Functional Communication Training Research Articles

Exploring factors that influence the efficacy of functional communication training.

Understanding factors that influence the efficacy of functional communication training has both practical and conceptual benefits. The current study extended research in this area by exploring data from 95 consecutive applications of functional communication training with extinction across two independent clinics. We selected candidate predictor variables based on conceptual analysis, conducted preliminary exploratory analyses, and then selectively applied quantitative methods that are used in precision medicine to examine their accuracy and predictive utility. Treatment outcomes were better when challenging behavior was maintained by a single function than they were when it was maintained by multiple functions; however, these differences were most apparent among cases with an escape function. We also analyzed within-session responding to explore the potential influence of unprogrammed establishing operations on decrements in treatment efficacy. Our within-session measure only distinguished responders from nonresponders when escape was one of the multiple functions. Additional research is needed to validate these findings with an independent sample and to address a number of clinical conceptual issues.

Comparison of Caregivers’ and Children’s Preference for Mand Topography During Functional Communication Training

Comparison of Caregivers’ and Children’s Preference for Mand Topography During Functional Communication Training

Mitigating Resurgence in Functional Communication Training: Teaching Varied and Complex Responses

Mitigating Resurgence in Functional Communication Training: Teaching Varied and Complex Responses

Communication Modality Preference and the Social Validity of Functional Communication and Mand Training

Communication Modality Preference and the Social Validity of Functional Communication and Mand Training

Assessment and treatment of multiply maintained self injury for a visually impaired elementary student with autism

AbstractAssessment of challenging behavior via functional analysis (FA) and subsequent treatment including functional communication training (FCT) is a common approach to treating severe problem behavior for individuals with autism and intellectual disability. Assessment and treatment for these behaviors exhibited by individuals who have a co‐occurring diagnosis of visual impairment and autism spectrum disorder present unique challenges to this approach. The current study included an 8‐year‐old White, visually impaired male on the autism spectrum who engaged in self injurious behavior (SIB). Based on the results of the FA, conducted in his classroom, the researchers began FCT to address the multiple maintaining functions of SIB. Results suggest that adaptations to FCT may be necessary for visually impaired individuals on the autism spectrum to make the communication response more salient to the individual and establish independent communication responses.

A retrospective analysis of the relation between resurgence and renewal of behavior targeted for reduction.

Functional communication training (FCT) is an evidence-based treatment for behavior targeted for reduction that often combines extinction for target responses and arranges functionally equivalent reinforcement for alternative behavior. Long-term effectiveness of FCT can become compromised when transitioning from clinic to nonclinic contexts or thinning reinforcement schedules for appropriate behavior. Such increases in targeted behavior have been conceptualized as renewal and resurgence, respectively. The relation between resurgence and renewal has yet to be reported. Therefore, the present report retrospectively analyzed the relation between renewal and resurgence in data collected when implementing FCT with children diagnosed with developmental disabilities. We found no relation when evaluating all 34 individuals assessed for resurgence and renewal or a subset of individuals exhibiting both resurgence and renewal. These findings suggest that one form of relapse may not be predictive of another form of relapse.

Reinforcement‐schedule thinning practices during functional communication training: A survey of behavior analysts

AbstractResearchers have investigated several schedule‐thinning approaches during functional communication training (FCT), including FCT with delay schedules (Delay FCT), FCT with discriminative stimuli (Signaled FCT), and FCT with delay‐and‐denial tolerance training (DDTT). Despite many publications on these approaches, it is unclear how regularly, how often, and under what conditions behavior analysts use these FCT thinning strategies. We analyzed survey data from 129 board‐certified behavior analysts® to determine (a) how often they use the three thinning approaches during FCT, (b) their most preferred thinning method, and (c) the variables (e.g., years of experience, treatment setting) associated with their most used and preferred approaches. DDTT was the most commonly implemented and preferred FCT thinning strategy. Relative to DDTT, Signaled FCT was more frequently used and preferred by doctoral‐level behavior analysts and those working in clinical settings. However, regardless of approach, behavior analysts reported several challenges that hold implications for practice and research.

Environmental restoration as a reinforcer in ritualistic contexts

AbstractWe conducted a functional analysis of severe problem behavior (aggression, disruption, and self‐injury). The analysis examined four potential socially mediated functions: attention, escape, receipt of tangible items, and restoration of environmental items. Restoration involved the experimenter replacing missing puzzle pieces, ring stacker rings, and shape sorter blocks without giving the items to the participant. An initial multielement functional analysis, followed by a brief pairwise comparison identified restoration of environmental items as the variable maintaining the participant's problem behavior. Subsequently, we conducted brief functional communication training to teach the participant to mand for restoration of disturbed items in the absence of problem behavior.

Always Consider Culture: Incorporating Cultural Responsiveness into Functional Communication Training

Functional communication training (FCT) is an evidence-based practice that can be applied across multiple populations of students. Despite extensive research support for FCT, its use can be impractical or ineffective if utilized with students who are from culturally, linguistically, and economically diverse backgrounds. That is because cultural implications are not considered through all intervention stages. In this article, we present culturally responsive strategies across each FCT step with the intent to improve the implementation of FCT in schools and behavior of students with disabilities who can benefit from this intervention.

A position statement on the post gene-therapy rehabilitation of aromatic I-amino acid decarboxylase deficiency patients

Aromatic l-amino acid decarboxylase (AADC) deficiency is a rare genetic disorder of monoamine neurotransmitter synthesis that presents with a range of symptoms, including motor dysfunction and limited attainment of developmental motor milestones. The approval of eladocagene exuparvovec, a gene therapy for AADC deficiency with demonstrated efficacy for motor improvements, now expands the range of motor outcomes possible for patients with this disorder. However, recommendations and guidelines for therapy following treatment with gene therapy are lacking. To ensure patients can reach their full potential following treatment with gene therapy, it is essential they receive rehabilitation therapies designed specifically with their impairments and goals in mind. Therefore, we highlight specific rehabilitative needs of patients following gene therapy and propose a set of recommendations for the post-treatment period based on collective experiences of therapists, physicians, and caregivers treating and caring for patients with AADC deficiency who have been treated with gene therapy. These recommendations include a focus on periods of intensive therapy, facilitating active movements, training for functional abilities, cognitive and communication training, parent/caregiver empowerment, collaboration between therapists and caregivers to develop in-home programs, and the incorporation of supplemental forms of therapy that patients and their families may find more enjoyable and engaging. Many of these rehabilitative strategies may be employed prior to gene therapy. However, these recommendations will be valuable for therapists, caregivers, and wider treatment teams as they prepare for the post-treatment journey with these patients. Furthermore, the considerations and recommendations presented here may prove beneficial outside the AADC deficiency community as gene therapies and other treatments are developed and approved for other rare diseases.

Functional Communication Training Including Discrimination and Tolerance to Denial for Elementary Age Students With Autism

Functional communication training (FCT) provides an efficient means for reducing a variety of challenging behaviors while increasing social communication. After establishing a functional communication response (FCR), interventionists may need to design a program to thin the schedule of reinforcement to provide more durable effects and maintenance in the natural environment. Hanley et al. provided one means for thinning schedules that involved the systematic introduction of extinction (or denial trials) following a process of delaying reinforcement. This study evaluates a classroom application of this thinning process with three elementary age students who engaged in a variety of aggression, self-injury, disruption, and crying. The results indicate positive effects of the FCT program with systematic introduction of denial trials once the participants demonstrated proficiency with the FCR. In addition, data for two participants show prolonged effects post-intervention. Results are discussed in terms of extending Hanley et al. and how these procedures can be used within typical school-based settings.

Evaluating functional communication training without extinction in public school settings

AbstractFunctional communication training (FCT) in the treatment of escape‐maintained problem behavior for children with disabilities often includes extinction for problem behavior, which is difficult for educators to implement in classroom settings. This study evaluated the effects of FCT with concurrent schedules, as an alternative to extinction, for two children with disabilities and multiply maintained problem behavior including escape functions. FCT with concurrent schedules reduced problem behavior for one participant and increased mands for both participants. The mixed effects across participants and behaviors may inform boundary conditions for FCT with concurrent schedules.

Functional Communication Training Without the Removal of a Tangible Item

Children with autism spectrum disorder (ASD) engage in challenging behavior that can result in missing out on potential reinforcers. A common intervention for challenging behavior is functional communication training (FCT). In FCT, the clinician reinforces an appropriate communicative response using the same reinforcer maintaining the challenging behavior. In some cases, the challenging behavior is too severe for traditional FCT procedures to efficiently teach a new response. In this case study, we treated a 4-year-old boy with ASD referred to as Mostafa using a modified version of FCT. We did not include a typical component of traditional FCT procedures – the removal of the putative reinforcer prior to the trial. Instead, we provided components of toys and games contingent on the appropriate communication response. None of the components had to be removed to continue conducting learning trials. Mostafa’s communication increased and challenging behavior decreased as a result of this modification. This modification may be useful for other cases in which the removal of a tangible item interferes with learning a communication response.

A comparative effectiveness trial of functional behavioral assessment methods.

Clinicians report primarily using functional behavioral assessment (FBA) methods that do not include functional analyses. However, studies examining the correspondence between functional analyses and other types of FBAs have produced inconsistent results. In addition, although functional analyses are considered the gold standard, their contribution toward successful treatment compared with other FBA methods remains unclear. This comparative effectiveness study, conducted with 57 young children with autism spectrum disorder, evaluated the results of FBAs that did (n = 26) and did not (n = 31) include a functional analysis. Results of FBAs with and without functional analyses showed modest correspondence. All participants who completed functional communication training achieved successful outcomes regardless of the type of FBA conducted.

Updated Recommendations for Reinforcement Schedule Thinning following Functional Communication Training.

Schedule thinning is a necessary treatment procedure following the acquisition of a communication response during functional communication training. In this article, we update and extend the Hagopian et al. Behavior Analysis in Practice, 4, 4-16, (2011) review and recommendations on schedule-thinning procedures following functional communication training. Since their publication, substantial research has been published on the efficacy, efficiency, and social validity of schedule-thinning methods. We provide updated recommendations for schedule thinning based on contemporary literature that has been published since 2011, as well as discuss key areas for future research.

Access to Care Limitations: When Distance and Lack of Evidence Meet.

Jimmy is a 13-year-old adolescent boy who was diagnosed with Down syndrome (trisomy 21) prenatally. Jimmy is the only individual with Down syndrome in the small, rural community where he lives with his parents. He has mild sleep apnea, and his gross and fine motor developmental milestones were generally consistent with those expected among children with Down syndrome. At age 4, his parents raised concerns about his limited language, strong preference to be alone, and refusal to leave the house. Parents had observed his marked startle response to loud laughter and adult male voices. At age 7, his preferred activities consisted of dangling necklaces or shoelaces in front of his face and rocking his body forward and backward when seated. After limited progress in special education, speech, and occupational therapies, he was referred, at age 8, to a specialty center 3 hours from his home for a multidisciplinary evaluation. There, he received a diagnosis of co-occurring autism spectrum disorder (ASD).Over the last year, his repetitive behaviors have become more intense. He hits the side of his head with his fist and presses his thumbs into his eyes, causing bruising. Any attempts to remove his dangle objects are met with aggressive behaviors, including hitting, kicking, scratching, and elopement. At school, he refuses to complete work and sometimes hits his teacher. Aggression stops in the absence of educational demands. School staff informed parents they are not equipped to handle Jimmy's behaviors.Jimmy recently presented to the specialty center for developmental-behavioral pediatric and psychology support at the request of his primary care clinician. The developmental pediatrician discussed with Jimmy's parents the possibility of a trial of medication to address disruptive/aggressive behavior if there is not improvement with initiation of behavioral strategies. The psychologist began weekly behavioral parent training visits through telehealth, including prevention strategies, reinforcement, and functional communication training. The strategies have helped decrease the frequency of elopement and aggressive behaviors. Self-injurious behaviors and refusal at school have remained constant.Despite some stabilization, limited local resources as well as the lack of evidence-based guidelines for people with both Down syndrome and ASD have impeded improvements in Jimmy's significant behavioral and developmental challenges. His parents have become increasingly isolated from critical family and community support as well. In what ways could the clinicians and community support this child and his family and prevent others from experiencing similar hardships?

Provider Self-Reported Use and Usefulness of Intervention Strategies for Externalizing Behaviors in Youths with ASD

ABSTRACT Objective To examine predictors of implementation and perceived usefulness of four empirically supported strategies for treating externalizing behavior in youths with ASD. Method Participants were 557 providers in the United States with experience treating externalizing behavior in youths with ASD. Generalized estimating equations were used to determine whether self-reported use and usefulness of four empirically supported intervention strategies (functional communication training, functional behavior analysis, visual tools/supports, token economy) were predicted by key provider characteristics: professional discipline, experience, and practice specialization (across three indices) in ASD. Post-hoc contrasts were performed to identify provider groups reporting the greatest use and usefulness of the four strategies. Results Strategies were most often used by providers with behavioral backgrounds, though perceived usefulness of strategies varied by providers’ professional discipline. Compared to providers with more than 10 years of experience, less experienced providers endorsed the highest average use and usefulness of almost all strategies. Regarding ASD practice specialization, a lower volume of ASD cases, treating fewer youths with ASD over a 5-year period, and having a higher proportion of practice time working with youths with ASD reported were associated with greater use and usefulness of the strategies. Conclusions Empirically supported strategies are widely used by and perceived as useful by providers who treat youths with ASD and co-occurring externalizing behaviors. Use and usefulness varies based on provider discipline, experience, and ASD practice specialization.

Telehealth Practice-Based Coaching in Functional Communication Training for Caregivers of Young Children with Neurodevelopmental Disabilities

Telehealth Practice-Based Coaching in Functional Communication Training for Caregivers of Young Children with Neurodevelopmental Disabilities

Functional communication training and a chained schedule of reinforcement to reduce escape‐maintained challenging behavior related to a daily routine

AbstractChildren 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.

Evaluation of schedule thinning following treatment for aggression maintained by access to higher level restrictive and repetitive behavior.

One of the diagnostic characteristics of individuals with autism spectrum disorders includes engaging in restricted and repetitive behavior. Research has shown that individuals will often display problem behavior when access to restricted and repetitive behavior is blocked. The purpose of the current study was to evaluate the use of functional communication training and schedule thinning to treat aggression displayed by three children diagnosed with autism spectrum disorders when higher level restrictive and repetitive behavior was blocked. Further, we assessed whether all steps in a schedule-thinning sequence were necessary as well as extended the practicality of these procedures by removing the continuous signal during the delay to reinforcement. The results indicated that functional communication with schedule thinning reduced aggression related to blocking access to engaging in higher level restrictive and repetitive behavior for all participants.