Primena funkcionalnog komunikacionog treninga za redukciju problema u ponašanju kod dece sa autizmom

Functional communication training (FCT) is a common function-based intervention for young children with or at risk for autism spectrum disorder (ASD) to teach an alternative communicative response to replace problem behavior. While FCT is effective in decreasing problem behavior, often the communicative behavior that is taught occurs at a higher rate than a caregiver can reinforce. For this study, we first examined the effectiveness of an FCT intervention to decrease problem behavior and increase appropriate communication. The intervention was based on a trial-based functional analysis (TBFA) conducted in the home. Next, we applied two approaches for thinning the schedule of reinforcement (i.e., delay to reinforcement and chained schedules) following the FCT. For all three young children (ages 3–5 years) with or at risk for ASD, at least one function of behavior was identified for each participant using TBFA and the subsequent FCT intervention led to a decrease in problem behavior and increase in functional communication. The procedure for thinning the schedule was selected based on the function of the behavior and results showed that both were successful in maintaining low levels of problem behavior following FCT. Implications for research and practice are discussed and suggestions for future research studies are presented.

Functional analyses of problem behavior for 4 young boys with developmental delays showed that problem behaviors were maintained by both negative and positive reinforcement. Functional communication training was conducted with one set of training stimuli in which the child's mother presented a work task in the family living room. Pretreatment probes were conducted with up to 10 sets of generalization stimuli that varied across tasks, settings, and people. Post treatment probes were conducted across the same generalization stimulus sets. Results for four dependent variables (problem behavior, task completion, manding, and social interactions) indicated that (a) problem behavior occurred across some but not all generalization stimulus sets during pretreatment; (b) following training, reductions of 90% or greater were observed within the context of the training stimuli; (c) reductions in problem behavior were observed for 70% of the post treatment generalization stimulus sets, but the reductions were not as large (M = 61%) as those observed with the training stimuli; and (d) the most consistent change observed during post treatment probes of generalization stimulus sets was increased task completion. Parents of all participants completed a behavior rating form and reported reductions in problem behavior across activities. Keywords: stimulus generalization, FCT, response generalization, developmental disabilities, severe problem behavior. ********** Functional communication training (FCT) has been an effective procedure for reducing the occurrence of problem behavior and increasing appropriate communicative responses for people who engage in destructive behaviors that are maintained by social stimuli, such as gaining attention, gaining access to preferred items, or escaping task demands (e.g., Brown et al., 2000; Carr & Durand, 1985; Fisher, Kuhn, & Thompson, 1998; Hanley, Iwata, & Thompson, 2001; Wacker et al., 1998). To date, the majority of research on FCT has focused on the effects of treatment within a specific training context, and the evaluations have been limited to the short-term effects of FCT on the occurrence of problem behavior and appropriate communication. To further evaluate FCT, analyses are needed on both stimulus generalization (e.g., responding across untrained antecedent stimuli such as persons, tasks, and settings) and changes in other positive social responses, such task completion and social interactions, following the completion of FCT. A few studies have evaluated the effects of FCT on behavior beyond the training context (Durand & Carr, 1991, 1992; and Durand, 1999). Durand and Carr (1991) demonstrated that reductions in problem behavior and increases in appropriate communication were maintained across untrained contexts (classroom settings, novel care providers) following FCT for 3 boys whose problem behavior was maintained by escape from academic demands. The reductions in problem behavior were maintained across non-trained stimuli over a 2-year period for 2 of the 3 participants without additional training. Similarly, Durand (1999) taught students with severe disabilities to use augmentative communication devices in their classroom to request stimuli that had been identified as maintaining problem behavior. In each case, FCT resulted in increased use of the communication device and a reduction in problem behavior in the classroom. Furthermore, use of the device increased and problem behavior decreased in community settings following the completion of FCT. Derby et al. (1997) evaluated the effects of FCT across multiple dependent variables including problem behavior, manding, toy play, and positive social behaviors with 4 young children over a 2-year period. Derby et al. demonstrated that the effects of FCT were not limited to problem behavior and manding, which were consequated directly within the FCT package. The results showed that gains in toy play and positive social behaviors occurred and were maintained for the 2-year period. …

Many children with autism spectrum disorder (ASD) have problem behaviors that interfere with learning and social interaction. This randomized controlled trial compared treatment with functional communication training (FCT) to "treatment as usual" for young children with ASD (n = 38, ages 21-84months). FCT was conducted by parents with training and real-time coaching provided by behavioral consultants using telehealth. FCT treatment via telehealth achieved a mean reduction in problem behavior of 98% compared to limited behavioral improvement in children receiving "treatment as usual" during a 12-week period. Social communication and task completion also improved. For children with ASD and moderate to severe behavior problems, parent-implemented FCT using telehealth significantly reduced problem behavior while ongoing interventions typically did not.

Functional communication training (FCT) was conducted by parents of 17 young children with autism spectrum disorders who displayed problem behavior. All procedures were conducted at regional clinics located an average of 15 miles from the families' homes. Parents received coaching via telehealth from behavior consultants who were located an average of 222 miles from the regional clinics. Parents first conducted functional analyses with telehealth consultation (Wacker, Lee, et al., in press) and then conducted FCT that was matched to the identified function of problem behavior. Parent assistants located at the regional clinics received brief training in the procedures and supported the families during the clinic visits. FCT, conducted within a nonconcurrent multiple baseline design, reduced problem behavior by an average of 93.5%. Results suggested that FCT can be conducted by parents via telehealth when experienced applied behavior analysts provide consultation.

In this study, we extended the meta-analytic literature on single-case experimental design (SCED) studies on functional communication training (FCT) using a linear mixed effects model (LMEM). First, we evaluated the methodological adequacy of each study using the What Works Clearinghouse (WWC) Standards. Second, we calculated a standardized rate difference (SRD) between the rates of alternative communicative responses and problem behavior. Third, we estimated a LMEM using SRD as the dependent variable to examine the effect of FCT across participants with different disabilities. Finally, we estimated a LMEM including only studies in which participants had a diagnosis of Autism Spectrum Disorder (ASD), without standardizing the rate difference. Results indicate that FCT was effective in increasing the SRD as suggested by the greater number of alternative communicative responses compared to the number of problem behaviors over time. Results also suggest that FCT is an effective intervention for participants with ASD and that it might not be necessary to standardize scores when using LMEMs to analyze data from participants with the same disability. We discuss the utility of analyzing SCED data using LMEMs and make recommendations for an SCED data warehouse protocol.

The purpose of this study was to investigate the effects of functional communication training (FCT) using Interview-informed Synthesized Contingency Analysis (IISCA) on the aggressive behavior and functional communication behavior of children with autism spectrum disorder (ASD). The functions of aggressive behavior in two children with ASD were analyzed using IISCA, and functional communication training was implemented using a multiple baseline design across subjects. The study was conducted over a total of 26 sessions, divided into four phases: functional analysis, baseline measurement, intervention, and maintenance. To enhance the effectiveness of the intervention, prompting was provided using a most-to-least strategy. The results of the analysis indicated that, compared to the baseline, both children exhibited a significant reduction in aggressive behavior and a significant increase in functional communication behavior during both the intervention and maintenance phases. The findings of this study suggest that functional communication training using IISCA is effective in reducing and maintaining reductions in aggressive behavior, as well as in increasing and maintaining functional communication behavior. This study is significant in that it demonstrates the effectiveness of behavioral interventions using IISCA, thereby highlighting the potential for introducing a new method of functional analysis.

The purpose of this study was to investigate the effects of functional communication training (FCT) using Interview-informed Synthesized Contingency Analysis (IISCA) on the aggressive behavior and functional communication behavior of children with autism spectrum disorder (ASD). The functions of aggressive behavior in two children with ASD were analyzed using IISCA, and functional communication training was implemented using a multiple baseline design across subjects. The study was conducted over a total of 26 sessions, divided into four phases: functional analysis, baseline measurement, intervention, and maintenance. To enhance the effectiveness of the intervention, prompting was provided using a most-to-least strategy. The results of the analysis indicated that, compared to the baseline, both children exhibited a significant reduction in aggressive behavior and a significant increase in functional communication behavior during both the intervention and maintenance phases. The findings of this study suggest that functional communication training using IISCA is effective in reducing and maintaining reductions in aggressive behavior, as well as in increasing and maintaining functional communication behavior. This study is significant in that it demonstrates the effectiveness of behavioral interventions using IISCA, thereby highlighting the potential for introducing a new method of functional analysis.

<p style="text-align: justify;"><strong>Objectives</strong>. The effectiveness of typing as an alternative and augmentative communication (AAC) tool for problem behavior management and the development of vocal request skill has been underexplored. This study compares the effects of two alternative communication systems—the Picture Exchange Communication System (PECS) and typing via a tablet application—on reducing problem behavior episodes and increasing vocal requests in a child with autism spectrum disorder (ASD).</p> <p style="text-align: justify;"><strong>Methods</strong>. From 2018 to 2020, a problem behavior intervention was implemented for a 10-year-old child with ASD who had difficulties using vocal speech. The primary method used was functional communication training (FCT) combined with an extinction procedure. Two AAC tools were applied sequentially: PECS with reinforcement of vocal requests; Typing requests in a tablet app, also with reinforcement of vocal requests..</p> <p style="text-align: justify;"><strong>Results</strong>. When using the AAC system based on typing, the average percentage of problem behavior relative to all responses (both functional communication and problem behavior) was 12%, compared to 25% when using PECS. The average number of vocal requests per school day was 25.9 when using typing in the app, compared to 8.8 with PECS.</p> <p style="text-align: justify;"><strong>C</strong><strong>onclusions</strong>. The acquisition of phrase-typing skills for requests in a specialized app led to greater reductions in problem behavior and a higher frequency of vocal requests compared to PECS. Further research is needed to explore the effectiveness of typing in a tablet app as an AAC tool for problem behavior management and vocal request development in children with ASD and speech impairments. Additionally, a possible mediating relationship should be investigated, where a change in AAC format may lead to an increase in vocal requests, which in turn contributes to a reduction in problem behavior.</p>

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.

Functional communication training (FCT) is a frequently used treatment for reducing problem behavior exhibited by individuals with developmental disabilities. Once the operant function of problem behavior is identified by a functional analysis, the client is taught to emit an appropriate communicative response to obtain the reinforcer that is responsible for behavioral maintenance. Studies on FCT have typically used small numbers of participants, have reported primarily on clients for whom FCT was successful, and have varied with respect to their use of other treatment components. The main purposes of the present study were to evaluate the efficacy of FCT for treating severe problem behavior in a relatively large sample of individuals with mental retardation (N = 21) and to determine the contribution of extinction and punishment components to FCT treatment packages. FCT with extinction was effective in reducing problem behavior for the majority of clients and resulted in at least a 90% reduction in problem behavior in nearly half the applications. However, when demand or delay-to-reinforcement fading was added to FCT with extinction, treatment efficacy was reduced in about one half of the applications. FCT with punishment (both with and without fading) resulted in at least a 90% reduction in problem behavior for every case in which it was applied.

Treatments based on differential reinforcement may inadvertently increase the recurrence of problem behavior in the face of challenges because reinforcers for appropriate behavior occur in the same context as problem behavior. The current study evaluated one potential approach to mitigating these problems with differential reinforcement treatments based on behavioral momentum theory. Specifically, appropriate behavior was trained in contexts without a history of reinforcement prior to intervening with problem behavior. Participants were 4 children with autism spectrum disorder. Treatment used telehealth to implement functional communication training (FCT) in three alternative contexts with minimal or no history of reinforcement for problem behavior before initiating FCT in the treatment context. Evaluations of the effects of treatment and tests of resurgence were conducted intermittently during treatment to evaluate maintenance. When FCT treatment was initiated in alternative contexts, initial results were comparable to more typical implementations of FCT. Resurgence was reduced to similar levels during tests of resurgence for all participants when compared to more typical previously published implementations of FCT, but clinically significant reductions in resurgence occurred more quickly in the present study. These findings support training appropriate behavior in an alternative context to mitigate the resurgence of problem behavior during differential reinforcement treatments.

Supporting parents in reducing challenging behavior of children with autism spectrum disorder (ASD) requires the identification of effective, feasible, and sustainable interventions. Functional communication training (FCT) is one of the most well-established interventions in the behavioral literature and is used increasingly by parents. However, there is a need for additional evaluation of the literature related to parent-implemented FCT. In the present review, we identified 26 peer-reviewed studies on parent-implemented FCT. We conducted systematic descriptive and social validity analyses to summarize the extant literature. Across studies, parent-implemented FCT was effective in reducing child challenging behavior, and in some cases, intervention outcomes maintained and generalized to novel settings and implementers. However, few studies reported fidelity data on parent implementation of FCT, and data regarding sustained use of FCT by parents were limited. Results of the social validity analysis indicate that while FCT is often implemented by natural change agents in typical settings, parent training is often provided by professionals not typically accessible to parents. These findings suggest that future research is warranted in the areas of parent training and long-term sustainability of parent-implemented FCT.

The potential for using functional communication training (FCT) as a means of preventing minor problem behaviors from escalating to more serious ones was investigated. Eight children who exhibited minor problem behaviors at home or at school participated in small learning groups focused on teaching language skills. Four of these children participated in groups in which the teacher employed FCT (i.e., functional communication skills to gain attention were taught and reinforced). The other four children participated in a control group receiving expressive language training (ELT; i.e., children were taught to answer wh questions). Children in the ELT group were subsequently switched to FCT in an extended intervention phase. The children who participated in the FCT group generally did not exhibit increases in either the intensity or frequency of problem behaviors over time. The level of their problem behavior remained low. However, children in the ELT group exhibited increases in both intensity and frequency of problem behaviors. Their problem behavior decreased after they were switched to FCT. In sum, FCT appeared to prevent minor problem behaviors from escalating to more serious ones. Critical variables in producing these results are discussed, as is the role of coercion processes. Heuristic suggestions are made for extending the investigation of FCT as a preventive strategy.

Functional communication training (FCT) is a widely used and effective function-based treatment for problem behavior. The purpose of this article is to present two cases in which FCT was unsuccessful in reducing the occurrence of problem behavior displayed by two young children with an autism spectrum disorder. Both children received the same functional analysis plus FCT treatment package via telehealth that had proven to be highly successful for the other participants. The FCT package was conducted within tightly controlled single-case designs for each participant, which permitted subsequent analyses to determine why FCT was unsuccessful. These analyses suggested distinct reasons for the treatment failure for each child. Although the negative results of treatment appeared to be similar for both children, the specific reasons for treatment failure were highly individualistic and identifiable via the single-case analyses conducted. We present findings from both our initial and subsequent analyses and discuss the implications.

Functional communication training (FCT) is a behavioral treatment that has been shown to reduce problem behavior and increase appropriate communication in young children with autism spectrum disorder (ASD). In this study, we assessed the effects of FCT on targeted and nontargeted problem behaviors outside of the training context, as well as parent stress, for 30 young children with ASD and their parents. Indirect measures of generalization treatment effects were administered prior to and following FCT treatment delivered via telehealth. Children demonstrated significant improvement on both targeted (measured via observation) and nontargeted (measured via checklist) problem behaviors, both within and outside of the training context, and parent stress was significantly reduced following treatment. These results suggest that the impact of FCT may extend beyond the training context for both the children being treated and the parents delivering treatment, even when generalization is not specifically programmed for during treatment.