parent-mediated interventions for challenging behaviors in this population at an early age.Trial registrationClinicalTrials.gov, NCT03510156. Registered 27 April 2018

We evaluated the effects of lag schedules of reinforcement during functional communication training (FCT) on the varied use of mands and challenging behavior by two individuals diagnosed with autism. Specifically, we compared the effects of Lag 0 and Lag 1 schedules of reinforcement during FCT. The results showed that each participant exhibited increases in varied mand responding during FCT with the Lag 1 schedule of reinforcement relative to Lag 0; challenging behavior remained low during both FCT lag conditions relative to baseline. Results are discussed in terms of treatment implications relating to FCT and the potential prevention and/or mitigation of clinical relapse during challenges to treatment.

Functional communication training (FCT) is a commonly used, often recommended intervention that involves teaching a functionally equivalent communicative response to replace challenging behavior. The purpose of this literature review was to evaluate the strength of the evidence for the use of FCT. A systematic review of the literature resulted in the identification of 215 single-case-design articles that evaluated the efficacy of FCT to reduce challenging behavior for individuals diagnosed with a disability. FCT resulted in a decrease in challenging behavior for 135 participants. The reviewers rated FCT as an evidence-based practice for individuals with autism, intellectual disability, other health impairments, and multiple disabilities based on What Works Clearinghouse standards. Overall, the extant literature indicates FCT consistently results in the reduction of challenging behavior in children with disabilities. Implications for practice and directions for future research are discussed.

Previous research related to functional communication training has demonstrated its effectiveness across various communication modalities. Additionally, at least one study has demonstrated that, while the intervention can be effective across various communication modalities, individual participants demonstrate a preference among available communication modalities (indicated by response allocation under a concurrent schedules arrangement). The current study evaluated preference among concurrently available communication modalities for 18 individuals with developmental disabilities, including autism spectrum disorder and intellectual disability. Results of the study indicated that each of the individuals demonstrated a preference between communicative response modalities, though preference was not always immediately ascertained. The results are discussed within the context of implications for design and implementation of functional communication training.

The purpose of this meta-analysis was to summarize single-case intervention studies in which Functional Communication Training (FCT) involving augmentative and alternative communication (AAC) was implemented in school settings. Overall, the findings suggest that FCT involving AAC was effective in reducing challenging behaviour and promoting aided or unaided AAC use among participants with disability. FCT was more effective for the participants who engaged in less severe forms of challenging behaviour prior to intervention. Additionally, FCT was more effective when informed by a descriptive functional behaviour assessment and delivered within inclusive school settings. Implications for practice and directions for future research related to FCT for students who use AAC are addressed.