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5/23/2017
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GregoryP.HanleyPh.D.,BCBA‐D
FunctionalAssessmentofSevereProblemBehaviorofPersonswithAutism:
AFocusonaSafer,Faster,andStillEffectiveProcess
Formoreinformationgoto:www.practicalfunctionalassessment.com
WorkshopforDetroitWayneMentalHealthAuthority June,2017
Whydo“lifestyles”dictatedbyproblembehaviorpersistforfamiliesofchildrenwithautism?
Wholeshavepropertiesnotpresentintheparts
andnotreducibletothestudyoftheparts
MightwebenefitfromatouchofHolism?
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Bewaryofincontrovertibletruths.
“Allmodelsarewrong;someareuseful.”
Box &Draper,1987,p.424
Functionalassessment
process todeterminethevariablesinfluencingproblem
behavior
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SomeAssumptions
Problembehaviorisanoperant
Certainsituationspotentiatecertainconsequences
GoalofaFunctionalAssessmentIdentifytheconsequencesthatmaintainproblembehavior
Identifythesituationsthatevokethebehavior
Inordertotreatproblembehavior
FunctionalAssessmentProcess
FunctionalAnalysisObservewhilemanipulating
IndirectAssessmentInterview
DescriptiveAssessmentObserve
Discovery Demonstrationand
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DefiningfeaturesoftheStandardFunctionalAnalysis
Multiple test conditions
Uniform test conditions
Isolated test contingencies
Reinforce dangerous behavior only
Toy-play control condition
Problem Behavior
Per M
inute
Sessions
Exampleofastandardfunctionalanalysis
Howdoweknowthisisthestandardfunctionalanalysis?
(Jessel,Hanley,Ghaemmaghami,2016)
1965‐2000(Hanleyetal.,2003)
64%SFAs1out3withmodifications
2001‐2012(Beaversetal.,2014)
85%SFAs1outof7withmodifications
Multiple test conditions
Uniform test conditions
Isolated test contingencies
Reinforce dangerous behavior only
Toy-play control condition
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IstheStandardFunctionalAnalysisEffective?
Doesitleadtoadifferentiatedanalysis?
Literaturereviews:Hanleyetal.(2003): 94%Beaversetal.(2014): 92%
Caseseries:Hagopianetal.(2014): 47%Slatonetal.(2016): 44%
IstheStandardFunctionalAnalysisEffective?
Doesitleadstolargertreatmenteffects?
Campbell(2003)HigherPZDwhenRxwasbasedon“EFA”
But,theselargereffectswerealmostexclusivelyobtainedwhenresearchersimplementedthetreatmentsincontrolledsettingsunderrichschedulesofreinforcement
IstheStandardFunctionalAnalysisEffective?
Notonestudyshowingasocially‐validatedoutcomeinarelevantsettingwhenimplementedbyarelevantperson
whenastandardfunctionalanalysiswasused
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Apparentsolutiontoineffectiveness:Excessiveelaboration
Elaborationofthestandardfunctionalanalysis(SFA)
PriortoaSFAFormaldescriptiveassessments
PreferenceanalysesDemandanalyses
PrecursoranalysesManualsoutliningextensiveteam‐basedprocesses
FollowingafailedSFAManyslightandsystematicdeviationsfromtheSFAcoreprocedures
FollowingafailedSFA‐basedtreatmentStimulusavoidanceanalyses
Morepreferenceanalysisandreinforcer analysis
DespitetheExcessiveElaborationoftheStandardFunctionalAnalysis…
Notonestudyshowing…
…apracticaloutcomeinarelevantcontext
…thesocialacceptabilityoftheprocess
…asocially‐validatedeffectonproblembehavior
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“Sinceallmodelsarewrong,thescientistcannotobtaina‘correct’onebyexcessiveelaboration.
Justastheabilitytodevisesimplebutevocativemodelsisthesignatureofgreatsciencesooverelaborationisoftenthemarkofmediocrity.”
GeorgeBox,1976,p.792
ResearchtopracticegapPossiblereason:
Becausetheoutcomesaremediocre
evenwhentheprocessiselaborate
Functionalanalysishasbeenaroundforapprox.50years(e.g.,Lovaas etal.,1965;Sailoretal.,1968)
Standardfunctionalanalyseshavebeenaround34years(Iwataetal.,1982)
Over300studiescontainingover500standardfunctionalanalyseshavebeenpublished(Jesseletal.,2016)
Yet,55to65%ofpractitionersrecentlysurveyedreportedneverconductingafunctionalanalysis(Oliveretal.,2016;Roscoeetal.,2015)
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Interview-informed Synthesized Contingency
Analysis
IISCA
StandardFunctionalAnalysisMultiple test conditions
Uniform test conditions
Isolated test contingencies
Reinforce dangerous behavior
Toy-play control condition
Interview-Informed Synthesized Contingency AnalysisSingle-test condition
Individualized test conditions
Synthesized contingencies
Reinforce precursors to and dangerous behavior
Test-matched control
Sessions
1 2 3 4 5 6
0
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3
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Escape/Tangible/Attention
Zeke
Pro
blem
Beh
avio
r pe
r m
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AnIISCA
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SomeImportantAspectsofourApproach
Closed‐endedindirectassessments(MAS,QABF,FAST)areneverusedintheprocessbecausetheydonotprovideanyinformationaboutpersonallyuniqueorqualitativefeaturesofpotentiallyinfluentialvariables
Anopen‐endedinterviewisalwayspartoftheprocess
Primarygoalsaretoidentify:
a) co‐occurringtopographiesofproblembehaviorb) events/interactionsthatappeartoroutinelyevokeproblembehavior
c) interactionsthatfollowproblembehaviorandarereportedtostopit
Interviewsallowfordiscoverieswhichcanthenbeverified(ornot)intheIISCA
SomeImportantAspectsoftheIISCA
Extensivedescriptiveassessmentsareneverpartoftheprocess
becausetheyare:time‐consuming
andusuallysuggestinvalidrelationsSt.Peteretal.,2005;Thompson&Iwata,2007
SomeImportantAspectsofourApproach
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Wesynthesize multiplecontingenciesintoonetestconditionwhichcontingenciesandthespecificmaterialsandinteractionsareinformedbytheinterview
SomeImportantAspectsofourApproach
Whymightproblembehavioroccur?Singlecontingencies:1. Attentionortoys(social‐positivereinforcement)2. Escape/avoidance(social‐negativereinforcement)3. Sensory/non‐social(automaticreinforcement)
Combinatorialcontingencies:1. Attentionand Toys2. Escapeto toys3. Escapeto toysandattention4. Escapeto automaticreinforcement5. Compliancewithmands6. Escapetoaccesstorituals,preferredconversations7. Etc…..
CaseExample(Bob,8yo,dx:Autism)Analyst:SandyJinSetting:Clinic
Inextricablesynthesis
Hypothesis:
Bobengagesinmeltdownsandaggressioninordertoobtain:
“Hisway”intheformofescapefromadultinstructionsandaccesstopreferredwaysofinteractingwithelectronicsoracademicmaterials
Pro
blem
Beh
avio
r pe
r M
in
Sessions
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Escape /Tangible
Escape /Tangible
Bob(Ipad context)
Bob(Math context)
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CaseExample(Dale,11yo,dx:Autism)Therapist:SandyJinSetting:Clinic
Hypothesis:
Daleengagesinmeltdownsandaggressioninordertoobtain:
“Hisway”intheformofescapefromadultinstructionsandaccesstopreferred(tangible)items,andadultattention.
Pro
blem
Beh
avio
r pe
r M
in
Sessions1 2 3 4 5
0
1
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Dale
Analyst
Escape /Tangible /Attention
TeCoTeCo
0
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Dale
Analyst
Escape /Tangible /Attention /Mand complianc
Electivesynthesis(withinitialverification)
Hypotheses:
Gailengagesinmeltdownsandaggressioninordertoobtain:
preferred(tangible)itemsandmaternalattention
0
1
2
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Tangible /Attention
AnalystMother
AnalystMother
Analyst
Gail
Prob
lem
Beh
avio
r pe
r M
in
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2
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Tangible
Sessions
2 4 6 8 10 12 14
0
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Test
Control
Meltdowns Col 46
Attention
CaseExample(Gail,3yo,dx:PDD‐NOS)Analyst:NicholasVanselowSetting:Clinic
Whysynthesize?
1. Seemstoemulatetheecologybetter
2. Isolatedcontingenciessometimesdonotcontrolbehaviorwhereassynthesizedcontingenciesdo.
• Calletal.,2005• Dolezal & Kurtz,2010• Hanleyetal.,2014• Ghaemmaghamietal.,2016• Muelleretal.,2005• Slatonetal.,2016• Slatonetal.,2016
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www.practicalfunctionalassessment.com
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8TestControl
Food,attention
Addison
AttentionTangible (food)Control
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Escape totangibles,attention
Jay
Control
AttentionTangibleEscape
0
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4Escape tocompliance withrequests
Franklin
EscapeRequestsControl
4
IISCA Decoupled IISCASynthesized Isolated SynthesizedType of
contingency
Pro
blem
beh
avio
r pe
r m
in
Slatonetal.,2016
Whysynthesize?
1. Seemstoemulatetheecologybetter
2. Isolatedcontingenciessometimesdonotcontrolbehaviorwhereassynthesizedcontingenciesdo
3. Doingsoleadstoeffectiveaction—meaningfultreatmenteffects
– Hanleyetal.,2014,Santiagoetal.,2016;Ghaemmaghamietal.,2016
Somereasonablequestions:
HaveIISCAsbeenreplicated?(I.e.,Dotheyhavegenerality?)
Yes.
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FromJessel,Hanley,and
Ghaemmaghami(JABA,2016)
0
4
8
12 Will
TestControl
Wayne Allen Kat (Cxt 1)Sam
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2
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6 Jack (Cxt 1) Keo
Kristy Jim
Roxy
0
2
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6 Alex (Cxt 2) Chris
Jeff Zeke Kat (Cxt 2)
0
1
2
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4 Mike Mitch
Gary Jian Earl
0.5
1.0
1.5
2.0
0
Paul Dan
Alex (Cxt 1) Beck
Sid
2 6 10
0.5
1.0
1.5
2.0
0
Lee
2 4 6
Steve
1 3 5
Jesse
1 3 5
Carson
1 3 5
Jack (Cxt 2)
Sessions
Pro
blem
beh
avio
r pe
r m
in
Sessions
Pro
blem
beh
avio
r pe
r m
inut
e
FromRajaramanetal.(2016)
Hastheprocessbeensociallyvalidated?Yes.
Social Acceptability Questionnaire Results
Ratings
Questions Gail Dale Bob Mean
1. Acceptability of assessment procedures 7 7 7 7
2. Acceptability of treatment packages 7 7 7 7
3. Satisfaction with improvement in problem behavior 7 7 6 6.7
4. Helpfulness of consultation 7 7 7 7
Note. 7=highly acceptable, highly satisfied, or very helpful 1=not acceptable, not satisfied, or not helpful
fromHanleyetal.,JABA,2014
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Hastheprocessbeensociallyvalidated?Yes.
fromSantiagoetal.,JADD,2016
HavesociallyvalidatedtreatmentsbeendevelopedfromtheIISCA?
HavesociallyvalidatedeffectsbeenachievedfromtheIISCA?
Social Acceptability Questionnaire Results
Ratings
Questions Gail Dale Bob Mean
1. Acceptability of assessment procedures 7 7 7 7
2. Acceptability of treatment packages 7 7 7 7
3. Satisfaction with improvement in problem behavior 7 7 6 6.7
4. Helpfulness of consultation 7 7 7 7
Note. 7=highly acceptable, highly satisfied, or very helpful 1=not acceptable, not satisfied, or not helpful
fromHanleyetal.,JABA,2014
Sociallyvalidatedtreatmentsandoutcomes.Yes.
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Sociallyvalidatedtreatmentsandoutcomes.Yes.
fromSantiagoetal.,JADD,2016
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Com
plex
FC
Rpe
r m
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Reinforcem
ent (%)0
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Prob
lem
Beh
avio
rpe
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in
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Sessions
5 10 15 20 25 30 35 40 45 50 55 60 65
Res
pons
e to
In
stru
ctio
ns (
%)
0
20
40
60
80
100
Treatment Extension
1 2
ComplianceNoncomp.
Levels3
BL FCT + EXT Denial and Delay Tolerance TrainingSimple FCR Complex FCR
Zeke
Sim
ple
FCR
per
min
Tol
eran
ce R
espo
nse
per
min
Response Chaining
fromSantiagoetal.,JADD,2016
Treatment:
Unpredictableandintermittentreinforcementof
communication,toleration,andcompliance
Implementedbyrelevantcaregiversinrelevantcontextswhoimposerelevantandhistoricallychallengingroutines
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BeonthelookoutinJABA forthisstudybyDr.JoshuaJessel&colleagues:
AchievingSociallySignificantReductionsinProblemBehaviorfollowingtheInterview‐InformedSynthesizedContingencyAnalysis:
ASummaryof25OutpatientApplications
Baseline Treatment0
2
4
6
N = 25
p < .001
Pro
blem
beh
avio
r pe
r m
in
1 2 3 4 5 6 7
You found the recommended treatment acceptable
You are satisfied with the amount ofimprovement seen in problem behavior
You are satisfied with the amountof improvement seen in
communication skills
You found the assessment andtreatment helpful to your home situation
Notacceptable/satisfied/helpful
Highlyacceptable/
satisfied/helpfulCaregiver Rating
But,didn’tDr.FisherjustpublishanarticleinJABAshowingtheIISCA’swerealwaysincorrect?
ComparisonsofsynthesizedandindividualreinforcementcontingenciesduringfunctionalanalysisWayneW.Fisher,BrianD.Greer,PatrickW.Romani,&AmandaN.Zangrillo2016
FromFisheretal.,2016DifferentiationSFA:4of5IISCA:4of5
Escape to Tangibles & Attention
Escape / Tangible
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Irrelevanceofacontingencyishardtoprove.
Genericfunctionscanbeeasilymoderatedinanalyses.(seeHanley,Piazza,&Fisher,JABA,1997)
Therearenopuretestsofcontrolbysinglereinforcers,especiallytangibles.
Thetruthcanbefoundin
effectiveaction‐Differentiatedanalysis‐Efficiencyofandcontrolinanalysis‐Meaningfultreatmenteffects
Slaton,J.,Hanley,G.,&Raftery,K.(2016)
IISCAvs.StandardAnalysis
0
1
2TestControl
Escape to tangiblesand attention
Tangible
Ignore/Alone
PlayEscape
Attention
0
1
2
3Escape to tangiblesand attention
1 2 3 4 50
1
2
3Escape totangibles
5 10 15
Diego
Mason
Riley
Pro
blem
beh
avio
r pe
r m
in
Sessions
IISCA Standard IISCA
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IISCAvs.StandardAnalysis
0
1
2
Escape topredictableschedule
ControlTest
EscapePlay
AttentionTangible
Alone
1 2 3 4 5
0
1
2Escape to tangibles,stereotypy, andattention
5 10 15 20 250
2
4
6
8
3Escape to tangibles
d
Prob
lem
beh
avio
r pe
r m
in Kyle
Jonah
IISCA Standard
Sessions
IISCAvs.StandardAnalysisIgnore/Alone
EscapeTangible
Play
Attention
0
2
4 Escape totangiblesand attention
0
2
4Escape to rituals
2 4 60
1 Escape to tangibles
5 10 15 20
Pro
blem
beh
avio
r pe
r m
in
Sessions
IISCA Standard
Dylan
Emily
Chloe
Jeff
0
2
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ControlTest
Escape totangibles
TreatmentComparisonResults
5 10 15 20 25
0
2
4
6
Escape torituals
BL FCT + EXT
5 10 15 20 25
EscapeBL FCT + EXT
0
1
2
3Escape totangibles
Escape
Tangibles
IISCA- based treatment Standard-based treatment
Pro
blem
beh
avio
r pe
r m
in
Sessions
Chloe
Dylan
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TreatmentComparisonResults
0
1
2
3
4
5
FCR
BL FCT + EXTEscape totangibles,attention
Problembehavior
BL FCT + EXTEscape
5 100
1
Escape totangibles
BL FCT + EXT
5 10
Attention
BL FCT + EXT
IISCA- based treatment Standard-based treatment
Pro
blem
beh
avio
r pe
r m
in
Sessions
Emily
Jeff
Thesupposedproblem(s)withtheIISCAImprecision Donotknowthespecificoperantclasstowhichanyparticulartopographyofproblembehaviorbelongs.
Donotknowwhethersomepart(s)ofthesynthesizedcontingencyareirrelevant
Donotknowwhetherbehaviorismaintainedbypos orneg sr Sometimescannotneatlydescribeorcompartmentalizethecontrollingvariables
Considertheeffectiveactionwithoutknowingthesethings
ImprecisionisnotUniquetotheIISCAInterpretiveambiguityfromanIISCA
PartlysynthesizedcontingenciespopulateSFAsInterpretiveambiguityfromanSFA
ThesupposedprecisionofaSFAisanillusion
Antecedent PB Consequence Interpretation
NoAttention/Notangible NoAttention/Tangible Might beevokedbylowattn.orlackoftangible,orbothandmaintainedbyattn.ortangorboth
Attention/Notangible Attention /Tangible Might bemaintainedbytangibleorattentionorboth
Antecedent PB Consequence Interpretation
NoAttention/Notangible Attention /Tangible Behaviormaybecontrolledbyone,theother,orboth
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“Allmodelsarewrong;thepracticalquestionis
howwrongdotheyhavetobetonotbeuseful.”
Box &Draper,1987,p.424
RecognizetheHistoricalSignificanceoftheStandardFunctionalAnalysis
• Movedusfrombehaviormodificationtobehavioranalysis– Taughtusourprofessionalhumility
• Inspiredustotranscenddescriptionandpredictiontocontrol– Allowedustobescientificpractitioners
• Showedushowtocreatestableandcontrolledbaselines– Allowedustodiscoverandenhancetreatments
Multiple test conditions
Uniform test conditions
Isolated test contingencies
Reinforce dangerous behavior only
Toy-play control condition
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Toachievethehumanepromiseofafunction‐basedtreatmentandasociallyvalidoutcome
Fromafunctionalanalysis:
WhatmustIknow?WhatcanIsafelyinfer?WhatdoInotneedtoknow?
ThatwhichImustknowviamyfunctionalanalysis:
ThatIcanreliablyturnproblembehavioroffwiththepresentationofthereinforcers
ThatIcanreliablyturnproblembehavioronwiththepresentationoftheevocativeevents
Andthatthereinforcersandevocativeeventswereidentifiedbyotherpeoplerelevanttothebehaver
ThatwhichIcansafelyinferviamyfunctionalanalysis:
Responseclassmembership
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ProblemBehaviorsreportedtoco‐occur(inorderofconcern)1. SIB2. Aggression3. DisruptiveBehavior4. Disruptivevocalizations
5. Whining/complaining
Thisanalysisshowsallformsofproblembehaviorareevokedandmaintainedbysamesynthesizedcontingency.
Thishappenseverytimeweconductthissortofanalysis.(Warneretal.,2016)
Thishappenseverytimeanybodyelseconductthissortofanalysis(SmithandChurchill,2002,Borrero&Borrero,2008,Herscovitch etal.,2009)
ThatwhichIcansafelyinferviamyfunctionalanalysis:
Responseclassmembership
Reportedco‐occurrence=maintainedbysamereinforcers
Iwillinferresponseclassmembershipandusetheirresponsetointervention(RTI)asverification
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ThatwhichIdonotneedtoknowviamyfunctionalanalysis:
ThesingleoperantfunctionofeachproblembehaviorWhetherproblembehaviorismaintainedbypositiveornegativereinforcementWhethersomeelementofasynthesizedcontingencyisa“true”contingencyormerelya“falsepositive”WhetherIcanneatlycompartmentalizetheoperationintheanalysisintoatidygenericclassofreinforcement
(e.g.,socialpositive,socialnegative,attn,tang,esc,etc.)
TheoriginalgoldstandardGeneralandsociallyvalidatedbehaviorchange
byrelevantpeopleinrelevantcontextsBaer,Wolf,&Risley,1968
Iachieveit:bybeingabletoturnonandoffproblem
behaviorinananalysisinformedbycaregivers
IachieveitwithanIISCA
Formoreinformationgoto:www.practicalfunctionalassessment.com
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Comeupwithatleastonequestionrelevanttoconductingthefunctionalassessmentprocess.
• Whyisitimportanttoconductafunctionalassessmentwithafunctionalanalysisaspartoftheprocesspriortotreatingsevereproblembehavior?a. becausethefunctionalassessment
processishumaneanddignifyingb. becausebehaviormodificationis
ineffectivec. becauseresearchreviewsshowthatmore
effectivetreatmentsresultfromfunctionalassessmentprocesses,especiallythosethatcontainafunctionalanalysis
• Identifythefunctionalassessmenttoolsthatcanbeomittedfromaneffectivefunctionalassessmentprocessofsevereproblembehavior.a. closedendedindirectassessmentandfunctionalanalysis
b. open‐endedindirectassessmentandformaldescriptiveassessment
c. closed‐endedindirectassessmentsandformaldescriptiveassessments
d. open‐endedindirectassessmentandfunctionalanalysis
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• Whataretheessentialcomponentsofafunctionalanalysisofproblembehavior?a. directobservationofproblembehaviorduring
least4rapidlyalternatingconditions(demand,attention,alone,andtoyplay)
b. directobservationofproblembehaviorinaconditioncontainingthereinforcingcontingencythoughttomaintainsevereproblembehaviorandoneconditioninwhichthiscontingencyisabsent
c. indirectobservationofproblembehaviorduringseveraltestconditionsandatoyplaycontrolcondition
d. directobservationofproblembehaviorinthenaturalenvironment
• Nominatetheessentialfeaturesofaninterviewinformedsynthesizedcontingencyanalysis(IISCA)a. Test‐matchedcontrolconditionb. Interview‐informedsynthesized
contingencyc. Singleandindividualizedtestconditiond. Reinforcementprogrammedfor
precursorstoanddangerousbehavior
• Whatdoesaninformedanalysisprovidethebehavioranalyticpractitioner?
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• Whatdoesaninformedanalysisprovidethebehavioranalyticpractitioner?a. ademonstrationofproblembehavior
sensitivitytoasuspectedreinforcementcontingency
b. thetruthregardingthevariablescontrollingproblembehavior
c. astableandsensitivebaselinefromwhichtoevaluatetreatment
d. aproperlymotivatingsetofconditionstoteachfunctionalcommunicationanddelaytolerance
Whydotheanalysisiftheinterviewresultsseemstoclearlyindicateaparticularfunction?
TakeHomePoint
Priortotreatingproblembehaviorofchildrenwithautism
1. Conductanopenendedinterviewtodiscoverthecontextandoutcomesthatseemrelevanttoproblembehavior
2. ConductanIISCA todemonstratethevalidityofthesuspectedcontingency
– andtohaveaccesstotheproperlymotivatingconditionstoteachskills
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Let’sroleplaysomefunctionalanalyses.
Hand‐tohead‐SIBandgroaningappeartobemaintainedby:
1. Tangibles
2. Escapefromdemandstoaccesstangibles
3. Escapefromdemandstoaccesstangibles,attention,andstereotypy
4. Compliancewiththechild’smands(Escapefromtheteacher’swaytoaccessthechild’sway)
Let’sdesignanalysesfromtheinterviewresults
Sometips:1. Donotputresponsesincontingencyclassthatarelikelytobe
maintainedbyautomaticsr.2. Doconsiderputtingsomeill‐formedmands (e.g.,protests)in
thecontingencyclassifseverityofpb isoutrageous.3. IncorporatethemostchallengingandconvenientEOs. UsechallengingandinconvenientEOsastestsoftreatmentgenerality
4. Conductanalysiswhereyouhavethemostcontrolandwillbeableteachtheskills.
5. Erronthesideofsynthesizingtoomanycontingenciesratherthantoofew.
TreatingSevereProblemBehavior:AFocusonStrengtheningSociallyImportantBehaviorofPersonswithAutismGregoryP.HanleyPh.D.,BCBA‐D
Formoreinformationgoto:www.practicalfunctionalassessment.com
WorkshopforDetroitWayneMentalHealthAuthority June,2017
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FunctionalAssessmentandTreatmentModel
Steps(expanded)
1 Interview
2 FunctionalAnalysis
3 SimpleFunctionalCommunicationTraining
4 ComplexFCT
5 ToleranceResponseTraining
6 EasyResponseChaining
7 DifficultResponseChaining
8 TreatmentExtension
IISCA‐BasedTreatment
• Processhasledtocomprehensivetreatmentswithlarge,generalizedeffects
• Treatmentreliesonstrengthening:functionalcommunicationdelay/denialtolerationcompliance
With
Intermittent&unpredictablereinforcement
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BL FCT + EXT Denial and Delay Tolerance TrainingSimple FCR Complex FCR
Zeke
Sim
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FCR
per
min
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eran
ce R
espo
nse
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min
Response Chaining
Problembehaviornolongeryieldsthereinforcers (escapetochild‐directedplayandteacherattention)
Asimpleresponse(buttonpress:“Mywayplease”)ispromptedandreinforcedwith(escapetochild‐directedplay&teacherattention)
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BL FCT + EXT Denial and Delay Tolerance TrainingSimple FCR Complex FCR
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per
min
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Amoreinteractionalresponse(shouldertap,waitforteacheracknowledgement,two‐buttonpress:MayIhave/Mywayplease”)ispromptedandreinforced
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BL FCT + EXT Denial and Delay Tolerance TrainingSimple FCR Complex FCR
Zeke
Sim
ple
FCR
per
min
Tol
eran
ce R
espo
nse
per
min
Response Chaining
Responsestodisappointmentarepromptedandreinforced:(Takeabreathandnoddingyes)
Now,FCRsarereinforcedhalfthetime.Theotherhalf,theteacherdeniesthebid(e.g.,says’s no,doyourworkwithoutme,please)
Cuesofdisappointment,Delaystoreinforcement,andunpredictableoutcomeshavenowbeenintroduced!
0
1
2
3
4
0
1
2
3
4
Com
plex
FC
Rpe
r m
in
0
1
2
3
4
Reinforcem
ent (%)0
20
40
60
80
100
Pro
blem
Beh
avio
rpe
r m
in
0
1
2
3
4
Sessions
5 10 15 20 25 30 35 40 45 50 55 60 65
Res
pons
e to
In
stru
ctio
ns (
%)
0
20
40
60
80
100
Treatment Extension
1 2
Compliance
Noncomp.
Levels3
BL FCT + EXT Denial and Delay Tolerance TrainingSimple FCR Complex FCR
Zeke
Sim
ple
FCR
per
min
Tol
eran
ce R
espo
nse
per
min
Response Chaining
Now,FCRsarereinforced1/3ofthetime.
TRsarereinforced1/3ofthetime.
Andcompliancewithprogressivelylongerandmorechallenginginstructionsisreinforced
5/23/2017
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0
1
2
3
4
0
1
2
3
4
Com
plex
FC
Rpe
r m
in
0
1
2
3
4
Reinforcem
ent (%)0
20
40
60
80
100
Pro
blem
Beh
avio
rpe
r m
in
0
1
2
3
4
Sessions
5 10 15 20 25 30 35 40 45 50 55 60 65
Res
pons
e to
In
stru
ctio
ns (
%)
0
20
40
60
80
100
Treatment Extension
1 2
Compliance
Noncomp.
Levels3
BL FCT + EXT Denial and Delay Tolerance TrainingSimple FCR Complex FCR
Zeke
Sim
ple
FCR
per
min
Tol
eran
ce R
espo
nse
per
min
Response Chaining
Whatisthetreatment????
Intermittentandunpredictablereinforcementoflifeskills:FunctionalCommunicationDelay/denialtolerationCompliance
Pro
blem
Beh
avio
r
per
min
0.0
0.5
1.0
1.5
2.0
2.5
3.0
Sim
ple
FC
R
p
er m
in
0.0
0.5
1.0
1.5
2.0
Com
plex
FC
R
per
min
0.0
0.5
1.0
1.5
2.0
Tol
eran
ce R
espo
nse
pe
r m
in
0.0
0.5
1.0
1.5
2.0
100
BL FCT + EXT
Sim
ple
FCR
Com
plex
FC
R
Denial BL Denial and Delay Tolerance Training
Treatment Extension
Response Chaining
Meltdownsandaggression
“Playwithme”
“Excuseme,”waitsforacknowledgementfromparent,thensays,“Willyouplaywithme,please”withappropriatetoneandvolume
Saying,“okay”whileglancingatparentwhojustsaid“No,”Wait,”“Holdon,”or“inaminute”
5/23/2017
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0.0T
oler
ance
Res
pons
e
per
min
0.0
0.5
1.0
1.5
2.0
Sessions5 10 15 20 25 30 35 40 45 50 55 60 65 70
R
espo
nse
to
Inst
ruct
ions
(%
)
0
25
50
75
100
Rei
nfor
cem
ent
(%)
0
25
50
75
100
Gail
1 2 3
Compliance
Noncomp.
Levels
Visits
2
Calendar Days (2012-2013)
3 6
12/1
312
/14
7
8
9 10
11
12
13
14
1/18
1/21
1/22
1/25
1/29
2/1
2/4
2/5
2/6
15
2/12
16 17 18 19
2/15
2/18
2/19
2/20
20
3/1
21
3/2
22
3/8
Reinforcement:TimewithMom’sundividedattentionandpreferredtoys
Compliance:DoingwhateverMomaskedhertodoquicklyandcompletely
Tol
eran
pe
0.0
0.5
Sessions10 20 30 40 50 60 70 80 90 100
R
espo
nse
to
Inst
ruct
ions
(%
)
0
25
50
75
100
Rei
nfor
cem
ent
(%)
0
25
50
75
100
Dale
Visits
1
Calendar Days (2013)
2 3
1/24
1/25
4
5
6 7
8
9
10
11
1/30
1/31
2/1
2/5
2/6
2/12
2/15
2/22
2/26
12
2/28
13 14 15 16
3/1
3/5
3/6
3/8
17
3/13
18
3/20
19
3/24
20
3/27
21
3/29
22
4/2
23
4/3
4/5
24
25
4/10
26
27
4/11
4/12
28
4/19
29
4/24
30
4/26
1 2 3
Compliance
Noncomp.
31
5/2
Levels
BL FCT + EXTDenial BL Denial and Delay Tolerance TrainingTreatment
Analysis
Dale
11‐yearoldboy
diagnosedwithAutism
PROGRESSIVE INCREASE IN COMPLEXITY OF INSTRUCTIONS
1 Simple motor movementsWalk over here, stand up, sit down,
clap your hands, touch your (shoulder, head, toes)2 Simple academics Draw a circle, write your name, copy what I write
Homework/Task preparationUnzip your backpack, take out the book, erase the board
come to the board, put these books on the book shelf
3 Complex academic: Reading skillsRead this paragraph, Answer this question….,
Sound out the wordsComplex academic: Math skills Solve this (addition, subtraction etc…)
Self-help skills Wash your hands, do this chore (e.g., organizing chairs)Play skills Throw or kick the ball
TreatmentAnalysis
Dale
11‐yearoldboy
diagnosedwithAutism
Pro
blem
Beh
avio
r
per
min
0
2
4
6
8
10
12
14
Sim
ple
FC
R
p
er m
in
0
1
2
3
4
Com
plex
FC
R
per
min
0.0
0.5
1.0
1.5
2.0
Tol
eran
ce R
espo
nse
pe
r m
in
0.0
0.5
1.0
1.5
2.0
Rei
nfor
cem
ent
(%)
0
25
50
75
100
Dale
BL FCT + EXT
Sim
ple
FCR
Com
plex
FC
R
Denial BL Denial and Delay Tolerance Training
Treatment Extension
*
Response Chaining
Sessions
Visits
1
Calendar Days (2013)
2 3
1/24
1/25
4
5
6 7
8
9
10
11
1/30
1/31
2/1
2/5
2/6
2/12
2/15
2/22
2/26
12
2/28
13 14 15 16
3/1
3/5
3/6
3/8
17
3/13
18
3/20
19
3/24
20
3/27
21
3/29
22
4/2
23
4/3
4/5
24
25
4/10
26
27
4/11
4/12
28
4/19
29
4/24
30
4/26
31
5/2
5/23/2017
32
Tol
eran
pe
0.0
0.5
Sessions10 20 30 40 50 60 70 80 90 100
R
espo
nse
to
Inst
ruct
ions
(%
)
0
25
50
75
100
Rei
nfor
cem
ent
(%)
0
25
50
75
100
Dale
Visits
1
Calendar Days (2013)
2 3
1/24
1/25
4
5
6 7
8
9
10
11
1/30
1/31
2/1
2/5
2/6
2/12
2/15
2/22
2/26
12
2/28
13 14 15 16
3/1
3/5
3/6
3/8
17
3/13
18
3/20
19
3/24
20
3/27
21
3/29
22
4/2
23
4/3
4/5
24
25
4/10
26
27
4/11
4/12
28
4/19
29
4/24
30
4/26
1 2 3
Compliance
Noncomp.
31
5/2
Levels
BL FCT + EXTDenial BL Denial and Delay Tolerance TrainingTreatment
Analysis
Dale
11‐yearoldboy
diagnosedwithAutism
MANNER IN WHICH TREATMENT WAS EXTENDED TO FAMILY AND HOME• Three analysts alternated while parents observed the sessions• Following training, the father was introduced after the analyst presented the evocative trial and
halfway through the session; the mother was present in the session room• The mother implemented treatment in the session room• Parents varied the type and amount of instructions during the delay period• Parents implemented treatment in the home while novel instructions were introduced
Treatment Extension
Takeamomenttoreflectonthisparticulartreatmentprocess.
Howisitsimilartoanddifferentthanthetreatmentyouimplement?
Discusswithyourneighbor.
TimeAssessment
Steps
# of Visits (1 hr each)
Cost (in US dollars)
Range Mean Range Mean
1* Interview -- 1 -- 200
2* Functional Analysis 1 - 4 2.3 166 - 800 467
3 Functional Communication Training
1 - 3 2 200 - 534 400
4 Complex FCT 1 - 4 2.4 200 - 860 487
5 Tolerance Response Training
2 - 7 4.6 300 - 1400 913
6 Easy Response Chaining 1 - 5 2.6 200 – 960 520
7* Difficult Response Chaining 2 - 11 5.1 400 - 2240 1,013
8* Treatment Extension 4 - 9 7.3 800 - 1800 1,467
Totals: 23 - 32 27 5,467
Supervision meetings: 16 - 28 20 1000 - 1750 1250
Report writing / planning: -- 4 -- 500
Grand Totals: 6225 - 8650 7,217
5/23/2017
33
CostAssessment
Steps
# of Visits (1 hr each)
Cost (in US dollars)
Range Mean Range Mean
1* Interview -- 1 -- 200
2* Functional Analysis 1 - 4 2.3 166 - 800 467
3 Functional Communication Training
1 - 3 2 200 - 534 400
4 Complex FCT 1 - 4 2.4 200 - 860 487
5 Tolerance Response Training
2 - 7 4.6 300 - 1400 913
6 Easy Response Chaining 1 - 5 2.6 200 – 960 520
7* Difficult Response Chaining 2 - 11 5.1 400 - 2240 1,013
8* Treatment Extension 4 - 9 7.3 800 - 1800 1,467
Totals: 23 - 32 27 5,467
Supervision meetings: 16 - 28 20 1000 - 1750 1250
Report writing / planning: -- 4 -- 500
Grand Totals: 6225 - 8650 7,217
Social Acceptability Questionnaire Results
Ratings
Questions Gail Dale Bob Mean
1. Acceptability of assessment procedures 7 7 7 7
2. Acceptability of treatment packages 7 7 7 7
3. Satisfaction with improvement in problem behavior 7 7 6 6.7
4. Helpfulness of consultation 7 7 7 7
Note. 7=highly acceptable, highly satisfied, or very helpful 1=not acceptable, not satisfied, or not helpful
IISCAshaveledsocially‐validated outcomes
fromHanleyetal.,2014
PersonalizedSocialvalidityData
Parents' Comfort Level of Presenting the Evocative Situation
Comfort Levels
Questions Pre-treatment Post-treatment
Gail
1. Taking away toys 1 7
2. Telling child "no" when they ask for something 3 7
3. Giving instructions 5 7
Dale
1. Interrupting child's preferred activity and telling them to do homework or other non-preferred activities
4 6
Bob
1. Taking away DS or iPad at meal times 3 7
2. Taking away DS or iPad on a transition 3 7
3. Interrupting or correcting math work 3 7
Note. 7=very comfortable 1=not comfortable.
5/23/2017
34
Someopen‐endedresponsesfromtheSocialAcceptabilityQuestionnaire
SrComplexFCR
SrComplexFCR “No” Toleranceresponse
SrComplexFCR “No” Toleranceresponse Instruction C
SrComplexFCR “No” Toleranceresponse Instruction Compliance
SrComplexFCR “No” Toleranceresponse Instruction Compliance
SrComplexFCR “No” Toleranceresponse Instruction Compliance
SrComplexFCR
SrComplexFCR
SrComplexFCR “No” Toleranceresponse
SrComplexFCR “No” Toleranceresponse Instruction Compliance
Reinforcementis:Responserequirementis:Function‐based VariableDifferential UnpredictableIntermittentVariableinduration
5/23/2017
35
TreatmentImplementation
*Materialsnotneeded:LaminateLaminatingmachineGluegunsVisavismarkersVelcroTokensTokenboardsTimersStickersCandiesAnythingthatwasnotalreadyin
thechild’senvironment!
1. Puttheseinyourpocket2. Pulloneoutwhilechildis
experiencingtheirreinforcers
3. Keepittoyourself4. Requirethatbehaviornext
time
1. Spinit!2. Keepittoyourself3. Requirethatbehaviornext
time
Appcalled“NamesinaHat”
Appcalled“Roundom”
5/23/2017
36
TenUniqueAspectsofourApproach(continued)
7.Ourfunction‐basedtreatmentsarealwaysskill‐based
PublishedinBehaviorAnalysisinPracticein2008(availableforfreeatPubMedCentral)
TenUniqueAspectsofourApproach
Wealwaysincreasethecomplexity,flexibility,and/orinteractionalnatureoftheFCRbeforeteachingdelay/denialtolerance
SimpleFCR: (“Myway”or“Myway,please”)
ComplexFCR:“Excuseme”
Afterasecondortwo,“Yes,Billy”“MayIhavemyway,please?”“Willyouplaymyway,please?”
Afterasecondortwo,“Sure,Billy”
Sessions10 20 30 40 50 60
Tot
al R
espo
nses
per
Min
ute
0
5
10
15
20
25
30
PBInd. FCR
3-s + Immediate
Luke
3-s + Delayed
0- to 3-s + Immediate
5
10
BL FCT
Prompting:Immediatethenfaded.
5/23/2017
37
Sessions
5 10 15 20 25
Agg
ress
ion
&D
isru
ptio
ns(r
pm)
012345
"Exc
use
me?
"[p
ause
]"M
ay I
hav
em
y w
aypl
s?"
(rpm
)
012345
"My
way
pls"
(rp
m)
012345
BL FCT + EXT
"May
I h
ave
my
way
pls?
" (r
pm)
012345
"Exc
use
me
may
I h
ave
my
way
pls?
" (r
pm)
012345
Jeff
Step 1
Step 2
Step 3
Step 4Shapethecomplexresponse
Differentiatethecomplexresponse
ImplementationquestionsregardingFCT?
Tips:1. Teachasimpleomnibusmand ratherthantrytoteachspecificmands fordifferentreinforcers atfirst.• Specificmands canbetaughtonceproblembehavioriszeroandtheomnibus
mand isoccurringindependently.
2. Relyonanovelmand ratherthanapre‐existingmand.3. Doeverythingpossibletoavoidchainingproblembehaviorwiththetargetmand.• Forinstance,becarefulofpromptingthenovelmand afteremissionofpb
o Eitherletextinctionofpb occurviatimeoutoruseanerrorlesspromptingtacticsuchasmosttoleastprompting
4. Startoutfastandsweaty;endslowandcool.
5/23/2017
38
ComeupwithatleastonequestionrelevanttoimplementingFunctionalCommunicationTraining(FCT)
TenUniqueAspectsofourApproach
9.Wealwaysexplicitlyteachdelay/denialtolerance
Thistakesupmostofourtimewithchildrenandfamilies(notthefunctionalassessmentorteachingtheFCRs)
Firstteachanexplicitresponsetoavarietyofdisappointmentsignals,thentomaketreatmentpractical:
• Chainimportantbehaviortothetoleranceresponse(thereisalwaysaprogressive component—agradualincreaseintime,stakes,orboth)
Asdelayincreases,FCRweakens&probabilityofPBincreases
WithonlyProgressiveReinforcementDelay:
5/23/2017
39
Sessions10 20 30 40
0
2
4
6
8
10No
DelayTerminal
Delay(no EXT)
NoDelay
NoDelay
TBPD(with EXT)
CBPD(with EXT)
Alex
Prob
lem
Beh
avio
r pe
r m
in
Scheduled Delay
Mean Experienced Delay
10 20 30 40
Res
pons
es p
er m
in
0.0
0.6
1.2
1.8
Ind TR
Ind FCR
Sessions
Time‐basedvs.Contingency‐basedProgressiveDelay
(LeadAuthor:MahshidGhaemmaghami)
Time‐basedvs.Contingency‐basedProgressiveDelay(LeadAuthor:Mahshid
Ghaemmaghami)
0
20
40
60
80
100
0
1
2
3
0
20
40
60
80
100
0
1
2
3
4
5
0
20
40
60
80
100
Pro
blem
Beh
avio
rpe
r m
in
0
1
2
3
0
20
40
60
80
100
App
ropr
iate
Res
pons
espe
r m
in
0
1
2
3
4
FCRTolerance Response
NoDelay
Terminal DelayWithout Extinction
NoDelay
NoDelay
NoDelay
Time-BasedProgressive Delay
Contingency-BasedProgressive Delay (CBPD)
Context 1
CBPD
% of S
ession Engaged in
Em
otional Responding
Dur
atio
n of
Del
ay (
s)
0
100
200
300
400
ScheduledExperienced
Sessions5 10 15 20 25 30 35 40 45 50 55
0
100
200
300
400
Terminal DelayWithout Extinction
% of D
elay Interval Engaged in
Alternative A
ctivity
Context 2
Context 1
Context 2
Context 1
Context 2
Jack
Time‐basedvs.Contingency‐basedProgressiveDelay(LeadAuthor:Mahshid
Ghaemmaghami)
0
20
40
60
80
100
0
1
2
3
0
20
40
60
80
100
0
1
2
3
4
5
0
20
40
60
80
100
Pro
blem
Beh
avio
rpe
r m
in
0
1
2
3
0
20
40
60
80
100
App
ropr
iate
Res
pons
espe
r m
in
0
1
2
3
4
FCRTolerance Response
NoDelay
Terminal DelayWithout Extinction
NoDelay
NoDelay
NoDelay
Time-BasedProgressive Delay
Contingency-BasedProgressive Delay (CBPD)
Context 1
CBPD
% of S
ession Engaged in
Em
otional Responding
Dur
atio
n of
Del
ay (
s)
0
100
200
300
400
ScheduledExperienced
Sessions5 10 15 20 25 30 35 40 45 50 55
0
100
200
300
400
Terminal DelayWithout Extinction
% of D
elay Interval Engaged in
Alternative A
ctivity
Context 2
Context 1
Context 2
Context 1
Context 2
Jack
5/23/2017
40
5CriticalAspectsofDelay/DenialToleranceTraining
1. Alwaysprovideimmediatesr forsomeFCRs
2. Teachanappropriateresponsetomultiplecuesofdelay,denial,ordisappointment
3. Progressivelyincreasetheaverageamountofbehavior (notjusttime)requiredtoterminatethedelay
4. Terminatethedelayforvarious amountsofbehavior(sometimesexpectverylittlebehaviorsometimesrequestlargerormorecomplextypesofbehaviorduringthedelay)
5. Probablybesttonotsignalhowmuchbehaviorisrequiredtoterminatethedelays
ComeupwithatleastonequestionrelevanttoimplementingDelay/DenialToleranceTraining
• Nominatethecriticalfeaturesofprogrammingtoteachchildrentotoleratedelaystothereinforcersmaintainingtheirproblembehavior.a. oncecompliancechainsareacquired,always
delaythereinforcerfollowingafunctionalcommunicationresponse
b. teachanappropriateresponsetodelayanddenialcuesbyprovidingpreferredcandywhenthechilddoesnotmeltdownfollowingadelayordenialcue
c. endthedelaywhentheamountoftimedeterminedpriortosessionshasexpired
d. reinforcethefunctionalcommunicationresponseimmediatelyatleastsomeofthetime
e. enddelayswhenthechildhasengagedinasufficientamountofanappropriateactivity
5/23/2017
41
• Inthisskill‐basedprogram,reinforcementis:a. function‐basedasopposedtoarbitraryb. differentiallydeliveredasopposedto
noncontingentc. continuousasopposedtointermittentd. consistentasopposedtovariablein
duratione. fairlyunpredictableasopposedtohighly
predictable
• Nominatethecriticalaspectsofdelayanddenialtolerancetraining.a. progressivelyincreasetheaverageamountofbehaviorrequiredtoterminatethedelay
b. teachanappropriateresponsetomultiplecuesofdelay,denial,ordisappointment
c. alwaysprovideimmediatereinforcementforsomefunctionalcommunicationresponses
d. donotsignalhowmuchbehaviorisrequiredtoterminatethedelays
e. terminatethedelayforvariousamountsofbehavior
• Fromthelistbelow,nominatetheitemsusuallynotnecessarywhenimplementingthetreatmentacrosstheday:a. Laminateandlaminatingmachineb. Gluegunsc. Visavis markersd. Velcroe. TokensandTokenboardsf. Timersg. Stickersh. Candies
5/23/2017
42
Comeupwithatleastonequestionrelevanttoimplementingthefunction‐basedtreatmentasdescribed.
Then,let’stalklogistics.
Afinalmessage
WithAutism,thereisahigherlikelihoodofproblembehavior
MeltdownsAggressionSelf‐injury
References:Baghdadli,Pascal,Grisi,&Aussilloux,2003;Horneretal.,2002;Kimetal.,2000;Murphy,Healy,&Leader,2009;Thompson,2009
freedom
fromthesebehaviorsforpersonswithAutismandtheircaregivers
isattainable
5/23/2017
43
Itisattainableformost
withoutdrugs
withouthospitalization
withoutharshpunishment
withoutcandies,stickers,andtokenboards
Itisattainable
byfirstunderstanding*whythechildisengagingintheproblembehavior
understandingcanberealizedquickly,safely,andanalytically
Itisattainable
whenchildrenaretaughtskills*tohelpthemnavigateourcomplexsocialworld
*Communicationandtoleration
5/23/2017
44
Itisattainable
whentheskillsaremaintainedviaunpredictableandintermittentreinforcement
whichisprobablythesamearrangementthatmaintainedthevariousformsofproblembehavior
GregoryP.Hanley.Ph.D.,BCBA‐D
AddressingStereotypyTheImportanceofaBalancedApproach
tothisCoreSymptomofAutism
Formoreinformationgoto:www.practicalfunctionalassessment.com
WorkshopforDetroitWayneMentalHealthAuthority June,2017
PersonsdiagnosedwithAutism
oftenengageinrepetitiveacts
thatappeartoservenofunction
5/23/2017
45
Theseactsarecollectivelyreferredtoas
stereotypy
duetotheformalsimilarityoftheacts
andtheperiodicitywithwhichtheyareemitted
5/23/2017
46
HFA = High functioning autism
LFA =Low functioning autism
DLD = Developmental language disorder
NALIQ = Non‐autistic low IQ
Stereotypycanservedifferentfunctions
FromHanley,Iwata,andMcCord,JABA,2003,p.166
Stereotypyisusuallymaintainedby
sensory(automatic)reinforcement)
5/23/2017
47
WhenisStereotypyaProblem?
….whenitisexhibitedwithimpairing frequency
WhenisStereotypyaProblem?
….whenitisexhibitedwithimpairing frequency
whenitinterfereswithattemptstoteachskillsorconcepts
WhenisStereotypyaProblem?
….whenitisexhibitedwithimpairing frequency
whenitinterfereswithsocialinteractions
5/23/2017
48
WhenisStereotypyaProblem?
….whenitisexhibitedwithimpairing frequency
whentheprohibitionofstereotypyresultsinmoreseriousproblembehavior
(DeLeon etal.,2011)
• Threeteenagers– Jon,Patrick,&Edward
• Stereotypy– Handflapping,fingertappingorflicking,bodyrocking,mouthing,eyepressing,earholding
Someapplicationsofthemodel
5/23/2017
49
Sessions
3 6 9 12 15
Res
pons
es p
er m
in(S
tere
otyp
y)
0
2
4
6
8
10
12
14Attention EscapeAlone Control
Jon
Sessions
2 4 6 8 10 12R
espo
nses
per
min
(Ste
reot
ypy)
0
2
4
6
8
10
AttentionEscapeAlone Control
Patrick
Step1:Functionalanalysis
Sessions
3 6 9 12
Res
pons
es p
er m
in(S
tere
otyp
y)
0
2
4
6
8
10
Attention EscapeAlone Control
Edward
ConclusionStereotypyisprobablymaintainedbyautomaticreinforcement
Step2:Conductapreferenceassessment
Seethesestudiesforthesuccessfultreatmentofstereotypybyprovidingfreeaccesstomaterialsidentifiedviapreferenceassessment
Favell,McGimsey,&Schell(1982)AIDD
Piazza,Adelinis,Hanley,Goh,&Delia(2000)JABA
Roscoe,Iwata,&Goh(1999)JABA
Step2:PreferenceAssessment
Du
rati
on (
in s
ec)
Sim
ple
En
gage
men
t
50
100
150
200
250
300
Items
BeadsLinks
StampsDinos
Intersta
rs
Play D
ohCups
Lite Brite
Res
pon
se p
er m
in(S
tere
otyp
y)
2
4
6
8
10
12
14
Jon
Items
Shape Sorte
r
Intersta
rsLegos
Lite Brite
Matching
StampsBead
s
Etch-a-
sketch
Stickers
Patrick
Items
ControlBead
s
Shape Sorte
rLaci
ng
Intersta
r
StampsLinks
Lite Brite
Legos
Edward
5/23/2017
50
Step2:PreferenceAssessment
Du
rati
on (
in s
ec)
Sim
ple
En
gage
men
t
50
100
150
200
250
300
Items
BeadsLinks
StampsDinos
Intersta
rs
Play D
ohCups
Lite Brite
Res
pon
se p
er m
in(S
tere
otyp
y)
2
4
6
8
10
12
14
Jon
Items
Shape Sorte
r
Intersta
rsLegos
Lite Brite
Matching
StampsBead
s
Etch-a-
sketch
Stickers
Patrick
Items
ControlBead
s
Shape Sorte
rLaci
ng
Intersta
r
StampsLinks
Lite Brite
Legos
Edward
ConclusionReinforcers earnedviaitemengagementwereneithersubstitutablefornordidtheyeffectivelycompetewithreinforcers earnedviastereotypy
Step3:AddPromptingofItemEngagement
Seethesestudiesforthesuccessfulapplicationofpromptingengagementwithfreelyavailabletoystoaddressstereotypy
Britton,Carr,,Landaburu,&Romick (2002)BI
Horner(1980)JABA
Lindberg,Iwata,&Kahng(1999)JABA
Jon
5/23/2017
51
Edward
Step3:AddPromptingofItemEngagement
Conclusion:Stereotypypersisted,so…..promptingapparentlydidnotresultinaccesstomoreorbetterreinforcers foritemengagement
Step4:Alterconsequenceofstereotypy‐‐addblocking
Seethesestudiesforthesuccessfultreatmentofstereotypybyblockingstereotypy
Lerman,&Iwata(1996)JABA
Reid,Parsons,Phillips,&Green(1993)JABA
Roscoe,Iwata,&Goh(1999)JABA
5/23/2017
53
Step4:Alterconsequenceofstereotypy‐‐addblocking
Conclusion:Stereotypypersistedorworsened
Why?• Interpretationoffunctionalpropertiesofstereotypywasincorrect
• Onlysawearlystageofextinction• Arenotremovingallreinforcers (therewereintegritybreaches)
• Motivationtoproduceautomaticreinforcementwashighwithnootherwaytoproducesimilarreinforcers
Step5:AdddifferentialreinforcementtostrengthensomedesirablebehaviorSeethesestudiesforthesuccessfultreatmentofstereotypyviadifferentialreinforcement
Charlop,Kurtz,&Casey(1990)JABA
Hanley,Iwata,Thompson,&Lindberg(2000)JABA
Wolery,Kirk,&Gast (1985)JADD
Jon
5/23/2017
54
Edward
Patrick
Thetreatment–
activitiesprompting(teaching)
blockingwhile teachingearnedaccesstostereotypy
canthenbeusedtoteachmorecomplexplayskills
5/23/2017
55
Sessions
10 20 30 40 50 60 70 80 90 100 110 120
0
5
10
15
20
# of Rs / FormRequirements
12345678910
0
5
10
15
20
Jon
Baseline
Res
pon
ses
per
min
Treatment for Shaping Specific Forms of Functional Engagement
Stereotypy
Prompted SFE
Specific FunctionalEngagement
/ 1 post on I-bar/ 2 posts on I-bar/ 3 posts on I-bar/ 4 posts on I-bar/ I-bar on posts (1 cube)
/ 2 cubes
5/23/2017
56
Sessions
10 20 30 40 50 60 70 80 90
0
3
6
9
12
15
# of Rs / FormRequirements
123456789101112
0
3
6
9
12
15
StereotypySpecific Functional Engagement (SFE)Prompted SFE
EdwardBaseline
Res
pons
es p
er m
in
Treatment for Shaping Specific Forms of Functional Engagement
/ 1 Lego/ 2 Legos/ 3 Legos/ 4 Legos/ 5 Legos
/ 2nd House
/ 6 Legos / 1st House
Isthisahumanetreatment?
Arestaffwillingtoimplementthesetreatments?
Doesthepersonwithstereotypylikeorloathethistreatment?
Table 2
Questions and Results of the Social Validity Questionnaire Responses
Questions Mean (range)1. Do you think that the treatment that involved prompting engagement, blocking stereotypy, and differentially reinforcing engagement with 30 s access to the participant’s own stereotypy was acceptable?
7.0
2. Do you think that the amount of behavior change was acceptable and sufficient?
6.6 (6 - 7)
3. I feel that the overall goals of this treatment were acceptable, appropriate and important for the individual.
6.6 (5 - 7)
4. I would recommend this treatment package to other therapists/providers that are attempting to decrease motor stereotypy and increase age-appropriate play skills.
6.8 (6 - 7)
5/23/2017
57
Similarinquiry,differentrespondent:Whichtreatmentdideachteenagerprefer?
Orange
Purple
Light Blue
Hot Pink
Royal Blue
White Pink
Teal
% S
elec
ted
0
10
20
30
40
50
60
70
80
90
100
Colors
Jon
5/23/2017
58
Blocking OnlyPink Card
Light Blue Card
Royal Blue Card
FR-1
Activities Only
Activities, Blocking, andContingent Access to Stereotypy
Initial Links Terminal Links
Contingency:
Trials
12 24 36 48 60 72 84 96 108 120 132 144 156 168 180
Cu
mul
ativ
e #
of S
elec
tion
s
0
4
8
12
16
20
24
28
32
36
40
44
No Differential Consequences for Selections
Differential Consequences for Selections
Jon
Pink Blocking only Light Blue Activities only Royal Blue Tx Package
Link Colors Correlated Treatments
(1) (2) (5)(3) (4) (6) (7) (8) (9) (10)(11)(12)(13)
(Sessions)
(14)(15)(16)(17)(18)(19)(20)
No Differential Consequences for Selections
(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)
Trials
6 12 18 24 30 36 42 48 54 60
Cu
mu
lati
ve #
of
Sele
ctio
ns
0
2
4
6
8
10
12
14
16
No Differential Consequences for Selections
Differential Consequences for Selections
Patrick
(1) (2) (5)(3) (4) (6) (7) (8) (9) (10)
(Sessions)
No Differential Consequences for Selections
Pink Blocking onlyYellow Activities only
Link Colors Correlated Treatments
Green Tx Package
5/23/2017
59
Trials
12 24 36 48 60 72 84 96 108 120 132 144 156 168
Cu
mu
lati
ve #
of
Sele
ctio
ns
0
4
8
12
16
20
24
28
32
36
40
44
No Differential Consequences for Selections
Differential Consequences for Selections
Edward
Blue Tx Package
Green Blocking Only Orange Activities Only
Link Colors Correlated Treatments
(1) (2) (5)(3) (4) (6) (7) (8) (9)(10)
(Sessions)
(11)(12) (13)(14) (15)(16)
No Differential Consequences for Selections
(17)(18) (19)(20) (21)(22) (23)(24) (25)(26) (27)(28)
ResultsSummary
Noonepreferredblockingonly
Nooneavoidedthetreatmentwithallthreecomponents
Twoofthreepreferredthetreatmentwithallthreecomponents
Whyapreferenceforthistreatment?
Preferenceforcontingencies?
5/23/2017
60
SomeTake‐HomePoints
Don’tassumefunction
Testforsensitivitytosocialreinforcers first;see:
SomeTake‐HomePoints
Itisimportanttorecognizethenecessityandinsufficiencyofblockingasatreatmentforstereotypy
SomeTake‐HomePoints
Immediatetreatmentgoalisnotelimination ofstereotypy
Moreappropriategoalishavingitoccurinacceptableplacesandatacceptabletimes
5/23/2017
61
Canwesimplyobtainstimuluscontroloverstereotypy?
Yes– butthenotionofacontingencyisimportantheretoo.
Multipleschedule
• S‐:stereotypyblocked• S+:stereotypyallowed
• ChangeoverbetweenS‐
andS+ componentsistime‐based
Chainedschedule
• S‐:stereotypyblocked• S+:stereotypyallowed
• ChangeoverbetweenS‐
andS+ componentsiscontingent
0
5
10
40MultipleChained
0
6
12 S-
0
20
40
0
15
30 S+
0
5
10
0
10
209 20 40
FR Schedule
30
0
5
10
0
10
20FR Schedule
123 5 7 10 20S- A
verage component
duration (minutes)
10 20 30 400
5
10
Max
10 20 30 40 500
5
10
Molly
S+
Ste
reot
ypy
per
min
Item
eng
agem
ent p
er m
in
Sessions
5/23/2017
62
0
5
10
40MultipleChained
0
6
12 S-
0
20
40
0
15
30 S+
0
5
10
0
10
209 20 40
FR Schedule
30
0
5
10
0
10
20FR Schedule
123 5 7 10 20S- A
verage component
duration (minutes)
10 20 30 400
5
10
Max
10 20 30 40 500
5
10
Molly
S+
Ste
reot
ypy
per
min
Item
eng
agem
ent p
er m
in
Sessions
0
5
10
40MultipleChained
0
6
12 S-
0
20
40
0
15
30 S+
0
5
10
0
10
209 20 40
FR Schedule
30
0
5
10
0
10
20FR Schedule
123 5 7 10 20S- A
verage component
duration (minutes)
10 20 30 400
5
10
Max
10 20 30 40 500
5
10
Molly
S+
Ste
reot
ypy
per
min
Item
eng
agem
ent p
er m
in
Sessions
0
5
10
40MultipleChained
0
6
12 S-
0
20
40
0
15
30 S+
0
5
10
0
10
209 20 40
FR Schedule
30
0
5
10
0
10
20FR Schedule
123 5 7 10 20S- A
verage component
duration (minutes)
10 20 30 400
5
10
Max
10 20 30 40 500
5
10
Molly
S+
Ste
reot
ypy
per
min
Item
eng
agem
ent p
er m
in
Sessions
5/23/2017
63
Okay,butdideitheryieldstimuluscontroloverstereotypy?
0
50
100
S-S+
0
50
100
Chained
0
50
100
0
50
100
Multiple
0
50
100
0
50
100
Chained
10 20 30 400
50
100
Max
10 20 30 40 500
50
100
Multiple
Molly
Sessions
Lat
ency
to
ster
eoty
py(%
tim
e el
apse
d)L
aten
cy t
o en
gage
men
t(%
tim
e el
apse
d)
0
50
100
S-S+
0
50
100
Chained
0
50
100
0
50
100
Multiple
0
50
100
0
50
100
Chained
10 20 30 400
50
100
Max
10 20 30 40 500
50
100
Multiple
Molly
Sessions
Lat
ency
to
ster
eoty
py(%
tim
e el
apse
d)L
aten
cy t
o en
gage
men
t(%
tim
e el
apse
d)
5/23/2017
64
0
50
100
S-S+
0
50
100
Chained
0
50
100
0
50
100
Multiple
0
50
100
0
50
100
Chained
10 20 30 400
50
100
Max
10 20 30 40 500
50
100
Multiple
Molly
Sessions
Lat
ency
to
ster
eoty
py(%
tim
e el
apse
d)L
aten
cy t
o en
gage
men
t(%
tim
e el
apse
d)
Okay,butdideitheryieldstimuluscontroloverstereotypy?
Yes– Thechainedschedule.
Thenotionofacontingencyisimportantheretoo.
Dochildrenprefer
time‐basedalternation(multipleschedules)
or
behavior‐basedalternation(chainedschedules)?
5/23/2017
65
3 6 9 12
0
2
4
6
8
10
MultipleChainedExtinction
Max
Free choice
Cum
ulat
ive
sele
ctio
ns
3 6 9 12 15
0
2
4
6
Molly
Free choice Forced choice Free choice
Trials
Thesechildrenpreferredbehavior‐basedalternation(chainedschedules)
Whentreatingstereotypyarewemissingsomeimportantopportunities?
Canweaddresstheothercoredeficitsofautism(languageandsocial)whileaddressingstereotypy?
Canweallowthechildmorecontroloverwhereandwhentoengageinstereotypy?
Canwemakethetreatmentmoreflexiblesoitfitsintoeverydaylifealittlebetter?
Ithinkwecan.
NewAlternative:Skill‐BasedTreatmentPermission/Check‐inbasedmodelinwhichcommunication,toleration,andcontextuallyappropriatebehaviorsarestrengthened(Hanley,Jin,Vanselow,&Hanratty,JABA,2014)
1. Teachchildtorequestaccesstostereotypy(viablockingandcontingentaccesstostereotypy)
2.Teachchildtotoleratedenialsofmands forstereotypy(viablockingandcontingent,intermittent,andunpredictableaccesstostereotypy)
3.Teachchildtoengageincontextuallyrelevantbehavior(viaprompting,blockingandcontingent,intermittent,andunpredictableaccesstostereotypy)
5/23/2017
66
Level Task Longest chain of demands
Total demands Field size
1 Matching pictures 3 12 3
2 + Matching numbers, letters 3 12 3
3 (Same as above) 6 18 3
4 (Same as above) 10 27 3
5 (Same as above) 10 27 4
6 (Same as above) 10 27 5
7 (Same as above) 10 27 6
8 + Matching objects 10 27 6
9 + ADLs 10 27 6
10 + Receptive ID of pictures 10 27 6
ResponseChainingSequence
0
25
50
75
100
0
5
10
15
20
BL
S-S+
FCT TRT Response Chaining
Mot
orst
ereo
typy
% o
f co
mpo
nent
S- duration (min)
0
5
10
15
20
Sim
ple
FC
Rpe
r m
in
0
2
4
6
15
Com
plex
FC
Rpe
r m
in
0
2
4
6
TR
per
min
20 40 60 80 1000
25
50
75
100
0
20
40
60
801 2 3 4 7 5 6 7 8 94 10
Milo
Sessions
Acc
urac
y (%
) # demands
Question Rater 1 Rater 2
The treatment that involved teaching a request for stereotypy, teaching an appropriate response to the denial of that request, and teaching the individual to complete an increasing number of demands before earning access to stereotypy was acceptable.
7 7
The amount of behavior change (i.e., the effects of treatment) was acceptable or sufficient.
7 7
The overall goals of this treatment were acceptable, appropriate, and important for the individual.
7 7
I would recommend this treatment package to other therapists or providers who are attempting to decrease stereotypy and increase appropriate engagement.
7 7
SocialValidityResults
5/23/2017
67
FC
R p
er m
in
0
10
20
30
40
Grant
*
TR
per
min
0
5
10
15
20
Sessions
20 40 60
Com
pli
ance
(%
)
0
20
40
60
80
100#
dem
ands
co
mp
lete
d
0
20
40
60
80
100S-
dur
atio
n (
min
)
0
2
4
6
8
10
Mot
or
ster
eoty
py
% o
f co
mp
one
nt
0
20
40
60
80
100
S-S+
Al. BL FCT TR RC Exten .[1] [2] [3] [4] [5] [1] [2]
l ses
sion
s {
1 = Strongly disagree 7 = Strongly agree
1. The treatment that involved teaching a request for stereotypy, teaching an appropriate response to the denial of that request, and teaching the individual to complete an increasing number of demands before earning access to stereotypy was acceptable.
7
2. The amount of behavior change (i.e., the effects of treatment) was acceptable or sufficient.
6
3. The overall goals of this treatment were acceptable, appropriate, and important for the individual.
7
4. I would recommend this treatment package to other therapists or providers who are attempting to decrease stereotypy and increase appropriate engagement.
7
NextStep
Evaluategenerality oftheskill‐basedtreatmentindifferentcontextsandwhenappliedunderlongerperiodsbyrelevantteachersandcaregivers
Evaluatetreatmentwhenappliedto:HandmouthingScriptingInteractive,imaginativeplay
5/23/2017
68
FinalTake‐HomePoints
Treatmentforstereotypy….
canbefunction‐based
shouldbecomprehensive
shouldinvolveastrong,intermittent,andunsignaled contingencytoinhibitstereotypyanddosomethingelsecontextuallyappropriateinordertoengageinstereotypy
Forautomaticallyreinforcedstereotypy:Permissionbasedmodelinwhichcommunication,toleration,andcontextuallyappropriatebehaviorsarestrengthenedviaintermittentandunpredictableaccesstostereotypy
1. Teachchildtorequestaccesstostereotypy(viablockingandDR)
2.Teachchildtotoleratedenialsofmands forstereotypy(viablockingandcontingent,intermittent,andunpredictableaccesstostereotypy)
3.Teachchildtoengageincontextuallyrelevantbehavior(viablockingandcontingent,intermittent,andunpredictableaccesstostereotypyandprompting)
Goodluckwithallthatyoudoforallwhoyouteachandprovidecare
Formoreinformationgoto:www.practicalfunctionalassessment.com
Contactinfo.:GregoryP.Hanley,Ph.D.,BCBA‐D
PsychologyDepartmentWesternNewEnglandUniversity
1215WilbrahamRoadSpringfield,Massachusetts01119
ghanley@wne.edu