Cynthia R Johnson

University of Pittsburgh School of Medicine

I. Description of Treatment II. Theoretical Bases III. Empirical Studies IV Summary

Further Reading

GLOSSARY

antecedent The preceding factor or stimulus that may cue the occurrence of the observable behaviors (an antecedent for tantrums in young children is being told "no"). applied behavior analysis Field of inquiry that studies variables influencing observable behaviors by use of a systematic experimental design. This term is oftentimes used interchangeably with behavior therapy and behavior modification. augmentative communication system An alternative communication designed for those impaired in verbal communication. Systems may vary from simple photographs, to picture symbols, to computerized devices programmed specifically for an individual. consequence The event or stimulus, occurring after a behavior, that influences the future likelihood of the behavior. A consequence may be a reinforcer (thus increase the likelihood of the behavior to occur) or a punisher (decrease the likelihood of the behavior). extinction Commonly called systematic ignoring; a behavior procedure by which reinforcement of an earlier reinforced behavior is withheld with the goal of reducing the behavior. punisher A consequence presented contingent on a particular behavior that results in the decrease of the behavior.

reinforcement A process in which the consequence of a behavior results in an increased frequency of the behavior. reinforcers A contingent consequence of a behavior that results in an increased frequency and long-term maintenance of that behavior. self-injurious behaviors Behaviors self-inflicted by an individual that have the potential to be harmful (hand biting, head banging, face slapping). single-subject design A research design often utilized in behavior treatment whereby measurements of a behavior are repeated under same and different conditions to determine the effects. Studies using this research design may have one to a handful of subjects. stereotypical behaviors Repetitive, seemingly nonpurposeful movements, also often referred to as self-stimulatory behavior (hand flapping, body rocking, finger posturing).

Functional communication training (FCT) is a treatment approach often implemented to attenuate challenging behaviors, most often in individuals with developmental and communication disabilities. The specific FCT procedures for an individual are determined by the findings of a functional assessment and analysis of the challenging behaviors to be treated. FCT is typically one component of a multicomponent treatment package. This article provides a description of this treatment approach, the theoretical underpinning, and a summary of empirical findings to date.

I. DESCRIPTION OF TREATMENT

The premise for the treatments that fall under this domain is that challenging, problematic behaviors may act as an unconventional but effective form of communication. Hence, the goal of FCT is to teach an alternative, more adaptive behavior that will serve the same function or purpose for the individual with the assumption this will in turn attenuate the occurrence of the challenging behavior. This treatment is a popular approach as one component to addressing the often-occurring challenging behaviors in individuals with developmental disabilities, communication delays, and other groups whose ability to communicate effectively is thwarted (hearing impaired, traumatic brain injury). FCT has been successfully implemented in treatment of such behaviors such as aggression, self-injurious behaviors, disruption, severe tantrums, and stereotypical behaviors. Common communicative functions these challenging behaviors have typically found to serve are (a) to escape or avoid a situation, (b) to gain attention or comfort, (c) to obtain access to a preferred tangible item or reinforcer, (d) and to gain sensory reinforcement. There are likely many more communicative purposes behaviors serve, but these are the ones most researched. Determining first what communicative functions challenging behaviors serve is critical to the implementation of FCT. Hence, a specific type of assessment precedes successful FCT. A functional assessment and analysis is conducted during which the function or purpose of the behavior is hypothesized. Subsequent to the functional assessment, the type of communicative behavior to be taught may be chosen (to end an activity, to obtain assistance, to request a preferred activity, to gain sensory input). Based on developmental and communication levels of the individual, the communicative behavior may be verbal, a manual sign, use of pictures, or other augmentative communication systems (electronic devices). To be effective, the alternative behavior response to replace the challenging behavior needs to be less effortful, more efficient, and consistent in obtaining the same end or the same need met for the individual. Steps in using treatments based on this paradigm are outlined below

1. Following a functional assessment and a determination of the function of the problem behavior, a replacement behavior is chosen. Table 1 provides examples of responses that might be taught based on

TABLE 1

Examples of Responses That Might Be Taught

TABLE 1

Examples of Responses That Might Be Taught

Challenging behavior maintained by

Teach

Examples

Escape—to get out of of or avoid a situation

Appropriate escape responses

1. Verbalize "I need a break."

2. Manual sign "Finish."

3. Push some items away

Attention—to gain someone's attention

Appropriate attention gaining response

1. Raise hand

2. Ring a bell

3. Press communication device programmed to say "Hey look at me."

4. Shake a rattle

Tangibles

Appropriate request for tangibles

1. Verbalization of "I want..."

2. Use of picture communication symbols to show an adult what is wanted

3. To lead an adult to what is wanted.

4. To manually sign "toy" if that is what is wanted.

Sensory feedback

Appropriate requests for sensory activities

1. Teach child to point to a bin of tactile, sensory items.

the hypothesized purpose or function of the challenging behavior.

2. The training of these replacement behaviors may initially take place out of the setting where the challenging behavior is likely to occur.

3. Once the individual has the chosen behavior in his repertoire, he is prompted to use that communication while often ignoring or interrupting the challenging behavior. For example, if an individual hits himself when given a difficult task, he may be prompted to request a break.

4. When individuals are consistently using the communication, replacement behavior in lieu of the challenging behavior, the addition of requests (in the case of escape situation) or increasing the delay for a response (in the case of receiving assistance) are typically systematically added. Differential reinforcement is often part of this step whereby the individual receives additional reinforcement for complying with requests and for the absences of the challenging behavior.

The replacement communication behavior chosen is dependent on findings from the functional assessment conducted prior to treatment planning. If it is determined the individual is attempting to escape or avoid a situation, then a likely communication to be taught would involve an indication of wanting a break, asking to leave, or of simply disliking an aspect of the situation. The communication behavior chosen to be taught depends on a number of variables. First, the skills of the individual obviously have to be determined. For individuals with no verbal skills, a nonverbal mode of communication will need to be chosen. Again, based on the developmental level of the individuals, the communication behavior could range from a sign, to pointing to a picture, or to using some other augmentative communication device. Augmentative communication devices now available include an array of sophisticated electronic devices that are individually programmed to support an individual in his or her communication needs. For example, the device may be programmed to "verbalize" the individual's favorite cereal when the key with a picture of that cereal box is pressed. Although the goal may be for the individual to use verbal communication, for purposes of FCT in decreasing a challenging behavior, a lower-level communication behavior is typically chosen. To illustrate this point, a child may have recently begun using phrases and short, simple sentences to make requests. This child however, when upset, uses no words. Hence, a possible replacement communication behavior may be a single word such as "help" to signal the child needs assistance from an adult in the setting.

A major advantage of this treatment is that a new, appropriate behavior is being taught versus the simple suppression of the challenging behavior. It may also be considered a more proactive approach instead of simply reacting when a challenging behavior is observed. Further, for individuals with limited skills to be independent and exert control and make choices, this approach builds more independence and choice making. Also of great importance is the increased likelihood of the effects of this treatment to maintain over time and to generalize to new situations. That is, the treatment will be effective over time and in new settings where not initially trained. For example, the individual will communicate the need to get out of a situation or to gain attention in a new classroom.

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